The practice of medicine offers physicians the opportunity to meet people from many walks of life.
In medical oncology, the relationships can become quite close as the gravity of the illness, the sweetness of success, and the bitterness of failure are often compressed into a few short months or a year or two.
One such patient presented almost four years ago to the day.
At 48, this gentleman presented with a cancer in the tonsil.
Standard chemotherapy and radiation appeared curative. But eighteen months later, shoulder pain led to a reevaluation that confirmed extensive metastatic disease. A surgery to stabilize the right shoulder provided us tissue for study and we identified treatments that worked extremely well for an additional two years.
During those years, the patient carried on a full life and enjoyed every day. I rejoiced in his success, but his subsequent recurrence challenged our every resource and we lost this very delightful gentleman in June of 2017.
There was something unusually good and kind about this patient.
He seemed to understand the gravity of his situation, but never allowed it to get in the way of his day-to-day activities, work, or most importantly, his time with his family. I remember early on when I complained about my own work schedule; he looked at me with a knowing eye and explained the importance of taking time to travel and interact with your family and how precious every day had become.
While I often write about my patient’s successes, I must admit most humbly that not every one of my patients survives their disease.
While I work diligently to control symptoms and disease progression, some cancers cannot easily be managed and even our best efforts result in failure. While I am deeply saddened by the loss this very nice patient he taught me a great deal and I use this occasion to suggest that every cancer patient, wherever they are in the course of their disease, take a page from his book, for he understood the importance of every day and cherished every minute.
What follows is an excerpt from the letter that I sent to his family shortly after we lost this patient.
After that, with permission, I reprint his wife's touching letter that I received over the Christmas holiday. H. G. Wells said, "Affliction comes to us, not to make us sad but sober; not to make us sorry but wise." Throughout the time that I knew him, Ed had the clarity of thought and the wisdom to make the most of every precious moment. My letter excerpt follows.
"Over the past 3-1/2 years we became friends. Ed had wisdom beyond his years.
Though he was younger than me I felt educated by his advice on the importance of family, his faith, and his deep understanding of what an amazing gift life is.
He got it.
He would advise me (his doctor) not to work too much and, most importantly, not to miss time with my own children. I believe that he made me a better father. I appreciated our every meeting."
And this is a letter addressed to me that I received over the Christmas holiday. It is reprinted with permission, in its entirety.
"Dear Dr. Nagourney:
For the last six months, I have toiled with how to thank you for the tremendous approach you took in fighting cancer with Ed. I came to the conclusion that Ed's life, in spite of the cancer, is the best thank you I can offer.
Before cancer, Ed would react to medical appointments with great anxiety. The relationship that you developed caused him to own what was happening in his body, actively engage in the fight, and become an expert in Ed (including dates, treatments, what worked/what didn't, etc.). We had all hoped that his initial fight would be his only fight but, alas, that was not what the future held. Despite the devastation of re-diagnosis, you gave him hope and the quality of life that enabled him to make more memories in 23 months, than most do in a lifetime.
As a family, we took trips to Yosemite, the national parks in Utah, Las Vegas, Carpinteria, New York, Santa Barbara, Joshua Tree, Alaska, and Vancouver, Canada. We also traveled twice to Dallas, Palm Springs, and Big Bear. Individually, Ed visited Philadelphia, Las Vegas, and Taipei. He took such joy in getting to still engage in life, to work through his "bucket list," to see his children's milestones like baptisms, sailing regattas, Iron Guards, an eighth grade promotion, and to be active in the bike industry that he had loved for all of his adult life. Ed was able to get Michael, our son, through all of his Eagle requirements, except for the actual project. This effort included Ed camping with Mike 19 nights. Ed also became an assistant scout master in our son's troop and coordinated several events including the troops' annual participation in the Long Beach bike tour.
Ed wanted to prepare us for life without him. He made our kids' dream of getting a dog come true. He carefully selected and trained our dog. He made numerous changes to our home and scheduled maintenance that would make life easier for his family in his absence.
Remembering back to the appointment where he chose his course of treatment, you offered the standard treatment which included hospital stays and poor quality of life, or your research treatment that would have ups and downs, but offered a livable quality of life. He chose your treatment and we are so grateful that he did. Our children remember him full of life, not sick in a bed. All of the memories made were possible because of the quality of life your treatments offer.
Thank you, Dr. Nagourney, with gratitude."
Every patient is unique and each of their stories unfolds in real time.
While we cannot cure every patient, we can do our best to confront the unique features of their cancer, provide the best and longest possible survival, and most importantly provide hope and encouragement. Though I could not cure Ed of this aggressive cancer, the life that he enjoyed was good and full.
That, in itself, is a victory.
As always, I appreciate your thoughts and comments.
Dr. Robert Nagourney, has been internationally recognized as a pioneer in cancer research and personalized cancer treatment for over 20 years. He is a TEDX SPEAKER, author of the book OUTLIVING CANCER, a practicing oncologist and triple board certified in Internal Medicine, Medical Oncology and Hematology helping cancer patients from around the world at his Nagourney Cancer Institute in Long Beach, California. For more info go to NAGOURNEYCANCERINSTITUTE.COM