“Robert” (TERMINAL CANCER) Last Semester, I spoke to a patient called “Robert” who had an M1 cancer (cancer that has metastasized), and was considered to be terminal (incurable, patient will die from cancer complications). He was one of the first terminal patients that I spoke to. A classmate recommended that I speak to him coz he had “interesting” physical presentations and was nice but was feeling quite sick. I wanted to see his physical presentations, but was initially hesitant on doing him coz he was feeling sick, and may not have wanted to spend energy speaking to another medical student, but I decided to try, because that’d be the only way to find out, and I didn’t like the uncertainty of never knowing what happened to him.
I went into the room, greeted Robert and introduced myself and asked if he could answer my questions regarding his medical history. He consented, and so I asked about his symptoms. He noticed a few lumps in his chest earlier last year, which later grew in size and became very painful to touch, and he felt a pain akin to being “hammered in the chest” whenever he breathed normally. He visited a GP and complained about the pain, in which he was prescribed analgesics. Eventually, investigations for his chest pain (X-ray, CT, biopsies) indicated that he had cancer which metastasized to his chest, and he was planned to start on “chemotherapy” quite soon. He was still experiencing a lot of pain in his chest and back, and found it disruptive and upsetting. I was able to see several lumps on his chest, and on his sternum.
He said the doctors may be considering radiotherapy as well, but he wasn’t looking forward to it because he thought that surgery would’ve been better (even though surgery isn’t usually indicated for his metastatic kind). Although I wasn’t 100% sure that his cancer was terminal (I only knew that when I spoke to the Oncologist later on), I suspected that the radiotherapy wasn’t curative, and was to treat the bone metastases, aiming to reduce its prominence on his ribs. I wanted to try to make my thoughts be more “valued” by him so I had to figure out what was of his biggest concern atm, which I (luckily) guessed was pain. I was confident that he was going to die within a few years or even a few months coz of his Cancer staging, and felt that long-term survival would be more important, but I DIDN’T DARE TO SAY THAT TO HIM coz I thought that informing him about death wasn’t my role yet, and I was scared that being an NT, he’d be more likely to get angry/offended instead of facing reality. This led to my hypothesis that he cares more about his quality of life.
I told him that he’s experiencing a lot of pain and it’s one of the negative things directly affecting him, and that the chest pain is likely to be caused by the metastases, and that if the radiotherapy targets the tumours and make it smaller, it may place “less pressure” on the intercostal nerves, thus producing less pain in the long term. He was pleased by this explanation and changed his attitude towards the radiotherapy and was optimistic, saying “oh that’s great then!” I wasn’t sure if he only thought of cancer as causing pain, and that he was aware that the radiotherapy was most likely not curative, but more to alleviate pain, and systemic complications leading to death are still highly likely. I didn’t want to instill false hope and tell him that it was going to be a cure, so I was trying to talk about the benefits of the treatment in terms of what he valued, and he was joyful. I initially felt kinda guilty coz I made radiotherapy sound really good (although it wouldn’t restore life, I didn’t say this) but I looked back and realized that I technically didn’t lie, and I’m sure that his priorities may have been different to mine, hence his response countered my initial concerns.
I was aware that he had pain, and I asked what medications he was on. He said he was currently using Endone and Oxycontin (IR and SR-oxycodone), Panadol, and an anti-inflammatory drug. I asked him if he felt constipated, nausea and loss of appetite on the Endone/Oxycontin. He said yes, and that it accelerated his weight loss, and that he can go for days without passing a bowel movement even if he ate 3 meals/day. I also asked him if it made him feel drowsy or spaced out, and he said yes, he felt sleepy and spaced out with poorer short term memory. He was happy that I knew what he was going through and said that I was the first person on the ward to tell him about these possible side effects, and said that I knew how he was feeling.
This experience made me realize that while I’m unable to intuitively empathize towards most patients, I could simulate “empathy” for most patients at a technical level by studying the common side-effects of varying medications at a pharmacological/physiological level, and ask them about these experiences. It can then give these patients the impression that I know what they’re going through, and that I value their experiences and “psychically” know them “better” (even though that’s sometimes not the case). The statistically more predictable effects of medications has given me more inspiration to study pharmacology in more detail when I have spare time, coz it enabled me to connect to patients (especially NT patients) more easily and make them feel a bit more comfortable even though I’m not the one looking after them.
His daughter phoned him, and he let me say “hi” to her on the mobile. I didn’t know why he asked me to say hi to her as I didn’t know her, but the gesture made me happy, coz it indicated that I didn’t piss him off, and I felt good that I made him feel a bit more comfortable that day even though his prognosis was technically poor.
I recently checked the patient database this year and discovered that he died a few months after my encounter (in the Palliative ward). RIP…
