Indexing Title:

RJOSON’s Medical Anecdotal Report [05-2]

 MAR Title:

Acceptance - the Best Way to Cope with a Stubborn Cancer

 Date of Medical Observation: March 3, 2005

 Narration:

 I have a female patient with breast cancer.  Seven years ago, she was 48 years old then, I did a left subtotal mastectomy with level I axillary dissection.  Histopath of the axillary nodes removed was negative. Two years after, there was a recurrence on the left axilla for which I did an axillary dissection.  There was no recurrence on the breast itself. The operation was followed by six cycles of intravenous cyclophosphamide, methothrexate, and 5-fluorouracil.  A year after, she experienced back pain which was due to metastasis as revealed by a bone scan.  She underwent radiotherapy which completely resolved the pain on her back.  One and a half years after the radiotherapy, she developed left supraclavicular nodal metastasis.  I treated her with tamoxifen with no response after 3 months of trial.  During the discussion at this point in time, she decided to seek faith healing with a nun in Novaliches.  I let her do what she wanted to do with her recurrent breast cancer.  I did not see her for almost a year until a month ago when she came back to me apologizing for not seeing me earlier and on a regular basis.  At this time, she had a very severe lymphedema with fixed suparaclavicular nodes and paralysis of her left upper extremity.  There was no recurrence on the breast itself. She was not insisting on a curative treatment anymore.  She has accepted the limitations of treatment.  She still goes to work everyday.  She just wanted to be under my care up to the last moment of her life – to be her advisor and to alleviate her physical suffering.

Insights (Discovery, Stimulus, REINFORCEMENT) / (Physical, PSYCHOSOCIAL, ETHICAL):

 I admire this patient of mine for her courage and open-mindedness to accept the reality of life, consequences of cancer, absence of guarantee of medical treatments, as well as limitations of physicians. Her attitude, personality, and behavior really make things easier for herself as a person and a patient as well as for me as a physician.  Several years back, I felt the syndrome of a mid-life crisis.  This consisted basically of a feeling of depression resulting in not wanting to practice medicine anymore.  I attributed this feeling to being burnt-out as a result of managing too many cancer patients, more so, with the experience of having quite a number of unsuccessful treatment in the forms of recurrences despite the best effort I put into the care of these patients.  I have since then realized that acceptance of the limitations of medical treatment is the best way to cope with stubborn cancers for both the physicians and the patients.  Personally, I have come to terms that I cannot save all the patients who seek my help. To make things easier for me as well as for my patients, part of my management strategies in patients with cancers, especially, those with far-advanced cancers, is to prime them early in the management course of the limitations of presently available treatment.  At present, there are only a handful of patients who can openly accept the harsh reality of life, consequences of cancer, and limitations of medical management.  How I wish we would have more patients like this particular patient of mine.