Championing the right care isn’t restricted to recommending therapy. With advanced cancers diagnosed this year, rescue has often reached its limits. Prince Phillip’s funeral this weekend after 99 amazing years, showcases his power at the end, bringing a difficult concept to light. Regardless the illness, I want to introduce to you a diagnosis that supersedes all others: “failure to thrive”.
In the clinic, Peter and I are having a much different conversation than Victor from last week’s message. With many physician specialists and undergoing significant healthcare for years, Peter has been able to live his best life. Until now. My attention is drawn from the fairly unrevealing scans to the man. Cachexia (weight loss and muscle weakness) is frequently found in advanced cancers. But Peter’s cancer isn’t overwhelming. His mind is sharp as ever, his resolve strong but the body is succumbing to the chronic cancer and years of chemo punctuated with radiation. Even the immunotherapy is taking a toll. Fifty pounds thinner on a lean frame requires a feeding tube. Peter is up for that and then “Wants to keep fighting with more treatment”. My solemn words, “You cannot Peter”. Most people think if they have the will they find the way, but for many the time comes when interventions just intervene with life.
“Peter, I don’t know what your many other Docs have told you, but you now have a new diagnosis.” His eyes are wide. “You have the most devastating one… failure to thrive”. I see this frequently in hospitalized patients when the body has given up regardless the will. Its a downward trend that is becoming irreversible. Above all else, Peter wants to avoid a hospitalization. My plan, which Peter accepts after the shock, is simple: a feeding tube, stop all treatment and rest. The therapies have taken their toll more than the cancers.
It is likely where Prince Phillip was when he chose to leave the hospital, choosing to die “with a blanket on his lap and sun on his face at home”. Peter isn’t ready in mindset and there is some chance he can improve with nutrition and rest from treatments. It is not a guarantee however. With no working immune system, beaten down by all the therapy, recovery may not occur.
Some doctors and patients may push until hospitalization is needed. When, after all the testing is done, the only diagnosis in front of the team becomes not the cancer or covid or heart disease or stroke or pneumonia, but instead the dreaded words: failure to thrive. It takes a new awareness and strength to take a step back and recognize that a new plan of supportive care is all that is needed. Then you or your loved one can sit and face the sun- thriving even for one day.