Josh now has the unfotunately too common squamous cell and melanoma skin cancers following a bone marrow transplant for a different cancer years ago. He tells me its a “sh.. sh..”now with several Moh’s surgeries and radiation treatments. The new melanoma requires more specialty care with lymph node dissection and scans. “Doc, after almost 20 years being cancer free, I feel as if it’s caught up with me”. Josh is a victim of survival success. He rightfully doesn’t like the pile – on. The patient is only now researching this phenomenon but he knows that regardless of the informed consent fine print, his options at the time were limited. Trading off long term survival for skin cancer risk was still a win.
Docs hone their skills and knowledge quickly and offer cutting edge therapies… what matters is NOW! Rescue the patient! We may too often be guilty of downplaying the side effects and risks to move the patient into life saving care. Practicing for thirty years, gives me the benefit of witnessing the disease, mutations, changes in therapies and very often the chronic problems that living with cancer causes. At least I can offer confidence and support as well as a reality check. When Tracey complains of triceps numbness years after breast surgery, she is relieved to know this is normal. When Frank has to use Oxygen from lung scarring after radiation, as long as the scans are still clear, he breathes a sigh of relief. When Arlene needed to move in with her daughter because memory loss from treating a brain tumor became a problem living alone, she happily describes the joy of living with her grandchildren.
The great news about cancer treatments are their increased effectiveness so that cancer is now a chronic disease. It is wonderful to see that patients who have been on the journey, are well equipped for whatever comes next. I embrace their fearlessness but recognize that there will be disappointments and frustrations.
Perhaps informed consents should be more complete. Missing from the fine print, I see several really amazing “side effects”. How about adding these?: You will be surprisingly tough. You will appreciate your days more. You will value your relationships. You will even love more deeply. You will be touched by other’s kindnesses toward and sacrifices for you. Your children will admire you. You will wear your challenges with great pride. You will tell your story with humility. You will inspire others the rest of your days. And…. you will be cherished.