A View from the Trenches

The line starts forming outside the building around 6 AM. When I walk from the parking lot to the cafeteria to get my morning coffee, I see my patients, crowded under the awning, ready for the monthly ritual of coming to a county cancer clinic. Many of them have bags packed with magazines and snacks. Some are catching up with other patients who have become their friends. Some are holding sleeping grandchildren in their arms. I marvel at how they have adapted their lives to a clunky bureaucracy that doesn’t respect their time. The ones who are first in line may get in before noon, and maybe even get their chemotherapy the same day. The ones in back of the line could be there until 8 pm at night, and then have to return the next day for their treatment. 

Inside the clinic hours later, I am running back and forth between two rooms, seeing patients as fast as I can. I sit down in one room and ask Maria how she is doing. Immediately, she bursts into tears. She lost her apartment this week because she has been unable to work. Her landlord wouldn’t even let her back in to get her clothes. Her nephew was kind enough to take her in, but her chemotherapy schedule has made it impossible for her to get a new job. We discuss how she has been through multiple lines of chemotherapy already, and options are limited. There is no cure and I can’t guarantee that what we are doing now will help. She nods acceptingly. Maria asks only one question: do I have a cell phone charger for her flip phone? The battery died, and her ride’s number is in there. We get lucky in the waiting room and find another patient who has a compatible charger with her. Maria is happy for the small victory.

I see Gloria next. It’s an easy visit. She has completed her treatment. When I enter the room, her husband has his arm around her shoulders, and her sister is holding her hand. They look at me with anxiety and anticipation. I cut to the chase. “I have good news. We don’t see any cancer on the CT scan.” I am pulled into a group hug. “You saved my life!” Gloria exclaims. Her sister cries, and the husband leans back in his chair with relief. I give my spiel about close monitoring. They ask if she can go to the Philippines for vacation. I joke, “Only if you take me with you!” Everyone laughs, as months of blood tests, side effects, and fear momentarily melt away.

I close out my day with Lily and her husband, quiet people who have been coming to the clinic for years; her disease is stable. Her husband tells me that on my recommendation, they bought a new bed. Not only has Lily’s back pain improved, he is also sleeping better. Lily’s wig is askew, and she looks distracted. She shares that her daughter is having a baby soon. I congratulate her and ask her when she is going to visit. She points to her percutaneous nephrostomy, a drain that empties urine from her kidney, and says she doesn’t think she can be around a newborn with that “dirty tube.” I see from her recent imaging tests that the kidney has minimal function, and I propose we remove the tube. Lily laments that it takes weeks to get an appointment with the interventional radiologist. I step out of the room to call; the radiologist confirms that it would take weeks for him to see her, and I ask for instructions to remove the tube myself. When I cut the hidden sutures and the tube smoothly slips out of Lily’s back, she stiffens for a moment, then relaxes. “Ok, I want to see the baby pictures,” I tell the couple. Lily smiles for the first time that day, “You are a good doctor.” Her husband beams at me.

When I chose to sub-specialize in gynecologic oncology, I thought my days would be filled with operating, concocting chemotherapy regimens, and staying up to date on clinical trials. What I found out very quickly was that being a gynecologic oncologist often has more to do with managing the fall-out of cancer, rather than the cancer itself. Patients come wanting you to make the cancer go away, because they think you have the secret to making their lives normal again. Over and over, my patients tell me they will do anything I say. They bring in soaps, fabrics, recipes, and herbs for my approval before use. They want my permission to take day trips. Betrayed by their bodies, they no longer trust themselves to know what’s safe.

The humbling reality is that there is no cure for most cancers right now. We can do everything right and cause harm to the patient; we can do everything wrong and the patient thrives. My job focuses instead on empowering the patients to regain each precious moment of their lives, despite the cancer. I try to convince them that cancer is an aspect, not the totality of their existence. And in the final moments when there is no earthly solution for the suffering, I try to help the families make peace with what can’t be controlled.

In this way, I am comforted that my work serves some good, even though it is far from perfect. In the trenches of the War on Cancer, the small daily battles matter just as much, because so many unique lives hang in the balance.