Tuesday, December 2, 2008

Oh, by the way...

These four words, just at the end of an appointment, usually are prelude to something of tremendous importance that the patient has spent most of the preceding hours trying to decide how to talk about.

Today I saw a 23 year old young man with relapsed metastatic osteosarcoma. He has already been treated with all five of the chemotherapy drugs that we know typically work against osteosarcoma. We looked hard, but there are no open Phase II clinical trials for which he is eligible. After much discussion and many emails, we decided on a low dose chemotherapy regimen in combination with another drug that we hope will help the chemo work better.

After reviewing the treatment plan and all of the potential side effects, the patient signed informed consent and we made plans for follow-up, including blood tests to monitor for side effects.

“Oh, by the way…”

This is when the patient told me he was hoping to hook his boat up to the back of his van and drive out west with a friend.

My initial reaction was… fear. I had just laid out a treatment plan with a long list of side effects. Without prompt medical attention, some of these side effects could be fatal. How was I going to tell this young man that he can’t go camping in the middle of nowhere while taking these medications? What if he went anyway, and something horrible happened to him? Something that could have been prevented had he stayed locally?

Should I let him go, or try to talk him out of it?

It didn’t take me long to decide he should go on his trip. His prognosis is poor, even if this treatment helps. At the moment, he is in good condition and will really enjoy his trip. As long as he fully understands the consequences of his decision, he should live as full a life as he can for as long as he can.

I just hope he has a safe trip and a great time.

11 comments:

jaime said...

ah, yes, in psychology this is known as "doorknob therapy" - as the client is leaving, they'll have their hand on the doorknob and drop a bomb like, "yeah, I've been feeling like I want to die, but I'll see you next week!"

Mary said...

Often cancer patients have a hard time getting out what is really important to them, and they feel like they should let the doctor "do his thing" first. I'm so glad you let him go. I have a friend who did a trip like this. He's gone now, but boy he saw the country and felt so FREE while doing it.

Kathleen said...

I think you did the right thing too - absolutely. Cancer patients SHOULD focus on living, so no worries on your part.

AJay Piniewski said...

no brainer doc.......thanks....hey, can I get you to post over at PAC2 someday?

Morah Mary said...

I think one of the hardest things, certainly as a parent, is to step back and let our kids experience grand adventures even if (or particularly when) our concerns for their well-being are legitimate. Thanks.

Elsa D. said...

I am always recharged when I come back from these trips, that I also tell my doctors at the end of the visit, "oh by the way I am flying tonight to Hong Kong" :)))). Several times I have left the treatment room and gone straight to the airport. I return happier and ready for more Phase Ones, more surgeries, more chemo. I am glad there are doctors that think like you.

"Elizabliss" said...

Truer words were never spoken. When quality of life is up against quanity, I always vote for quality. Live Life to the Fullest ought to be on a bumper sticker!

Kate said...

Wow. I'm sure that is a decision that you will not regret. Thanks for sharing.

Haven said...

My daughter is getting ready to start another year of Chemo and her pediatric office raised enough money for her to go to Disney World before Chemo starts at the end of January. I want to her to see everything...definitely a great story - thanks for sharing!

IRA said...

hello doctor! love reading ur posts :) i'm a 2nd year medical student..and very much interested in pediatric..so i hope u'll keep on writing about pediatric and i will surely keep on reading ur posts :)

Bere:) said...

When I reached the part of you questioning whether or not you should let your patient make this trip, my eyes became so big that it felt as if I looked like a frog...ok not literally...
But by the time I finished reading, tears began to fill my eyes.
You did a magnificent job Doctor David!
The Lord sees your heart and the willingness to serve others; may he continue to bless you.