VIRGINIA, March 7, 2014 — Sherrie Black had a hard 2013-14 winter, with repeated pneumonia, unexplained weight loss and chronic pain. After her pneumonia cleared up, she went for another chest X-ray followed by and MRI then told she had a mass in her left lung.
Sherrie wasn’t worried because she had a lung x-ray 10 months earlier and then another that revealed pneumonia. She did not take into consideration her 38 year pack-a-day smoking habit or the fact her mother had lung cancer and died from it four months earlier.
Sherrie believes at age 54 she is too young for a terminal disease, but is perplexed how within such a short period of time she went from no x-ray ‘shadow’ to full blown, inoperable cancer.
A biopsy and further testing revealed Sherrie has small cell, or oat cell lung cancer that has already spread to her liver. She was told her cancer is inoperable because if the surgery is performed, it may accelerate the cancerous growth.
This is not true, however. It is a myth because by the time lung cancer is symptomatic and surgery is performed, patients are already in later stages, and it only appears that surgery accelerates growth.
Her oncologist lied. Sherrie was not told of her true prognosis and did not ask for it. Sherrie was told after the first round of treatment: there is a ‘chance’ the cancer will return. Oat cell cancer returns.
If you were diagnosed with a health issue that had a statistically predictable end stage, would you want a detailed prognosis of what your dying process would be like and of when the statistics indicate you will “shuffle off this mortal coil,” “leave this vale of tears,” or any other euphemism for death?
Some folks do want to know and some do not, but there is a third group: those who are kept in the dark by their health care professionals.
While each case is different, statistics clearly suggest Sherrie will die from this cancer and treatments are palliative in order to give her more time.
As with many undergoing chemotherapy and radiation treatment, Sherrie believes she will be cured. Sherrie is among the 2/3 of lung cancer patients undergoing palliative treatment who believe the treatment is curative.
Doctors often take a “don’t ask, don’t tell” approach with terminal patients to keep them from deep despair, promote positivity, and who knows, their patient may be that one in a million who survive to a ripe old age.
When patients are uncomfortable going to their doctor for information, they ask others. Over the years, several terminal clients have asked me of their prognosis and my guess is they are more comfortable with someone they know than with an oncologist who only recently came into their lives.
When my father was diagnosed with advanced esophageal cancer, I departed from sidestepping the truth because I believed it was my responsibility to be direct.
Statistics clearly suggested that if my father, a 60 year smoker and now aged 80, underwent aggressive surgery requiring constructing an esophagus from stomach tissue with follow-up chemo and radiation therapy for peripheral tissue, he would have about two years of remaining life.
I explained to my father he was in the throes of his final illness. His oncologist, however, provided different information. The oncologist accepted my father’s decision to decline follow-up therapy, a decision which shortened his life even more.
The oncologist probably took my father’s age into consideration and figured it useless to argue over the discomfort that additional therapy would bring. What the oncologist did not consider was my father was a five day a week golfer and, aside from the cancer, in great shape.
After about one year, dad declined considerably and in the March of 2001, he again asked my opinion and again, I was honest. I was rightfully convinced dad was dying. His oncologist told him he would be golfing again by July.
From that point on, dad would not speak to me thinking he would live longer if he avoided my ‘truth’.
Having never golfed again, dad died in the third week of August and avoided me till the end.
Doctors avoiding true prognosis for the patient’s sake may be acceptable. Doctors outright lying is not.
If you are ill with a potentially fatal disease, tell your specialist what you want to know. Do not put pressure on others to speculate. If you would rather not know precise statistics, don’t ask about them and hope for the best.
Either way, hope is the salvation of both doctor and patient.
Paul Mountjoy is a Virginia based psychotherapist