Diagnosis = Cancer (How Does It Feel?)

Best Friends, Victor-Gabriel Gilbert.
Recently, an old pal was diagnosed to have cancer in the course of routine screening.  It soon developed that, in his panic, my every word was allowed to supersede his usually uber- methodical decision process.  This may have had more to do with friendship and trust rather than my profession as he has loudly ribbed me about being a "relentless drug pusher" in the past. Whatever, it made me antsy that he wouldn't even entertain referrals to other oncologists.  Suboptimal!  In my mind, I may have defensively screened myself off for more than just a bit in order to buy some objectivity, so much so that, in hindsight, I'd become stern.

For while the best approach may be clear as day, just how in the heck patients summon the will to stay the course is beyond me.  In the case of friends, I prefer the job of pure emotional support of that will.  In fact, its the only job I should be doing in that situation, if I'm to reach for the old "Eureka!", i.e., the elegant clarity of rational management in a complex case.  

One can so easily become overburdened by this business when the distance that a clinic desk affords is breached. 

As usual, my friend taught me a few things, and the experience highlighted some truisms in clinical practice.
  • Fostering acceptance of a dire diagnosis is a major job. 
  • Primary physicians should be congratulated for all their patients who actually walked into an oncologist's clinic.
  • I should pat myself in my back for all the times that I was entrusted with a stranger's care.  Why I accepted it as a routine aspect of the job before now is incomprehensible.
  • Patients simply don't go for a tough fix until they've overcome their initial shock.  "Me, cancer!?"
  • Success at making objective assessments does not imply that the patient has overcome his subjective assessment of you.
  • Your recommendations, no matter how sound, become suspect when your foibles are hilariously familiar.
  • In the absence of family, peer "sharing" by cancer survivors should not be expected to take up the entire slack.
  • "Sharing" among cancer patients can lead to either "acceptance" or uncontrollable fears.Support groups should have clear guidelines on how to approach individual patients.  Big sign on each forehead: Caution– vulnerable!   
  • For all our sakes, I should avoid my doctor-friends when I need personal medical advice.

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