Oncologists are often incurable optimists. I suspect that most of us have rather sunny dispositions, contrary to what many colleagues outside this discipline might think. It is true that many of our patients have terminal disease, but certainly the proportion is not as high as one might think. In some oncology outpatient clinics, perhaps over 70% of patients have curable or cured disease. At the same time, even when cure is not be an option, we optimists are able to assign value to a wide variety of little triumphs. Here are some of these little triumphs that I have imagined – if you think these stories are based on real events and characters, you think wrongly.
- A matriarch wished to see her favourite grandchild married off. Unfortunately, the wedding was scheduled in many months time, beyond what might be reasonably expected of her condition. Hence, the hospital room was transformed, with lucky calligraphy and ang-pows. The lovely bride and groom were prompt to offer their respects on bended knee with the dainty cups of tea. In the evening, an oncologist accompanied the oxygen-dependent lady to a pleasant dinner, and enjoyed ee-fu noodles at the main table with the rest of the family. I do not know if he received an ang-pow along with the happy couple!
- Pain can be terrifying. It dehumanizes and breaks down, particularly when it gnaws ceaselessly. In its extreme forms, we call it a ‘pain crisis’, a term that falls far short. I remember those patients, newly admitted from the clinic or the emergency department, agony still etched over every furrow. At the bedside, I carefully infuse morphine by bolus doses intermittently, titrating the dose to effect. Over a wonderful few minutes, I see a face that is previously wracked with agony soften and relax in relief. How can one not fail to be happy? This is the blessing of anaesthesia for physical pain. Now existential pain is harder to manage, and its relief comes in acceptance of the inevitable. This comes to some, but not all. One day, shall there really be no more pain?
- What happens when the situation looks uncertain, minutes are beginning to matter, and a son is studying in the United States, 24 hours away from the bedside? With the ongoing Singaporean diaspora, this is an increasingly common situation. I often have to make a snap decision whether or not to summon the clan from abroad. Family conferences with a child listening in on a mobile phone or a laptop from abroad (the marvels of Skype!) are not uncommon these days. When events unfold as planned, a timely reunion is often joyous but tinged with sadness at an inevitable parting. After all, few patients remain in ignorance of the reasons for the return of a distant relative. Those moments needed to say goodbye are a benediction for the living.
I’ve seen things you people wouldn’t believe. Attack ships on fire off the shoulder of Orion. I watched C-beams glitter in the dark near the Tannhauser Gate. All those moments…
– Roy Batty, Blade Runner
Should oncologists choose to be sad at an inevitable passing, or to celebrate a life fulfilled? This is how the Cheerful Oncologist would have advised his patients – “Your body is dying, but not your spirit. The fire that blazes within you, that has allowed you to carry on so long with this disease, is still bright. It will not vanish until your body reaches its final breath, and on that day, on the day of your death, the person that inhabited your body will indeed disappear, yet it will live on – in the memories of those who knew and loved you. Such is the power of the human spirit.“
