NINE MONTHS

This is not a post about the normal human gestation period in my wife or anyone else's wife for that matter. Nine months is the expected survival duration I quoted today to Mr. H, a 51 year-old man whose metastatic prostate cancer had exploded through two prior therapies.

Until last Fall, Mr. H had been working as a general contractor building houses. At that time, he found it increasingly more difficult to bounce back from a hard day's work due to bone pain and fatigue. He finally landed in an emergency room and was found to have a body riddled with prostate cancer. He was started on standard hormonal treatments and received palliative radiation therapy, but the benefit was fleeting. That is how he arrived in my clinic accompanied by his supportive ex-wife today.

We talked about his current symptoms, and we talked about the next steps: MRI of the spine to rule out compression of the spinal cord from his cancer, pain management, and chemotherapy. This naturally led to a discussion of his dire prognosis and what to expect.

I tried to tell him that the numbers we quote in Oncology are imprecise and that if I had a crystal ball I would be in Vegas at the tables. However, I also shared with him data from prior clinical trials that demonstrated that men like him live on average only nine to twelve additional months even with aggressive chemotherapy.

Understandably, he broke down, and he explained that he had two sons- one eight and another five whom he had not yet prepared for such bad news and with whom he still had much, much more to do. He said he had scheduled a trip to Lake Tahoe with them later this week, and he wondered if he could still go.

His condition was grave, and it was urgent that we start chemotherapy as soon as possible. However, I knew that his disease was incurable and that delaying his treatment by two weeks would make no appreciable difference to his cancer outcome but that it might make a significant difference to his boys and to him. Without missing a beat, I looked him in the eyes and told him to take the trip. I also explained that we had resources and strategies through our social workers to help him talk to his kids about his disease. Yet, deep down I knew that there were no easy answers for how to explain to his sweet kids that they were going to lose their dad.

We used a lot of tissues in that clinic room today, and no amount of time or experience makes these conversations any easier. Despite feeling emotionally drained, I was able to continue in clinic today for three reasons: 1) I knew that it was my duty to do everything humanly possible to make the care and experience of Mr. H and my other patients as optimal as possible in the face of cancer and such horrific odds, 2) I knew that my problems that day were nothing compared to Mr. H's and the rest of my patients, and 3) I knew that the only way to get home to my own smiling, innocent children was to forge on and grind that clinic out.



This afternoon, I was rewarded with many thank yous from my patients for the care I provide to them, and later this evening I was rewarded with with many hugs, kisses, and jokes from my own two kids. Only nine years with them would be unthinkable. Only nine months... well, that would be just plain cruel.