Cancer care rests greatly on physical and emotional interactions, more so than with many other specialties. A life-altering cancer diagnosis and treatment offer little scope for physical, and emotional, distance between the oncologist, the patient and their family.
As Siddhartha Mukherjee, an oncologist and writer, noted about his experiences with patients: “People are having poisons dripped into their blood, some are dying, others are being saved, and every conversation you have carries a kind of potency that you just don’t encounter in the rest of the world. It is immensely challenging, both intellectually and emotionally.”
All of this has been threatened by the highly transmissible coronavirus that has stretched our social bonds and thrust us into various degrees of isolation.
Like much of medicine, oncology has been unsettled by the pandemic. Screenings, diagnoses, surgeries, radiation treatments and chemotherapy have all been delayed. Patients have arrived to appointments short of breath, coughing or feverish, only to be sent home or taken to a hospital. More than a few times, I have learned of a patient testing positive for the coronavirus less than a day after I have examined them in the clinic. Colleagues have been infected.
Scarier still has been the increased risk of severe covid-19 in patients with active cancer who have had their immune systems obliterated by chemotherapy. Most poignant are the airtight restrictions that many patients on chemotherapy have placed on their lives to evade the virus.
But the marvels of science, coupled with public health measures, have allowed me, as an oncologist, to preserve the personal element that makes my patient encounters more meaningful. Coronavirus vaccines, high filtration masks and oral antivirals are making it easier for cancer patients to feel safe and cared for. Even if vaccinations fail to stimulate protective immune responses in individuals who are actively being treated with chemotherapy, have blood cancers or recently underwent stem cell transplants, other interventions can buttress flailing immune systems or reduce risk of infection.
There is now greater comfort in sitting close for short periods to discuss difficult cancer diagnoses and treatment options, review CT images to show the disease’s effects, share life stories and provide meaningful support to patients and their loved ones during uncertain moments. It is easier to fully humanize the mundane, but crucial, experiences of cancer care without pause, such as the one I experienced earlier in the year.
The cancer of one of my patients, Terry Queen, could no longer be treated. His body, weary and skeletal, could no longer tolerate the brutality of chemotherapy drugs. And he was quickly getting more sick as tumors caked his airways, and cancer cells metastasized to surround his brain and spinal cord. I had to discuss prognosis and end-of-life care with Terry, 67, and his wife, Sheila.
Outside Terry’s hospital room, the ultra-contagious omicron variant was circulating in America’s communities. Cases were rising exponentially and topped 1 million daily infections on Jan. 4. Even brief interactions, especially with absent or low-quality masking, could transmit the virus.
When I arrived in Terry’s room, he was visibly distressed. He could speak only a few words as his entire body was working in overdrive to help push enough air into his diseased lungs.
His wife and I stood masked and only inches apart at Terry’s beside. We talked about how the cancer had progressed quickly and why more chemotherapy would do greater harm than good at that juncture.
I wanted to know what Terry still hoped to experience from his remaining life and whether we could collectively get him there. Sheila told me about a son who had found love late in his life and was soon to be married. There was also an upcoming birth of a grandchild.
Sheila thanked me for all that I had done and, more important, for always believing in her husband’s resilience throughout the rocky course of his illness. And before I left the room, I put the pandemic on pause in my mind and did what felt right: I hugged her for as long as she needed me to.
This contact and these intimate conversations mattered, and they had to happen. It is what I owed my patients regardless of the fears that tugged at me daily with an unvaccinated 3-year-old son and high-risk, pregnant wife at home.
In the tumult and uncertainty of the pandemic, the one constant I can provide patients is my understanding, attention and a chair next to them. Accepting some risk of infection is how we bravely move forward in this coronavirus-altered world. Especially when trying to preserve something as sacred as the bonds that hold oncology together.