Visions of Tomorrow

My clinic today was brightened by several encounters with patients eager to share with me their happy news. First, a retired pipefitter announced with a mixture of pride and relief that his youngest of five daughters was engaged to be married this fall. After lunch I ran into a dearie who grasped my hand and told me she and hubby had just plunked down a hefty sum for an Alaskan cruise in August. My last patient of the day, a high school English teacher, was trying to coordinate some time off this spring in order to attend her daughter's college graduation. These people all emitted that quiet glow found in those fortunate enough to be distracted from the day's frustrations by thoughts of future joys. Coincidentally, they all asked me the same question:

"Do you think I will live long enough to see this?"

The human spirit contains enough strength that when released, like the ineffable birth of the universe, can expand to overcome almost all hardships - danger, discomfort, disappointment - nearly every worry the shaper of life can conjure up to provoke us. Not even the spectre of disease can separate a parent or spouse from an incandescent devotion to his or her beloved. The power within the soul, however, cannot exterminate the malignant parasite that slowly consumes the cancer patient from within. Viewing the future stretching out before them, basking in the radiant joy that awaits, they are unable to perceive the day when falling shadows will sunder them from all they hold dear.

"Do you think I will be alive then?"

How do I answer this question?

In addition to being the chief strategist behind the plan to kill cancer, the oncologist is also given a set of pom-poms and told: "Get out there and fire up the crowd!" He must become a tireless advocate of good cheer, for if the doctor - the presumed authority in a patient's case - becomes disheartened, why should anyone else be encouraged?

Is it my responsibility to prepare the patient for the worst and crush their hopes, or to keep on the bright side and be evasive, ignoring the fact that these happy plans may soon deflate like last week's birthday balloons?

My problem is that as I stand side by side with a man or woman who asks for nothing more than a chance to experience another day, I see too much. Discussing the future with a cancer patient is like watching a race between two warriors, each desperate to reach the finish line and declare victory - one celebrating all that is blessed in life, the other eager to cackle over the grave. Nothing I do today can guarantee that my patient will live to fulfill plans for tomorrow. I stand helplessly by the wayside - but not without a voice.

If there ever was a occupation where a certain phrase of the ancient poet Horace is taken seriously, it is medical oncology. His words are known to all:

"Carpe diem, quam minimun credula postero."

This is nice, neat advice but when you've got cancer what have you got to lose by living for today and tomorrow?

I therefore tell my patients to get out, to get together, but also to get going with their plans and live their lives as they do now - with every hope that the future will find them smiling with family and friends. Whether they make it to the ceremony or not, I want them to face the future as the rest of us do - with confidence in the worth of modern medicine, with determination that no illness can break our will, and with delight in every day that the sweet fruits of the world are within our grasp.