My Facebook Post:

Today was a bad day for a patient: diagnosed her with metastatic cancer – she won’t have long to live. She had a curable cancer a while ago but decided to not have chemotherapy and instead was working on a combination of cannabis oil, veganism, vitamins, and other alternative cures. She asked me what I would do if this diagnosis was in my wife, how would I fight it – I told her that I would take my wife to the best ski hill and let her ski until she couldn’t any longer – then bring her to a beach to listen to the ocean and watch the sun rise and fall until her last breath. Funny thing- I’ve done this medicine thing for a long time. I have had this conversation with a lot of patients and families. It is never easy on them – and it isn’t easy on me either.
When you open a person’s abdomen you can never predict what you will find. Even though we have great CAT scans, MRI scans we can never be certain what we will see when we look inside someone’s belly.

She was a lovely lady who had a hernia that needed repairing. Nothing complicated, just a hernia. What she didn’t know was inside of her a cancer had been growing and had spread.  She might have suspected it, as she was a “cancer survivor.” Proudly wearing the label after taking an alternative route to cure her cancer.

Looking inside her abdomen I found small little tumors, looking like florets of cauliflower – studding her surface. Most of them the size of Kosher salt – but if you see ten you know there are a thousand that are microscopic in size. In her there were thousands of bits of cancer and no way to remove them.

There are some cancers that we have good treatment for.  Years ago I was repairing a hernia in Frank, a good friend of mine, when I found the same speckling of cancer. His cancer was a lymphoma, and now – some 30 years later, he is still alive, having undergone several rounds of chemotherapy. Sadly, in 30 years and having opened many abdomens to find inoperable cancer, there are only a couple I can remember that were curable.

You hope, as a surgeon, when the pathologist calls you back that it is some good news. Some cancer that we have treatment for, or perhaps some other disease that won’t hurt or kill for years.

So I was waiting to hear from the pathologist about this lady, when his voice came over the loudspeaker of the operating room: “Is this a good time to talk?” He asked.

“Yes, the patient is asleep.”

“Looks like a poorly-differentiated adenocarcinoma, Terry. Did she have any history of cancer?”

“She had colon cancer a few years ago,” I told him.

“This is probably the same tumor, looks like a bad actor, I’m sorry.”

Telling the patient is never an easy thing. There is cancer, we don’t have good treatment for it. We also don’t know how long a person will live.

You may remember 9/11/2001 as the day that the twin towers came down.  I remember watching the towers come down as I was telling a nice lady that her pancreatic cancer was everywhere. The world changed for her- in two weeks she died. She should have lived months after that diagnosis – but she didn’t. I don’t know if seeing the world change when her world changed was too much, I don’t know if she gave up, I don’t know where her mind went, but her body chose to die – and I don’t think it was a coincidence.

I have a strong skeptical bent to medicine. I hate it when people are taken advantage of for some false hope for a cure for cancer. We see them all the time — like this lady who had used all sorts of things. Steve Jobs, as bright as he was, lost his life because someone convinced him that diet would cure his cancer – and he had a cancer that could have been cured.

We don’t have cures for every cancer – we have treatments. Some are effective, some are not. Just like we don’t have cures for pneumonia – we have treatments. But when we don’t have good medicine for a particular type of cancer, I am conflicted about people who seek cures.  I am not conflicted if they know it is a false hope, if they know there is no science behind it- and I cannot blame desperation.

Cancer took my brother.  For months he had not been feeling well. Chest x-rays didn’t show a problem, and finally a CAT scan showed a large tumor in his liver. It was lung cancer. We don’t have a good treatment for lung cancer. He was coughing all the time, and the cancer treatment doctor thought maybe a round of chemotherapy would reduce the tumor burden and help him. Shortly after the chemotherapy my brother became septic and he spent the last 18 days of his life on a ventilator in the ICU. I was the family member who had to make the decision to remove life-support.

The conversation isn’t easy for them. It isn’t easy for us.

One of my favorite paintings by Joe Wilder – a surgeon’s contemplation before surgery – I have this in my office