No matter how much education my staff and I participate in, we will never cover every single possible adverse event that an individual may experience. And in some cases, when a patient can't explain their symptoms, we can be at a loss as to how to help them.
Having cancer is tough. Harder for some than for others. Not just the treatment that can cause any number of side effects-nausea, vomiting, hair loss, neuropathy, rashes, etc. The list goes on. For patients on hormonal therapies, there are innumerable symptoms of a drastically altered hormonal system. Not just hot flashes and insomnia, but joint pain, emotional lability, fatigue, anxiety, memory decline-again this is not an exhaustive list, just examples.
No matter how much education my staff and I participate in, we will never cover every single possible adverse event that an individual may experience. I fully appreciate that and empathize when patients present with issues that we did not anticipate. My mantra has always been, “I would not have expected that but any drug can do anything.” In addition, there are some side effects of treatment that we can’t really fix-they just eventually resolve themselves.
There are times when a patient complains of something that I truly believe is not related to the treatment. Not infrequently, patients will attach a new problem to treatment of years gone by. Yes, I am aware that there can be late side effects, but a lot of the issues raised are not from chemotherapy or radiation from 5-plus years ago. It is not uncommon for another physician to plant the seed of “that must be from your chemotherapy.” Medical oncologists and cancer treatment do get blamed for everything!
A patient currently on treatment had seemed to be doing well. They were appropriately emotional at the beginning, but brought multiple family members to each treatment visit-we all got along, there was a lot of laughing, and they brought me food gifts. Then the nurses came to see me one day and said, “We just think you need to know about ‘X.’” Apparently, X was acting out terribly in the chemo suite. For example, they insisted on bringing many family members and friends who claimed multiple recliner chairs and blankets and became difficult when asked to move to make room for patients. A local store drops off day-old flowers to us for patients to take home, first-come, first-served. This patient went to the store and complained that they “never got any because they came at the end of the week.” I was shocked. I had never seen any of this rude behavior, so there was nothing for me to say to this person.
Until…X had transitioned to the less toxic portion of treatment and I was expecting things to be much easier. When I entered the room for a recent visit, I was accosted. X was screaming at me that they felt terrible, couldn’t eat, felt exhausted, cried all the time, and felt “bad all over.” The spouse sat there and said nothing for the 35-minute visit. I tried desperately to elicit exact symptoms, explain some of the issues, commiserate with their complaints, offer suggestions, medication changes, reassurance. Suggestions about past depression were met with an indignant rebuke. Nothing appeased X. The patient made it clear I was disappointing them.
I asked several times, “What can I do to help you?”
“Nothing,” X hissed back. “Let’s just get this over.”
I felt terrible that the patient was angry. It made for a very unpleasant exchange. I would love to know what I could have done to help X even a little bit.
This is not an isolated event. There have been other patients-and family members-over the years who became enraged, bitter, and angry at the care team. We want so much to help them but are truly at a loss as to how to reach them. When I see X next week, I hope the air is cleared and we can have a productive conversation.