Diane Reidy-Lagunes is a board-certified medical oncologist in the Division of Gastrointestinal Oncology in the Department of Medicine and Co-Director of the Department of Medicine’s Hematology-Oncology Fellowship Program.
It’s almost July, the time of year when an army of young and energetic physicians storm hospitals across the country and eagerly begin their residency and fellowship training. It’s also my first year as Co-Director of the Memorial Sloan Kettering Department of Medicine Hematology-Oncology Fellowship Program. With that title comes the responsibility to teach the leading young physician-scientists to be outstanding oncology researchers — and equally important is to educate them on being caring and compassionate cancer doctors. I share the following story so that my fellows recognize the challenges that they will likely face. I hope it will also serve to motivate and inspire us all to do better.
Hopes Raised, Then Dashed
After two CT scans showed no sign of cancer, everyone was feeling hopeful about Drew’s future. A 21-year-old college student with an upcoming summer internship, he had three months of adjuvant chemotherapy left, in which we’d attempt to eradicate any microscopic adrenal cancer cells that might still be lingering following his big surgery, which consisted of removing his right adrenal gland and part of his liver. After that, he planned to return to his senior year at a top university, where he would graduate magna cum laude. At least that’s what was supposed to happen.
Then his latest CT scan came back. New tumors were infiltrating his lung, liver, and lymph nodes. The cancer had recurred.
It fell to me, as his treating physician, to break the news — and I found myself struggling with it. How could I explain this to such an extraordinary young man and his supportive family? I retreated to my office to compose myself. When I summoned the courage to face them, it turned out that I didn’t even have to say much; my swollen eyes and the look on my face told the story.
Continuing the Fight
When it comes to cancer, these scenarios are heartbreakingly common — especially in my specialty. I research and treat rare forms of the disease, such as neuroendocrine and adrenal cancers, which don’t get the same funding and resources as more common cancers. I chose my specialty partly because I want to find better treatments for my patients. Developing methods to integrate molecular-based, or “targeted,” therapies and trying to understand how these rare cancers evolve so that we can best target them are two ways we’re attempting to improve our odds. But it begs the question: If we have so many more losses than wins, why do we keep fighting?
We fight because we do have many wins, and those gains are part of what motivate us to keep going. I am fortunate to work with some of the most brilliant and talented physicians and researchers in the world at Memorial Sloan Kettering, and we all fight daily to improve the chances for our patients.
Each one of us is driven by some internal motivation, whether it’s our innate desire to help others, our hope of advancing science to improve treatments, or that we’ve lost a loved one to cancer.
Staying in the Here-and-Now
But we’re not there yet. Although I am also a researcher, I view my primary job as a clinician caring for patients in my clinics right now, the ones waiting for my help and attention. And the truth is that many of them, particularly those with stage IV disease, will die from their cancer. For them, science has not yet achieved victory. We exhaust every option, controlling the cancer for as long as possible and tenaciously continuing our research, but a cure thus far ultimately eludes us. The patients I lose are young adults; they are parents of small children; they are grandparents. Although it is my duty to honestly explain patients’ prognoses, it is hard to escape the pain I feel as I look them in the eyes during that vital discussion. It hurts a lot.
With that painful realization, I also have a responsibility to give them the confidence that I, their treating physician, will be traveling this journey with each and every one of them — and sharing all their emotions along the way. Equally crucial is to provide hope, because the truth is that neither I nor anyone else can predict any one patient’s outcome.
After several more attempts at treatment, Drew passed away from metastatic adrenal cancer on Valentine’s Day of this year. Before he died, he wrote a letter entitled “Saying Good-bye to a Friend,” intending to send it to his friends and family. He never finished it.
I hope that one day I’ll help make those good-byes no longer necessary.