The Crossroads of Decision and Acceptance

Decision, acceptance, and rejection may be some of the stresses and dilemmas that a cancer patient may face. This could manifest in the beginning, during, or years after when recurrence occurs. 

Below are  2 cancer cases I navigated, each making you wonder how and why you would handle the situation, if you were in a similar position.

Case 1: The Patient Who Refused Surgery

• The first patient walked into our room after her cancer diagnosis. She had spent more than 45 minutes with the doctors. She was a tall, overweight Indian widow in her early sixties. She was the unofficial midwife for many years and had nine children—all married and settled. She lived with fifteen members of her family, the largest number of caregivers I have ever seen at one time. 
• She gave precise and accurate information, but when the question of mastectomy came up, she clamped up. She refused to say anything other than she was not keen, not wanting to keep to her future appointments, and did not want anyone to navigate her.
• I tried my best to convince her on early intervention as she was in stage 2, but she was adamant and completely sure how to proceed after her diagnosis.
• Soon, two of her sons joined in, also not keen on the mastectomy. They said all nine of her children were born at home, so they were confident she would manage.They were willing to buy morphine if needed.
• Finally one of the son’s said that his mum has 2 requirements before she would do the operation:-

• -the sons stated that every night  for the past 30 years before going to bed, she drinks 2 bottles of samsu(local alcohol) and smokes 2-3 cheroot (cigar) a night.she will need it the day  before the operation, on the day of operation and daily after that.
• I informed the doctor on duty and was responded that no doctor would be able to authorize this as it was against hospital policy.
• We never saw her again.she never answered the calls form the hospital or myself

Case 2: The Man Who Wanted His Freedom

• The next case was a Chinese man in a wheelchair with late-stage colon cancer awaiting chemotherapy. Formerly, he was a small-time contractor doing minor jobs. He spoke little English and Bahasa Malaysia. His wife, was well dressed, smart, formerly a staff nurse,who spoke fluent English and Bahasa. She had given up her job to cook Kuay Teow at a food court. 
• They had three children—a married daughter living nearby and two sons living in Kuala Lumpur. The children seldom visited because of work constraints. I asked how he spent his time. He said he awoke, had breakfast, then moved into his deck chair or bed.
• I wanted to see how I could help him pass the time. I suggested he help his wife at the food stall or walk to buy supplies, but he refused. His reply was always the same—his family never listened to him but wanted to change his lifestyle. Finally, I asked, ‘Do you watch TV?’ He said he hated it—every show was predictable. By then, his wife had to leave, and I promised to visit them during the last chemotherapy session.
• That same day, I called Dr. Shankar, the psychologist, and asked how I should help this patient. His reply surprised me. He said, ‘Why must he do anything? He worked hard all his life, bought a house, and brought up three children who are now independent. For the first time, he’s thinking of himself. Let him do what he wants.’ That conversation changed my perception and how I dealt with patients forever.

Lessons in Perspective

It was a major game changer in my approach to patients’ desires and how they wanted their cancer journey to unfold. In recent years, I have relied on immense inner acceptance and respect for patients’ wishes, irrespective of their financial or educational background.

When Families and Patients Differ

Patients today are taking on a more decisive role in their journey. Many do not want to spend their final weeks or months in hospital. They want to enjoy life with family and friends, doing their favourite things. When patients decide not to continue treatment, the hardest hit are their families and friends, who may spend days arguing over decisions. I’ve seen siblings divide over differing views.

If families can sit down and rationally speak of their fears and the difficulties ahead, much can be eased. Sometimes, a psychologist should be considered to help. We must always keep in mind what the patient says and wants. Sometimes, we have to do what is best, even when it’s difficult.

Closing Thoughts: Unity in Compassion

• There is no right or wrong in how you care for a patient. 
• Do what is best for them, listen to them and always remember that the doctors and family should show solidarity in the efforts to care for the  patients.
• We must remember that at the end of her journey—whatever the outcome—the family is still intact.