"Good morning," I answer at work, already knowing who is on the line, "I hope you had a good summer." But, unfortunately, my bright, cheery voice met with silence on the other end of the phone. "Not so good," comes the reply, and I hesitate, but only for a moment before asking, "what's going on?" “Stage 4 melanoma” is the response “in my bones, liver, lungs, and brain.” I'm shocked, but I've learned not to allow too much time to go by without giving some response. "Well, that sucks." I say. There is no script for a difficult conversation, whether a friend, client, or spouse, and cancer of any type is a challenging conversation to have with anyone.
I've been on the other side of this talk, and so I know from experience that just breaking the cancer news to a friend is complex, and their reaction to that news varies from shock and anger to something akin to blame. "Have you started treatment?" I ask, not sure if a recommended treatment is even possible in his situation, with cancer spread throughout his body to the extent it has; "not yet," I go in for a final consultation next week, and the doctors will have decided by then. He mentions chemo, and I casually mention the type of radiation treatment I received. There is a pause on the phone before he says, "I'd forgotten you had cancer too." That is generally all it takes, a simple connection of empathy that says I know to some degree what you'll be going through, and the conversation becomes more straightforward.
We talk about radiation sickness, vomiting, and lack of energy. I laid it out as truthfully as possible, reminding my friend that everyone responds so differently that it is impossible to know what will happen. Another pause, and then the question I know is coming, "is it worth it?" I know what he is asking; however, I can't answer the question, and I try to explain that although I'm a cancer survivor, I don't count what I went through as cancer treatments. Yes, I had cancer; however, they caught it very early before it spread. I received a pointed radiation treatment that burned cancer out at the source. My doctor was particular in his discussion that my treatment is considered a "cure," not remission, which is most often the sought-after result. Therefore, treatment was not a decision but more of something I needed to go through to get to the other side. Stage four, chemo, and everything else is a different ballgame, so I finally said, "as long as it is your decision and no one else, you'll handle whatever comes just fine."
I've run my practice for almost 30 years, and I am constantly amazed by the sheer number of difficulties everyday people face regularly. People kid themselves if they think they will get through this life without some difficulty. The end-of-life trials that appear the hardest on everyone are medical issues where the children or spouse don't want the ill person to die without a fight. And so the treatments begin, and the chronic pain ensues a brutal ending because although the children believe their beloved mother or father is fighting, the patient had given up way before the treatments started.
"You have to decide," or quite frankly, the fight isn't worth it. But, on the other hand, my friend is in his mid-seventies and strong. He has spent his entire life doing hard things, so in my mind, if the doctors can narrow the treatment to the point that a single treatment will affect the melanoma no matter where it is in his body, he has a good chance of extending his life.
We've chatted off and on since the original difficult conversation. I'm glad to announce that the treatments are going well, "I'm hardly ever sick after my chemo," my friend says, which is delightful to hear, and he jokes about giving his doctor a hard time because she postponed his last appointment due to the weather. "Two more treatments in this series and then we will stop and evaluate," and my friend walks to the door. He is a little worse for wear; however, a stranger who has never met him would be hard-pressed to know what he is going through as we say our goodbyes. "Keep us posted," I say, and he nods that he will as he walks through the door. All of us have just a lease on life, and it doesn't matter if someone is fighting cancer or simply living life; when they walk through a door, it might be the last time we see them. Treat the occasion with the reverence it deserves.
Written January 29, 2023