The Loss of My Friend

Jasmine Kamboj, MD

“Emperor of all Maladies” they call you.

Indeed, you cause and create so much melancholy

For not only the one who beholds you,

But also for the ones who behold them.

I care for and love my compadre,

Only to lose them in your arms someday.

My faith stays with me in our voyage,

Only to be shaken when my friend is gone.

Oh friend, oh dear friend,

I miss you terribly.

I tried my best to attack our adversary,

Only to realize no truce is possible.

Death is universal to us all,

And so is lamentation.

Grief, I have experienced all the stages,

But found no solace.

Animosity toward this infirmity is robust,

But despite the sadness, hope is not gone.

One day, yes someday, we will ward off this sickness.

Yes, that day is dedicated to all who endured, directly or indirectly.

“Emperor of all Maladies” they call you.

Indeed you cause and create so much melancholy,

For not only the one who beholds you,

The Specialty

But also for the ones who behold them.Every medical specialty is a unique subject, and oncology is no exception. Despite the vastness and depth that it entails, it resorts to some of the most universal laws of “being human.”

Every organ has a different kind of cancer, and each cancer is an independent disease in terms of its course, treatment modalities, and outcomes. Two people with the same cancer type can react in completely different ways, depending on their age, race, gender, lifestyle differences, motivational capacity, and physical strength.

The Bond With the Patient

When an oncologist starts caring for a patient, besides applying the guidelines to the case scenario, one cannot disregard the variables that accompany an individual as a virtue of their being. The oncologist and his or her patient are about to undertake a journey that is exclusive to only that one case.Most cancer treatments span from a few months to a lifetime, based on the stage of the disease. Beyond the physical stress and strain on the patient’s body, this long haul is besieged by overwhelming emotions. Anxiety, apprehension, fright, anger, and depression are just a few of the many feelings that come to haunt the patients and their families. And thus, while oncologists take care of the physicality of the disease, they become a friend and confidante of their patients and families— and sometimes even, in a sense, a family member as well.

The Doctor’s Sentiment

An oncology clinic is a place where no one would ever wish to be. However, when life does put an individual through that fight against cancer, patients end up forming a most powerful bond with their oncologist.While we oncologists consciously take care of our patients, putting the best data into clinical perspective, trying to discuss the difficult options for treatment, to ensure the best line of action, we are also establishing relationships of compassion, empathy, affection, and friendship with patients and their families. The physician is a human being first, and a trained oncologist second. And while it is a generally accepted rule to remain professional and keep emotional attachments to a minimum, it is rather difficult to practice this directive in oncology. Most of the time, logic and science have some sentiment and intuition at play in the background.

The Actual Loss

The Hope

When I state this fact, I must clarify, I am not referring to emotional bias influencing rational judgment; instead, I am talking about an oncologist’s dilemma and dismay when the current treatments are failing unexpectedly, there are no more treatment options left to pursue, or the patient has rapidly progressing disease. There are times when all the available treatment options have been exhausted, but the oncologist is not yet ready to accept the loss.Death is an inevitable part of life; it is the single most all-inclusive phenomenon. Although everybody knows this, nobody wants to see loved ones dying, and an oncologist is no exception. When a patient approaches the end of life despite treatment, the oncologist also confronts feelings of desolation and disappointment. Despite being well aware that they made their best attempt at treating a particular case, the oncologist can’t help but speculate about other possibilities. Was there any other option? Was there any clinical trial anywhere in the country that could have benefited the patient? Could there have been some out-ofthe-box treatment? Sometimes we just ask ourselves, when will we be able to find an answer to our questions and prayers? It’s hard not to have doubts about the fairness of the world.Ultimately, I would say most oncologists are optimistic individuals, people of forbearance. We see the alchemy of life and death on a regular basis, but this does not dampen our spirit to start afresh when we begin a new patient’s care. I don’t mean to imply that all oncologists are upbeat all the time; there are days when we feel worn out. However, we recuperate quickly, to put our best efforts into each patient’s treatment. There are new medications getting approved for most, if not all, tumor types. There are countless clinical trials in multiple cancer institutions all over the world. Many cancer treatments have achieved landmark success in transforming a once-fatal disease into a chronic disease a patient can live with for a prolonged period. There is an endless anticipation and aspiration to be better, to do better, and to keep persevering, as we strive to make this ghastly disease nothing but a piece of history.