I am always asked “what if?” When my patients are seeking the pessimistic alternative to the situation at hand. I have also heard of patients being given ultimatums with a deadline on their time to life. I love it when they break those barriers and surpass the times “allocated”. I have not handled these questions or these situations well. I touch upon my need to provide the right answer when I am asked “what if that happens to me?” and “when will it happen to me?” My tendency is to avoid it, try not to answer it and tonight I wonder why I do that.
Our predictive power as oncologists is very limited. In 2013 I am faced with an enormous speed at which we are discovering newer more innovative therapies to help patients. I find it hard to counsel patients in the future when there is hope for cures and longevity. This is very new for me, exciting and frightening all at once.
How does it feel for my patient? Anxiety is one of the most difficult emotions to navigate. Failing to provide them with the answers they seek creates a conflict that is not readily resolved. Science needs to help us understand outcomes of how disease may manifest in an individual and how it acts. A lot of our therapies are geared towards attacking the cancer head on. Newer approaches are taking into account how we might be able to isolate different individuals based on the behavior of their bodies and discovering better predictors for response to a therapy. I would like to tell my patient “I’m recommending this therapy because you are the one who will benefit from it.” We are clearly not there, and a lot of work needs to be done to help us be better at guiding patients down the best path for the treatment of their disease.
Like a compass leading in a general direction without pointing to a specific street or alley, when asked “Well what if that does not work for me what then?” I simply say – we’ll take it day by day and cross that bridge when and if we get there.
Mo
DOCTOR MO IOWA 
Mo,
Sorry this comment is late..I love the fact that you are the kind of doctor that didn’t put a stamp of time on my life with this cancer. Yes we wait for everything when it comes to a diagnosis and treatment but in the end you are trying to do what is best for each patient. I appreciate that you try to get the right one to the right person. I feel what you offered me was for me. Thank you for being there for each person individually. You are a amazing doctor of science Mo… Never change…
Claire
A Blessed Thanksgiving to you and yours, Dr. Mo!
Though I am a layman, I fully understand the dilemma you are facing. From the layman oriented literature I do read I perceive such promise in stem cell advances and especially in the field of nano-technology in terms of curing cancers. I have NO doubt there will be a major break through and it may very well be in this decade.
We remember the challenge AIDS presented in the beginning and the prospect of significant time passing before it could be controlled or eliminated. That has, blessedly, not been the case. Polio was the scourge of my childhood and I had an uncle, a wonderful person, who was severely disabled by the disease. Fortunately it left his amazing mind intact and we loved him and learned much from his gifts of wisdom. Another spent a productive life while confined to an iron lung and later to a portable breathing assist device.
I have a friend who is a patient of yours. I often counsel her that, at this point TIME is the blessing we seek as there WILL be a cure; that it comes soon enough is our prayer.
Your affirming counsel is a gift in itself and we so often hear how you have become her savior here on earth; bringing hope and healing into her life.
This day we are thankful that all of us are here read the thoughts you share and that, as you so cautiously offer, there is so much real help just over the horizon it is hard not to offer promises that seem too good to be true. Blessings happen! Thanks be to God! And to God’s servants on earth. Thanks for sharing.