Do Not Touch

Observe. Let’s say this is the decision I have to communicate to my patient. I analyze the data in front of me and come to the conclusion that the best therapy is to do nothing. To leave this patient alone and watch their disease rather than interfere. Easier said than done.  I believe this is one of the hardest decisions I have to make sometimes, because we as a society have become used to the idea of doing something. Doing nothing is just not acceptable. Why is that? Pressure from guidelines and treatment algorithms, difficulty in teaching my students who are learning the concept of observation, and exceptionally hard to explain to the patient and the caregivers.

There is an itch to treat. I compare it to an itch because it is hard to ignore.  I feel it.  It builds up inside us telling us to do something. We just can’t stand there and watch. Even when the odds are low, or the statistics are not favorable. That irresistible feeling to do something comes roaring from the inside. Where does it come from? Why do we listen to it? I ask these difficult questions because sometimes I think I should just shake my head and say no, leave it alone Mo. I think your best option is to watch. Allow the disease to declare itself, and show you what you need to do. “I am a good salesman, about to sell you a crappy car” I find myself quoting quite a lot to patients as I navigate this decision. I don’t want my patients to feel abandoned or dismissed.

I have evolved in the way I treat my patients today. When I was younger I was eager to get a treatment plan in place for a patient. I believed that it was important to have that ready to help patients fight their disease. Over time I have also seen my decision-making change. I am more observant, waiting for the right moment to intervene with a therapy. I always  hope I make the best decisions for my patients. It involves engaging the patient, the family and their goals. Slowing down and trying to let the decision be made for me by observing has proven very valuable.

To truly help you as a patient, I want to be in your shoes. So let’s reverse the roles, I am now you. Faced with a difficult disease, being bombarded with knowledge that overwhelms and intimidates.  Yes I can be that person since I am vulnerable to this disease and its effects. I self-reflect to what I hold sacred as I ask the deepest parts of me. I value my quality of life, my sense of well-being, and my vitality to those around me. I do not want to interrupt my life, I do not want to be sick or out of sorts; What would change my mind to accept a treatment, cure?  If that cannot happen, then why subject me to this treatment? What’s the goal? Doctor can you please answer me? What can you possibly offer me that may make a difference to me? Why is it necessary to put me through this? Why do I have to suffer?

Important questions that I ask as the patient and should be asked as a doctor. Can you be me for a change?  In the eyes of this doctor I seek understandings in why I have to present a treatment that may not be helpful to my patients. Perhaps the best treatment is “do not touch”……..reminiscent of the oath I took of “do no harm”.





3 thoughts on “Do Not Touch

  1. I just discovered your blog and when I came across this entry I felt like I was siting in your office all over again! It is a hard reality to accept but sometimes the best solution!

  2. Thank you, Mo for this post. Rarely are we, the young oncologists, taught how to wait and to observe. You have been a consistent teacher of the human/humane medicine for me. Even when your decisions seem inconsistent from patient to patient. I have learned to look deeper, to see and feel the person i am treating. It is scary sometimes, and occasionally, I just squeeze my eyes shut expecting a fight and tell them “my medicine is worse than the disease, lets wait”. More and more I open my eyes and see the relief especially in the patients who know me for some time.

  3. I was diagnosed with sarcoma in January post surgery so not the best case scenario. I was then referred to Mo. This was Mo’s advice for me – let’s wait and see. At first I thought he must be wrong and someone somewhere could do something more for me. In my world you didn’t just wait and see when you were dealing with cancer especially an aggressive form of cancer. So when Mo wasn’t looking I researched sarcoma and found lots of statistics that weren’t so hot. I consulted with other doctors and the majority opinion was the same, wait and see – not what I wanted to hear. So as I recuperated from my surgery and began to wrap my head around this wait and see approach I started to feel better and began to live with the diagnosis of sarcoma. I discovered that joy and happiness returned to my life as I returned to my gardening and other activities. What surprised me was how wonderful the gift of life seemed to be – mine,those I love and even those I’m not overly fond of. People seemed kinder, gentler and more loving. It was as if the sun shined a little brighter, the trees were a little greener and the flowers smelled a little sweeter. It seemed everything had become even more beautiful and goodness shined out from all that surrounded me. My family and friends were and remain in this with me and I am supported by the prayers of many. Sometimes waiting has wonderful surprises. I don’t know what the future holds for me but so far so good. Guess I’ll continue to wait and see.

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