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27 APRIL 2015

How much time do I have, doctor?


Once the fact has sunk in that the Stage 4 cancer is incurable, the question that eventually comes up is “How much time do I have left?”
I watched a colleague handle this question. He first answered the question with one of his own: “Do you really want to know the truth?”

The patient nodded with some apprehension. With a straight face, my colleague said: “I don’t know.”

It was probably the truth but I am not sure that I would have replied quite that way. Still, each doctor handles it differently and for each situation, we play the hand that we think best suits the patient, the condition and the prognosis.

I began looking after Mr Yeo in November 2004. He was referred to me by a senior surgeon who had just removed a cancerous portion of his large intestines. As there had been spread to the regional lymph nodes, the patient was deemed to have Stage 3 colon cancer.

Despite six months of chemotherapy, the cancer recurred in February 2006.

After a few cycles of chemotherapy, he finally asked the inevitable question. With my usual bravado, I replied: “How much time do you want?”

Mr Yeo sheepishly replied: “Ten years can or not?”

It is quite interesting what answers patients come up with.  A lady in her 40s, whom I have looked after for a double cancer – malignant lymphoma and breast cancer, said: “I want to be a grandmother!” Her daughter, who is a very talented musician, is only in her teens.  

Another lady who had just delivered her baby girl asked if she could be around to watch her daughter get into university. A gentleman in his 50s asked if he could last till his senile mother passed away.

As I flipped through Mr Yeo’s case notes the other day, I came across the entry I made on 25 May 2006 – “10 years enough.”

I reminded him of his long forgotten plea and jokingly said that his time was coming up and that he did not need to continue follow-up and treatment anymore. This may seem an insensitive or a particularly macabre sense of humour but in taking care of patients who have stared at death in the face for years – I find myself taking the same prosaic attitude as they do.

At the start, it may be difficult for a patient with Stage 4 cancer to imagine at the point of diagnosis that it is possible to be alive years later. However, it is a fact that there are patients who can.

The journey however, is not always an easy one.

Mr Yeo was treated with a very aggressive chemotherapy programme when the disease first recurred. The side effects of treatment included hair loss, nausea and diarrhoea.

Despite “burning” the liver metastasis using radiofrequency ablation, the cancer recurred in the liver in March 2007. He was then re-operated by the senior surgeon and had half of his liver removed. The cancer recurred in his bones in May 2008.
Mr Yeo has been on low dose chemotherapy together with bone- strengthening medicine ever since then. He has an intravenous catheter that is inserted just under his collar bone into a big vein in his chest.

An infusion ball, containing a chemotherapy drug called 5-Fluorouracil, is connected to this catheter and the drug runs in continuously every minute of the day. He changes the infusion ball once a week by himself at home. Once a month, he sees me to review his condition, adjust his medication and receive Zometa® to harden the bones and retard the progression of his cancer.

We have been tracking his disease with PET-CT scans every six months or so.

His disease has remained non-threatening with occasional flares but at other times, the disease is quiescent.

Through it all, he has remained alive and well enough to continue working.

I saw a young lady who had been diagnosed to have Stage 4 breast cancer. She underwent surgery for breast cancer over year ago. Despite advice from her medical oncologist that she needed chemotherapy to prevent the cancer from recurring, she refused.

When I saw her, I could sense the sea of emotions tossing in her mind – regret for not having had treatment; fear of the potential side effects of chemotherapy; apprehension of how little time she may have left.

She had many questions and I spent more than an hour counselling her. It was not medicine she was interested in, but more existential issues. I am not a philosopher but I felt she trusted me and answered the best I knew how.

Just before she agreed to start treatment, she asked the inevitable question: “Doctor, how much time do I have left?”
I smiled and replied: “How much do you want?”


By Dr Ang Peng Tiam

TAGS cancer doctor stories , cancer hair loss , stage 4 cancer
READ MORE ABOUT Breast Cancer , Colorectal Cancer

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