When Cancer Hits the Oncologist's Home

Short abstract

An oncologist reflects on the experience of a family member being diagnosed with pancreatic cancer and the lessons learned on the ensuing journey.

MD: “Hi. May I speak with Dr. Manochakian?”

Me: “Speaking.”

MD: “This is Dr. D from radiology. I'm calling regarding Mr. K's CT scan.”

Me: “Wow that was fast! He's actually my father‐in‐law and I'm with him in the car, on our way back home from the imaging center.”

MD: “Ah, I wish you hadn't told me that. I'm afraid I have some bad news.”

This conversation occurred 5 weeks after I moved to Jacksonville, Florida, to start my new job at the Mayo Clinic, accompanied by my family. My wife's parents had visited from overseas to help with the move, and it was then that my father‐in‐law, Misho, had told us of his abdominal pain, which we initially attributed to a known stomach ulcer. However, due to persistent pain and weight loss, I decided to order a CT scan.

Misho was a 68‐year‐old mechanical engineer from Syria (our home country), who had endured many hardships and losses during the endless, ongoing war. He survived a kidnapping in which he and other family members were held hostages by rebels for over 3 months. Finally, he and my mother‐in‐law were able to leave Syria and relocate to Russia (my mother‐in‐law's home country) before visiting us in the U.S.

Me: “Please go ahead Dr. D. We're pulling into the driveway now.”

MD: “I'm sorry to say that there is a large pancreatic mass that is most likely malignant along with…”

Me (cutting him off): “Oh…pancreas?”

I rushed out of the car and around to the passenger side. I opened the door for Misho and walked with him until he entered the house. I was still on the phone with Dr. D, and, with a brief eye contact, I told Misho I would be in shortly.

Looking back, I suppose I had expected bad news. Cancer had been on the differential diagnosis. Still, I was not ready to hear the words “pancreatic cancer.” I gathered more details about the scan from Dr. D, thanked him for the call and hung up the phone. I looked at the sky and whispered: “God, please help me. God, please help us.”

I am an oncologist, and I know that advanced pancreatic cancer has a terrible prognosis. I felt paralyzed and wanted to scream, but I knew the only choice I now had was to go inside, relay what I had learned, and then start on a journey with Misho and my family that we did not choose—a journey no one ever chooses. It turned out that cancer, the malicious emperor of all maladies, literally spares no one; that it can hit anyone, any home, at any time. Cancer had hit my home, hit my family, and it hit us hard.

Breaking such terrible news to the people closest to my heart was one of the hardest things I have ever done. In my situation, being an oncologist did not help me. I simply knew too much: the extremely unfavorable odds of surviving advanced pancreatic cancer, the treatment options and their side effects, and the reality that life was going to change forever. It was difficult to break this news to them when I, myself, found it very hard to accept what was happening.

Sitting with the family, I didn't know where to start. I stumbled over my words. I was angry, but wanted to project calm. I was scared, but wanted them to see my confidence. I was sad, but struggled for them to see hope. As I discussed cancer, I also tried hard to soften the news:

“At least, we know why you are in pain and we are going to fix that.”

“This is my field and there's a lot we can do now.”

Nevertheless, my desperate attempts to be optimistic failed miserably. My wife and mother‐in‐law broke down in tears. I needed to cry too, but how could I, when Misho himself, maintaining his unwavering strength, looked me in the eye, and asked: “OK, so what's next?”

The next few days were extremely difficult, trying to overcome complex social and medical issues. My in‐laws were on visitor visas and had no medical insurance in the U.S. We struggled between the options of sending him back to war‐torn Syria, where state‐of‐the‐art treatment would not be available, but where more family would be around for him, or staying with us in a city that had just become our new home and trying to find resources to receive care without health insurance. Misho initially said he wanted to go back home, but we soon realized that it was because he was concerned he would be a burden on us. In the end, there was no way that we would let him leave. He would stay with us. In our culture and in our family, it is a given that the doctor in the family cares for his or her loved ones. In this situation, it was even more compelling that I become in charge. I am an oncologist. I fight cancer for a living, and I, along with my wife, would do everything and anything to fight with and for my father‐in‐law.

And so our journey began…

As a patient, Misho was a trooper. He persisted despite social and cultural barriers, and fought through several chemotherapy treatments, procedures and complications. He followed every instruction I and other providers gave him. He was engaged in his care—asking questions and learning about the pancreatic cancer inside of him. He tried to exercise daily, even when in pain. His motto was: “I will not let cancer score a point on me.” Most notably, he never complained. He always believed that the cancer hit his family harder than it hit him. He cared most about minimizing any burden on us, especially on my wife and young kids. He spent hours building an airplane and a small ship for them out of boxes, water bottles, and straws. He was beyond thrilled when his first follow‐up scan showed good response. He was proud that he was beating the cancer.

Unfortunately, 7 months after his diagnosis, his cancer progressed. Although we were planning to start a new treatment, I could sense the change in his spirit—he was devastated. I could only watch, as the news of cancer progression seemed to suck the life out of him. A few days later, while having dinner, he said: “By the way, my brother's family is coming to visit you this weekend.” My wife and I glanced at each other, speechless. We both knew that her uncle's family was coming, but he said “you” not “us.” It almost seemed to be a sign that he knew he would not be here to see them. I also sensed it meant he was ready to stop further aggressive treatment and to live on his own terms, not on the cancer's terms.

The next morning, he woke up with respiratory distress and altered mental status. Within hours, his condition deteriorated. Hospice care was activated, and their wonderful team took over, ensuring his comfort until he peacefully passed away.

When I look back on my experience with Misho and my family, I realize how much I learned on that journey. I learned that caregiving is difficult and emotionally draining, even when you are an oncologist. Before this, home was never about cancer. Home was the place where I try to put cancer and everything related to my work aside, in order to spend quality time with my family. However, during this journey, home became about nothing but cancer.

I also learned on that journey that I was both stronger and weaker than I thought I was. It was ironic that I managed to stay strong, hopeful, and confident with my patients at work, while often feeling weak, hopeless, and scared at home. I realize now that I was scared every morning I left home, scared every time my wife's number flashed on my phone, and scared every evening while driving home, wondering what was waiting for me when I got there.

As an oncologist, I have always admired the spirit of the patients we care for. To me, they were the ultimate fighters. Caring for Misho helped me developed deeper appreciation for how much our patients and their caregivers actually endure, and it helped me understand the true meaning of a common statement I often hear from patients: “We will never ever give up.” I learned that responses along this journey of cancer are as different as those on the path itself—that faced with bad news, some people see a hopeless end, but others embrace an endless hope. Most importantly, caring for Misho reminded me that every day was a blessing and that with our strong faith in God, we were able to fight stronger and harder.

Finally, I learned that my family and I are surrounded by immeasurable love and kindness that lifted us up and fueled our spirits. We are blessed with wonderful family, friends, colleagues who had known me for only a few weeks, nurses, social workers, administrators, and many others who went above and beyond to help Misho and our family during our journey. We are forever grateful to each and every one of them.

It is still difficult and heartbreaking to accept the fact that Misho is dead. He left a void in my life—and that of my family—that can never be filled. Still, I know this void is only physical; we feel his spirit remains with us. I feel him watching over our family as we recover and move forward, over his grandchildren who have inherited his passion for building, and over me, his son‐in‐law, as I dedicate my life to fighting cancer for and with my patients.

I can still hear him saying: “Son, do not let cancer score a point. Keep up the fight. You beat the cancer when you fight the cancer.”

Disclosures

The author indicated no financial relationships.