Can you draw the picture of happiness– Treatment of a young woman with breast cancer during the COVID-19 pandemic

40-year-old painter with breast cancer patient came to our clinic one month ago. The patient had a tachycardia and she was breathing rapidly, but there was no fever or anything else. All evidence pointed to extreme anxiety. The patient had been offered adjuvant chemotherapy in another center. She refuses adjuvant treatment, because it has concerns about immunosuppressed status and it is at increased risk of developing severe complications from the coronavirus.

Patients with cancer are a high-risk group in the coronavirus disease 2019 (COVID-19) pandemic. The COVID-19 pandemic has become one of the anxieties and fear among patients. It is critical to understand their specific sources of anxiety and fear of cancer patients. We have never seen such widespread panic in my patient population as during the advent of COVID-19 pandemic. Multidisciplinary teams are the gold standard in cancer care, but there are times when guides cannot help you much. She wanted to express her thoughts on their chemotherapy and COVID-19 their feelings through painting. This thought seemed very surprising to us but painting as a nonverbal expression of emotions can help us understand patients’ view of COVID-19, their hopes and expectations, and their responses of fear, denial, helplessness, and despair (Nainis et al., 2006; Cohen, 2005).

As one of the greatest international poets of the twentieth century Nazım Hikmet (Translated by Randy Blasing and Mutlu Konuk, 1994) said that ‘’Living is no joke,

you must live with great seriousness.

like a squirrel for example,

I mean expecting nothing except and beyond living,

I mean living must be your whole occupation.’’

Two week later, my patient applied again with the pictures in her hand (Fig. 1 ). ‘’The word hope first appeared in English about a thousand years ago, denoting some combination of confidence and desire’’. It is an elevating, energizing feeling that comes from seeing, in the mind's eye, a path to a better future (Groopman, 2004).

Fig. 1.

Emotions of the patient who received detailed information on treatment modalities and COVID-19.

We are medical oncologists and radiation oncologists. We tell people they have cancer many times and their condition are incurable. Providing and maintaining hope for patients with cancer is something that medical and radiation oncologists recognize as important. Medical statistics only describe numbers such as Kaplan-Meier survival curve to be used to measure the fraction of subjects living for a certain amount of time after treatment. Could we divide the curve into sections, from” defeated” to “victory” to “pessimistic” to “hopeful? Hope can continue even as clinical treatments cease. It is never lost. Life is inherently uncertain and unpredictable, with or without cancer. In the Fig. 1, the fear of the COVID-19 virus disease is clearly observed. The patient depicts how the patient eventually embraced life for all the distress brought along with fear of COVID-19 virus. Real blindness was to live in a world where hope was exhausted. Because we know that we will see beautiful days, sunny days. The greatest of the Islamic mystic poets Jalal ad-Din AR-Rumi, better known as Mevlana, said’’ After hopelessness there is so much hope after darkness there is much brighter sun’’.

We have dedicated this poem to our healthcare professionals working in the COVID-19 pandemic around world who inspire and encourage us and our oncology patients.

‘’ You must take living seriously,

I mean to such an extent that,

for example your arms are tied from your back, your back is on the wall,

or with your huge eye glasses,

in a laboratory with your white shirt

you must be able to die for people,

even for people you have never seen,

although nobody forced you to do this,

although, the most beautiful, the most real thing,

you know that living is.’’

 Nazım Hikmet 1947

Research involving human participants and/or animals

This article does not contain any studies with human participants performed by any of the authors.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of Competing Interest

All authors declare no conflict of interest.