Richard C. Frank

“I need to know that you’re going to fight for me. I feel like you will, that you care. Are you going to f---ing fight for me, Doc?!” Thus asked my new patient, Joe. He was an imposing figure: Italian- American, with chiseled features, a body rippling with muscles and hands like anvils. The anvils, I would later learn, had leveled much larger men, but only when they deserved it.

This was our second meeting, and it was just us two, man-to-man. During his initial consultation, he came with his wife and two children. They were very handsome people but also warm, intelligent and fiercely determined. And, at that point in time, quite devastated that Joe, their leader, their rock, had pancreatic cancer that was inoperable. They were still in shock.

By the second meeting, Joe was more himself and had me cornered. “Yes, I will f---ing fight for you! I fight hard for all my patients,” I replied to his question. He laughed heartily and took great relish in my use of an obscenity, a sign that I might not be just another frigid doc. “That doctor in New York, forget about it,” Joe said. “I woke up from surgery [an “open and close” in which the tumor could not be removed] and he says I have a few months to live, take this chemo; it’ll make my fingers numb. He was like Lurch. I said, ‘Hell no, get me outta here!’”

One thing I learned quickly about Joe was that he was stubborn. It had to be his way.

Joe was referring to the drug oxaliplatin, a chemotherapy agent used to treat pancreatic and other cancers that can cause neuropathy (with symptoms of pain and numbness in the fingers and toes). Joe was a highly skilled heating technician and had been for 30 years. He was known throughout the state as the guy to call when no one else could fix a boiler. He improved the lives of thousands of people by his work, in which he took great pride. But he could not perform it with numb fingers, so I agreed not to treat him with oxaliplatin. Fortunately, the combination of gemcitabine and capecitabine led to a rapid reduction in his pain and improvement in his appetite and well-being.

Our relationship continued to solidify. He would bounce into my office, call me Richie (a term of endearment from my childhood that he spontaneously used), give me a bear hug and make sure I was doing OK. He asked a lot about my boys, as he had coached children in baseball and football for many years. He gave them a hitting lesson and turned their games around. He showed them around his weight-lifting gym in the basement of his house and hit the punching bag like Rocky. He showed them his speedboat. They were awestruck—he was simply larger than life. He had the same effect wherever he went. When he walked through our cancer center, he would tenderly encourage other patients to “keep up the fight” or loudly joke with the staff. When Joe was in the house, we all knew it.

But the capecitabine honeymoon was not for long. After he experienced hand-foot syndrome, with its puffy hands and peeling skin, he dumped it. One thing I learned quickly about Joe was that he was stubborn. It had to be his way. I relented. But what to use? I offered chemotherapies that involved hair loss, and he wanted nothing to do with them. This had as much to do with vanity as with the need to keep up appearances, so he could keep on working, for himself and for his family.

I managed to devise a series of treatment regimens that worked for Joe and, equally important, held the cancer in check. Certainly, he dealt with pain, loss of appetite, fatigue, diarrhea and depression. And since cancer can fell even the mightiest, the end did eventually come. But Joe survived nearly three years, and most of that time was good. Most important, he did it his way. This included making me a friend for life.

Richard C. Frank is a medical oncologist at Norwalk Hospital in Norwalk, Conn.

Articles

A strong bond makes all the difference to an oncologist.

My Patient, My Friend

I went to another wake today: A 50-year-old woman, in the prime of life, struck down by cancer. I was her oncologist. I went to pay homage to her life, to hug her family once again, to walk the final leg together of what was an intense two-year journey. All that needed to be said had been said many times before. I shed my tears a month ago when her condition took a dramatic downward turn; I didn’t know if I would once more.

As I drove toward the funeral home, I encountered heavy traffic. I thought to myself, 

It couldn’t be…all for her, could it?

 I looked ahead and saw a police officer directing traffic. Cars were being diverted to the shopping center across the street; the funeral home parking lot was full. Of course, it was all for her, for Sue.

Sue had legions of friends. She was deeply caring and intelligent—someone who could see right through the fluff in life and insincerity in certain people. She survived a major car accident when her three children were young and prayed that she’d make it to see them grown. She survived a divorce and raised them on her own, her way. When the diagnosis of pancreatic cancer hit, she faced it with fierce inner strength and a focus on living as long as possible, in the context of her life, so that she could put the finishing touches on her children (now in their 20s). It was always about the children. 

Keeping memories alive and maintaining a connectedness amongst those who will never forget the deceased is an essential part of feeling joined to humanity. 

I can’t go to every wake, but I always either call the family or send a card of condolence. It’s not only proper but also cathartic. I tell them how much I cared about their loved one, mention the special traits that I came to appreciate and acknowledge how much I know their loved one will be missed. I find it very sad when the spark of a life goes out. I feel for those who need them. My own father died when I was 9, and my mother died four years ago. I lost my best friend to cancer—I know the fragility of life. Keeping memories alive and maintaining a connectedness amongst those who will never forget the deceased is an essential part of feeling joined to humanity. I reach for it again and again. 

And so I sometimes go to wakes and funerals, even though they are difficult for “the doctor” to attend, for all the reasons imaginable. It doesn’t matter if it’s a small group or a large one. I imagine the eyes I’ve never seen peering at me, somehow knowing I’m the doctor who couldn’t save their friend or family member. When I stand in the receiving line, the air is thick and I hear murmurings about what people think actually happened to the person, medically speaking. Few know the details, the visits, the toll of treatment, the heavy conversations, the highs of good results, the misery of bad news. As a central figure in a cancer patient’s life, I am privileged to join the inner family circle, but it is only a temporary membership. 

The eyes can’t possibly know these things,

 I tell myself to bolster my nerve. A second later, all nerve evaporates with a thought—

It’s as it should be; I am the outsider.

Inside the funeral parlor, I quietly join the line and estimate an hour until I get to the front. I know I’ll never make it. After five minutes, the eyes get to me and I bolt out in a sweat. I

’ll come back later, when the crowd is thinner,

 I think. As I walk away, I run into one of Sue’s good friends and we embrace. Soon, Sue’s eldest son comes out to bring me in. Handsome, tall and mature, he’s totally in control. I see how well Sue did her job. I’m ushered straight to the front, and I join the inner circle one more time. 

The main challenges to being an oncologist are humanistic, not medical. We struggle to show our humanity to our patients and to let their humanity touch us. We form special bonds with those we care for, wrought through a common struggle, increasingly over the course of years. When a life ends, our bonds usually end and we grieve. It’s not quite closure, but it is vital for us to reach out to families after their loved ones die. It means so much to them and, surprisingly, to us too.

—Richard C. Frank is a medical oncologist at Norwalk Hospital in Norwalk, Conn., and the author of 

Richard C. Frank

My Patient, My Friend

The Fragile Bonds of Cancer

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