A colleague recently had a baby. Her patients were divided between a few medical oncologists to continuously deliver their medical care while she is on maternity leave. I met one of these patients a few months ago. While getting to know him, he said the most interesting thing.
Mr. R is forty-nine years young. He was diagnosed with an early and curable colon cancer in late 2021. He had surgery to remove his cancer in January 2022. No further treatment was required based on his pathology and stage at that time. Standard surveillance was started.
He was followed with a blood test called CEA, a tumour marker for colorectal cancer. His CEA started going up in 2023. By mid-year, he had a CT and biopsy confirming the worst possible news: metastatic, incurable cancer spread to his liver and lungs.
When seen by my colleague to discuss a possible treatment plan for his cancer, she learned Mr. R was consuming more than seven hundred and fifty milliliters of hard alcohol per day. She also learned Mr. R had struggled for many years with anxiety and depression. As in many cases like this, it is difficult to determine how much of his poor mental health was related to his alcohol use disorder – alcohol is a depressant after all.
To his credit, Mr. R knew he needed help. He had already engaged assistance for these concerns from his family doctor and a psychologist. Mr. R’s understood his drinking was negatively affecting his life, particularly his bowels, appetite, and sleep. He often had terrible diarrhea, likely a result of his pancreas functioning poorly. His nutritional intake was poor, usually getting his calories from his boozy liquid diet. He couldn’t sleep without his sleeping aid of choice, which was whatever alcohol he was having that night.
Mr. R was told his drinking affected our ability to safely administer chemotherapy. It would be next to impossible to give him treatment, let alone trust that he could report potentially serious side effects if he was drunk every day. So, Mr. R had a choice to make. Would he continue drinking and lose out on potential helpful treatment or would be stop and give chemo a try? He was going to die either way, he knew this to be fact.
It didn’t take Mr. R long to decide. He stopped drinking to have a chance at seeing a few more sunrises and sunsets.
Fast forward a few months to when I see him for the first time. I learned the above information from his chart. I also learn that the current chemotherapy he is on is not the same as that which he started shortly after he stopped drinking. The first concoction made him feel terrible. It also did nothing to halt the progression of his cancer. He was switched to a second-line chemotherapy option. He is tolerating this combination much better. It is controlling his cancer for the time being.
Mr. R gives me a rundown of how he feels he’s done over the last year. I ask if he’s drinking. He says he stopped completely a few months ago. Then, his revelation comes.
“I didn’t think this could even be possible with a terminal diagnosis, but I feel better than I have in my entire life.”
He went on to say he’s much less anxious. His mood is not nearly as labile. He wants to do things now. Cancer has completely changed the way he feels about himself, about his life. He says he can’t even believe he’s saying what he’s saying because he knows he has less than a few years to live. He’s only forty-nine. He shouldn’t be dying. He knows it doesn’t make sense. He rhetorically asks how it is possible that he feels so good about life and living when he knows he is dying. Indeed, how is it possible? He is dying. But he’s only just begun to live.
I sat watching him, listening to him. The usual rhythm of clinic interrupted by this special moment doctors who do what I do don’t get to experience often. He looked like he meant every word. His body language was positive. His eyebrows were raised as eyebrows do as if surprised by a fantastic gift. He was smiling.
Was Mr. R’s strength of character blooming because he knows time for him is short and he wants to pack as much living into whatever life he has left? Was it in part due to the depressive effects of alcohol being lifted from him allowing the rosier-colored glasses of sobriety to tint the world to a brighter shade of grey? Maybe it was both.
Thank you, Mr. R, for sharing with me your refreshing surprise of hope and resilience. These moments are part of the reason I love showing up for work each day. My hope for you is that you carry yourself forward as you presented to me in clinic that day. Sober. Enjoying all the moments you can. Eating them up slowly like you are savoring your favourite meal. Letting your belly get full. Trusting that when your last bite comes, it will taste like the best mouthful of them all. Yum!
Author Notes:
I have seen this before in some of my patients – a sudden change of spirit and a newfound engagement with a positive, hopeful perspective on life. Our human experience allows for magical things to happen in the face of adversity. I can’t pretend to understand it.
I wonder how someone who is less than half a century old could be so positive facing a cancer death sentence. How does this happen? Why does it happen in some but not others? Why can someone be happy when journeying through cancer and a healthy someone else gets angry if the traffic on the morning commute to work is too slow? What kind of life experiences, circumstances, or luck help to pick us up when we are down?
I marvel at the resilience in some of my patients and wonder where it lives within them. I think hope radiates from resilience. Or is the other way around? Is our gut, our heart, or our brain responsible for this? What role does our soul have, if we are to believe we have souls?
In the end, I suppose it doesn’t matter how hope manifests and where resilience comes from. It matters only that hope does happen and that resilience arrives in time.
I am curious to know reader, are you hopeful about your life right now? What are you most hopeful about? If not, what will you change to get closer to being hopeful?
