S1/E2 2: It's Terminal

the time. Through my mom's cancer journey. They had hired an oncology nurse, Kim, to come and check on Mom here and there, and it really helped to ease Mom's anxiety from growing through all of the various treatments and appointments, knowing that she had someone by her side at my parents house to help guide her through. Kim had been over the last few days since Mom had taken a turn for the worse. My mom. Mom's mother had passed away just a few weeks prior, and Mom had really

gone downhill since then. All of us really were just trying to keep our heads above water. I was so close with my mom. I'd visit her weekly and we'd eat ice cream and watch horror movies or American Horror story how awesome is it to say you watch American horror Story with your eight year old grandmother. My mom's death was truly tough on all of us, and the aggressive chemo Mom had been getting had been taking its

toll too. She was weaker than she usually was that mom Mom's funeral, Dad had pulled out a wheelchair for Mom to get in when she was getting out of the car. She had been having stomach problems and wasn't eating like she normally does, which really had never been much anyway. Seeing your mom in a wheelchair for the first time in your life just hits different. She was always superwoman to me, and now at my mom's funeral, here she was being wheeled in a wheelchair by my dad.

Due to COVID, attendance at my mom's funeral was severely restricted. Mom's care team had said that Mom and Dad had to sit separately from everyone else because of her chemo and the cancer. And since I didn't live with my parents, I sat with my Aunt Kim and the rest of my family while Mom and Dad sat across the aisle from us. I had so many feelings just flowing through me. At that point, I was sad for my mom, and

I was already missing her so much. I was worried about Mom, I was concerned about Dad, and here my parents were just ten feet away, and I couldn't even sit with them at a time I really really needed them. My family had asked me to give the eulogy for Mama, and I had worked on it for hours the day before. I looked over to Mom as I stood at the pulpit. She was crying, and although she was wearing a mask as we all were, I could see she was smiling at me, and that gave me comfort, just that look.

And Mom always had that ability. She is safety, she is home, she is love. When I finished the eulogy, Mom motioned for me to come sit with them. I quietly asked Dad if that's what she meant, and he said yes. Mom kissed me on the head through her mask, and I knew she was in so much pain, not just physically from the cancer, but emotionally from losing her mom. And here she was cancer and horrible pain, grieving, and

yet comforting me my safety, my home. Love. When we went to the cemetery from my mom, that's when Mom really broke down. She was sobbing, hysterically getting up from her wheelchair and nearly laying herself on my mom's casket. I could feel her pain. I missed Mom so much already, but now I'm hyper focused on Mom and her health. I just lost one of my two rocks, my two people, so now I'm terrified of losing the other one. I looked up at the wall that my mom would be

put in. She'd forever be with her husband Jim, my beloved pop up Aunt Kim would eventually be cremated and go in with them. Mom and Dad will be right above them, and I'll be cremated and go in with them. Aunt Kathie and Uncle Tom had their own place right next to them, and hopefully their son t J and his family would be there too, and my uncle Kevin and Aunt Michelle and their kids Brian and Megan. We could all be together forever. Mom collected herself and then

apologized for losing it. But who could blame her. My mom was a special woman with a huge heart, and that's a big reason why Mom was too Mom told me later that day that she felt embarrassed about how she acted. I said, Mom, you lost her mother. Nobody is judging you at all for crying over losing your mom, And I could tell Mom was a bit spacey, a

bit off. Ever, since my mom had passed the cracks and the foundation started showing up on Mom's cancer journey, it was almost like now that she was grieving momm she couldn't fight her cancer with energy too. I mean, it takes everything in you to fight a diagnosis like that. How could you possibly have the mental or physical energy to deal with the pain and grief and loss of losing your mother on top of fighting for your own life. And now here we are with Mom at the hospital

and my anxiety sky high. Dad had said I couldn't go in because of the COVID restrictions at the hospital, but he would update me just as soon as she was seen. I retreated back to my bubble with blue binging more unsolved mysteries, with my phone in hand, just anxiously awaiting dad's call. He texted an update that they were taking her in for some tests, and I begged him please keep me updated. Then once again I began praying, now more angry and desperate than ever. God, you can

change all this, so do it. Give us good news, Give her good news. I was no longer gracefully and humbly asking God to help Mom. That tactic clearly wasn't working. Now I was demanding it. I went over to watch a movie with my godson Aidan and his godmother, Michelle Shell had lost her father to cancer, and I was there with them through it all. She knew what I was going through, so I'd go over there a few times a week just to watch a movie and forget

about everything as best as I could. Tonight, though, I was having a really difficult time, not concentrating on anything else but waiting for Mom's test results. Since my mom had passed, it had really become this vicious cycle of Mom taking medicine to help her stomach so she could eat, but then not being able to keep the medicine down, which only made her stomach work, which meant that she couldn't eat, and then the cycle would start over again.

Dad called, and I immediately hopped up and answered, they're going to admit her. He said, They're gonna give her fluids through an ivy and put the medicine through that to help calm or stomach. Then they can work on getting real food in her and get her strength back up and get her home. Then Dad said something that

made me wonder if maybe God did intervene. He said, I'm allowed to stay with her until the morning, and then they're kicking me out, and Kim is going to be working tomorrow and the section Mom will be in, so she'll be there with her all day. This was a lifeline in an otherwise shitty situation. Mom's own dear friend and oncology nurse would be working in Mom's section. That would help her mentally for sure, which is such

a huge part of this battle. For the next few days, they did tests and determined that in addition to IBS, which is a completely common g I issue, the tumor had grown slightly and it was pushing up against part of her stomach. The plan was to put a stent in to push it away. That next day. The surgery was successful, but I could tell Mom was scared. She had texted me before that and said that she heard

it was cold outside. I couldn't help but laugh of all the things going on with her, and she texted me my hair, it's cold outside. Eventually she texted that the situation wasn't good, but it's in God's hands now, And when she said that, it really really hit me. The same God I've been praying to for years, begging, pleading with to help Mom, and we're just leaving this in his hands now. I tried to steer the conversation elsewhere, but she wanted me to know how much she loved

me and always has and always will. Of course I felt the same, and I let her know that. She said she had to go for an X ray and she texts me later. Once again, I just broke down in tears. Over the next few days, this roller coaster called cancer journey continued up and down and sideways and upside down. As it was getting closer to Christmas, it was becoming clear that the chances of her being home before then we're getting smaller. You wouldn't do that, right,

God right, Mom needs to be home for Christmas. You wouldn't do that. God right. My entire life, I had been with my mom on Christmas. It didn't matter how old I was. Mom always made Christmas special. It didn't matter if I was eight or eight. She had a way of going overboard in the best way, always knowing what you'd love while also covering what you wanted. And probably most important, getting you what you needed to And

it wasn't just like that with presents. She was like that with everything having to do with Christmas and all year really, but Christmas was just special with Mom. Mom and Dad always had Christmas at their house. It was tradition. The whole family would come over and we'd have dinner and laughing and presents and love. Christmas and Easter were

Mom's holidays and it always showed. Now, with Christmas Eve being just a couple of days away, my heart sank realizing that she probably wasn't going to be home this year. She'd be in a hospital bed and none of us would even be able to go in and see her because of COVID. That thought scared me so much. Mom's favorite holiday, and she'd have to spend it alone in a hospital bed, with no visitors and in pain. This

just wasn't fair. None of this was right, None of it is just I brainstormed with my family to see what we could do. We found out from her nurse Kim, that Mom could see out the window to the top floor of the hospital garage, so we planned a many surprise pop up party on the top floor of that garage. I would have sat out there all day if I

was allowed. After all, what's Christmas without Mom? Christmas Eve came and I decided that I was going to do something with that energy, that anxiousness, that the nervousness and anxiety that I was having. I was going to use that energy and do something good for the situation. So I wanted to bring dinner to the staff working on Mom's floor at the hospital. I went to Costco and bought a bunch of desserts, and then went to Boston Market and got a big turkey in a bunch of sides.

They were away from their families at Christmas, making sure that mine was okay. It was the least I could do for them, and once again it was one of the things I was able to control and an otherwise uncontrollable situation. I drove to the hospital and and let the guard know that I had food for them on Mom's floor, and he looked so happy and thankful. He called somebody from the floor and they came down and

got it and brought it all up. Of course, a few hours later, Christmas morning came and it was just another morning for me. There'd be no joyous Christmas morning with my parents, like there had been every year my entire life. I had bought presents for people, but couldn't even gather the emotional strength to wrap them. I retreated to my bubble with Blue, just counting down the hours

until we could surprise Mom. And when that time finally came, I gathered up the poster boards I had decorated to make signs telling her how much we love her, and I met my family and some of her close friends on the top floor of the hospital garage. We called Mom's nurse, Kim, who was working that day, and she wheeled Mom over to the window and we all screamed and hooped and hollered and told her how much we love her. This was Christmas with pancreatic cancer. It was

yet another thing that it was robbing us up. Shortly after that, Dad and I met at my parents house and went over to Aunt Cathy's. She was having Christmas dinner at her house in place of Mom's usual get together, and Dad and I really didn't feel in the Christmas mood, and with COVID it was probably just as well. We took our plates back to my parents house and just had a quiet meal together. Mom's presence was felt, but her absence was felt more. See that's the thing about cancer,

or any kind of terminal diagnosis. It doesn't just eventually rob you of your loved ones. It robs you of those moments along the way. Can rob you of Christmas morning laughing and enjoying each other's company. Can rob you of your mom's cooking, which you never realized just how much you'd miss. It. Can rob you of that hug you look forward to every time you see your loved one,

that shoulder when you need it. Pancreatic cancer was robbing Mom of her life, and it was robbing me of my mom, And it was robbing the world of a really damn good person. What cancer doesn't care. Cancer doesn't care that Mom had built her whole life around being a good person, doing for others, making people happy. But I do care, and I'm powerless as it steals her away. By New Year's Mom was well enough to go home.

That had called me to tell me that hospice was going to come in, and immediately I began having a full blown anxiety attack. He explained that it was actually the palliative care part of hospice that was coming in and the plan was to help Mom regain her strength so she could begin chemo treatment again and then be back on the road that we were on. I heard what he was saying, and I held onto that hope. But something in the back of my mind just knew

this was bad. This was really, really bad. The palliative nurses of hospice were amazing, and they'd come about twice a day to check Mom's fluids and make sure she was eating and moving around. Ultimately, they never did get to that rehabilitation stage, as Mom was simply fighting every every day to stay alive. Ever since she had gotten

home from the hospital, she was simply existing. The good days had turned into good afternoons, and soon those turned into good moments, and eventually those good moments were less and less. I was watching the person I love the most in this world fade away before my eyes. I cherished every moment that I could with Mom. It was so hard to see her in pain, but it was apparent that time was running out, and I was numb. It was almost as if my brain shut down everything

and I was just going through the motions. Except when I went to see Mom. And when I got too emotional to see her in the states she was in, I tell her how much I love her, give her a big hug and kiss, and I'd run to my car to cry it out. Almost every night, I'd leave my parents house and drive around crying, screaming about how unfair this is. Somebody that may have seen me driving down the road probably think I'm some kind of whack job.

Seeing this random dude driving down the road screaming and crying alone in his car with his hands waving everywhere. I'm sure it was a sight to see. And I did that every night that I would leave my parents house until one day it was different. One day I asked God to take her. Don't let her be in this pain anymore. Stop making her suffer. It's cruel, it's inhumane. How can you possibly allow her to live like this? Take her? God, take her. The guilt from saying that

hit me immediately. I had uttered the most reprehensible words I could imagine, but that's how I felt. I couldn't see her suffer anymore. Since the day she was diagnosed, I was always so positive and optimistic, and I would get angry at her when she wasn't matching my good vibes. But now I was raising the white flag. It was selfish of me to want her to stay here, not like this. She didn't deserve this, She didn't deserve any of this. The right thing to do is to want

her suffering to stop. Right right up next, I speak with a highly published oncology expert, Dr Gregory Masters, and we talked about the other side of a terminal diagnosis, which is the doctors who must give them when we come back. When we think of our own grief journey, do we really ever think of the people on the other side of it. On a cancer journey, were often intimately involved with an oncologist to help guide our loved

one on the right course of treatment for them. I was interested in how a doctor is able to give such devastating news and all the time, regularly throughout their entire career. I sat down with lung cancer specialist Dr Gregory Masters, an oncologist at the Helen F. Graham Cancer Center and Research Institute who also serves as an associate professor at Thomas Jefferson University Medical School in Philadelphia. Dr Masters is one of the world's foremost experts on lung cancer,

and he's published numerous papers on his studies. I wanted to know about that other side of the cancer journey. Mom's oncologists seemed to always be rooting for her, even when she disappointed him. Why is this do they give up? Dr? Masters lays it all out. I go into see a new patient with either suspected cancer or with cancer. I want to get all the information I can that's available

at that time, and sometimes it's incomplete. Sometimes that's one of the hardest things, is going in and not having all the information, because people want to know everything that's going to happen right away and that that's totally understandable. They want to know what's next and you know what's happening now. So I try and gather as much information as is available before I go in to see a patient. I may look at other UH specialists records from their

interviews and their encounters with the patient. I'll look at any radiology testing or X rays or CAT scans or m r I scans. I may look at any biopsies to see what the pathology is and if we know exactly, you know what the cancer is, where the cancer is. And then I have to, you know, prepare myself to go in and talk about something that's not really ever easy. My intent is to go in and learn as much as I can about the patient. Once I know as much as I can about the medical situation, and I

try and get to know that patient. You know, it's in a short period of time. But I try and get as much as I can from the patient and from the family because almost always when someone comes with you know, a family member or a friend, that person is there to help provide as much support as possible.

So I really think it's important to include that. But but I try and get as much as I can about you know, what the patient knows, what they fear, um, what they think is going to happen, and then to try and get to their questions about what might happen and what we're gonna do next. Is there ever resistance from the patient, and what I mean is culturally religiously, where there might you know, you might have to take those kinds of things into consideration. Is that a thing

or oh it's totally a thing. Yeah, So there's there's I guess to me, that's all part of my job that makes it interesting and challenging. Sometimes it can be a barrier to getting you know, good communication, But again I sort of feel like that's part of my job is to understand the patient and their family and their circumstances.

And it can go anywhere from some families who don't want the patient to even know the diagnosis um or don't want the patient to know that they're going to die, or don't want the patient to know that, you know, they may not be a candidate for some treatment that they're really depending on whether it's surgery or radiation. Sometimes it's there's a lot of fear to thinking about chemotherapy, maybe based on experiences they've had, or their friends or

their family has had. Sometimes those experiences are you know, a long time ago where we weren't as good. But what I try and do is to help, you know, as to understand people and try and understand their situation. And I don't try and treat every situation the same because I don't think that fits. At the same time, I do have as part of my job the role of telling them what's going on and helping them understand

as much as they're ready. For my mom, there were times, especially early on, she got better as it went on, but there were times where she was like, tell him to my dad and then he can he knows how to filter the information back because a big challenge for her doctor, which was my mom's and he was amazing.

He had a handful to deal with with my mom because she had had anxiety and she was generally pretty good about dealing with it in normal day to day life, but when it came to this, it was like it just opened up the floodgates, and so he had that doctor had his ends full with my mom and how to handle this, you know, delicately, and I'm sure, um, it's got to be tough, you know, in your situation, how do you handle somebody like that where you're not

just dealing with the physical part of it, you're dealing with the mental part of it as well well. I I think what you're describing as something that's common to all patients and all families in different levels. Um So, I do think it's important to to sort of get in there with the patient and their family and understand

that and figure out where they're coming from. Sometimes that comes out right away, and sometimes people are very reserved in the beginning, and it takes a little bit of getting to know them, you know, maybe talking about what their outside interests are, talking more about their family, talking more about where they've lived and what they've done. That helps me to understand a little better when they tell me something, you know, if there's maybe some other hidden

meaning behind that. So it's a really important part of my job, and I don't think I could do it well if I didn't listen carefully to what they're saying and figure out what their family dynamics are. It is hard having these conversations, but it's also a tremendous privilege to be part of that. We have a job as medical oncologist that's a combination of giving bad news, helping people understand bad news and deal with bad news, and also giving hope about what we might be able to

do to help them through it. So I try not to focus on, you know, how it's affecting me, But I can tell you in reality, each patient is affecting me, and each encounter is affecting me. And if I can learn from that and be a little bit better the next time, or the next time I'm surprised by a discussion or surprised by an emotion. You know. Then then that allows me to enjoy my job more and be a better doctor. So it's an ongoing experience, like anything in life. I think we all learn that over time

we're better at our job and never perfect. How do you give a diagnosis that I would think nobody wants to hear? Is that something you have to prepare yourself for. Yeah, it's totally something you have to prepare for. It's interesting. There's a lot of discussion about how we should give bad news, you know, and sort of academic discussions about that.

And yet when you get down to it and you're getting ready to go into see a new patient and their family and you may have bad news, you're not fully prepared because you don't know exactly how that's going

to play out. So again, what I try and do is to help he's into it by getting to know the patient a little bit, by getting to know the family a little bit, by being ready for what might come in that conversation, by knowing everything I can about you know, what we're going to discuss that day, So knowing their medical history, you know that sort of at a minimum, and then you know, trying to figure out how are they going to be able to hear this

news and continue on. So usually I'll talk about the medical facts of the diagnosis and figure out if they understand that part of it, and then talk a little bit about what that means, because for each patient, with

each diagnosis, there's uncertainty. And even if I'm completely prepared, it's not like TV where they say there's three months to live or six months to live, and that's how it is, and I think people sometimes are surprised by that, even though in all trually we know that everyone's different.

So I try and help them understand that there's a range of things that might happen, and then try and think through how we're gonna get prepared to deal with that and what are the best tools we have to try and fight that um And many people come in ready to fight, but some people aren't ready to fight, and I have to figure that out and figure out

where they are in terms of their goals. Some people haven't even thought about it at all because they might be too scared to think about it, or maybe you know,

in their culture it's not something you talk about. Maybe your podcast will change that, I hope, so, but I try and figure out where I can go and how far I can go in that conversation, but at the same time and hopefully all the time being truthful and being honest with what I know, because I don't think it's my job to hold back information that I know, but I think there are different ways to deliver it, and sometimes is easing into it helping them understand, you know,

what the tools are we have available, and that can help prepare for a discussion about a limited survival or a limited time to live, even if I don't know exactly what that is. Wow, it's got to be important for you as a human too. Um have positive outlets, I assume, right, Like whatever that is for you going to the movies or golfing or whatever, is that kind

of how it works, or like how do you decompress? Yeah, And I think that's important to think about because sometimes with whatever work we do, we have trouble separating what happens at work and what happens outside of work. But just like many people, I go home to a family and I have a job with my family too, I try not to forget everything that happened during the day.

But I also don't think that it's you know, part of what I need to do to go through every detail because sometimes I do need to compartmentalize that and I think we all do that with a stressful day at work. I really think it's important to be able to,

you know, separate my time at home. Um So, even though you know my wife is a nurse and spends a lot of time dealing with helping our kids through difficult times and dealing with all those kind of situations that that occur in the family life, I don't think I want to take home all the details of work because there's enough going on at home to deal with. So I like to you know, read, I like to exercise, a golf a little bit, but not as much as

you think. Um. I like to sail, and I like to spend time with other people and you know, figure out what they're doing. So you know, I I try and remember everything that's happening, but bring home all of that stress at least not all at once, and probably if you ask my wife, I bring home some of it. And so it's those things that are able to recharge you too when you go back to work, to be able to do it again. And you know, each day

and each patient is a little bit different. But every day, you know, there are situations that are joyful and hopeful, and every day there are some that are less joyful and less hopeful, and you know, discussions about things that it's hard to discuss, and so I try and get ready for each encounter. And you know, again that's that's my job, is to help people understand and work through their difficult times, and sometimes to give them chemotherapy when

I think that's the best way to help them. Because the medical part is is a big part. I don't mean to minimize that, but there's so many more things we can do now than we could even five years ago. And my hope is that five years from now there will be even more things we can do to help families like yours. Until really, right now, I didn't realize, you know, how much of a balance it is for you, that it's not just the medical part of it when

you're dealing with patients and families. You know, a huge part of it is is the mental part of it, to the psychological part of it as well. From my understanding of what you're saying, it's got to be a balance between those two because you can't really separate them, you know what I mean exactly. Yeah, I don't think you can separate those and I don't think I can communicate with the patient if I don't understand where they're

coming from. And I think that's also stresses the importance of that multidisciplinary approach, and you know, having a social worker help out, having a psychologist help out, having other people that can support the family, sometimes having the hospice team help out, when you know when that's a appropriate Because what I've learned over my time, you know, nearly thirty years same cancer patients, is that you really need all that help. No one person can do that by themselves.

And so if you use those resources and and help your patients understand the resources that are there, I think that helps ease that communication and helps improve the understanding. Coming up next, I asked Dr Masters how he handles issues when the family wants one thing and the patient wants something else. And do oncologists ever give up on a patient and truly say it's over. On Mom's cancer journey, there were times I became so frustrated by some of

the choices she made. How does an oncologist handle that? Do they yell do they give up? Do they run to their office and cry? Clearly oncology isn't the profession for me? But Dr Masters gives us the truth you mentioned, like a patient's family might say, you know, we don't want them to know, we wanna handle it or whatever. How do you deal with decisions like that where the family wants something and the patient wants another. I mean, that's got to be Is there a rule book for that?

Is it a decision by the doctor? How does that work? No? And it's an interesting question because over time, I think that's evolved. And you know, if you go back to the times of Hippocrates, he didn't you know, he wrote about not telling any bad news because that would hurt the patient or that would decrease their chance of getting through an illness. And it's taken a long time to understand. And what I believe is that the patient has to be part of these decisions, and to be part of

the decision, you have to have an understanding. Now saying that, I also think it's important to recognize cultural differences and individual preferences. So part of what I try and do is to figure out what does the patient want and if the patient doesn't want to know pieces of information like a specific prognosis. I don't feel like I have to force that on them. Again, I think communication and listening is is so critical to me doing my job.

And I suppose if you you know, if you talk to all the family when there are big differences, that there isn't always complete agreement, and so part of it is, you know, being a little bit of a referee in in deciding, you know, who gets what information and how with the understanding that that are in our current culture, the patient has a right to their autonomy and that sometimes means the independence to know, and sometimes it isn't an independence or an autonomy to not have to know

every bit. That's a hard part of the job as figuring out how you balance those and what does the patient really want? Because I do want to help the family understand and and I want to honor their wishes too, But ultimately, I think my my principal obligation is to to work with the patient and what he or she tells me is most important, and sometimes they don't say too much, so it's it's communicating and listening and trying.

I love that the the oncologists that had my mom. Uh, you know, I had he bless him, he had his hands full. You know. I had a real problem with her some of her decisions. There was a treatment um cyber knife, and she was going back and forth on if she should do this, and it was a lot of it was anxiety driven, and I had I'm like, what are you doing? You're going to do it? And I'm like telling my dad, I'm like, we can give

her zannex put it in her drink. And this is like crazy now thinking about it that I like having this discussion. My dad's like, Kyle, what are you talking about. I'm like, we can put zanex in her drink and then we can take her to the hospital and then she can get cyber And he's like, but she doesn't want to do it, you know, or she's not sure she wants to do it yet, and blah blah blah. And I'm like, well, she doesn't get the choice, Like we're gonna get this for her because in my mind,

you're gonna do any possible thing to survive. And in reality, it's not my choice, you know what I mean. And it's not that she wanted to give up, but there were some some things that she did not want to do and um, and no amount of getting angry at her or reasoning with her or whatever could change that.

And I had to learn eventually after she passed that I should have respected that journey a little bit more because it is her journey, you know, and she had valid reasons for not wanting to do certain treatments and overall, you know, she'd put her body through so much on the journey of trying to get better that she earned that right to say, you know what, I don't want to do this, and that I think it was radiation or something I've done, you know, six different types of

chemos over it was like two years of chemo treatments. I'm kind of tired, you know, of trying all of these things. And in my mind, that's totally unacceptable, you know. And so I like, I'm not joking when I say I had this conversation with my dad where I'm like, Dad, she doesn't get a choice, Like she's gonna wake up and she's gonna be there and she's gonna get it. And you know, my dad's like, well, why don't you

think about this? You're talking about drugging your mom. And then her waking up in a hospital like none of this is okay. And of course that's in my grief that or shock or whatever that that I want her to get better at any cost, and that's not taking into consideration, Well, who am I to say that she should be doing this? Who am I to say that she needs to go through radiation? It's not my decision.

So my all of that to say, I'm assuming there are at least a few people like my mom that when they're talking to their oncologists and their oncology team that there are limits to what the things that they're willing to do and things that they're not willing to do. Is that hard for you as a doctor if you are hopeful in certain treatments or are you more patient focused where you're like, hey, this really could help you, but it's about you and your journey, Like what how

do you balance that? And what is it? Like? I'll tell you, um, the things that you're describing are present and almost every family that I deal with, where you know, the wants and needs that the family sees and the patient sees are not always equal, and so sometimes family members want to be more aggressive or do more believe

it or not. Sometimes they want to do less, and I always assume that it's in the best interests of the patient, because you know, everyone thinks they know their family member and what they really would want, but that does get clotted with what we want as an individual.

To add to that cloudiness is what the oncologist thinks is best right, And sometimes all of those come together like a perfect storm, like a come to a point and and everyone agrees, this is something we can do, this is something we should do, and this is something the patient wants and the family wants. That's great, especially when it works out and it's successful, but just like reality, it's not always like that. And so a lot of times what I think is best medically um based on

imperfect knowledge. You know, I try and look at all the research that's been done. I try and reach back to my experience as an oncologist, and and believe it or not, I think back to even when I was training in medical school and doing my residency and fellowship

training and oncology. I think back to, you know, what my mentors would say in a situation like this, or what would they recommend, And that does get trickier as all the options change, but the way of discussing that, in the way of offering that to patients and families evolves, but doesn't really change. I think it's important to to listen a lot as an oncologist, because if you don't, you can end up saying this is what we're gonna

do because this is medically best. And that's something that I think oncologists learn over time, because it's a really hard thing to teach, you know. So if you if you look at the discussions out in the public about well did doctors learn to talk about death and dying? Do they learn to talk about, you know, how to decide on difficult differences between a family and a patient. You always hear, well, they don't teach that in medical school,

and I don't think that's totally true. I think they try and teach it, but sometimes we're not ready, you know, and sometimes um people aren't ready for information, and sometimes

oncologists aren't ready to learn that information. We go to medical school wanting to learn the facts about medicine, and I'm sure there are many exceptions to that, but but if you look overall, people go to medical school and learn facts, and the problem is not only do the facts change, but your own experience and your environment changes.

So I think you have to learn from those experiences and try and be patient, and try and be flexible, and try and always think how can you turn it back to what is really good for the patient, what does the patient want? And sometimes that's hard for families, and sometimes it's hard for oncologists or any professional dealing with someone in these critical sort of life threatening decisions. But I think we can learn. I think we can

learn to do it better. And and if we're patient and we allow ourselves the chance to learn from our patients and their families, um, we can do it better.

And and that's what I try to do. You know, I try and even after a negative encounter where someone is really mad that the treatment didn't turn out right or I didn't predict something correctly, you know, I try and learn how I can do better the next time, and you know, how can that conversation go differently so that you know, I can try and help people as best I can, because that's got to be my job. It's it's gotta be tough, you know. I mean, it's

it's uh. As we're talking, I'm realizing just how many things. An oncologist has to balance everything with every single patient, every single encounter. You know, so thank you for it's incredibly important work. Obviously. Is there ever a point in today's medicine and our culture here where an oncologist gives up? Are there always treatments available even if the prognosis isn't good.

So there are so many different things we can do, whether it's different chemotherapy, different types of radiation, different surgeries, other different interventions to help people that we almost never get to a point where there's nothing we can do. And so if you watch TV and the doctor comes in and says, I'm sorry, there's nothing more I can do for you, I don't ever say that to patients

because I don't think that's fair. There's always something you can do to help, but it may not be more chemotherapy, may not be more surgery, it may not be more radiation or CyberKnife treatment. And that's when the listening comes in.

And when I see a patient and we're running out of the best options, and I think that's sort of what you're talking about, then what I try and do is to offer some alternatives of thinking, do you want to do something more aggressive that may cause you more side effects and more difficulty and sometimes may not improve

improve your quality of life. Or do you want to scale back and take an approach where we focus more on managing your symptoms, dealing with comfort and quality of life and being able to stay home and not spend all your time going back and forth to the doctors. And what I hope I can do with those conversations is to help people see what I see as the options and often choose what I might choose, but they don't always choose what I would choose or even what

I recommend. And I think you're describing that. You know, CyberKnife is a type of focused radiation that can be very effective on a localized spot of cancer. So is it worth going through all the logistics to get to that for what the benefits going to be? And for some people it is, and for some people in some situations it is, and then other people it isn't worth doing that, even if we think that might buy a

little more time. And those are those are hard conversations, especially when our goals might not be totally in sync with the patient's goals, or the or the family's goals aren't totally in sync with the patient's goals. And again, I think it's part of my job to help not only the patient but also the family understand why would you choose this option and how can that option be a better option? And when it seems so obvious that the other option is the right option and there's no

magic to that. It's it's patients and trying Wow, and it's got to be uh, you know from what you're saying, there is no to duplicate conversations that you're having. Yeah, it's uh, it's completely tailored to that person, which is uh,

pretty crazy, you know if you think about it. Yeah, but if you think about society and you know what we see on TV and what we experience, you know, driving down the street, you can imagine that there are gonna be different ways of dealing with problems and different ways of trying to come to the best answer, right, And so you know the reality is medicine is like that too. They're the best answer may not be the

best answer for everyone. How do you work together to get to either the best answer for that patient or the best compromise for that patient, because sometimes it is

the best compliment. Yeah, I mean and that's ultimately what was I think what it was with my mom was that where the tumor was was at a place like right next to an artery or something, so they could do cyber knife, but they could also continue chemotherapy, which was working and shrinking a little more, so the margins were more and my my dad and I was like, well, if they're saying they can do cyber knife, now, like let's do it. And she's like, well, I don't know that,

you know. And and then of course what ultimately happened was she had to stop chemo altogether, which they had. She had done a chemo I think believe believe it's called chemo holiday or something um where she went like six months with no treatment and it had barely almost nothing grew. So we were very hopeful. I mean, I was terrified waiting for those results because I'm like, it might have been three months or something, whatever it was,

I'm terrified waiting for those results. And then it's like, oh wow, like it was almost nothing. But then you got to this point where she couldn't get treating and at all. Why didn't it do what it did when she did the holiday? You know? Why is it all of a sudden. Now you know, it's crazy and it's a roller coaster. I would hang on any positive bit of news that the doctor would give, like, oh, you know, it's been three months, she has she said, no treatment and it has you know, not grown at all or

microscopically grown or whatever. And I'm like, yes, that's awesome, I'm happy and blah blah blah blah blah. And then that follow up visit a couple of days before, I'm all like nervous again, and I'm waiting by the phone for my parents to get out. And it's kind of hanging on to every word that the oncologist says. And sometimes that's great and I'm up here, and sometimes that's bedding. I'm done here. But it's ultimately, you know, what I'm

learning is it's my mom's journey. You know, I'm along for those highs and lows, and I want all the highs obviously as she does. She did too, But these aren't my decisions to make, you know, and that that was the hardest thing I think for me, so so kindle, I think what you're describing as something that a lot of families go through, and um, you even said, you know, when you saw the oncologists, you might pick up on a little glimmer of hope, some piece of good news.

And I think what I try and do is to, you know, see who's there and who's listening, and who's hanging on every word. And when some people need to hear something positive, find something positive to discuss, and when some people sort of can't stand something that feels like false hope, I try and temper that. And what's amazing to me is that um people can come out of a conversation and take what they want out of it. Now,

sometimes that's good and healthy. Sometimes it's not so good and healthy because they get the wrong message, because they might, you know, really grasp on to one part of the conversation. But I think that's sort of like, you know, it's it's reality, right. There are good and bad things and everything that happens. How do we try and hope for the best, but prepare for the worst. And some days you're ready to grab that best part of it and the hope, and other days you really need the reality

of I don't feel well today. I don't like what's going on with my treatment. I don't like how the cancer is behaving, and that's okay too. I Mean, one thing I've found is I can't change all that. People come in and maybe they've had a long discussion about what we're gonna do if the scan is better or the scan is worse, and how we're going to react

to that. And I come into sort of a dynamic where there's a lot of water boiling, you know, and and I can say one thing, and I really am surprised by how much emotion can be released with that, And so, you know, again, I try and think about, well, what what would it be like to be in the other chair and hearing this news, and how are things going to be when they leave the room, you know, because that's all something that I am not a part of um. And yet you and your family and your

mom were a part of all of that. Right, there's that whole two weeks in between where I don't know what's happened, you know, How do you catch up in a half hour visit with all the fears and hopes,

you know, and emotions that have happened in between. One thing that I'm or I think the biggest thing that I'm taking away from our conversation is that you are really not a doctor of death at which is I think a big misconception that people have, like, oh, you don't want to go to the oncologist, you know what I mean, that's that's never good. Really, you're not a doctor of death, but a doctor of hope because you are offering potentially all of these treatments that could get

you to where you want to be. Yeah, I certainly hope that's the situation. I have a lot of hope in my work and hope that when I am interacting with patients and families that I'm going to be able to help them understand where things are. Part of that is understanding the reality, and part of that is grabbing some of that hope and saying, well, this is a bad situation, but what can we do to make it a little bit better. What can we do to understand it a little bit better? What can we do to

work on it together? And and some of the things that we work on are, you know, improving communication, improving relationships, and improving understanding. Even if we can't fix the cancer, which is important because that gives any remaining time that can make it more meaningful. You know, yeah, I hope so, because that that's what there is, is trying to grasp

whatever you can of that time that's left. And you know, you talked about trying to have memories of you know, maybe some of the better times or or some of the good times. I think that's an important thing that we can focus on. And sometimes going through more treatments or at least discussing more treatments allows that chance for hope, but that has to be balanced with you know, what are the consequences of more treatment and how is that

going to potentially drag someone down? And ultimately, you know, my goal is to help the patient and the family decide, you know, what's the best choice for them with some guidance from me. And what I think is, you know, medically the best option, but not with a feeling like they're letting me down if they don't have treatment, because

I think that's a real thing. I think, especially over time, people are are afraid of letting you know, the patients particularly are afraid of letting their family down if they don't do something, of letting their doctor down or the nurses or you know, other people who are helping them if they decide not to do a treatment, why are they deciding that? And and if they're deciding not to

do something that maybe we think could help. Part of my job is helping everyone understand, well, that's okay, because we're making our own choices and we're trying to decide what's right for me. Now to end on a bit of a positive note or a big positive note. When my mom's cancer journey started, the five year expected survival rate of pancratic cancer was nine percent. Three years later, now it's eleven percent, which is a huge jump in three years when it was nine for the previous decade.

How do you, as a professional see Are you seeing a trend positive we in regards to cancer treatments? Obviously from my understanding, I believe that cancer diagnosis is have risen, but it also seems like cancer treatments have also become expanded as well. Can you talk a little bit about that? Is that accurate? As so, we're getting better at understanding medical diseases and particularly understanding cancer and understanding the biology

of cancer. So as we understand how to reduce risk factors for cancer, as we understand how to encourage people to quit smoking, to exercise more to eat healthy, to get their screening tests. UM, we can improve the outcomes for cancer. Also, as we understand the biology of the cancer, we can offer better treatments. We can come up with more targeted or precise treatments for individual patients that may not cause as many side effects but may offer a

better chance to control the disease. We're seeing more and more that some patients have long term control of their disease. So even something where before we would have said, well, there's no cure, now we're seeing many patients live beyond

five years, and and some of those patients maybe are cured. Um. New targeted therapies that that target a specific gene mutation, or new immuno therapies that target the body's response to a cancer and using the immune system to help fight off the cancer are things that in the past we're

really just hopes and now are our reality. And so continuing to understand the disease and to help people understand the options available and hopefully to understand that oncologists are there to help with those decisions, that's what gives me hope. Thank you, doctor, I really appreciate you being so open and honest and candid about your career, the mist of buying a lot of the myths and kind of opening the curtain if you will, into something that can be

scary for a lot of people. Just your professional title, no offense, but I think it's extremely important what you've had to say to you know, help to demystify that. Yeah, and thanks Kyle for going after such a difficult discussion that obviously hits close to home for for you and for many people. And it's important to be able to talk about these things and to give a chance to let people learn, because I think knowledge and understanding and

communication and information is is critical. So I'm glad you're doing this. Thank you, Thank you very much. It gives me comfort to know that oncologists truly are doctors of hope. Dr Master's certainly opened up my eyes to the humanity behind not just oncologists, but the entire are oncology care team or any team relating to end of life care. These are people who choose decades of study followed by

a lifetime of work in this field. They want Mom to succeed, They want your loved one to succeed, They want you to succeed. Knowing that mom had a team behind her like that does bring a smile to my face, knowing that everyone working with her was giving her everything they had and for now, that's all we can ask for. On the next episode of Death, Grief and Other Ship, we don't discuss we explore what happens before people pass away and what about people who have passed away and

come back. I talked with Dr Jan Holden, president of the Inner National Association for Near Death Studies, about the science behind near death experiences and more. For more information and resources, please visit our website at Death and Grief dot show and joined the conversation on our Facebook and Twitter. I'm going to see my mother, she said, She me me when I crab. Just Google