Suneel D. Kamath, MD
The ASCO Post is pleased to reproduce installments of the Art of Oncology as published previously in the Journal of Clinical Oncology. These articles focus on the experience of suffering from cancer or of caring for people diagnosed with cancer, and they include narratives, topical essays, historical vignettes, poems, and photographic essays. To read more, visit jco.org.
In my final year of oncology fellowship, telling people in social settings that I treat patients with cancer continues to evoke both dread and appreciation. I dread having to tell yet another person that it is not as depressing as you think, but I appreciate the reminder of how much I love what I do. In the practice of oncology, I have found that a major source of joy comes from laughing with my patients. I never imagined I would feel this way before I started my fellowship.
Laughing comes naturally with patients who have been free of cancer for many years and return for surveillance visits. We spend the majority of the visit talking about their trips to exotic places, like Bora Bora or Peoria, Illinois. We laugh about their grandchildren wearing them out at the playground and talking their ears off. They come bearing gifts—homemade baked goods or that favorite brand and flavor of ice cream that I mentioned once in passing 3 years ago. You can only laugh in amazement that they committed this minute fact to memory and cared enough to find it.
I tell these patients that they probably no longer need a cancer doctor, but they feel safer coming back every year, and deep down, I am happy to see them too. As a medical oncologist, I am keenly aware of how little we contribute to these patients, who live free of cancer for decades and were probably cured by local therapy. Fortunately, these visits are not uncommon, and they remind us of what true success in cancer care looks like.
Relieving Tension Through Laughter
Sometimes laughter is less about joy and is more of a mechanism to relieve the stress associated with anxiously waiting for good news. This happens with patients who completed curative-intent therapy 1 or 2 years ago or with those who have stable metastatic disease and are returning to learn the results of a scan. They often come with multiple family members, and you can feel the tension weighing down on everyone like a humid summer afternoon.
I find that there is an odd dynamic—walking into a patient’s examination room, knowing a critical piece of good news that the patient does not yet know, and blurting out “your scans look good” before I am fully seated. There is simply no point in prolonging the tension associated with not knowing.
Patients often let out a nervous sigh and laugh within seconds of hearing the good news. In this setting, laughter serves to release the tension and expresses relief that the future seems as long and promising as the patient had hoped. In the same breath, this kind of laughter also acknowledges that good scans today are no guarantee of favorable results in the future.
Accepting One’s Fate With Humor
Laughter in oncology often comes during more difficult situations, such as when we have to tell patients that their cancer is back, their chemotherapy is not working, or the cancer has spread further than we previously thought. I remember Mr. Washington, an elderly gentleman with rapidly progressive, metastatic prostate cancer. He was a preacher and previously had localized colon and lung cancers, which had both been treated with surgery and chemotherapy years earlier.
[Humor] connects patient and oncologist on multiple levels and provides levity and stress relief in difficult circumstances.— Suneel D. Kamath, MD
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I watched with utter helplessness as his cancer spread to his lungs, liver, and nearly every bone in his body. Therapy after therapy failed to control his disease, and he was eventually hospitalized for pain control. This happened during one of my vacations, so when I returned, I immediately paid him a visit. I saw a shell of the man I once knew, but his spirit and his faith were still intact. He laughed as he saw me come through his door, the way two old friends do after a long hiatus. He told me, “There has been so much pain, so much suffering this past week. I have seen so many doctors in this hospital, but now, I have my doctor back.” I will cherish those words forever.
We talked for a while about hospice and what to expect in the weeks he had left. We laughed together about the time he was rear-ended by another car on the way to see me, but he kept driving to his appointment anyway. Humor helped us remember that there were a lot of good times despite how badly things had gone in the end. I interpreted his laughter as a way of expressing acceptance of his suffering and impending mortality, but I also feel that it conveyed determination or defiance. It was a way for him to say, “Cancer will kill my body, but it cannot take away my spirit or my faith.”
As I look ahead to my career, I still feel the same sense of privilege to be able to care for patients with cancer as I did on the first day of my fellowship. I have found humor to be tremendously useful when used at the appropriate time and in an insightful and sensitive manner. It connects patient and oncologist on multiple levels and provides levity and stress relief in difficult circumstances. It is also a powerful tool to alleviate the emotional burden of being an oncologist. ■
At the time this article was published in the Journal of Clinical Oncology, Dr. Kamath was practicing at the Northwestern University Feinberg School of Medicine in Chicago.