Ravi Kiran Pothamsetty, MBBS, DNB, Fellow AROI, GFPM
Mr. A was a young professional who walked into my outpatient clinic one morning with his mother by his side. He wore a warm smile, yet there was a quiet heaviness beneath it.
A few months earlier, he had been diagnosed with a malignant brain tumor and had undergone primary treatment. He was now receiving adjuvant chemotherapy.
Before discussing his illness, we spent time learning about his work, friendships, daily routines, and family life. As his initial hesitation eased, his concerns began to surface.
Treatment had interrupted his work, compromised his financial independence, and pushed him into social isolation. His anxiety about prolonged medical leave often manifested as irritability and unspoken distress.
He had been saving for an important family milestone and now felt unable to contribute as he had once planned. Over time, he began distancing himself from his family, who had previously been his strongest source of support. His mother, who knew him as cheerful and responsible, struggled to understand the change. The silence, irritability, and emotional distance weighed heavily on her.
Evenings once spent playing cricket with friends had been replaced by watching matches on his phone. His professional aspirations felt suspended. With each chemotherapy cycle, the sense of uncertainty deepened. Eventually, he voiced what had been building within him: treatment felt like a sequence of failures, each one without closure.
After a pause, he added, “I read that this cancer is uncommon in people of my age.”
I found myself wondering why this particular detail mattered to him. He already understood the diagnosis, treatment plan, and treatment intent. Yet he kept returning to its rarity.
Only later did I consider that he may not have been seeking information, but meaning.
The rarity did not change his treatment; it gave shape to an unspoken question:
“Why me? Why now?”
The numbers were not merely clinical facts; they had become a language for his suffering, giving voice to what otherwise felt inexpressible.
“Sometimes I feel like me without me,” he said quietly.
After a pause, he whispered, “I miss my life.”
There was no anger in his voice, only the quiet weight of a life interrupted just as it was taking shape. In that moment, any immediate response felt insufficient. Instead, I chose to remain present with his silence.
I realized that knowledge can reduce confusion, but it does not eliminate emotion. Suffering is not always visible through physical symptoms, prognosis, or clinical endpoints. Sometimes, it emerges from the loss of ordinary life itself.
Recognizing this distress, our psychologist joined his care team to help bridge clinical treatment and emotional reality. Through reflective conversations and journaling, she supported him in exploring what had changed, what remained meaningful, and how he wished to move forward through treatment. Together, we offered reassurance grounded in realism rather than certainty.
He had also searched online for information about his condition. We discussed how online information often reflects population-level patterns rather than individual trajectories. It was important for him to hear that his treatment was not a sequence of failures, but part of a structured plan, with each cycle intended to move him closer to recovery and to the life he hoped to return to.
His fear persisted: “What if chemotherapy fails?”
We did not dismiss his fears with culturally familiar platitudes (“shubh shubh bolo,” ie, “think positive”). Instead, we acknowledged and explored his concerns.
Each cycle felt like another delay in reclaiming the future he had envisioned. We also discussed his concerns about returning to work too early and how this could affect treatment tolerance and recovery.
“Think of this phase as a pause before what comes next,” I said, “not an end.”
We did not try to resolve his emotions. Instead, we focused on one small, realistic step that aligned with how he wished to move forward.
He nodded.
“I will sincerely consider what you have suggested,” he said. “I will meet with you again during my chemotherapy visits.”
While we worked with Mr. A, our psychologist also supported his mother, who was struggling with role reversal and feelings of helplessness. The focus was on helping her remain emotionally connected without interpreting his withdrawal as rejection, and on supporting him without becoming overprotective.
Before leaving, she said quietly, “I see a little confidence in him today. I haven’t seen this in months.”
What stayed with me was not only what he said, but how he said it. When he said, “I miss my life,” I initially heard a wish for recovery.
Looking back, I realized he was also mourning something more immediate:
His independence.
His professional identity.
His friendships.
The future he had imagined before cancer intervened.
Cancer threatened his survival, but treatment distanced him from himself. The very process intended to help him often felt like another obstacle between who he was and who he hoped to become again.
As clinicians, we often focus on prolonging life and sequencing treatment across lines of therapy. Patients, meanwhile, are often trying to understand what their disease means for their lives.
In young adults, suffering is not always expressed through physical symptoms. Sometimes, it emerges through interrupted plans, altered roles, and the unsettling realization that life is no longer unfolding as expected. Such conversations should not remain incidental or be confined to end-of-life care.
Scales and scores have their place, but they cannot fully capture what patients and families live through. Doing so requires openness, presence, and nonjudgmental listening. It begins with a willingness to stay with people as they grapple with questions for which no textbook, guideline, or investigation can provide complete answers.
Before patients can imagine a way forward, they may first need someone willing to acknowledge what they are grieving. The loss is not only physical. It is personal, social, and deeply felt.
That day, we did not give him answers.
We listened.
We stayed with him in the uncertainty.
Dr. Pothamsetty is a Radiation Oncologist and Consultant of Palliative Medicine, leading the institutional palliative care service within the Department of Medical Oncology at Meenakshi Mission Hospital and Research Centre (MMHRC), Madurai, Tamil Nadu, India.
