My Patient, My Friend

“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.