A Loss of Trust

by carlocmd

He was diagnosed with stage IV rectal cancer. It was everywhere. We talked of systemic chemotherapy. After a few cycles, a repeat evaluation showed that his cancer had progressed. Latest evidence says that with current treatment, his chances of being alive at 5 years is 8%. Very slim. He recently developed complete bowel obstruction which, if unrelieved, will kill him over the next few weeks.

we talked about his goals. as his physician, i needed his guidance. i needed to know what he considers important. i needed to know what he wanted me to do.

first, no pain. pain is perhaps the most scary thing a person with cancer thinks of. with pain is suffering. he did not want to suffer. he doesn’t have to.

second, maintain his quality of life. which meant providing his body nutrients and sustenance in whatever way. since his bowels are not working, this means feeding him through the vein. this also means regular monitoring of vital blood chemistries, to make sure he is receiving the right mix of food.

third, no unnecessary cost. there will always be people, good-intentioned, who will recommend this or that treatment. to go to this or that place. to see this or that specialist or “specialist.” but what worked for one, does not always work for all… testimonials are not good medicine. with far-advanced rectal cancer and complete bowel obstruction, the real options are very limited… unless the obstruction is relieved.

and fourth, opt for cure, as long as all other goals are in line.

we had an understanding. with the failure of first-line medicine, he did not want to undergo second-line treatment because the side effects of the chemotherapy was devastating.

frantically, the family began to panic. they listened to stories of other people cured of cancer. it’s like grasping a semblance of a truth in a haystack of words and misconstrued notions. i patiently sift through their stories and dissect away the lies and empty promises. it is not an easy thing to do. sometimes, i needed a day or two to consult other people and research on my own. always, i was in search of the truth and how these options can work within our goals.

mostly, i played a devil’s advocate. it seemed like with every story, when i gently gave them its merits and false claims, they did not want to hear it. to them, i was the bearer of bad news.

i continued to talk of hope and the need to search for answers.


someone came and promised that he will live an additional 30 years. but he has to forsake his current treatment. he needs coffee enemas to detoxify his liver and gallbladder. he needs to eat raw pancreas and liver. if he cannot eat this, wait there’s an option — pork liver and pancreas comes in a capsule you can get through me. he has a friend in another hospital who is a doctor and will take over his care.

i wanted to talk to this person with his promises because i was interested to know his methods, qualifications, and plans. i left my phone numbers. i never did find out why he avoided me. the next phone call i get was from the family telling me they have to leave now. i sensed their urgency, and probably their loss of trust. i asked that whoever it was that was taking over to call me so that i can endorse his plan of care, his goals.

nobody called. was it because the family did not want me to confront this new source of hope and shatter it?