The following was written in May 2020 by Dr. Richard Frank, Mark’s Oncologist.
Balancing Cancer and Covid
Cancer is not elective.
Even with our hospitals teeming with Covid 19 patients, with most of the doctors, nurses, and allied professionals totally focused on this modern plague, working inhuman hours and risking their own lives every day, cancer patients must be cared for. Those with curable cancers, such as testicular, lymphoma, breast and colon cancers after surgery, and many others, must receive their chemotherapy treatments on time; many with incurable cancers, such as pancreatic, lung, kidney, and many others, must receive their regular chemotherapy or immunotherapy treatments in order to stay alive.
So each morning we come to the cancer center and try to pretend everything is normal—if anything is ever normal in a cancer center—trying to reassure our patients, who are all too aware that they are among the most vulnerable to Covid infection. “One big C at a time,” I’ve found myself saying to some, hoping it doesn’t sound hollow. Sometimes we share a laugh, momentary relief, usually followed by a quick prayer or gesture to the Almighty, as they make their way to the chemotherapy suite. But fear, a regular and constant companion, is now on both sides of the stethoscope. Our patients did not choose to have cancer and they need their treatments but now have to decide whether they want to potentially risk immediate death or lose their life to cancer. So in reality, they have no choice. The probabilities demand that they have treatment. And so, I don’t have a choice either; my colleagues and co-workers have jobs to do even if this means our health is also at risk. Yet, the mood is good as we are all happy to serve and be useful at this frightening time.
My practice has become even more draining, which I would not have thought possible. But I also have the privilege of witnessing heroism every day, from every member of our team, especially our chemotherapy infusion nurses: accessing veins and ports, hanging bags of anti-cancer medicines, dealing with reactions such as nausea or rigors and being there for the patient every moment of every drip. I cannot convey how much I admire them for their tireless dedication and courage.
We are all used to the irregular, unpredictable rhythms of cancer, but our days are now punctuated by additional crises, which seem even more jarring. Recently, I saw a new patient in consultation for advanced prostate cancer. He was screened at entry, confirmed to be asymptomatic for Covid 19, and he had no fever. We were both wearing masks. I sensed, however, that he seemed ever so slightly unwell, but still I reviewed his personal and medical history, performed a physical examination, and proceeded to discuss the staging evaluation, treatment options and prognosis. Two days later I was tiger texted by a radiology colleague: “Mr. X’s chest CT looks like Covid lung,” followed by, “Is he positive?”
After a sinking feeling and private burst of expletives, I comforted myself that I’ve already been exposed on multiple occasions and must have immunity. If not, what can I do? Thousands of healthcare workers are on the frontlines and bear witness to incredible loss of life. I am one of the lucky ones, able to continue my specialty.
My nurse contacted the patient who agreed to be tested. If it came back positive, we would closely monitor each person in the department with whom he had come in contact. When the staff has to discuss something we huddle six feet apart, but no one can stay six feet from a patient. Nor can we wear full PPE for each patient—there is not enough to go around and we are not priority users. The following day I was informed that my new consultation tested positive for Covid-19. He is still well and will hopefully remain so. As for me, I can do nothing but wait.
It is immensely gratifying that our patients are aware of the circumstances, and appreciate that we are trying to balance cancer and Covid to keep them safe and well. These brave people, now forced to face cancer alone, have been inspiring in their praise of the staff, their gratitude for our being there for them, and their wishes for our safety. One of my patients with advanced pancreatic cancer, battling for each day, turned to me as she left the room and said, “Thank you. Really, thank you for being here.”
Do I need to explain why we show up?
Richard C. Frank, MD
Whittingham Cancer Center at Norwalk Hospital
Director of Cancer Research
Nuvance Health (Norwalk, Danbury, New-Milford Hospitals in CT)
Consultant in Medical Oncology, Memorial Sloan-Kettering Cancer Center