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VOLUME 13 | ISSUE 3
Personal Impact and Growth Reflection
Motivation to Fight
Lisa M. Cordes, PharmD
BCACP BCOP
Oncology Clinical Pharmacy
Specialist
National Institutes of Health each week, we once again discussed the
Bethesda, MD
As oncology pharmacists, we all carry
an unofficial list of memorable patients.
Some leave this world before we are ready
to say goodbye, and others defy the odds
with no logical scientific explanation.
Evidence-based guidelines and protocols
provide the framework of our treatment
plans, but as the great physician Sir William
Osler once said, “The good physician treats
the disease; the great physician treats the
patient who has the disease.” Each patient
has an intricate and unique web of internal
and external factors that will influence his
or her treatment outcome. Today, I tell the
story of one of my patients, David, whose
admirable fight and motivation reinforced
the need to focus on the individual.
I first met David about 1.5 years ago. He
was a 39-year-old teacher with a loving wife
and two beautiful children who had brought
his family to America for a better life. The
diagnosis of metastatic urothelial carcinoma
hit hard. He was decades younger than the
average patient with this condition, but his
disease was aggressive and his prognosis
poor. Many of our patients with this disease
are in their 70s with different goals and pri-
orities than someone half their age. As our
team discussed his prognosis and treatment
options with him, I couldn’t help picturing
myself in his shoes. To me, it seemed unfair
that he had to face such a challenging jour-
ney at his age. However, David was selfless,
and his focus was on his family. He made
it clear: “I want to fight, Doc.” As we would
soon discover, this declaration became a
recurring theme throughout his treatment.
David was a spiritual man, and at 5'2" and
65 kg, I couldn’t help envisioning the epic
battle of David and Goliath that we were
about to fight.
Following completion of his first chemo-
therapy regimen, David became hospitalized
around the time of the winter holidays.
As David required 6 liters of supplemental
oxygen and multiple blood transfusions
goals of therapy and encouraged hospice
care. David’s response was, “I want to keep
fighting, Doc.”
We had many difficult conversations
with David and his wife, but this conversa-
tion was one of the hardest. In fact, it was
one of the most challenging of my career. It
was in this conversation that we learned the
full gravity of the situation. If David passed
Understanding the true
‘why’ behind their decision
is one of the most important
variables in the equation
and will allow us to provide
care on a deeper level.”
away, his family would be deported back to
their home country—one without opportu-
nity and freedom as we know it. Obtaining
a green card for his wife was underway, but
the process is slow. He was motivated to
keep fighting because he refused to leave
this world without first providing stability
for his family. We were running out of
options and time, but we were overcome
with compassion and couldn’t give up. The
family’s future was in our hands.
David soon began a second-line regimen.
Two doses into therapy, David became
extremely fatigued, and his condition was
deteriorating. Once again, we heard his
familiar words, “I want to keep fighting,
Doc.” Through third-line therapy, his disease
kept progressing, but he continued to stay
motivated. With cancer patients, we often
discuss treatments that extend survival
and palliative care options. Patients often
say their goal is to live longer to spend time
with their family, and I believe this is where
we need to stop and listen. Understanding
the true “why” behind their decision is one
of the most important variables in the equa-
tion and will allow us to provide care on a
deeper level. Does an elderly patient simply
want to spend time fishing on the lake
with his grandson? Or is it more complex
with a family’s well-being at stake? David’s
situation reminded me that to truly care
for our patients and their families, we must
understand their desires and motivations.
David’s motivation was now apparent,
and following progression on third-line
therapy, we heard him say again, “I want
to keep fighting, Doc.” Fourth-line therapy
commenced and, after months of anxiously
awaiting, his wife received her green card.
The clinic was full of cheers and tears. He
did it; he achieved his goal.
Just this week, David’s restaging scans
have showed progression. True to character,
David said, “I want to keep fighting, Doc.”
We will soon begin a new chemotherapy
regimen, but David’s time on earth is
limited. Perhaps he will be with us only for
another month or two. Then again, I was
proven wrong when those thoughts came to
mind 8 months ago, and I hope to be proven
wrong again.
Whether their goal is being comfortable
or ensuring a better future for their family,
our patients often thank us for helping
them fulfill their last wishes. We credit our
hard work, training, and knowledge, but it
is patients like David who deserve much of
the credit. These inspiring patients remind
us that we don’t treat just the disease, but
also the patient suffering from it. Although
they may not always win the battle, their
unique stories and motivation to fight
inspire us to be better oncology pharma-
cists.
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