Throughout my treatment stage(s) my oncologist would ask “what’s something fun you have planned coming up ?” And it really helped me realize how important that is in life-especially when you’re dealing with cancer all the time. I would find myself making plans because he would be asking.
As a retired oncology certified nurse, Our office rarely limited patients desires to accomplish their bucket list. We supplied extra medicine, sent scripts to the pharmacist near them. I had snow birds, patients with homes in other countries. We tried hard to make their travel possible. One man just wanted to dance at his daughter's wedding. A year later he had done that and met his first grandchild. We never took away hope until the very end . Then we tried to keep them as comfortable as possible. Thank you for not losing sight of patients humanity.
I remember going to visit my liver transplant team on my one year anniversary. They invited the media. My doctors, nurses, donor, and even other recipient - who was the reason my donor and I were matched - was there. As I was talking with the other recipient, I had told him my wife and I had just returned from a cruise. He was shocked and asked if our nurse practitioner had given my approval to go on a cruise. I said, I never asked for permission, I just went. I didn't go through 2.5 years of chemo, 14 months of searching for a living donor, and the surgery and recovery, not to enjoy life. Yes, I don't drink alcohol, do drugs, etc. I do take all my medications, see specialists for all the side effects, and take care not to put myself in unhealthy situations. I can't tell you how many times I say no to supplements, enhanced drinks and over the counter medications because of the risk they may cause. But when it comes to travel, it's the one thing my wife and I love and I want to do while I'm still here. Yes, I fully understand the risk of getting sick on a cruise ship, which could lead to death for me, but the odds are so slim, that I'm willing to keep living and not focus on the what ifs.
Thank you for your honesty about the tough choices patients must make at this stage in their lives, and disease process. Thank you for acknowledging, without using these words, that the emotional and spiritual meaning of these decisions is just as important, and potentially much more important, to them at this stage, than the risks. I say this as a former hospice chaplain who also was an educator of a new generation of hospice chaplains. The whole person is also the doctor’s patient, not only the chaplain’s patient.
Amen! A good friend had metasisized breast cancer. She and her husband had married in Kenya where they were both archaeologists. At the end of the first year, after mastectomy and chemotherapies, she felt OK. So, they went back to Africa as tourists, stayed in safari camps, and visited the chapel where they had married. A wonderful trip.
6 months later, she took her last breath as her husband was telling me about that moment visiting the chapel. At her memorial, her husband who was a wonderful photographer shared their life together with pictures. the last picture was them outside the chapel. I’m so glad they went.
What an amazingly beautiful story. I am weeping with happiness for this woman. What a beautiful partner to be with her as she found her moments of joy.
Stage 4 here. I just got back from a trip to Alaska to visit my daughter. I came home to a progressed PET scan, new chemo plans, another liver biopsy and hip radition on both hips. That trip was so important to me and my daughter, and I'm so glad to still be making memories.
Several years ago, just before starting chemo for oesophageal cancer, I asked my oncology nurse if I could still see my two year old granddaughter. She advised me to do what I needed to look after my own mental health and they would look after my physical health. (This advice came with guidance about what was definitely not sensible!) She gave me the freedom to make my own choices and handed me back some control, and life.
Great work! Clinical decisions should be guided not only by evidence and guidelines, but also by each patient’s goals, values, and definition of quality of life. At the same time, it’s important to remind ourselves that achieving this balance is often complex. Clinicians must weigh potential benefits and risks while respecting patient autonomy, particularly when treatments may extend life but also affect comfort, independence, or personal priorities. Shared decision-making is most effective when patients are fully informed and their preferences remain central to the conversation. Perhaps one of the greatest responsibilities in medicine is recognizing that successful care is not measured solely by years added to life, but also by life added to those years. Supporting patients in making decisions that align with their values is one of the most compassionate and meaningful aspects of healthcare. Thank you for sharing this insightful reflection!
As a retired oncology certified nurse, Our office rarely limited patients desires to accomplish their bucket list. We supplied extra medicine, sent scripts to the pharmacist near them. I had snow birds, patients with homes in other countries. We tried hard to make their travel possible. One man just wanted to dance at his daughter's wedding. A year later he had done that and met his first grandchild. We never took away hope until the very end . Then we tried to keep them as comfortable as possible. Thank you for not losing sight of patients humanity.
As a retired oncology certified nurse, Our office rarely limited patients desires to accomplish their bucket list. We supplied extra medicine, sent scripts to the pharmacist near them. I had snow birds, patients with homes in other countries. We tried hard to make their travel possible. One man just wanted to dance at his daughter's wedding. A year later he had done that and met his first grandchild. We never took away hope until the very end . Then we tried to keep them as comfortable as possible. Thank you for not losing sight of patients humanity.
That care is for better *living* is true for cancer care and for all health care. I appreciate you noticing this unfortunately not-uncommon blind spot. I've been astonished by some of the recommendations I've received from doctors, with no realization of what actually that would mean for day-to-day living. Thank you for raising this topic — and through such a delightful story!
The nurse that accompanied him is an angel! Thank you for everything you do. I am in awe of and eternally grateful to everyone in your profession which I tried to humbly express in my essay:
I'm having another PET/CT tomorrow to see how much my lymph nodes have grown over the last 6 months. B symptoms are more pronounced, so I am expecting progression of my SLL. I was diagnosed in May 2025 and the CLL/SLL was added to the Malignant Melanoma I already had. But I have gone on 2 cruises with over 100 friends and, while it was nice, I realized they tired me out so much I am choosing not to go with them in 2027. Instead, I will meet them in port in the Florida Keys for one day and go back home to my writing solitude; I can rest when I need to and write when I can.
I love that you are in a cooperative relationship with your clients. I asked my oncologist for the "permission slip" that the ship required and she didn't even question it. I took care of my health so well, dozens of people in our group got COVID, including my daughter who roomed with me. I did not get it! And I wasn't wearing a mask, but all the other precautions helped me stay safe. Yay for a good immune system!
Thank you for sharing Fred’s story. I work with family caregivers who often face a similar tension: understanding the very real risks while also wanting to help their loved one continue living fully. It was especially meaningful to hear your reflection as a physician on how you navigate those moments.
Throughout my treatment stage(s) my oncologist would ask “what’s something fun you have planned coming up ?” And it really helped me realize how important that is in life-especially when you’re dealing with cancer all the time. I would find myself making plans because he would be asking.
What a blessing that was.
Yes!! I use that approach as well.
What a great approach! I may just borrow it. Thank you for sharing
As a retired oncology certified nurse, Our office rarely limited patients desires to accomplish their bucket list. We supplied extra medicine, sent scripts to the pharmacist near them. I had snow birds, patients with homes in other countries. We tried hard to make their travel possible. One man just wanted to dance at his daughter's wedding. A year later he had done that and met his first grandchild. We never took away hope until the very end . Then we tried to keep them as comfortable as possible. Thank you for not losing sight of patients humanity.
That’s wonderful
I remember going to visit my liver transplant team on my one year anniversary. They invited the media. My doctors, nurses, donor, and even other recipient - who was the reason my donor and I were matched - was there. As I was talking with the other recipient, I had told him my wife and I had just returned from a cruise. He was shocked and asked if our nurse practitioner had given my approval to go on a cruise. I said, I never asked for permission, I just went. I didn't go through 2.5 years of chemo, 14 months of searching for a living donor, and the surgery and recovery, not to enjoy life. Yes, I don't drink alcohol, do drugs, etc. I do take all my medications, see specialists for all the side effects, and take care not to put myself in unhealthy situations. I can't tell you how many times I say no to supplements, enhanced drinks and over the counter medications because of the risk they may cause. But when it comes to travel, it's the one thing my wife and I love and I want to do while I'm still here. Yes, I fully understand the risk of getting sick on a cruise ship, which could lead to death for me, but the odds are so slim, that I'm willing to keep living and not focus on the what ifs.
Yes!!🙌
"But cancer care is not only about avoiding risk. It is also about helping people live."
Beautiful
Thank you for your honesty about the tough choices patients must make at this stage in their lives, and disease process. Thank you for acknowledging, without using these words, that the emotional and spiritual meaning of these decisions is just as important, and potentially much more important, to them at this stage, than the risks. I say this as a former hospice chaplain who also was an educator of a new generation of hospice chaplains. The whole person is also the doctor’s patient, not only the chaplain’s patient.
Great points — appreciate your comments.
Amen! A good friend had metasisized breast cancer. She and her husband had married in Kenya where they were both archaeologists. At the end of the first year, after mastectomy and chemotherapies, she felt OK. So, they went back to Africa as tourists, stayed in safari camps, and visited the chapel where they had married. A wonderful trip.
6 months later, she took her last breath as her husband was telling me about that moment visiting the chapel. At her memorial, her husband who was a wonderful photographer shared their life together with pictures. the last picture was them outside the chapel. I’m so glad they went.
What an amazingly beautiful story. I am weeping with happiness for this woman. What a beautiful partner to be with her as she found her moments of joy.
Stage 4 here. I just got back from a trip to Alaska to visit my daughter. I came home to a progressed PET scan, new chemo plans, another liver biopsy and hip radition on both hips. That trip was so important to me and my daughter, and I'm so glad to still be making memories.
That’s what it’s all about
Several years ago, just before starting chemo for oesophageal cancer, I asked my oncology nurse if I could still see my two year old granddaughter. She advised me to do what I needed to look after my own mental health and they would look after my physical health. (This advice came with guidance about what was definitely not sensible!) She gave me the freedom to make my own choices and handed me back some control, and life.
Great work! Clinical decisions should be guided not only by evidence and guidelines, but also by each patient’s goals, values, and definition of quality of life. At the same time, it’s important to remind ourselves that achieving this balance is often complex. Clinicians must weigh potential benefits and risks while respecting patient autonomy, particularly when treatments may extend life but also affect comfort, independence, or personal priorities. Shared decision-making is most effective when patients are fully informed and their preferences remain central to the conversation. Perhaps one of the greatest responsibilities in medicine is recognizing that successful care is not measured solely by years added to life, but also by life added to those years. Supporting patients in making decisions that align with their values is one of the most compassionate and meaningful aspects of healthcare. Thank you for sharing this insightful reflection!
As a retired oncology certified nurse, Our office rarely limited patients desires to accomplish their bucket list. We supplied extra medicine, sent scripts to the pharmacist near them. I had snow birds, patients with homes in other countries. We tried hard to make their travel possible. One man just wanted to dance at his daughter's wedding. A year later he had done that and met his first grandchild. We never took away hope until the very end . Then we tried to keep them as comfortable as possible. Thank you for not losing sight of patients humanity.
As a retired oncology certified nurse, Our office rarely limited patients desires to accomplish their bucket list. We supplied extra medicine, sent scripts to the pharmacist near them. I had snow birds, patients with homes in other countries. We tried hard to make their travel possible. One man just wanted to dance at his daughter's wedding. A year later he had done that and met his first grandchild. We never took away hope until the very end . Then we tried to keep them as comfortable as possible. Thank you for not losing sight of patients humanity.
That care is for better *living* is true for cancer care and for all health care. I appreciate you noticing this unfortunately not-uncommon blind spot. I've been astonished by some of the recommendations I've received from doctors, with no realization of what actually that would mean for day-to-day living. Thank you for raising this topic — and through such a delightful story!
The nurse that accompanied him is an angel! Thank you for everything you do. I am in awe of and eternally grateful to everyone in your profession which I tried to humbly express in my essay:
https://substack.com/@jwratliff/note/c-295522361?r=3o60zv&utm_medium=ios&utm_source=notes-share-action
Thank you, Dr. Flora. You gave Freddie the very best care. Our family is forever grateful.
You guys have an amazing family — he was deservedly so proud of that accomplishment. Thank you for sharing this photo and for your comments.
I'm having another PET/CT tomorrow to see how much my lymph nodes have grown over the last 6 months. B symptoms are more pronounced, so I am expecting progression of my SLL. I was diagnosed in May 2025 and the CLL/SLL was added to the Malignant Melanoma I already had. But I have gone on 2 cruises with over 100 friends and, while it was nice, I realized they tired me out so much I am choosing not to go with them in 2027. Instead, I will meet them in port in the Florida Keys for one day and go back home to my writing solitude; I can rest when I need to and write when I can.
I love that you are in a cooperative relationship with your clients. I asked my oncologist for the "permission slip" that the ship required and she didn't even question it. I took care of my health so well, dozens of people in our group got COVID, including my daughter who roomed with me. I did not get it! And I wasn't wearing a mask, but all the other precautions helped me stay safe. Yay for a good immune system!
Thank you for sharing Fred’s story. I work with family caregivers who often face a similar tension: understanding the very real risks while also wanting to help their loved one continue living fully. It was especially meaningful to hear your reflection as a physician on how you navigate those moments.
Thanks Risa I’m glad you found it helpful.