Courage Under Fire
What I’ve learned from Andrea and so many other patients over the years continues to shape and refine me. It enhances my ability to be a better physician each and every day.
—Kishore K. Dass, MD
The following essay by Kishore K. Dass, MD, is adapted from The Big Casino: America’s Best Cancer Doctors Share Their Most Powerful Stories, which was coedited by Stan Winokur, MD, and Vincent
Coppola and published in May 2014. The book is available on Amazon.com and thebigcasino.org.
Born in Myanmar (Burma), an impoverished country, I was the eldest son of seven children in a destitute family. My parents were of firm Hindu faith, but I grew up in a Buddhist society until the age of 15. We then immigrated to Chicago, with great hopes and anticipation of achieving the American Dream.
At the tender age of 7, I lost my Nani, my maternal grandmother, to what I now presume was liver cancer. I remember telling my mother with immense anger, “I miss Nani so much! When I grow up, I want to learn about and destroy cancer so that no one loses their [sic] Nani ever again!”
I was a teenager when we moved to Chicago. I could not read or write, let alone speak, English. Despite this, I was placed in the ninth grade. One’s teenage years are challenging; here I was from a different country, facing a language barrier, and unimaginable culture shock. The human mind is a powerful engine: Faced with adversity or situations in which there is no option but to survive, the mind has the ability to overcome any obstacle.
Failure was not an option. I was determined to succeed, even if purely by willpower. My goals were to force myself to learn English, excel in high school and college, and make something of myself. Most children model themselves on the professional paths of their parents. Being a welder like my father never appealed to me. I wanted to impact lives. Anything else would equate to complete failure in my mind. But which career to choose?
Oncology Is My Calling
When I was in high school, two of my uncles—both oncologists—gave me the opportunity to shadow them at their outpatient clinics in the Chicago suburbs. On my first day, as my uncle entered a patient’s room, I saw the patient’s eyes light up, beaming with the utmost hope. My uncle answered questions thoroughly and with compassion. I noticed his words soothed all the patient’s fears. At that moment, I knew this was where I belonged. This was my calling. This is how I wanted to live the rest of my life, influencing lives and fulfilling the promise I’d made to my mother as a child. I’ve never looked back.
Fast-forward through the years. I’ve successfully completed my medical training, and I’ve been hired as a radiation oncologist into a private group practice in West Palm Beach, Florida.
In my 20 years in practice, I’ve had the privilege of caring for patients from all walks of life, afflicted with all varieties of cancers. Like all oncologists, I have experienced as many patient success stories as I have failures, but I’ve always tried to learn from each of my patients. They are responsible for the person I am today and the physician I’ve become. I will cherish these men and women eternally.
Lessons From a Nurse With Cancer
I would like to share the story of one patient who taught me the essence of courage, resilience, and optimism. Several years ago, while tending to a patient—he’d undergone a prostate radioactive implant procedure—in the post anesthesia care unit, I overheard a stern, yet soft, voice say, “Bed 5 is in extreme pain! Are you going to order something or what?”
I looked up and saw a petite young woman smile, then giggle. Like the surgeon she was addressing, I chuckled to myself. This was nurse Andrea. I observed her interactions with patients and physicians. She exuded incredible energy, channeled through a bubbly personality. I watched her multitask with precision and ease: checking on patients, taking vital signs, answering phone calls, joking with staff members, and relaying patient updates to the surgeons.
She possessed this positive magnetic force. I was drawn to her. Andrea was also very good at what she did and loved every minute of it. I decided I needed Andrea working side-by-side with me. I pleaded with her to transfer to my center. A perfectionist, she hesitated, feeling she didn’t have enough background or experience in oncology to do the position justice. I promised I’d teach her and send her for oncology-certified nurse training. She finally agreed.
I was amazed at how quickly Andrea learned oncology from pathophysiology to treatment and management (perhaps a little too much for her own good). Often she’d joke that if she grew extra appendages or developed cancer from the radiation, it would be my fault. Obviously, I’d discredit these nonsensical comments. We both knew it wasn’t possible, but it always made me smile. Andrea had this gift of making those around her relax, even if it was at her expense.
Within 2 months of joining my practice, Andrea was diagnosed with stage IIIA, locally advanced breast cancer with multiple lymph node involvement. She was 32 years old, a wife, and a mother of 4-year-old twin boys. Besides working full time, she was a homemaker and cared for her aging father.
I was devastated. I couldn’t help thinking, would she have this cancer if she still worked at the hospital recovery room? As medical providers, we often develop a numbness or detachment to the word cancer, but this was painful news to bear. On the other hand, Andrea looked at me and said, “Dr. Dass, don’t worry. Everything will be fine. I was meant to be at this cancer center. That’s why God sent me here. I’m a fighter, and I need your help to fight.”
Coping With Cancer
Andrea always saw the bright side of things. She opted for breast conservation and started systemic chemotherapy with doxorubicin and cyclophosphamide, followed by paclitaxel. Despite experiencing fatigue, nausea, and alopecia, Andrea never missed a day of work. She wore her pink cap every day with great pride and dealt with her hair loss by saying, “I never liked my hair anyway.”
There was a time when extremely swamped at work, she suffered peripheral neuropathy. I watched her struggle to pick up a pen. Instead of getting emotional or frustrated, Andrea stopped, closed her eyes, took a deep breath, and was able to finally grasp the pen. I was staggered by her tremendous determination.
After completing her chemotherapy, Andrea approached me for advice regarding radiation as part of breast-conservation therapy. She requested I be her radiation oncologist. Surprised, I asked, “Wouldn’t you prefer to be under the care of one of my partners since we work together?”
“Absolutely not!” she said. “If I’m to have radiation treatment, it will be under your supervision.”
Reluctantly, I accepted her as my patient. Assuming it would be strenuous for her to juggle work, her personal life, and radiation treatment, I suggested she take some time off. Unyielding, Andrea worked right through her treatment. To ensure her patients were taken care of, she underwent treatment during her lunch breaks.
Andrea endured the side effects of radiation, including lymphedema in her arms. She took it in stride and immediately went to see a lymphedema specialist. Never did she ever suggest quitting her job or taking a leave of absence. She picked up her kids from preschool every day, dropped them off for after-care, and came right back to work.
She never lost that great smile and positive demeanor. She tended to her patients as if nothing serious was going on in her life. She put their well-being before her own and gave them the undivided attention they deserved, day in and day out. She taught me that no matter the circumstance, patients take priority. I never saw Andrea cry. She never asked, “Why is this happening to me?” She never stopped living.
The Gifts of Optimism and Perseverance
Andrea reminded me that life has its ups and downs. That it’s okay if things are not always perfect. One must go on living. And yes, there is a happy ending to this story. Now 37 years old, Andrea has been cancer-free for 5 years. She works with the Susan G. Komen Foundation.
Oftentimes, when one of my patients is having a very difficult time accepting a newly diagnosed breast cancer, I have Andrea speak with her. After hearing Andrea’s story, I’ve seen patients come out with a completely different outlook: a willingness to defeat cancer; fear replaced with hope; anger replaced with humility; tears of sadness replaced with tears of joy.
Recently, I asked Andrea about the secret of her bravery. She gave me that mysterious yet warm smile and said, “I stick around for my husband, my boys, family, friends, and even you. Imagine how bored you all would be!”
What I’ve learned from Andrea and so many other patients over the years continues to shape and refine me. It enhances my ability to be a better physician each and every day and motivates me to continue the journey I began 20 years ago with the same level of enthusiasm and interest I had as a young resident physician. ■