The Courage of Your Convictions: Having Tough Conversations

PJ Hamel Health Guide
  • You have breast cancer. You’ve had surgery to remove the tumor, and the pathology report shows a fairly aggressive cancer, but no lymph node involvement. You desperately want to avoid chemo. Your oncologist wants you to have it “just in case.” In the end, you decide to go with your heart and skip chemo.

    How do you tell your doctor? How will he react?

    Your biopsy results indicate you’ll need a mastectomy. Your surgeon has an opening next week, and says your best bet is to take it and not wait. But you’re considering reconstruction, which means doing research on what kind is best for you, coordinating a plastic surgeon, scheduling time off from work… You can’t possibly have surgery next week.

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    Will the surgeon lose interest and stick you at the back of the line because you didn’t take the slot he wanted to fill?

    You’ve had bone mets for 6 years, and now the cancer has spread to your liver and brain. You’ve had enough; it’s time to let go. Your family desperately wants you to continue with chemo. How do you refuse without letting everyone down?

    Breast cancer tries to destroy your body. And the sheer number of decisions you have to make can be a huge challenge to mind and soul. Lumpectomy or mastectomy? Chemo, yes or no? Radiation – what type? Am I making the right choice? Doing the right thing?

    The problem is, none of these decisions are made in a vacuum. At the very least, your medical team is standing on the sidelines, pushing or pulling you in one direction, while you might very well be heading somewhere else. And if you have family – well, your mom has one opinion, your sister another, your daughter disagrees with everyone… it’s not easy, is it?

    Understand this: it’s your body, and your life. Sure, others love and depend on you; but at the end of the day, you have to do what’s best for YOU. Going through any treatment against your will is a sure path to unhappiness and resentment. And if the situation arises when it’s you against the world, then some tough conversations have to happen.

    Here are some tips on how to have those conversations.

    First, how do you deal with your medical team?

    Understand that they’re there to save your life, and that means everything – every surgery, dose of radiation, and drug – points to that end. My experience is that doctors always advise the course of action that will most reduce your risk of recurrence.

    Maybe chemo will reduce your risk of recurrence from 10% to 5%; that’s a 50% reduction, and one your doctor recommends.

    But in reality, it’s only a 5% reduction in absolute risk. If you’ve decided to avoid chemo, and you’re willing to take that extra risk, be prepared to stand firm in the face of your doctor’s reaction – which might be anything from gentle persuasion, to anger, to outright rejection.

    I have a friend who said that when she refused chemo, her oncologist shouted at her that she was committing suicide. Another friend said her doctor simply washed his hands of her, mentally and emotionally; he disengaged from her treatment.


  • So, decide ahead of time if your doctor is worth keeping. If you’ve been wanting a new oncologist anyway, you can pass along your decision via phone or email, and ask for a referral to a different doctor.

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    But if you want to retain your relationship with your current oncologist, meet in person, and be polite, but firm. Listen to what s/he says without arguing; clearly neither one of you will persuade the other. Despite all your online research, you don’t want to get into a situation where you’re putting your limited medical knowledge up against hers; that’s a battle you’ll never win.

    Your best bet is to tell the doctor you respect her opinion, but want to do what your heart tells you; and you trust this won’t affect your ongoing relationship. Hopefully you’ll both find a peaceful middle ground.

    Next, how do you deal with family members who advise a course of treatment – a clinical trial, another round of chemo, another surgery – you’ve decided to forego?

    It depends; the time you spend in discussion is probably directly related to your relationship. Obviously, your grown children deserve much more time and effort than your cousin Diane –  unless Diane is your best friend in all the world, and your kids have chosen to distance themselves. Look at the emotional relationship as well as the biological.

    Hopefully you’ve given your family the courtesy of listening to them, prior to making your decision. Understand that, like your oncologist, they want to keep you alive. Their heart is in the right place… but they can’t possibly understand how eviscerating cancer treatment can be. Once again, it’s your body; your soul. Your decision.

    So when it comes time to pass along this decision, explain that you’ve thought long and hard, weighed the pros and cons, and are doing what feels right to you. Tell them this is no reflection on your love for them, or their love for you; it’s simply what your heart and mind are telling you.

    Hopefully this discussion will end in hugs all around. And a mutual vow that you’ll continue to face this together – as a family. 

    Finally – how do you have a challenging discussion with yourself? The decision alone is tough; how do you live with it?

    As baseball pitcher Satchel Paige famously said, “Don’t look back.” Second-guessing, regret, and guilt are a sure path to misery. You made the best decision you could – with the information you had, and knowing your capabilities and limitations. You did the right thing; believe in yourself.

    My mantra is, do the best you can every day. Go to bed; sleep soundly. Get up the next morning, and do it again.

    None of us knows where life will take us; all we can do is try. And that’s good enough.

Published On: August 02, 2010