My patient refused all treatment. After her death, I learned why

'Every time I talk to you, I feel more distressed.” Tears stream down my patient’s face as she claps her palms over her ears to shut me out. I am stunned to my core by this completely unexpected office version of a devastating domestic diatribe from which you wonder how you will recover. In my small office, the distance between us feels suddenly uncrossable.

- Ranjana Srivastava

This is our umpteenth meeting. When she was first diagnosed with cancer, she faced a brutal series of treatments. Chemotherapy felled her. Radiation burned her. The constant needle pricks coloured her skin black and blue. She hated the rumbling noise of the scanner. Yet she persevered because a cure was within reach.

The unfortunate problem with many cancers, of course, is that when “everything is over” it is not always over. Being diagnosed in the first half of one’s life leaves the second half open to a recurrence. This is what happens some years later during routine surveillance.

Bracing myself, I prepare her for the bad news. I say that while the news is disappointing, this cancer, too, is curable – and thanks to new developments, the treatment will be less onerous. Like many patients, all she hears is that she has cancer. Again.

When she declares this can’t be possible, I respond with a respectful silence, knowing that most patients get past the early shock and ask what next. She walks out, perplexed but not ready to let me in.

The next series of consultations prove trying for us both. My consternation grows but it never crosses my mind that she will refuse curative treatment.