Blog post by Dr. Marco Cirillo, Heart Failure Surgery Unit Director at the Cardiovascular Department in Poliambulanza Foundation Hospital (Brescia, Italy)
“Good morning, madam,” said the doctor greeting the patient who was entering his office.
“Good morning, Doctor,” she replied.
“So, how are you?” he asked her, motioning for her to sit in one of the two chairs in front of his desk.
“Well, it’s not bad.”
The doctor looked at her carefully.
“So, this first dose of chemo… Did you tolerate it well, right?”
“Yes, Doctor. I passed it…”
“Troubles? Nausea? Vomiting? Other problems?”
“No, Doctor. Nothing,” she replied.
The doctor continued to watch her carefully. After her last answer he got up and went to sit next to her in the other chair that was in front of his desk. He took her hand and asked her again:
“So, madam: how are you?“
The patient shook his hand as if in silent thanks.
“Doctor, you are a good doctor.”
“I’m here to understand what you need, madam, what can I do for you.”
The patient thought a little longer before speaking.
“So, Doctor: the chemo didn’t bother me much, maybe because it’s the first one. Except that… In short, what was difficult was waiting together with the others, all talking about their tumor, where they have it, what chemo they are at, what happened to them, then the hairless ones with the turban on their heads, and how much hemoglobin you have, and what your husband said, and if they recognized you without hair…”
“I understand, madam. But it’s also a way to exorcise it, isn’t it? A way to share this bad experience, to not feel alone…”
She looked him directly in the eyes.
“Doctor, we are not all the same. These things bother me. Seeing how I will be in a month scares me. It doesn’t solace me to know that someone is sicker than me. And knowing that someone is better terrifies me…”
The doctor nodded his head.
“I don’t want to think about my illness and when I come here, I necessarily think about it. I have to think about it. At home I do many things, I see many people, I may not think about it. But when I come here… Then for days I see these scenes in front of me, as if I’ve never left… Believe me, I do not simply ignore the disease, I know what I have and what awaits me. But if I could, I would avoid everything in between, between me and my illness. Do you understand?“
“Of course, madam. I understand. For others it is the same thing.”
They went silent for a while.
Then, the doctor said:
“If you had a choice, ma’am, what would you want? What would make you bear it all better?”
She answered immediately, as if she had the answer ready.
“If I could, I would like to fall asleep and wake up when it’s all over! Don’t see the others, don’t even see the hospital, don’t hear what the nurses say, don’t see the drip, don’t feel the needle entering, don’t see the drop of poison that I have to let into my body to try to survive… Don’t feel the time passing so slowly, as slow as the drop of the drip, a time ‘lost’ that is part of the little time I still have left… I am forced to hope that this time will pass quickly, but at the same time I know that it is not convenient for me to pass quickly, because even this time of treatment is taken away from my life. From what remains of it…“
The doctor released her hand and leaned back in his chair.
The lady asked him:
“Did I say something wrong?”
“No, madam, on the contrary,” said the doctor. “You told me something wonderful.”
“Ah, really? It sounds trivial to me…”
“No, what a patient says when he talks about himself and his illness is never trivial. You gave me a very good idea, madam.”
“Indeed?”
“Sure! What you ask can be done.”
“That is…”
“I can set up a study in which to administer chemo during sleep and analyze the results,” the doctor said, then corrected himself by translating his words into more direct language. “Sorry: I can make you sleep during the treatment, maybe set the treatment during night, so it doesn’t alter your days. And then you will wake up when it’s all over. That wouldn’t prevent some side effects…”
“…but it would prevent me from living consciously at the time of treatment,” the patient completed.
“Sure,” the doctor confirmed.
“Like the Sleeping Beauty…” the patient said. “You know the tale, don’t you?”
“Sure, who doesn’t know it.”
“The fairy godmothers cannot avoid the evil witch’s curse, so they make her fall asleep instead of die. Waiting for a solution,” the patient sighed deeply. “So, Doctor, if you can eliminate the evil that hangs over me, do it. Otherwise, let me sleep before the spinning wheel stings me.”
The doctor looked at her with a grateful look. He had always felt that not only did he do something for the patients every day, but the patients also did something for him every day.
“Would you do this for me, Doctor?”
The doctor smiled.
“Of course, ma’am. For you and for all the people who want it. Just give me some time to organize this.”
“Take your time” the lady said enthusiastically, but soon after she added with a wink: “No, on the contrary: hurry up, I wouldn’t want to waste any more time…”
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Every doctor’s job is to heal diseases. When it is not possible to heal them, the best cure is to relieve the suffering. In Oncology, this second option is still extremely important. The psychological aspect of dealing with something that is often not guaranteed to heal is crucial.
This project aims to extend the concept of “care” by approaching the patient and his/her needs: it is not the patient who has to adapt to the hospital’s schemes, its timing, its protocols, but it is the hospital that must serve the patients, to “take care” after their problem in its multidimensionality.
The disease derails the life of the patient in a decisive way. We must as far as possible try to “sew in” the disease element into their everyday life, if we want them to experience it as something that is part of normal life. This can make them tolerate it better and perhaps improve the chances of overcoming it.
Here, this is the concept behind my research idea.
The study could be initially applied to a selected series of patients, and then extended, if the results are promising.
Certainly, there are some practical limitations related to this study. Arranging the administration during sleep requires many “beds”; it requires specialized nursing staff; if it is carried at home, it also needs allocating specialists for home visits.
It is true, however, that home care for cancer patients is already very common in advanced healthcare systems. Economic investment and funding of cancer research and treatment remain at the top, along with cardiovascular diseases, in all healthcare systems.
Cancer Centers nowadays abound around the world and are increasing in numbers. Comprehensive Cancer Centers, which are the largest in America, carry out transdisciplinary research, recognizing the importance of integrating different knowledge together for more effective treatment. The assistance and therapeutic network, the shared protocols, the sector research in Oncology already boast a very high level today. The coordination between centers makes use of all that assistance know-how. If I have to think of a medical field in which research, assistance, network of knowledge and uniformity of treatment are the most coordinated and efficient, this field is undoubtedly the oncology one.
I would gladly give my scientific contribution by collaborating with centers of Excellence and their teams, who would like to join me on this research project. I would also readily share some organizational ideas by integrating them with the specific knowledge of colleague oncologists. Let’s fight the curse and help people to bear it with the least physical and psychological suffering!
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Read the full Research Idea in Research Ideas and Outcomes (RIO Journal) at: https://doi.org/10.3897/rio.7.e71271
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Full citation:
Cirillo M (2021) Sedation-Led chEmotherapy Evades Pain (S.L.E.E.P.). Research Ideas and Outcomes 7: e71271. https://doi.org/10.3897/rio.7.e71271
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