In the corridors of where I work, in the several clinical meetings and conferences, in the ward rounds and any social gathering, whenever I am asked to introduce myself and say that I am an oncologist, people usually want to know what kind of a doctor I am. Of course, many people are familiar with obstetricians, surgeons and paediatricians but few especially among the general public in Rwanda are familiar with the word “oncologist”. So, my response is always the same ‘I am an oncologist and I treat cancer’. This response usually is followed by many questions ending with question and exclamation marks. These usually go as: - ‘Who is an oncologist?’ which I respond that he/she is a doctor who treats patients with cancer, several other questions still follow; ‘Eh why did you choose that?’ ‘Are you not always depressed?’ ‘Is cancer really cured?’ ‘Isn’t cancer a hoax from the west or made up by pharmaceutical companies?’ ‘When will you guys get a vaccine? ‘What is causing many cancers these days?’ These are generally fair questions to ask and sometimes they offer me an opportunity to raise awareness about the field and also cancer at large for prevention and early detection. The question that troubles me however, is that which questions my choice of a ‘depressing career,’ I usually interpret this in many ways for it could mean; Why I didn’t just do another specialty and let these patients with cancer die without someone to journey with them during their difficult moments or why I didn’t just choose another career and not give these patients chances of getting cured or why I didn’t choose another career and let patients with cancer die without anyone telling them that there is a possibility of hearing good news of survival. I understand what they mean though, because for many a cancer diagnosis has always been equated to a death sentence. This is why they wonder why someone would choose a career where they think everyone patient dies. I can’t blame them because they are not far away from the truth. Cancer diagnosis in many low-income countries was and is a death sentence and the role of a doctor to patients with cancer then was (is) always telling them the sad news, that their disease can’t and won’t be treated or even if treated won’t be cured. I always wonder what goes in these patients’ minds or their relatives. Do they start seeing death, I really don’t know and I can’t pretend to know despite having told many, such sad news. I started my career in cancer medicine six years ago. In these six years I have practiced in four African countries and also in some developed countries. What I have realised is that regardless of the many differing aspects such as economic status, people react the same way to sad news like a cancer diagnosis and the worst, when a doctor has to announce that after all the trials ,they have come to an end. I have to admit, two of my worst moments in this career are announcing the cancer diagnosis to a patient and family members. And the second is when everything has been tried but despite all, the disease progresses. These two moments are coupled with a sense of hopelessness. A cancer diagnosis whether of a curable disease or not is bad and sad news. For the curable and non-curable disease, the difference is usually known by the doctor but my little experience tells me that to the patient and family, it’s the same. This is because the diagnosis is attached to many bad things. Some have divorced, others have lost their friends, jobs and many have been stigmatised. To us cancer doctors, while it’s not something we don’t want to announce, cancer diagnosis carries a different weight depending on the stage of the disease. Usually the worst moment for me and I guess for every oncologist is announcing that the drugs or any other treatment we were giving isn’t working. This is the moment that I also have lots of questions with what will be running in the minds of my patients or their loved ones. The few minutes before I announce this sad bit, are the hardest. I try to put myself in their shoes though I can’t fit them, I see their future dreams, their hopes, their careers, and I see all the possibilities being put to an end. All their future hopes and dreams shattered with pain both physical and emotional, pain that can never be relieved by any anti-pain medication, pain that cannot be healed by comforting words of any phycologist/psychiatrist. The silence that follows and the tears, is so much painful. This is what leaves a mark on me. I try not to take my job with me when I go home but I fail so many times. I am called to attend funerals of some and at times get distressed by what I sometimes see on the WhatsApp status and profile pictures of my patients who have unfortunately succumbed to the disease. I see them sad, because of the passing of their loved ones which is what everyone feels and I share this with them, but a big part of me feels relieved as this person is done with the enormous pain caused by cancer. While we can’t eliminate this pain completely, the entire cancer community and our Government are doing all they can to curb this buy increasing awareness and availing cancer diagnostics and drugs. There is also training of more cancer specialists who deal with diagnosis (pathology), surgery, medical and radiation oncologists to nurse oncologist and palliative care specialists. Rwanda is now able to offer cancer care services including diagnosis, treatment (surgery, chemotherapy and radiation therapy) and palliative care. We are not where we want to be but it’s a step in the right direction. We have significantly reduced numbers of referrals abroad and we have started receiving many patients from neighbouring countries. In oncology, it is not always sad news shared; there are good moments, moments where a patient with a very huge tumour and no hopes responds well to treatment after few rounds of chemotherapy or radiation. But even when everything fails, I find gratitude in receiving a text or a call from a patient or relatives thanking me for trying to help. Humanism should stay at the centre of every conversation with a cancer patient and their relatives because cancer diagnosis is a journey that requires us (medics) to walk with our patients. It’s our hope and belief that these difficult moments will be reduced significantly in few years to come.
