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IIn March, just before the UK closes, I speculated about the challenges Covid-19 could pose for people under cancer treatment. Now, with the apprehension growing as we dive headlong into the second wave of Covid-19, I reflect on my last seven months as an oncologist. There is no doubt that 2020 has made the lives of those living with cancer even more difficult. It has also become more difficult for those of us who work in cancer care.
We had to adapt our communication skills. For some patients, the switch to telephone consultations is a welcome change. For others, a phone call eliminates the conversation part of consultations, where doctors and patients get to know each other. A physical exam tells us more about our patients than just physical results. The silences we so often employ in face-to-face conversations, generally intuitively without conscious thought, are embarrassing on the phone. Video consultations are better, but they don’t equate to real life. Normally we would never engage in difficult, life-changing conversations with the words, “Can you hear me?”
Learning to communicate behind a mask, without touching it, was horrible. It’s hard to describe how difficult it is to tell someone their treatment has stopped working, two meters away with facial expressions hidden. I didn’t appreciate the importance of non-verbal cues until they were taken away. Asking difficult and important questions became more difficult, so much so that I sometimes unconsciously avoided them.
One summer day, the specialist nurse I work with and I had to tell a teenager and his parents that his treatment had stopped working and there were no more options. There is never an easy way to do it, but we have done our best to deliver this impossible news with compassion, in the quiet room of the young teen ward, even if behind the masks.
Some time later, his mother and I went to the roof terrace to talk more. I suggested that maybe, since we were out, we could take off the masks. For the first time in months, I felt we could speak as human beings; I could correctly express from my heart how much I wanted to do more to help her son. As he got up to leave, we hugged. For me, this hug said more than any word. This is what oncology was like. This is the oncology I want.
One of the things I found most difficult was watching people go through cancer treatment alone, without the support of friends and families. Imagine spending three months in the hospital undergoing intensive chemotherapy without your wife and children being able to visit. Imagine getting the phone call that your husband was so overwhelmed with cancer that doctors had to insert a tube into his airway to help him breathe, but not be able to visit.
Imagine being in your early 20s, knowing you only have a few months to live, and making the difficult decision to try chemotherapy in the hopes that it will extend your life just enough to spend a few weekends with friends when the lockdown ends. And then to find that chemotherapy didn’t work and that you spent your last few months in and out of the hospital alone, without the opportunity to do the things that made you happy.
Imagine being so scared of the coronavirus that even if you are done with treatment, you are terrified of leaving home to take your kids to the park. Or you are told that you may die, but you are not allowed to receive visitors until a few days after the death. Imagine, at the age of thirty, going to a hospice as a bridge to die at home and not being allowed visitors even there.
Imagine watching this anguish week after week.
At the start of the pandemic, we were asked to prioritize cancer treatments from priority one (curative treatment) to priority six (non-curative treatment with a small chance of palliation or temporary tumor control). I’ve been lucky so far. Where I work, we’ve never been so limited in capacity that we have to use this categorization to prioritize treatments.
I may have had to advise against some treatments that we usually recommend. This is because we now consider that the risks outweigh the benefits. But I never had to tell a patient that I wasn’t able to offer treatment because we didn’t have the resources to provide it. Some colleagues elsewhere have not been so lucky. As we enter round two of Covid, this is again a real fear for us all, particularly as more and more of us have to isolate ourselves.
The NHS does not have the unused staff capacity to cope with excessive absences. I’m afraid the day I’ll have to tell a patient that I can’t offer him treatment because there aren’t enough pharmacists to do it, or enough chemotherapy nurses to provide it. I hope this day never comes.
The NHS has learned from the first round of Covid. We know more and are better equipped. But we are also tired. The three-month suspension in the summer allowed us to recharge our emotional batteries a little, but we are far from 100%. If we started fresh, motivated and full of adrenaline, we enter the second round tired, maybe even tired.
We just finished a marathon. We’re not ready to do another one yet. But we will make it. People always do. Day after day, our patients show us the extraordinary psychological strength of human beings thrown into adversity.
• Lucy Gossage is an oncologist
If you’d like to contribute to our Blood, Sweat and Tears series about healthcare experiences during the coronavirus outbreak, please contact us by emailing [email protected]
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