It happens several times a day if you are a thoracic surgeon. You have to inform patients and relatives about a very regrettable diagnosis. Lung cancer is one of these. I do this daily and always try to tailor my words to the man or woman seated in front of me. I try to understand if she/he is a father, a mother, a son, a husband or something else, and I try to explain what it means to have “lung cancer” and how many arrows we have in the quiver to fight and to win against lung cancer.
It happens many times a week that I can offer lung surgery to a patient to resolve her/his cancer, to improve his quality of life, to interfere with the natural history of his disease, or to give them a chance to go on living. This is my work. This is my daily life. I’m trained to do it. What I was not trained to do is to have to do this for one of my best friends!
Paolo is the friend I used to bike every weekend with and go for holidays with our families. We have spent hundreds of hours biking across the Dolomites, the countries and everywhere, sometimes fighting against our wives due to the long time spent far from the family, of course in the day off! We have spent lot of hours speaking about my and his job, about our professional satisfactions and failure; as I know a lot of his job, Paolo knows everything about my professional skills, that means lung cancer surgery, thoracoscopy and minimally invasive thoracic surgery, because these are the arguments we are talking about during our biking ride.
Consequently, when I have to say to Paolo that the cough he suffered for a month, the reason why he was actually under a CT scan, is not due to a complex bronchitis, but to an advanced lung cancer, I’m not able to replay any of the words I have used a hundred times. I’m not able to use any of my professional skills to find the right words. I would like to transmit safety to Paolo, but Paolo’s eyes were spreading panic to me. This time, I didn’t need to understand what kind of man is seated in front of me to tailor the right words. I knew everything about Paolo, I knew that he is now thinking about his wife Patty, about his three kids (Clara, the older, is 8 year-old!) and…. he was now probably shouting inside himself in a very loud silence!
I took as much courage as possible and I started to explain everything to him and then….I have deleted that moment from my mind! I don’t want to live that moment ever again. But I know that we will perform this journey together, like we have done for years biking. Paolo is always faster than me, but always will wait for me.
Paolo’s cancer is an ALK positive adenocarcinoma with N3 nodal spreading. Surgery is not required in this stage of disease at the moment, and this is my biggest regret, my surgical skills can be useful for a lot of patients except my best friend! But to be an “ALK positive” is a very good opportunity that now Paolo knows very well, because the therapy is well tolerated with great effectiveness.
After two months of therapy everything had changed in Paolo’s life, but nothing had changed in Paolo’s ability to face the life events; his bike skills are better than before and even in our last bike ride, three days ago, he was there, at the top of the hill, waiting for me!