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 with every weekend and go on holiday trips together with our respective families. We have spent hundreds of hours biking across the Dolomites, the counties and everywhere, sometimes fighting with our wives due to the long stretches of time we spend far from our families. We have spent many hours talking about our jobs, our professional satisfactions and our failures. I know a lot about his job, just as Paolo knows everything about my professional life and skill-sets – that means lung cancer surgery, thoracoscopy and minimally-invasive thoracic surgery.

Still, when it came time to tell Paolo that the cough he was suffering from for a month was not due to a complex bronchitis but to advanced lung cancer, I was not able to use any of my professional skills to find the right words that I have used a hundred times before. I wanted to convey a sense of calm and safety to Paolo, as I could see the panic in his eyes when he learned about his diagnosis. Instead, I focused on the fact that I knew everything about Paolo. I knew that he was thinking about his wife Patty, his three kids (Clara, the oldest, is eight years old). I knew that he was probably shouting inside himself!

I took as much courage as possible for me to star explaining everything to him. For the most part, I have deleted that moment from my mind; I don’t want to relive it ever again! But I know that we will take this journey together, just like how we have always biked together. Paolo has always been a faster biker than me, but he always waits for me.

Paolo’s cancer is an ALK-positive adenocarcinoma with N3 nodal spreading. Surgery is not required in this stage of disease for the moment, and this is my biggest regret. My surgical skills can be useful for a lot of patients – except for my best friend! But to be “ALK-positive” is a very lucky, something that Paolo now knows very well. The therapy is well-tolerated and is effective against the disease.

After two months of therapy, everything had changed in Paolo’s life, but nothing had changed in Paolo’s ability to face the unpredictability of life. His biking skills are better than before, and even in our last bike ride, he was there, at the top of the hill, waiting for me!

Thanks Paolo.