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Cancer Care Chronicles
November 2017

Afraid That I’ll Not Be Afraid—A Paradox of Care

Author Affiliations
  • 1Division of Thoracic Oncology, European Institute of Oncology (IEO), Milan, Italy
JAMA Oncol. 2017;3(11):1469-1470. doi:10.1001/jamaoncol.2016.3334

Mark, a 49-year-old nonsmoker, was diagnosed 2 years ago with metastatic adenocarcinoma of the lung. When he was given the diagnosis, he fell into despair, his mind befogged, no future, in total darkness, total solitude. He wanted to be left alone but was also afraid that his friends and loved ones would abandon him. He cried; he cried a great deal. He became depressed; he began saying good-bye to friends because he was convinced he had only a few months to live. He withdrew into himself and stopped wanting to see anyone. He also became aggressive toward his wife and children. He was beginning a process of separation from the world, from life. This was how he was when he came to my clinic accompanied by his wife. He was suffering from dyspnea, pain, and a deep feeling of desperation. He had chosen not to speak, letting his wife explain what he was suffering from. He averted his eyes, staring into space as if he were not there or just passing through by chance. It was if his wife and I were not talking about him, sharing his story. Initially, I let his wife speak but then began to ask him questions directly. But his wife answered promptly, always stepping in for him.

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