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Cancer Care Chronicles
October 2018

Sisu—The Ability to Keep Fighting After Most Would Quit

Author Affiliations
  • 1Division of Oncology, Massachusetts General Hospital, Boston
JAMA Oncol. 2018;4(10):1329. doi:10.1001/jamaoncol.2018.1571

The patient knew something wasn’t right. He asked to speak with me by phone a week before his flight to Boston for our initial consultation. At that point, I knew him only on paper: he had a diagnosis of metastatic melanoma. The primary lesion was never found. He’d undergone computed tomographic (CT) imaging of the chest, abdomen, and pelvis that revealed metastases in his lung and liver and maybe some retroperitoneal nodes. But now, I was hearing his voice. It was strong and assertive as he insisted that something wasn’t right and told me he would need to be admitted once he arrived. I was certain that he sounded too well for an admission, so I told him we could see how he was doing once he arrived. But then I heard the flicker of fear, “Please, Dr Cohen, I know something is very wrong. This is not good.”

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