"Why Me?", a Question of Opportunity

Listen to ASCO's Journal of Clinical Oncology essay, ""Why Me?", a Question of Opportunity," by Simon Wein, head of Palliative Care Service at the Davidoff Cancer Centre. The essay is followed by an interview with Wein and host Dr. Lidia Schapira. Wein considers if patients are able to make rational decisions about their health when they are able to accept the reality of illness. TRANSCRIPT Narrator: "Why Me?" , a Question of Opportunity, by Simon Wein, MD "Why me?" A question is an opportunity. It is also an invitation and a revelation. A question by its nature reveals something about the asker. When a patient or family member asks the doctor a question, the challenge for the doctor is to follow up the question diagnostically, then therapeutically, be the therapy medication, or talking. Some questions appear mechanical, such as "Will I be able to drive again?" while others are more obviously self reflective, such as "Why did I get sick?" However, even the most mechanically minded question may be fraught with emotional significance. A recent Art of Oncology poem entitled "Questions for the Oncologist" listed a litany of questions the doctor encouraged his patient to ask. All, except one: "But please, don't ask me that one thing./Don't ask, 'why me?'/You wouldn't like the answer. I don't." Later, the doctor-poet provided the answer: "Bad luck is a second-rate explanation, I know." The poem was sensitively, empathically, and thoughtfully written, apparently recalling an emotionally intense case. The poem reminded me of a patient I looked after some time ago and of a mentor past. An obese 60-year-old man came in. He was miserable and in pain. Ten months after definitive surgery and radiotherapy for lung cancer, the disease had returned with pain in his right chest wall. While awaiting full biopsy results, we irradiated the lesion and started nonsteroidal analgesics and duloxetine for the neuropathic pain (with the hope it might also improve his mood). Within 3 weeks, the pain had been significantly relieved although his misery was unchanged. We talked. He had been divorced for many years, worked in hi-tech, lived alone, and had lost contact with his two adult children. His parents had migrated in middle age, and he was an only child born in a new country. His parents struggled, and the family dynamic could be described as sullen. The family did little together and was silent a lot of the time. He recalls his parents, especially his father, as emotionally distant, involved in their own lives. Growing up he spent a lot of time alone. At university, he studied engineering and married his first girlfriend; however, the marriage fell apart as, in his words, "I did not know how to live together with someone else." In his sullen home life, he had not acquired the skills of building a family nor had he developed a coherent world view. Despite good pain relief, his sense of brooding and demoralized loneliness persisted. Underneath was a seething anger. He kept asking "why me?" I assumed at first that he was referring to the cancer. He was, but not only. I consulted with a mentor, and he said he often answered that question with: "Why not you?" I tried it. The patient was flummoxed. It pushed him to reflect. With further probing, over time, his thinking changed from a closed loop of "Why me," to "What is life asking of me?" And further afield he reflected on his childhood, his failed marriage, and estrangement from his children. Why did this happen to me? He shook off some of his depressed mood as he began to piece together his life's trajectory. In an insightful moment of acceptance he noted: "Indeed, why not me … What makes me special that I should not have the disease?" Sadly, there was no fairy-tale ending. He died alone. When a patient asks a difficult question such as "Why me?" or "How long have I got doc?" the psychologically astute analysis is, "Why and what does the patient want to know?" and "Why now?" Responding with the questio

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