As a surgical oncologist, most patients I see are older adults. I would consider someone with cancer in their 40s or even early 50s as a young patient. And I operate on more patients who are 80 and older, than those younger than 30.
Communicating with elders is usually not difficult. Some are effusive, others taciturn – but they have seen life, and most are quick to comprehend the overall import of a cancer diagnosis. They focus on the big picture, although sometimes the nitty-gritties (the exact treatment schedule, cure rates, potential complications, etc.) are harder to grasp.
Younger adults focus more on the details – what are the options, can I avoid chemotherapy, is robotic surgery superior, what are the costs, how much time off work will I require. They have other responsibilities – families to take care of, careers at stake.
But over the decades, a good clinician learns how to handle different backgrounds and viewpoints. How to empathize (never sympathize!), when (and when not) to give more information, when to let silence speak, how to handle outbursts.
Last month, it so happened that I had to perform surgeries on two teenaged boys. One with a soft tissue sarcoma of the thigh, and another an extra-skeletal Ewings’ sarcoma (post chemotherapy) in the shoulder. These particular illnesses are rare, but known to occur in this age group.
Now, surgical oncologists don’t have much professional experience in handling teenaged children. The communication dynamics are very different. The teenager is smart enough to understand most of the technical aspects, although it is difficult to assess how they are handling the emotional and psychological aspects (even though we often involve the psychologist/psycho oncologist in difficult situations). The decision-makers here are the parents, and they are themselves emotionally wrought – often more than the child himself/herself. The parents sometimes want to hide details from their child, although it is very obvious that the kid is completely aware of what is going on.
“So, Ajay” (name changed) “have you understood what we discussed?” A nod of the head. “Do you have any questions?” A shake of the head. “Don’t hesitate to ask or say anything at all – don’t keep anything to yourself”. A blank look. “Do you want to talk to me alone, while I ask your parents to wait outside?” a vigorous shake of the head, and a frown from the parents. The mother saying “Don’t worry, everything will be all right. You are in very good hands.” The teen’s condescending look at the mother.
This was the pattern of interaction with both boys. By the end of two outpatient consults, and a pre-operative ward visit, I had barely managed to elicit two spoken sentences from each.
The surgeries went well, and both got discharged soon. The post-operative outpatient visits were scheduled.
“The tumor has been removed completely, Ajay – the surgical margins are free. You don’t need any further treatment – but you have to come visit me regularly for check-ups”
“Mayank, (name changed), the response to chemotherapy has been excellent – there was no viable tumor in the surgical specimen. You should do very well”
Both had recovered very well physically – no functional impairment to speak of. Overall, very good news, and I told them so.
I paused. “So how are you now, Ajay? Any questions for me now?” “When can I go trekking?” A faint smile.
The other consult “All good, Mayank?” “Cool” and a thumbs up.
The ice seemed broken. A smile and a thumbs up are big signs of acceptance in the teen world. Thats what my own teenage son (in picture) has taught me!