Out of aces: Kenny Rogers, oncology and the novel coronavirus
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After learning that Kenny Rogers died this past weekend, my mind started to link the parallels between his lyrics to “The Gambler” and my “dealings” as an oncologist.
If you're gonna play the game,
You gotta learn to play it right .
You got to know when to hold ‘em ,
Know when to fold ‘em .
As oncologists, we find ourselves in a unique catch-22 these days.
As our communities lock down in an attempt to sequester the novel coronavirus and lessen the spread of this semienigmatic disease, we are asked to make decisions about which patients we bring in for treatment and which ones we ask to stay home.
We must decide whether a patient’s risk for contracting the virus — and subsequent morbidity and mortality — by coming to a medical facility is higher or lower than the risk of his or her cancer progressing if we hold chemotherapy for a “little while” until “things settle down.”
These decisions must be made rather quickly. Obliterating someone’s immune system with chemotherapy during a pandemic is no easy decision, but neither is allowing their cancer growth to go unchecked.
The problem with this approach is obvious: We don’t know when things will settle down, and we also are not experts at predicting how well someone can do during an unplanned “chemotherapy holiday.”
Every gambler knows
The secret to survivin’
Is knowin’ what to throw away
And knowin' what to keep
’Cause every hand's a winner
And every hand's a loser
During the next several months, we will be expected to synthesize several factors in a short timeframe, such as:
Our knowledge of the specific malignancy and its typical course, whether it is indolent or aggressive;
Our assessment of each individual patient’s hardiness and whether they can endure forgoing chemotherapy vs. contracting this virus;
Our impression of a patient’s support network in case of either scenario;
And finally, our gambler’s intuition
The gambler — he broke even
And in his final words I found
An ace that I could keep.
So we will stir all those factors together to make our decisions — consciously and subconsciously, one patient at a time.
We will need to collaborate with our colleagues, and be receptive to their input and anecdotes.
We will need to harness all the mental fortitude we can muster to deal with this quagmire.
But we must also be gentle with ourselves and realize that this is a gamble — one where we know what’s at stake while not quite knowing the odds.
And my last thought for this matter, borrowed from Randy Pausch’s “The Last lecture”:
“We cannot change the cards we are dealt, just how we play the hand.”
For more information:
Rujuta Saksena, MD, is an oncologist with MDA Oncology & Hematology in New Jersey. She can be reached at saksena125@gmail.com.
Disclosure: Saksena reports no relevant financial disclosures.
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