Roupen Odabashian, Hematology/Oncology Fellow at Karmanos Cancer Institute, and Podcast Host at OncoDaily, shared a post on LinkedIn:
” “Is this the last goodbye?”
She asked it quietly, almost casually, the way someone might ask if the clinic was closing soon. She was eighty, the kind of eighty that still walked the mall a few months ago, still cooked, still lived.
Now she sat in front of me, short of breath, with a cancer that had crawled into every corner of her body. We had tried more than one treatment. Each had failed her.
I didn’t know what to say.
It was Wednesday, the day before Thanksgiving. Those days are always the heaviest in the clinic.
The world outside is getting ready for family, food, and plans. Inside my exam rooms, I’m often doing something very different.
Some people I send home with scans that look stable enough, with plans for the next cycle, with something that resembles hope.
Others, I send home knowing this really might be the last holiday. With them, “see you next time” is a lie, and we all know it.
The conversation with this patient and her husband was one of the most peaceful I’ve ever had with someone so close to the end. There was no bargaining left. No “one more chemo” or “one more trial.” Just three people sitting in a small room facing what was in front of us.
We went over the options, and then we both admitted what we already knew: doing nothing was the kindest thing we could do.
Not neglect. Not abandonment. Just stopping the fight that was now hurting more than helping. She chose to go home, to enjoy what might be her last holiday with her family. She walked out of clinic with a plan for comfort, and I was the one left behind with a pile of self-reflection.
We spend years learning how to treat. Protocols, regimens, guidelines, dosing, side effects. Entire careers built on what to start, what to add, what to escalate.
We get much less training in when not to treat. In how to say, “Enough.” In how to talk about the near future when more treatment becomes harmful, or at best, pointless. That gap isn’t unique to oncology; it cuts across every specialty where the default is to “do something.”
I keep wondering how much of this is the culture we grow up in as clinicians, and how much of it is the system around us, reimbursement, expectations, pharma, the quiet pressure to always reach for the next option or always treat.
She went home to savor a holiday.
I went home thinking about how, in a profession obsessed with what we can do, some of the most important work is learning when to stop.”
More posts featuring Roupen Odabashian on OncoDaily.