Note: Patient details have been changed to protect privacy. This story reflects the spirit of an encounter, not the specifics of an individual case.
He was an older man who had lived a simple, steady life. He lived alone, with family nearby but not in his daily orbit. He moved only when he needed to—groceries, a little time outside, and, when he felt up to it, fishing. Fishing was what he loved.
When he came to the hospital, he was tired in a way that felt deeper than just age. Weakness, fatigue, and anemia brought him in. Bloodwork revealed something far more serious—acute myeloid leukemia. AML is an unforgiving disease. For some patients, there are treatments that can push it into remission, but those treatments can be as harsh as the disease itself.
As an oncologist, I’ll admit that leukemia is not my specialty. My work has been grounded in gastrointestinal, cutaneous, and connective tissue cancers. Still, in those moments—when blasts are staring at you from a smear, when the CBC doesn’t lie—you have to know enough to guide the first steps. I often find myself doing a quick five- or ten-minute refresher from trusted resources, reminding myself of the latest standards, before looping in sub-specialist or arranging transfer. There’s always a quiet undercurrent of angst: the weight of knowing this isn’t my deepest area of expertise, but also knowing that being present, honest, and steady for the patient matters just as much as the algorithm.
In his case, intensive chemotherapy was not an option. His health, his body, simply couldn’t take it. There were gentler therapies we could consider—medicines that sometimes buy people another year, maybe more. But they still come with hospital stays, transfusions, infections, and the uncertainty of how much strength the body has left to give.
At first, we planned to transfer him to a larger center, to sit with leukemia specialists and talk through those choices. But when I met him late one evening, the room quiet, just the two of us, it became clear where his heart was. He remembered watching his brother fight leukemia and decided he didn’t want the same path.
“I’ve lived a good life,” he told me. “I don’t want more hospitals. If I can go fishing one more time, that’s what matters.”
It was such a simple statement. And yet it shifted everything. Instead of talking about transfers and therapies, we talked about comfort. About palliative care. About what time, however much remained, could look like if he chose to spend it outside of hospitals, with his family, and by the water with a fishing pole in hand.
The next day, I visited again. He was sitting up, feeling a bit stronger after a transfusion. He spoke about his plans for the year ahead, and that’s when I realized—he thought he still had a year. Without treatment, AML rarely gives that kind of time. It’s weeks, maybe a month or two.
That was the moment I asked him: “Do you want to know about your prognosis?”
He looked at me. “Yes. Tell me.”
So I did. I told him what the disease usually means. That without treatment, time is short. That treatment could sometimes stretch life further, but not without cost. For a moment, I thought he might change his mind. But after a long silence, he shook his head gently.
“That doesn’t change anything,” he said. “I still want the same thing. Comfort. Family. Fishing.”
It was a moment of clarity—not for me, but for him. With the truth in front of him, he still chose the life he wanted, even if it was short. And in that choice, there was peace.
Medicine often pushes us to think about survival in months, years, statistics. But for patients, it’s not always about time. Sometimes it’s about moments. A sunrise on the water. A quiet dinner with family. A day without hospital walls.
That evening taught me again the importance of slowing down, of asking the direct question, and of listening for the answer. Not just once, but twice, or three times—because sometimes patients need space to absorb, to ask again, to really understand. And when they do, it allows them to choose the life that matters to them, not the life that medicine might push for.
For him, the gift was not another year. It was the chance to spend his final weeks doing what he loved. Fishing.
About the author
Dr. Sajeve Thomas is a distinguished medical professional and a compassionate guide in the field of oncology. With over a decade of dedicated experience as a board-certified medical oncologist/internal medicine specialist, Dr. Thomas has become a trusted expert in the treatment of melanoma, sarcoma, and gastrointestinal conditions. He brings a wealth of expertise to the complex and challenging world of oncology.
Disclosures:
Dr. Thomas serves as a speaker for Bristol Myers Squibb (BMS), Merck, Ipsen, Natera, Immunocore, Pfizer, and SpringWorks. He also receives industry grants in support of numerous clinical trials.