The next chapter is coming into clear focus. I’ll be sharing more soon — but for now, I’ve been reflecting on what led me here in the first place. This patient encounter reminded me why I chose this field — and why I’m so hopeful about what’s ahead.
It wasn’t supposed to be my case.
I was just in the locum-clinic that day when a nurse approached me with concern. There was a new patient about to start chemotherapy, and she wanted me to lay eyes on him. I hadn’t met him before, didn’t know his story, and hadn’t planned to get involved. But when a nurse comes to you like that, you listen.
He was an 80-year-old man with newly diagnosed metastatic small cell lung cancer — liver lesions, bone mets, bulky disease in the chest. The chart said he’d lost 30 or 40 pounds over the last few months. Before this, he’d been reasonably healthy. Now, his blood pressure was low — 80s over 60s — and he looked frail.
The team had already discussed the diagnosis and treatment options. Chemotherapy was on the table — the right decision, from what I could see. Still, the nurse was hesitant. She wanted to make sure we weren’t pushing something too aggressive on someone who looked so unwell.
When I walked into the room, the patient was seated in a chair — thin, yes, but alert, awake, engaged. His daughter sat to one side, probably in her 30s or 40s. On the other side, a woman I presumed was his wife — white hair with a splash of pink, intentional or not. She was quiet, but her eyes said everything.
I introduced myself, trying to break the ice. I made a joke — something about the family resemblance, asking if she was a daughter too. She smiled. Her daughter laughed. Small moments of connection matter.
What struck me most was what the nurse shared before I walked in: the family hadn’t wanted a doctor to come in. They were worried that a visit from a physician meant bad news — that we’d hold treatment, or hammer home a grim prognosis. They were still reeling, and I can’t blame them. Sometimes, when we as oncologists try to be honest and transparent, we end up sounding harsh. It’s a tightrope… an oncologic paradox or oncodox as we say — share too little and you seem evasive; share too much and you’re the one who took away hope.
But in this case, hope felt like the right medicine.
Small cell lung cancer, especially with a high disease burden like this, is not curable. But it is remarkably chemo-sensitive. Response rates can be high and fast — sometimes even within days. I’ve seen patients go from barely able to move, to sitting up and eating again in a matter of weeks. That’s not always the case, of course. But when it happens, it’s powerful. It buys time, relieves symptoms, and restores dignity.
So I focused on that. I talked about hydration, nutrition, holding his blood pressure meds for now. But most importantly, I encouraged them to move forward with chemo. “If this were my dad,” I said, “this is what I’d want for him.”
And when I said that, I saw the fear begin to lift from his wife’s face. She had expected a different conversation — one filled with limits and endings. Instead, we talked about taking it one step at a time. One dose at a time. We weren’t promising a cure, but we were offering a chance. A chance to feel better. To eat again. To regain some strength. And maybe, in a few weeks, to say, “We’re glad we did it.”
As I left the room, the nurse caught up to me and said the wife had pulled her aside — she was grateful. Even though she’d been hesitant, even though this wasn’t how she imagined the day would go, she was thankful someone came in and reframed the moment.
This wasn’t a grand medical intervention. It wasn’t a protocol shift or clinical trial. It was just a conversation. But sometimes, especially in oncology, that’s exactly what’s needed — a moment of grounded encouragement, cautious optimism, and clear-eyed compassion.
We’ll see how he does. One cycle at a time as I always say. But today, we offered something he and his family could hold onto: a reason to try.
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.