Hope and Reality

A hematologist wrestles with how to help leukemia patients make the right treatment choices

By Mikkael Sekeres, MD, MS

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In my outpatient exam room, we had arrived at that moment of silence that often marks the crossroads of unwelcome news and a difficult decision.

My patient, in his mid-60s, had endured a five-week hospitalization after he learned he had leukemia, a period of time that included expected complications of chemotherapy. Week by week, as he returned to my clinic, he became stronger and gained weight, and color had even returned to his cheeks – markers of vitality that my mother might cite, but that also have relevance for those of us who claim only objective assessments of health.

Unfortunately for my patient, though, the numbers didn’t lie. His blood counts failed to recover, and when we performed a bone marrow biopsy to determine why, the results showed that his leukemia persisted.

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“I’m not ready to die yet. I want the chemo,” my patient said. I asked him to take some time to think and to talk it through with his wife and his family. He was resolute though, and we admitted him to the hospital the following day. Two weeks later, he died of an uncontrollable infection, on a breathing tube in the intensive care unit.

I was left wondering, not for the first time in my career, if I had launched someone on a path toward premature death. At the very least, I was guilty of that act of hubris of which oncologists are often accused: giving chemotherapy to a person only days before his death.

Read the full New York Times column by Dr. Sekeres, Director of Cleveland Clinic’s Leukemia Program.

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Photo Credit ©Russell Lee