A Letter to My Patient, Whose Terminal Cancer Is the Least of Her Worries

Metastatic pancreatic cancer has a survival rate of less than 5% at five years and yet it seems like it’s the least of your problems. For many weeks now I have found this hard to understand and not only that, have been irritated when you have not shown up on time, held up a chemotherapy chair, or been late to your appointment. When you do make it in you are disengaged and even nonchalant, although never combative, which has led me to wonder if between the oncologist and the patient I am the one doing all the worrying.

Although your English is broken and our consultations time-consuming, between us we managed alright, I thought. For example, I know that the nausea bothers you, your pain arises in waves and your fatigue can be so consuming on days that you can’t lift your head off the pillow. But how is it that you don’t get the gravity of your situation? Are you a patient in denial or am I missing something? Nonplussed, I finally get an interpreter.

It turns out that you are a refugee. This much I knew but only this.

Now I learn that in your home country you escaped the militia barefoot, under cover of the night, hiding in thick jungles as you carried your youngest child while the older one held on tightly to your dress. Avoiding rape, accidents and death from starvation you and your children somehow made it to a refugee camp where you strived to relocate your missing husband. The news, when it filtered through from other refugees, was patchy and unreliable but eventually you received confirmation that your husband was dead. And you fled.

So here you are now in Australia, on a bridging visa, waiting to hear whether your application for permanent protection will be granted. You don’t know how long the wait is and you don’t know the strength of your claim; in the interim, you are surviving on meagre government assistance and charitable organisations that have found you a room in a derelict apartment and stocked it with donated furniture and threadbare blankets. The biting cold and the broken shower are nothing but it’s not so easy when the children go hungry. You had wanted to banish the thought of widowhood and find some work until you realised that you were prohibited from working under your visa conditions. So it was back to charity but the charities said they were overwhelmed and you couldn’t afford to exhaust their goodwill.

And so I discover that the real reason you don’t come to your chemotherapy appointments is because there is no one to mind the children. Sometimes you leave the six-year-old in charge of the two-year-old but it’s not safe, drug addicts roam the block, and although we say we will get you out of chemo as quickly as we can, you don’t drive and the wait for non-urgent transport can be hours.

Your neighbour helped for a while until he figured this was an unending commitment, which would end badly. Constantly relying on others for clothes, food and shelter is dispiriting enough – how can you expect someone to also mind your children? Of course you don’t take the painkillers I prescribe – how can you function in an opioid-induced haze? Of course you don’t answer the knock on the door – you know that it won’t be the nurse who declines to go to your rough neighbourhood after he was assaulted. You are not a fool – of course you know your cancer is serious but this isn’t the first time you have come close to dying. After a while, you say flatly, it’s all relative.

You used to be a teacher, a woman curious about the world. Lately you have wanted to douse that curiosity because people have abused you and your friends from their car, thrown beer bottles at your house and told you to be either grateful to this country or try your luck in another ocean. You keep wondering how you will shield your children from racist taunts.

The interpreter relates it all as he should, dispassionately. I listen, awash in mortification but also, an impotent guilt. A doctor’s traditional opening line is, “How can I help you today?” but it seems so derisory in this instance. Amid the paranoia you are exposed to how can I convince you that many decent Australians are moved by the plight of refugees and don’t view you and your young children as would-be terrorists? Can I somehow demonstrate to you the private angst and discomfiture of many at the treatment meted out to people like you?

I could tell you a story of working 10 years ago at the Asylum Seeker Resource Centre in Melbourne where I looked after a woman who succumbed to metastatic breast cancer and a fractured hip, in search of a basic blood test, hydration, and some morphine, neither of which any public hospital was prepared to offer. Why? Because back then “illegals” were not entitled to Medicare benefits. Volunteers pooled donations to buy her precious opioids that her daughter had to strictly ration, leaving her begging for analgesia on many nights. No one was more relieved than the daughter when the patient died. From this miserable story that burns in my mind I could try to distil the ironic consolation that at least the granting of your Medicare card will save you from that woman’s agonising fate. I could tell you other stories of sick and vulnerable refugees just like you and worse – but I doubt that this is an occasion where a sorrow shared would be a sorrow halved.

As I listen to you I keep thinking about my role as your treating doctor. I think of my colleagues in Texas who grapple with the problem of Mexicans, the ones in India who grapple with Bangladeshis and those in France faced with the troubles of African asylum seekers. And I wonder whether it might be best to leave governing to others and stick to prescribing chemotherapy. After all, one could make an argument that this is where my expertise is best used and really, it’s not like anyone wants an oncologist’s opinion on what should be done about the refugees intent on “invading” us.

You see, most of my friends, even the professional ones, have never met a refugee – they form their views from tabloids and the increasingly shrill sound bites of politicians. But the thing is, when I look at you, I don’t see a queue-jumping, illegal, unauthorised, undocumented alien or for that matter, any of the other names used to strip you of your dignity. I only see a thoughtful woman, a loving mother and a vulnerable patient, with no husband and two young children, cursed first by geography and then illness.

We return to your pain, the one thing I sincerely hope to spare you. You tell me that the pain of pancreatic cancer, one of the most severe patients describe, sometimes pales in comparison to the hurt of being a refugee in an unwelcome land. And we are back where we started, each feeling powerless in our own way.

But I am afraid our time is up. The interpreter has to go and I sense you are tired. Thank you for letting me in, I say. I am not a bad patient, you reply. Let me tweak your morphine a bit, I suggest. If you think it will help, you shrug.


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