Why Do I Suffer from Cancer? A Rhetorical Question

Sir,

The question asked by cancer patients, “Why do I suffer from cancer?” had always been a difficult one for me to answer till I attended the Certificate Course in Essentials of Palliative Care held at Dr. BRA IRCH, All India Institute of Medical Sciences, New Delhi. One of the speakers told us that this is actually a rhetorical question. When a cancer patient asks this question, he is not seeking an immediate answer; however, he wants to draw the attention of the oncologist to discuss his own ideas and reasons for suffering from cancer. And so, the oncologist should not be in a hurry to show off his wealth of knowledge, from genetics to molecular biology, about the etiology of the cancer. In fact, the oncologist should hold on and should direct the same question back to the patient, what, he thinks, made him suffer from the cancer. This is perhaps what the patient wanted, to come out with his ideas, which may vary from scientifically sound thinking to weird. The role of the oncologist is to root out bizarre ideas from the patient's mind, lest they continue to haunt the patient.

A 32-year-old lady came to the breast cancer clinic with her husband. She had already been worked up in a private hospital earlier and was diagnosed as a case of breast cancer. I explained her disease and the manner in which we would be managing it. When I finished my talk, I could sense that she desperately wanted to ask something, which was troubling her a lot. I asked her if she had any queries. And she asked “Doctor, why do you think I suffered from cancer?” I remembered the discussions held during the palliative course, and I was ready with my answer, in fact a “question.” I asked her, “What do you think made you suffer from cancer?” She cast a very angry look at her husband, perhaps cursed him as her eyes verbalized, and said, “We had unprotected sex a month back and I used emergency contraceptive tablets; I believe that has caused cancer to me.” I was amazed and perhaps stunned. She seemed a well-educated lady; perhaps the word “cancer” usually takes away all the wisdom from the patient. I firmly said, “There are a number of factors which might be blamed for your cancer; however, I can assure you single use of emergency contraceptive tablets cannot be blamed for your cancer.” I further continued, “So, you need not feel guilty and do not blame either yourself or your husband.” She relaxed, and I could hear a sigh of relief from her poor husband. They gradually walked away from the clinic. They left me thinking, “Had she not asked me this question today, she would have continued to blame herself and her husband, and would have spoiled her marital relationship.” I realized that the Certificate Course in Essentials of Palliative Care was worth attending.