Uncertainty

Medicine is a science of uncertainty and an art of probability.
-Osler


The cancer had been treated several years before. No recurrences and no new problems. Still, his wife remembers all of the details.

"I was really scared when we learned he had cancer," she reminds me. "It was a terrible time."

I remember, as well. There were many phone calls, anxious appointments, consultations, and questions. And there was one significant delay.

"Remember how long we had to wait for his surgery, Doctor? That was so horrible!"

Yes, I do remember. I had squeezed in his initial appointment on an off-clinic day just before I was going out of town for a much-anticipated family vacation. Before I left town, I had arranged his evaluation and had set everything up. There were plenty of instructions to provide and appointments to confirm. Still, my vacation had ended up delaying his surgery by several days. I could not deny that.

"Oh, Doctor, I was so certain that the cancer would have grown too large for surgery by the time you got back into town! I was certain that he would die!"

I had spent time reassuring her then, and I try to reassure her now. My usual discussion runs along these lines:

"By the time a cancer is big enough to be seen, it has usually been growing for several months. A delay of a few days should not matter." Still, I knew then and know now that tumor growth rates in a laboratory Petri dish might be different than in an individual.

She looks at me again. "Doctor, are you absolutely certain that he will be all right?"

Her question reminds me once again of that wonderful family vacation – and the few days’ delay in her husband’s surgery – that had occurred years ago. Not knowing with absolute certainty, I smile and assure her that he will continue to do just fine.