Dear friends and colleagues of the AUB community,
Twenty-two years ago, I was late for a clinic visit for the third time in a row with a patient carrying a rare, aggressive form of thyroid cancer. Although he understood on each occasion that I had to care for a patient whose illness had become more acute than his, he asked me to call in advance when I felt I might be delayed. His words have stayed with me since: “While I respect and trust you and am glad you are in charge of my medical care; I ask you to realize that my time is more precious than yours. It is not because my job is more important than yours. It isn't. But I have less time left than you do."
Those words intimately inform my approach to patients with cancer and beyond. Even as treatments for most malignancies have improved substantially, and in some cases dramatically, and even as supportive care has provided far more humane ways for patients to live out their final days, the value of the “time remaining" is still paramount. Time, health, and happiness are ultimately the most precious of human commodities, the ones most difficult to regain once lost. It is the support from cancer patients' families, communities, and societies that does the most to combat this loss.
“Time, health, and happiness are ultimately the most precious of human commodities, the ones most difficult to regain once lost."
Not surprisingly, the COVID-19 pandemic has proven devastating for cancer patients. Millions worldwide have delayed necessary screening, treatment, and prevention to avoid being infected by the virus, exacting a frightening toll on patients with cancer. Financial toxicity--the extraordinary cost that has spiraled over the last four decades with the discovery of new agents, modalities, and therapies--has had a severe impact during a pandemic which has seen millions of people worldwide lose their jobs or quit them voluntarily for their own well-thought-through reasons. Our world has seen cancer disparities grow dramatically between the highly industrialized and relatively affluent countries, and the far less advantaged majority in the Global South. What can be done to alleviate this challenge in addition to providing more advanced, state-of-the-art care to broader swaths of people the world over?
We are fortunate to have a veritable explosion in novel therapies, improved care, and enhanced empathy and understanding for cancer, and I have seen most of the 12,000 cancer patients I have treated benefit, yet I have also seen many less fortunate. Similarly, the inhabitants of Lebanon have gone from a multi-year project which culminated in state-of-the-art cancer screening and care guidelines, presented to the UNDP and Ministry of Health in February 2018, to a situation four years later where there is a critical shortage of most cancer medications and treatments. The path forward has narrowed and wise, strategic leadership is essential to galvanize both patients and societies.
“We are fortunate to have a veritable explosion in novel therapies, improved care, and enhanced empathy and understanding for cancer..."
Despite losing some stellar personnel, the American University of Beirut
Naef K. Basile Cancer Institute (NKBCI) and the St. Jude Cancer Center at AUB have worked to resource and support cancer patients of all ages, maintaining the same world-class standards they had prior to the concordance of catastrophes that have afflicted Lebanon and the world over. For the Basile Foundation to continue to add support and for St. Jude's to continue its partnership with AUB, speaks to their commitment to our patients and to the institution's quality of cancer care, prevention, and research across good times and bad. We also saw the launch of an adult
Cancer Support Fund led by Hala Dahdah Aboujaber and NKBCI director Ali Taher, whose public support was brought forward on World Cancer Day by Lebanese Prime Minister Najib Mikati (BA '79, MBA '80), followed by an uplifting concert sponsored by the Al Bustan Festival at AUBMC a few days later.
I recently revisited the definition of anti-fragile organisms outlined by Nassim Nicholas Taleb,
2016 AUB honorary doctorate recipient and author of the
Black Swan: a concept in which an entity grows or even thrives from the disorder and unpredictability we face in our lives. The American University of Beirut is just such an anti-fragile organism. We do some of our greatest work in times of profound crisis, which time and again have strengthened our resolve and enhanced our impact.
“We do some of our greatest work in times of profound crisis, which time and again have strengthened our resolve and enhanced our impact."
When he was 55, Bob Dylan released “Not Dark Yet," at a point when many had written him off. The haunting words of a man well past the apogee of his existence, feeling the shadows, still resonate a quarter of a century later:
“Shadows are fallin' and I've been here all day
It's too hot to sleep and time is runnin' away
Feel like my soul has turned into steel
I've still got the scars that the sun didn't heal
There's not even room enough to be anywhere
It's not dark yet but it's gettin' there"
“I was born here and I'll die here against my will
I know it looks like I'm movin' but I'm standin' still
Every nerve in my body is so naked and numb
I can't even remember what it was I came here to get away from
Don't even hear the murmur of a prayer
It's not dark yet but it's gettin' there"
Cancer patients can relate to Dylan's mournful tune better than most. If it is indeed getting dark, that darkness must be alleviated by hope and those who provide it. While the burden has long been disproportionately shouldered by patients, families, doctors, nurses and social workers, now academic and governmental institutions as well as determined philanthropists work in concert with these groups, as do researchers and funding agencies, to ensure that cancer patients, like others with serious illnesses, can hear and feel far more than “the murmur of a prayer."
All of us, however, face the plight described by my patient almost a quarter of a century ago, albeit not as acutely. As Dylan says: “It's not dark yet, but it's getting there." What we do in the time left each of us matters, possibly at least as much as all we have done. Every one of us has a limited amount of time remaining. It is therefore incumbent on all of us to use that time wisely, to make the most profound impact possible in the service of mankind.
“What we do in the time left each of us matters, possibly at least as much as all we have done.”
Fadlo R. Khuri, MD