POSTED: April 21, 2020

Feeling Impotent: Caring For Prostate Cancer Patients With COVID-19

Dr. Susan Slovin, MD, PhD, is a medical oncologist specializing in prostate cancer immunology at Memorial Sloan Kettering Cancer Center in New York City. 

Prostatepedia spoke with her recently about caring for her prostate cancer patients with COVID-19.

 What's going on this week? 

Dr. Susan Slovin: We still have patients coming in with COVID-19. I unfortunately lost another patient on Monday, which caused a lot of tears. This is somebody who we kept hoping could be treated. He went to a nursing home, but he did not like the nursing home and came back. He then tested positive for COVID-19. We let the nursing home know. We were optimistic because he had no fever or symptoms. Then, out of nowhere, he had respiratory distress and passed. It was awful.

I normally don't cry, but this time I cried my heart out with the wife via FaceTime because you can't go over to the hospital to help the patient or even be there for them. In some cases, they're dying alone. We're not allowing relatives to visit unless somebody is at the end of life. It's hard for the patients. It's hard for all of us who have intimate relationships with patients to then find out that we can't be there.

I have my third patient who is still intubated after last week's update. He called me because he was having some respiratory difficulties and was waiting for his local doctor to give him some antibiotics. I didn't like the way he sounded, so I said, "You need to come in right now or I'm going to go to Long Island and carry you there."

He tested positive for COVID-19 and was intubated 12 hours later. He's been intubated ever since. We're going full court press. It's one of those situations, unfortunately.

It must be difficult since you've been caring for these patients for many years.

Dr. Susan Slovin: Yes, I feel helpless. We have to work at home for most of the time, but we do come in and see patients. You can do all the video conferencing you want, but there's nothing like laying hands on a patient. There are subtleties that would not otherwise be detected without laying of hands.

So that's where we are right now, and we keep hoping with some level of optimism that we're going to get past that curve.

Being at home and working from home is making me a crazy person, but this is something that we're going to have to deal with on a daily basis. You can't prognosticate.

All we know is that it's extremely contagious and virulent. We don't know if there's going to be a recrudescence like the flu, where you feel good and then it comes right back two weeks later. It's better to be conservative and knock it out.

But we may not knock it out completely, which is why it's so frightening. That's our challenge, along with trying to be a good doctor in the absence of touching a patient, which is also scary.

How are you approaching that?

Dr. Slovin: There's nothing to do. We are encouraging patients to go to the emergency room or come to see us in the clinic if they're having oncologic issues or issues that need intervention. But there are the cases where I might pick up something on a physical exam or by observing the patient close hand. No video is going to take care of the whole body. It'll only take care of the head and the neck.

You're able to see people move, but it's not the same as a physical exam. There are subtleties, like lymph nodes and thrush, all sorts of things that require being in direct contact with a patient. I don't want my patients to get used to this completely. There's no question that this is going to be important in the future, but there will be patients for whom this is not going to be a reasonable option.

My biggest concern is seeing the pain on the faces of relatives and to see the television dossiers chronicling the death, the dying, and the coffins. I have a friend who is an Orthodox Jew, and her mother just passed after a pelvic fracture. It didn't have anything to do with COVID-19, but she and her sisters have medical issues. They're so fearful that they could not go out to the cemetery to bury their mother.

It is stories like this that wrench your heart out to think that a virus would put everybody and a family at such mortal risk that they can't bury somebody that's highly religious. It's inconceivable. The rabbi went and took the video camera and that's it, done deal. It's horrible. It's affecting every aspect of mourning, every aspect of living, every aspect of dying. They're going to sit shiva, but they're understandably not letting anybody come to the home. You want to be there for somebody, give them a hug, hold their hand, but you can't do that on the phone.

Even with patients' families crying at the potential complications of a COVID-19 infection, I can't hold their hands. I can't express condolences. I can't hug. I can't do a damn thing. It makes me feel impotent as a physician.

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