Game plan: When to fight and When to let go – Steve Jobs Decision to Delay Pancreatic Cancer Treatment

Steve Jobs was innovative and forward thinking in most areas of his life, but he hesitated when it came to his own health care. Diagnosed with pancreatic cancer, he initially chose alternative treatments over surgery. Usually alternative medicine is the weapon of last resort for patients with nothing else in their quiver and nothing to lose, but that is where he started from.

Did Steve Jobs hesitation cost him his life? Survival odds are much higher for patients where the cancer is caught soon enough and can be surgically removed before it spreads.  Mr. Jobs’ tumor was spotted during a routine CT scan for kidney stones in 2003.  Mr. Jobs was told that it was in the five percent of slow growing tumors (a neuro-endocrine tumor). He delayed  surgery nine months until July 2004 and he kept his condition largely private.  When he finally consented to surgery it was found that the cancer had spread to his liver (hence necessitating a liver transplant in 2007)

According to the New York Times, his wife, Laurene Powell, recalled those days, after the cancer diagnosis saying,  “The big thing was that he really was not ready to open his body,”

Although the decision frustrated and angered those who cared about him, ultimately the choice was his.  But, was he thinking clearly? Intelligence has very little to do with it. Few of us know how we will react when handed what might surely be a death sentence.  Some go into denial, some react aggressively, which Steve Jobs ultimately decided to do, and some work toward maximizing what is left of their life. And we are all of us living on borrowed time – something we rarely wish to acknowledge (read this earlier post by my colleague on what we can learn from Steve Jobs Death). Additionally, it is also a matter of respecting patient preferences, whatever they may be and for whatever reason they exist (for example some communities still refuse live saving blood transfusions. Historical figures like Gandhi too have refused western medicine in life threatening conditions, because of their philosophical beliefs. By the way, Steve Jobs had a picture of Gandhi in his room in the early days, perhaps he followed some Gandhian principles).

Ninety-five percent of the people diagnosed with pancreatic cancer will not be alive 5 years later. Steve Jobs died October 5, 2011.

When I heard the news I had been dithering over a will for months and had kept pushing it to the bottom of my to do list – I knew it was important, but I didn’t want to face it. I didn’t want to sum up my life in that manner.  Mr. Jobs’ death was the catalyst I needed.  I updated my will.  I also re-read a New Yorker piece, “Letting go: What should medicine do when it can’t save your life? by Atul Gawande.

It was scary, but I thought long and hard about what I wanted out of life – what combination of quality and quantity was right for me.   Deciding for myself when and how to fight and when to let go was emotional, but ultimately calming and liberating. I drew up that living will my doctor had been trying to get me to do for years.  I talked with my family about what they would want and the thinking behind my choices.

Although I probably wouldn’t chose juice over surgery, I’m more open to alternative medicine than I used to be so I thought about what combination of alternative medicine and traditional medicine I would be willing to consider. Knowing that there is currently a huge shortage of drugs in many areas of treatment I thought about what I would want if my optimum treatment is not available. I also decided I would enter clinical trials that were available to me.  It might not save me, but it could give doctors the knowledge necessary to save the lives of my friends and family later on. The same with organ donation.

When I spoke with my friends and family about my decisions they let me in past the superficial and opened up about their own decisions. Some things we agree on and others we did not, but we each honored the others right to make their own choices. And should that time come when they can no longer make their own decisions they have given me the directives necessary to make the decisions for them that they would have wanted.

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