I was holding a tray full of reconstituted chemo meds, and I realized that if I so much as sneeze and drop everything on the floor and the bottles break or roll to the other end of the room only to be run over by a speeding wheelchair while everyone in the chemo unit gasps– if that horrific thing expressed in a run-on sentence happens, then I would need to sell a property (maybe a car) to pay for everything. On today’s menu: pembrolizumab for melanoma, pertuzumab for breast cancer, bevacizumab for colon cancer, and brentuximab for Hodgkin lymphoma. Also on the tray–the now relatively lowly (in terms of price) gemcitabine, which, around ten years ago, was one of the most expensive chemo drugs available. It is still pretty expensive at around P18,000 per dose, but it’s peanuts compared to the deluxe monoclonal antibodies and the platinum deluxe immunotherapy. More new drugs, more options, more dilemma. In pure paranoia I’ve been hoarding insurance policies like crazy. Selling my action figures is not an option. Also, there are already vultures circling in the sky for my rare 2007 DC Direct Wonder Woman action figure based on the art of Terry Dodson, as well as my magnificent Silver Age Legion of Superheroes action figure set. They go to the grave with me!

I once attended a convention in Madrid where a drug company formally unveiled the final data of this particular metastatic lung cancer drug after decades of rigorous clinical trial. The data was so impressive it got a standing ovation. In current practice the drug is indeed fantastic and all my patients using it have well-controlled disease (so far). If only more people can afford it without having to go bankrupt, or cause a nasty dispute among family members. One of my least favorite scenarios in the clinic is when the children start fighting over the medical management of an elderly parent–usually it involves huge sums of money. Whenever that happens I cringe deep inside but I still manage to force a smile. Or a wince.

At least for weeping patients I can offer tissue paper as a gesture, but for bickering adults I can’t think of anything to give them that would signify: take it outside! Or if I’m in a zen mood: Take a deep breath and listen to your breath doesn’t it totally sound like the sea. Maybe a cup of relaxing tea.

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