Opinion | Why Accept Toxic Chemo but Hesitate With the COVID Shot?

“I don’t want to die. I just bought a house,” she paused for a second and glanced at the floor as if to ensure she still had solid ground underneath her. She then looked at me with a fervent intensity and continued, “I have two adorable grandchildren. I want to see them growing up. I want to live. So, do you have a plan?”

Sandra is 54 years old. When she was in her 40s, she was diagnosed with breast cancer and required surgery, chemotherapy, and radiation. She survived.

A few months ago, during one of her routine yearly visits, she complained about a dry cough that seemed to be getting worse. I sent her for a CT scan, which showed an abnormally shaped nodule in one of her lungs. She had a biopsy that revealed primary lung cancer. She underwent surgery and had half of her right lung resected. After that, she spent 2 weeks in ICU with complications: her heart paused for a few seconds, and she had to be resuscitated and taken back to the OR to drain the fluid that had accumulated around her heart. She survived.

She was petite, skinny, and feisty; she had lost so much weight since her surgery and looked even tinier in the sizeable blue medical gown that wrapped around her twice. The generously wide pink exam table she was sitting on was her battleground.

“Of course I have a plan,” I said, nodding my head a few times for extra assurance. I could feel my eyebrows knotting over my eyes in a serious furrow.

“Let’s hear it then,” she said.

Her hands clutched the edge of the exam table. She shrugged her shoulders, craned her head toward me, and started swinging her feet back and forth in a rhythmic pattern. I laid down the treatment plan: chemotherapy, immunotherapy, and radiation. She listened intently with her intense blue eyes piercing mine. She tried putting on an assured smile, but she couldn’t hide the trembling anxiety on her lips.

“We need to discuss the side effects in more detail. Do you want to do it at another session?” I asked, fearing I’d overwhelmed her with too much information at once.

“No. I had chemo before, I know how it is,” she responded.

“But these agents are different than the ones you had before, and they have different side effects.”

“Well, you just told me the most important things. We will discuss the details as we go along. I trust you will handle everything as you did before. When do we start?”

“How about in 2 weeks?”

“Sounds good. Let’s do it.”

Thick silence hovered in the room. The kind of silence that sticks to air particles and makes inhaling sluggish. Then, as if that silence coagulated into a ball of worries in Sandra’s throat, she blurted, “Now you’re not going to hound me with the vaccine thing, are you?”

I stopped writing, rested my pencil on the table, and leaned on the wall behind me — it was going to be a long conversation.

“What! You’re not vaccinated?”

She shook her head no and elaborated, “I don’t trust it.”

The furrow in my eyebrows loosened to rise in disapproval. “Sandra, people are dying right and left of the virus: That you should trust.”

“Yeah, but the vaccinated are getting it too.”

“True, but only a small percentage of them are dying.”

“I still don’t trust the stuff, not enough data,” she said. “Tell me the data. Tell me the data,” she repeated in an aggressive tone.

It was the end of the day, and I was tired and frustrated.

“Data, Sandra? I will give you the Internet links to read the data yourself. But my data are that you don’t want to die. My data are that you would accept possibly poisonous chemo to live, but not a vaccine that can save you. My data are the names of my patients who have died from COVID-19. My data are that you only have half of your breathing space, and you are immunocompromised, and if you get the virus, you will die, Sandra. It can’t get clearer than this. These are my data.”

“I need you to show me studies that prove the vaccine will not interfere with my chemo or make me sick.”

I was exasperated.

“I don’t have those data, Sandra,” I said. “You are not worried about the toxicity of chemo or immunotherapy, but you are worried about getting a vaccine that may save your life?! Can you explain this to me?”

“Well, the cancer drugs had been in trials for years. This vaccine came out of nowhere overnight. I am afraid of it,” she responded with a lower voice.

I, too, lowered my voice. “I agree that the speed of the vaccine development is astonishing. But if you think about it, the advancement in science that allows you to receive immunotherapy is the same that made the vaccine. And tomorrow, the same technology will allow the making of new drugs that may save your grand kids.”

I continued, “It is natural to be wary and to question something new, but you also need to allow yourself to be fascinated by it — not fear it! Can you do that for me, Sandra? Please do not let a virus kill you when you have the tools to avoid it. You did not choose cancer, but you can choose a vaccine.”

She dimmed in her large gown. “Let me think about it.”

“The best time to do it is before we start chemo,” I advised.

“Let me think about it,” she repeated.

In that moment, I wasn’t sure whether or not I convinced Sandra to get the vaccine, but I was content that we both took the time to exchange our points of view passionately and without judgment, and that was what mattered most.

Rana Bitar, MD, MFA, is a physician, poet, and writer who operates a hematology and oncology private practice near Albany, New York. She is the author of The Long Tale of Tears and Smiles: An Oncologist’s Journey.