I am an oncologist. This is what King Charles and my cancer patients have in common | Ranjana Srivastava

‘It must be cancer. Just look at her face and hair.”

Even though I knew she meant well, I stopped my friend from speculating about his aunt.

“It’s best not to guess,” I said lightly. “People will tell you when they want.”

The next day, King Charles announced to the whole world that he had gone to hospital for prostate surgery and emerged with a cancer diagnosis – a reason why doctors would be reluctant to attach the prefix ‘routine’ to any procedure. Details are scant: his cancer is unspecified, he has begun treatment and has withdrawn from public duties.

When Angelina Jolie revealed her damaging genetic mutation, which led to the prophylactic removal of her breasts and ovaries, patients flooded in with their questions. Could they have the gene? How can they be tested? What did it mean for their descendants? When I saw the ubiquitous headlines and “analysis” about the King’s diagnosis, I wondered how my patients would react. Not a word so far.

For my patients, life continues to unfold in all its grandeur and ordinariness. Parking is difficult to find, specialists even more difficult. Keeping appointments is a full-time job. Taking in good news and swallowing bad news – and enduring both at each visit – takes equanimity. Then, aside from the arduous logistics, there is the sheer emotional fatigue that comes with carrying a diagnosis that everyone is entitled to.

I work in an area with great socio-economic disadvantage. Many of my patients not only come from the other side of the tracks, they might as well live on another planet. They lack language and money, but above all freedom of choice. They are the kind of people who die waiting to find out how to ask for help. My patients are as far removed from royalty as you can imagine, and yet I can’t help but think that perhaps they are not so different in their core experiences.

The initial shock of a cancer diagnosis takes the wind out of everyone’s sails. What shall I do now? Did I ignore the signs? What does my future hold? It doesn’t help that the usual cancer story takes two forms: miracles and disasters. Either people defy the statistics or they face a horrible death. Of course, the truth lies somewhere in between: many cancer experiences have been transformed by modern medicine, flexible technology and compassionate palliation. But surrounded by well-wishers, my patients describe feeling alone at the moment of discovery; they know that the gravest implications will be on themselves as they negotiate in the silence among the noise.

Power and wealth undoubtedly buy access. Every patient on the waiting list (and their powerless oncologist) is entitled to a touch of jealousy when someone starts treatment immediately after diagnosis. For some people, doctors and institutions spare no effort, yet privilege cannot grant leniency to fears. The leader was terrified of incontinence. The commander shivering with vomit. The boss was struck by brain fog. And even when side effects are controlled, the era of frequent imaging has given rise to the vexing problem of ‘scanxiety’. Patients live from scan to scan and it takes a superhuman effort to suspend worries.

I called a patient twenty minutes late with the reassurance that she was still in remission. I shouldn’t have been surprised that she had been sleeping poorly since the night before the scan. Realizing how any additional delay on my part must have exacerbated the tension, I apologized. Then I felt guilty when she said she’d better call all the people anxiously waiting on their phones. The domino effect of a cancer diagnosis is real.

Unlike any other disease I can think of, cancer is a common diagnosis. The flip side of a flood of sympathy is a tsunami of advice. Try this; eat that; go here; look there. Last week, a patient arrived soaked in a herbal drink promoted as a cure. This week a patient asked if he should starve himself to starve the cancer (please, no). A lot of unsolicited advice is surprisingly bad, but still requires bandwidth. Patients deserve better.

Ironically, some of society’s sickest patients face the greatest pressure to make those among us feel better. So while their public side appreciates positivity and ‘beating’ cancer, inside they are scared and restless, as anyone would be. Cancer is synonymous with uncertainty; True success involves treating your body and mind. I think it’s a shame how little we do of the latter. Patients explain that the way to help is to neither demand optimism nor drown them in pessimism. Like so much in life, our response to people who have cancer requires moderation.

Oncologists like me go to great lengths to calm patients by emphasizing that every cancer is different, and every person is different. We do this to tailor the treatment and temper expectations. But if there is one (almost) universal truth, it is this.

Whether treated, healed, palliated, or somewhere in between, everyone wants human connection. Even the grumpy patients who berate us to ‘leave me alone’ and especially the proud patients who insist that they are ‘doing just fine’. There is a distinction between needing space and being alone – no one being alone is really fine.

In times of existential threat, knowledgeable professionals and loyal friends are a godsend, but the desire to embrace family and be embraced is deep-rooted. This is why, at my patients’ bedsides, I see former spouses showing mercy and estranged children pouring in. In-laws and grandchildren compensate for lost time with acts of care and reconciliation, born from the realization that late is better than never.

I know it doesn’t always happen this way, but when it does, the combination of mortality and love is profound and poignant, making me want this for all my patients.

Goethe philosophized: “He is happiest, whether king or peasant, who finds peace in his home.”

For King Charles, as for every patient facing cancer, this should be our sincere wish.