By Dr Ang Peng Tiam

When she took off her sunglasses, I tried hard not to let the shock show on my face. She was a scary sight.

Her eyes were literally popping out of their sockets and there were dark purple bruises on her eyelids and eye-bags. Her neck, armpits and groin were swollen and she had lost a great deal of weight.

Her passport photograph showed that she was once an attractive woman with a pleasant smile. This 54-year-old Indonesian woman first noticed the lumps in 2004.

Doctors suspected that she had malignant lymphoma or cancer of the lymph nodes.

She had been advised to have a biopsy to confirm the diagnosis and then go for chemotherapy.

However, over the past five years, she had resisted this hard truth. From Indonesia to Singapore, from the United States to China, doctors told her she was likely to have lymphoma.

She refused a biopsy and was adamant that she did not want any treatment.

Instead, she tried alternative therapies - herbal treatments, dietary changes, spiritual healing. Meanwhile, the swollen glands spread from one area to the next and eventually affected both eyes.

The space behind the eyeballs was packed full of tumour tissue, resulting in her eyes being pushed out of the sockets.

I knew she was in denial and fearful of the disease so I used the "soft" approach to put her at ease. Her cancer was in fact highly treatable.

After an hour of listening to me, she got up, thanked me and said that she would consider my proposal. I knew that I had failed.

Nurse counsellors followed up but despite several calls to her Singapore mobile phone, she declined to meet me. We lost contact with her and after a week, I knew that I had failed to convince her.

It was a moment of true loss because I knew for a fact that we could help her. I wanted the joy, thrill and satisfaction of watching her tumour melt away and seeing her restore her looks and not have to hide behind her sunglasses.

In fact, with her permission, I had already taken her "before" pictures to serve as a record of how she appeared before treatment.

Curious as always, I called up some of my colleagues to enquire if any of them had seen her. As luck would have it, she did indeed consult one of my colleagues who, like me, has a special interest in lymphoma.

"Oh yah. I saw her," he said gleefully.

"I bullied her into submission. I told her that her stupidity and stubbornness was going to kill her. The nurses could hear me scolding her in my consultation room. I literally dragged her to the surgeon to get the lymph node biopsied so that we could confirm the diagnosis.

"The good news is that she has a low-grade lymphoma and I have started her on chemotherapy." I was relieved and realised belatedly that I should have been a "bad cop" instead of a "good cop". Whatever it took, I am glad she has finally received the appropriate treatment.

The psychology of the patient's mind is one of the keys to recovery but, as this patient's story shows, it is clearly a double-edged sword. What is disturbing about this story is that there were those who would take advantage of her ignorance and fears.

There were Chinese physicians who sold her herbs, knowing full well that these would not help. She had even gone for bio-resonance therapy, which has been claimed to be able to cause cancer cells to die through electromagnetic oscillations. However, there is no conclusive evidence that such therapies work.

I must say that I do not forbid my patients from using alternative therapies to complement conventional treatment. I accept that some of them may indeed in the future be proven to be helpful. But the key word here is "proven".

Everyone who cares for the sick - whether a trained medical doctor, a traditional healer or a new age therapist - should work towards getting his patient well with clear and well-reasoned care and he must not trade on the patient's emotional state.

Cancer is almost always a matter of life and death and, in these matters, the mind is a powerful instrument that can make a defining difference.

However, the mind is emotion as well as reason. Patients should not forsake the benefits of science for mere psychological comfort.

angpt@parkwaycancercentre.com

Dr Ang, the medical director of Parkway Cancer Centre, has been treating cancer patients for 23 years. In 1996, he was awarded Singapore's National Science Award for his outstanding contributions to medical research.

This article was first published in Mind Your Body, The Straits Times.