I’m lucky. In the USA, I woud have to sell my house for the medical treatment I’m undergoing. I also don’t question the standard of care in the Netherlands. But is the standard of care comprises communication and awareness, then I do have reservations concerning one of the top cancer institutions in Europe.
After a scan image warned of impending disaster, I decided (via my GP) to be referred to one of he most respected institutes in Europe, the Antoni van Leuwenhoek Cancer Centre (AVL). I prepared everything: scans were being sent, my GP had written a referral via the electronic portal. I had personally prepared a detailed summary of my treatment since 2024 To no avail. The surgeon at the AVL didn’t know about my failed chemotherapy cycles, didn’t know that I was not eligible for immunotherapy due to the molecular profile of my cancer cells. He did clarify the nature of the growing liver lesion: a coalescence of three separate lesions. These were images that were made elsewhere, and yet on the reports, there was no mention of three separate lesions looking as one.
The next problem I encounter is related to protocols and guidelines. Whilst these are crucial in maintaining a uniform standard of care, it impairs the freedom that doctors have to use their intuition and individualise each case.
The Dutch word for doctor is arts. Even though the linguistic origins of art and arts are different, The Dutch have connected the two ideas through the word geneeskunst (the “art of healing”), which is the traditional Dutch term for medicine.
The Dutch call medicine an art because it requires human skills that cannot be automated by science alone. Science provides the rules, data, and technology. Art is how the doctor applies those rules to a unique human being using creativity, communication, intuition, and empathy.
“When the lesion was 3cm,” I asked the surgeon, “what would you have said if I had come asking for radiation. His answer: “First chemotherapy.”
The art of medicine is forgotten; the hazardous but brave crossing of rigid guidelines is not even considered. Too risky ? Too expensive? What is my life worth? I don’t know, and don’t care anymore because the dice have been thrown.
Deep down, I suppose that I accept that it may have been my own undoing. Not being alert to symptoms; still relying on a diagnosis that a GP had made 40 years ago. But is not my own body that has betrayed me, by staying remarkably fit, despite dwindling haemoglobin values ?
On the other hand, it may be the strength of my body that will keep me going for many months to come.