By Dr Ang Peng Tiam

I should not have but I did. I scolded the family members of a young man, once full of vigour and potential.

He had become bed-ridden, reduced to someone who needed feeding via a tube into his stomach and who no longer had meaningful interaction with his family and friends.

This young man, in his early 20s, had been referred to me after he was diagnosed with a germ cell tumour in the brain. Germ cell tumours are one of the most curable cancers and he was also fortunate that the disease was localised.

I had explained to him and his mum that all he needed was four cycles of chemotherapy and that he would most certainly be cured. After the consultation, they went on to see other doctors for more opinions.

To my horror, the family chose to leave the tumour alone, until it grew in size and bled.

He was subsequently seen in an overseas cancer centre in the United States. He was operated on and that left him in a vegetative state.

I would not have known about this outcome except that the patient's mum and aunt came to see me recently to tell me about him. Hearing them tell the story made me so upset that my nurses could hear me berating them loudly. My anger was borne of frustration.

I half-expected the two women to stomp out of my consultation room and perhaps complain to my bosses about my poor behaviour. Instead, they sat quietly and listened to me for almost an hour.

Several days later, the patient's mother called me and asked if I would be willing to transfer her son to Mount Elizabeth Hospital for further assessment. I thought there was little more to be gained as the damage to the brain had been done, but I agreed to accept the patient.

I regretted my earlier outburst. As a doctor with two decades of practice, I really should not have been carried away. After all, patients live and patients die. But the day I no longer become emotional will be, I think, time for me to say farewell.

My needs are simple and I have enough to provide for my family. The day I burn out, the day I no longer care, that will be the day I hang up my stethoscope and pursue other interests.

I ask myself: Why do I scold my patients? The answer may sound like a cliche but, if the truth be told, I scold them because I care.

Take this other patient whose family I met less than two years ago.

They did not bring the patient to see me but she was 82 years old then and had just been diagnosed with malignant lymphoma (cancer of the lymph nodes).

She needed chemotherapy and the family wanted to find out what the 'best treatment' for her would be. I explained that she had a type of lymphoma which was curable but for which aggressive chemotherapy was needed.

The family left to make a decision among themselves. About a year later, they returned but this time with the patient. In the year that had passed, they did not heed my advice but chose to be 'kind' to the old woman, by having her treated with a milder chemotherapy programme.

While this was able to shrink the enlarged lymph nodes, it did not do the job of eradicating the disease.

Indeed, repeated exposure to chemotherapy drugs - that did not eradicate the lymphoma - 'trained' the cancer cells and made them more resistant. This would make future attempts to cure the old woman more difficult. Once again, the patient and her family did not come back after the consultation.

However, the family recently showed up again with her. She had by then gone through almost 20 cycles of chemotherapy and was still struggling with her illness.

I felt exasperated. I told them that what they had done, in the name of love and filial piety, had done the old woman much harm.

The consultation did not end on a happy note (for me anyway) because the decision-maker, the son, said: 'If we want to go for a cure, we will come to Singapore to see you again.'

Why could he not understand that his folly had reduced his mum's chances of a cure?

It was at the tip of my tongue to tell him not to see me again. But I swallowed my anger and, with great restraint, I smiled.

Perhaps it is time I learn the folly of some of my own ways.

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