A patient’s dilemma: to cry or not to cry

I wasn’t crying while the doctor was surgically removing the worst-infected of my fingernails at each of our follow-up visits. Nail toxicities, as doctors call them, turned out to be a painful (and common) side effect of one of the most toxic of the chemotherapy drugs which I’d started before the first excruciating symptoms kicked in. (Thanks, Docetaxel!) As cancer drug research published in the Journal of the American Academy of Dermatology concluded:

“In recent decades, cancer mortality rates have declined due to development of systemic drugs targeting specific cancer pathways. Nail toxicities associated with these therapies are under-recognized by many, and contribute significantly to patient morbidity.“

Translation: Chemotherapy cancer drugs like Docetaxel – which affect every cell in our bodies – are very effective at killing off fast-growing cancer cells, but can also damage our fast-growing healthy cells, too – like fingernails/toenails, skin cells, blood-forming cells in our bone marrow, hair follicles, cells lining the mouth, digestive tract and reproductive organs – and the most disturbing reality is that our doctors won’t necessarily know how to help ease these “under-recognized” brutal side effects.

The journal paper also suggested this remedy:

“Frozen gloves or socks have demonstrated efficacy in reducing nail toxicities, especially those associated with taxane therapies like Docetaxel.” Taxanes are chemotherapy drugs that are widely used in cancer treatment since the 1980s. Researchers estimate that over 60 per cent of breast cancer patients treated with taxanes will develop “clinically significant” nail toxicities. Oh, joy! As if that wasn’t quite enough trauma, I also developed (among many other side effects) the Docetaxel-induced side effect called Hand and Foot Syndrome (HFS). Dutch researchers described Hand and Foot Syndrome like this in their 2020 study published in the medical journal called Oncology Reviews:

“Although HFS is not life-threatening, it can cause significant discomfort and impairment of function, and may seriously impact quality of life.“

SERIOUSLY IMPACT QUALITY OF LIFE!? No kidding!!

My experience of this painful chemotherapy-induced side effect included raw blisters that cracked open on the soles of both feet while large pieces of thickening skin were falling off both heels in chunks. That’s when my oncologist’s office arranged a walker on loan from the Red Cross just so I’d be able to move about – a walker I am still using to this day. So YES, I’d agree with the Dutch researchers that this side effect can “seriously impact one’s quality of life”!

But no, not even that drama explained why I was crying at the Urgent Care Clinic.

I was crying because that wonderful doctor was so kind to me.

Ever since I was diagnosed with invasive ductal carcinoma one year ago, I have met many, many physicians and nurses in the hospital and in the Cancer Clinic – but I have never ever encountered a physician or nurse who was so kind, so compassionate, and so PRESENT until that first night at the Urgent Care Clinic. My family described that wonderful doctor like this: “He should be teaching bedside manners to every med student in every medical school!”

Kindness should NOT be what makes patients cry.

It can however cause spontaneous weeping when we’re surprised by unexpected kindness – which tells a lot about the rarity of simple acts of kindness experienced in health care. Kind words, gestures or just simple courtesies offered to overwhelmed patients mean so much, yet cost so little. If that remarkable doc at the Urgent Care Clinic could be that kind, that compassionate and that PRESENT during those dreadful surgical procedures, why can’t every doctor and nurse (particularly those engaged in less dreadful tasks) do the same – or more?

Those creepy-sounding nail surgeries were done under local anaesthetic, which involved careful pre-surgery injections of freezing up and down each finger in question, one finger at a time. I was also prescribed a month’s worth of antibiotics to address the painful chemotherapy-induced pseudomonas bacterial infections that were attacking each nail bed, causing foul-smelling pus to seep out of each fingertip. (I know, I know – disgustingly gross!) I wondered at the time: “How much worse could I possibly feel?”

My oncologist had warned me about this specific chemo-induced side effect more than once early on after my breast cancer diagnosis: “Your nails will turn black, they will fall off, and it will be painful.” But in my case, my fingernails didn’t exactly fall off. They rotted off.

I could not have even imagined how excruciating the pain of infected nails turned out to be.

And those “frozen gloves or socks” touted to prevent nail toxicities?

As a breast cancer patient for whom stuffing my bare hands into painful “ice mitts” every three weeks for one long hour during each chemotherapy appointment had become routine, I can assure you that my now-deformed fingernails (i.e. the ones that have not yet been surgically removed) were NOT protected at all by those one-hour frozen mitt procedures. I still developed the “nail toxicities” despite hours in the Chemo Room wearing brutally cold ice mitts. These apparently work for some cancer patients – but for others, they just mean more pain.

My grown son Ben, who had rushed me to that Urgent Care Clinic the first night, and who stayed right beside me throughout the whole appointment was very brave, I thought (given how he tends toward squeamishness when things start getting bloody). Yet he still insists on referring to our Urgent Care Clinic appointments as “Mum getting her fingernails pulled out with pliers.”

By now, my toenails are next in line to exhibit signs of damage caused by Docetaxel chemotherapy – starting with the entire nail on my right big toe actually snapping off when I accidentally stubbed that toe against a wooden table leg – the toenail still looking freakishly “normal” (just a small amount of blood!) when I retrieved it from the carpet – complete with the original pearlescent pink nail polish from my last pedicure – almost as if it’s “normal” to have nails snap off near the cuticles. That is NOT normal at all, no matter how disinterested your oncologist is in your nails.

I used to feel embarrassed about crying in front of other people, especially physicians. But now, I’ve become a world-class crier whenever crying is the only reasonable thing to do. There are types of suffering in which crying should be considered compulsory. Why would we feel the need to try so hard to force back tears just so others won’t feel uncomfortable?

In fact, I highly recommend crying if you’re getting your nails pulled out.

♥ ♥ ♥

NOTE FROM CAROLYN:   I wrote more about becoming a patient (no matter the diagnosis!) in my book, “A Woman’s Guide to Living with Heart Disease”. You can ask for it at your local library or favourite bookshop ( please support your independent booksellers) or order it online (paperback, hardcover or e-book) at Amazon–  or order it directly from my publisher, Johns Hopkins University Press (use their code HTWN to save 30% off the list price).