When oncologists like me rain bad tidings on patients, they need one thing above all
“I would recognise those footsteps anywhere. I knew it was you even before I saw you!”
Making a mental note to soften my footfall, I extend my hand into hers. “How are you?”
Her eyes turn moist, her expression both resolute and resigned.
Over a decade ago at the peak of her career, she was diagnosed with cancer. She survived but suffered a lifelong complication induced by chemotherapy. Just as she was adjusting to that, unbelievably came a second cancer. Cue more surgery and more chemotherapy. She handled the ordeal admirably, holding down a busy job and raising children as a single mother, a paragon of self-reliance.
I privately cursed her bad luck but in all our encounters she never displayed self-pity, rather a pragmatic approach that said, “I will do my part, I trust you to do yours and together, we will get through.” One can only guess at her immense forbearance, but I know the deep gratification I derived from treating her and then, following years of surveillance, finally discharging her from clinic. At our last consult, she hugged me and said she’d be glad never to see me again.
Years later, we ran into each other at a bakery where she sombrely announced to my teenager, “I just want you to know that your mum is an angel and you should be very proud.” My daughter smiled politely but I had to laugh at the timely rescue from our robust discussion about the virtues of body piercings and my “so yesterday” view that one per earlobe per lifetime was about right!
And now, after the passage of some more years, here we are.
“I didn’t think we’d meet like this again,” my former patient sighs, making a visible effort to contain her frustration. Going about her day, she slipped and fell, tests revealing an unforeseen cancer diagnosis. Spotting her name, I hurry to find her on an unfamiliar ward with unfamiliar doctors. I share what is known and discuss the upcoming rigmarole of collecting more information.
Later she will confess to holding back her most pressing question until the end.
“When I get out, will you still be my oncologist?”
A surgeon quips that when he is out and about, he can tell his cancer patients from the haemorrhoid ones: the former hug him, the latter cross the street. I can attest to the bond between oncologists and patients. With a concomitant rise in life expectancy and cancer incidence, not all but many patients with a repeat diagnosis return to the same doctor. I have now been working long enough to have a small repertoire of such patients who provide a natural point for retrospection.
Like many people at the start of their career, I thought I knew things but in fact perceived many events as binary. Patients either lived or died. They either wanted treatment or not. People were either helpful or unhelpful. Conversations were either fraught or smooth.
But binary thinking is the enemy of nuance.
I remember rounding one Friday evening with a delightful boss. As I repeatedly jabbed at the button to “hurry up” the lift, he said softly: “Sometimes, the hardest thing in medicine is to do nothing.” Maybe he just wanted me to stop fidgeting or he was imparting a life lesson, but I have carried his words with me all these years, only gradually understanding their wisdom: a good doctor is nothing without nuance, patience and perspective.
While I have been working on myself, my patients have been doing their own growing up.
Thousands of people fall without the final diagnosis being cancer, so my thrice-struck patient is entitled to feeling shocked and even betrayed. But in the intervening years, she has seen enough to know that the vicissitudes of life don’t land evenly on us. Despite being cured of cancer, life has served other heartaches to test her resilience. Previously, she wasn’t inclined to peer into the future – there were dependent children and things to do. Now she insists on distinguishing treatable from curable before declaring, “Well, it may be so but it’s not going to rule my life.”
Cancer patients and oncologists now have access to a stupendous amount of information but how to incorporate that knowledge into action is not always clear. I have yet to meet a doctor who doesn’t want to be perceived as smart, but by now I have had enough healthcare encounters of my own to know what immeasurable value there is in a doctor who, above all, exudes calm.
Anxiety is infectious. The conduct of a doctor can trigger a ripple of anxiety or inject a sense of order, even when the news is unpleasant. Bearing the scars of past illness, returning patients are especially not looking to be shielded from reality. What they want is for someone to give bad news and remain steadfastly in their corner. As is unfortunately the case for many, you can rain bad tidings on people but if you steer the conversation with calm, compassion and most of all, a sense of shared humanity, they will find their feet. This is the part that I have found surprising to predict and moving to absorb.
No course teaches this, only time and practise.
Recently, a patient returning 15 years after her initial diagnosis marvelled: “I don’t know how you do it.” Of course, she was doing the heavy lifting of managing her disappointment and handling the family’s grief. I replied that I had the easier job and she beamed at the compliment.
Among medical tales, my favourite is hearing my wonderful GP friend talk about caring for the babies of the babies he once delivered – for so many of us such continuity of care has been reduced to a dream.
In the years ahead, I expect to encounter more of the patients I once treated. Oscar Wilde famously described a second marriage as the triumph of hope over experience. I like to think that a reunion with my former cancer patients might allow for the triumph of experience over hope.
• Ranjana Srivastava is an Australian oncologist, award-winning author and Fulbright scholar. Her latest book is called A Better Death
this fall.
Karaoke is an equal-opportunity sport, open to anyone regardless of the octaves in their range or ability to hit a note. That might even be the point. Carrie Underwood, who is karaoke mad, once remarked: “Karaoke is not meant for people who can sing!” Even so, there’s been a recent uptick of karaoke videos from artists like Lopez, Demi Lovato and Ed Sheeran, who embrace its unstudied sense of fun while also sounding markedly better than anyone doing karaoke has a right to. Intentionally or not, the trend also lines up with the unstudied intimacy that has come to define the music and images of young chart juggernauts like Billie Eilish, Olivia Rodrigo and SZA, whose lyrics sound like your group chat, and who shitpost just like you. For glamorous stars like Lopez or Lovato, spontaneous-feeling clips are a way of seeming relatable – at least, as relatable as you can from an exclusive island in the middle of the Mediterranean – as well as a casual flex, reminding us that we know their names for a reason.
It’s also a bankable way of going viral for the right reasons and ensuring the kind of positive press that isn’t always a given in the post-DeuxMoi world of celebrity gossip. Victoria Beckham recently posted a clip singing to Say You’ll Be There, scratching a nostalgic itch as well as, perhaps, winking at rumours of a Spice Girls reunion. In July, Ed Sheeran stopped off at a holiday-themed bar named Santas to play bartender and sing the Backstreet Boys’ I Want It That Way with fans fueled by one-dollar PBRs. Everyman cosplay, perhaps, but it looks like a great time.
Even in the SingStar era of the mid-2000s, karaoke never felt like something that blue-chip pop stars would want to get involved with. The tide seemed to turn around 2015 with the launch of James Corden’s Carpool Karaoke, which grew out of a 2011 skit that Cordon filmed with George Michael for the UK’s Comic Relief fundraiser. It was fun to see pop stars like Lady Gaga, Celine Dion et al goofing around, but the show’s best moments came when it surrendered to the chaotic absurdity of an actual karaoke night, like when Adele delivered a word-perfect rendition of Nicki Minaj’s Monster verse, pow pow-ing with gun fingers and bragging she’s in the Tonka, color of Willy Wonka.
Without that sense of unpredictability, karaoke falls flat. Post-Carpool Karaoke, which ended this April, staged singalong shows are two a penny, but rarely capture the mischief of the real thing. Jimmy Fallon’s groan-inducing That’s My Jam is a spin-off of a bit from The Tonight Show that should have stayed as a segment, Netflix’s Sing On feels oddly po-faced, and Hulu’s revival of Don’t Forget the Lyrics ignores the fact that flubbing the words is part and parcel of a raucous karaoke session. It’s efficient, neatly packaged TV to fold laundry to, occasionally enlivened by ebullient hosts. But the clean efficiency of these shows misses that the point of karaoke is to down seven Jägerbombs and belt out heartfelt, wholly unserious renditions of songs you love to your best mates, new friends or the stranger you just pulled on stage to sing Shallow.
A genuine reverence for the material has made Kelly Clarkson’s Kellyoke a phenomenon. Since The Kelly Clarkson Show’s debut in 2019, she has opened the show with a live rendition of a classic song or a recent hit, and sings them like she’s having the best time in the world. Clarkson is a vocal powerhouse – it’s a given that she will kill at an Aretha or Whitney classic – but inspired, kooky song choices from artists like Pixies, Radiohead or Post Malone have made Kellyoke appointment TV, or at least worth turning YouTube notifications on for. It paid off when Clarkson leaned into the label on her 2022 Kellyoke EP; that release’s storming cover of Billie Eilish’s Happier Than Ever has more than double the streams of any track from her recent studio album Chemistry.
Meanwhile, Miley Cyrus’s occasional Backyard Sessions series drew the focus away from pearl-clutching headlines and back to her soaring, lightly rasping voice, which rang out in a sun-dappled grove for a storming cover of Jolene. And while it would be a reach to call Cyrus’s 2015 cover of Don’t Dream It’s Over with Ariana Grande truly karaoke – the professional microphones and four-piece band say otherwise – the performance captures its spontaneous feel, down to the pair’s sweet off-the-cuff ad libs and animal onesies.
Pop star karaoke is at its best when it embraces the pastime’s innate silliness without irony or a sense that it’s beneath them. That’s what made Lopez’s disco moment so fun to watch. As pop’s unofficial patron saint of karaoke, Clarkson is naturally a master at this. This June, she jumped on the mic with two fans to sing Since U Been Gone at a party in a Manhattan piano bar. With a drink in one hand and mic in the other, she belted out runs, chattered over the music and jumped on the balls of her feet as the chorus hit. Were it not for the megawatt voice, she could have been any pop fan in any karaoke room, happy to be singing along.
environmentalists and scientists who warn that the forest, which is one of the world’s most important climate regulators, is degrading close to the point of no return as a result of forest clearance and river contamination. In between is the Brazilian state, which has become a political battleground for these two conflicting outlooks. This has resulted in a to and fro of sharply contradictory policies in recent years, often in tandem with the health of Brazil’s democracy.
The problem dates back several decades. In the 1970s and 80s, mining was encouraged by the military dictatorship, leading to an invasion of tens of thousands of garimpeiros into Indigenous land, bringing disease and violence. In the 90s and 00s, they were largely driven out as the Brazilian state demarcated more Indigenous territories and conservation areas. Over the past decade, they have returned under successive presidents who put more focus on the economy than the environment, culminating in the ultra-right president Jair Bolsonaro, who tore up restrictions and ran down protections, leading to a fresh tsunami of land invasions, fires, mines and forest clearance.
Operation Xapiri – named for the Yanomami people’s forest guardian spirits that refresh the land, cure the body and prevent epidemics – aims to reverse the tide. It has been timed to mark the anniversary of the notorious “dia do fogo” (day of fire), a nadir of the Bolsonarist era when land grabbers were so emboldened by the weakening of federal protections that they coordinated a mass burn-off of the rainforest.
The latest operation aims to declare that the state is back. As well as Ibama and ICMBio, the action involves federal police, transport police and other government bodies. The army has provided a base but no personnel or other logistical assistance – a far weaker level of support than in the past, reflecting the Bolsonarist pro-garimpeiro sentiment of many senior officers.
In the coming days and weeks, Operation Xapiri aims to destroy the remaining mining camps in the Tapajós region and set up permanent Ibama bases to prevent the miners from returning and to protect local opponents of the mines.
“The bases are fundamental to ensure this is not just a temporary change. We can’t control the region without them,” Loss said. “In these four years of Bolsonaro, criminal miners have advanced a long way into the forest and made it more difficult for us. They are in very isolated areas of the Amazon now so we need permanent bases to counter that.”
After Operation Xapiri, the authorities will turn their attention to other areas, such as the huge illegal mines in Kayapo territory. In the longer term, the Brazilian government also needs financial support from other nations so that it can provide alternative ways of life for the miners, many of whom are from poor families or co-opted Indigenous people who work in almost slave-like conditions.
At the Amazon summit in Belém last week, Brazil’s environment minister, Marina Silva, said other jobs had to be provided, but she said this “should not detract from the primary problem which was that these land invasions were illegal”.
Still, while the number of cable subscribers plummets, ever-increasing carriage fees are helping networks like Fox News stay afloat and buffer themselves from public accountability. Heresco says that arrangement always puts customers on the losing end. “I’m generally a pretty optimistic person,” he says, “[but] I don’t think these opaque, black-box, long-term, multibillion-dollar negotiations in which the audience is enlisted and weaponized by one company against another company – I don’t think there is any scenario in which that actually benefits democracy, or citizens, or education, or accurate information.”