Weeks before major surgery, a patient cancels his appointment with our geriatric oncology service, declaring it unnecessary. An astute nurse convinces him otherwise.

In his mid-80s, the patient has been diagnosed with an early cancer. The surgeon advises that surgery would be the only cure but, noting the lack of urgency, sends him to see me. I can see why. The proposed procedure is long and complicated; in elderly people, even temporary setbacks can result in long-term effects.

I start by asking the patient to describe his day.

Each morning, he tends the garden before having coffee with old friends. He returns home with the fresh salad leaves his daughter-in-law relishes. After dinner, which sometimes includes the grandchildren, he retires early. His son adds that his father’s memory is beginning to falter but an established routine keeps him functional. They both praise his quality of life as being ideal.

My patient hates the notion of an “intruder” in his body.

“I just want it gone,” he says.

I reassure him that this is understandable but we should discuss in some depth his decision to undergo surgery. The patient balks, his son is eager to talk.

I explain that his risk of any complication is high and even reversible events such as delirium, infection and electrolyte imbalance can cause prolonged difficulties. Patients often worry about “dying on the table” but........

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