A Story of Extraordinary Courage
By: Brian Hoeflinger, MD
May 5, 2025 | #45
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Disclaimer: Opinions are my own. Not medical advice.
Medical Trivia of the Week
What is the most common site of distant metastasis in prostate cancer? (the correct answer is at the end of this email)
- A) Liver
- B) Lung
- C) Brain
- D) Bone
Quality vs Quantity of Life
Today’s newsletter will be one of my most important newsletters that you can read. It is about courage. And it’s not the kind of courage one boast of themselves. It’s the kind of courage you find in selfless acts one commits for the benefit and peace of others.
I recently met an amazingly brave man who has metastatic prostate cancer. And for those who do not know what that means, he has cancer that has spread throughout his entire body including to his spine. He is now paralyzed from the chest down and has lost use of his hands. He was previously offered a second surgery to his spine, radiation and chemotherapy all which he declined. For the limited time that he has left, he decided to spend his time with his family and friends. And here are his thoughts and reasons. It was time he could spend talking to his children about his life before they were born. Memories that are too often lost forever if not talked about. He wanted to spend time with his friends and share one last time the stories that make up a full and happy life. He wanted to enjoy time with his grandchildren because he will never get the chance to watch them grow up. And most importantly, to spend time with his precious wife of 45 years until he could no longer interact with her.
You see, he wants to cherish the things that have been important to him his whole life, which are his family and friends. He needs whatever quality time he has left to mean something for others. This man has chosen quality over quantity. He does not want to spend his remaining days recovering from another surgery or feeling tired and sick from radiation and chemotherapy. Yes, these measures might extend his life a bit longer but the quality of that extended life would be greatly diminished. He wishes to spend his last remaining months with his family at home and not in medical facilities with doctors.
There is a powerful aura of courage and strength in what this man is doing because he is doing it for others and not himself. If he can’t spend quality time with his family and friends then the hours and burden of treatment, office visits with a multitude of doctors and the “not feeling well” consequences of additional treatment is just not worth it to him. He wants his last moments in this world to be filled with the joy and happiness he finds through the only life he has ever known which is being in his home with his family. It is more important to him to give this extra time to his wife, his children, his grandchildren and his friends than to give this time to the doctors, nurses, office staff, and machines that would treat him. He wants his last moments in this life to be meaningful and to give peace to others by letting them say goodbye in the home he and his wife built so many years ago.
I see this man as a fortitude of strength for others to help them transition through this devastating time in their lives. He worries much more about his family and their future than he does about his own. And he is the first to say that his decision to stop treatment is not for everyone. It is his decision alone. But what I do know is he is one of the most strong and selfless people that I have ever met. The courage he exhibits in facing his own impending death is hard to even comprehend. Getting to know him has been an honor and watching the way he has dealt with his own mortality has inspired me on so many levels. My prayers are with him and his family.
Prostate Cancer: Key Facts
Prostate cancer is one of the most common cancers in men:
- Incidence: About 1 in 8 men will be diagnosed in their lifetime.
- Typical age at diagnosis: Around 65.
-
Possible symptoms:
- Back or bone pain
- Blood in the urine or semen
- Difficulty starting or stopping urination
- Frequent urination, especially at night
Early detection is crucial. If you’re nearing age 50, or younger with a family history of prostate cancer, talk to your doctor about screening. A simple blood test can catch prostate cancer early; once it spreads, the consequences can be devastating.
Impactful Quote of the Week
"Courage is the most important of all the virtues, because without courage you can’t practice any other virtue consistently.”
- Maya Angelou
Best wishes,
Brian Hoeflinger
P.S. - if you enjoyed this newsletter, you may enjoy my book that details my life as neurosurgeon and the loss of my oldest son, Brian (see below a synopsis).
My Book
Life and Death . . . Two words with such opposite meaning and which inflict such contradictory emotions and yet are so closely intertwined in our lives. As parents, we bring meaning and life into this world through our children. Our lives become defined as a result. We learn the joy, hardship, and responsibility of shaping an innocent life. But a day will come when that life will be taken. For some, death will come too soon. This is the story of my son, Brian Nicholas Hoeflinger, who died unexpectedly at age 18.
https://doctorhoeflinger.com/products/the-night-he-died-the-harsh-reality-of-teenage-drinking
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Medical Trivia Answer:
The correct answer is D) Bone
