In many ways, this woman was similar to other patients I have seen after a diagnosis and treatment of breast cancer. Her hair was growing back, and I immediately noticed that she was comfortable enough to not be wearing a wig or head covering for our Zoom visit. I keep my hair very short by choice and I find this …
“How can I help you, sir?” I asked because it was clear he wanted help. I could sense the man’s distress over the phone. His voice cracked just a little, and he cleared his throat frequently. I hadn’t met him, and so had no image of him in my mind, but I thought he might be tall, broad-shouldered, and maybe …
Genital shrinkage is real. And so is the distress it causes.
Many health care facilities are enacting policies during this time of COVID-19 that restrict the number of people attending appointments in person. Family care providers are asked to wait outside or drop off the patient for their appointment and come back to pick them up later.
There are, of course, exceptions made for those receiving a new diagnosis or when the …
Do COVID restrictions in the office negatively affect patients?
I first met JB* when the receptionist at the clinic called to tell me that a patient was asking to see me. His name did not ring a bell, and on a quick review of my patient schedule for the week, his name did not appear. I went to the waiting room to see if I at least recognized his …
The sexual side effects after prostate cancer treatment
The patient was well over 6 feet tall and looked like he had recently lost weight. When he took off his winter coat and hung it over the back of the chair, I could see his scapulae like wings under his sweater. He folded himself into the chair and carefully crossed his legs. He sighed softly as he arranged his …
The one word that carries so much weight in the cancer experience
Mr. G* was diagnosed with advanced prostate cancer two years ago and has been on a succession of medications to control a progressive cancer. His PSA never nadired after surgery, and adjuvant radiation only increased his urinary problems. Androgen deprivation therapy added to his symptoms, and he is now considering taking a second-generation androgen-receptor antagonist. Fortunately, his cancer has not …
A physician’s inaccurate cancer prognosis
The couple that entered my office on a warm fall day seemed out of sorts. She looked nervous, and he looked irritated. Before he sat down I heard why he felt that way: “I don’t even know why we’re here.“
I explained briefly what my role is but this did not seem to clear up anything.
“I just want her to be …
Sexual recovery after cancer treatment
Do you ever wonder what the staff in hotel conference rooms think about what we talk about in presentations and lectures? I talk about sensitive stuff — sexuality, fertility, etc. — and I use words that many people have not said out loud in front of hundreds or thousands of people. I’m used to the words, of course, and they …
The unexpected people who’s listening to your conference speech
It’s become a common practice in oncology institutions across North America: A patient completes their prescribed course of treatment and they ring a bell. Usually, it’s a large bell, like one that used to be rung in schools signaling the end of recess. Or it’s a ship’s bell, attached to a wall outside the radiation department or the chemotherapy unit. …
After cancer treatment: It’s time to reconsider the ringing of the bell
Going through the process of diagnosis, treatment decision making, and often lengthy treatment without a partner can be challenging. While children, friends, and other family members are supportive, for the single individual, there is no one to talk to in the middle of the night when fear and doubt often surface. I often counsel people who have finished treatment for their …
Why would adult children disapprove of their parent’s happiness?
The woman waiting to see me looked every inch a lawyer or accountant in her black pencil skirt, pink shirt, and a Chanel-style houndstooth jacket. Her ankle boots were reminiscent of those worn by women in Victorian times with a row of small buttons up the side. She had a scarf loosely knotted around her shoulders, and her hair was …
What clothing choice says about a patient
I recently attended a lunchtime session on the Choosing Wisely initiative. This public and professional awareness endeavor attempts to educate the public and health care providers about procedures that do not benefit patients, and that may ultimately cause harm. It was an interesting educational session and while most of the content was not new to me, one of the statements by …
Let’s be more mindful of respecting the time of our patients
It usually starts with a phone call:
“Doc, can I come and talk to you about something?”
The “something” might be erectile difficulties or other side effect(s) from prostate cancer treatment. It might be confusion or indecision about what treatment to agree to. I always inform the caller that any of these issues are better resolved if their spouse/partner is present and …
When men struggle with treatment decisions
Sarah* is a new patient, referred to me because she is having difficulty deciding on treatment for breast cancer. I don’t know much else about her, and a quick review of her electronic medical record tells me that she is 48 years old and has hormone-positive disease in her left breast. There are numerous missed appointments, and it appears that her …
For those on the margins, access to cancer care is a struggle
As the patient talked, I found myself nodding my head. In so many ways, she was just like me. Highly educated, a professional, a woman who had worked hard and long to get where she was. And then cancer took it all away, or at least that’s the way she described it. She was diagnosed with metastatic cancer one year …
How silence can help us learn from our patients
I am in the privileged and humbling position of hearing the stories of patients’ pasts. Sometimes the stories are so horrendous that it takes all my energy to stop myself from crying as they recount the brutality of their experiences. I have heard harrowing descriptions of all manner of abuse done to patients when they were children. The abuse was …
How cancer treatment is affected by past abuse
I see these couples quite often: the man has been prescribed androgen deprivation therapy and his partner is distressed. He no longer has erections, although for some that had been a problem for years. But even then, they tell me, he at least tried occasionally. Now there is nothing. No hugs, no kisses, no hand holding, no touch. The partners are …
The loss of testosterone and how that affects the partner
I had never met the man, but from a brief reading of the notes in his medical record, I knew that this was not going to be easy. Thirty years old with stage III kidney cancer, the notes showed a long history of missed appointments and late arrivals. I had been asked to talk to him about sperm banking and so …
Treating the patients we cannot reach
The couples I see for counseling are not always perfect, not that any couples ever are. But when cancer enters the relationship, for some couples, things get ugly and get ugly fast. I believe that we like to think that cancer makes people “better”; that people rise to the challenge and become the best they can be. I think that we …
The unhappy couples after a cancer diagnosis
One of the nurses knocked on my door on a quiet Monday morning.
“Hey, can you see this patient? I guess it’s not urgent but he’s here now, and I think what the doctor told him just threw him for a loop.”
Of course I had time. In my role as clinical nurse specialist in a busy uro-oncology unit, I see men who …
What patients want isn’t always what they need
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