“Why did this happen to me?”
That question is perhaps the most common one raised by patients facing a diagnosis of cancer for the first time. There are so many campaigns about how to “avoid” cancer: no white sugar, no chemicals, all-plant diets, regular exercise, don’t smoke, don’t drink. I can see how one can get the impression that if …
Don’t blame yourself after a cancer diagnosis
I vividly remember meeting her, despite all the years that had passed. At 6 feet tall she towered over me (granted, anyone who has met me will know that’s not hard to imagine) and yes, I’ll admit it — she had physically intimidated me. But about 10 minutes into the initial consultation, I realized she was soft-spoken, kind, and, …
Is there a place for alternative therapy in cancer treatment?
Facebook is a remarkable thing. I use it for private matters — to keep in touch with family and friends from long ago. Because of it, I’ve reconnected with people from every stage of my life, as far back as third grade to high school to college and beyond. One of the …
A poignant Facebook birthday for this physician
A few months ago, I became aware of the ongoing measles outbreak that has been traced back to visits to Disneyland in Anaheim, CA, which began in December 2014. I remember reading the news reports, including the defense of those who did not believe that vaccines are safe, and witnessed the …
There should not be a body count to disprove bad science
She was so young — only 32 when diagnosed with ovarian cancer. She had given birth to a son only four months earlier and by all rights should have been celebrating being a new mother. But, instead, she had developed acute pelvic pain, undergone emergent removal of her uterus and ovaries, and was now in my office to discuss …
A patient this oncologist can’t forget
Every so often I see a patient who views cancer as a constant threat to be handled. The cancer becomes so significant that she feels she can never let her guard down. I always worry about this — partly because that singular focus on fighting cancer can sometimes detract one from other aspects of life, and those facets that give …
When you can’t let your guard down: Cancer as a constant threat
Mom. Dad.
Happy. Sad.
Friend. Trust.
I remember playing this game. A friend would say one thing, and then I would say the first thing that came to my mind. For some reason, it would pass the time. I remember how some words would spark an emotion or a memory. Sometimes happy, sometimes not so happy. But, playing that game was one of …
Let’s break the association of palliative care as hospice
I am looking out of my window on a cold and cloudy Boston afternoon and find myself pondering about life: How unpredictable it is, and how one minute can hold no assurance for what happens after. Before I left for vacation, I saw Joan.* She has been under my care for a number of years, living with and thriving despite …
A patient reminds a doctor: How unpredictable life is
I had just started the sexual health clinic at Massachusetts General Hospital (MGH) when I was approached to meet with a group of prostate cancer survivors. I was hesitant at first — my interests were in female cancer survivors who had experienced sexual dysfunction. This was partly because I had assumed men had an easier time accessing information on …
After prostate cancer treatment: What about intimacy for men?
Even after so many years, I take the process of starting someone on anticancer treatment very seriously. The drugs we use can cause damage, and that damage can persist long after the end of the last planned treatment. Platinum salts can cause neuro- and nephrotoxicity. Taxanes can cause neuropathy. Angiogenesis inhibitors can result in hypertension. The lists of potential …
Trivializing the significance of losing one’s hair during cancer treatment
In July 1991, I was beginning my first year of medical school in Rochester, New York. I was filled with excitement and anxiety on beginning a journey in medicine as I started on the road to becoming a doctor.
At that time, Rochester was in the national spotlight because of the actions of one of our faculty members, Timothy Quill. …
What does a good death mean to you?
I remember when I first started in oncology; I had joined the faculty at Brown three years after fellowship and was seeing a patient* with newly diagnosed breast cancer. She was in her 40s, an advertising executive, married, with two small kids. The diagnosis was unexpected (as it usually is), with a lump found while showering. She had come …
When patients seek a second opinion: It’s not about you
Whenever I speak about social media, much of it has to do with Twitter. It has become part of my daily routine, much like checking email or going to news media sites. I will often check-in on Twitter and will respond to items of interest — whether or not tweets were sent directly to me. However, I am cognizant …
Twitter counts for this doctor. Read why.
I had taken care of her for years. We had faced a new diagnosis, the toxicities of adjuvant treatment, the promises of having no evidence of disease (NED as my friend, Molly, refers to it), only to have it shattered with the first recurrence. Over the next three years, she had undergone treatment — chemotherapy, a trial of endocrine therapy, …
The public perception of oncologists: Is it really true?
I sometimes wonder what I would do if I was told I had cancer. How much would I subject myself to in order to survive, or to achieve remission? As a parent, I can answer only that I would likely go through hell and back if it meant being there for my kids — to watch them grow up, graduate …
Two women, two cancers, two different pathways
When I was a fellow, part of our training involved doing consults for patients, most of whom had just learned they had cancer or recurrence of disease. These consults were never easy, but the importance of sitting with someone who had just learned of their diagnosis was an integral part of learning the medicine and art of oncology.
Even after many …
Delivering bad news: Don’t pass the buck
“Your cancer has come back.”
These are words no one treated for cancer wants to hear, yet they are words I have said far too often in my own career. In this case, I had said this to a patient I had cared for ever since her initial diagnosis. At that time, she had stage III breast cancer. After her surgery, …
Cancer screening in those with metastatic disease
The world is a big place and here in the U.S., we are fortunate to live in a part of it where we have access to technology and advanced medical care, clinical trials, and new therapies, even before they are approved by the Food and Drug Administration. Indeed, even new agents approved for one indication can be prescribed off-label in …
Cancer care for international patients
Martha (name changed) had recurred yet again — her third in as many years. Despite our best attempts, remission proved fleeting. Fortunately, she had few (if any) symptoms of the cancer in her abdomen; no bloating, no nausea, no difficulty moving her bowels. Her concerns were more psychological — anxiety and frustration because her cancer refused to go away, and indeed, …
Treating cancer should not be paved in our patients’ financial despair
As characterized by Dr. Rita Charon in her JAMA article almost 15 years ago, narrative medicine is “the ability to acknowledge, absorb, interpret, and act on the stories and plights of others.” It is the recognition that scientific knowledge alone is not enough — not enough for our patients, for ourselves, and for society. It stresses the importance of not only hearing what our …
Can narrative medicine inform quality of care?
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