Kasey sits alone in the examining room, staring at the drug company calendar of a perfect Caribbean beach hanging above the doctor’s desk, but not seeing it at all. She is very frightened. After three years of treatment for cancer, she is in trouble. Kasey feels fine: no shortness of breath, no cough, no pain. Still, she is there to get the report on her CT scan, and she knows …
His reputation precedes him: Meet the bad news doctor
For days, I have been trying to get long-term patient, Stan, on the phone; his blood work came back abnormal, and we need to repeat it. I called the number in our file a bunch of times. The odd thing is that sometimes it rings without stopping, sometimes it is answered by a machine, which immediately beeps and disconnects, and at …
When patients yell at staff, they end up hurting themselves
I got a letter the other day from a local urologist requesting clearance for a patient of mine to have surgery. The doctor wanted to know whether there were any contraindications, from the standpoint of the patient’s cancer, such as bleeding, infection or poor wound healing, which would preclude local anesthesia, bilateral incisions, sharp separation, ligation, and electrocauterization of the vasa …
A perfect thank you note to an oncologist
Carrie is a 72-year-old retired real estate agent with a high school education. She raised three kids, but they do not talk to her anymore. Since her husband died, Carrie has lived alone. A melanoma was removed from her right shoulder 2 years ago. In my office, we stare at the CT scan display of a mass in her right lung.
“What does that mean?”
“Well, we wouldn’t know for sure until …
Has abolishing medical paternalism gone too far?
It was 1:35 p.m. when we realized that Tom was not just late for his chemotherapy treatment; he probably would not show up at all. A call from one of our staff confirmed, he had “troubles getting a ride” and wanted to move the vital therapy to another day. This was the third time in a month he had missed an appointment, thus wasting a treatment slot, nursing time and …
Giving challenging patients the best care
What do we want in the last days of life? We want no pain. We want simple dignity, the physical kind where we clean ourselves, organize our medicine and command our bowels. As important is the complex dignity of choosing where we spend our final days, make tough decisions for ourselves and, as much as possible, live as a person, not a patient. It occurs to me that these critical …
What is quality in end of life care?
The United States of America is addicted to narcotics. I do not mean the millions of individuals who are hooked. I mean the whole nation is jonesing for the stuff. I also do not mean the junk that slips into our nation in coffee cans or across midnight borders. I mean the billions of pills pouring off assembly lines. I could blame pharma or the FDA, but the truth is …
It’s time for doctors to say no to drugs
Three months ago, Anne finished chemotherapy. She is tired, overweight, anxious and her feet burn. Anne sleeps poorly, cannot concentrate at work and her relationship with her husband is distant, let alone intimate. In my office for a “survivor’s” visit, Anne asked the glaring question. “Will I recover? Will I ever be the same?” After a moment of thought I answer, “I hope not.”
Okay, I was not really that cold. …
Cancer takes so much, but can its passage give back anything good?
His wife thinks he looks like Tom Cruise. There is a resemblance, I can see him riding a motorcycle off the side of a burning building, jaw fixed, eyes on fire, ready to save the damsel … only he is not so short. Funny, brilliant and genuine, we have known each other for exactly two decades, sharing the growth of our families, the anxieties of middle age, and the vicissitudes …
As I look back, I remember teachers. One taught to be compulsive and complete. Another, calm and humor in the face of chaos. Another believed in me and thereby taught me to believe in myself. One made me write and rewrite. Above all, there was a mentor who opened my heart and eyes to the need for compassion. That special teacher was Dr. Black.
Tuesday afternoon, 8:30am, July 12, 1966: Dr. …
A mentor who opened my heart and eyes to the need for compassion
America is one of the sickest places on earth. We have the best diabetic care, but the most diabetes. First-rate cardiac care, but we are obese, hypertensive, inactive, and have high rates of heart disease. We are the world’s standard for cancer technology, innovation and access, but we have high cancer rates even while we waste most of the money from cigarette taxes on road repairs. At every socioeconomic level, …
How a hospice model can save American health care
Hegira: To take flight to escape. To travel from a place of danger to a place of safety.
“You have cancer.”
You hear the words. Your mind does not understand.
“You have cancer.”
Shock. Distance. Isolation. Someone else. A mistake. A lie. Bizarre, strange, you float above the room. Everyone speaks; nothing is said.
“You have cancer.”
A fog-like curse, a venomous reality, a phantom idea. A cold ghost foreign to the soul. I must run. …
To emotionally survive cancer, we must create perspective
Sometimes it seems that life is unfair and the odds are stacked incredibly against us. More than 1 in 3 persons will get cancer. The chance of survival if you get lung, pancreatic or brain tumors is pathetically small. The most common cancer in 20 to 30-year-olds is the deadly beast melanoma. We have no easy or effective early detection for most cancers.
However, there are remarkable stories of hope. Here …
A cancer story that defied the odds
Allow me to describe a recent case and ask your opinion. Today, you are the intake nurse at hospice and you are asked to evaluate Stan. This gentleman has incurable cancer, but treatment would probably prolong his survival. However, Stan has refused that treatment and been referred to you. It is your job to decide if he is “hospice appropriate.”
Why has Stan refused therapy? It is not that he denies …
Would you admit this patient into hospice?
Have you ever had a conversation that rattles around in your head for days? Maybe, it changed what you thought you knew about the world. Perhaps the ideas or comments did not make any sense. I had a discussion last week and it seemed that logic stood on its head. The means was defined by the end, with no connection to the beginning, or more exactly, the tail wagged the …
When insurers dictate medical decisions
It happens, now and then; not as often as one would wish, but occasionally. In other professions, a perfect day is when you make that super sale, finish a protracted project, win an important race or craft a special, remarkable piece of art. An oncology perfect day can be without bells, whistles, pats on the back, nor cash register’s whirr. Some of the best days lack pizzazz, vibrant emotion or …
A perfect day in the cancer clinic
Hot oil splatters as thick fatty fish slips into the smoking pan, next to boiling rice and simmering garlic greens. Quickly golden, she flips the fillet and turns down the heat. Small feet pound down the stairs, drawn by the crackling aroma, but it’s a mother’s trap; she motions the child to set the table. One by one, the family gathers, as plates and utensils clatter onto the wood and …
To every cancer patient: You give us courage
On December 23, 1971, President Richard M. Nixon signed the National Cancer Act of 1971, and declared the “war on cancer.” The allusion to combat appealed to the soul of the American people not long after their success in World War II and the humiliation of Vietnam; they intuitively understood the sacrifice, teamwork and massive effort, which is implied in the concept of War and they were ready for another victory. Committing dollars, …
Defeating cancer is not an armed conflict
Today, I hesitated to refer a patient to hospice. The patient is perfect for that model of care. She has strong family and friend supports, multiple opportunities to maintain quality, independence and dignity, and while she has a disease we cannot fix, she will do very well with personal palliation. Nonetheless, I almost did not recommend hospice, because I realize that hospice is going to completely fail to take care of a …
After hospice takes over, what happens to the physician?
A large woman, she has soiled herself. With practiced motion, Bob rolls his wife onto her side. Yellow diarrhea has leaked out of the diaper, soaking the nightgown and sheets, finding its way into each fold, crease, and flaw. The room fills with odor, but the winter house remains dark; outside wind blows down the empty street. It is 2:00am and Bob is cleaning shit. Only 90 minutes asleep, he …
Compassion is what connects us all
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