Miranda Fielding, MD

All doctors should be able to tell a patient’s story well

Education

September 29, 2013

An op-ed piece this past summer by Verlyn Klinkenborg in the New York Times decried “The Decline and Fall of the English Major.” As I read it, I reflected on my own experience in medical school and beyond, and I think that Mr. Klinkenborg’s message is one that medical school admissions committees should be hearing loud and clear.

Despite the fact that doctors are faced with increasing mounds of paperwork …

In the midst health care cynicism, an affirmation of enduring love

Miranda Fielding, MD

Physician

September 16, 2013

When I was young, one of my favorite stories was O. Henry’s “The Gift of the Magi.” Originally published in 1905, the short story became standard fare in public school reading classes and I doubt that there are any of you out there who have not read it. But just in case — the story is about a young couple, poor and deeply in love. At Christmas, they have no …

Treating cancer patients puts everything else into perspective

Miranda Fielding, MD

Physician

September 5, 2013

When I was about ten years old, swimming on a Texas swim team, I remember hearing that the child of one of the local coaches had been diagnosed with leukemia. The idea of a kid dying of an untreatable disease was so foreign to me that I am sure that I have blocked out most of the details. I do know that the child died, and it didn’t take very …

Know the human being behind the diagosis

Miranda Fielding, MD

Physician

August 26, 2013

When I was a resident in radiation oncology, I thought I already knew a lot about medicine. After all, I had just completed an internal medicine residency, and had taken and passed my boards. Needless to say, I was more than a little bit irritated the first time a patient “coded” in the radiation therapy department and I was shoved out of the way by the intern on the code …

When a doctor offers to speak the language of medicine for you

Miranda Fielding, MD

Physician

August 9, 2013

These days they have navigators for everything. When we got lost back in the day, we used to consult a map, or lacking a map, we would pull in to the nearest “filling station” (what we used to call gas pumps) and ask for directions from the friendly young man who would appear to wash our windshield, check the oil and the tire pressures, and of course, pump the gas. …

A watershed moment in my lifetime of treating cancer patients

Miranda Fielding, MD

Physician

July 26, 2013

I have had patients and their families do strange things during a consultation. Patients taking notes and recording what the doctor says are pretty commonplace these days, as are answering a cell phone and arguing with a spouse over what really happened while giving a history.

Some patients go to great lengths to disconnect from the process, filing their nails, or flipping through a magazine. I’ve watched babies’ diapers being changed, …

When the weight of illness suddenly descends on an individual

Miranda Fielding, MD

Physician

July 7, 2013

The sudden illness of a colleague is always a shocking surprise. As physicians, we are trained from an early age to ignore our own infirmities in the service of others. Apart from my three C-sections, I have been extremely fortunate in terms of my own health—I can count the number of sick days I’ve taken in the last thirty years on one hand and I am thankful every day for …

Childcare during medical training: Sometimes you just get lucky

Miranda Fielding, MD

Physician

June 15, 2013

Sometimes you just get lucky. When I was pregnant with my first child, during my radiation oncology residency, we had a guy living in the apartment over our garage, which we liked to refer to as “the carriage house.” He was a dog trainer by trade, and in his spare time he played softball in a local adult league. When we told him he had to move out, because we …

A proton therapy center opens: A radiation oncologist reflects

Miranda Fielding, MD

Conditions

May 24, 2013

When I was a radiation oncology resident in Boston in the early 80’s, a few brilliant minds in physics and medicine came up with the notion that it would be a good idea to treat certain cancers with a beam of protons. Protons are the positively charged particles which are created with a hydrogen atom is split into its component parts, a proton and an electron. When accelerated towards a …

As I sit by my father in the hospital, there is a choice to be made

Miranda Fielding, MD

Physician

May 6, 2013

With gratitude to Doctors Rafael Espada and Michael Madani, for fixing my father’s heart, twice.

When Michael Phelps was interviewed during the Beijing Olympics, the world first learned about the extraordinary amount of food needed to fuel the swimmer with the wingspan of a pterodactyl. He said that he ate 12,000 calories a day, and no one believed him except for me. I believed him because I too was a swimmer …

Radiation therapy: Don’t let me talk you into it

Miranda Fielding, MD

Physician

April 20, 2013

When I was young and foolish and just starting out in my career, I found it very hard to take “no” for an answer. If a patient needed radiation therapy, and he or she didn’t want to have it, I did my very best to talk that patient into it. I have always been a very persuasive person—if I didn’t get the go ahead on the first formal consultation, there …

What happened in the wake of 9/11 saved lives in Boston

Miranda Fielding, MD

Physician

April 16, 2013

Today the road all runners come,
Shoulder high we bring you home
And set you at your threshold down
Townsman of a stiller town.
-A.E Housman

As the afternoon’s events unfolded, I sat glued to my computer screen between patients. My life has really been a tale of three cities—Houston, Boston and San Diego. Boston was where I did my residency training, met my husband, had my three children and my first “real” jobs. I …

Patients who are in denial may be doing themselves harm

Miranda Fielding, MD

Physician

April 11, 2013

If you desire healing,
let yourself fall ill
let yourself fall ill.
–Rumi

Yesterday I saw a patient—an 80 year old woman with metastatic cancer involving her bones. She had near complete replacement of her twelfth thoracic vertebra by tumor, and also significant destruction of her fourth and fifth lumbar vertebrae, demonstrated by PET-CT scan and bone scan.

She had so much pain in her legs that it was difficult to walk. In …

Beware of hidden agendas in cancer support groups

Miranda Fielding, MD

Physician

April 3, 2013

My husband likes to say, “No good deed goes unpunished.”

I don’t always agree, but sometimes you just can’t argue that concept. One of my favorite patients, a forty nine year old woman who I treated for head and neck cancer a year ago is a good case in point. Head and neck cancer is on the rise, and is linked, like cervical cancer, to infection with human papilloma virus which …

When it comes to my patients, waiting is unacceptable

Miranda Fielding, MD

Physician

March 22, 2013

The waiting is the hardest part
Every day you see one more card
You take it on faith, you take it to the heart
The waiting is the hardest part.
-Tom Petty and the Heartbreakers

I’ve never been good at waiting for anything. Instant gratification has been my middle name, and I’ve gotten in lots of trouble because of it. I think that I have improved with age—I am less likely to become apoplectic when …

Caring for the emotional needs of a cancer patient

Miranda Fielding, MD

Conditions

March 10, 2013

Multi-tasking has never been my forte and so I like to keep my schedule organized. Mondays, I see all of my on-treatment patients. Tuesdays and Thursdays I see new patients in consultation. Wednesdays are reserved for treatment planning and research projects. But Fridays—well, Fridays are usually the best day of the week. Not only is the weekend approaching, with time to spend on my menagerie and the ever present home …

What would you do if this was your parent? I honestly don’t know

Miranda Fielding, MD

Physician

February 19, 2013

Yesterday I saw a 90-year old woman in consultation. She presented to the emergency room in September with abdominal pain, and in the process of working her up, a chest x-ray was taken which showed an infiltrate in her lingula, part of the left lower lobe of her lung.

As it turned out, there was nothing wrong with her belly, but a follow up CT scan of her chest showed this …

In oncology, hoofbeats are nearly always from zebras

Miranda Fielding, MD

Physician

January 29, 2013

It happened again today. A youngish man, age 59 (youth being relative these days) comes in for a consultation. His history began eighteen months ago when he started to notice hoarseness. Thinking he had laryngitis, he saw his primary care doctor. He was indeed diagnosed with laryngitis despite the fact that he had not been shouting for his grandson at the local soccer playoffs, nor had he had upper respiratory …

Why is Medicare going after hospices?

Miranda Fielding, MD

Physician

January 14, 2013

Seven months ago, in Carbondale, Colorado, staff at the skilled nursing facility where my mother had resided for over a year recommended that she be placed on hospice. My mother has severe advanced dementia and can no longer walk, speak, feed herself or recognize her family members.

As much as I know about hospice care for cancer patients here in San Diego, I knew nothing about hospice care in Carbondale for …

Read more…

Why is Medicare going after hospices?

Doctors should return phone calls because it is the right thing to do

Miranda Fielding, MD

Physician

December 27, 2012

My veterinarian answers my phone calls. The other day I called her office to ask for a renewal of the pain medication for my little dog Jack. He has been blind and deaf for over a year, but now his rear end is going and he is falling a lot and having a hard time getting up. When I asked for …

Miranda Fielding, MD

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