“I like good strong words that mean something.”
– Louisa May Alcott
My resident and I are removing a large, recurrent cancer from the neck. Dense scar tissue is everywhere from prior surgery and radiation therapy. The going is slow. Each move is arduous, and bleeding obscures the view of the anatomy.
“Watch out,” I tell her. “The jugular vein is nearby, probably buried in that scar.”
“Yeah,” she responds. “Look at this nerve! …
For many physicians, the term “compassion fatigue” may imply, as the words describe, that fatigue leads to the loss of ability to feel compassion for others.
After all, what physician doesn’t have a day when s/he is too tired, running on too little reserve, and feeling some degree of emotional numbness?
Many physicians may not realize, however, that compassion fatigue can go much deeper. According to the Compassion …
Recently, someone close to me was diagnosed with cancer. Due to a series of missed phone calls on both sides, he had not heard the results of his biopsy prior to his follow up appointment. When his young doctor walked in, he started with, “So you know you have cancer, right?” I just wanted to scream, “What the f*ck!” It is never easy to give someone bad news, but this …
So there I was — in deep denial. Maybe you’ve been there: Ignoring the symptoms. Hoping and praying that it would just “go away.”
A little knowledge is a dangerous thing. And as a doctor, I like to think I can Google with the best of them.
So when I had a persistent scary symptom (full disclosure: it was bloody discharge from my left breast. Not subtle. Not intermittent. Not OK, even …
Contrary to what my wife and colleagues think, it is not all about me. Well yes, I do get lonely sitting at my desk late at night, when my wife is busy, and the long-ago-moved-away kids are not available, and there is nothing running on NASCAR. Nonetheless, it is not really about my needs. I am talking, of course, about why I give patients my cell phone number.
It is printed …
I recently reported on Stephanie Waggel, the doctor fired by a prestigious U.S. hospital for getting cancer (story also the Washington Post). In a transcription of her whistleblower video, Stephanie describes how she nearly died due to obstruction of medical care:
It started during my intern year of residency. Which, bizarrely, was the happiest year of my life. And all my friends are …
In high school and college, I waitressed in a Dunkin’ Donuts shop that sat between Boston Common and the Combat Zone’s porn shops, strip clubs, and bars. The wages paid for school, clothes, rent, and food. At the time, I didn’t realize this job would provide useful skills for my later medical career, an early pre-med training of sorts.
Look the part. I donned the bubblegum pink polyester uniform that clearly identified …
“Life is just a short walk from the cradle to the grave, and it sure behooves us to be kind to one another along the way.”
– Alice Childress, American playwright, actor, author (1912-1994)
I am awakened in the wee hours by the sound of rain. Ordinarily I would return to bed in hope of stealing more sleep from night, but this particular day I know I have to rise at 4:30 …
This post is based on a “friend of a friend” situation. Important details have been changed to protect anonymity, but not the basic realities I want to discuss.
A 49-year old man was diagnosed with a rare form of lung cancer about a year and a half ago. This sad situation is compounded by the fact that he was in a stable marriage with a wife and two children, ages 10 …
The most exciting and difficult part of my job is keeping up with all the rapid changes occurring in the field of cancer treatments. It is amazing how each day there seems to be a breakthrough treatment coming along, shifting old cancer paradigms. Although this is a good problem to have, finding time to stay current is easier said than done. Even more difficult is making sure we can explain these …
It was recently pointed out that one of my partners had made an error in a patient’s electronic hospital chart. Did I want to correct the mistake? Curious, I looked at the computer screen. There in 12-point-black-on-white Cambria was the culprit documentation. The words were:
“Our therapy goal is palliative. Prognosis is good.”
Now, this was clearly not what the author had intended. In common practice when someone is so sick that …
“It’s strange how the worst day of your life often starts just like any other.”
– Joanna Cannon
I prepare for each clinic by reviewing the tests and scans of the patients who will be seen that day. Today, I am dismayed as I read a report for a longstanding patient. The news is not good; his scan shows that his cancer has returned.
Twenty years ago on a day like today, I …
When I graduated from medical school, my dad gave me several hundred dollars with instructions to buy something special. It was a kind gesture, but the pressure to self-select a meaningful gift was almost too much.
I wanted something to commemorate my transition from student to doctor. Books, stethoscopes, and the like seemed so uninventive. I wanted something for residency that would be …
Ben Stiller—one of the few comedians on this side of the pond who can make me laugh—said prostate-specific antigen (PSA) testing saved his life. I suspect he wasn’t being funny. Stiller had Gleason Grade 7 localized prostate cancer.
Is he right?
The honest answer is that we don’t know for certain. Before I get granular, we must visit proof, level of proof and burden of proof. The statement, “there’s …
Sometimes, I think that that guiding principal of the medical profession, “first, do no harm,” is hopelessly out-of-date. Clearly, a physician should understand her limits, and never should she give care, which hurts, more than helps. Nonetheless, this axiom implies that the doctor is in control, and decides the treatment. Some of the time, a modern motto, which recognizes the true position and limits of the modern doc, might be, …
My husband, Mark, called me at my practice. “I’ve been working on something; I need you to come home now.” He spoke definitively, urgently. “Is it the kids?” I was instinctively anxious. “No, not the kids, just come home now.”
6 p.m., a cool evening, an ordinary day. The life before the fact. And then life afterward, irrevocably and catastrophically changed.
A tense ride home, then the revelation. “I’ve been having difficulty …
Doctors have several bad habits. They order piles of tests just to get a vague, unfocused view of a patient’s health. They order expensive and invasive tests to rule out the unlikely or extraordinarily rare. The worst “bad test habit” is when doctors order a test, which, no matter what the result, will not change what they are planning to do.
Why do doctors over order? These same people thought a …
Medicine can wear down our hearts and souls. My journey in pediatrics has been filled with many rewarding experiences but haunting ones as well, like this one from my third year of residency. By that final year of training, I was no longer certain medicine was really the right choice for me. I was struggling with the notion that after almost 11 years of education, the destination was not quite …
Just three weeks earlier, she had noticed something strange about one of her breasts. An irregular shape. Her daughter brought her to the doctor, and soon the patient, I’ll call her Amanda, was diagnosed with breast cancer, stage “to be determined.” In fact, she was now in an oncologist’s office, learning what tests she would receive to determine the extent of her tumor. And sitting between her and the doctor …
“Observe, record, tabulate, communicate. Use your five senses. Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone you can become expert.”
– Sir William Osler, “The Father of Modern Medicine” (1849–1919)
In this modern era of oncology, the potential extent of malignant spread is staged by high-quality scans. Further, when …
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