The surgical team filed out of the patient’s room. I looked over my shoulder to see a shaken daughter holding the wrinkled hand of her quiet, elderly mother who lay in the bed. I shuddered as I thought of the surgery her body would endure the next day. I knew I needed to return to her room later in the day to find out more about her history. After rounds …
1. Cancer is not rare. Technically, childhood cancer is rare compared to adult cancer, but it’s not as rare as you think. Outside of my work, I can think of 3 people who I know personally that had a childhood cancer. A teammate on my high school basketball team, my sister-in-law, and a high school debate teammate. My guess is that you also know someone from church, a coworker’s …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 77-year-old woman is evaluated for frequently fluctuating INRs (<1.8 to >3.5) while taking warfarin therapy. She has undergone INR testing every 1 to 2 weeks and frequent warfarin dose adjustments. She reports a consistent dietary intake. Medical history is notable only for recurrent deep venous thrombosis. She takes no other medications.
On physical …
I am a medical oncologist specializing in breast cancer. I often try to conceal what I do for a living when I meet people for the first time as it always leads down a particular road. “Is that so depressing? I don’t know how to deal with that all day, every day.” But in truth, it …
It’s 9:30 a.m. on a Wednesday, I get on the elevator, and I hear a man in his 40s, having a conversation on his cell. He says: “He had a brain bleed yesterday, and they had to put a breathing tube in, they don’t know how much damage his brain has suffered at this point.” He gets off on the adult ICU floor. I quickly think “that sucks” and carry …
I’ve been practicing as an interventional pain management physician for over six years. It was a long road to get here — four years of medical school, four years of residency in anesthesiology and one year of fellowship (in addition to the four years of undergraduate education). So people say, “You must really love what you do.” Sure, during residency there was light at the end of the grueling tunnel …
Perhaps one of the hardest things about medicine is cross-coverage, that is, to be the covering doctor for your partners, whether for the occasional night, weekend, or longer. It’s not something done only in oncology. All specialties in medicine have this system, which allows us to have lives outside of our hospitals and clinics. What’s …
I met David on the internet. It was to become on of the closest, most intense relationships of my life. For you see, a few months before he crossed my path his daughter finished the same protocol for the same type of brain tumor that my daughter just had started. They had successfully traversed the waters that to me were completely unknown — and frankly terrifying. On the pediatric brain tumor listserv, …
For almost 20 years, the value of the digital rectal exam (DRE), a long time staple of the complete examination of the trauma patient, has been questioned. Performing a rectal examination on all trauma patients is no longer advocated except for a few specific indications.
As recently as two months ago, trauma surgeon Michael McGonigal blogging at the Trauma Pro reinforced the message. Because a rectal examination is so uncomfortable …
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 …
When it comes to colon cancer prevention, the polyp is the key player to know. Colon polyps, called adenomas, are precancerous growths originating from the inner lining of the colon wall. There are other types of polyps in the colon which are not considered precancerous, but for our purposes in this article, we will consider the terms colon polyp and adenoma to be …
Part of the challenge in oncology is the balance between hope and reality, and that is probably the most important thing to strive for for patients living with metastatic disease. Often times, the important conversations relate to treatment options, goals of care, and patient preferences (i.e., how frequent the visits to the doctor and for …
It’s 10 p.m. on Wednesday night, and I’m finishing up my notes for my patient visits from this morning while I do my bowel prep for my colonoscopy tomorrow.
Now, I know we can argue the biomechanical challenges of doing both of these tasks at the same time, and this certainly may be TMI, but it struck me as I was sitting there trying to do both of these things how …
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Bruce Wilson, MD, is a hospice doctor and former cardiologist who was diagnosed with pancreatic cancer in February of 2017. In the months that followed, he publicly discussed events as they unfolded on a CaringBridge blog. The irony of the situation was profound: a hospice doctor being handed what some consider a death sentence. A physician who dedicated his career to changing the conversation about end of life care now …
It was a long December.
A few years ago, my husband of 37 years got his death sentence: recurrence of liver cancer with mets to his lungs and lymph nodes.
He had a “Whipple” — a surgical procedure for pancreatic cancer — on Dec 24, 2015, and the surgeon discovered liver cancer too. So it was a 16-hour surgery. We were told he might die on the table.
His eyes haunted me as …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 63-year-old man is evaluated for severe mid-upper back pain following a minor fall 1 day ago. He also notes progressive fatigue of 6 months’ duration and a 6.8-kg (15-lb) weight loss. Medical history is notable for an 80-pack-year smoking history, although he is currently a nonsmoker.
On physical examination, temperature is 37.3 …
In a recent episode of the television series, The Good Doctor, a patient played as Robbie Ato does not tell his doctors he has a history of cancer. You can see his surgeons stare in disbelief as one consulting surgeon recognizes the patient’s name and then alerts the team leader that she treated him three years ago for cancer.
This is one of the very most troubling and dangerous acts of …
Harry understood at last that he was not supposed to survive. His job was to walk calmly into Death’s welcoming arms … All those times he had thought that it was about to happen and escaped, he had never really thought of the thing itself: His will to live had always been so much stronger than his fear of death … It was over, he knew it, and all that …
7 a.m. began as it always did; the overnight doc was threatening to quit while rubbing her bloodshot eyes and smearing mascara beneath them. Between heavy sighs, she listed the patients transferring into my care ending with Mr. Mandel.
“He’s eighty-something,” she explained, “hospice care. Cancer with metastases. Came in from home because family ran out of morphine and he was in a lot of pain. Anyway, he’s actively dying now, …
So stated one of our children in their autobiography assignment for school. I kept reading, curious what would come next.
“My dad usually stays home and cleans up, and takes care of the pets.”
I thought for a moment. “That’s very good, honey, but do you think you could write something else about Dad?” I suggested. “He does other stuff too, add some more nice things.”
“OK, how about … ‘And he takes …
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