I feel …
Much better than I did after my last chemo cycle.
I feel tired, but not bad.
I feel really glad that using a smaller needle for the lumbar punctures spared me the headache.
I feel thrilled to have a port and have that PICC line out. There’s nothing like having medical tubes dangling out of your arm to make you feel extremely cancery. Plus, with the port buried under my skin, water …
Increasingly, the stuff we buy is electronic. In fact, not only that, but increasingly the stuff we buy with is electronic, too. We are using gizmos to shop for gadgets, or possibly gadgets to shop for gizmos.
In any event, we are ever more frequently in the company of the energy fields our electronic devices, and in particular our smart phones, generate. This deserves more attention than most of us accord …
Cell phones and brain cancer: Is cellular technology innocuous?
At my hospital, we are committed to offering a lot of clinical trials in the community. But it’s hard — nationally, only about 3% of patients with cancer participate in clinical trials. Even at some academic centers, it may be below 10%. With less research funding available, we need to find new ways to make it easier and cheaper …
Use crowdsourcing to develop clinical trials
Twitter — its functions, benefits, risks and limitations — has figured prominently in the heated discussion about Emma and Bill Keller’s respective editorials in The Guardian (since deleted, though the archived version is still available) and the New York Times about the Twitter feed of Lisa Bonchek Adams. I have followed Lisa for a long time and greatly admire her thoughtful, highly …
Why I tweet: A patient advocate view
Where I come from, when most people refer to the Good Book, they are referring to the Bible. This is not true for my father, because to him, the Good Books are something else entirely.
He describes a scene early in his career as a plastic surgeon, when he had taken his doting mother to see his new office. Coincidentally, a lovely thank you note had just arrived from one of …
When patients write to doctors, and what it means
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
I spent 4 hours on New Year’s Eve sitting in the surgeon’s chair getting a skin cancer taken off my nose. Nothing about the experience fits the “benign” label so many professionals, including yours truly, have used: routine; easy to treat; nothing to worry about. Friends, after this experience, which left me looking like a tall, white-haired Rudolph the …
Skin cancers are never truly benign
An advantage astrologers have over genetic testing is that the prediction of astrologers are personally verifiable. An astrologer once emphatically stated that I had no chance of a career in international cricket or Bollywood. So far both claims have turned out to be remarkably accurate.
How does one personally verify a “12.5%” increased chance of lung cancer, the sort of number the vendor for genetic testing 23andMe produces? If one develops …
The FDA and 23andMe puts a libertarian in a dilemma
I was recently readmitted to the hospital for my second round of chemotherapy.
I’m doing a regimen called Hyper-CVAD, which involves four rounds of two alternating cycles of treatment, for a total of eight rounds of chemo.
For my first cycle I got cyclophosphamide, doxyrubicin, and vincristine, along with an intrathecal injection of a drug whose name I’ve since forgotten. This round I’m getting intravenous methotrexate and cytarabine and TWO (insert frowny …
When undergoing chemotherapy, savor the small victories
When counseling patients and families about end-of-life care, I try to focus on a simple, clear standard. Knowing that events are overwhelming and complex, I say, “Look at each treatment, each action and each moment and ask; How does it improve quality of life?” My goal is to reduce the choices during a chaotic time of life to the simple goal of comfort.
For example, most families are very concerned about …
The role of chemotherapy in palliative care
Elton John had it right: “It’s sad, so sad. Why can’t we talk it over. Oh, it seems to me that sorry seems to be the hardest word.” Mistakes are all to common in medicine, but can we say the “hardest word” when we’re involved?
Example 1: There’s a diagnosis of recurrent lymphoma in the ICU. The oncologist gives a phone order for cytoxan, prednisone, and vincristine. The recorder, working a double …
After a medical mistake: Honesty is the best policy
On one afternoon last week, I sat at my desk working on a paper when my iPhone buzzed, telling me I had a new message. This message, forwarded from my Twitter account, alerted me to an editorial published in the Guardian (which has since been removed because it was “inconsistent with the Guardian editorial code).
Entitled, “Forget funeral selfies. What are the ethics of tweeting …
Twitter and cancer patients: What to make of the outrage?
Many years ago, Alfred Korzybski wrote that “the map is not the territory.” Gregory Bateson went on to argue that the map, which represents reality, is not the reality. This distinction has implications for the role of patient voice in health care planning and policy.
Today, many organizations are making serious attempts to include the patient voice in policy and decision-making. Unfortunately, more than a …
Speaking on behalf of patients is not the same as speaking as a patient
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Not long ago a woman in my community, who was a patient of an esteemed local oncologist, died. Let us call her “Beverly” and let us say she died of “breast cancer.” I am familiar with the details of the case because one of my partners saw her in consult, but HIPAA and common courtesy forbid me to be any more transparent. Beverly was very popular in our town and …
Doctors often don’t have the time to address social slander
When I was first diagnosed with cancer several weeks ago, I didn’t have much time to think. I was just trying to survive after getting punch to the gut after punch to the gut of bad news.
First I went to the ER thinking I had pneumonia, and was told that no, I had cancer. Then I was told instead of it being a more common, more …
Thoughts after being diagnosed with cancer
At first glance, no diagnosis seems more terrible than cancer. Although it remains a huge killer in the developed world, cancer has also taken on new meanings in modern medicine. As an ordinary person, I certainly fear the word and would dread the diagnosis. Cancer. It has such a damning and unforgiving ring to it. After 3 years of residency in a tertiary referral center, where I’ve seen …
Prevention, detection, and treatment of cancer has become more nuanced
Each time I reach the point of recommending radiation treatment for someone with a brain tumor or head and neck cancer, I ask for a higher level of trust from each patient than usual: let us make a mask to keep you safe.
Radiation therapy is already a leap of faith — who wants invisible rays shooting through them? Fear of unknown …
Radiation therapy is a leap of faith
I don’t have much in the way of eyebrows. They were victims of too much plucking back in the 1960’s and when you do that, sometimes they don’t grow back. There’s a very nice woman in Solana Beach who shapes and darkens what I have left, infrequently, when I bother to think about it which isn’t very often.
I was in there about a year ago when she told me, “I …
The cost of peace of mind: A case of unneeded bilateral mastectomy
I guess it shouldn’t have been a surprise.
Her house was exactly as I expected it to be. The door couldn’t have been more fitting; red wood with a green holiday wreath attached perfectly in the center. The carpet was so white that I almost took off my shoes on the front porch before entering through the threshold. The room was warm. The ambient temperature was accentuated by a plethora of …
Inside a home visit: Seeing her as she really was
I recently wrote about how our world is ruled by love, and circumstances conspired to show me just how true that really is.
Love is when I go to the ER at UCLA, where I work, for a cough and feeling that “something isn’t right,” and even though my complaints are mild, I’m brought right in and treated respectfully.
Love is when the chest x-ray comes …
My cancer shows how our world is ruled by love
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