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 …
Radiation therapy: Don’t let me talk you into it
“Great,” I thought, as I stood at my desk, looking at my patient list early in the morning. She was coming in today. “She” was a patient of mine in her forties, with newly diagnosed triple-negative breast cancer, without nodal involvement. Our first meeting had been several months ago, and it had not been a good one.
I had asked about her …
Medicine does not compel us to like everyone we treat
When my daughter was born, I hired a nanny. Her name was Kelly. She was great, a savior. She collaborated with me in running the household, enforcing the rules of the home. She even had a set of her own rules. I learned from her and her rules because she had more experience tending children than me. She wasn’t a dictator, …
How the nanny state mentality hurts public health
I was watching a macho shoot-em-up movie the other day; the type where everyone shoots everyone and in the final scene, the dirty blood-stained hero rides homeward on a helicopter or maybe a horse, into a red sunrise or sunset. He stares blankly, focused on nothing, focused on everything, his look reflecting the turmoil of what he has seen, done and lost. The hero’s grease-smeared face shows the understanding that …
No one asks oncologists how they feel
Just three words, a short phrase, heard from an ICU nurse that changed my friend’s well-being as she lay in an ICU bed. In fact, it is the only phrase my friend remembers from her entire hospital stay after having brain surgery to remove a tumor.
She was experiencing nausea, a sick feeling, and needing and wanting care, direction, and guidance from hospital staff. And three powerful words spoken from a …
The power of words in guiding patients toward recovery
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 …
Patients who are in denial may be doing themselves harm
I was very saddened to learn of the death of Roger Ebert. I, like so many around the world, was impressed and inspired at how he handled himself in the aftermath of his cancer surgery years ago that left him disabled and disfigured and unable to eat, drink or speak. And yet, despite his struggles he remained a dominant force in film …
Roger Ebert did not lose his battle with cancer
When we told the patient and his family that the mass in his lung was highly concerning for cancer, he didn’t say anything. His daughter asked about his symptoms. His son-in-law asked when and how he could get a definitive diagnosis. His wife asked when he could go home. Finally, he spoke.
“I’m sorry for being so much trouble.” The tone was casually apologetic, …
Our medical education system does not tolerate emotional cracks
Most of us have spent some time thinking about our own deaths. We do it with a sense of dreadful curiosity, but then we push it aside with “well, we’ve all got to go sometime.”
Unlike most people, I probably know the how, the why, and maybe even the when of that event. It is profound information that turns the world upside down for us, our families, friends and caregivers.
I have …
The simple act of truth in the face of incurable cancer
As an oncologist who also runs a sexual health clinic for women treated (or under treatment), I am discovering that my perspective on both issues of cancer treatment (and survival) and life after cancer (and quality of life) is somewhat unique. I am conscious of how difficult it is to bring up cancer therapy and survivorship (let alone sexual health) within …
Sexual health in women treated for cancer
Andrews was easily the most anxious patient I took care of that month, a gray Michigan February (is there any other kind?) which I spent in the hospital caring for patients admitted to the general medical ward at the Ann Arbor Veterans Affairs Medical Center. (Andrews is a pseudonym, as are all the patients I blog about, unless otherwise indicated.) He had plenty to be anxious about, too. His leukemia …
I let my hope and optimism interfere with accurate communication
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 …
Beware of hidden agendas in cancer support groups
The cavernous hospital amphitheater in Tel Aviv, normally used to screen videos and new surgical procedures, was illuminated only by tea candles floating in decorative dishes of water on a recent Wednesday in January. Hundreds of doctors, nurses and other medical personnel filled the seats, as usual. But we had not come to learn the latest life-saving technique.
Dr. Ofira Ben-Tal, one of Israel’s leading hematologists, had lost her battle with …
Are physicians more afraid of death than the general population?
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I have been married and practicing medicine for 32 years and during that time I have learned lessons that equally apply. First, listen carefully; both wives and patients need to be heard. Second, prepare and think before you speak; as the saying goes “put brain in gear before operating mouth.” Finally, perhaps the hardest lesson of all is, when necessary, be 100% inconclusive.
Any man or woman, who has been in …
Marriage and medicine: Both are not exact sciences
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 51-year-old man is being followed in the hospital after receiving chemotherapy for acute myeloid leukemia 1 day ago. Kidney function was normal at the start of his treatment, which consisted of normal saline at a rate of 200 mL/h and rasburicase on the day of chemotherapy. He reports no symptoms except for some …
MKSAP: 51-year-old man with acute myeloid leukemia
IBM’s Dr. Watson of Jeopardy! fame has finally completed its residency and fellowships and, presumably to its creators’ utter delight, is now a practicing oncologist.
The prodigy “cognitive system” completed its training in less than a year at the illustrious Memorial Sloan-Kettering Cancer Center, and although only proficient in lung cancer right now, Dr. Watson’s career as an advisor to oncologists …
IBM’s Watson starts its medical career
I recently presented Yale Surgical Grand Rounds focused on “Cost and Quality in Cancer Care.” Amidst the talks in Washington regarding our unsustainable health care spending, and provisions of the Affordable Care Act rapidly taking hold, it seemed appropriate to start to critically evaluate how we spend our health care dollar and the value we receive in return. The data are …
It’s our duty as physicians to avoid needless tests
I believe the role that God plays in our lives is often magnified during times of great suffering. How we perceive that role is a question of faith, often strong and steadfast in some, especially my patients, but sometimes unreliable and inconvenient to others, like myself, on a journey of understanding and acceptance.
During the terminal stages of my grandmother’s colon cancer, I recall her saying, “Je pense que le Bon …
A frequent witness to the power of faith
Think you know something about oncology? Ok then, pop quiz: If you are giving chemotherapy to a patient who does not have cancer, how can you tell if it works? Ridiculous question? Not at all. The answer to that question is; “hopefully, we will never know,” and it is at the core of modern cancer care.
In the 1960s, breast cancer surgeons had a serious problem. They were doing large complex …
How can you tell if adjuvant chemotherapy works?
My phone rang a few weeks ago, the morning of January 26th. It was my brother saying “Mom has cancer in her spine. I’m bringing her to the hospital this afternoon. They’re operating Monday.”
I threw my stuff in my suitcase, jumped in the car and drove back home from the conference that moments before had seemed so important.
But before I left, I spoke at length with the orthopedist who’d delivered …
What can you say to the people who saved your mother’s life?
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