“Bongi, I have a patient who came in last night with appendicitis. Can you operate him for me?”
My colleague was known to load shed and mostly I didn’t really mind. That day, however, I just didn’t feel like any extra work, so it took a bit of effort to fake enthusiasm.
“Sure! Any time.” I lied. “Anything special or straight appendicitis?”
“Well, I saw …
The gift of a smile is really not that small after all
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 …
When it comes to my patients, waiting is unacceptable
A loyal reader sent me a doctor-written column with the provocative headline, “My Patient, Killed by The New York Times.”
First, keep in mind that the website that posted this, Mediaite, is all about the media covering (really fawning and dishing) itself. The purpose of this story, with its provocative headline, sad outcome, and mea culpa tone, is to generate “buzz.”
Then understand that this is a story of one patient who made …
The New York Times didn’t kill this patient
God helps those who help themselves.
-Something that sounds like truth but fortunately isn’t mentioned in any religious text
“I’m gonna beat this thing again, Doc! I just know it!”
Over the course of several years, I helped care for a man with a very rare cancer that recurred over-and-over. With each new tumor, he became more focused on beating the disease and despite the repeated setbacks, he remained eternally positive. He spent …
Cancer patients who are positive in the face of terrible adversity
The first instinct of a bureaucracy is self-preservation, and health care bureaucracies are no exception. This rule applies not only to government agencies, but to academic and industry settings as well. This was the conclusion I came to after listening to a panel of scientist and physician “whistleblowers” at the Selling Sickness 2013 conference in Washington, DC.
One by one, they described their painful discoveries that widely prescribed …
Empower whistleblowers to improve the health of all Americans
As we embark on our cancer journey, writing can be a way to help us understand, work out issues, and help us accept and come to terms with our fate. The wide variety of blogs and discussion fora, whether religious or secular in outlook, optimistic or pessimistic in tone, medical or emotional in emphasis, all reflect the richness of our individual lives, circumstances and perspectives.
My cancer journey was no different. …
The evolution of writing during a cancer journey
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 65-year-old man is evaluated for a 2-year history of daytime somnolence, snoring, and apneic episodes during the night as witnessed by his wife. He does not have blurred vision, tinnitus, or headache. He has no cardiopulmonary symptoms and does not smoke cigarettes. The patient has hypertension for which he takes lisinopril and atenolol.
On …
MKSAP: 65-year-old man with daytime somnolence
At tumor board recently, we discussed what we tell our patients about prognosis. Some oncologists give detailed information, including specific survival times. Others never discuss the future, and let the events of the illness teach patient and family. All try to adjust what they say by what the patient needs, because each physician expressed one core goal; “Whatever I say I don’t want the patient to lose hope.” I thought …
The fine balance between hope and cope in cancer patients
An email was waiting for me one morning from my wonderful nurse, Laura. “Very sad day,” it said in the subject line. I opened the email quickly upon receiving it and read that one of my patients had died. This age-old dilemma again made me wonder what I should do: Should I call the family? Send an email or a card …
The importance of saying goodbye at the end of life
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 …
Caring for the emotional needs of a cancer patient
It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity.
The woman lying on the gurney was motionless. Her chest moved up and down with a timid but halting regularity. The calmness of her face was in sharp contrast to the panicked despair of the …
When end of life approaches: 2 pathways of care
You might be surprised to know that I’m lying here in bed still thinking of you two weeks after you’ve died.
During the month that I watched you die, I often wondered what it felt like to be you, with your deep, husky voice, rounded belly and stubborn anger. You’d once owned your own mechanic shop; now you were sitting here in a hospital bed, staring up at the medical team …
I tried to find peace in the loneliness that comes after a death
Dad didn’t feel like dying. He felt full of life and longing to live. He had more to do, more to say, more to feel, to taste, to write, to experience. He was angry and sad, disappointed and confused, scared and brave, unaccepting and, finally, accepting.
For the past three years, I talked to him daily to be as close as I could. I listened as he told me everything he …
Accepting the inevitable: The last days with my Dad
ADVERTISEMENT
To state the obvious: 1) most advanced cancer patients have pain, and 2) we have excellent pain medications which can effectively treat more than 90% of cancer pain. Therefore, most patients with cancer receive proper prescriptions for pain. Obvious, yes? True? No.
In Europe, Australia and North America narcotic analgesics are widely available, and frequently prescribed. While there is access, many patients, particularly those in certain groups such as seniors and …
Do most patients with cancer receive proper prescriptions for pain?
Suffering from chronic pain or illness—or, as is often the case, both—can feel like a full-time job. One reason for this is that we must constantly assess and evaluate if we’re managing our health and our relationships as skillfully as possible. This ongoing decision making makes up a major part of the workload in this full-time job—a position we certainly never applied …
Being chronically ill or in pain can feel like a full-time job
I knew he was sick when he told me he’d thrown out his cigarettes on account of how badly he felt.
Mr. P had gotten used to the breathlessness when he climbed stairs and the hacking, dry cough that followed him everywhere. What else could he expect after smoking three packs a day since he was six years old? But he had shown …
Smoking has become hidden in the shadow of obesity
One of the toughest situations in oncology is the discussion about next steps, particularly when it comes to treatment of recurrent or metastatic disease. I believe very much that it is realistic to offer a patient the hope of cancer as a “chronic disease,” that treatment can result in disease stability, even though I cannot predict how chronic “chronic” is.
I was …
Physicians: Improve the experience of communication
Disclosure. I am a pathologist, and I work at the interface of molecular oncology and information technology.
Approximately 600,000 American cancer patients emerge uncured from standard of care treatment by medicine, surgery, and radiation each year. That is 1,600 every day. What then?
Enlightened palliation on the way to hospice care does make sense for many. But now there are additional options based upon emerging science.
Molecular testing of the actual cancer tissue …
Pathologists face a stark career choice
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 …
What would you do if this was your parent? I honestly don’t know
“Look at all those beautiful little white flowers,” I said to my wife. “I don’t remember seeing them there before.”
In the neglected ten-by-thirty foot corner of our garden, a crop of white flowers began to emerge toward the end of the summer.
“You never saw them because they are weeds,” my wife said.
“What do you mean … weeds?” I asked. “They are beautiful!”
“Weeds …
Leukemia crept into my home and attacked my wife’s body
Get free updates delivered free to your inbox.
