Mo About Cancer

Category: Perspectives

  • Compass

    I am always asked “what if?”  When my patients are seeking the pessimistic alternative to the situation at hand. I have also heard of patients being given ultimatums with a deadline on their time to life. I love it when they break those barriers and surpass the times “allocated”. I have not handled these questions or these situations well. I touch upon my need to provide the right answer when I am asked “what if that happens to me?” and “when will it happen to me?” My tendency is to avoid it, try not to answer it and tonight I wonder why I do that.

    Our predictive power as oncologists is very limited. In 2013 I am faced with an enormous speed at which we are discovering newer more innovative therapies to help patients. I find it hard to counsel patients in the future when there is hope for cures and longevity. This is very new for me, exciting and frightening all at once.

    How does it feel for my patient? Anxiety is one of the most difficult emotions to navigate. Failing to provide them with the answers they seek creates a conflict that is not readily resolved. Science needs to help us understand outcomes of how disease may manifest in an individual and how it acts. A lot of our therapies are geared towards attacking the cancer head on. Newer approaches are taking into account how we might be able to isolate different individuals based on the behavior of their bodies and discovering better predictors for response to a therapy. I would like to tell my patient “I’m recommending this therapy because you are the one who will benefit from it.” We are clearly not there, and a lot of work needs to be done to help us be better at guiding patients down the best path for the treatment of their disease.

    Like a compass leading in a general direction without pointing to a specific street or alley, when asked “Well what if that does not work for me what then?” I simply say – we’ll take it day by day and cross that bridge when and if we get there.

    Mo

  • Befuddled

    Cancer is a crippling disease. It frustrates us. It spares no one when it presents itself to us. For those watching and those it involves. Minds struggle with it. Others find it fascinating. It can teach you everything from finding the will to fight, to understanding the human struggle with death, to elucidating all the facts about how our cells behave. I am wrestling with this frustration today, because I could not explain what was happening to my patient. It was like entering the twilight zone.

    I sat opposite her staring in disbelief. A puzzle. Baffled. How could this be? I thought. It was not bad news. It was not good news. It was news that did not make logical sense. I took refuge in the words of those who taught me “treat the patient not the numbers”. There she was sitting looking absolutely great. The treatment she was getting was working for her. But her blood work spoke something different. Impossible; now I know what that word means. How could that be? I kept asking. I left the room walked to my computer, and started asking others what they thought. The more minds I could harness the better the decision I made felt. This is where the proverb of “too many cooks spoil the broth” failed. Here is where I needed as many cooks as I could find. This is how our collective, collaborative consciousness comes together to help me understand what I had not been taught yet.

    Some have asked how we do it. “We” the ones who are watching this process. It’s 9:52 pm tonight and look at what has captured my mind. What has me thinking, contemplating and wondering. It’s this curiosity that cannot be destroyed. It makes me walk in places no one dares to. It gives me a depth of understanding that helps me see more about human beings and life than I could possibly explain. I try and I am stumped. So I sit and watch the sun set unable to explain how, knowing in time that someone someday will say “well the earth is just revolving around itself” and that is how the sun sets.

    Mo

     

  • Stretch.

    I walked into the room and I could see that the surgeon who had seen my patient before me had already relayed the bad news. The cancer was back. The weight of this news still not complete in her mind. How could it be? She had been cancer free for so long. She had battled it once, and now she is being asked to do that again. On seeing me and my somber expression, she burst into tears. The weight of the situation finally reaching her and she gave in to her emotions.

    This cannot be happening. I thanked the surgeon for meticulously working out the plan for me as the patient relayed to me what she was to do. I could be a little lost in this struggle with the patient for a change. Sometimes depending on my day and where I am at I let myself be sucked in. It was that kind of day where I was just as disappointed at the appearance of the cancer that I identified with this person, where I was struggling with many things in side of me and I just could not say much to her.  

    I reached out to my patient as her tears flowed before me. I told her not to worry, that we would walk beside her on this journey today. Step by step. That it was our responsibility to see her through this to let us worry for her as I tried to help ease her suffering. The easiest thing to do was give her a pain pill, and that brought her around to a better place. I have often marveled at the little things that calm us when we are stressed. The soft touch of a hand, the forgiveness from a friend or the comforting words of a caring loved one.

    And she replied “I know you will Mo.”

    With the faith she had in me, and the passion in her eyes to live, we began our battle.

    Mo

  • Readers Asked.

    Instead of doing my usual blog post this week, I thought I’d change things up by answering some reader questions that have come through Melanoma Iowa (Facebook), Sarcoma Iowa (Facebook), @MelanomaIowa, @SarcomaIowa and my LinkedIn page. A new page will be added to my blog called “Readers Asked” that will include your questions and my answers. Here’s the first of many more “Readers Asked” blog posts.

    Readers Asked:

    How did you become interested in treating cancers, specifically melanoma and sarcoma? Why the focus on these two cancers?

    I decided to be a doctor at the age of 12. It was a personal experience for me that started after I had gotten stitches from falling down. During my medical schooling I was inspired by hematology the study of blood disorders and became fascinated with the cellular make up of this viscous substance. My curiosity of blood drove me to a career in cancer. During my 3-years of lab work I was asked to do sarcoma as it was the clinic that people feared. It opened my eyes to a whole new world that I found mirrored what I was seeing in the laboratory. Blood and sarcomas came from the same stem cell: mesenchymal stem cells. I would say sarcoma became more attractive as it encompassed such a variety of different types (150+ subtypes).

    Why melanoma? The science behind it is riveting, it is smart and relentless; it grew on me and has made me very motivated to “figure it out”.

    How do you have the energy to keep up with the emotions and science that an oncologist has to endure?

    I think I am very passionate about what I see in cancer and its abilities scientifically. It’s the first cell to cheat death. The science is maddening and absolutely beautiful. My patients make me “bounce” and because of that I have grown more compassionate and it helps me endure.

    Have you ever wanted to give up your job and find a more peaceful life without the stress of being a doctor that deals with cancer and all of the terrible outcomes that come with it?

    Absolutely. Many times. My wife would say I am “attention-seeking” when I tell her I wish I was a garbage man, I really do. It’s a noble job that helps humanity clean up its mess but a shower fixes everything at the end of the day and I do not carry so much in my heart. What has transpired is I have discovered that because of what I know now I have a responsibility to help those around me, it is hard for me to turn my back on all the knowledge I have acquired and my ability to deliver excellent care.

    How do you find work-life balance? What’s a day in your life?

    Ah yes, this one perhaps I will blog about – thanks for asking this. Not easy. I do thank my wife for being ground zero to come home to. It’s why perhaps I married a psychiatrist. 

    Can you give any ideas or suggestions on how the families of those with Melanoma can help support and say the right things to their loved ones fighting this disease?

    I have learned that the best ideas come from you. Those in the battle, if only doctors would take the time to listen to their patients’ struggles. You are in the best position to offer the advice for other families who can learn from what your own experience has taught you. I often connect patients together to let them talk to each other. I really do not know what chemotherapy feels like or what a side-effect is. I counsel then connect. Tell me of your experience; it likely was the right one for the person you helped in their battle against this disease.

    Do you have something you want to ask me? Email my assistant at julianna-kennedy@uiowa.edu with your question and I’ll add it to my next “Readers Asked” blog post.

  • Holiday.

    What does that word mean to me? My patients battle daily with cancer and the therapies I impose on them. Coming in for their chemotherapy; tolerating the side-effects. They grow weaker and more tired as the cycles trudge on. It’s like doing 100 miles on a bicycle ride. The first 25 miles has me saying “I can do this”, the last 25 miles I am screaming “when will this end?” That is the closest I can come to imagining what they are possibly going through.

    I watched today as I told my patient “let’s take a break, a holiday; a chemotherapy holiday”.

    He looked at me and said “really?”

    It is always fun for me to break this type of news. It’s when I get to really say “yes, you’re done with the therapy and your tumors are stable and not growing, I do not see a reason to push this treatment any further. Take a break”. I smile ecstatic, “stay away from Mo” (that brings a laugh). “Let me see you back in 8-12 weeks”.

    “Wow that long huh?” This is usually followed by a sigh of relief, and I sometimes see a small “Mo are you sure?” or the even better look  “3 months away from you, I think I will miss you.”

    It tickles me to send them off. They need this break. It’s what they fought for. They go back to life; to their days, it’s a road to recovery. Like the changing seasons. On therapy, it’s like autumn becomes winter, and off therapy it’s like winter wakes up to spring. I bet you cannot guess what I look forward to the most. Go on… guess?

    There is a joyous moment in my heart in meeting my patients 3 months after they are done with their chemo, and it truly is that I forgot what they looked like with hair.

    Mo