Mo About Cancer

Category: Perspectives

  • Unsolicited

    I did not have my regular clinic today. I was in Ottumwa yesterday as part of a mini-medical school bringing the knowledge of melanoma and cancer to the public. We were supposed to go to Creston this morning but that was cancelled so I had a day to play catch up. I went to work in jeans, sat in front my computer and began checking the usual things, my inboxes in the electronic medical record and my email. Our emails are plagued with spam, despite all the mechanisms that we have in place to stop what we do not want to come to our emails, we are bombarded with unwanted things. I spend more time deleting emails than I do reading them.

    Cancer finds ways to prevent itself from being deleted. We have so many mechanisms in our bodies that act to prevent cancer from forming. Despite these, cancer manages to trick the system into accepting it as part of the body. Like Spam, cancer is real and disrupts the organized tissue that is trying to maintain how cells behave in a tight environment. As I was deleting what I felt unneeded I remembered that our body goes through a similar daily process of removing cells that have a tendency to cancerous formation and this is an active ongoing process. It requires energy. I humanized the feeling that this is tiring, annoying and maybe the body as myself becomes lazy or just bored with getting rid of all this. I thought out loud, how can I minimize this with less effort from myself!

    Perhaps instead of attacking a cancer that has established itself, one should work on enhancing the mechanisms that remove cancer formation from the very beginning. This would be like redirecting spam away from my viable inbox and save me from deleting them myself. Research in understanding these mechanisms are difficult but we are making exciting progress in immunotherapy. I reflected on the talk I gave to the audience that listened. Fascinated that I talked to ages that spanned 12 years to 80. Their questions penetrating and deep, catching me off guard. It was refreshing to know what they needed to know, what myths to dispel, and what unneeded information to block. It was an active interaction. My knowledge helped them remove spam from theirs and fortified a more secure picture of what cancer really is.

    Mo

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  • Interception

    The little interactions with my patients are the highlights of my clinic. They help me in knowing them as people, understanding the pattern of disease globally and managing the side-effects that they could face. More importantly it is getting to know how they view their disease. Many of the therapies that we as oncologists give are as toxic and cause symptoms that can mimic the cancer coming back. It is hard to separate sometimes what is the cause of the complaint that people present with, is it the cancer, or the chemo? It takes time, a skill and patience. Providing the right atmosphere for the patient to talk is crucial for them to share freely their complaints. Providing a supportive and encouraging state, makes it raw and uncut but always honest.

    Today one of my patients inferred that his disease was not responding to the chemotherapy that I was giving him. I listened, and let him narrate what he was feeling. He was feeling weak and had lost weight. I asked him some questions and he began to describe his symptoms. He described a high and low, like being on a roller coaster.  What appeared to me was a difference in the interpretation of his perception of what might be happening. I guided and steered him away from making assumptions, allowing him to tell me exactly what he was feeling. We juxtaposed his perceptions with what we both knew objectively and we worked together to a common ground where things were clearer.

    I intercepted. I gave him my opinion that I felt what he was describing seemed more like the symptoms I would expect from his chemotherapy. I watched his face change expression. A relief came over him. “I trust you” he said “So you think I should keep going with the therapy?” Nothing had changed, it’s important to do the evaluation of the disease at the right time to make the correct deduction on whether the therapy was truly helping him. I stood by my recommendation, explaining carefully that it is hard sometimes to separate chemotherapy toxicity from cancer symptoms. His faith in the therapy seemed renewed and I said “it’s best not to cross the bridge before getting to it first”.

    Mo

     

     

     

  • Reconciliation

    I shared an email I received from a patient’s wife in clinic today. That patient had passed away a few years back. We were all sitting in clinic going about our daily business. The email asked me to say “hi” to everyone. I had forgotten about it but then someone reminded me of him. So I pulled it out and I shared it out loud.  It tugged at us and told us “you are always in our hearts”. As I was reading I was unaware that Wendee my nurse had started to cry, she sobbed “don’t they know that they never leave us too?”. Everyone around me was silent, and I said “I think they do know”. The email was gracious, magnificent if you asked me. She was telling me that she loved my blog and that she felt her husband beside her as she read it, that his children, when they grew older, would read it too. She thanked me for the years I gave them together and how she held us in her heart, of how we are always on her mind.

    I take the bus home on occasions. It was a strange ride for me today. I could not shake the feeling of this email, it stayed with me. I had read this alone and it had a different effect. It was Wendee’s words that were echoing in the hollows of my mind. I stared at the advertisements that were plastered on the bus. One said in bold letters “have you ever saved a life?” My thoughts floated away, I remembered a younger version of myself talking to this man as a brother and confidant. I remembered our bond, our relationship. Paul Coelho a Brazilian lyricist says “When a person really desires something, the entire universe conspires to help that person to realize his dream.” This was this man to me. He was a pragmatic man that understood his fate, but he realized a dream that I could not possibly understand. Here was his wife thanking me for years I gave. Yet I felt I lost the battle. The truth is no I did not “save” a life.

    The bus stops close to my home but a walk away. I crunched through the cold, walking to my house. Thoughts and images of my interaction with him. I miss my friend. What a man he was. A man of my age, his wife still thankful, still appreciative, still supportive. “Do they know they never leave us too?” And I reconciled that disconnect that I have. I felt I failed, and she felt I won. Simple exchanges from one human to the next make a difference far greater than one can expect. I really appreciate the kindness, in helping me feel a loss is a victory nonetheless. 

    Thank you.

    Mo

  • Inconvenience

    Last night it seems one of the pipes connecting our water heater froze in our home. What an inconvenience! Stranded I was unable to go to work this morning. Commitments needed to be canceled, meetings moved and rescheduled, I disappointed many but this is important, we have no water in the house and I needed to stay home and wait for someone who understands pipes to come and tell me what is going on. I needed a specialist who could help me evaluate and manage my problem. But I had to change my plans and my day is not going as I had wanted it to.

    When my patients are on chemotherapy (chemo), they are at the mercy of the cancer, the side-effects, their blood counts and the specialist. What I am feeling now is an understatement to how it must feel for them to be stranded with a situation that they have no control over. My patients make plans and have lives outside of their cancer that they really do not want to interrupt to be hospitalized and receive chemo. When they come all prepared to be admitted for their chemo, sometimes they do not get what they want. I have many a times delayed a chemo regimen and offset plans that they had. I see how frustrated they become and hear them say “but this means I am going to miss the wedding now”.  This is an aspect of my job I do not enjoy. Most patients receiving chemo are healthy and live active lives in between cycles, and I have stressed that they don’t let the cancer rule their lives, and that they should plan and we will work around their plans. That is easier said than done. Cancer interferes, ruining moments and events and it does not have a schedule.

    In delivering chemotherapy to a patient an oncologist will try to stay on track but what patients don’t know is we sometimes have “wiggle room” as I like to call it. We can add a day or subtract a day to get things to accommodate some plans that my patients have. So when they come back for an unanticipated admission or are delayed for things beyond their control I do enjoy giving back “wiggling” their plans back into their lives. The plumber said he would be here at 9am but showed up at 10:30am. The weather is bad today, the roads slick, and cars in ditches, but he came through. He has taken up half my day, but he came, and now the hot water is back. I do strive to ensure that all my patients driving through their bad storms get to where they need to in the end. While the outcome can be as bright as simply fixing a problem to help a patient reach a goal that they wanted – it does make for a better day.

    Mo

  • A confession to a friend

    Dear Hannah,

    Where does one start to talk to you? I guess simply saying happy birthday might be the easiest place. Last week Iowa read about you and it was refreshing to see how they were saying we miss you.

    I remember when I first met you; I kicked your family out of the room so you and I could talk alone. Something tells me you liked that, and you felt I wanted you to tell me what you wanted from me as your physician. I acknowledged your adulthood and maturity. You had grown too fast while facing your cancer. That day we formed our bond of trust. I am honored to know that your family shared with me that you valued what I had to say. I felt very deeply about you and I was hurt badly the day you left us.

    I read Molly’s blog with a deep admiration of her courage and how she wanted to grow.   I mustered up the courage to talk to you in a letter sharing my thoughts that have needed to come out. It is my way of closure. You stretched my heart to a place it had never been, your search for hope in me made me realize how we believed in each other. Knowledge of things sometimes makes it harder to watch what actually happens. I confess that I struggled to tell you in part due to how I felt. Your amazing spirit, the love of your family gave me the strength to do so.

    I remember the love around you. The fear, the kindness and the respect. I remember your quiet demeanor.  On the day I knew it would happen, I stood silently beside your bed. I fought back my tears as I watched your shallow breaths. I sent you a million prayers in my heart, my eyes talked to you as I stood there in my own language and I said goodbye. Something I have done to so many who have allowed me the privilege of being a part of it.  

    Perhaps I am realizing now that I can talk to you every day. Through those who love you and care.  

    Dear Hannah with love from Mo.