Mo About Cancer

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    Eclipse

    It is hidden, and it is beautiful. It is like a veil that conceals but it is a phenomenon worth watching. Over time we have come to understand how and what it is. Does this knowledge subtract from its beauty when we know the truth of what actually happens? I feel that it adds a dimension of appreciation that is not easy to explain.  My team and I visited a scientist lab that transported me to new dimension a place that is foreign, different and exciting.

    We walked through the halls like a maze to a room. Sometimes it feels like I’m in a spaceship walking through the different passages. What I saw was new and strange. Where were the rules? Cancer has no boundaries. Ok let me stretch my mind around what I am seeing. Can I see what I am not seeing?  Cancer is constantly redefining the boundaries of those past ideas that attempt to limit it.

    It was my first glimpse at a 3 dimensional live reconstruction of a tumor growing in a petri dish. We had grown accustomed to seeing cancer through a microscope after it had been sectioned and placed on a glass slide. This process was not 2 dimensional at all. I pushed the 3D glasses closer to my eyes as I tried to understand what it was I was looking at. Marveling at what I guess I knew all along but had not seen it to believe.

    This makes sense, of course it behaves this way, how else could it have behaved? It moves, it is not static, it is alive, and it evolves. It is intelligent. Even the scientist trying to explain it was searching for how to explain its unique nature.  I left the lab thinking to myself that the world is now round it is no longer flat. Was I now convinced that I should change how I think about this process?

    I do not know how to share the beauty of a process that is too fascinating to ignore, its power lies in that which we cannot see.  It is unfortunate because it involves us, humans, and makes us suffer. I look back at my clinic today and all those affected by cancer who have to face it with courage. It is in the hidden complexity, the eclipse that takes our breath away, when what is not seen is revealed. Just like the moon that shields the rays upon the sun allowing us brief moments to contemplate what an amazing natural process this truly is.

    Mo

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    Happy Holidays

    Dear Readers,

    Wishing you the best of holidays. I will be back blogging in a couple of weeks. ‘Til then… take care.

    Mo

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    A Good Laugh

    Let’s all laugh. It’s infectious, heartwarming and welcomed. At any time during a conversation. Throw a joke, a comment that grabs attention, a statement that has everyone doing the same action. Laughing with our hearts together as one. Today I was pleasantly taken by surprise. I walked into a room with the most delightful patient. She was on fire. Exploding with one comment after another like she was doing a standup comedy or as she said it “I’d prefer to sit down”. It was my turn to laugh. She had me reeling with laughter till I almost cried. My turn to be entertained. I loved her spirit, her joy, her courage to laugh, to face her cancer head on and to live life fully. She told me of her preparations for her holidays, of her family that was coming of the adventures she will have with cooking, food and sleeping bags.

    I needed that laugh. It removes my callous nature when faced with the extremes of this disease. Like a massage removing the tense conversations after a long day. Helping me fall asleep relieved and relaxed. Yes it makes a difference to us all in the field. To be able to laugh with you about such an ordeal. For you to see that as a way to connect and share your thoughts and secrets. You amaze me. Your insecurities and our inefficiencies the food for our amusement. But you make it happen. You add the spark. You allow me to build on the fun of it. And you share with ease your feelings about how when faced with such an adversary that you laugh. I have only you to thank for that.

    I love it when I was told “I’m 3 years disease free now, I am glad you have me to feel good about your day”. And I do feel good about that. That you all are out there, showing me the positives of our fight; that you exist. It’s like you better exist, how else could I be who I am? So I urge you, make fun of me, laugh with your heart, share with your smiles and come together as one. And if you really need to just give me a punch, you know the one I promise; I would never punch back. It’s my way of sharing with you the ability to overcome your greatest fear, of being left alone to deal with this disease.

    You are definitely not alone. You are family, thank you for making me find laughter even in the midst of the hardest time. For that I hope you soar, high and you roll in laughs as you fight your battle against something that can never take that away from who you are.

    Mo

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    Do Not Touch

    Observe. Let’s say this is the decision I have to communicate to my patient. I analyze the data in front of me and come to the conclusion that the best therapy is to do nothing. To leave this patient alone and watch their disease rather than interfere. Easier said than done.  I believe this is one of the hardest decisions I have to make sometimes, because we as a society have become used to the idea of doing something. Doing nothing is just not acceptable. Why is that? Pressure from guidelines and treatment algorithms, difficulty in teaching my students who are learning the concept of observation, and exceptionally hard to explain to the patient and the caregivers.

    There is an itch to treat. I compare it to an itch because it is hard to ignore.  I feel it.  It builds up inside us telling us to do something. We just can’t stand there and watch. Even when the odds are low, or the statistics are not favorable. That irresistible feeling to do something comes roaring from the inside. Where does it come from? Why do we listen to it? I ask these difficult questions because sometimes I think I should just shake my head and say no, leave it alone Mo. I think your best option is to watch. Allow the disease to declare itself, and show you what you need to do. “I am a good salesman, about to sell you a crappy car” I find myself quoting quite a lot to patients as I navigate this decision. I don’t want my patients to feel abandoned or dismissed.

    I have evolved in the way I treat my patients today. When I was younger I was eager to get a treatment plan in place for a patient. I believed that it was important to have that ready to help patients fight their disease. Over time I have also seen my decision-making change. I am more observant, waiting for the right moment to intervene with a therapy. I always  hope I make the best decisions for my patients. It involves engaging the patient, the family and their goals. Slowing down and trying to let the decision be made for me by observing has proven very valuable.

    To truly help you as a patient, I want to be in your shoes. So let’s reverse the roles, I am now you. Faced with a difficult disease, being bombarded with knowledge that overwhelms and intimidates.  Yes I can be that person since I am vulnerable to this disease and its effects. I self-reflect to what I hold sacred as I ask the deepest parts of me. I value my quality of life, my sense of well-being, and my vitality to those around me. I do not want to interrupt my life, I do not want to be sick or out of sorts; What would change my mind to accept a treatment, cure?  If that cannot happen, then why subject me to this treatment? What’s the goal? Doctor can you please answer me? What can you possibly offer me that may make a difference to me? Why is it necessary to put me through this? Why do I have to suffer?

    Important questions that I ask as the patient and should be asked as a doctor. Can you be me for a change?  In the eyes of this doctor I seek understandings in why I have to present a treatment that may not be helpful to my patients. Perhaps the best treatment is “do not touch”……..reminiscent of the oath I took of “do no harm”.

    Mo

     

     

     

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    Impact

    Brace yourself. Get ready. I am about to deliver news about the status of your cancer and whether you responded to the treatment I persuaded you to try. Wait for me, I know you are anxious. Understand that I bring you the truth. Good or bad it is disbelieving. And what I say cannot change.

    When looking at the statistics associated with cancer it is more likely for me to be delivering news that my patients do not want to hear but have to. I have also shared moments of triumph and victory with many patients. The impact of this news regardless of what it is, is the truth of the situation. Say it the way it is and help the patient understand. It is my experience which has proven so very valuable. Understanding mishaps and bad decisions in medicine has been a cornerstone in improving my level of the care that I provide to each patient. This is what I teach the next generation of doctors.

    What impact does seeing and telling the truth about cancer have on me? Is is the seed of my understanding that grows into a tree. It offers me a chance to improve on what I have already learned and challenge myself to do better each time. I am more than me; I am an institution I teach so many that “art” of medicine. I store all the nuances that occurred that helped shape the decision I made. I draw on so many instances where I could not find a right answer, where I saw a positive outcome in others that helped me make a better decision for each individual. “Practice makes perfect” was the old idiom.

    I thank my patients for making me a better physician for the next person I have to serve. We are partners in this reality and it is the truth that nourishes our growth.

    Mo