Once more into the fray

I want to be politically correct about this; I do not want anyone getting the wrong idea.  Do not think I am some sort of weird-disease-fighting junkie.   Do not think I am not humbled to have the opportunity to practice medicine.  Nonetheless, as I return from vacation today, rejoin the war against the dread disease, I am thrilled.

I suffer with my patients, cry with their loss and lose sleep from their pain.  But, I have to admit that after a few days off to rest, read, walk and write, the energy which radiates from the battlefield is inspiring.  As I catch up on my calls, emails and files, I feel cancer warriors together on the attack, and the resolve that drives them on.

Each patient is different, at a different place in their care, in their lives. Some, recently diagnosed, are just learning about the disease and making plans.  I made multiple calls today, explaining first tests and next steps.  It is confusing to be a neoplasm neophyte, nonetheless I am astonished how fast people learn, how amazingly they cope, and their determination to move forward.

Other patients are in the middle of simple or complex treatments, which may have gone on for weeks, months or years.  While, they are more sophisticated in their concerns, they are often tired and dealing with side effects and healing.  Several of these patients, on active therapy, had saved questions or ideas awaiting my return.  These conversations take the most thought and discussion, because these patients and families have a greater understanding of the disease process.  As a group, they teach me the most.

Other patients, beyond active therapy, are at two completely different times in life.  The first, are those in remission, trying to rebuild.  This is often a severe challenge, not nearly as simple as just starting over.  The second group, are those whose cancer is progressing.  They and their families are making the toughest decisions of their lives, as they try to use the remaining time well.  Depending upon how they have prepared, these patients may require the most time and listening.

Amazing office staff caregivers support each of these groups of patients and families, and the break serves to remind me of the compassion of these incredible people. Clerical, administration and billing staff help patients slug through the nuts and bolts of getting things done, even when patients feel miserable; it requires real patience and skill to do their jobs.

The nurses who not only put in IVs, give drugs, clean wounds, wipe bottoms, organize the days of their patients, but also hold a hand, wipe a tear and always-always-always are ready with a gentle smile.  Technicians, housekeeping, maintenance and in the hospitals a massive staff, keep the care machine giving.  These people blow me away.

And finally, doctors.  Be they students, interns, residents, fellows or my companion attendings, the commitment of physicians to lead the war against the malignant scourge, makes me honored to stand by their side.  Be it at the bedside, in the lab or behind a desk, working 60 – 80 – 100 hours a week, year after year, they infuse their profession with intelligence, passion, and always the hope of healing.

Once more, into the fray.  Can you feel the power of numbers and resolve?  More than pale hope, feel the righteous anger, courage and selfless sacrifice!  There is a war here.  It is a war against a disgusting, pathetic foe.  It is an enemy from which we will never give quarter, never rest and never stop our attack, until the disease is no more and the weakest among us, is forever healed.



  • Alyce Kowal
    Thank God you are there to lead and to give help to all who are your patients, your practice and to the rest of us on your blog.
  • Leonard Russikoff
    That last paragraph, in boldface,provides a tremendous boost to all concerned.
  • Paula Kaplan-Reiss
    I love this, thanks. It is always helpful to see your side of it. Hope your vacation was restful! I am in Hawaii, which is the place I envisioned going when I was sick. I feel so lucky.
  • Bridget Ryan
    Cancer as war and cancer as some kind of golden light experience never resonated with me during my two bouts of the disease. Instead, I chose to be disciplined and pragmatic just to get through the grind of treatment. I complied with the medical requirements, but never engaged in the battle metaphor nor the syrupy goo of the breast cancer sisterhood. With that said, I am glad you feel re-energized and hope your team also takes the time they need to restore their spirits and strength. It is frequently exhausting and on so many levels, taxing for patients and medical staff. Each person finds his/her own route through the ordeal.
    • Well said!
    • Liz
      Bridget - like you I hate the "war" metaphor and the "makes you stronger so glad I had it" stuff as well. Can't stand wearing on my sleeve I have had and have cancers. Cancer is what I have and not who I am. It sucks, I hate it and is the reality I have to deal with. So eventually I had to learn how to cope and still have a life outside of cancer (admittedly hard in the middle of chemo). Learning to cope is easier if one's oncologist is not burned out, is empathetic and able to deal with the range of emotions cancer patients can have (including the anger, short fuse, etc. that can come with begin overwhelmed with the stress of dealing with having cancer - that seems to be harder for many oncologists to deal with). I would imagine being an oncologist can be a burnout job, just like any other job that requires high intensity caring/giving emotional support with more than its share of people dying/having really bad things happen to them along with the joys of seeing people be cured. Glad you (Dr. Salwitz) are still capable of being refreshed by a vacation so that you are able to recharge sufficiently to give patients what they need rather than have to demand they bury their emotions, needs, etc. so you can cope and still do your job because you are burned out.
      • James Salwitz, MD
        Thanks very much for the support. jcs
      • Bridget ryan
        I always open my oncology visits with a request to know how the team is doing. Sometimes I know they are sad or worn down. It's a sense of mutual care. It is so very important for them to re-charge or grieve. I appreciate being in place of honesty, although sometimes that is also very hard. Vacation is a good thing!
        • James Salwitz, MD
          Doctors tend to be so task driven that we forget to sometimes touch base with our "team." I commend you for making sure they are intact ... goes a long way towards giving the best care and retaining good people. jcs
  • Mike
    Very fortunate is the cancer survivor who knows what he or she needs at any point in their (hopefully long) journey. One year, it was the bare minimum information, another year it was all I could stomach to learn, and 9 years later, the syrupy goo helps when anger and frustration alone do not suffice. Damn right it's a war, and regardless of the outcome, the disgusting pathetic foe will have quite a fight on its hands. Thank you to all those who sharpen the sword every day.
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  • survival, braving and sometimes loosing, the war..regardless of worthiness, say..the family will discredit you..no cancer..the Dr. says "I get the baby", family to discredit you says..oh you must be mentally ill...all kinds of idiocy exists..power and control, money..I give up!
  • gopja
    Dr Salwitz, You have a passion for our career that fuels only the most compassionate, well rounded, and finest physicians. Your mention of the support staff shows that you value each player as an integral part of the team, and no doubt they sense this. I pray your enthusiasm infects the young residents, and we troops in the background will continue to cheer them on to lead the charge one day. May God continue to bless your efforts. They are appreciated!
    • James Salwitz, MD
      I hope you are right that my staff understands how much they mean to our patients and me. Somehow it is hard to say THANK YOU loud enough. jcs

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