Today in the life

When things get to be a little too much I have a secret for getting by, for coping with the mess and pressure. It may seem strange, given the tasks of an oncologist, but if I am honest with my readers, and myself, it helps every time.   When push comes to shove and the world closes in, I go to work.

That sounds ridiculous … a doc finds reassurance, focus and hope seeing patients who are fighting the dread disease?  However, people with cancer are people still, except on steroids (often literally).  They are fighters, thinkers, a little crazy, and a daily inspiration.  Yesterday was a great day and I thought it only reasonable to share.

Early in the morning, I saw Barbara.  She indicated that she wanted to stop the treatment she is receiving for her breast cancer and try an exciting new alternative she discovered on the Internet.  Barb is very concerned about the side effects of chemotherapy.  The new therapy is a mixture of cod liver oil and pistachio ice cream.  I think side effects may be the least worry.

When asked why she was an hour late for her appointment Betsy complained that her “wings” had grown quite tired.  I must conclude that she now has to walk, instead of fly.  I changed the dose of her medicine so she feels stronger.

Allan and Sue were in.  They are world travelers, have been essentially everywhere, and have lived with primitive tribes on two continents.  They are both recovering from complex environmental diseases.  Allan became critically ill with a brown recluse spider bite.  Sue got the malaria like disease, Babesiosis.  Despite their many voyages, they acquired both problems at home and in their own garden.  Somewhere deep in the Congo a doctor is telling a man, “Hey, if you are planning to go to New Jersey, you had better get your shots.”

Ester was in.  She is 99 years old.  She was worried about her heart and asked me to listen carefully.  After a minute or two with my stethoscope to her chest, I said, “Well, Ester, I hear a clink.”  “A clink?”  “Yes indeed, a clink.”  “Is that bad?”  “No, that is the normal sound of your heart, when it is made of gold.”  She seemed reassured.

Not long after a somewhat anxious patient wanted to know why I kept tapping on his abdomen during the exam.  What was I looking for?”  I told him I really had no idea.

Taking my own advise, in my recent blog, to talk openly to patients about their sex lives, I asked 67 year old Joan, whether, despite her cancer therapy, she and her husband were intimate.  After a moment of thought, she explained that while those days were past, she was able to get a great deal of satisfaction from a particular new slot machine in Atlantic City.  “If you play that game with the maximum bet and you win anything at all, the whole thing, even the chair, starts vibrating so much that I swear the machine is having an orgasm.”  Safe sex?

Merlin was in.  His cancer is in remission. His diabetes is under control. His heart is in regular rhythm. He has lost 38 pounds and can walk three times as far.  He is miserable.  I asked him why.  “Come on doc, look at how I am living?  What kind of a man has to order berries for desert.”   A point well taken.

One of my partners sent an urgent text regarding a suddenly ill patient.  Apparently, the gentleman was being rushed to the hospital because of the side effects of “clogging in the ravine.”  The makers of the chemotherapy drug, “cladribine” may wish to call the Spell-Check folks.

I was honored to see Brad.  A life long volunteer and mainstay of a local rescue squad, he rode with the ambulance 3 times in the last week, attended a long and difficult planning meeting and ran a benefit for children with Asperger’s.  What makes this astonishing is that he recently received a liver transplant and he is on aggressive chemotherapy for metastatic cancer.  There are no words to appreciate or express my appreciation and respect.  I would long ago have crawled into a hole.

The last visit was a new patient with lung cancer.  He started the meeting off asking me in an urgent and pressed manner, whether I was a “lumper” or  “splitter.”  A lumper consolidates data into its basic parts and a splitter breaks it down into minutia.  I answered that I was a lumper in conversation and teaching and, like most docs, a splitter in analysis and decision-making.  He was satisfied with that answer. He said he might not have much time to go, and did not want to waste it on long, boring, discussion.  I considered explaining myself more clearly, but decided he might not appreciate the detail.

I end such days tired, but always thoughtful about what I have heard and what I have been taught.  An oncology office is indeed life on steroids and remains an astonishing and uplifting experience.



  • Liz
    LOL Barbara - Hope she doesn't ruin the ice cream by pouring the cod liver oil over it. Geesh they need to teach more science in school. Betsy - hey - why wasn't I given wings to fly when I started chemo - no fair!! We must have the discount chemo around here since my onc doesn't hand out wings. Allan and Sue - Personally I think we might need shots just to go to the ER/hospital - that place collects sick people, all sorts of germs, bad food, land sleep deprived docs who make decisions as if they were legally drunk (documented research finding on the cognitive decline that happens due to missing a night of sleep) - not to mention lots of people die there, come out missing body parts... It is down right dangerous there . Brad - as for crawling in a hole, no you probably wouldn't do that- somewhere along the line you have to learn how to put one foot in front of the other and keep going... (speaking as a single parent who had to do chemo, had to put my 40 hours in even the weeks I was out two days having chemo, had no help and did chemo alone...) you learn to do that - not because you want to, but because you have to. And whatever you have always done with your life (good like Brad, or otherwise), you learn to keep doing it because one way to forget, even if it is just for a moment, all the cancer crap is to do what you have always done, to the extent it is possible, because then you can pretend, even if only briefly, that life is normal. And if you are very lucky, you won't be thinking about cancer even once during that particular moment in time.
  • The benefit for children with Asperger's Brad....much needed and I am going to reference a situation to plea for law enforcement to be educated about this. A neighbor. Out of control. I watched as the EMT's took her downstairs tied onto the gurney with panty hose, in her underwear, a cupf over her mouth. Her Mom inside with a woman PO holding a 'collar' restraint to restrain her if she tried to protect her daughter. Fear should not begat humor in brutality. Off the subject but... Another insightful post!
  • Mary
    I hope that my new PCP-an internist-has your sense of humor and compassion. I see him Tues. My main concern is that he practices MED 101, no matter what his opinion is of me. it's so nice if you can smile with a doctor or laugh together once in awhile. If my thyroid is controlled, almost everything else falls into place. When I was on the phone with his staff, they looked at my EHR, and they told me not to worry. He knows my oncologists and ENT. In my region it's getting hard to find a doctor. I am grateful to my doctors that immediately enter notes, updates, and test results in my EHR. They can see what I'm talking about, and I don't sound so crazy.
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  • Angela Evans
    Are you blogging less? I find myself looking looking for your posts more often lately and have wondered if you have cut back? Your blog is something that I genuinely look forward to reading. Thank you very much. Sincerely, Angela Evans,R.N.
    • James Salwitz, MD
      Missed one last week (my wife is running for the NJ State Assembly and it takes up an incredible amount of time). Sorry about that. Have not in any way lost my interest or excitement about writing and I appreciate the kick-in-the-butt. jcs

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