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.