Monday, April 03, 2006

Monday, April 3rd, 2006


"Picture: University of Pittsburgh Hillman Cancer Institute"

First day....

8:30 am, Presbyterian hospital:

A 52 y.o. lady, previously healthy, was just diagnosed with an esophageal adencarcinoma. The primary team just gave her the brief news, and promised her the oncologist will come and address all issues.
My first patient as a fellow.

The patient looking at me after I was talking for at least 10 minutes, explaining about the cancer, the options of treatemnt, the side effects of treatments...etc.
"well, doc, I really appreciate the detailed information, but what I need is an answer to one question". Still looking at me, "why me? I never smoked, I always tried to eat healthy, live healthy, so how come I got cancer?".

10:30, Hillman Cancer center:

A 53 y.o. lady, with a diagnosis of active chronic lymphocytic leukemia (CLL), is being given the pre-transplant education.
"So, the immediate mortality from the mini-ablative procedure is, as you see on the graph, 10-20%, with a response rate of 30-35%, and the rate of GVHD side effects is this, while the failure is that...ect etc", Said the transplant attending.
The lady calmly says "with all my respect to the statistics you're giving, Doc, I really don't care. What I care about is where I fit in this graph...with 10-20% unlucky poor who will die, or those who'll make it? Where do I stand? Can you tell me?".

3:15 pm, Still in Hillman cancer center:


An 81 y.o. gentelman, with a history of myelodysplastic syndrome, just got the bad news that his disease transformed to acute myeloid leukemia (AML). After I examined him, and talked with him, he grabs my arm, and says in a weak voice " I'm not dying, doc...am I? I know you won't let me die...right?"
"this is just my first day..." I was thinking. Never dared to say it, however.

What a day!
I felt so limited in what I can do.
How much I need to read.
And still, how much I need to learn, from the patients!
How much we miss the whole point, and concentrate about their least concern.
Do we treat cancer, or people with cancer?
I definitely learned today I'm ought to talk more to patients.
Meanwhile, Ghassan, Mirvat, and all the people in cancer research, we need your help guys...
God knows how much we need you!

Ok, tommorrow is a new day.

(I apologize from my friends with nonmedical background for using medical terms here, but those were just presented to the poor patients as such)

6 comments:

Ghassan said...

How scary that in science I feel so far from reality, from patient-reality that is... from what you're talking about.
and who knows one day I might end up studying drosophila wing development, just because the metastasis screens I'm doing led me there...

Mirvat said...

yes hashem. it's so sad that science is so uncoupled from medicine and clinical applications so that we don't really feel that we're doing much difference. i hope that on the long run, science and small steps like the ones we take, are going towards a better understanding of cancer, at least.

hashem said...

Ghassan,
Science has become so vast that we had to separate, and here the problem started.Drosophila wing development? why not...as long as you'll give me something that will benefit a patient....
I can't stand research for the sake of it...it's a research searching for something...

Mirvat,
You are making a big difference...
and every single step counts...
at least I always blame you in the lab for not getting us all the answers and treatment for cancer...;)

Anonymous said...

Why are we so afraid of death...why?...its the wheel of life...why we in medicine take it as defeat of some sort...sometimes we need to let go...to me..western medicine knows to value life but forgets abt valueing death...and no i am not saying we should not fight disease...but why dont we understand that death is not always a defeat of medicine rather a celebration of the life in its utmost glory....

hashem said...

Anonymous,
I'm not sure anyone of us said he/she are afraid of death, and not sure where did you get this.
I was presenting the patient's concern...their fear....their deepest deepest fear...
Western medicine afraid of death? Well, no my friend....we in the east are much more...
here, it's legal to have a living well saying I don't want much to be done, and doctors are allowed to take this decision if they feel the sitiuation is futile.
btw, why don't you put your name?

Anonymous said...

the 53 y.o. lady made a very important remark statistically, telling patients the mortality and morbidity rate does not translate to anything on personal basis. If one was told that their procedure is successful in 10 out of 100 patients who is to say they are the 10 or 90? People are not grouped in distinct samples and samples are not a true representative of the population as statisticians claim. When it comes to the individual it is always 50-50 either you make it or you dont....ma hek hashem?