Tuesday, May 7, 2013

Dr. Salwitz, Oncologist

Believe it or not, the morning's most upbeat post thus far is by a cancer doctor.  

My oncology day
Posted by James Salwitz, MD on May 7
Often the response to learning I am an oncologist is, “boy, that must be a hard job,” or “don’t you get depressed?” Usually that is the total conversation regarding my vocation, unless it is to add, “how can you deal with cancer every day?” The reality is that I love oncology and know it to be challenging, satisfying and emotionally invigorating. In the office today, I was reminded of the uplifting and even humorous side of my job. 
The day began with Ida. In remission and stable, she nonetheless felt it was time she, her daughter and I had a serious and critical conversation. Ida wanted me to know that even though she was doing very well now, that I should not expect that to always continue. She said that as her doctor I must understand and be realistic that she was indeed getting old. I assured her I would keep this in mind … especially now that she has turned 101. 
Soon after, in walked 71-year-old Betty. She is doing very well and her disease is in excellent control. That is good because she is about to retire and she wants my permission to take a long road trip, over many months, all over the United States, including a sojourn to Alaska. I reassured her that the prolonged jaunt would be OK. Betty said was greatly relieved, because her family has been concerned about her driving her motorcycle too far. 
Joey came in, now four years after treatment for Stage III metastatic testicular carcinoma. He and his wife looked happy and healthy. So did 2-month-old Joey Junior, who managed to sleep, despite the excitement and gushing love of our front desk and nursing staff. Instead of cancer, a community grows. 
Then there was the wife of my patient who was extraordinarily happy that he has recently been diagnosed with sleep apnea. I said, “Oh, he has been keeping you up with snoring, has he? Now that he has a diagnosis he will get better rest.” “No, that’s not the main thing,” she said. “The really wonderful part about sleep apnea is that with that mask on his face all night, maybe he will keep his hands off me.” Good luck. 
I saw a very frightened couple, Dan and Doris. Dan learned yesterday he has colon cancer. After the “reassurance” of a well meaning friend (“it doesn’t matter what they tell you before surgery, they always do a colostomy”) and an ill fated visit to the Internet (“if you are having any bleeding it means the cancer has spread”), both of them were a complete wreck and almost unable to walk into my office. An educational and supportive 90 minutes later, they strolled out the front door with, I kid you not, broad smiles on their faces. Lots to do, but his prognosis is excellent and a colostomy unlikely. 
Edna was in the office to start treatment for her lung cancer. She had a shaking-chill reaction to a drug only 10 minutes into the first chemotherapy. She and her husband were impressed and reassured by the immediate, professional and successful response of our nurses. The couple left the office, after the chemo was complete, believing that maybe, just maybe, things would be all right. 
I teased Bill that the chemo must not be working very well, as he still has a few strands of hair. “Perhaps, I will have to increase the dose.” Rushing to his defense his wife glared at my proceeding scalp and said, “Don’t listen to him Bill, he’s just jealous.” 
Ron is nearing completion of treatment for his aggressive non-Hodgkin’s Lymphoma. One cycle of chemo to go. I sympathized with him, making sure he understood that I appreciated how tough things had been. He was not convinced. “Doc, you have no idea how hard this has been, and how much I have had to give up. Thank God it’s almost done, because once I get rid of this cancer I will finally be healthy enough to smoke.” What we have here is a failure to communicate. 
83-year-old Margaret and I have been together through three cancers over the last 20 years. She is in remission and doing well. Sadly, because I consider her a friend, she is moving to be near family in South Carolina. Today, she asked me to find an oncologist in her new hometown. “That will be no problem,” I said, “Although finding a doctor who is handsome enough to match your beauty, may be hard.” “That’s OK,” she said, “I’m sure he’ll be better looking than you.” That’s going to leave a mark. 
Oncology; Part patient; Part family; Part community: Part of the story of man.

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