Resolutions of a Cancer Doctor

This post was originally published on this site


My mom was given a diagnosis of lung cancer this past year. And whether I liked it or not, almost midway through my career, it put me squarely in the position of being re-educated about cancer from the other end of the biopsy needle. It also gave me the opportunity to approach my patients with a new resolve in the coming year.

My mother lives in Rhode Island, and I live in Ohio. It took weeks for her to get her diagnosis, and I quickly found, as family members of my own patients have told me countless times, how difficult it is to coordinate the care of your loved one from a distance. Fortunately, my mom’s cancer was caught at an early stage, and I convinced her to come to Cleveland for surgery at the hospital where I work. She was discharged from the hospital following removal of the mass to my house, where she spent the entire month of May recovering.

For anyone who has never played the role of assisted living facility for a septuagenarian who has undergone a major medical intervention, it isn’t easy, either for the patient or her host. Our expectations for participation in physical and respiratory therapy diverged wildly. I had been raised in an era in which regular exercise was approached with near religious conviction. She came of age at a time when people joked about exercise: “Can’t you pay somebody to do that for you?” And it turns out that mothers do not want to be told what to do by their sons.

Even when they have medical degrees. And specialize in cancer. And are taller than she is.

And sons don’t like to see their mothers sick with cancer. Not surprisingly, it is nearly impossible to separate that emotional reaction from calm, clearheaded guidance to your own mother.

Resolution No. 1: I will never again make the flippant suggestion that it should be easy for a parent to just stay with his or her child while going through chemotherapy or surgery. Nor will I be surprised when conflict or non-adherence arises from such an arrangement.

But my mother and I got through it, she regained her strength, and returned to the East Coast. Her follow-up appointment would be in six months.

“I timed it to when I normally visit for Thanksgiving,” she told me. “And then I’ll time my next doctor visit for when I’m back for the graduation, in May,” when my older son would complete high school. I think she liked the efficiency of tying her obligate medical follow-up to her visits with us.

When November rolled round, and the skies became a hue grayer than they had been in late spring, she arrived a couple of days earlier than she ordinarily would have, for her scans and the appointment with her surgeon.

My stomach was in a knot, and our usual carefree conversations were slightly more halting. I quickly realized that this Thanksgiving, along with future ones, would no longer be a purely joyous event, one of the few times a year we saw each other and engaged in our silly holiday rituals. From here on out, it would be tinged with apprehension, as we awaited the news of whether her cancer had recurred. None of us would relax until that appointment happened.

Resolution No. 2: I will not be cavalier in suggesting that patients who live at a distance see me when they would be visiting their families anyway over holidays or for their grandchildren’s birthdays. Happy occasions should remain exclusively happy, especially when cancer may limit the number of such occasions that remain.

I accompanied my mom to our radiology department for her CT scan, and immediately afterward we took the elevator up to her doctor’s appointment. In the exam room we tried to make conversation as we waited to be seen. We talked about my kids. We discussed the wintry mix weather. We reviewed what would be served at Thanksgiving dinner. But we thought only about the scan results. A nurse practitioner walked into the room.

“Hi, the doctor is in surgery right now, so I’m going to see you today,” she said. Fair enough, and understandable. “How have you been?” she asked my mom.

“What were the scan results?” ricocheted through my head as my mom talked about returning to work and the resolution of her post-op pain.

“Tell me about your diet,” the nurse continued.

“What were the scan results?” I thought again. My mom discussed lunch and dinner.

“The reason I ask is because you have a hiatal hernia on your scans, where part of your stomach has slipped into your chest. Do you get heartburn often?” she asked my mom.

Were we really talking about reflux now? “What were the scan results” became a brain worm, repeating with such frequency I couldn’t focus on much else. The nurse reviewed lifestyle modifications with my mom that could improve her heartburn. When she finished, I piped up.

“Excuse me, were the scans O.K.?” She looked surprised that I asked.

“Oh, they were fine. I would have told you if they showed cancer,” she said. My mom looked relieved.

Resolution No. 3: I will convey test results as soon as I enter the exam room. A follow-up appointment that I consider “routine,” with low chance of cancer recurring, is anything but routine to my patients and their families.

My mom walked back to the car a little more quickly than when she left it earlier that morning. And I walked back with a lot more insight into how I should approach my patients.