Can narrative medicine inform quality of care? As characterized by Dr. Rita Charon in her JAMA article almost 15 years ago, narrative medicine is “the ability to acknowledge, absorb, interpret, and act on the stories and plights of others.” It is the recognition that scientific knowledge alone is not enough -- not enough for our patients, for ourselves, and for society. It stresses the importance of not only hearing what our ...

Read more...

When patients ignore the evidence: Try to understand their valuesI still remember being taken aback by how young she was. “She” was Mary -- a 28-year-old woman who had completed chemotherapy for stage II breast cancer. She was treated elsewhere and had moved cities when her husband got a promotion. “I’m still getting used to this area, but I am happy my hair came back before we had to move. I ...

Read more...

Are physicians ready for the e patient movement?I gave a talk recently to a group of my peers about addressing the needs of patients after a diagnosis of cancer, emphasizing points where transitions occur -- from treatment, to end of therapy, surveillance, recurrence, and extending all the way up to the end of life -- and how important it is to consider the entire journey of a person ...

Read more...

Twitter and cancer patients: What to make of the outrage?On one afternoon last week, I sat at my desk working on a paper when my iPhone buzzed, telling me I had a new message. This message, forwarded from my Twitter account, alerted me to an editorial published in the Guardian (which has since been removed because it was “inconsistent with the Guardian editorial code). Entitled, “Forget funeral selfies. What are the ethics of tweeting ...

Read more...

The desire to have a baby in the face of metastatic cancerShe came to see me, alongside her husband. She was 26-years-old, diagnosed with metastatic myeloma involving her bones, which had presented when she fractured her hip while jogging. Her disease had progressed on treatment and she was to start a clinical trial. Despite being pale, she looked well. I imagined she often heard, “Wow -- you look too good to have ...

Read more...

Valuable lessons I have learned as an oncologist come from patientsEvery once in a while, something unexpected occurs that shakes me to my core -- where I question the point of life, ask why we even bother; when in the end, it all just ends. This time, it happened on a Sunday morning. I woke up in a good enough mood -- the sun was shining through my windows, and my cat, ...

Read more...

There can be hope at the end of lifeI remember when Susan*, a close friend of mine with breast cancer (who had been living with metastatic disease for about a year before), was told she was  terminal. Beyond the shock and fear, Susan felt grief and anguish that her life would end so much sooner than she (or any of us) had expected. Suddenly, Susan had so many big ...

Read more...

People who participate in clinical trials are trailblazersJoan was 42, married, but appeared to be younger than that. Her husband was with her when we first met, as was her beautiful two-year-old son. “We couldn’t get a baby sitter, if you can believe that!” she said. Sarah was 38 and was also married. She and I were closer to the same age, which was not lost on either of ...

Read more...

I am no more immortal than my own patientsI was lying in bed, watching something with my son when a chat message popped up on screen. It was my dear friend, Narin, whom I haven't seen in years but remain in contact with (thanks to the wonders of social media). "Did you hear that Dave died?" she had written. "I just read it in our college alumni magazine. I am so ...

Read more...

The complicated existential dilemma of living with cancerMaybe I should’ve noticed how she looked.  “She” was a new patient, Louise*, and she had been diagnosed with stage IV cervical cancer. Only in her 40s, the diagnosis had hit her extremely hard. At her first meeting, she wanted the “truth,” and I had told her what I felt to be most relevant -- that her cancer had spread, that ...

Read more...

4 Pages