A baby’s smile reflects the purity in their heart.   An infant’s world is a marvelous place of possibility and love.   Children see themselves as special, capable, even omnipotent.   Time teaches failure, loss, and mortality.  How much we lose of that original perfection, that first excitement, that natural confidence, determines how we face the challenges and tragedies of life; whether we will be happy.  It may even determine how we cope ...

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I knew immediately it was a problem.  It was not just that Faith’s cancer had spread with innumerable masses in her liver, golf ball-like tumors in her lungs, punched out holes in her bones.  It was not that the chemo, third round and toxic, had failed.  Those were awful things.  Rather it was her response as I began to tell her.  As soon as I said, “I looked at the ...

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Once upon a time, I was a lifeguard.  This was the natural result of swimming fairly well, Red Cross training, and team competition.  I saw myself as a handsome, tanned guardian at the ready.  OK, I was prone to self-delusion.  When I became a doctor I carried over that image of high-perched protector on stilt chair, whistle in hand, rescue float close, ready to dive to the assistance of a ...

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I have written many columns urging doctors to be honest with their patients, especially about difficult news.  Too often patients are lead on false hope therapy rides, rather than empowered with honest information so that they can cope with their disease and future. Doctors are not the only ones who can keep a painful secret. I admitted Sarah to the hospital late on Saturday night.  For over two years, she had ...

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Kasey sits alone in the examining room, staring at the drug company calendar of a perfect Caribbean beach hanging above the doctor’s desk, but not seeing it at all. She is very frightened.  After three years of treatment for cancer, she is in trouble.   Kasey feels fine: no shortness of breath, no cough, no pain.  Still, she is there to get the report on her CT scan, and she knows ...

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For days, I have been trying to get long-term patient, Stan, on the phone; his blood work came back abnormal, and we need to repeat it.  I called the number in our file a bunch of times. The odd thing is that sometimes it rings without stopping, sometimes it is answered by a machine, which immediately beeps and disconnects, and at least once it sounded as if the receiver was ...

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I got a letter the other day from a local urologist requesting clearance for a patient of mine to have surgery.  The doctor wanted to know whether there were any contraindications, from the standpoint of the patient’s cancer, such as bleeding, infection or poor wound healing, which would preclude local anesthesia, bilateral incisions, sharp separation, ligation, and electrocauterization of the vasa deferentia.  In other words, could my patient, a 42-year-old ...

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Carrie is a 72-year-old retired real estate agent with a high school education. She raised three kids, but they do not talk to her anymore.  Since her husband died, Carrie has lived alone.  A melanoma was removed from her right shoulder 2 years ago.  In my office, we stare at the CT scan display of a mass in her right lung. “What does that mean?” “Well, we wouldn’t know for sure until ...

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It was 1:35 p.m. when we realized that Tom was not just late for his chemotherapy treatment; he probably would not show up at all.  A call from one of our staff confirmed, he had “troubles getting a ride” and wanted to move the vital therapy to another day.  This was the third time in a month he had missed an appointment, thus wasting a treatment slot, nursing time and ...

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What do we want in the last days of life?  We want no pain. We want simple dignity, the physical kind where we clean ourselves, organize our medicine and command our bowels.  As important is the complex dignity of choosing where we spend our final days, make tough decisions for ourselves and, as much as possible, live as a person, not a patient.  It occurs to me that these critical ...

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