A large woman, she has soiled herself.  With practiced motion, Bob rolls his wife onto her side. Yellow diarrhea has leaked out of the diaper, soaking the nightgown and sheets, finding its way into each fold, crease, and flaw.  The room fills with odor, but the winter house remains dark; outside wind blows down the empty street. It is 2:00am and Bob is cleaning shit.  Only 90 minutes asleep, he ...

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When counseling patients and families about end-of-life care, I try to focus on a simple, clear standard.  Knowing that events are overwhelming and complex, I say,  “Look at each treatment, each action and each moment and ask; How does it improve quality of life?”  My goal is to reduce the choices during a chaotic time of life to the simple goal of comfort. For example, most families are very concerned about ...

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Not long ago a woman in my community, who was a patient of an esteemed local oncologist, died.  Let us call her “Beverly” and let us say she died of “breast cancer.”  I am familiar with the details of the case because one of my partners saw her in consult, but HIPAA and common courtesy forbid me to be any more transparent.  Beverly was very popular in our town and ...

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One of the spinoffs of being an oncologist is that you do not to take the world for granted.  Each morning, I walk around the yard and smell the morning breeze. I am thankful for my children, my wife and my own health.  I am thrilled, if occasionally skeptical, to have the opportunity to pay taxes in a country that I love.  So, who would believe I would take our ...

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10:11am Tuesday, June 5, 2006:  This was the moment Marge was told the mammogram showed a mass, which was probably breast cancer.  “But, don’t worry, the tumor is very small and with surgery and radiation, you will be fine.” 1:55pm Wednesday, March 25, 2009: This was the moment Marge was told that the breast cancer had spread to her ribs. “But, don’t worry, the tumors are small, and with hormones, you ...

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One of the most satisfying sports is to make ourselves feel better by degrading another.  What better way to make up for our own inadequacy, then to shove someone else’s face in theirs?  We see this at work, in our families, in politics and in almost every type of social interaction.  Nonetheless, it is particularly painful and tragic when we project our own fear and frailty onto someone that is ...

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I have outstanding, compassionate and dedicated partners; rarely goes by a day that they fail to teach me by their intelligence and example.  Nonetheless, yesterday, in the middle of 30+ patient office hours, one of them said, “You know there are times when I just can’t stand to listen to another complaint.”   He took a deep breath, straightened his coat, and opened the exam room door and, smiling, greeted the ...

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It occurs to me that I talk to my patients more about death and dying, than about sex.  It is not that I lack interest or an appreciation of the importance of intimacy, but like most physicians I fall into the trap of fighting the dread disease, instead of focusing on the wonders and power of wellness.  Still, we do not rise each morning planning for our demise, rather we ...

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When a patient leaves you for another physician, they simply cancel their appointments.  You might get a message that says they are moving on and, two months later, you get a follow up letter from the new doctor. However, Sam was unusual. He came in to tell me that because of my mistakes, his wife was transferring her care. What made our confrontation remarkable was that Sam was wrong. I had recommended that ...

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It is in our nature to lie.  Falsehood is one of the most creative things we do and the most remarkable of the human arts. We construct castles from ether and support their ephemeral walls on a foundation of accepted truths, which themselves are wisps of previous lies. The more we live within lies, the greater the challenge and more the harm. We pay a heavy price for fabrication.  What happens ...

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