Allow me to describe a recent case and ask your opinion.  Today, you are the intake nurse at hospice and you are asked to evaluate Stan.  This gentleman has incurable cancer, but treatment would probably prolong his survival.   However, Stan has refused that treatment and been referred to you.  It is your job to decide if he is “hospice appropriate.” Why has Stan refused therapy?  It is not that he denies ...

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Have you ever had a conversation that rattles around in your head for days? Maybe, it changed what you thought you knew about the world.  Perhaps the ideas or comments did not make any sense.  I had a discussion last week and it seemed that logic stood on its head.  The means was defined by the end, with no connection to the beginning, or more exactly, the tail wagged the ...

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It happens, now and then; not as often as one would wish, but occasionally.   In other professions, a perfect day is when you make that super sale, finish a protracted project, win an important race or craft a special, remarkable piece of art.  An oncology perfect day can be without bells, whistles, pats on the back, nor cash register’s whirr.  Some of the best days lack pizzazz, vibrant emotion or ...

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Hot oil splatters as thick fatty fish slips into the smoking pan, next to boiling rice and simmering garlic greens.  Quickly golden, she flips the fillet and turns down the heat.  Small feet pound down the stairs, drawn by the crackling aroma, but it’s a mother’s trap; she motions the child to set the table. One by one, the family gathers, as plates and utensils clatter onto the wood and ...

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On December 23, 1971, President Richard M. Nixon signed the National Cancer Act of 1971, and declared the "war on cancer."  The allusion to combat appealed to the soul of the American people not long after their success in World War II and the humiliation of Vietnam; they intuitively understood the sacrifice, teamwork and massive effort, which is implied in the concept of War and they were ready for another victory.  Committing dollars, ...

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Today, I hesitated to refer a patient to hospice. The patient is perfect for that model of care.  She has strong family and friend supports, multiple opportunities to maintain quality, independence and dignity, and while she has a disease we cannot fix, she will do very well with personal palliation. Nonetheless, I almost did not recommend hospice, because I realize that hospice is going to completely fail to take care of a ...

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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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