A perfect day in the cancer clinic

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 pulsating light.  A perfect day in the cancer clinic is when I am overwhelmingly, exhaustingly, bored.

It started with three breast cancer survivors; long recovered from surgery, radiation, chemotherapy; living full lives, in complete remission. No lumps, burns or pain. We talked about normal labs, normal mammograms and the normal lives of their normal children and families.

Then there was a lymphoma patient, four years off chemotherapy. No cough, fever nor fatigue.  We tried to talk about her plans for spring and the need for a follow up scan, but the constant interruption of her precociously articulate 18-month-old daughter, proved an intense distraction.  Her examination is fine, as best I could tell; the child insisted on sitting on Mommy’s lap, through the whole thing.

Naomi came in, anxious, because a CT scan report was read by her primary doctor as showing a growing thoracic mass.  He told her she might need a biopsy, to talk to me.  The “mass” was scar tissue left by surgery and radiation.  She left smiling.  I returned to my desk, drenched in ennui.

Two chronic leukemia patients were in.  Their leukemia’s remain just that, chronic. One is in complete remission on a pill.  He feels completely well.  The other is without any change in her blood count for years.  She feels completely well. No treatment to design, no tests to order, no side effects to explain.

A stage IV ovarian cancer patient came to see me.  She is 12 years s/p intensive abdominal surgery with infused intra-abdominal chemotherapy.  She remains NED (no evidence of disease).  Her physical and labs are benign, including CA125 at the bottom of the range.  She complained about being tired.  Apparently, three grandchildren are visiting and keeping her up late.  I have no therapy for that.

Sue was in.  She carries an unknown cancer gene.  She has survived breast cancer, lymphoma, sarcoma and melanoma.   Sue needed urgent advice regarding which vaccines to take for her trip to India.  I may have slept through that lecture, so I referred her to a travel infectious disease doc.

Joyce, the incredible, dropped by for her annual.  A carrier of the BRCA2 gene, I treated her for breast cancer, 15 years ago.  The amazing thing about her is not that she is alive and healthy.  The incredible thing is that somehow she failed to give the gene to any of her five children.  A 1:32 mortal gamble that saved suffering for each. Still, that is old news.  Joyce was out the door in minutes; I will see her again in 2015.

Renewed Alan’s medical marijuana. It is working, and he is able to eat and rest without nausea. He is looking forward to his grandson’s first birthday party.  His cancer is in control with chemo, which he gets regularly and does not need to be changed.

Nancy was there, because she felt a mass in her upper abdomen. She was concerned her kidney cancer had returned.  There was no evidence of cancer, but I have to admit the xyphoid process of her sternum does stick out a little.  That is normal anatomy and the way she has been since birth.  She left, reassured.

Finally, Mel, status post bone marrow transplant for multiple myeloma.  He complained of pain.  Finally, something to evaluate.  Mel twisted his knee skiing through the trees at Stratton.  Moist heat, three times a day, passive and active range of motion, and don’t forget to wear a helmet.

It happens now and then. Not as often as I would wish.  It was a day without new tumors, pains, scary x-ray findings, bad news or terrible fear.  No excitement, life saving intervention or tears.  A day of boredom.  Is there anything more exciting than that?

James C. Salwitz is an oncologist who blogs at Sunrise Rounds.

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