The surgical team filed out of the patient’s room. I looked over my shoulder to see a shaken daughter holding the wrinkled hand of her quiet, elderly mother who lay in the bed. I shuddered as I thought of the surgery her body would endure the next day. I knew I needed to return to her room later in the day to find out more about her history. After rounds ...

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“I want answers!” My mother was upset over the care for her ill husband. Previously able to converse normally, he was now incoherent and disoriented. The recent recipient of a bone marrow transplant to treat his advanced leukemia, he probably experienced a brain infection because of the immune suppression therapy needed to accept the marrow. The marrow transplant didn’t work. He was sent home from the hospital on hospice care ...

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asco-logo It usually starts with a phone call: “Doc, can I come and talk to you about something?” The “something” might be erectile difficulties or other side effect(s) from prostate cancer treatment. It might be confusion or indecision about what treatment to agree to. I always inform the caller that any of these issues are better resolved if their spouse/partner is present and ...

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1. Cancer is not rare.  Technically, childhood cancer is rare compared to adult cancer, but it’s not as rare as you think.   Outside of my work, I can think of 3 people who I know personally that had a childhood cancer.  A teammate on my high school basketball team, my sister-in-law, and a high school debate teammate.   My guess is that you also know someone from church, a coworker’s ...

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This must be my eighth cancer scare. (No, I really don’t undergo excessive testing.) Decades ago, I’d noted a possibly normal finding but dropped it after getting no response at subspecialist visits. Recently, following pertinent CME, I asked again and the physician bit. You can guess the rest. One night while dodging traffic I accessed on my phone the ultrasound report from the designated cancer center’s (DCC) patient portal, revealing a ...

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Watching patients suffer and die is not an easy thing to do. Left unchecked, I don’t think most front-line doctors would last too long immersed in that kind of setting.  First, the emotional toll would be too high to maintain over a long period of time. Second, working at the extremes of emotion doesn’t allow a physician to competently and objectively apply medical knowledge to heal disease and alleviate suffering. ...

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Recently, a patient came in around 11 p.m., just as the chaos of the day had settled, and I was thinking of rest after 16 hours of work. He was an older gentleman with vague and concerning complaints that would demand a thorough workup. I suspended my thoughts of self-preservation and stepped in to evaluate him. After an hour and a half, I had found a source of infection that explained ...

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July was an interesting month for artificial intelligence in medicine. A study from MIT found when human doctors order tests on patients, they factor in something that artificial intelligence is not currently aware of. The authors analyzed charts of about 60,000 ICU patients admitted to Beth Israel Deaconess Medical Center in Boston. By looking at physician progress notes with positive or negative sentiments in patient records, they derived scores which they correlated ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 77-year-old woman is evaluated for frequently fluctuating INRs (<1.8 to >3.5) while taking warfarin therapy. She has undergone INR testing every 1 to 2 weeks and frequent warfarin dose adjustments. She reports a consistent dietary intake. Medical history is notable only for recurrent deep venous thrombosis. She takes ...

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asco-logo In the second week of April, I headed to San Francisco where I took part in the SWOG Semi-Annual Meeting. To those who might be unfamiliar with us, SWOG is a member organization of the National Clinical Trials Network (NCTN) and is tasked in running clinical trials across disease sites and scenarios, from prevention to ...

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