PRECOCIOUS

I have mentioned how "little" Cate is quite advanced for her age, but this video speaks for itself. She is 15 months going on 20 years. By the way, the Picasso is her favorite... like her old man.

THE MEANING OF MASSACHUSETTS

Yesterday, Scott Brown, a little known Massachusetts State Senator, pulled off one of the biggest upsets in modern political history by coming back from 30 points down to beat Martha Coakley, the Massachusetts Attorney General, to take Ted Kennedy's old Senate seat. There has been a lot of discussion in the blogosphere (and I am sure on TV, which I do not watch) about the meaning of that decision. I think both parties will be talking about Scott Brown for months and years to come.

For the Republicans, the lesson is clear. Run hard against the President and put up likable, moderate candidates in "blue" states to try and claim the center and win over independents, who are a growing political force and who ultimately decide elections. They did not send in Sarah Palin, and they did not require a purity test for Brown, and it paid off... big, or at least for 6 years in that seat.

For the Democrats, the lesson is even more clear. President Obama has failed on almost every front in his first year. While he was one of the greatest campaigners in modern political times, he has presented no coherent message or vision to the American people. If Reagan was the "Great Communicator," Obama has been Charlie Chaplin, a star of silent films as you may recall. He has ignited the fury of Republicans and independents who believe that he is trying to insinuate government into every sphere of American life, that he is fiscally irresponsible, and that he is simply out of touch with the problems and struggles that the average American faces. I used to think that many of these excuses were a cover for racism, but I think that bigots make up a minority of those who oppose the President.

At the same time, President Obama has alienated previously strident supporters like me who knocked on doors, wrote checks, pestered family members and friends to do both these things, and who made calls to swing voters. I cannot recall when I last opened an email from the Democratic Committee or President Obama's "Organizing for America." Rather, I simply delete them because I feel as though the President has not been clear with the American people about where we are going, what we will need to sacrifice to get there, and what he is thinking. In short, on issues from Afghanistan, to the economy, to bank bailouts, and to health care, he has not led!

That said, I ultimately believe that Scott Brown's victory has the potential to be a boon, long term, for the Democrats if they learn from that defeat, get up, and move forward. Someone once said winning elections is the easy part. It is governing that is hard.

If I were the Democrats (i.e. President Obama), I would get out there and discuss what my priorities for the nation are, what it will take to get these things done, and why we need to get them done. I would engage the Republicans in debate while not expecting any of them to even feign cooperation. I would make it clear to the America people that one party has ideas and solutions to help them (taxing the Wall St. firms and the auto industry, creating jobs for the jobless, and providing health care to the uninsured, whose ranks will swell as long as unemployment rises). If the American people are included in this dialogue, they will realize who is truly for them and who is merely against the party in power, and the center will be re-claimed (see campaign 2008).

Health care reform may be dead, at least temporarily, but I do believe that a more rational and transparent approach to its incremental reform is possible. On this and a host of other issues, he who claims the microphone (not by trying to be all things to all people or by compromising one's principles so much that every political faction feels disgusted) and who fashions a narrative that resonates with the average American will ultimately win the center and the support of the American people for far longer than a 24 hour news cycle or a 6 year Senate term...

PLEASE GIVE!

The poorest country in the Western hemisphere just got its world rocked. Tracy Kidder in a nice Op-Ed in today's NYT's lays out the long history of suffering by the Haitian people due to both external and internal forces. He notes that the hospital run by Paul Farmer's Partners in Health is the only functional hospital in the country currently. Please consider making a donation to Partners in Health today!

LUCKY NUMBER 7

My office at work is also in the same building as the outpatient Oncology clinic. However, while my office is on the 14th floor, the clinic is on the 7th floor. Often when I ride up the elevator, I see patients hit the number 7 button, and my heart always sinks a little. Why? Because these folks presumably have an appointment in our clinic as opposed to the plastic surgery (5th floor ) or dermatology (16th floor) clinics, and they have cancer. However, today I was reminded of the joy that can occur on floor number 7 when I saw Mr. J., a long-time patient of mine in clinic. This will not be your typical Hollywood happy ending, but it does shine a light on what I have learned as an oncologist and attending physician on that floor.

Mr. J. came to me from a urologist at my hospital some 3 years ago. At that time, his cancer had progressed despite standard hormonal treatments. For men like him, the median survival is about 18 months. I quoted Mr. J. that statistic, but I also said that I did not have a crystal ball. If I did, I told him I would be in Vegas playing the slots. He and his family laughed at that and cried at that, but they said that they were emotional people who "even cry at Safeway openings." I treated him with 3 approved therapies and on 2 investigational protocols, in each case after his cancer had progressed on the prior therapy. He was set to try another clinical trial, but recently he was plagued by severe nausea and vomiting, which was likely due to the narcotics he had recently required to treat cancer pain. Today, we sat down to discuss where to go from here. I recommended a few adjustments to his medications, but I also said that hospice was the next step. I said that while I had exhausted all medical treatments, which could be given safely, to make his cancer go away, I wanted to continue to focus on making his symptoms go away. He and his family were tearful, but they also reminded me of how I predicted he would be dead one and a half years ago. I said I was happy to have been so off the mark.

His son went on to say that while his dad had not asked for cancer, God had a reason for bringing it upon their family. Countless people had grown closer to Mr. J. because of his cancer; several drugs completed their testing on clinical trials because of his cancer; countless staff and doctors had learned from Mr. J because of his cancer; future students would dissect Mr. J's body due to his wish that it be donated to science because of his cancer. I added that I, myself, was touched by him and was reminded of the capacity for human courage and hope in the face of cancer. In essence, I was grateful for all that Mr. J. had taught me and how he had made me realize how lucky I am to have my health and to be able do what I do for a living.

The next time I see someone press the number 7 button in the elevator in my building, my heart will not sink. It will race, as I envision all the ways that this person's life (and the lives of those who have been touched by this person's cancer diagnosis) may have been blessed. There is beauty in that.

GOT HEALTH INSURANCE?

I met a patient while on call this weekend named Mr. M. He has a newly diagnosed sarcoma wrapping around his spinal column, for which he had emergent surgery followed by chemotherapy last week. While he has this aggressive cancer, he does not have health insurance. He was aware for sometime prior to coming in that he might have something serious, but he hoped for the best and delayed seeking medical care despite new-onset incontinence and the need for a walker for ambulation.

His cancer, despite my description, may be curable as it is a chemoresponsive type of tumor called Ewing's sarcoma. However, cancer may be the least of his problems as his treatment will involve several multi-day hospitalizations for chemotherapy, CT scans, and expensive anti-nausea medications, all of which are expected to cause thousands of dollars. He will, in essence, have to spend all of his savings and liquidate all of his assets before becoming eligible for the Oregon Health Plan, our indigent medical care plan here. To anyone who opposes health care reform (I have not inquired about Mr. M's prior views on health care reform, but I am pretty sure about his current thoughts on this matter), I want them to explain to Mr. M and people like him that health care costs and lack of access to medical insurance is not a problem. For him, health care reform will not come soon enough.