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.