WHY I COACH

This fall, I am the assistant coach on Nicholas' soccer team for the second season in a row. This is probably one of the most - for what word I am looking? - challenging things I have taken on. It is not for the reasons you might suspect - worry about favoritism of Nicholas, worry about being too critical of Nicholas. Rather, it is because many of these boys on our team act like five year-olds rather than eight or nine year-olds.

One of the top coaches in the world is Arsene Wenger, the manager of Arsenal Football Club in the English Premier League. He is famous for saying, "I am here to help players who are motivated. I am not here to help motivate players." The life of an under 9 (U9 for short) coach is a a far cry from Anfield Stadium in North London where Mr. Wenger plies his trade.

However, despite the disobedience and disrespect exhibited by some players, I have enjoyed watching every minute of Nicholas practice and play.

Yes, his footwork and ball handling have improved, and Nicholas routinely scores goals. More importantly, Nicholas is a leader on and off the field. He does not misbehave. He listens to advice from me and the head coach, and he tries to get his teammates back on task if they act up. There is a calmness about him, and he does not get frustrated despite several blow-out losses this year and fairly crummy conditions due to the Pacific Northwest fall weather.

Nicholas truly loves playing the game of football, and he has an encyclopedic knowledge of the contemporary teams and players. He spends hours drawing out scenes from games and writing down the squads for teams - both great and meek.

I hope Nicholas never changes, and I hope I have many more years of watching him play this game. At some point (perhaps soon), I will be sitting in the parents' section rather than the coaches section. However, I will always remember these two seasons with him up-close. I hope he will have fond memories of these seasons, too, one day.

Put simply, Nicholas is why I coach.

NEKO CASE LIVE!

Last week Kathleen and I went to see Neko play at Music Fest Northwest. We thought that Neko would be the second of three performers that night and had planned for an early Sunday night. However, it turned out that Neko was the closing act of the three. So, we suffered through the two opening acts and waited for two hours for Neko to finally come on.

It was a beautiful night and the concert venue - Pioneer Square in downtown Portland - was very picturesque.

Neko's performance was electric as usual, and it was certainly worth the price and the wait.

Here are a few outtakes. Enjoy!

THIS IS FORTY?

I could write about a lot of things tonight, especially since I have now officially spent forty years on this planet. I could write about each of these items shown on this hog's body from my futsal team's shirt, but I will spare you!

Indeed, when I thought about this post in recent weeks, I had very different ideas about what to write than I do tonight.

First, we will get the accounting out of the way.

I have been a parent for over twenty percent of my life - 8 years.

I have been a cancer researcher for over twenty-five percent of my life - 10 years.

I have been married to the same woman for over twenty-five percent of my life - 10 years.

I have been with said woman for over one-third of my life - 14 years.

I have been in medicine for nearly half of my life - 19 years.

Historically, I have thought of life as a continuous, mind and soul-numbing struggle for more years than I can count. Pico Iyer recently reminded us that there may be value in suffering, but try telling that to one who is suffering.

My adult world view can ultimately be distilled to a simple proposition - we have limited control over the outside world, but that does not mean we are powerless. Indeed, in a world devoid of God, we are responsible for everything we do. We are accountable to ourselves, to the ones we love, and the ones with whom we share this life. With this world view, a higher power becomes superfluous.

I came to see life this way through a variety of experiences - how others treated me (see high school and college years - you know who you are), through mistakes I, myself, made, and through the works of others - Camus, Kieslowski, Kundera, among others.

Thinking about this adult world view, reminds me of the perspective that my parents tried to instill in me as a child. I was trained to be thankful for what I had. I cannot count the number of times my mom said, "Look down and not up! Think of all the people who are less fortunate than you rather than those who are better off!" 

With all due respect to mom and dad, the past twenty years have been about constantly looking up. In college, I was motivated to get the best grades possible because that was necessary to get into a good medical school. 

In medical school, it was impossible not to stress out over grades, class-ranking, and standardized test scores because a great residency was at stake. 

In residency, I came to realize that I was quite good at doctoring. I went the extra mile not only because the patients deserved this and because that is the way I was raised. The opinion of my peers and my teachers was also at stake as was the spot of Chief Resident - an honor bestowed on the two top doctors out of each residency class at my institution. When I was named Chief Resident, additional opportunity and pressure followed. What top fellowship program would I apply to? 

During fellowship at arguably the nation's best hospital, I was surrounded by the best and brightest. It was hard not to look up at my peers who were more successful and more fluent in the language of research, especially since I was a beginner at science in such a competitive environment. 

Next came a faculty position and the pursuit of career development and advancement at my current institution. I recently completed my packet for promotion. For promotion, I wrote a three page letter describing why I thought I should become an Associate Professor. As I read the finished product, I found myself asking, "What was the opportunity cost of doing all the things I had done in the past six years to advance my career?" "What research opportunities had I missed out on due to administrative obligations?" "What family events  had I missed out on?" Two summer vacations my family took without me because of grant deadlines and countless seven day work weeks in the lab come immediately to mind. 

All of this is to say, that the past twenty years have been spent looking up - higher and higher and higher - almost to the point of vertigo.

Today, as I thought about writing this post later tonight, I considered how my experiences these past forty years have colored my vision and made me who I am. What struck me more than anything was how events in recent weeks have conspired or inspired me to write an altogether different account of my forty years than I would have written even one month ago. Indeed, these past few weeks seem more influential than nearly all the other weeks of my life combined. I think this ultimately comes down to a change in my perspective.

Recently, I have learned volumes from others' writings (e.g. George Saunders), others' songs (e.g. Neko Case), others' life stories (e.g. Emir Kamenica), and my own writing and my own experiences. I have learned that life is not not something to be suffered through. Life is a gift. Kindness is a lost treasure that can be shared and found. Beauty still exists on this earth. 

I am reminded by new and old friends alike (you know who you are!) and my family, especially my mom and dad and brother and sister, that I am fortunate to have people in my life who care about me and love me unconditionally. 

Despite the challenges of my marriage, I am fortunate to have a wonderful family and two loving, adorable children whose imagination and talents are equally matched by their potential to be forces of positive change in this world.

All of this brings me to to a revelation I had tonight on my way home. In the past two months, I have been riding my bike to work each day, which is a gift in itself. It is a peaceful ride that allows me to clear my head, get some exercise, and reflect on many things. Tonight, as I crossed the Willamette River I happened to look back - westward - at downtown. I saw the sunlight reflecting off the water and the buildings. I realized I was strong enough and well enough to ride 5.5 miles each way without difficulty due to my good health. I realized that I live in a place where it is safe to ride one's bike without fear of stray bullets or cars due to a caring populace and good urban planning. On this short commute, I saw my own life's journey of forty years in perspective. 

In short I took the time to look around, rather than looking up or down. What a novel concept! Indeed, appreciating what I have without regard to who has less or who has more, to quote Frost, has made all the difference.

I will leave you with the final number from Neko Case's show last night. 

I love Neko and this song, but I do not wish to be anything other than what I am tonight. 

May the next forty years be as sweet as the last forty year have actually been!

SHE'S BACK

This week, Neko Case released her new album, "The Worse Things Get, the Harder I Fight, the Harder I Fight, the More I Love You." While it has been four years since her last album "Middle Cyclone," this album was well worth the wait.

Her album is all the more refreshing because of the foolishness that currently monopolizes radio airtime [think Miley Cyrus, Robin Thicke, et al]. In stark contrast, Neko sings about the juxtaposition of despair and beauty that is ever-present in our world. She has the ability to capture moments in life that demonstrate the frailty but vibrancy of life like few artists, and that is what I love most about her songs.

No doubt her songs are colored by her own upbringing (or lack thereof) and recent battle with depression. Emotive is the word I would use to describe her songs more than any other, and the new album is no exception.

One song in particular completely blows me away. That song is called "Nearly Midnight, Honolulu," which Neko sings a cappella. I cannot do the song justice with my words, and I suggest you listen to it. Better yet, I suggest you buy the song and the album.

I am not sure yet whether "The Worse Things Get, the Harder I Fight, the Harder I Fight, the More I Love You" belongs in the class of "Middle Cyclone," one of the finest album of the past decade. However, Neko's new songs are quickly growing on me. Stay tuned!

It just so happens that Neko will be performing in Portland on Sunday, and I just snagged some tickets. Pics and musical memories to follow!

Good night and thank you Neko for reminding me of the beauty that is ever present in our world despite all our travails...

WHY I FIGHT

Today was Tuesday, which means I was in clinic. It was a hectic day because I had an overbook at noon, several patients were running late, and I was scheduled to speak to our Prostate Cancer Support Group at 5:30.

Nonetheless, I was reminded today why it is a privilege to be a doctor and an oncologist.

My first patient was an engineer in his early fifties. He had surgery but had concerning features suggesting that radiation could be useful. We talked not only about side effects but also about how he wanted to be around for a long time for his 11 year-old daughter. I told him that that was my hope, too, and that we had a good chance to control his cancer long-term. This visit reminded me that patients worry not so much about dying but about leaving love ones behind or leaving unfinished business. Life is until further notice.

The next patient was an emergency room physician whom I had seen as a second opinion on several occasions. His cancer was now back with a vengeance, and he was too weak for any more treatment. I was honest with him and said that I believed that more treatment would not help and that focusing on shrinking his symptoms with hospice rather than trying to shrink his cancer made more sense. I shared the Kleenex box with his wife on several occasions, and I explained that stopping treatment did not mean that his doctors would stop caring for him. If anything, hospice would allow his family members to go back to being family members rather than medical providers. With hospice, we would have our eyes, ears, and hands in his home. We hugged as they left my office for the last time. Baseball games in front of the TV with their grown son, with whom he had recently traveled to several stadiums, awaited as did quality time with his loving wife. I shared that if I were to become sick, Nicholas and I would surely try to see the great football teams of Europe in their stadiums. Cherish every moment.

Another long-time patient in his nineties came in. He had advanced prostate cancer that is responding to targeted therapy. He joked about wanting to make it to 100, and as usual asked for my cell phone in case of emergencies. Sorry. As usual, he asked about the kids and said he would bring them See's candy again next time. Life is like a box of chocolates sometimes.

One other patient was also particularly touching. He and his wife are lawyers and among my dearest patients and favorite people. He is in his sixties with a son in college, and I have treated him with several therapies, most recently chemotherapy. His clinical picture was a little confusing today, but all in all his disease looked stable. We talked about next steps and whether to take a break from chemo. He talked about closing his law practice and said he wanted to head to the East Coast for several weeks to see family. I endorsed this idea and said we could work treatment around his schedule. There was a pause, and then he and his wife asked the inevitable question, "How much time do I have left?"

I told them that I did not have a crystal ball and that if I did I would be playing the tables in Vegas. Knowing me for the past few years, they both replied, "You would not be caught dead in Vegas!" I chuckled and agreed with them. I said, "Worst case scenario is 6-9 months, and best case scenario is 12-15 months."

Like water rolling off a rock, these two brave souls took this news in stride, and we moved on to other matters. We exchanged hugs at the end of the visit, and I told them I would see them next time. I hate being wrong, but oh what I would give to be proven wrong about his prognosis.

Four brief visits. Four exceptional individuals. Four stirring vignettes. All true. Too true. So true that it hurts.

People often ask me why I went into Oncology. The short answer is that I wanted to do something epic, and there are few jobs more full of the big stuff - life, death, love, and longing. However, I have come to realize that I am not interested in these themes in the abstract or in characters from a novel or a play. I am interested in real people in the flesh and blood, and I am interested in helping them live as long as possible and as well as possible.

You might think that when I look at my patients, who are all older than me, I see my dad. Sometimes that is true. However, more often I see myself. I think about all the things I hope to achieve, all the places I hope to go, the grown-ups I would like to see my children become, and the life that I would be grateful to live to an old age.

Moreover, I do what I do because someday I know I will be on the other side of the exam room with a serious illness like cancer. When I think about that, I try to care for my patients as I hope someone might care for me. I know I am far from perfect, but my patients make me a better doctor and a better man.

I will leave you with a quote from the author Colum McCann from his wonderful novel and ode to New York City Let the Great World Spin that sums up why I fight. "The world spins. We stumble on. It is enough."

Tuesdays remind me that stumbling on is indeed more than enough...

QUOTABLE QUOTES

Catherine Reese is always one to entertain, but recently she has had quite a few verbal quips.

Here are but a few:

On hearing a loud argument- "What's all the hullabaloo?"

Contemplating wealth- "If I had money, I would spend it all on pizza and ice cream!"

What a cutie!