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...