TOUCHSTONE

If we are lucky, we have certain people in our lives become touchstones, a point of reference, that helps to center and guide us. I am fortunate to have had several individuals like this from various phases of my medical training. These people have made all the difference when I faced challenges or was contemplating big life decisions. Dr. L. David Hillis, who was Internal Medicine Program Director during my time in Dallas and a key role model in my early career, is one of those touchstones.

Whenever we visit my sister during the holidays in San Antonio, I always check in to see if Dr. Hillis is free to catch up. Nearly every year he is available, and seeing him is always a highlight of the trip. It is not just because we reminisce about the good old days. Rather, it is because he has such a wise and thoughtful perspective, having navigated academic medicine for 50 years at some of the top centers in the country. In addition to being a great leader, Dr. Hillis had the opportunity to be surrounded by some of the true giants in medicine, Dr. Eugene Brauwald, Dr. Donald Seldin, and Dr. Daniel Foster. These men were larger that life and clearly left a major imprint on him. I was fortunate to know the latter two, and I still remember the fondly and try to live up to their example. 

On this visit, I was grateful to have Dr. Hillis' advice as I contemplate how to chart this next phase of my career and decide how I could be most impactful while feeling most purposeful. He provided clear guidance on what factors to consider while never telling me what to do or how to choose. That is the hallmark of a great friend - one who helps you think about a problem without providing their own solution. 

Whenever someone from my field or my institution reaches out to me for advice, I think about the amazing touchstones I have had. I always takes these meetings or calls and try to help that individual talk through what is one their mind in the same way Dr. Hillis might. That is a tall order, but it helps to have had such an amazing touchstone for the past 25 years!

SAN ANTONE

We have been coming to San Antonio for years since my sister moved here, but somehow every trip to this city feels special.

San Antonio exudes an ethos and pace that is refreshing in this world that is very self-centered and moving at 100 miles per hour. Here, there is a distinct feeling of community and blending of cultures and world views. Despite being the seventh largest city in the country, people appear to take the time to slow down, savor life, and enjoy time with their friends and families. At least, that is the feeling I get from observing people out and about in San Antonio.

I feel my heart beat slow do a little and the stress subside when I am in San Antonio. Maybe that is because I am not back home and away from all the pressure of the real world. Undercutting that is theory though is the fact that I have visited plenty of cities on vacation but none makes me feel this way. Perhaps it is the blend of family here, the city layout, the food, and the beauty of the Texas hill country. 

I will not try to explain San Antone. Instead, I will just enjoy it once again!

DIAMOND IN THE ROUGH

When I moved to Michigan five years ago, I gave up a lot of things - the least of which was my frequent flyer status on Alaska Airlines, my preferred airline back in Portland. Here in Michigan, I have been flying Delta almost exclusively. I graduated to the second highest frequent flyer status two years in. This year, unbeknownst to me, I was very close to hitting an even higher status- Diamond. However, it looked as though I would be a few miles short. 

I turned to my friend, Amit, who is a connoisseur of airline points. He recommended I take a "mileage run," taking a flight purely to wrack up the miles necessary to achieve the mileage status goal. Therefore, I booked a round trip flight to Chicago - on Christmas Eve, one of the busiest travel days of the year. I landed, spent an hour on the ground, and then headed home on the same plane that had brought me there. That trip, coupled with my flight to San Antonio the next day for Christmas, put me over the top!

In many ways this quest for Diamond Status parallels the hustling I have been doing these past few years to get back to where I was before the move or to soar to even higher heights. It has not been easy, and along the way, I have been humbled so many times. On this day, though, I could see how far I had come and exactly the ingenuity and countless miles it to took to get here. I'll savor this moment, knowing that the mileage clock and the achievement clock resets anew each year. Here we go again!

GROWTH

As a parent, one cannot perceive the change and growth in one's children unless there are away for a prolonged period of time or unless one really looks hard.

I had the same sensation last week at lab meeting when two of my trainees presented their project progress. Both had joined the lab nearly five years ago knowing virtually nothing about prostate cancer - and, in one way - virtually nothing about cancer, generally. However, on this day, both trainees demonstrated a clear command of the field, in general, the problems they were studying, and their own data and projects.

As I sat back and took it all in, a sense of pride washed over me. I was not happy because I felt as though I was responsible for their success. Rather, I felt happy because I appreciated just how responsible they had been for their own growth and development. I felt lucky to have these two on my team, knowing that the people in our lives, including our coworkers, are not forever.

I will try to remember this feeling on the hard days when things are not going to plan or individuals do not do their best or demonstrate the command I expect them to have. Growth does not happen overnight, and if we do not pay close attention we can miss it. On that day though, growth was on full display. 

DEAR FELIX

Dear Felix,

Last weekend I made the short but eventful trip to San Francisco to say goodbye to you and to pay my respects to you, my dear friend Felix Feng, who was taken from this earth far too soon at the age of 48.

I first met you nearly ten years ago when we began collaborating on a team science project called the West Coast Prostate Cancer Dream Team. You were a new member to the team, having recently relocated from the University of Michigan, Almost immediately, you left your mark on the Team and helped turn it around by refocusing our projects and dreaming very big.

Countless ground-breaking papers followed, several of which you gave me the opportunity to lead. You appreciated that deep down most of us just want the opportunity to fulfill our potential. This seems basic, but far too often in life we are never given a chance to prove what we can do.

You were a guiding light for so many of us. I consider myself so lucky to call you a friend and to have had your wisdom and insights touch so much of what I have attempted to accomplish in the past decade. 

I did not make a major life decision without consulting you, Felix, during the past 10 years, and I consider you to be a member of my family. You are truly one in a million.

There are many luminaries in the prostate cancer field. Most of their contributions come from discoveries made in their own labs. You, on the other hand, developed so many careers around the globe, including those whose success did not directly benefit you. Felix, you are the epitome of a team scientist and made our field more collaborative and kinder. 

You will always be in my heart, Felix. The same goes for your family, and I know I speak for all of us when I say we will always be there for you Mary, Eric, and Emily. 

We promise to continue to build the community you helped to create and remain focused on solving the most pressing problems patients with cancer face. Thank you for always leading the way, Felix. I love you and will miss you.

Love, 

Joshi

UP IN THE AIR

I had four trips in the past two weeks, which meant I had quite a bit of time in the air. I normally sit in the aisle, if I have a choice, but on this flight. However, on this flight I was in a 1-2 configuration, sitting in the solo seat on one side. Therefore, I took advantage and spent a good amount of time looking out the window.

What I saw was almost ethereal. The clouds literally looked like the snow covered earth - or according to Nicholas the Uyuni Salt Flats in Bolivia -  and I was so captivated by their beauty. It was a reminder of how much beauty is all around us and how grateful I am to be alive.

THAT'S WHAT FRIENDS ARE FOR!

I visited Seattle this past week to give a seminar and visiting professorship. However, this trip was more than about academics. It was a chance to catch up with dear friends, some of whom I have known for 15 years and who are among my closest collaborators. 

Time not only breeds content, but it also breeds connection. It was so wonderful to spend two days with them catching up and finding out how their lives are going. The trip made me realize how lonely the past five years here have been and how limited my friend circle is. 

There are several explanations for why it is hard to make new friends as one gets older. We are pulled in many directions by work, kids, parents, and marriage. There are fewer opportunities during the day to see each other because of work from home. People want to disengage from work, so seeing a work colleague after hours is not necessarily top of the list.

It made me sad to think that this was my situation and that there was not an easy fix to solve it. However, I was reminded just how lucky I have been all my life with such amazing friend groups each step of the way and how it takes work to build community.

It was interesting that one of my colleagues in Seattle remarked to me that I seemed to adjust well to change and find ways to connect with others. I did not have an explanation in the moment. However, as I reflected, I realized that these were skills I was forced to learn after attending five different schools in five years growing up with our many moves first from Canada to Oklahoma City, then to Round Rock, and finally to Wells Branch. When you are an Indian kid with a funny accent amidst a sea of people unlike yourself, you have to find common ground. 

I have never thanked mom and dad for the skills and resilience I built up during those moves - mainly because I did not approve or understand these moves in the moment or for many years after. Now though, I do understand what those moves did for me and how they influenced the rest of my life. Connection and closeness are incredibly important to me, and that is probably because there were so many times that I struggled to find those things. If the past is a guide, I will hopefully find my people again. Until then, I will keep trying!

MY OLD ASS

Last night, the kids and I watched the recent movie, "My Old Ass," with Aubrey Plaza. It was a high school coming of age story, but it was so much more than that!

In the film, the eighteen year old main character is about to head off to college. Like many her age, she takes her family and everyday experiences for granted. However, one night will experimenting with drugs, she is magically visited by a 39 year old version of herself played by Plaza.

Her older version tries to give her advice about how to live differently - mainly about appreciating the people in your life and making better life choices. Somehow, this sinks in, and e teenage version of the main character begins to make changes small and big.

I will not spoil the ending, but suffice it to say that we might all live differently if we appreciated that our time with our loved ones was finite and that they will be gone one day. That is the main lesson I learn each week in clinic.

Watch "My Old Ass" and share it with someone whom you love who could benefit from these lessons. You won't regret it! 

FATHERS AND SONS

This Thanksgiving was a reunion of sorts. Nicholas came home for break, and my dad came to visit, too. It had been five months since we last saw him when we went to Houston in July. Since that time, a lot had elapsed. We had a presidential campaign. Nicholas and Cate went back to school. We lost the election. And so many other significant events had occurred - many of which caused any number of us great consternation.

That is why it was so lovely to connect and just enjoy each other's company. We went for walks. We ate out. We watched a lot of football and soccer. It was incredibly enjoyable and relaxing - just what we all needed.

Today, I dropped Nicholas and my dad off at airport. They had similar flight times, and so I was able to do it in one trip. Since Nicholas flight was later and because my dad had a heavy bag without wheels, I asked Nicholas to forgo TSAPreCheck and go through regular security with my dad, so he could help him to the gate. Nicholas graciously obliged and got grandpa to the gate safely. This gesture was emblematic of full circle between fathers and sons - when roles get reversed and the son or the grandson becomes the caretaker. 

I am so grateful to be a son and a dad. It has been the joy of my life to be loved and love. I will always be thankful for this year's Thanksgiving with two amazing men. I love you, dad and Nicholas!

GRATITUDE

Being grateful is an acquired taste for many people. That is because so much of our world and our lives does not conform to our notions of how we wish things were. However, sometimes gratitude sneaks up on you and shakes you awake, recalibrating your expectations and resetting your world view. That was the gift the family of one of my patients gave to me this week.

I first met Dr. P two years ago when he was diagnosed with metastatic prostate cancer. He was weak and felt ill most likely due to the renal failure his obstructive cancer was causing. We started treatment, admitted him to the hospital, and stabilized his kidney function. We were able to improve his symptoms for a few months, but then the cancer began to grow. Despite multiple additional therapies- new hormonal pills, immunotherapy, chemotherapy, injectable radiation, his cancer marched on. I had discussed experimental therapies, but he declined these because of the time commitment that was involved. It was not that he was worried about the inconvenience of additional study-related visits. He was concerned because he was the primary caregiver for his wife, who had had a stroke several years back. He was unwilling to sign up for anything that might interfere with his ability to get home to her every weekend by 3 PM, so he might relieve her in-home nurse.

A few weeks back, I met with him in clinic with his brother, sister-in-law, and son. I explained that we did not have any safe options left and that I recommended hospice. Dr. P said he understood and thanked me for all my efforts. As I stood to leave, I gave him a hug and did not hold back my emotions or my tears. 

Indeed, hardly felt I had done much for him, especially since most of the treatments I had recommended had not worked at all to slow down his disease.

A few weeks later, his sister-in-law emailed me letting me know there would be a visitation and funeral the next day. She said, "I thought you would want to know." 

I cleared some time in the morning and headed over to the visitation. There, I met his two sons again and other family members. I told this sons how proud he was of them and how he always talked about them. I thanked his brother and sister-in-law for being there for him on hospice. They, in turn, thanked me for what I had done. When I lamented that I was not able to do as much as I would have liked, his daughter-in-law interjected, "Dr. P had one goal - outlive his wife so he could remain his caregiver. You helped him achieve that!"

I am not sure I have ever been given a greater gift from a patient's family than the knowledge of what his goals were and how I helped to make that goal a reality. It reminded me of the importance of asking patient's what they hope to achieve and to not overestimate what they expect when faced with a terrible diagnosis. It was also a reminder of all the things to be grateful for in my life - my family, my health, my work.

I left the church that day in a new frame of mind - a more grateful frame of mind. I pray that the lesson I learned there persists. What a life.