Compliment Day

On Friday January 24, 2014, one of my patients, after a difficult discussion regarding the management of her recurring lymphoma, said that she had heard on NPR radio that it was National Compliment Day and that she wished to pay me a compliment!

Let me lay the ground work for the compliment. Ms W is a statuesque handsome black woman, widowed for 2 years and still grieving the loss of her husband. Soon after his death from lymphoma, she was discovered to have lymphoma involving her stomach and because she was bereft, she chose to delay her therapy. She eventually was given radiation therapy with apparent control. Unfortunately, a recent surveillance endoscopy revealed diffuse recurrence in the lining of her stomach and she came to see me for a second opinion regarding management of the recurrence.

When I first met her, she was clearly sad. I was struck by her beauty. When our eyes met I felt she was searching for something. Perhaps simply a better understanding of her predicament but perhaps also a means to get to a better place for her life. We talked a bit about her husband’s illness since I was quite concerned that his experiences might easily influence her decision making. Interestingly, she began by saying that earlier in his life he had prostate cancer and she wondered whether that illness played a role in the onset of his terminal illness with lymphoma. Knowing that black men often have a more virulent form of prostate cancer for reasons not explained by differences in socioeconomic status, I gently asked her if he was black. Her eyes brightened and she said, Oh he was Jewish! I was a little startled but I guess I should not have been surprised. I reassured her that his lymphoma was unrelated to his prostate cancer or its treatment.

After further testing, Ms W returned on National Compliment Day to have a discussion about the management of her lymphoma. She was very pleased to hear that the proposed therapy would not nearly be as harsh as the type her husband had to cope with. And she was delighted to hear that her outlook was exceptionally good. She asked about whether she could plan to travel and whether she could return to teaching at Hunter College. I sensed she was emerging from an emotionally draining bad place. I encouraged her to make those plans and her face brightened. I felt comfortable with the notion that with some closure regarding her uncertainties, she might now be able to move beyond the grief process and reengage with life. I suspect she will find joy again as she rediscovers what life has to offer.

At the end of the discussion, she brought up National Compliment Day. She said that after our first meeting she had dinner with a couple who are friends and the wife happened to be a physician. When she told them she had a consultation with “Dr Greg Mears”, they were thrilled since the woman physician has known me since her days as a medical student at Columbia. Although I was somewhat embarrassed by their accolades, I was still pleased that the assurances Ms W obtained from her friends had cemented our relationship together. She concluded by saying she thought I was a “real Mensch”! Knowing her story, I was not surprised! I repaid the compliment thanking her for putting her trust in me.

It was an excellent day for me. I was again reminded by this encounter that supportive, positive comments are powerful tools for annealing friendships, personal and professional.

A New Year’s Resolve

“Annus Horribilis” is an apt phrase to describe the year 2013 for me.

It has been a year of great personal losses for me and a year of learning more about who I am. I have learned that control over one’s destiny often rests with others and that invincibility is an illusion. I have learned much more about the many facets of love.

I have spent many sleepless nights in torment attempting to understand why  my journey has taken perilous turns and I have struggled with finding solace. I  recall Kubler-Ross’s five stages of grief: Denial, Anger, Bargaining, Depression, Acceptance. I have experienced a similar sequence and Acceptance is increasingly  at hand in good measure because of the support of others.

I have received an outpouring of love from my sisters, who are my bedrock and who will not let me fall, my yoga instructor with the incredibly long hair and soft touch, my Dallas/NYC physician friend with whom I have rediscovered the meaning of debridement and who has inspired me to try my hand at writing this blog, my Cuban/NJ friend who is always looking out for someone to make me happier and my really good friend and confidante Susan.

But, I also receive much nourishment from my practice and when I feel low, I always find comfort from my patients. A case at hand is Astley, a man from  a Caribbean island who, with his wife, came to the US hoping for a better life. They lived frugally and raised two accomplished, attractive and articulate children who dearly love their parents. I learned this the hard way when I proposed a bone marrow examination for Astley and his beautiful daughter solemnly informed me that I was not allowed to hurt her father! I was not sure of the consequences but I clearly got the message that I needed to treat her Dad with great care and respect. The bone marrow went well and led to a vary unusual diagnosis, missed by a very renowned Cancer Center in NYC. I spent considerable time and effort to help this poor man and the family has become very appreciative. The daughter gave me a Christmas present and when she presented it to me, she said I “needed” it. This was a most unusual presentation, so I was anxious to find out what it was. The gift was a bottle of wine and a box from Papyrus that contained a fine pen and a leather covered journal. The gift was an encouragement to write! I think the daughter sensed my need to express myself in a different way. She is perceptive and supportive of me as are my many friends.

And so I am encouraged to move on and get beyond 2013.

I plan to spend New Year’s Eve at Zagara Wine Bar in Chelsea which happens to make a near perfect pear martini to meet the New Year. I am excited by the prospects of 2014 and I predict my patients will continue to inform my life and loves. It is my resolve to honor them and by illustration to weave a fabric that protects and supports us as we face the sometimes difficult realities of life.

Survivorship – Young and Old

I am taking a brief respite from wintery NYC thanks to a generous patient who flew me to Florida in his private jet. It was an experience worth repeating!

He is a three time survivor of different cancers and of course he was interested on the flight south in discussing cancer and his survival. As he described his initial interaction with the specter of cancer, he noted with gratitude that chance and some luck brought him to a major cancer center, in his case Columbia University’s Cancer Center. If he had stayed with his initial local physicians, he would have likely succumbed to his first cancer. For reasons left to others, many physicians tend not to think clearly through the puzzles an ill  patient presents, often choosing the easy or obvious path. This may be acceptable 90% of the time, but occasionally a serious and life shortening disease will be neglected and cure will become elusive. My patient, not satisfied with what seemed to him a nonchalant approach to his complaints, felt uneasy and sought another opinion at Columbia. This clearly saved his life.

As we discussed the emerging understanding of the biology of cancer, he asked how I could face the tension and disappointment of dealing with ill patients at high risk of dying prematurely from cancer. I responded with the simple testimonies of success with young and old patients, stories that embolden me to continue to seek answers for very ill patients.

One example occurred the day before the flight when I was delighted to see a 30 year old patient of mine, seven years from her diagnosis of Hodgkin’s Disease who came to the office 30 weeks pregnant with her first child. She was ecstatic, stating how she had been so worried that because of her chemotherapy she would not be successful in getting pregnant. Although I had informed her at the time of therapy that the data strongly suggested her fertility would not be affected, she harbored a lingering fear that she would not be able to be a mother. She married last year and I was not surprised to see her carrying a healthy child. I have a stable of young women who have survived lymphoma chemotherapy to go on and have many healthy children. I almost wonder whether they have become more fertile than their peers because I know of no young woman in my practice who could not have a baby after chemotherapy!

My generous patient’s serendipity in landing in the right hands to be cured of his various cancers also reminded me of a patient I met 10 years ago when at age 99 he presented to a New Jersey hospital with abdominal pains. A CT scan showed a mass in his pancreas and he was informed he surely had pancreatic cancer and at his time in life this was not treatable and to go home and put his affairs in order. He had the temerity to seek a second opinion at Columbia that led to a biopsy of the mass yielding a diagnosis of lymphoma, a potentially curable disease. Despite his advanced age, I gave him the appropriate chemotherapy that he accepted without difficulty. The disease melted away and he is alive at age 109, pleasantly demented but aware of his surroundings and the focus of love of a large family. Surely he would have died 10 years ago if he listened to his first doctors.

Not every story is a success, but care and thoughtfulness go a long way in providing the best chance for long term good quality life.

The conversation with my patient as we flew over the Carolinas and Georgia reminded me that serendipity, luck and good fortune interplay in our lives. He is grateful and I am also grateful to have helped him and others do their best as they face life altering illnesses.

I am also grateful to NetJets for the lovely bottle of champagne presented to me upon landing in Palm Beach. I am happily consuming it as I write this post. Jet Blue will be my egress on Sunday, serviceable but not the same degree of pampering. My generous patient reminded me that life is short, pampering may be deserved, and that one should travel this way if at all possible! I agree!

A New Orleans Experience

As a prelude to the 2013 American Society of Hematology meeting being held this year in New Orleans and in maintenance of a tradition (defined as one previous time), I and my colleagues visited the New Orleans Cooking Experience last Friday to again be regaled by Chef Boo’s Cajun stories and jokes as she helped us make a roux used to make a seafood gumbo and a chicken stew followed by a rich bread pudding for dessert. Of course, the “Experience” was enhanced by a wonderful red wine, with copious amounts served beginning at 11:30 AM! Only in New Orleans! Despite our best efforts to burn the roux, the food was delicious and the company was great and once again the “Experience” was a great entree to the annual Hematology meeting, which I have attended for close to forty years now and still find incredibly stimulating and educational.

When I was young and newly involved in the field, this meeting was attended by about 2000 folks and I got to know most of the active academic “players” in the field. The meeting was comfortable and convivial. Common interests were well served by helpful exchanges of information and the highly valuable ability to network with colleagues nationally and internationally. I felt early on I was a major contributor to the field at a time when laboratory research was my major focus. I usually left the meeting feeling very fulfilled and newly energized to push on with scientific discovery and better patient care.

How times have changed!

This year’s meeting is attended by over 25,000 people, mostly from international sites. It remains very stimulating to me but the tenor has changed from “small town” comfort to anonymous corporate sophistication as illustrated by the presentation of large complex multinational clinical trials that require Mr Wizard to understand and by highly advanced and sophisticated molecular biology talks in which the vocabulary is arcane and punctuated by letters, numbers, acronyms and other short hand that only the anointed few who do this work daily can appreciate.

I can sense value but the task of discerning the take home message is daunting. Medicine is becoming encased by science even though as investigators dig deeper, surprises continue to emerge and as one might expect, the machinery of human cells is too complex to be displayed on a power point slide with arrows, and lines and circles trying to simplify pathways of metabolism that took eons to develop.

It is also increasingly clear everyone is different. Our genetic apparatus is unique to ourselves. This is good and bad but on the positive side next generation technology may allow precision medicine to become a reality. But innate in the uniqueness, is the emerging knowledge that all of us develop mutations at a constant rate in our stem cells and that the end result is a group of age related disorders including cancers that may be fundamentally stochastic with some influence by the environment.

So, last night I had some lucky hands playing Black Jack at Harrah’s Casino here in New Orleans whereas my good friend Susan got wiped out. I left with more money in my pocket. Such is the luck of the draw and so it seems with much of the illnesses I encounter as a physician. I am leaving the meeting again stimulated to do well by my patients but sobered by the reality that all of us are at increasing risk of serious illness as we age. However, I am still counting on the positive power of the polyphenols in red wine to at least slow down the process!

Thanksgiving

I have just completed two teaching assignments at my medical school, Columbia P&S. I was a preceptor for four second year students learning to take a medical history and examine a patient. Separately I taught a seminar regarding cancer, also for second year students.

The experiences were refreshing for me and a reminder about how earnest young people develop important skills to become bedside clinicians. All of the students at this medical school are very accomplished, bright and well motivated. What is striking is the transition from hard working student to empathetic clinician. The skill set is subtle. It is amazing to watch. I could see their beginning recognition that all of their book knowledge was only a fragment of what is required to be an excellent physician. Although compassion probably cannot be taught, I do think that when a student recognizes the unique position in to which they are placed in the intimacy of the patient – physician relationship, a change occurs. I can see a student develop a new respect for the complexities of human life and a discernment that he/she can make an important impact on another person’s health and well being. There are few other relationships as potent as this. It is striking how a stranger will present him/herself to a physician and open the windows into a unique life with all that is good and bad. The trust is palpable and requires great respect. The interaction is amazing and so fulfilling.

So, the students have gotten a glimpse of what is to come for them. I can see changes developing in them. I sense they are beginning to finally get to where they want to be as clinicians and not students and for them this time in school is truly transforming.

Last night, I received a phone call from my niece Emily, a nursing student who is also at the beginning stages of trying to understand the opportunity offered to her to become a clinician with its unique look into the lives of strangers. For now, for her, just coping with some of the awful insults to humanity now being presented to her is challenging enough. But, again, I got a sense of a budding clinician who will relish her opportunity to intercede and make a positive difference in the lives of her patients.

There is a wonderment about the process of becoming a clinician that I still find so stimulating. And for this opportunity to transmit what I have garnered from the practice of medicine to another generation, I give great Thanks today.

Transfiguration

When I walked into Edith’s room on the fancy floor of the hospital, she was sitting in a chair near the window overlooking the Hudson. The sun was low on the horizon and its rays reflected off her craggy face providing an unusual glow as if she were transfigured.

We are old friends as she has been a regular patient in my practice for many years dealing with recurrent iron deficiency anemia from blood loss from a longstanding rectal prolapse. There has always been a lingering worry that something more sinister was causing the blood loss and iron deficiency  but there were mechanical limitations to examining her colon and she was 90 years old with severe aortic stenosis that would have made any operation prohibitively risky.

I was paying a visit soon after she was told she had a widespread cancer problem that could not be treated. She had always been stoic about her life and her illnesses. At this visit, her impending death from cancer was not spoken about. Instead we discussed her good fortune in having a wonderful loving family and we reviewed a recent photo from the bris of a great grandson in which she was surrounded by a large and loving family.

She was proud and the reflected glow from the sun made her appear regal. Her immediate concern was her worry about leaving her family and the fear of that departure. She asked if I had a pill to deal with the anxiety that she was facing. I thought for a bit about this request. Not spoken was her fear of death and the loss of her conscious presence among her family. Of course this is a universal concern in my experience and one where no pill can fully alleviate the worry. My quick answer was of course, we have medicines that will make your passing easy and worry free. We looked at each other and she again told me how much she respected me as one of her physicians and that she was so grateful that she had been honored to know me. Left unsaid was her certain knowledge that I in reality did not have a pill to ease her transition. We kissed each other and promised to see each other in my office in the near future. This promise is also not likely to be fulfilled.

Later that night, I went to Zagura, a wine bar in the neighborhood where on a previous visit I had enjoyed an excellent pear martini. This time I ordered one hoping that it was still as good as the first time and to remind myself of Edith’s holiday gifts to me of bottles of vodka. It was excellent and the memories of her many gifts to me were equally luscious.

Remembrance Day

What do you mean you thought I was kidding?

Dear Dr. Oh You:

First, put your phone down for once and view this with your laptop or desktop. I’m sorry for the delay, but my laptop died, plus I was vivisected last week.

You have to pick a name for the blog!

Once you send me the (anonymous?) email account you want to use, you can get to the dashboard to see how it all works to change/add things/delete my nonsense. I think it’s a little frustrating at first (wordpress, not my nonsense).

By the way, I was very happy to learn about all this through trial and error, even if you don’t use it. Maybe I’ll have a blog one day and the knowledge will come in handy.

for the millions who will read this:

video trial

 Why would those spiffy men in this scene from Shame put olives in their pear martinis?