Thoughts on the Journey of a Cancer Patient
Received an email from a patient with what sounds like metastatic esophageal cancer. He wrote me after reading my caringbridge page. I am including an edited excerpt from my emailed reply, as a glimpse into my thoughts as a cancer patient. Thoughts that I have been trying to put to paper for some time now. Thoughts that hopefully can encourage other cancer patients that stumble on to this blog.
'My personal thoughts are that if we (as cancer patients) are able to overcome the negativity of a cancer diagnosis, and continue to live (and for some even die) with grace and dignity, we will have already won the victory against cancer. Some journeys with cancer will be longer, and others short, but what matters most is how we walk that journey. That journey need not be filled with angst, bitterness, 'why me' questions, denial, rage, depression, or even in some cases an unrealistic pursuit of a cure/long life. We should not allow fear of the dreaded 'C' word to dictate how we live our lives. Rather, that journey, no matter how long or short, can be a path filled with courage, acceptance, love, hope, faith, peace, joy, fellowship, serenity, a sense of purpose, grace and dignity. We and our loved ones did not choose to be 'afflicted' with cancer, but we have a choice of how we deal and cope with this difficult diagnosis. I pray that God will grant us the courage to choose our paths wisely, the hope to live a meaningful/purposeful life, and the inner strength to live (and die) with dignity.
My life took an interesting turn on Oct 19, 2007 when I was diagnosed with metastatic esophageal cancer. How roles have changed... A week prior, I was a fellow in Hematology / Medical Oncology seeing patients with cancer. Today, I myself have become a 29 year-old cancer patient.
I first noticed some mild dysphagia, always with dry food. I didn't make much of it, but did take some OTC proton pump inhibitors which seemed to help with the symptoms. A few weeks later I noticed an enlarged Virchow's node (Left supraclavicular node). I saw a hematologist/oncologist at work who subsequently referred me to an ENT surgeon who performed a needle biopsy on the spot. Things moved quickly from then. I got the preliminary pathology results showing a high-grade carcinoma later in the afternoon. We decided on proceeding with a PET/CT which was done 2 days later. This showed a Gastro-Esophageal (GE) junction mass with metastatic regional and distant lymph nodes (Left supraclavicular). The following day, I had a EGD/EUS for the definitive diagnosis. This showed a partially obstructing grade 4 adenocarcinoma of the GE junction.
Met with a Medical Oncologist, a Radiation Oncologist and a Thoracic Surgeon. As the cancer has metastasized to a distant lymph node, we decided to start on chemotherapy first. The chemo regimen is EOX (Epirubicin, Oxaliplatin and Xeloda) every 3 weeks, Xeloda is given as pills twice daily. The plan is to get a few cycles of chemo, if there is a good response with no further spread of the cancer, one would then consider chemo/radiation followed possibly by surgery.
I am currently on my 3rd cycle of chemotherapy. My journey with cancer will be chronicled on www.caringbridge.org/visit/towshungtan
This blog will likely be inactive for now. For now, I have stopped seeing patients and is currently on 'research'.
I was interested to learn that the American Academy of Pediatrics has issued a policy encouraging parents to donate their newborn's cord blood to public cord banks (Pediatrics. 2007;119:165-170).
Finally, a coherent and sensible policy by a well-respected organization. One of my pet-peeves has been the shameless exploitation of new parents by Private Cord Banks. These for-profit companies make profit off the fear of these parents during an emotionally vulnerable time. Which new parent wouldn't be fearful of a potentially fatal disease that could strike their precious child, regardless of the actual likelihood of that disease being one that would benefit from stored cord stem cells.
These private cord banks market their services as an insurance policy in the event that the child could need it in the future. That to me is like paying expensive insurance to cover one's child from the unlikely event of getting struck by lightning. I am sure the Private Cord Banks never let out the dirty little secret that they almost never have to retrive stored cord blood.
A more rational approach would be to store as many newborn's cords as possible in public cord banks, in order to benefit as many people as possible. Obviously this brings up the issue of who would then pay the cost of storing these cord blood. Hopefully with better technology and increased volume, the actual cost would decrease. There are already public cord banks scattered around the US. Maybe one day, Malaysia will have a National Public Cord Bank Foundation to champion its cause.
Was reading TIME magazine when I came across an interesting article titled 'Doctors without Dollars'
. The author writes about a number of his doctor friends who had left medicine for greener pastures here in the US.
From selling 'magnetized' water to body hair removal, doctors in the US are leaving medical practice for more lucrative fields.
Unfortunately, some doctors are going into quasi-medical fields which the author terms as NRWATS or "nothing-really-works-anyway therapies". These doctors often give undeserving credibility to these unproven therapies. The lay public is then deceived into thinking that since it is endorsed by a M.D. that it actually works. Personally, I have also been approached by people who would tempt me with easy money to lend my name to promote such products.
What a SCAM!
Thanksgiving phone call
Here in the US, we just celebrated Thanksgiving day, which falls on the last Thursday of November. The 1st Thanksgiving day was observed in 1621, after the Pilgrims had a bountiful harvest that year. In more recent times, it has become one of the major holidays of the US calendar. Family get together for a meal, and reflect on the 'blessings' they have enjoyed in the past year. That's the theory anyways.
I wanted to share about a phone call I received on Thanksgiving evening. I was oncall for Hematology, when I received a call through the hospital operator from a patient's wife. Accessing his medical records (I was at the hospital anyways for an emergency consult), I found out that Mr. X has relapsed follicular lymphoma that was progressing. He had undergone an autologous hematopoetic stem cell transplant a 6 months ago for the lymphoma, but was found to have relapsed recently and his condition was declining quickly, despite experimental therapy.
One of her first words over the phone was ' I am not even sure why I am calling you, but...' She went on to tell me how her husband was feeling really tired, not eating, sleeping a lot, and not as interactive as usual. We talked about his symptoms. They were non-specific, and it could have been anything from dehydration, infection to tumour progression. However, as we were talking, reading through the lines, it become apparent to me that she did not want a diagnosis, or a medical spiel about his condition.
She wanted someone to talk to on a day usually filled with laughter, joy and hope. She wanted a shoulder to lean on because her husband's was giving way. Above all, I think she wanted someone else to give her 'permission', to tell it is okay for her to let go and to allow her beloved husband to give up a fight he was suffering through but not winning.
So, we talked more. Over the phone, I tried to convey as much empathy as I could. To try to comfort her with words, to provide a 'virtual' shoulder to lean on, a 'virtual' hug of comfort. I told her it was okay for her not to have to subject Mr. X to more tests, interventions, chemotherapy. I told her that hospice and comfort care were reasonable options. I gave her 'permission' to keep Mr. X comfortable at home on Thanksgiving, rather than bringing him to a hospital.
She cried, and I almost did. But by the end of the phone conversation, I want to think that she was more at peace with the decision that she knew she wanted to make all along. She thanked me and wished me a happy Thanksgiving. After I put down the phone, I said a little prayer for Mrs. X, for comfort, peace and strength, to do a most difficult task, that is to let go of a loved one.
Woohoo!! I passed my boards...
ABIM (American Board of Internal Medicine) recently released pass/fail status to it's 2006 examinees through a secure website... Woohoo!! I passed my internal medicine boards!!
Phew... what a relief... I don't have to spend another USD 1000 to retake the exam next year. So 4 board exams down (USMLE 1,2,3 and ABIM), 2 more to go. Next up are the Medical Oncology and Hematology boards.
Unlike the the UK specialty exams, ABIM board certification is good for 10 years, after which one would need to recertify. The recertification process includes at-home CME-like modules and a final exam at 10 years. In fact, currently most of the major specialties require recertification here in the US. This process is separate from the CME (continuing medical education) requirements for medical licensure. I suppose it forces physicians to keep up to date on current practice, which can only be a good thing for patients.
Passing the boards doesn't change my life by much unless I leave my fellowship to work as a board-certified Internist. I don't get a promotion, nor a pay rise. I don't even get more alphabets behind my name :).
I'll just go out for a low key celebration... nothing fancy... movie with friends and maybe a meal tomorrow in the Twin Cities... then I have to start preparing for my Oncology boards... hahaha...
Fellowship has been a roller-coaster ride. There were some awfully busy months with 15 hour days and patients that drive me up the wall. But there are also many days that makes me realize how blessed I am to be able to pursue oncology as a vocation.
So, no regrets yet about going into oncology.
Anyways, currently on the Hematology Consult service. Interesting/educational consults have included:
HIT-T (Heparin induced thrombocytopenia with thrombosis), post cardiac surgery presenting with pulmonary embolus and thrombocytopenia.
CNS relapse of Burkitt's-like lymphoma, presenting with cranial nerve neuropathies.
New diagnosis of Burkitt's-like lymphoma.
MAHA (microangiopathic hemolytic anemia) of unknown cause.
Factor XI deficiency presenting with post op bleeding without prior bleeding history.