A Day in the Life of an Oncoligist – Life Lessons Part 2

PART 2:

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“A mother’s love for her child is like nothing else in the world”…anonymous

… I knew nothing about Sammy before her visit into Fox Chase Cancer Center.  When I saw her for the first time, I was perplexed by the intense power of chemotherapy and the side effects that she was suffering. It has been 6 months since she was diagnosed with breast cancer and 2 months since she delivered a healthy baby boy and had a double mastectomy.

The scars on her breasts are recovering well, but her emotional scars will forever be present.  She is a strong person for doing what she did, after all she said it was because she just wanted to make sure as much time with her son as she can.

Doctors never know if the cancer will come back after a mastectomy. And if in fact it does come back, when will it come back and in what organ will it find its nest.  Our plan for Sammy was to enter her into a clinical trial for chemotherapy for post-mastectomy patients, looking at the effect and rate of reoccurrence of disease. My only hope is that her cancer stays in remission long enough so she can raise her son like every mother should have the opportunity to do. Sadly, as I go on to my next rotation I will never know what becomes of Sammy.

 

2 weeks later…

It is hard to believe that two weeks went by. My time spent working with cancer patients was educational, rewarding and emotional. By working with world renowned physicians and researchers, I was able to obtain a sneak peak at the latest research being performed on cancer treatment and was introduced to current clinical trials that people come from all over the country to take part in. And just as cancer patients are a unique breed, so are their doctors. Their compassion, intellect, and desire to help people with cancer goes far beyond the expectations that their patients have.

I wrote ‘A Day in the life of an Oncologist Part 1″ with the idea in mind that I could share some of my memorable patient encounters and shed some light on this disease that so many people are affected by.

In Part 1 we met Sammy, our courageous breast cancer patient, and now in Part 2 we will meet a few more patients – each that taught me a little something more about my self that I did not know. What I have gained so far as a doctor is a great deal of life lessons from each of my patients that I will continue to grow on as I continue my medical training and thereafter. I have learned something from every patient I have ever taken care of, and at Fox Chase Cancer Center, the patient’s remarkable stories have shown me that life is worth reflecting on. I call these lessons learned my “KROL Lessons”, which touch on aspects of Kindness, Resilience, Optimism, and Laughter – the key ingredients for a balanced life.

Lesson #1 – The Smallest Act of Kindness Is Worth More Than The Grandest Intention  HoldingHands

One small gesture can make someone’s day and even make you a hero in their eyes. At times we may find ourselves shying away from people when we know they’re having a rough time. We assume we should wait for them to approach us, so we’re not intruding. But as a doctor, we do not have that choice. When I met Jake, a 27 years old male with no past medical history, he was scared and overwhelmed by his newly diagnosed metastatic pancreatic cancer.  He lived a normal life – had a girlfriend, worked as a Chef in a restaurant, enjoyed swimming and fishing in the summers, but what he did not know that he had an aggressive cancer growing inside. Jake told me that he has always been kind to people, why did he get cancer? As I wish I had the answer to that very common question in this setting. What I did tell Jake is that it is no one deserves cancer, and just because you have it, doesn’t mean that you don’t stop living your life just like you were.

I talked to Jake for about an hour, his parents were in the room, more scared than their son, and at the end of our conversation Jake thanked me for my time. He was given hope, but realistic expectations for his prognosis. He even said that I made he feel a little bit better, even though I feel like I didn’t do much at all besides be kind to him and his family.  “If you can make someone’s day a little bit better it will actually make your day a little bit better,” Jake said. He was referring to my kindness towards him, but I like to believe what he said is a key ingredient for Oncologists.

 

Lesson#2 – A Resilient Mindset Will Change Your Life

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I call it the “Bounce Back” factor. The ability to bob to the surface after being pushed down by the storms of life, the ability to survive when the world around you lacks the nutrients to grow. We have all heard this before : “What doesn’t kill you makes you stronger” and then there is the “Live each day like it were you last.”  I heard these words, or something to their nature, too frequently this week. But it wasn’t until I heard them from a 39 year old patient stricken with metastatic colon cancer at a young age did I really started to believe the meaning behind these words.

Marlie was 33 when she was told by doctors that she needed her ovaries and uterus out because the cancer from her colon had spread to those organs. Unfortunately Marlie never had children. She had always dreamed of it one day, but when the diagnosis of cancer came it was too late. Marlie came to the clinic for routine visit with us, as she is 5 years out from her disease. Marlie has since volunteered at the Children’s hospital in the city, and would one day like to adopt her very own, she told me. But all we can do as physicians is encourage her resilience and the strength to fight back.

Lesson#3 – Optimistic Attitudes Overcome Life’s Challenges

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In 2010 a research study published in the Journal of Thoracic Oncology (JTO) explored the importance of a patient’s outlook on life as it related to their health status. What did they find? By taking a group of lung cancer patients with life expectancy less than one year and Utilizing the Optimism – Pessimism scale of the Minnesota Multiphasic Personality Inventory, (a scale that identifies pessimistic and optimistic personality styles among patients), the study revealed that there was a 6 month potential benefit to related to having an optimistic attitude.

I researched these findings after meeting Mr. Q, a young gentleman, 43 years old, I met in clinic that has beat Metastatic Melanoma. Some may call it a miracle, but did Optimism have something to do with it? Mr. Q had been on the transplant list for a new kidney from the time he was 39 years old until he turned 41.  And when the call came that he would be receiving one, he though that his life was saved. The transplant went as expected, and Mr. Q was moving on with his life. But when he received a phone call from his doctor 6 months after the transplant that something may be wrong, Mr. Q started to panic. The transplant surgeon had received word that one of his other patient’s that received a lung from the same donor that Mr. Q received his kidney from had been recently diagnosed with Melanoma in his newly transplanted lung, a deadly form of skin cancer that has the potential to spread to other organs. The fear was the organ donor had Metastatic Melanoma, and never even knew it at the time of his death, not knowing that his Melanoma would now be implanted into his organ recipients bodies.

Mr. Q fought a long 8 month battle. He had his kidney removed and was treated for metastatic melanoma, a disease that is incurable. But Mr. Q was came to the office today for a follow up to hear the words “You have no sign of disease, we can’t find a trace of it anywhere.” Stricken by this man’s story, my biggest question to him was, “how do you get through your days without losing all hope?”  He said, “I just know that tomorrow will always be better.”

 

Lesson #4 – A Life Without Laughter Is A Life Not Worth Living

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I was invited to work with one of Philadelphia’s rated Top Docs and known nationally as an expert in Pain Management and Palliative Care this week. When the program was founded over 10 years ago, the goal in mind was to safely and effectively help to alleviate the pain and suffering that comes along with cancer, especially during chemotherapy or later on in the disease process. Here is where I met Mrs. Harley who taught me that a life without laughter is a life not worth living. She was 79 years old, and diagnosed with thyroid cancer this year, and she was accompanied by her husband of 50 years. Chemotherapy took a toll on her body and made her incredibly weak, and it was time to take a break. A large portion of a patient’s first visit to the Palliative Care clinic is to obtain a detailed history of the patient, especially social, because palliative care medicine’s foundation is built upon treating the patient suffering while supporting the family. I asked what the secret is to a long marriage likes hers. She looked at her husband sitting in the chair, and said he makes me laugh.

Laughter is a birthright, it is a natural part of life that is innate in us all. It is one of the most powerful tools we have to be in a positive emotional state to support good health. The conversation I had with Mrs. Harley and her husband that day was far from morbid, considering she was choosing to be comfortable for the remainder of her life. The laughter she and her husband had throughout the 50 years of their marriage is what bound them together and increased their happiness and intimacy. “I laugh at myself” she said, “All the time. But sharing my embarrassing moments has only made my life more enjoyable.”

Final Thoughts…

It just so happens that we do not pick our date of birth, and we are equally powerless over the day that will be our last on earth, but it sometimes takes illness to make us become aware of the power that we have in between those times.  We do not need to look far to see that cancer patients provide us with insight into a life worth living. As Randy Pausch did in “Last Lecture” and Steve Job’s did in his commencement address to Stanford University, we see that cancer has a way of teaching us valuable life lessons. Every once in a while, things happen in my life, that make me stop and think of all the lessons that I have learned from cancer patients, and I am grateful for their inspiration.

**For patient confidentiality, the names listed above have been altered.

 

 

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DanielleKrolMD
Dr. Danielle Krol, a native of the Philadelphia area, spent the majority of her early life growing up in New Jersey. With over 15 years’ experience in Dance and Theatrical Arts, Dr. Krol was pursuing a career as an actress until her mother was diagnosed with metastatic breast cancer. For the 3 years that followed, Dr. Krol placed her life on hold and took the responsibility of Caretaker for her terminally ill mother. Her passion for medicine came about during her mother’s illness, and her determination to become a doctor came about after her passing in 2002.