Monday
[This week The Cheerful Oncologist wishes to offer his readers, at no additional charge, a disturbing peek into his world as he reviews selected momentous happenings from each day. These random observations are guaranteed to represent actual emissions from the smokestacks of his mental factories, where deep within teams of Oompa-Loompas scurry about the dusty neurons and axons in an attempt to keep the good doctor’s intelligence quotient from dropping faster than a peregrine falcon hovering over a nearsighted mouse.]
1. Am I less of an American if I don’t drink coffee? I feel so left out when, galivanting about town, I see the happy throngs of customers queuing for lattes and mocha cappuccinos. They are members of a club I had to resign from but long to rejoin. The smell of freshly brewed beans plows through the air, filling the heart with songs of the earth. I have heard the baristas singing, each to each.
I do not think that they will sing to me. In fact, I hear a distinct chortle emanating from the hearty throats of java slingers when I order a meek cup of tea. I sneak over to a forlorn corner of Starbucks and sip it quietly, looking to the world like Wally Cox . My heart pines away for a real mug of joe, an honest cup of coffee like the ones Jack Webb used to down on Dragnet while chasing down forgerers and their ilk. Instead, the ancient ritual of the tea leaves becomes my new morning worship.
Let’s face it - I just want the caffeine without the heartburn.
2. When a patient complains about the cost of a new treatment I remind them that often new agents are initally given at much higher levels before a final dose is established as the most cost-effective and efficacious, and that the reason these more expensive agents get approved by the FDA is because they produce superior outcomes compared with older regimens, frequently with much less toxicity - cf. imatinib for the treatment of chronic myelogenous leukemia for an example.
3. I don’t mind producing scientific articles of support to convince an insurance company to pay for an innovative treatment. Doctors must prove that there is medical evidence showing that a new medicine is worth covering. It does discourage us though when promising new treatments are distributed to patients at a rate similar to the speed at which Uncle Louie picks up the dinner check.
4. Some patients live much longer than the average survival time mentioned in textbooks. I visited with one such patient today and while admiring his longevity could not help but wonder why millions of cancer cells, scattered hither and thither in his liver and other superstar organs, had laid down their spears for a peace conference. I was reminded of Octavius Caesar’s armies, spread out upon the plain outside Alexandria, waiting and waiting for the command to attack Marc Antony. Some day that order will be given and my patient’s life will once again be under siege.
When that day occurs it might be helpful if I gave the Queen of the Nile the bum’s rush from the old commander’s tent and went back to soldiering against this most odious plague of modern times.
[Up next: Tuesday (what, you were expecting Wednesday maybe?)]
