Archives of The Cheerful Oncologist, Volume 2

Why are we here? Where are we going? It’s time that we found out.
We’re not here to stay; we’re on a short holiday.

Life is just a bowl of cherries,
Don’t take it serious; it’s too mysterious.
You work, you save, you worry so,
But you can’t take your dough when you go, go, go.

“Life is Just a Bowl of Cherries”, 1931
lyrics by Lew Brown, music by Ray Henderson

Into each of our lives a little sun must shine, a little joy must visit, a little praise, good luck, achievement, contentment or unexpected relief must occur - whether we deserve it or not. It’s only natural that the law of averages dishes out happiness from time to time, and when we receive it we might consider it to be simply payment for services rendered, or like myself, call it a gift - a delight as pleasing as finding a bowl of plump, juicy cherries on a sunny countertop. Enjoying the merry-go-round called life helps us to cope with those times when it becomes as toilsome as clearing brush under the August sun, or as irritating as waiting for the check after a lousy meal. Such nuisances are all a part of the world we occupy, so maybe we should buck up and do the song says. Don’t take everything so hard. Don’t worry so much. Cheer up - you’ll be finished on this planet before you know it so why not enjoy its delights while you can?

This is a pleasant argument, if not somewhat hackneyed. In fact even the song, as pretty as it is, soon gets tiresome, as if one is stuck in a pew listening to an extremely long sermon. Why doesn’t some wag come up with a more timely metaphor for life that can soothe the tortured souls commuting to work each day, their heads churning with chaos and stress? Who has even been to the kitchen lately to see if they’re still setting out heaping tureens of the crimson fruit for our meditation? Can’t some aspiring writer scratch out a few new lines depicting life in the 21st century with all its mystery?

Okay, I’ll do it, but just this once.

Actually what I’ve been pondering about lately is how life with all its burdens and strains can sometimes be thought of as a strand of DNA. The gentle reader will bear with me while I explain:

In order for an organism to survive, it must be able to generate new cells by replicating its genetic code contained within the double helices of DNA, then proceeding with cell division, or mitosis. In a way our life mimics this process, as we must continuously move forward in order to survive, growing in size and intelligence, gaining experience and maturity, learning to give and love. Stopping this evolution is like suddenly standing still. Unless we begin to move again we will certainly die.

The cell’s strands of DNA - its code for survival - are so long they cannot be stored within the nucleus unless they are compacted into pretzel-like coils called superhelices, similar to a telephone cord twisted into corkscrews. This is great for storage but when its time for the cell to divide the process of uncoiling the DNA creates too much tension on the strands to straighten them out, so in order to salvage mitosis clever enzymes called topoisomerases are called on to create breaks in the DNA where there is stress and tension. Again, think of detaching an twisted telephone cord so that it unwinds. By splitting the double helix the enzyme allows the supercoiled strand of DNA to pass through the breach and relieve the strain on it, then seals the rupture so as to maintain the gene’s integrity. Now as the strand untangles itself it relaxes and can form its proper shape for replication - for moving on with life.

So it is with our life. Sometimes we come under so much strain and tension that we feel ourselves curling up into a snarled knot of frustration and despair. Our hearts lie entrapped within coils of fear, anger or discouragement, and we cannot honestly imagine how we can go on any further. It is at this time when we need a catalyst to tear a breach in the strangling loops of stress, to release the pressure on our throat so that we can breathe again and straighten ourselves out - so that we can once again move on with our life.

Where does the release come from? What serves as the life-saving enzyme that cuts away the tension and allows us to heal?

Ladies and gentlemen, this is where I get off the stage. I suspect each of us has multiple remedies at our disposal, and it would be presumptuous as well as conceited of me to pretend that I know all the answers. I do know one thing, though, and I offer it to you as proof that your worries will soon fade, that the stress in your life pinning you down will soon snap as cleanly as a snipped strand of DNA. It is this: living cells have never failed to unbind themselves from strain, (otherwise this planet would really be known as the “Third Rock from the Sun”). This process is as natural as any other part of life, and because it occurs life passes down from generation to generation. Tension does not last long within the nucleus of a cell, and it will not last long within us. It is impossible to keep healing from occuring, so relax and wait for it to happen.

The sweet things in life, to you were just loaned,
So how can you lose what you’ve never owned?
Life is just a bowl of cherries,
So live and laugh at it all.

One of the frustrations of educating the public about new developments in cancer care is that most people get their information from the mainstream media, which in my opinion often fails to report these stories clearly and accurately. This leads folks to make broad assumptions about cancer and its treatment that can lead to disappointment and disillusion when they are eventually proven to be false.

Here is a case in point: this news story suggests that “doctors have found statistical evidence that alternative treatments such as special diets, herbal potions and faith healing can cure apparently terminal illness.”

This internet article is grossly misleading and incomplete. The abstract from the actual paper reveals the following:

1. The patients were all from Australia, which simply means that any conclusions made cannot necessarily be extrapolated to include Americans with lung cancer.

2. These 2337 selected patients were all given low dose radiation therapy, defined as less than 36 Gy (standard ‘curative’ RT would be at least 60 Gy). They were not given alternative treatments such as herbal potions.

3. Of the 2337 patients, 25 survived five years and 18 of those 25 patients were not only alive five years later, but still free from progression of their lung cancer. One percent of patients survived five years - this is a “cure”?

4. The five-year survivors “were less likely to have distant metastases (P=0.020).” Now there’s a shocker! Who knew that people with localized lung cancer have a better chance for long-term survival than those with widespread metastases?

5. The conclusion of the authors, in contrast to the conclusion of the news article, is that “approximately 1% of patients with proven NSCLC [non-small cell lung cancer] survived for > 5 years after palliative RT, and many of these patients appeared to have been cured by a treatment usually considered to be without curative potential.” In fact, one researcher is even quoted in the news story as stating that “it is important that the frequency of this phenomenon should be appreciated so that claims of apparent cure by novel treatment strategies or even by unconventional medicine or ‘faith healing’ can be seen in an appropriate context.”

Translation: If one percent of all patients with lung cancer are cured with low-dose radiation therapy, which is considered not to be a curative treatment, then perhaps one percent of all lung cancer patients survive for five years no matter what treatment they are given, or whether they are treated or not.

Oh, now I get it…I can peddle anything I want as a cancer cure as long as my customers can live with a proven success rate of 1% and weather the criticism from skeptics who say that my treatment t’weren’t even the reason they’s alive!

Or, to put it in the lingua franca of academia, one who assumes his alternative cancer therapy is the cause of his patient surviving is commiting the logical fallacy of “Post Hoc, Ergo Propter Hoc.”

Lord knows we oncologists have our work cut out for us when it comes to disseminating accurate information. That is why we thrive on counseling patients, for every day that we break through the wall of ignorance entrapping those patients or caregivers who are experiencing the agony of cancer is a day when we have earned the right to watch the setting sun canopy the sky with layers of pink and orange, and feel satisfied.

“Fish Oil Probably Doesn’t Fight Cancer”

Now, there’s a misleading headline if ever I saw one - do they mean that fish oil is too chicken to put up its dukes against a cowardly band of sneering, narcissistic cancer cells? Is fish oil destined to join its comrade laetrile on the ash heap of ineffective cancer treatments?

No, that ain’t it. No one is saying fish oil is a flop as chemotherapy against cancer. Read on:

Researchers examined data from 38 studies that tracked patients for up to 30 years, and said most showed there is no cancer protection from omega-3 fatty acids. The reviewed studies examined the effects of fish oil - in both pill form and as food - on 11 kinds of cancer, mostly tumors of the breast, colon, lung or prostate.

We have all heard that ingesting fish oil can prevent sudden death, lower triglyceride levels, open up rusty pipes, grow hair on a billiard ball and promote inter-galactic peace. Now comes this story that, much to the disappointment of the investigators I’m sure, suggests omega-3 fatty acids don’t reduce the risk of getting cancer. Does this study of 700,000 patients (wait a second - 700,000 patients? Does anyone think that there might be some problems with standardization of variables here?) mean that we’ve proven any definitive conclusions about eating fish oil? Listen to what “chronic disease researcher” Julie Buring, from the Brigham and Women’s Hospital in Boston has concluded about this report:

“It doesn’t tell us it’s unlikely or likely,” Buring said. “What is supported is that right now we don’t know.”

Oh, so we don’t know! Now, how do we know we don’t know what we thought we knowed?

The review is unlikely to be the last word on the issue. Diet is known to play a role in cancer and the researchers evaluated observational studies, which provide mostly circumstantial evidence.

That’s putting it mildly. Not only do dietary prevention studies have to prove that subjects ingested the proper protective foodstuff (fish oil capsules, or Saumon sur un lit d’epinards?), in the proper amount (determined by whom?), for a meaningful length of time (one can of tuna a year is unlikely to guarantee 100 candles on your birthday cake), they must also show that the beneficial health effect is a direct result of the ingested substance, not the fact that all 700,000 of your mackeral-munching minions just happened to be non-smoking fitness buffs.

So we don’t know if fish oil is truly a waste of time in the battle to prevent getting cancer, but having taken the capsules once (on a health kick, of course) I can vaguely recall a unique side effect of this product. My memory seems to have failed me, but perhaps if I ask for divine effluvium to guide me, afflatus will inspire me to pass remembrances of zephyrs past along to you, the gentle reader. Semper ubi sub ubi ubique!

UPDATE: In response to a request, here is a link to the actual article, published in the Journal of the American Medical Association.

The 38-year old French woman who received the world’s first “face transplant” after being mauled by a dog has started smoking cigarettes again.

Well, we doctors all would agree that smoking is bad for one’s health, but it is certainly legal. What makes this story so interesting?

Both critics and supporters of facial transplant surgery agree that cigarette smoking can significantly impair tissue healing through a variety of mechanisms.

Uh, oh - I can see where we’re going here…

“The main problems with chronic smoking during wound healing are an increased rate of infection and increased rate of flap failure,” said Victor Neel, M.D., Ph.D., director of dermatologic surgery at Massachusetts General Hospital.

No, don’t tell me this patient is willing to put her love of cigarettes ahead of her health! Surely she understands that smoking could be disastrous to her facial transplant.

“A face transplant is the ultimate high-risk procedure. Light-to-heavy smokers have something like a six- to tenfold increased risk of the skin flap dying,” Dr. Neel said.

“Six- to tenfold risk? Oh, is that all? Why, that’s nothing, Doc - I won’t even break a sweat until you tell me there’s a 75% chance my new face will fall off! In fact the gang down at the corner bar-salon is so happy to see me they’ve been buying packs of cigarettes for me to enjoy.”

Dermatologists have a term for the effects of tobacco on skin: “smoker’s face,” defined as premature deep wrinkling and discoloration of facial skin.

Why, that’s an insult! How dare they engage in such cruel name-calling! It wouldn’t surprise me a bit if the People for the Sensitive, Easily Hurt Victims of Being Alive filed a class-action lawsuit against every physician in America for such abusive language!

I’m not as quick as I used to be, but it seems to me that a patient receiving a face transplant who willingly endangers her skin graft is like a lottery winner who, flush with cash, can finally begin to make arrangements to receive all that money Dr. Olu Oboba, the Nigerian Minister of Natural Resources has been begging to send him.

For some reason I have been tossing off apothegms to my patients this week. I know doctors love their wise old adages - for example when I was an intern my favorite one was, “The intern always eats,” which means (of course, bubeleh, if you already know what it means then you obviously survived an internship) that since the intern is low-doc-on-the-totem-pole, forced to stay up all night admitting the bibulous, the nauseated (two afflictions often found in the same corpus), and the insomnious, he must be allowed to put away enough victuals for the long night ahead. I remember other sayings from those years ago, pithy (pithy? Dr. Charles call your office!) quotes designed to rally the troops at the witching hour of an on-call shift, which usually was around 11:00 P.M., the time when the evening admissions were all tucked in and the great engine of the hospital began to slow down for the night. It is during these crucial hours, when the quicksand of fatigue starts to wear down a doctor’s will to perform, that the brave cry out things like, “Never let the sun set on a pleural effusion!” and the sarcastic announce, “I’m off to bed; call me if you want but remember - it’s a sign of weakness.”

I guess I have been a fan of medical aphorisms since I was old enough to understand The House of God, which is the bible of quotations for all doctors who have been infected like myself with the black humor virus. Anyway, here are a few of the words of wisdom I have been slinging this week:

“Remission is like a free stay in a luxury hotel that won’t tell you when your time is up.”

“No matter how effective chemotherapy is, there comes a day when you’re better off without it.”

“I’d rather have you asleep and free from pain than wide awake and in agony.”

“The job of the oncologist is to look into the future and prepare the patient for what lies ahead.”

“Cancer works 24 hours a day - without ever taking a break. We need to be just as aggressive in killing it.”

“Please don’t worry too much - that’s what you’re paying me to do for you.”

“I can’t guarantee that your cancer can be destroyed, but I can guarantee this - we will have a plan to defeat it.”

“My goal is that you and I are looking at each other one year from now - and laughing.”

I’m sure there are a myriad of doctors’ sayings out there. Someday the medical blogosphere needs to compile them and entertain the world with our witticisms and wise proverbs culled from a lifetime of trying to live up to our patients’ expectations of ourselves while simultaneously giving out free demonstrations of what Hemingway meant by the phrase “grace under pressure“.

Researchers from the University of Maryland are reporting that brachial artery blood flow increased in volunteers who watched comedy film clips, whereas it was reduced after watching movie scenes that were distressing or sad.

Lead researcher Dr. Michael Miller said, “The extent of the impact of watching a sad film was of the same magnitude as remembering episodes of anger and doing mental arithmetic, while the impact of watching a funny film was equivalent to a bout of aerobic exercise or starting on statin treatment.”

Dr. Charmaine Griffiths of the British Heart Foundation weighs in with this comment: “Scientists are becoming increasingly interested in the possibility that a good giggle has positive effects on heart health. Whether sharing a joke with friends or watching a comedy, a good laugh is likely to be good for your heart.”

I’ll let you in on a secret - some of us Earthlings who are blessed with a pervasive sense of humor, if not a keen wit (as wits go), have suspected this for years - and now our prayers have been answered! The more we laugh, the faster our blood flows! This could be the most delightful discovery of the new century since they reported that eating dark chocolate cures male-pattern baldness (or something like that).

Given the fact that medical entrepreneurs scour the countryside like a cloud of locusts, looking for the next fad to peddle to the American people, can it be long before we are all renting AHA-approved movies from our doctor’s offices? If so I would like to go on record as being the first physician to have the foresight to advise all potential heart-attack victims to go to the video store (or Netflix) and check out something from this top 100 list immediately. Hurry! Time is of the essence!

(P.S. - Just between you and me, film number 61 on that list is a heck of a lot funnier than number 2 - and I could never understand what was so great about number 89…I just didn’t get it. Will this take a year off my life?)

UPDATE: Ali from the group blog Blendor says number 15 is tops on his list, but let’s get serious - if you were scheduled for a cardiac cath there’s only one movie that is guaranteed to keep you alive until your stent has been placed, and that is number 36.

Out through the fields and the woods
And over the walls I have wended;
I have climbed the hills of view
And looked at the world, and descended;
I have come by the highway home,
And lo, it is ended.

from Reluctance, by Robert Frost

The following was inspired by a patient of mine who, while getting ready to start a difficult and potentially dangerous course of chemotherapy, asked me if I could guarantee that her treatments would be successful.

An average couple, the kind that one meets at a soccer tournament or on vacation, blessed with friendliness as well as normalcy, awoke one day to find themselves in a strange land. Frightened, they began to search for a way to return home. They began to hike through a dense field sloped against a mountain, and after a while the husband came across a map resting on a stump. He carefully examined it and saw their hometown depicted in the center but was unable to identify any of the country surrounding it.

“We must find someone who can read this map,” he said. They continued to walk along until a village tucked in a narrow valley came into view. Soon they were knocking on doors, asking the inhabitants for help. The villagers were unable to decipher the markings but they all said to take it to the professor who lived next to the school, who was considered the smartest person in the valley. The couple hiked up the low hills to his house just as the sun was setting.

“Yes, may I help you?” asked a cordial voice through the weathered door.

“We’re sorry to bother you but we are lost,” said the wife. “We heard that you are able to read maps and thought maybe you could take a look at this one to tell us how to find our way home.”

The professor invited the man and his wife in and seated them before him. He studied the map for a long time before speaking.

“This is written in an esoteric language and the landmarks appear to be in code, but I’m fairly familiar with it from my studies. The problem is that even if I give you directions you will still need to be able to read the map as you travel along.”

The wife frowned and leaned toward her host. “Would you be willing to take us home? We’d pay you well.”

He smiled and said, “If I agree to help you I’ll actually receive a fee from our government. You would only need to pay for my gasoline. I’d be happy to be of service, but it will require that I drive. My vehicle is quite complicated to master.” He set his teacup down and asked if they had any questions.

The couple expressed their gratitude and the following morning after packing enough food and supplies for the trip the trio set out. The roads were wide at first but as the days went on they became rutted and in some areas dangerously narrow. Again and again the professor consulted the map as he raced across bridges and climbed hills flecked with aspen. As the days turned into weeks the couple became weary. Several times they groaned with disappointment when their driver announced that he was off course and had to turn back. The terrain soon became treacherous, and the husband noticed the wreckages of many cars that had gone off the road and crashed into the ravine below. He began to lose confidence in his guide and one day finally confronted him. The professor admitted that they were lost.

“You told us you could interpret this map!” he cried. “We’ve stuck it out with you for months and now you tell us you can’t figure out how to find our town! Why did you say that you could help us if you weren’t sure?”

He pulled over to the side and turned toward his two passengers.

“If I told you I wasn’t certain I could find your home would you have agreed to take this trip?” The professor stared hard at the couple, yet his voice was tender. “Or would you have continued to wander aimlessly until you both died of heartbreak? I confess that this map is difficult to decode, and I don’t know if I will ever be able to discover the correct route to your town, but I am willing to continue trying if you are.”

The man looked at his wife and after a pause they both nodded their assent. The professor put the car in gear and started off. He smiled knowingly at them and put his hand on the wife’s shoulder.

“Remember, when you hired me you charged me with driving you both home - safely home. I can’t promise you that we will ever reach it, but I can promise you one thing - that I will always keep my eyes on the road.”

Ah, when to the heart of man
Was it ever less than a treason
To go with the drift of things,
To yield with a grace to reason,
And bow and accept the end
Of a love or a season?

A study of 17,643 patients over 30 years found that “being overweight in mid-life substantially increased the risk of dying of heart disease later in life - even in people who began the study with healthy blood pressure and cholesterol levels.”

NO! Say is isn’t so! I’m shocked, shocked to find that obesity is associated with medical illness! Next thing you know we’ll all be told that gambling is associated with having less money, that alcohol ingestion is linked to intoxication, and (heaven forbid) cigarette smoking has been found to be a possible cause of yellow fingers and brown tongues! How do we cope with this latest attack on our brazen love affair with sultry vices?

A guilt-wracked thoughtful soul, especially one who has just ordered a hearty slice of peanut butter and chocolate cheesecake, might respond to the above news by eschewing the tempting plate of joy and declaring to his compatriots that he is “going on a diet.” The vast majority of the accused, however, will likely tut-tut over this new revelation and, vowing to watch what they eat, continue to shovel it in like a human garbage disposal. Is this a mistake, as the article suggests, or do we all have the right to smear as much fat on our bones as earth’s gravity will allow?

When I counsel overweight patients I like to ask them, “What do you like to eat?” The most common answer I get is a chuckle followed by “Everything!” It seems that many of us rationalize our addiction to fattening foods by indulging in a little self-centered teasing, as if having a sense of humor about our excessive calorie consumption legitimizes the habit. Hey, it’s great that you can laugh at yourself - in fact, if you listen carefully you can hear drug companies, cardiologists and funeral directors guffawing, too.

Again I ask- is this an abomination? Should we all feel guilty about our eating habits, and report to the monastery for a room and a small salad - with no dressing?

Hey, I’m not the guy with the answers, just the questions! I will say though that the first scientist to uncover the secret of why some of us eat until we waddle around like a walrus deserves the Nobel prize, if not a patent more valuable than King Midas’ warehouse. Until then the two debate teams will continue to scream at each other, one arguing that the government needs to arrest overeaters and shut down fast-food restaurants, and the other advocating our right to do whatever nasty things we want to do to our formerly pristine bodies, all in the spirit of truth, justice and the American way, or as their tee shirts say: Quam bene vivas refert, non quam diu!*

*How well you live is important, not how long. -Seneca

Our tour through this strange and mysterious building known as The Museum of Medical Secrets has now reached the third room. Those who were not listening to the docent during his commentary on Room One and Room Two may perform an about-face and recap by clicking on the respective hyperlinks. The rest of you may walk on. Please raise your hand if you have a question or need to visit the lavoratory.

Despite the entreaties of some of their more anxious patients, most doctors are not available 365 days a year. If I may be so bold as to comment - this is a good thing. No sane person one would jump at the chance to be cared for by someone so overworked they looked like an extra from the cast of Night of the Living Dead. Doctors therefore typically rotate weekend duty with their partners or with friendly peers. In this standard arrangement the covering physician performs hospital rounds for his missing colleagues and then on Monday morning updates them about the events of the last two days.

This certainly sounds like a straightforward, if not a particularly uninspiring way to spend a weekend, but Oh, Oh, Oh! The trauma actually felt vigorously giving vast attention here! If the gentle readers could only experience the intrigue and mayhem coiled within those fateful 72 hours, they would gladly cancel their season pass to the Grand Guignol. Actually, weekend rounds are like going on a military patrol. One has to trudge hour after hour through dangerous territory, always under the risk of being attacked - in the doctor’s case by a difficult patient or problem.

Smart weekend warriors, therefore, approach call like a battle-hardened soldier saddling up for duty - with a mixture of preparation and trepidation. After sixteen years of taking call, I ought to know. The following assessment is completely hypothetical, of course. Here’s how I break the scenario down:

Wake Up Sleepyhead! Every Saturday morning on call I awaken to hear a debate between a little angel sitting on my right shoulder and some mustache-twirling creep in a red union suit perched on my left. It’s always the same argument - do I cut slumber short and dash off to my rounds, thereby guaranteeing I’ll be so exhausted by afternoon that the dog, finding me unconscious on the couch, will try to bury me - or do I sleep in? What’s the catch, you ask? The later I arrive at the hospital (fully rested, of course) the more family members there are hovering around the bed. If I start my work before the first rays of dawn caress my grimy windshield I’ll be more likely to finish up before the visitors arrive with their myriad of questions.

Dress Code? What Dress Code? Yes, I know that some physicians get a kick out of dressing up in fancy suits and pressed white shirts. Even I try to put a necktie on during the week, but come the weekend - forget it. Even that pompous flunky Hermann Goering got to romp around the Black Forest occasionally without having to don the clown outfit. Oh, I’ve paid the price for my “casual coordinates” look - once I got fired by a patient for showing up on Sunday sans socks. I now always wear socks, even at the risk of getting kicked out of the Preppy Doctor’s Club. As for keeping a smooth face - can you believe that some of my colleagues actually don’t even shave prior to hitting the highway for weekend rounds? May I be struck down by lightning if I’ve ever shown up at a nurses’ station stippled with stubble!

Yoo Hoo! Here I Am - Anyone Have a Crisis for Me? Doctors tend to be superstitious creatures, hence the well-known slang term black cloud, used to chastise physicians who tend to be an irresistable target for every possible medical crisis or lunatic patient available for quick and easy take-out. In order to minimize the risk of getting slammed with a horrific case I love to accomplish a perfect game, set and match of what I call “ghost rounds.” This is where the doctor walks onto the floor, sees his patients, writes his notes and orders in the chart and exits without any nurses ever noticing him. Hey, they can’t hurt you if they can’t see you, right? I’ve heard stories about interns who went months on service without anyone figuring out what their speciality was, but this could be apocryphal.

“You Look Marvelous!” “How ya’ doin’?” “I’m jes’ goin’ ’round checkin’ on folks.” Let’s face it - it’s hard to be committed to a complete and thorough evaluation of patients when the Saturday sun is streaming through the window, begging for a chance to baste a pasty-faced doctor with ultraviolet radiation. Just like Count Dracula being asked to sink his fangs into a victim of aplastic anemia, when I round on strangers I think - where’s my motivation? No matter how fabulous a job I do on the weekend, come Monday my partners will resume all responsibility for care, and all my hours of sacrifice will fade from memory faster than the laurels in my rose garden withering under the brutal August sun. So I tend to assume a folksy manner, dispensing words of encouragement without actually getting tangled up in the messy details of a patient’s prolonged and/or onerous hospital stay. Some experts call this crisis blindness. I call it slaloming, baby.

So Long, Farewell, Auf Wiedersehn, Goodbye! Whether I spend five minutes or five hours tending to my weekend patients, there comes a time when I must enter my spaceship and return to Earth, to the land where my wife and family await me, to the place where my little doggie languishes, her tail wagging with anticipation. Thank God I am not someone who has to work 24 hours a day, like a philosopher. Being a physician is an unbelievably rewarding profession, as long as one is willing to put up with working weekends. Now that I think about it, it’s not so bad being on call. It does get one out of doing household chores, or yard work, or helping with homework - at least until I pull back into the garage.

[Editor’s note: apparently the narrator still pines for his youth, as only a doofus would write such a corny title, a phrase that according to legend was last uttered by a bespectacled chemistry teacher in Dayton, Ohio on October 24, 1979, while dancing to “Disco Duck” during the high school homecoming dance. Sic Transit Gloria Mundi!]

Regular readers of these musings may recall my efforts at chronicling all of the peccadillos doctors propagate in the course of their dealings with the ill. I myself committed the sin of assumption last week while interviewing an 80-year-old man who had developed locally advanced cancer. I considered offering him combination chemotherapy in an attempt to relieve his shortness of breath and give him a chance to prolong his life (No, not prolong his life compared with garrotting him as sat there…Sheesh! Everybody’s a comedian!) As I obtained what we pros in medicine call the “social history,” I asked him what he used to do for a living.

“I own my own company and still run it,” he replied.

“Hey, that’s great!” I bleated, while that part of my brain where the famous Herr Doktor postulated the existence of the cruel jury known as the superego began to wail the following announcement:

“He just made an ass out of you and me!”

No one would convict me of the sin of insensitivity just because I assumed an octogenarian was retired, would they? If it wasn’t for decades of economic prestidigitation that encouraged most men over the age of 65 to call it quits I would never have assumed that my patient was certainly through with his life’s calling.

I began to feel new found respect for this man who, struggling with an illness destined to eventually take his life, nevertheless still wanted to work.

“You know what?” I said. “You’re my role model. I’m with you - just keep on truckin’. You know what people who love their job say, don’t you?”

He smiled and shook his head.

“‘I’ll retire one day before the funeral!’”

He is on treatment now with both chemotherapy and targeted therapy, and we’ll soon know whether or not his tumor is susceptible to the glorious, insidious treachery lurking within each of the billions of molecules now sluicing through blood vessels and, reaching the end of the line, knocking on the door of these most foul creations of life.

Let us hope that his medicine works as long and as hard as he has. Let them both stand side-by-side and face the task before them, with confidence that until the last rays of the sun vanish into eternal darkness, neither partner will ever admit defeat.