Archives of The Cheerful Oncologist, Volume 2

Here hung those lips that I have kissed I know not how oft.

-Hamlet, Act V, Scene 1

“New research shows that smokers are more likely than nonsmokers to get root canals.”

Whadda lollapalooza! Now don’t get me wrong, folks, as a practicing medical oncologist I am extremely sensitive to the ravages of smoking-related illnesses. It’s just that in The Examining Room of Dr. H. [with apologies to our literary colleague languishing in some undisclosed location in the East] when I set out to punish a disease caused by Old Man Tobacco the stakes are higher than saving a rotten tooth. Nevertheless this is an interesting headline. It seems that folks who smoke for longer than twelve years are twice as likely to need a root canal procedure, and even smokers of just a few years are more likely to find something rotten in the state of dentition, based on a review of x-rays of smokers vs. non-smokers.

Hmm…here’s an interesting quote from the story:

“The x-rays [showing root canal surgery] don’t show why cigarette smokers were more likely than nonsmokers to get root canals. ‘We couldn’t in this study determine what the biological mechanisms might be,’ [Boston University dental professor Dr. Elizabeth] Kaye says.”

Nope, we’ve got no idea why smokin’ them unfiltered Luckies would erode yer teeth as efficiently as an Arizona creek with 6 million years to kill. Oh, wait - the authors do have a hypothesis after all:

“Smoking makes it harder to fend off infections. Smoking increase inflammation. Smoking damages the circulation system and lowers oxygen levels.” And that’s just for starters!

At least the researchers were able to put a positive spin on this startling revelation about the evils of smoking. Says Dr. Kaye, “There is good news from this study for people who do smoke, and that is that if you quit, your risk of root canal treatment will go down.” Now there’s a conclusion refreshingly free from the moral ambiguity and please-don’t-hit-me spineless equivocation heard daily in scores of discussions occurring in places like a midtown Manhattan bar. You tell ‘em, Doc!

So stopping smoking might just save the canals of your pearly whites - hey, whatever works. Maybe we should be putting up billboards on Times Square showing the consequences of years of running with the fashionable crowd. It’s just that I can’t help but feel the sly grin of irony spreading across my face when I read that dentists are now being admonished to refer their patients to stop smoking clinics, and provide them with nicotine patches. I applaud their rectitude and wish them Godspeed in their mission to reduce the rate of smoking in this country.

I won’t exactly start looking for another line of work, though. I’ve seen too many people who simply will not stop smoking - not after watching their spouse die from a tobacco-related cancer, not even after surviving cancer themselves. How can we expect them to eschew the dastardly banes just to avoid wearing the bastardly panes - dentures, that is.

Unless, of course, vanity is a stronger motivator than life itself.

You left me standing here
A long, long time ago,
Don’t leave me waiting here,
Lead me to your door.

-Lennon/McCartney, 1970

The old woman lay propped up on two rather stiff pillows which were tucked under her at what seemed to be uncomfortable angles. Her voice trickled out with the hesitant phrases of the seriously ill as she cautiously shifted her body in the bed. Above her a spiderweb of tubing hung from several poles, and outside in the hallway a vacuum cleaner roared back and forth slowly across our ears. I got up and closed the door.

The old woman was my patient, now entering her eighth (or ninth, perhaps) day in the hospital after developing pneumonia and severe esophagitis from simultaneous chemotherapy and radiation therapy. The first 48 hours had been terrible for her, and I began to grieve when I thought that she was going to die, another victim of the good intentions of a team of doctors.

The old woman was tougher than we thought. She was blessed with a beautiful combination of both undauntedness and good luck and survived the initial storm - the fevers and hypoxemia that lash cancer patients who show any signs of weakness. Now she was beginning to recover. According to my schedule she had two more cycles of chemoradiotherapy left before completing the full course. She had just asked me how long she would be off of treatment.

“I don’t believe it is safe to continue on with any further therapy,” I said. She stared straight ahead as I spoke, and I turned to the window and continued my argument, swinging my head back and forth between her and the far side of the room, for sitting over there on the sill were her husband, son and daughter-in-law.

I presented my case to them, explaining that because of this setback any further complications could prove fatal. In my opinion this patient was now officially off of all treatment. From now on, the journey ahead would be toward recovery and hopefully a return to the normal home life we all tend to take for granted in times of good health.

“Because Mom hasn’t finished all of her chemotherapy and radiation therapy won’t that hurt her chances for remission?” asked her son.

Good question, I thought, but putting everything into perspective I felt that she had received enough treatment to deal a serious blow to her tumor - perhaps enough to induce a long remission, perhaps not. It was irrelevant at this point, but I wanted to convey that information to the family in a way that they would understand, without resorting to quoting impersonal statistical data (also known as medical lingo). I paused for a second and then came up with this explanation, which I shared with them:

“Think of two cancer patients beginning treatment as two cars who need to cross a dangerous mountain in order to reach home on the other side. The first car drives over the mountain without any difficulty and eventually pulls into the village safe and sound. The second car takes a bad turn and careens off a cliff, crashing into the rocks far below, killing the passengers. The first car represents those who sail through their treatment without difficulty and obviously the second car represents those patients who die from the toxic side effects of treatment before they have a chance to see if they have defeated their cancer.”

“Excuse me, Doctor, but it seems that Mom isn’t in either one of those groups, is she?”

I turned toward my patient and addressed her directly. “That’s right - you weren’t in either one of those cars. You are in a third car that made it all the way to the summit, then broke down. You are still alive, but in order to stay alive you’re going to have to walk down that mountain. It will be a long journey, but with help from all of us, you just might make it all the way home.”

“Mars Inc., maker of Milky Way, Snickers and M&M candies, next month plans to launch nationwide a new line of products made with a dark chocolate the company claims has health benefits.”

No! It can’t be! If this story is true this is the greatest news I’ve ever heard in my life, except for the day they cancelled the “Donny & Marie” show. The wizards of Willy Wonka land are whipping up giant tubs of the stuff that sweet dreams are made of - as a way to improve our health? This does seem a bit dubious - perhaps we should take a closer look at this story to see if the company’s claims convey correct conclusions.

First let’s look at the headline: “Candy Makers Cater to the Health-Conscious.” They’re kidding, right? Since when do the health-conscious complain that they’re not getting enough high-fat high-sugar chocolate in their lives? Wait a minute - the headline is misleading. It seems that the chocolate used here, called “CocoaVia”, is packed with flavanols, “an antioxidant found in cocoa beans that is thought to have a blood-thinning effect similar to aspirin and may even lower blood pressure.”

Sound the trumpets! Let the chorus begin to sing all praises to thee, O Mars, the god of chocolicious ecstasy, and now the patron of all vigorously beating hearts and oil-slick smooth arteries.

“But researchers are skeptical about using chocolate for its medicinal purposes and experts warn it’s no substitute for a healthy diet. With obesity already a serious problem, ‘the last thing we need is for Americans to think they can eat more chocolate,’ said Bonnie Liebman from the Center for Science in the Public Interest.”

Oh, that’s it - throw water on our party even before we get started. Well, I’m not going to just stand around and let researchers or professors or spokespersons from some Orwellian social “center” put my life at risk. I’m turning over a new leaf as of today and damn the consequences. I hereby ask all those within earshot of my voice to join me now and raise their right hand to take The Cheerful Oncologist’s Oath for Healthy Living:

I (state your name),
Do hereby solemnly pledge to eat dark chocolate
Without guilt or shame
For the rest of my life
Or until they invent chocolate-flavored scotch whisky,
So help me Hershey.

Let the healing begin, and may all those who choose to join me in this noble quest for perfect health and longevity be blessed with the sweetest breath if not the stickiest fingers ever recorded since the dawn of time.

How did your week go? Mine was rather interesting for the fact that two events occured almost simultaneously. First, a vicious Canadian cold front crashed into the city like a bull charging the buffet line at a wedding. No hint of the oncoming storm was given to those of us who like to live dangerously by avoiding the forecast, which made it all the more exciting. Right in the middle of a rare February afternoon when one could, if one was so inclined to be the talk of the neighborhood, actually lie in the backyard hammock, the temperature dropped from 73 degrees to 38 degrees in one hour. The only clue before the whirlwind struck was a whispering breeze that seemed to rise in intensity by mid-day, as if a soloist whistling across the rivers and hills was joined each minute by another member of the chorus. As I sat in my examining room interviewing a patient I became distracted by what sounded like an squadron of fighter jets outside my window. This was the storm, which brought hail, rain and snow to the city. Now as I type this my thermometer displays a single number, and that number is six. My family is asleep. The dog and I are fighting over the afghan, and if this was a professional wrestling match I would be on the mat, semi-conscious, about to receive a canine Banzai chop.

Pardon me while I look for another blanket.

The other event of the week was I came down with a nasty virus - what we typically call a “cold.” This too announced itself like the storm, first with a slight tickle or maybe a bit of phlegm mysteriously appearing in the back of the throat, certainly nothing so alarming as to dial up an ambulance escort to the local emergency room. When I first became aware of the change in my body’s forecast I did what many doctors do when they suspect a cold coming on - I ignored it. Far be it from me to cancel my day and rush home to a likely unsympathetic family while my dear patients have to muddle through the week without my help.

One pays a price for such legendary undauntedness, I suppose. By the time I arrived back home to the log cabin the arctic wind was shaking the rafters almost as violently as I was shivering. The skies spat out great gusts of sleet all over the streets, while I blew my nose with equal vigor. The overall mood was dark gray, both outside and inside, and exhaustion set in around 6 P.M. Now only sleep can cause the world to turn and bring back sunny skies, and sleep is exactly what I did. My ally is now the clock, for with the passing of each hour the frozen grip on our city loosens, just as my cold will soon melt away. In fact, it won’t be long until my buddies the talented song sparrows warble the birth of spring as I lace up my shoes for the first run of the season - each of us the picture of health.

If only cancer, the unwanted storm, would leave us as predictably as the turning of the seasons. If only.

“Development and Validation of a Prognostic Index for 4-Year Mortality in Older Adults”

-headline of article by Lee SJ et. al., Journal of the American Medical Association, February 15, 2006

Hey gang - there’s a new fun test out there for the parents and grandparents to take! As the JAMA article title refers to, it is a predictive model or a “mortality prediction index” that consists of twelve simple questions to determine a person’s risk of dying in the next four years.

Exactly what type of “person” are we referring to? Well, the quiz is only for “community-dwelling inviduals older than 50 years,” which excludes those living in nursing homes (for good reason one assumes), as well as youngsters (who need not bother since they are destined to live forever anyway). The index gives a point total that places one in either a high-, intermediate- or low-risk group for biting the dust sometime during the next four years. For example, a score of 0-5 points means one has only a 4% risk of dying within four years but a score of 14 or more points places that risk at 64% (yikes)!

The test is only accurate 81% of the time, so let’s not all get our hopes up if we have a perfect score, nor should we get fitted for a pine box if our point total would win 99 per cent of all major league baseball games played this summer.

Of course, the mainstream media in their typical News-You-Can-Use fashion is hyping this story with such idiotic headlines as “When Will You Die? Take This Quiz.”

Now there’s a little piece of bedtime reading that will bring sweet dreams, eh? I guess we had better practice pushing chairs across the living room if we want to be around for a few more decades or see the Cubs go to the World Series again, whichever comes first.

Some of the questions in the index are self-explanatory, such as “Have you smoked cigarettes in the past week?”, or “Has a doctor told you that you have cancer or a malignant tumor, excluding minor skin cancers?” I don’t doubt that a “yes” to those two might just put one at a higher risk for dying, but pushing a chair across the room? That’s just not fair to Grandma to expect her to perform what I consider to be a Herculean task at any age (we have really heavy chairs in our parlor - believe me). It’s not fair - but it is accurate, and if she can’t pull nor push the rocker over to the bay window Granny is going to get one point added to her score. Lord, how cruel these geriatricians be!

Don’t get me wrong about this prognostic index - I wholeheartedly applaud its development and wish that all adults over 50 (sorry, I’m too young to take the test) would take its warnings to heart. It’s just that this concept is not new to those of us who spent the first year out of medical school working in what is called “the internship.” Back then we had our own test to determine the risk of not surviving this 12 month sentence at hard labor, and used it to encourage those doctors who were unlikely to live to see the next summer to drop out of the program before it was too late.

As part of our policy here at The Cheerful Oncologist to disclose all secrets of the medical profession it gives me great pleasure to print this formerly suppressed prognostic index for all the world to judge. I encourage all interns to answer these twelve questions honestly. The life you save may be your own.

“Development and Shameless Self-Promotion of a Prognostic Index for 12-Month Mortality in Interns”

[All “yes” answers are worth 2 points unless otherwise stated.]

1. Has a nurse ever looked at you and made the sign of the cross?
2. Do you consume over 40 cups of coffee per day? (add 1 extra point for eating stale danish)
3. Have you ever spent over one hour attempting to perform a lumbar puncture?
4. Would you consider eating food off of a patient’s tray rather than walk to the cafeteria? (add 1 point if patient put up fight)
5. Give yourself one point for every consecutive day you have gone without bathing.
6. Have you ever released a hyena-like laugh when informed of a patient’s demise? (4 points)
7. Have you ever smoked a cigarette while at work? While standing outside the hospital with one of your patients? (add 3 points)
8. Have you ever examined a patient while he or she was sitting on a commode?
9. When presenting a case to the Chief during morning report have you ever used the phrase “well-known dirtbag”? (3 points)
10. Have you ever tried to coach a demented patient to shout out a new repetitive phrase? (add 1 point if a nurse’s name was involved)
11. Give yourself one point for every second you wait between the time your code blue beeper goes off and you start running to the patient’s room. (maximum 60 points)
12. After being informed of a patient’s fever, hypotension, tachycardia or hypoxemia have you ever responded as follows: “Who gives a sh*t?”

BONUS QUESTION: Have you ever wanted to write the following order: “Pith in A.M.”? (10 points)

Unfortunately the scoring system was lost after the great V.A. hospital fire of ‘87, but as I recall the only intern who ever broke the record for points ended up doing a Psychiatry residency in Brownsville, Texas.

One can clearly see how valuable these prognostic indices are when attempting to come to grips with the challenges of our modern world. I only hope that those who choose to take these tests handle them with the same care as if they were a duffel bag full of red kryptonite. Arrivederci!

Why is the last mile the hardest mile?
My throat was dry, with the sun in my eyes
And I realised, I realised
I could never
I could never, never, never, go back home again.

“Is It Really So Strange?” The Smiths, 1988

It’s funny how certain song lyrics get stuck in one’s head - I can still recall how many times in college I dashed over to the stereo to turn it off when the first strains of “Feelings” oozed through the speakers like an alien plot to turn all of us into lovesick basset hounds. Now, after decades of downloading tunes both sublime and nauseating into my own personal I-Pod-like noggin I have dozens of song lyrics available for any medical situation that requires muscial inspiration. I’m sure most doctors share the same ability; for example, when working with critically ill heart attack victims in the CCU I used to hum U2’s classic song “Sunday Bloody Sunday“:

And it’s true we are immune
When fact is fiction and TV reality,
And today the millions cry,
We eat and drink and tomorrow they die.

Rather cynical, I might add, but can you blame us when we were young interns working 50 hour shifts?

Now as an oncologist I find myself replaying more poignant ditties, with lyrics that create less gruesome images. This comes with maturity, you know. Lately I have been turning this particular line from The Smiths over and over in my mind, examining it as closely as if it were one of the Amarna letters.

Why is the last mile the hardest mile?

The lyric should have meaning for physicians, who see patients every day struggling to overcome illness, injury or a difficult operation. Patients often become discouraged with their lack of progress and it is up to their doctors to convince them that the finish line is nearer than they think, to cheer them on through the final mile of their journey toward recovery. Their reward is so close, if only they can hang on for a little while longer. Think of the marathon runner who approaches the final stretch, and how wonderful it will be when the race is over.

It is not quite as wonderful in the field of cancer medicine, as many of my patients will never return to good health. What then becomes of those who slowly walk mile after mile, not toward recovery, but toward the end of life?

Why is the last mile the hardest mile?

The end of life shouldn’t be that hard. Using appropriate palliative care we can alleviate many of the symptoms cancer patients might experience during the final leg of their journey, so that their time remaining is as free from suffering as possible. Often they simply drift off to sleep at the end, at which time their pain and nausea are things of the past. As professional or family caregivers we do everything we can to ensure that patients afflicted with terminal illnesses end their life with peace and dignity. We are not just successful in performing this task - we are masters at it. We have to be; the alternative is too horrific to imagine. So what does the phrase actually mean then? The reader may have already surmised the answer, but let me share it anyway. Listen:

“Why is the last mile the hardest mile, when we work so hard at helping those who are dying remain comfortable?”

“The last mile is not the hardest mile for the patient. It is the hardest mile for you, because once the one you care for can go no further, you carry this person upon your back to the end.”

“OVER A HALF-MILLION DEAD - HOORAY FOR PROGRESS!”

“The war on cancer may have reach a dramatic turning point: For the first time in more than 70 years, annual cancer deaths in the United States have fallen.”

“The number of cancer deaths dropped to 556,902 in 2003, down from 557,271 the year before,” a new statistical review of U. S. death certificates reveals. Let loose the cannons! Release the white doves! Bring out the Rolling Stones to play for the crowd! We’re on our way to a cure for the world’s most disgusting disease - or are we?

It does appear remarkable that this decline is the first ever recorded since cancer deaths were tabulated in 1930. There’s nothing like cancer to rack up a string of 75 straight years of growth, but what does this drop really mean? How significant is it that 369 fewer people died of cancer in the year 2003?

369 divided by 557,271 equals a 0.06621 % drop in the death rate, which coincidentally matched the annual percent decline in my I. Q. until I became the father of a teenager, at which time my brain cells began to curdle faster than one can download a hundred bucks worth of speed metal songs from I-Tunes. But I digress - what I mean to say is that this microscopic decline certainly appears less than awe-inspiring when converted into a percentage. Is this the source of our applause?

This report identifies a drop not in the cancer death rate, which is defined as “the calculated number of deaths per 100,000 people.” This rate for your information has been going down 1% per year recently, to the delight of all. Rather, these new statistics refer to the overall number of cancer deaths in each year. Why is this distinction important? As the story relates, since we started counting bodies in 1930 “the actual number of cancer deaths still rose each year because the growth in total population outpaced the falling death rates.” In other words, up until 2003 more people died of cancer each year because, for one reason, there were more people alive in each succeeding year to die from cancer. Now, as stated by an epidemiologist in the story, “Finally, the declining rates have surpassed the increasing size of the population.” This could represent real progress as more and more Americans eschew smoking, keep their weight down, exercise and agree to regular early screening tests.

What about more effective treatments - don’t they play a role in the drop in cancer deaths? Those of us who read the oncology literature know that new treatments are proving to be helpful in raising the survival rate in some malignancies, but not all. Compared with preventing cancer these modern day treatments play a very small role in reducing deaths, in my opinion.

369 more lives saved in one year. Even Churchill might have difficulty announcing that this development represents “the end of the beginning.” If we really want to impress our fellow countries with progress against cancer, think of the publicity we would generate if every smoker decided today to quit, or if the number of teenagers per day who light up their first cigarette ever dropped in half (the number in case you’re wondering is 8000 per day). 50,000 lives saved here, 100,000 lives saved there and pretty soon people will begin to believe what the generals in the war on cancer are saying about progress.

Until then, reports such as these should serve mainly to remind us of the need to take better care of ourselves, to stop lying to ourselves that enjoying a post-double-cheeseburger cigarette while driving our electric cart from the restaurant to our parked car is probably not going to lead to anyone starting the eulogy at our funeral with the phrase, “What a long life he lived.”

Editor’s note: From time to time we hear from young adults considering a career in medicine who want to know if the C. O. has any advice for them. No offense to the good doctor but this is like asking King Midas if he can spare any gold trinkets lying around the palace. From helpful hints to meddlesome twaddle, our narrator is a wellspring of guidance, and the topic of nurturing the inchoate physician is dear to him. Therefore ladies and gentleman, without further ado here he is, bulging with words of wisdom for all those students out there thinking of raising the right hand and swearing by Hippocrates to serve the sick and injured. Please welcome The Cheerful What’s-His-Name.

[A smattering of applause is heard, coming mainly from the front rows.]

Thank you for that warm welcome. It’s a pleasure to be standing here today in front of such an attentive crowd. As you heard in the introduction our topic today concerns the traits that comprise a great doctor, or as Sammy Davis would say, what kind of fool am I to want to go into medicine?

[Sound of crickets chirping…]

Well then, let me proceed. [Drops notes on floor - brief pause while he gathers them up and places them in order…janitor walks out on stage and adjusts microphone stand, then trips on way out, much to delight of crowd.]

Pardon me. As I was saying, here are the attributes that I believe identify the individual who would prosper in the medical profession. Think of these features as clues that can be used to identify a young adult, even a youth, who just might have what it takes to become not just a successful doctor, not just one sincerely happy and satisfied with a life in medicine, but one who will never fear, never falter and never fail in his devotion to the sick and injured. May I have the first slide?

WHAT MAKES A GREAT DOCTOR?
A HIGHLY BIASED APPRAISAL
BY THE CHEERFUL ONCOLOGIST
WWW.CHEERFULONCOLOGISTGEARFORTHEWHOLEFAMILYCASHORCREDITONLY.COM

1. A great doctor loves the written word. One has to possess not only strong reading comprehension skills in order to be a great doctor, but one must crave reading - it must consume the waking hours (when not eating, exercising or watching American Idol). If you don’t enjoy reading you should consider a different career, because doctors have to read constantly to understand what is going on with their patients, not to mention keeping up with new advances in medicine.

2. A great doctor is curious. He asks Why? and How? throughout the day and throughout his life. He is not satisfied with the status quo or with answers such as “Just because,” or “It’s always been done that way.” He will challenge the rules, search for alternate solutions and think of ideas never before considered until he sees evidence of progress. He has an insatiable desire to learn.

3. A great doctor is observant. One doesn’t become a master clinician by failing to recognize all the clues strewn about a case, just as one does not become brilliant by viewing the world through dull, apathetic eyes. A great doctor is always aware of his environment; some can even read people like a book, which helps significantly in counseling patients. You wouldn’t walk over a one hundred dollar bill without noticing it would you? Then why not use perspicacity in all your endeavors?

4. A great doctor is a problem-solver, not an excuse-maker. He states with confidence, “The buck stops here,” and doesn’t try to get others to perform duties that are his responsibility, no matter how exhausting the task ahead may be. He tackles a difficult situation with a steadfast sense of optimism, even though he knows the outcome may turn out to be heartbreaking.

5. A great doctor enjoys the company of other people. He likes to meet new folks of all ages and backgrounds, and is truly interested in their lives and what they have to say. This in my opinion is the Achille’s heel of all physicians, and woe to those who get far into their career before they realize that they hate seeing patients. The poison from this sting may not be deadly, but it can rot the heart, alienating the doctor from his source of strength.

6. A great doctor has no hidden agenda. He starts each day as a tabula rasa, and does not prejudge anyone based on their look (or smell for that matter), or their attitude, or their beliefs. His job is to serve those who are sick whether he would ever invite them over for a cuppa or not.

And finally, a great doctor possesses fortitude - an unshakable sense of hope, a deep appreciation of how difficult today’s struggles are yet a powerful belief that tomorrow will be better. He is a faithful soldier, never leaving his post unless he is no longer needed, or he can no longer stand.

You’ve been a great audience. Thank you very much.

Yikes! I guess we American oncologists are just as guilty as all the other professions when it comes to taking our free market society for granted. Here’s a depressing headline from a country espousing socialized medicine:

“Spotty access to new cancer drugs violates principles of medicare: report”

Report? What report - from China? No, not China - good heavens, it’s from our dear neighbor to the north!

The Cancer Advocacy Coalition of Canada just released its annual report card grading “access” to 24 new cancer therapies such as trastuzumab (Herceptin) and bevacizumab (Avastin) in each province, and found that “variability of access to an essential segment of cancer care is leading to a different calibre [sic] of treatment across provinces.”

[Ahem, as a public service to our readers the Doublespeak Committee from our website’s Division of Propaganda will provide running translations of all quotations cited in this report. Their first message is coming over the wire now - “We have deciphered the above statement as follows: in some parts of Canada bureaucrats have successfully blocked the introduction of expensive new cancer therapies.”]

With cancer rates rising and costs of the new drugs in the realm of tens of thousands of dollars a treatment course, governments are being forced to take a hard look at their health-care bottom line.

[Translation: Tough luck, Grandma - we’ll never get voted out of office for slamming the door on hopeless cases like yours!]

Medical oncologist Dr. Kong Khoo: “These drugs are all very expensive. And on the long term, I think there are solutions to containing that cost, finding the patients that best benefit from them…”

[Translation no. 1: The fewer people we treat, the more dough we can throw into our new bridge project linking downtown Toronto with downtown Toronto.]

[Translation no. 2: Yes, we know you’ve been waiting four months for a supply of drug, but the Senator’s mother was just diagnosed with the same malignancy!]

Dr. Khoo: “I think we have to incorporate all the existing payers in order to provide these drugs.”

[Translation: Sure, I can give you this exciting new treatment for your previously untreatable cancer - just pony up 25% of the cost. How much? Oh, I’d say it will run you around $1500 a month. Hello? Hello? Are you still there?]

The coalition…criticized several provinces, including Ontario, for not providing waiting times for cancer care. Cancer Care Ontario posts waiting times on its website every month and has done so for the past two years, said Terry Sullivan, president and CEO of Cancer Care Ontario, adding when the coalition asked for that [sic] data his organization referred them to the website.

[Translation: They’re complaining about the government not posting waiting times for cancer care? After reading what the waiting time is for a patient to start chemotherapy for breast cancer I can only say: can you blame them?]

“Could we do a better job? A more streamlined job? Maybe. I think that probably could be done,” Sullivan said.

That’s the difference between my practice and that of a Canadian oncologist, I guess - I’m more streamlined. In fact, I’m so streamlined I don’t tolerate any delays in patient care due to insurance thumb-twiddling, so-sorry-all-full radiology scheduling departments, vacationing surgeons, scanty inventories, inadequately staffed hospitals or steadfast slothfulness, not to mention a government that has decided to ration health care by limiting the personnel and resources available to help the sick. I won’t stand for such nonsense because my boss would have my hide if he ever found out I was loafing instead of putting every ounce of my waking energy into the care of these wonderful people. My boss, he’s a real faccia di stronzo, as they say in Rome, but he’s not a bad person. He’s just one of those bosses who can’t be content until all is well, which in my profession requires asking for an uninterrupted string of miracles.

I shouldn’t be so hard on him. He’s actually quite clever - even has his own website. Here, I’ll show you where it is - just click on this link. Until next time - Ciao!