The Navigator
“Act with kindness, but do not expect gratitude.”
-Confucious, 551-479 B.C.
Please read the following problem, then select the one best answer to the question that follows:
A 52 year-old post-menopausal woman is diagnosed with infiltrating ductal carcinoma of the breast. Her tumor size is 3.5 cm and angiolymphatic invasion is present. She undergoes a lumpectomy and sentinel lymph node biospy, and two out of five nodes contain metastatic carcinoma. No further disease is found on routine imaging studies which include fusion PET/CT imaging. Her tumor is estrogen-receptor positive, progesterone-receptor negative, and HER-2 is overexpressed by fluorescent-in-situ-hybridization (FISH).
She is treated with adjuvant dose-dense chemotherapy using sequential doxorubicin, paclitaxel and cyclophosphamide, followed by radiation therapy and a 52-week course of trastuzumab monoclonal antibody therapy. A five-year course of the oral aromatase inhibitor letrozole begins upon the completion of radiation therapy.
The patient develops the following side-effects during her treatment: severe alopecia, nausea, anemia, one episode of fever associated with neutropenia, fatigue, numbness of the toes and feet, diffuse myalgias from pegylated filgrastim injections requiring the use of oral narcotics, erythema and dry desquamation of the skin over the breast.
One year later, her oncologist states that she can now have her portacath removed and won’t have to return to the office for three months. He offers congratulations to her on successfully completing all of her intravenous therapy and says, “Hooray - you made it through!” The patients replies, “Thanks to you, Doctor. You and your staff worked so hard - you are all the greatest.”
The correct response to this compliment is:
A. “Thank you. It’s very kind of you to say that.”
B. “Hey - that’s what we’re here for.”
C. “I know - I’m lucky to have such wonderful nurses.”
D. “It was a long haul, wasn’t it? Did you ever think it would end?”
E. “Well, I couldn’t let you down now, could I? I don’t want to ruin my reputation!”
The proctor will now collect the answer sheets. No peeking at your neighbor’s paper, now. Are all the sheets in? Good. Now, the correct answer was:
F. NONE OF THE ABOVE.
Did we fool you? Perhaps you’re wondering why The Cheerful Oncologist rejected all of the above replies to his grateful patient and came up with a different answer. Pehaps you are also wondering why you didn’t pick the winning numbers in last month’s 360 million-dollar lottery, as our narrator is. Never mind that - here is what I said to my patient:
“You did all the work, not me. Think of what you went through last year as a crucial airplane trip out of a dangerous country to the land of good health. You owned the airplane and you were the pilot. The fact that you made it safely home is due to your efforts, not mine. I was just ground control, sending up directions and messages of encouragement to you. You made all the sacrifices and now, with a little more help, you’ll get to enjoy the rewards of this investment in your future.”
I bet you are a wonderful Cancer Dr! I fought cancer for 5 years myself,I was very lucky that I had an Oncologist with a wonderful personality, who truly cared about his patients. People have a special connection with their Oncologists that’s hard to explain..It’s kind of like when the rest of the world seems to not understand how you feel or what you face everyday, there is that one person who completely gets it! God Bless You!
Comment by Cathy — March 9, 2006 @ 12:23 am
great job, Doc.
I’m feeling as though I’m not being treated with as much respect from my doctors, right now. Today my radiation oncolgist seemed annoyed that I asked her a question about a new symptom, as if I was a complainer, when in truth I am far from it. I have had unsatifactory pain-relief due to a bone met and resulting hip fracture, and recently began a steroid in preparation for radiation, and miraculously the hip pain I have been trying to eliminate almost completely subsided…and I felt frustrated and left alone that someone hadn’t thought to suggest a stronger anti-inflammatory than the ibuprofen I was taking (and was not helping)
sigh
can I come to St. Louis?
Comment by Feisty — March 9, 2006 @ 5:39 am
As you have advised me from time to time during my bout with Lung Cancer, your post regarding the proper “expression” of the doc is spot on. As a psychotherapist of some 30 plus years experience, that is what I always tell my patients at the end of therapy. For they truly have done all the hard work, they walked the walk AND talked the talk. No therapist should ever take credit for success of the patient for if we do, we rob them of the victory.
Great post Dr. Hildreth, GREAT post!
Comment by GM Roper — March 10, 2006 @ 4:50 am
hahahhahaha - a “bout” with lung cancer. Like it’s a cold that lasts a week.
Sorry. Just found that amusing.
Comment by geena — March 10, 2006 @ 10:41 pm
Just a note to tell you how much I enjoy visiting your blog, today’s post was wonderful.
Comment by tbtam — March 10, 2006 @ 11:51 pm
What? You mean “C” was incorrect? That’s not what they’re teaching us over here in nursing school.
Nice post, Doc. And nice pix of Dr. Kildaire, too.
Comment by ThirdDegreeNurse — March 11, 2006 @ 1:34 am
Geena, I meant bout as in a fight… I’m fighting for my life (and so far, the news is good) but it is a fight,every step of the way… and I’m glad you found some humor there, humor is a good weapon in the bout.
Comment by GM Roper — March 11, 2006 @ 4:34 am
Thanks CO, this was a great answer. It was a perfect explanation of our battle and where we stand as patients. I was able to use it at my support group where one of the ladies was struggling as to how much input she really had when it came to where her treatment was going. Her doc was trying to explain it, but your description was spot on.
There is not only humor, but pathos in the way you relate to patients.
Comment by Vicki — March 13, 2006 @ 1:06 am
You’d be surprised how many patients apologize for coming in and wasting the ER’s time. I tell them #B! We’re here for them and even though it was nothing serious they now have peace of mind. I do mention that sometimes, if they have a doctor they really know well, they can often get advice, reassurance or a prescription over the phone and save themselves a trip!
Comment by Kim — March 31, 2006 @ 4:36 am
OK, this is from one who has been there but I was diagnosed in stage 3a, with high grade multifocal IDC the largest tumor over 5 cm’s. Nine positive nodes the largest tumor in the nodes being 3 cm’s. ER/PR-, Her2-neu strongly positive. All of this was after having a clean mammogram 18 months prior to treatment. Because of a pre-existing heart condition herceptin is not adviseable. I’m sure that you’d love to see me walk into your practice. Eight months later my doctor was smiling as he told me I had no evidence of disease. I know that all I did was show up for treatments. I didn’t do anything. It was his knowledge and guidence that saw me through this. I love the man, and I get to see him every three months for the rest of my life. You should just accept the admiration that you so obviously deserve.
Comment by Emmy — April 11, 2006 @ 12:55 am