Palliative care
One of the questions I have always been asked when they find out I’m an oncologist is “how can you work in such an area that so many people die?” I usually answer them this way: The first thing is that the majority of patients diagnosed with cancer today survive, they’re cured, they go on with the rest of their lives and are able to live out healthy, meaningful and productive lives. This gives oncologists great satisfaction. The second thing I always tell people is that you have an extraordinary opportunity as an oncologist to get to know your patients. Spending time with them, understanding what their lives are like is so enjoyable. I am able to see my patients much more frequently than almost any other medical specialty. I may see a patient with breast cancer weekly for months, and this gives me the opportunity to establish a relationship that I would otherwise not be able to have. This opportunity wouldn’t if I was in internal medicine, or cardiology or some other specialty.
The other thing that I tell patients is that I don’t view death necessarily as a bad outcome. Death is something that is a very human experience and is something that is universally shared by all of us. The bottom line is that we are all going to die. Dying of cancer is only one of the many ways in which people go from this life into the next. As an oncologist, I believe that my skills in helping patients go from this world to the next with as little pain and discomfort is probably my biggest challenge I face. This area of oncology is called palliative care. It’s basically the care of patients who are in the last months of life. It involves primarily symptom control and comfort care. This has always been an area of great interest and also an area of great pride for me. I believe that I have done a good job in relieving patient’s suffering as they approach their death. Palliative care has grown as subspecialty in medicine. It is also an area of focus within oncology. It is somewhat still in its infancy. Palliative care programs have been established at many hospitals. They provide a great deal of comfort in the patient’s lives that they come in contact with. However, we still have a very long way to go. It maybe interesting to know that many oncologists find having conversations about ending treatments or the end of life issues very difficult. You would expect that men and women who have spent their lives treating patients in oncology would have developed expertise in these kinds of conversations. Unfortunately this is not always true. In my own practice, we are working diligently to develop a practice wide palliative care program. Hopefully this program will help patients be treated aggressively for symptoms related to their end of life.
Lastly, I find oncology a very rewarding field, both spiritually and emotionally.
This comes from a great faith in God and a sense of God’s purpose for people in this world. I believe we are here to help each either to do good in this world wherever possible. I believe that I may do more for patients who are dying of their cancer than those patients who ultimately are cured of their cancer.
Nice thoughts Dr. Bob. Also your post regarding Miracles may give hope to many people reading your blog. It gave hope to us. Thanks for writing such nice, helpful blog.
I am from India and my wife has lung mets for ES. Right now she is undergoing AIM chemo. Recent CT didn't find any growth or further mets so chemo will be stopped after 6th cycle. Also her pleural effusion stopped after the second cycle.
Our oncologist here now say that we need to keep scans getting done every 4 months to monitor her cancer and that's how we are probably going to spend rest of our lives.
Anyway things are looking somewhat positive atleast.
BTW I have a software firm specilising in mobile solutions. If you think you would like to have case history of all your patients with you all the time on your mobile. Let me know and we can do a small mobile application for you as a goodwill gesture without charging anything from you.
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