November 2008 Archives

In Washington DC, I had an afternoon free and I walked down to the mall.  It was a beautiful day, sunny, warm and there were many people enjoying the weather.  I walked by The New World War II Memorial, walked by The Vietnam Memorial and the impact of these two places on me were quite profound.  I went to The Lincoln Memorial and The Jefferson Memorial spending sometime at each of these wonderful places. I loved the sites but mostly I  just enjoyed the day spending time  reflecting on thoughts of our country and its most recent election.  It was one of the most enjoyable days that I had had in a long time.  Over the hours that I was there at the mall, thoughts of many of my patients that had passed away came to mind.  They were on my mind because of the conference that I had attended were I had talked about end of life care and how as physicians we must do a better job helping our patients' transition from life to death.

 

One of the patients that came to my mind was Jennifer Ireland.  It is a bit strange how a young lady, despite passing away now several years ago, still frequently comes to my thoughts.  I believe that the end of her life was one a struggle for her.  She so much wanted to live.  She had so much to live for; her young family and, loving husband.  At the end, her acceptance of her fate was quite profound and I believe she died in peace.  At times, I feel like she is looking down at those of us who are trying to carry on in her name and she must be pleased.  The Jennifer Ireland Foundation is trying to fulfill a desperate need in this country.  Illness when it strikes puts such great stress on families both financially and emotionally.  I hope that as The Jennifer Ireland Foundation continues to grow and prosper, that we may be able to relieve some of this pressure.

 

The other thought that I had as I walked around the center of our capital was that we again need to feel so blessed to live in a country that has as much potential and resolve.  I am proud of our country for the way it handles its elections.  I am proud of the country for its becoming ever more colorblind to patients' skin color.  I am proud of our country because as it struggles against some very difficult obstacles, I believe that there is truly a sense that we will be okay. We will get through this period of time and we will solve the problems that face our country.  That optimism was certainly evident in other peoples that were enjoying the day in DC with me.

I was in Washington D.C. this last weekend at a conference on palliative care. It brought people from all over the country to talk about the end of life care that occurs in this country. I general this country does a poor job taking care of people in the final months and days of their lives. We spend a huge amount of resources (and money) in the last year of a person’s life. The economics of dying in this country are in bad shape. As the general economy worsens the money we spend on any part of the health care system is going to be looked at very closely.  In oncology we have to do a better job of facing these facts. We must use our resources as wisely as possible.

I had a man in my practice that has lung cancer. His cancer was initially localized and was treated with radiation and chemotherapy. He did well for over a year but unfortunately in cancer reoccurred. Additional chemotherapy was given with only minimal response. His overall health also declined. His most recent CAT scan showed that the cancer was growing again. I talked to him at length that additional chemotherapy would have little chance of helping his situation.  It would likely make matters only worse and weaken him further. I explained that honestly that hospice care was in his best interest and that this is all that I would recommend to him.

 He is now getting chemotherapy from at an oncologist in another part of town.  This situation doesn’t make me angry at the patient but I must question the decision of the oncologist now treating this patient. At some point the only reasonable action is to not to proceed with additional chemotherapy.  This patient, the patient’s new oncologist and this country must begin to understand this.

I pray that this man has a good response to this new therapy and that when the time comes that he will be able to except that further treatment won’t be helpful. 

Last night we had the lastest JIF board meeting. We had four new members join the board and I am so excited to have these new talented people joined our foundation. It always amazes me that people will take time to work to improve the lives of others. I look foward to a great year and to contiued growth of the foundation.