January 2009 Archives
One of the initiatives that I have been working on for my practice over the last six months is to develop an ongoing palliative care program. I am really excited about some of the things that we are putting in place for our patients. Palliative care is the treatment of patients who are having symptoms due to a terminal illness. My hope is that through these new initiatives in our practice that we will begin the process of palliative care much earlier in our patients. The patients who are diagnosed with advanced lung cancer, metastatic breast cancer or other ultimately terminal cancers probably should see a palliative care specialist early in their treatment. This is what our program is striving for. By bringing palliative care specialists into our practice to see our patients, I am hopeful that a transition between active treatment and palliative care and hospice will be made smoother. The stopping of treatment for advanced cancer is a very scary thing for the patients. Many physicians have difficulty discussing the subject of stopping therapy. One concern that I have today is the high degree of patients who received chemotherapy within two weeks of their lives. In many studies this was 10-20%. These patients are obviously not benefitting from this chemotherapy as their condition is such that the chemotherapy is likely doing more harm than good. It is our duty as medical oncologists to do a better job explaining to our patients the risks and the benefits from our therapies. As the patient's disease progress and they go on second and third-line therapies, a patient should know that the benefit or the chances of benefit from our chemotherapy become very, very small. The risks of increased side effects become increasingly large. I am hopeful that the new palliative care initiative that is going on in our practice will make this transition both smoother and hopefully earlier in a patient's disease course.
One of the partners that we have partnered with in our palliative care program is the Center for Practical Bioethics, which is here in
While on my medical mission in Jamaica, I saw hundreds of patients with chronic illness. Diabetes, hypertension, and obesity ran rampant in the Jamaicans. The sad fact of the matter is that the people of this country are too poor to afford the medicine that would help control these illnesses and possibly extend their lives. As a physician who cares very much about the patient that he sees, it was frustrating for me to know that in many parts of the world and even many parts of our own country that people do not have the money for proper treatment. This is becoming more and more prevalent in oncology. It is becoming more and more difficult to take care of patients as the number of the patient’s who are uninsured increases. It just breaks my heart to see any family struggle with the possibility of huge bills for medical care.
One particular patient in Jamaica has stuck in my mind. She is an elderly widow who lives alone with her dogs. She was desperate to be seen in our clinic and receive medications at no charge in order to stay healthy so that she could continue to take care of the “ones” that she loved, her six dogs. The intensity, great passion and care for these animals gave her great joy and great companionship. Her situation was particularly bad because in such a poor country there is very little in the way of retirement income. The elderly rely on their children and grandchildren to care for them and she had no such family to care for her. I believe as our country goes forward over the next 5-10 years and as the economic crisis becomes more severe, we are going to be faced with the same thing. We are going to have to be willing to take care of our elderly mothers, fathers and grandparents. I think our country has lost a great deal by scattering our extended families, brothers, sisters and others far across the country. Grandparents can offer families so much .Grandchildren could use their compassion and any helpful guidance. I hope that as an unintended, but positive consequence of the hard economic times, that families will stay closer, be less spread across the country and be forced to take care of the elderly of our society. That would be one silver lining to the dark clouds that our country now faces.
I had the wonderful opportunity to spend the first part of 2009 in Falmouth Jamaica on a mission trip through The United Methodist Church. This trip was the second time that I had participated in this medical mission. I was fortunate enough to go last year also. This trip to Jamaica truly brings into sharp focus the great blessings and great advantages that we in the United States have. The people that I took care of were desperately poor, had little in the way of personal belongings, and some were malnourished. Purchasing medicines is a luxury that many of them could not afford. Despite their poverty, they were respectful, they were appreciative and in most cases very loving and spiritual group of people.
There are three things that I felt like God drove home to me on this trip; messages that I found myself thinking of as I returned home and over the last few days as I reflected on the trip. The first thing was that people are basically the same wherever you go. Their hopes, their dreams, their love of life, love for their children and their hope for a better life for their children seems to be an universal truth. I think this is tied up in an universal belief in God and the belief that people are born destined to do right and to help their fellow man.
The second thing that I learned was how giving people can be. My fellow missionaries on my trip included nurses, nursing students, pharmacists, pharmacy students, and lay people from my church. All these people came together to help people in whatever way they could far from home. They helped people that they may never see again. It was an amazing group of people. They really have inspired me to continue to work hard here in our own country to help as many people as I can.
The final thing that I realized from this trip is the notion that we truly don’t have the ultimate control of our lives. As a believer in God, I believe that God is real and works very diligently in our lives. God is closer than we realize. On the trip, I was fortunate enough to read a book named "90 Minutes in Heaven." It is a wonderful book that I would recommend to anyone. I believe books like this reinforce the idea that God is truly closer than we believe. As we go through our lives we need to take more time for our spiritual self and to cultivate a relationship with God.
I pray for the people of
This is a wonderful time of the year for the world as we celebrate this wonderful holiday. It gives me time to reflect on all the wonderful people that have come into my life, patients, nurses , nurse practitioners and other physicians. As we go through the year working to take care of the patients the best we can, our faith in god gives us strength to continue day after day. Christmas also gives me great hope for the future. It is a time of great giving and a time of great renewal of our faith. I truly believe that as healthcare providers, we make a difference in our patients' lives and as such, change the world in a better way. I wish all who are fighting cancer, taking care of cancer patients or living with family members who have been touched by cancer a Merry Christmas and a peaceful New Year.
