February 2009 Archives
Facing the diagnosis of cancer can be the most challenging time in a person’s entire lifetime. It takes great courage to face the diagnosis and treatment of cancer.
Cancer of the gallbladder is a devastating disease. It is a rare disease most commonly found late in its course and usually discovered only after it has spread widely throughout the abdomen. Currently, I am treating a young lady with gallbladder cancer. She is struggling with this diagnosis and is dealing with a great deal of pain. I am amazed at her perseverance and strength despite things not going well. She has spent the last several weeks in the hospital trying to get her pain under controlled. She has approached her diagnosis with strength, resolve and I certainly admire her for these characteristics. I am not sure I would be as strong.
We have talked about her family and her youth in Tennessee. I have met her father and have seen the caring and worry on his face. She is in a loving long term relationship with another woman. The dedication and love for each other is readily apparent. Her sense of peace is amazing. I love her smile and her Tennessee ascent. I pray that the therapy she is receiving will be successful.
I think we can all take a lesson from these wonderful patients who are battling against insurmountable odds. As we go through our day, struggle with the present economic crises, and struggle with difficulties in our personal life I think we should realize things could be a great deal worse. We should be thankful for our health, and all the blessings we have in our lives.
Sarah died this week. She died of her breast cancer way to soon. Nothing really went right with her case.
She was diagnosed so very young. She struggled through her adjuvant chemotherapy. Nausea, fatigue, and pain were a constant for months as she took Adriamycin, Cytoxan, and Taxol. She finished therapy only to lose her insurance. Not feeling she could aford care she canceled apointments and was "lost to follow up".
Four months ago she returned to my practice after finally getting a new job and the insurance that came with it. Her first blood tests revealed signs of possible reoccurrence. This was quickly confirmed by CT scan and PET scan. Her disease was in her lungs, bones, and liver. She quickly developed severe pain and fractured her hip stepping over the threshold to her home. Hip surgery lead to post-op infections which made it difficult to give her additional chemotherapy. She had to have her hip prosthesis removed because of the infection. She struggled with the anesthesia with each surgery. She struggled with more nausea with her pain medication. She struggled to stay positive in the face of one set back after another.
She leaves behind a 10 year-old daughter, a devoted and loving husband and a family that I sure will miss her dearly.
We have made such great progress in the treatment of breast cancer in the last 10 years. Many women are cured and even when faced with metastatic disease many women live long lives. But it is CANCER that we fight, it is a terrible disease and it sometimes takes an awful toll.
I was so mad at the nurse I could hardly see straight. Mr. Jones had just received chemotherapy for non-Hodgkin's lymphoma. Unfortunately, a mistake was made and the nurse gave him another patient's treatment that was for lung cancer. I could not believe that she had made such an error. How was I going to tell the patient that he had just received the wrong chemotherapy? Sure the chemotherapy that he received may have some activity in his disease, but how could he ever again trust me, my office, or the nurse again. What would his side effects be? I didn’t talk to the nurse the rest of the day.
I was so mad. The nurse called me at 3 a.m. in the morning. I awoke out of a sound sleep as I answered the phone. Trying to get some bearing on where I was I heard the nurse tell me that the patient in room 520 had not had a bowel movement for three days. The patient was wondering if he could have something orally to help him have the bowel movement. I exclaimed in my sleepiness that this was certainly something that would be best handled on morning rounds. I slammed the phone down. The next morning I complained to the charge nurse.
I was so mad. I had just gotten the word from a insurance company that they had denied my patient her treatment for the third time. I had spent hours writing letters, faxing records, talking to the Medical Director of the insurance company only to receive the "final review" that the therapy that I felt was best for my patient was not going to be covered. I slammed my office door shut and began to throw pencils out of pencil drawer at the wall. One stuck in the wall.
I was so mad. I had come to the hospital to see a patient who had been dying of breast cancer for the last three months. She had wound up in the hospital because of shortness of breath. I had specifically made her "no code blue," however, during the night, her respiratory failure had gotten worse. Despite my orders and despite the fact that she had a living will indicating that she wanted no life-support, her family had demanded that she be intubated. She was now on the ventilator. I felt like the patient's trust in me had been somehow broken. As I stood there watching her as she struggled on the ventilator, it just broke my heart. I left the hospital avoiding the patient’s family.
I was so mad. The consultant physician I had called had not shown up to see my patient. The patient was irritated that she had sat in the hospital for the last 24 hours without having the consultant see her and make his recommendations. I could not understand why he had not yet been by to see my patient. I had to sit and hear to the patient complain for a half hour. I cussed under my breath as I left the room knowing that I was now late to the office.
Thinking back I am so angry that I had allowed by emotions to affect my patient’s care. All the above instances were situations where my anger ultimately got in the way of taking care of my patient the best way possible. In a healthcare system that is made up by hundreds of thousands of people, mistakes, delays, and miscommunication are going to occur. One thing that I have learned as time has gone on is that it is best to control my anger , to be more approachable and less quick to let my emotions flare when things don’t exactly go right.
In January, a new leadership standard from The Joint Commission (the body, which certifies the operations of hospitals) was developed to define physician and healthcare workers behaviors. This standard develops procedures to discipline inappropriate conduct by individuals working at all levels of an organization including management, clinical, and administrative staff members. Anger and intimidation only stifles communication. The hope is that this new standard will foster the free flow of communication between all members of the treatment team. Anything that impedes communication between members of the treatment team potentially produces a barrier to safety and good patient care. I think this new standard is long overdue and it is something that I myself need to be careful to follow.
