Dr. Robert Pluenneke : April 2009 Archives
My son and I visited two universities over the last several days. We looked at Belmont University in Nashville and Loyola University in New Orleans. It was a fun and interesting trip. Hours on the plane and many hours in a car gave us a chance to talk like we haven’t had in years. It has been an amazing transformation to watch him mature into a young man. We don’t agree on everything in life (music, politics’ etc.) but his thoughtfulness shows a level of maturity that I respect. As parents we hope and pray that our children “turn out right”. I think that is more important that they find their own way and develop a sense of themselves. If there is one thing that I hope I can give all my children is the idea that developing that sense of oneself is a lifelong process. It is one of the most fulfilling parts of life.
To be diagnosed with best cancer at the age of 25 must be one of the most difficult things a human can go through and endure. At twenty five people still feels invincible, with their whole life ahead of them. A patient of mine went through this almost five years ago. Chemotherapy, radiation therapy and nearly 5 years of antiestrogen therapy put many of her dreams on hold. She had wanted a family with her new husband and looked forward to the possibility of having a child after her 5 years of antiestrogen therapy was completed. Over the last 5 years she has become one of my closest patients. I looked forward to her visits, as did all my staff. She is kind and always smiling.
Tragedy struck this week. After being only ill with the “flu” for one week she went to her home town doctor and was found to have a white blood cell count of 150 thousand (100 times normal). The work up included a bone marrow biopsy which revealed the diagnosis of acute leukemia. She is now in the second fight of her life. This leukemia is almost certainly related to her previous treatment for her breast cancer. How can this happen? It is a known complication of certain kinds of chemotherapy. The chemotherapy damages the bone marrow in some way that eventually allows the development of this kind of “secondary” cancer. This is a very rare but feared complication of the treatment of many kinds of cancers.
Treatment of her leukemia will require aggressive chemotherapy and eventually possible a bone marrow transplant. If she survives the first couple weeks of her treatment, which is in no way certain, she will face years of potential treatments and side effects. Her ability to have children has been lost. The amazing thing is her attitude has not changed. Despite the pain, fatigue, difficulty breathing, and the prospect of a long hospitalization her spirit and smile hasn’t dimmed. These are the characteristics that give her a fighting chance….. Everyone’s payers would help also.
I was in Austin Texas recently for the American academy of Hospice and Palliative Care Medicine (AAHPM) meetings. This was my first trip to this organizations meeting. This specialty takes care of chronically ill and dying patients. It was a very different sort of meeting for me. Many of the national meetings that I have attended over the years have been so focused on the molecular basis of cancer. Don’t get me wrong, this is important and interesting but it also seems to sometimes forget the patients. The care of patients on a day to day basis has very little to do with the biochemical pathways of the medicines we use. Yes, these pathways ultimately determine the actions, responses and the side effects of the medicines but the individual response of patients is personal. It is unique to each patient. These pathways don’t even come close to determining the reaction of the patient both mentally, spiritually or emotionally.
The AAHPM meetings were different because the majority of the talks, lectures and meetings were focus directly on the patient. There were sessions on how to listen and talk to patients. There were studies on pain control, insomnia, and shortness of breath. The research that is going on in palliative medicine is in its infancy. Palliative medicine is a new medical specialty and the people who work in this field of medicine are on the “cutting edge and uncharted water “. There is an excitement and a passion that is difficult to describe. Talk of spirituality was freely overheard. The emotions, stresses and thoughts of patients, their care givers, and the professionals that care for them were the highest priority.
I think that the doctors, nurses, social workers and ministers that work in this new and expending field of medicine understand the finality of life. They are not so concerned with the statistical difference in survival between two chemotherapy drugs. They understand that we have a finite amount of time on the world and how we live is much more important than how long we live. I can’t wait for next year’s meeting in Boston.
