In today's edition of the NYtimes, there is an article about the use of radiation therapy in treating various cancers. The title, "Radiation Offers New Cures, and Ways to Do Harm" itself is interesting on so many levels. Psychological dichotomies are very strange, I'm often able to see things from different perspectives; in this case, that of a training physician but also that of a patient. I say strange because I don't think there's actually a division or dichotomy actually present. Our minds constantly try to divide and categorize into black and white, good and bad, reason and emotion, etc but in my own experience truth is more of a bowl of chili as opposed to steak and potatoes. Regarding the perspectives of physicians and patients, the views are certainly different. One of the important things the article brings up from the doctors point-of-view is the idea of taking responsibility and apologizing. I would argue that today's medical students are being taught differently than the physicians of the past. Reading through the article, other important themes were running through my mind.
The first is one that is the source of so much pain in this country; patient's feeling as though they have been wronged in some way and doctors not being upfront about the issue. In medical school today, we are shown data to back up the notion that when doctors screw-up, they need to tell the patient about it. (How do I emphasize that period more?). We are taught to take responsibility for not just our actions but for the actions of the entire care delivery team. We are taught to apologize. It sounds so normal and humane, but it is actually a departure from the way my parents were taught as medical students.
The second theme that ran through my mind reading the article, is how incredibly dangerous radiation can be. In pathology, when we see slides of a patient's biopsy tissue who has a known history of cancer and the tissue looks 'ugly or disrupted', the first question is always whether or not the patient has received radiation. I wish I knew more about physics or was as smart as a nuclear physicist with regards to the balance of harm and benefit from radiation. In some cases radiation reduces the incidence of cancer. Solar radiation allows life to exist as we know it. In other times, cancers come from radiation. Many people with my type of thyroid cancer have a history of radiation exposure. As far as we know, I've never had such an exposure.
The most amazing and inspirational aspect of the article was the story of Scott Jerome-Parks and Alexandra Jn-Charles. Their experiences, as incredibly painful as they may be, serve us. They embody one of my favorite Einstein quotes: “Three Rules of Work: Out of clutter find simplicity; From discord find harmony; In the middle of difficulty lies opportunity.” They made cancer their work. "As Scott Jerome-Parks lay dying, he clung to this wish...that his fatal radiation overdose be studied and talked about publicly so that others might not have to live his nightmare."(nytimes)
A few days ago, I wrote about how as I lay on the table being scanned this past Tuesday a new kinship became apparent to me that I've never been able to either intellectually or emotionally accept. The kinship is created by cancer. Indeed, the molecular pathology, underpinnings, biological behaviors, and the causes of the various forms of cancer that affect human beings are vast and diverse. But, there's still a connection in the lives of those affected by cancer. And the connection goes beyond personally experiencing a diagnosis to include the family and friends of those who must face their own cellular biology going awry.
I am at a point in my life where I have a number of choices ahead of me. I've been through 2 years of medical school and 6 months of advanced training in pathology. I've read some of the best textbooks in the world, cover-to-cover, actually multiple times on the cellular biology of cancer. I have also continued to ride my bicycle and this year will be well beyond where I ever thought I'd be racing. I also have an incredible wife and 15-month old daughter whom I live for, care for, and who walk beside me through these recent developments in my own journey.
I've also just been given the news of a bone metastasis. And I still am not quite sure what it means. I've spoken with 2 doctors who care for me and who's opinions I trust but I still haven't spoken with my main doctor. Right now, the consensus seems to be that we'll probably wait a year and see how this past radiation treatment has worked.
Ok, one last quote from Einstein before I end and go for a ride. I had never read this before, but really like it: “Strange is our situation here upon earth. Each of us comes for a short visit, not knowing why, yet sometimes seeming to a divine purpose. From the standpoint of daily life, however, there is one thing we do know: That we are here for the sake of others...for the countless unknown souls with whose fate we are connected by a bond of sympathy. Many times a day, I realize how much my outer and inner life is built upon the labors of people, both living and dead, and how earnestly I must exert myself in order to give in return as much as I have received.”