Thursday, November 15, 2012

"We Need More Patients Like You..."

...said the P.A. out at M.D. Anderson.

"You're the miracle patient,"  said a nurse there last year.

"Metastatic Melanoma patients three years out are...not many."  Dr. Homsi, my main medical Dr. for 4 years.

None of these quotes are aimed at drawing high-fives & attaboys for me.  I want you to think of what's behind each one of them.

Picture with me.  You're on the way to another day at work.  You work for one of the great healthcare facilities anywhere.  You are close to the top of your profession.  You're probably fairly well paid.  (Aside: from this patient's perspective, I certainly hope so!)

And yet, despite all of that, you know that you'll spend this day the same way you spent most of your days at work: giving people bad news.  In many cases, VERY bad news.

Where do such people come from?  How do they face such grim workdays on a regular basis?

I couldn't do it.  The worst things that ever happen at my job are a student failing a test or a class or not graduating because s/he didn't make a high enough grade from me.  That's rough, and I dislike any of those scenarios. 

But that's not in the same UNIVERSE of bad that the average medical professional at Anderson (and other such facilities) faces on a daily basis. 

During the course of 20-something appointments seeing various Drs. & NPs & PAs & nurses, ranging from pretty bad-news visits to very good-news visits, I've asked.  Pretty pointedly.  "So, how do you handle coming in here knowing that you'll be the bearer of news usually from bad to VERY bad?"

The consensus seems to range from "We focus on the good news" (see comments above) to "We try to comfort whatever the news" to simply looking away & saying "It's tough..."

After nearly 30 visits in 4 years, plus 4 surgeries, plus 2 cycles of high-dose immunotherapy, I am still simply awestruck at the men & women out there.  They're good at what they do, sure.  But lots of people are good at what they do.  What strikes Lisa & me is the depth of feeling & passion about what they do, in the face of what has to seem like an absolutely overwhelming hill to climb.

Again, I'm WAY outside the boundaries of probabilities for stage IV metastatic melanoma patients in terms of, well, still being here.  Every good Dr. or nurse or NP or PA puts the patient first & foremost, and most try to relate to the patients as people.  But picture doing this, knowing that your personal connection with your patients is likely to be rather short-term.

Lisa & Jim & I have commented that there's a feel out there that--at the risk of overdramatizing it--feels like those folks show up at work thinking "this could be the day"..."the day we've all worked toward & waited for"..."the day when this insidious thing called cancer is pushed back into the darkness of unpleasant memories"..."when an outright cure is found."

That goal & expectation is part of the DNA of Anderson (so to speak).

"The mission of The University of Texas MD Anderson Cancer Center is to eliminate cancer in Texas, the nation, and the world through outstanding programs that integrate patient care, research and prevention, and through education for undergraduate and graduate students, trainees, professionals, employees and the public."

Simple, isn't it?

108,000 patients last year.  1 0 0 8 0 0. 
10,000 patients participating in clinical trials.
$623,000,000 spent on just on cancer research last year.
6,800 medical professionals trained there last year.
18,000 employees total, spread among 50 separate buildings.
1,100 volunteers.

I've NEVER felt like I was merely part of a production process.  NEVER felt like just a number.  It's always "How are you doing, Mr. Madaris?"  P.E.T. techs, nurses, phlebotomists, patient transport folks,...

Which probably explains why "for the 6th consecutive year, The University of Texas M.D. Anderson Cancer Center has been named the nation's top hospital for cancer care" by U.S. News & World Report.  (press release here)

"We shall be the premier cancer center in the world, based on the excellence of our people, our research-driven patient care and our science. We are Making Cancer History. "

"Everyone at MD Anderson - each one of our 19,000-plus employees and 1,100 volunteers - contributed to us remaining the number one cancer center in the nation," said Ronald A. DePinho, M.D., who is experiencing the national ranking for the first time as president of MD Anderson. "It's an honor we share with all of our patients, survivors and their loved ones, who challenge and motivate us every day to pursue our mission, advance our knowledge and improve each person's experience at our institution."  (quoted in the press release linked above; emphasis mine)

(1-minute video with Dr. DePinho, MDA's President; I loved the phrase "that will bring this disease to its knees.")

I say again, I'm in awe.  And I am so very thankful.

Sunday, November 11, 2012

I Cannot Imagine

I hung out with three veterans today on Veterans' Day.  Two pilots & one logistics/admin type.

One is my Mom's husband Leo.  Leo was a USAF pilot who flew various fighter planes throughout his career.  As a squadron commander in Vietnam, he had to write those terrible letters to brides & parents & children that begin, "It is with great regret..."  He knows the sound of anti-aircraft fire hitting his plane & the look of the trails made by S.A.M. missles coming toward the plane he was flying.  He once landed a plane with one of the two engines knocked loose by a-a fire; the plane was scrapped because of this.  He knows how to drop close air support ordinance on enemy troops, thereby greatly assisting our own troops.  I cannot imagine.

The other two are my brother Jim & his wife Sandi.  Jim flew anti-sub P-3s for the U.S. Navy around the Atlantic during the bad old days of the cold war.  He knows the chill of pre-flighting a plane and seeing nuclear weapons attached, and knowing that a certain set of circumstances + commands could've resulted in him launching & thereby beginning a nuclear war with the (then) Soviet Union.  He knows how to identify a submarine as a "fast attack" or a "boomer" (missle-launching) sub.  He knows the screech of the missle-lock warning in his ear that signalled that they had been "locked on" by enemy ships' anti-aircraft missle systems.  I cannot imagine.

Sandy was also an officer in the USAF for her career.  She worked in supply & logistics & in hospital administration.  She knows that behind the budget numbers & boxes of requisitioned supplies are military men & women needing medical care.  I cannot imagine.

Had we been in town today, at church I'd have seen my friends Jim & Lance.  Jim served in Iraq with the Marine Corps, and Lance served with the Army.  I might have seen my friend Bob.  Bob was a pathfinder with the U.S. Army during the Normandy invasion in 1944.  His were literally among the first Allied boots on the ground in our invasion of Hitler's Fortress Europe.  I would likely have seen my friend Philip, who served as a gunner on an armored personnel carrier in the Army.  I would also likely have seen my friend Gary, who serves with the Army, and who has served in Afghanistan.  I cannot imagine.

One of my students does missle defense; he returned from a year deployment earlier this year.  He knows the sound of his defense systems taking out missiles aimed his way.  He also knows the rumble of the explosions caused by a couple that they didn't knock down before hitting the base.  Another friend from WCU is a crew chief on a cargo plane.  He has accompanied caskets home from the middle east.  Caskets that were flag-draped and were not empty.  He has greeted the grieving families "on behalf of a grateful nation."  I cannot imagine.

My Dad served with the Army Air Corps, the predecessor to the USAF.  His first duty post was with the Army of the Occupation near Nagasaki, Japan.  Just after a nuclear bomb there helped end WW2.  Lisa's Dad served as a combat medic in Korea.  He was assigned to a rifle company very much in harm's way.  He knows the sounds of bullets pinging off the rocks around him as he was tending to a wounded soldier.  I cannot imagine.

A day is coming when soldiers & sailors & airmen will no longer be needed.  When "He shall judge between the nations, and shall decide disputes for many peoples; and they shall beat their swords into plowshares, and their spears into pruning hooks; nation shall not lift up sword against nation, neither shall they learn war anymore." (Isaiah 2:4) 

I. Cannot. Imagine.

But just as the veterans mentioned experienced & trained for things that I cannot imagine, so we will all one day experience war's end, when the Lord Himself will render war obsolete.  Until that day, I honor those who put on a uniform & take a pledge & stand in harm's way on behalf of a nation conceived in liberty.  I thank God for raising up men & women exemplified by the few I've mentioned here.  It's easy to build a monument and to salute a flag.  That requires very little courage.  But what our veterans have done?  Courage beyond measure!

Whatever your thoughts on the current administration or on any particular current military conflict, I hope you took time to honor our veterans today.  I hope you take time to honor them every day.  For truly, every day that we are free is Veterans' Day.