Q: What's it like to work with a patient through what may be one of the scariest things they will ever go through?
Every new patient that I meet facing a cancer diagnosis is scared. My main job is to explain their particular case and then recommend a customized, individualized treatment program. Once people see that it's not as bad as it seems and that we have a plan, they relax and are reassured.
Q: Do you ever use the word "cure"? When? And why would you pick a field where sometimes after you've gotten patients through treatment you won't know for sure they are cured? And why did you gravitate to a field where often the best you can do is buy time and make the person's life the best it can be?
In 2013, cures of cancer are happening every day. We probably cure more patients than we do not cure. Take breast cancer as an example: Statistics show that an overall cure rate is approaching 80 percent. This means that 80 out of 100 women diagnosed in 2013 will be alive and cancer-free in 2023.
Choosing to be an oncologist was an easy choice for me as my father is an oncologist. He encouraged me and taught me how to be the best doctor I can be. Many people ask how I can do this job day after day, losing patients to their illness. I tell them it's because I can help them through their treatment.
Q: Could you pick a specific treatment regimen you rely on often and give (in layperson's terms) a step by step of what happens from start to finish?
Curing breast cancer is how Oncology got its start and we know more about breast cancer than all the other cancers combined.
In a typical case of breast cancer, the cancer is detected very early on a routine mammogram. She has surgery, followed by four rounds of chemotherapy (one dose every three weeks) directed by me to clear-up any residual cancer in the body. This is then followed by radiation to the lumpectomy site over several weeks.
Once radiation is done, I will then bring the patient back to discuss lifestyle changes (diet, exercise and vitamins) and initiate an oral anti-estrogen pill for five years which is usually very well tolerated.
As you describe the technical elements of the process, can you tell us what you are thinking? The bulleted questions below will give you an idea of some of what I'd like to know as far as what is going through your head. (answered below)
Q: How are you relating to the patient & what do you hope for through the process?
This whole process usually goes extremely smoothly, which I think surprises many people. The patient first and foremost must have confidence in the doctor. I try to ensure their trust by showing the patient (using the Internet) that their case is being treated by me the same as in other institutions. Once the treatment with chemo starts, the goal is to get through the process without complications.
Experience in giving chemo and knowing beforehand what someone will "handle" is very important. Customizing doses for each patient's unique circumstances is an example of the experience needed. I assume the role of being the patient's main "doctor" throughout their chemotherapy so that they can rely on me. Open communication is the best way to relate to the patient.
Q: What is the tension like when the outcome is uncertain?
Tension is always high when waiting for results, particularly for a scan or lab work. Tension decreases once results are revealed, regardless of the results because a new plan is set in motion.
Q: What do you feel when there is an immediate crisis, but you have gotten past it and the patient will survive?
Crisis is ever present in medicine. There is not a day which goes by that life threatening problems or complications develop in the life of my patients. Remaining calm, acting fast, and relying on experience and training will pull people through their crisis and then there is a sense of relief.
Q: What does it feel like when someone is still here five years later when the odds were against this?
I am constantly amazed as to what is possible today using the newest available treatments for cancer. I have so many patients that if they had been diagnosed 15 years ago with the same diagnosis, they would not have survived long. I'm seeing miracles every single day of long-term survivors of lung cancer, leukemia, breast cancer and other cancers that I cannot keep track of them all.
Q: What does it feel like when you've done all you can but lose the person? How do you talk to this person and what's it like for you?
Dealing with people who are dying is the hardest part of being an oncologist. I promise to relieve suffering to the best of my ability and that I will never abandon a patient, even though hope for a cure or remission is gone. Once people know that you are not going to leave them, they accept the dying process with much more grace.
Q: What have you learned/experienced that has kept you in this field? Have you had any surprises?
Oncology is a tremendous field. You have an opportunity to truly help people every day. I am grateful for this chance and I hear the appreciation from the patients on a regular basis. This helps so much in continuing-on in this difficult field with such high stakes.
Q: How have your accomplishments changed your life, both as a doctor and as a person beyond your profession?
Being an oncologist changes your perspective on life because we see that there are neither guarantees nor warranties to this life. I learned to appreciate every day, knowing that each day is a true gift from God. I try to live life to the fullest, enjoy the everyday things and not sweat the small stuff.