The Inquisitr offers a daily mix of original and syndicated content from across the web, covering a diverse spectrum of topic areas.
Saturday, October 17, 2009
Thursday, October 15, 2009
Funny stuff happens when you have cancer. Seriously.
Take last winter, when I was in the middle of hormone therapy and radiation for an aggressive case of prostate cancer. One of my relatives came by the house and said: "You know, if you need any weed to get you through this, I know where to get it."
After politely declining — I was truly and deeply touched — I just cracked up. The laughter and the tears made me feel better than any amount of marijuana would have. All I could imagine was this relative getting busted and then pleading, "But, officer, I'm getting this for a guy who has cancer."
As I've recovered from cancer surgery, treatment and its aftermath, it has been important to me to try to see the absurd plaid lining in a difficult situation. Just because the stakes with cancer are dark and mortal, that doesn't mean there aren't moments of high hilarity.
The classic family one-liner that stems from me having cancer is this one: "You take the dog out. I have cancer." That soon morphed into infinite variations, along the lines of: "Can I sit in that chair? I have cancer," or "Do you mind switching from HGTV to the Patriots game? I have cancer."
So, please, read this post and e-mail it to a friend. I had cancer.
Being able to laugh in the face of cancer lets you continue to own yourself, as hard as that might be, rather than ceding ownership to the disease. A good laugh reminds you that you are not your cancer.
After surgery, I was swollen, urinating blood and had drains hanging from my body that the nurses called "grenades" (because of their shape), and it hurt to laugh.
But I laughed, anyway, because there was a certain earthy humor to all these bodily insults. And in telling these stories to my friends with a grin after the fact, I could let the listener know that I'd journeyed to a narrow place of darkness, but had come back.
There's a part of me that would like nothing better than to do cancer stand-up comedy — please cue up a neurotic, put-upon Rodney Dangerfield voice:
Or there was this moment.
I know that sometimes laughter seems impossible. After my cancer diagnosis I plunged into a bleak funk. And these days I'm struggling with a post-treatment depression that leaves my days swaddled in wearying grays.
But no matter how remorseless the gloom, we humans tend to have our antennae for humor out. We're the animal that wants to laugh, wants to unlock itself through a chuckle and a chortle. And laughter lets us cope, even in awkward moments.
There was the time last winter when a colleague gave me the get-well gift of a book. Being a wiseguy (maybe I should blame it on the hormone therapy), I cracked, "Oh, great, it's probably '1,000 Places to See Before You Die.'"
My colleague gasped, then blushed as she handed me a copy of "1,000 Recordings to Hear Before You Die." We both laughed (and I apologized for wising off). But she only laughed after I laughed first.
to overcome societal, physical and financial obstacles that come with
aging to live a fulfilling second part of life.
On beginning to read this book, I found myself thinking almost obsessively of not very funny doctor jokes, of the good news/bad news variety. Doctor: "I have bad news and good news." Patient: "Tell me the bad news first." Doctor: "You have terminal cancer." Patient: "What's the good news?" Doctor: "See that nurse down the hall? I'm making it with her."
Shortly thereafter, the book disappeared. I searched for it frantically, to no avail. Then quite as suddenly it reappeared. It had been in plain sight and I had not seen it. (Interestingly enough, at the time of its disappearance I was reading the chapter on Alzheimer's.) It was only then that I recognized what now seems obvious, that the book had evoked some characteristic defenses, first that manic streak which makes light of the dark, and when that failed, stark simple denial.
This book can do that to you. As its author, a professor of surgery at Yale, tells us, "dying is a messy business." Even fairly sudden deaths will seem messy when described graphically enough. In the first chapter, Nuland writes of his own rite of passage as a third-year medical student, when "it was my unsettling luck to encounter death and my very first patient at the same hour."
The patient was a fifty-two-year-old executive, hard-driving and high-living, who had had an infarction which was seemingly stabilized. Young Nuland was asked to help out at a busy time at the hospital with a simple admissions workup. He was eager to do so. He entered the room, introduced himself, and then the following event took place:
As I sat down at his bedside he suddenly threw his head back and bellowed out a wordless roar that seemed to rise up out of his throat from somewhere deep within his stricken heart. He hit his balled fists with startling force up against the front of his chest in a single synchronous thump, just as his face and neck, in the flash of an instant, turned swollen and purple. His eyes seemed to have pushed themselves forward in one bulging thrust, as though they were trying to leap out of his head. He took one immensely long, gurgling breath, and died.
Many of the descriptions of death and dying presented here have the same shocking clarity, whether the demise is sudden, as in this case, or painfully drawn out over many years.
Nuland's intention is not to frighten us or to appeal to a sort of mortuary prurience. He feels, rather, that the contemporary attitude to death is compounded of illusions, denials, and deceptions, so much so that we are unable to deal with it effectively. And so we are to take the book's title seriously. Nuland tells us, lucidly and precisely, just how we die, the mechanics and the dynamics. In particular, he takes us through the more common paths to death: heart disease; stroke; Alzheimer's; the traumas of homicide, suicide, and accidents; AIDS; the cancers. He chooses these because they are common but also because
they are representative of certain universal processes that we will all experience as we are dying. The stoppage of circulation, the inadequate transport of oxygen to tissues, the flickering out of brain function, the failure of organs. . . .
A friend who is also an oncology nurse told me a particularly harrowing story about a patient, a man in his 60s, who was admitted to her floor with a new cancer diagnosis.
Treatment would involve a month of hospitalization and surgery to insert a central line in his chest to administer the chemotherapy. The patient was reluctant to go through with it, but the night before the operation, his daughter talked him into it.
The next morning, however, he balked. He refused to go to the operating room and said he was refusing treatment. His wish, he said, was to go home, sit on his porch, drink beer and smoke cigarettes.
It wouldn't be my choice, but I also can understand why a treatment plan involving weeks in the hospital and multiple infusions of potentially lifesaving, but also toxic, drugs would be difficult to accept, even if death was the alternative.
The doctor on the case, an oncologist in training, didn't see it that way and told the patient how he felt about the decision to refuse treatment. "If you were my father," he said, "I'd be disappointed in you."
My friend, the nurse, wanted the patient to answer, "And if I were your father I'd be disappointed in you for not supporting my decision." But the patient just said that he wanted to be referred to hospice and be given narcotics to control the pain he knew would come. He wanted to be in his home enjoying life his way for the last few months he would have.
At one point the doctor asked my friend to step out of the room, and she did, thinking he wanted to speak to her privately in the hall. He actually just wanted her to leave so that he could talk to the patient alone. My friend refused. "I'm the patient advocate," she told him.
Back and forth they went, until finally the doctor accepted that he was not going to change the patient's mind and that he couldn't bully the patient into accepting treatment.
But the doctor did refuse to refer the patient to hospice. The medical team listed the patient as leaving A.M.A. — against medical advice — and said a hospice referral posed too great a liability risk in that case.
My friend said work had never made her quite as angry as she was that day. Together she and the nurse who arranges discharges did an end run around the oncologist and had the patient's primary care doctor set up the hospice referral, giving the patient access to the pain medications and end of life treatments he would need.
In the book "How We Die," the surgeon Dr. Sherwin Nuland offers an explanation for the oncologist's behavior. Dr. Nuland argues that over the past 20 years we have made so much progress in treating cancer that doctors feel they should err "on the side of doing more rather than less."
"The very success of his esoteric therapeutics," Dr. Nuland writes, "too often leads the physician to believe he can do what is beyond his doing and save those who, left to their own unhindered judgment, would choose not to be subjected to his saving."
Americans admire people who fight, who struggle to the bitter end. We root for the underdog. But maybe this patient didn't need anyone's admiration or cheers; maybe he just wanted to go out his own quiet way.
Such people often get labeled cowards, failures or, as the doctor suggested, disappointments, but how many of us could look a cancer diagnosis in the face and say, "I do not want your hospital and your needles and your drugs, even if it means I will die?"
I feel certain I could not, even that I would not. It wouldn't be because I'm strong where this patient was weak, but only because I would be willing to trade the challenges of treatment for the possibility of more life.
Wednesday, October 14, 2009
A healthy young man suddenly loses his memory–making him unable to remember the events of each passing hour. Two patients diagnosed with Lyme disease improve after antibiotic treatment–only to have their symptoms mysteriously return. A young woman lies dying in the ICU–bleeding, jaundiced, incoherent–and none of her doctors know what is killing her. In Every Patient Tells a Story, Dr. Lisa Sanders takes us bedside to witness the process of solving these and other diagnostic dilemmas, providing a firsthand account of the expertise and intuition that lead a doctor to make the right diagnosis.
Never in human history have doctors had the knowledge, the tools, and the skills that they have today to diagnose illness and disease. And yet mistakes are made, diagnoses missed, symptoms or tests misunderstood. In this high-tech world of modern medicine, Sanders shows us that knowledge, while essential, is not sufficient to unravel the complexities of illness. She presents an unflinching look inside the detective story that marks nearly every illness–the diagnosis–revealing the combination of uncertainty and intrigue that doctors face when confronting patients who are sick or dying. Through dramatic stories of patients with baffling symptoms, Sanders portrays the absolute necessity and surprising difficulties of getting the patient's story, the challenges of the physical exam, the pitfalls of doctor-to-doctor communication, the vagaries of tests, and the near calamity of diagnostic errors. In Every Patient Tells a Story, Dr. Sanders chronicles the real-life drama of doctors solving these difficult medical mysteries that not only illustrate the art and science of diagnosis, but often save the patients' lives.
I was covering the emergency room the morning that Sarah (not her real name) presented with excruciating abdominal pain. Married, in her late 40s and otherwise healthy, she had come to our clinic a few weeks earlier with a benign blood vessel tumor in her liver. Because of the risk of spontaneous rupture, her surgeon, the most senior member of our department, suggested she have the grapefruit-sized tumor, a hemangioma, removed electively and as soon as possible. They settled on a date, but as Sarah left the clinic, he offered one cautionary piece of advice. "If you develop pain in your belly, come in right away. It may be a sign that the tumor has ruptured."
In the emergency room that morning, we all assumed the tumor was at least leaking if not already in the early stages of rupture. Sarah lay on the narrow emergency room gurney, her face pale and covered with a patina of cold sweat. In the few minutes that it took for her surgeon to arrive in the E.R., the operating room personnel had prepared a room and warned the blood bank that she might need an emergency transfusion.
The surgeon asked Sarah several questions: how her pain started, where it was, and how she might describe it. He put his hand against her belly, gently palpating the area of her liver, around her belly button and near her pelvis. His hand rested for a moment in the bow of her pelvis, and he lowered his head and closed his eyes. Slowly he began moving his hand in small circles, as if feeling for something below.
"I don't think her diagnosis is hemangioma," he said as he emerged from Sarah's room. "I think she's got dead bowel."
That diagnosis, usually seen in the elderly or in those with rare clotting disorders, had never crossed my mind that morning. It, too, would require an emergency operation, but there would be no life-threatening hemorrhage and an entirely different set of issues to consider post-operatively. Caring for Sarah with dead bowel would not be the same as caring for Sarah with a ruptured hemangioma.
Later that morning in the operating room, Sarah's surgeon would peel free a perfectly intact hemangioma from her liver. But deeper down in her belly, he would find what only he had felt in the emergency room, the cause of her excruciating pain — a two-inch segment of dead intestine, telescoped so tightly on itself that it had kinked off its own blood supply.
That Sarah's surgeon could make such a specific and accurate diagnosis still mystifies me, and her story has become one of several diagnostic mysteries I find myself recounting over and over again. Like doctors everywhere, I relish anecdotes like hers because they are evidence of extraordinary medical sleuthing and intuition.
But, as Dr. Lisa Sanders shows in her thought-provoking new book, "Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis" (Broadway Books, 2009), my fascination, our fascination, with diagnoses may have more to do with the importance of having a diagnosis than with the robustness of the process itself.
Few individuals have considered the diagnostic process as extensively as Dr. Sanders. For the last seven years in The New York Times Magazine, she has offered readers a new diagnostic dilemma every month, a peek into the way doctors think about disease.
Her new book is filled with similar fascinating patient stories — the young woman who turns "highlighter yellow," the medical student who suddenly becomes inarticulate, and the muscular man who suddenly can no longer hold a coffee cup or walk straight. But unlike her column, where each story is the focus of discussion, the patients who appear in the book are springboards for a discussion of how methods of diagnosis, or lack thereof, ultimately drive patient care. With a diagnosis, the doctor-patient relationship has direction, a purpose, a common goal. Without it, both the patient and physician are unmoored, cast in a sea of overwhelming and often paralyzing possibilities.
With an understated but unwaveringly clear narrative voice, Dr. Sanders takes readers on an examination of the tools of diagnosis, touching upon the obvious and the not-so-obvious — the physical exam, the effect of physician biases, and even the reliability of computers and Dr. Google.
Tuesday, October 13, 2009
My heart began pounding as I listened to the sound of the dial tone in my ear. After three rings a woman answered groggily and uncertainly, "H-hello?"
"Mrs. Peterson?" I asked. My voice trembled slightly. It was 2 a.m. and I'd awakened her from what I imagined had been a troubled sleep.
"This is Dr. Lickerman. I'm calling from the hospital." I paused. "I'm calling about your husband."
There was silence. Then a breathless, "Yes?"
"Mrs. Peterson, I'm the resident on call taking care of your husband. Your husband—your husband's suffered a complication. You know the heart attack he came in for was very serious. A large part of his heart had stopped working. Well, Mrs. Peterson, I just don't know how to say this to you but…your husband passed away tonight. We tried everything we could to save him but there was just too much damage to his heart. It just couldn't keep pumping blood. I'm…really sorry. I don't know how—I'm just really sorry. I wish I weren't telling you this over the phone…"
A few more minutes of silence passed, and I realized she was crying. "I understand," she said finally. "Thank you." Then she asked, "What do I do now?"
Relief coursed through me. "There's a hospital administrator on the line—"
"Hello," the hospital administrator said gently.
"—he's going to explain everything you need to do." I paused. "Mrs. Peterson, I am just so sorry…"
"Thank you," she said quietly. When I hung up I found my hands were literally shaking.
I was a first year resident, and this was the first time I'd ever had to tell a family member a loved one had died. It had happened in the middle of the night so I'd had no choice but to deliver the news over the phone. Not only that, but because I was covering for another resident and had only met Mr. Peterson (not his real name) that night after his heart had stopped and I'd been called to try to resuscitate him, his wife ended up hearing the news of his death from a total stranger. It was an experience I will never forget.
DOING IT BETTER
In the years since then, I've had to deliver that kind of news to families a score of times and bad news of a slightly lesser magnitude hundreds of times. In all honesty—and contrary to the popular saying—it has in fact become easier, partly because I've learned to do it better, I think, and partly because the more you do anything the less it stirs up the emotion that initially accompanied it. What follows is the approach I've developed over the years to deliver bad news in the most compassionate manner possible.
The first patient I ever saw as a first year resident came in with a litany of complaints, not one of which I remember today except for one—he had headaches. The reason I remember he had headaches isn't because I spent so much time discussing them but rather the opposite: at the time I knew next to nothing about headaches and somehow managed to end the visit without ever addressing his at all, even though they were the primary reason he'd come to see me.
Then I rotated on a neurology service and actually learned quite a lot about headaches. Then when my patient came back to see me a few months later, I distinctly remember at that point not only being interested in his headaches but actually being excited to discuss them.
I often find myself thinking back to that experience when I'm confronted with a patient who has a complaint I can't figure out, and I thought it would be useful to describe the various reactions doctors have to patients in general when they can't figure out what's wrong, why they have those reactions, and what you can do as a patient to improve your chances in such situations of getting good care.
Blog by Kairol Rosenthal, author of the book Everything Changes: The Insider’s Guide to Cancer in Your 20s and 30s
treatments we are taking that interest me as much as what we do with
our lives after the big cancer bomb is dropped in our laps.
By age twenty-nine, I had spent two years in the confines of the
cancer world; graying AARP patients to my left, pitying nurses to my
right. I attended young adult support groups, where 20 and 30-
somethings stuttered hesitant feelings. (The brain cancer patient
researching her own hospice care didn't want to scare the crap out of
the dude recently diagnosed with lymphoma. The stage I cervical
cancer patient didn't want to sound like a whiner next to the guy
with lung metastases.) We all meant well but politeness prevailed.
Sex, death, parenting, pain management, and career goals were a
parade of elephants in the room.
Cancer did not make me brave, outspoken, or grateful. I've always
known you only have one shot at life, and you have to work hard and
take chances to try to get what you want. What I wanted was real
conversation. And, to live out my dreams of playing Terry Gross, the
host on NPR's show Fresh Air.
I wanted to know if other young adult cancer patients cried
themselves to sleep at night, wrote their wills on scrap paper while
riding the train, or lied to dates about their scars. I wanted to
know if other cancer patients still ate greasy hamburgers, stayed out
way too late, and put their dream jobs on hold. I wanted to get
inside the heads of these patients and to not feel so alone.
Five years ago I emailed friends and family, asking them to
contribute cash towards a professional grade voice recorder. I
received a travel grant from The City of Chicago Department of
Cultural Affairs. I posted ads on Craigslist, networked with social
workers, and sent out fliers that hung in laundromats and churches
across the country. The calls started pouring in. From the Bible Belt
to the Big Apple, young adult cancer patients across the country
invited me into their homes.
Digging up the cancer dirt was easy, all I had to do was listen.
Patients confessed to me what they had never told their doctors,
therapists, friends, parents, partners, or other survivors. Greg
taught me a magic word to help get what I want in hospitals. Amilca
admitted to crying like a two year old because she couldn't eat
Krispy Kremes. Mary Ann said she'd go against the Catholic church and
ask to be removed from life support. Geoff, a drug addict, told me
how he charmed his nurses into giving him stellar narcotics.
I had spent my twenties and early thirties working as a modern dance
choreographer. Now I'm a healthcare blogger, reporter, and writer
living in Chicago. I didn't even have to go to grad school for this
second career. All I had to do was get cancer and listen.
Monday, October 12, 2009
Scary. Like aliens. That is how Kerry Mastera remembers her twins, Max and Wes, in the traumatic days after they were born nine weeks early. Machines forced air into the infants' lungs, pushing their tiny chests up and down in artificial heaves. Tubes delivered nourishment. They were so small her husband's wedding band fit around an entire baby foot.
Having a family had been an elusive goal for Jeff and Kerry Mastera, a blur of more than two years, dozens of doctor visits and four tries with a procedure called intrauterine insemination, all failures. In one year, the Masteras spent 23 percent of their income on fertility treatments.
The couple had nearly given up, but last year they decided to try once more, this time through in-vitro fertilization. Pregnancy quickly followed, as did the Mastera boys, who arrived at the Swedish Medical Center in Denver on Feb. 16 at 3 pounds, 1 ounce apiece. Kept alive in a neonatal intensive care unit, Max remained in the hospital 43 days; Wes came home in 51.
By the time it was over, medical bills for the boys exceeded $1.2 million.
Eight months later, the extraordinary effort seems worth it to the Masteras, who live in Aurora, Colo. The babies are thriving and developing their own personalities — Wes, the noisy and demanding; Max, the quiet and serious. Like many other twins conceived through in-vitro fertilization, the Mastera boys will go down in the record books as a success — both for the fertility clinic that helped create them and the neonatologists who nursed them to health.
But an exploration of the fertility industry reveals that the success comes with a price. While IVF creates thousands of new families a year, an increasing number of the newborns are twins, and they carry special risks often overlooked in the desire to produce babies.
As I mentioned in my first post I would like to bring some awareness to an issue facing many of us returning war veterans. Post Traumatic Stress Disorder (P.T.S.D.) is a monster that war veterans have been facing since the beginning of armed conflict. In a nutshell, it is the stress brought on by a traumatic event. I understand that it is more complicated than that but I would like to keep it as simple as possible for our purposes here.
I am living with P.T.S.D., and I am thriving in some respects and having problems in others. In this and future posts I plan to use myself and my experiences as examples.
Post-traumatic stress can manifest itself in many different ways. It is usually brought on by a trigger mechanism, or what some might call a catalyst. It can be something very minor that can be easily controlled or it can be so large that it has life altering circumstances.
So what do I mean when I say I am both thriving and having problems at the same time? Well, I can tell you that in school I am thriving. I have been back for a couple of years now and continue to pull a 3-plus grade point average every semester. It is in other parts of my life that I am struggling.
My relationship with my wife has been strained because of the way I react to certain things; my relationship with my stepson has suffered as well. I have quick reactions full of emotion that are not checked before they come out. In many cases they are very aggressive and quite counterproductive. I am impatient in numerous situations and become frustrated easily. To top it all off I often have to overcome bouts of anxiety, especially when I am outside my house. I do well in social situations but I find them physically taxing. I have been receiving help with all of these problems and I am improving at a good rate. My wife and I have worked hard to help me overcome a lot of these symptoms.
One of the most common problems facing our war veterans when we return home is drug and alcohol abuse. We turn to these to escape from emotions. I drank heavily when I returned home. I would drink to the point that I would pass out at night. I would do this because I could not sleep. I could not sleep because there were a healthy wave of emotions that I refused to face. What made sleep hard was the P.T.S.D. in conjunction with a traumatic brain injury. When I would finally sleep I had to deal with some strange and horrific dreams.
21st Century Babies - Painful Choices With Fertility Treatment That Leads to the Most Dangerous Pregnancies - Series - NYTimes.com
It was the last piece of advice Thomas and Amanda Stansel wanted to hear. But their fertility doctor was delivering it, without sugarcoating.
Reduce, or you will lose them all, he told them.
For more than a year the Stansels had been relying on Dr. George Grunert, one of the busiest fertility doctors in Houston, to produce his industry's coveted product — a healthy baby. He was using a common procedure called intrauterine insemination, which involved injecting sperm into Mrs. Stansel's uterus after hormone shots.
But something had gone wrong. In April, an ultrasound revealed that Mrs. Stansel was carrying not one but six babies, and Dr. Grunert was recommending a procedure known as selective reduction, in which some of the fetuses would be eliminated.
The Stansels rejected Dr. Grunert's advice and, since then, their vision of a family has collapsed into excruciating loss: the deaths of three children after their premature births on Aug. 4. More than two months later, the three other infants remain in neonatal intensive care, their futures uncertain. One of them, Ashlyn, is near death.
PUBLIC health officials are now battling not only a fast-spreading influenza virus but also unfounded fears about the vaccine that can prevent it.
Since April, more than a million Americans have caught H1N1 flu, more than 10,000 have been hospitalized, and about 1,000 have died, including 76 children. And it's only the beginning of October. Yet, in a new survey, 41 percent of adults said they will not get vaccinated.
The good news is that for the first time in more than 50 years we've made a vaccine against a pandemic strain of influenza before the onset of winter, when lower temperatures and humidity allow the virus to spread more easily. Distributing this vaccine to those who need it most — pregnant women, health care workers, children older than six months and people with compromised immunity — will be difficult enough. But the task is made harder by the various myths, spread on TV talk shows and Web sites, suggesting that Americans have more to fear from the vaccine than from the deadly disease it prevents. Here are some of those myths, and why they're wrong:
Sunday, October 11, 2009
We build and staff hospitals in rural Ecuador to serve the poorest of
the poor, daily saving the lives of women and children and long term
improving the quality of the lives of many.
But really we do much more…
First, our hospitals are self-sustaining, which is the result our
private-public partnerships with the local, regional and national
Second, we operate a large residency program for doctors and nurses
in cooperation with the Catholic University of Quito and La Concordia
University. These doctors and nurses will revolutionize how health
care is delivered throughout rural Ecuador. These trained physicians
and nurses will provide the best medical and administrative practices
available anywhere to assure quality care to rural Ecuador.
Finally, we operate a Global Health Research Center whose mission is
to assure that our model of success spreads throughout Ecuador and
Andean Health & Development (AHD), a U.S. based 501(c)3 corporation, was founded in 1995 by Dr. David Gaus and Rev. Theodore Hesburgh, CSC, President Emeritus, University of Notre Dame, and Past President of the Rockefeller Foundation, to establish models of self-sustainable, comprehensive healthcare in poor, rural areas of Latin America where there are high risk populations of women and children