You Only Die Once

Cancer is a battle for some people. But for others it's a negotiation. And palliative care is a large part of that. I'm happy to see more health care professional training on how to make a patient comfortable when there's not a lot to be done clinically. 

I am hearing more about doctors having those tough conversations with patients about their options, and their risks. The way we talk about this matters a great deal. Patients who think they have to fight as hard as possible, for as long as possible, may not have time to do what they need to at the end of their life (because they aren't aware that the end is near.) 

When described as "feeling well for as long as possible" or "free of pain" or "time to say goodbye," palliative care can allow a person to deal with what is coming. Death from cancer or a terminal illness should not be a surprise. The need of clinicians, historically, to avoid admitting defeat, should be secondary to the primary need of patients to know what is happening to them, and what is coming next. 

As scary as it is, we need to talk about death. And a dignified, peaceful death is something to strive for -- let's help make that the standard. 

The Emperor of All Maladies

The book, The Emperor of All Maladies by Siddhartha Mukherjee, was a rarity in it's history, breadth and insight into cancer. In fact, it's cleverly subheaded "A Biography" as if cancer is a single unit with an identity. I enthusiastically recommended it to people, who gave me odd looks I guess because why would they want to read a big book about cancer?

I'm surprised by how the film by Ken Burns and Barak Goodman changes the experience of consuming the information in a different way. Seeing the cancer patients is so much different than reading about them. The interviews with patients and doctors bring home so much more sharply how it feels to be fighting this beast. Like in episode two, a surgical oncologist undergoing surgery for breast cancer with her fellowship mentor. 

Another very effective use of film as a medium is the news clips. How we fight cancer has been controversial, and I think that is often overlooked. We might all want to cure it, but the road to get there has been full of misguided attempts and battles of ego. At one point, everyone thought things like high dose chemotherapy, radical mastectomies and deeper margins were the way to go -- basically overwhelming the systems to the highest degree possible without killing the patient. 

What I think is important about this history is that we need to look back and see that while our  knowledge was good, it was incomplete. Or it was based on bad assumptions. So, I see it as a call to look up, think differently and collaborate -- that's what's needed for us to move in one direction.