Tuesday, December 14, 2004

Nightmares of an Oncologist

You don't hear much about this in the media and therefore, dear reader, perhaps you have concluded that the mood of doctors is calm and secure, but let me reassure any doubters out there:

The practice of medicine still is intellectually and emotionally grueling.

Far be it from me to whine about a career that I enthusiastically volunteered for, but would it be fair to allow me to "share" with you some examples of why oncologists sometimes do not sleep restfully? It isn't just because so many of our patients succumb to their illness. It is the way in which such a life was lost - the slow, relentless deterioration of a once healthy being - that breeds fear, anger, distress, pity, and hopelessness in both the patient and the doctor. I suppose these emotions are not unique to my profession, but are they encountered on a daily basis in other specialties? Wouldn't such continuous exposure to sorrow turn any oncologist to ashes?

Well, maybe not - this stress hasn't broken me yet and doesn't appear to be crippling our profession, as cancer providers are more confident than ever in the many new treatments available.

Even so, there are certain traumatic events in the professional life of a medical oncologist that haunt slumber. They are the oncologist's nightmares. They have visited me in my past.

I await their inevitable return with patient frustration.

Rather than dilate upon this any further, let me illustrate, with a brief explanation of their effect, the four worst nightmares of my career:

Patient Suicide: Three times in my career have my patients violently taken their own life after being diagnosed with cancer and before receiving any treatment. One of the patients had an indolent lymphoma, which is associated with years of remaining life. Why, I asked myself did he do it, especially after I told him about his relatively good prognosis? My initial shock of each patient's death led me to blame myself - I felt that my counseling skills must be pitiful if this is the result of a visit with me.

Treatment-Related Death: I have sat by the side of a smiling patient receiving chemotherapy on a bright afternoon only to be standing helplessly next to her in the ICU at 3 A.M,. as she dies of septic shock. Oncologists cannot predict with exact precision which patients will survive treatment, so we must use our best judgment in choosing a course of care, sometimes treating those with a higher risk of complications. Whether a patient is lost due to infection, pulmonary embolus or renal failure the end result is the same - we have failed in our mission to kill the patient's cancer, and we feel worthless.

Hostility: There is nothing more traumatizing for me than to have to meet angry people and try to convince them that I am the one to entrust the care of their loved one. It is a miserable experience to deal with hostile patients or families, and feels like trying to hold a discussion in a burning building with a gun pointed at your heart. The reason why it upsets us so much is not their ire, which is easy enough to understand, but because we often get irritated at being treated in such a manner, and an angry doctor is a inferior healer.

Irreversible Decline: How would you like to take a job where you meet delightful and interesting characters - former World War II veterans, teachers, grandparents, retired musicians, book lovers, ministers - and get to watch them slowly, inexorably lose their appetite, energy, weight, strength, hair and ability to share their lives with their loved ones? I realize this is what every caregiver and family member must suffer when their beloved is afflicted with cancer. It is a tragedy beyond measurement. An oncologist, however, feels that he or she has the power to stop this misfortune - if only the right treatment was given at the right time, with the right amount of luck or heavenly blessing. So we offer treatment, and if it is ineffective, if death then begins its unrelenting assault, gradually transforming robust flesh into a gaunt visage, and all we can do is watch it happen...

That to me is the oncologist's worst nightmare.

Since I have not named this blog The Frightened Oncologist, you may ask "How do you reconcile these distressful aspects of practicing medicine with your chirpy title?"

Ha!

Ever heard of the term fortitude? "Strength of mind that enables a person to encounter danger or bear pain or adversity with courage."

That, my readers, is the secret - if you don't have fortitude, you won't last long in this profession. Fortitude is the power that allows an oncologist to extract himself from the wreckage of discouragement, find another bicycle, and begin again to pedal uphill toward the place where his responsiblity and his patients await.

10 Comments:

At 10:02 PM, Blogger Exactamundo said...

Ohmygod: I stumbled upon this extemely well-written blog from a link at Chris Muir's Day by Day.

I read a lot of blogs. I like the wide range of opinions blogs bring you. But this -- THIS -- blog is just mind-blowing. Please continue to share your insight and permit me to sign off now. Just wanted to day that.

 
At 11:32 PM, Blogger Dr. Craig Hildreth said...

To exactamundo:

Thanks.

 
At 12:26 PM, Blogger Saint Nate said...

I just finished a conversation with a co-worker about how demanding it must be an oncologist before I read this entry. Your fortitude and strength of character is truly remarkable.

I see a similar attitude in many neurologists, particuarly those who focus on Alzheimer's or Parkinson's patients. There, though the attitude is more resigned to simply trying to slow the condition's progression as much as possible. These diseases are incurable, so there is no hope and conversely there is no disappointment when the patient passes away.

I don't care to speculate which specialty has it harder, but I will say you have a more cheerful disposition than most of the these neurologists.

 
At 1:38 PM, Blogger Dr. Craig Hildreth said...

To Saint Nate:

I can't blame these neurologists for being less than perky - I couldn't spend all day delving into the mind of a patient with dementia without resorting to black humor of the meanest kind...

 
At 7:15 AM, Blogger Doctor Disgruntled said...

Nice post. One of the things that makes it all so difficult is that it can be very difficult, or might even be impossible, to know how much fortitude you have until you're in the middle (or the late beginning) of your career. When I was a med student, for example, I had this vision of myself as the guy running to meet the ambulance as it skirls into the trauma bay. And I'm pretty good in an emergency, it's just that now that I have repeatedly experienced that feeling, I pray that those calls never come again. My "fortitude" in real life is, I think, at a different level than I would have thought.

Or maybe it's like one of those military cliches about a soldier thinking he's a coward because he's petrified, and the CO telling him, "We're all scared, son, but if you go in there and do what you're trained to do you're no coward."

 
At 10:43 AM, Blogger Dr. Craig Hildreth said...

To D.D.:

...or as Winston Churchill said, "When you're going through hell, keep going."

 
At 7:41 PM, Blogger Texas Libertarian said...

The Cheerful Oncologist said:

"I suppose these emotions are not unique to my profession, but are they encountered on a daily basis in other specialties?"

Probably not on such a protracted basis. However, I would analogize your experience to that of an emergency medical technician (which I was for some time) who, when the call comes in, whether it be trauma- or illness-related, knows they are going to arrive at the scene of an emergency where everyone present is depending on you to make it right.

I experienced all of your nightmare scenarios in my rather brief (6 years) as an EMT;

The patient who, in spite of your pleas, pulled the trigger of the 12 gauge resting under his chin;

The patient who, because of your lack of attention to one injury or because of your improperly prioritizing treatments for multiple injuries, simply slipped away;

The patient whose loved ones are beating on your back and pleading with you to resume CPR or to transport their too-long-deceased beloved to a hospital; and

The patient who you know, despite your best efforts, just isn't going to survive (particularly those who are initially conscious as you begin your futile attempts to save them).

I'm not one-upping you or diminishing the hardships of your profession...just trying to show there are those who identify. Aside from the protracted and, in the case of suicide, horrifically unexpected nature of your business, I believe anyone in any profession dedicated to caring for other humans is bound to, in some form, encounter these nightmares...

But, if I may, I would like to share the one memory that still haunts me -- these 20 years after I stopped screaming to accident scenes and intubating the breathless.

It is the words of a father of the 12-year-old girl who, after falling through the camper door at 70 mph, was lying lifeless on the highway at my feet..."Am I going to get into trouble for this?"

That indifference still makes me sick to this day.

Again, thank you for your poignant yet positive insights into the medical profession, particularly those of oncology.

God Bless you!

 
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A reasonable guide to the purity of an essential oil is its price. Pure essential oils are generally more expensive. Common oils such as lavender and geranium are much cheaper than frankincense and carnation oil. It is advisable to become familiar with essential oil prices and then rely on this knowledge when purchasing oils from unfamiliar sources. Keep in-mind that you will generally get what you pay for. A price list from a reputable dealer is a valuable resource when purchasing essentials oils.

Usually, pure essential oils cannot be applied directly to the skin and must be mixed in a base oil to reduce their strength. Base oils such as almond oil or wheatgerm oil are commonly used for this purpose. Base oils are generally derived from seeds, nuts or vegetables and allow you to create essential oil remedies that can be massaged into the skin.

So, what do you need to get started with essential oils and natural remedies?

Without a doubt, Lavender is one of the most useful and desirable oils. Not only does it work wonders on cuts, bruises and burns, it also aids sleep and helps with relaxation.

The Tea Tree and Eucalyptus oils are useful for treating a variety of respiratory ailments. These are excellent for the treatment of colds and coughs. They can be massaged into the chest or burned in an oil burner to help clear the airways and prevent congestion. Tea Tree oil is a natural antiseptic and can be dabbed on cuts, bites and stings. It is often used to treat spots and pimples and when diluted with water, acts as a mouth gargle (keep in-mind it should never be swallowed).

Another basic antiseptic is Geranium oil. With its distinctive perfume and pain relieving properties, it is a necessary inclusion when starting out.

Peppermint oil should also be purchased as it treats digestive complaints and may be used in preparations for freshening breath.

For fragrant perfumes and establishing ambience in a room, buy some Patchouli and Ylang-ylang oils. Often combined in scented candles and air fresheners, a few drops of each in an oil burner creates a wonderfully perfumed home. Orange oil mixed with Cinnamon oil is a lovely winter alternative that evokes seasonal, holiday smells. Besides their perfume qualities, all four of these oils have other properties. Patchouli treats eczema and dandruff. Ylang-ylang is reputed to relieve stress, palpitations and high blood pressure. Orange is used in natural remedies for depression and nervous tension and Cinnamon is excellent for warts and viral infections.

The herbs, Thyme and Rosemary can be grown in pots and used when needed. To create essential oils from herbs, stew some large amounts in pure water, collect the steam and cool it. The oil will rise to the top of the drained water and can be collected with an eyedropper. Alternatively, a "flower still" can be purchased to make the job easier. Thyme and Rosemary are both antiseptics and can be used in skin care preparations. They are also delicious when used in cooking.

Lemon oil and fresh lemons will purify water and, when mixed with honey, are effective remedies for colds and flu. Lemon and white vinegar are highly efficient cleaning agents that can be used for domestic cleaning tasks without damaging the environment. Use white vinegar as a natural disinfectant or mix it with water to clean windows and wooden floors. It is also handy to keep a bottle of white vinegar in your car if you swim in the ocean. It will bring instant relief from jellyfish stings.

Citronella oil is perfect in summer to keep the insects at bay. Another natural repellent is Garlic. Fleas will not bite a dog that has been eating garlic, so a few garlic capsules in the dog food are a cheap solution to your pet's flea problem. A soft collar soaked in Citronella will also do the job.

Garlic also helps to promote a healthy immune system when the weather turns cold and viruses begin to circulate. In fact, most of the oils and herbs listed above are effective in helping to prevent many common winter illnesses.

Whether you are looking for remedies or nature friendly products to use around the house, the oils and herbs suggested above should help get you started. You will be ready to make some healthy changes in your way of life!

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At 7:09 AM, Anonymous Anonymous said...

Essential oils, roots and herbs can be used in a variety of ways to promote healthy living and stress factory. They are used to create natural remedies for treating ailments common to both people and animals, to add flavor to food, to make perfumes and to create environmentally friendly cleaning products.

You do not have to own a garden to tap into the benefits of plants, roots and herbs. A few herb pots located by a sunny window are enough to get you started. Then, all you need are some essential oils and you are ready to go.

For therapeutic purposes, only the purest oils will do. It is possible to be fooled into thinking that you are purchasing a pure oil. Often, a lesser quality blend of several oils is used to mimic the properties of the pure oil. Blended oils are acceptable for fragrance purposes such as for perfuming a room, but pure oils are a "must" for medicinal purposes.

A reasonable guide to the purity of an essential oil is its price. Pure essential oils are generally more expensive. Common oils such as lavender and geranium are much cheaper than frankincense and carnation oil. It is advisable to become familiar with essential oil prices and then rely on this knowledge when purchasing oils from unfamiliar sources. Keep in-mind that you will generally get what you pay for. A price list from a reputable dealer is a valuable resource when purchasing essentials oils.

Usually, pure essential oils cannot be applied directly to the skin and must be mixed in a base oil to reduce their strength. Base oils such as almond oil or wheatgerm oil are commonly used for this purpose. Base oils are generally derived from seeds, nuts or vegetables and allow you to create essential oil remedies that can be massaged into the skin.

So, what do you need to get started with essential oils and natural remedies?

Without a doubt, Lavender is one of the most useful and desirable oils. Not only does it work wonders on cuts, bruises and burns, it also aids sleep and helps with relaxation.

The Tea Tree and Eucalyptus oils are useful for treating a variety of respiratory ailments. These are excellent for the treatment of colds and coughs. They can be massaged into the chest or burned in an oil burner to help clear the airways and prevent congestion. Tea Tree oil is a natural antiseptic and can be dabbed on cuts, bites and stings. It is often used to treat spots and pimples and when diluted with water, acts as a mouth gargle (keep in-mind it should never be swallowed).

Another basic antiseptic is Geranium oil. With its distinctive perfume and pain relieving properties, it is a necessary inclusion when starting out.

Peppermint oil should also be purchased as it treats digestive complaints and may be used in preparations for freshening breath.

For fragrant perfumes and establishing ambience in a room, buy some Patchouli and Ylang-ylang oils. Often combined in scented candles and air fresheners, a few drops of each in an oil burner creates a wonderfully perfumed home. Orange oil mixed with Cinnamon oil is a lovely winter alternative that evokes seasonal, holiday smells. Besides their perfume qualities, all four of these oils have other properties. Patchouli treats eczema and dandruff. Ylang-ylang is reputed to relieve stress, palpitations and high blood pressure. Orange is used in natural remedies for depression and nervous tension and Cinnamon is excellent for warts and viral infections.

The herbs, Thyme and Rosemary can be grown in pots and used when needed. To create essential oils from herbs, stew some large amounts in pure water, collect the steam and cool it. The oil will rise to the top of the drained water and can be collected with an eyedropper. Alternatively, a "flower still" can be purchased to make the job easier. Thyme and Rosemary are both antiseptics and can be used in skin care preparations. They are also delicious when used in cooking.

Lemon oil and fresh lemons will purify water and, when mixed with honey, are effective remedies for colds and flu. Lemon and white vinegar are highly efficient cleaning agents that can be used for domestic cleaning tasks without damaging the environment. Use white vinegar as a natural disinfectant or mix it with water to clean windows and wooden floors. It is also handy to keep a bottle of white vinegar in your car if you swim in the ocean. It will bring instant relief from jellyfish stings.

Citronella oil is perfect in summer to keep the insects at bay. Another natural repellent is Garlic. Fleas will not bite a dog that has been eating garlic, so a few garlic capsules in the dog food are a cheap solution to your pet's flea problem. A soft collar soaked in Citronella will also do the job.

Garlic also helps to promote a healthy immune system when the weather turns cold and viruses begin to circulate. In fact, most of the oils and herbs listed above are effective in helping to prevent many common winter illnesses.

Whether you are looking for remedies or nature friendly products to use around the house, the oils and herbs suggested above should help get you started. You will be ready to make some healthy changes in your way of life!

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