It seems that like many other things in nature there is a rhythm to medical practice. I’ve heard other GPs confirm this, not just for infectious disease, which only makes sense, but for other disease entities for which there is no rational explanation. Many is the time I’ll see an uncommon clinical entity, one I hadn’t seen in years, then suddenly spot a second case not long afterward. One might argue that I was sensitized and more likely to make second diagnosis. This does not explain my recent spate of terminal malignancies.
Over the last six months I’ve diagnosed more cancer than in the previous five years. In one instance, a brother and sister, both in their 70s, were diagnosed with lung cancer within days of one another. Both were smokers (despite my frequent admonitions to quit) and both seemed unsurprised with the diagnosis. A third sister was just diagnosed with metastatic colon cancer and then the youngest sister, a diabetic, ended up in the CCU with a heart attack. The family still retained its sense of humor enough to joke that the youngest sister always had to be different.
Not all the victims have been elderly. One man, I’ll call him Bill, in his early 40s (it’s always particularly disturbing when the patient is younger than me) died not long after his diagnosis of metastatic colon cancer, leaving a wife and two young boys. Bill was an outstandingly nice fellow, a favorite at the clinic, and very compliant with his treatment protocol.
In contrast, another of my patients, we’ll call him Tom, was not. Tom was a crusty self-employed businessman who also had metastatic colon cancer. Compared with Bill, he was demanding, tried every natural therapy in the book and salted our discussions about the hospital system with four-letter words. He tried lots of new and experimental chemotherapeutic agents and saturated his system with anti-oxidants. Bill died just after his diagnosis while Tom lived far longer than expected. I don’t think it was the treatment; I think he was just too cantankerous to go without a fight. Despite his crusty exterior, I got along well with Tom and liked him. After he passed away his family gave me a crystal paperweight, which incorporated a swirling pattern of colors within a green glass sphere. This perfectly evoked Tom’s personality and it reminds me of him when I see it on my desk.
In my experience it is this personality type that survives malignancies best, but in some cases it can be carried to the extreme. One of the few long-term lung cancer survivors I’ve had in my practice managed to alienate just about everyone (premorbidly, I might add) including his wife and daughter. Despite severe COPD he lived for years afterwards. Perhaps there is some truth to the old adage “the good die young”. (Having said that, I have many nice patients who are cancer survivors).
While some patients handle terminal disease with relative aplomb, others who have apparently been cured, develop chronic anxiety symptoms prompting many visits, and are difficult to reassure. I guess this is understandable given the horror the diagnosis of a cancer carries. I find survivors of childhood malignancies often remain anxious later in life, due to the disruption surgery, chemo- and radiotherapy cause to school and social life.
We are fortunate in our area to have a superb palliative care program coordinated through our regional hospital and Victorian Order of Nurses (VON). Some patients who are still in denial are reluctant to enroll at first. Without exception the program has provided invaluable support to these patients and their families, and has made my job caring for them a lot easier. With the number of new cases I’ve referred them, I’m on a first name basis with most of the staff.
I was recently invited to participate in the annual commemorative service. This program includes doing readings and lighting candles for the deceased, a touching memorial to people who have touched our lives with their courage in the face of adversity.
A colleague mentioned recently that he knew a young physician in practice for five years who had just diagnosed her first malignancy. Indeed, I had a younger practice at the five-year mark than at my present 25 years in practice. Of course, an older practice will produce more malignancies, but I think I see another trend persist resulting in the diagnosis of more cancer.
Guidelines in managing risk factors for atherosclerosis have changed dramatically over the last two decades. As I assiduously reduce my patients’ blood sugars, serum lipids and blood pressures, and hound them into reducing or quitting smoking, I feel that their rates of ischemic heart disease, stroke and congestive heart failure have dropped dramatically. Since we all have to die from something, perhaps we are simply substituting one cause of death for another.
In any event, the avalanche of new cancers in my practice has begun to die down to a flurry. I hope it stays that way.
I’ve often grown very close to these people, looking after them and their families for decades, perhaps even having delivered their children or grandchildren. The impact of their deaths is that of losing a friend. Lately I feel more like a palliative care specialist or oncologist than a GP and my heart goes out to those who specialize in these challenging and emotionally draining fields.
CMMooney @ Flickr.com. creative Commons. Some Rights Reserved.
Did you enjoy this article?
Please let the author know by leaving them a comment below!
And, subscribe to our free weekly digest!
Simply add your email below. A confirmation email will be sent to you.