WHEN TUMOR IS THE RUMOR AND CANCER IS THE ANSWER INTRODUCTION

INTRODUCTION

Hi Dr Ryan here Medical oncologist and this is whentumoris the rumorand cancer is the answer     I AM SURE YOU ARE FAMILIAR WITH THE  SONG FROM CHARIOTS  OF FIRE. A MAN HAS A PLAN AND IN A DAY IT IS CRUSHED…… SO IT IS WHEN YOU HAVE BEEN TOLD YOU HAVE CANCER ,THOUGHTS OF LOSS OF CONTROL, SOUL SUCKING ANXIETY, WHAT ABOUT YOUR FAMILY AND THE LIST GOES ON as it HITS  YOU LIKE A TON OF BRICKS. HE ROSE ABOVE IT IN THE FILM  AND SO YOU TO WILL BE A HERO ………I HAVE SEEN NO EXCEPTION NO MATTER HOW AFRAID YOU ARE

WELL IT HAPPENS 1.7 MILLION TIMES A YEAR AND 600,000 THOUSAND DIE WITH AN EVER INCREASING SURVIVAL RATE. IT USED TO BE THAT 65% DIED JUST 25 YEARS AGO , NOW IT IS 45%% AND FALLING . THE NUMBER OF CASES MAY BE INCREASING AND IT SOON WILL BE OUR NUMBER ONE KILLER BUT THAT IS BECAUSE WE ARE AGING . OVER 80% OF US KNOW, KNEW OR WILL KNOW SOMEONE WITH CANCER, CONSIDER THE FAMILY MEMBERS, THE LOVED ONES, FRIENDS, ,,,,THUS IT TOUCHES NEARLY EVERYONE..

SO WHETHER YOU ARE A NEWLY DIAGNOSED PT OR A FAMILY MEMBER, THIS SHOW IS FOR YOU

THE SHOW WILL AIR EVERY TUEDAY AT 3 PM EST AND WILL COVER A NEW TOPIC ON THE JOURNEY WITH EACH EPISODE POSTED ON THE WEB SITE AND IHEART RADIO AS WELL IN A SHORT TIME AS WELL AS PRIOR RADIO INTERVIEWS NOT TO BE MISSED

THE BOOK, WHEN TUMOR IS THE RUMOR AND CANCER IS THE ANSWER; A COMPREHENSIVE TEXT FOR NEWLY DIAGNOSED CANCER PATIENTS AND FAMILIES INFORMS THE RADIO SHOW, ITS WEB SITE IS THE TITLE  WWW.WHENTUMORISTHERUMORANDCANCERISTHEANSWER.COM WITH NO SPACES  IT HAS HAD A MILLION HITS. THOUSANDS OF LIKES AND FRIENDS AND A BLOG AND FACEBOOK AND TWITTER WITH OVER 450 PROFOUNDLY INFORMATIVE ENTRIES ABOUT THE STATE OF THE ART OF CANCER WHICH  COVER A HUGE RANGE OF TOPICS . THE BOOK WON A GOLD MEDAL AS BEST INDIE AND HAS ALL FIVE STAR REVIEWS AND AN ENDORESEMENT FROM A FORMER SURGEON GENERAL/ IT IS COMPREHENSIVE, COMPREHENSIBLE AND COMPASSIONATE.

IF YOU WANT A COPY IN ANY FORMAT ( AND THUS HAVE ALL OF THE SHOWS AT ONCE) IT IS AVAIABLE ON THE WEB SITE OR AMAZON…BUT THE SITE IS MEANT TO BE THERAPEUTIC AND HAS ALL KINDS OF INTERVIEWS AND FILMS AND EXCERPTS , THE BOOK PUTS IT ALL IN ONE PLACE THE SHOW WALKS US THROUGH THE TOPIC WEEKLY. I AM NOT REALLY TRYING TO SELL BOOKS I AM TRYING TO HELP FRIGHTENED PEOPLE AND THEIR LOVED ONES

 

IT COVERS WHAT YOU NEED TO KNOW IN THE JOURNEY FROM START TO FINISH AS ANXIETY IS ALWAYS BEST FOUGHT WITH KNOWLEDGE. IT IS NOT ABOUT ONE SPECIFIC CANCER OR ONE PERSON ALTHOUGH STORIES OF REAL PATIENTS ARE IN THERE AND EVERY NOW AND THEN I WILL READ ONE . IT NEITHER ATTACKS OR SUPPORTS COMPLEMENTARY AND ALTERNATIVE MEDICINE BUT YOU WILL SEE I GIVE IT REASONABLE, TRUTHFUL AND FAIR TREATMENT WHEN WE GET THERE. WE WILL TAKE OUR TIME SO FEEL FREE TO WRITE IN YOUR QUESTIONS AT WWW.W4CS.COM AND I WILL TRY TO GET TO THEM

 

WHY DID I WRITE IT? WHY DO I DO THE SHOW … POPULAR DEMAND  AND  BECAUSE NO ONE ELSE DID IT OR IS DOING IT IN  MY OVER THIRTY YEARS OF PRACTICE

AS YOU WILL HEAR IN THE FOREWARD FROM THE BOOK WHICH I WILL BRIEFLY SHARE TODAY/ THIS SHOW IS MEANT TO SAY THANK YOU TO THE THOUSANDS WHO PUT THEIR LIVES IN MY HANDS AND TO THOSE YET TO COME

WHO AM I

I AM A SUMMA CUM LAUDE PHI BETA AOA GRADUATE FROM GEORGETOWN UNIVERSITY AND MEDICAL SCHOOL WITH A FELLOW SHIP IN IMMUNOPATHOLOGY FROM THE NATIONAL CANCER INSTITUE I AM AN MD WITH 2 MASTERS AND A FELLOW OF THE AMERICAN COLLEGE OF PHYSICIANS. I AM TRAINED IN INTERNAL MEDICINE, HEMATOLOGY, ONCOLOGY AND PALLIATIVE CARE AND A FULL PROFESSOR AT UC D.  I AM A MEMBER OF THE AMERICAN SOCIETY OF CLINICAL ONCOLOGY AND EMERITUS MEMBER OF THE SOCIETY OF HEMATOLOGY.

I AM ASLO A RETIRED FULL COLONEL , A MEMBER OF INTERTEL AND A CANCER SURVIVOR   I HAVE BEEN THERE AND I SELF DIAGNOSED AND THAT IS A STORY IN ITSELF

ENOUGH OF THAT

 

ALL OF THIS IS NON PROFIT WITH PROCEEDS TO THE AMERICAN CANCER SOCIETY

 

 

 

WE WILL ALSO IN TIME COVER IMPORTANT AND INTERESTING NEW DEVELEPMENTS IN         CANCER RESEARCH,       THE fda The NIH and NCI, Immunotherapy, Cancer and genetics, Cancer ethics, Hospice and palliative care, new therapies and discoveries of how cancer cells work and how to kill them, cancer pain, clinical trials cancer anxiety. cancer and the family, cancer prevention AND WHAT IS NOT TRUE REGARDING THAT AS THERE IS A LOT OF DYSINFORMATION WHICH IS TOTALLY UNPROVEN BUT TAKES YOUR MONEY AND PERHAPS MORE, side effects, the personality of Oncologists, assisted suicide AND euthanasia

DEDICATION

 

 

First in line is my mom. I affectionately refer to her as the Sicilian Tsunami Mommy. She is a ninety plus years young, former first grade teacher who incessantly encouraged me to get this work done. IT TOOK YEARS , IT WAS HARD TO WRITE BUT I HAD THE BEST EDITORS AND CHEERLEADERS IN THE WORLD- MY PATIENTS, NURSES AND STUDENTS. Since the loss of Dad to small cell lung cancer, she wisely invested herself as a hospital volunteer. Among the many lessons learned from her, she imparted a love of knowledge and the belief that failure is unavoidable but one must never, ever quit.

I dedicate this to my patients. I remain humbled by their pluck under fire and unfathomable courage while going toe to toe with a fearsome and formidable foe, cancer.

I dedicate this to my wife whose sensitivity and wisdom are a blessing. We were at Barnes and Noble perusing what was in print which might be similar to my goals. We were spying our way through all the volumes written on every aspect of cancer by the legions of patients, family, friends and health care providers. Feeling increasingly overwhelmed, I mumbled something like; “I really don’t believe I am going to do this” My beloved’s answer was simple and swift. With a smile that could support all fears and eyes brimming with knowing tears, she quietly said, “You always have been”. AND NOW WE HAVE A RADIO SHOW…I NEVER DREAMED

Finally, I thank the architect of everything, God. The journey of this book has reinforced fundamental lessons imbedded in our nature and authored by Him which when remembered smooth the stones in the journey and level the mountains of anxiety. There is calmness available to the clinical practice of Oncology when seeing humans as fundamentally not wired differently from each other.  None of our emotions at their core is so novel to escape understanding. They are as universal and sustaining as the breathing of air and the pulsing of your blood. Thus, no matter how intricate the case and no matter how seemingly unique the patient, patients can be understood and reached.

There is enormous comfort in knowing this. Although the heart is perhaps an often lonely hunter on a journey whose very beginning and end are quite alone, all stories are filled with folks made of the same stuff. PONDER THAT FOR  MORE THAN A MOMENT

Thus, I happily thank God. For my nickel, God got the recipe of man’s nature just right. Our being heavenly hard-wired informs the entire health care team in their journey of caring for those afraid in their fight against cancer.

Life is not about fairness and the outcome is predictable. If you seek to control events, you cannot. Bad things will happen to good people. Cancer befalls saint and sinner equally. Once again, the core sameness of humanity by design encourages us that no one rows the treacherous seas of life alone.

Finally then, this work is dedicated to those friends, family and well doers and volunteers who grab an oar in the communal sea of life, pull hard and when called upon, help the less fortunate lovingly ashore. I AM SURE YOU HAVE DONE THAT AND ARE THE MORE HUMAN AND HUMANE FOR HAVING DONE SO

 

THE FOREWARD OF THE BOOK NEEDS TO BE STATED IN THIS FIRST SHOW TO GIIVE YOU A FINAL DOSE OF CREDIBILITY

Maurie Markman, M.D. FACP

 

Former Vice-Chair, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York

Former Chairman of the Department of Hematology/Oncology

and Director of the Taussig Cancer Center at the Cleveland Clinic Foundation

.

Former Professor and Vice President of Clinical Research MD Anderson Cancer Center and Chairman of the Department of Gynecologic Medical Oncology.

Senior Vice President of Clinical Affairs & National Director of Medical Oncology Cancer Treatment Centers Of America.

HERE IS WHAT HE WROTE AFTER READING THE BOOK

.

On Becoming a Cancer Survivor

 

Cancer is an intensely personal experience. Yet, it routinely involves a variety of social interactions with family, friends, co-workers and employers. The diagnosis of cancer brings up serious concerns of death, pain, suffering, and loss of control and dignity.

It is an interesting observation that while overall survival following a diagnosis of malignancy is at least equal, if not superior, to that of a diagnosis of “heart failure”, few people told they have heart disease will declare, “Oh no, I am going to die.” However, such a response is not uncommon when the diagnosis is CANCER.

No group of diseases generates more fear and anxiety: Why me? How did I get it? What did I do wrong? Will I transmit the cancer to my children through my “genes”?  Will I experience the same miserable death my mother told me my grandfather experienced when he was diagnosed with some “unknown type of cancer” 40 years ago? Can I survive? Will I be able to work during treatment? Does radiation therapy “burn”? How bad will the vomiting be after chemotherapy?

There are so many questions, with answers desperately sought, some very complex and not answerable, others very direct and simple (“Will I lose my hair?). All of this is rushing into one consciousness over a remarkably short period. It can be truly overwhelming.

Thus, we see the important need for a common sense, straight-talking book that describes the “Cancer Experience” to patients and their families, including standard diagnostic and therapeutic techniques, management options, and toxicities of treatment. The book should help the patient, and his/her family through this “experience”, answer commonly asked questions, and point to where one can receive appropriate responses to other concerns (e.g., “Where do I find information I can use to help me ‘understand’ my cancer?”).

Of great importance, the book should have as a major aim the goal of reducing anxiety, and helping those confronted with this disease to marshal their internal resources to conquer their natural fears and ultimately learn to become “Cancer Survivors.”

Does such a book exist?

You are about to read AND HEAR IT.

 

 

 

 

Here is the table of contents WE WILL COVER IN THE SHOW so you see how thorough we are going to be I WILL JUST MENTION THE MAIN TOPICS AS EACH HAS MANY SUBSECTIONS

 

 

 

 

 

TABLE OF CONTENTS

 

 

 

 

FOREWORD

PAGE

Maurie Markman MD FACP

 

 

READ THE DIRECTIONS FIRST

 

Keys to “La Dolce Vita” (The sweet life)

 

 

READ THIS SECOND

 

              Autonomy

 
ANXIETY VERSUS FEAR
 
 
THE ENEMY
             

 

BROAD OVERVIEW OF NUTS AND BOLTS ABOUT ONCOLOGY

Training Requirements and Overview Of Specialty

Specific And Related Fields

The Scope Of The Problem of Cancer

            Scope Of Chemotherapy

Scope Of Lay Knowledge Of Malignancy

Scope Of Adult Oncology Practice

Treatment Setting

Brief Comments on Prevention

Brief Comments on Screening

Causes Of Cancer

Pathophysiology of Cancer

Life Cycle Of Cancer

Tumor Growth Characteristics

Rational Naming of Cancers

Pathological Diagnosis

Signs and Symptoms

Stage Of The Cancer And Prognosis

Broad Concepts of Goals and Timing of Treatment

Vocabulary Of Survival

 

 

 

THE ONCOLOGIST

             

Why Oncology

MD – What Is In a Name?

What About Oncologists?

 

 
             
WHEN YOU SUSPECT THE DIAGNOSIS

 

 

 

THE DIAGNOSIS

 

The Opening Pitch

How You Say It

Lies, Damn Lies, And Statistics

Listening for Those Whispering in the Patient’s Ear

Preconceived Ideas

Assess Patient Goals

Psychological Issues

Sex and Significant Others

Spirituality

The Role of the Family

Teach Your Children Well

Cultural Differences

Focus On Symptomatic Relief

Introducing Clinical Trials

Introduction to Complementary and Alternative Medicine

Media Matters

Antidotes For Anecdotes

Prognosis and the Future

Take the Time and Avoid Timelines

Remember Statistics Can Be Your Friends

Second Opinions

The Contract

Remember Autonomy – It Begins And Ends There

A Final Few Words AND DON’T FORGET FIDO( DOG)

 
 
TREATMENT OVERVIEWS

 

Example of Finding Just One Cancer Cell

Staging

Chemotherapy

Radiation Therapy

Principles of Surgical Oncology

Therapeutic Monoclonal Antibodies

Other biological therapies

Angiogenesis Inhibitors

Bone Marrow and Stem Cell Transplantation

Targeted cancer therapies

Gene therapy for cancer

CART

VACCINES INTRA TUMORAL

GENETIC MANIPULATIONS

Hyperthermia

Laser

Photodynamic therapy

HIGH FREQUENCY ULTRASOUND

 
CLINICAL TRIALS

Statistics

 

 

SYMPTOM CONTROL AND SIDE EFFECTS
             

Alopecia (Balding)

Anorexia and Cachexia (Loss of appetite and uncontrolled weight loss)

ANXIETY

Bleeding and Thrombocytopenia (Low platelet count)

Constipation NEW AGENTS

Dental problems

Depression

Diarrhea

Edema  (Fluid Retention)

FAMILY AND SIBLINGS

Fatigue

Flu like Symptoms

Infection and Neutropenia (Low white blood cell count)

Infertility and Sterility

Insomnia

Lymphedema    (Swollen lymph glands and vessels)

Menopausal Symptoms

Mucositis (Inflamed mucous membranes)

Nauseas and Vomiting

Neurological Symptoms

Palmar-Plantar Erythrodysesthesia (Painful soles and palms)

Photosensitivity Reactions

Sexual dysfunction

Xerostomia (Dry mouth)

 
 

THE PROBLEM OF PAIN

BREAKTHROUGHS

PERIPEHRAL RECEPTOR NO ADDICTION

BLOOD BRAIN BARRIER NO ADDICTION

 

 

ALTERNATIVE AND UNPROVEN METHODS OF CANCER TREATMENT

 

Introduction

ANTIDOTE ANECDOTE

Types of CAM

CANNABIS VS THC

What Is Really Going On

WHAT MAY WORK

Why

Sacred Cow Killing

Complementary Exercises for People With Cancer

Physician Patient Communication

Patient Communication

 
 
BIOLOGICAL THERAPY AND THE FUTURE                    

 

Understanding Cutting Edge Therapies

New Diagnostic Tools

NOT READY FOR PRIME TIME

IN VITRO VS IN VIVO

PHASE 1 TRIAL VS PHASE 3 MULTI INSTITUTION

 
SPIRITUALITY

NOT JUST GOD

 
 
SELF TALK

Why Me

Laughter and Beauty

Baby Steps

Daily affirmations

Toxic Stress

Live the Moment

Honor Your Thoughts

Conspire Against Your Emotions

Set Goals

Support Groups

Forgiveness, Gratitude and Unconditional Love

 

 

BUT WHAT DO I SAY?

 

When visiting those diagnosed

 

 

FRONT OFFICE STAFF

              SMILE AND SERVE

              ANTICIPATE

              IT IS ABOUT THEM NOT YOUR DAY

              LOVE PURE AND SIMPLE

 

 

THE NURSING STAFF

              CONFIDANT

              CARERS

              SNITCH IN A GOOD WAY

              LISTEN TO THEM

              ANGELS

              LOOK FOR BURNOUT

              TEACH PATIENTS, TEACH THEM

 

 

THE INPATIENT EXPERIENCE

              OVERWHELMING

 

 

PSYCHOSOCIAL-HOSPICE-END OF LIFE

 

 

ETHICAL PRINCIPLES

 

Principles

Managed Care

Truth Telling

Living Wills

Discontinuing Care

Sedation and Symptom Control

 

SOME MEDICO-LEGAL ASPECTS OF ONCOLOGY

 

Legal Aspects of Cancer

 

INTERNET

 

PROGNOSIS

 

 

HEROES *

 

The Telling

Hitting Home

Snow Job

The Lioness

The Flood

The Gift

A Leprechauns’ Laser Light Of Life

The Connection

Mercy

We

 *Although the stories are true and all patients granted authority to tell their story,

all names and minor details have been changed to protect anonymity.

 

 

EPILOGUE

 

 

Our first topics  NEXT TIME will be cancer pt autonomy and if time,  THE GOOD LIFE AND cancer anxiety

 

DOING THIS OVER 30 YEARS I HAVE NO doubt you will know a lot and your anxiety will be DIMINISHED dramatically

AND NOW THE INTRODUCTION

 

INTRODUCTION

 

So why this book and who is it for? The odds are over 80% that cancer will touch one’s life. Our nation spends over $150 billion dollars directly on cancer care per year. It is one of the largest single expenditures of the national health care budget. There will be over 600,000 deaths per year and over 1.7  million new cases. Including families, cancer touches almost 15 million people per year. There are few common medical realities that is surrounded by as much malefaction, mystique and misunderstanding. “When Tumor Is the Rumor and Cancer Is the Answer…” helps one see past the understandably macabre mythology.

This SHOW attempts to address the needs for knowledge when receiving the overwhelming news that you may or do have cancer. It attempts to cover not just the fear of the diagnosis or certain aspects of the journey of care but the entire trek from when tumor is the rumor and cancer is the answer. It tries to envelope with knowledge the soul sucking sense of loss of control, anxiety’s favorite fodder and fuel.

REMEMBER THE TABLE OF CONTENTS? We open by addressing the hit in the gut issues that come up immediately. First are some thoughts about the right recipe for the right mindset in handling the journey. Believe or not, we are well wired to handle this stress. Thus, in ‘Read the Directions First’ we look at how we might have a recipe for mental and emotional success as we gird up to weather the storm.

Then we specifically address the crucial issue of autonomy, that you are an individual with explicit defined rights and that you can and will be in control. MD DOES NOT MEAN MAGTNIFICENT DEMAGOGUE

We then address the problem of anxiety, its distinction from fear, the nature of cancer and the oncologist and the team they lead in your journey as well as how their world will become yours. This book teaches that anxiety and fear are not the same and knowledge in all spheres, not just sterile clinical facts, is power and a therapeutic balm. Informed fear is a call to action and the more informed the better the clarity of resolve and less the anxiety.

The section “The Enemy” paints how cancer is almost the perfect medical predator. It introduces the villain for what it is and prepares the stage for our fight against it. That fight starts and ends with defeating ignorance using knowledge as our greatest weapon. The book addresses suspecting the diagnosis, the diagnosis, standard and alternative treatment and symptom relief. This is followed by an in depth discussion on the problem of pain, clinical trials, future therapies, spirituality and self-talk; how to talk with yourself when confronting cancer.

We then move into useful chapters on the ethics of cancer care, challenges of managed care and psychosocial issues with ethical-legal components and how end of life concerns play a common role in the care of oncology patients. Difficult concepts such as physician assisted suicide, durable power of attorneys, living wills, failure to diagnose or lost opportunities in life, euthanasia and death by secondary intent ( death occurring during course of treating the patient and alleviating suffering) have lead to cancer cases being second in frequency of law suits after, “Why did my baby not turn out right?”

One team member is largely shrouded in mystery despite their core responsibility often shouldered rather alone. This is the oncologist and more than not, just as orthopedists or pediatricians do, they share similar traits. Understanding those, in general, can not only be fascinating but fruitful. After all, to some degree these physicians are somewhat boxing with God and against a most mysterious of infirmities that affects all organ systems; all the while engaging deep psychological and spiritual issues. The field is more on the cutting edge of applied genetics and immunology than others and practitioners must master multiple modalities of care from chemotherapy to surgery, radiation therapy and transplants and now increasing biological, immunologic and elegant genetically based treatments.

Oncologists hold a very special position in the eyes of those they treat in no small part owing to the nature of the enemy they fight. AS I SAID They are not magnificent demagogues (M.D.’s) parsing out secret poisons to patients indifferent to the gravity of their daily toils. Nonetheless, they can find themselves often and appropriately playing the role of parish priest, psychologist, father confessor, coach, confidant and counselor; it goes with the turf. In addition, as what little research there is suggests, they may not always be strong on emotional or psychological communication or expressing empathy. AND THE DEMANDS OF PAPER WORK AND THE ELECTRONIC RECORD OFFER GREAT CHALLENGES TO PATIENTS HAVING ENOUGH TIME

Oncologists are human; we hurt with our patients and families. Ironically, though, there is not a lot of structured support out there for cancer doctors. The data is scarce but what is there is sad, not surprising and sobering regarding “burn out” and psychological pain in oncologists.

Although a cardinal rule is to always remember that the patient is the one with the CANCER THE FAMILY MAY HAVE VARIOUS DISEASE, DEPRESSION, ANXIETY, OBSCESSION, XCOMPULSIVENESS, ALWAYS COMING UP WITH INAPPROOPRIATE COMPARISONS OR SOULTIONS TO NAME A FEW , I HAVE SEEN THEM ALL…, there is no doubt that the more informed we all are regarding the whole enterprise, from rumor to advanced tumor and the weight and impact and role each diagnosis has all the players on the team, the better outcome in significant ways.

This book thus looks at why some Oncologists chose such a sobering field and offers to the practitioner different insights into managing the whole patient and in part, themselves, during a difficult emotional journey for all.

Oncologists inhabit a world of words, wonders, hospital wards, and clinics that are foreign to the patient. This book looks into the front and back office staff as well as the rules of the road while an inpatient. The more one understands where they will spend so much time, the better for all.

Most family and friends experience considerable discomfort when interacting with a seriously ill or perhaps dying friend or loved one. They wonder… “But what do I say” Although the singular moment of death is experienced alone, the journey need not be. In the section “But what do I say,” I offer some help and observe that we are in this boat of life together. When it is time to dock for some, we must hold fast to the loved ones hand and help them lovingly ashore.

We close by sharing some true stories of remarkable patients and their journeys.

This is not a medical text on the treatment of malignancy per se, or prevention ALTHOUGH WE COVER THAT AND WHAT IS NOT PROVEN AS WELL, screening or cancer survivorship. This book describes what happens and what works best for the whole team when the possible diagnosis becomes the proven and potentially fatal. A major aim is the goal of reducing anxiety and helping those confronted with this disease to marshal their internal resources to conquer their natural fears and ultimately learn to become “Cancer Survivors. I hope to address many of the often unspoken truths that now found in one place can act as a guide for what is for many the most frightening time of their lives. I hope to return that crucial sense of control.

Why do it this way? In large part, it is because little other work OR SHOWS do. This book highlights the gift improved patient physician communication can be especially when the patient and family are more fully informed. There is never enough time in today’s practices to fill all those gaps; this SHOW will help. This is big picture thinking with the picture being you and how it all can be decipherable instead of a transaction of doing as advised but not as fully educated as you might have been.

Embracing that overarching concept is of incredible assistance when we see this as a journey with many well-known milestones and probable adventures along the way with common waypoints for most. Think of it AS understanding in more depth the nature of what largely happens to and for all. In explaining a professional sport, one needs to have context and overview in addition to the details of how the game inevitably proceeds and who does what when. That requires time and careful organization. Having such a continuum of understanding not only engages everyone more in the fight but steels them to do their part to their best and prepares them for what is next.

This SHOW is needed because medicine is enveloped and cloaked in mystery. It is replete with magic decoder rings and secret handshakes. Irrespective of Hollywood’s latest or greatest umpteenth version of a real Doctor show, society is largely ignorant of the mysterious and frightening world of cancer medicine. Cracking that code and empowering the patient with knowledge will undoubtedly lead to healthier lives and happier journeys for all.

This SHOW is about teamwork. Patients are experts in teaching us physicians to be a complete clinical oncologist.  There is plenty of angst and agony to go around when pursuing diagnosis and committing to do battle against a malignancy. Wise physicians embrace patients as partners in many regards on the journey whose informed engagement is crucial to success.  We ideally want them informed, forewarned and feeling that although they are the one with the disease, although their autonomy is first and foremost, this journey is a team effort. The more we all know about the terrain, the better.

Superb cancer care is only possible with teamwork. The enemy is the cancer and many times, the anxiety it and its treatment fosters. Everyone brings different skills, needs, agendas, perspectives and languages to the fight.

Thus, the audience of this SHOW is everyone on the team. It is an enormous responsibility and burden to care for cancer patients. It is no less an enormous burden and responsibility to be a patient with cancer or a family member of those diagnosed. There is the rub. The knife cuts both ways. Patients and families have a responsibility to learn as much as they can and participate in their disease as much as possible. Furthermore, using all manner of techniques, health care providers have a responsibility to share their perspective on the burdens and responsibilities of their role on the cancer care team and express appropriate empathy, a sure fired road to increasing trust.

Musician Roy Clark penned some great lines in his tune, “Yesterday, When I was Young”… “I ran so fast that time and youth had last run out. I never stopped to think what life was all about. And now it’s only me on stage to end the play…” I hope that this book will help you gather more tomorrows and realize you are not alone.

NOW SOME PERSONAL COMMENTS I HAVE BEEN THERE AS PHYSICIAN, PARISH PRIEST, COUNSELOR,, PSYCHIATRIST, FRIEND, CONFIDANT AND SO MANY MORE ROLES AND AS I SAID PATEINT LET ME TELL YOU ABOUT THAT AND WHY IT TOO LED TO THIS SHOW

 

I FEEL FOR YOU AND YOUR FAMILY I ALWAYS DID AND I TRIED WITH ALL MY STUDENTS TO INSTILL BEYOND ACADEMIC EXCELLENCE SPIRITUAL AND HUMAN AND HUMANE EXCELLENCE. THIS IS HOW I WOULD DO IT WHEN A NEW PATIENT ARRIVED—

 

FIRST READ ABOUT THEM AND PREPARE THE TEAM AND THE RECORD SO IT REALLY IS NOT THE FIRST TIME. BE PREPARED DON’T BE READING THEIR RECORDS WITHEM SITTING THERE

 

MEET AND GREET WITH ALL AND ASK WHO IS THAT SPECIAL SOMEONE, THE CARETAKER THE NOTE TAKER THE CONFIDANT AND BRING THEM IN ( AND MAYBE OTHERS)

 

SAY THANKS THEY PICKED YOU NOT SOMEONE ELSE AND MAKE SURE UP FRONT THEY CAN GET A SECOND OPINION

 

ASK ABOUT PHYSICAL SPACE AND STAY OFF THAT DAMN COMPUTER AS MUCH AS POSSIBLE

EYE CONTACT AND SMILE BE REAL

 

TELL THEM TO WRITE AND ASK NO MATTER WHAT TELL THEM THIS IS NOT AN EXERCISE IN INTIMIDATION

 

TEACH AND REHEARSE AND TEACH AGAIN

 

LOOK FOR CLUES OF CLINICAL DEPRESSION OR ANXIETY NEEDING HELP AND GET IT

 

ASK ABOUT PROBLEMS WITH FAMILY

 

AGAIN REVIEW THE ROLE OF EVERYONE

 

MENTION THE BOOK AND THE SHOW

 

ASK ABOUT SPIRITUALITY IT WILL DEAL THEM NO MATTER WHAT THEY FEEL DO NOT PREACH

 

LISTEN

 

TALK ABOUT DR GOOGLE THEY HAVE ALREADY VISITED

 

EXPLAIN THE NIH THE NCI THE NEAREST MEDICAL CENTERS AND WHAT THEY CAN DO

 

PROMISE NO LIES NO GLOSSING OVER

 

LISTEN LISTEN LISTEN  ANSWER ANSWER ANSWER

 

THE TIME YOU SPEND WILL PAY FOR ITSELF OVER AND OVER AGAIN

ASK ABOUT COMPLEMENTARY AND ALTERNATIVE MEDICINES AND DON;T BE AN ASS BE AN AUTHORITY IF YOU ARE BUT FIND OUT WHAT THEY ARE TAKING

 

THANK THEM FOR THEIR HONESTY

 

BE SURE THEY KNOW WHAT IS NEXT AND WHY

 

BE SURE THEY GET AN MP3 RECORDER FOR EVERY VISIT NEXT TIME

SHAKE THEIR HAND AND THANK THEM THEY ARE HUMAN NOT ANOTHER CASE

 

TELL THEM ANGER AND FEAR ARE NORMAL AND OK ……NOT GUILT