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Oncology Times:
doi: 10.1097/01.COT.0000317246.70314.73
DEPARTMENT: poetry by cancer caregivers

The Vicissitudes of Care

Dauber, Leonard MD

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Associate Professor in the Comprehensive Cancer Center at Our Lady of Mercy Medical Center in the Bronx, NY.

Prologue: Morning

Doctors are human and heir to species' ills.

We, too, pay the piper his sickness bills.

Does it help to know disease symptoms and signs

As age advances and health declines?

Does early diagnosis make for better care,

If denial is denied and professional acumen is there?

The physician who cares for himself is double the fool,

Once as a doctor and again as patient—so says the rule.

But I'm well-trained, practiced and educated,

And I know my field, its literature however stated.

How could my doctors not be expected to share

Decision-making while attending to my care?

One Hour Later

So here I am, Oncologist: cancer care is what I do.

My father died of prostate cancer. That's my family history for you.

I'd SOAP it up.1 Nearing 65, some early prostatism: “S” to bother me.

(Acronyms abound!) Objective findings: none, including DRE;

TRUS isn't helpful, but PSA is mid-range five to six.

A TRB shows low-grade PIN. And here's the fix:

Repeat biopsies are normal but PSA rises slowly

Over the next years to seven. What's the next “A” and “P”?

Back to the Urologist and another set of TRB's with US and gun.

And now the familiar waiting until the histopathology is done.

24 Hours Later

In this disease, the data, you know, is conflicted.

Mortality here and abroad is the same in the afflicted

Whether early or late diagnosis. What varies is the cause

Of death. Anyway, my personal story must pause

Pending outcome. I've reviewed the NCCN Guidelines for my care.

My Urologist has followed the algorithm that's there.

Decision-making in cancer involves a balance between rewards and risks

But it's cohorts, not individual patients, who make the statistics

72 Hours Later

Histopathology is reported: again, normal tissue.

I'm back to six-month surveillance. PSA change is the issue.

I'm temporarily reassured, having heeded the advice of my doctors two.

“Physician, heal thyself!” Would that injunction be easily made true.

96 Hours Later

Burning dysuria, frequency, fever and chills—

A GU infection to add to my ills.

An uncommon complication of biopsy, to be sure,

But as I'm the patient, discomfort is mine to endure.

Antibiotics will get rid of the infection,

Albeit with some gastrointestinal insurrection.

Still, it's back to Morning, juggling the two me's

Trying as a physician not to be foolish but wise about disease.

Four Months Later

Following prostate biopsy normality, at month four,

My PSA has risen to greater than 10, and that score

Generates a transrectal magnetic resonance imaging

And “saturation” biopsies under a general anesthesia fling.

(After the MRI, medical staff had left. No one was about.

Left to myself, I had to take my own IV out.)

Adenocarcinoma is found in two cores:

Gleason 6, the histopathologic scores.

I confer with my urologist on my care;

And the doctor-patient dilemma remains there,

Except that I remain these two in one. Choices

Should be made dispassionately by data. Voices

From the medical literature confound

And many and varied treatments abound:

Radiation therapy, internally implanted or externally delivered;

Surgery, standard or robotically considered.

No randomized prospective study is there

To define an outcome preferential in care.

Even watchful waiting is a treatment choice,

Although the patient in me refuses that option in a still small voice.

My preference (attack the disease early) is surgical prostatectomy

Knowing the potential post-op pitfalls awaiting me.

I am scheduled for operation a week before my seventieth birthday.

A wise decision? Only time (and outcome) will say.

Six Months Later

I feel terrible. I feel better.

A week post-op and two days before the red letter

Birthday. The path report shows Gleason 7. I am in stage T2c:

Bilobar disease and a microscopic focus of capsular extension.

I need now only routine postoperative attention.

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Reference

1. Weed LL: Medical Records that Guide and Teach. NEJM 1968; 278:652–657.

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Section Description

The world of poetry is a means of expression and source of comfort for many who care for cancer patients. We welcome submissions from oncologists, oncology nurses, oncology pharmacists, and other cancer caregivers. E-mail only, please, to: OT@LWWNY.com, and include your affiliation/title, address, and phone number, along with a photo, if available.

© 2008 Lippincott Williams & Wilkins, Inc.

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