How many times at the beginning of the school year did the teacher ask you to write a short essay (so he or she could see how you write)? This summer had earthquakes, hurricanes, drug shortages, contentious debates about health care costs, and a surreal personal medical issue that put priorities in perspective. The last, in particular, has made me “practice what I have preached” for over 3 decades and recall what I have learned from my patients and their families. I wrote a column about the time I became chief editor of the journal entitled “Carpe Diem”1). I was privileged to spend some time with kids on their own turf specifically, the Hole in the Wall Gang Camp. They showed me how to live with disease and the unknown. I was reminded of that by the mother of a patient I treated about a decade ago. He was 3 months from starting preschool when diagnosed with ALL and now is in junior high school. She reminded me that I told her the goal was to stress “normalcy,” and that we expected to cure her son. In the short run he would start day school on time and long term; I expected to at least attend his high school graduation. When he (now 13) was told of my diagnosis he asked his mother “why didn't doctor Kamen get a pass from this disease because of all children and families he has helped?”. I recognize that I am not the first oncologist to deal with a personal oncological diagnosis, but we are certainly and fortunately a minority. So, for the vast majority of the readers, I would like to share my summer vacation.
Instead of catching up on reading and writing, attempting to lower my handicap on the golf course and spending time with family, at the end of May I had a synovial cell sarcoma removed from my lung and by Labor Day (first Monday in September) had multiple cycles of chemotherapy. I went to the operating room with the tentative diagnosis of a mediastinal mass, likely a thymoma, the plan was to biopsy and if a lymphoma, stop and if the expected diagnosis, to have a surgical resection. My wife learned before I did that I had a tumor in my lung, but it was not lung cancer and that the surgeon removed it. It was however, not benign. In informal and formal discussions with the gurus in the field, it was suggested that adjuvant therapy in the form of adriamycin and ifosfamide be given. As the plans evolved, it became clear that it was much harder being a patient than an oncologist and that there was little energy to be spent/wasted on asking the question “why me?” From my view (and that of our Rabbi), there is no answer. The questions to ask seemed to be: what do I (we) do about it? And what if any good can come of this? I suggested to my family that this would make me a better doctor, more sympathetic! My wife, figuratively speaking, took a swing at me. She reminded me I have basically spent 24/7 attending to my patients, so I should not visit that question. I then also recalled another column I wrote,2 which was both a book review and in a manner of speaking a tribute to Dr Joseph Simone, the author of the book, a friend and teacher. There are pearls in there about life and being a physician.
When faced with the personal diagnosis of cancer, we need to learn from the people we care for, treat families/people not disease and continue to move forward. I have found myself a little short with mundane issues and I have felt sadness and frustration and then I remember some Sunday school discussions and a line that has been attributed to Chinese, Indian, Jewish, Irish, or Persian lore; “I cried because I had no shoes, until I met a man who had no feet.”
As a physician-scientist, husband, son, father, eldest brother, and more, there is always too much to do and now the time frame may or may not be compressed, so the only thing to do is to Carpe Diem!
I thank you all for writing for the journal and to my associate editors, editorial board members, publishers, and assistants and especially my patients and family for reminding me what is important and how to conduct business and privilege of living. And now back to work.
1. Kamen BA. Carpe Diem! J Pediatr Hematol Oncol. 2004;26:359–540
2. Kamen BA. On maintaining the honor and sanctity of our profession: reflections and personal trials and a book review: sustaining the dignity and nobility of medical care. J Pediatr Hematol Oncol. 2008;30:187–188