How Much Do You Want Your Doctor to Smile?

During yesterday's meeting, my oncologist needed to make a call (to someone else), and warned me that now I was going to hear him when he's mad.

I commented that he was probably scary when he was mad, adding that he's a bit scary even when he's not mad.

He was a little taken aback and I felt bad for not thinking before saying what was on my mind.

"Do I really scare you?" he asked.

"Yes," I answered meekly, wishing I could be anywhere else, but not wanting to lie.

"Then you should find another doctor..." he advised.

PANIC -- did I just mess up my relationship with my doctor, of whom I am in awe?!?!

"But I like you," I quickly responded. I should have added "and I trust you, and respect you, and like that you are available on email, and answer my questions, and don't laugh at me, and..." I could have gone on and on.

It is not so easy for me to find a doctor I like, and I like my doctor.

"So, why am I scary?" he persisted, "is it because of me or because of what we discuss."

That was a fair enough question.

"I don't know," I answered honestly, wondering if I would be less intimidated if we were not talking about cancer.

I tried to switch the conversation, but my doctor sincerely wanted to know. "Tell me, so that I can improve."

So, I thought about it and suggested "you don't smile enough."

This surprised him. "Really?"

He noted that many patients want their doctor to look serious.

I can understand that. We discuss serious things. I don't think I would want him to be joking around all the time. So, what do I want?

Later, I asked my date-for-the-day, who is a former cancer patient, what she thought. "I don't want my doctor to smile more; I want him to be serious."

Hmmmmm

Smiling to me reflects optimism, a faith in the future.

My doctor always looks so serious, especially when he is walking around. I know that his head is in a million places, thinking, processing, exploring, and trying to meet the needs of all his patients. I know that cancer is serious business, and the news is not always good.

Sometimes, I'll catch his eye, and he'll raise an eyebrow. I never know quite what it means. Usually I interpret it as "yes, I see you; no time to stop; you know how it is here...." But sometimes I wonder if he is thinking "oh no, you don't have another question, do you?"

I guess I would like to see him smiling when he is walking around. Or, maybe, I just want him to smile when he sees me.

Smiling is inviting. Perhaps that is the problem. Maybe if he smiles more, then everyone will approach him in the hallway with all their not-as-short-as-they-thought questions. Or maybe patients will not feel that he is treating their illness seriously.



This is one of those areas where I do not assume that all patients think like me.

Apparently, I am not your typical cancer patient.

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After reading this, Moshe asked rhetorically, "You know what I like about [our oncologist]? He's always smiling."

I looked at him curiously.

"It is always there, behind his eyes. He has this dry, wry sence of humor, that I really appreciate."

True. But I think my husband "gets" him more than I do.

I am the kind of person who needs things spelled out for me, even jokes (certainly sardonic remarks).

"He does not need to smile," Moshe added, "It would be overkill."


Please daven (or send happy, healing thoughts) for RivkA bat Teirtzel.

With love and optimism,
RivkA

The 20-Year-Plan

Something has been bothering me for a while now.

A few weeks ago (or maybe it was a few months ago), during one of my meetings with my oncologist to discuss switching to Taxol, I casually asked if this change is going to "interfere with my 20-year-plan."

My doctor immediately became serious. "Who gave you that number?" he queried, adding "I did not give you that number."

"I know," I responded, reassuringly.

I completely made up that number. It is a random number, representing my intention to live with this cancer-thing for a long time.

But then, I got worried.

"Why," I challenged, joking, "is it too short?" Then, I added, verbalized my fear, "Or is it too long?"

But my oncologist would not play that game.

"I do not do numbers," he declared, quite seriously, "You know that."

I do. But the Pandora’s Box was open. Perhaps I was just living in my own little fantasy world.

So, today, I got up my courage and asked, "Am I deluding myself?"

Now, though this conversation has been plaguing me for months, it was not immediately obvious to my oncologist that I was referring to his comment about my 20-year-plan. So, I reminded him of our conversation and, a little bolder now, repeated my question. "Am I deluding myself?"

"It's a bit of a long shot," began my oncologist. (ouch) I imagine my face fell a bit. "I am not telling you something you do not know;" he continued, leaning forward in his chair, eyes locked on mine, "you are familiar with the statistics. But you also know that I do not make predictions." (yeah, I know)

He cited a patient of his who has been living with metastatic breast cancer for 23 years. (He did not give me any details, of course)

"It is reasonable," he continued, a bit softer, "to plan for the future."

And, though it is unusual for him to give his opinion about what I should do, he added, "I think it is right to live your life that way."

I wish I could remember exactly what else he said, because he gave me a rare compliment about how I am handling living with cancer exceptionally well. It was really nice.

Then he asked me: if I knew I had 18 months left to live, would I do anything different?

I said I would get things in order. To which he responded, quite sternly, "you should do that anyway, and it has nothing to do with cancer."

Then he continued, "my guess is that if you knew that you had only a year and a half left to live, you would accelerate your lifestyle, not slow it down."

I conceded that his assessment was accurate. But still, I persisted. "I talk with my children about the future, even about the long-term future."

I wanted him to understand that it was important to me not to be deluding myself, and also not to be deluding my family.

He got it.

"Planning for the future is the best thing you can do for both you and your children."

He wanted to make sure that I got it too.

I got it.



Please daven (or send happy, healing thoughts) for RivkA bat Teirtzel.

With love and optimism,
RivkA

Chemo Day -- Herceptin: YES, Taxol: NO

Apparently, a "little break" is one week.

I received Herceptin today, but no Taxol. My next Taxol treatment will be next Thursday.

I was a little nervous about skipping the treatment, but my oncologist was pretty insistent. When I pressed him about it, he offered to give it to me if I was willing to sign a waver, taking full responsibility for any possible complications. I politely declined, to which he responded "I thought that's what you'd say."

So, I will focus on kicking this cold, which is pretty much taking up all my energy and then some.

I felt a bit better this morning, but by the time I got home I was wiped. I went straight to bed and slept for three hours!

At least I got the Herceptin. (This dose was the free dose provided by Roche)

We still hope to make an evaluation before I am due for my next dose, in three weeks.



Please daven (or send happy, healing thoughts) for RivkA bat Teirtzel.

With love and optimism,
RivkA

Cancer vs. The Common Cold

It occurred to me that having a cold might affect my ability to receive chemo tomorrow.

I emailed my oncologist, who wrote back: "come and we will decide tomorrow--sounds like you will get a little break"

What does that mean?

Do I have the nurses open my port as usual?

I am scheduled to receive both Taxol and Herceptin. If "we" (and by "we," I mean "he") decide to postpone treatments, do we postpone both medications? By how long? A few days? A week? What is a "little break?" (To me, a "break" would be at least a month! We know that is not happening, as we have already established (here) that we can not postpone the Herceptin by more than a week)

Last week, my doctor told me that we would evaluate the efficacy of my treatments in the next two weeks. How does postponing treatment affect our ability to evaluate if the drugs are working?

All these questions, just because of a stupid cold, from which, we agreed last year (see here), cancer patients should be exempt!

It seems that when push comes to shove, the common cold trumps the cancer card!



Please daven (or send happy, healing thoughts) for RivkA bat Teirtzel.

With love and optimism,
RivkA

Ups and Downs

"So, kiddo, how are you doing?" asked my oncologist, as he opened my files (the one on his desk and the one on his computer).

"Well," I began, "my mood has been swinging up and down...."

He stopped.

"You get depressed?" he asked, with a puzzled look.

"Yeah, she does," confirmed Moshe.

"'cause I don't see it..." continued my oncologist.

Even in the chemo ward, my mood is usually upbeat -- probably because every week a different friend comes to hang out and I just enjoy the company so much!

"What are you feeling?" he asked, looking at me seriously.

"I'm having a hard time with the "long term" thing," I explained (not for the first time). "I just wish I could look forward to a time when it will be over."

"Do you want to see someone?" he asked (also not for the first time).

The thing is, I am not clinically depressed. I get out of bed in the morning. I am active. I have a strong support network: family, friends, my support group, and my blog.

What more would I get from therapy? I asked. There is no clinical indication that I need a psychologist. It all depends on how I feel.

Overall, I feel I am handling things pretty well. Both my husband and my oncologist agree.

But I still have mood swings. I still wish it would all just go away.

Someone once told me that all the cancer stuff would eventually fade into the background, like white noise from the radio.

I hope that is true.

Meanwhile, I hear the radio blaring and I really wish someone would change the channel.




Please daven (or send happy, healing thoughts) for RivkA bat Teirtzel.

With love and optimism,
RivkA

STUCK

I met with my oncologist this past Tuesday. I had a list of questions for him. Most were simple. Some were not...


I asked: "What's the plan?"

He answered: "To keep doing what we're doing."

I clarified: "Do I understand correctly that I keep taking these drugs until they stop working, and then I take something else?"

He answered: "Yup."

I asked: "Will I get any breaks?"

He answered: "Nope."

I persisted: "I've met people with metastasis who have breaks in their treatment."

He stated: "I don't know about other patients."

I asked: "But will there be times that I don't need to be on chemo?"

He responded: "That's a rephrase. I've answered that question."


He emphasized that we are aiming for stability; that our goal is that the cancer doesn't grow. I don't like that. I don't want it to "stay the same." I want the cancer to shrink. I want it to go away.

It is difficult for me to accept that I will always have cancer.

I am having a hard time with the chemo-for-life thing.

Yeah, yeah, I know... "It's better than the alternative."

It still sucks.

I can live with it.

People get used to it.

I'm stuck.

I gotta' get past it.

This is the way it is.

Accept it and move on.

I have cancer.

Next.


Please daven (or send happy, healing thoughts) for RivkA bat Teirtzel.

With love and optimism,
RivkA