Words of Wisdom, Chapter One

[Editor's Note: the following anecdotes were selected from I Love the Sound of My Own Voice: Twaddle and Bromides from The Cheerful Oncologist, published by Venal Literary Infatuations Press, 2006. The author has asked me to announce that first editions will be available as soon as his secretary is finished with the copy machine.]

I leaned up against the exam table, inspecting a woman who had finished a course of aggressive chemotherapy and chest radiation therapy for limited-stage small cell lung cancer. She still had some areas of increased 18-FDG uptake on her follow-up PET scan, but to me the lesions were not necessarily indicative of persistant cancer - they could also represent post-obstructive infiltrates. Since the next treatment decision, whether or not to offer prophylactic cranial irradiation, depended upon her having a confirmed complete disappearance of her cancer, there was nothing to do now but wait it out and re-check another scan soon. She asked me, "If my cancer begins to grow again will I have to go back on chemo?"

"Wait - let's not jump the gun," I replied. "You and I can't assume that these spots on the PET scan represent lung cancer. My own best guess is that you are in complete remission, but I have to prove it before recommending brain radiation. You need more time anyway to get your strength back and recover. Let's concentrate on that. As to what we're going to do next - we'll cross that bridge when we come to it."

I paused for a moment and then said, "But remember - the only way to get to the bridge is to keep walking."

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Last week I had the privilege of informing a patient that his lung nodules were almost completely gone - a success of the modern-day tandem of chemotherapy with targeted therapy. He smiled broadly at me and said, "Does this mean I don't have to come to the office every week now?"

"That's right - in fact, you can take the next three months off. How about that?"

We whooped it up a little and then said our goodbyes. Later that day while daydreaming I realized yet another quirk contained in the career of the medical oncologist and imagined it as a sign on my desk, something Harry Truman might have enjoyed had he gone into medicine. I guess it applies to all specialties, but as a cancer doctor this sign is particularly pleasing. It looks like this:

A LONELY ONCOLOGIST IS A HAPPY ONCOLOGIST, FOR HIS PATIENTS NO LONGER NEED HIM.