I also remember feeling very uncomfortable about role-reversing from
provider to patient, especially when your providers are colleagues and
friends. Previously collegial-seeming relationships can quickly turn into
the most awkward, embarrassing moments of your life! Examples include
hospital gowns that occasionally leave you exposed, urinary catheters that
require somebody else to insert, and, perhaps worst of all, uncontrollable
antibiotic-induced diarrhea that demands thorough cleanup by that cool
night-nurse dude you played basketball with that one time.
My internal-medicine residency faculty members and colleagues were a
HUGE source of support as I went through this ordeal. My parents, who
lived across the country, checked in on me – but, importantly, not too
frequently. I’d say that was one of the most unexpected lessons I learned:
There is such a thing as too much love. Too many visits from friends or
family, no matter how well-intentioned, can be overwhelming when the
patient is critically ill.
After the initial surgery (right frontal craniotomy with MRI-guided
resection), I required six weeks of daily IMRT (intensity-modulated
radiation therapy) and chemotherapy, two weeks of inpatient rehabilitation
(physical, occupational and, to a lesser extent, speech), six months of
outpatient rehab and one year of weekly chemo.
Thankfully, my cognition, speech and personality were largely unscathed.
Kacy, my girlfriend at the time (now wife and center of my support
system), thought I had become a touch nicer.
I missed about eight months of residency time. During that
rehabilitation, I had time to reflect on what I really wanted to do with
my life. I got to weigh the different options, something most of us don’t
get a chance to do once we’ve started down a residency path. It gave me a
renewed sense of drive and conviction to finish what I started and pick up
where I’d left off mid-residency. Amazingly, my program director at Santa
Barbara (California) Cottage Hospital went above and beyond to make
sure I could come back in a way that was beneficial to my learning and safe
for patients. I cannot thank my mentors and colleagues enough.
This experience also reminded me of something I learned at FSU. When
I got to spend a day with a neurosurgeon-turned-hospice director in
Fort Pierce/Port St. Lucie, it was the first time I really understood what
hospice/palliative care was all about. My impression had been that its main
purpose was helping patients die. What I saw that day at hospice, though,
was about living well till the very end.
In July, at the National Institutes of Health outside Washington, D.C., I
started a fellowship in hospice and palliative care.
Unfortunately, I won’t ever be able to say, “Whew, I’m cured!” Even
genetic testing now performed routinely for tissue pathology. My prognosis with the IDH-1 mutation, I still have an aggressive brain cancer that
is vastly different from my father’s, thanks to a mutant form of the enzyme could theoretically pop back up at any time, and I’ll need scans at least
isocitrate dehydrogenase 1. This mutation, combined with aggressive semiannually for the foreseeable future.
study show most of these patients alive at the 20-year mark.
Before learning about the IDH1 mutation, I went through dark,
That said, I did feel a tremendous sense of victory at the two-year mark.
I was with my oncologist and had received results from a routine brain
scan that showed stable residual scarring with no signs of tumor regrowth.
profound denial. After the endless nights studying, the loan money spent, My oncologist said that a number of patients like me have lived full,
the effort that went into training me to save lives, how could this happen? prosperous lives for decades, and that at the rate cancer therapy is evolving (i.e.,
It was maybe the lowest point of my life. immunotherapies), I’ll always be ahead of this thing if it ever pops up again.
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tumor removal, renders a very different outcome. Results of one Harvard