Why I am not in Oncology

This can be found in entirety at:http://rupertroo.blogspot.com/
Paul Newman died today of an unspecified cancer. I never thought he was the best actor in the world but I really liked Cool Hand Luke, The Sting and Butch Cassidey. He made some other cool films too, but those were my favs. I cannot help but feel sadness for his family and friends, although I clearly never met the man. However, I have met many other people dying from cancer.

One I recall was a pleasantly jaundiced 45y/o Hispanic man, Mr. X. He drank at holidays but never smoked. He was a DirectTV installer in Texas. He had 2 kids and a nice wife. He had colon cancer that had metastasized throughout his body, causing his jaundice. He was a Bears fan, and learning that I grew up in Chicago would call me Dr. Walter, knowing I adored Walter Payton as a kid. When surgery wouldn’t take him to the OR I tried to stand up to them, arguing he would be obstructed soon and suffer greatly. I got more upset about it than he did. He was calm. After discussing the pros and cons, Medical Oncology gave him the option of chemo. He reluctantly agreed, at his wife’s pleading. We tried to place him in home hospice, but apparently DirectTV has some really shitty health benefits. A wk later he acutely worsened. He had already agreed to “Do Not Resusitate” orders. Pupils were fixed and mid-dilated. No carotid pulses felt. No heart sounds across the entire prechordium, and no lung sounds bilaterally. I declared him dead that morning. His wife’s howl, when I called the time, is etched in my brain.

If the best you can offer people is a chance to live another 6 months of suffering… If the best you can prescribe is medicine that will make you vomit, lose weight and have your hair fall out... If the best you can expect is waiting to perforate your colon. Your best isn’t good enough. I don’t aim to attack Oncology, and I am grateful that smart people are willing to dedicate their time and genius to finding better treatments for Mr. X. But right now the technology kinda blows. It’d be like being a car salesman for a Model T in present day and everyone else is driving a Prius or Honda Accord. It’s not good enough yet. I know a lot of being an MD is giving consolation, support, hope and care to your patients. But I went into medicine to help and try to cure people. I don’t know if I’m overly sensitive and can’t take these big losses or maybe I am just a big pussy emotionally. I do know that I’m not cut out to be an Oncologist. I sure am glad that other people are.