Home: PCU
6|2003: Editor's note
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Editor’s Note |
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| The Waiting Room |
"You tell a patient that they have cancer and they don't hear anything else. Sometimes you see a glazed-over expression - they're just overwhelmed. Also, as a female physician trying to deal with a cancer in a sexual organ in a man, I tread very lightly. A lot of men say, "Honey, what do you know about what I'm going through?" And slowly, but surely, I've developed a better sense of what it's like for men dealing with prostate cancer. And the wives deal with it differently than their husbands, even though they're dealing with the same cancer. I don't think we ever really understand what patients go through, although we try hard. There are certain common situations where we think we have a sense of what patients face, but until you walk in those shoes, you never really know."
Colleen A Lawton, MD, FACR
Recently, I accompanied a close friend to Mark Soloway's office at the University of Miami, Department of Urology, for a second opinion on a complex and serious condition. The waiting room - filled with anxious couples and men by themselves - was virtually silent. "I'm so scared," my friend whispered as she clung to me in a trembling embrace. There was nothing I could say or do to alleviate her totally understandable fear.
As we waited in silence, I began to imagine Mark, calmly going from room to room, seeing mainly prostate cancer patients, and I realized that for almost every person visiting his clinic that day, this was a seminal moment in their lives. Doing my best to comfort my terrified companion, I thought about some of the patients discussed in this audio program and the thoughts they might have had as they waited to be evaluated.
How did Greg Merrick's patient feel as he waited for the results of his most recent PSA assay? Having been through brachytherapy for Gleason 6 disease two years previously, successive rises in his PSA levels had convinced Dr Merrick that this man likely had recurrent and probably systemic disease.
The patient had undoubtedly learned of the potential side effects of androgen deprivation, and might have believed that this was the visit that treatment would begin. I wonder if he or Dr Merrick would have predicted that the elevation was a post-radiation "PSA bounce" and that six years later the patient would remain untreated with an undetectable PSA.
What was Judd Moul's patient thinking as he pondered the dilemma of a less than definitive but concerning prostate biopsy, which was complicated by an eight-year history of androgen replacement therapy for hypogonadism? After suffering through a miserable experience when the testosterone was withdrawn, would this man and Dr Moul risk restarting androgens and stimulating what seemed to be a low-grade tumor?
How would Colleen Lawton's patient with locally advanced prostate cancer react, as he waited for his initial treatment with an LHRH agonist and bicalutamide, which would precede by two months, intensity-modulated radiation therapy? This educated man and his wife knew what to expect in terms of side effects from this therapy. What were their thoughts and feelings about how treatment might affect their relationship and family?
Thinking about these different scenarios, I realized how difficult it can be for a physician to understand the true human impact of a serious illness like prostate cancer. In this program, Dr Lawton shares with us a personal experience that clearly changed her perspective.
Three years ago, her father was diagnosed with locally advanced prostate cancer, and she accepted the role of a family member, and provided support and advice. How did her father feel as he sat in the waiting room of his treating radiation oncologist's office, knowing that his daughter had a central role in developing and testing the therapy that would render him biochemically free of recurrence?
Mark Soloway's clinic was bustling with residents and medical students who filtered through the waiting area. I remembered a scene from the movie, "The Doctor." In the lead role, William Hurt is a somewhat gruff surgeon whose personal experience with his own cancer dramatically changes his perspective on medicine and patient care, which he expresses to medical students on rounds.
"Doctors, you have spent a lot of time learning the Latin names for diseases your patients might have. Now it's time to learn something simpler about them. Patients feel frightened, embarrassed and vulnerable, and they feel sick. Most of all, they want to get better. Because of that, they put their lives in our hands. I could try to explain what that means until I'm blue in the face, but you know something? It wouldn't mean a thing. It sure as hell never did to me."
Experienced physicians usually develop an empathetic connection with patients and family members that assists them in understanding the human experience of a cancer diagnosis. We owe it to future generations of patients to allow training residents and students the opportunity to explore this essential part of medical care.
My friend and I followed Mark's nurse into the exam room, and once again I realized how different it feels at the other end of the doctor-patient relationship. The exam table looked cold and clinical, and it seemed as if there was not enough air to breath. We anxiously waited for the door to open.
-Neil Love, MD
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