Cell 2 Soul: The Humane Health Care Blog

October Poem

By Shirley Adelman


October, when breast cancer
testimonials almost outnumber
Pharma ads. Survivors thanking
hospitals and medical staff for
today when tomorrow seemed
as improbable as breast cancer
yesterday.  Now, twenty-three
remembering the struggle,
to struggle on:

 

An adjunct rushing from treatment
to college to college until my body
gave out.
Walking from the sofa
                            to the kitchen,
a destination
                         I struggled to reach.

 

A Department Head argued,
I should have known
I had breast cancer before
starting the semester.
In the future, when the future
seemed as illusive as an income,
he threatened to give me
a midnight schedule at the Navy Yard,
a distant satellite campus.

 

He came close to fulfilling
his threat by giving me
evening classes in a tough
neighborhood where, waiting
for public transportation meant
risking a mugging.

 

Cruelty leaves scars deeper
than surgery, more lethal
than invasive breast cancer,
and so I cry.

 

I wonder: What is the average
lifespan of an adjunct working
from paycheck to paycheck,
dependent upon department
heads who teach the humanities,
but lack heart. 

 

Previously published in "Blue Collar Review," Fall 2016, pp.29-30

Empathy: A poem

By Shirley Adelman

 

My daughter suffers
for another's suffering.
Shadows of eyebrows
on a mother,
with more tumors
than fingers can count.

Her daughter,
ashamed of suffering,
confides only in mine,
knowing
    I was lucky.
Cancer left me   left me

with a scarred breast:
tattooed dots,
a frame to radiation,
beamed
so early in the morning,
birds sang their thanks,
for another day.

Previously published in: "Canadian Woman Studies," Women and Cancer, A York University Publication, Spring/Summer 2010, (Volume 28, Numbers 2,3 ) p.29.

The author writes: “When my children were in their teens, I was diagnosed and treated for breast cancer, which greatly impacted upon them.  Years later, my daughter became the confidant of a colleague whose mother had late stage cancer.   The young woman was ashamed of her feelings, yet was able to share her suffering with my daughter, knowing I had been treated for breast cancer.  She did not know that my daughter's enormous capacity for empathy was provoked by the feelings of suffering she felt when I had cancer.  It was heartbreaking to see her so distressed.”

Three Vignettes by Susan Blevins

Susan Blevins writes: “It appears that my ministry in this life is to care for the sick and the dying. These are vignettes honoring my mother and my friend, Carla.  It was a privilege for me to be there for them, to hold the space for them, and I hoped, to offer them guidance as the end approached.  The most important things in life are love and service.”

Silver Curls  Download SILVER CURLS copy

Willing Humor:  Download WILLING HUMOR

The Scream:  Download THE SCREAM

They also serve who only stand and wait.  Milton

Henriette Thompson: Nonagenarian Pianist and Marathoner

Harriette Thompson, a classical pianist and cancer survivor who started to run marathons when she was 76 and ran the fastest time in a marathon for a woman over 90, died on Monday, October 16 in Charlotte, N.C. She was 94. NY Times Obituary.

[In the past few years, she ran] while wearing white tights to cover the open wounds on her legs from radiation treatments for cutaneous squamous cell carcinoma. Over the last seven years she had also dealt with a recurrence of oral cancer, which first struck her in 1986. The short and instructive New York Times obituary has many teaching points and is inspirational.

1. This 94-year-old musician and athlete died from a fall at the facility she was living in, not from her cancers.
2. Although she had squamous cell carcinoma of her legs and was being treated with radiotherapy the skin cancers were not proximate causes of her demise. This corroborates the work of E. Linos on “Nonmelanoma Skin Cancer in the Elderly.” In my opinion, we pay far too much attention to skin cancers which are billable to Medicaid and Medicare than to having patients use canes or having 94-year-old people being extremely cautious about stairs.
3.  This remarkable woman was a pianist until her death, she was an athlete. She had great meaning of her life.

For me, as a dermatologist, this reinforces the fact that treatment of non-melanoma skin cancer in the elderly, especially people over age 85, is not likely to improve their quality of life. Before recommending therapy, we may need to step back and not scare our elderly patients into having unnecessary surgery but, as experts, we should have honest discussions with them. Lesions in certain areas are best treated (around the eyes, nose, ears); but lesions on the torso and extremities can often be followed by active surveillance.These short You Tube videos will interest some of you.

 

 

Tom Brokaw on Myeloma

October 2, 2016 New York Times

"For most of my adult life I have answered the question “Occupation?” with one word: journalist. I still do, but now I am tempted to add a phrase.

Cancer patient."

So begins this eloquent essay on Mr. Brokaw's myeloma. 

It's Not Cancer: Doctors Downgrade a Thyroid Tumor

“There’s a growing concern that many of the terms we use [when labeling a tumor] don’t match our understanding of the biology of cancer.” Calling lesions cancer when they are not leads to unnecessary and harmful treatment, he said.

A new study clarifies that: “it is not the presence of nuclear features but the presence of invasion that can make the difference between cancer and noncancer,” Nomenclature Revision for Encapsulated Follicular Variant of Papillary Thyroid CarcinomaA Paradigm Shift to Reduce Overtreatment of Indolent Tumors.

An April 15th NY Times article by Gina Kolata explains this paradigm shift well.

This is an important step; but there are many other tumors that likely fall into the same category. As practitioners and as patients when we receive a diagnosis of cancer, it behooves us to question the necessity of aggressive treatment for indolent tumors. Breast, prostate and a number of skin cancers quickly come to mind, but there will be many others. The study reported in JAMA Oncology hints that we have a ways to go and that we are in the infancy of this endeavor.

David B. Oliver's Reality TV

Ellen Rand writes us: "What’s the reality of caring for loved ones in decline? We’re not likely to see the rawness, the intimacy, the messiness, the profundity of it in the movies or on TV – except for a few rare  pathfinders. David B. Oliver was one of them.

David and his wife, Debra Parker Oliver, possessed a deep knowledge gained over their professional lives researching and teaching about aging and end-of-life issues. That he responded to his own deadly illness in a meaningful way is tied both to his character and to his life’s work."

Ellen's beautifully written introduction to the Oliver's moving and instructive videos will interest many of you.  We are grateful to her for having sent us her essay (which you can access here: Download Reality TV

You can find the Oliver's presentations at: David Oliver's Cancer VideoBlog -- Episode 1: David Reveals Diagnosis

 

Ellen Rand has been a journalist for more than 40 years, including five years as a housing columnist for The New York Times. She is a hospice volunteer with Holy Name Medical Center in Bergen County, New Jersey, a member of the Hospice Volunteer Association and the Association of Health Care Journalists. Her essays have appeared in several medical humanities publications, including Pulse—Voices from the Heart of Medicine; KevinMD; and Life Matters Media. She blogs at http://lastcomforts.com.  Ellen is the author of the recently published:  Last Comforts: Notes from the Forefront of Late Life Care  which has been called "a must read for caregivers, individuals with serious illnesses, their loved ones who care about their care and elected officials. A must read for caregivers, individuals with serious illnesses, their loved ones who care about their care and elected officials. "

On A Neurosurgeon Dying Young

In his 37 years, Paul Kalanithi wore many hats.  Near the end of his neurosurgical training at Stanford, he was diagnosed with widely metastatic lung cancer.  He wrote a memorable Op-Ed piece for the NY Times in January 2014.  He continued working when he could.  He and his wife, Dr. Lucy Goddard Kalanithi, had baby Cady on July 4, 2014. 

A palliative care colleague wrote: “His ‘dual citizenship’ as a doctor and as a seriously ill patient taught him that respectful communication is the bedrock of all medicine. We [came to] understand that the so-called soft skills of medicine are the truly hard skills to teach and to learn.”

Too few of us, these days, have the gift of time.  Spending a few moments with Paul Kalanithi will be worthwhile.  If you can take the time, start with the video produced at Stanford. 

Some resources:

NY Times Op-Ed. How Long Have I Got Left?  January 24, 2014

Stanford Magazine (March 11, 2013), Paul Kalanithi, writer and neurosurgeon, dies at 37

Stanford Magazine Podcast (February 25, 2013).  Days are long, years are short: Paul Kalanithi on time.

A.E. Housman.  To An Athlete Dying Young

There are many more…

Art is Powerful Medicine

Art is powerful preventive medicine. Looking at a picture is like walking through an endless series of doors, with each succeeding door leading us deeper and deeper into a rich experience.This journey stimulates our minds, our emotions, our souls; it makes us more alive. Ultimately the esthetic experience heals us and makes us whole.  -- Robert Pope, Illness and Healing, Images of Cancer, 1991.

Susan Gubar in a February 7, 2014 NY Times essay, Living with Cancer: An Artist's View writes: "Though we accept ambiguity in art, it is harder to accept in science, harder still in medicine." 

Robert Pope (1956-1992) was a dedicated Nova Scotia artist who died of Hodgkin’s Disease at the age of 36 after a ten year battle with the illness. (The link to the Rpbert Pope Foundation is not live now.) His work "reminds us that often patients and caregivers cannot fathom what we sign up for. Even when physicians try to communicate the consequences of their prescriptions, patients need to make a leap of faith.

"Mr. Pope’s paintings make one wonder: Is cancer treatment a form of religion, a means of transformation that involves its own rituals, trials, high priests, sacraments, vestments and bodily signs for people in need of a miracle and convinced that we have to be stripped of everything before we can be reborn?"

Even after two weeks, Susan Gubar's article still resonates with me.  Read it if you have a chance, and the moving comments as well.

Related articles

Well: Living With Cancer: An Artist's View

Art in Healthcare - UF's Arts in Medicine

She Battled the Breast Cancer Industry

May 20, 2013 – NY Times:  Barbara Brenner, Breast Cancer Iconoclast, Dies at 61.  by Denise Grady

Barbara Brenner, who led the group Breast Cancer Action and shaped it in her own combative image, pillorying the medical establishment, industrial polluters and even other cancer research advocates, died on May 10 at her home in San Francisco. She was 61.

Full NY Times Obituary.

Ms. Brenner wanted her obituary to say "she died after a long battle with the breast cancer industry.”