When a doctor is the patient

When doctor is a patient

This was an anxiously awaited visit by Tom to his oncologist. He himself being a physician, knew what was to come. He had been tracking his blood tests and had seen an increase in the M-protein, silently announcing that Myeloma, the blood cancer had relapsed.  

That morning he has had a conversation with his wife. She had listened to him with an attentive but silent look, saying nothing but giving him a big hug.

Tom and his wife could talk openly and freely when it came to the health issues. They had developed an understanding that they would share good and the bad news and will not hold any secrets. He hoped that being a doctor’s wife and being in a medical environment, she will understand what these abnormal test results meant.

On that fateful day, they arrived at the clinic early in the morning. Tom had requested the first appointment of the day, knowing very well that the delays increase as the day goes by. There are always un-anticipated emergencies that can cause waiting time to increase from an hour to sometimes two hours.

They looked at each other incredulously when the door opened, and the medical assistant summoned to the consultation room. He looked at his watch and it read 9:20 am.  His appointment was at 9:30 am.  His wife expressed relief with a subtle smile as they were led to the designated examination room.

The doctor walked in and greeted them warmly. He knew them and particularly had known Tom for quite a while since both were specialists in cancer and blood diseases.

The doctor reviewed the latest blood tests, the previous notes and plans of care. As anticipated, he told them that the blood cancer had relapsed. He said that the M-protein, a marker for Myeloma had reached a level that called for the treatment to be resumed. This time, he said, “we are going to go for a cure”.

The doctor looked at Tom as he delivered the news and instantly knew how Tom will respond.  “Cure! Multiple Myeloma is not curable,” Tom said. “This is the second relapse. We had chosen to stop the treatment last time after I had achieved a remission. We did not go for Cure then, why now?”.  

“Well”, the oncologist looked him in the eyes and said “things have changed since then. Now cure is possible for Multiple Myeloma. Here, let me show you the data.” 

The oncologist switched the display on his computer screen from the patient’s chart to his academic notes and opened a power point presentation that he had recently delivered at the annual meeting of the American Society of Hematology.

As he was scrolling through the slides on the computer screen, pointing to the response and survival curves with different treatment regimens, he was uttering the words, abbreviations and phrases like CAR-T, Dara, Kyprolis. Imids, Pom, steroids etc. He specially spoke with excitement about CAR-T immune therapy. He said that even though a single course of this treatment costs about half a million dollars, it seems to be effective in Myeloma.

Seeing the bewildered look on Tom’s wife, the doctor realized that he was in his clinic and not at a cancer conference. For a moment he had forgotten that although Tom being a oncologist was following his PowerPoint remarks, for his wife it was all Greek.

CAR-T, he said facing Tom’s wife, is a newly approved immune therapy. Unlike Chemotherapy where chemicals are used to kill cancer cells, CAR-T cell therapy involves removing certain types of killer immune cells from patient’s blood. The cells are then genetically modified to recognize specific targets or “receptors” that have been isolated from the patient’s cancer cells. These custom modified killer immune cells are then grown to a zillion plus number in the laboratory. Once ready, the cells are infused back into the patient to eliminate the cancer. So far it is working well in blood cancers, he said.

She nodded to acknowledge him, indicating that she understood all that scientific gobbledygook even though it was still Greek to her. She has had this experience in the past where another doctor had spoken to her husband as “physician to physician” forgetting, that she was also sitting right there in front of him. She remembered asking the doctor to address her directly in lay terms and not leave it to her doctor husband to explain it to her after they got home.

She also remembered that Tom used to tell her that many of his patients and their families walk out of the office with blank looks. They hear what is discussed in the doctor’s office but don’t remember most of what was said as they step out. The combination of anxiety, fear and medical jargon makes it very difficult to remember everything.

This time she was prepared. She had her questions written down and was taking notes. She had planned to gather her children and grill her husband on what did the oncologist mean by all those terms. What was minimal residual disease, disease free survival and overall survival. She was hoping that it will all work out and as the oncologist said, her husband will indeed be cured this time around.