How Do You Do This?

How Do You Do This?

David L. Graham, MD, FASCO

Mar 05, 2012

This is probably the question I get asked the most when I tell people that I am an oncologist. It’s a question I have asked myself a number of times in the past as well. Now it’s a question I am facing again...

My first exposure to this was when my father was diagnosed with pancreatic cancer in the 1970s. He passed away when I was a junior in high school. I didn’t miss any class because I saw keeping things going was the best way to "get through" the immediate impact. Looking back, that was the start of a coping mechanism I still use.

My son has had a couple of situations that put me into those coping patterns again. As I was faced with each of them, I was able to intellectually respond and, seemingly rationally, think the situation through and deal with the immediate questions and decisions required. Emotions came later.

Six months ago, my White German Shepherd was found to have a high grade nerve sheath sarcoma. It was resected with involved margins. He has been maintained on low-dose daily oral cyclophosphamide and piroxicam (with literature support) without progression. Today he is in surgery for an intestinal perforation. Prior to surgery, there was no evidence of recurrence. With that information in hand, I had no hesitation in choosing the surgical option. Looking back the last few hours, I’m sure at that moment I sounded dispassionate. I have not been that way the rest of the day.

I’ve realized today that this is also how I approach my patients and my practice. We all see tragic cases on a regular basis. Nevertheless, we can still make informed recommendations for what we see are the best options. I certainly have to look during these times from a somewhat distanced perspective. That doesn’t mean that, during other times, my heart isn’t aching for these folks and their families. If I didn’t have that distance during the analysis, I could never be the best advocate for that patient, and that’s what we all strive to be.

"How do we do this?"...never in an uncaring way, but rather, caring enough that we are willing to suppress things in ourselves at times to serve our patients the best.


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Michael A. Thompson, FASCO, MD, PhD

Mar, 06 2012 11:57 AM

David -
Thank you for the thoughtful insights. I think we all hear the same commentary and need to build up some defense mechs to keep going.

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