I just finished reading pages 28-42 of Dr. Jerome Groopman Book: Anatomy of Hope, and felt the need to stop reading and writing this piece to share with you what I learned. For more than ten years ago I met with many cancer patients. Within me I felt all along that many or most oncologists are often misled by their patients to their treatments. Today, after reading a story written by no less than one of the world's leading oncologists and researchers, I now feel I was right all along. Allow me to relate what Dr. Groopman wrote about what happened sometime in 1978-1979.
actors in this story
1 Patient:. 52-year-old Frances Walker, an African American with a teenage daughter, Sharon
2 Chief Medical Officer: 50-plus-year-old Dr. Richard Keyes in the Department Russell, a city north of Los Angeles, California, USA
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3 Second doctor:. Dr. Jerome Groopman, a 27-year-old, and come to the doctor for blood diseases fellowship at the University of California, Los Angeles
Frances had traces of blood in her stool over a year systematically pregled.Kolonoskopija indicated tumor in the lower intestine. She underwent surgery to remove the tumor, but the surgeon found that the cancer has spread to lymph nodes and invaded the left lobe of his liver. Medicine is considered Stage 4 metastatic colon cancer.
Frances and her daughter, Sharon, came to Dr. Richard Keyes in the clinic. They were warmly welcomed by the physician who examined Frances continued to work early. Everything seemed fine. They sat down to discuss the follow-up treatment.
Richard Frances, all traces of cancer were eliminated from the colon and surrounding lymph čvorova.Nekoliko small towns of the tumors were found on the left side of the liver. But we chemotherapy to take care of them.
Frances face showed great relief.
Richard: I'll give you chemotherapy is highly active against those of the liver. I expect some side effects such as mouth sores, diarrhea and anemia, but will be monitored. All effects can be managed and will eventually reverse. Any questions?
Frances thinks for a moment and understand what to do. Richard wrote in the patient's file, "Patient and family understand the risks and benefits of proposed treatment ."
Frances left the clinic.
Groopman Richard: When I was with (the patient), if a direct question comes up, I must emphasize remission, right?
Richard: Yes, I certainly would not look at Frances and say. "Ma'am, cancer of the liver will kill you," What is the purpose? All it does is make the rest of the time even more miserable. Or the cause of her panic and refuse to relieve the pain. Richard went on: Each doctor has their own style, their way of doing things. Believe me, for patients in situations like this, too much information is overwhelming.
After the first shot of chemotherapy Frances had some nausea and dry heaves. But she seemed to be in good spirit, despite the side effects. She said: "I am a fighter." Later, she suffered a painful mouth sores and had to be hospitalized and put on drips. After that had to be hospitalized again due to fever and abdominal cramps and diarrhea.
Three months of chemotherapy
to Frances Richard: Look at the CAT scan. It is the liver ... those deposits are a treat. They are about half the size of what we started.
Frances: Does this mean that I'm partially cured?
Richard: You're well on your way to forgiveness. Thank God. It goes away.
Frances's daughter, Sharon, eyes closed and head bowed in silent prayer.
Time passed, and it was January 1979
Dr. Groopman Frances shook his hand and felt it tremble. France liver function tests showed elevated values as they were before. Dr. Richard Keyes abdominal.
Richard: Your liver edge was tender and blood tests are slightly abnormal. Sometimes chemotherapy can inflame the liver as a side effect. You are due for a follow-up CAT scan in a week. Until then, I'll give you a prescription for some painkillers. Do not be reluctant to use it if necessary.
Frances left the clinic.
Richard on Groopman: You know, it really makes no difference clinically if the cancer is, and not chemo. There is little we can do about it. By Sharon says Frances and now we just add a few more weeks of care. In this way they have something to hold for a bit longer. Richard looked Groopman politely and continued: You're at the beginning of his career, Jerry ... SUSTAINED Ignorance is a form of bliss. May be she will be happy and will turn out to be a side effect of drugs.
Two weeks later, Groopman reports Frances saw the scan and wrote. "Liver metastases was more than doubled in size, and new deposits have appeared in the spleen, the organs looked as if they were riddled with large-caliber bullets, leaving a gaping holes. scan also showed fluid is building up in the belly. I knew that patients like Frances rarely survive for several months. I noticed a faint color of yellow in her eyes. it is jaundice, signs that the cancer blocks the hepatic secretion of bile. abdomen was so distended from ascites to push her belly button outward like a balloon ."
Frances came to the clinic.
Groopman: How are you?
Frances: Very tired. I have no appetite. I have to force myself to eat because the food does not go down easily.
Groopman: We have to drain ascites to relieve pressure. You should feel better afterwards.
Sharon: So that means that it is expanding rapidly, is not it?
Frances: I have no energy. I felt for some time that something is wrong ... But Dr. Keyes said that the chemotherapy treatments.
Sharon: I thought you and Dr. Keyes said that chemotherapy can cure her.
Groopman: It is not - not - say quietly. We said that was a good chance to go into remission, which is what happened. Groopman then explained what forgiveness means and how it differed from the drug.
Sharon: Why do not you tell us before?
Groopman: Colorectal cancer is behaving this way. Shrinkage during the treatment then becomes resistant to it and grow again. I'm sorry.
Groopman has written: "The last time I saw (the patient) is early March, Frances was not able to eat more than a few bites of solid food if the drinks are too cold or too hot, she regurgitated them ... Each drainage ascites, provided only a few days before the relief of fluid re-accumulated. Frances declined further chemotherapy after hearing my recitation Frank data on your chance to work.
Sharon: I think he (Dr. Richard Keyes) do not think people like us are smart enough or strong enough to handle the truth.
Groopman: This question is not smart enough. Dr. Keyes and I were trying to spare you worry. Well, we were both wrong.
Frances died shortly thereafter. Groopman wrote: "The feeling of shame and guilt gripped me Richard and I did not (patient) This is a fallacy to say to yourself that what Richard did and what I accepted as his disciple was best for them ... Ignorance is not bliss, and not when it does not matter. abandoning the truth, Richard and I left Frances, and through our delusions we left Sharon alienated and bitter ."
Comments: It is amazed that the same story played over and over again different doctors everywhere. It does not seem to matter if it is in Malaysia, Indonesia, Singapore and the United States.
Groopman felt shame and guilt. I wonder how many others felt the same way after they failed. How would they ever cope with their patients, knowing that in "trying to do their best," they are actually deceived or misled their patients?
Groopman was right when he wrote that the episode left Sharon alienated and bitter. Who would not feel disappointed, betrayed or deceived? In ten years from my own experience, I met patients and their family members who felt bitter and angry at those physicians who take them for a ride. Many have lost their loved ones, except that in the face trying to settle the medical debt. For some who are poor, they resorted to selling their property - land or house. It was a bet that took a "buy" on the "wrong medicine" by doctors who said they were promising, indeed. Patients may not realize that the "so any oncologist," they can do when faced with cancer.
All these years I have always argued that patients should be told the truth or provide a sufficient and unbiased information that will enable them to decide for themselves. There is no need for anyone to "play God" and try to be a hero. Groopman was right - he and Richard were wrong in trying to "protect" Frances to hide the truth. Or withholding the truth, they were trying to protect Richard's "income "?
By writing this, I am not "anti-doctor." I hope that patients, their families and even doctors are learning from what Dr. Groopman wrote. I have great admiration and respect for this author, Dr. Jerome Groopman. From an early stage of his career, he has shown himself to be a man of integrity filled with love and compassion. i'm proud of him and regards him for his fairness and integrity. This is the kind that the world needs doctors and patients need to ask for help. Unfortunately i'm skeptical and not too sure about some oncologists. Patients or their family members told me that their doctors more often than not, they were "after my money is not after my cancer." These oncologists had no time for them or showed no compassion at all. When patients ask about the side effects of chemotherapy, the response is often diminished or banalizirajući ". Oh, it's nothing much - a bit of hair loss and nausea, "In actual fact, some patients go through" hell ", and the chemotherapy drug without insurance. If patients ask more questions, the answer was often:" Why do you ask such a physician or i am a physician.. "There was an oncologist who said." i'm not cheap if you do not have the money to go to other doctors Otherwise, go home and sell your house and then come and see me ."
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