Photo by Chandra Oh on Unsplash For months, I have been caring for a man with severe nerve pain from cancer that has invaded the nerves of his shoulder and arm. The pain is burning, lancinating, relentless. He is on an elaborate regimen of opioids and adjuvant analgesics, and has been through a series of interventional procedures, none of which made a lasting difference. What … Continue reading The Worst Day, Not the Average Day
I have been thinking about Mark Earnest’s profound NEJM perspective for a week, mostly because of how truthful it is about patients who will not, or cannot, tell us what they want. A note before you read on. Go read the essay first if you have not. There are spoilers below. Jack, his 91-year-old protagonist, grew up above his grandmother’s bar in a Polish neighborhood … Continue reading Some patients tell us their goals only by what they refuse.
When the conversation is complete, and the patient is still lost. Photo by Frederic Köberl on Unsplash Anne (not her real name) asked me this in our urgent care. She was recently diagnosed with locally advanced pancreatic cancer that was deemed unresectable, and presented with vomiting and abdominal pain. She was 75 years old, lived alone, supported by an elderly sister who lived at a … Continue reading What if, with the chemotherapy, I am going to feel worse than I am now?
She sat on the exam table with her eyes closed, back straight, completely still. She was in her late 30s, a mother of young children, a professional. Months earlier, she had undergone extensive surgery for head and neck cancer, followed by radiation. The treatment was brutal. Part of her jaw was removed, and she required skin grafting. Then, she underwent multiple weeks of radiation to … Continue reading Between Pain and Suffering
A Case That Stayed With Me During a recent clinic, I was asked to urgently see a 65-year-old woman with metastatic lung cancer after multiple lines of therapy. For weeks, she had been declining: confused, exhausted, not eating, losing weight, and no longer sleeping. Her oncologist had decided that further cancer-directed therapy wasn’t feasible. When I walked into the room, she was in her home … Continue reading Between Algorithm and Presence: The Future of Palliative Care
A few months ago, I met a man in his late sixties with advanced gastrointestinal cancer that had spread to his liver and lymph nodes. His wife had recently died. He lived alone in a three-story house. He knew his disease was incurable, but he was motivated; he wanted “more time.” At each visit, he told his oncologist he felt okay. His pain was controlled. … Continue reading The Language of the Body: Why Patient-Reported Symptoms Predict Survival
Photo by National Cancer Institute on Unsplash My mother had symptoms for months before her stage IV colon cancer diagnosis in the early 1990s. My father’s younger brother was a surgeon, we had medical expertise in the family, yet the cancer still went undetected until it was far advanced. At the time, I chalked it up to the limitations of medicine in that era, before … Continue reading The Pattern We’re Finally Seeing
A few weeks ago, I sat with an elderly man with locally advanced bladder cancer and his daughter. She was worried; he no longer seemed like himself. He slept most of the day. He had no appetite, not even for her cooking, which he had once loved. She described how he used to fill the kitchen with stories from his morning walk—the neighbor’s new dog, … Continue reading Shattered and Adaptable: Two Books, One Truth About Being Human
Photo by Kelly Sikkema on Unsplash The HIV Transformation In the mid-1990s, as a young resident new to the U.S., I was still learning about HIV/AIDS when a patient arrived in our Connecticut ER one night – a young man, close to my age, muscular and healthy-looking but desperately short of breath. I remember him vividly. His chest glistening with sweat, he heaved with each … Continue reading The Parallel Frontier: While We Cure Cancer, Can We Deliver Those Cures?
Fifteen years ago, Dr. Abraham Verghese introduced us to the concept of the “iPatient” – digital representations in electronic medical records that were commanding more physician attention than the actual humans in hospital beds. Today, we face something far more profound: the “AI Patient,” where artificial intelligence not only stores data but diagnoses conditions, generates treatment plans, and writes clinical notes. What’s striking is how … Continue reading From iPatient to aiPatient: Balancing Algorithms with Empathy
Marcin Chwistek, MD 