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 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?
While many healthcare institutions nationwide face challenges in enhancing goals-of-care discussions with seriously ill patients, an unexpectedly simple study from the VA demonstrated that a different approach could change how we think about these conversations. In 2013, at the Palo Alto VA Medical Center, Dr. Manali Patel proposed what seemed like an unlikely solution: What if individuals without medical training could assist veterans with advanced … Continue reading When Less is More: A Simple Solution to Complex Healthcare
The Chef’s Voice I was driving home from clinic on a rain-soaked Monday when I heard something that made me pull over and listen. It wasn’t about medicine or cancer or the patients I’d just spent the day treating. It was chef Matty Matheson, who plays Neal Fak on the acclaimed TV show “The Bear,” being interviewed by Kara Swisher. “Food is an uncompromising love,” … Continue reading When Food Loses Its Appeal: Medicine’s New Understanding of Cancer’s Oldest Companion
The Evolving Challenge of Cancer Prognostication Over the last decade, I’ve witnessed a remarkable transformation in my supportive oncology practice. The advent of targeted therapies and immunotherapy has moved us beyond the traditional triad of surgery, chemotherapy, and radiation. While these advances have dramatically improved the survival of many patients, they’ve paradoxically made one of our core responsibilities—prognostication—more complex than ever. Understanding Modern Cancer Trajectories … Continue reading Beyond Numbers: Making AI Work for Patients with Advanced Cancer
It turns out that there is yet another thing that exercise helps for – chemo-induced peripheral neuropathy (CIPN). It not only helps to diminish the symptoms of neuropathy that already took place, but it can prevent it (!), which many other things that have been vigorously tried before (vitamins, fish oil, medications, etc.) failed to do so. It is potentially quite paradigm changing finding that … Continue reading New Insights: Exercise to Combat Chemotherapy Neuropathy
Between Gravity and Grace: Discovering the Role of Levity in Patient Care “She had always been interested in standup comedy, and it occurred to her that what’s funny is true. That’s why people respond because the unspeakable is getting said.” I came across these words in Ariel Levy’s 2017 New Yorker profile of Elizabeth Strout, and they stopped me in my tracks. For years, I had struggled … Continue reading Finding Space for Humor in Serious Illness Care
Marcin Chwistek, MD 