Cancer therapy, circa 1896

From Tyson’s The Practice of Medicine: the treatment of Hodgkin’s lymphoma,

Treatment . . . may avert the fatal termination for a long time. Extraordinary results in this respect have followed the administration of arsenic, and even recoveries have been reported. Large doses, arrived at by gradual increment, should be attained and kept up until some physiological effects are observed.

Five-year survival for Hodgkin’s lymphoma was 40% in the early 1960s, just under 92% in the early part of this decade. What do you suppose it was in 1896? I’d guess less than 5%, with or without treatment. Oh! Just googled it and I was damned close. Five-year survival of untreated Hodgkin’s disease is 6%, ten-year survival zero. We’ve come a long way.

Sort of. Depending upon your choice of cancer. With regard to pancreatic cancer,

The prognosis is unfavorable, and the treatment only symptomatic.

Nowadays, five-year survival is less than five percent. So there’s the spectrum, folks, from one of our greatest success stories to one of our persistent dismal failures.

But at least there are some success stories.

D.

Remembered

ERs have a smell, as do ER waiting rooms. Blood, mostly, but there’s always a background of fear-sweat and other body odors. It’s not like most folks have the leisure time to shower before visiting their local emergency room.

It’s all so much more noticeable in the middle of the night. I’m not sure why that is. Meanwhile, from a doctor’s pov, life takes on a clearer hue; You’re there for one purpose and one purpose only. Depending on the magnitude of the emergency, all other body functions take a back seat to getting the job done. You ignore your thirst, your hunger. Most of all you ignore the desire to sleep. Sleep is the reward at the other end of getting the job done.

I miss residency for one thing only: colleagues. Rare is the case that doesn’t benefit from discussion. And so this morning, I felt the need to talk to someone from the U. Any U. But this morning, it was my U, USC.

Shirley, one of my nurses from back in the 90s, took the call. “Is this our Dr. Hoffman?” she asked.

“I don’t know,” I said. “Is this my Shirley?”

I remembered her, of course. I always remember the pretty ones, and the nice ones, and the ones who mothered me. I suppose she was a bit of all three. Don’t know why she remembered me, other than the fact I tend to be notorious wherever I go. She handed the phone to another nurse who remembered me. She’s the cousin of Jake’s nanny, and she said that whenever they got together they always talked about me (and Jake, of course).

Times like this, I’m happy to be a doctor, even though I’m tired and foggy right now (could only manage five hours sleep after getting home) and worried, too. In TV medical dramas, bad outcomes occur only when there is much angst to be squeezed from the death — wet hanky melodrama. And even then, the tragedy is often temporary. The sting is there for the pulling. In real life, we know that bad things can and will happen to good people, and our only recourse is to do the best job possible. At least then, afterward, we can still live with ourselves.

It would sap the will if good things didn’t happen with the bad. Being remembered helps, too. It isn’t always obvious the impact we have on people’s lives, not just patients, but coworkers, too.

Note that I don’t ask why they remember me. Some things are best left to the imagination.

D.