Thursday, February 24, 2005

Tumor Board

Our university department hosts a Tumor Board.

Before I ever attended one, I had all kinds of strange ideas about what it was exactly that they did. "Tumor" and "Board" -- the possibilities could be scripted by Robin Cook or Dean Koontz. Alas, the reality is much tamer.

The group is composed of the department docs, their residents and fellows, a radiology doc, a pathology doc, a lab guy, a couple of random people I haven't figured out, and me -- we all meet to discuss particularly difficult or unusual cases of cancer in their patients.

It's one of those "two heads are better than one" approaches, only in this case it's about 20 heads. And a few of us don't have a clue. Sometimes more than a few of us, if the residents are tired.

Anyway, the patients come in one at a time, are introduced to the group, and the patient's doc points out where the cancer is. Then all the students get to palpate (that's the medical term for "squeeze", pretty much) the tumor. If it's really tricky, every single one of the docs will line up to feel it (which always strikes me as funny).

Then the patient is ushered out, and all the docs look at any films from radiology (sometimes there are dozens of films -- this can take awhile if they decide to argue about it). If a biopsy's been done, they may look at slides of that.

It's pretty cool for the patient, usually; they really feel like their case is getting plenty of attention -- which, of course, is true. And sometimes the patient's course of treatment will be changed after this mass consultation; but usually it's more of a learning experience for the residents and fellows.

Anyway, today there were no patients to present. So the discussion turned to a particular type of recurrent cancer which has a very low remission rate -- 12.5% -- after surgery and treatment whichalmost always ends in death on a respirator with a feeding tube.

I have to admit that I was shocked -- and pleased -- when our department head stated that it was probably better to provide palliative care for most of these patients than to give them such pain and suffering. So often medicine seems to be a "beat death at any cost" mentality, instead of "how can we give this patient the most out of what s/he's got left?" mentality. And in the end, shouldn't it be the patient that is the winner, not Death or the MD?

7 comments:

Gone Away said...

Interesting thoughts, Jodie. It must be an agonizing decision to have to make at times, what course of action to take. I wouldn't be in your shoes for anything.

Jodie said...

Luckily I don't have to make the choice. :)

A friend of mine, who worked with me when I did psychiatric research with the mentally ill, had a son who died of a brain tumor. Over the course of year, he steadily failed and then died. She said, "After seeing some of our patients, really Lenny's death was kind in comparison to the living hell some of them face every day."

Of course, not ALL or even MOST psychiatric illnesses are that bad.

jag said...

Hey Jodie
Just wanted to say thanks for your insight on "normal."
It helped.
Also enjoyed reading your posts.

Jag

jag said...

Hey Jodie
Just wanted to say thanks for your insight on "normal."
It helped.
Also enjoyed reading your posts.

Jag

Ned said...

A very important point.

My mother made her decision years before she developed cancer. When the tumor was discovered, she amended it slightly to allow for one surgery to remove the basketball-sized growth from her abdomen. She refused to go back, the task of getting her to allow just the one ultrasound done following the surgery was herculean.

But one was all they needed. There was the suspicious growth near the kidneys, the signs of other growths nearby. Histio-sarcoma was the pathologist's declaration. It didn't matter though, she didn't research, she didn't know that radiation was not effective, she would never have gone for it anyway.

Yet she lived with hope. She lived past the doctors' predictions, she lived without the severe pain we were warned of. The hospice nurses were amazed at her peace, amazed that she was not in pain, amazed that she was still able to eat, long after the size of the tumor had reduced the space for internal organs to a tiny slot. The night before she died, at home, in her own room but by this time in a hospital bed for comfort, she sat up on the side of her bed (the sheer weight and size of her torso making this task seem impossible, yet she did it) and ate a small supper at her side table.

I wonder if the choices we would have made for her would have been different. I wonder if we would have chosen to fight, even knowing we would lose. All we could do was honor her choices and in the end, they were the right ones. To accept and make peace with our destiny. I don't know if I could do it, certainly I could not do it with the grace and strength she exhibited.

Gone Away said...

I salute the courage of your mother, Ned. She demonstrated to all of us that there is a choice in these matters. Do we go along with the world's view, that this life is all we have and therefore we must take every avenue of preserving it, regardless of how miserable such an extended life may be? Or do we have the courage of our convictions, that this is merely the beginning and that far better awaits us on the other side? In these decisions are our true beliefs reflected.

Jodie said...

Ned, your mom sounds like a wonderful lady.

One of the studies that I worked on in the past was a palliative care study for women with terminal ovarian cancer. I called them several times a month to ask them the same 25 questions about pain, depression, anxiety, etc.

I don't know if the doc in charge of the study learned anything, but I learned much about grace, and acceptance, and courage.