Close-ups

A Patient's Perspective

Sidelined by Cancer



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Am Fam Physician. 2008 Dec 15;78(12):1354.

My family physician noticed that I had been sniffling continuously. When the medication she gave me wasn't working, she sent me to Dr. H, who sent me to Dr. M, who found out that I had carcinoma of the esophagus. My team of nine doctors and specialists assembled and, after joint rounds of radiation and chemotherapy, they extracted the carcinoma during a 12-hour surgery.

The surgeon explained how difficult the procedure was, delving into the center of my chest to remove the tumor. My doctors are all very honest. Dr. M always looks over those glasses of his and tells me exactly what he is going to do. I appreciate their honesty and dedication.

I remember one particular time when I was in the hospital because of fluid in my right lung. Dr. O visited, sat down next to me and said, “You are going to be fine. I am right here beside you if you need me.” It is empowering to know that my doctors genuinely care about me. I have a strong will to live, and my doctors knew from the start that I was depending on them to get me through this. They always listened to my concerns and advocated for my best interests.

Now I'm being monitored constantly—my doctors are still in the process of trying to get me well. Every so often, I have low temperatures and low white and red blood cell counts. I have difficulty swallowing, loss of my voice, constant coughing, and stomach pains after eating. I am trying to regain strength after losing 60 lb, and I will get there. What has gotten me through all of this, you ask? Guts. I want to live. I've never thought of giving up. I told my doctors to take every last bit of that cancer out, because I have to see my grandsons grow up.

Through my experiences, I've learned what a good doctor is about. I am very fortunate to have a good team. I know I can depend on them. My doctors were always there for me, and they still are. As long as they are here, I'm not going anywhere.—L.H., 78

COMMENTARY

Shortly after sharing his story, L.H. called to report symptoms of progressive dysphagia, with an inability to swallow any food or liquid. He was again hospitalized, and died soon after. L.H. was shuttled from home to hospital and in and out of the offices of his medical and radiation oncologists, surgeon, and gastroenterologist. He and his family relied on me, as his family doctor, to assemble an excellent team and to stay on top of his progress. In cases such as this, it may seem that the family physician loses the role of the primary caregiver. In fact, our patients and their families rely on us more than ever to provide guidance and support, and to be there when the end is near.

The author thanks Caroline Hobbs, MD, for interviewing L.H. and transcribing his story.

RESOURCES

National Cancer Institute. Resources on the role of the family physician in end of life care. http://www.cancer.gov/cancertopics/types/esophageal.

Ngo-Metzger O, August KJ, Srinivasan M, Liao S, Meyskens FL Jr. End-of-life care: guidelines for patient-centered communication. Am Fam Physician. 2008;77(2):167–174. http://www.aafp.org/afp/20080115/167.html.

Michiels E, Deschepper R, Van Der Kelen G, et al. The role of general practitioners in continuity of care at the end of life: a qualitative study of terminally ill patients and their next of kin. Palliat Med. 2007;21(5):409–415.

Anvik T, Holtedahl KA, Mikalsen H. “When patients have cancer, they stop seeing me”—the role of the general practitioner in early follow-up of patients with cancer—a qualitative study. BMC Fam Pract. 2006;7:19.

Close-ups is coordinated by Caroline Wellbery, MD, associate deputy editor, with assistance from Amy Crawford-Faucher, MD, Tony Miksanek, MD, and Jo Marie Reilly, MD. Questions about this department may be sent to Dr. Wellbery at afpjournal@georgetown.edu.

The editors of AFP welcome submissions for Close-ups. Guidelines for contributing to this feature can be found in the Authors' Guide at http://www.aafp.org/afp/authors.


Copyright © 2008 by the American Academy of Family Physicians.
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