The Cheerful Oncologist's Little Book of Rules: Number 18

But at my back I always hear
Time's winged chariot hurrying near;

-Andrew Marvell, "To his Coy Mistress"

Exactly seven days ago I walked into Exam Room Number 3 and happened upon a woman in distress. Her symptoms, physical findings and laboratory abnormalities suggested to me that she had advanced stage ovarian cancer, which by the way is highly treatable. The usual sequence of events is to surgically remove as much tumor as possible and then give several cycles of chemotherapy, which frequently produces long term survival.

In this case, though, the patient was about as likely to tra-la-la through an operation as she was to win the standing block chop competition at the lumberjack olympics. She was weak, nauseated and showing unmistakable signs of failing nutrition - observations that make oncologists' stomachs roil with uncomfortable thoughts. While formulating a plan I was reminded of the following helpful bit of advice:

RULE NUMBER 18. THE SERIOUSLY ILL PATIENT'S TIME IS MORE PRECIOUS THAN YOURS - DON'T WASTE IT.

Sometimes this rule is easy to follow and sometimes it isn't. In this case both patient and doctor were committed to getting the show on the road as quickly as possible. Considering that I had to come up with the correct diagnosis and counsel the patient about chemotherapy, things went smoothly. Fortunately the concept of "teamwork" was in exemplary display here, for as of today we have a diagnosis and she has taken her first treatment. As they say in those World War II documentaries, "Now the fighting back has begun." Thanks to the concept of working fast, my patient has a chance to recover before she ends up hospitalized from the effects of her tumor. As the intravenous premeds were being started I said "Today is the day that the cancer begins to die."

She liked that sentiment. It's not exactly "Once more unto the breach, dear friends, once more," but then again, they're not paying me to orate, but to mortally wound this patient's malignancy. It was just a little snippet of encouragement, but hopefully 'tis enough,'twill serve.