TOO MANY CARDS TO SHUFFLE

I have never been a collector of other people's business cards nor have I been anxious to pass out my own. But suddenly, I have a stack of business cards from people I barely know, but who will play an important part in my life and treatment. I have glued them into my blue "RoRX" binder.

As I said earlier, I have an environmental disease, malignant melanoma, probably associated with lots of unprotected sun exposure when young and when sunburn and tanning were promoted  as culturally appropriate, In those days, the "healthy look" included a significant tan, but if one's ancestry included a fair skin, that look presaged trouble years later as strange spots became cancerous and spread.

So now I am surrounded by people whose business cards not only reflect "MD" and "RN" status, but FACR, RTT, Research Coordinator, PH.D, and BSN appellations as well as the initials of the various professional groups and associations to which they belong.  As a person who practiced hematology (involving malignant oncology) I note that medical care no longer reflects a solitary physician-controlled activity, it reflects a team approach involving people who work with - but not necessarily for - the doctor in charge.

Years ago, I  received a published research paper from a university medical school professor whose patient I had informed about the nature of the procedure to which that academic had convinced him to participate (I asked the patient to ask the professor about the benefit that he - the patient - would receive from participating in an invasive and potentially dangerous procedure) bearing the inscription "to Henry Kaplan, MD, without whose help this paper would have been published ___ years earlier"  I consider it a welcome change to see the inclusion of individuals in care who believe - and act on the principle - that he and she are responsible for providing highly competent care to an informed patient even though even though the individual's business card does not say "MD" or "RN".

I'll figure out all of their names somewhere down the line.  I'm sure that I haven't finished accumulating their printed business cards. Pictures on those cards would be a nice addition.

Yesterday, I spent 3 hours at the nearby university hospital which will be providing me with radiation oncology services, met at least 8 non-physician people previously unknown to me and left the facility with the feeling that I had been well cared-for by well trained highly competent professionals who took satisfaction from the work they were doing. 

Medical knowledge has improved. And so has medical care.

A WISH BEFORE SURGERY

My surgeon called yesterday to tell me that he had accomplished every reasonable goal we had talked about, for the surgery performed 9 days' earlier.  It is comforting to know that perhaps those prayers and wishes I had before the surgery were answered. 

My prayers and wishes were probably a little different what my readers might imagine.  So let me share them with you - to give you the advantage of my years of medical practice, sometimes in the operating room when things did not go well during a procedure.

I wished my surgeon a really good night's sleep.  I wished him a terrific relationship with his spouse and a home (including parental) life free of tension and difficulty. I wished him enjoyment of his surgical practice and a good professional relationship with patients, with his surgical team, with the nurses and staff people caring for me, and the hospital administration of the institution where he performs surgery (so that he has the environment, equipment, staffing and supplies appropriate for the day's work).  I wished him the ability to focus specifically on the issues at hand when he performed surgery on me, to the exclusion of any possible distractions, even momentary ones.  I wished him freedom from the oppression of economic burdens, good transportation between his home and the hospital, and a bright sunny invigorating morning which he could enjoy in good health. And I wished him knowledge competence and judgment appropriate for the procedure at hand.

If all of these prayers and wishes were granted, I - the patient - would do just fine. 

And I guess that's what happened.

THE "RIGHT" APPROACH - BUT NO GUARANTEES

The recommendations for surgery were interesting, but I had treated a sufficient number of patients with this aggressive form of skin cancer, and chose to discuss a preliminary option with my physicians.  As described a recent blog post, the purpose in having a  medical test is to get information which will substantively affect patient care decision-making. And the PET scan ordered by my physician, which showed no activity outside the known location of metastatic melanoma, allowed me to accept my physicians' advice to have surgery.

Did this PET scan  offer me a guarantee? No - because no test is 100% accurate or complete (particularly when looking for a few malignant cells outside the known focus of 10,000,000,000 which a cubic centimeter of tumor  may contain). But having the test was rational, appropriate and medically indicated.  I had the surgery six days ago.

Pathology pending.  Further treatment plans pending. More to come.