Posts by Brett Hendel-Paterson

The Gift of Cancer

From the start, let me say that I do not mean to imply that anyone diagnosed with cancer or any other disease is lucky for having received the diagnosis. I also want to emphasize that there is a tremendous spectrum that anyone living with cancer can experience, from benign to devastating. The word “cancer” has a lot of power in our culture.  It can hang as a black cloud over our lives or the lives of loved ones.  We may think of powerlessness, uncertainty, death, pain, suffering, weakness, debility, or a host of other fearful connotations. It is almost assured to suck the air out of any conversation when it comes up. When someone I have not seen in a while asks, “What’s new?” I have to decide whether to bring up the CLL diagnosis and let that hijack the conversation, or to leave it unsaid. But cancer can also…

Do You Want Us to Do Everything, Or…

“One more question:  do you want us to do everything, or do you just want palliative care.”  The first syllable of the word “palliative” emphasized, drawn out, left hanging.  This is one version of the five-second, halfhearted code status discussion for seriously ill patients being admitted to the hospital with either a new disease or an exacerbation of an existing one.  We all have phrases that grate on our nerves, and this is one of mine. There are similar statements that are not much better.  “Well, we’ve done all we can, how about palliative care?”  Or, “You know, I think it’s time to go the palliative route.”  These are sometimes said as providers are backing out the door, mentally and physically disengaging from their patients. We have a problem in our culture with discussions about end-of-life and advanced care planning.  Politicians and pundits use distrust of the healthcare system to…

What’s in a Number – Part II

Numbers – we are surrounded by them in the hospital. The first thing I do in the morning after arriving is “get the numbers.”  Overnight vital sign trends, blood counts, hemoglobins, creatinines, other labs. Myself, my group, my hospital – we are judged by numbers.  Numbers of patients seen, RVU’s, satisfaction scores, length of stay, 30-day readmission rates, and many more. As a scientist, I like numbers.  They are quantifiable. They are “objective,” (though they often fall far short).  I base many of my medical decisions on numbers.  Residents and medical students I teach learn about diseases and pattern recognition in part through numbers (vital signs, labs, other signs/symptoms).  And patients I care for are often hungry for numbers to help them understand what to expect from a disease.  One of the first things a patient or family asks after a diagnosis of a terminal illness is “how long do…

What’s in a Number – Part I

119 – that’s one of my numbers. 3.5 - that’s another one. One hundred and nineteen months is the most recent estimate I could find for median survival for CLL.  Three and a half years is the most recent median time from diagnosis until the first treatment is needed. These numbers recently became “mine” after a diagnosis of chronic lymphocytic leukemia this past June.   But what do the numbers actually MEAN? First some context:  I was in Vietnam on a work trip when I noticed the cervical and axillary lymphadenopathy.  I ignored it for another month until a “curbside” with a friend and colleague who encouraged me to actually get it worked up. I was in the midst of a busy and stressful week on our academic hospitalist service, trying to do my best to teach, lead the team, care for patients, and move people through admission to discharge in…

On Culture, Compassion, and Chronic Disease

You could say that being a doctor was in my blood.  My father is a small town family physician in Fergus Falls, Minnesota.  I watched him take care of patients and families from before birth to after death.  He did inpatient and outpatient care, seeing patients in clinic, admitting them to the hospital, and following them after discharge.  He maintained close connections to his patients, which I admired, and around the holidays there were often gifts of various home-canned treats.  Growing up, the two things that emerged for me were a love of science and a love of helping others.  It sounds cheesy, but this is what I said in my med school application, and they believed me (or at least let me in on other grounds). In my second year of med school I hatched a plan to delay graduation to study abroad.  With a vague notion of wanting…