The patient doctor: Facing the sum of all fears

I walked outside and breathed in the afternoon freshness. I phoned my wife who had been anxiously awaiting my call. She would pick me up outside what we now simply called the Odette—The Odette Cancer Centre at Toronto’s Sunnybrook Health Sciences Centre. I paced back and forth along the sidewalk, testing the integrity of my lower extremities. I was still in biopsy recovery mode when my wife arrived. I got into the passenger seat, not my favourite vehicular placement, belted up and began the detailed descriptives of my travails in the biopsy suite. This conversation continued until I was repatriated home and repeated many times over the next few days. It was replayed in living colour most nights, usually around 3 a.m. I had relatively minor and expected post-biopsy symptoms, nothing that would prompt a call to the “team.” I checked MyChart, as was my established pattern, and on June 22, the surgical pathology report was posted. “Adenocarcinoma” was identified in all of the four targeted biopsies and one in the left mid-region. Gleason score 7/10 ( 3+4). The virtual phone visit with the oncologist was scheduled for June 28, and I would wait for that, somewhat impatiently. There was a lot riding on that phone call. I am not a patient doctor. For almost 50 years I regularly scrutinized similar reports. Patients were then called and booked in for an office visit to review. “Bad news” should never be delivered by phone, email or text if at all possible. Patients were always provided with the last appointment of the day. Partner, spouse, family member(s) always encouraged to attend, and, sufficient time was allotted for questions and answers as best I could provide at the time. There was nothing “virtual” about these life-changing realities. These scenarios demanded the best of our humanity. I could never have imagined being the “patient” under similar circumstances—that is, until now. This would take some serious getting used to. The cellphone rang on the morning of June 28. I put the call on speakerphone so my wife could participate as listener and/or inquisitor should I get bogged down in the devilish details. The oncologist reviewed the report. I informed him that I had studied the pathology report posted in MyChart since the previous week. The conversation turned to therapeutics. There were numerous radiotherapeutic combos, treatment options and clinical studies in which to participate. He spoke of prognostics, survival rates and acute and long-term adverse events associated with each treatment choice. He provided extensive detail and allowed sufficient time for me to articulate an informed decision and ultimately, verbal consent. And now for the acronyms. We spoke specifically about SBRT (stereotactic body radiotherapy) with five fractions (treatment sessions) without gold seeds being embedded, deftly delivered by the MR Linac (MRI-linear accelerator hybrid combination Elekta machine), a recently introduced technology at Sunnybrook and currently the only site of its kind in Canada. The radiotherapy would be guided by MRI, in real-time, in a single delivery system with the oncologist in mission control. The non-invasive nature of the treatment was of particular interest to me. I did not wish to be lithotomized and penetrated yet again with sharp, sabre-like objects. Next up, treatment simulation/planning with both CT and MRI on July 14. These were relatively straightforward procedures. In addition, there was the tattooing, tiny punctuate markings meticulously placed on my lower abdomen to serve as coordinates for the intricate measurements and directional focus of the radiation beam. I had imagined a small crab emoji on my left deltoid as an attractive alternative. Both imaging units were “open,” assuaging my phobic reactions to lengthy tunnel confinements. When I next checked MyChart, the radiation schedule had been posted with the first of five fractions to be delivered on Friday, July 29, exactly four months from the time my PSA’s upward trajectory determined this fateful odyssey. The following two weeks were the ultimate exercise in patience. It had become an interminable and tortuous learning curve for me. I was not a patient doctor, but there would be light at the end of the tunnel.

The patient doctor: Facing the sum of all fears

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Blog Author

HOWARD GOLDSTEIN