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Four Legs & a Tail

Posted Aug 26 2008 11:25pm
Or: The hunt for the right oncologist
My original oncologist, my first and only, is deadpan but with no humor. I found him increasingly hard to talk to. He also didn't return my shrink's first call about possible drug interactions (didn't get the message, oh well) and he was dismissive about the clinic's not booking me for my last chemo treatment. When I told my shrink I was going to switch doctors, she said she hadn't wanted to tell me before, but she'd heard this guy was difficult. My friend M from yoga likes her oncologist a lot ("I tell her all about my personal life") but I looked the doctor up and she doesn't specialize in breast cancer. My student B likes her oncologist a lot ("We just talk about writing") but he's at another hospital. My friend T likes her crusty female oncologist in her early 70s, but I thought I don't want crusty. I want soft, even on the outside. And since I'm going to be seeing an oncologist for the rest of my life, I don't want to start with someone near retirement. I asked my surgeon's nurse for suggestions and she gave me names of two female oncologists that she found easy to talk to. One had no publications. The other, according to the web, is interested in breast cancer, colon cancer and genetics. Since my grandfather had colon cancer (twice), I thought she'd be a good choice. She also smiles in her picture and looked young and open. My friend P made inquiries of her friend who's a chaplain at Fancy Hospital, but I was getting confused with all the options. I decided to go with the breast-colon-genes gal with the curly hair. By chance, she showed up at my genetic counseling appointment where I got the results. She seemed friendly.

It seems everyone these days has an oncologist. And we just accept. One in eight. That's fine. That's how it is. And some of those one in eight will die of breast cancer. Oh well. Tie a pink ribbon 'round the old oak tree, to remember me by.

The appointment was Friday. I thought I would take myself afterwards to the Shedd Aquarium to see the lizard exhibit. I'd been meaning to see it since I love lizards (I grew up chasing green anoles through the bushes), but during the summer the lines at the Shedd were out the door. It makes me happy to watch lizards. L urged me to ride my bike (he's always urging me to ride my bike) to the hospital and that way, I could take the lakefront right to the Shedd. That sounded good. I'm always afraid to ride my bike because I imagine my death by car-crush at every moment, but once I get on it, I'm fine. I hadn't ridden that far for a while. It was an easy ride, about four or five miles. L and I arrived at Fancy at the same time and we took the elevator up to Ye Olde Cancer Floor. The receptionist said the wait would be about 20 minutes. After less than that we were shown to the examination room. I took off my t-shirt and put on the hospital gown. It had a safety pin in it. Not just a safety pin, but one bent at the top, as if it had gone through the wringer a few times. There is nothing safe about having a safety pin on a hospital gown, so I threw the pin away.


The physician's assistant came in and seemed alive and interested and knowledgeable. We talked about my hot flashes, which she took seriously. I told her about the three anti-despair medications I'm on, and told her my shrink had concern about an interaction with Tamoxifen, which it was clear I was going to be taking. Then she left. Then we waited. Then we waited. Then the nurse came in and said the oncologist was coming, but she was delayed. I asked why. Could be she had to give bad news, she said. I told L, Aren't oncologists always giving bad news? but even as I said it, I knew that wasn't so. I'm hoping to never get bad news from an oncologist. But it's true, if you're seeing one, you know you're already in trouble.



Two hours after the time of the initial appointment, the curly-haired oncologist came in. She made the mistake of asking how I was. I told her. I said I was annoyed at having to wait so long. She said she was sorry and that she'd spent 15-20 minutes looking to see how Cymbalta interacted with Tamoxifen. I said, Aren't all my medications listed in the computer, so that you could have looked it up already? Believe me, I said this in a calm way. She said she doesn't have time to consult with patients' charts two days before an appointment. She looks at them right before. She said that there aren't studies about Cymbalta and Tamoxifen because Cymbalta is new, but Effexor, which is similar, has been studied and it seems safer. (Effexor is also supposed to help with hot flashes, but she said if Cymbalta wasn't helping them, Effexor probably wouldn't either. Tamoxifen is also known to bring on hot flashes.) She said she would see if my psychiatrist could make the change. She gave me a prescription for Tamoxifen but told me not to start taking it until I heard from her or the physician's assistant. She touched me on the leg when she walked in and while she was talking to me. It seemed a little scripted. (Touch patient to establish humanity.) I asked her about Vitamin E for hot flashes and she said that it had the same success rate at the placebo, but I could try it. I asked if E was safe because the oncology nutritionist had told me not to take it any more. The oncologist said, You just shouldn't take it during chemo. I said, She was talking about after chemo, because there have been reports of cardiac problems. The oncologists brushed that aside. You'd think people who worked down the hall from one another would agree. I guess not. She said it's not clear that I'm menopausal and that I should take another FSH test, either then or later. I said, Well, I was going to go somewhere, not wanting to tell here I was counting on seeing the Komodo Dragon. I realized I wouldn't get to the aquarium before it started to close. So I decided I'd take the blood test then.

I'm not sounding angry, because my anger has dissipated. But I was still angry that she was late. After she left, L said I shouldn't switch again. You've already burned one bridge (oncologist #1), he said. I don't want to keep having appointments with new oncologists. He left and I got the blood test. The phlebotomist was friendly and she said she recognized me. She talked about surgery she'd had on her thumb. It's common with people who take blood, she said, because of repetitive motion. What exactly? I asked her, and she said she's always using her thumbs, to pick up tubes and so on. Or did she say the injury was common in nurses? I don't remember. In the hallway I saw the very very nice nurse-phlebotomist who always commented on my earrings. She was so very friendly. I was surprised that she remembered me. Is that all I want, someone to remember me? I want an oncologist who remembers all the little facts of my case. That's what I want. I'm assuming all the ones at Fancy Hospital have the same access to medical studies and research. I'm just trying to pick the softest medium for the message.

Afterwards L called and asked how I was. Angry, I said. You can be a little angry, he said, but you shouldn't be very angry. I can be however angry I want, I said.

I decided to stop at the dog shelter, so that I could at least see some animals. (There are cats there, too, but who would want to see cats?) I was on my way there when I saw my friend R, whom I'd run into downtown the day before. She loves dogs and came with me to the shelter. It smelled and there were no hounds, only terriers and shepherds and labs and a mix that had that disturbing Rottweiler jaw. I have to admit, the Jack Russell was cute. It's upsetting to see how small the cages are. R made a donation on the way out. Your Shabbat tzedakah (charity), I commented. She asked if it counted if the recipient was animal and not a person. Oh yes, I said.
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