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Sometimes sessions with my oncologist resemble meetings with a therapist. Why am I entranced with a woman who continues to prescribe procedures that distress me? The attraction was instantaneous, maybe because I had been so dismayed by her predecessor.
After I first learned I had ovarian cancer, four years ago, the oncologist who appeared at my hospital bedside struck me as shifty. He made his pitch with darting eyes, explaining that the patients he treats are grateful because he lets them off the hook when they are exhausted and want an extra week between infusions. Another person might have found his attitude protective. I found it patronizing.
To be fair to him, I was in a state of shock and would have reacted with revulsion against any oncologist. When I was first diagnosed, the disease felt like a death sentence that needed to be mourned. Neither the promise of a week’s respite during treatment nor the convenience of a doctor’s office minutes from my house could override my (undoubtedly irrational) antipathy.
Should it matter what oncologist we choose, since the “gold standard” of many chemotherapy protocols remains the same throughout many medical institutions in this country? Whether you are being treated at a private practice or in a research center, oncologists tend to recommend similar regimens in response to various cancers. Most patients need to find someone well certified within a 60-mile radius of their home.
But not anyone will do. Unlike surgeons, oncologists conduct their business over a course of months or years. During the many 15- or 20-minute sessions, patients and doctors relate to each other through small talk, one of the most intimate of human exchanges.
Yes, there is the occasional prodding finger, or a stethoscope might appear. But more often the oncologist and the cancer patient engage in conversation. If the doctor seems hurried or arrogant or incomprehensible, it may be impossible for trust to evolve. And, odd as it may seem, trust is the heart of the matter. For few of us patients comprehend the biochemistry of cancer treatments. And without a judicious adviser, how can we calculate the tradeoffs of protocols that may gain us time but pain us in the process?
It was pure luck that I found the perfect oncologist.
Brandishing my list of questions, I traveled to Indianapolis, 50 miles from my home, focusing on my need for brute honesty. There I would see Dr. Daniela Matei, whose Romanian origins, I told myself, would perfectly serve my needs. Who can think about Romania without considering its tormented history, its ruined orphanages and gypsy traditions and gothic vampire myths? She had a background that would make it possible for her to recognize the tragic dimensions of my fate.
My vision of Romanian gloom-and-doom, so hilariously stereotypical, evaporated the moment an ebullient 40-something woman with earnest brown eyes and bouncy brown curls entered the room. Although I could take in only a fraction of the complex medical information she carefully enunciated, she answered every question with candor and understood better than I did that my ultimate outlook was bleak. But she nevertheless seemed to relish her work and even our chat. She was an academic, like me, with an immigrant past not unlike that of my parents. She resembled my young colleagues, except she wore snazzier shoes.
I was overjoyed when I learned that Dr. Matei was a published poet. At the time, I knew this meant we both cared passionately about language. Now I realize that she understands and fosters my need to write . . . sometimes about her.
The strange rightness of our relationship underscores how quirky the needs of cancer patients are. Some people want physicians with the best record of keeping their patients alive the longest amount of time. Others look for a Jewish or an Indian doctor or an older man of high rank. Some put their faith in a particular research center, others in a particular referral system. Some need a good deal of time spent on reassurance, others crave the clarity of honest disclosure, as I do.
Because I trusted Dr. Matei’s truthfulness, I enrolled in many more protocols than I ever thought I would. In return, she gave me a priceless gift. While she implicitly accepted my conviction that the disease would kill me, she offered a limited quantity of quality time — four years in which I have been able to write . . . usually not about her.
Although I profit from the research investigations of Dr. Matei, what I cherish is my sense that she will level with me when medical interventions cannot control the cancer and become pointless, or worse. Our monthly dialogues revolve around our families or our writing, and in the process I believe that she has discerned and respects my values.
As a scientist, Dr. Matei assumes that talking has nothing to do with curing. As humanists, we both know that talking helps me live with cancer and leads me to imagine dying at home, with my family, and not in the midst of debilitating treatments. From small talk, small hopes spring eternal.
To go to original site:
http://well.blogs.nytimes.com/2013/07/11/a-cancer-doctor-of-ones-own/
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