Book
Introduction
- A disease of the soul
- Out of suffering comes wisdom
- How not to be my patient
- Your best bet -- the daily double
Overview of How Not to Be My Patient
If you could have three wishes, would one of them be that you would never grow old? That you would never get cancer or another scary disease? Edward T. Creagan, MD, writes a prescription for living a long and vigorous life. No scams. No snake oil. No mystery potions or powders. Everything you need, you already have.
In his amazing formula for survival, Dr. Creagan empowers readers to take responsibility for their own health for one simple reason: "No one has a greater stake in your health than you do." Lifestyle issues and early detection, not high-tech toys with names such as CT, MRI and PET, figure prominently in Dr. Creagan's prescription. Readers will feel empowered because this sound advice is coming, not from a celebrity doctor or a movie star who discovers a new diet plan, but from a cancer specialist who see patients every day in clinic and has delivered the stunning words, "You have cancer," to more than 55,000 men and women over the course of his brilliant 30-year career at the Mayo Clinic.
It's a fact: More than half of all cancers are related to lifestyle choices: what we eat or don't eat, if we exercise, how we handle stress, whether we drink and smoke. Dr. Creagan explains how every lifestyle decision we make, from what time we go to bed to what we eat for breakfast, might make a big difference in our long-term survival - whether we ever develop a life-threatening disease or live longer with one. He turns the biology of living longer into a prescription for survival.
Hand-in-hand with the preventive power of lifestyle choices comes early detection of disease. The mantra of screening for detection of disease in its early, treatable stages is embedded into the fabric of the Mayo Clinic and is the watchword of the American Cancer Society, with whom he is closely tied. Dr. Creagan, in a frank exam-room-type chat, explains to each reader how the physically fit and spiritually focused among us, with a support system intact, will do far better with any illness thrown at us than the isolated, disenfranchised warrior.
Dr. Creagan walks us through the screening tests we need, when to have them, and what the results really mean. Readers will find answers to the questions they wish they could ask their own doctors and discover surprisingly revealing insights about testing and test results doctors never have (or take) time to tell patients. It's as if the reader is inside a Mayo Clinic exam room with all the time in the world to ask questions and hear answers from one of the most authoritative medical sources. Doctor visits will never be the same once readers arrive at doctors' offices armed with this new knowledge by feeling empowered to be the smartest patients their doctors have ever treated. Dr. Creagan shows how to cement that partnership because he, the "go to" cancer specialist, doesn't want any reader to ever become his patient.
The news of a dreaded disease such as cancer comes like a sledgehammer into the stomach, devastating millions of Americans each year. With those words, "You have cancer," patients and their families are launched on a journey of a lifetime that often involves technical medical decisions made during tense emotional times. Dr. Creagan presents the essential knowledge every patient should know and follow, no matter what the diagnosis. These observations from the bedside are among the most insightful tidbits of inside medical information available anywhere.
Dr. Creagan helps readers chart a steady course and make sense out of chaos when life is interrupted with a scary diagnosis. Readers become students in Medical School 101 taught by a doctor who has taken the journey of dreaded disease with his patients (plain folks, farmers, and rock stars, politicians and princes) and their families. He explains how readers must sit in the driver's seat, how to talk frankly with their doctors, how to understand their diagnosis, and what to do when something goes wrong.
Americans fear cancer more than any other medical condition. The reality is that cancer can be detected early and treated. And the best news is that with understanding and armed with knowledge, readers can become empowered partners in their own health - from prevention to early detection to treatment.
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THE BOOK'S INTRODUCTION
How Not to Be My Patient
Edward T. Creagan, MD
"He has cancer," they would whisper with pity and dread. The residents of my grandmother's rooming house would go to great lengths to avoid John G., the unemployed factory worker in room 212, as if somehow by even talking to him they would catch his horrible disease.
Most residents of 615 Hunterdon Street were down and outers, renting rooms by the day, week or month. Most were unemployed, but a few worked at a neighboring bar called the PON, Pride of Newark (If there ever was a contradiction in terms, this was it!), if they weren't on the other side of the bar struggling with the battle of the bottle.
Having cancer in 1952 was as close to a death sentence as awaiting the electric chair from prison's death row - perhaps faster. What we didn't know then about cancer could fill volumes. But for me, a precocious second-grader living with my Irish immigrant grandmother who owned the 22-room rooming house in the ironbound section of Newark, New Jersey, being around someone with cancer was a defining moment - maybe not in medical history but in mine.
You see, the gentleman in room 212 had a colostomy - his bowels emptied into a bag on the outside of his body because colon cancer had destroyed part of his intestine. I was able to comfortably change his appliance (bag) and simply knew that this is what I would do for the rest of my life. That was the way it was. No debate. No discussion. I just knew. This was my first experience with cancer. I was eight years old.
My first clinical encounter was as a second-year medical student at New York Medical College. The year was 1968. I was assigned an elderly black woman with advanced cancer of the stomach. Sunken eyes, hollow cheeks, skin stretched over bare bones - she was a living cadaver. When I first walked onto the ward and saw her, I thought she was dead. But I found the courage to approach her bedside.
Who was this woman? Did she have a family? What made her laugh or cry? What biological nightmare brought her to this dismal fate? I found it intriguing - fascinating in a morbid way - that one cell went haywire, robbed her of her future and eventually resulted in her death. She had no chance for a reprieve.
How did this happen? I was "hooked" on the journey to find answers to the cancer question. My classmates thought I was crazy to deliberately seek out the cancer patients. It was hopeless, they said. I was wasting my time and efforts. They were wrong.
I was initially attracted to the biology and the genetics of cancer and was intrigued with the notion of mixing various types of chemotherapy (chemicals used for treatment), then adding radiation and immune-related treatments. But it was soon obvious to me that my attraction was not a fascination with cancer as a disease of the body but cancer as a disease of the soul.
Over these past 30 years, I have pursued a path chosen years earlier in a grungy rooming house helping a sick and sad old man. Through him and the 55,000 other cancer patients I've worked with at one of the world's foremost medical centers, I have discovered the majesty and the resiliency of the human spirit. I learn from my patients. I listen to their stories. And I learn to treat each day as a gift. A day not to be wasted.
In effect, the oncologist (the cancer specialist) becomes the spiritual leader -- priest, minister and rabbi -- for patients and their families. I'd estimate that at least 70 percent of our time is spent simply listening to patients and hearing their stories rather than dripping toxic chemicals into their bodies.
As a physician, I'm inspired to hear the survival skills and tactics of patients who are at risk of being crushed by life's unfairness. It is their eleventh hour. And no Governor is standing by on the hotline to commute their sentences. Those stories keep me going.
Every cancer patient is surrounded by a litany of emotional nightmares: the prodigal son who did not return; the wayward daughter who never comes back; the mortgage which is never paid off; the business reversal; shattered dreams; now-adult children born from moments of indiscretion unknown to the rest of the family; and missed opportunities (especially the chance to say, "I'm sorry" or "Forgive me").
The most painful words I hear far too often are these: "I will never know how good I could have been. Maybe I could have made the big time, and now there is no time left." Yet, somehow, these patients continue to thrive and are a tremendous source of courage and admiration.
What I have learned from them is not to sweat the small stuff, to savor each moment, to grasp it firmly, and to try to make the world a little bit better than it is right now. For me, each patient is a gift to be cherished.
The oncologist has "defining moments" every day if he or she takes the time to listen. Everybody has a drama. If we are patient, we doctors can come to know the human spirit.
The number one fear of the person on the street is not heart disease, AIDS or arthritis. It is cancer. Public speaking is a close second, I am told.
We are each put on this planet to do something that no one else can do quite as well as we can. The lessons from thousands of patients are that everyone has a story. The overarching need of every human being is for recognition and acknowledgment. We want to be listened to, not preached at. We each say, in a special way, make me feel important. I am unique.
Someone once said that every one of us has at least one book, and perhaps this is mine. I write this book so that you can avoid cancer but also that those who are diagnosed with cancer and their families can understand the reality of cancer. As a patient, you must become the most empowered, the most knowledgeable person about your disease - because you are in charge of your decisions about treatment. No one has a greater stake in your health than you do.
"You're the doctor," some patients say, implying that I should tell them what to do. "No," I tell them. "You are the patient, you are in charge. Together, we will take this journey."
Sometimes, together, as doctor and patient, we may have to look at the relative futility of trying to treat advanced disease with current treatment plans. Many cancer treatments may worsen quality of life, and patients need to understand this reality. But let me be perfectly clear: For some cancers, the track record with current treatment is positive, hopeful and holds the potential for cure, even in the face of an aggressive, widely spread cancer.
Let me share an amazing story. In fact, throughout these pages, I will introduce you to people I have come to know in my own journey. It was 1983. I had the privilege of evaluating a 56-year-old man for advanced lung cancer. He was referred to us at Mayo Clinic from a prestigious medical institution in the Midwest. When I asked him what he was told about his illness there, he said, "They told me to pick out a good blue suit and six pallbearers."
He has returned to my clinic every year for the last 17 years. He has the same blue suit. Five of the six pallbearers are dead, and his original oncologist is in a nursing home. He always asks me how I am doing. Astonishing! He has lived with cancer and he asks me how I'm doing!
This is what keeps us cancer specialists coming back.
My father had a serious medical condition. He had an aversion to something called "gainful employment." He was intrigued with numbers and horses and was convinced that there were reasonably predictable patterns of why some horses won races and some did not. He parlayed this passion into a career as a professional handicapper. As a young boy, I spent many days at his side in Parimutuel Palaces. They had exotic names such as Aquaduct, Gulfstream Park, Hialeah and Saratoga.
He spoke in the argot of the shadowy world of the track. Terms like speed ratings, track variance, the "smart money," post-position and track bias, blinkers, run-down bandages, shadow rolls, shippers, maiden claimers and bug boys were factored into decisions of whether to bet or not to bet. I never remember my father working, but I do remember him driving new Cadillacs and wearing $600 suits. He was very successful at what he did.
I inherited his fascination with the Sport of Kings and eagerly await the arrival of the Triple Crown. Most of us know the names of some of these races: the Kentucky Derby, mile and a quarter, the greatest two minutes in sports; the Preakness, 1 3/16 miles, Baltimore; and the Belmont, the mile and one-half route in New York that often signals the end of many thoroughbreds' careers. Three-year-olds were not meant to run that distance, especially under imposts of 126 pounds.
I learned a lot at the track - far more than from any courses in sociology. Rule #1: Be nice to everybody. The folks you meet on the way up the food chain, you will certainly meet on the way down…and they have real good memories. Rule #2: Never invest in anything that eats or that needs to be repainted. Now what does this have to do with health and wellness?
The casual bettor at the track will consistently lose his shirt, drawers and everything else without some understanding of the Daily Racing Form, an arcane publication with reams of data on past performances of horses. The medical game is played the same way.
Consumers of health care need to understand how the game is played. Medicine is at the crossroads. There are presently 77 million baby boomers marching in lock-step cadence into their 60s and 70s. These are the ages when they will place crushing pressures on the health care system. As every reader knows, we are faced with a crisis in accessing medical care. Sure, if you have crushing chest pain and go to the emergency room in a major metropolitan area, most likely you will get excellent care. But if you have a routine, nagging concern, you may have great frustration getting an appointment. You may not even see a doctor but may see a "mid-level provider" such as a nurse practitioner or physician extender. Each plays a very important role in medicine. The sands of time are changing, and Marcus Welby, MD, is quickly fading from the scene.
Another part of this drama is much less publicized. Bureaucratic strangleholds on medicine and a bewildering number of regulations are driving physicians to retire at younger ages and at higher rates than ever in the past. If you doubt me, ask your doctor, especially if he or she is older than 50. Large numbers of patients need care. Fewer physicians are available to deliver care. And patients are bombarded with information on the Internet. What's a person to do?
Your best bet - the daily double
It is hardly rocket science: An ounce of prevention is still well worth a pound of treatment. Early detection of disease and lifestyle choices are your best daily double as we head into an environment of cost containment and the ratcheting down of access for medical services.
I'm going to share with you how to make the best choices, the most important choices, you will ever make in your life. And I'm not talking about track tips or stock tips. By the time I see most of my patients, they have weeks, not months, left to live. Let there be no doubt, they are courageous, and we have many, many success stories that defy what we know about cancer. But truth be known, half of our patients never needed to walk into exam rooms because their cancers were related to lifestyle choices they made along the way.
I'm not placing blame or guilt. There is little merit in looking back. I'm telling you the reality. And in this book, I will tell you what you can do, for yourself and your family, so you won't ever be my patient.
Although we cannot prevent all cancers and all dreaded diseases, we can place ourselves "on the rail" in a position to make the final sprint to the finish line. A guarantee? Of course not, but what I learned at my father's side at the track is that we can shift the odds in our favor if we have the knowledge to be proactive and involved in the most important race of our lives.
You can bet on it.
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