 Well, it's like the day that my husband found out he had cancer. His doctor called him in and he was having this pain and so they did a chest x-ray and that's when they were pretty sure it was cancer and so they sent him for a biopsy. Then he just came in the room and you could tell by the look on his face when he was going to tell you. He just said, well, I have really bad news. You do have cancer. However, I have a really good doctor to send you to and he just got out of the issue real fast and didn't really discuss anything with you. It's like he just wanted to hurry up and get you to the next guy so he didn't have to deal with it. I mean, that's how you felt. When it was determined that the axilla node was malignant and probably consistent with lung cancer, although they were not sure. My surgeon had made the diagnosis. When he got the pathology report, his first question was, do you have an oncologist here at the university that you would like me to refer you to? Everything was done very abruptly. He left the room and my husband and I were sitting there waiting to know, well, what happens now? The doctor came back and he said, okay, you can go up and see the doctor. He'll make some room for you in the schedule and good luck. He didn't know what to do with me. I got a call late in the day that a young man was being admitted. He had advanced head and neck cancer and what I was told is there wasn't much to do for him but he was being admitted and I, being very tired hearing, well, there wasn't much to do, put him off until the end. I saw him at about two o'clock in the morning. I was very tired. I went into the room. His head was swollen because of the progressive cancer in his neck. He was gasping for breath. He was short of breath. He was very uncomfortable and I didn't know what to do. I remember vividly rounding on a patient who was facing cancer over the lung diagnosis and she asked my colleague, what would you do, doctor, if you were in my shoes? Well, my colleague did not know what to do. He had not been prepared and he said, well, Mrs. I'm not in your shoes. I don't know what I would do. And he exited the room a little too hastily. This was a wonderful physician. This was a wonderful man. This was a good person who wanted to do well. But this was a person who had not been trained, was not competent, was a little taken aback by that. I had to look within my own self and say, would I have done any better? I would not have. I remember taking care of a patient again through the night, somebody else's patient, another intern's patient, who was a fairly young man dying of metastatic cancer. He had been in terrible pain and at that time was getting injections of morphine. And as the night went on, the imperative that I had inherited from the departing intern was, keep him alive until morning and don't bother the attending physician. So through that night, I went on the one hand, give him more morphine because of the pain and give him Narcan to wake him up, alternating that through the night, through relative rest, catapulted back into wakefulness and terrible pain and I didn't know any better. I remember once being on thoracic surgery rounds, and the thoracic surgeon went into the patient's room, just had had surgery, didn't know the diagnosis yet, sat down in a chair, picked up the newspaper, started to leaf through it, all of us standing around his bed. And he said, well, have you ever been to Paris? And the guy said, no. He said, you gotta go. And then told him he had lung cancer and left. It was astounding and horrible and we all knew that, but none of us were empowered to help that man. We have inherited a curative framework for all of our medical endeavors. And if the curative framework is the only one we operate out of, if we're so inflexible that we can't adopt our framework to meet the needs of the patient, then we are set up for failure. Oncology training is very much focused on treating the disease and I think we still need to learn to treat the patient. There are individuals clearly that are leaders in their field, but it's sometimes by serendipity that you get to be in clinic with them or get to be on service with them and really learn and model yourself after them. The strategies come about, unfortunately, they did for me probably just through practice. And as you take care of each dying child, probably, you get a little better and better at it. If you have a fundamentally caring, empathetic nature, I think it does make you better. I have seen many pediatric oncologists, though, who cannot really deal with it, and tend to withdraw, as I'm sure medical oncologists or surgical oncologists, too, they distance themselves from the patient when they see the end is coming, and that's just when the patient needs you the most and just when the family needs you the most. Patients respond to your emotional connection with them, not to your intellect. The real issue is to convey to them that you're caring and devoted to their welfare. They'll accept the fact that you're an eligible physician based on how you talk to them about the treatment options, your training, how you present yourself. Patient really has no way of knowing whether a doctor is a good doctor or not a good doctor. They look at the wall and they see that he graduated from such and such school, but they don't know how good he is. They learn very quickly what is compassionate, how he feels about people. Is he doing his best? Is he considerate? I think sometimes they feel that you'll look at them as a failure if your loved one dies, when quite honestly you know everybody's going to die eventually and it's not the physician's fault that you got cancer, it's not like he gave it to you. I mean they just have to know that they're human and we know that it's not a mistake. They didn't screw up somewhere, you got cancer, you come to them for relief and their job is to relieve your pain. If they can save you or cure you, that's what you hope for, but if they can't then relieve your pain and make what days you have comfortable. That's all you really want. Medicine has done very well with technology and in some ways the technology has outstripped our ability to take care of people. The blend needs to be more perfect so that we use the technology to truly make people better and that's not just treating the disease, it's making the patient better, which means that if you cure the cancer and you leave them with horrendous symptoms, particularly long-lasting ones, you have to think twice about what you've really provided for that person. And similarly, curative therapy can be given with good symptom control and that's how it should always be given. Because of the kind of patients we see in oncology, it's the ideal field to set the bar, to make pain management matter, to make symptom management across the board be an integrated part of care. At one level, all treatment we do is palliative care. What we're trying to do is to improve their quality of life and the duration of life with good quality. So palliative care is really trying to do just that. It's make patients feel better, make patients comfortable with the situation in which they are in. It can be done relieving any type of symptom that they have that is affecting their life at that time. Science of palliative care is, I think, more and more prominent. Even with all the advances we're having in curative care. I actually don't think there's a distinction and I think that's where we have to train oncologists. There isn't curative care and palliative care, there's care. And oftentimes, even when we're doing curative care, we know it's palliative, life is palliative. Nobody's going to live forever. So everything we tend to do tends to be towards improving that journey. Depends on where you are in that journey. The development of palliative oncology or palliative care oncology really parallels in many ways the progression of oncology as a medical discipline. If you would have asked me what palliative care meant when I was either a surgeon in training or a young surgical oncologist right out of my training, I would have thought that it meant end of life hospice care. After practicing for 12 and a half years as a surgical oncologist, I have many patients who've not only beaten their cancers and survived their care with sometimes very radical surgical procedures. Now I think we're seeing the next evolution of these two specialties where palliative care is being considered as part of the comprehensive care of the surgical patient. I don't think palliative care is anything new. What's new is we actually realize that it's there and it's something that we really need to develop and we need to develop it with the fervor that we are developing new cancer drugs or new anti-cancer drugs. Palliative care has never been so powerful that we as a profession have not yet incorporated this into our armamentarium of patient care is something that we need to urgently fix. The point really is that we have it and we need to make it ours for patients, for their families and ultimately for ourselves. How we treat patients, whether it's heart disease or diabetes or kidney cancer, is how we're going to be treated. I don't want to go through illness with symptoms that can be controlled. I don't think our patients do either. The challenge is to combine our achievements in science. That we know more about the human body than ever before, but it takes more than that to be a physician. We need to combine our expertise in being a scientist with our knowledge of human beings and what it means to suffer.