My family was always a bit of an anomaly in the backwoods of West Virginia; as the last grandchild of the clan, I had a half-dozen much older cousins who were doctors - a radiologist, a heart surgeon, a - literally - brain surgeon, even a dentist or two - but the greatest influence was Doctor Paul A, the local general practitioner, as they were called in those days.
He'd been trained in the late 'thirties, when coal-miner was the highest aspiration of anyone he knew. His family was so poor that in medical school he hitchhiked from Richmond, Virginia across the Appalachian Front and back every two weeks, bringing his laundry home for his mother - my dad's sister - to wash the required white shirt and tie, since he didn't have the money for laundry. He was the kindest, gentlest, most dignified man I ever met - and a giant. I remember how odd it was to watch him write a prescription; the pen just disappeared in his giant paw. (Thank God he didn't go into gynecology!) He told me that when he visited home, his mother always had a few dollars for him; he always wondered how she scraped it together. (I knew; her brother - my father - made bootleg whiskey and she sold it. Their other brother, the constable, kept down competition. Paul died without knowing the answer to his question, and I never told him. That's how it's done among mountain people.)
My best memory of him was when he described getting this new drug - penicillin - to try. In those days, nothing was resistant to penicillin, and after treating several cases of pneumonia - so universally lethal to old people that in those days it was called, "the old man's friend," he became famous as a "pneumonia doctor" and spent the next few years shuttling all across the coal fields treating that dread disease.
He had an abiding respect for cancer, though. He related that, after the unparalleled success of antibiotics, the doctors were told that "cancer would be cured in the next ten years." That was over seventy-five years ago. Now, with CRISPR and genetic sequencing available, that may finally just be true. Let's hope.
My wife and I had a wonderful daughter, Molly, who was diagnosed with a bi-thalamic glioblastoma when she was four. Any of you who know anything about cancer know what the ultimate outcome of this story was, but we fought and fought for as long as she could.
At one point we were hopeful that it was a benign astrocytoma and she received weekly chemo treatments that were not helpful. We hoped that her continued decline was being caused by hydrocephaly so we pushed for surgery which was also not helpful except for allowing surgeons to get a piece of the tumor to confirm the worst, that her tumor was not benign. Additionally, shortly after the surgery, she suffered a stroke that left her unable to move or talk.
I struggle with our decision to push on with aggressive treatment after that, still worrying that she was in terrible suffering and pain, but she fought on. When a doctor suggested that we give up, I fired her, telling the team, "You cant give up because I cant give up - because that little girl in the next room is not going to give up until she wins. We'll do our job and keep fighting - you go and do your job. Go find the cure for Molly and other kids."
The treatment was grueling - intense radiation every week and daily chemo - and my wife and I, with family and friends, never left Molly alone. After 2 1/2 months of this, the treatment was finished and we had to wait 4 weeks for inflammation to subside before we could get a PET scan and a CAT scan.
Why bore you all with this sad story that is unfortunately too common? To let you know what our doctor's reaction to the results was.
After waiting for hours in a waiting room, our nurse came out beaming, telling us that the doctor wanted to show us the results himself - the tumor had shrunk by more than 50 % and its activity had pretty much gone away. The doctor couldn't take his eyes off the screen and he just slowly shook his head.
I was overjoyed and said, "Thank you so much for all of your hard work, doctor." Never taking his eyes off the screen in front of him, he just said, "Don't thank me, Tim - there are bigger hands than mine at work, here." I'm still dumbstruck by his words, 12 years later.
Unfortunately, after a beautiful summer with our daughter, her cancer did return, and it grew and took her. We grieved and mourned and were sure that we would never survive her loss, but we're still here and we did have another daughter a couple of years later. Life is good and beautiful and even though I miss my Molly ever second of every minute of every hour of every day, I am grateful for having had her in my life and know that those bigger hands are always there for me, my wife, and our family.
Doctors like Dr. Prasad might not always be miracle workers, but their hard work and sacrifice sustain all of us and we respect and love them for it.
It isn't just that we never hear of the cases such as the one you described, but we never hear too much about the doctors like you, who in their infinite humanity, put the patient and their oaths above all. My late wife had such a doctor; her version of this awful disease was much different, but I will never forget those who gave us the extra time we had. Yes, the system is completely bereft of any humane calculation but people made it that way, and smarter and better people can still beat it, or at least break even.
I was a pediatric oncology nurse back in the day. Most people say, how did you do that, it had to be so depressing. I would always tell them that the kids were so resilient and uplifting. I would also explain how great it was to connect with the parents who would just love to talk about anything but their child’s cancer. It sounds strange but we had so much fun, and of course we also dealt with the unbelievable sadness in between. I am grateful for the perspective it gave me as I raised my own children. I just wanted to say, that I totally understand why you chose oncology, and we are all lucky that you did.
Huge lump in my throat and wiping tears - I too was treated for this same cancer 18 yrs ago so this story and your dedication to this horrible disease is particularly touching for me. The gratitude that I felt toward my healthcare team was and is to this day, immeasurable. I also wondered how they did it...you've helped me understand. "Thank you" just isn't enough, but I'll add yet another - you are a white-coated angel.
Dr. Prasad, I believe we have an essence about ourselves that is often revealed in what we pursue in life professionally and personally. Thank you for sharing your essence that drives your why.
Great, and uplifting piece!! What a privilege to be a Physician!! I am a surgeon and feel exactly the same way. Thank you for your wonderful care ! “The secret to caring for patients is caring for patients “
I have to put a plug in for “Emperor of Maladies” wonderful book about cancer!!
A beautiful Thanksgiving story giving me hope that, even though our system is corrupt beyond belief, we will be ok because of compassion that most in healthcare pour out in a not-so-easy profession. Thank you, Dr. Prasad, and doctors like you, who dedicate your life to healing. We need you more than ever.
I don’t how many readers will read these words by Dr. Prasad, shrug, and think it’s ok. It is not ok. Our medical system has become an abomination, a vast honey pot for commercial players obstructing good doctors in order to make obscene profits in ways only insiders understand. The system can be reformed, without being nationalized, but public indifference and resignation to the wholesale corruption is the first, most important obstacle: “I knew the system was corrupt and often an obstacle to good care. I knew it’s the doctor’s job to deliver the best care to the patient, and that the wishes of the hospital, the university, the insurance company, and the drug company don’t matter.
Any obstacle to the best outcome for my patient is an obstacle that I’m unable to accept. I had practiced, and keep practicing to this day, all the techniques to manipulate the system for the best interests of my patient. I am willing to do anything, including: playing nice, kissing up, escalating the situation, putting pressure on the system, public shaming of the organization, and advocating for my patient relentlessly. I was skilled at documenting in the way necessary to facilitate good care. I was practiced in defeating useless hospital bureaucrats, and incompetent insurance reviewers to get the right treatment for my patient.@
I have huge respect for doctor’s like VP. I am currently a stage 4 cancer patient (melanoma) and only 31. My oncologist specializes in melanoma and, thankfully, is also a research doctor and assistant professor. She literally saved my life when MD Anderson said there wasn’t anything more to do (they were my second opinion when I had gone through all the standard of care). She looked through old trial data to find something that would save my brain from more brain tumors and found Yervoy (3x dose) + Temodar. Yervoy is the only drug that works for me and I’ve been on it three times now. That study she found? It was done at freaking MD Anderson.
Jim Wills, as usual, is being entirely too modest. He was one of the best residents I ever trained. He may talk about his uncle with great reverence, which I’m sure is well deserved. But je hasn’t said a word about what he’s done to take care of patients. Let me give an example of how quietly—but competently—aggressive he can be in the role of caretaker.
Once upon a time at a university hospital, there was a staff radiologist we’ll call Dr. A. Dr. A, like other academics, had his own teaching file (TF), which is a set of copies of x-rays of patients that are educational or otherwise interesting to the person who owns them. This was in the days before we used digital imaging, so a TF consisted of actual film. The way it worked was that you would make copies of images. It was pricey, but it was an unstated/understood perk of being in academic medicine.
Dr. A got an offer to work at another hospital far from ours and he accepted that offer. He hadn’t played well with most of the people at our place; no one was very sad to see him leave. He assembled his TF and had it in his office waiting to pack it up. One Monday morning he came into my office, obviously agitated and asked me if I had heard what happened. No clue what he was talking about. My teaching file! Someone stole it! Who steals a TF? No one else would know what each case illustrates. He didn’t believe me and suggested as much.
Eventually the back story emerged: he had simply gotten ready to steal original films on then-current patients. No copies made. A radiologist’s best friend is the old film--it lets us compare what we see with things looked like before: to the degree that any examination is a sort of experiment, the old film is the control arm for it. No number of words allows that; seeing is believing. When I heard that part of the story, I knew who was behind the counter-heist. My only question was whether it had been a solo effort.* Jim is a kind of Renaissance man, expert in a lot of areas. One of them involved understanding how locks and lock systems work. He was able to let himself into any room in the hospital.
Miraculously, a few weeks after Dr. A’s departure, his TF mysteriously appeared one Monday morning on the department chairman’s desk. Intact. In environments like that, Robin Hoods often pop up spontaneously. Jim was among the best of them.
* It hadn’t been. He had an accomplice, and it equally obvious who that had to have been. I found this out by finding Jim, who had been doing an angiogram. I looked into the room he was in. He saw me and knew what was on my mind, so flashed a huge smile in my direction, which I reciprocated. Then I said, “I’m trying to figure out a number.” Blank look. “The number might be one, two, or possibly even three.” Puzzled look, then, “Oh. Two!” Another smile. Tom had been the second part of the spoiling raid.
My family was always a bit of an anomaly in the backwoods of West Virginia; as the last grandchild of the clan, I had a half-dozen much older cousins who were doctors - a radiologist, a heart surgeon, a - literally - brain surgeon, even a dentist or two - but the greatest influence was Doctor Paul A, the local general practitioner, as they were called in those days.
He'd been trained in the late 'thirties, when coal-miner was the highest aspiration of anyone he knew. His family was so poor that in medical school he hitchhiked from Richmond, Virginia across the Appalachian Front and back every two weeks, bringing his laundry home for his mother - my dad's sister - to wash the required white shirt and tie, since he didn't have the money for laundry. He was the kindest, gentlest, most dignified man I ever met - and a giant. I remember how odd it was to watch him write a prescription; the pen just disappeared in his giant paw. (Thank God he didn't go into gynecology!) He told me that when he visited home, his mother always had a few dollars for him; he always wondered how she scraped it together. (I knew; her brother - my father - made bootleg whiskey and she sold it. Their other brother, the constable, kept down competition. Paul died without knowing the answer to his question, and I never told him. That's how it's done among mountain people.)
My best memory of him was when he described getting this new drug - penicillin - to try. In those days, nothing was resistant to penicillin, and after treating several cases of pneumonia - so universally lethal to old people that in those days it was called, "the old man's friend," he became famous as a "pneumonia doctor" and spent the next few years shuttling all across the coal fields treating that dread disease.
He had an abiding respect for cancer, though. He related that, after the unparalleled success of antibiotics, the doctors were told that "cancer would be cured in the next ten years." That was over seventy-five years ago. Now, with CRISPR and genetic sequencing available, that may finally just be true. Let's hope.
God bless you, Dr. Prasad, and all the good doctors out there fighting the uphill battle against our depressingly corrupt healthcare system.
My wife and I had a wonderful daughter, Molly, who was diagnosed with a bi-thalamic glioblastoma when she was four. Any of you who know anything about cancer know what the ultimate outcome of this story was, but we fought and fought for as long as she could.
At one point we were hopeful that it was a benign astrocytoma and she received weekly chemo treatments that were not helpful. We hoped that her continued decline was being caused by hydrocephaly so we pushed for surgery which was also not helpful except for allowing surgeons to get a piece of the tumor to confirm the worst, that her tumor was not benign. Additionally, shortly after the surgery, she suffered a stroke that left her unable to move or talk.
I struggle with our decision to push on with aggressive treatment after that, still worrying that she was in terrible suffering and pain, but she fought on. When a doctor suggested that we give up, I fired her, telling the team, "You cant give up because I cant give up - because that little girl in the next room is not going to give up until she wins. We'll do our job and keep fighting - you go and do your job. Go find the cure for Molly and other kids."
The treatment was grueling - intense radiation every week and daily chemo - and my wife and I, with family and friends, never left Molly alone. After 2 1/2 months of this, the treatment was finished and we had to wait 4 weeks for inflammation to subside before we could get a PET scan and a CAT scan.
Why bore you all with this sad story that is unfortunately too common? To let you know what our doctor's reaction to the results was.
After waiting for hours in a waiting room, our nurse came out beaming, telling us that the doctor wanted to show us the results himself - the tumor had shrunk by more than 50 % and its activity had pretty much gone away. The doctor couldn't take his eyes off the screen and he just slowly shook his head.
I was overjoyed and said, "Thank you so much for all of your hard work, doctor." Never taking his eyes off the screen in front of him, he just said, "Don't thank me, Tim - there are bigger hands than mine at work, here." I'm still dumbstruck by his words, 12 years later.
Unfortunately, after a beautiful summer with our daughter, her cancer did return, and it grew and took her. We grieved and mourned and were sure that we would never survive her loss, but we're still here and we did have another daughter a couple of years later. Life is good and beautiful and even though I miss my Molly ever second of every minute of every hour of every day, I am grateful for having had her in my life and know that those bigger hands are always there for me, my wife, and our family.
Doctors like Dr. Prasad might not always be miracle workers, but their hard work and sacrifice sustain all of us and we respect and love them for it.
It isn't just that we never hear of the cases such as the one you described, but we never hear too much about the doctors like you, who in their infinite humanity, put the patient and their oaths above all. My late wife had such a doctor; her version of this awful disease was much different, but I will never forget those who gave us the extra time we had. Yes, the system is completely bereft of any humane calculation but people made it that way, and smarter and better people can still beat it, or at least break even.
I was a pediatric oncology nurse back in the day. Most people say, how did you do that, it had to be so depressing. I would always tell them that the kids were so resilient and uplifting. I would also explain how great it was to connect with the parents who would just love to talk about anything but their child’s cancer. It sounds strange but we had so much fun, and of course we also dealt with the unbelievable sadness in between. I am grateful for the perspective it gave me as I raised my own children. I just wanted to say, that I totally understand why you chose oncology, and we are all lucky that you did.
Made my day. Thank you.
Dr. Prasad is why, despite all the craziness and tumult of the past few years, we continue to love and respect our doctors.
Huge lump in my throat and wiping tears - I too was treated for this same cancer 18 yrs ago so this story and your dedication to this horrible disease is particularly touching for me. The gratitude that I felt toward my healthcare team was and is to this day, immeasurable. I also wondered how they did it...you've helped me understand. "Thank you" just isn't enough, but I'll add yet another - you are a white-coated angel.
Dr. Prasad, I believe we have an essence about ourselves that is often revealed in what we pursue in life professionally and personally. Thank you for sharing your essence that drives your why.
Great, and uplifting piece!! What a privilege to be a Physician!! I am a surgeon and feel exactly the same way. Thank you for your wonderful care ! “The secret to caring for patients is caring for patients “
I have to put a plug in for “Emperor of Maladies” wonderful book about cancer!!
Really happy to have read this today. You changed her life not just with treatment but with your kindness
A beautiful Thanksgiving story giving me hope that, even though our system is corrupt beyond belief, we will be ok because of compassion that most in healthcare pour out in a not-so-easy profession. Thank you, Dr. Prasad, and doctors like you, who dedicate your life to healing. We need you more than ever.
I don’t how many readers will read these words by Dr. Prasad, shrug, and think it’s ok. It is not ok. Our medical system has become an abomination, a vast honey pot for commercial players obstructing good doctors in order to make obscene profits in ways only insiders understand. The system can be reformed, without being nationalized, but public indifference and resignation to the wholesale corruption is the first, most important obstacle: “I knew the system was corrupt and often an obstacle to good care. I knew it’s the doctor’s job to deliver the best care to the patient, and that the wishes of the hospital, the university, the insurance company, and the drug company don’t matter.
Any obstacle to the best outcome for my patient is an obstacle that I’m unable to accept. I had practiced, and keep practicing to this day, all the techniques to manipulate the system for the best interests of my patient. I am willing to do anything, including: playing nice, kissing up, escalating the situation, putting pressure on the system, public shaming of the organization, and advocating for my patient relentlessly. I was skilled at documenting in the way necessary to facilitate good care. I was practiced in defeating useless hospital bureaucrats, and incompetent insurance reviewers to get the right treatment for my patient.@
Well this was a tear jerker, in a nice way.
Happy Thanksgiving, for all concerned.
I have huge respect for doctor’s like VP. I am currently a stage 4 cancer patient (melanoma) and only 31. My oncologist specializes in melanoma and, thankfully, is also a research doctor and assistant professor. She literally saved my life when MD Anderson said there wasn’t anything more to do (they were my second opinion when I had gone through all the standard of care). She looked through old trial data to find something that would save my brain from more brain tumors and found Yervoy (3x dose) + Temodar. Yervoy is the only drug that works for me and I’ve been on it three times now. That study she found? It was done at freaking MD Anderson.
A noble man following a noble tradition of a noble profession.
Jim Wills, as usual, is being entirely too modest. He was one of the best residents I ever trained. He may talk about his uncle with great reverence, which I’m sure is well deserved. But je hasn’t said a word about what he’s done to take care of patients. Let me give an example of how quietly—but competently—aggressive he can be in the role of caretaker.
Once upon a time at a university hospital, there was a staff radiologist we’ll call Dr. A. Dr. A, like other academics, had his own teaching file (TF), which is a set of copies of x-rays of patients that are educational or otherwise interesting to the person who owns them. This was in the days before we used digital imaging, so a TF consisted of actual film. The way it worked was that you would make copies of images. It was pricey, but it was an unstated/understood perk of being in academic medicine.
Dr. A got an offer to work at another hospital far from ours and he accepted that offer. He hadn’t played well with most of the people at our place; no one was very sad to see him leave. He assembled his TF and had it in his office waiting to pack it up. One Monday morning he came into my office, obviously agitated and asked me if I had heard what happened. No clue what he was talking about. My teaching file! Someone stole it! Who steals a TF? No one else would know what each case illustrates. He didn’t believe me and suggested as much.
Eventually the back story emerged: he had simply gotten ready to steal original films on then-current patients. No copies made. A radiologist’s best friend is the old film--it lets us compare what we see with things looked like before: to the degree that any examination is a sort of experiment, the old film is the control arm for it. No number of words allows that; seeing is believing. When I heard that part of the story, I knew who was behind the counter-heist. My only question was whether it had been a solo effort.* Jim is a kind of Renaissance man, expert in a lot of areas. One of them involved understanding how locks and lock systems work. He was able to let himself into any room in the hospital.
Miraculously, a few weeks after Dr. A’s departure, his TF mysteriously appeared one Monday morning on the department chairman’s desk. Intact. In environments like that, Robin Hoods often pop up spontaneously. Jim was among the best of them.
* It hadn’t been. He had an accomplice, and it equally obvious who that had to have been. I found this out by finding Jim, who had been doing an angiogram. I looked into the room he was in. He saw me and knew what was on my mind, so flashed a huge smile in my direction, which I reciprocated. Then I said, “I’m trying to figure out a number.” Blank look. “The number might be one, two, or possibly even three.” Puzzled look, then, “Oh. Two!” Another smile. Tom had been the second part of the spoiling raid.
It was a good day.