I can make this devil work for me: A doctor lives with bladder cancer

Dr. Richard Waltman’s story about his own cancer:

Yes, the tumor was there, and yes, I needed a second trip to the O.R., but the procedures went well, the catheter eventually came out, and the BCG treatments [which use something originally developed as a tuberculosis vaccine] have been relatively easy. Most of the time I feel so good that I don't think about my illness. Then it reminds me, sometimes loudly, "This is your bladder cancer speaking; I'm still here."

"No, you're gone," I answer. "The last cystoscopy looked great, and the BCG treatments will keep you away."

"Okay for now," it responds, "but I'll be back." And, you know, it's probably right.

In tournament play, professional soccer features something called "extra time"—an additional 30 minutes in the event of a tie after regulation time. It's the game's way of saying, "We'll give you a little more time. Take advantage of it."

In a way, this is my "extra time," and I have every intention of using it to do what I love most: being with my wife and sons and taking care of my patients. Only I plan to do these things better and enjoy them more.

I've been in practice for 23 years, and my experience as a cancer patient has taught me a few things, and confirmed things I suspected all along.

I can make this devil work for me. I haven't made any formal announcement of my illness at work, but neither have I kept it a secret. I've even told a few patients. One woman, for example, was ready to stop chemotherapy for breast cancer. "What's the use?" she asked me. I told her of my malignancy and treatments. We do it, I told her, because there are people who don't want to lose us, and because we're not ready to lose them. We made a deal: We'd both continue treatment, and we'd both get better.

Advice to cancer patients: Find ways to “make this devil work for you.”

Read another of our cancer survivor stories, or read Dr. Waltman’s source story. Thank you, Helen Haskell.

Not a single fall: A geriatrician’s help

She was 85, with oval glasses, a lavender shirt, and a smile. Small but sturdy, Jean Gavrilles had come in walking steadily, no support required beyond her orthopedic shoes. She said her internist had recommended she come in to see Dr. Jeurgen Bludau, a geriatrician.

She mentioned lower back pain over the last few months, arthritis in her fingers, high blood pressure, glaucoma, some recent “bathroom problems” that required her to wear a pad, and a lung nodule.

A widow with a home near Boston, she had long lived alone except for her Yorkshire terrier. She did her own cooking and cleaning, and managed her own medicine and her bills. She told Dr. Bludau about her day, and her diet, in response to his questions.

Then the doctor asked her to sit on the examining table. She struggled to climb up, her balance teetering on the step. The doctor spent much of the exam time in looking at her feet.

She was doing well, he said—mentally sharp and physically strong. The danger was losing what she had. The single most serious threat she faced was not the lung nodule or the back pain; it was falling.

The three biggest risk factors for falling are poor balance, taking more than four prescription medicines, and muscle weakness. She had two, or even three, of the risk factors, putting her at grave risk of a debilitating fall. Her balance was poor; she walked with splayed feet, and her feet were swollen, with her toenails unclipped. There were sores between the toes, and the balls of her feet had thick, rounded calluses. And she did not seem to be eating enough to keep up her strength. She admitted having lost about seven pounds in the previous six months. She was on five prescription medicines, one of which risked dehydration, which may cause dizziness.

His job was to support her quality of life—here, to help her retain as much function as possible, he said. So he had Jean see a foot doctor (a podiatrist) every four weeks, for better care of her feet. He switched one medicine so it wouldn’t cause dehydration, which could make her dizzy and maybe fall. He recommended a snack, and getting rid of the low-calorie and low-cholesterol food, and having friends or family join her at meals, so she would eat more, and build her strength.

Nine months later, Jean turned 86. She’s eating better, and has gained a pound or two. She still lives comfortably and independently in her own home. And she has not fallen, even once.

Advice for elderly people and their patient advocates: Get a geriatrician!

Read a story about a frail elderly woman, or Dr. Atul Gawande’s source story in the April 30 issue of the New Yorker.