Doctors and patients who battle cancer together can develop a unique bond: corned beef on chemo day.
Claudia Kalb - NEWSWEEK

They are two women engaged in the universal banter of motherhood. "I brought wedding pictures," says Karen Ulisney, pulling out her photo album. "Kristina got married to a great guy. She's so happy." Claudine Isaacs leans forward and smiles. "How old was she when we met?" Isaacs asks. "Sixteen. And Matt was 6," says Ulisney. Isaacs laughs. Ulisney beams. "He's five-ten now. He's such a handsome young man," says Ulisney, flipping to a photo of mother and son walking arm in arm. "You look just a little bit happy," says Isaacs. "I didn't think I'd make it to the wedding," says Ulisney, tearing up. "That was a milestone."

These are not old friends catching up at a coffee shop. The setting, instead, is an exam room at Georgetown University's Lombardi Comprehensive Cancer Center. Ulisney, 51, is a 10-year breast-cancer survivor in for her annual checkup. Isaacs, her oncologist, is at the cutting edge of compassion. Yes, the doctor performs a physical exam. And she and Ulisney discuss her patient's medications and concerns. (Should she have genetic testing? Does she need a breast MRI?) But their interactions transcend the clinical. The two women are partners in an odyssey that combines medicine with the human spirit.

In the past, most doctors learned how to connect with patients by trial and error or, if they were lucky, from mentors. Today, virtually every U.S. medical school offers a course in patient communication.

At Mass General, a young patient with Hodgkin's disease recently talked about cancer's stigma (do you disclose all on a first date?) and told doctors she appreciated humor. "Knowing what to do medically isn't the challenge," says Lynch. "The challenge is connecting with the patient."

Dr. Lois Ramondetta, a gynecologic oncologist at M.D. Anderson Cancer Center in Houston, met that challenge with Deborah Rose Sills, who had stage III ovarian cancer. Ramondetta was not Sills's primary doctor; she had a team of caregivers. But the two women became so close they wrote a book together, "The Light Within: The Extraordinary Friendship of a Doctor and Patient Brought Together by Cancer." The book, published last month, is a poignant account, filled with stories about children and romance, the women's views on spirituality and medicine, and tales of their travels abroad together. Ramondetta was captivated by Sills's luminous spirit and her bellowing "Good morning, Lois!" even when she had tubes coming out of her body. Sills, a professor of religion, relied on Ramondetta's straight talk, especially when her cancer recurred. When Sills asked what would happen when her body finally gave out, Ramondetta talked honestly about bowels and bloating and nausea. Toward the end, she visited Sills at home, then wrote her a letter acknowledging her dying: "I wish you peace of mind and an end to pain and suffering." Sills died in May 2006.

Read the entire article here

The article is entitled" Cancer Doctors Dodge the Death Talk" published on the CNN.com/health website. Citing recent research, the authors highlight four points:
-Most cancer doctors do not discuss end-of-life care
-Those who had end-of-life talks are less likely to be on breathing machines
-About 7 percent of all patients in the study develop depression
-Sometimes doctors have trouble accepting that the end is near

The research supports the efforts being made to encourage doctors and patients to have end-of-life talks as early on in the treatment process as is possible and appropriate. From the perspective of a chaplain, I believe it would also be important for doctors to suggest chaplaincy resources to the patient and caregivers, so that they can receive the benefits of holistic care in the context of advanced care planning.

The CNN artcle can be viewed at: http://www.cnn.com/2008/HEALTH/conditions/06/15/cancer.talk.ap/index.html

My interest in this book stems from the fact that, with Dr. Lois Ramondetta, we co-authored a chapter entitled: "Spiritual Care of the Cancer Pain Patient". Our intent was to describe spirituality, and spiritual care in the context of the cancer patient's journey. We've included a number of referrals to various models of spiritual care, including assessment and interventions, with a focus on the multi-disicplinary context at M. D. Anderson Cancer Center. We also included case examples to help illustrate the value of proper assessment of spiritual needs with the patient. We believe our contribution may be useful for clinicians, as well as chaplains, social workers, nurses, caregivers, and patients suffering from cancer. The name of the book is: Cancer Pain Management, by Michael J. Fisch and Allen W. Burton.