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.
I enjoyed your story as much as Dr. Prasad's Those of us of a certain age well remember the family docs like Doctor Paul, who came out in the middle of cold snowy nights to bring hope to families with sick young children.
My God, we have lost so much. So very much. People like us, who remember the past well, are a tremendous threat to the socialists, communists, and Great Reset crowd; they cannot prevail unless they destroy the past and all its memories, but have no doubt: the West, and especially America, are worth saving.
While I have a good internist, I can’t help but notice the image of the insurance company rep standing behind her shoulder influencing her decision making, creating hoops for her to jump through and hampering her freedom to operate.
She still is, Bruce. She still is. Americans are the friendliest people anywhere - regardless of politics, religion, or status. I'll never stop believing that. And that's why this country will survive.
I agree that Americans are the friendliest people, but I am not confident that that is enough to survive. I am a Canadian but the situation up here isn't much different from that down there. Both countries have allowed a teeny tiny minority to dictate public policy.
Those past generations in medicine were out there everywhere, which is why I remember people standing up when a Doctor came in the room. There were many parts of the old days that were shameful as well, but the bad stuff is all the kids are brainwashed to believe. We can build and improve on the past, but when we tear it down it leaves a void.
I grew up in the 50s, when the family doctor who came to the home to treat his patients was the rule; rather than the exception. Now we are in the era of corporate medicine where the EMPLOYEE physicians have performance goals re how many patients the_nust see in a day. The individual practitioner has been gone for more than 30 years. We have lost a lot.
A few still remain. My husband made 4 house calls this week to patients; to a pt with ALS, a quadriplegic, a pt with a "bad" leg, and a teacher who couldn't get off work. He is an employed physician who did that on his own time and without compensation. He has been in practice for 28 years. I am afraid that students coming out of medical school now would never do that. Medicine has become about the transaction, not the patient.
All Jim’s comments are like this. I have been following them for some time now. If Jim doesn’t collect his comments into one document, I shall start doing so. ☺️
The writers like Conan Doyle, Schiller, Rableais, Chekhov and Bulgakov who shaped western culture were doctors. Theirs is a special brand of prose that is much needed at all times. Jim, this must be your second calling.
My God, my life has been so rich. Not because of any great accomplishments or adventures during that life, but because of the people who have passed through it, their stories and especially stories of people who were dead long before I was born. I heard such mountain tales in my childhood and still remember most of them, including the names.
An old friend was Jim Comstock, editor of "The Hillbilly," one of then-two remaining weekly newspapers in the Nation. (He called it a "weakly" paper.) I admired him so very much because, having spent his entire life in the backwoods of West Virginia, he was not in any way blind to its many faults. But he loved it. Really loved it, and loved its people. And he loved them warts and all.
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.
So sorry to read of your loss but not sorry in a different way as it evokes much for me. For my wife and I, our Addye's pediatric cancer (neuroblastoma) was a long, winding roller coaster. Bigger Hands were and are there indeed, even after 39 years. And we understand that missing of every second of every day.
Thank you - I think that may have been the best way to cope - understanding that there are so many people in the same boat and we all have to help each other.
There's a film called Collateral Beauty about a story like this. As a teacher who's classroom was adjacent to one where a child with bone cancer struggled valiantly, inspired all of us and eventually died, in a state of acceptance and peace, I can only say we must always remember and hold dear the collateral beauty. A couple of years later, her younger brother was in my PreK class. This family will always be remembered. Thank you.
My 26 year old daughter has stage 4 cancer and I can’t breath anymore. I think I understand your pain. I am a physician and I have had many children pass away in my arms as my field was pediatric emergency medicine. My heart cries for you. I am deeply sorry for you and for Molly’s loss of life.
Thankful to you this Thanksgiving for opening up and sharing your story. I will use it, along with others, to constantly remind myself that no matter how bad something may be in the moment, others have been through real hell and are still standing.
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.
You are a better, stronger person than I. I couldn't work as a janitor in a pediatric cancer ward. I would not be able to stand the emotional strain. Seeing children suffer, for me, is unbearable.
My mother and my sister died of cancer. You get so angry at something you cannot physically fight. To me, the frustration drives into an impotent rage which isn't helpful at all.
When I was in radiology training, they always called Dr. Kim or me to start IVs on the tough-to-stick kids. I'd spent a lifetime working on mechanical things and had what they called "good hands;" Kim was just a damned genius in general; good - no great - hands were the least of his gifts.
I always hated it when the called me; I hated hurting the kids. Peds oncology rotation was torture, not the least reason of which was that I had to hide my anguish behind a professional face. As John Walton said to the ghost of his father in that great television series, "You were right, Pa; nobody can hurt you like your kids."
Again, Jim, you're a better man than I. I've faced danger and I have faced death and I thought I handle it pretty well but I could never do what you did, never.
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.
When CEOs of "health insurance" companies are paid multiples of what we pay our doctors something is seriously amiss. When clerks at those "health insurance" companies are allowed to second guess our doctors, we are making a big mistake. When so much of our health care system is composed of layers of bureaucracy - both in private insurance and government programs - we are simply wasting precious resources.
The father of my dear governor was CEO of the largest healthcare insurance company in the state. Power, money, family! I can’t disagree with any of what you said. I know none of this will stop…just trying to be hopeful that good conquers evil, and what is currently happening is nothing but evil.
Bruce, you are so spot on in all these multiple comments. People need to consult tables easily available that show the ratio of CEO pay to the average worker in their company from 1960 until today. Unbridled anything is inviting a chain reaction to disaster. Can we just sit here and watch the average American life expectancy dwindle? Even factoring out covid, the graph is not heading the way it should.
Why are you complaining about CEO pay? Are you against the free market? Deregulation and an unbridled/unrestricted market makes everyone's lives better. There is a trickle-down effect when CEOs, etc. get tax breaks. They're the job creators.
Some of these notions are dogma with a lining of truth.
1. Billions do not trickle down efficiently unless the excess capital is used efficiently to create more. Non taxed money in someones Cayman island acct for instance is both greedy and bad business for a society. There is a point where excess salary bears no more fruit or productivity. Irrational extension of capitalism renders the fabric of society asunder just as much as the anarchy and despotism of a far right or far left government which often follows in its wake. Anarchy or Fascism is also disastrous. Sustainable Moderation is and has always been the golden mean to achievement and in its best form is a personal and societal choice but not imposed.
That's not what the GOP & Fox News says though. You sound like a woke socialist that hates America and wants to have a threeway with Bernie Sanders & AOC. You should leave the country if you hate it so much.
Bruce - you hit the nail on the head. The gigantic monopolistic “health care” conglomerate structure (pharmacy benefit managers, insurance companies and national chain medical practices and pharmacies) is (of course) a direct outgrowth of government interference, and regulatory support for these mega-monopolies.
Now, simplistic trolls will suggest that the current situation is the natural free market, and would be solved by socialized medicine. That’s a ridiculously false dichotomy, and they all know it.
I’ve lived for many years under (supposedly) the best socialized health care in the world. I watched 7 friends suffer inexcusable harm (including multiple deaths) directly from that system’s inability to provide the most basic universal care.
There are enormous problems with the US system, many/most of which are now caused by the intersection of government and the private sector (another nice recent example is the now-clearly-deadly mistakes in our Covid response.). The government is the problem, not a solution.
So who was it that thought putting third party for profit entities in charge of modern health care was a good thing to do? It is now health business run by algorithms created by profiteers.
Lol. And you continually and stupidly voting against your own interest is showing. You should definitely tuck that in....and stop breathing through your mouth.
Obamacare destroyed many checks and balances, as well as much of the health care providers’ autonomy. One of the largest sources of deadly limitation to healthcare in the market today are pharmacy benefit managers. PBMs.
It’s easy to find harrowing stories of medical care denial and extreme levels of revenue skimming by PBMs today. How do that happen?
Under Obamacare, the PBM‘s were supposed to drive the cost of prescriptions down so they were given an extremely large amount of power and leeway to merge with other healthcare providers including pharmacies themselves. It’s interesting to look back a decade and see what some of the arguments for Obamacare were at the time, and how devastatingly wrong they were.
Obamacare mandates have concentrated and multiplied the PBMs power exponentially, to the point where approximately half of drug costs paid now go to the PBM supply chain.
Similar issues exist with PBMs and Medicare drug coverage:
PBMs aren’t the only problem, but they certainly are a huge part, and the exemplify what happens when health care decisions are centralized by government action.
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.@
It is absolutely not ok - the gymnastics that good doctors have to do in order to practice in a way that actually upholds their oath is unconscionable. If only the public knew or cared - it is the greatest tragedy that our system has evolved into THIS.
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.
Yes, true. The Dr at MD Anderson had that attitude of “my hands are tied”, which is very frustrating. There ARE things they can do (as VP illustrated), but they have to want to do that.
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.
Thanks Jim.
I enjoyed your story as much as Dr. Prasad's Those of us of a certain age well remember the family docs like Doctor Paul, who came out in the middle of cold snowy nights to bring hope to families with sick young children.
My God, we have lost so much. So very much. People like us, who remember the past well, are a tremendous threat to the socialists, communists, and Great Reset crowd; they cannot prevail unless they destroy the past and all its memories, but have no doubt: the West, and especially America, are worth saving.
While I have a good internist, I can’t help but notice the image of the insurance company rep standing behind her shoulder influencing her decision making, creating hoops for her to jump through and hampering her freedom to operate.
It is the specter of the algorithm. I fear it is how we lose our humanity.
Agree.
Well.....anything else would be SoCiALism.
Very much so. And it is up to us to make sure that people remember how good and kind America was. And can be again.
She still is, Bruce. She still is. Americans are the friendliest people anywhere - regardless of politics, religion, or status. I'll never stop believing that. And that's why this country will survive.
It's still great..
I agree that Americans are the friendliest people, but I am not confident that that is enough to survive. I am a Canadian but the situation up here isn't much different from that down there. Both countries have allowed a teeny tiny minority to dictate public policy.
Lol....yeah....when was that? 1940s?
No matter what your age, or when you're from, in kindness, in presence, you can always begin again.
Ok... well maybe "start" might be more applicable than "begin again."
Just wondering where people get these mythologized eras of America.
Those past generations in medicine were out there everywhere, which is why I remember people standing up when a Doctor came in the room. There were many parts of the old days that were shameful as well, but the bad stuff is all the kids are brainwashed to believe. We can build and improve on the past, but when we tear it down it leaves a void.
You got that right. Totally agree.
Lol! Well that didn't take long.
Did someone pull your string?
"Workers of the world unite, Mommy!"
"Soma, Daddy!"
Ha ha ha
Your daughter did.
Unregulated, free market is the solution to everything.
"I'm complaining about healthcare that I voted for, Mommy!"
no daughter. is that your idea of originality? who's complaining about healthcare? mine is cushy. what a pathetic turd.
I grew up in the 50s, when the family doctor who came to the home to treat his patients was the rule; rather than the exception. Now we are in the era of corporate medicine where the EMPLOYEE physicians have performance goals re how many patients the_nust see in a day. The individual practitioner has been gone for more than 30 years. We have lost a lot.
A few still remain. My husband made 4 house calls this week to patients; to a pt with ALS, a quadriplegic, a pt with a "bad" leg, and a teacher who couldn't get off work. He is an employed physician who did that on his own time and without compensation. He has been in practice for 28 years. I am afraid that students coming out of medical school now would never do that. Medicine has become about the transaction, not the patient.
Wonderful story, well told. Thank you for sharing it. You are such a good writer.
It’s a wonderful story, but I m teaching my ten year old son hand washing his shirt tonight.. ironing next week. 🧚
Jim, this reads like the opening page to a memoir. Well done..
All Jim’s comments are like this. I have been following them for some time now. If Jim doesn’t collect his comments into one document, I shall start doing so. ☺️
The writers like Conan Doyle, Schiller, Rableais, Chekhov and Bulgakov who shaped western culture were doctors. Theirs is a special brand of prose that is much needed at all times. Jim, this must be your second calling.
Yes!!! And yes on Chekhov!!
I had chills twice while reading this, thank you for sharing.
My God, my life has been so rich. Not because of any great accomplishments or adventures during that life, but because of the people who have passed through it, their stories and especially stories of people who were dead long before I was born. I heard such mountain tales in my childhood and still remember most of them, including the names.
An old friend was Jim Comstock, editor of "The Hillbilly," one of then-two remaining weekly newspapers in the Nation. (He called it a "weakly" paper.) I admired him so very much because, having spent his entire life in the backwoods of West Virginia, he was not in any way blind to its many faults. But he loved it. Really loved it, and loved its people. And he loved them warts and all.
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.
So sorry to read of your loss but not sorry in a different way as it evokes much for me. For my wife and I, our Addye's pediatric cancer (neuroblastoma) was a long, winding roller coaster. Bigger Hands were and are there indeed, even after 39 years. And we understand that missing of every second of every day.
Godspeed to you and your family.
"The club that nobody belongs in"
Thank you - I think that may have been the best way to cope - understanding that there are so many people in the same boat and we all have to help each other.
Yes!!
❤️
There's a film called Collateral Beauty about a story like this. As a teacher who's classroom was adjacent to one where a child with bone cancer struggled valiantly, inspired all of us and eventually died, in a state of acceptance and peace, I can only say we must always remember and hold dear the collateral beauty. A couple of years later, her younger brother was in my PreK class. This family will always be remembered. Thank you.
My 26 year old daughter has stage 4 cancer and I can’t breath anymore. I think I understand your pain. I am a physician and I have had many children pass away in my arms as my field was pediatric emergency medicine. My heart cries for you. I am deeply sorry for you and for Molly’s loss of life.
Thankful to you this Thanksgiving for opening up and sharing your story. I will use it, along with others, to constantly remind myself that no matter how bad something may be in the moment, others have been through real hell and are still standing.
Yes 🙌
❤️❤️
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.
You are a better, stronger person than I. I couldn't work as a janitor in a pediatric cancer ward. I would not be able to stand the emotional strain. Seeing children suffer, for me, is unbearable.
My mother and my sister died of cancer. You get so angry at something you cannot physically fight. To me, the frustration drives into an impotent rage which isn't helpful at all.
God bless and keep you LP.
Thank you, Lynne
When I was in radiology training, they always called Dr. Kim or me to start IVs on the tough-to-stick kids. I'd spent a lifetime working on mechanical things and had what they called "good hands;" Kim was just a damned genius in general; good - no great - hands were the least of his gifts.
I always hated it when the called me; I hated hurting the kids. Peds oncology rotation was torture, not the least reason of which was that I had to hide my anguish behind a professional face. As John Walton said to the ghost of his father in that great television series, "You were right, Pa; nobody can hurt you like your kids."
Again, Jim, you're a better man than I. I've faced danger and I have faced death and I thought I handle it pretty well but I could never do what you did, never.
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!!
Will read. Hope it’s uplifting as my daughter has cancer and I am a physician. I am looking for anything that may help.
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.
When CEOs of "health insurance" companies are paid multiples of what we pay our doctors something is seriously amiss. When clerks at those "health insurance" companies are allowed to second guess our doctors, we are making a big mistake. When so much of our health care system is composed of layers of bureaucracy - both in private insurance and government programs - we are simply wasting precious resources.
The father of my dear governor was CEO of the largest healthcare insurance company in the state. Power, money, family! I can’t disagree with any of what you said. I know none of this will stop…just trying to be hopeful that good conquers evil, and what is currently happening is nothing but evil.
Bruce, you are so spot on in all these multiple comments. People need to consult tables easily available that show the ratio of CEO pay to the average worker in their company from 1960 until today. Unbridled anything is inviting a chain reaction to disaster. Can we just sit here and watch the average American life expectancy dwindle? Even factoring out covid, the graph is not heading the way it should.
I agree completely.
Why are you complaining about CEO pay? Are you against the free market? Deregulation and an unbridled/unrestricted market makes everyone's lives better. There is a trickle-down effect when CEOs, etc. get tax breaks. They're the job creators.
Some of these notions are dogma with a lining of truth.
1. Billions do not trickle down efficiently unless the excess capital is used efficiently to create more. Non taxed money in someones Cayman island acct for instance is both greedy and bad business for a society. There is a point where excess salary bears no more fruit or productivity. Irrational extension of capitalism renders the fabric of society asunder just as much as the anarchy and despotism of a far right or far left government which often follows in its wake. Anarchy or Fascism is also disastrous. Sustainable Moderation is and has always been the golden mean to achievement and in its best form is a personal and societal choice but not imposed.
That's not what the GOP & Fox News says though. You sound like a woke socialist that hates America and wants to have a threeway with Bernie Sanders & AOC. You should leave the country if you hate it so much.
Well....anything else is SoCiALized MeDiCiNe
This is the system you keep voting for.
Bruce - you hit the nail on the head. The gigantic monopolistic “health care” conglomerate structure (pharmacy benefit managers, insurance companies and national chain medical practices and pharmacies) is (of course) a direct outgrowth of government interference, and regulatory support for these mega-monopolies.
Now, simplistic trolls will suggest that the current situation is the natural free market, and would be solved by socialized medicine. That’s a ridiculously false dichotomy, and they all know it.
I’ve lived for many years under (supposedly) the best socialized health care in the world. I watched 7 friends suffer inexcusable harm (including multiple deaths) directly from that system’s inability to provide the most basic universal care.
There are enormous problems with the US system, many/most of which are now caused by the intersection of government and the private sector (another nice recent example is the now-clearly-deadly mistakes in our Covid response.). The government is the problem, not a solution.
So who was it that thought putting third party for profit entities in charge of modern health care was a good thing to do? It is now health business run by algorithms created by profiteers.
Who?.....The GOP.
Anything else is SoCIaLiSM.
Your ignorance is showing. You should tuck it in.
Lol. And you continually and stupidly voting against your own interest is showing. You should definitely tuck that in....and stop breathing through your mouth.
Of course, ignore the troll.
Obamacare destroyed many checks and balances, as well as much of the health care providers’ autonomy. One of the largest sources of deadly limitation to healthcare in the market today are pharmacy benefit managers. PBMs.
It’s easy to find harrowing stories of medical care denial and extreme levels of revenue skimming by PBMs today. How do that happen?
Under Obamacare, the PBM‘s were supposed to drive the cost of prescriptions down so they were given an extremely large amount of power and leeway to merge with other healthcare providers including pharmacies themselves. It’s interesting to look back a decade and see what some of the arguments for Obamacare were at the time, and how devastatingly wrong they were.
https://www.pharmexec.com/view/rx-industry-pbms-and-obamacare
Obamacare mandates have concentrated and multiplied the PBMs power exponentially, to the point where approximately half of drug costs paid now go to the PBM supply chain.
Similar issues exist with PBMs and Medicare drug coverage:
https://www.healthaffairs.org/do/10.1377/hpb20171409.000178/
PBMs aren’t the only problem, but they certainly are a huge part, and the exemplify what happens when health care decisions are centralized by government action.
Thanks for the insight. And links.
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.@
It is absolutely not ok - the gymnastics that good doctors have to do in order to practice in a way that actually upholds their oath is unconscionable. If only the public knew or cared - it is the greatest tragedy that our system has evolved into THIS.
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.
Becky, unbelievable story! Wishing you continued good health and research doctors that don’t give up.
I think you are actively illustrating what happens when doctors are not allowed to make the decision. As is the goid doctor who penned this article.
Yes, true. The Dr at MD Anderson had that attitude of “my hands are tied”, which is very frustrating. There ARE things they can do (as VP illustrated), but they have to want to do that.
Patients must know that they are their own best advocates. The best MDs will support them
My concern is that VP has provided evidence against himself.
Oh, what do you mean?
He has acknowledged non-compliance. I think k that is a very good thing. Not sure the medical/pharma/hospital complex would agree.
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.