First, do no harm
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I turned 40 years old on Nov. 11, 2022. The usual jokes of “Once you hit 40, you start to fall apart” were plentiful that week. The next day, I noticed a testicular lump.
In a whirlwind of 4 weeks, I went from a healthy husband, father and orthopedic surgeon to a patient receiving chemotherapy for stage 1B embryonal carcinoma. At no point was I ever in denial about my situation, but even to this day, I remain in some state of disbelief that it happened to me.
I consider myself lucky that I was treated for one of the few cancers that can be “cured.” There were folks in that infusion suite with far worse prognoses and far more rounds of poison than I would have to endure. It is a weird thing to thank God for what I am dealing with compared to others, but perhaps that is the point of it all.
Lessons learned
So now here I am – a cancer survivor. The work is not done. I have to continue with my follow-up appointments and scans to, hopefully, make sure that my aggressive approach has put this all behind me. I know though that it is never really behind me. It is a part of me now.
As I have gone through this journey, there have been some important lessons that I have learned along the way. These are lessons that we were not taught in medical school or residency. But these are the lessons that are probably more valuable than anything I have garnered from a textbook. These are lessons that transcend my experience and are valuable to my colleagues and patients alike.
Lesson 1
We are hardwired for success, but maybe too much. Leading up to my diagnosis, I was worrying about the same stuff that we all do. Was my noncompliant patient going to heal? What delay is going to occur in my OR today? Am I on track with my relative value units to get a bonus? Will my abstract get accepted? How come I am not getting any consulting gigs? What do I get my wife for Christmas? When does this job get easier?
It is the same white noise that constantly floods our thoughts as high-achieving members of society. We get bogged down in success, constantly comparing ourselves to our peers. It is what the path to becoming a physician feeds on. We are competitive by nature. It starts in high school and college and only grows as we keep moving on to the next level.
I am not going to lie. Even as I was staring the diagnosis of cancer in the face, I panicked at how I was going to reschedule my patients and how I was going to make up the lost time and cases. It sounds like lunacy, but the white noise is loud. It consumes us. The truth is there are many things that we worry about, and we waste a lot of time and energy worrying about things. When in reality, these things do not matter. We are doing better than most even when we are having a bad day. Appreciating that privilege is something we owe ourselves.
Lesson 2
God (fate) exists. As physicians, we are believers of science. We like to see how things logically move from point A to point B. Yet, there are times in our lives, both professionally and personally, where we cannot deny that things happen for a reason and there is more to how our world exists than just pure chance and millions of years of evolution.
The fact that my urologist had just happened to email me about using one of my ORs 2 days after I had found the lump is serendipity at its finest. The fact that he was the urologist on call Thanksgiving weekend and was able to do the orchiectomy just 2 days after my diagnosis is fate. The fact that had I not switched jobs to the University of Pennsylvania 2 years prior and would have probably never had an interaction with a urologist as quickly as I did, is God knowing the plan far in advance of me.
There is a book I keep in my car called The Daily Stoic. It is a motivational book, which is the sign of any physician reaching middle age, that provides a one-page nugget of wisdom for each day of the year. The day of my surgery, I opened the book to the date of Nov. 25, as my wife drove me home. The passage was titled “Funny How That Works Out.” It talked about how the things we expect from an experience can end up being something different entirely.
I was awestruck as the passage referenced a Metallica song, noting that I had chosen to wear my Metallica sweatshirt to the hospital that day. Then I came to the end of the passage which read: “And yet the most common response from a cancer survivor, the person who went through the thing we all dread and fear? It was the best thing that ever happened to me. Funny how that works out, isn’t it?”
Now if that is not a sign of divine intervention, then I don’t know what is.
Lesson 3
When faced with the unknown, we behave just as our patients do. We have all had the scenario where patients come into the office and immediately start spewing off a bunch of stuff they read on the internet about their condition. As a surgeon, it makes me shudder. Having to weed through the misinformation and self-diagnosis to try and assure patients their condition is something I see every day. Well, when I was diagnosed with testicular cancer, guess who suddenly did a 1-week fellowship in urologic oncology? Granted, I wasn’t searching Reddit blogs to get my information. Instead, I scoured PubMed for every detail about my condition: adverse events, prognosis and recurrence rates.
It is amazing how all objectivity goes out the window when you become the patient. I was suddenly convinced that I would be the exception to all the statistics in my favor. I was convinced that I was screwed. I was scared. It is the human condition that we are all susceptible to fear the unknown. And that fear is what drives us to start doing our own research as we desperately seek to take control of an uncontrollable situation.
When something as life altering as a cancer diagnosis is thrust upon us, we do not think rationally, and we succumb to some of the behaviors that we will roll our eyes at as treating physicians. Remember that when patients sit in our office. They are in an unfamiliar place, and they are scared. They are human. We are too.
Lesson 4
Communication is key. As the leaders in the OR, we rely heavily on good communication. Surgical ability is important in what we do, but being able to communicate as a team is what makes an OR run efficiently and effectively. We are social creatures and communication is the way we thrive.
Interestingly, when I was first diagnosed with cancer, I was private and quiet about my condition. The fact that the cancer involved my reproductive organs added a level of embarrassment and so I initially figured I would keep it to myself and fight the battle alone. Don’t do this. We do not do well in isolation. Look at the rising rates of depression, anxiety and suicide that coincided with the lockdowns during the COVID-19 pandemic.
When I finally decided to start telling family, friends, and eventually colleagues about my condition, the love and support was overwhelming. Grown men told me they loved me. People I hold in high regard personally called me to wish me well. The sense of appreciation and self-worth that support gave me is indescribable.
Everyone is going through something. It could be a physical ailment, mental stress, divorce or a sick child. Whatever it may be, we are better equipped to handle and overcome it with the support of others. And the only way to gather support is through communication. There are people who care about you, more than you think and you will be astonished with how many people that truly is, but only if you speak up.
Lesson 5
Time and health are our most valuable commodities. As high achievers, we focus on success and measure it in the amount of money we make, the number of articles we publish, the number of podiums we present and the things we own. These measures become our focus and for me, it was no different until my diagnosis when suddenly all the things that I thought were so important were not. The commodities of my time and health were front and center.
As physicians, we do a terrible job of valuing these two unrenewable sources. Our time and our health are the most valuable things we have, and the sad truth is we have less of both with each passing day. Getting the most of these commodities requires us to take care of ourselves both mentally and physically.
In recent years, the topics of burnout and mental health have been at the center of physician well-being. While there is no doubt that we must continue to advocate for our mental health, I would argue we are equally as bad at caring for ourselves physically. The adage of “Physicians make terrible patients” is strikingly real. We focus on our patients and our paths to success, but we will often do so while sacrificing our own well-being. We cannot achieve anything if we don’t take care of ourselves.
This last and most important lesson I share with you is to take care of yourself – mentally, physically, whatever is needed. We must wash away this notion that the best days are to come and live for the here and the now because tomorrow is not guaranteed, and life can change in an instant.
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