Principles of Medical Ethics 

Before You Donate

Think very seriously before donating to any breastcancer organization, or fundraising program until you read their Annual Report to see who their top contributors are, and if they have a product that appears frequently in the message the organization sends to the public. That would be unethical and its illegal. The same applies to a request that the public buys products, but does not receive a "donor receipt" for tax-deductible purpose. Read any and all food labels that breastcancer "non-profits" are promoting to raise money. Some organizations tell the public to help them raise money by asking you to visit their websites, but that only gives them "hits" to increase their sponsors.

Another tip, "signing" an online Petition is not acceptable, so don't fall for such antics. An ethical non-profit, or professional will not request your visit to their website, nor use "cookies" placed on your computer when you visit their site.

Purchase the Breastcancer Postage Stamp, the Post Office will always give you your charitable deduction receipt. Its a valid form of fund raising.

Selecting An Oncologist

Cancer Specialist

The oncologists  I've met are the most knowledgeable and patient doctors I've ever known (especially mine). How they cope is beyond me—just with me, alone. If you don't feel that your oncologist is "there" for you begin a search for another one, quickly. They seem to be out there and doing a great job from what I've heard. Don't ever let them fade from a primary position with your insurance company. I don't think other specialties could take on their incredible challenges. They save the industry a lot of money, and we are going to need a lot more of them within ten years. There will be more cancer.
 

Once you've decided on a surgeon, ask him or her for a referral to meet and speak with an oncologist.  Talk to oncology staff registered nurses at local hospitals. Other patients (you'll generally hear how much they favor their oncologist - we place a lot of trust in this one physician).  This is a very important specialty in cancer treatment. Talk to your insurance company about it, and if they won't approve, speak to the oncologist about an introductory visit.  Whomever you decide upon, this will be your physician for the rest of your life.  Yes, for the duration of your cancer treatment, and for appointments to keep your disease under control, or "disease free."  This person has to have post-graduate experience as a Fellow, for example, after internships and residencies are completed.  They, like other specialists, spend many years learning.

The oncologist is often a hematologist, too (blood cell specialist), and/or radiologist, endocrinologist, and other combined specialties. S/he knows your particular type of cancer, and determines the best approach to stopping it's growth.  That may include chemotherapy, such as in my case.  The field is changing so rapidly that they have to keep attending seminars, becoming computer literate to keep up with clinical trials for their patients who have no other choices left except "experimental" treatments, and find time to maintain interactions with the specialties that affect their patients, and more . . .

Presenting me with his decision about chemotherapy was a day I'll never forget. But, my doctor's supportive manner surrounding his explanation about how he came to that decision and the frankness of how he viewed chemotherapy, and it's side effects (very honestly) gave me a complete "picture." That included the facts, but it also included the effects and the possible side effects, and how my body may react (yes, he told me all of it), and very importantly, that he felt confident in his ability to now be able to help me, and that he would be there each time if I wanted him to—I did!

This specialty is a very important member of the team, even if you would need to only enter in a cancer prevention program. Oncologist are used to the ups and downs a person goes through when they've been told they have cancer, and I've found them to be sincere, honest, and caring—well, for the most part (there was one or two who were rather pompous and I'm sure wished he'd gone into research—we do!).

Everyone who knows me believes that this was one member of my Team who came as a Gift!  I'd worked hard to find the others, and determine if they were the best for this journey of mine. But, my surgeon (a wonder herself) referred me to my oncologist and everyone I knew in medicine knew of him. Later, even his office staff and RNs at the hospitals consistently felt the same way about him. After my first appointment I knew that if I was going to need an oncologist (this was before my mastectomy), that this would be the doctor.

For example, after surgery my pathology reports came back clear. Gracious how my children were relieved, my church, and ME! One of the chaplains remarked that she could tell how worried I'd been because of the look on my face when my surgeon told me everything was all right (she did mention the other staining wasn't back yet, " but. . . "). As happy as I was I told my nurse to let the oncologist know, if he saw him. He told me, "He's on his way in here right now!"  The oncologist was happy too, we joked about not being teammates, and he was heading out of town now because "you don't need me." I remember him leaving my hospital room, and thinking, "Thank God I found him, If I ever need an oncologist, I've found one already!"

Within twenty-four hours, my surgeon had to be notified that the pathology she'd ordered (a special staining) showed invasive cancer in the lymph and she had to tell me. The pathologist later told me that she fell silent when he informed her, and then asked him, "Are you sure?" Believe me, your chosen team will be caring individuals.

It was a horrible day for me, my children, and for my team.  I asked my surgeon to please call my oncologist right away. He phoned me that night from out of town . . . and began ordering scans and told me that I'd feel better that he was doing something about this and said something like "you need your oncologist now!"

He was right!  As drugged as I was when he called (sedated), I felt he helped move us forward. I was on the offensive. It isn't the first time he's been right— he's right so often its disconcerting. But, it keeps me informed about how my body will react to the "chemo."  He had my hair loss down to the day, and warned me a week before. Somehow, he's always been able to move me on to the "next step."

We also agreed that he would tell me whatever he found out as soon as he knew no matter what. I recall one late night when he did that, he had to do that, we'd agreed. It made me trust him so much more, and kept me in control, although I did go into that "tunnel" for a while afterward.  However, he and my surgeon had been somewhere on my behalf and I decided that I would let her know that I was "all right with the news," and I phoned her also at a late hour.  She was relieved, saying she was leaving town for ten days and it made her feel better to talk to me.

My case was causing a stir, I could tell and my oncologist searched for the right answers, the right protocol, and sent me for consultations. One consultation trip I took was primarily because, as a member of my own team, I wanted to meet the gurus that he and my surgeon had presented my case to at an oncology meeting. They had given their opinions and were on the cutting edge of this very situation. I felt that down the road, as I was fed up with the torture of chemotherapy, I may question my oncologist, and that wouldn't be fair to him. I wanted to take equal responsibility for my life and health, too, and not dump it all onto him however tempting it was to do just that. He sent me an E-Mail for a good send off, and assured me that IF I found I felt more comfortable at the place I was going and with the oncologists who were doing the consultation he would still be here for me and always care for me when I came home!  Ha! Never would I willingly leave his expert care, and caring.

My philosophy is that my primary task is to care for the Gift of Life I've been given so that I may then in turn help others. So, I am the responsible one and I am thankful for those who've joined in to help me when I'm not doing a very good job.

Receiving a diagnosis of cancer we all know there shall be some very tough times ahead, including, perhaps: surgery, chemotherapy, radiation, invasive tests, needle sticks, tubing surgically placed in a major blood vessel such as a "chest port" to prevent your arm veins from giving out, and on and on. We know there will be times when we just plumb give out, and maybe, for a while, give up. That is very difficult to do and to anticipate when you're looking for your team. But it may lurk in the back of your mind because by this time, you've probably blown a "gasket" or two! Many times, my friends and family have told me that the only good thing about what I'm going through is that I found "that doctor," and something like, "If I ever get cancer, I already know who I'm going to see!" Two of my friends sent him a "Thank You" E-Mail because his care for me relieved them so.

My oncologist knows that I am a "chicken." I feel comfortable telling him that.  Well, by now my entire team knows that I am far from stoic! Some of us who have worked in the profession only remember the extremes when we are ill ourselves. We also find ourselves in a new psychosocial group—we cannot help others or ourselves!

There is a tendency on my part to not take pain and other medications when I really should. If I'm in pain, or ill, I'm afraid I won't remember what I'm doing or remember to write them down, etc. I am getting over that, especially when I'm told about the effects of pain and stress on one's health. 

Get one of his partners on the phone with you on a weekend night and you'll hear of the value of taking meds when you need them—they are all in concert with your well-being and comfort. His partners always seem to "know" my case, too, and, for the most part, very empathetic.

Remembering long "Call" pulls for births, I thought, "I better take this medication— he needs some sleep, not me screwing up!" and I began writing down every pill I took (he doubled my meds). It helped. Not me, but when I could more accurately report, "nutin works!"

I recall speaking to one who sounded asleep, or subdued, and one other who would absolutely NOT even tell my doctor about a report I'd received (we were waiting  to come in), and I needed to talk to him, by prior arrangement. It turned out he was in the office until 10 that night and he did feel badly about the whole mess when we finally talked the next morning (that on-call physician was terrible, and he received the ire of many, many people that night, and me). Worse, my oncologist overheard his conversation with me and felt grateful "it wasn't one of my patients." (frown)
 

Make sure you find an oncologist that you feel comfortable with, too. You'll be team members for a very long time.  Cancer and its prevention will be with you forever. This disease will change your life, you can count on it.

The other night, a most competent physician who's parents were well-known physicians  told me there are two things to do when deciding on a doctor: One, check all their credentials, and two, if s/he is not taking time for you, giving you thorough explanations, and a treatment plan, or sticks with "odds" rather than how your life is being affected by this disease, "Find someone else!"
 

POINTERS TO FIND AN ONCOLOGIST:

• Visit the one your surgeon or primary care physician refers you to—  they have a sincere interest in helping you.
• If you don't feel you've found your Teammate, go back to the resources for finding a surgeon, and focus on oncologists (Questions to Ask and Forming Your Team.
• By now, anyone who's ever had cancer or knows anyone who does or did, will be giving you referrals. Listen carefully to how these people describe the care the oncologist gave, and make notes.
• Write down what would be your most important attributes in this person who is going to try to help you with this malignancy).
• Education and post-doctoral training is an asset in an oncologist, often called "Fellowships."  Varied experience is helpful, rather than at just one institution.
• Determine his/her comfort with discussing alternative therapies and other things that are vitally important to you (your spirituality, pain tolerance, family concerns, money/insurance, etc.). Whatever will make it easier for you to cope with any treatments you can imagine.
• Do you feel that this doctor will understand when you need him/her (fear, anger, pain, depression, nausea, etc)?
• Is his/her staff capable of helping you during the doctor's absence (there are lots of other cancer patients, too).
• Does it appear that s/he can give you an idea of what you may expect from treatments for your particular type of cancer (not odds, etc.) but what will happen to you (this is important)?
• Call the oncology floors at the area hospitals, and talk to the RNs. You'll soon get a quick reply if a particular physician is highly respected by these in the trench professionals.
• I myself have found that joking with me when I had my diagnosis wasn't helpful (and usually I just love to laugh). But. cancer wasn't funny! It sometimes helps to find someone whose spirit/personality/demeanor matches your own (I do laugh at myself a lot, though).
• Go easy on yourself.  Many of us aren't really ourselves, or we may be exactly ourselves, no hidden agendas, no time . . . we just want to do our best to find the best person to help us on this very unplanned journey over which we often have little control. Control takes the form of finding those you know can help you.

SOME TIPS:

I think it would help if we didn't have to go to the oncologist's main waiting room for our first visit. In general, I found it very upsetting. Worse were the offices or mammography centers decorated with garlands of ribbons, birds, flowers and/or literature on things that can prevent cancer such as organic diets (if we knew these things for sure, we could stop cancer. I did wonder how such an office full of such literature must make other patients feel).

Gracious, none of us ever think we are going to be a cancer patient. We certainly haven't gotten to the 'cancer survivor' level at this point, yet. Ask the oncologist if there IS a way you could meet the doctor at another office, or even in the hospital, or at your surgeon's office. 

Then, it would help if that doctor showed you around the facility/office. And, buffered you or had hired a patient advocate to be a 'go between' everyone: patients, physicians, nurses, etc. but wanting to know the patient! The "social workers" are truly absent in most practices, so don't get your hopes up.

My feelings are not unique. These ventures only further compromise our determination to push forth and survive the best we can.

Trust me, you will gradually become comfortable in the setting but it takes time. You are changing your social group, and have found yourself among the suffering. It's hard. I will certainly be there for anyone who may need my help with this in the future.

I wanted to be an equal member of my team. I said this in July, 1998. Recently, something happened and I felt I couldn't cope with one more stressful situation. I asked my oncologist to please stop me if he thought I was "shooting myself in the foot" and to just take this for me for a while.  He takes such incredibly good care of me. Every surveillance exam he does he calls me and tells me every result (blood, scans, etc.) and faxes them to me and all of my other doctors (some new ones don't reciprocate). He jumps when anything else is going on as soon as he hears about it from my internist or myself. He has a bounty of angels around him at all times.  
 

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  reviewed 07/02/05