Chapter 08: Stories about Work with Cancer Patients and a Switch to Oncology

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Chapter 08: Stories about Work with Cancer Patients and a Switch to Oncology

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In this chapter, Dr. Benjamin tells stories of his work with cancer patients at the Baltimore Cancer Research Center, work that convinced him to focus on oncology. He first tells a story about a patient with stage four Hodgkin's disease who achieved a long-term complete remission with the MOPP treatment. He next tells a story of a lung cancer patient "who had more effect" on Dr. Benjamin "than anybody." After treatment with Adriamycin, this patient lived for eight months. Dr. Benjamin is very affected by telling these stories and stresses the "life and death" issues that working with cancer patients brings to the surface. He notes that the standard practice at the time was to withhold a cancer diagnosis and specifics of the prognosis from patients (and demonstrates with an anecdote). Dr. Benjamin stresses that patients are "smarter than you think" and that transparency is important. He mentions the film "Ikiru," by Akira Kurosawa, that tells the story of a man with stomach cancer and shows the "strength of the human spirit." Dr. Benjamin stresses that the dilemmas of cancer patients "are moving, people are important."

Identifier

BenjaminR_01_20141212_C08

Publication Date

12-12-2014

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Professional Path; Professional Path; Character, Values, Beliefs, Talents; Evolution of Career; Professional Practice; The Professional at Work; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Inspirations to Practice Science/Medicine; Influences from People and Life Experiences; Discovery and Success; Human Stories; Offering Care, Compassion, Help; Patients; Cancer and Disease; Formative Experiences; Patients, Treatment, Survivors; The Life and Dedication of Clinicians and Researchers

Transcript

Robert Benjamin, MD:

But the other thing I learned very quickly was sort of from the Mac Schubert point of view of, well, you know, I don’t care what the book says; show me the data. So we took care of the patients who were in the hospital with—I don’t remember exactly how the rotational system worked, but we rounded on the various groups of patients, and then one day a week you were in clinic and you saw some follow-up patients. And one of the first follow-up patients I saw was a patient named $$Norma Halligan [phonetic], who had stage-four Hodgkin’s disease involving her liver and her bone marrow, and she came into clinic to see me and had basically no problems whatsoever. She had been on this experimental protocol called MOPP four years before.

Tacey Ann Rosolowski, PhD:

What does that stand for?

Robert Benjamin, MD:

Mustard, nitrogen mustard, Oncovin, procarbazine, and prednisone. And that was the first combination chemotherapy regimen in any solid-tumor patient, again designed at the NCI, and the Baltimore group had participated with the Bethesda group in doing this. Vince DeVita was the first author on the paper about MOPP, saying that there were long-term complete remissions in Hodgkin’s disease. And, you know, but I’d been taught that chemotherapy never helped anybody, but I’d also been taught that if you had Hodgkin’s disease involving your liver and your bone marrow, you’re going to be dead in three months. Well, this lady was alive and well four years later, you know. Teaching was wrong. One patient could teach that.

Tacey Ann Rosolowski, PhD:

What was your reaction when you saw her?

Robert Benjamin, MD:

I was so excited seeing, you know, this is somebody who is supposed to die, and she was absolutely fine, and the chemotherapy that I’d been taught never worked and never helped anybody, if it hadn’t cured her, it clearly had had a major impact on her life and she was great. So that’s part of the reason that I went into oncology, because I found that it was fun taking care of these patients and that there were things you could do to help them.Baltimore was—the program was basically the experimental drug. The Phase One group of the NCI was Baltimore. So we used all of these experimental drugs and tried to find out what they did to people. And I had another patient, whose story I remember but whose name I don’t, who had lung cancer, and I saw him and he was clearly doing badly. He had been on three different experimental protocols and none of them had helped him. I asked him about each of the drugs that he’d had, and he told me that, “This drug caused my fingers to go numb, and this drug caused terrible nausea and vomiting and I wound up in the hospital with an infection, and this drug made my mouth really sore and I couldn’t eat for days, but then I got over it.” And none of these things had helped him, and he came to me and said, “So what’s next, Doc?”And I looked at him and said, “Why are you doing this to yourself? Why are you here? All of these drugs have made you sick. None of them have helped you. Why do you keep coming?”And he said, “Oh, that’s easy. The doctors and the nurses here take care of me. They care about what my problems are. When I have nausea, they give me medication for it. When I have pain, they give me medication for it. When I have whatever problem, they treat me, and they treat me like a human being.” He said, “When my doctor at home found out that I had cancer, he was so frightened of me because he didn’t know what to do, that he basically shut me out. So I would call with a problem, and he really didn’t want to see me. The doctors here at least care for you and try to deal with your problems. And I know they haven’t helped me, but they at least treat me with respect and try to help out with the problems that they can.” And I wish I remembered his name, because he probably had more effect on me than anybody.One of the things that I did get formally taught when I hit the BCRC was the Kübler-Ross stuff about death and dying and dealing with the emotional aspects of what’s there, and the idea that given that a patient is going to die and there is little or nothing you can do to prevent that, that it’s much better to be straightforward and talk about it and give the patient the opportunity to live out his last days, weeks, months in the way that he wants to, knowing what’s going to happen, and dealing with families and dealing with the issues, that it’s the initial blow is hard, but it’s much better to deal with the problem that’s there rather than to avoid it, and that patients are usually smarter than you think. And if they’re really sick and you tell them they’re well, they know that you’re lying. They may not know exactly what the problem is. They may actually think that the problem is worse than it really is. They may think, “Oh, I’m going to die tomorrow,” when, in fact, they may have six good months. So it’s better to just say, “Here’s the facts. Let’s figure out how to deal with them.”

Tacey Ann Rosolowski, PhD:

Was it standard procedure that if someone had a cancer diagnosis that looked really dire, that that information would be withheld from the patient at that time?

Robert Benjamin, MD:

Absolutely. Absolutely. I mean, the teaching that I had in medical school was we discussed that issue, and it was the most dramatic representation of it that I can ever imagine. One of the students asked the professor, “Why don’t you tell the patient what’s happening?”And the professor looked at him and said, “What’s your name?” He said, “Okay, pack up your things. You’re not in medical school anymore.” And the guy sat there stunned. He said, “Get out of here. I don’t want you in my lecture. You’re not going to be here anymore. Why are you sitting here?” So finally the guy got up and walked to the back of the room, and then the professor called to him and said, “See, that’s what it feels like when you tell them they have cancer. You can come back now.” So that’s what we were taught. It’s such a terrible thing to say to someone that, “You have cancer,” that your job as the physician is simply to hide it.So around this time, there was one of the best movies ever made, Akira Kuorsawa’s Ikiru. If you haven’t seen it, you should get it.

Tacey Ann Rosolowski, PhD:

Ikiro?

Robert Benjamin, MD:

Akira, A-k-i-r-a. Kurosawa. Ikiru, I-k-i-r-u. The translation is “to live.”

Tacey Ann Rosolowski, PhD:

Oh, interesting. I don’t know that movie.

Robert Benjamin, MD:

It’s just incredibly powerful. It’s the story of a man who is sort of bureaucratic lower-level government office worker who has stomach cancer, and it’s his reactions to finding out that he has stomach cancer and dealing with it, and it brings out just some of the wonderful strengths of the human spirit that you don’t see, and it’s all done in the context of Japanese culture where people are never told they have cancer.

Tacey Ann Rosolowski, PhD:

You obviously find that movie very moving.

Robert Benjamin, MD:

Yeah. Well, it’s just—it’s people are moving. People are important. And it’s a great exploration of the strengths and weaknesses of the human spirit and different ways of doing things. But the way it’s put, it’s just brilliant. So, anyway, I saw that around the same time that I had these experiences with these couple of patients, and that’s what got me into oncology.

Tacey Ann Rosolowski, PhD:

As you’re talking, something in me is saying that this sounds almost like a spiritual practice. Is that something that resonates with you at all? I mean—

Robert Benjamin, MD:

No, not really.

Tacey Ann Rosolowski, PhD:

It sounds like you are dealing with some very, very fundamental, just very human issues in cancer and—

Robert Benjamin, MD:

Life and death is very human.

Tacey Ann Rosolowski, PhD:

Yeah, yeah. Wow.

Robert Benjamin, MD:

It’s what we’re about.

Tacey Ann Rosolowski, PhD:

Yeah. So this was all in 1970, early seventies, that this is like a complete transformation of your perspective on what your future would be.

Robert Benjamin, MD:

Yeah, yeah, right.

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