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needed to be cancelled. Cathy underwent intraperitoneal
chemotherapy (an intense regime given into the abdomen)
and remained in remission. One year after completing
treatment, she completed a climb of Mr. Kilimanjaro at
age 68. Jim, her husband and best cheerleader, traveled
with her. About a year later, a small recurrence was
found. An aggressive approach was discussed, and
Cathy underwent additional surgery, chemotherapy, and
radiation. She remains in remission 15 years after initial
therapy. No more mountains but she did win her age
group in the ten tough mile run across the island of St.
John, Virgin Islands and she and her husband have biked
across Europe. Cathy spoke eloquently at my retirement
and I was almost brought to tears. I don't do tears easily.
Another young woman, Jane in her 40s, came to see
me with a recurrent disease in limited pelvic lymph
nodes. I operated on her and removed the cancer.
She returned to her medical oncologist and received
additional chemotherapy. I suggested Jane get pelvic
radiation as this was the only site of her recurrence and
many gynecologic oncologists have had success using
this technique. Jane decided against this. Unfortunately,
within a year there was disease back in the same area.
Repeat surgery, chemotherapy and now radiation
continues to keep Jane disease free after 10 years.
Many patients, however, run out of therapy options
and need to be on hospice care. I always tried to make
home visits of my patients on hospice care. One vivid
memory was Marianne. After three and a half years of
treatment, Marianne had agreed not to continue further
therapy and to go home with hospice care. During my 30
plus years of practice, I had referred many patients for
home hospice. I was proud that we could give patients
the information they need to understand that while not
treating the disease the health care team was still treating
the patient. I called Marianne's house to see if a home visit
would be appropriate. Her husband said yes. I arrived and
Dan, her husband, was not present. His daughter said he
went out. I was perplexed as we had a good relationship
and expected him to be there. I went up to Marianne's
bedroom. She was on a morphine pump for pain relief
and bedridden. We talked and she expressed her relief
to be home and was at peace with her decision to die at
home. At this point, Dan appeared with a martini for me.
He knew I enjoyed this drink and had gone out to buy
gin. I toasted Marianne and we tapped a martini glass and
a morphine pump. It is a distinct and emotional memory
for me. It is clearly not a sad memory but neither a happy

one. I had gotten the message to this family and patient
that we continued to care for her through diagnosis,
treatment and finally end of life. I was proud to have
helped her and her family. I was very sad at her passing.
I thought back to my father's death. Joe had been ill
with a metastatic renal cancer for three years. It was
remarkable that his quality of life was good considering
at that time only hormonal therapy was available. This
was 20 years ago. Today, there would be significant
immunotherapies available that may have prolonged
his life even further. Until approximately a month
before his demise, he suffered little discomfort and
had excellent quality of life. Ultimately, of course, the
cancer progressed, and he required hospitalization
for pain control. During that admission, Joe said he
did not want resuscitation and wished to go home on
hospice. My mother was resistant but we persisted to
get him home. He passed away four hours after being
brought home. He was at peace in his bed and home.
This episode had a profound effect on me and I sought
to give my patients similar relief if they desired.
Isabel was a long-time patient. Her son was a neighbor
and good friend. During one admission which was
lengthy Isabel's daughter brought her a surprise visitor.
Isabel, the daughter, is a free spirit sixties child. Isabel's
dog missed her so the daughter snuck the dog in and
the nurse found Nellie, the dog, curled up in bed with
Isabel. I was informed of the unusual visitor on Monday
morning. Of course this was against hospital policy! I
thought maybe this should change and some hospitals in
the US do have limited pet visitation rights. I thought the
French might also, but it does not appear so. Restaurants
allow dogs, even sitting at the table, but no hospital
visits. It was a great story and I tell it to this day.
Isabel's husband had been treated at my hospital with
a referral from me to a medical oncologist. I felt that
Isabel's husband did not receive the personalized care
he deserved. My referrals to that group declined. Isabel
had advanced stage ovarian cancer. She was a high
spirited 72-year-old who understood the prognosis of
her disease. After her 3rd recurrence she developed a
bowel obstruction. I went to her home with the idea of
initiating hospice. Unfortunately, Isabel was in distress
and needed significant hydration and pain medications
best administered in the hospital. After admission, while
trying to get her home, she became unresponsive and we
initiated in hospital hospice care. The hospital has some
Continued on next page.




Bucks Montgomery Physician Winter 2021

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