Tuesday, March 25, 2014

My Oncologist’s Puppy Dog

Last week I received infusion number 13 of intrathecal methotrexate, administered over a period of two years. A local cancer clinic provides this service in partnership with my neurologist. As such, I’ve come to know my oncologist fairly well, and I’ve grown fond of him. I think the feeling is mutual.
Nine weeks ago, when I received infusion number 12, I informed him that the treatment was no longer working like it did during the first year. As a result, my neurologist and I decided I would get only three more treatments before giving up, unless it unexpectedly starts working again. My oncologist appeared to take this in stride, as I expected.
Keep in mind that every oncologist, especially one nearing the end of an accomplished career in medicine, has witnessed untold human misery. When you sign up to be a cancer doctor, you know that all of your cases are going to be of the life and death variety. As a matter of personal survival, you must develop the means to temper your natural grief response. Of course, oncology isn’t only about misery, it’s also about sometimes guiding your patients back to health, rescuing husbands for their wives and children for their parents.
When my oncologist greeted me last week, as usual, he asked how I was doing. I rather bluntly confirmed that the treatment was still no longer working, and that I would probably be back for only one more session. I continued to give him more specifics, in a clinical and dispassionate manner. “My legs are shot, and my hands are headed in the same direction” – that sort of thing.
I was taken aback by his reaction. His eyes betrayed the heartache that he felt. I hadn’t meant to elicit an emotional response. I guess I assumed that if there was anyone with whom I could speak so candidly, it would be my oncologist.
Am I to take from this interaction that, at least in his view, my condition is worse than that of a dying cancer patient? No, I don’t believe so. I think about it this way: when the evening news is blaring on my television set, and I am only half listening, if a story comes on about the death of a person in a tornado, I am desensitized enough to feel little or no sadness. But if there is a report of a puppy dog harmed in the same storm – an innocent, helpless creature – I stop what I’m doing, look up at the television screen, and experience a more tangible sadness. “Even the puppies?” I may lament. “Even the puppies?”
As I explained above, my oncologist is understandably conditioned to the suffering of cancer patients. But when his one and only MS patient is doing poorly, it’s more unbearable than it might otherwise be.
“Even the MS patient?” He must wonder. “Even the MS patient?”


  1. Very well written piece and great analogy. I had a similar reaction from my oncologist as well when I told him my methotrexate wasn't working anymore. I think he thought of me as a new challenge and was hoping for the best for me. -Kathy

  2. What an interesting observation. I'm going to ask my husband's oncologist if he has any MS patients on methotrexate.

    When I was first Dxd they had me on 1000 MG of IV Prednisolone for 5 days in a row and I got that at a cancer infusion center. Boy was I chatty compared to everyone else in the place--I remember that!

    btw, I don't know how you got only numbers to come in the "prove you're not a robot" verification system, but thank you, thank you....it used to take me 3 tries or more to get verified when it included letters too.

  3. Kathy, thanks for your kind words. Did you find that intrathecal methotrexate worked for a while, like it did with me?

    Daphne, I take no credit for the improved verification system. Google finally figured it out on their own! I'm glad it works better for you.

  4. Yes, the methotrexate seemed to work for a bit. Although I'm not sure if it worked at all. My MS just always seems to quietly progress on me. Decided to try Tecfidera which I've been on since August . Don't seem to have progressed thus far. Kathy

  5. Mitch, very good post about what must've been a very unsettling experience. I often think about how MS neuros are among the few doctors who never cure any of their patients. Although oncologists see a lot of misery, at least they occasionally can help someone "B" cancer.

    Very sorry that the methotrexate has stopped working. We'll have to find some new voodoo to try…

  6. That should read "beat" cancer. Stupid voice recognition software…

  7. Marc, thanks for introducing me to intrathecal methotrexate. I think it bought me about a year of delayed progression, and that's significant.

    Regarding the comparison of MS to cancer, I was so bold as to write about it once, here: