"Questions for the Oncologist," by Barry Meisenberg: an oncologist struggles to answer a patient’s “Why me?” question.   Transcript   Narrator: Questions for the Oncologist by Barry R. Meisenberg, MD (<a href= "https://ascopubs.org/doi/full/10.1200/JCO.22.00158">10.1200/JCO.22.00158</a>)   Go ahead, ask me anything. Decades of meeting beseeching eyes has prepared me. Ask me anything except that one thing. That one thing that neither colleagues nor study has helped me comprehend. Ask me instead about prognosis; I will be honest, but gentle. Ask me about side effects; I will use a small spoon so as not to overfill your vessel. Unfold your notebook. Ask me anything:   “-how many cases like mine have you seen before? -what is the nectar of the bone marrow? -what (and how) should I tell the children? -is it wise to lay in the sun? -is it safe to have sex? -should I get the vaccine? -what’s next if this doesn’t work? -what if it were your wife?” Go ahead, ask me anything. But please, don’t ask me that one thing. Don’t ask, “why me?” You wouldn’t like the answer. I don’t. I could fill your notebook with a tale of random errors in the genes. Tiny rivulets of mutation that flow into a tumultuous river. But, I don’t think of them as errors. Rather, they are Nature’s engine of biodiversity. Individuals suffer, so that species survive. “Bad luck” is a second-rate explanation, I know. So please, don’t ask me that one thing. Search for a better answer within, as I have. Unsuccessfully, so far.   Dr. Lidia Schapira: Welcome to JCOs Cancer Stories: The Art of Oncology brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the world of cancer care. You can find all of the shows including this one at podcast.asco.org. I'm your host, Lidia Schapira. And with me today is Dr. Barry Meisenberg, Chair of Medicine and Director of Academic Affairs at Luminous Health. We'll be discussing his Art of Oncology article: Questions for the Oncologist. Our guest has no disclosures. Barry, welcome to our podcast. Dr. Barry Meisenberg: Good morning. Thank you very much. Dr. Lidia Schapira: It's a pleasure to have you. And before we start to talk about your poem, and the reason for your wanting to share this with a broad readership, mostly of Clinical Oncologists, let me start by asking if you are a poet and if you often write to reflect on your experiences as a physician, or for other reasons? Dr. Barry Meisenberg: Well, I will never give myself that label of poet. I have written several, what I would call reflections on what it is to be an oncologist, which this section of the JCO covers so well. Sometimes I've submitted work and said it was a poem and the editor said, 'No, this is a vignette.' Another time I thought it was a narrative and someone said, 'We liked your poem.' So, increasingly, I've entered this area reflecting a career's worth of introspective thoughts about what it is we do. Dr. Lidia Schapira: So let me ask you, given your very particular vantage and your experience, why do you think it's important for us to write and read reflections? What does narrative give us as physicians, as cancer doctors? Dr. Barry Meisenberg: Well, I think it gives us the other parts of our brain and the other parts of our personality as humans. The most humanistic of all the sciences is medicine. We can't neglect that. Mostly for our own health. But also, I think it makes us better physicians when we think about what we're doing. You know I think it was a physician author, who said that we walk around in the midst of stories. Every one of our patients has a story, sometimes multiple stories, and if we miss that, and don't really capture that, then we're just sort of functionaries. Dr. Lidia Schapira: Such an important thought. There's definitely plot. There are characters. There's the scenery. There's all of this very rich life and human content and I couldn't agree with you more. So, before I ask about this particular essay, what are you reading now or what have you read in the last year that you would recommend to your colleagues? Dr. Barry Meisenberg: Well, it's interesting you say that because, recording here in April of 2022, I've talked to many of my neighbors about their pandemic hobbies, both medical and nonmedical, and they're, you know, learning to bake, reteaching the piano, and working on developing their rhomboids. I've been doing a deep dive into the history of other pandemics. I may be little obsessive, but I've been reading about pandemics throughout history, and just appreciating the fact that human nature hasn't changed very much, nor has medical behavior. So, in Defoe's book, I think it's called Journal of a Plague Year, which by the way, is not history, is a fictional journal but based on reality. We have the same sort of medical charlatanism. We have false hopes. We have people trying to beat the quarantine for their own good. At the same time, we have just public-oriented behavior as well, feeding those who couldn't be fed or who would become orphaned by the plague. The same thing is true of the 14th-century plague. It's just remarkable how little we've changed as a species, all the behaviors on display today, both good and bad, were on display then. And so, I've been reading quite a bit about pandemics. Dr. Lidia Schapira: It’s so interesting. Now, with that, let's focus on your beautiful poem, the question that you can't answer after all your scientific work and after your decades of clinical experience, “Why me?”. Tell us a little bit about what inspired this poem that I found so moving, and I'm not a great reader of poetry. But this one message was so clear that I think most of our readers will understand the sentiment. What inspired you to write it? Dr. Barry Meisenberg: Well, I woke up with this one. Sometimes that happens, you wake up with a poem that is nearly fully formed, or a narrative is nearly fully formed in your mind. Although I did get some excellent suggestions from my reviewers that I do appreciate. And I realized only after it was on paper, that seven years ago, I wrote a piece for a different oncology journal about this issue of random chance. And you may remember, in 2015, there was an article, or a science magazine published an article by Thomas Heti and Bert Vogelstein about their mathematical calculations of errors in stem cell division. They didn't do any new experiments. They accumulate what was already known, and they were able to correlate that with the incidence of cancer from the cancer databases. And their conclusions were, when stem cells make random errors, there's more likely to be cancer. Now, they didn't cover every type of cancer. They covered several. And they came up with this idea that cancer is stochastic, that is a random process. Now, stochastic is not a poetic word. And so, we didn't use it in the poem, but random, and that was covered extensively in the New York Times and other media, and a big debate about what it meant. So, I wrote an essay about that, and I realized it's been on my mind all this time, and whether it's a helpful notion or a harmful notion. Helpful in that patients can understand you didn't do anything to give yourself cancer, despite all the media noise about that, but harmful, potentially harmful, in this idea that maybe my life doesn't have meaning if this is just a random process. And so, I talk to patients about this when appropriate, because many of them have thought about it. So, it's sort of been on my mind since this article I wrote in 2015. And I must say, it disturbs me that I don't have a good way of explaining that or helping patients overcome this. Dr. Lidia Schapira: So, when a person asks you why me in some way, I mean, you, first of all, you tell us that you have answers for most of the other questions, what is my prognosis? You can answer. How do I tell the children? You can answer. Is it safe to have sex? You can answer. But the “why me” question is still with you and still troubles you. What is it, in your view, that a person is really asking you? What is the question behind the question when they say 'why me?' Dr. Barry Meisenberg: Well, that is the question. And then I think what they're saying is what does my life mean? Yeah, if the answer to Dr. Vogelstein is correct, that it's stochastic, doesn't mean my life doesn't have a meaning. I hope people wouldn’t draw that conclusion. So, random things happen to people, both nice people, and mean people all the time. I remember when I was in New York doing a year of research at Sloan Kettering, there was a helicopter accident, and it didn't just kill the people in the helicopter, but a piece of the blade broke off and spun out over Manhattan, killing someone who was about to walk into a retail store, totally random. It had an impact on me in how all our lives hang by a thread, or it can, and cancer is like that. Dr. Lidia Schapira: What I hear in the “why me” question is also sort of a plea for, please reassure me and keep me safe, because this happened, and you have no explanation, I have no explanation. So, it's interesting that you talk about life's meaning. I see it more as a cry for help. If I can't deal with the uncertainty and the chaos of the universe. Dr. Barry Meisenberg: That's an excellent perspective. And you may well be right, at least for many people. It's almost like a real issue of faith and religion, or more faith and religion. When I say in the piece, 'you have to look inside for that answer, why me and what your life means?' Yeah, people ask questions for a reason. Some of it is just fact downloading, the risk of mucositis, how to treat mucositis, and so on. But other, the more important questions are these. Dr. Lidia Schapira: And that's one of the beauties, I think, of poetry and why we love to publish great poems because it's almost like a bit of a Rorschach too, right? You can read into it, you can interpret, you can use a poem as a way of exploring an important topic, and bringing perhaps to the surface some of the questions that you also deal with, as a human, instead of only your skill, as an oncologist or as a physician used to counseling people. Dr. Barry Meisenberg: I think that is one of the values of poetry. I run a program here at this health system that we call the Diastole Hour because it's important for relaxation. You can't live your whole life in systole. That's the message. And we use poetry a lot, mostly written by patients about their medical experiences, sometimes written by doctors about what it means to be a doctor or be a better doctor. And then, of course, some art that covers medical topics. And the whole goal is to train that other part of our brain to make us better at the business part of being a doctor, and I think the two are related. Dr. Lidia Schapira: Do you read poetry with your fellows or with your trainees or junior faculty? How do you incorporate this kind of thinking in their professional life? How do you use it to build a community? Dr. Barry Meisenberg: Well, that's a great point. I wish we could do more. So, I read some poetry. I am not trained in it and I tend to look for poems that one doesn't need to be an expert in the classics to understand and we use them at this event I've told you about. But also, I've been known to sneak them into Grand Rounds presentations and other venues, trying to make people pause and think a little bit about it. There's some wonderful poetry about the physician experience, for sure. And I sort of collect them. Dr. Lidia Schapira: What are some of your favorite pieces? Dr. Barry Meisenberg: There's a neurologist named Ginsburg, who has written, I remember one poem, in particular, called “Line Drive”. And it's about a man, presumably, based on a true story, who is explaining to someone their brain tumor anatomy during a hospital visit, and pointing at shadows, but recognizes that he doesn't actually do any touching. He doesn't enter their lives. He doesn't answer all their questions like the one we just talked about. And then he's driving home, and he stops at a little league Park and watches some boys play baseball. And one of the boys is struck by a line drive. And he's so moved, by the way, his teammates gather around him and offer support and touch him and help him that he drives back to the hospital to redo the consultation he had just finished doing, but this time with the touching. I thought that was a wonderful poem. Dr. Lidia Schapira: It's an amazing poem. Dr. Barry Meisenberg: I read that poem in Abu Dhabi, actually, to an audience, few of whom knew baseball, so I sort of had to explain it to an audience of oncology professionals. I might have missed my mark, I don't know, but I wanted them to understand certainly the importance of entering patients' lives. Dr. Lidia Schapira: Have you always felt this way about using narrative and poetry as a means of reflection, self-expression, and dialogue? Or is it something you came to later in your life as a more mature professional? Dr. Barry Meisenberg: Definitely the latter. I mean, I was fortunate in that I had good cultural capital growing up, but I didn't really incorporate it into my other life, my professional life until I'd say the last 10 years or 15. I've always been an admirer of Shakespeare, by the way, he wrote about the plague a little bit too, indirectly. And then one time I actually wrote an essay about this: I was given a poem by a patient, who was from Ireland and this is sort of like the national poet of Ireland. And it was his way of telling me, he didn't want any treatment. And the poem is about loss and lamentation that accumulates through life, and all his friends were in the graveyard. He wasn't interested in therapies that are designed to induce a response rate. He didn't want any treatment. The way he communicated that was through a poem. And I began to understand that really in a more realistic way that poem can do that. Dr. Lidia Schapira: Well, thank you so much for your insights. It's been a wonderful conversation. Is there something else you would like to tell our listeners and perhaps even a thought for future readers of the poem? Dr. Barry Meisenberg: By the way, I should say that the name of that poem I just referred to is called “Oft, in a Stilly Night”. It's the first line of an Irish folk song. But I would hope people take the time to indulge. Many medical journals have sections like this, they're usually short. And I will tell you, that's the first thing I read in these medical journals. I hope people will follow that pattern. Dr. Lidia Schapira: Thank you so much, Barry. It's been a lovely conversation. Thank you for your work, and thanks to the readers. And more next episode of Art of Oncology. Until next time, thank you for listening to this JCOs Cancer Stories: The Art of Oncology Podcast. If you enjoyed what you heard today, don't forget to give us a rating or review on Apple podcasts or wherever you listen. While you're there, be sure to subscribe so you never miss an episode of JCOs Cancer Stories: The Art of Oncology Podcast. This is just one of many ASCOs podcasts. You can find all of the shows at podcast.asco.org.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product or service organization, activity or therapy should not be construed as an ASCO endorsement.

<description>&lt;p&gt;"Questions for the Oncologist," by Barry Meisenberg: an oncologist struggles to answer a patient’s “Why me?” question.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;&lt;strong&gt;Transcript&lt;/strong&gt;&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;&lt;strong&gt;Narrator:&lt;/strong&gt; Questions for the Oncologist by Barry R. Meisenberg, MD (&lt;a href= "https://ascopubs.org/doi/full/10.1200/JCO.22.00158"&gt;10.1200/JCO.22.00158&lt;/a&gt;)&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;Go ahead, ask me anything.&lt;br /&gt; Decades of meeting beseeching eyes has prepared me.&lt;br /&gt; Ask me anything except that one thing.&lt;br /&gt; That one thing that neither colleagues nor study has helped me comprehend.&lt;/p&gt; &lt;p&gt;Ask me instead about prognosis; I will be honest, but gentle.&lt;br /&gt; Ask me about side effects; I will use a small spoon so as not to overfill your vessel.&lt;br /&gt; Unfold your notebook.&lt;br /&gt; Ask me anything:&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;“-how many cases like mine have you seen before?&lt;br /&gt; -what is the nectar of the bone marrow?&lt;br /&gt; -what (and how) should I tell the children?&lt;br /&gt; -is it wise to lay in the sun?&lt;/p&gt; &lt;p&gt;-is it safe to have sex?&lt;br /&gt; -should I get the vaccine?&lt;br /&gt; -what’s next if this doesn’t work?&lt;br /&gt; -what if it were your wife?”&lt;/p&gt; &lt;p&gt;Go ahead, ask me anything.&lt;br /&gt; But please, don’t ask me that one thing.&lt;br /&gt; Don’t ask, “why me?”&lt;br /&gt; You wouldn’t like the answer. I don’t.&lt;/p&gt; &lt;p&gt;I could fill your notebook with a tale of random errors in the genes.&lt;br /&gt; Tiny rivulets of mutation that flow into a tumultuous river.&lt;br /&gt; But, I don’t think of them as errors. Rather, they are Nature’s engine of biodiversity.&lt;br /&gt; Individuals suffer, so that species survive.&lt;/p&gt; &lt;p&gt;“Bad luck” is a second-rate explanation, I know.&lt;br /&gt; So please, don’t ask me that one thing.&lt;br /&gt; Search for a better answer within, as I have.&lt;br /&gt; Unsuccessfully, so far.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;&lt;strong&gt;Dr. Lidia Schapira:&lt;/strong&gt; Welcome to JCOs Cancer Stories: The Art of Oncology brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the world of cancer care. You can find all of the shows including this one at podcast.asco.org.&lt;/p&gt; &lt;p&gt;I'm your host, Lidia Schapira. And with me today is Dr. Barry Meisenberg, Chair of Medicine and Director of Academic Affairs at Luminous Health. We'll be discussing his Art of Oncology article: Questions for the Oncologist. Our guest has no disclosures. Barry, welcome to our podcast.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Dr. Barry Meisenberg:&lt;/strong&gt; Good morning. Thank you very much.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Dr. Lidia Schapira:&lt;/strong&gt; It's a pleasure to have you. And before we start to talk about your poem, and the reason for your wanting to share this with a broad readership, mostly of Clinical Oncologists, let me start by asking if you are a poet and if you often write to reflect on your experiences as a physician, or for other reasons?&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Dr. Barry Meisenberg:&lt;/strong&gt; Well, I will never give myself that label of poet. I have written several, what I would call reflections on what it is to be an oncologist, which this section of the JCO covers so well.&lt;/p&gt; &lt;p&gt;Sometimes I've submitted work and said it was a poem and the editor said, 'No, this is a vignette.' Another time I thought it was a narrative and someone said, 'We liked your poem.' So, increasingly, I've entered this area reflecting a career's worth of introspective thoughts about what it is we do.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Dr. Lidia Schapira:&lt;/strong&gt; So let me ask you, given your very particular vantage and your experience, why do you think it's important for us to write and read reflections? What does narrative give us as physicians, as cancer doctors?&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Dr. Barry Meisenberg:&lt;/strong&gt; Well, I think it gives us the other parts of our brain and the other parts of our personality as humans. The most humanistic of all the sciences is medicine. We can't neglect that. Mostly for our own health. But also, I think it makes us better physicians when we think about what we're doing.&lt;/p&gt; &lt;p&gt;You know I think it was a physician author, who said that we walk around in the midst of stories. Every one of our patients has a story, sometimes multiple stories, and if we miss that, and don't really capture that, then we're just sort of functionaries.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Dr. Lidia Schapira:&lt;/strong&gt; Such an important thought. There's definitely plot. There are characters. There's the scenery. There's all of this very rich life and human content and I couldn't agree with you more.&lt;/p&gt; &lt;p&gt;So, before I ask about this particular essay, what are you reading now or what have you read in the last year that you would recommend to your colleagues?&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Dr. Barry Meisenberg:&lt;/strong&gt; Well, it's interesting you say that because, recording here in April of 2022, I've talked to many of my neighbors about their pandemic hobbies, both medical and nonmedical, and they're, you know, learning to bake, reteaching the piano, and working on developing their rhomboids.&lt;/p&gt; &lt;p&gt;I've been doing a deep dive into the history of other pandemics. I may be little obsessive, but I've been reading about pandemics throughout history, and just appreciating the fact that human nature hasn't changed very much, nor has medical behavior.&lt;/p&gt; &lt;p&gt;So, in Defoe's book, I think it's called &lt;em&gt;Journal of a Plague Year,&lt;/em&gt; which by the way, is not history, is a fictional journal but based on reality. We have the same sort of medical charlatanism. We have false hopes. We have people trying to beat the quarantine for their own good.&lt;/p&gt; &lt;p&gt;At the same time, we have just public-oriented behavior as well, feeding those who couldn't be fed or who would become orphaned by the plague. The same thing is true of the 14th-century plague.&lt;/p&gt; &lt;p&gt;It's just remarkable how little we've changed as a species, all the behaviors on display today, both good and bad, were on display then. And so, I've been reading quite a bit about pandemics.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Dr. Lidia Schapira:&lt;/strong&gt; It’s so interesting. Now, with that, let's focus on your beautiful poem, the question that you can't answer after all your scientific work and after your decades of clinical experience, “Why me?”.&lt;/p&gt; &lt;p&gt;Tell us a little bit about what inspired this poem that I found so moving, and I'm not a great reader of poetry. But this one message was so clear that I think most of our readers will understand the sentiment. What inspired you to write it?&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Dr. Barry Meisenberg:&lt;/strong&gt; Well, I woke up with this one. Sometimes that happens, you wake up with a poem that is nearly fully formed, or a narrative is nearly fully formed in your mind.&lt;/p&gt; &lt;p&gt;Although I did get some excellent suggestions from my reviewers that I do appreciate. And I realized only after it was on paper, that seven years ago, I wrote a piece for a different oncology journal about this issue of random chance. And you may remember, in 2015, there was an article, or a science magazine published an article by Thomas Heti and Bert Vogelstein about their mathematical calculations of errors in stem cell division.&lt;/p&gt; &lt;p&gt;They didn't do any new experiments. They accumulate what was already known, and they were able to correlate that with the incidence of cancer from the cancer databases. And their conclusions were, when stem cells make random errors, there's more likely to be cancer.&lt;/p&gt; &lt;p&gt;Now, they didn't cover every type of cancer. They covered several. And they came up with this idea that cancer is stochastic, that is a random process. Now, stochastic is not a poetic word. And so, we didn't use it in the poem, but random, and that was covered extensively in the New York Times and other media, and a big debate about what it meant.&lt;/p&gt; &lt;p&gt;So, I wrote an essay about that, and I realized it's been on my mind all this time, and whether it's a helpful notion or a harmful notion. Helpful in that patients can understand you didn't do anything to give yourself cancer, despite all the media noise about that, but harmful, potentially harmful, in this idea that maybe my life doesn't have meaning if this is just a random process.&lt;/p&gt; &lt;p&gt;And so, I talk to patients about this when appropriate, because many of them have thought about it. So, it's sort of been on my mind since this article I wrote in 2015. And I must say, it disturbs me that I don't have a good way of explaining that or helping patients overcome this.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Dr. Lidia Schapira:&lt;/strong&gt; So, when a person asks you why me in some way, I mean, you, first of all, you tell us that you have answers for most of the other questions, what is my prognosis? You can answer. How do I tell the children? You can answer. Is it safe to have sex? You can answer.&lt;/p&gt; &lt;p&gt;But the “why me” question is still with you and still troubles you. What is it, in your view, that a person is really asking you? What is the question behind the question when they say 'why me?'&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Dr. Barry Meisenberg:&lt;/strong&gt; Well, that is the question. And then I think what they're saying is what does my life mean? Yeah, if the answer to Dr. Vogelstein is correct, that it's stochastic, doesn't mean my life doesn't have a meaning. I hope people wouldn’t draw that conclusion.&lt;/p&gt; &lt;p&gt;So, random things happen to people, both nice people, and mean people all the time. I remember when I was in New York doing a year of research at Sloan Kettering, there was a helicopter accident, and it didn't just kill the people in the helicopter, but a piece of the blade broke off and spun out over Manhattan, killing someone who was about to walk into a retail store, totally random. It had an impact on me in how all our lives hang by a thread, or it can, and cancer is like that.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Dr. Lidia Schapira:&lt;/strong&gt; What I hear in the “why me” question is also sort of a plea for, please reassure me and keep me safe, because this happened, and you have no explanation, I have no explanation. So, it's interesting that you talk about life's meaning. I see it more as a cry for help. If I can't deal with the uncertainty and the chaos of the universe.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Dr. Barry Meisenberg:&lt;/strong&gt; That's an excellent perspective. And you may well be right, at least for many people. It's almost like a real issue of faith and religion, or more faith and religion. When I say in the piece, 'you have to look inside for that answer, why me and what your life means?' Yeah, people ask questions for a reason. Some of it is just fact downloading, the risk of mucositis, how to treat mucositis, and so on. But other, the more important questions are these.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Dr. Lidia Schapira:&lt;/strong&gt; And that's one of the beauties, I think, of poetry and why we love to publish great poems because it's almost like a bit of a Rorschach too, right? You can read into it, you can interpret, you can use a poem as a way of exploring an important topic, and bringing perhaps to the surface some of the questions that you also deal with, as a human, instead of only your skill, as an oncologist or as a physician used to counseling people.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Dr. Barry Meisenberg:&lt;/strong&gt; I think that is one of the values of poetry. I run a program here at this health system that we call the Diastole Hour because it's important for relaxation. You can't live your whole life in systole. That's the message.&lt;/p&gt; &lt;p&gt;And we use poetry a lot, mostly written by patients about their medical experiences, sometimes written by doctors about what it means to be a doctor or be a better doctor. And then, of course, some art that covers medical topics. And the whole goal is to train that other part of our brain to make us better at the business part of being a doctor, and I think the two are related.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Dr. Lidia Schapira:&lt;/strong&gt; Do you read poetry with your fellows or with your trainees or junior faculty? How do you incorporate this kind of thinking in their professional life? How do you use it to build a community?&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Dr. Barry Meisenberg:&lt;/strong&gt; Well, that's a great point. I wish we could do more. So, I read some poetry. I am not trained in it and I tend to look for poems that one doesn't need to be an expert in the classics to understand and we use them at this event I've told you about. But also, I've been known to sneak them into Grand Rounds presentations and other venues, trying to make people pause and think a little bit about it. There's some wonderful poetry about the physician experience, for sure. And I sort of collect them.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Dr. Lidia Schapira:&lt;/strong&gt; What are some of your favorite pieces?&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Dr. Barry Meisenberg:&lt;/strong&gt; There's a neurologist named Ginsburg, who has written, I remember one poem, in particular, called “Line Drive”. And it's about a man, presumably, based on a true story, who is explaining to someone their brain tumor anatomy during a hospital visit, and pointing at shadows, but recognizes that he doesn't actually do any touching. He doesn't enter their lives. He doesn't answer all their questions like the one we just talked about. And then he's driving home, and he stops at a little league Park and watches some boys play baseball. And one of the boys is struck by a line drive. And he's so moved, by the way, his teammates gather around him and offer support and touch him and help him that he drives back to the hospital to redo the consultation he had just finished doing, but this time with the touching. I thought that was a wonderful poem.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Dr. Lidia Schapira:&lt;/strong&gt; It's an amazing poem.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Dr. Barry Meisenberg:&lt;/strong&gt; I read that poem in Abu Dhabi, actually, to an audience, few of whom knew baseball, so I sort of had to explain it to an audience of oncology professionals. I might have missed my mark, I don't know, but I wanted them to understand certainly the importance of entering patients' lives.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Dr. Lidia Schapira:&lt;/strong&gt; Have you always felt this way about using narrative and poetry as a means of reflection, self-expression, and dialogue? Or is it something you came to later in your life as a more mature professional?&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Dr. Barry Meisenberg:&lt;/strong&gt; Definitely the latter. I mean, I was fortunate in that I had good cultural capital growing up, but I didn't really incorporate it into my other life, my professional life until I'd say the last 10 years or 15.&lt;/p&gt; &lt;p&gt;I've always been an admirer of Shakespeare, by the way, he wrote about the plague a little bit too, indirectly. And then one time I actually wrote an essay about this: I was given a poem by a patient, who was from Ireland and this is sort of like the national poet of Ireland. And it was his way of telling me, he didn't want any treatment. And the poem is about loss and lamentation that accumulates through life, and all his friends were in the graveyard.&lt;/p&gt; &lt;p&gt;He wasn't interested in therapies that are designed to induce a response rate. He didn't want any treatment. The way he communicated that was through a poem. And I began to understand that really in a more realistic way that poem can do that.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Dr. Lidia Schapira:&lt;/strong&gt; Well, thank you so much for your insights. It's been a wonderful conversation. Is there something else you would like to tell our listeners and perhaps even a thought for future readers of the poem?&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Dr. Barry Meisenberg:&lt;/strong&gt; By the way, I should say that the name of that poem I just referred to is called “Oft, in a Stilly Night”. It's the first line of an Irish folk song. But I would hope people take the time to indulge. Many medical journals have sections like this, they're usually short. And I will tell you, that's the first thing I read in these medical journals. I hope people will follow that pattern.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Dr. Lidia Schapira:&lt;/strong&gt; Thank you so much, Barry. It's been a lovely conversation. Thank you for your work, and thanks to the readers. And more next episode of Art of Oncology.&lt;/p&gt; &lt;p&gt;Until next time, thank you for listening to this JCOs Cancer Stories: The Art of Oncology Podcast. If you enjoyed what you heard today, don't forget to give us a rating or review on Apple podcasts or wherever you listen. While you're there, be sure to subscribe so you never miss an episode of JCOs Cancer Stories: The Art of Oncology Podcast. This is just one of many ASCOs podcasts. You can find all of the shows at podcast.asco.org.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p align="center"&gt;&lt;em&gt;The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.&lt;/em&gt;&lt;/p&gt; &lt;p align="center"&gt;&lt;em&gt;Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product or service organization, activity or therapy should not be construed as an ASCO endorsement.&lt;/em&gt;&lt;/p&gt;</description>

"Questions for the Oncologist," by Barry Meisenberg: an oncologist struggles to answer a patient’s “Why me?” question.   Transcript   Narrator: Questions for the Oncologist by Barry R. Meisenberg, MD ()   Go ahead, ask me...

Questions for the Oncologist

A physician attempts to ease a patient’s pain, a painful moment somewhat eased by the joy of music.

A physician attempts to ease a patient’s pain, a painful moment somewhat eased by the joy of music.

Ode to Joy

In the poem, Housekeeping, by David Harris, a patient struggles with what it means to be saved. Read by Seema Yasmin.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care, and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.   Welcome to JCO's Cancer Stories, The Art of Oncology, brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content, and offering enriching insight into the world of cancer care. You can find all of the shows, including this one, at podcast.asco.org.   Housekeeping by David Harris. I've been clearing out my closets so that my husband won't have to afterward. She wiped her eyes on her hospital gown. I imagined her at home, pulling out hangers and holding up clothes to her wasted body, choosing what to save and what to throw away.   And by save, I mean leave behind for her husband afterward. Me imagining her imagining him, pulling out hangers, loosely dangling clothes, a Christmas sweater, the jeans he liked, a scarf, a blouse. Him wondering what he is supposed to do with a pink blouse.   Should he throw it away or bury it in some unsorted pile, half forgotten, or save it, leaving it hanging in the closet of their bedroom? I am talking to her about CPR now. About what we can save and what we can't. And by save, I mean prolong.   And she turns to me and asks what she is supposed to do with the word terminal. Afterward, after latex gloves are peeled off hands, after the bag is found and zipped around her quiet body, after all the things I said or didn't say, this is what we save. Her hospital gown, unbuttoned, washed clean, folded onto itself, with thousands of other gowns.   With me today is Dr. David Harris, a palliative care physician at Cleveland Clinic. Dave, welcome to our podcast.   Thank you, Lidia. I'm grateful to be here.   It's great to have you. You're the author of a poem that we recently published called Housekeeping. Before we start to talk about your poem, tell me a little bit about what you enjoy reading and perhaps what's on your nightstand right now.   Sure. I've been reading some nonfiction work on behavioral economics by Predictably Irrational or Thinking Fast and Slow by Daniel Kahneman. But I should also probably talk about poetry that I like reading, since the poem in JCO was published.   Two of my favorite poets, and if you read my poem and you want to find more like it, would be Mary Oliver and Marie Howe. And if you're looking for a place to start with those poets, you could look for What The Living Do by Marie Howe or The Fourth Sign of the Zodiac by Mary Oliver.   So training does one need to have to read and appreciate poetry?   Oh, that's a great question. I think when I was in high school, I kind of got scared away from poetry because it felt like something that I really didn't understand and that you had to have a lot of training to read and appreciate. But I don't think it necessarily has to be that way.   I find poetry really nice because it's short, and if you find authors that keep their poetry accessible, you can just read it and spend a moment appreciating it, and go on with your day. So I'd say you don't really need a lot of training other than just being a human being and bringing to the poem the experiences that you've had in your life.   I love that. And with that, let's talk a little bit about the poem that you wrote and that I've had an opportunity to read and love it, and that is Housekeeping. There's a line here that drew me right in, and that is the line, a very simple line, me imagining her imagining him.   It seemed to me that that's almost the perfect definition of empathy. Is that what you had in mind? The ability to connect and just imagine what it's like to be somebody else, to see the world through the mindset of another person?   Yeah. Thank you, Lidia. That's exactly what I was going for. I mean, I think that this poem is mostly in the speaker's imagination. The inspiration for the poetry was the quote at the beginning of the poem, which was told to me by a patient. I'd been cleaning out my closets so that my husband won't have to afterward.   And I think we've all had patients tell us something, and after we leave the room, we just pause and say, like, wow, I can't believe that that conversation just happened. And, you know, what a strange, and meaningful, and powerful thing that patient said to me. So that was the inspiration for the poem. And then for the rest of the poem, I was just sort of imagining different scenes or different thoughts that were inspired by that line.   So in the poem, you talked about having the difficult conversation with a patient, and you state this in the present tense. I am talking to her about CPR now. And then you bring us also to the world of the very practical task of having this conversation and imagining a time when the patient is no longer present, her death.   And then you have this parallel process where you describe all the tasks, the very practical housekeeping tasks, of what happens after death. The sorting of possessions and the dispatching of the body. Tell us a little bit more about how you thought about putting these two things together, and so compactly and beautifully.   Oh, thank you, Lidia. Yeah. I think as I was writing the poem, I began to think more and more about those material pieces of our lives, that they're of special significance when we're thinking about end of life. And that came from the patient who was going through her closets and holding out clothes and thinking, you know, am I going to wear this before I die or can I throw this away, and thinking about how much clothing means to people.   And then I thought about the hospital gowns and how much of a contrast that is, how impersonal that is compared to what people wear in their day to day lives. That sort of focus on these material possessions and these tasks that can be kind of mundane at times came out as I was writing the poem.   And there is this parallel, also, about what we do as physicians when we are looking after patients who are so ill. There are some very practical things, but then there are conversations that have to do with the ultimate abstraction, which is imagining not being here.   I think the title grounds us in the same way that some of these tasks, perhaps, ground us in our day to day world. I also thought that it was very interesting that you used the word afterwards twice, including leading with it in the last stanza. And I imagine that, perhaps, as you were thinking of a title, another title could have been Afterward.   Yeah.   So does that capture some of your process?   Yeah. Afterwards was a rough draft title. You guessed it. Because I think that so much of the poem is about thinking of the future or we're thinking about what's going to happen next.   I think I chose Housekeeping instead because one of the things that I really am interested in in art and in talking with patients is the importance of daily lives, or the importance of these kind of mundane tasks that we all go through.   And how, for people who have cancer and are struggling to maintain quality of life, sometimes doing the laundry or cooking suddenly becomes really meaningful and important to them, or maybe even housekeeping becomes meaningful and important to them. So that title felt like there were more layers to it, which is why I chose it.   You know, as I was reading this, and I read that you were imagining your patient imagining her husband's grief and her husband's reaction to her passing, I was imagining what you, as the clinician in this situation, were imagining and feeling. It was very impactful to me.   And there's something about how simple the lines are and the language is that really drew me in. Tell me a little bit more about your feeling and what this kind of an encounter with a patient does to you as palliative care physician.   Thank you for asking me that, Lidia. You know, this meant a lot to me. And after I left the room after having this conversation with the patient, I was struck by how profound that moment was and how meaningful having those conversations with patients is for me.   And part of the purpose of writing this poem and publishing it is to share that experience. I think most of us in oncology and palliative care go into the field because we look for moments like this and we appreciate moments like this. But also, day to day life can kind of make us blind to these things with all the paperwork we have to do and all of the red tape.   And when I talk to physicians who are feeling burned out, I notice that they don't really bring up moments like this anymore, and I feel like they're not noticing them the way they used to. So noticing moments like this and appreciating them helps me from being burned out, and I'm hoping that people will read this poem and sort of be able to be resensitized to those moments in their practice.   That's a lovely thought. I also would add that one of the themes that we find in the submissions we receive to Art of Oncology is this very sincere desire to honor a patient. And I read that also in your line.   Yeah. I mean, this patient has passed away, but they've made such an impact on me, and it feels like I need to do something to remember them. That's part of what made me write this piece as well.   Well, thank you for sharing all of that with us. And I hope our readers go back and read your beautiful poem, Housekeeping, over and over. Let me finish by just asking you a little about the process of writing. You-- are you a repetitive writer? Do you have time set aside to write, or do you write when you're inspired or when it calls you?   That's a great question. And I feel like people who have previously been on your podcast have said something similar. But for me, I have these moments, and it feels like there's something in me that has to come out. It feels like I already know there's a poem there, and I just have to start writing it.   So usually, that's how things begin. If I'm not feeling burned out and I'm in a place where I can notice those feelings, and then I start writing. And then once I've begun writing, I notice different ideas that I want to develop in the piece.   These are things that you picked up on, sort of this interest in the mundane, daily tasks of life, or another thing that I wanted to develop in this piece was the idea of saving, and what does it mean to save something. And then, you know, I just kind of keep writing and trying to figure that stuff out until it feels like the poem is done.   Well, thank you so much, Dave. I loved Housekeeping, and I hope you keep writing. So this ends our podcast. Please join me again for more of about cancer stories.   Until next time, thank you for listening to this JCO's Cancer Stories, The Art of Oncology Podcast. If you enjoyed what you heard today, don't forget to give us a rating or review on Apple Podcasts or wherever you listen. While you're there, be sure to subscribe so you never miss an episode. JCO's Cancer Stories, The Art of Oncology Podcast is just one of ASCO's many podcasts. You can find all of the shows at podcast.asco.org.

<description>&lt;p&gt;In the poem, Housekeeping, by David Harris, a patient struggles with what it means to be saved. Read by Seema Yasmin.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care, and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;Welcome to JCO's Cancer Stories, The Art of Oncology, brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content, and offering enriching insight into the world of cancer care. You can find all of the shows, including this one, at podcast.asco.org.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;Housekeeping by David Harris. I've been clearing out my closets so that my husband won't have to afterward. She wiped her eyes on her hospital gown. I imagined her at home, pulling out hangers and holding up clothes to her wasted body, choosing what to save and what to throw away.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;And by save, I mean leave behind for her husband afterward. Me imagining her imagining him, pulling out hangers, loosely dangling clothes, a Christmas sweater, the jeans he liked, a scarf, a blouse. Him wondering what he is supposed to do with a pink blouse.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;Should he throw it away or bury it in some unsorted pile, half forgotten, or save it, leaving it hanging in the closet of their bedroom? I am talking to her about CPR now. About what we can save and what we can't. And by save, I mean prolong.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;And she turns to me and asks what she is supposed to do with the word terminal. Afterward, after latex gloves are peeled off hands, after the bag is found and zipped around her quiet body, after all the things I said or didn't say, this is what we save. Her hospital gown, unbuttoned, washed clean, folded onto itself, with thousands of other gowns.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;With me today is Dr. David Harris, a palliative care physician at Cleveland Clinic. Dave, welcome to our podcast.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;Thank you, Lidia. I'm grateful to be here.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;It's great to have you. You're the author of a poem that we recently published called Housekeeping. Before we start to talk about your poem, tell me a little bit about what you enjoy reading and perhaps what's on your nightstand right now.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;Sure. I've been reading some nonfiction work on behavioral economics by Predictably Irrational or Thinking Fast and Slow by Daniel Kahneman. But I should also probably talk about poetry that I like reading, since the poem in JCO was published.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;Two of my favorite poets, and if you read my poem and you want to find more like it, would be Mary Oliver and Marie Howe. And if you're looking for a place to start with those poets, you could look for What The Living Do by Marie Howe or The Fourth Sign of the Zodiac by Mary Oliver.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;So training does one need to have to read and appreciate poetry?&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;Oh, that's a great question. I think when I was in high school, I kind of got scared away from poetry because it felt like something that I really didn't understand and that you had to have a lot of training to read and appreciate. But I don't think it necessarily has to be that way.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;I find poetry really nice because it's short, and if you find authors that keep their poetry accessible, you can just read it and spend a moment appreciating it, and go on with your day. So I'd say you don't really need a lot of training other than just being a human being and bringing to the poem the experiences that you've had in your life.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;I love that. And with that, let's talk a little bit about the poem that you wrote and that I've had an opportunity to read and love it, and that is Housekeeping. There's a line here that drew me right in, and that is the line, a very simple line, me imagining her imagining him.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;It seemed to me that that's almost the perfect definition of empathy. Is that what you had in mind? The ability to connect and just imagine what it's like to be somebody else, to see the world through the mindset of another person?&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;Yeah. Thank you, Lidia. That's exactly what I was going for. I mean, I think that this poem is mostly in the speaker's imagination. The inspiration for the poetry was the quote at the beginning of the poem, which was told to me by a patient. I'd been cleaning out my closets so that my husband won't have to afterward.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;And I think we've all had patients tell us something, and after we leave the room, we just pause and say, like, wow, I can't believe that that conversation just happened. And, you know, what a strange, and meaningful, and powerful thing that patient said to me. So that was the inspiration for the poem. And then for the rest of the poem, I was just sort of imagining different scenes or different thoughts that were inspired by that line.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;So in the poem, you talked about having the difficult conversation with a patient, and you state this in the present tense. I am talking to her about CPR now. And then you bring us also to the world of the very practical task of having this conversation and imagining a time when the patient is no longer present, her death.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;And then you have this parallel process where you describe all the tasks, the very practical housekeeping tasks, of what happens after death. The sorting of possessions and the dispatching of the body. Tell us a little bit more about how you thought about putting these two things together, and so compactly and beautifully.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;Oh, thank you, Lidia. Yeah. I think as I was writing the poem, I began to think more and more about those material pieces of our lives, that they're of special significance when we're thinking about end of life. And that came from the patient who was going through her closets and holding out clothes and thinking, you know, am I going to wear this before I die or can I throw this away, and thinking about how much clothing means to people.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;And then I thought about the hospital gowns and how much of a contrast that is, how impersonal that is compared to what people wear in their day to day lives. That sort of focus on these material possessions and these tasks that can be kind of mundane at times came out as I was writing the poem.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;And there is this parallel, also, about what we do as physicians when we are looking after patients who are so ill. There are some very practical things, but then there are conversations that have to do with the ultimate abstraction, which is imagining not being here.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;I think the title grounds us in the same way that some of these tasks, perhaps, ground us in our day to day world. I also thought that it was very interesting that you used the word afterwards twice, including leading with it in the last stanza. And I imagine that, perhaps, as you were thinking of a title, another title could have been Afterward.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;Yeah.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;So does that capture some of your process?&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;Yeah. Afterwards was a rough draft title. You guessed it. Because I think that so much of the poem is about thinking of the future or we're thinking about what's going to happen next.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;I think I chose Housekeeping instead because one of the things that I really am interested in in art and in talking with patients is the importance of daily lives, or the importance of these kind of mundane tasks that we all go through.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;And how, for people who have cancer and are struggling to maintain quality of life, sometimes doing the laundry or cooking suddenly becomes really meaningful and important to them, or maybe even housekeeping becomes meaningful and important to them. So that title felt like there were more layers to it, which is why I chose it.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;You know, as I was reading this, and I read that you were imagining your patient imagining her husband's grief and her husband's reaction to her passing, I was imagining what you, as the clinician in this situation, were imagining and feeling. It was very impactful to me.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;And there's something about how simple the lines are and the language is that really drew me in. Tell me a little bit more about your feeling and what this kind of an encounter with a patient does to you as palliative care physician.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;Thank you for asking me that, Lidia. You know, this meant a lot to me. And after I left the room after having this conversation with the patient, I was struck by how profound that moment was and how meaningful having those conversations with patients is for me.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;And part of the purpose of writing this poem and publishing it is to share that experience. I think most of us in oncology and palliative care go into the field because we look for moments like this and we appreciate moments like this. But also, day to day life can kind of make us blind to these things with all the paperwork we have to do and all of the red tape.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;And when I talk to physicians who are feeling burned out, I notice that they don't really bring up moments like this anymore, and I feel like they're not noticing them the way they used to. So noticing moments like this and appreciating them helps me from being burned out, and I'm hoping that people will read this poem and sort of be able to be resensitized to those moments in their practice.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;That's a lovely thought. I also would add that one of the themes that we find in the submissions we receive to Art of Oncology is this very sincere desire to honor a patient. And I read that also in your line.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;Yeah. I mean, this patient has passed away, but they've made such an impact on me, and it feels like I need to do something to remember them. That's part of what made me write this piece as well.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;Well, thank you for sharing all of that with us. And I hope our readers go back and read your beautiful poem, Housekeeping, over and over. Let me finish by just asking you a little about the process of writing. You-- are you a repetitive writer? Do you have time set aside to write, or do you write when you're inspired or when it calls you?&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;That's a great question. And I feel like people who have previously been on your podcast have said something similar. But for me, I have these moments, and it feels like there's something in me that has to come out. It feels like I already know there's a poem there, and I just have to start writing it.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;So usually, that's how things begin. If I'm not feeling burned out and I'm in a place where I can notice those feelings, and then I start writing. And then once I've begun writing, I notice different ideas that I want to develop in the piece.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;These are things that you picked up on, sort of this interest in the mundane, daily tasks of life, or another thing that I wanted to develop in this piece was the idea of saving, and what does it mean to save something. And then, you know, I just kind of keep writing and trying to figure that stuff out until it feels like the poem is done.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;Well, thank you so much, Dave. I loved Housekeeping, and I hope you keep writing. So this ends our podcast. Please join me again for more of about cancer stories.&lt;/p&gt; &lt;p&gt; &lt;/p&gt; &lt;p&gt;Until next time, thank you for listening to this JCO's Cancer Stories, The Art of Oncology Podcast. If you enjoyed what you heard today, don't forget to give us a rating or review on Apple Podcasts or wherever you listen. While you're there, be sure to subscribe so you never miss an episode. JCO's Cancer Stories, The Art of Oncology Podcast is just one of ASCO's many podcasts. You can find all of the shows at podcast.asco.org.&lt;/p&gt;</description>

In the poem, Housekeeping, by David Harris, a patient struggles with what it means to be saved. Read by Seema Yasmin.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care, and is not...

Housekeeping

Dr. Hayes interviews Dr. Bloomfield on her role as one of the first physician-scientists to investigate treatment for acute myeloid leukemia (AML).   TRANSCRIPT The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. [MUSIC PLAYING] Welcome to JCO's Cancer Stories-- The art of Oncology brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the role of cancer care. You can find all of the shows, including this one, at podcast.asco.org. [MUSIC PLAYING] Welcome to today's version of the ASCO Cancer Stories podcast. Today, my guest on the podcast is Dr. Clara Bloomfield. Dr. Bloomfield was instrumental in the early studies investigating the biology of leukemias and lymphomas, and also the interaction between various molecular markers and treatment. She founded the Correlative Science Committee of The Cancer and Leukemia Group B, which is now designated the Alliance in the 1980s. And I believe that was probably the first such committee in the cooperative groups, and she chaired it for at least 25 years. Her work resulted in numerous groundbreaking insights that led to changes in practice. Personally, and having worked with her for several of those years in CALGB, I really consider her one of the first investigators to perform what we now blithely called, quote, "translational," end of quote, science in cancer. Dr. Bloomfield was born in New York City, but her father, who was an expert in labor and industrial relations, moved the family to Washington, DC during World War II. And after the war, he then took a position at the University of Illinois, leading Dr. Bloomfield to have a nearly lifelong association with the Midwest. She attended undergraduate school at the University of Wisconsin, but then graduated from San Diego State College during a brief foray to the West Coast. She returned to the Midwest to attend medical school at the University of Chicago, and then completed her internal medicine residency and her medical oncology fellowship at the University of Minnesota, where she stayed on faculty until 1989. She then became chair of the Department of Medicine at Roswell Park Cancer Institute in Buffalo for the next eight years, and then moved to the Ohio State University, where she accepted the position as director of the comprehensive and now designated the James Cancer Center. She's remained at OSU and is currently a distinguished university professor and the William G. Pace II professor of cancer research and a senior advisor at the OSU James Cancer Center. Dr. Bloomfield has authored hundreds of peer-reviewed papers. She is an elected member of the National Academy of Medicine and the National Academy of Sciences. She's, frankly, won just too many awards that I can name here. But importantly, she served on the ASCO board of directors, and in 2009, she gave the David A. Karnofsky Memorial Lecture, the highest honor our society can bestow. Clara, welcome to our program. Thank you. You know, I have a lot of questions for you, many of which I thought about that I should have asked you 30 years ago or so when we first started working together in CALGB. But I think the biggest one is, how did you get interested in leukemia in the first place? Were any particular personal insights that resulted in the basis of your career? Or was it just happenstance? I think it happened because in grade school, I had a number of classmates who developed leukemia. And they were sent to the National Cancer Institute because people in those days didn't treat leukemia. And they returned with steroid-bloated faces and soon died. And I thought, well, wouldn't it be cool to develop medicine that could save kids from dying? I'd already decided to become a doctor, so seeing the real-life effects of cancer helped shape my early desire to become an oncologist. So that must have been about the same time, a little bit after, that Drs. Frei, and Freireich, and Holland started combination therapy for leukemia. They must have had a big impact on your career then. I don't remember. [? No, ?] I'm kidding. Actually, the other question-- I know that you spent some time at Stanford and ran into Henry Kaplan. And there was a cute anecdote, I think, about how you presented with his backing at one of the conferences. Can you tell us a little bit about Dr. Kaplan and your work with him? Sure. During my junior and senior years in medical school, I did a sub-internship at the University of California at San Francisco. And I saw a patient with Hodgkin's disease who was not being treated with curative intent. And I said to the attending, you're not giving this patient modern therapy. And the attending replied, well, if you're so smart, we'll have you do grand rounds on how to treat Hodgkin's disease. Remember, I was a medical student. So I called Professor Henry Kaplan at Stanford for advice. And he was great, and he said, well, they never want me to come. I'd be happy to come and help you give grand rounds. So to the surprise of my attending and awe as a medical student, I conducted grand rounds at the University of California at San Francisco with Professor Kaplan. That must have been a big surprise. Yes, I think it was. Actually, one of my interviews has been with Saul Rosenberg, and he also had some great stories about Dr. Kaplan when they first started giving chemotherapy at Stanford. And Kaplan was apparently quite supportive of doing this. So-- Yes, he was. --I never got to meet him. Yeah. Another question, again, about the time you entered the field, I referred to what I consider the big three, Frei, Freireich, and Holland, but their therapy was really pretty empiric for leukemia. It was just hoping that giving more drugs would be better than one drug. But you really got us into genetics. What made you do that? I mean, what made you think that we could treat people, really, with precision medicine better than we did in those days? Well, my second research project I had as a fellow, which was presented at ACR in May of 1972 and published in April of 1973, involved daunorubicin-prednisone therapy for AML. And in that, the question was raised in patients without Auer rods, the question were these of CML in blast crisis was raised, so chromosome studies were done. And this got me started studying cytogenetics in leukemia, and subsequently molecular genetics. And also, you asked if I had a role model, and the answer is no. I did not have a role model. I know that very early on in your career, you published a very controversial paper suggesting that the Philadelphia chromosome could be found in acute lymphocytic leukemia, which at the time, I think, was probably heresy, since it had been associated with CML. I understand that you interacted with Avery Sandberg, the [? tube ?] giant. I remember hearing about Avery Sandberg when I was a freshman in college in genetics, and he supported you. What was the background behind that? At the 1975 ASH meeting, I presented an abstract, I gave a talk on the Philadelphia chromosome-- on Philadelphia chromosome positive acute leukemia. And after that talk, many prominent cytogeneticists raised questions about the validity of my findings. However, Avery Sandberg, while surprised by the findings, said, she may be right. Sometimes these youngsters get things that we've missed. And did you walk out beating your chest? That must have been quite a moment. I was happy that he-- I was happy that he supported me. Well, I want to go on to some of your other work, but I'm going to tell you that in our fellows clinical conference here a couple of weeks ago, which I attend every week, one of the fellows started talking about FLT3 leukemia. But his comment was leukemia is described as the most genomically defined cancer. And I didn't bring it up at that meeting, but I thought, you owe Clara Bloomfield for that statement. You should be really proud of your work. I almost picked up the phone to call you to tell you that our fellows don't know that you did the work. They should, and that's why we're doing these podcasts. So the only thing-- I know you challenged dogma was the treatment of older patients with leukemia. And as you and I both get older, I think it becomes more near and dear to our heart. Can you give some insight into that? I mean, my impression, when I was a fellow, was we just kind of said, oh, you're over 60, it's not worth treating you. But I think you really challenged that and changed that dogma. So ASH [INAUDIBLE] the third paper I published and project that I started on when I started as a fellow, because I was asked to do this by one of my attendings, was to look at treating older patients with acute leukemia. In the early 1970s, which we're talking about, it was considered that standard intensive treatment of patients with acute leukemia over the age of 40 or 50 years of age was malpractice or at least wrong. So when I was asked to look at this, we had a few patients over the age of 60 with AML treated with what was then standard intensive chemotherapy. So I compared the outcome of patients aged 21 to 40, 41 to 60, and 61 to 86 years. And what I found was that patients aged 41 to 60 and greater than 60 responded equally well. As a result, we said that patients over 60 should be treated. This meant that what we did was told major researchers in leukemia that they were wrong. This caused quite a stir, as you might imagine. And interestingly, within the next five to 10 years, they all came back to me and said they had been wrong. In that regard, I watched you in CALGB. I was on the solid tumor side, obviously, but you were really a pioneer in organizing and conducting translational research and correlative research in leukemia in the cooperative groups. When you started, I don't think there was any of that, was there? Were there a lot of obstacles to doing that? I think everybody just takes it for granted now, especially with so-called precision medicine. But what did you have to do to get that started at CALGB? From 1982 on, I was chair of the Correlative Science Committee in Cancer and Leukemia Group B. In 1984, I actually started to have NIH grant to support correlative science in the CALGB cooperative group. In 1984, we already had a trial in Cancer and Leukemia Group B to do cytogenetics in acute leukemia. I mean, a lot of this work was based on my work in cytogenetics. And while there may have been clinicians who were opposed, I had the support of important people like Professor Janet Rowley and the cytogeneticists at the CALGB institutions. And there really were not significant obstacles that I can remember. Of course, if there were people who tried to block me, I probably didn't care and worked around them. I'm sure that's true. I am too. This is part of what-- when you're one of the few women, as I was when I started in the field, I mean, I suppose I was always getting blocked about things, I just don't think much about it. I didn't then and I don't now. That segues into my final question, actually. And these days, more than half of our medical students are women. More than half of our residents are women at the University of Michigan. More than half of our fellows in hem-onc are women. Increasingly, the faculty is there. But when you started, you were really a pioneer, I think, in introducing women into clinical and laboratory research in oncology and academic medical leadership. And I just want to list the things, because I don't think you will, that I think you've done. First, I understand you were the first woman chief resident at the University of Minnesota, the first woman full professor in medicine at the University of Minnesota, one of the first women chairs of medicine in the United States when you were at Roswell Park, the third woman to be director of an NCI-designated Cancer Center. And frankly, as I was preparing this, I was on an airplane and I was watching A Matter of Sex about Ruth Bader Ginsburg, and I thought, this is a really familiar story. Do you have any war stories that you thought were particularly telling when you began? And especially, for example, I know you have a story about what the dean told you when you were considering becoming an academic professor. Do you have anything to inspire the people listening to this podcast? I'm sure there were some probably pretty aggressive war stories that I don't remember. And as I said, I don't tend to think about what happened in the past since I'm trying to keep up with the present. But I guess there are a couple of stories. Unbelievably, when I was a medical student, I always sat in the front row in class because that was the only way I could see the slides. And the dean, medical school dean, called me into his office and said it was not ladylike to sit in the front row. And I told him-- it's unbelievable really-- I told him that when he became a lady, he could tell me how to act like one, and walked out on him. But the more important story, I suppose-- that I can remember-- is that when I was appointed an associate professor, which occurred three years after I became an assistant professor, so the head of medicine called me in and said, congratulations, Clara. This is a great accomplishment. He went on to say, however, that since your husband is on the faculty and gets a good salary, we are not going to increase your salary. So when I came home, I told my husband, where upon he called the dean, who called the University president, who said, you be sure she gets the same salary or higher than the highest one you've ever given a new associate professor in medicine. Thus, my pay issue was immediately resolved. It's hard to believe that's a true story, except I saw similar things myself as I was going up, and they were getting corrected, at least. Well, anyway, we're running out of time. And I just want to thank you for all the things you've done, the contributions you've made to the field. Your legacy is incredible, in my opinion. And I think people will long remember what Clara Bloomfield has done in terms of changing how we treat leukemia, changing the treatment of leukemia into groups of patients who traditionally weren't treated, like older folks, and probably the pioneering work you did in bringing women into science and medicine, especially in oncology. So thanks for taking time to speak with me today. And I think people are going to be really thrilled to listen to your story as they drive to work and say, wow, I didn't realize that that's what it was like back in the old days. So thanks so much. And I think, especially, our young and translational scientists, particularly women, and also, most importantly, our patients deserve to give you credit for all of the things you've done and [? thanks ?] you've done. Until next time, thank you for listening to this JCO's Cancer Stories-- The Art of Oncology podcast. If you enjoyed what you heard today, don't forget to give us a rating or review on Apple Podcasts or wherever you listen. While you're there, be sure to subscribe so you never miss an episode. JCO's Cancer Stories-- The Art of Oncology podcast is just one of ASCO's many podcasts. You can find all the shows at podcast.asco.org. [MUSIC PLAYING]

Dr. Hayes interviews Dr. Bloomfield on her role as one of the first physician-scientists to investigate treatment for acute myeloid leukemia (AML).   TRANSCRIPT The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. [MUSIC PLAYING] Welcome to JCO's Cancer Stories-- The art of Oncology brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the role of cancer care. You can find all of the shows, including this one, at podcast.asco.org. [MUSIC PLAYING] Welcome to today's version of the ASCO Cancer Stories podcast. Today, my guest on the podcast is Dr. Clara Bloomfield. Dr. Bloomfield was instrumental in the early studies investigating the biology of leukemias and lymphomas, and also the interaction between various molecular markers and treatment. She founded the Correlative Science Committee of The Cancer and Leukemia Group B, which is now designated the Alliance in the 1980s. And I believe that was probably the first such committee in the cooperative groups, and she chaired it for at least 25 years. Her work resulted in numerous groundbreaking insights that led to changes in practice. Personally, and having worked with her for several of those years in CALGB, I really consider her one of the first investigators to perform what we now blithely called, quote, "translational," end of quote, science in cancer. Dr. Bloomfield was born in New York City, but her father, who was an expert in labor and industrial relations, moved the family to Washington, DC during World War II. And after the war, he then took a position at the University of Illinois, leading Dr. Bloomfield to have a nearly lifelong association with the Midwest. She attended undergraduate school at the University of Wisconsin, but then graduated from San Diego State College during a brief foray to the West Coast. She returned to the Midwest to attend medical school at the University of Chicago, and then completed her internal medicine residency and her medical oncology fellowship at the University of Minnesota, where she stayed on faculty until 1989. She then became chair of the Department of Medicine at Roswell Park Cancer Institute in Buffalo for the next eight years, and then moved to the Ohio State University, where she accepted the position as director of the comprehensive and now designated the James Cancer Center. She's remained at OSU and is currently a distinguished university professor and the William G. Pace II professor of cancer research and a senior advisor at the OSU James Cancer Center. Dr. Bloomfield has authored hundreds of peer-reviewed papers. She is an elected member of the National Academy of Medicine and the National Academy of Sciences. She's, frankly, won just too many awards that I can name here. But importantly, she served on the ASCO board of directors, and in 2009, she gave the David A. Karnofsky Memorial Lecture, the highest honor our society can bestow. Clara, welcome to our program. Thank you. You know, I have a lot of questions for you, many of which I thought about that I should have asked you 30 years ago or so when we first started working together in CALGB. But I think the biggest one is, how did you get interested in leukemia in the first place? Were any particular personal insights that resulted in the basis of your career? Or was it just happenstance? I think it happened because in grade school, I had a number of classmates who developed leukemia. And they were sent to the National Cancer Institute because people in those days didn't treat leukemia. And they returned with steroid-bloated faces and soon died. And I thought, well, wouldn't it be cool to develop medicine that could save kids from dying? I'd already decided to become a doctor, so seeing the real-life effects of cancer helped shape my early desire to become an oncologist. So that must have been about the same time, a little bit after, that Drs. Frei, and Freireich, and Holland started combination therapy for leukemia. They must have had a big impact on your career then. I don't remember. [? No, ?] I'm kidding. Actually, the other question-- I know that you spent some time at Stanford and ran into Henry Kaplan. And there was a cute anecdote, I think, about how you presented with his backing at one of the conferences. Can you tell us a little bit about Dr. Kaplan and your work with him? Sure. During my junior and senior years in medical school, I did a sub-internship at the University of California at San Francisco. And I saw a patient with Hodgkin's disease who was not being treated with curative intent. And I said to the attending, you're not giving this patient modern therapy. And the attending replied, well, if you're so smart, we'll have you do grand rounds on how to treat Hodgkin's disease. Remember, I was a medical student. So I called Professor Henry Kaplan at Stanford for advice. And he was great, and he said, well, they never want me to come. I'd be happy to come and help you give grand rounds. So to the surprise of my attending and awe as a medical student, I conducted grand rounds at the University of California at San Francisco with Professor Kaplan. That must have been a big surprise. Yes, I think it was. Actually, one of my interviews has been with Saul Rosenberg, and he also had some great stories about Dr. Kaplan when they first started giving chemotherapy at Stanford. And Kaplan was apparently quite supportive of doing this. So-- Yes, he was. --I never got to meet him. Yeah. Another question, again, about the time you entered the field, I referred to what I consider the big three, Frei, Freireich, and Holland, but their therapy was really pretty empiric for leukemia. It was just hoping that giving more drugs would be better than one drug. But you really got us into genetics. What made you do that? I mean, what made you think that we could treat people, really, with precision medicine better than we did in those days? Well, my second research project I had as a fellow, which was presented at ACR in May of 1972 and published in April of 1973, involved daunorubicin-prednisone therapy for AML. And in that, the question was raised in patients without Auer rods, the question were these of CML in blast crisis was raised, so chromosome studies were done. And this got me started studying cytogenetics in leukemia, and subsequently molecular genetics. And also, you asked if I had a role model, and the answer is no. I did not have a role model. I know that very early on in your career, you published a very controversial paper suggesting that the Philadelphia chromosome could be found in acute lymphocytic leukemia, which at the time, I think, was probably heresy, since it had been associated with CML. I understand that you interacted with Avery Sandberg, the [? tube ?] giant. I remember hearing about Avery Sandberg when I was a freshman in college in genetics, and he supported you. What was the background behind that? At the 1975 ASH meeting, I presented an abstract, I gave a talk on the Philadelphia chromosome-- on Philadelphia chromosome positive acute leukemia. And after that talk, many prominent cytogeneticists raised questions about the validity of my findings. However, Avery Sandberg, while surprised by the findings, said, she may be right. Sometimes these youngsters get things that we've missed. And did you walk out beating your chest? That must have been quite a moment. I was happy that he-- I was happy that he supported me. Well, I want to go on to some of your other work, but I'm going to tell you that in our fellows clinical conference here a couple of weeks ago, which I attend every week, one of the fellows started talking about FLT3 leukemia. But his comment was leukemia is described as the most genomically defined cancer. And I didn't bring it up at that meeting, but I thought, you owe Clara Bloomfield for that statement. You should be really proud of your work. I almost picked up the phone to call you to tell you that our fellows don't know that you did the work. They should, and that's why we're doing these podcasts. So the only thing-- I know you challenged dogma was the treatment of older patients with leukemia. And as you and I both get older, I think it becomes more near and dear to our heart. Can you give some insight into that? I mean, my impression, when I was a fellow, was we just kind of said, oh, you're over 60, it's not worth treating you. But I think you really challenged that and changed that dogma. So ASH [INAUDIBLE] the third paper I published and project that I started on when I started as a fellow, because I was asked to do this by one of my attendings, was to look at treating older patients with acute leukemia. In the early 1970s, which we're talking about, it was considered that standard intensive treatment of patients with acute leukemia over the age of 40 or 50 years of age was malpractice or at least wrong. So when I was asked to look at this, we had a few patients over the age of 60 with AML treated with what was then standard intensive chemotherapy. So I compared the outcome of patients aged 21 to 40, 41 to 60, and 61 to 86 years. And what I found was that patients aged 41 to 60 and greater than 60 responded equally well. As a result, we said that patients over 60 should be treated. This meant that what we did was told major researchers in leukemia that they were wrong. This caused quite a stir, as you might imagine. And interestingly, within the next five to 10 years, they all came back to me and said they had been wrong. In that regard, I watched you in CALGB. I was on the solid tumor side, obviously, but you were really a pioneer in organizing and conducting translational research and correlative research in leukemia in the cooperative groups. When you started, I don't think there was any of that, was there? Were there a lot of obstacles to doing that? I think everybody just takes it for granted now, especially with so-called precision medicine. But what did you have to do to get that started at CALGB? From 1982 on, I was chair of the Correlative Science Committee in Cancer and Leukemia Group B. In 1984, I actually started to have NIH grant to support correlative science in the CALGB cooperative group. In 1984, we already had a trial in Cancer and Leukemia Group B to do cytogenetics in acute leukemia. I mean, a lot of this work was based on my work in cytogenetics. And while there may have been clinicians who were opposed, I had the support of important people like Professor Janet Rowley and the cytogeneticists at the CALGB institutions. And there really were not significant obstacles that I can remember. Of course, if there were people who tried to block me, I probably didn't care and worked around them. I'm sure that's true. I am too. This is part of what-- when you're one of the few women, as I was when I started in the field, I mean, I suppose I was always getting blocked about things, I just don't think much about it. I didn't then and I don't now. That segues into my final question, actually. And these days, more than half of our medical students are women. More than half of our residents are women at the University of Michigan. More than half of our fellows in hem-onc are women. Increasingly, the faculty is there. But when you started, you were really a pioneer, I think, in introducing women into clinical and laboratory research in oncology and academic medical leadership. And I just want to list the things, because I don't think you will, that I think you've done. First, I understand you were the first woman chief resident at the University of Minnesota, the first woman full professor in medicine at the University of Minnesota, one of the first women chairs of medicine in the United States when you were at Roswell Park, the third woman to be director of an NCI-designated Cancer Center. And frankly, as I was preparing this, I was on an airplane and I was watching A Matter of Sex about Ruth Bader Ginsburg, and I thought, this is a really familiar story. Do you have any war stories that you thought were particularly telling when you began? And especially, for example, I know you have a story about what the dean told you when you were considering becoming an academic professor. Do you have anything to inspire the people listening to this podcast? I'm sure there were some probably pretty aggressive war stories that I don't remember. And as I said, I don't tend to think about what happened in the past since I'm trying to keep up with the present. But I guess there are a couple of stories. Unbelievably, when I was a medical student, I always sat in the front row in class because that was the only way I could see the slides. And the dean, medical school dean, called me into his office and said it was not ladylike to sit in the front row. And I told him-- it's unbelievable really-- I told him that when he became a lady, he could tell me how to act like one, and walked out on him. But the more important story, I suppose-- that I can remember-- is that when I was appointed an associate professor, which occurred three years after I became an assistant professor, so the head of medicine called me in and said, congratulations, Clara. This is a great accomplishment. He went on to say, however, that since your husband is on the faculty and gets a good salary, we are not going to increase your salary. So when I came home, I told my husband, where upon he called the dean, who called the University president, who said, you be sure she gets the same salary or higher than the highest one you've ever given a new associate professor in medicine. Thus, my pay issue was immediately resolved. It's hard to believe that's a true story, except I saw similar things myself as I was going up, and they were getting corrected, at least. Well, anyway, we're running out of time. And I just want to thank you for all the things you've done, the contributions you've made to the field. Your legacy is incredible, in my opinion. And I think people will long remember what Clara Bloomfield has done in terms of changing how we treat leukemia, changing the treatment of leukemia into groups of patients who traditionally weren't treated, like older folks, and probably the pioneering work you did in bringing women into science and medicine, especially in oncology. So thanks for taking time to speak with me today. And I think people are going to be really thrilled to listen to your story as they drive to work and say, wow, I didn't realize that that's what it was like back in the old days. So thanks so much. And I think, especially, our young and translational scientists, particularly women, and also, most importantly, our patients deserve to give you credit for all of the things you've done and [? thanks ?] you've done. Until next time, thank you for listening to this JCO's Cancer Stories-- The Art of Oncology podcast. If you enjoyed what you heard today, don't forget to give us a rating or review on Apple Podcasts or wherever you listen. While you're there, be sure to subscribe so you never miss an episode. JCO's Cancer Stories-- The Art of Oncology podcast is just one of ASCO's many podcasts. You can find all the shows at podcast.asco.org. [MUSIC PLAYING]

Dr. Hayes interviews Dr. Bloomfield on her role as one of the first physician-scientists to investigate treatment for acute myeloid leukemia (AML).   TRANSCRIPT The purpose of this podcast is to educate and to inform. This is not a substitute for...

Conversations with the Pioneers of Oncology: Dr. Clara Bloomfield

The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. The Bomb, Andrea M. Watson. I sit paralyzed at my desk. Everyone has left the clinic. I can hear the sound of the broom in the hall as the after hours cleaning begins. No phones ring. No patients hurry to appointments. No chatter lingers in the air. The silence is oppressive, the air is heavy, and the distance from my office to the hospital an eternity. I've just hung up the phone with the radiation oncologist. His words echo in my head. "Radiation will cause more harm than good. I'm sorry. I wish there was something more I could offer." Dread rises like a tide as my last hope recedes. I want to share the burden of this terrible news. But all my colleagues have left for the day. And I am alone. I'd been taking care of Mallory for nine months when the progression of her disease took me by surprise. Her tumor had responded so well to upfront radiation followed by nine months of intensive chemotherapy. With just a few months of treatment left, the end was in sight. Mallory was an avid JRR Tolkien fan. And plans for a Make a Wish Foundation trip to New Zealand were underway. She wanted to see the Lord of the Rings filming location and visit the small hobbit village she'd read about in travel books. She wanted to wait until it was summer there, our winter time, to travel. When Mallory's disease progressed on therapy, that fall, the timeline shifted. Goals shifted. There was no realistic hope for cure. There was just hope for time. The trip became the goal. And she bravely chose to continue with aggressive treatment, hoping it would open a window of time for travel. But further progression got in the way. When the futility of chemotherapy became clear, hopes were pinned on radiation to buy time. Now hanging up the phone, I realized that this strong, brave, beautiful 16-year-old girl who had been through so much will never get to New Zealand. And I have to tell her that tonight. I start out toward the hospital. But walking through the hall, my steps slow, my chest becomes tight, and my head swims with the devastating message I carry. I stop and look blankly at the man sweeping the floor wondering if he can tell I am carrying a bomb meant for a young girl and her family. He keeps sweeping, unaware. I trace my steps, fighting back tears. Back in my office, the sobs come. I cry for Mallory, for her parents, for her little brother and her best friend, her sister, for all they would never share together and for all the sorrow they had already faced. I cry for myself and for the terrible burden of delivering the blow, extinguishing the candle of hope that this trip had become, and speaking the words they'd dreaded since the moment we met. And when the tears finally stopped, I am empty. I take a deep breath and walk out the door. Mallory is not surprised by my news. Her gaze shifts away from me to a far off place. Silent tears stream down her face. And she says, "I know." That's all she says. I meet with her parents alone in the family room. Their reaction is raw and palpable. Flooded by tears and sobbing, they cling to one another lost in a storm of grief. When her brother and sister join us, I unfold the news slowly, choosing my words with great care as the disbelief on their faces quickly melts into sorrow and then tears. My heart feels as if it will break. I sit quietly by trying to fade from the scene that plays out before me. I fight back the tears but lose. I have done my job, delivered the bomb. There is nothing more to do but bear witness. Then something beautiful happens. Mallory's parents silently hug one another with new resolve and in turn embrace their children. Without a word, they stand up and walk together into Mallory's room. Hand-in-hand, they pull her in and encircle her with fiery love. I quietly take my leave feeling the power radiating from the room as I walk down the hall and out of the hospital into the night air. Mallory's funeral program bore a poignant quote from the Lord of the Rings film in which Gandalf assures Pippin that death is not the end, but rather another path we must take. The journey doesn't end here. Death is just another path, one that we all must take. The gray rain curtain of this world rolls back and all turns to silver grass. And then you see it. "The journey doesn't end here. Death is just another path, one that we all must take. The gray rain curtain of this world rolls back and all turns to silver glass. And then you see it." "What, Gandalf? See what?" Pippin asked anxiously. "White shores and beyond, a far green country under a swift sunrise." Shortly after Mallory died, her sister reflected that although she never saw the lush green of New Zealand, Mallory's journey had taken her somewhere even better. Likewise, the journey of those left behind continues. Families lives are forever changed after a child dies. And our lives are never the same either. Each patient we care for can teach us lessons about how to live well even when you die young. The privilege is great and the responsibility that comes with it greater. Delivering devastating news to beloved patients and their families may be the most dark and difficult moments of one's career. But compared with the burden that families carry, it is light. And if you stay long enough and you listen hard enough, you may see the blinding love shining through the darkness. Now the end of the day. After the noise and activity fade, I find myself thinking of Mallory. Some days, it's with a renewed awareness of the heavy burden we carry. Other days, it's with a lightness of being and gratitude for those who go before us leaving their courage as testament to what they've believed in. The silence unearths a deep ache in my heart. Sometimes I cry. Then I hear the comforting sound of sweeping in the hall. I take a deep breath and walk out the door. Welcome to Cancer Story, The Art of Oncology series podcast brought to you by the Journal of Clinical Oncology. I'm Lidia Schapira, editorial consultant for Art of Oncology and your host for this program. With me today is Dr. Andrea Watson, a general pediatric hematologist oncologist working at Essentia Health in the Duluth Clinic in Minnesota and the author of The Bomb published ahead of print, February 11, 2019. Andrea, welcome to our program. Thank you, Lidia. It's a pleasure to be here. I've been looking forward to it. That's terrific. Let me start by asking you a question I ask many of our authors. People who write usually like to read. What are you reading now? Oh, that's a great question. I, on any given day, I do read quite a few children's stories. Not only am I a pediatric oncologist, I have five children. So there's a lot of bedtime story reading, which also cuts into my leisure reading. I don't have a lot of time for fiction. But right now, I am reading a book called Invitation to Love, which is by a Cistercian monk about centering prayer. And I'm in the middle of a series that he has written about the topic. And it's wonderful. That's so interesting. So with that, let's talk about your writing. You have written and published before. So tell me a little bit about how you write and when you write and why you write. Yeah, thank you. I have discovered writing in my career in the past few years, although I recall my grandmother giving me a journal when I was 12 or 13. And it was called The View From my Window. And I really have been journaling on and off throughout my life since that time. And it wasn't until I experienced a series of patient deaths that were all very close and difficult for me three or four years ago that I really took to writing as more than just journaling. And I would say looking back, it really felt like more of a compulsion than anything else. After one of the deaths, a few weeks had gone by. And I just-- I felt physically drawn to it, almost I had to get this out. And I just-- I started on my computer. And from that came the essay that you were kind enough to publish a few years ago called Let It Be Hard. And that was just such an incredibly rewarding experience for me, not only in the process of writing and processing these deaths and all of the events surrounding it, but also in the aftermath in connecting with others who had read it or who were also writers or who had a similar experience. It was a very rich, rewarding experience. And subsequently, I have come back to that kind of as needed. I had another very difficult patient death last year. And she has become the topic of this essay, which was very much more raw and intimate for me. But that's-- I guess that's where I am in my career. It's been 10 years now that I've been practicing in a smaller town in northern Minnesota. And this has been a really important way for me to stay balanced and keep coming back to work every day. That's so interesting. And I really appreciate how you take readers also to a place of deep, deep emotion. I remember in the first essay you published, you talked about how difficult the work is. And you also said, and I wouldn't want to be doing anything else. And in this particular piece, The Bomb, you walk us through the process of delivering incredibly terrible news. And you do it with such sensitivity. Tell us a little bit more about this, the reservoir of emotion and how you handle it, how you keep it from bubbling over. Well, that is the question. And luckily for me, writing is part of the answer. In this essay, The Bomb, I think I really was looking to dive into that time where you as a provider, as an oncologist, are aware of information but have yet to deliver it. And I really hadn't experienced it so intensely before this case, although it happens all the time. It happens every day as we look at scans or look at the lab reports and then meet with patients. But in this particular instance, this whole essay is about the backstory and the aftermath. But I really wanted to focus on those minutes where it's so dark. And it's so hard. And it's so heart-- gut-wrenching and heart-wrenching to carry that without being able to share it or get rid of it or change it. And for me physically, I wanted to paint that scene to try to bring people to what it feels like and physically walking from one building to the next and how everything around you is life as normal-- life as usual. The janitor is sweeping and cars are passing by. But in fact, it's this horrendous bomb that you are delivering. And then the incredible grace that comes after, I mean, for me writing really is a meditation and a way to honor these children, these families, and their strength and their resiliency. And I think without taking that time away, that time apart, to look at that and to tell that story, you don't really appreciate it. I don't. And when I am able to do that, that turns all the intense sorrow and grief and just the horror of it all into something quite beautiful. And I think many of your guests have alluded to that in oncology. Whether it's adults or children, there's such great suffering but so much life and growth and love that comes out of that that that's what I think is just an amazing aspect of what we do. And that's certainly what keeps me coming back every day and picking up a new patient and kind of moving through it again because there's no end. So you have brought up so many very deep and insightful, wise pearls there. I think this idea of connecting through love and beauty and that is sort of almost like the antidote to the sorrow. It's beautiful. But I want to take you back a little bit to this idea that you are holding this bad news, this bomb, because delivering the bomb sounds so dramatic and so explosive. Is that, in fact, the way that you experience this delivery of bad news? Well, it certainly is a dramatization of it. I wouldn't say that every day, I feel like I'm running across the field with a bomb. But when I was first drafting this essay, and I went to save it, that title just-- I said-- it just came-- it's The Bomb. That's what I'll call it. And in that case, because we had such a strong relationship, and it was just-- it felt so tragic in part because she was such a special girl and so, so just wise beyond her years and this wonderful family. She was also the age of one of my children, my oldest daughter. And that, as many of us in pediatric oncology at least know, that makes the-- it turns up the intensity. And it's a much more emotionally challenging situation. So that particular news delivery I think was probably the most poignant for me, the most difficult. And it happened as I describe it. But that's not what every day is like thankfully. No, I-- thankfully not. But what I want to bring us back because you say that the bomb is really the way it felt to you. And then you also talk about the fact that, I mean, one of the things that I loved about this essay so much is you talk about starting to walk towards the room and then having to go back to your office and close the door and sob and feeling empty. Because I do think that the emotional impact is huge on us as well as you describe as the oncologists here. And then of course, you pull yourself together in the most professional way to deliver this therapeutically. But it is important to remember that it is emotionally a very dramatic. And it feels that way. And you certainly have made that so beautifully clear to the readers. Thank you. I think one of the things I learned from the first piece I wrote, Let It Be Hard, was just that. And that was something that one of my palliative care idols said to me one day when I was struggling with this case. He said, let it-- it is hard. Let it be hard. And that I think is what got me to where I am now with the story about Mallory and that I learned from him it's OK to shut the door and cry. And it's OK if those cries are sobs. Now we can't function on a daily basis if we're emotionally out of control. And that certainly wasn't my-- what I was trying to depict. But that let-down I think and just letting it hurt is moving through it. And from that, I-- that and by the grace of God had the strength to go over and very calmly and peacefully relay this news, which, of course, as often is the case, she already knew and help be a support person as the family really absorbed the reality that was unfolding. And that's, for me, all we can do is walk through it. We can't run away. We can't escape it. And it has only made my work and my relationship with these families richer and deeper. And that's another important piece for me. With both of the families, actually, many-- three kids that I talked about in the first one and this one, we maintain a relationship with these families long after the children have died. And they are part of our healing as much as we are part of theirs and keeping that memory alive and honoring their struggle and what they taught us. So personally, for me to do this difficult, very painful work has been offset by those relationships and the knowledge that you're growing through a very difficult time, the worst time in a family's life, and a hard time in your career. But there is growth. And there is hope. And there is meaning. And you beautifully did your work as a writer by framing this high-intensity emotional moment against that sound of that gentle sweeping, the man who was cleaning the floor. And you just remind us that there is normalcy all around this chaos and this crisis. But it's a beautiful piece. Thank you so much for sending it in and for sharing your wisdom. I want to thank Dr. Watson and hope you will join me next time for another conversation about The Art of Oncology.

<description>&lt;p&gt;The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.&lt;br /&gt; The Bomb, Andrea M. Watson. I sit paralyzed at my desk. Everyone has left the clinic. I can hear the sound of the broom in the hall as the after hours cleaning begins. No phones ring. No patients hurry to appointments. No chatter lingers in the air. The silence is oppressive, the air is heavy, and the distance from my office to the hospital an eternity.&lt;br /&gt; I've just hung up the phone with the radiation oncologist. His words echo in my head. "Radiation will cause more harm than good. I'm sorry. I wish there was something more I could offer." Dread rises like a tide as my last hope recedes. I want to share the burden of this terrible news. But all my colleagues have left for the day. And I am alone.&lt;br /&gt; I'd been taking care of Mallory for nine months when the progression of her disease took me by surprise. Her tumor had responded so well to upfront radiation followed by nine months of intensive chemotherapy. With just a few months of treatment left, the end was in sight.&lt;br /&gt; Mallory was an avid JRR Tolkien fan. And plans for a Make a Wish Foundation trip to New Zealand were underway. She wanted to see the Lord of the Rings filming location and visit the small hobbit village she'd read about in travel books. She wanted to wait until it was summer there, our winter time, to travel.&lt;br /&gt; When Mallory's disease progressed on therapy, that fall, the timeline shifted. Goals shifted. There was no realistic hope for cure. There was just hope for time. The trip became the goal. And she bravely chose to continue with aggressive treatment, hoping it would open a window of time for travel. But further progression got in the way.&lt;br /&gt; When the futility of chemotherapy became clear, hopes were pinned on radiation to buy time. Now hanging up the phone, I realized that this strong, brave, beautiful 16-year-old girl who had been through so much will never get to New Zealand. And I have to tell her that tonight. I start out toward the hospital. But walking through the hall, my steps slow, my chest becomes tight, and my head swims with the devastating message I carry.&lt;br /&gt; I stop and look blankly at the man sweeping the floor wondering if he can tell I am carrying a bomb meant for a young girl and her family. He keeps sweeping, unaware. I trace my steps, fighting back tears. Back in my office, the sobs come. I cry for Mallory, for her parents, for her little brother and her best friend, her sister, for all they would never share together and for all the sorrow they had already faced.&lt;br /&gt; I cry for myself and for the terrible burden of delivering the blow, extinguishing the candle of hope that this trip had become, and speaking the words they'd dreaded since the moment we met. And when the tears finally stopped, I am empty. I take a deep breath and walk out the door.&lt;br /&gt; Mallory is not surprised by my news. Her gaze shifts away from me to a far off place. Silent tears stream down her face. And she says, "I know." That's all she says. I meet with her parents alone in the family room. Their reaction is raw and palpable. Flooded by tears and sobbing, they cling to one another lost in a storm of grief. When her brother and sister join us, I unfold the news slowly, choosing my words with great care as the disbelief on their faces quickly melts into sorrow and then tears.&lt;br /&gt; My heart feels as if it will break. I sit quietly by trying to fade from the scene that plays out before me. I fight back the tears but lose. I have done my job, delivered the bomb. There is nothing more to do but bear witness. Then something beautiful happens.&lt;br /&gt; Mallory's parents silently hug one another with new resolve and in turn embrace their children. Without a word, they stand up and walk together into Mallory's room. Hand-in-hand, they pull her in and encircle her with fiery love. I quietly take my leave feeling the power radiating from the room as I walk down the hall and out of the hospital into the night air.&lt;br /&gt; Mallory's funeral program bore a poignant quote from the Lord of the Rings film in which Gandalf assures Pippin that death is not the end, but rather another path we must take. The journey doesn't end here. Death is just another path, one that we all must take. The gray rain curtain of this world rolls back and all turns to silver grass. And then you see it.&lt;br /&gt; "The journey doesn't end here. Death is just another path, one that we all must take. The gray rain curtain of this world rolls back and all turns to silver glass. And then you see it." "What, Gandalf? See what?" Pippin asked anxiously. "White shores and beyond, a far green country under a swift sunrise."&lt;br /&gt; Shortly after Mallory died, her sister reflected that although she never saw the lush green of New Zealand, Mallory's journey had taken her somewhere even better. Likewise, the journey of those left behind continues. Families lives are forever changed after a child dies. And our lives are never the same either. Each patient we care for can teach us lessons about how to live well even when you die young.&lt;br /&gt; The privilege is great and the responsibility that comes with it greater. Delivering devastating news to beloved patients and their families may be the most dark and difficult moments of one's career. But compared with the burden that families carry, it is light. And if you stay long enough and you listen hard enough, you may see the blinding love shining through the darkness.&lt;br /&gt; Now the end of the day. After the noise and activity fade, I find myself thinking of Mallory. Some days, it's with a renewed awareness of the heavy burden we carry. Other days, it's with a lightness of being and gratitude for those who go before us leaving their courage as testament to what they've believed in. The silence unearths a deep ache in my heart. Sometimes I cry. Then I hear the comforting sound of sweeping in the hall. I take a deep breath and walk out the door.&lt;br /&gt; Welcome to Cancer Story, The Art of Oncology series podcast brought to you by the Journal of Clinical Oncology. I'm Lidia Schapira, editorial consultant for Art of Oncology and your host for this program. With me today is Dr. Andrea Watson, a general pediatric hematologist oncologist working at Essentia Health in the Duluth Clinic in Minnesota and the author of The Bomb published ahead of print, February 11, 2019. Andrea, welcome to our program.&lt;br /&gt; Thank you, Lidia. It's a pleasure to be here. I've been looking forward to it.&lt;br /&gt; That's terrific. Let me start by asking you a question I ask many of our authors. People who write usually like to read. What are you reading now?&lt;br /&gt; Oh, that's a great question. I, on any given day, I do read quite a few children's stories. Not only am I a pediatric oncologist, I have five children. So there's a lot of bedtime story reading, which also cuts into my leisure reading. I don't have a lot of time for fiction. But right now, I am reading a book called Invitation to Love, which is by a Cistercian monk about centering prayer. And I'm in the middle of a series that he has written about the topic. And it's wonderful.&lt;br /&gt; That's so interesting. So with that, let's talk about your writing. You have written and published before. So tell me a little bit about how you write and when you write and why you write.&lt;br /&gt; Yeah, thank you. I have discovered writing in my career in the past few years, although I recall my grandmother giving me a journal when I was 12 or 13. And it was called The View From my Window. And I really have been journaling on and off throughout my life since that time. And it wasn't until I experienced a series of patient deaths that were all very close and difficult for me three or four years ago that I really took to writing as more than just journaling.&lt;br /&gt; And I would say looking back, it really felt like more of a compulsion than anything else. After one of the deaths, a few weeks had gone by. And I just-- I felt physically drawn to it, almost I had to get this out. And I just-- I started on my computer. And from that came the essay that you were kind enough to publish a few years ago called Let It Be Hard.&lt;br /&gt; And that was just such an incredibly rewarding experience for me, not only in the process of writing and processing these deaths and all of the events surrounding it, but also in the aftermath in connecting with others who had read it or who were also writers or who had a similar experience. It was a very rich, rewarding experience.&lt;br /&gt; And subsequently, I have come back to that kind of as needed. I had another very difficult patient death last year. And she has become the topic of this essay, which was very much more raw and intimate for me. But that's-- I guess that's where I am in my career. It's been 10 years now that I've been practicing in a smaller town in northern Minnesota. And this has been a really important way for me to stay balanced and keep coming back to work every day.&lt;br /&gt; That's so interesting. And I really appreciate how you take readers also to a place of deep, deep emotion. I remember in the first essay you published, you talked about how difficult the work is. And you also said, and I wouldn't want to be doing anything else.&lt;br /&gt; And in this particular piece, The Bomb, you walk us through the process of delivering incredibly terrible news. And you do it with such sensitivity. Tell us a little bit more about this, the reservoir of emotion and how you handle it, how you keep it from bubbling over.&lt;br /&gt; Well, that is the question. And luckily for me, writing is part of the answer. In this essay, The Bomb, I think I really was looking to dive into that time where you as a provider, as an oncologist, are aware of information but have yet to deliver it. And I really hadn't experienced it so intensely before this case, although it happens all the time.&lt;br /&gt; It happens every day as we look at scans or look at the lab reports and then meet with patients. But in this particular instance, this whole essay is about the backstory and the aftermath. But I really wanted to focus on those minutes where it's so dark. And it's so hard. And it's so heart-- gut-wrenching and heart-wrenching to carry that without being able to share it or get rid of it or change it.&lt;br /&gt; And for me physically, I wanted to paint that scene to try to bring people to what it feels like and physically walking from one building to the next and how everything around you is life as normal-- life as usual. The janitor is sweeping and cars are passing by. But in fact, it's this horrendous bomb that you are delivering.&lt;br /&gt; And then the incredible grace that comes after, I mean, for me writing really is a meditation and a way to honor these children, these families, and their strength and their resiliency. And I think without taking that time away, that time apart, to look at that and to tell that story, you don't really appreciate it. I don't. And when I am able to do that, that turns all the intense sorrow and grief and just the horror of it all into something quite beautiful.&lt;br /&gt; And I think many of your guests have alluded to that in oncology. Whether it's adults or children, there's such great suffering but so much life and growth and love that comes out of that that that's what I think is just an amazing aspect of what we do. And that's certainly what keeps me coming back every day and picking up a new patient and kind of moving through it again because there's no end.&lt;br /&gt; So you have brought up so many very deep and insightful, wise pearls there. I think this idea of connecting through love and beauty and that is sort of almost like the antidote to the sorrow. It's beautiful. But I want to take you back a little bit to this idea that you are holding this bad news, this bomb, because delivering the bomb sounds so dramatic and so explosive. Is that, in fact, the way that you experience this delivery of bad news?&lt;br /&gt; Well, it certainly is a dramatization of it. I wouldn't say that every day, I feel like I'm running across the field with a bomb. But when I was first drafting this essay, and I went to save it, that title just-- I said-- it just came-- it's The Bomb. That's what I'll call it. And in that case, because we had such a strong relationship, and it was just-- it felt so tragic in part because she was such a special girl and so, so just wise beyond her years and this wonderful family.&lt;br /&gt; She was also the age of one of my children, my oldest daughter. And that, as many of us in pediatric oncology at least know, that makes the-- it turns up the intensity. And it's a much more emotionally challenging situation. So that particular news delivery I think was probably the most poignant for me, the most difficult. And it happened as I describe it. But that's not what every day is like thankfully.&lt;br /&gt; No, I-- thankfully not. But what I want to bring us back because you say that the bomb is really the way it felt to you. And then you also talk about the fact that, I mean, one of the things that I loved about this essay so much is you talk about starting to walk towards the room and then having to go back to your office and close the door and sob and feeling empty.&lt;br /&gt; Because I do think that the emotional impact is huge on us as well as you describe as the oncologists here. And then of course, you pull yourself together in the most professional way to deliver this therapeutically. But it is important to remember that it is emotionally a very dramatic. And it feels that way. And you certainly have made that so beautifully clear to the readers.&lt;br /&gt; Thank you. I think one of the things I learned from the first piece I wrote, Let It Be Hard, was just that. And that was something that one of my palliative care idols said to me one day when I was struggling with this case. He said, let it-- it is hard. Let it be hard. And that I think is what got me to where I am now with the story about Mallory and that I learned from him it's OK to shut the door and cry. And it's OK if those cries are sobs.&lt;br /&gt; Now we can't function on a daily basis if we're emotionally out of control. And that certainly wasn't my-- what I was trying to depict. But that let-down I think and just letting it hurt is moving through it. And from that, I-- that and by the grace of God had the strength to go over and very calmly and peacefully relay this news, which, of course, as often is the case, she already knew and help be a support person as the family really absorbed the reality that was unfolding.&lt;br /&gt; And that's, for me, all we can do is walk through it. We can't run away. We can't escape it. And it has only made my work and my relationship with these families richer and deeper. And that's another important piece for me. With both of the families, actually, many-- three kids that I talked about in the first one and this one, we maintain a relationship with these families long after the children have died.&lt;br /&gt; And they are part of our healing as much as we are part of theirs and keeping that memory alive and honoring their struggle and what they taught us. So personally, for me to do this difficult, very painful work has been offset by those relationships and the knowledge that you're growing through a very difficult time, the worst time in a family's life, and a hard time in your career. But there is growth. And there is hope. And there is meaning.&lt;br /&gt; And you beautifully did your work as a writer by framing this high-intensity emotional moment against that sound of that gentle sweeping, the man who was cleaning the floor. And you just remind us that there is normalcy all around this chaos and this crisis. But it's a beautiful piece. Thank you so much for sending it in and for sharing your wisdom. I want to thank Dr. Watson and hope you will join me next time for another conversation about The Art of Oncology.&lt;/p&gt;</description>

Read by Susan Sullivan

The Bomb

JCO's Award Winning podcast Cancer Stories: The Art of Oncology features stories, dialogue, and personal reflections that explore the experience of living with cancer or caring for people with cancer, hosted by Dr. Lidia Schapira.

Cancer Stories: The Art of Oncology

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