Thursday, June 30, 2016

Tumor Board

The Nightingale (female oncologist): So something happened today, that has never happened before. I had a patient in my office, she was on IV Dilaudid. She was very sick, throwing up, and I tried to call in some Fentanyl to her pharmacy. The pharmacist denied it. Told me I had to have her on three days of morphine, before they approved the Fentanyl. She has metastatic cancer. She was tolerant. She needed it. She's throwing up in my office, and I'm on the phone. I'm always on the phone - insurance companies, pharmacists now? Two hours I spent trying to get her what she needed. Help?

Swagger and Sagacity (male oncologist): WHAT? Those aren't RULES SET IN STONE. They are guidelines. They are there to prevent the family practitioner from prescribing Fentanyl patches to people with backaches that have no tolerance of pain medication. To prevent them from being killed by OD'ing on Fentanyl patches. Don't let this go. You need to call the National Association, and report it.

The Nightingale: I had to admit her to the hospital, to get her what she needed.

Swagger and Sagacity: You need to tell them that because of that person's ignorance they caused unnecessary hospitalization. They need to PAY FOR IT. This is not KUMBAYA, where everyone is holding hands. We are the CAPTAIN of this SHIP, and they need to realize that.

The Nightingale: Thank you, that helps. Next case?

The Tigress (female oncologist): This is such a great space. Can we bring Mimosas? Is that allowed?

The Nightingale: I want to have a party. At my house. No really, I'm not kidding. Let's celebrate practicing the art of medicine. This space, this community, without all the financial interest noise, is combating burnout.

Swagger and Sagacity: Do you know how much this means to my patients? When I tell them I'm meeting with 15-20 great minds about their case on Thursday morning I can feel a palpable sense of relief. Hell I'm relieved, to have help with the tough cases.

I think we all are. We run through 10-15 cases in the space of an hour. They started this tumor board last October. My group learned about it three months ago, and we are permanent fixtures. About seven years ago, this space was envisioned by Jim (male oncologist), and he and I had three meetings hatching its existence. A month later he was killed in a motorcycle accident. I like to think he is watching over us, viewing the radiology, quizzing the pathologists, giving his take on treatment plans, spinning his tales (he was a writer with some local and national acclaim), and orchestrating our existence.

Cid Vicious (in between 10 pages): I'll be there.

Everyone else nods and agrees to a celebration with guarded optimism. It is 7am. We all have a long day ahead of us. And we are only on our first or second cup of coffee.

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