Oncology theme music

If anyone can think of any other songs, let me know.

Garbage: Only Happy When it Rains
Harvey Danger: Flagpole Sita
Smiths: How Soon is Now?
Radiohead: Creep
P.J. Harvey: Down by the Water
Moby: Extreme Ways
Blue Oyster Cult: Don't Fear the Reaper
Aimee Mann: Wise Up (also, One is the Lonliest Number, but I draw the line at songs used for dramatic effect in Shrek 2).

The sad stories we tell about work

I was out to dinner tonight with friends, and the husband is a security officer with local law enforcement. He prefaced a story with the disclaimer, "it's a sad story, but..." and proceeded to tell us a story about the heroin addict jonesing for methadone, unfortunately locked up awaiting release.
I tried a joke, "Yeah, I also have a lot of sad stories from work, but you probably don't want to hear them." He always gets this pained expression on his face when I try to make light of work, or find some humor in it. We had a lung cancer patient die this week--he flamed out across the sky pretty quickly. He got hypoxic New Years' Eve - I sent over a bottle of oxygen. He wouldn't last through the Super Bowl.
It would have been a decent story, if only because I got my pound of flesh from the family, a nice thank-you. His sister came on like a tough guy after he fell out of bed one morning. She marched into the office, accompanied by two reluctant henchmen, her cousins. She had just come from the bedside, an awful bloody mess. I called a surgeon in to fix up a nasty scalp laceration. Took ten stitches to fix it up!
Anyway, she was shaken by the fall, how could the hospital let this happen, etc. I had written a DNR that morning with the patient's muttered acquiescence (a little sheepishly, I might add), and she demanded we call right now to rescind the order since I hadn't talked it over with her, his power of attorney. She had a point, but it was a little irrelevant. I used the old timeworn chestnut, "let's think about things in terms of the patient's best interest". She seemed fond of the old guy (these patients and their premorbid relationships are something of a mystery to me, since they are miserable wretches by the time they reach me, in many cases. The property tycoon, the teacher, the railbird, the secretary, the mother, their lives all have a final common pathway, as all of ours undoubtedly will when we find our terminal physicians), which was a boon, since she really responded positively to the best-interest argument. I call it a chestnut a little cynically since it really isn't possible to argue best interests for a person you're close with--there are conflicts of interest, and bias seeps in.
Anyway, I reminded her that we didn't want to put him through a nasty code if we could help it, and she had also had experience with her parents in a long ICU stay, and didn't want to go around again with that. So the meeting ended pretty amicably. One thing I do well is an end of life discussion.
So we stitched up his eye. I got a young surgeon to do it. It was a bone to throw him, since he's just starting out like me. In training, I would have had to pull teeth to get a surgeon to throw stitches in a scalp lac. That day, on the other hand, the stitches went in lickety split. This was the neatest row of stitches you ever saw, too. Looked like a picket fence.
The next day, I decided to try for hospice. I usually don't mix DNR with hospice unless the family is willing. It's hard enough to give up resuscitation, let alone hope for treatment. Some families are willing, I should say. So I called the sister, and told her I was just checking in. We talked a little about the stitches, and I asked had she thought about hospice. She got fixated on the issue of heparin (which is pretty irrelevant in a patient going on hospice), so I used my usual canard, "We'll keep talking about it." She gave me a very nice thank you, thanked me several times. I think she was mainly happy about the stitches--things went wrong, but order had been restored. No matter, I was pleased with the words of appreciation. Most of the time, you don't really understand what people are thanking you for. I think I understood her thanks to mean I had done a small good thing for her brother. Doing the thing was its own reward, but the words were well-received too.
The patient died the next morning, comfortable as far as anyone could tell. The nurses told me when I arrived. I filled out the death certificate, but I haven't heard from the family.
Sometimes we get a card about a funeral, mostly not. You know what I'd really like? A nice, thoughtful obituary. Like they print in the New York Times, or The Economist. One that doesn't just tell you who the person was, but about the time they lived in, and the issues encapsulated in their names. Like Sontag, "New York Intellectual," Iris Chang, "Rape of Nanking," Kubler-Ross, "Hospice Movement." They remind you that ideas can live on even after people die.

Update on breast cancer survivor

I saw the same breast cancer survivor this week, and examined her, told her she's doing well, all that. She complained about her breasts again, reminded me of something I had blown off before, that the surgeons had told her that there was nothing more that they can do to make her look better.
Before we parted, I shared with her the insight I had developed, that I thought it was okay if she wasn't all that happy with how her new body looked.
That moment was probably the highlight of an otherwise tough week--her sheer joy of being validated. She exclaimed that even her husband told her she ought to feel lucky to just be alive--*nobody* had the nerve to tell her it's okay to feel let down about how her body looked.
I think the larger lesson here is something I've learned a few times: we shouldn't be too quick to minimize people's thoughts as inconsequential or wrong. Even irrational thoughts are true in the person's mind. My dad's death taught me that even though your impulse is to silence the nagging worry, sometimes you need to meet it and say, "well, you certainly seem to feel that way." It takes a little courage to do that.