At age 55, Mark Singer was a successful engineer and a brilliant biophysicist, a happily married man who was generally satisfied with his life. He had recently switched to his dream job: adapting a proton accelerator to attack cancer. However, a few months later, his world stopped. His job acquired a new relevance – he himself was diagnosed with prostate cancer. Over the next few years, Mr. Singer would be broken down and built up by his diagnosis. Though not something he would like to go through again, coping with his illness allowed him to gain a new perspective on what makes for a good doctor.
At a routine visit, his family doctor felt a small lump during a digital rectal exam. A specialist may have missed this finding, but his family doctor knew him well enough to know that something was off. A biopsy of the lump revealed a cancer with Gleason score 4N3. What should have been well-organized packed islands of prostate cells were misbehaving, looking more like a Jackson Pollock painting instead of a cross section of a bunch of drinking straws.
Mr. Singer then had his prostate removed and began weighing the benefits of a systemic treatment for his cancer. Forgoing radiation, to the worry of his doctors, Mr. Singer decided to wait until the proton accelerator was available for use in the clinic. The accelerator is more precise than many traditional cancer treatment methods – it aims a beam of protons at a tumor, directly damaging the DNA of tumor cells and, ideally, no other cells. Despite being treated with the proton accelerator instead of radiation, his therapy was still grueling and miserable.
Initially, Mr. Singer distracted himself from the reality of his diagnosis by keeping himself busy with work and other responsibilities. He approached his illness clinically. Outwardly, he seemed to be doing well. Inwardly, Mr. Singer was terrified out of his mind. It soon became clear that the treatment was taking a toll on him; he would come home and immediately fall asleep, exhausted from treatment and the emotional burden of his illness. His wife encouraged him to join a writing group run by radiation oncology. It was only in this group that Mr. Singer began to process the reality and manage the emotional burden of his diagnosis. Though causality remains to be established, as he learned to deal with the emotional burden, his physical health improved as well. Mr. Singer’s PSA levels declined over the next few months.
Through the writing group, Mr. Singer learned that the physician’s responsibility is not to cure, but to do what is within their ability to improve their patient’s quality of life. The focus should not just be on beating the disease. This is unrealistic. Though we are trained to cure, at some point, physicians must be able to understand when they need to provide palliative treatment and support. Making matters worse, we also often view the patient experience as something we are immune to. Mr. Singer recounted an instance at a conference where he was meeting with a group of surgical residents who were discussing their patients as a distant, othered population. Their conversation struck Mr. Singer as odd. After all, he remarked, all of us will be patients one day.
Mr. Singer encounters these overly solution-oriented attitudes from physicians outside of the clinic’s walls, too. One of his relatives, a neurosurgeon, kept saying that Mr. Singer would fight the disease. Another relative, an oncologist, was dismissive of the seriousness of his diagnosis. He did not find the overly optimistic views of his relatives particularly helpful. Their words felt hollow, leaving him disappointed and annoyed. From his perspective, the disease did not care if you fought it. Instead of glossing over the uncomfortable reality, Mr. Singer wishes that his physician relatives had just asked him open-ended questions or expressed a desire to learn more.
Mr. Singer remarks that he had felt supported and listened to at Penn, and advises that all physicians follow a similar lead by striving to make their patients feel the same level of care. At times, physicians hold the view that they must either be good at the technical side of medicine or good at the humanistic side of the field. Mr. Singer strongly believes that these two skills should not be mutually exclusive. While knowing the technical is important to diagnose and prognosticate, the humanistic side can make or break a patient interaction. He recalls the story of one relative who chose to have a knee replacement done at a community hospital over a highly rated hospital simply because he had a good relationship with the doctor at the community institution. In order to break out of the dichotomous view of medicine we are taught, Mr. Singer offers us what he describes as a controversial and difficult piece of advice: envision being a patient yourself and being out of control. What type of doctor would you want?
Author’s note. I met Mr. Singer near the beginning of my second year of medical school. I am so grateful that Mr. Singer was willing to share his story on resilience with me and hope that his story has meant something to you as well.
Faith Arimoro is a MS2 at the Perelman School of Medicine. Faith can be reached by email at [email protected].
