In this episode, Dr. Denise Millstine is joined by bestselling author Jonathan Evison and radiation oncologist Dr. Samir Patel to explore the emotional and medical journey of oral cancer through Evison’s novel The Heart of Winter. Inspired by his mother’s diagnosis and his own caregiving experience, Evison crafts a poignant love story between Ruth and Abe Winter, a couple navigating the unexpected upheaval of oral cancer in their later years. The conversation delves into the realities of diagnosis, treatment and recovery from head and neck cancer with clinical insights from Dr. Patel, and highlights the often-overlooked role of caregivers.
In this episode, Dr. Denise Millstine is joined by bestselling author Jonathan Evison and radiation oncologist Dr. Samir Patel to explore the emotional and medical journey of oral cancer through Evison’s novel The Heart of Winter. Inspired by his mother’s diagnosis and his own caregiving experience, Evison crafts a poignant love story between Ruth and Abe Winter, a couple navigating the unexpected upheaval of oral cancer in their later years. The conversation delves into the realities of diagnosis, treatment and recovery from head and neck cancer with clinical insights from Dr. Patel, and highlights the often-overlooked role of caregivers.
This episode was made possible by generous support from Ken Stevens.
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Dr. Denise Millstine
Welcome to the “Read. Talk. Grow.” podcast, where we explore health topics through books.
Our topic today is oral cancer, and our book is “The Heart of Winter” by Jonathan Evison. I'm your host, Dr. Denise Millstine. I'm an assistant professor of medicine at Mayo Clinic, where I practice women's health, internal medicine, and integrative medicine.
My guests today are Jonathan Evison, who's a “New York Times” bestselling author, former punk rocker and the podcast host of “A Fresh Face in Hell.” His award-winning novels include “Land Boy,” “West of Here,” and “The Revised Fundamentals of Caregiving.” He lives in Western Washington with his wife and family. “The Heart of Winter” is his latest book. Jonathan, welcome to the show.
Jonathan Evison
Thank you for having me, Denise.
Dr. Denise Millstine
Our expert guest is Dr. Samir Patel, who is the clinical practice chair of radiation oncology at Mayo Clinic in Arizona. He's a professor of radiation oncology and specializes in the use of radiation therapy for complex cancers of the head, neck and skin. Samir, welcome to the show.
Dr. Samir Patel
Thank you so much, Denise.
Dr. Denise Millstine
Samir and I have been talking about doing a book on “Read. Talk. Grow.” for at least a year now. And Jonathan, we were thrilled when we found “The Heart of Winter,” which features a patient with oral cancer.
“The Heart of Winter” is a love story of a long marriage between Ruth and Abe Winter. We meet them and their family on Abe's birthday, which at his age, he wonders, might be his last. And shortly after, Ruth, who has long been the caregiver and the backbone of the marriage, discovers a tumor in her jaw that is eventually diagnosed as cancer and will be the focus of today's episode.
Okay, so you know how “Read. Talk. Grow.” works; we discuss books that portray health topics in an effort to better understand health experiences through story. In this case, we will discuss oral cancer. Jonathan, tell us your inspiration for this book.
Jonathan Evison
The diagnosis. The oral cancer diagnosis was actually that of my 86 year old, 87 year old at the time, mother who lives with us. I was the one that sat by her bedside. I was with her through diagnosis, through radiation, through aftercare. I slept with her at night and helped her get to the bathroom.
I was her caregiver, and as I went through that, and I was honored to do that for my mom, who's done so much for me raising her on my own. But I thought, you know, I wish she deserved to have her forever chosen partner with her. And so I wanted to write her the love story that I felt she deserved.
Enter Abe, not that Ruth is my mom, but I wanted her to have the husband she deserved because she was unlucky or unwise in love or whatever. She was lucky to have me, I guess, there, but I wanted her to have somebody else by her side.
Dr. Denise Millstine
And as the incredible author that you are, this is not romance. For our listeners who are accustomed to hearing us talk about romance, this is truly a love story. So it was a wonderful partner and husband, but he is far from perfect. And maybe we'll talk a little bit about that during the show. Samir, tell us your reaction to the book and also what your practice as a radiation oncologist who focuses on head and neck cancers is like.
Dr. Samir Patel
Yes, no, thank you. This book was beautiful in its storytelling. And I really was engaged in how Jonathan brought in this current cancer battle and wove it into a 70 year experience of this growing family, young love, and children, and the unique dynamics that come along with a catastrophic diagnosis like oral cavity cancer.
Practicing as a radiation oncologist that treats oral cavity cancer, it is one of the most challenging sites to treat, as it has a major impact on quality of life, and it can definitely stress family dynamics, because there's significant care requirements that are needed at home, and there's logistical burdens that are added when you think about radiation therapy and you ask someone to come back and forth for 30 plus treatments, and then the recovery portion is also challenging. So there are a lot of elements that are woven into our care model and trying to get someone through the short-term, but long-term aspects of this cancer.
Dr. Denise Millstine
Yeah and you can tell not only did you research the cancer, Jonathan, but your personal experience in the details of how challenging this journey can be were really remarkable when you're depicting Ruth.
So Jonathan, Ruth and Abe are this elderly couple. They've settled into their life. It's got its quirks, it’s got its patterns. And Ruth has just a loose tooth. She's otherwise really quite healthy. Can you tell our listeners about this and kind of her reaction to whether she needed to even worry about the loose tooth.
Jonathan Evison
Yeah, obviously in this story, it's meant to just subvert reader expectation right off the bat because Abe awakens thinking, this is going to be my last birthday, thinking about the loose ends, he needs to tie up and one of them being the old dog that's probably not long for the world. And you know, reflecting a bit on his marriage and how Ruth has always been the caretaker in the relationship and suddenly, you know, with the diagnosis at the end of the chapter, all of that is suddenly reversed.
I mean, that was my goal for the diagnosis to have something, and that's how it was with my mom. Something as innocuous as a loose tooth ends up being something a lot more serious. You know, when you talked about the research, it's like, you know, they always say, write what you know. And I say, no, no, no, no. Like my impetus is to write what I don't know, to try to discover but use what I know.
Knowing her personality, I knew I had to if I just, like, kept her on point. Like mom when you read this, I need you to really track the cancer stuff for accuracy, like your experience. It kind of allowed me to run interference and that the emotional core of that so she could get that the book was for her, not about her. And it did exactly that. Like the only mistake she said, actually, that was not a radiologist we talked to that was the oncologist, things like that.
But it really allowed me, I think, to gift this book to her in a way where she wasn't reading it with that self-critical. I just wanted to give her this love story. And it's not a boy meets girl up, up, up. love story. I mean, this is all about the travails.
Dr. Denise Millstine
No, it made a lot of sense, and it really does speak to how authentic it was, because it's not just in the details, but it's in that really sunk into the experience.
Samir, I have a question for you. But before we go there, I think there's a lot of people who think you're a radiologist. As a radiation oncologist, what do you say when people make that mistake?
Dr. Samir Patel
You know what? It's very easy. The interesting part is radiation oncology used to be part of radiology. We're still under the same board and used to be called therapeutic radiology. And so I just say, well, I'm not in the diagnosis side. I'm on the treatment side and we treat cancer. So I help try to provide that. And it's easy to confuse the two as you contract radiation oncology.
And it definitely is something that I just help navigate them just explaining. I don't sit in a dark room reading films. I'm out there giving treatment.
Dr. Denise Millstine
Yeah, my husband is a radiologist, so I can promise listeners that if they have an oral cancer, they want to see Dr. Patel and not my husband if they're looking for a treatment.
But okay, back to the story. When Ruth has her imaging her dentist, orders some testing and wants to do a biopsy because this mass has been detected. The doctor essentially reassures her, we don't think this is anything, and then is surprised after the biopsy results come back that this is a cancer. Setting Ruth on this path for treatment. Can you elaborate on the common treatment strategies for oral cancers in terms of what the approach, just typically is?
Dr. Samir Patel
Yes and, you know, I have to definitely applaud, Jonathan, as you mentioned, the experience and how he outline that this is a super common way that oral cavity cancers present. Is the dentist at the first line detects this, just an abnormality and common things being common or frequently think it's just something that's non-cancerous. And one thing that really stuck out to me when he was delivering that diagnosis, the oral surgeon, I believe it was, this is not benign and that is not how I would deliver a diagnosis.
And Abe was very quickly to snap. I said, hey, wait a second, does you mean this is cancer? You know.
Jonathan Evison
So you would go ahead. You would go ahead and just drop the bomb. I was always taught to sort of deliver it easy.
Dr. Samir Patel
Yes. I feel like I'm like to be transparent and upfront, but then to also then follow up with the plan. And going into a common treatment approach, oral cavity cancers frequently are approached with a combination of surgery and radiation, and that radiation could have chemotherapy along with the radiation therapy. So there's definitely bi- or tri-modality therapy being administered. So it is a heavy lift.
Jonathan Evison
As I recall, and I don't think I put this in the book. It was almost presented as an option to let it run its course just because of my mom's advanced age and this was going to be a really rough road. But, you know, she came through it at the end. They said she came to it like a 30-year-old.
Unfortunately, she broke her shoulder shortly after recovery. And that, you know.
Dr. Denise Millstine
Oh gosh. Well, and that's an interesting point about your chronological age and your health age, right, which are not necessarily the same thing. But I'm glad you brought that up about letting it run its course, Jonathan, because that was my next question for you.
Ruth does ask, well, what if I just leave this be? Because she can't believe that aside from a loose tooth, she feels absolutely fine. She is completely unaware that there is this aggressive process happening in her body. So when she asks the doctor, well, what would happen, they said in about 3 or 4 months you'll be on hospice. You think this is realistic? Do you think this is maybe what your mom's similar experience was? Was that aside from being told she had cancer, she couldn't really tell in her body, shy of a loose tooth.
Jonathan Evison
Yeah, well, I also think, I mean, listen, she's aged like ten years since this, like, she got through it, all right. But like I said, the broken shoulder after that, she's just lost a lot of weight. She kind of hunches now. So when she walks down the hallway, I'm like, the bells, the bells. You know, she's kind of shuffles her feet. I've really seen her age. You talk about chronological age and medical age. A couple months back, she had a little growth on her head, and I thought, if it's back, I don't know that she'd make the same decision. I think at this point it's taken so much out of her. The two things back-to-back like that, that I think she might choose hospice this time, I don't know. I'm glad she's out running errands right now and not hearing this conversation. So I don't know.
Dr. Denise Millstine
Yeah, yeah. But it's true that, you know, you can get through something as really big as a cancer, aggressive as a cancer, and then have a fall and a fracture and that can be the thing that tips the balance. So really important.
Samir, when Ruth talks to her three children. So she's three very different children, very different personalities. She talks to all three of them about her recent diagnosis, and the youngest is her free spirit. And what she says is you don't have to let them blast you with radiation you know, it kills everything, good or bad. Have you thought about alternative medicine? What are your thoughts about that response?
Dr. Samir Patel
No, that really resonated with me. Because I frequently will encounter all three children just like Kyle, Anne, and Maddie, you know, in that room where they'll be very disparate opinions there. And all too often with the World Wide Web and internet, folks are always looking at a natural way to cure their cancer. And that really just resonates with folks.
And so it's common for us to have folks come on with all kinds of different vitamin infusions or different anti-parasitic type treatments that they're on, because there's some type of, following on the internet. So we do have to spend some time demystifying that.
I'm fortunate that I have partners like you, Denise, that I can send to integrative oncology for a consult so they can help navigate what has evidence space and doesn't. But yes, this is a frequent question here.
Dr. Denise Millstine
Yeah, thanks for the shout out to integrative oncology. And just for our listeners who don't know, alternative medicine is usually where you choose another course of action and you're not doing what we would consider conventional medicine standard care. Integrative medicine is often more supportive and is always aligned with the conventional medicine approach.
So Jonathan, you highlight another aspect of healthcare that's difficult for those that practice medicine. And that is when Ruth asks several of her team members, why, why did this happen? Or how did this cancer happen? She was told, well it's bad luck, plain and simple. And what you're highlighting here is that as much as we understand about the body and like to pretend we know about the body, there is a lot that's unknown. Is that what you were going for?
Jonathan Evison
Well, yeah. I mean, A, I just think nobody wants to hear. I mean, if it's lung cancer, they could probably point to lifestyle. But like cancer’s just so elusive that way.
You know, one thing I learned, I had medical problems myself a couple of years ago, and it was a ghost in the machine sort of situation.
And what I learned is I navigated this medical thing is like how much of a tree it is. We watch “House,” you know what I mean? We watch medicine on TV and we want this experience of this holistic doctor that can tell everything and the whole team gets together in one room and they speculate.
Dr. Denise Millstine
Yeah. And I think often we wish we knew more. And yeah, it is the TV shows and the stories that are so clean where there's the moment and this is what it is. And look, here's this simple fix and now everything is is all better. So I actually think it's honest to say that there's just so much more for us to learn, which is, you know, why we continue to study and grow.
Samir, staying on the topic of this bad luck or we don't know. There's perhaps one of my favorite quotes from the book, where they're in the ICU and Ruth starts thinking, “It didn't matter what you did to ward off disaster, what precautions you took to avoid it. Never mind all the life choices, the kale and prune juice and avocados and lean white meat, the sunscreen, the fish oil, the natural toothpaste, the vitamin, supplements, and medications aimed at protecting the body from grim possibilities. In the end, you still had to account for bad luck.” What do you say when patients come in and they say, I did my prunes and natural toothpaste, how could this still be happening to me?
Dr. Samir Patel
That is a great question. My main thing, as Jonathan mentioned, is oral cavity cancer. For majority of them, we cannot point to a lifestyle causative factor.
What I tell them is listen, I am sorry you're encountering this. I try to provide a lot of support. There is a team effort here. I'm fortunate I can work somewhere where I can incorporate a whole team, and not just the medical doctors, the surgeons. I introduce myself as a zapper, but the radiation doctor or the chemo doc, but a whole interdisciplinary team to provide that support, not only the physical side, dietician, swallowing specialist palliative medicine, but also psychosocial support. We have social workers and psychology and psychiatrist on staff to help provide that whole initial adjustment about the journey they're about to embark on.
We do see quite a few of elderly women with a preponderance of oral cavity cancer. And we don't know what it is exactly. Anything that causes chronic inflammation in the body over many years can turn into. So we've seen chronic cheek biting or ill-fitting dentures, result in certain cancers or in someone that advanced stage, the immune system starts getting slowly suppressed with age and these little lesions start appearing. And it's a good question why does it happen? How can we manage it? A lot of times our surgeons are playing what we term, like Whack-a-Mole with these little pre-invasive lesions, trying to be very conservative and avoid these from developing into an invasive cancer.
Jonathan Evison
And it just takes one cell, right?
Dr. Denise Millstine
Yeah. I'll often tell people you know, thank goodness you did do the prunes and the natural toothpaste otherwise you might have been here ten years ago. Right. So age and accumulation. But the more toxins you add, the faster that process can be sped along.
So speaking about when it gets invasive, Jonathan, and the treatment that often involves surgery, you made Ruth into this stunning, beautiful woman her whole life, including into her later years, and she's just devastated by the effect of the surgery and later, the radiation on her physical appearance. Can you offer some thoughts about how difficult that aspect of oral cancer is?
Jonathan Evison
I think, you know, she was so undaunted by this. She was so ready for the fight with the cancer. I think the vanity might have been the hardest thing on her psyche. Even before the surgery, she was worried she was going to look like Quasimodo and like they did an incredible job. You know, they shaved the tibia and rebuilt her lower mandible, and it's really hardly noticeable. She didn't have chemo, luckily, so there wasn't a lot of hair loss with the radiation. But, you know, immediately she planned to try to grow her hair longer. I'm actually shocked at how I can hardly tell now. And I think, you know, at her age, I mean, before the cancer did, she was 85 out push mower in a half an acre.
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You're talking about your mom here, but Ruth also, she has this really aggressive surgery and then, later we hear somebody in the family describe her as, you know, a slight asymmetry, but it's not as obvious as certainly she pictured it was going to be when she woke up following the operation with gauze. And after the surgery has been described to her, she's thinking she's going to have this. Well, I think she describes it as a caved in face. And that is not at all what the final cosmetic result is. I know we can all understand how important that is. Of course, people want the cancer gone. Of course they want their life to be extended, but we can't disregard how important the cosmetic result, particularly for a cancer that involves the face, the head, the neck. Samir, do you want to comment about that?
Dr. Samir Patel
Yes. This is a frequent issue that we navigate for each patient as they come in. Is that just the oral cavity and just the head and neck in general, is so vital to our quality of life. That's how we interact, interface with the world. Right. And our treatments are going to impact taste, moisture in your mouth, may lose certain functions, swallowing impact and etc. and that is one thing to actually be able to deliver the physical part. But there is a mental adjustment, right, that is significant, and many times goes under-recognized. And I think we see that with Ruth as soon as she has that surgery, she wants no visitors, right? She did she didn't want the family to visit.
Jonathan Evison
And that was the case with my mom. It was just me.
Dr. Denise Millstine
And in Ruth's case, only Abe was allowed to see sort of the reality of what was happening and similar. You mentioned taste and swallowing, but another really important impact of these treatments is communication. Can you talk about that a little bit.
Dr. Samir Patel
Yeah. So frequently oral cavity cancers, if they're involving the tongue, that can definitely impact on your speech. And that is definitely a difficulty and we have speech language pathologists. But you know what your speech may not be the same depending on someone's occupation or their capabilities, as Jonathan mentioned, that can really restrict your baseline or current capabilities and quality of life or employment.
And folks naturally are thinking about the future, if they're working or what am I going to be like? How am I going to be that in the long run? And it's a dynamic situation that's evolving. You take someone that has Ruth’s types of surgery, it can be disfiguring and a lot of swelling and a lot of healing time. And then you say, okay, you're healed up. Now let's start radiation. Now radiation is a drawn out, 6 to 7 weeklong process. And they said, just come by, you know, five days a week every day. And that's a heavy lift and, burden just not on the patient but the family. Right. To get in and out of radiation every day. Then there's the side effects in the short term, you're trying to manage and navigate for the patient and then the recovery process. And you really don't know what the long-term baseline is going to be like for at least a year after that treatment. There's so much healing and recovery that's happening.
What's amazing is that, as Jonathan had mentioned, is how resilient and adaptable humans are, and they're able to, over time, shift their baseline and adjust to a new normal. But it takes time.
Dr. Denise Millstine
So for listeners who haven't read the book, the radiation comes very far at the end of the book. But I promise talking about it does not spoil the story in any way. And I really love when they're meeting with the radiation oncologist to talk about starting treatment, she says. I'm not going to sugarcoat it. We're talking about a lot of pain, a lot of discomfort, which we'll manage as best we can. We're talking about fatigue, nausea, intense burning inside and out.
Samir, are these the typical warnings you would give and also you mentioned a year to recover. But what do those symptoms look like when somebody is going through active treatment. Are they going to get them right away with their first treatments or does it take a little bit.
Dr. Samir Patel
So you know great question. So the side effects build up slowly. So I always tell them the first couple of weeks it's almost like a little honeymoon period. You really just going through the process. You're not really feeling much. Third or fourth week slowly starts building up where they may notice some early mild sores, pain, taste changes, dry mouth, thicker saliva, potentially some skin changes. And we navigate that with the whole interdisciplinary team on a weekly basis.
Behind the scenes, we are trying to deliver very precise radiation in a very focused manner. So we want patients to maintain their weight and that can be a challenge. You've just introduced major pain, taste changes, dry mouth, and now you're asking someone to just take in the same number of calories every day and stay hydrated.
Jonathan Evison
The dietician was like, really pretty stern with me. They like, this is your assignment. I need you to put five pounds on her before we start radiation and it wasn't easy. Obviously, post-surgery, I mean, it was so hard for her to eat. I thought I was going to be pureeing her food for the rest of her life, I really did, but that only lasted like a month and she is just really resilient, just as you describe it was my mom like at first for about a week. It was like, oh, this isn't so bad. And then then it slowly started to the point where, I mean, like, you could see the redness on the outside of her skin.
Dr. Denise Millstine
That's a good point that, you know, I think for many women, they spend all of their lives thinking about not having too many calories and maintaining weight and managing weight. And this shift over to really get those calories in, is a total flip. And many people struggle with figuring out how to do that. Samir, do you have tricks that I mean, besides switching from the diet food to the high carb?
Dr. Samir Patel
Yeah. No, the way I kind of pose it is we're going to war with this cancer, and we are deploying a team. Cancer, unfortunately, is not convenient and our treatments are not going to be convenient and I'm going to keep you busy with appointments. So what I mean by that is I'm going to bring in a dietitian to give that calorie goal, make sure they guide them on the appropriate amount of protein they should be getting. And tips and tricks, as Jonathan mentioned, smoothies and such that they can do to help get be very efficient with their calorie intake.
I said for the during the radiation, I really need you to maintain the weight so that mask fits nice and snug. So we make a special mask, right? And we have to talk patients through that. Everyone's claustrophobic. I've had that mask made on myself. No one wants that mask. It's unnatural, but most adapt to it. But that mask needs to fit nice and snug for us to be able to deliver that high precision radiation and not treat normal tissues unnecessarily. So we'll guide them through that. I explain the rationale why we need that precise radiation, and how they're maintaining their weight will factor into their success for the treatment.
I said, after you're done with the treatment, you're welcome to work with your primary care physician. If you have an integrative team to go on a healthy or long-term Mediterranean diet, whatever you like. But for the time being, we're going to have to be very calorie efficient and deploy a whole team effort to make sure that folks are being pushed.
So I empower caregivers, too, which introduces a new dynamic, right? When I have some loved ones that say, you know, what? Are patients not going to feel like eating? There's no taste, and we're going to have to try to really push. It introduces a new dynamic, and Jonathan probably knows better than I do about how that can become a little bit more, test relationships.
Dr. Denise Millstine
I want to go to talking about caregivers. But before we do Samir, I wonder if you'll just comment really quickly on when you do planning for the therapy. You said the weight and the fit of the mask are incredibly important because, and correct me if I'm not saying this right, but when you are planning, you are literally planning to the millimeter. So you're trying to design this field of impact that is so precise that when somebody has a swing in their weight and the mask isn't fitting exactly as it was at the beginning of therapy, that throws off that calculation. Is that how you would describe that.
Dr. Samir Patel
100% correct. Denise, you have a radiation career in your future. You describe that extremely well. I wish all my colleagues could describe it so well. Because we're always in the basement or I think we call it the concourse level here. But a lot of times radiation is this black box and folks are not understanding how it works. So even within our medical colleagues and you're correct.
To plan radiation, we do something called a simulation the day we make that mask. So the day we make the mask on, Ruth, that version of Ruth we're trying to replicate 30 times over six weeks. And our planning is based on that CT scan with that mask, the head and neck is incredibly compact. Right. Where you're the oral cavity is where the jaw bone is, where the swallowing musculature is, the salivary glands, the voice box, the spinal cord, hearing structures, the brain. So many structures we factor into our planning and they're all compact there. And we only have millimeters of space. So we are very tight in what we're trying to target to get maximal sparing of all these structures, to try to help keep quality of life as high as possible.
So that's where the weight maintenance and the shared effort with the work at home. I tell the patients we're giving you a full-time job at home. We're going to do our part with the treatment delivery here, but you're just a full-time job at home to factor into the success here.
Dr. Denise Millstine
Yeah, and I'm hoping that people who are listening to this, maybe who care about somebody who's going through a journey like this, will think about some of the ways they can support their friends and loved ones to do these high calorie smoothies and things like that. So these are things that friends can do for other friends.
But Jonathan, the caregiver role, so sweet Abe is this elderly man who's dawdling to begin with. He's come to an advanced age and suddenly he becomes a caregiver for his wife, who he loves very much and who he's partnered with for so many decades. And of course, his children are all knowing and critical and tell him what he should be doing, what he can't be doing, and how he should be doing it better.
Can you talk about how important caregiving is, how difficult it is, and how really nobody's perfect at it, but what people need to bring to the table as caregivers.
Jonathan Evison
First and foremost, patience. So when you take that sort of “Revised Fundamentals of Caregiving” course, well, they call it “The Fundamentals of Caregiving.” I wrote a novel called “The Revised…” because it doesn't. They teach you how to create this sort of professional distance in order to avoid burnout. It's all about avoiding burnout. Or if you're doing it professionally, liability as distasteful as that sounds.
But I think patience is the main thing, because what happens is when you care for somebody daily. I'm not going to sugarcoat this. They drive you crazy. Everyone of their little idiosyncrasies or their stubbornness is or just their little habits, like whether it's they breathe out of their mouth, whatever it is starts to drive you insane. It's kind of a suffocating thing. So you have to be able to. And I do it a little different. I don't shut off that empathic. I'm not robotic about it. That's helpful, I think, but I take everything personally. I'm an empath, so it's very important for me personally to build up, build these, boundaries, but remain empathetic.
And I mean, patience is sort of in the Venn diagram, kind of in the middle of that is just like taking things in stride, trying to hear, to see things from their perspective instead of just, you know, I told you, I kind of do it with an iron hand, do this, do this. But I in order to do that, I need to be able to answer to their concerns and even speak to their concerns. I know you don't want to do this because it's this. Or like you need to have this communication where you actually understand and empathize with what they're going through so that it's not just me being prescriptive and them going, well, you don't understand. It hurts to do that or you know, so that understanding I think patience, patience is huge.
And what I think a lot of medical professionals could learn, no offense to present company, but some bedside manner.
I think medical care in general can be so isolating. You know, when you're the patient and you have this dynamic of the prescriptive caregiver and the caretaker, and I think that can be very isolating. But I think that a lot of times what gets lost in this quagmire of them is just that human touch. I would like to hear how difficult that is from a medical professionals angle. Like to try to bring that to the table with every patient.
Dr. Samir Patel
You bring up a great point is, physicians right now are in a position where they're having many stressors from an institutional level for production, for, sense of loss of autonomy. And there can be a sense of trying to get through the day, you know, and trying to having these kind of business-oriented pressures. And then working in the cancer space. Some physicians build a wall, right, as a protection mechanism to avoid depleting themselves because they're doing this day in day for hopefully 30 plus years.
What I try to do, and I try to remind myself is, this is day one for this patient, even though I may have treated a thousand different patients and I know how to treat the case, this is day one and this is completely new to this patient. And I have to demystify radiation therapy, which is frankly this really scary, right? We try to avoid radiation, right? At all costs and try to demystify them, make them feel comfortable with the plan. And I try to really dig into compassion.
So I had a really nice nurse that said, for us as a provider don't have to dig into empathy, but dig into compassion. That way you're in a position to provide endless compassion, but you don't need to put yourself through the wringer with emotions if you're being an empath every time, that's been my philosophy.
Jonathan Evison
Yeah, well, you also have kind of a nice and disarming person. I mean, some of it is just personality, you know what I mean? I think that some people that become doctors probably are very good critical thinkers, very logical, very maybe not to begin with the most, sociable people, you know what I mean? I think it requires a certain amount of mental discipline and drive and ambition and stuff that's not necessarily conducive to some of these other qualities.
So what you said now about this is day one for them really resonates for me. Because even though you know all the vagaries of it and the whole process, they don't know anything and they kind of need their handheld there. And I think there's a way you can do that that's sort of businesslike. But I mean, even if you're not taking it into your heart, personal, just body language, tone of voice, just to sort of talk to this.
Dr. Denise Millstine
I love this, and I think it's a good place to stop, but it's just really important that we come with our human selves. And even when we have a task at hand, we take a breath and we recognize that we can sit with this even when it's hard, and that it's not always going to be sunshine and roses. Just like the love story of Abe and Ruth. And I really encourage our listeners to go out and buy a copy and read “The Heart of Winter” by Jonathan Evison. I want to thank you both for being here with me today.
Jonathan Evison
Yeah, thanks. It was a really good conversation. I learned some stuff. I like that.
Dr. Samir Patel
Yeah. No, thank you so much. I really appreciated the invitation.
Dr. Denise Millstine
“Read. Talk. Grow.”is a product of the Women's Health Center at Mayo Clinic. This episode was made possible by the generous support of Ken Stevens. Our producer is Lisa Speckhard Pasque and our recording engineer is Rick Andresen.
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