Full Transcript Introduction and Christieu2019s Background 0:06 Welcome to the Doctors Making a Difference podcast, where we help physicians to be empowered with the tools they need to successful in medicine, 0:13 in finance, and in life. 0:15 Join us as we highlight doctors and other professionals around the world who are making a difference. 0:26 We are privileged to welcome Dr. 0:28 Cristina Gomez. 0:29 Dr Gomez, she's given me permission to call her Christie, is here with us today. 0:34 She is a GI oncologist and I'm really interested to hear her story. 0:39 she has published a wonderful book that I want to talk about. 0:41 And I hope she'll share some of her journey as an oncologists and as a human being. 0:46 So Christie would you mind introducing yourself to our audience? 0:48 Tell us a little bit about yourself. 0:51 Thank you so much, Peter, thank you for having me. 0:54 Thank for being among physicians who maybe make a little difference at least from my angle. 1:00 So I'm Christy Gomez, honored to be here. 1:03 But I am a medical oncologist and my focus is in GI cancers. 1:07 I think if I jump a little bit, I chose that. 1:09 A resident asked me the other day, why GI? 1:11 And I thought, because we have 13 organs in the GI tract, and so I couldn't pick one. 1:16 So I said, let's do GI. 1:18 But I knew I wanted to be a physician early on. 1:20 I was born and raised in Miami. 1:23 medicine wasn't in our lineage, in genealogy, it's not passed down. 1:29 Like Rachel Naomi Remen, the author says, right, that we are of the lineage of Maimonides. 1:35 Well, my genetic lineage was not. 1:38 In fact, when I mentioned it to my parents, They were blown away. 1:41 My parents are Cuban. 1:42 They came to this country. 1:44 my dad came in the 40s, but my mom did come in 1960. So, you know, immigrant, refugee, exiled were ethic that they were teaching us. 1:55 And here I was like this little kid saying, I want to be a doctor. 1:58 The opportunity that brings I think was new to them. 2:02 as they were just building life, but seeing that the American dream was possible now, right? 2:07 First generation in the States, so Cuban parents, Miami upbringings, and that thread or that interest to be a physician never wavered. 2:17 I highlight a little bit in a book that my father asked me. 2:21 every few years, three, four years. 2:24 So age five, nine, 17, are you sure you want to do this? 2:28 Do you know the sacrifices? 2:30 do you what it entails? 2:32 And I told him time and again, I said, what's a thread that doesn't disappeared, hasn't wavered. 2:38 I think one of your guests talked about how we all dream of being firefighters or astronauts in our youth, but that he too had this thread or this interest 2:48 in being a physician since early on, and that moved me because it was my story. 2:53 And by high school and college, I said to him, hey, dad, can't let this go. 2:59 And so right then he gave me his full support. 3:02 And I joke that part of my medical degree belongs to him because he would work late at night. 3:07 When he'd get home, my light was on and my anatomy books were spread on the floor. 3:13 So medicine came to me early on, and I'm so honored. 3:17 Here I am almost touching the door of 50. I love what I do. 3:21 That's so neat. 3:22 I can reflect so much on that because I think, like we talked before we hit record, we're humans first. 3:27 We're people first, and then we choose to become a physician. 3:30 And hopefully most people choose that, because they want to heal. 3:33 They want help.They want make a difference. 3:35 All the things that are themes of the podcast.All of us wrote a personal statement before applied to medical school. 3:41 Those themes ring true to us when you go back and think like, why did I do this thing? 3:46 Why did i make this sacrifice? 3:48 And it's good to reconnect with that. 3:50 It's really interesting. 3:51 You have that desire even as a very young child. 3:53 Yeah, that was wild. 3:55 And I remember we'd play. 3:56 I grew up with a sister and a cousin who was like a Sister and they played in retail or teachers and I was always asking to be the doctor. 4:05 It stuck around and now looking back or listening to, as you and i were sharing, your podcast community, it's a select group of people, 4:14 right? 4:14 Tribe or we're a certain pattern of individuals and so I'm honored. 4:19 i think i was born to do this. 4:21 I think so too. 4:21 One of my friends, she's not a physician herself, but she works with a whole bunch of physicians. 4:27 And she always says, you guys are so weird because we designed a continuing medical education course and we were talking about all the different people 4:35 that could talk to us. 4:36 There was one that was just like. 4:38 totally nerded out on all the different updates and the journal articles and practice changing things. 4:44 And she thought it sounded boring and we're like, are you kidding? 4:46 That's the most interesting thing there is. 4:48 It was the one that received the highest marks and everybody was totally into it because it was relevant on boots on the ground, 4:54 going to make this change in my practice. 4:56 Anyway, it's just fun. 4:57 You're right. 4:57 We are all cut from a similar cloth. 5:00 That is for sure. 5:01 Maybe this is like my own little CME. 5:04 I recently adopted a little boy five years ago. 5:07 And I don't know what I'm doing, right? 5:09 That's what parents say. 5:11 Maybe I am one of those weird people because the way that I was parenting him is that medicine is master. 5:17 My only way to teach is using medicine. 5:21 So something as simple as a scrape on his knee, But I'm using it ideally, that it may have ripple effects, and everything really heals.
How the Book Was Inspired 5:30 Things take time, but they'll heal, right? 5:33 That may be the adoption process or any heartache. 5:36 And he'll remember that because I taught him in medicine that the scrape on his knee is going to heal. 5:41 I am using these big terms like, everything heals, it just takes time. 5:46 Like surgery, or I was using my practice to raise a little boy. 5:51 Maybe that's really weird parenting. 5:54 No, I'm a parent. 5:54 I have four kids. 5:56 And I think it's one of the most humbling things ever. 5:58 You think you're a pretty okay, good person, and then you have kids and you like, wow, i am not very patient and I've got so much to learn. 6:07 and yet, when I, think about my life, it is my most important work. 6:13 provide a good income for my family and I want to do all these things with my life. 6:17 But the only legacy I really will leave is my kids. 6:20 After I'm long gone, probably the people that will remember me really are my children. 6:24 So I hope I leave a legacy, even if I teach them in my own nerdy doctor way. 6:30 You got it. 6:31 Your patients, your colleagues, but yeah, our kids will tell our story. 6:36 That's right. 6:36 Well, tell us about this book. 6:38 This is a wonderful book, those who are on the video viewing this can see the book is called Stopped in My Tracks, and it's a collection of cancer patients quotes. 6:47 And obviously you, Kristy, have been a doctor for a number of years. 6:50 You've met lots and lots of oncology patients at this point. 6:54 But I want to hear what inspired the creation of this a book? 6:57 I read through it, I love it. 6:59 Like I said, before we hit record, i am really going to put this in my waiting room. 7:03 I think my patients will love because it's not like hundreds of pages of reading. 7:07 It's just little nuggets of truth that patients have shared with you throughout the years. 7:11 And each page is just delightful. 7:13 So tell me how you came up with this. 7:15 Thank you, thank you so much. 7:17 So I think weaving your first question and now this one. 7:22 I knew I wanted medicine, so I went the science track, the biology track. 7:26 But I was blessed with amazing English teachers, creative writing teachers in high school. 7:35 letters, if you will, right? 7:36 Not only sciences, but the art and in particular writing arts. 7:40 And I remember in college proceeding with minor and because I was so excited to get into med school, I didn't finish a major. 7:47 But this thirst to write or to combine words together that sounded better together was an attraction for me. 7:57 Then fast forward to med school, there was a clinical skills course. 8:01 It was called, which I think it was really humanities. 8:04 They didn't call it that in my school but it, was art of medicine. 8:07 And they reminded us to look to physician writers, those who have written before us. 8:13 I mentioned Rachel Naomi Rehman, her book was gifted to everyone in the freshman class, the book Kitchen Table Wisdom. 8:21 and her invitation to speak to our patients, like if we're sitting at the kitchen table. 8:27 So all of that was planted first year medical school. 8:31 And then they asked us to keep these notebooks. 8:33 This was before iPhones or iPads, but we had still to pen to paper, knowledge. 8:40 They asked to us keep little notebooks in our white coats. 8:43 to jot down kind of pearls or nuggets of what you learned. 8:48 If you saw something for the first time that you had only previously seen in the textbook, Capulet Medusa, ascites and what it looks like, 8:56 what the heart sound sounded like with the murmur, What you say in pediatrics or OBGYN or radiology, right? 9:05 In our vast knowledge, they asked us to chop these things down. 9:10 And I confess in the book that almost like parenting, right? 9:14 I messed up every day. 9:15 I was so busy. 9:18 That booklet was empty, page after page. 9:21 Was empty. 9:22 And felt almost I like I missing out on something. 9:25 When I went back to that I said, God, I'm gonna forget all of this. 9:29 There's been so much money in my medical education. 9:31 This is where real knowledge happens or real learning happens at the bedside. 9:37 and I am not writing this down. 9:40 Whatever I prayed that my memory in its youth would be okay. 9:44 And then I would know what I needed to know. 9:45 I had a mentor in school who said, you can't know everything, right? 9:49 So in medicine, You'll know where to look it up. 9:53 So then they found myself once I was a fellow, once, I wasn't oncologist pausing at the patient words about their experience with chemotherapy, 10:04 their experienced with the diagnosis, they're experienced, with life and death, the experience, side effects. 10:10 And I remember then, as I'm taking their history, on the side of the note-taking, jotting their quote, literal quotes, and I'd rip the paper and stuff 10:21 it in the bottom of my coat. 10:22 Like you're ripping paper off the exam table? 10:25 Yeah, exactly. 10:27 Paper towels, exam room paper towels. 10:30 Exactly. 10:30 I draw them a picture of what their liver was looking like and then their, quote. 10:34 And rip it off, stuff into the top of a coat, And I didn't know what I would do with that. 10:40 I joked with them. 10:41 Hey, one day I'm going to write a book. 10:43 Can I quote you? 10:44 And, I remember that my teachers taught us to quote someone if you were going write an essay. 10:50 Right? 10:50 Almost like a leader passage. 10:54 And then I think we grew up with this show that was like kids say the darndest things. 10:59 Yeah. 11:00 So I joke with him that patients say that darendest thing. 11:04 My truer knowledge, my trurer learning was happening right there with their words. 11:10 And sometimes I literally stopped in my tracks, paused. 11:14 That moment when we're holding the doorknob and we are about to leave. 11:19 Many times I, not for their last question, but for mine. 11:24 I'd let go of the doorknob and say, can you say that again? 11:27 Because I was moved. 11:29 And I am moved so often. 11:31 I've stopped collecting them, I have to keep doing it. 11:34 But that's how the book was born. 11:36 That was just a seed, right? 11:38 We were taught about physician authors, we were talked to write down the pearls of knowledge, and I collecting quotes. 11:47 Fast forward, that was at Yale University, faculty there for a little bit and it was pandemic. 11:53 And in physician wellness, they had a writer's afternoon, physician writing afternoon so that we could channel the immense stress that were faced with. 12:03 We had only studied epidemics and pandemics, we had studied it as a definition almost, and now we were living it. 12:12 But that author was an editor and a publisher. 12:17 She said, what do you guys think? 12:19 What are your thoughts? 12:20 Where's your writing? 12:21 And I almost like virtually pulled out these little scraps of paper and stopped in my tracks was born. 12:28 That is so neat. 12:29 I was just thinking as you said all that earlier today, I had the opportunity to show a second year medical student how to do a C-section for the first time. 12:38 She'd never seen one and it's an amazing procedure and there's a new baby and then there is lots of blood and fluids. 12:44 And we do them all the time. 12:45 And it's just kind of part of the practice and my practice partner and I were doing this and it was great, but I was caught off guard or stopped in my tracks. 12:52 As you said, when I just, you could just see the wonder in this student's eyes. 12:57 She just was so excited to see it and just thrilled to the birth of a baby.
Narrative Medicine and Patient Quotes 13:02 This was. 13:03 a C-section and I just wonder how often we get so busy, so, busy doing all these things. 13:09 And I got to rush to the next thing. 13:10 I've got somebody else waiting on me and finished charting all this stuff. 13:14 There's a thousand different things, but I probably should write that down and just say like, I go to channel, watch somebody experience that for the first time. 13:21 You see the wonder in that person's eyes and then all of us do it again and again. 13:26 That's what you're talking about. 13:29 both the pain and the bravery and just all the experiences that a patient has in their oncology, their cancer experience. 13:37 You were able to capture lots of those little nuggets and then reflect back on not just your experience as a doctor, but what that patient, 13:44 it was their first experience with it and what it meant to them. 13:46 And anyway, that's pretty cool you did that. 13:50 Thank you. 13:52 Maybe I'm doing it a little differently. 13:54 I had a resident this week and I introduced him to my patient. 13:57 And I asked the patient permission, but it was okay that the resident listened in, learned from the patients. 14:02 The patient happens to be on surveillance. 14:04 He's doing really well. 14:06 and he stopped the rest of my interview and said, hold on a second, young physician, I want to tell you something. 14:14 I trust Dr. 14:15 Gomez because she talks to me like a friend. 14:18 And so maybe I'm getting these quotes or these opportunities, like how they want to live or how the want a down life or what things really feel like. 14:27 Maybe because I have the opportunity to just sit back and have a conversation like this. 14:32 Like we were early taught that the patient physician relationship is unique. 14:36 And so, yeah, you took me back right now to my first OB-GYN rotation when I saw my little beating heart on an ultrasound machine. 14:44 I was a third year medical student and you just took back to that. 14:48 We know so much. 14:51 we can write case reports on the things that we see or we're learning so every day. 14:56 But something about what they said, I guess it was art, right? 15:01 Or literature. 15:02 What the patients were saying, that I was able to walk into a moment between a spouse when they look at each other and say, 15:08 honey, it's really your choice, or I'll do the chemotherapy for you. 15:13 Those things stopped me in my tracks, like we are privy to sacredness. 15:18 There are sacred moments that you see. 15:20 And again, I know I'm just as guilty as anybody else of just bulldozing through it because I get so busy and you're like, 15:27 boy, don't have time to do the touchy feeling thing. 15:29 I just need to move on to the next thing, but when I do that, i leave myself shortchanged. 15:35 i'm missing out on those important things that experience because of your unique position as a doctor. 15:40 Nobody else will. 15:42 experience that and so it is really good to write that stuff down and your book just captured it so beautifully. 15:47 So many little quotes in there. 15:49 I try to keep every thank you card that anybody ever writes to me because that's a little word from the patient or maybe a family member of a patient that 15:56 has gone through something and it means a lot to be when I go back and look at them later. 16:01 But I probably should write down when somebody says something really funny or crazy or unique or poignant and just write it down. 16:08 Cause someday I will look back on it. 16:09 I don't know if I'll ever be brave enough to write a book as you have done, but I think it's really good for me to remember like, 16:15 oh yeah, those are the experiences that the patient had and I got to be part of it, a powerful experience to do that. 16:21 Thank you for that. 16:21 I find that I use it to teach, right? 16:24 So that if a patient says, what is this going to feel like? 16:26 I said, well, someone else said this is how they described it. 16:29 Right? 16:30 Just this week, a patients said to me, have you tried that medicine? 16:34 She had oral thrunch. 16:35 And I say, look, I'm going give you some of my statins. 16:38 Some patients hate it, but it's going clear this up. 16:40 You're going taste again. 16:42 you're gonna gain some weight. 16:43 Come on, let's do it! 16:45 She said, have you tasted this? 16:47 And it reminded me of these quotes or how people describe things. 16:52 We use it in everything, right? 16:54 We used it any other things. 16:55 We read reviews of where to stay. 16:57 This Airbnb's reviews or we're purchasing something. 17:00 I think maybe some of these quotes are patients' reviews on this journey. 17:06 And really, they're the authors of the book and they are the teachers. 17:09 You don't want to be a patient to have to like take a taste of your own medicine. 17:12 But I do remember in medical school, it was a pharmacology class. 17:18 Must have been in the third year of medical school during one of the rotations. 17:22 We had a pediatric pharmacist come and they made us taste test a bunch of pediatric medicines. 17:27 Like just a little taste, you get, this is what amoxicillin tastes like. 17:31 And then this was what clindamycin tastes. 17:33 If you ever tasted that, it tastes horrible. 17:35 or this is what prednisolone tastes like, also tastes horrible. 17:38 And so it is good to reflect with patients like well, I can't say I haven't been down that path, but I could reflect you. 17:44 So that is really good that you get those honest experiences that patients will share with you and instead of being bugged by it, 17:51 you are taking it and just making it human, making real. 17:54 I'm assuming patients really enjoy it. 17:56 It sounds like they enjoy talking to you because you talk to them just like you would with somebody else as a neighbor or a friend. 18:03 I think we have fun. 18:04 And you mentioned about bulldozing through the schedule. 18:07 I thing my nurse and my team sometimes worry about the clock that melts away when these conversations happen. 18:13 Right. 18:14 Time and again, I'm moved. 18:17 Some of them say to me, What would you do, right? 18:20 We're so respectful. 18:22 We are taught to be so respect for people's choices. 18:25 Just today, three times, I had the discussion of, hey, you don't need to do any of this if you want. 18:30 But two times this week, someone said to me, but wait, what would YOU do if this were you? 18:37 not only your relative, like, what would you do? 18:40 And so they turn the tables on me. 18:42 It reminds me of what I'm trying to grow in narrative medicine. 18:46 Columbia University has a great program with narrative, medicine, I am trying do it virtually. 18:50 But recent grad reminds us that medicine is storytelling, but that storytelling is medicine So since day one, we're taught how to tell the story. 19:00 We need to our residents and our attendings, and we tell each other. 19:04 Tumor board this morning, I told story after story so that my colleagues can pitch in or share their experience, their knowledge, 19:14 So in telling the story, we gain knowledge and we can serve the patient. 19:18 But in the telling of their story there's healing too. 19:21 And I hope that's what happens. 19:24 In my exam room, that what's happening with the book. 19:27 That's happens to all of us. 19:29 Ideally when we share with a friend, a colleague, as you share in your podcast that we should go to each other in our physician community. 19:37 When we're already out in world, it's easy to just work and come home, but that we too need to share these stories for what it does to us. 19:46 Another patient today said, how do you do this? 19:49 And I knew I was going to talk to you this afternoon and I thought, How could I not? 19:54 I like that concept of narrative medicine. 19:57 It really is at odds with the schedule because you're right, there's always a schedule. 20:01 There's all this pressure to see people and legitimately so people need to know what time to come to the doctor and how long to stay. 20:08 And we don't want to make them wait too long. 20:09 Those things we try to do to keep a busy schedule, but on the other side, you do have to sometimes just stop and say. 20:16 Okay, I'm here. 20:18 What do you need? 20:19 Let's sit down and talk. 20:20 Knee to knee, eye to eye, what is it that you'd need because the patients are dealing with it. 20:25 And I shared with you, shared on the podcast, that I get to be a patient and often I am doing my treatments and then I m a doctor and back and forth and 20:35 I mean, a doctors office as a. 20:37 I might be calling the same consultant the very next day on a patients that am seeing like a back-and-forth. 20:42 It's such an interesting juxtaposition of those two roles. 20:46 But I'll tell you, the thing that matters to me the most is not the medical knowledge of the person. 20:51 For me personally, I can look up stuff, find out how to read studies, assimilate a lot of medical information. 20:57 But what I want to know is on the other end of that conversation, there's an expert who not only knows the information, but someone who actually cares 21:05 about me and my family and in my life. 21:07 Because if that doesn't happen, I'm not sure that it's any better than me just looking up the information myself. 21:12 And so I need the expertise, but I also need this humanity of someone to understand and say, hey, we'll walk this road with you. 21:19 Even if we don't know the end, We'll go through this together and I'll be there step by step. 21:23 It means everything to me. 21:24 I am assuming it means a lot to all of our patients as well. 21:28 So many things that are coming to mind. 21:31 I remember your story when you shared that you just wanted to get back to your patients, right? 21:37 That's our commitment and how they know our stories. 21:41 Yesterday was the first day of school and patient after patient today asked me, how was that first year of for your little son? 21:46 It reminds me also of my family. 21:49 Medicine rotation as a medical student. 21:52 The doctor, the attending was a few minutes late. 21:55 He came to the front of the classroom. 21:57 We were in an auditorium. 21:58 So maybe just starting our clerkships.
Listening, Uncertainty, and Breaking Bad News 22:01 And he started the class, the lecture, by saying, hey, guys, sorry I'm running a few minutes late. 22:07 My kid was sick last night. 22:08 And my wife and I were up many hours. 22:12 Then he gave a whole lecture on family medicine. 22:14 At the end of the last lecture he said, you may not remember anything I said. 22:18 But you'll remember that my son was ill last time, that wife I was up late, so that's how I want you to treat your patients. 22:25 And so I had never thought about this story in years. 22:28 Med school was 20 years ago. 22:30 But the way you talk about us being physicians, people, and the human side of medicine. 22:37 So another mentor said he was a gastroenterologist. 22:41 He actually won the Presidential Medal of Honor, Dr. 22:44 Pedro Greer. 22:45 And he said, I've never had a liver walk into my office. 22:48 It's not about the hepatitis or the hepatocellular carcinoma. 22:52 it's the person with this liver that is sick. 22:55 And so we're so gifted to see that. 23:00 I think another one of your guests talked about what really matters, not what the matter, Dr. 23:06 Abramson. 23:07 So that story that they know that I have an eight-year-old who just started third grade and that, I was nervous yesterday, 23:14 probably more nervous than the kid, that it was the first day of school and then would I be called on the 1st day school because of anxiety and first days 23:23 from summer. 23:24 that they understood that. 23:26 One patient saw me again today and said, how was yesterday? 23:29 Did he do okay? 23:30 So did they know that we're behind the clock, that were reading the data on the newest trials, they were thinking of enrolling them in trials or what's 23:40 the latest chemotherapy, but that where human and that worried about some lunch money for a third grader or whatever it be. 23:49 Yeah. 23:49 I think it really does matter. 23:50 We've made the point a couple of times, but patients need to know that they matter to you as a doctor. 23:57 And I've, again, I don't think I was ever bad at doing this before, But especially since I have been a patient myself a bunch to realize like, 24:06 oh, that really doesn't matter and so those interactions, taking the time to sit down with somebody and look them in the eye and make, 24:13 even if you really only have just a few minutes, make those few minutes all about them. 24:18 Like it really does help patients and it helps us. 24:21 Cause when you come out of an interaction like that, you can write down the stories like you said, or you could say, I thought about that and you'll remember 24:28 something about. 24:29 Not just their diagnosis. 24:30 And so I. 24:31 Anyway, I love what you're doing. 24:32 I appreciate that you've brought this narrative medicine. 24:36 You did it through writing about patients, but in your book, you quoted patients. 24:40 So you are giving voice to these really poignant special moments that they shared with you. 24:45 And that's a really unique way of doing it. 24:46 Never seen it happen quite like that. 24:48 Thank you for writing that beautiful book. 24:53 Thank you. 24:54 Another question, I just want to shift for just a second. 24:56 So you've done this for a long time. 24:58 You know how to make diagnoses, you know, how people in trials, know to come up with treatment plans, that you're an excellent communicator with your patients, 25:07 You've developed all these skills over a lifetime. 25:10 And my question I've got a couple of questions on this, but one of them is, What do you tell an aspiring medical student? 25:17 I think medical students are super aspirational and they're like, I'm going to be the best communicator. 25:21 I want to do the thing. 25:23 And so what do tell someone who's in the training path? 25:25 And then you get to residency and fellowship and you realize that you really are drinking from a fire hose and it's hard to keep the humanity in it because 25:33 you're so tired and he worked for so many hours. 25:36 But what would you tell somebody who's in those learning stages to keep that humanity, keep, that narrative of medicine alive, 25:42 despite the challenges of modern medical care? 25:47 Oh, wow. 25:47 So a couple of things come up in what I would tell them. 25:50 And then this last part, you asked, it's almost like, how do we take care of us? 25:55 But first thing is, and I don't know that this is a popular thing, so I'm going to go out on a limb here. 26:02 that I think holds true, that, I feel is cemented in me, is that while this is a great profession, noblest of professions, 26:10 all of us are so called to it, still to this day, from early on, it's that it is not for everyone. 26:16 Do it if you love it. 26:19 That quote that if love what you do, you don't work a day in your life. 26:22 This is hard work, but you gotta love. 26:25 And it may or may not be for every one. 26:29 that kid who says, no, I gotta do it. 26:31 That kid like me who said, it's a thread that doesn't go away. 26:35 So one, do if you love it and love. 26:37 Two, is this really listening. 26:40 Really listening to the patient. 26:42 Know about the wedding and the christening and know one story. 26:47 Peter, if I may, have a patient today who say, what do we do next? 26:52 His cancer's progressing, the toxicity's multiplying. 26:57 But he showed me a picture of his home in Colorado. 27:01 It's just the home and a snow-covered mountain. 27:06 I'm in the desert of Phoenix right now. 27:09 He's here because of MD Anderson in Phoenix. 27:13 Only here, because that. 27:15 And he says, I just want to go home. 27:17 That was a couple of weeks ago. 27:19 Today, The can doesn't look gray. 27:23 The side effects are adding up. 27:24 How do I get you to that home? 27:27 Because I close my eyes and I see your home and the white mountain. 27:33 And he lit up, he smiled through cracked lips. 27:38 He remembered and could close his eyes to see the picture he showed me. 27:43 The last thing I would tell a medical student is to practice the pause, something I'm still working, right? 27:50 The pause to answer. 27:52 We're so taught to keep the schedule where we know what to say, but to listen to understand, not to listened to answered, 28:01 and it's okay to leave silence for what it is. 28:04 If the patient may need the silence to the question, or the patients may needs silence after they've made a decision, For us to be okay with the silence 28:16 is something I would tell young house staff who practice for the rest of their lives, because that's where I was moved, where that where healing happens, 28:25 I think. 28:26 And I that then that just leads to why we stick around. 28:30 I want that patient to go back to Colorado, and I don't know if he may be able to. 28:34 The closest cancer center is two hours away, the big cancer centers four hours from his home, but he said I just want to home. 28:43 So remembering the wedding, the christening, and the baby that was going to be born. 28:48 The house in the mountains that he dreams of returning to. 28:51 I think that's where healing happens. 28:56 Well, those are really personal, poignant things. 29:00 If you get to know somebody and get know what makes them tick and say, what is the reason that you are doing this? 29:05 Why are you all the way down here in Arizona when you want to be in Colorado? 29:10 Because obviously the person wants to there, but do you down to that why or that core reason of why they're doing it? 29:16 You can find alignment and maybe that will result in this patient continuing on this treatment pathway. 29:22 And maybe they'll choose something a little bit different. 29:23 It depends on what the journey results in. 29:25 But the fact that you took time and listened will mean everything to that patient. 29:29 When they go home, they will be like, yeah, Dr. 29:30 Gomez listened to me and will make a decision and I'll feel good about it. 29:35 because it was the right decision for that person. 29:37 But it does make a big difference when you sit down and listen. 29:39 I wanted to ask another question. 29:41 Again, your expertise as an oncologist for years, you've had lots and lots of experience or an expert in your field. 29:50 All these things that we deal with as patients, they just present so much uncertainty. 29:55 And I think about the night that I found out that had a 28 centimeter tumor. 30:00 I've shared on this podcast. 30:01 It was wild.I was working in the emergency room and I just happened to glance at my scan. 30:06 Had gone in to see my practice partner and he ordered a CT scan because there was this kind of felt like a bump on my side, 30:13 inside my abdomen. 30:16 Everything in that moment, it just felt crushing. 30:18 Like how can I go on? 30:20 And I was just doing fine. 30:22 I'm 43 years old and having my family and working really hard. 30:25 And suddenly I can't have cancer. 30:27 What's going on? 30:28 I guess the question I would ask you is reflections on what do you tell patients in those moments of deep uncertainty when somebody has been given news 30:37 that is really devastating or disappointing? 30:40 because it's real. 30:41 It's something we get to deal with a lot as physicians, but I think particularly in the world of oncology, it presents a tremendous amount of uncertainty. 30:49 So I'd be interested in any thoughts or guidance you could give from your own experience. 30:54 And then again, most people listening to this podcast are physicians. 30:56 What do you advise us to do? 30:58 Because these are hard conversations. 31:01 Thank you for that question, because I'll be even more honest. 31:04 I grew into this. 31:05 And I remember in my training and having hard conversations that are now normal lectures and core curriculum opportunities. 31:16 In fact, I was able to participate in one the other day for the School of Medicine at University of Arizona. 31:21 It was honored that they were having an entire class on breaking bad news. 31:27 But I remembered thinking, patients don't really want to know. 31:30 just sit with them, make it all a feel-good visit. 31:35 I remember that in my trainee, and patients have taught me time and again, they really want to know. 31:41 In fact, there's data on this. 31:43 Do people want know numbers, or do people wanna know now that we've got circulating tumor DNA that can... 31:50 prognostic age, risk of recurrence, I thought nobody wanted to know. 31:54 And the data is that over 90% of patients want to. 31:58 So I am grown into this truth to light that patients wanna know, and so I get to be the bearer of truth, that I got to the one to walk with them. 32:11 They're really coming to me not for sugar coating, not marshmallow soft, They want to know. 32:19 And so the gift is how we relay this message. 32:24 I speak to uncertainty for what it is, that there is so much in life that is gray. 32:28 There's so uncertainty in all aspects of our life and that now we're in this. 32:49 Hey, I can't imagine what you went through. 32:50 I have a colleague who also came upon his pathology results and he was with a full team of house staff, nurses, Eptecs.
Final Reflections on Walking With Patients 33:01 And he's like, oh my God, have cancer. 33:05 So a very intimate and private moment, but that you are not alone at home, your community, put the community in medicine there to walk with. 33:14 Am honored by what life can give us and what The body can give us, if I'm teaching my young son that medicine is the way, 33:21 that body remains master in that. 33:24 We don't need to make a decision today that we can listen to all of these options and that the body will tell you, right? 33:30 Yes, I am strong enough for this line of therapy. 33:32 I was strong for the surgery. 33:34 Or, Doc, let's do a shorter course, radiation, and I'm going back to Colorado. 33:39 So, speaking to that, I think I wake up every morning with the spirit that I can offer patients options, right? 33:44 So there's this line of therapy, this one of the therapy and then there is a clinical trial, but also maybe options with life, 33:50 Right? 33:51 Newly diagnosed, biliary trapped kids, she's fit, no medical problems. 33:54 I was sure she was going to take treatment. 33:58 And she looked at me at the end of the visit and said, I'm at peace. 34:00 I've lived my life. 34:02 My kids are big. 34:04 And tired. 34:05 Actually, they're struggling with addiction, and I can't help them anymore, And I don't want to do treatment. 34:12 So the opportunity to even sit and speak, that option, That remains an option. 34:17 You don' need to this. 34:19 When my father dealt with cancer, the oncologist spoke. 34:23 My mom and my sister were like, OK, we can do this. 34:26 We can come here on Wednesdays and Fridays. 34:28 And I stopped, and maybe because I was physician and daughter, oncologists and doctor, I said, hey, dad, but do you want to do? 34:37 And I remember my mom and my sister almost like stopped breathing, gasped, like if I was asking a sinful question. 34:44 Right. 34:44 But that option remained. 34:46 That treatment should look like whatever you want to test, independent as if you wanna get married or have kids. 34:52 We get a chance to choose those things or practice medicine in a rural or in the desert or the northeast to chose a job by where we wanna live. 35:00 I think that's been my invitation to the uncertainty, going back to what do you really want? 35:06 And then the gift that that is for them, for me, the physician, but the gifts that it's for the family, choosing how they want to walk the journey, 35:15 how do they wanna live it, and how the want close it. 35:20 Yeah. 35:21 No, thank you. 35:22 That's powerful counsel. 35:23 I think I'm going to go back and listen to this again and try to channel that with my patients. 35:28 It does matter so much. 35:29 And I like the idea that you talked about giving voice or acknowledging the uncertainty. 35:35 What I've found in my life is that Everything is actually uncertain and it was always uncertain. 35:40 I could die in a car wreck on the way to work. 35:42 You could have a heart attack when you're young, you could a stroke. 35:45 Like one of our former guests in her 40s, You can have all sorts of things that can happen in just a moment. 35:51 We really are faced with uncertainty in this life every day. 35:54 And yet we live in these little bubbles of self-assurance. 35:57 And we think that everything's going to be okay. 36:00 And yet the uncertainty is actually there. 36:02 A medical diagnosis, I would say, especially maybe a cancer diagnosis presents, it just brings to light so much uncertainty. 36:10 It doesn't mean you can't navigate those waters safely, but it really matters. 36:14 Just like what you said, acknowledge the uncertainly and we'll be there with you. 36:18 You're part of a team. 36:19 I've had to learn that. 36:23 And I've had to learn to walk with my team and really count on them and let other people help. 36:31 And so that discussion of just honestly acknowledging the uncertainty and saying we'll be there with you step-by-step, even if you can't solve it and you 36:42 You can see three or four steps ahead as a doctor, you know what's probably going to happen, but you can't tell with certainty. 36:47 So it's just such wise counsel. 36:49 And I want to emphasize it. 36:51 Like I said, I'm going go back and replay this because I think that is so useful. 36:55 Thank you. 36:56 That is exactly what I share. 36:59 The things that we don't know in our life. 37:01 We've lived with that, and now it is just under the umbrella of our health and saying this may or may not work, then let's make another plan. 37:10 Right? 37:10 And looking at that, if this doesn't work, what's plan B and C and D? 37:14 I'll walk with you. 37:15 I will be there through every step of it. 37:16 That's really helpful. 37:19 Yeah. 37:20 It means everything. 37:23 You're not alone. 37:24 We were taught that in med school, that patients don't want that you can guarantee that there's no pain. 37:30 And I think through my years in this, 16, 17, 20 years, More than that, because we've got the meds, we got husbands, the nerve block. 37:41 They want to know that they're not alone. 37:44 Yeah, they want answers for all the medical stuff, but you need to that you're alone and that your team is there with you. 37:50 So I think this has been so instructive. 37:53 Like I said, I'm going to put this book in my waiting room. 37:56 I want to channel this. 37:57 It's been one of my favorite episodes to record because I love that you are doing it and you've written down the stories. 38:03 And I am going take from this that I need to write things down a little bit more. 38:06 Because when I reflect back on my day, sometimes you're like, ''I don't know I saw 20 people I can't remember.'' But if you write it down, 38:13 and like, oh yeah, I have this wonderful conversation with this person. 38:16 I think those things bring joy and value to our lives. 38:20 And that communication stuff you shared, all those pieces of wisdom, will be useful to all of us. 38:25 As we wind up here, do you have any final thoughts for our audience? 38:28 Because I just think this has been a wonderful interview. 38:32 Well, wow, let me see. 38:35 Just this morning I got a text, hey, Christy, one of my friends is undergoing a biopsy and planned chemo. 38:42 And what do I do? 38:43 Right? 38:43 And so it's funny because I think I wrote the book for just that, right? 38:47 What do we do. 38:48 One, we walk with each other. 38:49 Right. 38:50 That's what I told her. 38:51 The same thing that we were echoing. 38:53 She may want to be a lone wolf. 38:55 she may wanna hide. 38:56 To remind her that you're there. 38:57 I thank you because what you are giving us in this platform is that were not alone. 39:01 that this work is hard, and then we rush to our families who love us and need us, but that we're not alone. 39:07 It's been an honor to meet you, to listen to your podcasts in preparation for meter research and where we were going to take this. 39:13 But thank you for reminding us that were not along as physicians, as healers, that can continue to do this in this uncertain world. 39:21 Thank you. 39:22 So much. 39:23 Dr. 39:23 Christy Gomez, look up the book. 39:25 I really appreciate it. 39:26 Thanks so much for taking the time to this and keep in touch. 39:30 Thank you. 39:30 You bet. 39:31 I appreciate this. 39:32 Thanks. 39:49 Please note that while I am a physician and many of the guests on this program are also physicians or other professionals, 39:55 the discussions on the podcast do not represent my employer or any professional organizations to which I belong. 40:01 This podcast is for your information and entertainment only, and should not be taken as professional advice. 40:07 You should seek appropriate professional advise pertaining to your own situation. 40:11 Please check out more of our content on our website, DoctorsMakingADifference.com. 40:16 Also, please follow, like, or subscribe on your podcast player or YouTube channel, and give us a five-star rating. 40:22 It really helps to spread the message. 40:24 Finally, if you'd like to be a guest on the podcast, Or if would like nominate someone else to a be guest, Please visit the website or email admin at Doctors 40:34 Making A Difference dot com. 40:35 See you next time.
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