Reflections in a Head Mirror

We say we exchange words when we meet. What we exchange is souls.
-Minot J. Savage


It was Monday evening. The shelves in the electronics department overflowed with different styles, prices, and brands of headphones, all displayed in sealed plastic cases. I was in the mood to buy but was baffled by the array of options in front of me. This was not going to be as simple as I had thought.  

A young salesperson broke off his conversation and sauntered casually to where I was struggling. Grinning impishly, he leaned on the display.  “Hey,” he wanted to know, “how was your weekend?”   

“How was my weekend?” I repeated silently to myself. I neither looked up nor answered. What kind of question was that? Was this some new technique he had learned guaranteed to increase the likelihood of a sale? I’m here looking at headphones and he wants to know about my weekend?  

I put down the package I was examining and glanced up at him. “It was busy but I doubt anything that happened would be of much interest to you.” My desire to spend money at that store had evaporated. As I headed toward the door, he called after me to wish me a nice day. I can only imagine his facial expression as he did so.    


The next morning, I was in the office seeing a newly diagnosed cancer patient. Each question about her cancer and its symptoms elicited more anxiety. She nearly shook as she related the problems she had experienced: worsening pain, trouble swallowing, difficulty talking.  Her unease only grew as I probed her smoking and dietary habits. Her family tried to reassure her.  

I crossed the room to begin the examination. As I checked her skin, I noticed that she had a faint sunburn. Maybe there was a story there. “So tell me,” I asked with a smile, “how was your weekend?”  

Her face lit up. As I continued the examination, she told me about how Saturday had been spent outdoors watching her grandchildren play soccer, taking them both to the park, and then stopping for ice cream. Sunday had started with church and then a quiet afternoon with an old and dear friend. By the time she finished, she had visibly relaxed and I had a context through which to understand how her upcoming treatment would affect her, her family, and her close friends.  

I suppose it was presumptuous of me to ask about my patient’s weekend. I had, after all, bristled at the notion that the young salesperson considered it his right to ask about mine. Occasionally, a patient will let me know that I have crossed a boundary when I steer the discussion toward the more personal.  

Most of the time, though, my patients are very willing to share their stories. From my perspective, there are practical reasons to understand social contexts and relationships; what they choose to share often points to the people and things that are most important to them.    

Months from now, when the fear of the disease has been mastered and she finally sees her life as pre-cancer and post-cancer, it is very possible that my patient will turn to me with a smile and ask about my weekend. As I happily summarize my time away from work, maybe I will throw in the tale about how I was so rude to the young salesperson. I suspect we will laugh at both his ingratiating tactic and my overly sensitive reaction. After all, when I tell it correctly, it really does make for a great story.

All would live long, but none would be old.
-Benjamin Franklin


When I first met him three decades ago, he was a clever, accomplished 60-year-old. He was self-aware, well-versed, well-read, and well-travelled. He was rigorously honest, selfless in his actions, and generous with his time. He was engaged with friends and colleagues from around the world. His self-deprecating humor was well-known to everyone who knew him. At the time, he was about to retire from a career combining his gifts as a beloved teacher, a respected leader, and a deeply spiritual intellect.

One thing really annoyed me, though: It seemed that whenever a conversation had reached a stopping point and I had taken a couple of steps toward the door, he would invariably call out one more question. It happened all the time. With each new query, I would turn back, finish the conversation again, and retreat. Sometimes, this happened two or three times before I would finally escape.

Over the years, I became accustomed to this propensity of his. Sometimes, I found ways to distract him as I snuck out. (“Look! A huge bird! Right behind you!”) Too many times, I mumbled an answer or pretended that I had missed his final question. I did not like being rude. Sometimes, though, it seemed the easiest way out.

During the final years of his life, Alzheimer’s Disease tightened its grip. His eyes still sparkled when he got a hug from his grandchildren. He remained pleasant and attentive, playing card games with help. He could answer simple questions appropriately when they allowed for an automatic response and was able to maintain a social veneer long after the ability to reason had abandoned him.

Somewhere along the way, though, he stopped calling me back for just one more question. I never noticed when the habit vanished.

Who would have thought that his loss of spontaneity would be manifest by no longer needing to prolong a conversation? Who would have thought that he would still be able to process and answer simple questions but no longer be able to create his own?

As he neared the end of his life, I was not surprised to find that I missed those moments every time we concluded one of our simple conversations and he sat quietly, watching me walk away. 

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The following is feedback received for this blog: Sorry for your family's loss. - rlbates http://rlbatesmd.blogspot.com/ Your blog just beautifully summarized what my family is experiencing with my father-in-law. Thank you for putting it into words. - Nora Sale Nicely done, Dr. Campbell. I wonder how many times this pattern has been replicated? That which was so annoying becomes that which we miss... - richard holloway Dr. Campbell- isn't it interesting that the things that often irk us most about family are the things we miss the most when they are gone! Sorry for your loss. - karen rudzinski What a beautiful tribute to your father-in-law! Your honesty allows us to identify with our own situations and recognize how we might strive to make the best of our relationships. Thanks for being so open, and so caring. My best to your family. - Susan L

If you have to ask what jazz is, you will never know.
- Louis Armstrong


The stillness in the meeting room was electric.    

First, one panelist addressed the audience members who have never experienced a malignancy. She described the unique and powerful bond that exists between cancer survivors. She described how the brush with mortality forces each survivor to renegotiate terms with Life itself. She reminded everyone that the cancer care system too often lets down both cancer patients and survivors.    

Then she addressed the cancer survivors.  “As a fellow survivor, even if you and I have never met before, I would bet that we would find common ground within fifteen seconds.” Other survivors in the room agreed with her immediately.    

This was not a typical cancer conference. The Cancer Survivorship Forum was part of the recent Wisconsin Comprehensive Cancer Control Summit. An eye-opening presentation on the value of physical activity for cancer patients and survivors was followed by a panel of articulate survivors and their significant others (co-survivors) reflecting on which policy initiatives will have the biggest impact on future cancer patients. Everyone in the audience was engaged from start to finish.    

What did the survivors want? Patients and survivors expect appropriate, user-friendly, and balanced information about their treatment. They expect compassion from every person with whom they have contact. They demand quality, timely care that does not leave them financially devastated. They deserve a network of support for themselves and their families. They expect more resources that work and fewer things that do not.    

The survivors were not shy about describing their experiences or how they felt about the care that they had received. With each comment from the panel or from a survivor in the audience, there was applause. Survivors craned their necks to see who was speaking and later made contact.    

At most scientific meetings, I sit in rooms full of fellow clinicians, hear about the latest research, and jot down ideas for new projects. The following year, I realize that I never quite got around to initiating many of the project ideas I had explored. Oh, well, I think. Maybe next year. I shrug my shoulders and make excuses. Cancer will still be there.    

At the Survivorship Forum, though, surrounded on all sides by people who have experienced cancer treatment, it is much harder to pass off our lack of progress. In the stillness of the conference room, the survivors listen intently to the presenters who articulately speak for them. They look at the clinicians and researchers expectantly. It is clear that cancer survivors can hold our feet to the fire in ways that petri dishes of cancer cells cannot. If we fail to act, the survivors will be at the next meeting. They are the real people to whom we will answer.

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The following is feedback received for this blog: I've been reading your blog for a few years now and just caught up with your survivors' expectations post. I have to say that Froedtert more than met those expectations for us. If I can sit here four years later and still think of the experience as positive, well, you must be doing something right over there. My husband is just completing 7 months of apparently successful obliteration of a gastric adenocarcinoma that was incidentally discovered during treatment planning for an acoustic neuroma. Our initial all-consuming terror at this diagnosis crumbled by infitesimal degrees over time, and has been replaced by a genuine sense of hope not only for a future, but for one that provides an acceptable quality of life. Despite having worked at Froedtert & Medical College of WI with lung and esophageal cancer patients for 22 years, I was and continue to be stunned by the array of caregivers that immediately entered our lives to support us both during this journey. Your statement that cancer survivors (and co-survivors) in the audience bonded within 15 seconds of realizing each other's shared stigma is profoundly correct. While I always felt that I had a gift for my role as our patients' first phone contact for a thoracic surgeon - helping our patients face what they must - my ears are now intimately more attuned to the subtleties of each individual's needs as expressed "between the lines" of their communications. I feel more confident than ever that what we are offering people here goes far beyond the physiologic aspects of cancer care. We are presenting them with a community of teachers that provide the skills to go on.

All change is not growth; as all movement is not forward.
- Ellen Glasgow  


Pity the poor Public Health research scientists! They just do not get any respect. An essay in the New England Journal of Medicine points to four reasons why Public Health research is rarely celebrated with outpourings of enthusiasm:

Reason #1: The benefits of Public Health tend to lie far in the future. We need to invest resources now in order for our children to reap the rewards later. Not a popular concept these days.

Reason #2: The names and faces of the people who will benefit are not known. The entire population might be healthier, but there is no way to know who, exactly, will remain healthy.

Reason #3: The people behind the initiatives are often unknown. Since the benefits are widespread and diffuse, there are only a few well-known heroes like Jonas Salk or John Snow.

Reason #4: People often resist altering the status quo. We do not like change even when it might be to our benefit.  

Solid science often runs headlong into strongly held beliefs. This conflict came to mind recently as the Wisconsin legislature passed a bill to legalize direct-to-consumer sales of raw, unpasteurized milk.

The backers of the legislation hope to return raw milk to the societal acceptance it had in the 1920s, claiming that raw milk tastes better, is more natural, and has health benefits. Raw milk supporters also believe that pasteurized milk is less healthy than raw milk and might cause "everything from allergies to heart disease to cancer, but when Americans could buy Real Milk, these diseases were rare." Unfortunately for this particular argument, the leading causes of death in 1920 did include heart disease and cancer, as well as influenza/pneumonia, tuberculosis, stroke, kidney disease, accidents, diarrhea/enteritis, premature birth, and childbirth related conditions. The diarrheal diseases and infant deaths associated with contaminated raw milk consumption led to the pasteurization of all milk sold commercially in the United States.

So, what is the Public Health perspective? The CDC reports that raw milk can be contaminated with pathogenic bacteria including Brucella, Campylobacter, Listeria, Mycobacterium bovis, Salmonella, Shiga toxin-producing E. coli, Shigella, Streptococcus pyogenes, and Yersinia enterocolitica. At least 45 known outbreaks were reported to the CDC which resulted in over 1,000 illnesses and at least two deaths over a recent seven year period.

We all take risks every day. None of us is obligated to minimize our own personal exposure to things that might kill us. There are those who are well aware of the risks and still continue to smoke, sleep in the same bed with their infants, refuse to use seatbelts, drink and drive, decline vaccinations, forego exercise, abuse drugs, and eat poor quality diets.

I suspect, though, that the underappreciated Public Health scientists will continue to plug away, hoping to find ways of breaking through our resistance to living better, longer — and safer — lives. 

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Hemenway D, New Engl J Med 2010 (May 6); 362:1657-1658.

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The following is feedback received for this blog: Interesting observation you have concerning raw milk. There are a lot of factors that I believe you may have overlooked to reach the conclusions you made. Raw milk advocates have research on their side as well, it is just being ignored. If you would take the time to research it a bit more thoroughly, I believe you would come to a much different conclusion than your current one. - Karoline Rehm Karoline - Can you share references to the research you mentioned? - Ron Stubbers