She completed her last chemotherapy treatment in November 2002. She had no major complications, but has neuropathy in her hands and feet. "My hair is back and so is my weight, unfortunately," she said.
Today, Dr. Febo-San Miguel practices family medicine two half-days a week at Maria de los Santos Health Center in Philadelphia. She spends the rest of her time as executive director of Taller Puertorriqueno Inc., a Philadelphia-based cultural and educational center on Puerto Rican and Latino heritage.
"I maintain the same attitude with myself that I maintain with patients," Dr. Febo-San Miguel said. "My approach is that I want people to know the reality, the extent of the problems that they're dealing with, but always maintain an optimistic view of the situation because the inner strength that people have can overcome incredible obstacles."
In February of 2000, William Tierney, M.D., was 25 days into his new job as director of the division of general internal medicine and geriatrics at Indiana University, Indianapolis, when he was diagnosed with stage IIIA non-Hodgkin's lymphoma. Oncologists estimated that his chance of survival was 50-50.
"I was fortunate enough to respond to the chemotherapy, but only about half of the people do," he said.
The most frustrating part of the experience, he said, was the chemotherapy-associated cognitive dysfunction he experienced over six courses of treatment. "I work in a world where I spend half of my life on e-mail," he said. "I'm managing about 16 problems simultaneously by jumping from one to another. When I was getting chemotherapy, each [jump] took an extraordinary amount of time and energy to make sense to me. I felt like I used to feel after being up all night on call."
That reaction lasted for a year after his final chemotherapy treatment. Physical side effects include residual peripheral and autonomic neuropathy from the vincristine. "I can't feel my toes," he said, "and I have trouble walking in the dark because I don't have proprioception."
He missed only a few days of work during chemotherapy, but he said he wishes someone had given him two pearls of advice when he received his diagnosis:
"First, find a health care provider you trust and do everything that person tells you," said Dr. Tierney, who is also coeditor of the Journal of General Internal Medicine. "Don't second-guess them. Don't be noncompliant. Do what you're told."
Second, admit that you have an illness. "I tried not to alter my schedule," Dr. Tierney explained. "I tried to do all the things I normally did until I dropped from exhaustion."
When recovering from chemotherapy, "expect to be at half-speed for the duration. If you get chemotherapy for 6 months, it's going to take you 6 months to recover."
He recommends making a list of all the important things you do in a routine workweek and sorting them by priority. Write down the number of hours required for each item. Once you reach 50% of the hours in your workweek, "draw a line across the page and don't do anything below that line," advised Dr. Tierney, whose cancer is in remission. "Tell people that you're not going to be able to do [those things] for a year. It's a matter of managing expectations. Be realistic about it."
On his office desk, Dr. Tierney keeps a photograph that was taken when he had no hair on his head, a short-term side effect of chemotherapy.
At that timewell aware that he might not live another year"my priorities were much more family-focused and personally focused," he said. The more the likelihood of death recedes into the distance, "the more you start making compromises. I keep the picture on my desk to remind myself of the things that were important back then. I can't say I do a very good job of that, but I try."
By Doug Brunk, San Diego Bureau
Books on How to Cope With Illness
The following material may help physicians who are facing a serious medical illness:
▸ "Blindsided: Lifting a Life Above Illness: A Reluctant Memoir," by Richard Cohen (New York: HarperCollins, 2004).
▸ "Writing Out the Storm: Reading and Writing Your Way Through Serious Illness or Injury," by Barbara Abercrombie (New York: St. Martin's Press, 2002).
▸ "When the Physician-Researcher Gets Cancer: Understanding Cancer, Its Treatment, and Quality of Life From the Patient's Perspective," by William M. Tierney, M.D., and Elizabeth D. McKinley, M.D. (Medical Care 2002;40[suppl. 6]:III20-27).
▸ "Coping With Long-Term Illness," by Barbara Baker (London: Sheldon Press, 2001).