Podcasts about mikkael

Full HP 1.675 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

Full HP 1.674 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

Full HP 1.673 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

Full HP 1.672 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

Full HP 1.671 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

Full HP 1.670 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

Full HP 1.669 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

Full HP 1.668 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

Full HP 1.667 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

Full HP 1.666 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

Full HP 1.665 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

Full HP 1.664 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

Full HP 1.663 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

Full HP 1.662 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

Full HP 1.661 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

Full HP 1.660 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

Full HP 1.659 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

Full HP 1.658 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

Listen now to the latest episode of JCO Cancer Stories: The Art of Oncology, North Star, by Dr Manuela Spadea. As a pediatric oncologist, Spadea shares a luminous, gut-honest reflection that reminds us that beyond protocols and outcomes, the deepest medicine is presence. TRANSCRIPT Narrator: North Star, by Manuela Spadea, MD  Mikkael Sekeres: Welcome back to JCO's Cancer Stories: The Art of Oncology. This ASCO podcast features intimate narratives and perspectives from authors exploring their experiences in oncology. I am your host, Mikkael Sekeres. I am professor of medicine and Chief of the Division of Hematology at the Sylvester Comprehensive Cancer Center, University of Miami. What a pleasure it is to have joining us today Manuela Spadea, an assistant professor of pediatrics at the University of Turin in Italy and consultant oncologist at the Regina Margherita Children's Hospital in Turin, Italy. We will discuss her Journal of Clinical Oncology article and second place winner in our Narrative Medicine Contest, "North Star." At the time of this recording, our guest has no disclosures. We have agreed to address each other by first names. Manuela, thank you for contributing to the Journal of Clinical Oncology and to our Narrative Medicine Contest, and especially for joining us to discuss your winning article today. Manuela Spadea: Hi Mikkael. Thank you for having me today. It is a pleasure and an honor being invited to speak with you. Mikkael Sekeres: No, the pleasure and honor is mine, I promise. You know, on these podcasts, I often like to ask our guests to tell us something about yourself. Where are you from, and walk us through your career and where you are right now. Manuela Spadea: Sure. I am from Italy. I work in Turin, where I work as a consultant pediatrician, a consultant oncologist, and also as an assistant professor of pediatrics. So my work is divided in these two duties: clinical duties on one hand and on the other hand, research and also teaching activities. I was drawn to choose pediatric oncology because this sits at the intersection of science and humanity, in my opinion, of course. I think that in pediatric oncology, we face different and several challenges, so we need to perform at our best in diagnosis, treatment, and whatever. But also, we are asked to not forget being human and to connect always with our children and their families. So it was basically this intersection, this connection between science, research on one hand, and humanity and heart on the other hand that led me to what I am today. Mikkael Sekeres: It is a fantastic explanation, and it is interesting how you have framed that, that there is an aspect of arts and humanities that you have found in focusing on pediatric hematology oncology. I do think that is more so than what we face in adult oncology. Manuela Spadea: I think that it is kind of different because if you think about our world and you think about a sentence, just putting the words 'child', 'cancer', and 'death' in the same sentence is very hard to think about. An adult is someone that has already had the chance and the gift to grow up. Mikkael Sekeres: Huh. It is an interesting perspective on it. Manuela Spadea: Yeah. A child is someone who is growing up and cancer stays in between his possibility to become an adult or not. Mikkael Sekeres: So the emotional burden right out of the gate of having a child with cancer and the possibility of death and the reaction to the compromise of a full life and the shortening of a full life automatically invokes that extra step of humanity and arts and how we have to approach a medical situation. I had not heard somebody put that into a concise phrase like that before, but you are absolutely right. When did you start writing narrative pieces? Manuela Spadea: I started writing when I was an adolescent, basically. And writing for me was a way to cope with whatever kind of feeling I felt during my life and during what I experienced as a human beforehand. But thereafter, when I became a clinician, writing was a way to cope with difficult shifts or hard nights in which you are asked to make very hard decisions as a clinician. Mikkael Sekeres: Often, either on this podcast or outside of it, doctors will approach me and want to get into writing and write a piece. And I think what many people do not realize is it is entirely possible later in life to start writing and to be very skilled at it. Many of our authors for JCO's Art of Oncology, though, have been writing their entire lives. It is not like they woke up one morning and decided, "Today I am going to write and I am going to write creatively." We have all been working on it for decades. Manuela Spadea: Sure. Mikkael Sekeres: I wonder who are some of your favorite authors or are there writers who have influenced your own writing? Manuela Spadea: I would go with Paulo Coelho and Alda Merini. The reasons are very different because from Paulo Coelho, I learned how to express life as a journey and how to use and exploit, of course, symbolic images to express what we want to tell to our readers. From Alda Merini, I learned that pain and suffering are worthy of being mentioned and they still deserve a place in our writings. And she taught me how to collocate, how to find the right place and the right words to express pain and suffering that are parts of our life, of course, in pediatric oncology, of course, and are worthy being expressed in a manner that can reach our readers and touch them. Mikkael Sekeres: Well, as you have beautifully in your essay, I wonder if you could give us an example of a symbolic image. Manuela Spadea: For example, referring to my essay, "North Star." I chose the North Star because it is a very important image because it recalls to us about being a fixed point in a collapsing world. Basically, it is the world of our children that is collapsing and you are the one who represents this fixed point, this anchor. Mikkael Sekeres: So in your essay, which our entire editorial staff just loved, you write about, and I am going to quote you to you, which is always a little bit awkward, but here I go. You write about "the unbearable beautiful vulnerability of being a North Star for a child with cancer." And you write, "We never call it that, of course, not in rounds, not in protocols, but that is what we become: a fixed point in a collapsing sky. When nothing else makes sense, when numbers fail and outcomes blur, they look to us, not because we promise survival, but because we promise we won't leave." Wow. I mean, that is an incredible collection of sentences. I wonder, in our relationships with our patients, when does that happen? When do we become a North Star? Manuela Spadea: I think that we become a North Star when our patients experience our humanity because they can trust us, not only for our degrees or our experience as clinicians, physicians, researcher, whatsoever. They trust us as a North Star when they feel that we are empathetic with them, when they know that we are feeling what they are experiencing. And so they leave their feelings to us, they share their feelings and they begin to connect with us. Mikkael Sekeres: When does that happen in the timeline of when we meet a patient? Is that something that can happen at our very first meeting where a patient may identify us or a member of our team as their North Star, or is that something that only happens over time as we build trust and build empathy? Manuela Spadea: It is definitely something that happens over time, day by day. Sometimes, but only occasionally, in my opinion, it can happen on the very first days, for example, the days in which we give them the diagnosis. But these are only small occasions because in the majority of cases, in my experience, the trust is built day by day. Mikkael Sekeres: There are also times that doesn't happen, though, right? What are those scenarios like when either patients do not need us to be a North Star or when that deep connection never happens? Manuela Spadea: I think that these are very challenging situations. It can happen when outcomes blur, of course, because sometimes patients are experiencing too much suffering and they cannot share with us because they are not able of sharing with us their feelings. Sometimes it is just because you are not their North Star. Sometimes it is inexplicable, basically. "I do not trust you, not because you are not what I am looking for, but because I do not feel I can trust you. And I do not know how to explain because I cannot trust you." Mikkael Sekeres: It is interesting. It is complicated to develop that relationship where you become a North Star. It sounds like what you are saying is it is a combination of trust, first and foremost, honesty, attentiveness to a patient's needs, and time. Manuela Spadea:Sure. Mikkael Sekeres: In your piece, you write about a couple of patients you have treated, Eva and Cecilia, and you write, "In both Eva's and Cecilia's journeys, I was not the most experienced doctor in the hospital. I wasn't the one who had written the protocol they were enrolled in or published the paper that dramatically shifted their chances. But I was the one who stayed, the one they chose. Incredibly, this is both a gift and a responsibility." There is a lot in those sentences, Manuela. You give patients the agency to identify us as a North Star, not us. Can you talk about that a little bit? Manuela Spadea: I think that there is a word in pediatric oncology that could be used as recurrent. And this word is 'impossible'. Why I chose this word? Because we live impossible diagnosis. Let's be honest. Impossible diagnosis, impossible suffering, impossible losses. When you face the impossible, being a North Star without being burned out by this, it is accepting that you are going to face uncertainty just being present. Because you are not the one that will change the outcome, or you can't be sure that that child will have the chance to survive. So if you give the possibility to face the uncertainty, being sure that whenever it goes, you can just be present for your patient and remember every day to your patient that you are there for them. So basically you win. And on the other hand, you also need to protect yourself because being a North Star is a responsibility, as I wrote. And a responsibility can be overwhelming for the one who is responsible for that child. So in that case, the only thing that can protect you is taking the part of being a North Star with boundaries. So you should also try to maintain your objectivity as a clinician and protect that objectivity that allows you to also serve as a good clinician. Mikkael Sekeres: So I wonder if I could follow up on that a little bit. It is a lot of work to be a North Star, isn't it? I mean, we have to choose our words and our actions so very carefully when we are in a room with a patient and that patient's family. Do you think serving as a North Star contributes to burnout or is it actually the opposite? It keeps our work vibrant and real? Manuela Spadea: Good question. I think that it is both, indeed. I think that burning out comes not by being a North Star, but by being a North Star in isolation, without caring about yourself, without finding a way to cope with your grief, with your sense of fear because we are human, so it is basically we experience these feelings. I mean, if we do not have a way to cope and to protect our feelings, we can absolutely go into burnout. On the other hand, it can be very important thing for our work because it can give our work the possibility to be vibrant and real because we are allowed to take the journey of our patient in a moment in which their journey is very unbearable. This is also not only a responsibility, but also a very important place that we have in their lives. This is very beautiful for me. This is astonishing because we are allowed to enter our patients' lives in a very difficult moment, and we can walk with them. Basically, being present and walking through what cancer journeys reserve for them. Mikkael Sekeres: Well, I think that is a lovely place to end our podcast. What a real pleasure it has been to have Manuela Spadea, who is an assistant professor of pediatrics at the University of Turin, Italy, and consultant oncologist at the Regina Margherita Children's Hospital in Turin, Italy, to discuss her essay, "North Star." Manuela, thank you so much for submitting your article both to JCO and to our contest, and for joining us today. Manuela Spadea: Thank you, Mikkael. It has been an honor to share these stories with you. Mikkael Sekeres: If you have enjoyed this episode, consider sharing it with a friend or colleague or leave us a review. Your feedback and support helps us continue to have these important conversations. If you are looking for more episodes and context, follow our show on Apple, Spotify, or wherever you listen, and explore more from ASCO at asco.org/podcasts. Until next time, this has been Mikkael Sekeres for JCO Cancer Stories: The Art of Oncology. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Show Notes:Like, share and subscribe so you never miss an episode and leave a rating or review. Guest Bio: Dr Manuela Spadea is an Assistant Professor of Pediatrics at the University of Turin, Italy, and Consultant Oncologist at the Regina Margherita Children's Hospital, in Turin, Italy.

Full HP 1.657 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

Full HP 1.656 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

Full HP 1.655 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

Full HP 1.654 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

Full HP 1.653 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

Full HP 1.652 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

Full HP 1.651 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

Full HP 1.650 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

Full HP 1.649 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

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Full HP 1.632 - Noticias de videojuegos de lunes a jueves. Si acabas de llegar dale al follow y la campanita. ------------------ Patreon -------------------------------------- ¡Apóyanos en nuestro Patreon! https://www.patreon.com/FULLHP ---- Kickstarter de Bestiario, el juego del amo ---- ¡Dale a las notificaciones! https://www.kickstarter.com/projects/robwiggin/bestiario-a-fast-paced-tactical-rpg/ ------------------ Patrocinadores --------------------------- ¡Utiliza nuestro link de referidos en Amazon! https://amzn.to/2nOHboW --------------Nuestras redes ------------------------- Mikkael: https://x.com/ggMikkael FullHP: https://x.com/estoesfullhp

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Listen to JCO's Art of Oncology article, "Final Silence" by Dr. Ju Won Kim, who is an Assistant Professor at Korea University College of Medicine, Medical Oncology. The article is followed by an interview with Kim and host Dr. Mikkael Sekeres. Dr Kim explores the burden of silence when caring for dying patients. TRANSCRIPT Narrator: Final Silence, by Ju Won Kim  Dr. Mikkael Sekeres: Welcome back to JCO's Cancer Stories: The Art of Oncology. This ASCO podcast features intimate narratives and perspectives from authors exploring their experiences in oncology. I'm your host, Mikkael Sekeres. I am a Professor of Medicine and Chief of the Division of Hematology at the Sylvester Comprehensive Cancer Center, University of Miami. We are so thrilled to have joining us today, Dr. Ju Won Kim. She is Assistant Professor at Korea University College of Medicine, and she is here to discuss her Journal of Clinical Oncology article, "Final Silence." Ju Won, thank you for contributing to the Journal of Clinical Oncology and for joining us today to discuss your article. Dr. Ju Won Kim: Hello, Mikkael. It's really nice to be here. Thanks so much for inviting me. Dr. Mikkael Sekeres: It's so nice to have you here today also. Thank you for also taking time so late in the evening because our time difference is so huge. Dr. Ju Won Kim: Yeah, it's not that late. It's 9 o'clock in Seoul. 9:00 PM. Dr. Mikkael Sekeres: I wonder if I could start by asking you if you can tell us about yourself. Could you walk us through your career so far? Dr. Ju Won Kim: Yes. I am Ju Won Kim from Korea University in Seoul. I was born and also raised here and never really left from Seoul. I did my residency in internal medicine and fellowship in oncology at the same hospital, and now I'm an assistant professor there. So you could say I've spent my whole life on the same campus, just moving from one side of the hallway to another. Dr. Mikkael Sekeres: That's a beautiful way of describing it. Is that common in Korea for somebody to remain at the same institution for training and then to continue through your career? Dr. Ju Won Kim: It used to be common about a decade ago, but nowadays it is not that common. Most of my colleagues are from another campus or another hospital. Dr. Mikkael Sekeres: Well, I'm so curious, what is a typical week like for you? How many days do you spend seeing patients and how much time do you spend doing research or writing or have other responsibilities? Dr. Ju Won Kim: Usually, I spend four times for my outpatient clinic, but in Korea, there are so many cancer patients and so little number of medical oncologists. I usually treat so many patients in one clinic, like maybe 20 to 30 in one time. Dr. Mikkael Sekeres: Wow. Dr. Ju Won Kim: Yeah, that's a burden. Most of the time I spend treating my patients, and rest of them I use to spend for my research with my lab students, and maybe with my colleagues, and I have to write something like documents or some kind of medical articles. That is about 10 or 20% of my working time, I think. Dr. Mikkael Sekeres: Okay, okay. That makes sense. So, and do you specialize within oncology, or do you see any person who has cancer? Dr. Ju Won Kim: I'm a medical oncologist, and I used to treat breast cancer or biliary pancreatic cancer or some kind of liver cancer or rare cancer, maybe, also. Dr. Mikkael Sekeres: Okay, okay. It's such a long trip. Are you able to make it to the ASCO Annual Meeting in Chicago? Dr. Ju Won Kim: Actually, I've been Chicago for ASCO meeting just one time in this year. Actually, I gave birth to my son in March, and I was in the long vacation for my birth, and the last part of my birth vacation, I went to Chicago to participate in ASCO. It was a really good time. Dr. Mikkael Sekeres: Oh, fantastic. That's great. How about your own story as a writer? How long have you been writing narrative pieces and when did you start? Dr. Ju Won Kim: Actually, I've always thought of myself more as a reader than a writer. Reading was my comfort zone from childhood. Then I started a small book club with friends about 10 years ago, and we began writing short reflections after each meeting. That's how writing slowly became part of my routine. When reading feels heavy, I write. When writing feels tiring, I read. It's a rhythm that keeps me balanced. At first, it was only academic writing like medical articles, but a few years ago, I challenged myself to post one short reflection a month on my Instagram, usually a quote from a book and a few sentences on why it mattered to me. It was my life about writing. Dr. Mikkael Sekeres: That is really remarkable. So, did you take any formal writing classes at university? Dr. Ju Won Kim: Not really. It was just a hobby of my own. Dr. Mikkael Sekeres: It always impresses me when people come into writing organically like this, where they just discover it and start and don't have formal teaching because your writing is very, very good. Dr. Ju Won Kim: Oh, thank you. Dr. Mikkael Sekeres: And how do you find the time to read and write when you have a busy career, academic career, and you have a child? Dr. Ju Won Kim: It was my old routine that I used to read it before going to bed, from my bedside with a small light, I used to read some novels and get to sleep easily. But after I started to work as a medical oncologist, it was a very busy job as you know. I used to sleep more and not have time for reading. I try to read more when I get some free time. Dr. Mikkael Sekeres: I love how you talk about alternating reading and writing and how when one gets too heavy, you go to the other, and then you switch back. One of the most common pieces of advice I've heard from writers is to read more. Dr. Ju Won Kim: Yeah. Dr. Mikkael Sekeres: You can see how other people put thoughts together and the cadence of their writing, and also it inspires your mind to develop new ideas for writing. Dr. Ju Won Kim: Actually, the new idea also comes from the book, I think, when I came into a new book and the idea bangs up with me, so I started to write and that's an easy way to have some idea about writing. Dr. Mikkael Sekeres: I'm always impressed by people who are facile with languages and bilingual or trilingual. I think I'm unfortunately a hopeless monoglot. Dr. Ju Won Kim: Maybe you can try Korean. Dr. Mikkael Sekeres: I'd be embarrassed to even attempt it. When you read, do you read in Korean or do you read in English or other languages? Dr. Ju Won Kim: Definitely in Korean. Dr. Mikkael Sekeres: Okay, okay. And when do you find the space to write? Do you need to be alone at home in a special room or at a special desk, or do you write at work, or do you just find any time to write? Dr. Ju Won Kim: I usually don't have much time on my own because I have my baby now and some family gathers frequently. So, I always write every free time I'm trying to, any short free time in my work maybe. Dr. Mikkael Sekeres: If you feel comfortable doing so - this is a very heavy piece, and a lot of us have dealt with deaths of our own patients, of course, we see this unfortunately commonly in oncology, but many of us, myself included, have also dealt with patients or their family members who've committed suicide - can you tell us what prompted you to write this piece? Dr. Ju Won Kim: As an oncologist treating biliary and pancreatic cancers, I've witnessed many deaths, as you know. Most fade with time because I treat so many patients, but just one family stayed with me, I think. It was early in my career, just months after I started this specialty, and even 5 years later, I still think about them, the family I wrote about in the "Final Silence." The story eventually became the piece I wrote. Dr. Mikkael Sekeres: And what is it about them that caused you to think about them so much even years later? Dr. Ju Won Kim: I'm not sure. That's the only experience I came into someone's suicide so closely in my life, I think, and also it happened in my very early career. That's the impact. Dr. Mikkael Sekeres: It is amazing how certain patients stick with us even years or decades later, particularly when they're tied to an emotional response to illness, and that can be our patients' emotional response or our own. Can you talk some about Korean culture and how cancer is viewed? Is it discussed openly? Dr. Ju Won Kim: In Korea, death is still a quiet topic. Cancer equals death in many people's minds, and death equals grief. Even today, some families ask doctors not to tell their patients about the diagnosis, but Korea is aging so fast, so I see more older patients now, but culturally, we are still learning how to talk about dying openly. That's the big problem as a medical oncologist, especially treating biliary and pancreatic cancers. Dr. Mikkael Sekeres: I can just imagine. When you first meet a patient and their family is in the room, do you tell them that they have cancer, or do you need to check in with the family and with the patient how much they know about their diagnosis first? Dr. Ju Won Kim: Actually, I usually try to tell them there is a cancer, which can never be treated perfectly, because I used to treat patients with stage four, which is incurable, but I'm not sure is it okay to tell them that your life is about 3 months or 6 months or 1 year. It is not that okay for the Korean patients, especially the first time when they meet me in the clinic. I try to tell them about the truth just a few times later. Dr. Mikkael Sekeres: I think that's common. I think we do that in the United States also. We may not mention a number to patients during that very first meeting because when you're talking to somebody and once you mention that number, often people will shut down. They won't hear anything else that you say. And you need to build up a relationship and some trust with somebody and also get the sense how much they want to know about their cancer and their prognosis before entering that conversation. I've certainly had instances when I'm in a room with a patient, and that patient's spouse or children, and someone else in the room will say, "How long does Dad have to live?" And I've turned to my patient, "Dad", and said, "Is this a number that you want to know?" And the patient has said, "No, I don't." Dr. Ju Won Kim: Yeah, that happens. Dr. Mikkael Sekeres: So sometimes we have to be careful and check in and remind ourselves in the high emotions around a cancer diagnosis that our first responsibility is always to our patient and what they want to know about their diagnosis and their prognosis. Dr. Ju Won Kim: Do you have any opposite cases where patients really want to know the numbers? Dr. Mikkael Sekeres: Yeah, I do. And, you know, you can almost predict who that's going to be depending on what they did during their lives. Dr. Ju Won Kim: Yes. Dr. Mikkael Sekeres: So I have patients who are engineers or who have a math-based career like they're accountants and they'll come in and they write every number down and they want to know the number about their prognosis. I have other patients who are English professors and they want descriptively to know what the prognosis is but maybe don't want a number. So... Dr. Ju Won Kim: I think most Koreans want the number, the specific number. Yeah. Dr. Mikkael Sekeres: I'm curious, is cancer in a father or a son dealt with differently than cancer in a mother or a daughter? Dr. Ju Won Kim: I don't think there's much difference between sons and daughters, or maybe moms and dad, because every child is very precious in Korea now, but between husband and wives, I think the dynamic stands out. People often say when a husband gets cancer, the wife becomes his main caregiver, but when the wife gets cancer, sometimes the husband disappears. I've heard that from my colleagues, though not often in my own clinic. Now, what I do see is many middle-aged women who have been diagnosed with breast cancer, women coming to treatment alone, strong and very independent. Dr. Mikkael Sekeres: Interesting. So I was going to follow up by asking if you've seen that in your own clinic. Have you seen- is it more likely that your female patients who have a cancer diagnosis come to clinic alone but the male patients come with their spouse and with family support? Dr. Ju Won Kim: Yeah, it is not just because of their sex, but most of the breast cancer patients who are female are in good condition, but biliary pancreatic cancer male patients have very poor condition, so... Dr. Mikkael Sekeres: Ah... Dr. Ju Won Kim: Maybe, I think that's the problem. Dr. Mikkael Sekeres: Interesting. The part of your essay in which you describe the attempted suicide of your patient's daughter is absolutely chilling. How did that affect you? Have you ever had a patient attempt suicide before? Dr. Ju Won Kim: Yes, the event I wrote in my essay was extremely shocking for me, but it's the only experience I have. It wasn't my patient, but I've heard a few cases where someone in the hospital tried to take their own life. I haven't had that happen directly, but I've seen patients fall into deep depression or break down in tears. In those moments, I always suggest psychiatry nowadays. That used to be taboo in here, but the stigma is fading, and many patients actually feel better afterwards. I also check in with close family members because their mental state affects the patients, too. It's something I hope never to experience again. Dr. Mikkael Sekeres: It's so unsettling when that happens, and as I mentioned, I've had a patient who took his own life, and you go back and back and back to it to wonder if there's something you could have done to intervene quicker or to get that psychosocial support in place to help that patient so that you avoid it in the future. And, you know, you protect your patients and yourself. Dr. Ju Won Kim: Yeah, I try to. Dr. Mikkael Sekeres: Speaking of protecting, you write, and I'm going to quote you to you, "I told myself I was protecting her, that to burden her in her final hours with such unthinkable news would be cruel. But a deeper truth is that I was protecting myself. I didn't know how to say it. I didn't know how to bear the weight of her devastation on top of my own shock and helplessness, so I avoided it." Do we owe it to ourselves sometimes to protect ourselves from the pain we sometimes impart to our patients? Dr. Ju Won Kim: That reflection came from realizing how doctors sometimes say we are protecting patients from pain, but really, we are protecting ourselves, I think. It's human. We can't hold every piece of suffering we see. Setting emotional boundaries isn't weakness. It's survival. What matters is recognizing when it's self-protection and being honest about it later. Dr. Mikkael Sekeres: Well, I think something that really helps with that is being able to talk to our colleagues about times when this happens and recognize we're in a shared experience and that we have the support of our colleagues, and they recognize how hard it is to be the bearer of bad news to other people and to bring pain to them sometimes. Dr. Ju Won Kim: That really works. Dr. Mikkael Sekeres: Dr. Ju Won Kim, it has been such a pleasure having you on this show. Dr. Kim has written just a fabulous essay called "Final Silence" for JCO Art of Oncology. Thank you so much for sharing your article with us and for joining us today. Dr. Ju Won Kim: Yeah, thank you so much for the conversation. It was a pleasure talking with you. Dr. Mikkael Sekeres: If you've enjoyed this episode, consider sharing it with a friend or a colleague or leave us a review. Your feedback and support helps us continue to have these important conversations. If you're looking for more episodes and context, follow our show on Apple, Spotify, or wherever you listen and explore more from ASCO at asco.org/podcasts. Until next time, this has been Mikkael Sekeres for Cancer Stories. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Show Notes: Like, share and subscribe so you never miss an episode and leave a rating or review. Guest Bio:Dr Ju Won Kim is an Assistant Professor at Korea University College of Medicine, Medical Oncology.