Podcasts about mikkael

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.

Full HP 1.627 - 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 1.626 - 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 1.625 - 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 1.624 - 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 1.623 - 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 1.622 - 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 1.621 - 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 1.620 - 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 1.619 - 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 1.618 - 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 to JCO's Art of Oncology article, "Smell," by Dr. Alice Cusick, who is a Hematology Section Chief at Veterans Affairs Ann Arbor Health System and Assistant Professor at the University of Michigan Division of Hematology and Oncology. The article is followed by an interview with Cusick and host Dr. Mikkael Sekeres. Dr Cusick shares a connection to a cancer patient manifested as a scent. TRANSCRIPT Narrator: Smell, by Alice Cusick, MD  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'm Professor of Medicine and Chief of the Division of Hematology at the Sylvester Comprehensive Cancer Center, University of Miami. Joining us today is Alice Cusick, Hematology Section Chief at the Veterans Affairs Ann Arbor Healthcare System and Assistant Professor at the University of Michigan, Division of Hematology and Oncology, to discuss her Journal of Clinical Oncology article, "Smell." Alice, thank you for contributing to Journal of Clinical Oncology and for joining us to discuss your article. Dr. Alice Cusick: Thank you so much for having me, Mikkael. I appreciate it. Dr. Mikkael Sekeres: It's really a pleasure, and as usual, Alice and I discussed this beforehand and agreed to call each other by first names. I always love to hear your story first. Can you tell us about yourself? Where are you from, and walk us through your career, if you could. Dr. Alice Cusick: I'm a Midwesterner. I grew up in Iowa and Illinois and went to a small college in Illinois, played basketball, Division lll, and was an English Literature major. I took one science class and was going to be an English professor. And then my father's a physician. My senior year, I realized I don't think I could spend all my time in a library. I didn't feel like I was helping anyone. And so I talked to my dad, and he said, "Yeah, I think you could be a doctor." So I thought I would help people by being a physician. So I moved to Iowa City and spent two years working in a lab and doing science classes and took the MCAT, which was the first year they had the essay on there, and I rocked that. That was my highest score. I got into the University of Iowa and then went on to residency and fellowship at the University of Wisconsin, just in hematology. I didn't do solid tumors. And then went on, spent a couple years there, worked in Pennsylvania in more of a group practice, and then came back to academics at the University of Michigan about 10 years ago. And then five years ago, I became the Hematology Section Chief at the VA in Ann Arbor. So I work there full time now. Dr. Mikkael Sekeres: I love that story. I served on the admissions committee at Cleveland Clinic and Case Western when I was also a Midwesterner for 18 years. And I always wondered if instead of searching for science majors, we should be searching for English majors because I think there's a core element of medicine that is actually storytelling. Dr. Alice Cusick: Oh, very much so. My father was a country doctor for many, many years in rural Iowa in the fifties and sixties. So he did house calls, and he talked about how you really got to know people by going to their house. And I'll never forget the first time that I did a full history and physical, I think I was maybe a second-year medical student, and I was telling him, "Oh, I'm so excited. I'm going to do my first history and physical." And he said, "Alice, don't talk to them about medicine right away or about their problems right away. Talk to them about something else. Get to know them because you know about sports, talk about sports." I said, "Dad, that's called establishing rapport." You know, that's what they had taught us. But it was intuitive to him. I'll never forget that he just said their story is important and how they live and where they live and who they live with is so important. It really helps you figure out their medical issues as well. And I've always tried to carry that through. Dr. Mikkael Sekeres: It's funny what we glean from our parents. My dad was a journalist for the Providence Journal-Bulletin. He was a reporter for a couple of decades, and I almost feel like some of what I'm doing is acting as a reporter. It's my job to get the story and get the story right and solicit enough details from a patient that I really have a sense that I'm with them on the journey of their illness, so I can understand it completely. Dr. Alice Cusick: Oh, very much so. And that's one of the things I really harp about with the fellows because sometimes I remember more of the social history than I do sometimes the medical history when I'm seeing a patient. I remind them, you need to know who they live with and how they live. It helps you take care of them. Dr. Mikkael Sekeres: Well, and that must be particularly germane with your patient population. When I was a medical student, my first rotation on internal medicine was at the Philadelphia VA, and it's actually what convinced me to specialize within internal medicine. What is it like caring for veterans? Dr. Alice Cusick: This is the best job I've ever had in my life. And I think because it speaks to my sense of duty that I got from my parents, particularly from my father, and I really feel I got back to my original focus, which is helping people. So that sense of duty and serving those who served, which is our core mission, this job is the most rewarding I've ever had because you really feel like you're helping people. Dr. Mikkael Sekeres: How much do you learn about your patients' military history when you first interact with them? Dr. Alice Cusick: It can come up in conversation. It sort of depends on what the context is and how much you ask and how much of that is incorporated into what's going on with their medical history. It comes up a lot in terms of, particularly cancer, because a lot of cancers that veterans develop can be related to their military exposures. So it can come up certainly in that context. Dr. Mikkael Sekeres: You write about how your patient and his wife brought in photographs of his younger self. Can you describe some of those photos? Dr. Alice Cusick: So a lot of it was about the sports he was doing at the time. He was kind of almost like a bodybuilder and doing like martial arts. So there were some pictures of him in his shirt and shorts, showing how healthy he was. He was much younger, but it was such a contrast to how he was at that time as he was nearing death. But it really rounded out my understanding of him because, as we all know, when we meet people, we see them when they're at that particular age, and we may not have that context of what they were 20, 30 years ago. But that still informs how they think about themselves. I mean, I still think of myself as an athlete even though I'm much older. So that's important to understand how the patient thinks about himself or herself. Dr. Mikkael Sekeres: You know, it's funny you mentioned those two photographs. I- immediately flashed into my mind, I had a patient who also was a martial arts expert, and I remember he was in his early seventies and hospitalized, but he made sure to put up that photo of him when he was in his prime, in his martial arts outfit in a pose. And I've had another patient who was a boxer, and all he wanted to talk about whenever he saw me was his first experience boxing in Madison Square Garden and what that moment felt like of climbing into the ring, squeezing in between the ropes, and facing off in front of what must have been some massive crowd. Dr. Alice Cusick: Yeah. Dr. Mikkael Sekeres: Why do you think it was important to them to bring in those photos to show you? Dr. Alice Cusick: I think it was to help me understand what he had been. I think it was important for him, and because we had a relationship, it wasn't just transactional in terms of his medical problems. It was really conversations every day about what he was doing and how his life was going. And I think he really wanted me to understand what he had been. And so I felt really honored because I think that was important. It told me that his relationship with me was very important to him. I found that very, very humbling. Dr. Mikkael Sekeres: Yeah, I find it fascinating the details that patients offer to us about themselves as opposed to the ones that we solicit. I think it speaks to also the closeness of the relationship we have with patients when they want to share that aspect of them. They want to show you who they were before they were ill. And it's not a point of bragging. It's not flexing for them. I think it's really to remind themselves and us of the vitality of the person who's sitting in front of us or lying in front of us in the hospital johnny or sitting on an exam table. Dr. Alice Cusick: Oh, very much so. And I've experienced that even with my own parents as they got older and were in the medical system. I remember vividly, my father had had a stroke, and the people taking care of him didn't understand what he had been. They didn't understand that his voice was very different. We kept asking, you know, "His voice is different." They had no concept of him beforehand. So that also really hit home to me how important it is to understand patients in the whole context of their lives. Dr. Mikkael Sekeres: And as a family member, do you think it's equally important to share that story of who somebody was before they were ill as a reminder to yourself and to the people taking care of a relative? Dr. Alice Cusick: Oh, very much so. I think it's very helpful because it also makes you feel like you're supporting the loved one as well by, if they can't speak for themselves, particularly when they're very ill, to help people understand, it may help the physicians or any provider understand their illness better, especially if there's a diagnostic dilemma, thinking about going home, what are they going to need at home, those sorts of things. I think it's always important to try to provide that context. Dr. Mikkael Sekeres: Patients will often talk about their deaths or transitions to hospice as an abstract future. Do you think they rely on us to make the decision about a concrete transition to hospice, or do you think they know it's time and are looking for us to verbalize it for their family and friends? Dr. Alice Cusick: I think it depends on how much groundwork you've done beforehand. So when you talk about end of life with people well before that transition it's almost mandatory, I think it's very important. It makes the transition much smoother because then they understand what hospice is, and they can prepare themselves. When they're not prepared, I think it's much more of a very clear transition. So it's almost like you're shutting one door, disease treatment, and moving on to, "I'm just going home to die," versus when you're laying the groundwork and you make sure that it's about how you live. I always try to emphasize, it's how you want to spend your time. It's how you want to live. Hospice is helping people live the best they can for as long as they can. And if you haven't prepared people, I think then they think much more you're closing the door and you're just sending me home to die. Dr. Mikkael Sekeres: It's tricky though, isn't it? Because as an oncologist or hematologist-oncologist, in our case, people look to us for that hope that there's still something to do and there's still life ahead of them. But at a certain point, we all realize that we need to transition our focus. But once we say that out loud, do you ever feel like it almost shuts a door for our patients? Dr. Alice Cusick: Again, it depends on the situation, and it depends on the support they have. It's different when you're dealing with somebody who's out in an outpatient world who has good family support and you've developed a relationship versus the patient who's taken a very sudden turn for the worse, and maybe is in the hospital, and things are more chaotic, and maybe they've been on very active treatment beforehand, but suddenly things have changed. So in my mind, it depends on the context that you're dealing with and what the relationship you have prior to. Maybe you're covering for your colleague, and you don't have a relationship with that particular family or that particular patient, but yet you have to talk to them. Somebody gets transferred from another hospital and you have a very brief relationship. And so I think the relationship kind of dictates sometimes how patients feel. But as long as you can help people understand the process of end of life as best as you can, I think that sometimes helps the transition. Some people are going to be angry no matter what. And that's totally understandable, angry about their family member dying, angry about what's happening to them if they're the patient. I think that's always part of the process, but it's hard to make things smooth all of the time. We do the best we can. Dr. Mikkael Sekeres: I was going to ask, has anyone ever been shocked when you start to talk about palliative care or hospice and never really did see it coming? Dr. Alice Cusick: Oh, of course. I think, especially if you've been doing this for a while, you sometimes see the future. You know what's, well, I mean, not exactly, but you have a good sense of what's going to happen. And there can be times when you start talking about end of life and palliative care or hospice and people are shocked, particularly family members, family members who may not be there all the time, who may not have seen their loved one frequently and haven't just understood what the disease course has been. And that certainly can be shocking. And again, totally understandable, but it's my responsibility to try to smooth that over and help people understand what's going on and make it a conversation. Dr. Mikkael Sekeres: It's a nice description of what we do. We make it a conversation. When talking about what you smelled that day when you saw your patient, you write, "Did I suddenly have a gift? Could I float through the hospital wards and smell the future? Or maybe I could only smell inevitability." It's a beautiful sentence. "Could I only smell inevitability?" What do you think it was that led you to know that his time had come? And I wonder, was it a distinct odor or what I refer to as a Malcolm Gladwell "blink" moment, you know, in which your 25 years of experience allowed you to synthesize a hundred different sensory and cognitive inputs in a split second to realize this was the time? Dr. Alice Cusick: I think I knew it was time because I had been seeing him so frequently and I knew him very well. The smell was very real to me. My husband and I disagree because I've talked to my husband about this. He thinks it was a real smell and that I did smell something. I think it was more that amalgamation of my experience and, as I said in the piece, a scent took the place of a thought. Dr. Mikkael Sekeres: Huh. Dr. Alice Cusick: But it bothered me so much, and that's when I talk about, "Did I have a gift?" You know, there are people who can smell diseases. There's a report of a woman who could smell Parkinson's disease. I thought, "Have I suddenly developed some sort of gift?" But in my mind, I thought, "You know, it was inevitability." I mean, it was inevitable that this gentleman was going to die of this disease. So that was my thought. I don't think I had a gift. I think it was smelling the inevitability that I understood through experience and knowing this patient so well. Dr. Mikkael Sekeres: Why do you think that smell haunted you so much afterwards? I mean, you really think about it and really dwell on it. I think in a way that any one of us would. Dr. Alice Cusick: I think because I thought there was something wrong with me. As I said in the piece, I thought it made my experience of that patient, my memory of that visit in particular and the whole relationship with him, I was thinking more about myself instead of thinking about him and his experience and his family's experience. And you know, you always grieve for patients, and it was interfering with my normal process. And so it really bothered me. In the end, it was more, "What was wrong with me?" This was weird, and it just sort of played with my usual understanding of how these things were supposed to go. And that's what really bothered me. Dr. Mikkael Sekeres: It is true. We really feel acutely our patients' loss, and it's so much more, I don't know if "acute" is the right word, or so much more meaningful when it's someone we've gotten to know over years, isn't it? Dr. Alice Cusick: Oh, very much so. You grieve for them, you miss them. At the same time, you also, you know, especially with this patient, his death was how he wanted it. So helping someone with the, quote unquote, "good death", the death surrounded by family, the death where there is no suffering or as minimal suffering as possible, you do find that helps with the grief, I think, instead of thinking, "Oh, what did I do wrong? What did I miss?" You can make it somewhat helpful in processing the grief. Dr. Mikkael Sekeres: It's perhaps one of the more exquisite aspects of the art of medicine is helping people with that transition in their final days and sharing in the emotions of that. It has been such a pleasure to have Alice Cusick, who is Hematology Section Chief at Veterans Affairs Ann Arbor Health System and Assistant Professor at the University of Michigan, Division of Hematology and Oncology to discuss "Smell." Alice, thank you so much for submitting your article and for joining us today. Dr. Alice Cusick: Oh, thank you so much. I really appreciate it. Dr. Mikkael Sekeres: If you've 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'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 Alice Cusick is Hematology Section Chief at Veterans Affairs Ann Arbor Health System and Assistant Professor at the University of Michigan Division of Hematology and Oncology.

Full HP 1.617 - 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 1.616 - 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 1.615 - 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 1.614 - 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 1.613 - 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 1.612 - 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 1.611 - 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 1.610 - 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 1.609 - 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 1.608 - 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 to JCO's Art of Oncology article, "Are You Bereaved?" by Dr. Trisha Paul, who is an Assistant Professor in Pediatric Hematology/ Oncology and Palliative Care at University of Rochester Medical Center. The article is followed by an interview with Paul and host Dr. Mikkael Sekeres. Dr Paul reflects on a grieving father's question about her own bereavement. TRANSCRIPT Narrator: Are You Bereaved?, by Trisha Paul, MD, MFA  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 experience in oncology. I'm your host, Mikkael Sekeres. I'm Professor of Medicine and Chief of the Division of Hematology at the Sylvester Comprehensive Cancer Center, University of Miami. Joining us today is Trisha Paul, an Assistant Professor in Pediatric Hematology Oncology and Palliative Care at University of Rochester Medical Center to discuss her Journal of Clinical Oncology article, "Are You Bereaved?" At the time of this recording, our guest has no disclosures. Trisha, thank you so much for contributing this terrific essay to the Journal of Clinical Oncology and for joining us to discuss your article. Dr. Trisha Paul: Thank you so much for having me today, Dr. Sekeres. Dr. Mikkael Sekeres: So we agreed for everyone listening to call each other by first names, and then Dr. Paul just called me Dr. Sekeres. Dr. Trisha Paul: Still adjusting to being an attending. Dr. Mikkael Sekeres: That is fantastic. Dr. Trisha Paul: Thank you so much for having me, Mikkael. Dr. Mikkael Sekeres: That was great. Well, you already gave us a little bit of a hint. Can we start off by my asking you if you can tell us about yourself - where are you from - and walk us through your career thus far? Dr. Trisha Paul: Sure. I'm originally from Ann Arbor, Michigan, born and raised there, and I completed my undergraduate medical school education at the University of Michigan. I proceeded to do a general pediatrics residency at the University of Minnesota and then went to St. Jude Children's Research Hospital for a combined fellowship in pediatric hematology oncology and hospice and palliative medicine. What brought me into this area of medicine was early experiences as a high school student volunteering at a children's hospital in my hometown. And that's where I found myself in a playroom, spending time with children with cancer and their families. And these experiences of being with patients and families and getting to know them outside of their illnesses was really what brought me to wanting to be not only a pediatric oncologist, but also a palliative care physician who could care for patients holistically. Dr. Mikkael Sekeres: Wow. So you were introduced to this field at a preternaturally young age. Dr. Trisha Paul: Yes, it's been more than a decade that I've been aspiring to be a pediatric oncologist and a palliative care physician, and I feel fortunate to be there now. Dr. Mikkael Sekeres: That's fantastic. And I should say, given your University of Michigan pedigree, 'Go Blue'. Dr. Trisha Paul: Thank you. Go Blue! Dr. Mikkael Sekeres: Although, at the time of this recording, Miami is undefeated in football, so, you know, go us. In your essay, I really love how you draw us as readers into your story. You signed up to volunteer at a writing workshop for bereaved parents of children who died from cancer. Can you set the scene for us? Where did this take place? How many people attended? And why did you sign up for the workshop in the first place? I can imagine this would be an incredibly moving experience. Dr. Trisha Paul: Yes. Day of Remembrance is an annual event hosted at St. Jude Children's Research Hospital. Many hospitals have similar events where we honor patients who have passed away and we invite their families back to campus to honor these patients. And I started my fellowship in 2021, and so we were still coming out of the pandemic. This workshop that I attended was the first time that I was having an opportunity to attend the annual Day of Remembrance. And at the time, I had completed my palliative care training, and I was wrapping up my pediatric oncology fellowship. The annual Day of Remembrance this year was hosted at a convention center on the banks of the Mississippi River, nearby and next to St. Jude Children's Research Hospital. And it was a large convention center that kind of spans the horizon. And it's one of those spaces where you go for medical conferences typically, and it was interesting to walk into this convention center space and all these conference rooms and instead see poster boards that are sharing the stories and the lives of all these children and adolescents who had died over the past several years. One reason I think the timing of this event occurred for me was that I realized that I also knew several patients and families who might be in attendance at this event. I was several years into my fellowship at the time. And so I think the other reason I chose to volunteer at this event was I had spent a lot of time with patients and families whose child was approaching the end of their life, and I had kind of gotten to be with parents and siblings in that period of time. But what often happens for me as a palliative care physician and as an oncologist is the relationship is different after the child dies. And so for many of the patients I cared for as a palliative care physician, or as an oncologist, I wouldn't necessarily see these parents after the death of a child. There are some times where I've been able to see them at a memorial service, but otherwise we spend all this time with families leading up to a child's death. And often there's kind of this black box around them and their lives afterwards. And so I found myself really wanting to better understand the experiences of families after a child's death, which is what led me to participate and volunteer in the annual Day of Remembrance event. I did not want to just attend, I wanted to be able to do something concrete and actionable with these families to learn more about their grief. And for me, as a writer, volunteering at the writing workshop with bereaved parents seemed like a perfect way for me to be able to spend time with them. Dr. Mikkael Sekeres: Many of us as oncologists place boundaries between our interactions with patients, confining them to the workplace, but many do not. That you attended this workshop tells me that you may fall into the latter category. Was this a deliberate decision or something that evolved over time? And do you ever worry that erosion of such boundaries could contribute to burnout, or is it actually the opposite, that it reminds us of why we do what we do? Dr. Trisha Paul: Yeah, I think this is a great question that I have been asking myself for years and that I anticipate spending the rest of my career wondering about and rediscovering for myself each time I have a patient and a family before me that I am exploring what I want those boundaries to look like or what I want those relationships to look like. I think that for me, my thinking about this has evolved even throughout the course of my training. And I think I've better understood that these are decisions that are made on a very personal level as well as decisions that have to be reassessed with each patient and with each family that we get to care for during this time. And so I think I'm always asking myself about, beyond being an oncologist and beyond being a person's palliative care physician, how do I want to care for them as another person? Dr. Mikkael Sekeres: Really nicely said. Did you recognize any of the parents at the writing workshop you attended or at the larger conference when you were there? Dr. Trisha Paul: I did. Dr. Mikkael Sekeres: And what was that like, seeing them out of context? Dr. Trisha Paul: In this specific situation, I think it was a little bit jarring in the sense that it was kind of this surprise, that especially these are patients I had cared for in the past several years, and so there was a little bit of a moment to recognize and place them in where we had seen each other before. And then there was this fleeting wonder about whether they also recognized me. Some of these are patients that I might have met while on service as a palliative care physician for a brief visit or an initial consultation. And so for some of those families that I knew, there was less longevity to the ways in which I had known them. And it was curious to wonder if they remembered me and then to wonder about that memory. Dr. Mikkael Sekeres: Did any of them? Did any of them come up to you and say, "Oh, Dr. Paul, it's good to see you again," or, "Do you remember me?" Dr. Trisha Paul: No, I did not have that happen. Dr. Mikkael Sekeres: I think jarring is a really interesting word to use. A lot of our interactions are so contextual, and I find it difficult when I run into a patient or a family member and I'm outside of work and have to remind myself of, not so much who they are, but where they are in their treatment course. And sometimes you forget because it's out of the context of our clinic rooms. Dr. Trisha Paul: Mm hmm. I think that's exactly right. Dr. Mikkael Sekeres: The author and grieving father who led the workshop in your essay writes in your copy of his book that he thanks you for your work. The way you describe that and isolate that phrase in your essay is to the reader, I will use your word again, jarring. Why was that so jarring to you? Dr. Trisha Paul: It definitely felt jarring when I read those words in my book. There is something about the word work and kind of the connotations of work that separate it from a humanity of caring. It feels a little bit like an obligation or a task or a livelihood. Dr. Mikkael Sekeres: You think of what we do as a calling? Dr. Trisha Paul: I don't think the phrase of it being a calling resonates with me personally that much. But it is more than just a thing I do. I think that's the problem with work. I think it's undermining why a lot of us choose to do this. Which I think for many people, kind of this idea of a calling is how they think of it. I think the calling implies there's a lot more choice than I actually feel. Ever since some of the first patients and families that I met within this space, I understood that these are the people I wanted to spend the rest of my life caring for. And I guess that kind of sounds like a calling. But... Dr. Mikkael Sekeres: I was not going to say it, but it sounds like a calling. You know that word, and I love how you reflect on semantics in this essay. The notion of a calling sounds so highfalutin and almost religious and as if we're being spoken to. But I don't know. I think you could define it as something that just feels right to you and something that you should be doing and that you fall into and you do not have as much deliberate choice in going into this field, but everything just feels right about it. Dr. Trisha Paul: I think that's exactly it. So I think it's just that you do not really question- for people who choose to do this work and to be with these patients and families, a lot of us from the time we arrive at the realization that this is what we want to do, we don't find ourselves really questioning it in a concrete sense because we understand it. It makes sense to us. Dr. Mikkael Sekeres: I think that's a great summary of that. It just makes sense to us. Dr. Trisha Paul: I think it's a mysterious idea to so many other people who don't do this work. And that's part of why it's interesting to a lot of people who just respond and say, "Oh, I can't imagine how you do this." Dr. Mikkael Sekeres: Well, it just feels as if we're contributing something so substantive to humanity by focusing on hematology, oncology, and particularly palliative care. I don't know about you, I do not know if you have children. I have certainly tried to impart to my children to do something meaningful, to do something that makes other people's lives better with whatever career they choose, because it's so meaningful not just to ourselves, but to other people. Dr. Trisha Paul: Mm hmm. Dr. Mikkael Sekeres: We are talking about semantics. In your essay, you reflect on the notion of bereavement. Should we, as medical caregivers, cop to being bereaved, or are we misappropriating a word that really wholly belongs to close family members and friends of a person with cancer? Dr. Trisha Paul: Yes. And I think that this essay was me kind of struggling to wrap my mind around what this question means and kind of what my own reactions to this idea of what it would look like and feel like to call ourselves bereaved. And I don't have an answer to this question. I think it's a question that everyone in this work should consider and think about and what it means for them as an individual. Dr. Mikkael Sekeres: Are there patients you have lost whom you think about even one, two, three years later on a regular basis? Dr. Trisha Paul: Yes, I would definitely say so. I am early in my career, but I anticipate that that is kind of an essential way in which I do this work. It's part of my own practice, and it's dependent on each patient, but I find ways that I keep their legacy alive in my life. Dr. Mikkael Sekeres: Yeah. I thought a lot about your essay since I first read it, and I think it's okay to say that we grieve the loss of our patients. I think that is a form of bereavement. Dr. Trisha Paul: I think so too. I think that it was interesting to realize my own hesitation about specifically calling ourselves bereaved when we do, as clinicians, talk about grief and secondary grief and something about using the language of grief and grieving feels more appropriate and within our purview as clinicians. But something about specifically identifying as bereaved felt like a different step. Dr. Mikkael Sekeres: It's closer, isn't it? I don't know, it feels like more of a personal relationship rather than a professional relationship to be bereaved. Dr. Trisha Paul: And I think that that's simultaneously terrifying and empowering as a way of acknowledging what the loss of a patient can do to us and also honoring the affection we have for people we care for. Dr. Mikkael Sekeres: I hope it's okay that we end on that phrase that you just said: It's both terrifying and empowering to admit to being bereaved and to feel that closeness to one of our patients. It has been such a pleasure to have Trisha Paul, who is an Assistant Professor in Pediatric Hematology, Oncology, and Palliative Care at the University of Rochester Medical Center to discuss her essay, "Are You Bereaved?" Trisha, thank you so much for submitting your article and for joining us today for this enlightening conversation. Dr. Trisha Paul: Thank you so much. Dr. 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 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 Trisha Paul is an Assistant Professor in Pediatric Hematology/ Oncology and Palliative Care at University of Rochester Medical Center.

Full HP 1.607 - 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 1.606 - 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 1.605 - 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 1.604 - 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 1.603 - 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 1.602 - 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 1.601 - 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 1.600 - 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 1.599 - 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 1.598 - 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 1.597 - 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 1.596 - 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 1.595 - 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 1.594 - 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 1.593 - 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 1.592 - 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 1.591 - 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 1.590 - 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 1.589 - 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 1.588 - 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 1.587 - 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 1.586 - 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 1.585 - 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 1.584 - 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 1.583 - 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 1.582 - 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 1.581 - 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