On Millard, H pylori, and Great Cases

Robert M. Centor, MD

Disclosures

August 17, 2005

In This Article

Meeting Millard

The following article is adapted from a speech delivered by Robert M. Centor, MD, on August 6, 2005, at the annual White Coat Ceremony at the University of Alabama at Birmingham School of Medicine, marking the beginning of a new school year.

"Millard" was the most famous person in town. He anchored the morning radio show during the era when everyone listened to the morning radio show. He was famous enough that President Ronald Reagan called to wish him a happy birthday on the air.

Millard had a husky voice, one that betrayed the fact that he was a long-time smoker.

Millard was my patient back in 1993. In fact, I had been his physician for several years, when one day he "dropped in" for treatment of an upper respiratory tract infection. He thought it was simple bronchitis, but I was not sure. You see, part of medicine uses the "Lt. Columbo" standard. For those of you who have never watched Peter Falk's brilliant depiction of detective Lt. Columbo, when he was leaving the room after an interview, he often would stop, turn, and say, "Something is bothering me." Well, that day, something about Millard's story bothered me. So, I ordered a chest x-ray, which revealed an early lung cancer.

I was thrilled that the cancer was small enough that it seemed curable. Millard underwent surgery to remove the cancer and part of his lung. We found no evidence of spread.

Fifteen months after the surgery, Millard again "dropped in." I remember his words to this day: "Would you be my doctor?" I told him I already was his doctor and would continue to be his doctor; what did he mean?

I then learned that after Millard's surgery, he had gone in for periodic chest x-rays (CXRs). The most recent one had shown a recurrence of his cancer. The thoracic surgeon (who had not informed me of the CXR results) had referred Millard to an oncologist. The oncologist had given Millard the choice between chemotherapy and a decent quality of life. Unfortunately, chemotherapy for most lung cancers – and specifically the type he had -- rarely provided any significant clinical benefit, while causing very undesirable side effects.

When Millard rejected the chemotherapy option, the oncologist seemed to lose interest in his case. What Millard wanted and needed was palliative care. Back in 1993, however, palliative care still was a relatively new concept.

So, I began seeing Millard on a regular basis. I had no curative options, but I did understand the principles of providing care. Millard and I would talk for 20-30 minutes each month. We established his advanced directives so that I understood his wishes precisely. Millard produced an audio tape of remembrances of his life to share with family and friends; he produced his own legacy.

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