COMMENTARY

Positive Takeaways From This Annus Horribilis

Mark A. Lewis, MD

Disclosures

December 24, 2020

This transcript has been edited for clarity.

Hello . This is Dr Mark Lewis, the director of gastrointestinal oncology at Intermountain Healthcare in Utah. When I think of how to sum up 2020, the phrase that comes to mind is annus horribilis, Latin for "horrible year." That phrase dates back to the 19th century when an Anglican publication objected to the Catholic principle of papal infallibility. Since then, shorn of its origins and arguments about religious doctrine, it has come to mean any particularly awful year. I think most of us can agree that 2020 was exactly that.

But this is a particularly interesting time when, frankly, I feel emotionally conflicted. As Walt Whitman said in "Song of Myself, 51," "I contain multitudes." On the one hand, I believe that we should still take the COVID-19 threat extremely seriously and should continue to mourn the hundreds of thousands of Americans lost to this virus. On the other hand, we are also celebrating the arrival of an effective vaccine, possibly even several vaccines. My wife is a physician, and she and I have received notice that by the end of this week we will receive our first doses of the Pfizer-BioNTech vaccine. That is something to celebrate.

We do have to remember that this vaccine is not going to be ubiquitous and available to every American yet. It will be rolled out in tiers, by a sort of triage system so that, hopefully, the most vulnerable and those at the front line can receive it early. We also know that there can be a therapeutic latency. In fact, the curves show an early separation in efficacy between the vaccine and placebo. Nonetheless, it takes time for the full benefit to be seen; there will be a lag and we cannot let down our guard.

I feel similarly about this year in oncology. We have so much to mourn, so much loss — not just of human life, but of some of the compassion and presence we normally provide in cancer care. I've had patients who have been admitted to the hospital for months on end, and I may be the only familiar face they see because their families and friends cannot visit them because of visitor restrictions. There also has been tremendous turnover in the inpatient workforce, so sometimes the outpatient oncologist is the common thread between patient and family. And I've realized that family and friends are profound — and, frankly, irreplaceable — therapeutic allies in the care of a patient with cancer.

Here in the clinic, I try to be extremely selective about who I bring into the practice so that, as a potential mode of transmission, I'm not endangering them, nor am I potentially bringing someone contagious into the clinic. That has led to some awkward encounters when, from behind a scrim of personal protective equipment, I've had to break bad news without the comfort of holding a hand or giving a hug. So I realize that some of the tangible and intangible aspects of the in-clinic encounter have gone missing.

On the other hand, there are some things to like about how we have modernized cancer care. Necessity is the mother of invention, and through all of this we have come to realize what we absolutely must do in person and what can, when appropriate, be transitioned to a digital medium. I think telehealth, and home and patient centrism, are here to stay. We've grown more confident in our ability to safely and effectively deliver the relatively nonnoxious immunotherapy infusions in our patients' homes. We've also been conducting virtual house calls when patients are too infirm to come to the clinic. For years, the paradigm has been to bring our patients to us, even though they may be quite unwell, sometimes incurring massive opportunity costs and even financial penalties to travel to our centers. Thus, learning what we can and should do virtually, vs what we absolutely must do in person, has been a valuable lesson and one that will be a silver-lining legacy of the pandemic.

As 2020 draws to a close, I will end by thanking Medscape and other online communities that have given me strength and support through this year. At times, the sense of social isolation has been staggering, but we've been able to get around that and foster significant collegiality through platforms like this one.

I wish you good health in 2021!

Mark A. Lewis, MD, is director of gastrointestinal oncology at Intermountain Healthcare in Salt Lake City, Utah. He has an interest in neuroendocrine tumors, hereditary cancer syndromes, and patient-physician communication.

Follow Medscape on Facebook, Twitter, Instagram, and YouTube

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....