Imagine…
You are a physician in your 50’s. You have devoted your professional life to public health, and are a recognized international expert on tobacco control. You have been active in medical affairs from the beginning of your professional career, and you rise in stature in several leading local, state and medical organization. You are highly regarded by your colleagues and your friends (many of whom fit both categories). You lead a “good” life, doing everything right. You have a wonderful family, devoted with love to each other. You are reflective and admired for your accomplishments and your insights. You have unusual level of humility for one who has achieved so much.
In June, 2007 you are inaugurated as the President of the American Medical Association and become the primary representative of the voice of medicine not only in the United States but in the world as well.
In March, 2008—while actively serving in your capacity as a leader of medicine, travelling the country, speaking in Washington, meeting with physicians and opinion leaders at the highest levels—you become ill. You are diagnosed with Stage IV pancreatic cancer, and you know the outlook is not good. You openly share your disease with your family, friends and colleagues around the world—and there are literally thousands of concerned people from all walks of life who care about this man.
Such is the real life story of our current President of the AMA, Ron Davis MD.
Ron is a realist. He has shared his journey openly on his care page. He is not ignorant of his disease or its prognosis.
Yesterday afternoon, Ron Davis gave his last talk as the President of the AMA at the AMA’s annual House of Delegates meeting I am currently attending in Chicago.
I doubt there was any one of the over 1000 physicians, spouses and staff who relished the thought of hearing that speech. I also doubt there was anyone who would have missed it.
Say what you will about doctors, the reality is that those of us who participate in the politics of medicine are a very committed group. We may differ in our ideas, we may argue and disagree vigorously, we may never share the same points of view. But there are few groups so devoted to each other in terms of our respect and our care for our colleagues in distress.
I have been interviewed frequently about the impact of cancer in celebrities, their prognosis, and what their impact can be on the public. Peter Jennings, Patrick Swayze, Senator Kennedy and many more come to mind.
I always make the comment that, although celebrities and public figures are important in our national lives—they are still people. And, they really serve as surrogates for so many others that have developed cancer and been treated for it. They represent the hopes, the struggles, the successes and unfortunately the failures of all those who have had cancer make an unwelcome entrance into their lives. So although they are highly visible, they are also very human like the rest of us.
Ron Davis is our celebrity. This cancer thing shouldn’t happen to anyone, much less to someone like Ron who has done so much for so many, and done so much to commit to a healthy lifestyle for himself and his family.
But it did happen, and here we are, listening to someone who is one of us now going through chemotherapy to do what can be done to save his life, and reduce his pain and discomfort.
And here is, ready to give his final AMA Presidential speech. What do you say, standing in front of a crowd whose prayers for the past 3 months have focused on your treatment and recovery?
The lights in the room dim, the sound comes up, and the “Circle of Life” video and opening song play through the hall. And what you see—bald from his chemotherapy—is the same person who has always been there. Looking well, speaking calmly, and focused on the issues. Just as if nothing much was otherwise wrong in his life.
But something is very wrong in this life. As Ron begins to speak, one wonders what tone and path this speech will take.
Traditionally, these “final speeches” focus on AMA policy successes over the past year, current issues that need to be addressed, and a hearty thank you to everyone who make the successful presidential year possible.
This speech would not be traditional. Those in attendance knew it.
So bear with me as a provide excerpts from Ron’s speech, focusing on those topics
that may be of importance to some of you who either face or have faced a battle with cancer whether your own, or with someone you love or someone you know.
Remember that this is from a physician, who is now no longer just a doctor, but a man with a serious illness as well. This is a man who has decided to fight his battle with cancer vigorously, publicly and while always moving forward with his responsibilities every day as a leader in medicine.
Read this and envision the laughter, and understand the tears.
“Legacies in the Circle of Life”
Opening Session of the AMA House of Delegates
Hyatt Regency Chicago
Chicago, Illinois
Saturday, June 14, 2008
Ronald M. Davis, MD
President
American Medical Association
Thank you so much. Good afternoon.
I wanted to start out with that song, because “The Lion King” was by far the best stage play I’ve ever seen. And that opening music reminds us that we all eventually will take a journey around that circle of life. What’s important is what we accomplish on that path. Leaving a good legacy is something each of us will eventually consider, some sooner than others.
This year has been the most eventful year of my life, in large part because I’ve had the privilege of being the president of this extraordinary organization. And as those lyrics said, “There’s more to see than can ever be seen; more to do than can ever be done.” I can’t think of a better job description. It’s overwhelming.
It’s also been an eventful time because I was diagnosed earlier this year with pancreatic cancer. And I want to thank all of you for your thoughts and prayers over these past few months. They mean the world to me, and to my family.
Things were especially eventful a couple of weeks ago when my hair began falling out because of a toxic chemotherapy reaction. I used to have a pretty decent head of hair. Now, as you’ve seen, I have this new hairstyle.
It’s actually been kind of fun, to be honest with you. I very briefly had a Mohawk, and an earring. There’s evidence out there, somewhere. And being bald is a medical reminder of our natural state of being. It happens to those who age, and those who get sick. We very often lose our hair, there’s simply no denying it. But getting back to the circle of life, that’s how we came into the world as well. Telly Savalas used to say, “We’re all born bald, baby.”
There’s another quote I actually prefer, from the Roman philosopher Seneca the Younger. He said, “I don’t consider myself bald, I’m just taller than my hair.” My wife Nadine’s favorite is that there are three ways a man wears his hair: parted, unparted, or departed.
As a physician trained in epidemiology, I look for data to understand the effects of illness. So I was happy to find a survey on HairBoutique.com in which more than 2,600 people answered the question, “What do you think of bald men?” Of course, this survey does not meet the CDC’s standards for valid epidemiologic research. But I was interested to read that the top response was, “Bald men are hot.”
I’d argue that there’s no profession as closely identified with the circle of life as is the physician. Even before conception, we have those who specialize in Reproductive Medicine. Then we have the OB/GYNs who administer prenatal care, and bring newborns into the world. We have Pediatricians and Family Physicians who nurture our children. The majority of physicians care for adults. And then we have Geriatricians and physicians who specialize in Hospice and Palliative Medicine who take care of people in their twilight years. So we physicians help people move through the circle of life.
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I’d like to end with some personal comments about being a patient.
Of course, having a serious illness is not what I’d call fun. But I’ve always been a cup-half-full kind of guy, so let me tell you about some of the good things that have come out of my experience.
First, getting back to this business about being bald. My son Connor no longer tells me in the morning that I have “wacky hair.” I didn’t have to pack a large tube of hair gel in my toiletry bag. And when I was walking here in the Windy City a few days ago, I reached for the comb in my pocket, and then realized that I didn’t have one. And I didn’t need it.
Also, people are giving me caps to wear. Just a few days ago, a few AMA staffers gave me a collection of AMA caps, plus a cap to recognize my affection for Star Trek. It shows a quote from Dr. Leonard McCoy, the ship’s physician in the original Star Trek series. It says, “Damn it, Jim! I’m a doctor, not an engineer.”
The caps come in handy because I’ve now realized, for the first time in my life, that it can get cold up there, especially when the air conditioning is blasting away. And as we move into the hot summer months, the caps will help me avoid getting sun burns on my newly exposed scalp.
On a more serious note, I’ve learned about another noble cause, raising awareness about pancreatic cancer, and raising funds for research to improve treatment for this nasty disease. Pancreatic cancer is the fourth leading cause of cancer death in the United States. This year, more than 38,000 Americans will be diagnosed with pancreatic cancer, and more than 34,000 will die from it. But pancreatic cancer research accounts for less than 2% of the National Cancer Institute’s research funding.
The Pancreatic Cancer Action Network (or PanCAN) is leading an effort to enact and fully fund a National Plan to Advance Pancreatic Cancer Research. I’m very proud that our son Jared and many other members of my family put together a team of walkers who raised $25,000 for PanCAN at the PurpleStride Walk, right here in Chicago six weeks ago. AMA staff and Michigan State Medical Society delegates and colleagues at Pfizer were among the major contributors to our team effort.
Another good thing to come out of my illness is that I’ve learned about a few essential ingredients in improving the quality and safety of health care, from the patient’s perspective. In my president’s column in our “eVoice” newsletter two weeks ago, I wrote about the value of team care, and how it has benefited me. I’ve had wonderful care from physicians representing many specialties, and from oncology nurses, registered dieticians, genetics counselors, and many others.
Of course some teams work well, and others do not. So we must ensure that health care teams operate within a framework based on good communication, coordination, and cooperation. I’ve seen breakdowns in communication, now from the view of an educated patient, that have led to several near-misses. And so now I’m more convinced than ever before, that we must continue to intensify our efforts to improve communication, among our colleagues and with our patients, in order to prevent medical errors.
Another positive to come out of my illness is that family and friendship have been redefined for me. It’s cliché to say this, but yes, a serious illness does force one to reexamine one’s priorities in life. And I’ve been so very happy to be able to spend more time with Nadine and our three sons during these past four months. A person cannot be president of the AMA without having incredible love and support back home. And when you add the big “C” to the mix, that love and support become your lifeline. So Nadine and Jared and Evan and Connor, I can’t thank you enough.
I’ve been so happy, as well, to reconnect in a more meaningful way with many members of our large extended families. I’ve been happy to hear recently from friends and former classmates with whom I’ve had no contact for years, or even decades. And I’ve been blessed to receive good wishes and prayers from many of you.
I’ve been asked several times, “What’s it like being a physician with your illness? Does being a doctor help or hamper your situation?”
Well, here’s my answer: A benefit of being a physician is that I understand what’s happening to me. But a disadvantage of being a physician is that I understand what’s happening to me.
As a physician, I know the survival statistics for someone with stage 4 pancreatic cancer. But if the five-year survival is 5%, that’s not zero. And as someone with relative youth, good functional status, outstanding health care, love and support from family and friends, and a thirst for life that feeds into a strong mind-body connection, then who knows what the future holds for someone in my situation. So never take away someone’s hope.
And there’s one more ingredient to add to that equation, and that’s faith and spirituality. Through the years I have not had a strong religious faith. But since my diagnosis, it has been rekindled.
Dr. Ed Langston, chair of our AMA Board of Trustees, pointed me toward Proverbs 3:5: “Trust in the Lord with all your heart and lean not on your own understanding.” Applied to my situation, it seems to say that I should ignore the statistics on the prognosis for pancreatic cancer, but instead put my faith in God. And so, Nadine and I have prayed together several times, asking for God to help my chemotherapy to work, and for Him to heal me, and to give strength to my family in dealing with this situation. And so I count that rekindling of faith as another positive that has come out of my illness.
The last benefit of my illness that I’ll mention is that it has helped me to appreciate, and to teach others about, the value of patient websites, such as those on CarePages.com and CaringBridge.com. Many of you have been reading the updates I’ve posted on my own CarePage. These websites make it easy for patients and their families to share information, to receive good wishes and prayers, and to build a community of support. I’m pleased that the Associated Press ran a story last Monday about patient websites, and I encourage physicians to educate their patients about this therapeutic tool.
When I’ve experienced pain from my cancer, or nausea from my chemotherapy, my physicians and nurses have often asked me to rank that pain or nausea on a one-to-ten scale. Part of the reason for that, as you know, is to assess my response to treatment, and the effectiveness of anti-nausea and analgesic medication. Hearing this, my wife began to ask me the same question: “How’s that Compazine working? How bad is the nausea now? What’s the number?”
Well, I got tired of saying two, or three, or four. So at one point, I said, “I’d put my nausea at Pi.”
She said, “What?”
I said, “You know, the Greek letter Pi. 3.14159. That’s where my nausea is right now, on a one-to-ten scale.”
Pi, as you know, is connected to the circle in a fundamental way. It’s the ratio of the circumference of a circle to its diameter.
What got me thinking about Pi was a book I’d read recently by Daniel Tammet, entitled “Born on a Blue Day.” Tammet, a 27-year-old Briton, described his life as an autistic savant with Asperger syndrome. His functional level was not only good enough to allow him to write a compelling autobiography, but also enabled him to establish the European record for reciting Pi to 22,514 digits. He did so on March 14, 2004, as a charity event to raise funds for epilepsy, a condition he experienced as a child.
So what’s Daniel Tammet’s legacy? I think, in part, it’s to remind us how extraordinarily powerful the human mind is. To remind us that anything is possible, as we contemplate what legacy we want to leave.
If a person with autism can recite Pi to more than 22,000 digits, we ought to be able to figure out why some cancers are so amenable to effective treatment, while others are not. We ought to be able to figure out how to get more of ourselves and our patients to live a healthy lifestyle. We ought to be able to figure out how to get off the SGR hamster wheel. And we ought to be able to figure out how to provide health insurance to all Americans.
There’s one thing that we may never be able to figure out, and that’s how I had the good fortune to become the President of the American Medical Association. I’ve been humbled with the privilege of representing the healers of this nation. I’ve been one of your designated advocates with the leaders of our government. You put me in a unique position to try to make lives better for both physicians and patients, all across this country.
So thank you. Thank you all, for your part in this great association. Thank you for your help in our achievements during this last amazing year. And thank you for your friendship, as we continue our journeys through the circle of life. God bless you all.
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My friends, this is an extraordinary man in ordinary circumstances, living with cancer. I admire Ron Davis, and share that admiration with many of his friends and colleagues.
I hope you understand why I wanted to share his thoughts and his perspectives with you, and hope that in his words you will find—like I did--some humor, some laughter, some hope, some reality and some understanding.
Perhaps you will even see a bit of yourself as you pass through your own circle of life.
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Editorial note: I know this is a very long blog entry. But I made the decision to include as much of the speech as possible and relevant. I hope you agree that was the right choice.
This is the link to Dr. Davis' entire speech (including his comments regarding AMA specific activities):
http://www.ama-assn.org/ama/pub/category/18670.html
6/19/08:
The video is now posted on the AMA website:
http://www.ama-assn.org/ama/pub/category/18187.html
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