An excerpt from Dr. Jerome Groopman’s How Doctors Think:

“Availability” means the tendency to judge the likelihood of an event by the ease with which relevant examples come to mind. Alter’s diagnosis of subclinical pneumonia was readily available to him because he had seen numerous cases of the infection over recent weeks.

This Monday, we started our Neoplasia/Hematology block of our Mechanisms of Disease course (Pathology and Pathophysiology). We have been learning the basic categorization schemes and behaviors of various neoplasms (cells growing uncontrollably), including both benign growths and malignant growths such as carcinomas and sarcomas. Today, I sold an amplifier (from my bygone days as a band leader, song writer and guitarist) to a friendly, local fellow. When he drove up, the first thing I noticed was the white bandage that covered his right eye. We chatted briefly about music, guitars, and the amplifier, and he also asked me a couple of questions about medical school. Then, he asked me if I had learned anything about oncology. I had been curious as to the nature of the bandage, but I haven’t quite figured out when it’s appropriate for me to ask about an unknown person’s afflictions (since as a physician, I will have the ability, and sometimes the responsibility, to cross social boundaries that most people do not, even outside the setting of the clinic or hospital). He went right ahead and told me: he had rhabdomyosarcoma in his right eye when he was a child, a very high grade, malignant cancer that at the time only had a survival rate of about 20%. Fortunately, he survived and seemed pretty healthy except for the loss of the eye (the cancer required surgical resection). How ironic that I learned about rhabdomyosarcomas yesterday, and then saw the consequences of one example of the disease today! It reminds me of how when one learns a new word, it seems as though everyone subsequently starts using that word.

Furthermore, it reminds me of one important thing I learned in my days (actually, years) as a volunteer in a cancer clinic: Cancer is not always a terminal disease, and as time goes on, we’re finding better ways to help people live fuller and better lives beyond the diagnosis and treatment of cancer. No matter what field of medicine I decide to work in, I will be working against cancer, and that is one fight I look forward to.

Lastly, my conversation with him was encouraging: without exception, I have found that individuals who have suffered from severe or potentially severe diseases are very grateful and trusting of physicians, as I wish all people were. This alone further inspires me to go towards a field of medicine involving the care of very sick patients, because I think one of the best parts of medicine is being able to help pull someone back from the edge of existence.


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