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INTRODUCTION

MY PATIENT WAS a 36-year-old woman with recurrent small cell carcinoma of the cervix, an incurable condition. In addition to facing the prospect of death, she also faced the collateral damage that cancer invariably inflicts on its victims’ personal lives. “Who will care for my children?” she asked through sobs. “My husband can't be trusted. He's a no-good drunk and a cheat who can't hold down a job. My parents are divorced and my mother has a bad heart.” Then after a brief pause to consider her seemingly hopeless circumstances, she steeled her resolve and said, “I'm not giving up! I have to be here for my children.” It was late in the afternoon, at the end of a clinic packed with many other patients who faced similarly grave prognoses. I operated that morning from 6:30 until clinic began at noon, so I was fried and desperately needed to finish my work and get home. Yet her plaintive voice droned on, and as it did, the proverbial angel on my shoulder engaged in mortal combat with the devil on my other shoulder. The little angel stood tall and proud as alwaysin his starched white coat, clean-shaven and composed. He said, “Stay calm. Take a breath. Stick with it. Give her a few more minutes.” However, her sobbing showed no signs of abating, so the little devil emerged from his cave and crawled up on my shoulder wearing dirty scrubs and a three-day beard, disheveled, frustrated, and exhausted. He yelled in my ear, “I can't take another minute of this. I need to get out of here before I scream! What does she expect me to do or say about her personal problems?” As I thought about how to respond, I wondered, “What would Dad do in this situation?”

A MAJOR ROLE MODEL

My dad was an obstetrician-gynecologist in private practice in Santa Monica, California. He spent most of his life in New York and then spent the first two years of his career after residency at Edwards Air Force base in the Mojave Desert caring for the wives of service members during the Vietnam War. After his military service, family beckoned from the north, but the allure of sunny California was too strong. Although his practice was in Santa Monica, my parents could not afford a house there, so they built one in Malibu, which was about 15-minutes’ drive from the hospital. This was the ‘70s, a time when Malibu was still a beach community rather than the playground of the rich and famous it is today. I remember many trailer parks up and down Pacific Coast Highway, although we lived in a regular, middle-class neighborhood. Nonetheless, my dad cared for several famous actors who lived near his office in Santa Monica. One day, my father asked one of his new patients what she did for work, as he did all his ...

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