Carpe Diem

Carpe Diem

By Amir Steinberg, MD, FACP
June 25, 2015, Volume 6, Issue 11


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Amir Steinberg, MD, FACP

We are so preoccupied with what we are supposed to be doing, we often miss out on what we would most like to be doing. And if it is possible to pursue the things we love, get out of our rut, and seize the day, then maybe we should.
—Amir Steinberg, MD, FACP

My life as a cancer survivor and an oncologist has taught me the importance of living every day to the fullest.

Sometimes we all need a little reminding to appreciate life to the fullest. When I think of my former patient, Marc, that is what comes to mind. When I was a senior in high school, I was diagnosed with Hodgkin lymphoma. It was tough going, but I had a lot of support from my family, friends, teachers, and my doctor Fredrick B. Hagemeister, MD (Professor of Medicine in the Department of Lymphoma/Myeloma at the University of Texas MD Anderson Cancer Center in Houston). Dr. Hagemeister told me on my first day meeting him to “Live your life as normally as possible.” Since undergoing therapy over 20 years ago, I have tried to do just that.

Along the way, I used my life experience as a cancer survivor as motivation to pursue a career in medicine. Like Dr. Hagemeister, I wanted to be a lymphoma specialist, working at a large hospital, involved in research. And through the various stages of my medical training, hematology-oncology fellowship, and bone marrow transplantation fellowship, that continued to be my goal. However, sometimes when one is so goal oriented, life becomes all about pursuing the next step and not appreciating the present. Although it is important to think about the future and plan for that future, one can lose sight of living in the present day. My experience with Marc has helped remind me that today is equally important to focus on, as are the future tomorrows.

A Life Interrupted

I met Marc during my first year as an attending physician in Los Angeles. He was close to finishing his education at a local university with a degree in art. He had been studying abroad in Hong Kong, doing what he does best, living life to the fullest. While there, he developed chest discomfort. An x-ray of his chest was performed and showed a mediastinal mass. He returned to California, where a surgeon performed a biopsy and diagnosed him with T-cell lymphoblastic lymphoma.

He was soon referred to my team, and we took over his care. The therapy for his diagnosis would require several months of intense treatment, mainly inpatient. This precluded Marc from completing his last semester in college. I remember Marc often challenging me with complex questions about his therapy. He would ask me what he could and could not do physically, and he was most concerned about whether he could continue surfing, one of his great loves. Through it all, he tried living his life to the fullest, just as he had done prior to his diagnosis.

After undergoing 8 months of intense chemotherapy, and getting ready to start his 2-year maintenance chemotherapy, Marc began noticing blood in his urine and some discomfort on urination. A bladder mass was noted, and he was found to have recurrent lymphoma. As a result, he needed to undergo an allogeneic stem cell transplant. Although his sister’s stem cells were not a match for his immune system, fortunately, a near-match was found from the National Marrow Donor Program registry.

After his transplant, Marc went through several difficult months, but slowly his new immune system began doing its job, and he had no evidence of recurrent lymphoma. Marc began to feel well enough, and it became safe enough, to resume his education and complete his degree, and most importantly to Marc, to get back to the sport he loved, surfing, and living his life.

Throughout his illness and therapy, Marc had used art as an outlet to deal with his diagnosis and recovery. When I was leaving Los Angeles to take a position at Mount Sinai Hospital in New York, Marc presented me with a print he had created titled “Land of the Blind.” It depicts a wrinkled, worn face resembling Marc (though he indicated to me he did not consciously intend for there to be a resemblance), blind in one eye, wearing a crown with a “king” label, which now hangs on my office wall. It is an allusion to Erasmus’ phrase, “In the land of the blind, the one-eyed man is king.”

What was the meaning of this image to Marc? Clearly, the face (perhaps subconsciously his face) depicted in the print has been through a struggle and looks aged, thin, and weary from that struggle. And yet, in terms of the overarching message, perhaps Marc’s message was that until we have all been through such a difficult ordeal, we are blind to the meaning and the essence of life. And he is no longer completely blind to the essence and meaning of life because he’s been through a life-threatening situation, so he feels he can grasp life a bit more robustly than everyone else and put things into perspective a little bit better. And yet, even with this ordeal, no one truly knows the meaning of life, hence, continuing to be blind in one eye. At least that is my interpretation of his print.

Patient/Physician/Cancer Survivor Bond

A few months into my new job, I got an e-mail from Marc. He was driving across the country in a truck. During the drive, he explored the towns and cities he passed through and visited national parks and other tourist attractions he passed along the way. He would surf when he had the opportunity and then sleep in his truck to help maximize his finances for the trip. This was the essence of who Marc was and is. He knew that he had an opportunity to do this trip and that it would allow him to see America and enjoy surfing along the way. And he knew he should take advantage of this opportunity while he was healthy and could enjoy the journey without worrying what the next day would bring, truly following the Latin maxim carpe diem (seize the day). Doing things a little bit on the fly, doing them off the beaten path, and doing them because it was something new, something enjoyable, and something educational.

Marc arrived in the Big Apple and wanted to drop by for a visit. We hugged when we saw each other and then reminisced about his experiences as a cancer patient and about the experiences I had shared with him regarding my own journey as a cancer patient 20 years earlier. There was no doubt that we had formed a patient and physician bond, but I sensed we had also developed a bond as two former cancer patients, both diagnosed at a young age. The difference of those 20 years from where Marc was in his life and in the healing process and where I was in my life truly put my role as a physician into focus and showed me how I gave meaning to my own diagnosis by becoming an oncologist and helping provide Marc and other patients the opportunity to overcome their cancers and to live, long, healthy, productive lives.

I asked Marc what his future plans were and he replied “I’m not sure yet.” He did indicate, however, that he would seek out something he enjoyed doing. A few years later, I decided to e-mail Marc and see what he was up to. It turns out he had just returned from spending several months in Indonesia. He had worked at a local electronics shop in California to earn money to go on this trip. He spent his time surfing and experiencing the local cuisine and culture. I found it quite apropos for Marc that he would go on this trip. Once again, he was seizing the day. “Carpe diem!”

Living in the Present

Some may wonder why Marc doesn’t settle down, get a steady job, and start a family. Maybe someday he will do all those things, but right now his experience as a cancer survivor has given him different priorities and perspective on life. After all he has been through, he wants to take advantage of every day.

I understand and appreciate Marc’s “live for the day” philosophy. And I’ve learned important lessons from him. We get so caught up in our busy lives sometimes we lose sight of the essence, the spice, and the meaning of life. We are so preoccupied with what we are supposed to be doing, we often miss out on what we would most like to be doing. And if it is possible to pursue the things we love, get out of our rut, and seize the day, then maybe we should.

Marc is a young man, and if his cancer stays in remission, he has his whole life ahead of him to do what he is “supposed to do.” That being said, none of us knows when the next tragedy in life may strike, so why not enjoy life to the fullest right now, while we are still healthy and can pursue our dreams?

Talking with Marc and reflecting on my own life choices have prompted me to look inward as well and to try to get out of my comfort zone a bit. I’ve also learned to appreciate the little things in life every day, whether it is talking with my parents over the phone, reading to my son, taking my daughter to school, treating the family to ice cream, or having a thought-provoking discussion with my wife.

Like Marc, I’m seizing every day. Carpe diem! ■

Dr. Steinberg is Assistant Professor in Medicine in the Division of Hematology-Oncology at Mount Sinai Hospital in New York.