March 17, 2007 - A Gap in the Record

Today, I officiate at a St. Patrick’s Day wedding ceremony. The couple chose this day to honor the bride’s Irish heritage, but they had an uninvited guest: a fellow Irishman named Murphy (as in Murphy’s Law – “If anything can go wrong, it will”).

Last night’s rehearsal took place in the middle of a Nor’easter – sleet, snow, high winds, the works. Not all the wedding party made it to the church, but enough did that we muddled through.

Today – the wedding day – one of the missing groomsmen never does arrive (airline flight canceled), the church roof springs a leak (melting ice dams) and the groom’s father arrives on crutches, having slipped on the ice outside his hotel and broken his ankle. Before the ceremony, Murphy’s Law ruled, but not after we got started. Everything goes just fine, from “On behalf of the families, I welcome you...” to “You may exchange a kiss.” I’m happy about this couple’s prospects. They’re fine people, and their unseasonably icy wedding day will provide some colorful stories at a future anniversary party.

Afterwards, I do as I usually do, and record the essential details in my pastoral record-book. This book is a sort of events diary, a log of significant liturgical occasions at which I’ve officiated. I started it years ago, before I was even ordained, on the advice of one of my mentors in ministry. It includes baptisms, weddings and funerals, as well as the titles and scripture texts of all my sermons. It’s an old-fashioned sort of record: pen-and-ink entries on archival-quality paper. No electronic data storage here (which, given the rapidly-evolving world of digital storage media, is a good thing).

Anyway, as I record the new entry, I notice there's a gap in the record. Between December 30, 2005 and June 10, 2006, there are no weddings. That period of time coincides with the months when I was undergoing chemotherapy.

I do something like a dozen weddings a year, on the average. It just so happened that, when I was diagnosed with cancer, I didn’t have any weddings on my calendar for many months. That was just as well, as it turned out – I didn’t have to call anyone and beg off. I didn’t accept any new wedding bookings for a while, directing all inquiries to Robin (our associate pastor). It’s hard to make firm commitments when you’re getting chemotherapy.

Now, my file of wedding applications at the church is bulging again. It’s another sign that life is returning to normal.

The gap in my pastoral record-book is a reminder of what I’ve had to go through, in this strange season of my life. The beginnings and endings of this season are indistinct; it took two or three months to diagnose the cancer, and even now I don’t know for sure whether I’m out of the woods. It was a time when nothing was happening, and everything was happening. I’m still living into a full realization of what it is I’ve been through, and am still going through.

March 14, 2007 - A Doctor Shortage?

News articles about the aging of my own "baby boomer" generation abound. The news media has been sounding that particular drumbeat for so long, I hardly notice it any more. Yet, one article I saw today made me sit up and take notice.

It comes from Newsweek, and has to do with a predicted shortage of oncologists in the years to come. It's not that the absolute numbers of these specialists is decreasing (although the article does talk about "a slowing growth in the supply"). The bigger issue is that the demand for their services is going up.

Three factors seem to be exacerbating the problem. First, as we boomers age, there are getting to be more older people in general – and we all know that, statistically speaking, the likelihood of contracting cancer increases with age. Second, people who do have cancer are living longer – a good thing, to be sure, but it also means that oncologists' relationships with their patients are continuing over much longer periods. Third, as cancer treatment becomes more complex, fewer and fewer family-practice physicians are directly involved in treating cancer patients. Nearly all cancer patients are now being referred to oncologists, who manage most aspects of their care.

As the doctor shortage worsens, it will become harder to get an appointment with an oncologist in the future. Some oncologists may begin referring patients back to their primary-care physicians for some aspects of their care, with the oncologist consulting from a distance – although the continuing trend toward highly-specialized cancer treatments makes this move problematic.

The Newsweek article also reports on a troubling personal characteristic of many younger doctors entering the oncology field today: they evidently don't have as strong a work ethic as their elders. Younger oncologists see significantly fewer patients per week, on the average. Some are intending to retire early, and others are seeking to work part-time during certain phases of their careers.

I'm aware of how hard Dr. Lerner works to keep up with his roster of patients – and, in talking with other cancer survivors, I hear similar stories about their own doctors. The need is great, and growing bigger all the time. The medical establishment is only just beginning to wake up to this looming problem, and to take steps to address it (increasing the number of oncology residency slots in teaching hospitals, for example).

A year ago, slogging though chemotherapy side effects, I was wondering whether my treatments would succeed in putting me into remission. The fact that I now have the luxury of worrying whether, years into the future, I'll still be able to get in to see my oncologist speaks volumes about how far I've come. Yet, it's a worry, all the same.