Doctor Michael Engelberg is an oncologist of 40 years, based at Cedars-Sinai medical center in Los Angeles, California.
Aurora: Let’s say I’ve just been diagnosed with cancer, or another terminal illness. What should my first steps be?
Dr. Engelberg: I think what people do in that situation is gather a support team from their family and closest friends, to let their loved ones know what’s happening and that they’re going to be needing support. Particularly women come into appointments with a sister or good friends, who will never let them be alone with all this. I have a few patients who are show business women who have a community from networking and bring those friends with them to chemo so they’re not alone. I think it’s really crucial for a new cancer patient to have support from friends and family.
Recently, I was seeing a Korean patient who had five children — two daughters in St. Louis, a daughter in L.A., a son in New York, and a son in Seoul. There were always at least two of them with their father when he was in my office.
As a new patient, you won’t necessarily go through all the bullsh*t Kubler-Ross stages… but there is some truth in it. People with a terminal condition have a tendency to at first deny that they are dying, and accept it at a later stage. But it’s not my place to tell people what they should do. It’s never OK to hear something like that.
Aurora: Is it important to get a second opinion, as far as treatment is concerned?
Dr. Engelberg: No. If for a particular patient it’s necessary for his or her peace of mind, then get a second opinion. But almost always you will hear the same thing from anther doctor.
Aurora: Have there been any recent developments in cancer research?
Dr. Engelberg: There is always incremental progress. Last week, there was a meeting of the American Society of Clinical Oncologists (ASCO) in Chicago, and two important papers were presented; one about a new chemotherapy for melanoma that is dramatically better than anything we’ve had up until now, and one about new treatments for breast cancer that are dramatically better than anything we’ve had up until now. For high-risk women (such as those who have already had breast cancer, are obese, etc.), taking a drug called an aromatase inhibitor will put them at a much lower risk for this condition.
Aurora: Describe one or two of your most inspiring patients or experiences as an oncologist.
Dr. Engelberg: For me, the most gratifying experiences are the rare patients I actually cure. There are also patients who I put into remission for a number of years, who get a lot more life because of my treatment.
But for most patients, I make it easier for them to die and for their families to have them die. That is the most important role of an oncologist, I think. It’s not often acknowledged but it’s true. There’s an old expression: “nobody gets out of life alive.” My goal is to make dying OK.
Oftentimes, dying brings families together and that is inspiring to watch. For instance, the Korean family I mentioned. This man came to the U.S. to be a professor of ancient languages, married a Japanese-American woman, and had three daughters in St. Louis. Later on, they split up and he moved back to Korea, where he re-married to a Korean woman and had two sons in Seoul. So his two sets of children didn’t really know each other until his cancer brought them together as a family. I went to the funeral dinner and it was very touching. Because of his death, all of his children now have each other.
Aurora: What is your idea of a good death?
Dr. Engelberg: A good death is to die at 137 of what I call Red Sanders syndrome. Red Sanders was a famous football coach at UCLA and a very moral, extremely upright Christian man who died in bed with a hooker.
Aurora: *Ahem* …Seriously, you think that’s a good death?
Dr. Engelberg: Yes!
Aurora: OK, fine. What about for someone with cancer?
Dr. Engelberg: You should die at home, where you are much more comfortable and less frightened. There should be hospice nurses present, as well as loved ones. You should be on a morphine drip, with someone running it that isn’t afraid to keep you completely comfortable. You should drift away in a haze of narcotics.
After the patient dies, at least I get to say, “your loved one is not suffering anymore.”