Category: Guest Column

Tech Notes: Backing Up Your Data

droze header SAVE
Backing Up Your Data

File backup is probably the most important thing when we talk about the gadgets and computers we use nowadays. However, there are many ways to back up with pros and cons for each type. All backup strategies can fall under one of two ty
pes:

‐Local Backup : this means your data is backed up to another device that is physically with you. Whether it is an external hard drive, USB flash drive, CD or DVD, or SD Card, you can physically touch and hold these devices.

‐Pros : generally cheaper. More control. Not vulnerable to security breaches.

‐Cons : more room for error, less automated, can be stolen, misplaced, or damagaged.

‐Cloud Backup : this means your data is backed up “off site” to another system out in cyberspace.

‐Pros : More automated. Less Room for User error. Good if your place has been damaged by fire, electrical or flood or a victim of theft. No hardware to buy.

‐Cons : more expensive in the long run.  A little less control of your data. More vulnerable to security issues/breaches.

Let’s talk about the different devices we need to backup:

‐Computers (PC or Mac) – can be backed up locally using built in software (Apple – Time Machine, found in Preferences or Windows – Windows Backup – found in Control Panel) or you can sign up with a 3rd Party Cloud Backup (Carbonite – http://www.carbonite.com or Mozy – http://www.mozy.com)

‐Smart Phones and Tablets (Androids, iPhones, iPads, iWatch) – generally easier to back them up using the Cloud (Apple products – Settings >> iCloud >> Backup or Androids ‐ Settings > Accounts > Google account > Settings > Backup & Reset).

However, it’s a good idea to also occasionally backup these devices locally to your PC or Mac. For Apple products, plug your device in using it’s charger/sync cable and open iTunes. Find your device on the left hand side and click Back Up Now under Manual Backup. For Androids, plug your device into your Computer and go to Explorer >> Look for the SD Card and Drag it to your Desktop to create local backup.

When many of our customers have run out of room on their computers, they purchase an External Hard Drive or Flash Drive and offload some files (photos, documents, etc) to these devices in an effort to free up space on their systems. That’s a great idea in theory, but, if you move those files to an external hard drive, that means there’s still only one copy of those moved files. If that external hard drive dies, or flash drive gets broken, (which can and does happen), you still don’t have a second copy of those files. Be careful when doing this.

For our many Apple products (iPads and iPhones) we highly recommend upgrading to the 50GB iCloud package through Apple (.99 cents). With 50GB, that will backup all data on most users devices, unless you are a very heavy photos and videos user, then you may need more Cloud space to accommodate the space needed to backup these types of files.

Finally, concerning local backups, it might be a good idea to keep your backup device in a separate place in the house when not in use. If fire, water, or electrical damage or theft were to occur, you lessen the chances that both your computer and backup are damaged simultaneously. It would be similar to having your house key and the spare key on the same key ring. Just not good common sense!

-Submitted by Chad Droze

http://www.compu‐experts.com and http://www.twitter.com/c0mpuexperts
Post and Computer Center (Freshfields Village)

Tech Talk: Solving Common Network Issues

ChadDrozeHello Seabrook. This is my first post to Tidelines. I am glad to be a part of this very informative blog and I hope I can contribute to your knowledge of “all things tech.” My intention is to briefly teach topics and share news about all different types of technology.

Since technology is what I deal with everyday in my job (both my own technology and my customer’s gadgets and gizmos), there’s a bunch of stuff that I intend to discuss in each entry to the blog. Unlike the tech forums that I host at the Lake House (which tend to focus on the iPhone and iPad devices), the blog will allow me to speak on a wide variety of topics.

I figured I’d start off by talking about something Mark and I deal with on a daily basis. We’ll get the call and it usually starts out the same way each time – “Chad, I can’t get online. HELP!” And of course, it’s right when you need to send an important email or get online and pay an important bill.

We’ve done this enough times that we could do this in our sleep. Many times, if the customer is able and willing, they can repair the problem themselves. The first step is identifying where in your home your network begins. You’ll want to start here and work your way down. Here is a step-by-step guide to repairing the problem.

1) Identify the location of your Modem and Router. Sometimes these may be two separate boxes, or it may be one box (we call this a Gateway). A Gateway is a box that is a modem as well as a router all-in-one box. Once you’ve identified these devices (labeling them with a post-it note is a good idea).

2) Unplug only the Power cable on your modem (or your Gateway). This is usually a black cable going from the device to the power outlet. I tend to reach around the back of the device and feel for the cable. Pull it out. If the lights go out on the front of the device, then you’ve pulled the right one. There’s never any risk pulling the power cable from these devices. If the device fails to turn off, it may have a battery that needs to be pulled out as well. The trick is, to get all lights to turn off to remove all power from the device.

3) After a few seconds of being off, plug the cord back in. Give it 2-3 minutes for the lights to slowly come back on. (If you see no lights on, you have a power problem, or a dead device) While you wait, proceed to the next step.

4) Repeat steps 2 & 3 if you have a router. The lights will slowly come back on (again, if no lights appear, you have a power problem, or the device is dead)

5) Next, you need to fully turn off all devices that use the Internet. I stress the work “fully” because on tablets and phones, simply putting the device to sleep isn’t enough. You must hold the power button down on the device and shut them down. For computers and laptops, shut them off by clicking Shut Down on the screen. For printers and other devices (Smart TV’s for example), press the power button to shut them down.

6) Turn all the devices back on. This will force them to establish a fresh connection to the network (either Wirelessly or Hard Wired). Be patient as the devices need some time to boot up.

7) Try to open your Internet browser and see if Internet has been restored. Either open a webpage and see if it comes up, or go into your email and see if new email comes in.

By the way, the same steps can be performed if suddenly your wireless printer stops printing. Generally, the router, the printer, or the computer/tablet/phone, (or all three) has become unstable and needs a reboot.

Pulling the power cable does not erase any important data from the device. There are usually factory-reset buttons on routers and modems but you want to be careful not to press those (unless you are advised to). Luckily those are harder to press on accident, as you need a paper clip or pin to press those buttons.

If you’ve done all the steps and still cannot access the internet, then you may have a bigger problem. It could be an outage in the area, at which point all you can do is wait for the ISP (Internet Service Provider – aka Comcast, AT&T) to repair the problem.

If an outage is not the problem, then you have a deeper issue that rebooting devices will not fix.

Submitted by Chad Droze, Post and Computer Center (Freshfields Village)

Introduction to Chad Droze, New Tidelines Columnist

ChadDrozeWe at Tidelines are delighted to introduce you to Chad Droze, someone many of you may know if you have attended any Seabrook Tech Forums where Chad has described how to use your computer, phone or tablet.   He will become a twice a month contributor to Tidelines, starting at the end of June.

Dennis Pescitelli and I met with Chad at his office in Freshfields Village.  We discussed the kinds of articles he might think about writing.  The rising cost of cable came up and what your options might be in this category.  He will write on new and interesting apps and how they could be useful to you. He talked about discussing wearables such as Fit Bit versus the Apple Watch.  He will do forum follow-ups, home security issues and even wireless systems that allow you to set up a wireless network throughout your house.

Chad has a Computer Science and Math degree from Charleston Southern.  He has been with the company, Post and Computer Center, for some eleven years.  His expertise is in both Apple and Microsoft systems. In addition to computer expertise, he also sells chargers, printers ink and cable hook up devices, which will save you a trip into town in case you need any of them.

He has become well known in Seabrook as the forums he conducts are always packed.  We look forward to having him as a regularly contributing editor to Tidelines.

– Barbara Burgess, Tidelines Writer

Seabrook March Blog

Seabrook Island resident and guest columnist continues his series of blog posts on critical issues in the practice of modern medicine. —Tidelines Editors

header sessions

Pregnancy and Concurrent Maternal Cancer

Last month, I wrote about modern revisions of the ancient Hippocratic Oath, and in closing that essay I mentioned that this month’s blog would delve into one of the most contentious of contemporary debates – abortion – an act specifically banned by the Oath. Abortion is the sine qua non of societal divide – a topic that bring up intense feelings and deep differences, none of which can be reconciled by this author. Since my areas of expertise are less cerebral, I will not presume to discuss the right or wrong of the subject, but will only touch on it as it pertains to the issues about which I usually write. Bottom line = pregnancy and cancer are not mutually exclusive; pregnant patients sometimes develop cancer, and cancer patients sometimes become pregnant. With the uncommon exception of serious surgical emergencies, the dilemma is unique in all of medicine. Thankfully the situation is encountered infrequently, but when it does happen, the oncologist’s responsibilities differ from that of the obstetrician – the latter has two primary patients.

One of the important themes in the core of my writings thusfar has been the importance of patients’ trust of their doctor because of that trust, an enormous responsibility is de facto bestowed on the physician. The physician must be careful to give advice that is totally unselfish and is in the best interest of the patient; that is to say, is based on beneficence. So while it is correct to be forthright in telling a patient what you would recommend for your own family, it is entirely inappropriate to exceed that in an attempt to convince the patient to breach her own moral code on something as important as the termination of a pregnancy. To paraphrase an old cliché: be careful what you recommend to people, they may do it. And once it is done, you own part of the consequences. Over many years of dealing with patients, I have come to realize that most cancer physicians don’t begin to realize how powerful their influence really is. Frightened patients are especially vulnerable, and when a trusted physician pushes in one direction, real power is in play. This is especially problematic in a pregnant woman who has cancer. There are conflicts within such a patient that are almost unimaginable. In a way, the primordial instincts of maternal protectiveness are juxtaposed to the equally primordial instinct for self-survival, and when one adds the woman’s sense of responsibility to her other children and her spouse, the dilemma can be paralytic. In this particular situation, parents and spouse are often unhelpful, since, understandably, their concern is more often than not skewed in favor of the mother. Thus, the trusted physician has extraordinary influence over a frightened patient, and it must never be exploited to promote values that are not beneficent. To do so is a form of betrayal.

A vigorous and often contentious debate continues within American society over the issue of whether an abortion is ever justified. Even though the United States Supreme Court has upheld a woman’s right to choose in Roe v Wade,2 there remains a large segment of the population that feels otherwise. In fact, a Gallup poll done in May 2009 reported that 51 percent of Americans polled call themselves pro-life (antiabortion) rather than pro-choice (mother’s choice) on the issue of abortion. An April 2009 Pew Research Center poll showed a softening of support for legalized abortion compared to the previous years of polling. People who said they support abortion in all or most cases dropped from 54 percent in 2008 to 46 percent in 2009. That the country is deeply divided over the legality of abortion is reflected by the fact that 23 percent of those polled in the Gallup study say it should never be legal and 22 percent say it should be legal under all circumstances.

As part of medical training, doctors are conditioned to sights and occurrences that repel lay people—autopsies, cadaver dissections, gruesome trauma, and so on—that type of conditioning goes with the territory and is unavoidable, even desirable. It is critical, however, that doctors not allow this state of societal desensitization to advance to the point of tolerance for that which is clearly wrong. As a means of lending realism to the possibility of insidiously crossing that line, one needs look no further than the shameful complicity of physicians with Nazi sadism in the 1930s and 1940s, when medical experimentation and murder were imposed on Gypsies, Jews, the disabled, the retarded, and others. Before that, during the 1920es in which the desensitization that resulted from the practice of eugenics, set the stage for the psychopathy of Nazism. As it pertains to the discussion of abortion in the United States, even though the pro-choice faction prefers not to discuss this issue in the same context as euthanasia and capital punishment, in fact the outcomes are the essentially the same. Attempting to justify any one of the three—abortion, euthanasia, or capital punishment—by minimizing the solemnity of the action is to wrap the issue in a type of intellectual delusion that diminishes the sanctity of life.

Importantly, the medical profession, however, must neither passively nor actively encourage further erosion of the value that our society assigns to human life. In saying this, I am reminded of the words of the British author, John Donne (1572–1631) that were put in a modern form by Ernest Hemingway, “Any man’s death diminishes me, because I am involved in Mankind; and therefore never send to know for whom the bell tolls; it tolls for thee.”1 I remind the reader that this author neither advocates nor opposes in this writing – instead it is meant to stimulate thought and discussion of this extraordinary topic.

When a pregnant woman develops cancer, or when a cancer patient who is under treatment becomes pregnant, those that advocate therapeutic abortion justify it because of their concern that the cancer treatment places the unborn child at risk of serious birth defects or mental damage or that optimal treatment of the mother is compromised by the pregnancy. This posture is abhorrent to many, however, and Roman Catholic doctrine unequivocally refutes it. Even though the issues of birth defects and fetal injuries from nuclear energy and anesthetic and chemotherapeutic agents are far more than theoretical, and are real possibilities with which the physician and the family must deal, the orthodox pro-life way of thinking contends that possible or even probable injury to a fetus does not legitimize its eradication. To protect victims from potential harm by killing them is counterintuitive. The very basic question in this line of thinking: Is there harm worse than death?

However, because pregnancy and cancer are not mutually exclusive, and when a pregnant woman develops cancer, or when a cancer patient becomes pregnant, heart-wrenching decisions are sometimes required. In this circumstance, there is no place for an indecisive cancer doctor. In such an undesirable situation, it is not enough for the doctor to say, “Here are your options, but I don’t have a recommendation—what you do, is up to you.” Of course, it is “up to you,” but in this situation a pregnant cancer patient is dominated by family and social influences, their own considerable fear of cancer, their preconditioning regarding the morality of abortion, and the hormonal instincts to protect the pregnancy that result from millions of years of evolution. For the cancer physician not to offer clear advice that might help a woman decide what to do is to shirk an important responsibility.

Despite the fact that the “right” or the “wrong” of the matter depends on personal beliefs of the patient, it is incumbent on the cancer physician to lead the discussion, and in the process of doing that, lend their own opinion on the matter. The hardest question for the physician is “Doctor, what would you advise if this occurred in your family. Would you recommend that the pregnancy be terminated if I were your daughter?” In other words, the physician should weigh in on the discussion, and above all, be able to answer the very fair question that I have just theorized. It is important to distinguish what I might recommend and what one of my daughters would actually do. As intelligent and independent individuals, they would, of course, decide that on their own.

My next essay will expand on this topic, and in order not to diminish the momentum of what is written here, I will put it forth sooner than usual.

—Roy B. Sessions, MD, FACS

Seabrook Island, SC

References:

1. John Donne, quoted in preface of Ernest Hemingway, For Whom the Bell Tolls (New York: P.F. Collier and Son, 1940).

2. Roe v. Wade, 410 U.S. 113 (1973)

Guest Columnist Dr. Roy Sessions on the Hippocratic Oath in Modern Medicine

Seabrook Island resident and guest columnist continues his series of blog posts on critical issues in the practice of modern medicine. —Tidelines Editors

header sessions

A Practical Adaptation of an Ancient Oath in Search for Modern Relevance 

Times are changing = the understatement of the year, and hardly a surprise!  It’s probably safe to say that this cliché is especially applicable to what we euphemistically call the American Medical System.  In January, when I departed somewhat from the usual style of this blog, I promised to come back to cancer related issues in the future, and I will – but not just yet.

Other things have been on my mind as of late, and I want to explore several contemporary medically related topics for the next several blogs; however not in the usual way that concerns the mechanics of the system – Medicaid, Medicare, Obamacare, etc.  Instead I want to discuss certain behavioral matters from an historical and ethical perspective, hopefully catalyzing thought and discussion about topics that often stimulate strong individual feelings. The reader should think of this as food for thought and discussion, and in no way advocacy or opposition on my part. Let’s go back in time for the foundation for this discussion.  Continue reading “Guest Columnist Dr. Roy Sessions on the Hippocratic Oath in Modern Medicine”

Guest Columnist Roy Sessions, M.D. – Protecting the Educational Process

header sessions

Protecting The Educational Process: Capitalizing on the Gene Pool

“He plants trees to benefit another generation”
—Caecilius Statius, quoted by Cicero

My goal today – somewhat of a change of pace – is to express some of my thoughts on education; and while this piece is slanted to medical education, it could well be directed to other venues, because it involves selection, mentorship, and the basis of leadership. In recent blogs, we have discussed some pretty sober topics – suicide, failure of cancer treatment, and others – and I’ll get back to that type of subject matter in due course. Starting out the new year, however, in an upbeat and futuristic way seems like a good idea – at a minimum, I asked your indulgence for this change of course. Continue reading “Guest Columnist Roy Sessions, M.D. – Protecting the Educational Process”

Classic Novels from the British Library

header indigo book bag

The early half of the twentieth century was the “Golden Age” of mystery and crime writing in Great Britain.  Indeed, one of the most famous and prolific British writers, Agatha Christie, and her novels still epitomize British detective fiction.  The British Library began to identify other writers of that era who were immensely popular but did not have the robust body of work like Lady Agatha or who had disappeared from the ranks of popular writers.  The books were collected into the British Crime Classic series and the British Library Spy Classics series.  In 2015, Poisoned Pen Press began to publish and distribute the titles in this country.

As one would expect, these are quintessentially British, full of manors and the countryside and the rough East End of London–all within the context of the 20’s, 30’s and 40’s.  The stories range from traditional village cozies to closed room puzzlers to spy thrillers, intriguing and engaging stories told with the sensibilities of a different age.

Stories aside, I love the covers of these books!  They are certainly of the period and resemble vintage poster art in many cases.  They are the perfect lure into the stories inside.

Several titles have already been released and more will be issued during 2016.

Submitted by Indigo Books

Gardening with Native Plants – Fall Color

header gardening with native plants

FALL COLOR

Upon moving to the Lowcountry, many of us miss the brilliant fall colors of the trees in our former location. We have some Sweetgums, Hickories, the occasional Dogwood and a few other trees with fall displays, but we just do not have the diversity and intensity of tree color that many areas have. This does not mean, however, that our Lowcountry landscapes must be completely devoid of fall color.

unnamed-12
As this photograph of Sweetgrass in the morning dew taken by Patricia Schaeffer demonstrates, we do have some unique fall color of our own. Our native Sweetgrass, or Purple Muhly, (Muhlenbergia filipes) displays its stunning purple to pink panicles from unnamed-11October to November. It is ideally suited to our soils, is pest free, and, although it appreciates some supplemental water during very dry summer periods, is drought tolerant. It even grows naturally in the rear sand dunes along the Bobcat Dunes Nature Trail. It is a true icon of fall in the Lowcountry.

SUMAC&GROUNDSEL
The combination of Winged Sumac (Rhus copallina) and the Groundsel Bush (Baccharis halimifolia) provides a brilliant red and white fall display that would excite many college football fans. Winged Sumac ( not to be confused with the non­related Poison Sumac) is a 10’­20’ deciduous tree whose lustrous green leaves turn a brilliant red in the fall. The non­distinctive greenish­yellow flowers of summer produce panicles of reddish­brown fruit which serves as fall food for many birds and small mammals. Since Winged Sumac readily spreads into dense clusters through shallow roots, it is best planted in a natural area where it has some space.

Groundsel Bush is a 5’­10’ evergreen, oval to rounded shrub with soft gray­green leaves. The greenish­white flowers of the female plant explode into a white, cotton­like froth enveloping the plant in the fall. The male plant flowers are not nearly as showy as the female’s but are one of the most highly preferred nectar sources for the Monarch Butterfly. The blooms are available just in time for the peak migration period of the Monarch over Seabrook Island in October.

Both Winged Sumac and Groundsel Bush are comfortable in our soils and do not require a lot of water. Groundsel is very salt tolerant and is often found adjacent to our salt marshes. Groundsel is very deer resistant but deer do occasionally browse on Sumac.

BALD CYPRESSOne of the few conifers that looses its needles in the fall, Bald Cypress (Taxodium distichum) provides an impressive fall color display of russet to orange­ brown. It is a conical shaped tree that can reach a height of over 100’ over its very long life­span. The second oldest Bald Cypress in the U.S. is a 1,500 year old specimen growing in South Carolina’s Beidler Forest. Like the plants discussed above, the tree does well in our soils but generally prefers more water. It is frequently found in nature in and around fresh water swamps but adapts very well to a landscaped environment. Bald Cypress can tolerate standing water for an extended period of time. With the recent deluge, we were reminded that this can be a very important characteristic for a plant to have on Seabrook Island. The limbs of the Bald Cypress are very flexible and will not break off in hurricane winds as easily as those of pine trees do. The plant is also deer resistant and relatively pest free.

Continue reading “Gardening with Native Plants – Fall Color”

Guest Columnist Roy Sessions, M.D. – When Cancer Treatment has Failed

header sessions

 

 

WHEN CANCER TREATMENT HAS FAILED!

When it becomes obvious that cancer treatment has failed, the patient and family not uncommonly feel anger for the medical team; however, with a mature response to this emotion, the doctor is usually able to make the point that the cancer, not the team, is the enemy. The key to overcoming this initial response to failure is for the physician to have established early on a trusting and affectionate relationship with the patient and family—ideally, starting at the time of the first office visit. The building blocks of enduring trust between patient and doctor are laid early and are based on a number of factors: having correctly identified the enemy and having established a doctor­patient alliance in the fight against that enemy (“we are in this together”); the continued nourishment of the partnership by physician availability; consistent compassion and sincerity; patient education; and finally, the comfort of the patient and family in knowing that they will not be abandoned, no matter the outcome.

Lest the reader underestimate the importance of this last thought, I should say that when dealing with cancer, the most deeply felt component of the physician­-patient relationship is trust—not just in the truthfulness of the doctor but, just as important, in the patient’s confidence that the caregiver be there until the end. It is an understatement to say that a pervasive fear— sometimes subliminal and sometimes overt—of most cancer patients that they will be abandoned. On many occasions, I have felt my own inadvertent emotional separation occurring when I realized that a patient’s situation was hopeless. Yes, there are even occasions when one begins to pull away without even realizing it. The members of the cancer team share this vulnerability to inadvertent emotional detachment as death approaches.

When I was doing ground­work for a book I later wrote, I sought to separate this topic from the theoretical by interviewing a number of families of deceased cancer patients. Many—not a random few—remarked how they had felt the oncologist had emotionally withdrawn from their loved one as the end approached. In reflecting on this, I choose to believe this is more often than not an unintentional slight that represents a human instincts spawned from self-­protectiveness. Being explainable, however, doesn’t make it right; all members of the team, especially the lead oncologist, must be vigilant not to let this happen. The dying and their families are keenly sensitive about this subject.

Confession is good for soul, so if the readers will grant me the latitude of self­-revelation, I’ll tell a story that saddens me even today. Late in my career, a delightful nineteen­ year­-old woman (I’ll call her Angela), was referred to me for treatment of a high­-grade salivary gland malignancy. Despite the lack of evidence of metastasis, her prognosis was guarded because of the normal behavior of this particular type of tumor. While frightened, Angela was optimistic and filled with idealism and hope. The intimacy and love between her and her accompanying parents were something to envy. In fact, she reminded me of one of my own daughters— that alone led me to an almost instant bond with her. The cancer strategy was outlined in an upbeat conversation—surgery followed by postoperative radiation. Everything went without a hitch, and even ten months later, there was no evidence of disease­ all seemed OK. In the meantime, I had come to a state of real mutual affection with the whole family. Their emotional Italian dealings with me were loving, demonstrative, and filled with heartwarming hugs, small presents such as food, and things for my wife—you get the picture. Angela had gone back to college and was moving on with the verve of youthful optimism.

The sudden thunder of realization came, however, at the one­-year visit, when the CT scan showed lung metastasis. All was well at the surgical site ­ we had apparently won the head and neck battle, but given the fact that there was no effective drug for this particular type of tumor, the lung metastasis heralded almost certain overall defeat. Giving up was not on Angela’s agenda, however, and during the ensuing year of chemotherapy, this young woman repeatedly demonstrated extraordinary courage. She comforted her parents, and even periodically gave her doctors a pat on the back for encouragement. When the relentlessness of the cancer became obvious, in an attempt to respect her adulthood, I sat with her and talked about death and dying. This young woman was intelligent and, as it turned out, had not been deceived by blind optimism. I proceeded to assure her that I would stick with her until the end. Angela died some months later, at home, surrounded by those she loved—cachectic and exhausted— but still of brave countenance.

The point of this story is to confess two things: first, the chemotherapy made her feel terrible, and the whole medical team knew it would be ineffective. Perhaps we should have let her get the most out of the last part of her life unencumbered by nausea, hair loss, and other unpleasantness; second, as I look back on that time after the discovery of recurrence—when the outlook was clear—I realize that despite my awareness of the tendency to emotionally pull away, and despite my admonition in this writing to guard against doing so, in this particular patient, that’s exactly what happened. This despite my having tried to compensate and cover up the inexorable force of the self­protectiveness that was having its way with me. This young woman had easily found residence in my heart, and when she died, my wife grieved with me, since she knew the whole story. We attended the wake*, which was on Long Island. The greetings were as one might expect—emotional and tearful. During an embrace, Angela’s father told me how happy they were to see me, because they had sensed that I had separated from them, and that perhaps, I didn’t feel the same as before. My attendance, and especially the accompaniment of my wife, had reaffirmed their daughter’s importance to me. Aside from the guilt associated with the accuracy of their instincts, I was blown away by the realization that the family—and almost certainly the patient—had sensed that which I did not even realize myself. I was reminded of the importance of my original commitment to the patient and the family. They really had heard what I said many months before when I pontificated about my staying power. More than any other of my experiences, this story verifies the fact that the dying and their families are keenly sensitive to a doctor’s instinct to pull away. As I reflect on this, it is sobering that after many years of caring for cancer patients and after so many “death experiences”, I was once again forced to come to grips with the extraordinary weightiness of my life’s work.

The notion of the cancer team doctor remaining in attendance until death is obviously an ideal, and when geography allows it, there does exists a solemn responsibility for that doctor to remain in attendance if in the hospital, or in touch until death if at home or hospice. The practical implementation of this is not always possible, however, because cancer patients are often referred from their hometown setting into an urban medical center for treatment. When this is the circumstance, the local physicians have to do the best they can with the resources available.

As our sophistication in cancer management has matured, the concept of the cancer team in the cancer center has developed such that now it is virtually the gold standard. Despite the fact that there are many excellent physicians and surgeons in smaller towns, oncologists tend to congregate in the medical centers, where they are part of a multidisciplinary team. Following treatment, those patients who have come from afar are at home under the care of the referring physicians, except for the regularly scheduled follow­up visits with the treating team. When treatment fails, the responsibility for terminal care usually falls on the referring physician. It is impractical for dying patients to relocate to be near the cancer team that treated them, and more importantly, they generally prefer to remain in a familiar setting for the final chapter of their lives. For the cancer specialist to depend on the referring doctor at this stage is not a violation of the covenant with the patient, such as would be the case if the patient lived and died within the practice territory of the cancer physician.

Depending on the locations involved, the same problem occurs when the patient is referred into the hospice setting. In those circumstances, the patient is back in the care of the referring physician, with whom the patient and family have a relationship. The important thing in these circumstances is that the cancer team members see the matter through to its conclusion when possible, even if it is only through communication with the medical and hospice people.

Roy B. Sessions, MD, FACS Seabrook Island, SC

  •  The wake is a medieval custom, not necessarily of Roman Catholic creation, but one that is perpetuated in contemporary Catholic funeral ritual, in which a watch or vigil over the body of the deceased is held before burial. In times prior to modern transportation, a period of days or more were allotted for family members and friends to travel from afar to attend the funeral procession. During that time, the body of the deceased is displayed around the clock in the funeral parlor, usually with a family member in attendance. By contrast, traditional Judaism requires a burial shortly after death, and the ritual equivalent to the wake is known in Hebrew as the shivah – a period of mourning in which friends and family visit the survivors of the deceased in a social venue, without the deceased. The verb is utilized in the the expression “to sit shivah”.