Family History of Cancer; BRCA mutations; The Second and Third Sisters

By Larry Puls @Larrypulsauthor

Sisters with Ovarian Cancer; Family History of Cancer

A year had passed. I had not forgotten the young woman who lost her battle to ovarian cancer. Her smile was still visible and I could almost recall her laugh. Thirty-two-year-old patients are particularly memorable. So few women die that young due to gynecologic malignancies. Many of the details about her final days were still fresh on my mind. In many ways, the more tragic the scenario, the more you remember. But her death in my career was not in vain, for I learned much about the chronic use of chemotherapy and its long term side effects. Things you don't always learn in training. She changed my style of practice. Her bone marrow death in the midst of treatment has to this day, influenced my use of drugs, their duration and their dosing, well past her life—even now. Her death I believe, has helped me help others.

Family History of Ovarian Cancer; A Tale of Three Sisters

By Larry Puls @larrypulsauthor

Family History of Cancer, Ovarian Cancer

By the early 90’s, oncologists had obviously observed for some time that certain families were far more affected by various malignancies than others. They knew intuitively that a gene, or genes, tied these cancers to the families, but that genetic component couldn't be readily identified by testing. Today, advances in the study of genetics is changing all of that, allowing us to frequently identify who might be at an increased risk for cancer, even before they develop one. The rapid discovery of new deleterious (bad) mutations allows us to identify individuals who are at an increased risk and to tell them what that risk is over the norm. Knowing this presents us with an opportunity to screen more effectively, to potentially intervene before the cancer starts, to counsel multiple generations within a family, and often prevent certain at risk members from losing their own lives secondary to a malignancy.

Cancer in Pregnancy; The End of Life; A Young Mother's Final Day

By Larry Puls @larrypulsauthor

The Death of a Mother

I walk into the room and cannot even recognize her face anymore. How far we have come over the last two years. Laying there, I see a very thin layer of skin covering her collar bone, painted with an ashen pallor. A physician's heart is crumbling. I conclude the end is very near. My desire is to leave the room. My job is to stay by her side. The smell of death is unforgettable.

I pull back the bandage and stare at her wound. There, gazing back at me is the enemy, the cancer, the "small cells" I could not eradicate—though for two years I tried—in fact, many of us tried. Looking at the wound, I see the pulsating beat of the major artery moving her skin up and down, up and down, surrounded by the advancing malignancy. Her pain meds have rendered her groggy and minimally verbal, but at least she looks comfortable. She wakes up enough to ask about end points, about timing of other treatment, about whether or not I have further plans for her. I don’t honestly want to answer those questions. How do you say "I have run out of plans"? I have no other magic pills, magic bullets, magic cocktails. I can only wait. And wait for what? I just can't verbalize that, since I don't want to think about what is to come. God is totally in control of all things now—and always has been, lest I think differently. But what I do know, from where I stand, is that there is very little time left--and that the life here before me is hanging on the edge.

Cervical Cancer, Recurrence of Cancer, A Young Mother's Story

by Larry Puls @larrypulsauthor

Recurrence of Cancer for Young Mom

Two weeks after the cesarean and her lymph node dissection, she comes back to see me. Before we discuss the tough stuff, she proudly shows me her child. Looking down at the sleeping baby, I wonder how will I explain eight positive lymph nodes, the small cell carcinoma, and give hope all in the same breath. The little girl looks so peaceful, dreaming childhood dreams. Deep slumber. An amazing gift. Her understanding of her mom’s situation will not come for years. And I question if she will ever really know her mom--or remember what she looked like. Time will answer that. Yet I know intuitively her pressing journey is about to begin, and it will be every bit as taxing as childrearing. She will need God-given strength for the marathon of therapy facing her... “Where do we go from here?” she asks. Where do we start? I ponder my first words.

Cancer in Pregnancy; A Young Mother Fights for Her Life

by Larry Puls @larrypulsauthor

Pregnancy and Cancer

Even now, I still remember the unspeakable sadness and the tragic outcome. It was twenty years ago, and counting. The events still flash back into my mind every time I walk onto the floor where the saga culminated... And ended... The beginning of the two-year journey started something like this--as my mind remembers it anyway: A colleague called and asked me to see a patient she believed had cancer... And was thirty-six weeks pregnant. 

Within an hour, a young woman walked into our facility. She was graced with beautiful long blonde hair, a subtle trace of a German accent, and a very gravid abdomen. Her pleasant smile and handshake could not hide the trepidation I sensed was trickling through her veins. I'm just sure that that morning when she woke, her life had felt so full of promise. And now in the blink of an eye, it was marked with a growing sense of uncertainty.

A Gun in the Hospital; A Shooting

by Larry Puls @larrypulsauthor

Medical School, Fear

Kaboom... Kaboom... Kaboom...

A tsunami of terrified people running in every direction, some left, some straight, some right. We suddenly see them bounding into our hallway packed with gurneys, equipment, and injured human lives. Twenty or so people, fleeing towards us into a "safe" zone. Who could possibly know how safe it would prove to be? The wave of frantic runners was stirring up increasing chaos. Panic that stimulated more panic. All the frightened individuals were now engaged in a game of musical rooms, trying to secure safe places for themselves. Someone bad must be stalking the ER and we were all in harm's way. Fears forced the treatment room doors open. People dove in, and then barricaded themselves inside respective fortresses. My first patient was no exception, flying off his table as well, with his stitch and needle swinging from his arm. Desperation was plastered on his face, on every face.

Run for Your Life; Who Said Medical Education Was Worth Dying For?

By Larry Puls @larrypulsauthor

Medical Education, A Brush with Death

Three AM. The witching hour. I was twenty-four, naïve, roaming the hallowed halls of Parkland Hospital, trying to piece together what I’d learned from my first two years of medical school. Living on short naps. Living on a hope that one day, all of this would make sense. Our team’s mantra was, "sleep is for the weak". I think that’s how it went. Such a different world back then.

We finished rounding. Yes, three AM. Did I say that already? Do patients really want to be seen then? Mine was not to reason why, mine was but to do and (?)... Concluding the floor work, I was hopeful I might slip off and sneak a little sleep before prepping for “morning” rounds. But that thought disappeared with a phone call, a pleading request. Help was needed down in the Emergency Department. A backlog of cases had been created by the nebulous Dallas Knife and Gun Club—or so it seemed. My next three hours had just been defined. Not going to be pretty.