There is no life experience that can prepare one completely for the words from a physician like, "You have renal failure and will need dialysis." Or, "You have cancer and it is metastatic." In all the years that I have told countless numbers of patients dialysis would be needed, I silently admired them because I did not think I could ever endure hearing those or similarly fateful words.

To my horrid dismay, on the first of July, 1998, I had such an experience, as a routine chest x-ray revealed metastatic lesions in my lungs. It is amazing how rapidly we accept bad news and how we regroup to develop a strategy to cope with and overcome it.

The first thing I did was become disoriented. I actually got lost in the radiology department where I did my internship. But, after getting a grip, I grasped the resolve to fight this dragon.

There is no excuse for any patient not to have full information about every clinical trial, every protocol, the side effects and benefits of therapy. He or she has merely to push the correct keystrokes to become very informed. The National Library of Medicine’s PubMed was my first stop. I reviewed every possible scenario and therapeutic opportunity, and wanted to be secure in the choices of treatment that would be of the most benefit to me. Yahoo.com was an alternative source. I found my support group on ACOR, The Association of Cancer Online Resources, Inc., and the most valuable oncology resources on the Web. The ultimate source of knowledge is the experienced physician. Even doctors need doctors.

Except for the fact we are both fighting a bad disease, there is a world of difference between the nephrologist, your friendly supporter through the odyssey of dialysis and transplantation, and the oncologist. An oncologist today may on the surface be Marcus Welby. But, underneath that veneer of professional polish, lies a warrior. No Mr. Nice Guy to the chromosomally endowed little critters thinking of my lungs as a picnic site.

Today’s successful oncologist, at least in my case, is your military commando. His war is mitotic cancer cells. He comes in like a general with a battle plan, yes friendly and caring, but also firm and decisive. You are the battlefield and have been invaded by the enemy. His job is to pursue, attack and destroy the enemy, cut out the resistance, then spray again with Agent Orange or Adriamycin or some other certifiable poison until all remnants of the enemy, its family and friends, are dead. It is pure genocide, pure hatred and a military attitude that drives the best of oncologists. Do not let the fact that they may wear a button that says, "Searching for sushi" fool you - these men and women are Rambos. Once the beast is dead, cut off its blood supply. Then grow hair back and "have a nice life."

One of the most useful sources for me as a physician has been e-mail discussion groups. I have been around the world touting this message for NKF cyberNephrologyTM and the International Society of Nephrology. Our focus was establishing links to the famous nephrologist’s discussion (and sometimes support) group NEPHROL, headed by Dr. Kim Solez. I have always lurked on DIALYSIS and several patient groups, and even awarded NEPHROL and DIALYSIS the coveted Golden Nephron Awards based upon my impression of how useful they were to patients and nephrologists. Little did I know how truly valuable these are until I, too, got sick. My SARCOMA e-mail group is made up of a closeknit group of supporters. I have never seen, nor had the pleasure of smiling at or hugging one of them in person, but on the Web they are my special extended family. Support, prayers and information are at the heart of these groups, and there is one for you, regardless of your disease.

I have spent a tremendous percentage of my time telling my patients they needed to show up for dialysis, needed to stay for the full treatment. I have heard every type of excuse for cutting times and treatments. Some patients have cussed me out. One said, "Get out of my face." Another said, "You have no idea what it is like to go through this." I have sometimes become unpopular among patients because I would not accept the selfish remark, "It’s my life." My response, "But what about your wife, your children, grandchildren and your friends? It is selfish to rob them of your beauty just because you are too impatient to sit in a chair four hours."

Maybe it is fate, but my chemotherapy time was the exact time as my average patient’s dialysis - four hours. I went to a state hospital, and sometimes had to wait two and a half hours to be put on. I had a pesky pump as my companion, and either watched boring soap operas, read or slept. I could complain, laugh or cry.

There is only one thing and one thing only, I could not let myself do - cut my time short. There are no guarantees how we will respond to therapy, dialysis or infusions. The best we can do is follow recommendations because they are the results of past experiences and at least we have the benefit of pioneer patients that went three hours and five hours, and settled for four. With a great deal of humbleness and humility to my patients, I can now very safely proclaim, "It is a lot easier to be the doctor than the patients."

I also chose to let this experience become an eye opener for me - making me a better person. My partner and colleague for fifteen years told me, "God just gave you a speeding ticket."

We go through our lives in a work-sleep-work cycle. For me it is a work-Internet-sleep-work cycle. Pretty soon our kids are going to college, our hair is thinning. We forget how to live. We rush through life. Why do we do this? Each is endowed with a tremendous inability to see that we are mortal. We think life is endless, and that someday we can retire and then start to enjoy its full pleasures. Only when a close friend or loved one dies do we ever think about the possibility we may also die. But all too soon it’s off again to work-sleep-work-sleep. As tragic and horrible as it is to have any type of cancer, there is some good in that it serves as a reminder that every day is precious. We accelerate the parts of life that are enjoyable. We think about all the wonderful and fun things that we were going to do during retirement, and do them now.

So, dialysis patients, friends at Anderson and on the Web, and the rest of you, find what you enjoy the most and do it now. Do not wait to retire. There are wheelchair ramps and dialysis machines on most cruise lines. Your medical history is a keystroke away from a doctor in Paris, London or Bangkok. You can get excellent transient dialysis in Kathmandu. It is well worth it to have that future trip in mind when you are sitting in the chair for four hours.

Stephen Z. Fadem, MD, FASN, FACP, is Co-Medical Editor of aakpRENALIFE. He serves as a member of the AAKP Medical Advisory Board and is Vice President of the AAKP Board of Directors. Dr. Fadem is a practicing nephrologist in Houston. To read Dr. Fadem’s entire article about his cancer diagnosis, log onto Nephron.com.

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