The Pharmaceutical Journal
Vol 279 No 7469 p306
15 September 2007

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Emotion versus maturity

Counting the hidden cost of cancer care and treatment

An overture of last-minute brinkmanship

Growing older gracefully, one day at a time

Emotion versus maturity

My uncle was a world famous musician and screen writer with any number of musicals and revues under his belt. Once, when l was still a youngster, I wanted to impress him with my vast knowledge of music; after all I had passed “O”-level music.

I told him that although I loved listening to Ludwig Van Beethoven, especially his violin and piano concertos, I failed to understand what there was to appreciate or enjoy in Mozart’s music. I told him that it just left me cold.

His reply has stayed with me from that day to this. He answered that it all boils down to maturity.

“Beethoven wrote his music in such a way as to appeal to the emotions. Poignant and exciting music appeals to teenagers, who being less mature are easily touched and aroused,” explaining why his music spoke and appealed to me so much.

“On the other hand Wolfgang Amadeus Mozart is all about intellect and maturity. Maturity, by its very definition takes many years to develop, and so an appreciation of Mozart similarly takes time to cultivate.”

As I progressed in my career as a hospital pharmacist I realised that this analogy could easily be applied to the practice of my profession. Indeed I have used this story many times in a wide range of situations from lecturing at international pharmacy conferences to simply teaching individual pharmacists.

Shortly after becoming a registered hospital pharmacy addict, I moved into the field of cytotoxic reconstitution in far from ideal conditions. I had little or no knowledge of the inherent dangers involved and felt that government of professional guidelines only hampered my style. It was all enthusiasm (emotion if you like) to get on with the job.

The patient came first. It took 20 years of experience before I appreciated that guidelines exist to protect both the patient and the health care provider. It took some time before the intellect was able to harness the young enthusiasm and bring about a harmonious blend.

Young pharmacists of today should be taught to appreciate that working according to guidelines does not cramp their style but protects them and may even save their lives.

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Counting the hidden cost of cancer care and treatment

Being ill is an experience all of us would happily forfeit. If one has to be ill than at least let it be something not too serious.

The word “cancer” strikes fear in man’s heart. This dreaded disease is estimated to affect about one in four of the Western population at some time in their lives. The treatment options are not particularly enviable either: surgery, chemotherapy, radiotherapy, bone marrow transplantations etc.

These options usually involve many days of hospital care combined with all sorts of different tests, some more unpleasant than others. It is true, of course, that cancer has many survivors who have overcome both the disease and its treatment successfully, returning to their normal lives and regular routines — albeit rudely interrupted for maybe a year or more.

There is no doubt that overall the quality of life of cancer patients undergoing treatment leaves something to be desired. It happens sometimes that the extent of the ravage from the side effects of chemotherapy is really brought home to me.

Recently a friend told me that he still had to queue to have his passport stamped instead of using the fast-track-lane and his special smart card and fingerprint ID — an option open to his fellow countrymen. When I asked why, he smiled ruefully and explained that after receiving Oral 5-fluorouracil his skin peeled from his hands and he no longer had the same fingerprints.

I was dumbfounded to learn that even your “identity” can be erased by chemotherapy. It is, therefore, especially sad to read the results of research recently published in the Journal of the National Cancer Institute, which sheds new light on the human costs of cancer. It appears that cancer patients lose thousands of hours unnecessarily in hospital queues.

There are untold hours spent sitting in doctors’ waiting rooms, queuing for the CT scan and watching chemotherapy drip into veins. These hours do not include the time driving to medical appointments, waiting one’s turn, undergoing blood tests, scans or check ups.

Then there are the days spent at home in bed recovering from surgery or chemotherapy. Battling cancer steals a lot of time from the people who can least afford to lose it.

The study attempts to put a price on the time that people spend being treated for 11 of the most common cancers and comes a the staggering estimate of at least $2.3 billion for patients in the first year of treatment alone. The cost of treating cancer is more than just the expense of hospital stays and medication; there is also an expense due to the lost opportunities for patients.

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An overture of last-minute brinkmanship

Despite my deep admiration for Beethoven, who overcame his many disabilities and produced such amazingly beautiful, soul-stirring romantic music, my favourite musicians’ story revolves around Gioachino Rossini.

If the legends are true, Rossini was a real character. He was in the employ of the local baron, who paid him to write music for special occasions. He never failed to miss a deadline. When the time came to give out the score to the orchestra so that they could familiarise themselves with the music, nothing was ready.

On the day of the concert, nothing was ready. Two hours before the William Tell overture was to be played for the first time, nothing was ready.

Finally as the guests assembled in the concert hall the baron’s bodyguards broke down the door of Rossini’s room and dragged him to his carriage. Once in the carriage he scribbled a few notes. Then he entered the hall, threw the music to the orchestra and the William Tell overture was born — true last minute brinkmanship. A man after my own heart.

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Growing older gracefully, one day at a time

Baron de Rothschild’s widow, Lady Rothschild had reached the grand old age of 96. Her physician was attending to her on one of his regular house visits. After concluding his examination he turned to her and said: “You know my dear lady I cannot make you any younger.”

She smiled and replied: “My dear doctor I don’t wish to be any younger. I just want to get older, one day at a time!”