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Doctors who treat terminally ill balance composure, compassion

Oncologists show strength for patient and hide their heartbreak.

By Jacob Bennett

Evansville Courier & Press

EVANSVILLE, Ind. — Johnny Phillips would die, and Dr. Daniel Shirey couldn’t save him. He would give Phillips some pain medicine and try to make him comfortable for the next few months. But eventually, his cancer would kill him.

Phillips thanked his doctor.

“He said, ‘Even though there’s nothing he can do for me, he really cares about me,’” said Phillips’ wife, Anita, 63, who is now seeing Shirey for her own cancer, which started in her right breast.

“He makes you really feel like when he’s talking to you, you know he’s got gobs and gobs of patients, but I feel like he wasn’t thinking about anyone else.”

Such is the delicate balancing act of oncologists, who must be pillars of gentle guidance as they deliver verdicts of life and death. In doing so, oncologists become closer to their patients than perhaps any other type of doctor, said Kathy Dockery, president of the Greater Evansville Affiliate of the Susan G. Komen Breast Cancer Foundation. Patients often contact their oncologists on nights and weekends, when they have questions, when they have unfamiliar symptoms and when they need reassurance.

Shirey, an oncologist for 25 years who has partnered with nurse practitioner Kelli Dempsey for six years, often offers advice that is not only medical, but is useful in tying up the legal business of dying.

“I go home just dragging most days, both emotionally and physically, but I feel like I really helped people,” said Dempsey, 48, of Evansville.

“If I didn’t feel that way, I would quit, because it’s too hard.”

Shirey and Dempsey arm their patients with knowledge about what can be done, what can happen and what can’t, thus giving patients who feel powerless the power to choose. If the cancer is terminal, they broach the subject of living wills, hospice care and other end-of-life business.

“It is hard to have those conversations with patients,” Dempsey said. “You know how devastated the patients are to hear the news. We wouldn’t be doing our jobs if we told these people the news and we’re falling apart ourselves. You have to put that aside and be strong for them. That’s what they’ve hired us for, is to tell them what’s going on.”

Shirey and Dempsey recommend people awaiting test results come with someone.

If the diagnosis is cancer, there is a lot of information to take in, and an extra pair of ears is helpful. Even then, they send home literature with the patients to help them understand their choices.

The choices vary from patient to patient and depend on what stage the cancer is in. A patient could be facing surgery, chemotherapy, radiation or hormone treatments.

“Some can be cured, some controlled, some all we can do is help control symptoms,” Shirey said.

“You have to be very clear about what our goal of treatment is. Once you do that, you discuss options and side effects.”

What a patient’s insurance will cover influences their treatment options; Dempsey said the staff of 15 works to figure out what resources are available to patients with gaps in covered treatment. When Anita Phillips was diagnosed with a cancerous lump in her right breast in 2003, she knew she wanted Shirey to treat her.

Shirey, who remembered treating Phillips’ husband for lung cancer in 1998 and 1999, recommended radiation and chemotherapy. He told her it could come back, because they’d found it in her lymph nodes.

In March, follow-up blood work revealed it was back. She is now undergoing chemotherapy and taking medicine. The cure rate, she said, is 20 percent.

A letter came last month for Shirey, Dempsey and their staff, from the family of a former patient. It said they missed him, and thanked the staff for everything they tried.

Shirey lingered for a few moments, remembering the patient’s strength at such a vulnerable time. But another patient was waiting.

“We’ve got to go now,” Dempsey said quietly.

They had bad news to deliver.

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