Monthly Archives: September 2025

Helping to Decode a New Language

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She wrote the number “8” smoothly. Months prior, it would have taken her five tries to get it. She was close to remembering all the colors of her home country’s flag. She wrote her name and birthday without issue – things she hadn’t yet learned when we started working together. Her English vocabulary was expanding. She understood simple words and phrases I said often during our classes together. Perhaps the progress was slow, but she was learning English and how to write.

For the past year I’ve taught English to a new American. I’ve taught English as a second language before, on multiple occasions, but she was my first student who couldn’t read or write. She was also my first student who couldn’t speak Spanish fluently. The lack of Spanish mattered since it was the only language I spoke other than English. She and I had no language in common, but we came together over her desire to learn English and my hope to teach her English. We came together over her desire to learn how to read and write and my belief that such knowledge is a human right.

Before she and I started working together, I’d never taught someone the alphabet or how to write. I found it interesting how her writing progressed just like children’s writing does. At first, her letters and numbers were large and sloppy. With time the shapes of the letters and numbers became more precise and smaller. At first, her spacing was off – she frequently ran out of room on our little whiteboard halfway through a word. Now, word spacing is seldom a challenge for her.

She impressed me with her focus and hard work. It was apparent she studied between our weekly classes. She studied English despite running a household and raising four children – three of whom were in middle school or younger. While helping her learn important things, like her birthday so she could fill out forms, I discovered we were born the same year.

Our life journeys have been different despite sharing a birthday year. Yet, our paths intersected over English. I wish that we could communicate better. I want to learn more about her. I want to hear her thoughts about the world. Perhaps, someday, we’ll be able to have such a conversation.

Patience with Patients

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The patient had stage 4 lung cancer which meant it was advanced. They’d already been admitted to the critical care unit (ICU) several times because they couldn’t breathe. There was one test to determine if the patient’s cancer had spread beyond their lungs pending. Given their rapid decline, I suspected that it had. The patient’s cancer doctors recommended chemotherapy. Yet, the patient wasn’t sure they wanted chemotherapy. When I saw the patient, they were taking a medicinal herb and a medication they bought online to treat parasites. They explained, not entirely incorrectly, that cancer is a parasite of sorts.

Autonomy is a guiding ethical principle in medicine which states that patients have the right to decide what happens to their bodies. I believe that autonomy is one of the most important ethical principles in medicine. I also think that it differentiates modern medicine from historical medicine. This patient’s story provides an example of autonomy in action.

On the one hand, my heart dropped upon hearing the patient’s plan. There is no research to suggest that the herb or anti-parasite medication they’d opted to take would slow or cure their cancer. There is robust evidence behind radiation, chemotherapy, and surgical treatments cancer doctors recommend to treat cancer. There was the hard truth that if this patient’s disease progressed as expected, they’d be dead within the year without science-supported treatment. There was a risk that if the patient waited too long before starting chemotherapy that they’d be too weak to survive chemotherapy treatment, making it no longer an option. On the other hand, chemotherapy is extremely hard on the body regardless of how strong a person is when they start it. And there was a chance that chemotherapy would make the patient feel terrible and fail to save their life or even prolong it.

When I saw the patient, they felt okay. They needed oxygen at night but, overall, were able to function almost normally. They’d taken steps to improve their health by decreasing the amount of alcohol they drank and the number of cigarettes they smoked. There was no research saying that the herb and anti-parasite medication they’d decided to take were harmful.

I collected my thoughts. My job as a doctor is to provide advice. My goal is to provide enough information so that patients can make their own informed decisions about their health. When I spoke, I acknowledged the dearth of research to support the over-the-counter treatments the patient had chosen for their cancer. I reinforced the truth that they had control over their body. I discussed the reasons their cancer doctor recommended certain treatments. I cautioned that there might come a time when they would be too sick to endure the treatments their cancer doctor recommended. I also reminded them that a middle ground was possible where they took the herbs and medications they chose on their own while also taking the treatments their cancer doctor recommended.

The patient decided that they would think about their options while continuing only their current home remedies. It’s seldom that there is only one right path in medicine. I felt that the patient understood enough to make their own decision. I worried about the patient, but I also knew that they were balancing all aspects of their life while I was mostly focusing on their medical conditions. I, undoubtedly, didn’t know some parts of their story. Only they could decide the best course of action for their body.

The doctors I’ve grown to respect throughout my training are the ones who have patience with patients. I strive to be that kind of doctor – one who isn’t scared to have hard conversations but is respectful of the path patients chose for themselves. In the end, the patient with lung cancer’s life was only theirs to live. I would be there to offer advice as we gathered more information and time went on. I would be there to offer an encouraging word and support. But I was not the one living in their body each day as the end of their life unfolded. Their cancer was theirs, alone, to fight. And though I was an expert advisor, their cancer battle strategy was theirs to decide.