The boys are back in town and baseball season is underway. Fast ball, curve ball, fast ball, curve ball… Scott the dosimetrist for the practice is demonstrating to me the “tell”. How, with just a thirty degree turn of the wrist, the batter can anticipate what the pitcher will throw. Scott’s parallel life as coach, mentor to many and father of three sons who are outstanding players themselves, sharpens his own vision for life corollaries. The glance of the pitcher is another “tell” or give away. Awareness, experience and years of training bring a formula for success. Scott and I have a conversation about therapy here at the cancer center and his life lessons to his team. There is always as he says, “a game within the game”. I am completely naive about baseball (even as my hometown Phillies are in first place this week yay!) However I appreciate the metaphor for cancer patients and want to share this concept with you.

My own “listening” to patients with cancer is almost never just about the therapy. I am always looking for “the tell”: the facial expression, nervous tics, interaction with family present, the ability to climb onto the table, dullness in the eyes, the “I give up” or “I am strong” demeanor. Awareness of these layers is all so critical to success – even if the outcome is comfort not cure. Often the “game within the game” is the family in the room. Interactions, support or lack of it, frustration, arguments, tears, boredom or fear all tell the story surrounding the impact of the disease.

Healthcare workers may have their own “tell” of indifference, overwork, or burnout. Those “in the game” physicians who recognize the nuances of patient care are more fully aware of these cues. We may not sense all of them but paying attention really helps us to give more individualized care. It begins with that very first visit, as we walk into the room and the energy shifts. Experience helps but doesn’t always ensure that we will fully appreciate everything that is going on for the patient. Frankly sometimes you actually do have to tell us.

The best advice I have for a patient is to develop your own awareness of the “game within the game”. You know that it isn’t all about the cancer. Try to be open and unguarded with your doctors. Help them to be aware of your concerns. Don’t expect the doctor to be sensitive to “the tell”. Be direct about your own game plan. The curve ball of cancer has already released- you can’t hit it out of the park without clarity and focus from the whole team. Every therapy isn’t a home run but lets always try to make the very best winning effort.