You have done your part for mitigation. We all sacrificed at the alter of the novel corona virus. The hygiene, separation, cleaning, all sacrifices have given time to improve outcomes- people are living, not with cure, but with treatment tackling the infection’s manifestations in the body. Six months into it I am weary of the fear mongering which encouraged patients to avoid care. You know my thoughts by now and this week proved my points unfortunately.

Patients are now being evaluated with signs and symptoms they have held onto for the past months. Up-migration has occurred. Cancer didn’t fear COVID. It didn’t distance. It kept growing.  It took advantage of the unsuspecting. All those trying to stay safe and healthy who now have a different life-threatening disease are hurting my heart.  I am looking at scans obtained this week of patients with advanced tumors and we both sit in shock. I give the news through our masks and hand out tissues – we all try to sniffle. Its awful. Doctors knew this was coming- unintended consequences. After some really difficult conversations, I come home wondering how to do this better. I just have tools to help but wonder what else can I bring to the practice.

For my patients, I have a golden rule- I always have a plan. After the pain of the news, I move them into action. While discussing this up-migration of cancer stages, I find that my week is filled with people who themselves have migrated to the US expecting the best care- not hospitals and offices shut down from fear. Mike has migrated from Ireland. He is 41 years old with a nine year old daughter to raise. The now metastatic colon cancer must be managed aggressively for longevity. Tony migrated from Albania. He is 37. The brain tumor needs control, “Please, doctor, I need to support my children.”  Sonja migrated from Kazakhstan; the small lump in her breast in November being “watched” is now 15 cm and requires a complicated plan, but she says, “Really doctor, at 81 I don’t want to burden my son.” Her own plan must be respected.

Docs from across the nation had a call yesterday with Senators regarding 10-15% cuts in Medicare slated for January 2021. Yet management has become more complicated because treatments were on hold. On the call, we agreed that migration to advanced disease is what every specialty is seeing today. All the therapies that would have taken place the last 7 months to rescue patients were on hold. The doctors are weary of the bureaucrats. We also have migrated, toward careful care.  We encourage our patients to put their health first.

Once again I say to take control for yourself. Be wise.  Call your doctors, get your screenings and do not let the virus encourage you to procrastinate. It is time to be disciplined, vigilant and fearless. Let’s migrate together toward strength, determination and recognizing our own power. Its September already. Fall is a perfect time to shed what is no longer working for us.