FIFTY/FIFTY

When I was 30 years old, I learned the true meaning of optimism.  During my residency, I was fortunate enough to have as a mentor one of the world’s greatest radiation oncologists for head and neck cancer.  This man was  born in China to two Chinese Christian missionary parents.  He and his twin brother were brought to the United States as teenagers, and both managed to graduate from the most prestigious medical school in the country.  Years later, both brothers had established themselves as pre-eminent leaders in their respective fields of surgery and radiation oncology.

My mentor celebrated his sixtieth birthday while I was on his service, yet he was as energetic as men half his age.  Day after day, I would stand behind him looking over his shoulder as he examined some of the most desperate patients in the world, patients who came from every state in this country and from every country in the world, having failed standard treatments for their cancers in top medical centers near their homes. They would wait anxiously as he reviewed their cases, and would lean forward to have their throats and necks examined by the great expert.

And then they would ask the question, the inevitable question—”Doc, what are my chances?”  And the good doctor always had one answer:  “Fifty/fifty”.  Every single time the question was asked, the answer was “fifty/fifty”.  Now I was a good student and a good resident.  I knew that these patients, having such advanced disease and having failed so many other treatments, did not have anywhere close to a fifty-fifty chance of survival.  I knew that at best, their chance of making it five years was 3%.   Or maybe 5% if they were lucky and all went well.  So one day, I couldn’t stand it anymore.  I felt that the patients were being misled, if not actively lied to.

You must understand that it took some courage, not to mention a good dose of moral outrage, for me to confront the great man one day, outside of the exam room.  I said to him, “Dr. W, why do you tell these patients that their chances of survival are 50-50.  You KNOW that is not true!   Why do you say that to them?”  He sighed wearily as if I were the slowest resident in the world,  looked me in the eye, and said something I’ve never forgotten.  It helps to imagine his Chinese accent, still strong more than 40 years after arriving in this country.  He said to me, “Statistics, statistics, STATISTICS!  All you residents ever want to do is quote statistics!  For every patient, either he gonna LIVE, or he gonna DIE!  FIFTY-FIFTY!”

That my friends, is the definition of optimism.  Take it to the bank!

(This man also said many other rather unforgettable things.  When a resident managed to get an answer right during morning conference, he would positively CROW:  “In the land of the blind, the one eyed dog is KING!”  But that’s another story…)