Memorial Service for Dr. Hamblin

The following post was just brought to my attention and while I realize only a handful of readers here will care about its contents, my admiration for Dr. Hamblin is such that just the opportunity to help spread the word of a memorial service in honor of his life is a privilege. And my thanks to England's Dick Morris, my new friend and fellow soldier in the war against CLL.who shares my feelings about Dr. Hamblin and who kept me informed during Terry's final battle. Thank you sir. Hopefully we will meet during the celebration marking a cure. The announcement:

A Service of Thanksgiving for the life of Professor Terry John Hamblin, will take place at Lansdowne Baptist Church, Bournemouth, UK, at 1.30pm GMT on Tuesday 24th January 2012. All are most welcome to attend. The service will also be streamed live across the internet at the following URL. http://www.lansdownebaptistchurch.org.uk/live/

Donations if so desired can be made in favour of the Bournemouth Leukaemia [sic] Fund, via Harry Tomes Ltd, Funeral Directors, (01202) 394340, http://tributes.harrytomes.com/terence-john-hamblin/ '

Dick Morris.  UK.
13qdel 90 % and other markers,  W & W

R.I.P.: Dr. Terry Hamblin, 68

The world is poorer today. Those of us battling Chronic Lymphocytic Leukemia have lost a true friend and someone who was never too busy or too sick to share his opinion about their proper course of treatment they should pursue. Dr. Terry Hamblin, one of the world’s acknowledged experts in our rare cancer of the immune system, died last Sunday in a hospice facility near his English home. He was 68 and way too young to be taken away from us.

I never met Terry in person, but we talked often. For many years, he took it on himself to answer hundreds of questions from frightened patients in the middle of their wars with the cancer. Some of those questions were from me. An intelligent, deeply religious man, Terry’s answers were always written in a way that stressed whatever hope he could find in the situation. But, by the end of his note, the patient Terry was addressing always knew the facts, the truth about his situation, the choices he faced and Terry’s opinion which was the correct choice to make.

Dr. Terry Hamblin, M.D.

Dr. Hamblin knew patients deserved and needed the truth. Because he was a wonderful communicator, an honest doctor and a compassionate person, he was an indispensable part of our little community.


Following the rules of Britain’s National Health Service, Terry was required to retire when he reached 65. A short time later, he was diagnosed with cancer of the appendix, a rare form that is very difficult to treat. It was, and the doctor was required to endure countless chemotherapy protocols, all of which are described in his wonderful web site “mutations of mortality.” I remember after one especially brutal session that Terry said he used to advise patients they would handle without trouble, Terry said the experience had taught him that doctors are among the last to learn how difficult the treatments can be and he suggested a new medical specialty that would produce doctors who cared from patients suffering through difficult chemo protocols. 
 
Among Terry’s favorite targets was “Bad Science,” where scientists altered data or simply lied about the results of their studies in order to nail down or extend their lucrative research grants. 
 
One of my favorite essays he left us for about the placebo effect. I don’t have the heart to edit a word of it, so here it is for your enjoyment. If you would like to read it in context, click here:

The Placebo Effect

By Terry Hamblin, M.D.

Penicillin was a wonderful discovery. Before that doctors had very few medicines that worked - morphine, aspirin, digoxin, ether, chloroform, atropine, adrenaline, cocaine, and very few others. Penicillin opened the door to a huge pharmaceutical revolution that continues to this day. Despite this, there have been doctors around for thousands of years. Whatever did they do?

Their practice was very similar to that of the purveyors of alternative medicine today. First, they had a uniform. It differed from age to age, but when I was young it included a frock coat, top hat and arrogant affect. Later doctors had white coats and other paraphernalia. Nowadays it is likely to be surgical scrubs.

Second, they had equipment. To be honest it is very hard to distinguish the various noises heard down a stethoscope - chest physicians always believe the X-ray rather than their 'tubes' and cardiologists want an ECHO whatever their stethoscope tells them. Anyone other than an ophthalmologist looking with an ophthalmoscope is probably making it up, and ophthalmologists prefer to use a slit lamp.

Third, they had a ritual. Part of this is the medical examination. We hospital doctors are apt to scoff at general practitioners who don't examine their patients, and certainly the physical is good for some things. I once was referred a case of anemia to investigate by a consultant surgeon. Imagine his embarrassment when I stuck a finger in the rectum and detected a stonking great, bleeding carcinoma. Most complicated is the neurological examination with its reflexes and finger-nose pointing. But whenever a neurologist came to see one of my patients the first thing he would do was ask for an MRI scan, no matter what we had found on examination.

The physical examination is of absolutely no use when performed by a junior doctor. They do not have sufficient gravitas. The examination should be undertaken with a serious face at a deliberate pace, with pauses for reflection and many a "Hmm" interspacing the touching. "Say '99'" is a wonderful device; it shuts the patient up and adds a sense of mystery. It is very important that the patient completely disrobes. Stethoscopes poked through a gap in the clothing do not have the same therapeutic effect.

Ritual is very important. The consultation should always begin with the doctor rising to greet the patient. Hand shaking is very effective even if it does spread germs. Eye contact is good. Taking the history well is more important than anything and it is vital to let the patient tell his or her story in his or her own words. Leading the witness misleads the physician. It is important to get the story right, but of even more meaningful is the process of instilling in the patient the feeling that he or she is of value and worth listening to. Without the enormous modern medical bureaucracy the doctor of old had time to listen and put the patient at ease.

Never let anyone tell you that alternative practitioners have nothing to offer. Of course their oils and needles have no therapeutic effect, vast doses of vitamins and strange diets are completely useless. Enemas are good for constipation and colonic washouts are useful as preparation for colonoscopy, but they incorporate no magic cures. A recent study demonstrated that acupuncture needles stuck in the wrong places were as effective as needles stuck in the proper meridians - but they were effective. Just as doctors in the 1930s were effective. They all make use of the placebo effect.

'Placebo' is Latin for 'I please'. The placebo effect is what happens when a doctor goes through all the ritual of diagnosing and treating a patient and prescribes colored water. Although this sounds like deceit and fraud, the fact is that a proportion of patients will get better from whatever they are suffering. Ye, whatever they are suffering from. You might well expect a response from patients with chronic fatigue or headaches or backache, but placebos can heal up ulcers, abolish angina and even produce remissions in cancer.

Studies have been done on the placebo. Two pills are better than one. Injections are better than pills. Green pills are better than red ones, unless you are looking for a stimulant effect when red or orange ones are best. It is even possible to cure nausea by instilling a drug designed to make you vomit, directly into the stomach if you are able to convince the patient that what you are giving is an anti-emetic rather than an emetic.

You may believe that you are immune to the placebo effect, but if you are then why do you buy branded painkillers rather than straight ibuprofen. I know they work better but why? Because of the placebo effect. And they cost more. That's part of the placebo effect; expensive placebos work better than cheap ones.

Back in 1972, that sensible physician Richard Asher (yes, he was Jane's father) wrote, "If you can believe fervently in your treatment, even though controlled tests show that it is quite useless, then your results are much better, your patients are much better, and your income is much better too. I believe this accounts for the remarkable success of some of the less gifted, but more credulous members of our profession, and also for the violent dislike of statistics and controlled tests which fashionable and successful doctors are accustomed to display."

The problem with placebos is that they involve lying to patients. Placebos don't work if you say to a patient, "I'm giving you a sugar pill. There is absolutely no reason why it should make you better except for the 'placebo effect' which no-one understands but it probably acts psychologically." Or do they? A trial of sugar pills for pain that had been diagnosed as 'neurotic' was carried out at Johns Hopkins Hospital, with just such an explanation. The patients improved considerably.

Never apologise, never explain, goes the old adage. But we can't get away with that these days. We are obliged to tell patients the truth and to explain fully what we are about to do. The Philosopher and doctor Raymond Tallis has written, "The drive to keep patients fully informed has led to exponential increases in the formal requirements for consent that only serve to confuse and frighten patients while delaying their access to needed medical attention."

Alternative practitioners are not burdened by the same restrictions. They can look into your eyes and give you an explanation that sounds sciencey, but is in fact gobbledygook. Watch the TV for adverts for anti-aging creams to see what I mean by sciencey.

Actually, I think it is possible to invoke the placebo effect without telling lies and good doctors do it all the time. After I retired I handed on my patients to other physicians. I was surprised at how many of them promptly died. There was no change in treatment, only a change of treater. One patients illustrates the case starkly. She had cancer of the body of the uterus. She had refused surgery, chemotherapy and radiotherapy and all I did was see her, take a blood test and talk to her. I was astonished that her cancer did not progress. It remained static for three years. Then I retired and six months later she died. Somehow she had fixed on me as a walking placebo.

It should be possible to say to a patient without too much mendacity, "We have exhausted the latest treatment - we must now start thinking for ourselves. This is a concoction that I have tried before in cases like yours and it sometimes works. I don't know how it works - I could make up a scientific sounding explanation if you like - but I won't insult your intelligence. It is important though that you take it in the way that it is prescribed. You must take it on an empty stomach (and here you can invoke any ritual you think they will wear - standing on one leg, facing Mecca, drinking out of the back of the cup or prunes for breakfast) and I will see you every week if you can afford it. Unfortunately, it's not cheap, but if it works it will certainly be worth it."

Some of these people could sell snow to the Eskimos.

 

   

  

THE ANGEL ON EAST 96TH STREET

Hope still thrives in New York City. It’s out there in the streets all over the city.. Most of the time, you don't even have to look for it to find it. You just have to want it.

I think there's so much hope to go around in the city because New Yorkers, who move at a faster pace then other Americans, don't usually slow down to take their share. As they move through the city's sidewalks, there's someone on every block who wants smething (money) from them or wants to give something (advertisements) to them. It's tough makinhg so many moral judgements. You can't possibly stop for everyone so most of us decide to avoid anyone who wants our attention. Sometimes that means you might miss something good.

I found what seems to be an almost limitless supply of hope on East 96^th Street. It’s in the crumpled plastic bags of a beautiful New Yorker who always seems to be looking for anyone who could make use of a ounce of optimism,

Wilma in her East 96th Street office

The name of this angel who holds all this hope is Wilma. Her office is a rent-free table on the north side of 96^th between Park and Lexington Avenues.  In addition to selling costume jewelry and giving away hope, Wilma finds the time to act as the de facto mayor of the stretch of sidewalk in front of her table. She makes sure the tiny fields of dirt the city allots to its trees are carefully tilled, planted and weeded each spring. Then she protects them from the deposits of the over-fed canines of the Upper East Side.

Wilma also keeps a supply of quarters and makes sure that motorists who park at meters near her table are protected from the army of  zealous public servants once known as “meter maids” in less politically-correct times who do their best to destroy hope so they can balance the city budget. 

Wilma sells costume jewelry from her little table on the sidewalk outside the basement entrance to a locksmith's store on East 96^th Street. She’s there all year, absent during only the most inclement weather, selling inexpensive earrings, bracelets and broaches for prices ranging $5 - $10. 

East 96^th Street. is a nice New York mix – mostly a residential  pre-war and newer doorman apartment buildings, about half of which have a low-key mix of small commercial properties on the street. It’s light-years away from the mostly commercial mix they have on East 86th  Street to the south –  where most of the stores have morphed into national chains. The street stubbornly holds onto the 20^th Century,

To the West, it ends at Fifth Avenue, which skirts Central Park’s eastern border with direct connections to the slighty less-tony Upper West Side via a transverse road that speeds your car  without a glimpse of the greatest urban park in the world (designed that way so park visitors wouldn’t see the horse-drawn carriages which plied that expressway when it was built 150 years ago).

To the East lies the East River and – more importantly – major entrances to the FDR Drive which cuts off access to the water to residents for the benefit of north and south-bound cars skirting city traffic. South of the street still marks the unofficial border of the very expensive Upper East Side (car towing fees triple south of 96^th St.). The sprawling Mt. Sinai Hospital stands to the north as a buffer separating the UES from Spanish Harlem.  A single block north is where speeding trains on the busy Metro-North Commuter RR take their last breath of fresh air before diving under Park Avenue heading toward the  underground delta of train platforms that used to mark a much more exotic and grand Grand Central Terminal. 

The IRT subway line has a local stop on the street at Lexington Ave. as will the new Second Ave. line when – and if – construction ever ends on that project. The street also boasts a Catholic Church, a NY Public Library Branch and the largest Mosque outisde the Middle East.  And all these people and all these institutions work together in peace and freedom,. 

Wilma introduced herself after a few months of my buying dozens of earrings from her costume jewelry collection – almost $50 worth. “I’m Wilma,” she said, adding, when she saw the strange look on my face: “Wilma, like the Flintstones.” I’ve never forgotten her name once after that. Brilliant.  

Wilma knows my wife is on TV, wears earrings, but loses them all the time because she takes them off whenever she’s on the phone, which is all the time. So Wilma searches through flea markets for the clip-on variety especially for Marcia. She watches for Marcia on TV frequently and always knows when Marcia is wearing a pair of her earrings. I’ve bought over 100 pairs of earrings from Wilma over the years.

I’m likely to see Wilma each time I visit a doctor I see whose office is on 96^th Street. I usually see him every two weeks and I’ve been a patient for over five years. You do the math. Each time I see Wilma I learn a little more about her. I know she loves classical music and once considered pursuing a career as a concert pianist.  I know that she has a sister who is a nun in a New Jersey convent. She’s a mother superior, I think. And I know she has access to the Internet and infrequently checks out my web site.

I learned this last item when she asked me about a story I posted about a drunk hunter who blew the beak off a bald eagle and left it to die. The bird was saved by some good people who nursed it to health and donated their talents to construct several artificial beaks until one worked well enough to allow it to live a fairly normal life. I wrote how strange it was that humans could be capable of such cruelty and mass murder but also be capable of producing such sublimely beautiful things as Beethoven’s Ninth Symphony.

I told  Wilma that post resulted in messages from all over the globe and how much that piece of music moves me. I also told her a tale I had heard that the composer worked for years to make it perfect – and then debuted it with several sections that were obvious and deliberate errors and the theories about why he did that.

She was delighted with the tale and had a surprise waiting for me when I returned to her table after my appointment an hour later. Patiently waiting with her was a young lady who Wilma introduced to me. After telling me to be quiet and listen, Wilma turned to the woman and began singing with Wilma providing perfect harmony while conducting her one-piece symphony orchestra, The two sang, in perfect harmony, an unplugged version of Beethoven’s “Ode to Joy.” The noise of the passing traffic disappeared as they sang. The nearby subway didn’t rumble for a minute. People stopped and listened. The two women sounded like they were on the stage of Carnegie Hall, which sat empty just 39 blocks to  the south. When they finished, I knew I should thank them and tell them how beautiful they sounded. But I just couldn’t find the words. Any words. I gave them a round of applause.

 

One year before, I was driving my car when the cell phone rang and flashed an unfamiliar telephone number. On the other end of the line was a woman with a totally unfamiliar voice. She asked for me and when I told her she had found me, she wanted if I knew Wilma. Oh no, I thought, something’s wrong with Wilma. But she said she was Wilma’s sister and Wilma was worried about me because she hadn’t seen me in a couple of weeks and was worried. She didn’t have her own phone so she asked her sister to call using a number on a business card I had given her several years before in case she ever needed to reach me. It took me five minutes to convince the sister that I really “was alright” and then get her assurance that so was Wilma.

But there was one day with Wilma that changed my life just a little. I was still working downtown and Wilma’s table was on a direct line to the subway. After I spent about 10 minutes picking out Marcia’s earrings and talking to Wilma, I told her that I wasn’t in great shape and was about to start a round of chemotherapy.  “Wait,” she called as I turned to leave. “I want you to have this.”

She handed me a string of rosary beads. Attached to it was the traditional crucifix with a gory replica of the agonized body of the dead Jesus hanging from the cross. I was stunned and just a bit flabbergasted. “But Wilma, I’m Jewish.” I said.

“I know,” she said, using her fingers to close my own over the rosary. “But I want you to have it. Please.”

“Okay. Thanks,” I said as I turned to leave. “See you in two weeks.”

It was about a half a block to the subway entrance. I walked it in silence thinking about why she would give me a rosary. I was only a few yards from the steps going down to the Lexington Avenue IRT when Wilma’s reason began to reveal itself in my mind. 

Tears had started filling my eyes as I went down the staircase, swiped my Metrocard and waited on the platform for the downtown local.

By the time the doors opened and I got on the train, they were flowing down my face and my eyes must have been a very sad shade of red. I think someone got up just to give me his seat  but I’m not sure if he was only getting ready to get off.

I took the seat and cried all the way downtown. I never considered switching to the express at Grand Central.  By that time, it felt good to release the emotions unleashed by Wilma’s gift. She didn’t give me a rosary. She gave me something even more valuable.

I’ve never told Wilma, but I carry it everywhere I go.  I carry hope with me. All the time.

.    

AUTHOR’S DISCLOSURE: I’ve wanted to write this piece for a few months but every time I began writing something urgent came up. Although I fear this preface might appear to be a plea for the reader’s pity, a reader deserves to be aware of recent events in my life, including those that surely changed what was supposed to be a short tale of a Manhattan street vender. Instead it seemed to morph into a longer story describing how New Yorkers find hope in places that seem bereft of anything so precious. So be aware that as I wrote these words I was obsessed with leukemia, my nemesis for the past eight years. The cancer has renewed its assault on my immune system after a hiatus of almost three years. What complicates decisions about how to fight the disease is that reams of new research is being published each day that is changing almost everything we thought we knew about the disease. Ultimately, the choice of treatment is mine to make. “Animated arguments” (screaming matches) with my doctors over these “life and death” decisions have already begun. And since its my life or my death that’s involved,  the stress added to each day to my life is considerable and unavoidable. The other day, medical considerations had to share my stress scale with a family crisis (one that will remain private for now) that suddenly developed. Throughout my uncommonly lucky life, I think I’ve handled stress in fairly well. But I confess that there have been moments during the past week when I’ve felt nearly overwhelmed.  So I admit it’s possible that I inadvertently wrote the following tale at the wrong time. On the other hand, it remains about hope and the unexpected places where it might be found – which might be exactly what I need right now. So I’ll go ahead and present the following tale in the hope that it might teach me about how to find more hope while I still have some.

MK; Westchester, NY;  January 2012