His mother, whose brother died of malaria, before she died in childbirth when Fazlur Rahman was only 7 years old, told him, “One day you will be a doctor, Fazlur, and help people.” He accepted his plea. Rahman, who is a native of what is now Bangladesh, in South Asia, remembers the people living in the small village where he was born dying of epidemics, and often did not receive medical treatment.
After leaving home and eventually completing his studies in New York City and Baylor College of Medicine, in Houston, in his 30s, he had to decide where to go. Most of his medical school friends were headed to big cities like Dallas and Phoenix, but advice from a counselor put him on a different path. Rahman told me: “Oncology was very unique at that time. “We’re talking about 1974, ’75. There was no oncologist in all of West Texas. My mentor said, you know, if you go to San Angelo, you’re going to make a difference.
That’s where he continued to practice for 35 years, until his retirement in 2011. Although medicine has come a long way over the decades, for rural Texans, like those living in the San Angelo area, the best treatment is often outside. to reach. As rural hospitals struggle to stay open, many have closed their chemotherapy departments, and a recent study found that 382 hospitals across the U.S. eliminated those services between 2014 and 2022. In Texas, nearly half of the rural hospitals that once offered chemotherapy have now stopped. .
This week, Texas Tech University Press is publishing Rahman’s book, Our Connected Lives: Caring for Cancer Patients in Rural Texas. The book combines scientific discussions with personal stories from Rahman’s work. The doctor emphasizes the need for oncologists to treat their patients as individuals who are not completely defined by their cancer. “That’s why I love medicine,” said Rahman, who turns to books and poetry to help him understand what his patients are going through. “Because science alone can’t take care of you.” The doctor and the writer spoke to Texas Monthly about how he hopes his book will help others understand the experience—medical and psychological—of battling cancer in rural west Texas.
Texas Monthly: Can you tell me about your transition to West Texas?
Fazlur Rahman: At first it was very difficult for me. Then I found that I can take good care of patients and their families, their loved ones. In teaching, I mean, everybody’s the same, whether it’s in New York or Houston—you’re very busy; You go to one patient, another; they don’t see it. But here, you have more opportunities and more time, in the sense that you know people, get to know them. I have always been interested in the inner life of people, especially patients.
TM: I think of San Angelo as a small medical city, like a small island in the region. Can you tell me what this place means to your patients?
FR: It was difficult for people. Because if you came from Big Bend, it’s 300 miles. He also needed attention. Or Midland-Odessa, which is 120 kilometers. And then many farms, they are quite far. They may be 50 kilometers away but it takes 1.5 hours to travel through country roads. So when you gave them chemotherapy, and they got sick at home, that was very difficult for the patients. And it was hard for me too, to see them like that. Many family doctors, not used to caring for chemotherapy patients, did not feel comfortable. So sometimes patients have to drive to come here, so that I can accept them here and take care of them.
Austin is about 220 miles away; San Antonio is about that; Dallas is about 275; Houston, 400 miles. Nothing was close to San Angelo. So sometimes it was difficult for me, because I wanted to have a second opinion. But then I would honestly tell patients what I know and what I don’t know, and they would say, ‘No, do whatever you can. We don’t want to go to Houston. We are small town people, farmers and ranchers.’ And it almost always went well.
There are many oncologists now in town. Now there are oncologists in Midland, in Odessa, so this becomes a little easier.
TM: In the book, there is a patient you call JD, who gives many examples of the problems we have in Texas. Can you tell me about your experience with patients who are facing such problems?
FR: Texas has the highest uninsured rate in the country. And we really hate the Affordable Care Act. My feeling is that it doesn’t make sense, because taxpayers can pay anyway: People get very sick and end up in the emergency room. It’s expensive and difficult for people.
The second is that having insurance is sometimes not enough. JD is an example. He went into remission with Gleevec, which was a new drug, but very expensive. Then he got fired, so JD couldn’t make it. And what happened to JD? He stopped taking it. Then he began to have acute leukemia from chronic leukemia. And that required two years of treatment: long-term treatment, expensive medical treatment, including additional treatment. We had good medicine, but how can it help if patients can’t afford it?
The third is your distance problem. These people tend to have less measurement because they have to travel far, especially in rural areas. A lot of old people live there, a lot of vulnerable people live there. They have diabetes, high blood pressure, and other related problems. And so on top of that, when they have cancer or leukemia, that’s an added burden, the cost and everything.
So this is kind of a mixed response. One is opportunity, the other is cost, the other is that there are several problems when people grow up, and those things must be considered. The traffic is much better now, the access is a little better, but still, distance is distance. And the older we get, the higher the incidence of cancer. As I wrote in this book, the 85-plus age group is the fastest growing population in the country. So it is people who also face medical problems. So you have to decide medically, ethically, and then as a society, how we deal with this.
TM: You talk about how much has changed in the years since you started practicing, in terms of medical advances and the options patients now have for their treatment. Can you tell me about it?
FR: I think the biggest, in my opinion, change has been in the recognition, and the treatment has progressed. And another thing that is very important in health care: end-of-life care. End-of-life care, when it first started, was like a child getting medicine.
We never even talked about it when I was in education, either in Houston or New York—like, “If it happens, we’ll worry about it,” something like that—fifty, sixty years ago. So end-of-life care, we talk in advance now, that, “Look, these are choices.” We can still control it for a while, but if it has passed, then we have to decide what to do. ” And it gives them time to think, time to make wishes and beliefs.
Before we had inpatient care, I had a large oncology room, 25 beds, because many patients died in the hospital. Our goal was to make people live as long as possible, but quality of life and end-of-life care were secondary issues. So home health care can’t take care of them, they can’t go to a nursing home, the family can’t take care of them. So where did he go? They were hospitalized. But when hospice came along, it was like a lifesaver.
End-of-life care is end-of-life care, this is important. Even with the progress we’ve made—I’m not trying to be negative—many metastatic cancers are not curable.
TM: Who is the book about, and what do you hope people will take away from it?
FR: Cancer patients and their loved ones. Also trained by doctors, because it talks about some moral issues, bed issues. For example, JD received treatment for three years. It’s easy for a doctor to lose compassion, because he always had the same complaint: “I’m nauseous, I’m weak, I can’t sleep, I feel aches and pains.” As an oncologist, you have to make sure you don’t get discouraged; you still have to listen. I hope we don’t forget that we are still caring for that person.
As a healthy person, sometimes you don’t understand what a cancer patient goes through. So I think some people will benefit from it, understanding cancer patients, what they go through and their families. Loved ones suffer like cancer patients sometimes.
And this can be another window into cancer, because remember that when you’re at MD Anderson or Methodist or Baylor College of Medicine or Memorial Sloan Kettering, you’re in a different environment. Your thoughts are very different from the outward appearance sometimes. So I feel like maybe this will help them understand what happens in a small town.
This interview has been edited for clarity and length.
When you purchase a book using this link, a portion of your purchase goes to an independent bookstore and Texas Monthly he receives a job. Thank you for supporting our journalism.
#San #Angelo #Doctors #Book #Highlights #Rural #Medicine #Challenges