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“Our patients lives and identities may be in our hands, yet death always wins. Even if you are perfect, the world isn’t. The secret is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet struggle to win for your patients. You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.” -Paul Kalanithi in “When Breath Becomes Air“.
This week, after considerable thought and with great ambivalence, I began saying goodbye to my patients. I have intentionally made my “retirement” a prolonged process, stretching back nearly 15 years and beginning with turning my research laboratory over to a wonderful trainee/fellow, Tom Flaig (now Vice Chancellor for Research at CU). I began to stop writing grants (for the most part), working more in the clinic on other people’s ideas, and continuing to write this blog while serving on various boards and IDMC panels (including with the two authors of that IDMC link). Eventually, I reduced my clinic time to one day/week, focusing entirely on prostate cancer and seeing patients only at our outreach site, the Shaw Cancer Center in Vail. But, as I anticipate turning 75 this summer, and as my wife has pointed out, “no one really wants an ‘over the hill’ physician” (even if that doctor is still doing well by his/her patients). It is time to leave the clinic. As Kalanithi points out, inevitably “your hands or judgment will slip”. And even if they haven’t or never do, I believe there is joy and elegance in stepping aside at the right time to provide opportunities for younger physicians to take your place and to the extent they wish, offer advice (wisdom?) if needed.
But what to do with a blog?? As an early adopter, I had great satisfaction helping ASCO develop its website, www.ASCO.org and wrote about what I envisioned as the evolution of internet oncology in this article. My colleagues and I assisted in moving much of the society’s print media online as well as hosting what I think may have been one of the first “virtual meetings” of a medical society in 1995. With the help of a contractor, we digitized 35mm slides, recorded audio, then merged them “by hand” and posted presentations on the internet (within hours of their live presentation) for viewing around the world. Shortly thereafter, I was invited to write medical blogs, and when that effort became commercialized with ads, I elected to start writing this blog “commercial free”. As the internet technology continued to evolve with the evolution of social media (twitter, instagram, tiktok, etc.) I opted out, and so this blog is all that remains of my “brief but spectacular” foray into content creation for the digital world.
The statistics on 733 subscribers to this blog suggest that relatively few visit the website, although I suspect more read the essays themselves which are sent out by the site as emails. Here are the stats for the last quarter:
The way you got this email (or link if you are reading on the wordpress site) is “push technology”. You opted in/subscribed to receive the emails. This led me to wonder what happens to an email or blog when you change pages or “delete”. We all know that they stay somewhere “forever”. I know this means bits and bytes on some server. But when I tried to think about it in Kalanithi terms to title this essay, I tried to imagine “When Pixels Become Electrons” or something similar. I failed. Here is how pixels work and this is how electrons control them. What happens to blogs is still mysterious to me, but I’m switching formats to “pull technology”: responding to queries/ideas rather than guessing what you might want.
There are now numerous online sources for prostate cancer information. If you want excellent push technology to keep you up, I recommend subscribing to “The Prostate Cancer Daily” written by and for experts in the field. If you want to look something up, like the latest clinical trials, please read this blog I previously posted.
Thus…I have decided to change states – just like the LCD crystals that change the polarization of the pixels that have turned black to provide you this text. Going forward, I will use this blog to try and help patients/families only IF they want, by responding to questions, but not by trying to guess what subjects may be of interest and creating a post. I am happy to do whatever research is necessary to explain advances and comment on the science behind them if you send a topic or question to me at prost8blog@gmail.com. I will post monthly answers here as essays on www.prost8blog.com so everyone can see them who is a subscriber. The person(s) who submit questions/ideas (if any) will remain anonymous and I will NOT provide case specific advice. I will also not send return emails from the gmail account except to indicate I have received your request/idea.
BOTTOM LINE: This will be the last post on this blog unless I receive a topic request or question at prost8blog@gmail.com. I will monitor that email site on a monthly basis and post here as needed. I have loved being a part of helping prostate cancer patients/families and wish the best to all of you who have subscribed. If the new approach works, great! And if not, I thank you (and your computer pixels) for sharing some of our lives together. Godspeed…
prost8blog 
Thanks for all your efforts over the years. They have been extremely helpful.
Dan Gallagher
Thanks Dan. It has been a real pleasure.
Dr Glode,
Hell of a ride and thank you! I began as an active surveillance patient 10 years ago and went fishing on the internet only to find your kind of essays few between. As a layperson, although “reasonably” well educated in the sciences at Berkeley, I kept my dictionary and eventually Google medical definitions handy as your essays elicited considerable thought, something pray we need in politics. Much appreciation for your guidance as I have survived my emotional throes instead relying on well reasoned science from your wealth of knowledge and advice. I’m still on AS!
Thank you so much, Dr. Glode. I have appreciated you emails and
information therein more than you know. You have helped many people
through your blog including a good friend and my brother.
All the best in your retirement! I retired 3 years ago at 75 and my
goodness, how the world changes – much more relaxing and lots of time to
reflect. Harry Cross, Arlington VA
Thanks Harry! I certainly agree about the changing world, and of course our collective time to reflect over the past pandemic years has been a mixed blessing. Hope you continue to do well.
Great job Mike!!
Thanks Brent. Looking forward to seeing you!
Thanks for all of the good work you have done through your blog. It helped me and I am sure it helped a lot of other people. Enjoy your retirement and I am glad I can still reach out for advice.
Let me know the next topic and stay well. -mg
Thanks Mike. I have enjoyed your blog for several years now. I did not realize you were affiliated with Shaw. I had radiation there under Dr Hardenbergh’s direction in 2015. All clear so far!
Good news for you Bill. Glad you are doing so well. Keep it up!
Michael, I have wonderful memories of the early years when we conducted the first multi-center clinical trials on Lupron. We were blessed with memorable, courageous patients (and their wives), and you were one of very few oncologists who discussed the potential as well as the disadvantages of hormonal treatment in depth with them. It was a great pleasure to work with you! I wish you well as you find new ways to share your wisdom.
Thanks Nancy! What a trip…all starting with a letter to Abbot about their new drug Abbott 43818 and your impeccable help treating the first patients in the world to receive it. Great to hear from you. Best wishes, mike
Thank you for writing this blog. I feel you provide quality information, and I try to pay attention when I see it arrive in my inbox.
I’m sorry I came to the blog so late, but then, my prostate had thoughtfully ignored me for more than 50 years. Now, it appears I must pay attention to my prostate for the rest of my life.
I will miss this blog, and the helpful information.
Best wishes to you in retirement. I hope to join you soon.
Ray Akers
Mercer Island, Washington
Thanks Ray. I will still blog when people give me a topic, so it’s not completely over …yet!
Thank you so much for what you have done for so many of us. Clarifying research is very helpful .
25 years in as a patient
The pleasure has been all mine. Thanks for your kind words. I miss seeing you!
My best wishes to the best. When I met you for a second opinion via Tomi Crighton, you gave me hope, a pathway to be rid of residual prostate cancer with options. Following your suggestions, now 18 years later, still active, hunting the mountains of Montana for elk, hills of Missouri for turkey, deer and duck. Alive, as far as I know cancer free, few treatment residual annoyances, and irritating your political wisdom. Congratulations on your gracious way to wind down with full honors. A professional, professor, student forever, way to manage a practice that any student beginning today should have held out to him or her as a model of perfection in how to be a physician.
Phil, you are too kind. The pleasure of being a physician/teacher is hard to beat and I have been so very fortunate. Best wishes and I’ll keep sending you the occasional counter argument on your facebook page!
Hi Dr. Glode,
Thank you for all of the postings you contributed year after year.
Although Roger, my husband for 59 years passed away July 7, 2021 of vascular dementia…we continued to appreciate your postings concerning prostate cancer. Sometimes witty…sometimes earth provoking…sometimes serious in nature. You always said Roger would not die of prostate cancer but with prostate cancer…YOU WERE RIGHT!
Thank you for all of your insight into this troubling and challenging disease.
May you enjoy some aspects of retirement and know how much you helped patients and their families and how much you are LOVED by those that knew you.
Margo
Thanks so much for the kind words Margo. We can all hope for progress in the dementia field to be as dynamic as it has been for pca during the last decade.
I have enjoyed reading your Blog. I was your patient 2010-2011 with a Gleason 8-9. I am doing very well and in excellent health at age 76. Thank you for all your research and service to your patients.
Paul Classen
Thanks Paul. Sorry to be late in looking at comments and replying. Hope all continues to be well for you!
mike
I never met you, Dr. Glode, but your humility, kindness, and compassion have always radiated from my computer pixels out into my study. I’ve always looked forward to the next email from you, knowing I would learn something new. Yes, all good things must come to an end, so I’ll just wish you a healthy, happy retirement.
Warmly,
Len Sierra
Thanks Len. Sorry to be late in reading comments and getting a reply out, but such is retirement!
Dr. Glode, I am happy that you are going strong in your 75th year and will have time and good health to enjoy other interests in life. Your wife is a good influence on you. Your blogs and information have been invaluable to me as the researcher and caregiver for my husband who has had prostate cancer for 21 years.
Thanks Mary. Hope all is well with you and your husband. Best wishes!
I really enjoyed reading this blog, rich of information brought to the level of the average patient. It was a bit like having an expert, sitting next to you and sharing part of his experience. It is something critical when you are in doubts, worried. When discussing with other Pca comrades, I checked more than once this blog, to see what Dr Glode would said about it, and found either a comment or the appropriate link.
Glad it was helpful Fred. Sorry for the late reply. Best regards, mike
Dear Dr Glode, I want to thank you for your care of my husband starting back in 2013. We were so thankful to have your caring optimism at the time. And then you moved on and were helpful in getting Gary into doctor Flaig’s practice. You both gave us hope, but eventually death won in 2019. But I continued to take an interest in Prostate cancer and have followed your blog. But recently have not delved into them as I used to, not that they weren’t helpful, but the time it requires to really understand it, was more than I choose to continue giving. And I guess my reason to continue being knowledgeable on the matter seemed to leave me. I still read them, just don’t study them as I used to, but I’m sure there many of your over 700 subscribers who do. Like you it’s time to move on. Thanks for your care, intelligence and wisdom over the years, that will never cease to be important.
Lori Boudreaux
Sent from my iPad
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Hi Lori. Many thanks for your kind words. It means a lot, and I’m glad Tom and I were able to be of help to Gary along his journey. Best wishes to you and your family going forward.
-mg
Hi Lori. Just read this, as I have been remiss in updating and keeping up myself. I’m glad the blog was useful to you in the time that you needed it and hope your “afterblog” life continues to go well.
Thank you, Dr. Glode, for all the wisdom you have shared over the years. I will save this email in the event we have a question. I appreciate all the help you gave when my husband was diagnosed with prostate cancer in 2016. Fingers-crossed, he is doing well. I hope you enjoy your full retirement. Thanks again and thanks for being an early blogger on ASCO Connection when I was tasked with the job of getting people to participate. You were an early adopter! Best wishes.
Hi Amy. So glad that your husband is still doing well and it was a pleasure to blog on ASCO Connection. Hope all is well with you and the family. Mike
Hi Dr. Glode,
I will let Don know that you are going to truly retire, and I know that we’ll miss you. I really like the idea of retiring at the time of your choosing, instead of wating for a forced decision of one sort or another. I think we know you well enough that I can easily predict that you’ll fill your time with lots of enjoyable and interesting pursuits.
Thank you for the great care that you took with Don over the years. He’s doing really well and we hope that his progress continues as time goes by.
Molly
Many thanks Molly. I’m sure Don will do well with the new doctors and I look forward to introducing you to them.
Dear Dr. Glode, I am one of the seemingly invisible 733 people out here in the ethersphere who has avidly read your blog for now about 15 years. I have always been amazed how you can write so beautifully about such a complex subject…truly a sign of a gifted communicator and indicative of one who completely dominates his subject.
I remember so well coming to your office with my wife Bernice about 15 years when I got the dreaded diagnosis. You were calming, informative, and I then entered under care with Dr. Maroni. Collectively with my wife, Dr. Maroni, and you, we decided on “watchful waiting”. Specifically I remember you pointing us to the Kloss studies in Canada concerning Avodart. Many many DREs, MRIs, PSAs and multi-poke biopsies later we have seen no recurrence of cancer, and Dr. Maroni now refers to me as his longest living watchful waiting patient. Let us hope that my streak continues…
Love your writing, love your reassuring bedside manner, love your lifetime of experience and knowledge which you have so freely shared.
It’s said that when we retire we die…so please keep your hand in and don’t get too committed to wondering what to do each day.
Thank you sincerely for your commitment to medicine, and despite the pessimistic admonitions from Kalanithi, please know that you came as close to the asymptote of perfection as humanly possible!
John Klug
Wow. Your comments are definitely over the top, but much appreciated. It means a lot to me. Glad that the blog has been useful and so happy you are continuing to do well. Keep it up! 👍