The frustrations of teaching

I went for a walk in the woods two weeks ago with a good friend. We’d both had a tough week and needed some time in nature to try to put our heads back on straight. She teaches high school kids. A good part of what I do now is teach adults–or try to.

I still don’t know how to do what needs doing.

I find teaching adults far more frustrating than I ever found teaching high school students. Listening to my friend, it became clear that job has become far more difficult–largely because adults with no idea of what goes on in the classroom have increasingly forced their way into day-to-day practice. The paperwork now required would make it impossible for either Jane or I to do what we did.

What we think we know

Adolescents think they know everything. Adults know they know everything. Both groups are wrong. Sometimes teenagers can be reasoned with. Their brains are more fluid–more open to persuasion. They have limited experience and often have discovered how wrong they can be.

I went for a walk in the woods…

Adults… Adults believe their experiences have taught them everything already. They can’t perceive how the very different experiences of others have led them to very different conclusions. Worse, new facts or new evidence don’t seem to change their perspective very much. They believe what they’ve always believed because that’s the way they learned it over the course of their lives.

The problem with adults

Ultimately, both our problems stem from adults and what they’ve done or refused to do–or what they are doing and what they refuse to do. I admit, kids are crazy. But more often than not, adults made them that way. But kids can change fairly quickly and relatively easily with the right help at the right time–except when the adults refuse to let them.

Adults know they know everything.

My problem is I deal almost exclusively with adults. Their beliefs about everything were forged sometimes 40 years ago. Sometimes their beliefs are based on knowledge of that same age–knowledge that no longer is valid. We’ve discovered a lot of things over the course of my lifetime–things that have stood the world on its head.

What we believed vs. what was true

For example, about the time I was born, a computer scientist supposedly said he could not imagine why we would ever need more than about four computers on the entire planet. Others said flying to the moon was impossible–and even if it were, it would not happen in my lifetime. And cancer? We had no answers and never would.

We’ve discovered a lot of things…

Of course all those statements and ideas proved entirely untrue. I have a computer in my phone that is far more powerful than the best computer we had in 1952–and seemingly everyone has one. Cars all have computers in them. Every writer I know uses one nearly every day. Every teacher, too. No scientist could get through the day without one.

Moonshots

We’ve been to the moon and sent two probes beyond the edge of our solar system into interstellar space. We’ve discovered worlds spinning around distant suns and begun to perceive the structure of the universe.

…four computers on the entire planet.

And then there’s cancer. I hear several times a month from people that cancer research is the biggest boondoggle in history. “We’ve spent all this money and we still have no cure? The drug companies and the researchers are covering up the cure so they can make more money.”

Before there were cures

In 1952, childhood cancer was nearly an absolute death sentence. Childhood leukemia absolutely was. Breast cancer? Lung cancer? Get your affairs in order. And many people still think this is the case.

And then there’s cancer.

Sidney Farber wasn’t an oncologist. He was a pathologist at Children’s Hospital in Boston. He had the corpses of all these children arriving on his slab on a seemingly daily basis. It drove him to act. He’d go to parents of terminally ill children and get them to let him try chemicals that killed cancer cells in a test tube. Most did no good. But he kept trying.

The changes we don’t see

Today, 90 percent of children diagnosed with leukemia live, many into adulthood. We have a treatment in trials that seems to work for many childhood glioblastoma cases. I know a large group of women, including my younger sister, who are 20-year or more breast cancer survivors. We have cures for lots of forms of cancer–just not all of them yet. Those cures don’t work on every kind of cancer–don’t work on every cancer they are designed to take down.

Sydney Farber wasn’t an oncologist.

Once or twice a year I get to spend time with physicians and researchers working at the cutting edge of cancer. Sometimes, the news is almost too good to be believed–what’s happening with some cancers and immunotherapy leaves me speechless. Sometimes, the news is worse than I can begin to imagine. Every study, every experiment, every trial, adds a new piece to the puzzle, brings a new piece of evidence to the case. Sometimes those things open new lines of investigation. Sometimes they end up being dead ends.

Learning from failure

But we don’t know where something will lead until we try it. Early rockets blew up on take-off more often than people think who were not there to see it. But every failure led somewhere–taught us something we needed to know. People forget that some of our early Mars missions ended in complete failure. Today, we have rovers traveling that planet finding all kinds of interesting things.

Those cures don’t work on every kind of cancer…

Cancer research works the same way. Farber didn’t give up when his first patients died. He didn’t give up when the second group of patients died–or the third or the fourth… Success grows from failure more often than from immediate success.

What we now know

I keep telling myself that. It’s not helping very much this month. Nine years ago, my wife was dying from a cancer her doctor had never heard of, that few oncologists ever expected to see in their entire careers.

…every failure led somewhere…

Today, we know NET cancer stands second only to colon cancer in terms of patients in treatment for GI cancers. We know it stands as the most common of the rare cancers that make up about 30 percent of all human cancers. We know it stands on the verge of crossing out of the legal definition of a rare disease.

Nothing changed when much changed

But medical schools still don’t talk about it much. It appears on no national medical exam. Virtually no primary care physician or nurse practitioner knows it exists if they haven’t encountered a patient with it–a patient who likely heard the same words Jane did when she was diagnosed: “I’ve never heard of this kind of cancer before.”

I keep telling myself that.

I’ve worked at changing that for close to nine years now. Some things have certainly changed during that time. We have online support groups for patients; two organizations have put out books on the subject to help patients become more knowledgeable about the disease and better advocates for themselves; nationally, we’re raising–and spending– more than 10 times as much money for research as we were in 2010. I don’t pretend I’ve had a lot to do with any of that–much of it I’ve had absolutely no involvement in.

The other awareness

But awareness outside the NET cancer community has not changed at all. Many of us have shouted from the rooftops. Primary care physicians have not heard us. Nurse practitioners have not heard us. Medical curriculum groups have not heard us. The general public has not heard us.

But medical schools still don’t talk about it much…

Until that changes people will continue to be diagnosed with advanced disease we have no way of curing. We’ll only be able to ease their suffering some of the time when the drugs and treatments we have work. We may buy them some time with a better quality of life than they might otherwise have.

Changing ignorance

And there will continue to be patients who are never diagnosed; who will die without even the treatments we have that might help them with their symptoms, might get them to a graduation or a wedding or the birth of a grandchild.

Many of us have shouted from the rooftops.

We need to get those medical schools and nursing schools and medical curriculum designers to listen. They need to know the universe of neuroendocrine cancer exists–that what they think they know about the size of the problem is badly out-of-date–and dangerously wrong.

The walk in the woods calmed my mind but brought me no answers. I still don’t know how to do what needs doing. But I’ll keep trying. I hope you will, too.