Priscilla Stumpf, MD | Indiana

Priscilla Stumpf, MD
Sue Ann Wortman Cancer Center,
Hancock Regional Hospital
Greenfield, Indiana

Priscilla Stumpf, MD, is the mother of four young children, the wife of a mensch named Charlie, one of seven sisters in a close-knit family, a jogger, a nature lover with a special interest in ornithology, and a radiation oncologist. She and one of her sisters who also happens to be a radiation oncologist, Julia Compton, MD, staff the rad onc clinic at the Sue Ann Wortman Cancer Center at Hancock Regional Hospital in Greenfield, Indiana, about 30 minutes east of Indianapolis, out in farm country.

Monday 

Tag team morning rush with Charlie: make breakfast, pack lunches, double check homework completion, wrangle a couple of kids into car seats, drop them off at school. And then the mom frigatebird brain hemisphere gets turned off, and doctor hemisphere gets turned on.

Inside the department her staff is already answering calls, rooming the first patient, and ushering others to the linac. She needs laser focus in a conference with her nurse, taking inventory of urgent tasks, prepping. The first new patient has a base of tongue cancer. He is nervous, but his supportive daughter is with him. While the lidocaine takes effect to allow for scope, Dr. Stumpf is called to the machine to check a prostate SBRT setup. And so the day goes on, follow-up visits and a new consult with a woman with newly diagnosed anal cancer, and more bread and butter radiation oncology. About 25 patients are under treatment, 70% Medicare or Medicaid. Eventually, the workday ends, but she will have some notes to complete once little ones are tucked in, because it is time to turn off doctor hemisphere and turn mom on again. Drive home, evening dinner, homework and bedtime routines.

Tuesday 

Thick clouds on the ground. Evapotranspiration, aka corn sweat.¹ It’s a Midwest phenomenon. Corn and other crops release lots of water into the atmosphere when temperatures rise, peaking in late summer. There was a two-hour school delay one time because of the dense fog that made roads undriveable. Dr. Stumpf is extra careful, driving slowly with her hazard lights flashing, though people who grew up there hardly notice it and zip right past her.

Wednesday 

She is adding on a new patient who wants to be seen as quickly as possible so he can get through treatment before harvest season begins — a common scenario. She does her best to work appointments and times around harvest duties without compromising outcomes. This patient has a metastasis in his femur, and while he doesn’t require prophylactic fixation per her discussion with the academic MSK oncologist, Dr. Stumpf advises that he shouldn’t jump down from his tractor. He smiles and says, “Oh, it’s been a long time since I’ve jumped off anything, but I can still drive it right?”

Resisting a Rest

The frigatebird often flies across the ocean for days at a time without stopping. A 2016 study using electroencephalograms showed that they are effectively able to turn off one half of the brain at a time to allow for unihemispheric sleep while the other half keeps them going.

REFERENCE

1. Rattenborg NC, et al. Evidence that birds sleep in mid-flight. Nat Commun. 2016 Aug 3;7:12468.

Photo credit: Andrew Turner. Galapagos Archipelago, Ecuador. No changes to original. License: https://creativecommons.org/licenses/
by/2.0/deed.en

Thursday 

She hears the local resident pileated woodpeckers before seeing them. Her backyard abuts a field with a creek and woods running behind it that transitions into a neighbor’s farm. She feels lucky to have a pair of these massive birds to enjoy watching through her kitchen window many mornings.

Friday  

The Wortman Cancer Center has grown in recent years though is still building a palliative care service, so end-of-life care at times constitutes a big portion of Dr. Stumpf’s workload. When one of her patients dies, she usually waits a week or so before calling the spouse or partner or whoever was closest with the patient at the end.

It is time for Dr. Stumpf to call the wife of a farmer with metastatic non-small cell lung cancer who had had multiple courses of systemic and local therapy over the four years since his diagnosis. They lived way outside the small town of Greenfield, and they used to want to have follow-up visits around 11:30 a.m. so that they could treat themselves to a lunch at the Mexican place in town on their way back home. He always wore a rainbow-colored visor with a shoulder-length blonde wig attached, at first his way of thumbing his nose at chemo-induced alopecia, and eventually a signature fashion statement that said he refused to lose his sense of humor. During the visit they would tell Dr. Stumpf what they would be selecting from the menu, because they had thought about that a lot prior to the visit.

Alas, at some point the cancer progression began to outpace the therapies. Diminishing returns, downward slides in quality of life with each aggressive intervention. Lots of long, difficult conversations with the patient and his wife. Transition to hospice. Peace of mind. Peaceful death at home.

On the phone the wife is devastated. It was a second marriage between a widow and widower, a second chance at love, an affront to loneliness. She is not getting out of bed. She is sad.

Dr. Stumpf listens and listens and listens and tells her about support groups and a program at Christmas where family members bring an ornament to hang on the big tree in the lobby in memory of their loved one. About a month later, she comes to the clinic and wants to talk some more. And she starts sobbing. She’s lost without her husband and wants to go to the Mexican place but can't go without him. They hug. Dr. Stumpf reconnects her with the social work team.

About six months later she comes to the Christmas program. She looks beautiful. Her hair is done up, and she meets up with friends there. She smiles and hangs a rainbow visor with blonde wig on the tree.

The weekend - Family time. Maybe some bird-watching. Joy.