Salem Oncology Centre RSS Feed

Mondanite Magazine

Elaine Melnyk — Fri, 27 Nov 2009 18:15:00 GMT

Dr. Salem’s Interview

Mondanité Magazine

Beirut, Lebanon

November, 2009

It would be impossible to know the true Philip Salem without appreciating the strength of his attachment to the land and the people of his birth. Indeed, throughout his life, the little village of Bterram where his life story began has remained his spiritual and emotional anchor.

I can still remember when I traveled from Australia to meet with him one summer while he was visiting his family home in Bterram, he told me quite candidly that it was here, among the limestone houses and the olive and fig trees, that he was happiest. At that point, he had been living outside of Lebanon for almost 20 years and yet the allure of his birth place had not faded. “

Frances Mourani
Editor of a new book entitled “Philip Salem, the son of Lebanon”.

Q. Dr. Salem what does it mean to you to be of Lebanese Origin?

A. I have always said that if I were not Lebanese, I would not recognize who I am. I am in love with Lebanon and its people, and I am very proud of being Lebanese. Although I live in America, and I travel all over the world, the only land I feel is my land is Lebanon.

As a doctor, of course, I feel I am a citizen of the world. The whole world is my home, and all mankind is my family. However, my political and cultural identity is Lebanon.

Q. Tell us about your childhood and youth memories in Lebanon?

A. Until I was 14 years of age, my village, Bterram, was the whole world to me. By now I have been in America some 23 years, but whenever I visit Bterram, I feel that every tree and every stone recognizes me, and welcomes me. I feel very fortunate to be born in a village. You cannot possibly know the truth of Lebanon if you have not lived in a Lebanese village.

I was also very fortunate to have the parents I had. My father believed in the importance of reason, education and hard work. My mother on the other hand believed in the importance of love and giving. My father emphasized the power of the mind, my mother emphasized the power of the heart. I was fortunate to inherit their genes. The family house in which I lived in Bterram remains the most sacred place to me in the whole world and it is the center of existence for me. Only in that house, I am 100% myself. I have had only love, joy and happiness in that house. Until today, there is no place on earth that could give me the warmth and the peace that I need more than that house.

Q. How did you choose to be an oncologist?

A. I graduated from the Medical School at the American University of Beirut in June of 1965. From 1965 to 1968 I trained in internal medicine, and I was preparing myself to be a kidney specialist. However, one incident changed my whole life. A woman, who was very close to me, developed ovarian cancer and I accompanied her through her journey with the disease. I was very traumatized by that experience. That experience made me decide to be a cancer doctor rather than a kidney doctor. I loved the challenge and I had all the passion for it. When I discussed this decision with my family, friends and teachers, very few encouraged me to do so, but I was convinced down to the bone that this is the best thing that I could do. I never regretted that decision.

Q. Can you tell us something about your journey with cancer?

A. In June 1968 I joined Memorial Sloan-Kettering Cancer Center in New York and my boss was David Karnovsky, the founder of cancer medicine. Six to seven months into my training at Sloan-Kettering, Dr. Karnovsky and I bonded like father and son. He, himself, developed cancer and I took care of him. Before he died he visited Iran and on his way he stopped in Beirut and visited Bterram for three days. He stayed in our house in Bterram all that time and when he returned to New York he told me that this was the most fascinating trip he ever made. I had told him so much about Bterram that he felt the urge to visit and meet its people. He was very moved by the reception he had in the village.

After I finished my training at Memorial Sloan-Kettering I went to the M. D. Anderson Cancer Center in Houston and I did an extra year of training. I returned to Beirut in 1971 and I joined the staff of the American University of Beirut (AUB). From 1971-1986 I was in charge of the cancer program and I trained 23 physicians; 20 of whom I eventually succeeded to bring with me to the United States and to train in the best cancer centers. Some 5 to 6 of these are now national leaders in cancer research. This is probably one of my biggest achievements having trained all these doctors and eventually seeing them flourish to become world leaders in cancer research. In addition to being in charge of the cancer program at AUB, I was also the president of the Lebanese Cancer Society and I did many campaigns to educate the public about cancer.

In January 1987, I returned to the United States and I served on the faculty of M.D. Anderson Cancer Center as a professor of cancer medicine and research. In 1991 I established Salem Oncology Centre and until now I am the president of this center, and the director of cancer research at St. Luke’s Episcopal Hospital. St. Luke’s Episcopal Hospital where I have privileges, established a chair in my name, the “Philip Salem Cancer Research Chair“, in recognition to my contributions to cancer medicine. I am very humbled by this honor.

Q. What are the latest research results and treatment to cure cancer?

A. First, let me tell you in simple terms that if we exercise all knowledge we know about cancer, we can eradicate at least 75% of all cancers. The major problem today is that we are not able to exercise the knowledge that we have accumulated about prevention and treatment of cancer. Only very few patients (probably less than 5%) receive appropriate treatment and this is the major problem.

At the same time we cannot say that the problem of cancer has been conquered. Although we can cure a minimum of 40-50% of patients, we still lose too many. However, research is making a lot of progress and it now revolves around two major concepts.

· The first concept is developing drugs which target only the cancer cells and do not harm the normal cells. We already have several drugs like this. One of these drugs is Gleevec which is only a pill that a patient takes. Patients with chronic myelogenous leukemia may even achieve cure by treatment with Gleevec.

· The second concept is that a chronic infection may eventually lead to cancer. When I was a professor at AUB, I published extensively on a disease that afflicts people in the Mediterranean countries and the Middle East. This disease was a model of how an infection in the small intestine may eventually lead to the development of cancer. I did not realize the significance of that concept then. But a few years later, this concept became the cornerstone in the development of a new field in cancer research called chemoprevention. Take for example cervical cancer in women; we now know that an infection by the Human Papilloma Virus may lead to cancer of the cervix. If we prevent this infection with the vaccine Gardasil, the cancer will never develop. This is a model of how we can develop strategies to prevent infection and consequently prevent cancer. I am proud to say I was one of the very early researchers in the seventies who came up with this concept. You can imagine if we identify all kinds of infections that could cause cancer and we develop strategies to prevent them, we can probably cure or prevent a lot of cancers. I strongly suspect that many cancer diseases could be the result of chronic infections.

Q. How can we prevent cancer?

A. One of the biggest challenges to mankind is tobacco smoking. The cigarette kills a minimum of 5 to 6 million people a year worldwide. There is no war that would kill that number of people annually. Although this is a huge problem, its prevention is not that difficult. The major obstacle here is the interfacing between politicians and the tobacco industry. In America most politicians are supported by the tobacco industry. Approximately 1/3 of all cancers that afflict man are tobacco related.

It is difficult to say in few words all the strategies for the prevention of cancer. The best advice I can give to people is to identify one day a year for a check up. This is the most important advice that I can give to the public. This is so important because most cancers are curable when diagnosed early.

Q. Do you believe that cancer can be cured by a supernatural miracle?

A. I have 42 years of experience in cancer medicine and research and I have not yet seen a single patient who has been cured of cancer from outside the miracle of the mind. Only God can make miracles, and God has created the human mind which is capable of acquiring knowledge and with knowledge we can conquer disease. I was on several committees that relate to the authentication of miracles, and every “miracle” I had examined was not a miracle. I only believe in the miracle of the mind. At the same time I would like to say that I cannot believe that there is anyone who has more faith than I do. I thank the Lord everyday. I am a great believer in his power. I believe it is only He who can make miracles; no one else can.

Q. You say I believe “when you treat cancer we need to remember that we are not treating the disease in vacuum, we are treating the human being who has the disease there is a big difference between giving a good treatment and giving a good care” can you explain this?

A. When we treat cancer, we are not only treating the disease. There is a human being behind the disease who has concerns, fears, and anxiety. He is threatened by death and is in a state of shock. He should be recognized as a total person, and the need to alleviate his fears and to address all of his concerns is of extreme importance. Doctors who only treat diseases are failures. It is only when you love your patient and you treat the patient as a whole, you can cure him. Also, I want to emphasize that when we treat patients, it is not only the medical treatment which is important, but supportive treatment as well. Supportive treatment is what we give along with chemotherapy to prevent the toxicity of chemotherapy and to make the patient live as close to normal as possible. In addition to supportive care, good care means easy accessibility to the doctor and to the nurses, it means continuity of care on Saturdays, Sundays, and holidays, and it means that the doctor is always ready to sit down and talk to the patient. In the climate of medical care we live in today, doctors are only interested in treating diseases. They have no time for the human being behind the disease. Taking care of the whole patient is time consuming and some doctors are not willing to give a lot of their time. This is a major challenge for medical care, not only in America but all over the world. In the treatment of cancer, compassion, love, caring, understanding, and human warmth are as important as the basic medical treatment. This is why I am in the process of finishing a book on cancer treatment, entitled “Knowledge alone is not enough”

Q. What are the most important factors that determine the cure of a patient?

A. This is an extremely important question because unfortunately more than 90% of patients do not receive adequate treatment that could provide them with cure. The factors that determine cure are the following:

1. The exact nature of the cancer and how malignant it is.

2. How far advanced the cancer is.

3. The adequacy of the treatment the patient receives.

4. Courage and perseverance, not only on the side of the patient but more importantly on the side of the doctor. Many cancer patients die because their doctors give up on them very early. Those doctors do not have the courage and perseverance necessary to go forward. Also, if the patient does not have enough courage and perseverance, he may choose to stop treatment early. The only people who win the war are the ones who go to war fully charged and prepared to win.

Q. You deal with life and death, hope and disillusionment, courage and fear, where do you get your strength from?

A. I believe in the power of hope and I believe in what I am doing. I believe treating the cancer patient is the most noble thing in the world. I cannot think of a job more noble than mine. My strength originates from my belief in the power of science and knowledge. Also, I believe in the power of love and compassion. My motto has always been “the doctor who does not love his patient cannot cure him”. There is no joy greater than the joy of curing a cancer patient and I must tell you that I have cured hundreds of patient whom I did not think I could cure when I started their treatment. It is the power of courage and perseverance that eventually led to their cure. We should never forget that a patient, who is not curable today, may become curable tomorrow. As time passes by, new drugs emerge and a drug which is not available to us today may become available in a few months; therefore, you can rarely say that this patient is not curable. One should never lose hope and faith. My philosophy is to do my utmost and only after I do my utmost, I would pray to God and I would ask him for help. I never ask for help before I make sure that I have done my very best.

Q. You say “here in my clinic I am closest to God. Here I feel the awe of responsibility, the responsibility of life and death. Also here I feel the awe of nobility and sacredness?”

A. A cancer doctor’s work and his relationship with his patients are sacred. To achieve sacredness, the doctor should rise above himself.

Q. Can you tell us more about the sacred responsibility?

A. This is an extremely important concept. I do not believe that my relationship with my patient is a relationship between a doctor and his client. This is not a business relationship, nor a legal contract, as it is thought here in America. Medicine is above business, above law, and is above everything else. The relationship between me and my patient is sacred because it is partially divine. Only God can give life, and I am here with God’s hand touching mine to help me cure my patients. This is a kind of recreation of life; conquering death, salvaging life; a divine act which is something from God. It is something sacred, and this is not a normal relationship between one human being and another. It is a relationship between a human being who is threatened by death and another human being who is working hard to salvage his life.

When I say that the doctor should rise above himself, I mean, as I always say, the difference between a great doctor and an ordinary one is that an ordinary doctor thinks of his interests when he sees the patient, while a great doctor thinks of the patient’s interests and not his own. When you are a doctor, and you are treating patients, the focus should be the patient, not you, not your prestige, not your business, not your income, not your name, and not your reputation as a doctor. The only one who is of importance is the patient and his life. This is why I always emphasize that the doctor should keep his ego at home before he goes to work.

Q. Seeing so much pain and suffering of so many human beings, does this affect your faith, what have you learned?

A. I always wondered whether there has been a human who has seen more cruelty than I. I have seen the cruelty of disease against man in my 42 years of experience with cancer and I have seen the cruelty of man against man in the war in Lebanon. I believe the cruelty of man against man is more cruel than the cruelty of disease against man. My experience with death and suffering has taught me the importance and the beauty of life and health. It is a pity that people start thinking about their quality of life when they get close to death, and it is a pity that people at large take life for granted. Life is the greatest gift we have and I cannot think of a greater gift than the gift of health. If you have health, you have all the wealth. This is why my sympathy does not go to the poor. The poor who are healthy do not have my sympathy. My sympathy, compassion and love are all focused on the sick. My motto has always been, “if you are healthy you have no reason to complain”.

Furthermore, I must tell you that my knowledge of the human body and how the body functions makes me a great believer. You cannot see the beauty of the human body and how this body functions and not be in awe of the creator. The more you know about life and the biology of life, the more you realize that life cannot be the product of an accident. It is by a power far beyond us. I am one of those who believe that scientific knowledge is the way to God. The more you know about man and about the cosmos, the more you should realize that this could not have possibly been a result of a physical accident.

Q. What about your political engagement?

A. As much as I am committed to the struggle of man against disease, I am committed to the struggle for the resurrection of Lebanon. I lived the Lebanese war, and during the war I treated many of the big political players in that massive tragedy. I knew what the problem was. The problem in Lebanon has always been the lack of a political leadership. Since the creation of Lebanon, Lebanon has never witnessed or had an intelligent political leadership. The Lebanese leadership has always been incompetent, and in most cases very corrupt. I am a great believe in leadership. If the best people in the world do not have a leader, then nothing can be achieved. Leadership is what takes people to the peak of glory.

Also, I would like to say that Lebanon has been the victim of its geography and its politicians. In regard to geography, Lebanon is chained between Syria and Israel. Israel does not want Lebanon because it is the anti-thesis of Israel. Lebanon is a pluralistic culture and society where Islam and Christianity coexist, where the East and the West can have dialogue. Israel is a country carved only for an ethnic and religious group. It is the only country in the whole world which is based on ethnicity. On the other side Syria has always believed that Lebanon has been severed from greater Syria and it would like to recapture it back. This is the reason why Syria never recognized the independence and sovereignty of Lebanon. Also, when I say that Lebanon is the victim of its politicians, this in, my opinion, is probably the root of the Lebanese crisis. The bulk of our politicians have no loyalty whatsoever to Lebanon. They are always ready to trade it for anything that would bring back wealth and prestige. There are very few Lebanese politicians who could rise above their own personal interest. When Iraq invaded Kuwait over a period of many months, the Iraqis could not identify more than 6 or 7 Kuwaitis that would cooperate with them. In Lebanon, if Syria goes into Lebanon and occupy it the next day, three quarters of Lebanon would be with Syria. If Israel invades Lebanon, thousands of Lebanese would ally with Israel. This question of loyalty is an extremely important factor in the continuing drama of the Lebanese crisis. There is no country in the Middle East that has the resources of Lebanon, not even Israel. In spite of that, look where we are. When you have a leader and loyalty, like Dubai, you can see what a leader had made out of the sands. Out of nothing he made a paradise, while we here in Lebanon we had a paradise, but we did everything humanly possible to make it hell.

Q. A personal message to the Mondanité readers?

A. my message is the following:

· Life is not something you have earned, it is something that is given. Please treat it as the best gift you will ever have.

· Most people work hard for a mirage. People believe that success and money are the basic objectives in life, and many times when they achieve them, they realize that their hands are empty. In Lebanon, and the Arab world, people believe in appearances. It is a culture of appearances, but what is important is this internal journey you make inside of yourself. You know that you have succeeded only when you are proud of the person you see in the mirror; and only when you achieve that internal peace and comfort between you and yourself. The real journey in life is inside you and it is not in the public eye.

· The third message is that people should be trained to give, and the easiest form of giving is to give money. I encourage you to give of yourself. Only by giving you reach fulfillment and joy. Please support life, support a sick child who is poor and cannot afford medical care. Support charitable organizations that support life. Be part of the war against disease and against suffering and pain. Be part of the real world. Giving gives your life a meaning. We need to change the motto in the world from “I love you because I need you” to “I need you because I love you”.

27-Nov-09 12:15 PM

KNOWLEDGE ALONE IS NOT ENOUGH by Philip A. Salem, M.D.

Elaine Melnyk — Wed, 02 Sep 2009 01:00:00 GMT

Every morning, I close my eyes and embrace the Lord and thank him. I thank him everyday, and I will continue to thank him everyday until my last day. I thank him for everything because if it were not for him, I would not be here. In particular, I thank him for the opportunity he has given me to treat cancer patients.

And, every morning, when I drive to my office in the city of Houston, I ask myself three questions: Is there any work greater than that of treating people threatened by death from cancer? The answer is no. Is there any work which is more noble than saving the life of a human? The answer is no. Is there any work I love more than mine? The answer is no. At this moment I am filled with joy and I am soothed with warm inner peace,

When I arrive in my clinic, and I see my patients, I feel I am as close to God as possible. My clinic is my church. Here I pray, during the day, all day. My prayer is in sharing with my patients their pain and their suffering, and also in sharing with them the joy of hope and the glory of resurrection of life. Here in my clinic I feel the awe of responsibility; the responsibility of life and death. Also, here I feel the awe of nobility and sacredness. A cancer doctor’s work and his relationship with his patient are sacred. To achieve sacredness, the doctor should rise above himself. He should forget who he is and what his interests are and should only work for others not for himself. To achieve sacredness, the “I” should melt away and become “you”. Giving life is God’s work, and although God alone is capable of giving life, He has bestowed upon man the human mind. This mind is the ultimate miracle of his creation. Without it, there is no being. God has created the mind for man to acquire knowledge. Knowledge is a must to control disease and alleviate suffering and pain. Knowledge is what defines medicine and its greatness. Without it there is no medicine. In medicine there is nothing outside knowledge, and in my 41 years of experience as a cancer physician, researcher and educator, I have never seen one patient who was cured without scientific knowledge, and I have never seen a single miracle beyond the miracle of the human mind.

This is all about knowledge, but the secret that many people, patients and doctors may not know is that knowledge alone is not enough. To cure the cancer patient a lot more than knowledge is needed. The four most important things you need are: love, hope, courage and perseverance.

My motto has always been, and will forever remain, the doctor who does not love his patient, cannot cure him. The patient, in particular the cancer patient, needs a doctor who loves him. Love is the power that bonds the patient and the doctor in an eternal embrace. Without love and compassion, the doctor will never know the human behind the disease, and will not be able to shepherd the patient through his journey with his disease and its treatment. “Love never fails”

Also, hope, I believe is essential for the conquest of disease. I do not think that a doctor has the right to strip the patient completely of hope, even though he may believe that he knows the truth, the whole truth. Khalil Gibran said “who saw the truth coming down from heaven?” Also I say, what might be true today may not be true tomorrow. Science and knowledge grow and expand everyday. Recently, I had lunch with a woman whom I treated 35 years ago. When I started her treatment, I did not believe she had any chance for cure, but during her treatment new drugs emerged and she eventually achieved a cure.

Also, the road to cure needs a lot of courage and perseverance. It is not only the patient who should have courage and perseverance but also the doctor. Many patients lose the courage and perseverance needed to continue treatment because the doctor gives up too early. The road to cure is long and brutal. There are many roadblocks and many big holes. There are countless failures and multiple frustrations. Should the doctor or the patient retreat, every time there is a failure or the patient slides into a hole, they will never reach the end of the road. To reach the end of the road you have to accept failure. You have to accept sliding into the hole and persevering to get out of it and to continue forward with determination. This scenario may happen many times before you reach the end, and achieve cure. Only those who have courage and perseverance reach the end of the road. Only those who go to war and fight it with all their power win the war.

Giving in all its forms is great, but the highest of all of them is giving a human back his life. The life of the doctor is the lives of others, the lives of his patients. There is a great verse in the Quran, "The one who cures one human, cures all mankind".

1-Sep-09 8:00 PM

Michael Debakey - The Real Man Behind the Genius by Dr. Philip A. Salem

Elaine Melnyk — Mon, 21 Jul 2008 01:00:00 GMT

When Michael DeBakey passed away on July 11, 2008, it was a sad day for the world and for mankind, and it was a shock to those of us who had always loved him and admired him, for we considered him immortal. It was difficult to believe that the power of his mind and body could be conquered by disease and death, as for he had always been their conqueror. Since his passing much has been said and written about Michael DeBakey, the foremost heart surgeon, the pioneering researcher, the innovator, the gifted medical educator, the international medical statesman, and, above all, the genius, but little has been said about the man behind the genius. Indeed very few people have had the privilege to know the real man. I feel profoundly privileged to have been one of his close friends and one of who had come to know the essence of man behind the genius. For many years I had the honor of having lunch with him at least biweekly, and I have travelled with him to Lebanon and throughout the world many times. It was not medicine that bonded us, it was Lebanon; our beautiful ancestral country that we both loved so deeply. We were also both reared in the Orthodox Christian faith, and we both adored and revered our parents. Michael DeBakey loved Lebanon, and the Lebanese people reciprocated with affection, pride and admiration. To the Lebanese his name was redolent of a young Lebanese poet Gibran Khalil Gebran who some 100 years ago stood before the towers of New York and said “I’m the descendant of the people who built Damascus, Byblos, Tyre, Sydon, and Antioch, and I am now here in America to build with you and with a will”. In an address he made to young Americans of Syrian origin, Gebran said “I believe that even as your fathers came to this land to produce material riches, you are born here to produce riches by intelligence and labor”. Michael DeBakey, who himself was the American born son of Lebanese immigrants did, indeed, “build and with a will”; did indeed produce “riches by intelligence and labor”; riches that shaped the future of American medicine and defined the greatness of America. No American contributed more to modern medicine, and no surgeon is more deserving of the label “Greatest Surgeon of all time”. How fortunate to be a contemporary of this man, and what even greater honor to be his friend.

Both Gebran and DeBakey were universal in their messages. The message of Khalil Gebran was the power of love; the message of Michael DeBakey was the power of knowledge. Bertrand Russell, the renowned British philosopher and Nobel Laureate, described the combination of love and knowledge as “the greatest force in the world”. It is this combined force, and not physical force, that is needed to save the world and mankind.

Having been raised in a warm and loving Lebanese family, Michael DeBakey had a penchant for Lebanese food, and my office staff, over the years, learned the routine. The Lebanese lunches were served by my staff mainly in his office in the Alkek Tower of the Fondren/Brown Building, and occasionally in my office at St. Luke’s Medical Tower. Sometimes we had a few guests, but usually we were alone. The last time we had lunch together was a week before he died. During that time, he said “Philip, I do not have a lot of time, and I have very few close friends like you. Can we make this lunch regularly every week, when you return from Italy?” “With great pleasure, we certainly will” I answered. Seven days later, I heard the shattering news when I was in my hotel in Rome, Italy. I was stunned and I kept switching channels just to confirm that it was indeed, my friend, Michael DeBakey, who had passed away. I was frozen in disbelief for a few hours, immersed in deep thought about the man I loved deeply who was a father figure as well as a treasured friend to me. He is no longer here. There are no more lunches. That great privilege is gone. Somehow, Houston appeared so distant and so empty.

What do I know about this international icon that the world didn’t? What was real and what was mythical? There is indeed a myth that surrounds every great man, and almost always the myth is larger than the real man, but with Michael DeBakey, the reverse was true. The man towered over the myth.

Unlike most doctors who devote their lives entirely to their work and know little of the outside world, Dr. DeBakey had a panoramic mind with an endless landscape of knowledge. His knowledge was far from limited to medicine, but reached into history, politics, philosophy, religion, music, and literature. He was a Renaissance intellectual in the true sense of the word. There was no field or area of knowledge he was not versed in. With the little time he had for nonmedical adventures, he read extensively, and this mind memorized almost everything he read. What an enhancing memory he had, and what an enormous intellect that not only absorbed knowledge, but assimilated, expanded, and refined it. In politics and history, the Middle East was his favorite. We talked endlessly about the plight of Lebanon and the conflict in the Middle East. Although I lived more than half of my life in Lebanon and have always been a political activist in Lebanese and Arabic affairs, I never left his office without learning something new from him. One thing we never discussed at these sessions was medicine.

Although he was a great scientist, he had a strong and profound faith. I have never known of any man who revered more Christianity and its message. He was a strong symbol of love and forgiveness. He never questioned the reality of Jesus Christ, he always admired His example. He was ever thankful to the Lord for granting him that great mind, that great body, that long life, and his unparalleled achievements. He studied and mastered the human body in all its complexity and wonder, and was puzzled by those who were not in awe of the Creator when faced with the ingenious mechanisms of the human body and mind. He reminded me of the great Arabic Persian, physician and philosopher, Avicenna (Ibn Sina), who said “I studied medicine to understand and appreciate God. Didn’t God create man in His image?”

Few people understood the innocence deep in Michael DeBakey’s heart. To me that innocence was clearly visible and palpable. When he was comfortable and contented, he always gravitated to talking about the young Michael DeBakey who lived in Lake Charles and, at the age of 10, visited with his parents their hometown of Marjayoun, Lebanon, known at that time as the Paradise of the Middle East. His favorite subject of conversation was his father and mother, and he spoke endlessly and lovingly of them and of their enviable qualities. The father was a highly intelligent and prosperous entrepreneur who indoctrinated in his children the highest human and Christian values and who emphasized the importance of education and diligence. His mother whom everyone called a queen, read the Bible daily and radiated love in the home, and he learned from her the art he applied to sewing Dacron grafts. Both of his parents were extremely charitable, but almost always silently. His favorite food was Lebanese, the food his mother prepared when he was a child, and his favorite dish was kibbee, his parents and siblings favorite as well. More than any other human being, his mother was the center of his love and life. He repeatedly told me how fortunate he was to have such model Lebanese parents, who cherished family love, high principles and education. He knew that I was listening and heard his words and that I understood. That bond with his parents and with his siblings was what bonded the two of us.

He was not only fortunate to have model parents, but siblings as well. Anyone who knew Dr. Michael DeBakey as well as I do is aware of how devoted to, and proud he was of, his late brother Ernest, a superb thoracic surgeon of Mobile, Alabama. They were extremely close throughout their lives, and called each other often, whether they were at home or traveling. He was also exceptionally close, personally and professionally to his sisters Selma and Lois, both internationally recognized Professors at Baylor College of Medicine, with whom he shared his office suite and who acted as his colleagues/aides, involved in and supporting every aspect of his spectacular career. They were ever present to help him, support him, and advance his efforts. Colleagues around the country told of his unfailing tributes to them for their support of his efforts and for their pioneering contributions in their own discipline. They dedicated their lives to him; he was their world. He respected their intellect and their integrity, which his parents had instilled in all of them, and he considered it a blessing to have not one, but two such treasures, whom he called his “angels,” in whom he confided his innermost thoughts and ideas, and whom he entrusted his most valuable honors and archives objects. It was a mutually fulfilling and productive triumvitrate. Working with their brother cannot be better described than in the apt words of Khalil Gebran: “Work is love made visible.” And: “You give little when you give of your possessions. It is when you give of yourself that you truly give.” Michael DeBakey could not have reached the peaks he did without them; they are inarguably a part of his legacy.

The real man was neither harsh nor arrogant, as many people thought. He was very humble and loving. Indeed, this was the only side I ever saw of him. All I saw was love and tenderness, but I can understand the façade of severity and harshness, the product of his total commitment to excellence and his unyielding devotion to his patients. He was certainly a great researcher, innovator, and educator, but beyond any shred of doubt, he was a greater physician. Nothing came before the patient, not his ego, his name, his prestige, or his interests. He was invariably intolerant of mediocrity and could never accept anything less than the best. When it came to the patient’s life, niceties did not count, and he always cut through to the heart of the matter. He was the strongest patient’s advocate, and he never compromised on their lives. That was what made him the great doctor he was.

He exuded confidence, but he was indeed humble. He was a man of integrity - solid integrity. In an era when we witness the assault of bureaucracy, government, and insurance companies on the quality of medical care and on the very essence of the humanitarianism of medicine, none had the courage to challenge those forces more than Michael DeBakey. Of all the “products” of America, the very best in my opinion has been American medicine. Dr. DeBakey was instrumental not only in making this excellent product, but also in preserving its sanctity. In this era of materialism, mechanization, and decline in human values, Michael DeBakey stood as a monument of character, integrity, courage, and above all, humaneness. Despite his giant stature; however, this man was in constant awe of new and expanded knowledge, of the wonder and complexity of the human body, and above all the Creator.

With his death, a part of me has also died. I will miss the lunches, I will miss the dialogues, I will miss the endless hours talking about Lebanon and our parents, I will miss our pure and mutual friendship, I will miss his love and tenderness. I will always miss him deeply. My only solace is that part of him is still alive and still with us. That part is in Selma and Lois. Every time I hug them, I feel he has not died.

May the Lord bless him in heaven, as He blessed him on earth.

20-Jul-08 8:00 PM

GENTE

Elaine Dittoe — Tue, 24 Jun 2008 19:15:00 GMT

/attachments/wysiwyg/1/GENTE.pdf

24-Jun-08 2:15 PM

Interview with Sabah Newspaper

Elaine Dittoe — Tue, 24 Jun 2008 19:00:00 GMT

Istanbul, Turkey - July 2004

AN INTERVIEW WITH

PHILIP A. SALEM, M.D.

Director, Cancer Research Program

St. Luke's Episcopal Hospital

Clinical Professor of Medicine

University of Texas, Houston

Question:

What are the latest developments, the latest research as far as cancer is concerned, and what are the latest treatment methods?

Answer:

While progress is steadily being made, it is certainly not fast enough. I wish we could have a drug tomorrow that would cure all cancers. However, I do not believe this will happen in the foreseeable future. Progress so far has been gradual, but is definitely going in the right direction. It is important to emphasize that right now, we are able to cure 40%-50% of all cancer patients if these patients are given the proper treatment. The tragedy is that more than 90% of cancer patients all over the world do not receive appropriate treatment, and this is why the results of the treatment of cancer have not been very impressive. The key to the proper treatment of cancer is to provide patients with access to cancer experts who work in institutions or programs where group consultations and teamwork are feasible. Cancer cannot be treated by one single doctor; it needs a team of doctors who work together as one single entity, in harmony, to provide the best care. Also, you need the supportive measures. This means that you have to have a very high-level pathology service to provide the right diagnosis. You also need to have a very sophisticated diagnostic radiology facility where patients can undergo the most modern imaging technology. This simply means that it is not enough to have a great doctor; you have to have a great system, a great network of cancer experts and network of supportive systems for diagnosis and treatment. This scientific climate is available only in a few centers in the world.

Question:

How close is the link between cancer and infection, and which infections can cause cancer? Which types of cancer are caused by infections?

Answer:

By now, there is little doubt that some chronic infections may cause cancer. H.Pylori in the stomach is associated with higher incidence of stomach cancer, including lymphomas and adenocarcinoma. There is little doubt that schistosomiasis infection in the bladder causes bladder cancer. This is why bladder cancer is the most common cancer in Egypt. Also, there is a strong suspicion that Hepatitis (infection of the liver) would eventually cause cancer of the liver.

Question:

What about cancer vaccines. When will the first cancer vaccine be on the market according to you? Can you give a date, like in 10-20 years?

Answer:

I cannot give a specific date, but vaccine therapy remains in the experimental phase. At this point in time, there is no vaccine which is used in the actual treatment for cancer. There are different experimental protocols evaluating vaccines, but at this point in time, they do not have vaccines available for the treatment of cancer. I would expect that vaccines would be more important in the prevention of cancer rather than its treatment.

Question:

Gene therapy and stem cell transplantation seem to be very promising. Do you think that treating cancer will be much more easier in the future, when these methods are developed?

Answer:

I have no doubt that treating cancer in the future will be much easier and the results will continue to improve. Stem cell transplantation has a very promising role in the treatment of cancer, so does gene therapy. At this point in time, bone marrow transplantation has been shown to be very effective in the treatment of leukemias and some lymphomas. Gene therapy, however, remains in the experimental phase.

Question:

Why is there an increase in cancer cases? What are the major reasons for cancer?

Answer:

The most important cause for cancer is tobacco smoking. Smoking kills four million people every year all over the world. There is no war in the history of man that has killed as many people. There are of course, many other reasons like exposure to asbestos, extensive exposure to sunlight and exposure to radiation.

Question:

How do you see the future as far as cancer is concerned?

Answer:

I believe the future is very promising, but progress in cancer will continue to be step-wise. The speed of progress is going to be log rhythmic, and research is going extremely fast. Within ten years, I am almost certain that most cancer diseases will be treatable and many of them will be like any other chronic illness like diabetes and hypertension.

Question:

What are the most important factors that determine the cure of a patient?

Answer:

Cure depends on three major factors:

1. The nature of the cancer

2. How advanced is the cancer in the body

3. Whether the treatment of the cancer was appropriate or not

Question:

In your opinion, what is the cornerstone of excellence in cancer care?

Answer:

The basic cornerstone is scientific knowledge. Without updated state of the art scientific knowledge, you cannot build a treatment program. However, because of the recent explosion in scientific knowledge relating to the treatment of cancer, it has become of utmost importance that doctors who treat cancer seek group consultations because there is not one single expert in cancer who knows everything about the disease. Therefore, treatment has to be designed by a group of cancer experts rather than by one single expert. Although I graduated from the two most prestigious cancer centers in America (Sloan-Kettering Cancer Center and M.D. Anderson Cancer Center), and I was on the faculty of M.D. Anderson as a professor of cancer treatment and research until 1991, and I have been in academic medicine and research for 36 years, I still feel that I cannot make the final treatment plan on a patient without a group consultation. Group consultation provides the cornerstone for guaranteeing the fact that the patient is receiving state of the art treatment.

Question:

In spite of this progress in cancer research and cancer treatment, I have heard you say many times that cancer medicine in America is in a crisis. Why is that?

Answer:

I have told you that scientific knowledge is the cornerstone of treatment in cancer and in any disease. However, scientific knowledge, though necessary by itself is not sufficient. In cancer, the patient needs far more than scientific knowledge concerning the treatment of the disease. I believe that when we treat cancer, we need to remember that we are not treating the disease in vacuum; we are treating a human being who has the disease. These two philosophies are very different and demand different strategies. I believe in the latter. However, the latter demands a lot of time, a lot of care, and a lot of giving from oneself. In addition to scientific knowledge, what the cancer patients mostly need is love and care. They need to be treated by a doctor and medical staff who love them and come to know them very well as an individual, and who want to give them the best care in the world. It is not enough to give the scientific knowledge; because without love and care, the patient will not receive the absolute appropriate care.

People at large do not appreciate the big difference between giving a good treatment and good care. Good care means far more than giving good treatment. It means that you attend to the patient as a person; you attend to his fears, his concerns, to his images of death, dying and pain. You attend to the most divine and sacred essence of the person. This is why I have always believed that the relationship between the cancer doctor and his patient should almost be divine. There is no relationship among human beings which is more divine than the relationship between two persons, one threatened by death and the doctor struggling to salvage him from death. Love is a very important component of the patient's care.

Question:

Is there anything else that good care entails?

Answer:

Of course, a lot of other things:

1. The patient needs to be monitored almost daily. These patients are fragile and they need to be examined and seen almost daily, to make sure they do not develop fatal complications like bleeding and/or a very low blood count that predisposes them to infection and possible death. Also, chemotherapy may produce major side effects. If these side effects are not addressed in a preventive and prophylactic manner on a daily basis, major health problems and complications may occur You simply cannot put a patient on chemotherapy and ask him/her to come and see you once a week. Good care demands more than that.

2. Good care also demands continuity of care. Therefore, patients need to be seen on Saturdays, Sundays and holidays. Disease does not take a vacation and you cannot be in charge of patients if you do not provide them with daily care. At Salem Oncology Centre, we are open every day and we have staff that is on-call 24 hours a day, 7 days a week, 52 weeks a year. Any discontinuation of care could be disastrous. Diseases do not take weekends off and do not celebrate holidays.

3. Also, one of the important issues in cancer care is that the patient receives therapy at the hands of the same doctors, nurses, and the paramedical staff every day. Cancer patients cannot afford to have different doctors every few weeks because this will certainly cause a lot of turbulence in the continuity and quality of care. It is also important that the patient receives therapy at the hands of the same nurses and staff, so if any complication occurs at night and he calls, the voice that he hears on the other side of the phone is a familiar voice who knows the patient extremely well and can immediately diagnose the problem and recommend the exact and precise treatment for it.

4. The emergency outreach program. One of the major issues in cancer therapy is the fact that if the patient develops a major problem at 2:00 o'clock in the morning and somehow could not come to the emergency room at the hospital, there are very few programs which are available in America and the rest of the world where the facility would send a nurse or a doctor to the hotel or apartment where the patient is staying. I am proud to say that at our facility, should the patient call at 2:00 o'clock in the morning and there is an emergency problem, one of my staff will immediately be dispatched to where the patient is staying and will deliver the treatment at that specific location. I know of several patients who died because they were too sick to come to the emergency room at night, and the hospital had no outreach program to dispatch medical professionals to see them at their hotels or apartments.

All the above emphasize the importance of having a dedicated team of medical professionals who take care of the patient daily, without interruption and the delivery of care 24 hours a day. This component of therapy is of utmost importance. I know of patients who receive the best treatment in the world, but who eventually died because the care component of therapy was not good enough. Therefore, I reemphasize again that excellent care is far more than excellent treatment. This is where, in my opinion, in big academic American institutions, these institutions may fail to provide what I consider the best care because they do not have enough medical and health professionals to attend to the overall needs of the cancer patients.

Question:

Why, in your opinion, this kind of care not delivered?

Answer:

The answer is simply because this kind of care is very time-consuming and demands a lot of medical staff, and both of these issues are very expensive.

One of the challenges to American medicine is to allocate adequate time for patients. This is a problem because insurance reimbursement policies do not consider time in their equation. In a consultation, whether you see a patient for 5 minutes or 5 hours makes little difference. Therefore, with the reimbursement climate in America, doctors are forced to see a large number of patients to make ends meet. This leaves very little time for the doctor to allocate to every single patient. Also, because of cost containment strategies in America, physicians, hospitals and medical facilities are trying to cut down on costs, and this eventually leads to inadequate staff to attend to all the needs of the patient.

An additional important factor is that doctors in America are not trained in attending to the psychological and emotional issues associated with disease. It has not been clearly understood yet, that treating a human being takes far more than treating the disease that he has. The doctor has to be very sophisticated in the art of communication with the patient and should allocate a lot of time to lift the patient's spirits and educate him about his disease. We always have to tell the patient and family the truth, but there is delicate balance between telling the truth and maintaining good morals and spirits in the patient. In my opinion, at no point in time should the patient be stripped of hope. I believe there is always hope. I have treated many patients where I felt that the cure rate was zero percent and I have seen these patients ten years later. We should never forget that when we talk about the future, we are building our arguments and assertions on research done in the past, and sometimes we forget that new drugs may emerge as the patient lives on. I can easily say that in my lifetime, I have seen more than 100 patients where, when I started therapy, the chance for cure was zero and eventually new drugs emerged and the patient was lucky to live long enough to receive these agents and achieve cure. This is why I emphasize that the patient should never be stripped of hope.

Question:

Dr. Salem, I know you are of Lebanese origin. How do you feel being of Lebanese origin and being a very important doctor in America? You are in the last three editions of the America's Top Doctors.

Answer:

I believe being of Lebanese origin has been a great advantage for me. Being from the Mediterranean world, I brought with me several weapons that I used daily. I brought with me the human warmth, the compassion, the ability to embrace the patient as a family member and the ability to give him of myself and of my time. Although I believe these traits are present all over the world, they are of special importance in the Mediterranean culture where I come from. Also, being of Mediterranean origin, I understand the world outside America much better. I know Europe extremely well and I understand the European mind. Also, I understand the Latin mind. Coming from the Mediterranean world has been a great advantage in practicing medicine in America because when you practice medicine, you have also to understand the culture of the patient you are treating. Dealing with the sick takes far more than science and knowledge. You have to understand his mind, his philosophy, his mythology, and his culture.

Also, as you well know, diseases and patterns of diseases change from one geographical area to the other. Being, of course, from the Mediterranean world, I understand more Mediterranean diseases. Take, for example, one cancer like lymphoma. This cancer has a very different pattern in the Mediterranean than the pattern in America. I devoted a good part of my life to researching a specific kind of lymphoma that afflicts the small intestine and exists only in the Middle East and the Mediterranean shores. Also, for example, lymphoma in bone is common in the Mediterranean world, but is extremely uncommon in the West. So being of Mediterranean origin is a great advantage for me to treat, here in America, people who come from the Mediterranean countries.

Question:

Dr. Salem, can you single out one achievement you have made at Salem Oncology Centre?

Answer:

Probably, the most single achievement I have made here at Salem Oncology Centre is the fact that we have succeeded (my staff and I), in providing a facility which is the closest possible to home for the patient. Patients love to come to our facility daily because they love the nurses who take care of them and they feel very much at home here. Above all, they feel they are loved and cared for. We not only care for their medical needs, but we also care for other needs, including the family's needs. Patients from all over the world, Christians, Muslims, Jews, Buddhists, and Atheists come to this facility and get bonded by love. I am a great believer in the universality of man because I have seen patients who come from Argentina who are not any different, in essence, from those who come from Turkey and those who come from Turkey are not different from those who come from Mexico. All humans want to be loved, want to feel secure and they do not want to die.

24-Jun-08 2:00 PM

ACCEPTANCE SPEECH OF THE ALMA AWARD

Elaine Dittoe — Tue, 24 Jun 2008 19:00:00 GMT

LAS VEGAS, NEVADA

February 25, 2006

I would like to start by thanking the president of the American Lebanese Medical Association, Dr. Paul Wakim, the organizing committee of this convention, and the board of the association, for bestowing upon me tonight this great honor. I am not sure that I deserve it, but I happily accept it, and I will certainly work hard to earn it. What is dear to my heart in this honor is the fact that it comes from people who are the descendants of a sacred land, Lebanon. I am here in America and America has been extremely generous to me. I am grateful, thankful, and I acknowledge allegiance to it. There is nothing that I wouldn't do to promote its prosperity and greatness, but at the same time, when I look into my own deeper self, I realize that my identity is Lebanese. There is no contradiction whatsoever in being a devoted Lebanese and a grateful citizen of the United States of America. In fact, people like me who came from distant lands appreciate America and American values more than those who were born and raised here. In my office in Houston, I have a branch of an olive tree from my land in Lebanon and on my desk, there is a bottle of oil from El-Koura, and a vessel that contains soil from my village, Bterram. Also, the license plate on my car is Lubnan. This is not to remind me from where I came, but to remind me of who I am. Khalil Gibran said that "if Lebanon where not my country, I would have made it mine." I say "that if Lebanon were not my country, I would not know who I am." Let us all pray for a quick resurrection of Lebanon from Death.

One of the big challenges for the American Lebanese Medical Association is to contribute to Lebanon. We should try to reverse the brain drain and put our talents and our resources in the service of Lebanon, not only in the area of medicine and medical care, but also in areas that would eventually shape the new Lebanon we aspire for. It is not true that the Lebanese talents in diaspora go to waste. The Lebanese in diaspora should be a major resource to the new Lebanon that we want to build. Also, they should be an integral component of the Lebanese population and should not only contribute in finance, medicine, engineering, science, and in arts, but they should also have the right to contribute to the new political formula that should emerge.

Also, I would like to remind you that our major commitment to America is to contribute to it. In medicine, we can contribute enormously. In the area of quality of medical care, we should infuse the American medical culture with the values that we brought with us from Lebanon: mercifulness, compassion, caring, loving, and humaneness. These are values which are unfortunately fading away in the everyday practice of medicine in America. Only when the patient is considered sacred to us, are we worthy of taking care of him. Medicine is not a business. The patient is not a client. Medicine is a mission and the patient is a sacred human being who deserves our best care and our utmost love. Also, we need to contribute to the science of medicine and to expand the frontiers of medical knowledge. This cannot be done without research. Only research leads to knowledge and I would like to encourage every one of you, whether you are in private practice or in academia, to be involved and engaged in one way or the other in research. The objective of research is not only to expand human knowledge, but also to expand the mind. I want you to remember that when you contribute to research and you bring about new knowledge, this new knowledge is not only a gift to America, but it is also a gift to the whole world. The great Lebanese who contributed to America indeed did not contribute to this country alone, but to the whole world. The writings of Gibran, the innovations of Michael DeBakey, the mission of St. Jude's Hospital of Danny Thomas, are all gifts to all mankind.

May God bless you, bless our sacred land of Lebanon, and bless America.

24-Jun-08 2:00 PM

AN INTERVIEW WITH PHILIP A. SALEM, M.D.

Elaine Dittoe — Fri, 11 Apr 2008 21:00:00 GMT

Questions:

What are the latest developments, the latest research as far as cancer is concerned, and what are the latest treatment methods?

Answer:

Question:

How close is the link between cancer and infection, and which infections can cause cancer? Which types of cancer are caused by infections?

Answer:

Question:

What about cancer vaccines. When will the first cancer vaccine be on the market according to you? Can you give a date, like in 10-20 years?

Answer:

Question:

Gene therapy and stem cell transplantation seem to be very promising. Do you think that treating cancer will be much more easier in the future, when these methods are developed?

Answer:

Question:

Why is there an increase in cancer cases? What are the major reasons for cancer?

Answer:

Question:

How do you see the future as far as cancer is concerned?

Answer:

Question:

What are the most important factors that determine the cure of a patient?

Answer:

Cure depends on three major factors:

1. The nature of the cancer

2. How advanced is the cancer in the body

3. Whether the treatment of the cancer was appropriate or not

Question:

In your opinion, what is the cornerstone of excellence in cancer care?

Answer:

Question:

In spite of this progress in cancer research and cancer treatment, I have heard you say many times that cancer medicine in America is in a crisis. Why is that?

Answer:

Question:

Is there anything else that good care entails?

Answer:

Of course, a lot of other things:

Question:

Why, in your opinion, this kind of care not delivered?

Answer:

The answer is simply because this kind of care is very time-consuming and demands a lot of medical staff, and both of these issues are very expensive.

Question:

Dr. Salem, I know you are of Lebanese origin. How do you feel being of Lebanese origin and being a very important doctor in America? You are in the last three editions of the America's Top Doctors.

Answer:

Question:

Dr. Salem, can you single out one achievement you have made at Salem Oncology Centre?

Answer:

11-Apr-08 4:00 PM

Forty Years of Experience with Cancer; What Have I Learned?

Elaine Dittoe — Fri, 11 Apr 2008 21:00:00 GMT

I'm delighted to be with you tonight and to share with you this beautiful evening. Also, I feel privileged to be asked to speak to you and I'm very thankful to the organizing committee and to Mr. Ayoub for inviting me.

Today, I'm going to focus on my experience as a physician, and more specifically, as a cancer physician, and how this experience has helped me shape a new vision and a new philosophy towards life. This philosophy is not based on the abstract, it is based on the harsh realities of life; it is based on a real and intense personal experience with disease, pain, suffering, agony, dying, and death.

I was born on July 13, 1941 in a small village called, Bterram, of El Koura District of North Lebanon. My horoscope is cancer. In that very same year, Memorial-Sloan Kettering Cancer Center, where I was to go later in life and study, was also established. I received my elementary education at the Elementary School in Bterram. Thereafter, I studied at the Bishmizeen High School and in Tripoli. At the age of 16, I joined the American University of Beirut and I graduated from its medical school in June, 1965. Before I entered medical school, I majored in Philosophy. I did not study medicine because I thought it was a good, prestigious, and glamorous job. I went to medical school with the objective of helping the sick, and with the deep conviction that medicine is not a job, but a noble mission. The early 60's were the days of ideology and idealism in Lebanon. At that time, I was a young, idealistic and a pure student. After graduating from medical school, I did three years of training in internal medicine. At the same time, I was studying philosophy at the American University of Beirut, and I was also teaching biology at the Lebanese University. I decided to study cancer in 1966. That decision was based on a painful personal experience with a friend who died of cancer. At the same time, I felt that in those days, cancer was treated only by ignoring it. People who developed cancer then, were left to suffer with pain and die with indignity. In June, 1968, I arrived in New York to study at the Memorial-Sloan Kettering Cancer Center. I was convinced that within the coming forty years, cancer would be conquered. I was wrong. At that time, Memorial-Sloan Kettering was the Mecca of cancer therapy. And thus, I was privileged to treat many famous, rich, and powerful people. It was there where I discovered that being famous and rich does not mean being happy. After spending two years at Memorial, I went South for a third year of training at the M.D. Anderson Cancer Center in Houston, Texas, which eventually, has become my professional home in America. In 1971, I returned to Beirut with the objective of establishing the best cancer treatment and research center for the Middle East. When this was done, war erupted in Beirut. In the early days of the war in Beirut, nobody ever dreamt that this war would last sixteen full years; but it did, and I lived in Beirut through the war. Thus, it was my destiny to witness the cruelty of nature via a disease like cancer for forty years; and also to witness the cruelty of man via a war in Lebanon for sixteen years. I left my beloved City, Beirut, for the last time in 1985 and I was forced to come to America in January of 1987, where I joined M.D. Anderson Cancer Center. Since 1991, I have been in charge of the cancer research program at St. Luke's Episcopal Hospital in Houston, Texas. I'm here tonight to tell you of the lessons I have learned from this experience; with disease and with war.

Lesson #1: Life is a privilege, not a given. Life begins with an accident of biology. We are here by accident and not by design. Being here is a privilege that was given to us, and not a privilege that we have earned. We are also here for a specific period of time and eventually, we wither and die. The challenge is to make maximum use of this privilege. Enjoy life, carve some depth and some meaningfulness into it, carve a path and a mission worthy of you, think about the wonders of life and the universe, and the millions of questions that remain without answers as to the origin, direction, and fate of the universe. We are tiny little things in this unlimited and infinite universe, yet, each one of us is an infinite universe by himself/herself. Whatever direction you take; whether it is space or biology, the line will be infinite. Joy, in my opinion, is the essence of life. To achieve joy, you have to achieve peace with the world and peace with yourself. My advice here, is to enjoy every day of your life. To do that vertically and in depth, and not horizontally and superficially. Your joy should be part of the joy of the world and part of a noble mission.

Lesson #2: Health is the greatest gift. Although health is determined to a large extent, by genetic factors, the greatest wealth that you may achieve is to maintain that health. It is true that the inheritance of your genes was not done by your choice, but it is also true tht it's your choice and your responsibility to maintain your health. Many diseases are preventable, and if not, are treatable. The most important basic right to man, is the right to medical care, because this right is the first step towards good health. Without health, there is very little that could be achieved in life. Health is the major cornerstone for living, and living well, and with meaning. Most people understand their rights to freedom, liberty, education, and other basic needs, but very few people appreciate their rights to health. The keys to health include the following:

(A) Public health education. You do not realize your basic rights in health, because you are not educated about health. It's only when people get educated about these rights, that they become aware of their significance. Health education is a major key to health. It is time to incorporate health education in our school and college curricula. It is no longer permissible for a woman to graduate from college without knowing some basic information about cancer of the breast. The difference between knowing this information and not knowing it, is the difference between life and death.

(B) The second key is the availability of good medicine. When you are sick, you do not need only medicine, you need good medicine. Quality is the key in medicine, without it, there is no medicine. When you need a doctor, go to the best. After being in medicine for forty-six years, I can honestly tell you that when I'm sick, I'd rather see a physician who is knowledgeable and would charge me $1,000., rather than a physician who is not knowledgeable and who would not charge me at all. One great lesson that I have learned from my experience with medicine, is that I would rather pay with dollars, rather than with blood and life. America is now embarking on an adventure in medical care, that will eventually lead nowhere, but to a scandal. You must have heard a great deal in the last three years of cost-effectiveness; cutting costs, accessibility to medical care and managed care. All this will eventually lead to a major victim, quality. Without it, American medicine will plunge to levels unimaginable and undesirable.

(C) Medicine and politics are intertwined. Without moral and courageous politicians, it will be difficult to institute the real health policies we need. The 21st Century is on our doors and yet, even in America, people are allowed to buy severely toxic and addictive substances like tobacco. Politicians know that every year, tobacco kills three million people all over the world. It is the influence of industry, money, and lack of courage that make them unwilling to take radical moves to stop this crime against humanity. Politicians know that dumping nuclear and chemical waste on the shores of the Mediterranean, the Pacific, and other shores of the developing world, will eventually lead to hundreds of diseases in these areas. They do so for financial reasons, without the slightest respect for the moral implications involved. It is Khalil Gibran, the Lebanese poet and author who said, "If you kill one person, you are a criminal; if you kill a nation, you are a hero." One would add now, if you kill many nations, you are a super hero. In regard to health, my advice is, if you are healthy, try to maintain it; if you are not, seek the best medicine.

Lesson #3: Disease, not man, is the major enemy of man. There is no enemy that belittles man like disease. There is no enemy that humiliates man like disease. In the last twenty Centuries of recorded history, man has waged war against man. Shall we dream that man in the 21st Century will at least start to transcend this level of vision to a higher one where all mankind will unite against a major enemy called disease? The real enemies to man at the moment are: AIDS, cancer, heart disease, and infectious diseases. Man may not be convinced that disease is his major enemy until, (and hopefully, we will never witness that), a global outbreak of infectious disease occurs. I have little doubt that twenty Centuries from today, man would look at us as primitive people who believed in nationalism, primitive people divided by boundaries of geography and political ideologies. It is only a pity that man continues to devise technology and science in order to kill man. All over the world, nations invest in technology and ideology to fight other men, rather than in major programs for healthcare and education. I would only hope that eventually, man would mature enough to realize that man is his brother, not his enemy, and that the real enemy is disease.

Lesson #4: Love, not power is the greatest force in the world. Although I deal with the body, with the concrete, with the visible, my experience with diseease has led me to believe that it is love and not power which is the greatest force in the world. Without love, there is little meaning and there is little joy. It is indeed love that makes life worth living. It is unfortunate that in America love has been reduced to its pure physical component. This is indeed a tragedy. The breakdown of love is responsible for the breakdown of the family and the breakdown of friendships, and the breakdown of moral values in America. It is this fierce philosophy of materialism in America that I'm afraid will eventually lead to the collapse of American civilization. America can win the whole world by technology, science, and war, but it will lose the major war, if it does not win the battle inside America. Children are being taught every day, that the index of success is material wealth; at any cost. Values and moral directives are being eroded for the sake of accumulating more wealth. To love your parent, to love your grandparent, to love your brother, to love your friends, to love people is a basic need. The major motto of America now is "I love you because I need you". We need to make a major effort to reverse this motto for another motto which says, "I need you because I love you". Without love, there is no joy and without joy, there is not much sense in being and in living.

One of the greatest joys is giving. The major emphasis in America today is on taking, and not giving. It is the joy of taking; it is the joy of promoting the self. Everything is now centered on the self. What is in it for me is the motto. It is time to teach our children and to teach in schools, the art of giving, the art of selflessness. It is only when you extend yourself to your friends and to others, that you experience real joy. I was personally privileged to experience the joy of giving the best that you could ever give, and that is life. There is no joy which is superior to giving life. That should be the reward of the physician.

Lesson #5: The triangle of glamour, money, and power is poison. I have been privileged to see during my professional career, a large number of people who have been plagued with this triangle. And I have seen how sad and miserable they are. Most people work very hard to achieve this triangle, and once achieved, they realize that it is a mirage. Power, money, and glamour are wild horses, if you do not know how to reign them in, you will eventually fall off their backs. It takes character to reign in these wild horses. Power is poisonous and corruptive, unless you are really powerful from the inside and you realize that it should be used for the service of others. Money is dizzying, unless it is used to help people. Glamour is toxic to the brain, unless accepted with humor and humility. It is only when you get close to death, you realize what life is about, and the depth of the meaning of being alive. It is only when you get close to death, you see and you see very clearly, that power, money, and glamour are at the periphery rather than the core of being.

Lesson #6: Courage is the fuel of life. What I have learned from my patients is courage. It takes a lot of courage to fight disease and despair. In cancer, where treatment is intense, prolonged and sometimes, physically and emotionally mutilating; only those who had courage to go through a difficult journey achieved cure. This is also true of life; only those who have courage to face life and its cruelties will eventually make it. When you see cancer patients struggling with pain and agony; and suffering with dignity and courage, how dare you not have the courage to say the truth; how dare you not have the courage to live by your beliefs; how dare you not have the courage to stand up and refuse to accept what is unacceptable; how dare you not have courage and be yourself?

Lesson #7: Perseverance is the key to success. No cancer patient would have made it to cure without perseverance. And no cancer researcher would have achieved a breakthrough without perseverance. Those who give in easily, fall off in the beginning of the journey. Only those who work hard and persevere reach the end of the line. To my mind, the three essentials for success are: hard work, perseverance, and courage. Genius comes second to these three essentials. In my daily work and fight against disease and death, it always takes perseverance on my side and perseverance on the side of the patient, to achieve cure. Patients who give up, die. Physicians who cannot endure, fall. The key test to determination is perseverance.

Lesson #8: Arrogance is sickness, humility is power. I have learned humility from my experience with cancer research. Research taught me how little I know; and how infinite is that, that I do not know. I have also learned how important it is to change my mind. Those who are arrogant and who think that they know almost everything will never make progress and will never achieve anything. The truth needs humility; progress needs the ability to change your mind constantly and adjust to new realities. I want to dare to tell you tonight that the major objective of science and research is really not to discover the truth and new realities, as much as it is to train the mind and make it malleable and innovative. The objective of science is to eradicate arrogance, since arrogance is a disease which plagues the human spirit and human mind. I was most arrogant when I was a chief resident of medicine in 1968 in Beirut. As I matured in research, the arrogance in me has decreased steadily. The more I have learned about cancer and disease, the more I have realized how little my knowledge is, and how vast the unknown remains. The deeper you plunge into research, the greater becomes your wonder about the world, the universe and the creation. Whether you study the cell or the universe, both are immense and limitless. How can you not be humble when you realize how little you are in this boundless universe? How can you not be humble when you realize that the cell which is the smallest structural unit of the living is also boundless, immense, and limitless.

Lesson #9: Do not sell yourself for success. Most people look at success and progress as a ladder that they have to climb, and unfortunately, every step they climb, some sell parts of themselves to others to make the step. By the time they arrive at the top, they have already sold everything they had, and whatever they had achieved of material wealth, power, fame, and image, will be totally meaningless and empty. If I have a message for you tonight, it is to beg you not to ever lose yourself. Climbing the stairs should not be made at the expense of selling yourself. The greatest mistake you could ever make is to lose yourself for the sake of accumulating wealth or brightening your image. Neither wealth nor image would have meaning without "yourself". At the end of the day you go back home and you will be alone; And if you had sold yourself, you would be a terribly lonely and miserable person.

Lesson #10: The ladder of progress is only a mirage. If I have learned anything from my experience and journey, it is that this imaginary ladder of progress is nothing but a mirage. The journey that you have to make in life is not upwards; it is inwards. It is not a journey to achieve something outside you, it is a journey to achieve something inside you. It is a journey to recapture yourself. The ultimate objective of life is to be at peace with yourself; to be respectful of yourself; to be proud of yourself and to be in joy with the world. If you do not realize that, at the end of the fight, at the end of the journey, and at the end of the day, you will regret it tremendously.

Ladies and gentlemen.....I would like to apologize to you for this sermon, but I thought you might be interested in knowing what a man who has been at war with disease, cancer, and death for forty years, has to say. I thought you might be interested in seeing the other side of the coin. You always have the opportunity to hear the healthy, the successful, and the powerful speak. But I come here to you to speak out of pain and out of my experience with disease. I'm somebody who has seen the other side of life. I thank God for showing me the light, for curing me from the common diseases of man: greed, power, money, and glamour; and above all, for giving me the strength to serve the weak, the sick, and the dying.

I must tell you that my journey with disease has been very enriching. It made me closer to my elements. It has taught me that the greatest joy is in giving; It has taught me that the greatest power is in serving. May God give you the power to see, the courage to believe, and the gift of living the life which is worthy of your living.

Thank you.

Forty Years of Experience with Cancer

What Have I Learned?

1. The joy of being.

2. The importance of health.

3. Love as the greatest force.

4. Courage to face disease.

5. Perseverance as the key to success.

6. Teamwork.

7. Research teaches you that you know so little; teaches you humility.

8. Disease is a major enemy of man.

9. Lack of public health education.

10. The myth of money, fame, power triangle.

11. The joy of giving, rather than the joy of taking.

12. The need for love rather than love for need.

13. When you struggle to go upstairs, do not lose yourself. The stairs are a mirage. Do not feel criticism. Don't let praise go to your head. Do not let success corrupt you.

14. Don't take life or health for granted; Enjoy every minute.

11-Apr-08 4:00 PM

AN ADVENTURE WITH CANCER: THE JOY AND THE PAIN

Elaine Melnyk — Wed, 26 Mar 2008 22:00:00 GMT

First, I want to thank the British-Lebanese Association for graciously inviting me to be your speaker tonight. This is indeed an honor and privilege that I shall cherish for years to come. Many people worked to bring this evening into reality, and I want to thank them all. However, to one person, I would like to extend very special thanks: Lisa Zakhem. Without her, I would not have been here tonight. Also, I want to thank you all for coming.

Ladies and gentlemen, I have chosen to speak to you tonight about my personal adventure as a doctor treating cancer. In exactly eight months, June 1998, it will be 30 years since I had started my journey with this disease and my war against it. At this point in a long and tedious journey, I would like to pause, and rewind the video tape. What did this adventure mean? Was anything accomplished? Were there any lessons learned? What is the message? I am not sure I have a message, but I certainly have the urge to say something. I would like to say something to the healthy and the living since I have spent a great deal of time with the sick and the dying. Indeed, it is life's irony that you come to appreciate life and understand it only when you get close to death or think you are close to it. It is painful to realize that we appreciate things only when we lose them or when we are threatened by their loss. If I have learned anything, I have certainly learned to appreciate things when I have them, and to appreciate life when I am still healthy.

My story starts in Bterram, a small village in north Lebanon. As a child, I listened attentively to the stories of my father who believed fiercely in the power of education, and I believed them all. He also believed in the power of hard work, discipline and excellence. If you had a tough time making it in school, you had a tougher time making it at home. To him, life was an opportunity to succeed, to excel, to climb the mountain, to reach the peak. He had little compassion for those who fell along the way and little mercy on those who did not try very hard. However, we were blessed by a mother with a different vision. Her's revolved around the family, including the extend family with its remote boundaries. Every one of us was extremely important and precious. She did everything with love, ease and peacefulness. She radiated happiness and joy all over the house. She made us believe that the whole world was there for us to enjoy. Although my father and mother held two distinct and different visions, I loved them both immensely, and whoever I am today, I owe to them. They are certainly the two most important people in my life and where they rest now for eternity is the most sacred site on earth for me.

I descended into the world gradually. After I finished my elementary education in my village, I went to study in a neighboring village and thereafter, in Tripoli, a city only 10 miles away. From there, I went t to the American University of Beirut, where I studied medicine. Although I had been seasoned to become a doctor, the year before I entered medical school, I hesitated to do so. I excelled academically in philosophy and literature, and entertained journeying in that direction. When my mother learned of my hesitation, she summoned me to her room and reminded me that I had promised her to study medicine, become a doctor, and take of her when she becomes old and sick.

This was true. As a child, I had suffered a great deal from seeing my mother struggle with recurrent bouts of kidney stones, and I had indeed promised her I'd become a doctor and take care of her. Unfortunately, however , after I'd become a doctor, she never developed kidney stones, and when she grew old, she developed Alzheimer's disease and I was unable to help her, not even a little bit. To help hundreds of people who suffered from cancer, and to watch my mother deteriorate day after day and not be able to do anything for her, was one of the most frustrating and painful experiences of my life.

I graduated in 1965, and immediately started my specialization in internal medicine at the University of Beirut. I was being nurtured to become a kidney specialist, but suddenly, a woman very precious and very close to me developed ovarian cancer. I accompanied her through her journey with the disease, and that experience changed the direction of my professional career forever.

At that time, there was no treatment for ovarian cancer and physicians did not discuss openly and frankly with patients those issues relating to diagnosis and therapy; much less, issues relating to life and death. That woman was left in solitude to suffer alone with her pain. Physicians came to see her rarely, and when they did, they rushed out quickly before she had a chance to ask questions. They had no answers for her questions. Because cancer was a taboo, she was left alone. She made me read Tolstoy's, The Death of Ivan Ilyich, and many times she enjoyed repeating this quotation: "Why hast Thou done all this? Why hast Thou brought me to this?" Why does Thou Torture me so? For what? He did not expect an answer, and he cried because there was no answer, and there could be none."

A few days before she died, she squeezed my hand and said: "Very soon, I will be here no more. This whole ordeal will be over. Would you, however, promise me that you will do something about this disease in the future so others will not have the pain that I have had? And should you ever become a cancer physician, would you remember that the real agony is not the physical pain, it is the non-physical". I promised, and I remembered.

June 1968 was a milestone in my professional career. I crossed the Atlantic for the first time, landed in New York City, and joined Memorial Sloan-Kettering Cancer Center. Since then, my life has been a continuing and a daily struggle to conquer a vicious enemy called Cancer. New York was too far from home. I could not go on weekends to visit family and friends in Bterram. People were different and far too tall for my taste. The culture seemed strange and cold. Many times I packed and decided to return to Beirut. Yet the challenge held me. The target was clear but the road was unknown. For me, life in New York was a mixture of sadness and excitement. I was sad because I was homesick, and I had left a younger brother who was newly diagnosed with multiple sclerosis. I wondered whether I would find him alive on my return. I saw his face in every page I read, in every patient I treated. Still, I was excited at the prospect of conquering a vicious and historical enemy; of embracing a new culture; of climbing a new mountain. At Memorial Sloan-Kettering, I studied under Dr. David Karnovsky, an intellectual giant who was to become the founder of cancer medicine. The son of a Russian immigrant, he had a panoramic mind and an imposing presence. Scientists in his audience fell silent. He spoke very little, but when he did, his words echoed far. A special and a unique relationship developed between us. I was fond of the power of his mind and the largeness of his heart. He was intrigued by me, a young small man from a small country that he had learned of only in the Bible. He constantly asked me about Lebanon, the Middle East, and family. Almost daily, we had breakfast together and debated political, philosophical, and moral issues. A bond cemented us. I was to become the son he did not have. One day, while he was writing a note, his hand shook and could not complete his sentence. He was admitted to the hospital and was soon found to have lung cancer that had spread to his brain. It was felt that his cancer was the result of his long-term exposure to the poisonous chemical Nitrogen Mustard. In the early forties, he conducted extensive research on this chemical as a potential cure for cancer. He tried to find out whether nitrogen Mustard could kill the cancer. Instead, and after years of exposure, the Mustard killed him. In the last few days of his life, I was one of the very few people by his side. I took care of his daily needs and gave him pain killers and intravenous fluids. Dr. Karnovsky was the victim of his own research. He was conquered by the disease he wanted to conquer. Before he died, he advised me not to return to Beirut immediately. "Beirut will wait," he said, "Before you return to Beirut, you must spend at least one year in Houston. You will come to know two intellectual giants who will certainly shape the future of cancer medicine, Dr. Frei and Dr. Freireich." It was extremely hard for me to spend one more year in America. I was already psychologically prepared to return to Beirut, but he was someone to whose deathbed wish I could not say no.

In Houston, I found a warmer people and climate. M.D. Anderson was then a small hospital, not among the biggest and most prestigious cancer centers it has now become. Under Drs. Frei and Freireich, I learned the art of research. By 1971, I was mentally and emotionally ready to return home and start building my dream. Just a month before I had to leave, Dr. Frei was offered the presidency of Harvard Cancer Center, the so called Dana-Farber Cancer Institute. He called me to his office and asked me to join him at Harvard. I refused. This time, there was no power on earth that could have forced me in a different direction. I wanted to go back to Beirut. Indeed, he had never heard of the latter before we met. There was no way for me to explain to him my attachment to my country, my people, and my family. At that time my commitment to my people was stronger than my commitment to science.

Arriving in Beirut in the summer of 1971 was joy beyond words. My younger brother, whom I thought would be in a wheelchair, and whose personnel diagnosis crushed me during my whole stay in America, was healthy. The diagnosis of multiple sclerosis was false. The family was all there, happy and joyful. Lebanon was at its peak of glory and beauty. It was a dream fulfilled. At that point, the only place I wanted to be was Beirut. My dreams were big, but the resources limited.

Since nobody else wanted to deal with the cancer problem, I was soon asked to be in charge of the cancer program at the American University of Beirut. I was elected the president of the Lebanese Cancer Society. There I was, in the very place I had always wanted to be. The road was clear to me and there was little hesitation on my side to go forward. I wanted to achieve three major objectives:(1) The establishment of an excellent cancer treatment and training program at the American University of Beirut, (2) Creation of a cancer research program focusing on diseases peculiar to the Middle East and to our geographical region, and(3) Education of the public about prevention and early detection of cancer. None of these objectives was easily attainable. With every inch of progress, there was blood on the floor. Cancer was a taboo, its prevention was considered a myth, its treatment was considered an act of charlatanism. Research was considered a luxury that developing nations could not afford. More importantly, clinical research (that involved patients) was considered "experimental" and unethical. Public education about cancer was severely discouraged because of the anxiety and fear that it might produce. Twice, I was threatened with being fired from the institution. The first time, I had spent the previous night explaining on television the early signs of breast cancer. Half the women in Beirut got no sleep that night. The second time, I had treated a young man with liver cancer in an original way. The 24-year old patient was almost totally consumed by cancer, and I was faced with the option of either leaving him to die or doing something for him. I did the latter, and I introduced catheter in the blood vessel that feeds the liver. I treated him with chemical agents that I delivered through the catheter directly into the liver. This was the first time in the history of medicine that a patient with lymphoma of the liver had received treatment in this manner. The next day I was reprimanded by the administration. I was told that "experimentation" on people is unethical, and should I continue to treat the patient in this manner, I would certainly be fired. I continued the treatment and I was not fired. The reason was not out of mercy for me, but because the patient responded extremely well and was eventually cured. Interestingly enough, he married the nurse who took care of him. I will never forget how, when I summoned them before the wedding and explained how serious his condition was, and that there was no guarantee that he would be cured, her answer was clear and decisive. "Should he live only one day, I want to marry him." Today, some twenty years later, the man, the wife, and their beautiful children are all alive and well.

By 1975, I felt very well entrenched. The cancer program at the University was flourishing. The public had by now accepted cancer education as a necessary evil, and those who had thought that I was crazy and weird had acclimatized to my presence. People started to utter the word "cancer". In research, we made minor strides. We were very fortunate to identify a disease which is more or less unique to the Mediterranean countries and to the Middle East. We focused on it and we did well. Several publications appeared in highly- respected research journals, and we attracted the attention of the world to this unique and fascinating disease. The local response at the university was favorable. The administration felt that after all, we might be doing something right. By spring 1975, I felt on top of the world. I had won by now, not all, but many of the battles. All the troubles seemed now behind me.

Little did I know of the trouble that was to come: nothing less than a full scale war, probably the most cruel and barbaric war in the history of man. It was a war that devastated Lebanon and has yet to come to a concrete and complete halt. My life was turned upside down. The life of every Lebanese was turned upside down. The challenge now was no longer research, education and the conquest of disease. It had become a basic human challenge: mere survival. Very few people probably know that for approximately 15 years Beirut was shelled almost daily. Every morning, you would wake up and think that Beirut had been erased from the surface of the earth, but then you walk out and see that Beirut is still there, and people were still going to work. Everyday people slept in the shelters, and every morning they went to work out of these shelters. The distance between the workplace and the shelter was the distance between death and life. You might die at any minute, any second. It was only a question of luck. My house was only half a mile from the university, but there were five locations where I might spend the night. If the shelling was extremely severe, I slept in my academic office at the university. If it were slightly less severe and I could cross one street, I slept in my private office. If I could afford some luxury, I hid in a nearby apartment that my relatives owned. If the shelling was not insane, I might make it to my wife's aunt across the street from my house, and if things were unusually quiet, I might reach home.

Reaching home was not the end of the journey, because I had to be prepared to go down to the shelter any minute during the night. When death ruled everywhere, I moved my family out of west Beirut and started to commute between east and west Beirut. I was one of thousands of people who parked their cars daily near the national museum and walked the traditional crossing between east Beirut and west Beirut. In the evenings, I walked in the opposite direction. At any time, there were thousands of people crossing on each side and in each direction. We walked under fire. We became accustomed to the constant threat of death. People became fatalistic. They refused to allow the militias to divide the city. My students, staff, and fellows also had to commute. Every morning, we spent the first hour talking about the ordeal of crossing, and in the evening we spoke of the ordeal of returning home. While this was a daily ordeal for many, many years, it was also a daily triumph over the war. Never before in history was a city shelled so extensively for such a long time. The objective was to flatten it, but it stood erect. The objective was to divide it, but it remained unified. Never before had people been so crushed to the bone, yet they remained dignified. Never before had people had been so pressured to become alienated from each other, but they remained unified. Unity was most exemplified in the shelter. Under ruthless bombardment, people would leave their home and descend to the shelters. There, Christians, Moslems, rightists, leftists, were all one against the horror. They were all cemented by love, cemented by the fear of dying together, cemented by their refusal to accept the insanity of the war.

I remembered one day, late in the evening, being in my clinic talking to a woman with breast cancer who also happened to be my neighbor. I was trying to alleviate her anxiety and reassure her that treatment would make her well that she would survive to see her kids graduate from university. We both left my clinic at 7:30 p.m., only to be united one hour later, in the shelter, doctor and patient together with hundreds of other people from the neighborhood. Shelling outside was absolutely intense and insane and my daughter, 2 months old, was crying in my lap. She was hungry, thirsty. We had not brought milk with us down to the shelter because we thought the shelling was going to be very brief. Seeing my daughter hungry, thirsty, and frightened, I became extremely anxious. My patient, whom I was trying to reassure in my clinic a few hours earlier, came to me to assure me that I need not worry, that should the need arise, she would venture outside and bring milk and food. "After all", she said, "I would rather die from a bullet than from disease." In a matter of hours, the roles had been reversed. Earlier, I had been the doctor reassuring an anxious patient. Now, I was an anxious father reassured by a loving friend.

Life in the shelter became routine, and eventually, a pleasant one. After all, my friends and the people I loved most were there. I spent night after night in the shelter and I wrote most of my important research papers from that shelter. In Ras-Beirut Lebanese war was unique in the sense that it was not a war between the armed and the innocent. It was a war against the people, all the people of Lebanon. It was a war against the greatness of the Lebanese people. It was a war against what was special and unique, about Lebanon in the "orient". So many times I wondered during the war how I could have been destined to see so many cruelties: the cruelties of nature via a disease like cancer, and the cruelties of man via a war like the Lebanese one. As always, the big questions have no answers.

In the mid eighties, it became clear that many of our patients could no longer reach Beirut to receive treatment at the university, and consequently, we established a satellite program at a small hospital in Byblos, some forty miles north of Beirut. I would leave Beirut every Thursday and spend Thursday and Friday in Byblos, returning on Saturday to Beirut. This became a routine. One night, alone in my beach house in Byblos, I heard a knock on the door. It was two o'clock in the morning. The telephone was out that day and I thought someday was trying to reach me by phone and could not, thus he came in person. I opened the door, but could not believe what I saw. A uniformed and bearded young man whom I did not recognize was standing in my face. He hugged me emotionally and reminded me that he was a patient I had treated for testicular cancer few years earlier. Now, he was cured and is a member of one of the militias. He had come by sea from West Beirut in a tiny boat to advise me not to return to Beirut the next day. His militia planned to kidnap me on my way back and he was to execute the plan. This was an attempt by his militia to recapture their hostages from rightists in the Christian area. At that time, my brother was minister of foreign affairs and this young man's militia had reasoned that pressure on my brother would put pressure on the president of the Republic. He, in turn, would then force the rightist militia in East Beirut to liberate the hostages from west Beirut. Rather than returning to Beirut the next day, I decided to leave the country. I reasoned to myself that as a physician devoted to preventing disease, I now needed to prevent a catastrophe. As the father of three very young children, and the husband of a young wife, the risk was too high.

In January 1987, I left Beirut for Houston. The journey was traumatic and painful. I had made this trip before many times, but this time was different. This time I had left a country that I thought I would never see again, and I had left family and friends that I thought I would not see again. I flew in a helicopter from Beirut to Cyprus, and as the plane went farther from the mountain of Lebanon, I went farther from my reality. It was like being peeled off from your own skin. By the time I arrived to Houston, I felt as if I had been split in two halves, the physical half in Houston and the other half still remained in Lebanon.

Upon Rejoining the M.D. Anderson Cancer Center, the institution felt almost like home to me. I had a courtesy staff member for many years and many of the students that I had trained in Beirut were already entrenched at the institution. Most of the faculty members there were very close friends of mine. I found myself back in the mainstream of cancer research again. I shall never forget the kindness, warmth, and support that my friends at M.D. Anderson and Houston gave me when I first arrived. Each tried to help in one way or another. I felt like a cancer patient. As the cancer patient is threatened by death, I was threatened by losing myself. It took me time to recover from the shock, to readjust to the new realities and harsh realities. I was no longer in my own country. The dream has shrunk to a simple ambition: peaceful existence. I, a physician who spent his life reassuring cancer patients, raising their morale, boosting their egos, expanding their hopes, was surrounded by friends and colleagues trying to do the same, but to no avail. The wound was very deep. The healing was very slow.

One year later, my friends at Memorial Sloan-Kettering must have realized my agony and wanted to cheer me up. The institution chose me as the distinguished alumnus of that year. This meant that I had to go to New York and give a talk on the research I had done in Beirut. I did, and at the end of the lecture, a very close friend of mine came to me and asked me whether I could find a job in Houston. He could not see eye to eye with his boss and wanted a new challenge. I returned to Houston and after a month I found him the job he wanted. But when I called him to tell him the good news, he asked me to wait one more week, because something new had come up. When he realized how angry I was with him, he reassured me that should this "new thing" come to fruition, I would be very happy.

A week later, my secretary came into my office to inform me that somebody on the phone was trying to kid me: "He says he is calling from the White House." I took the phone. It was Burt's voice. "Have you heard the news?" he asked. "What news?" I responded. "I am in the White House" he said. "What could you possibly be doing there?" I responded. "President Bush has asked me to be his personal physician." "Has he lost his mind?" I said. Burt was nobody else but Dr. Burton Lee, who was to become the man closest to President Bush.

That telephone conversation was the beginning of a new phase and a new direction in my life. He asked me to serve on one of the committees he chaired. In three weeks, I was at the White House shaking hands with the most powerful people in the world. When I went back to Houston, I told my wife, that indeed, it had taken a big shock, the White House, to lift me out of my depression. This new era of medical politics was certainly very educational to me. All my life, I had been focused on cancer. This was a new challenge. America's focus was now on health care for all, and the rights of the American people to receive the best possible healthcare. During this period I learned how interrelated and how deep is the relationship between politics and health, and what a myth is the division between the professional and the politician. I became convinced that professionals should become involved in the political process and it is naive to think that politics is the responsibility of politicians alone.

With my new experience in healthcare and government in America, I became a marketable item and in 1991, I was offered the directorship of the cancer program at St. Luke's Episcopal Hospital, where I am today. I did not hesitate to accept the job. This was a new challenge. But this time, I had recovered at least partially from the trauma of Lebanon. I was totally immersed in cancer research and in healthcare. Now I had an offer to be in the driver's seat and take the steering wheel. Here was the challenge of discovering new drugs in cancer, the challenge of genetic restructuring, and the potential of gene treatment. Here was the challenge of understanding the immune system, and how we could potentially manipulate it to conquer cancer and other diseases. Here, the new challenge of understanding the new epidemic, the new plague, AIDS, and how it eventually produces cancer, the challenge of eventually conquering both diseases, salvaging millions of lives and alleviating enormous human suffering and pain. These, I thought, are the real battles. This is real war, man against disease, rather than man against man. By now, the boundaries of my vision were no more Lebanon and the Middle East. The boundaries had widened to encompass the whole world and all mankind.

At this stage in a long journey riddled with frustrations and disappointments, I feel I am the luckiest man on earth. I have been fortunate to have been in front trenches fighting disease, helping people, serving the sick. The question, though, you may ask is "what is in this journey for you?" "What message may we take home tonight?" My message is simple. You cannot attain joy without pain, you cannot make progress without failure, and you cannot go forward without having a few backs.

It has been a long and a bumpy road on which joy was mixed with pain, yet at every point the pain overwhelmed the joy. At no time, however, did I feel I was pursuing the wrong direction, and at all times I was at peace with myself. My greatest joy come in curing patients, in turning them from being threatened by death to being welcomed by life, in salvaging them from the claws of despair to the joy of hope.

Many people have spoken of the joy of giving and the different forms of giving. Giving is certainly beautiful in every way, but it is most beautiful when you give what is most precious in life, and that is life itself. I shall never forget how a 13-year old Lebanese girl came to see me with cancer after her family was told by a prestigious cancer center in America that her disease would kill her. Her father slept under her bed, as she was his only child, to make sure that she kept breathing all night. He told me that one day, should she die, he would rather die, too, because his life without her would be hell. How can I possibly describe to you the joy of seeing her now at the age of 32, a graduate of the most prestigious London schools in engineering, and married to a man from this city.

How can I describe my joy when I'm reunited in Houston with a friend of mine, of my age, and from my village, in Houston, 8000 miles away from home, 35 years later? She, a patient with advanced ovarian cancer, and I, a cancer specialist in an American hospital? She came to tell me that should she die any way, she wishes to die at my hands. Now, five years later, she is alive, free of disease and enjoying a normal life. Whenever I experience a moment of despair, I always remember the words of the Koran, "The one who cures one human, cures all humanity."

There has also been rewards in treating patients who were never cured, because in every patient, no matter how advanced and how severe the disease is, you can help alleviate suffering, decrease pain, and instill hope. At no point in time have I kept silent in the face of dying; I always have a word to say, a ray of hope to instill. And believe me, to the sick, money, power, prestige, and glamour lose all significance. They are totally replaced by compassion, caring, loving, and sharing.

My pain, my greatest pain, was in losing patients, in seeing people I loved and cared for dwindle and die. Thirty years of battling cancer, and yet my skin remains thin. Every time a patient died, a part of me died with him. And it wasn't painful only when an individual patient was lost; it was even more painful when I also lost his whole family. To appreciate physicians when they succeed is natural and instinctive, but it takes a depth of sophistication, education, and civilization for people to appreciate physicians when they fail.

Pain is not confined to losing patients, it is also experienced in seeing them suffer and agonize. Love has a big price. It does not entail only giving, but also sharing pain with others and absorbing that pain. Love is like an immense lake to which all the rivers eventually run to tranquility and peace. To provide love, you need to spend time, a lot of time. It takes little time to treat diseases, but it takes a lot of time to treat people.

This is where modern Western medicine has failed. It has yet to realize that medicine is not the science of curing disease, but it is also the art of treating people. Modern medicine has failed to recognize that physicians never treat diseases; they always treat people who have diseases. In spite of the advancements in technology and in science, medicine will certainly fail, should physicians lose compassion, caring, and the ability of loving. If I could pinpoint one major problem with the West, it is this: the failure of the West to see in man what is invisible. Somehow, we have become entangled with the mania of quantitating and measuring things. Anything that cannot be measured and quantified and logged in the computer does not exist and should be ignored. Let me say that one conclusion I've reached in my long journey is my strong belief that what is most important in man defies quantification and defies measurement. It also defies computers and technology. The greatest component of man is the immeasurable one. How could you possibly measure goodness, compassion, loving, caring, giving? How could you possibly measure fear, agony, pain, frustration? To understand man, we need to dismantle ourselves from the mania of quantification.

There was great joy in research, and in the discovery of new knowledge. A greater joy is translating this new knowledge to better treatment of human diseases and reducing human suffering and pain. The excitement in research has been central to my personal life. It was a boundless joy when in the early 70's, we and other colleagues discovered how repeated and chronic infection in the small intestine may eventually lead to cancer, and how this cancer could start as a relatively benign process before it became malignant; and also, how we were able to reverse the benign phase of that process with simple antibiotics before it had the chance to become malignant. These simple concepts, ridiculed in the early 70's, are now the cornerstones of chemoprevention (the new art of reversing the malignant process), a new discipline in modern cancer research. Also, these concepts are essential for the understanding of the relationship between infection and cancer, and the process by which cancer may evolve from a totally benign process to eventually a process which overwhelms the body.

What a joy it was when we succeeded in modifying and taming an extremely toxic drug like Cisplatinum. This was a drug which was considered of little use because of its injury to the kidneys. After several years of research, we succeeded in making it far less toxic and more useful. Millions of people all over the world benefit from treatment by this drug as a result of our research. Let me now hasten to emphasize that in research, you never do anything alone. You are always part of a team. I never did anything significant alone. I was always part of a team. The credit for everything I have done should never be given to me, it should always be given to the team. Great things in life could not be accomplished without teamwork. This is as true in medicine as it is in science and politics. People who have never learned how to work in a team will forever be left behind in the progress of civilization because very little can achieved by individuals who can not work within a team.

At last, let me capture the moment to thank all those I worked with and worked under. In particular, I would like to extend my very special thanks to my students, who were always the source of my joy and the source of my optimism. Also, let me reiterate to all young researchers all over the world, that research is not a story about success. It is primarily a story about failure. It is a story about failing most of the time and succeeding sometimes. It is the story of accepting failure in order to achieve success. In the beginning of my professional career, failure in research was very traumatic and was very personal to me. Now, after thirty years, I have realized that failure is a necessary component of success. You cannot succeed if you are not ready to fail. Those who fear failure can never make progress. People must accept failure as a given for going forward. Failure should be considered an opportunity to refuel, to reassess, to gain momentum, and to go onward again. It should never be an excuse to go backward. To my great surprise, I have also learned that failure is extremely useful, it teaches you humility, a virtue which is necessary for making progress, a virtue which is necessary for making you a great student of science.

Ladies and gentlemen, this was my story, my adventure with cancer: a story of joy mixed with pain. But how about your story, your concerns, your worries? One of your concerns, of course, is your health. You may all know that health is a great gift - a gift from heaven. However, you may not know that staying healthy is a great challenge and this challenge is your responsibility. To remain healthy is not merely a question of destiny and genetics but it is also a question of responsibility and commitment. I cannot understand why one would work hard to succeed but work less hard to remain healthy. What does success mean if you lose health? The reason most people do not appreciate the responsibility to preserve health is because health education is, at best, poor.

Here is the most sacred and most important basic human right: the right to life; the right to health, the right to remain healthy and the right to be treated properly, should you become sick. The authors of the U.N. Declaration of Human Rights ignored this right. This is where citizens fail: in demanding from their government their basic right and their most important, the right to health. It is the responsibility of the government to provide all of what it takes for prevention of disease, all what it takes for making proper diagnosis of disease, and all measures to ensure that all citizens receive the best treatment when they become sick. In my opinion, this responsibility is the prime responsibility of government. There is nothing more sacred and more important for the government to provide to its citizens, than the dignity of health. The right to remain healthy entails promotion of public health education programs. It entails introducing health education into schools; incorporating health as a major function of government and making the media engaged in educating the public about health . The right of the sick to receive the best treatment is not only the responsibility of physicians, but it is also the responsibility of community and government. I'm sure you are aware of the debate in the West in regard to the access to medical care, the right to be treated when you are sick. Nobody argues with this right; it is a sacred right, which is almost totally ignored, is the quality of care you receive once you have access to care? People fail to appreciate that access without quality means very little. What we are witnessing now is the slaughter of quality at the expense of access. This has happened because governments do not understand what healthcare is. In every profession, quality is the borderline between mediocrity and excellence, between good and bad. But in medicine, quality is the borderline between life and death. It is tragic and ever ironic to see how in spite of advancement in knowledge and technology, the quality of medical care in Europe and in America is deteriorating, and unless we make some serious and painful decisions, this deterioration will result in disaster. The major victim of this deterioration in quality is the patient himself. It is you and I. It is all of us.

This is about health. And I agree with you that health alone is not enough to make one happy. Health alone is not enough to erase your sorrows and your pain. How about your dreams and your daily struggle to reach somewhere? Don't we all want to climb the mountain? Don't we all want to go upstairs and reach the peak? And what is the peak? I must tell you, with all honesty that unfortunately, many people pay very expensively to climb these stairs. They sell parts of themselves, part of their integrity in their march upwards. Every step they climb, they sell a part of themselves. When they reach the peak, they discover that they have already sold everything they had, that they have lost their integrity and their self-respect. And now, they can't neither enjoy the peak nor maintain it. To enjoy the peak, you have to be the master of your destiny, and to be the master of your destiny, you have to grasp your reality, you have to have integrity, you have to be your own real self. Those who sell themselves cheaply have nothing to be proud of at the end of their journey. Also, let me tell you, that the mountain and the peak exist only in your imagination. They do not exist in reality. The road to happiness is not upwards; it is inwards. Happiness is a journey that does not end up at some peak, some mountain; it is a journey that does end within yourself. It is a journey that will end with peace, satisfaction, and pride within your soul. The peak is not outside; it is certainly inside.

One of the secrets I have learned about achieving the peak is to understand what joy is about, and to appreciate that the greatest joy is derived from giving, not from taking. One of the major problems in the West now is that children grow up in a cultural climate where giving is irrelevant. The young are being told every day how to make it, how to acquire wealth, how to gain power, how to make money. The question many people ask every day is, "what is in it for me?" The most popular formula now in America is that "I love you because I need you." Those who have the courage and vision to reverse the formula to "I need you because I love you," are ridiculed and are considered naive. It is my conviction that the philosophy of considering yourself the center of the universe, believing that you have the right to exploit everything and everybody to your personal benefit, does not lead to happiness and joy. What leads to happiness and joy is to give, and to give generously. To give not only of your money and your time and your power, but also of yourself. To give is to share joy and pain, to be part of all, and in particular, a part of the weak and underprivileged. Kahlil Gibran, the Lebanese poet, was right when he said, "Do not say that God is in my heart, but say I'm in the heart of God." Thus I say, to be in the hearts of people, you have to have the people in your heart.

During thirty years of intense debate with a killer, I have come to believe in the oneness of all mankind, in the goodness of all people. Most importantly, however, I have come to believe in the enormous power of love. But what about the power of knowledge? I must remind you that I am a student of science and I'm also a believer in knowledge. I believe Bertrand Russell, the English philosopher and one of the most important thinkers of the 20^th century, was right when he said, "Knowledge and love should be inseparable, either one alone is dangerous." This is absolutely true, but with the advancement of science and the enormous weight of knowledge, I feel that love is being crushed and is being progressively diminished. I'm worried about the potential survival of love in a world which is becoming more and more in the grasp of science and technology. This, in my opinion, will constitute the major challenge for the 21^st century. My fear, my greatest fear, is that someday, one day science may crush love; the mind may crush the heart. Let us not let this day come. A world without a beating loving heart, is a world without a soul, a life without a meaning, a life not worth of living.

Ladies and gentlemen, with all my heart, I thank you again, and may God bless you all, put light in your souls, infuse love in your hearts.

26-Mar-08 5:00 PM

Director of Cancer Research at St. Luke’s Receives $200,000 Grant from American Cancer Society

Elaine Dittoe — Wed, 26 Sep 2007 23:00:00 GMT

HOUSTON (October 16, 2007) - Philip A. Salem, M.D., Director of Cancer Research of the Cancer Center at St. Luke's Episcopal Hospital, received a $200,000 research grant from the American Cancer Society in Dallas, Texas, on September 29, 2007. Presented at the Society's annual Cattle Baron's Ball in Dallas, the grant will support research programs at St. Luke's Cancer Center.

Dr. Salem expressed appreciation to the American Cancer Society and Cattle Baron's Ball members by saying, "In my professional life, I have always believed that research is the key to the advancement of knowledge and science. Without it, knowledge and the sciences remain stagnant. I am very privileged to have the opportunity to conduct research and we should never forget that the ultimate objective of research is not only to expand knowledge, but more importantly to expand the human mind, which is the miracle of life. I am most honored to receive this generous grant for cancer research at St. Luke's Episcopal Hospital."

Programs at the Cancer Center that will benefit from this grant include:

Clinical trials relating to the treatment of pancreatic and ovarian cancers, exploring the role of genetic therapy and immunotherapy;
Breast cancer prevention;
Studies on the combination of radiation therapy and genetic treatment for prostate cancer - a relatively new approach to treatment with extremely encouraging preliminary findings;
Clinical trials relating to the treatment of malignant melanoma, for which there is currently no treatment;
Exploration of the clinical usefulness of new target therapy agents in the treatment of lymphomas and a variety of neoplastic diseases.

Dr. Salem is a physician, researcher and educator with over 40 years of experience in cancer research and treatment. Dr. Salem was a professor of cancer medicine at M.D. Anderson Cancer Center before he was appointed Director of Cancer Research in 1991 at St. Luke's Episcopal Hospital.

"St. Luke's is proud that renowned physicians such as Dr. Salem are working in such a vital research field. He is certainly deserving of such a prestigious award that further encourages his contribution to cancer research at St. Luke's," said David C. Pate, MD, JD, CEO of St. Luke's Episcopal Hospital. St. Luke's is establishing the Philip A. Salem Chair in Cancer Research in recognition of his contributions to St. Luke's and to cancer research.

With regular appearances in America's Top Doctors, one of his greatest contributions to medicine is the discovery of the link between infection and cancer. He established in the early 1970's that an infection in the gastrointestinal tract can develop into cancer if left untreated. His research was considered the gateway for research that captured the Nobel Prize in Medicine and Physiology in 2005.

Dr. Salem has also received the Ellis Island Medal of Honor by the National Ethnic Coalition Organization (NECO) and was named "Scientist of the Year" by the Italian Foundation for Promotion of Science and Culture. He is also a recipient of the Senatorial Medal of Freedom from the U.S. Congress for his contributions to science and medicine.

###

St. Luke's Episcopal Health System comprises the flagship St. Luke's Episcopal Hospital in the Texas Medical Center, founded in 1954 by the Episcopal Diocese of Texas; St. Luke's Community Medical Center-The Woodlands, opened in 2003; St. Luke's Episcopal Health Charities, a charity devoted to assessing and enhancing community health, especially among the underserved; and Kelsey-Seybold Management, LLP, overseeing 21 area clinic locations. St. Luke's Episcopal Hospital is home to the Texas Heart® Institute, founded in 1962 by Denton A. Cooley, MD, and consistently ranked among the top 10 cardiology and heart surgery centers in the nation by U.S. News & World Report. Affiliated with several nursing schools and two medical schools, St. Luke's serves as the primary adult teaching hospital for Baylor College of Medicine. St. Luke's was the first hospital in Texas named a Magnet hospital for nursing excellence, and the Health System has been recognized by FORTUNE as among "100 Best Companies to Work For" and by Houston Business Journal as a top employer in Houston for three consecutive years.

26-Sep-07 6:00 PM

Caring Beyond Medicine 3

Wed, 13 Jan 2010 20:37:40 GMT

Caring Beyond Medicine 2

Mon, 28 Dec 2009 21:29:24 GMT

Caring Beyond Medicine

Fri, 13 Nov 2009 18:22:11 GMT

Philosophy and What Makes Us Different

Sat, 26 Sep 2009 00:21:02 GMT

We do not simply treat diseases, we treat people who have diseases. Up-to-date medical knowledge and science are the cornerstones for quality management of the patient, but we believe that cancer treatment must be delivered with compassion and care. Each patient is given individual care tailor-made for that person. Commitment to Excellence: Excellence is achieved by making sure that every patient receives the very best possible treatment. Treatment plans are only designed after an in-depth evaluation of the diagnosis and the anatomic extent of disease. At that point, group consultations are obtained to make sure that the proposed treatment plan is the most effective one available. Our number one priority is the patient, not research. Patients are enrolled in research programs only when we are strongly convinced that the research program is the best treatment option for the patient. Dr. Salem abides by very rigorous standards. He begins by confirming pathology to make a definitive...

About Salem Oncology Centre

Sat, 26 Sep 2009 00:07:48 GMT

Salem Oncology Centre, established in 1991, is a world-renowned private cancer medicine facility located in the Texas Medical Center, Houston, Texas. It is dedicated to the delivery of the most up-to-date and the highest quality of cancer care, including prevention, diagnosis and treatment. Salem Oncology Centre strives to provide caring beyond medicine, where the practice of medicine is not a job, but is a mission. With the major focus on the individual patient, we provide the best possible care which includes the most up-to-date knowledge, combined with compassion and caring. Therefore, each patient receives a personalized treatment plan and high-tech measures are taken to avoid possible side effects. Salem Oncology Centre has provided care to patients from around the world. Our multicultural- sensitive staff serve the needs of our patients and their families. We look at the patient not only as a person, but as family rather than disease. Dr. Salem and the staff at Salem Oncology...

**Homepage About Dr. Salem

Fri, 25 Sep 2009 23:57:59 GMT

Dr. Philip A. Salem, physician, researcher, educator and a medical statesman, has more than 40 years of experience in cancer research and treatment. He is one of the leaders of cancer medicine in America and in the world. He served on the faculty of M. D. Anderson Cancer Center as a full professor of cancer medicine before he established Salem Oncology Centre in 1991. He has been annually selected as one of America’s Top Doctors (Castle Connolly Guide).

More About Dr. Salem

OTV

Wed, 24 Jun 2009 20:04:16 GMT

MBC - April 8, 2009

Wed, 24 Jun 2009 19:59:49 GMT

TV Show Interviews

Thu, 26 Feb 2009 20:41:12 GMT

TV Shows featuring Dr. Salem

TV Show Interviews - Naharkum Saiid

Mon, 23 Feb 2009 23:31:42 GMT

Part 1

Part 2 Lorem ipsum survey

noemail@pasalem.com — Fri, 15 Feb 2008 22:25:18 GMT

Objectives:

Lorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diem nonummynibh euismod tincidunt ut lacreet dolore magna aliguam erat volutpat. Ut wisis enim ad minim veniam, quis nostrud exerci tution ullamcorper suscipit lobortis nisl ut aliquip ex ea commodo consequat. Duis te feugifacilisi.

Duis autem dolor in hendrerit in vulputate velit esse molestie consequat, vel illum dolore eu feugiat nulla facilisis at vero eros et accumsan et iusto odio dignissim qui blandit praesent luptatum zzril delenit au gue duis dolore te feugat nulla facilisi.

Ut wisi enim ad minim veniam, quis nostrud exerci taion ullamcorper suscipit lobortis nisl ut aliquip ex en commodo consequat. Duis te feugifacilisi per suscipit lobortis nisl ut aliquip ex en commodo consequat.Lorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diem nonummy nibh euismod tincidunt ut lacreet dolore magna aliguam erat volutpat.

Ut wisis enim ad minim veniam, quis nostrud exerci

Release Date: 15-Feb-08 4:25 PM
Expiration Date: 15-May-08 4:25 PM

Ut wisis enim ad minim veniam, quis nostrud exerci

Salem Oncology Centre Patient Room

Wed, 10 Mar 2010 16:12:29 GMT