Mark Lewis Profile picture
Director, GI Oncology, @Intermountain. Interests: neuroendocrine tumors, cancer syndromes, empathy (even had a Whipple myself). Tweets my own.
Virtual Salute Profile picture 1 added to My Authors
Jun 4 12 tweets 3 min read

Every Ethics 101 student wrestles with the trolley problem.

In this exercise, you are placed by train tracks watching a runaway trolley race towards 5 people who are going to be crushed unless you intercede.

THREAD/ If you pull a lever, the trolley will divert on a different track, where it is bound to kill one person.

In this situation, is it better to be passive or active?

Should you pull the lever or not?

Oct 17, 2021 5 tweets 1 min read
Years ago I enrolled a young man on a clinical trial as his last therapeutic hope. He was not saved.

But before he died he asked me to convey the results of the research to his family posthumously.

This week, that study matured & showed a significant survival improvement.

Making good on my promise, I let his widow know.

I wasn't quite sure what tone to take. Certainly it was bittersweet to share a net positive result with her when her husband had not been helped. In fact it seemed almost cruel to tell her.

Aug 5, 2021 10 tweets 3 min read
Got sent this meme and oh boy do I have some thoughts as an oncologist

THREAD/ First of all, please don't minimize the experience of patients with cancer

It is, frankly, offensive to equate the toxicity of chemo with the side effect profile of the vaccine

Despite my best efforts to maximize tolerance, my patients can get very ill from their treatments
Jun 2, 2021 6 tweets 5 min read
In no particular order, 5 abstracts that caught my eye as a GI oncologist preparing for #ASCO21



1/ Image NETTER-1:…

cc: @NANETS1 @CureNETs @CarcinoidNETs @ncukcharity @netcancerfound @RonnyAllan1 @Globeseek @PamelaKunzMD

2/ Image
Feb 5, 2021 4 tweets 1 min read
If cancer eventually kills me I don’t want my tombstone to say “FIGHTER”

I want it to state my most obvious characteristic: “RIDICULOUSLY GOOD-LOOKING”

Seriously, this disease already does a lot that robs us of control

But you can decide how best to frame it & define yourself For instance, I’m a fan of silly GIFs:
Jul 1, 2020 10 tweets 2 min read
I have a confession to make.

I've been Tweeting angry.

It's not good social media practice, in general, and it can seem unbecoming of a physician speaking in a public forum.

But allow me to explain

THREAD/ I am angry because I took an oath to protect my patients and everyday I see them needlessly endangered.

It has never been hard to keep them healthy (says the doctor who is routinely -- understandably?! -- accused of being a poisoner).
May 31, 2020 17 tweets 7 min read

Today, during an #ASCO20 clinical science symposium, I'm honored to comment as a patient-physician on the meaning of drug development for rare diseases

Inspired by @DavidFajgenbaum (but not half the man he is) I am going to share my own story It started with a call from the embassy.

We were moving to the U.S. and needed chest X-rays to exclude TB.

My father's CXR showed no concerning cavitation, but his right hemithorax was mysteriously opacified 👇
Mar 20, 2020 16 tweets 7 min read
So as has been widely reported, personal protective equipment (PPE) is running low for medical personnel during #coronavirus #Covid_19

Today my awesome pediatrician wife & my mother-in-law used at-home materials to sew masks


They used 100% cotton fabric and cut one 9”x8” rectangle and one 9”x7” rectangle, as well as cutting a pipe cleaner to 6”

Mar 15, 2020 6 tweets 2 min read

It may be self-evident but if you get such respiratory distress from #COVIDー19 that you are placed on a ventilator, you will be unable to speak.

I know it’s hard but, as you gather with family, tell them what you would want done in that event.

Designate a surrogate decision-maker (healthcare proxy).

Better yet, document your wishes through an advance directive.

@AARP has a very helpful website where you can find appropriate forms by state:…

Mar 13, 2020 14 tweets 3 min read
I'm an oncologist and a patient with cancer.

Surely now is the time in America to uncouple employment and healthcare coverage.

In fact, it's long overdue ...

For years now, cancer patients have faced double jeopardy: their malignancies have endangered their ability to carry out their pre-morbid jobs, and when they lose those benefits, their treatments become financially toxic, often to the point of bankruptcy.

Mar 12, 2020 8 tweets 3 min read
Walk with me, won't you, through a thought experiment THREAD

I awake to find a tiger in my house
1/ Perhaps later, at a less alarming moment, I might concern myself with where the tiger came from. But for now I am most preoccupied with the tiger that is -- let's not forget -- NOW IN MY HOUSE.

I would not care if it were, for instance, a Bengali tiger vs. a Siberian tiger.
Aug 7, 2019 10 tweets 4 min read
Eponyms are falling out of favor in medicine. They aren't descriptive and essentially require twice the memory space to recall both the name & the associated term.

But pancreaticoduodenectomy doesn't exactly roll off the tongue so I suspect the Whipple is here to stay. 2/
Dr. Allen Whipple was a pioneering surgeon whose contributions to the field also include a still-relevant understanding of insulinomas (see also: Whipple's triad).

Still his incisive approach to the pancreas, small intestine, and bile ducts remains why he is best-remembered
May 30, 2019 10 tweets 4 min read
Landed in Chicago.

Opened email to find yet ANOTHER rejection.

Went to @artinstitutechi to cheer myself up before evening meetings at #asco19.

My manuscript is no masterpiece. But I started thinking: what if our greatest artists had faced the fearsome Reviewer #2?

THREAD/ "If I wanted swirls, I'd order gelato.
Thank u, next"
Feb 19, 2019 20 tweets 4 min read
Today marks exactly 25 years since I lost my father to cancer.

Since it was his illness that catalyzed my career in oncology, I’m reflecting on what’s changed a quarter-century later, and what’s remained the same about this wretched disease.

THREAD 1/ There's still no right way to break bad news, but there are many wrong ways. Words matter. Especially words that force you to confront your own mortality.

Diagnosed at 42, my father called cancer a mid-life crisis that could prove closer to his life’s end.

He was right.