So often Dr. Heather Allen sees it - a patient arrives, most often a woman, with anxiety buzzing inside her head like a power drill.
The woman is afraid, truly afraid, in a way that makes her sweat in an examination room where the air conditioning is strong enough to make the medical staff happy to don lab coats or sweaters.
Fear is a natural response to a threat, the physician knows. And the threat her patient has received - a diagnosis of breast cancer - can leave her patient too shell-shocked to focus on survival, particularly if she does not believe a legitimate counterattack is at hand.
It is largely for that reason that the 62-year-old Allen - after working 12-hour days Monday through Friday - is in her South Eastern Avenue office every Sunday at Comprehensive Cancer Centers of Nevada, carefully studying test results, trying to find the best way to attack each patient's disease with the drug weaponry she has at hand.
"This is a quiet time, when patients and staff aren't here, when it's easier for me to ascertain what the best options are," the oncologist said on a recent Sunday. She notes there is no single way to fight a disease that researchers now know comes in many different forms, where today's diagnostic system frequently looks at targetable genetic mutations.
More than 72 gene-based drug therapies are now available, a fivefold increase from 2006.
As she studies data on the computer, Allen, who did her undergraduate work at Stanford and received her medical degree from the University of California, San Francisco, wears the same shorts, top and tennis shoes she wore while bicycling earlier in the day with her husband.
"I didn't have time to change if I was going to get done what I wanted to get done," she said. "It is important that my patients know we are doing cutting-edge, that I will be with them doing all I can no matter the prognosis."
Once patients have that confidence, confides Shannon West Redwine, a patient of Allen's who is battling metastatic breast cancer, they direct their fear into a controlled rage against the disease, summoning the strength to fight to survive something they cannot see - out-of-control cell growth.
The will to live, Allen says, cannot be underestimated. She believes it is a major reason West Redwine is alive today.
Allen does her homework and delivers her battle plan to a patient with a preternatural calm that is reassuring beyond words, says Craig Carrell, who was stunned that as a man, he had breast cancer. Men account for about 1 percent of breast cancer cases.
"She gives you confidence that everything is being done that can be done," said Carrell, who is cancer-free after having surgery, chemotherapy and radiation a year ago.
How she treated a woman with incurable cancer three decades ago - and how that woman's husband treated his dying wife - led to Allen's marriage to contractor John Robert "Bob" Payne.
"He said he appreciated my caring and concern for his wife," she recalled. "I appreciated the same thing in the way he cared for his wife."
The couple now has a daughter studying for her doctorate in chemistry at Rice University in Houston.
Before their marriage, Allen reminded Payne of the hours she works.
"Unlike so many marriages involving physicians, he knew what he was getting into," she said.
The one full day they have together each week is often spent on a boat around Meadview, Ariz., where the Colorado River flows into Lake Mead from the Grand Canyon.
"Sometimes at the end of a week, particularly when I've had to give someone bad news, I don't know if I can do this job anymore," Allen admitted.
"But then I chill for that one day, become reinvigorated, and realize I have a passion for what I do."
Paul Harasim is the medical reporter for the Las Vegas Review-Journal. His column appears Monday. Harasim can be reached at firstname.lastname@example.org or 702-387-2908.