Oncos: My month on Heme/Onc

Last month I was on an elective month – hematology and oncology. Part of my inspiration for going into medicine was the book The Emperor of All Maladies, a poetic walkthrough of the history of cancer and medicine from ancient times to present day by SM. The writing in the book is superb, but not the topic of this post.

The month gave me a first-hand look into the face of malignancy. The recurring theme of the month, it seemed, was mortality. Patients and I alike were fascinated by the prognosis of the grim diagnoses and outcomes of disease. There was a definite gravity in the specialty rotation because it seemed (in contrast to my IM rotation) that there was a serious finality or consequence in everything we did. The staging, the cycles of chemotherapy, the radiation treatment. Everything was momentous for me, and moreover, the patients. I, a student with some inkling of education, could barely grasp the totality of the underpinnings of what was partaking in front of me when the oncologist would outline a regimen and discuss the rationale behind it. The historicity of the evidence, the experience of the attending and the fellow, and the confidence of the rest of the team all reassured me that there would be some positive outcome for the patients we treated. However, in my readings, I often encountered scarce data and evidence behind certain therapies.

Part of the reason I was originally drawn to medicine by oncology was the fact that there is something so primal and visceral about cancer that it poses as a problem that must have a primal and visceral solution. Another thing that drew me to it was the fact that it is so prevalent, and can happen to anyone (beyond the obvious associations, many of the patients I saw seemed to have the worst luck if nothing else). And of course, there must have been some macabre fascination I had in my imagination years ago of what being an oncologist would be like, fighting death with science and commiserating with my dying patients if there was no remedy to their fate.

As naïve as those reasons might have been, they now have the weight of some real experience behind them. Now that I have seen the groundwork of oncology in an inpatient setting and in the clinic, I have a more real sense of what that lifestyle and goals might be like, were I to pursue that path. At this time, I still know there is much for me to do and see, including obstetrics, gynecology, surgery, and pediatrics.

Lastly, I will say that the elective did have a few brushes with death. A patient on our service coded and failed to be revived; another passed away after a chronic battle with cancer. These were routine in the hospital setting, but that did not lessen their impact on me. When confronted with such a grim truth, it is hard not to consider my own life and think of other outcomes. One thing my mother told me a not too long ago still resonates with me – she said that if she were diagnosed with cancer and only had a few months to live, she would not waste a single day with chemo or in the hospital. I cannot say I disagree – while there are certainly appropriate times for therapy, I think, there are also times that are not. Seeing the hardship of surgery, the stress of chemo, it is too much for a hypothetical question.