Abstract
Dear Editor:
It has been a little over one year since I started my lifelong dream job as an academic oncologist. Like many others, I have had different expectations of how the transition from a trainee to an independent oncologist is going to be, especially in the academic settings. However, my first year as an oncologist exceeded all my expectations in so many ways and at so many levels.
During my first year as an oncologist, as I have become the key physician in my patients' journey of battling cancer and with more continuity of care compared to when I was in training, I have appreciated more a very important fact, which is that beside all the endless science of oncology I have learned during fellowship training and will continue to learn throughout the rest of my career, there are much more important things I cannot learn or read about in textbooks or in the medical literature, things that can only be learned, experienced, and lived through communicating with those very special human beings I have the privilege to care for, and I mean the fearless cancer patients.
During my first year as an oncologist, I have experienced with my patients and through my patients so many different kinds of feelings and emotions, maybe more than I experienced throughout my entire life before I became an oncologist.
During my first year as an oncologist, I have lived with my patients and through my patients some wonderful moments of happiness and satisfaction as well as some terrible moments of sadness, sorrow, and frustration. In addition, I have often had to transition back and forth through these completely opposite emotions during the same day or even within the same hour, as I could be celebrating a moment of joy upon giving some good news to a patient and family, just to move on very shortly after to another patient and family and share with them the deep pain of bad news I just broke to them, and then move on to another patient and so forth.
During my first year as an oncologist, it was very clear to me that although the actual bad news and how I break it to my patients and their family may seem to be all that count for them, the conversation that comes after breaking the news and how I handle it is as critical to them.
During my first year as an oncologist, I have ascertained that during this era of exponentially growing technology and medical advancements, this era of innumerable tests and procedures we put patients through, nothing could or will ever accomplish more than proper and compassionate communicating and engaging with patients.
During my first year as an oncologist, I have realized what an amazing time it is to be an oncologist. When I look at what cancer research has achieved over recent years and how it has changed forever the way we treat cancer and how many cancer patients are being cured or at least living better and longer, I cannot but feel excited about the future of oncology and cancer care. On the other hand, I have also learned to always remind myself that despite all the promising research and scientific advancements, some of my cancer patients are still going to die because of their cancer and many others are going to fight cancer for the rest of their life. As an oncologist, I need to be always prepared to accept this frustrating fact and more importantly I need to prepare and help those patients to accept it as well. On the same note, during my first year as an oncologist, I have learned that while I should always be honest with my patients and prepare them for the worst, I can never ever and should never ever take away their hope. Hope is the strongest weapon they fight cancer with and they will be miserable without it. In fact, I will be also miserable without their hope. On my office door I have framed a very beautiful saying by Richard P. Evans (American author): “It is often in the darkest skies that we see the brightest stars.” It is a saying my patients teach me every day.
When I was in training, I had the privilege of taking care of a very special woman for a few hours during an inpatient hospital admission. This genuine patient had fought breast cancer for years. When I met her, she was very sick, and while I was taking a medical history and asked her if she had any other medical problems like heart diseases, she smiled and answered, “Doc, my heart is strong, my heart is full of faith and full of hope, and please do me a favor and write that down in my chart.” During my first year as an oncologist, I have always remembered and pictured that special patient. Maybe not every cancer patient I have encountered could express verbally what she told me, but certainly every one of them has been a courageous trooper and a great example of what George C. Scott (American director and producer) said best: “The human spirit is much stronger than anything that could happen to it.”
During my first year as an oncologist, I have appreciated much more the role of palliative care especially for those patients with advanced disease. Palliative care is so crucial and we can never emphasize enough how important and helpful it is to integrate it as early as possible when caring for cancer patients. At the end of the day, we always have to remember that oncology is not only about treating cancer, it is rather about doing everything possible to help patients fight the cancer with minimal suffering if any, and that is best done with and through palliative care.
During my first year as an oncologist, I have come with my own answers to questions oncologists get frequently asked: “How can you do it?” and “Isn't it so hard to be a cancer doctor?” Here are my answers: “First, I am not really the one who is doing it. It is the cancer patients who are doing it all. Second, yes it is hard, it is actually very hard as I try to be one of their tools while fighting cancer, but it is also an honor and a privilege. Last, I practice oncology with full hope and faith and I know that better days are yet to come in the science's battle against cancer.”
Finally, during my first year as an oncologist, I have understood better what has been described and published about the amount of stress and burnout physicians (and oncologists in particular) could go through. Considering how emotionally overwhelming caring for cancer patients could be, in addition to how easily an oncologist can get caught up trying to keep pace with science, research, meetings, conferences, emails, and many other important activities beside direct patient care duties—considering all that, I have learned that I need to break out of the cancer world periodically and not forget my personal life.
During my first year as an oncologist, I have realized that I can, I need to and I should spend more time with my family. Certainly, being a cancer doctor and witnessing what patients and families go through is enough to make me come back home every night hurrying to hug my family very hard, but that is not the main reason why I like to do that. It is rather because my family is everything to me. My family is what keeps me going. My family will always deserve more from my time and I need to be there for them when they need me and when they do not.
My first year as an oncologist may be behind me but it was absolutely a very special milestone for me and I will remember it for the rest of my life. I know that I am still at the very beginning of the challenging journey I chose, during which I strive to help patients throughout a journey they did not choose. I also know there will be so much learning, working, and adapting to do on a daily basis during the years to come, but I am confident that as long as I can keep some of the fighting spirit of my cancer patients, then I can do it and I can do it well.