Monday, September 24, 2012

I Have Such a Cool Job

Today it really struck me what a cool job I have. After years of struggle, long hours, and really unrewarding, thankless work at near minimum wage pay despite years of post-graduate school and training, in the past year or so I've really begun to see the light at the end of the tunnel. Now as I'm approaching the end of the tunnel (1 year and 9 months until I'm done with training) the light is starting to shine directly on me. My job is really starting to rock.

Currently I spend about 1/2 of my time in outpatient clinic seeing cancer patients and the other 1/2 working on research papers. The research stuff lends flexibility to my schedule, which is great, but I don't find the work very rewarding. It's basically like writing college essays over and over. Boring stuff. Clinic, however, is wonderful. I don't mind going to clinic and when I'm there I'm happy to be there. And clinic is how I will spend 85% of my time when I am done with fellowship so I think I'm in good shape to have a happy, healthy career. I hope so, anyway.

Let me give you a few examples of why my job is so great. All day long I see patients who have recently been diagnosed with cancer (i.e. I'm the one to tell them), to those currently going through treatment that is working (yea!), to those whose treatment was working but is now failing, to those who are dying, to those who are cured. I find each type of patient rewarding in their own way.

The newly diagnosed patients are usually terrified (and rightly so) and hanging on every word you say, so words must be chosen very carefully. At the time of diagnosis, it is important to be realistic but it is also important to give hope. And most of the time, it is not hard to be hopeful. Oncology is a rapidly changing field with new drugs being approved by the FDA (Federal Drug Administration) monthly. If you spend any time at an Oncology conference or meeting, you'll soon see that the pace of change and progress is dizzying. Whenever I get an email with a new FDA approval, I feel like it's Christmas. Patients who have no chemo options one month may have multiple options the next. It's truly incredible. Even for cancers that are "the worst of the worst" like metastatic pancreatic cancer or metastatic melanoma, new drug combinations and new drugs are extending survival by months and even years. There is much to be hopeful about.

One thing I focus on with all my new patients is that everyone is different. No one can predict how one individual person will do. Recently I saw a patient who has had metastatic pancreatic cancer since 2005. He still hasn't required chemo. His quality of life is excellent- he is playing tennis and working out daily. I have many, many metastatic colon cancer patients diagnosed over 5 years ago. All have been on treatment intermittently, and many are still thriving. Metastatic lung cancer is another disease that no longer carries an eminent death sentence. Do many folks die within a few months of diagnosis? Yes, unfortunately they do. But others enjoy fantastic quality of life for years, often by only taking a chemotherapy pill. Yes, a pill. And there are more chemo pills in line to be FDA approved every day. Metastatic breast cancer patients live 5-10 years with their disease with some frequency. I don't mean to make light of these serious, life shattering, diseases. But I will say that being an Oncologist- while occasionally sad- is far from depressing with so many great advances we can offer our patients.

Not to mention the patients themselves. What an amazing privilege to be able to work with and help such strong, inspirational, caring and often hilarious folks. I don't know if nice people are more prone to cancer (I sure hope not) or if something about getting cancer makes you nice but I'm telling you there is something different about cancer patients. And their amazing families. A few quick stories from the past weeks:

  • "Thank you for telling me I have cancer". Back when I was consulting on the inpatient service, I had a lovely middle aged female patient who had melanoma (skin cancer) years ago, that was surgically removed. She came to the hospital with fatigue, vomiting, weight loss. Evaluation showed masses in her brain and her liver, places somewhat typical for recurrent- and now metastatic- melanoma. She was a savvy lady and knew what was coming from the get go, but after a few days of tests and the biopsy of the liver lesion, finally the pathology results came back so I headed to her room to officially give her and her husband the bad news. Like I said, they knew it was coming, so I didn't mince words and explained the diagnosis and what it meant in terms of treatment options at this point. I went through my careful spiel about how her disease at this point is not curable, but is certainly treatable. I gave them time to digest. I answered their questions. I passed her the Kleenex box. I held her hand. They were such a sweet couple. When we were done and I got up to leave the room, she called me back. She grabbed my hand again, looked directly in my eyes, and said "Thank you for telling me I have cancer. That must have been hard for you." Tears sprung to my eyes. Here this lovely lady has heard the worst news probably of her life and she is thanking me for telling her!! Where does she have this reserve of kindness and empathy? Absolutely incredible. I told her she was an amazing woman. She was. I'll remember her and those simple sentences for the rest of my life.
  • "Time for renovation." A few weeks ago I had a clinic patient with metastatic lung cancer. She was initially diagnosed about 2 years ago with a mass in a very dangerous place- nearly invading her heart. She responded so well to initial chemotherapy that she was able to take a chemotherapy "holiday"- a period of time off chemo where we pursue "active surveillance" with doctor visits to access for symptoms and frequent CT scans to look for disease growth. One of these scans showed a new site of metastatic disease outside of her lung, indicating disease progression. Her and her husband took this news in stride, joking that they'd have to schedule the biopsy of this new lesion around their home renovation schedule. She turned to me and said "After I was diagnosed, I never thought I'd live this long, so I decided to deal with the nasty windows and closed floor plan of our house. But now here I am, two years later, so I decided it was time to renovate!" Her husband then quipped, "Yeah, and our son borrowed money from her promising to pay it back in 3 years.....turns out he's going to have to pay up!" We all shared in a big chuckle, overjoyed that she's continuing to exceed all expectations.
  • "I have cancer, let me help you." Sadly, I have multiple, young, 20-something patients with incurable cancer of may kinds. Leukemia, colon cancer, liver cancer. It is indeed very, very sad. However, the sadness of these young adults' stories is completely overshadowed by the amazing things that they are doing with their lives. They are not sad folks to be pitied. Quite the contrary, most of them are motivating, inspirational examples of how to live the life you've been given. One of my patients is a cancer nurse, many others are actively involved in not-for-profits for adults and kids with cancer even as they continue to fight their own diseases. The grace with which these patients juggle jobs, kids, side effects and tough treatment decisions when they should be enjoying the prime of their live is amazing. Absolutely amazing. Uplifting>>sad.
I hope these stories show a bit of the empathy, wisdom, humor and selflessness of the folks I get to work with each and every day. My job is easy compared to their daily struggles. They motivate me to learn everything I can so I am best prepared to help each patient that walks through my door for the next 30 years.

So, sad? Sometimes. Depressing? Definitely not. Rewarding? Every single day. Every day I'm reminded how lucky I am to be healthy and how privileged I am to work with such great patients. I just might have the best job in the world.

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