First Month of Consults Complete

Yesterday I finished my first month of consults as a heme/onc fellow. Fellowship has a very different tempo than internal medicine residency. Wards and ICU rotations in residency were punctuated by early mornings where I would wake up at 5:30 am, arrive at the hospital by 6:30 am to “pre-round,” and then round formally with a team from 8:30 am to noon. Afternoons were spent calling consults, placing orders, writing notes, responding to pages, and working on placements so that patients could be discharged. Days during fellowship, on the other hand, never start before 7:30 am. Rounds on consults are in the afternoon around 3:00 pm, which gives me the day to see patients, write notes, read and learn. We rarely admit, discharge, or serve as the primary team for patients, so there are far fewer interruptions throughout the day. It’s a great pace and I feel so fortunate for my training program.

I had several proud moments in the past week. 

The first was a diagnosis that I helped explain to a patient when a biopsy result became available. It was a new lymphoma that will require chemotherapy. The patient was young, so I knew this would be life-changing for him/her. I still remember the first time in residency I had to tell a patient he/she had cancer, and I remember that I was not particularly effective at it. I gave too much information all at once, and the patient became overwhelmed, understandably. My attending at the time had to step in and break the information down into pieces and terms the patient could understand. This week when I went to talk to my patient about his/her lymphoma, I went prepared with lots of information, but I also reminded myself not to overwhelm him/her with it. I asked what he/she knew about lymphoma. I sat at the bedside and explained the disease and how it’s treated, slowly and with frequent pauses. I felt like my patient and his/her family really understood what was going on and that they felt confident in the treatment plan. It was a 180-degree contrast from the first time I did this in residency.

My second collection of “proud moments” this week were experiences in helping to manage end-of-life planning for multiple patients. Each patient had an advanced stage cancer of some type, and each one had limited treatment options remaining. I was asked to talk with each of them regarding prognosis and future treatment options. In each circumstance, I felt like I did a good job listening to the concerns and wishes of my patients so that I could provide the information and reassurance they needed to plan for the next few months of their lives. I also spent a lot of time on the phone talking to family members to help them understand the health of their loved ones and what to expect in the months ahead. Just as with the lymphoma diagnosis, I remembered to pause frequently and provide recommendations without pushing a particular course of action. My experiences have taught me that every person’s end-of-life journey is unique. Some people are confident they want comfort care, some want to keep treating their cancer regardless of side effects, and a great number of people are somewhere in between, undecided about what to do next. 

One question I have faced many times since choosing oncology is “How do you do something where so many people die?” The answer I have decided upon is this: We all die. While it is sad when it happens from cancer, there is great pride to be found from helping extend a life through treatment, cure cancer when possible, and provide comfort and reassurance no matter which way the journey takes. Having cancer can be a scary prospect, and I know if I were faced with it, I would want someone like to help navigate the path.