Hematology/Oncology in Ohio

Patients can find out about their cancer in some of the most unexpected ways. One patient had a neck injury and they found her bones filled with cancer on the CT scan. A few have presented with symptoms as vague as "abdominal pain" or "bloating." Several have unexplained blood clots. I can't imagine the feeling of going to the hospital for one thing and then getting blind-sighted by finding out you have stage 4 cancer. 

For those who don't know (I don't blame you), a Hematologist/Oncologist is a Blood and Cancer Doctor.

We have worked with patients with stage 4 breast/lung/prostate/skin/colon cancer, multiple myeloma, lymphomas/leukemias, hypogammaglobulinemias, renal cell carcinoma, carcinoid, gynecologic cancers, and cancers of the bladder/esophagus/pancreas/head and neck. We even had patients with mesothelioma and undifferentiated pleomorphic sarcoma of the left atrium of the heart. We saw many genetic disorders (some I never even heard of) because they are at higher risk for malignancies. We also managed patients with blood disorders - MDS, ITP, different types of anemia, recurrent clots, sickle cell disease, polycythemia, etc.

I was so nervous for my first day that I could barely fall asleep the night before (so rare for me) because of the new house, new city, and new hospital where I didn’t know anyone. But when I got there in the morning and met a few people around the hospital, I realized how friendly everyone was. And to top in off, the guy sitting across from me at orientation had an x-ring on. 

The hospital we are in is pretty fancy and it is somewhere that I would want a family member to be treated. The staff are all great and there is a lot of healthy academic debate happening. There is a student lounge, a legit medical library, valet parking, and a balcony that looks out over the lobby just like Grey’s Anatomy. I get into the computer system with my fingerprint and they even gave me a free gym membership.

We are living in a house specifically for medical students that is run by the hospital staff. We have been walking to work since our house is so close to the hospital. It is actually really nice and it saves me from finding parking. Things that help me feel safe in the area are: (1) People smile and say hi to me on the street, (2) our neighbours have extensive lawn trinkets that do not appear to be tampered with, and (3) the guy across the street pulled our garbage bins to the road for us.

The doctor I'm with walks me through each patient before we see them in clinic or she will have me see any patients that are new to her. She manages to quiz me and teach me without making me feel stupid which I think is a great balance that not many people achieve. The patients are so friendly and accepting of having a medical student around even though they could be having some of the worst appointments of their lives. They treat me with kindness and interest and I am very appreciative of that. One unfortunate thing about this rotation is that I’m not able to work independently in clinic. I definitely don't feel as useful as I would in a primary care clinic. Fortunately, my preceptor does this thing where she thinks out loud so that I am able to go through the process with her. Plus there are always updates in guidelines and drugs so we are constantly looking things up together. 

There are an incredible amount of new chemo drugs that are being put on the market which means lots to keep up with over the course of daily pharm rep lunches. The doctor I’m with even says that it is hard to keep track of all the new information that helps her pick the right drug and about the side effects of each one. The reps are literally introducing new treatment regimens every day. It's an exciting time to be seeing this field grow. We have so many patients who are living prolonged and better quality lives due to new and improved groups of drugs. I don't mind free lunch either.

Of course, compared to some other specialties, oncology comes with significant losses. My preceptor will get notified about the death of her patient by a one-liner on her pager. We will see a patient and then get informed that they passed minutes or hours later. We had one patient that we saw and decided to discontinue her chemo on Tuesday, smiled with her about how she was having a great day on Wednesday, and she was deceased on Thursday. There is something beautifully tragic about how the family was able to see her well for one last day. 

I got a glimpse into the mind of my preceptor when another doctor told her that she must be so tough to deal with the cases she deals with and she responded: “not as tough as you think.”

People actually have health insurance at this hospital. Which means we can actually treat them the way we want to. Yay!

It is interesting to me how the doctor responds to different patients so differently. She takes into account their coping level and their defence mechanisms as she communicates with them. This varies from celebrating a positive attitude with one patient to telling another to be more realistic. My passion for psychology and psycho-social issues is definitely fulfilled in the cancer world. Seeing how patients and families cope and process their illness is all very interesting to me. Watching the despair that families experience when patients decide to discontinue care is absolutely heartbreaking. 

One patient didn't want imaging of his cancer done because he thought it would require taking out his nipple rings. I'm sorry, what?

Another approach that differs in oncology is the prescribing of narcotics. Often, narcotics are used as sparingly as possible. I’ve met some physicians who don’t prescribe them at all. There is an entire branch of medicine dedicated to pain management. But when you have a patient with cancer, alleviating their pain becomes more important than the potential for addiction. 

A patient told me that he was self treating his cancer with "grounding" which involved going barefoot in the dirt so that your electrons line up and you rid yourself of free radicals. I am curious if the use of Grade 11 Chemistry terminology made him feel like it must be legitimate. My face did not stray from absolutely serious. I think I deserve some credit for that.

I wrote a post of Facebook during my first week about how I have witnessed the full spectrum of human emotion and that continued to hold true throughout the month. I saw denial, stone cold determination, hope in the face of tragedy, relief, exhaustion, and humour through teary eyes and quivering lips. Many will delegate to a family member or to a higher power. All types of family dynamics come through while we gather the history and when we make decisions on continuing treatments. One thing I can assure you is that not one person believes that cancer will touch their lives the way it does until it happens. It is often thought of as something that happens to "other people" and it almost always feels like an injustice.

Interacting with and observing the chemo nurses has also been really wonderful. One example is of a patient who was starting chemo for the first time and was really nervous. The nurse talked her through the process, included football analogies, gave her a calendar of her appointments, and gave overall emotional support. She placed her in one of the more private cubbies with one other patient that had been going through chemo for years and knew the drill. I smiled when I looked over and heard her laugh at the other patient's jokes and again later when I saw her fast asleep in her chemo chair.

I spent the first week getting lost all over the hospital, but somehow by the end of the month, it felt like a place I could definitely fit in at. I hope to return soon.