Matters of Life and Death: A Day With an Oncologist

When many people think of cancer, they think two words: "death sentence." Hence, the prospect of treating people with cancer could be summed up in one word: "depressing." And it's true that some of Dr. Park's* patients were dying. There was the woman whose lung cancer had metastasized to her brain. Her whole family - husband and three children - had accompanied her to her appointment to get an update, and the news wasn't good. They could do chemotherapy, and it could prolong her life, but chemo could not cure the cancer. And chemo would cause many toxic effects, including hair loss and nausea, Dr. Park said. You could tell the family had grabbed onto that little bit of hope and was clinging to it. Dr. Park had to bring them around to reality. He explained that without treatment, the average survival time for a person with her condition was four months. With treatment, the average was a year. And those were only averages. Chemotherapy was no silver bullet. One of the daughters was sobbing at this point. I reached to hand her a Kleenex box, but she had found some tissues in her purse. The woman with cancer, sitting on the exam table, said she thought she wanted to try the chemo and see how it went. Dr. Park agreed, and said that they could always stop if it became too much to bear. The woman, who had remained calm, collected, and still throughout the whole appointment, then spoke. Her voice broke ever so slightly, and she twisted her hands together. "I just want to go fishing," she said softly. 

My heart broke for that family. For what they were going through, for what they would continue to go through as this woman's disease progressed and even after she was gone, dealing with the loss of their wife and mother. 

But there were survival stories too. Like the woman who had beaten breast cancer, even though it had cost her one of her breasts. She came in laughing and joking, obviously happy to be there for a routine check-up rather than for chemotherapy treatment. For her, cancer had not been a death sentence. And she was obviously resilient, having bounced back from a major surgery that would deeply affect anyone on so many levels - physical, emotional, psychological, sexual. I honestly don't know how I would handle such an intensely emotional situation. But here she was, offering to let me feel the difference between her reconstructed breast tissue and natural breast tissue. "Whatever you can learn from me, that's wonderful," she said. 

I am still in awe of that woman, and of every patient I met in Dr. Park's downtown Nashville office earlier this month. What was I doing in a Nashville oncologist's office, of all places? Isn't that what everyone does on their summer vacation? In all seriousness, that is what I did on my summer vacation. In early May, I was in Nashville, Tenn. visiting a dear friend (who is also a non-traditional pre-med student). Her husband is good friends with Dr. Park, a Nashville oncologist. And Dr. Park was more than happy for the two of us to hang out with him for a day at his office. And as I have already suggested, it was an amazing day.

From the beginning, Dr. Park told us that he wanted to make the experience as educational and beneficial as possible, and that he would try to walk the line between explanations that were way over our heads and explanations that were so simple they might insult our intelligence. He found that balance perfectly and effortlessly, it seemed; he was a natural teacher. Before each patient's appointment, he would pull up the patient's history on the computer (their office had completely gone to electronic medical records, or EMR), explain the person's disease, prognosis, treatment plan, and reason for that day's visit. We would also go over the patient's most recent labs together; these values often determined whether a cancer patient was well enough to get chemo that day, or whether a hematology patient needed an adjustment of his or her coumadin (a blood thinning medication). 

While so much of the oncology world was (obviously) new to me, I was able to make connections to what I already knew. And that is always a rewarding experience for me. Those lab results we looked at for each patient? They were the same types of results that we had gone over when I rounded with the ICU director in Chicago several weeks ago. So I was familiar with what some of the normal ranges were, and therefore also when something was amiss. One patient, who had myeloma, also had a kidney problem that had him on dialysis. Dr. Park told us that before they had started any cancer treatment, they had to make sure that he really had myeloma, not just an amyloid issue with his kidneys, because the two treatments were very different. Amyloid ... the word struck a chord in my brain. "Is that in any way similar to the beta-amyloid protein accumulations that are a feature of Alzheimer's disease?" I asked. Dr. Park looked surprised, and said yes, that they were both protein accumulations (although the histologies are very different). Another connection I made had to do with tissue structure, something we learned last fall in General Biology I. A woman came in as a new patient, having had a bilateral mastectomy (both breasts removed), and her physician wanted Dr. Park to evaluate her pathology and lab results to see whether she would benefit from any chemo treatment in addition to the surgery that had already been done. DCIS - ductal carcinoma in situ - was the type of cancer she had, meaning that it had not yet spread to the basement membrane (and this is a good thing), Dr. Park explained to my friend and me. I remembered learning about the basement membrane, and could picture exactly where it was in relation to the other types of cells in human tissue.   

But to the woman with the DCIS, it didn't really matter so much where the basement membrane is, or even what it is; what she cared about was that her surgery had most likely gotten all of her cancer, and that chemo was not needed. "Praise Jesus," she murmured as she listened to Dr. Park's good news. "Hallelujah."

That particular woman clearly had a faith that helped sustain her through her breast cancer. But another breast cancer patient we met seemed to be all alone, almost aimlessly so. Her cancer had metastasized to her bones - her skull, sternum, femurs. Yet she seemed not to be able to come to terms with the fact that she was dying; her main concern was that she had intense back pain. So Dr. Park worked out a plan with her to get her the immediate relief she needed, suggesting radiation treatment. I felt bad for the woman, because not only was she going through a torturous disease, she was doing it alone. That's something no one should have to do.

My friend has an extensive family history of cancer, and she told me she didn't think oncology was something she could imagine herself doing. I completely understand that. But the other day when someone asked me what type of doctor I want to be, I found myself blurting out "oncologist." I was a little surprised at myself, honestly, but I ran with it in the context of the conversation. Clearly, I have plenty of time to make these decisions. But it doesn't hurt to try a professional hat on (in the most basic way) and see how it feels.

Thank you, Dr. Park.

*Name changed.