Happy 2016!
A new year means the start of another rotation. I chose to stay close to home for this one, even if it meant spending one month in Internal Medicine rather than Pediatrics. It wasn't a hard decision to do this rotation since I really enjoyed IM as a third year. After surgery, IM was my second favorite rotation, primarily because I loved all the clinical diagnoses that spans all of Internal Medicine and all the variables that must be thought through before arriving at a diagnosis. On the other hand, adults and the elderly are just not my cup of tea.
I started off this week doing Hematology-Oncology at Kaiser Santa Clara. This hospital is super near and dear to me. I used to volunteer here, doing anything from wheeling patients out of the hospital once they got discharged to pointing visitors and patients towards the right department and even working in the Newborn club, teaching new mothers how to breastfeed, doing jaundice checks, and my always favorite, swaddling and holding the newborns.
On the other hand, while the hospital was very familiar to me, Heme-Onc in my mind was absolutely terrifying. Like many other people out there, the word cancer scared me. I couldn't imagine diagnosing anyone with cancer. I saw a close family member pass away because of cancer and I saw the unbearable side effects of undergoing chemotherapy and radiation. Doing this rotation was a definite eye opener. There wasn't a single day of the week that my Attending did not diagnose a patient (usually over 75) with some type of cancer (lung cancer, metastatic breast cancer, prostate cancer, renal cell carcinoma, myelodysplastic syndrome and cholangiocarcinoma just to name a few). Often times for these patients, the prognoses were not great and there were no curable treatments available for their stage of disease, only treatments that could make them more comfortable or prolong life.
One of the roughest chemoradiation treatments I saw was for head and neck cancers. Patients undergo high intensity cisplatin chemotherapy for weeks in addition to constant radiation to their head and neck region. The high dose cisplatin can burn their veins as it's being infused into the body and cause multiple side effects including severe nausea and vomiting, kidney toxicity, peripheral neuropathy which is damage to the nerve endings in your hands and feet, hearing loss, and several electrolyte abnormalities particularly with potassium and magnesium. In addition to that, radiation 5 days a week for multiple weeks causes the worst sunburn ever in your head and neck region. I could not ever imagine the pain, yet I saw patients at the tail end of their treatment, still managing to smile and push through even though they were coughing and spitting up mucus every 5 seconds secondary to horrific mucositis and had already lost 35 pounds in three weeks.
Though there were many cases that were extremely sad, there were also cases of cancer that was cured - mostly those that were initially diagnosed at an earlier stage - early stage breast cancer, ovarian cancer, testicular cancer. I was able to meet many cancer survivors who are so brave and so strong and I felt so lucky to see them after being cured because it makes the word cancer, a little less daunting in my mind. It also reminds me to stay healthy, exercise and eat well, see my PCP yearly, and get my routine labs and screening done as I age. Most importantly, it reminds me to make sure that my entire family is staying healthy too, which of course means they keep up with the mammograms and colonoscopies!!!
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