Oncology

Today we started a two week stint in oncology. Our first day we started in radiology oncology. You know when you hear about people getting blasted with focused radiation to treat various malignancies? Well that's what we were supposed to be seeing: the first presentations, the follow-ups, the complications, the improvements, etc.

Begin 9am in the resident's room where we are told that there isn't much to be done today despite being scheduled for the whole day. We force introductions upon the resident who seemed reluctant to tell us her name. Since two of us get stuck without anyone to follow who's actually seeing patients, we head to the lead-lined basement where the irradiating takes place. Here, we actually see how the patients are set up using their tattoos and lasers in the wall and machine to line them up in all three dimensions. The actual irradiating part takes less time than the setup most of the time. As interesting as it was, and despite the fact that every patient is different and requires a different setup, we realize very quickly that the radiation technicians are busy and have their own student to teach so we go search for a doctor to follow.

We get rejected with a shy smile and a slightly empathetic "Soon" from the other resident who forgets to explain to us that she has no patients to see until we ask what's happening. An hour before things are scheduled to wrap up, we are sent to lunch only to return in two hours.

Upon our return, this time all four of us are completely ignored. There's no test for this rotation, just a paper and a presentation but the residents are using the computers in the residents' room (makes sense, doesn't it?) and we discuss the weekend, the local restaurants, and the big debate whether or not to write a foreign medical licensing exam. One student decides he's going to leave, but backs out and jumps in on my action with a patient.

We interview my one patient of the day. He's a man with lung cancer. He reminded me so much of my grandfather before he fell ill. It was everything about him: the shape of his face, the big glasses, the clothes, the way he talked, his expressions. His prognosis wasn't good. The cancer had been eroding his ribs for at least a year now. There at least weren't any signs that the cancer had spread further, but sadly it's only a matter of time. The thing about lung cancer is that it just really doesn't respond well to any treatment we have, so the best thing to do is to not smoke, but that's a public health issue that I won't delve into right now.

We present the man's case to the doctor who goes in and sees the patient. Turns out there's a waiting list for radiation therapy. I cannot imagine how frustrating it is to have a malignancy and need treatment and then be told that there's a waiting list for radiation. At least chemotherapy doesn't have a waiting list. After seeing the patient, we head to the doctor's office to talk about the case. He rants a little about how he would rather be treated in Brazil because of our waiting times. We talk a little bit about staging cancers and that's it for the day.

We grumble. Make mental notes of everyone's names so we can give appropriate evaluations on our time well wasted (one patient in a whole day is not acceptable really).

Tomorrow we're off to the medical oncology department, which, from what I hear from fellow students, is a much more student-friendly environment.

Let's hope