Hematology has been a different world from life at the VA. The new cancer center is amazingly nice...big, well decorated rooms, floor to ceiling windows, fake hard wood floors, a meditation room, a courtyard with a giant sculpture, bamboo, a staff sanctuary...it really does create a good atmosphere. Never underestimate the importance of beautiful pictures when you feel like hell. The rotation itself has been a little awkward, even the resident doesn't really operate with anything like autonomy, which I guess is how it has to be in a super subspecialized acute care setting. In one week I've seen lots of AML and multiple myeloma...along with ALL, CLL, ITP and some lymphoma. It's been interesting to see how adult oncology differs from pediatric oncology...different diseases (I'm actually glad I'm doing hematology not oncology since most pediatric cancers are leukemias), slightly different chemo regimens, and those poor adults have to be awake during bone marrow biopsies (I don't think I truly appreciated how painful they are). The tranquil setting definitely helps.
Today was an interesting day. I was grilled by my attending, Dr. F, over pulmonary and cardiovascular physical exam findings. Scary but actually super helpful...when I can get over feeling like an idiot, I definitely learn the most when doctors ask questions and really teach. I could use more of it. Then I got to observe Dr. F in his bone marrow transplant clinic and see him grilled by a similarly type-A patient who wanted to know his prognosis...not just statistics but a specific number of years...an impossible question. Dr. F's response "Only God really knows, and he hasn't told me". I could do without the God part, but I think it captures the degree to which outcomes can be very patient specific and hard to pin down despite all the risk stratification. Control what you can control because so much is out of your hands. One of our patients, a woman in her 20s with refractory AML, has been growing fungus in her blood and now it's spread to her skin despite anti-fungal therapy. She has no white count and she can't fight the infection until she has a white count which probably won't happen for several weeks, if she even lasts that long. No one has told her yet.
Speaking of God, today the director of palliative care and a hospital chaplain performed a blessing of the hands ceremony for all the doctors and nurses caring for cancer patients. It was very symbolic and beautiful...they personally washed each of our hands and anointed them with oil (?!?). I love the idea of the ceremony, "blessed be these hands that have touched life, and felt pain, and embraced with compassion" but it was also way too non-secular/O Holy God, for me. I'll happily swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, but I'm not about to join STO.
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