May is on research this month. She finally lives a "real" life, lifewithout sleep deprivation, life without missing meals, life withoutrunning up and down 10 flights of stairs, life with things other thanwork! However, something has been haunting her throughout thisbeautiful month. The fellowship application! Not more than a year ago,she said "see ya" to ERAS. Is it time to come back again?! May wasdetermined to be an, an, oncologist, till 2 months ago. She was soinspired by the miracle targeted chemotherapy and thrilled bydischarging patients out of the oncology clinic. How nice it is to sayto your patient, "Mrs..., you have completed all the required treatmentand from the previous monitoring, there's no signs that the cancer iscoming back, you may followup with your PMD for annual mammogram andcome back to us should any issue arises. Have a good life!" Bravo! Jobwell done! Well, reality is never so simple. May's dream was totallycrushed during her oncology rotation at a cancer center last month.Most of the patients are discharged to a particular place, the heaven.99% of time, oncologist are treating cancer or treatment relatedcomplications. Oncologists spend more amount of time discussing aboutend of life issues with patient and family than any other healthprofessionals, except maybe critical care doctors. Can May answerherself the question, "what is the meaning of life"? At what point,should we say "enough is enough"? Is it a meaningful life to liveknowing most of the conscious time is in pain, more complications tooccur and more procedures to undergo? Sometimes, May said to herself,"if I ever get cancer, I do not want anything beyond first line oftherapy. If I failed, let me go." But, think about that nice lady withmetastatic colon cancer, failed 4 lines of chemo, she is so sweet.She's reading her book in bed and walking in the hall way. Her room isfull of laughters on weekend when her family come to visit her. Is itthat a meaningful life? Maybe the meaning of life depends on how youview it. If a cancer patient still has a heart that still beats withthe world that is outside his/her disease, then the life will go on. Ifall the cancer patients give up after failing the first line of chemo,then how would we have known what to use as second line? Somethingsuddenly occured to May, it is the human instinct that we want to livelonger and thrive that drives the development of medicine. May becameinspired by the cancer patients and their family. They are fighters,fighting with their disease along the years, adapting one major changeafter another in life. Most of them lose the fight eventually. But thetreatment experience we accumulated pushed forward the currentdevelopment, especially those who participated in clinical trials.Oncology is the specialty that has the highest number of activeclinical trials. Why is that? Because cancers still defeat us, humanbeing. We get disabled from cancer and we die from cancer. For majorityof cancers, we don't have an effective treatment. Thus, it provides thereasons for setting up a testing, comparison environment to evaluatethe existing treatments and select the best available for our patients.As clinical trial stated, it is not intended to obtain efficacy in theindividual subject. It is to be considered as a group and serves forfuture reference. May starts to think, cancer is a career, to whichthousands and thousands of people commit their time, money, emotion andeven life. Every living day of theirs, under oncologist's care, is acontribution to man kind, which will improve our understanding of thedisease and help future patients to live longer and live better.Looking back, we are making progress: CML used to be a deadly disease.Now people can say, "oh, by the way, I have CML, I am on gleevec". Asif someone is saying, "oh, I have diabetes, I am on insulin". Giventime, oncology will become today's infectious disease, except the newchallenge from AIDS. Cancer will be a disease that people live with orput into part of the past medical history, rather than die from. May ismuch happier after thinking through all these. But it is not it. Theoncologist's busy schedule freaked her out. They are up from 7-12Mon-Thur and taking calls 4/7 nights! May thought residency was herworse nightmare. Now looks like dawn is not around the corner, night isonly getting darker! She still has to see how she is going to handle that...
