Voices: Gavin Jones, MD
"It hurts most right here, Gavin," my patient remarked, pointing to a rather sizable lump on his waist. "And in my right chest too. I can't even swallow."
I looked him over. His body reminded me of a kite, with rigid skin pulled taut over harsh and angular bones. The metastases were scattered everywhere — too numerous to count. Sensing the look of consternation on the faces of his wife and daughter, I knew it was time for an earnest conversation. As I left the room to fetch a chair, I could hear the stentorian cough of my other patient boom throughout the ward corridors.
This was my first week on 8 West, the hospital's inpatient oncology wing. Everyone in my medical school class, even many of the residents, knew that I was interested in this field of medicine. The truth is that I had always found cancer, in all its multifaceted complexity, to be the most human disease. Human in its biology: the idea that cancer stems from a corruption of the very genes responsible for our phylogeny and existence, accentuating a delicate interplay between cellular stability and mutability. Human in its emotional impact: how a diagnosis of cancer brings the significance of our actions and the preciousness of our lives into sharp relief. And lastly, human in its universality: the notion that everyone who lives on this planet will inevitably be affected by cancer as friends, family members and, perhaps, even we ourselves eventually succumb to the disease. For someone who pursued medicine to better understand and elevate the human experience, the attraction to this field was innate. From the micro to macro level, cancer is the common thread that undergirds a shared narrative: where we came from, how we got here, how we live and what is important to us.
All of these thoughts swirled in my mind as I pulled the chair up next to my patient and his family. He was here to enroll in a new clinical trial for bladder cancer. In the meantime, he was in extreme physical pain, unable to eat, severely nauseated and plagued by persistent hiccups. "There are things we can do to make you more comfortable and help with your symptoms," I averred. "Have you ever heard of radiation therapy?"
For coupled with my thoughts on cancer the disease was always an inclination toward the pragmatic and procedural — an attraction to targeted techniques, technology and tangible results. I had done research in radiation oncology at the end of my first year of medical school and relished both the broad scope of malignancies treated with radiation and the novel means of doing so. Here was an intellectually challenging, research-driven field that also afforded substantive relationships and interactions with patients. Most importantly, radiation could make a significant difference in people's lives; my patient's case seemed like the perfect opportunity. I decided to broach the idea of palliative radiation to my attending. She agreed.
The end of his story was an affirming one in the utmost sense. Over the subsequent weeks, I watched the once-prominent pelvic and sternal nodules wane and nausea and hiccups yield to a stable appetite. "The pain is a lot less, too." Buoyed by the hope of the new clinical trial and bolstered by the effects of the radiation, his improvement reinforced my attraction to a field that could clearly do so much to better the lives of its patients.
I carry this story around with me as a constant reminder that, in the end, all of our endeavors in this specialty come down to people. Amid the Kaplan-Meier curves, fractionation regimens, RTOG trials and monitor units calculations, the core of the practice of medicine remains a heartfelt and therapeutic exchange between two individuals. I have always had a desire to contribute to the field of radiation oncology in manifold ways: as a scholar exploring the intersection of evolving medical and radiation domains and an educator amid a spirit of innovation, sense of collegiality and didactic impetus offered by a professional career in an academic setting. But the most fundamental is on an intimate level, by bringing a genuine sense of care and compassion to all my patients. In these most trying of times, we must strive to never lose sight of this raison d'être of the physician.
University of Kentucky College of Medicine