Tuesday, January 18, 2005

In the Temple of the Giants

I walked into the doctor's lounge the other day and suddenly felt like a pan-pipe tooter in the halls of Mount Olympus. Instead of the usual tableau of snoozing anesthesiologists in the corners and scrub nurses sneaking sodas from the refrigerator, all the giants of medicine were there. They draped themselves about the couches and chairs, chatting with fellow colleagues, or back-slapping each other with that hail-fellow-well-met ferocity found in the supremely confident.

I could see Cardiology slathering a bagel with ambrosia, while Obstetrics sat next to him reviewing last night's scores. Across the room was Pulmonary, yakking with Urology about some mutual patient; leaning idly against the counter, General Surgery nursed a quiet cup of nectar. Across the room the king of the gods - Cardiothoracic Surgery - was in his court, issuing maxims to the small crowd of admirers gathered around him.

How did it ever come to this, that I, Oncology, was fitted with a shepherd's rags? Was I not charged with a noble responsiblity - not pursuing the cause of say, diarrhea, but engaged in a mountaintop-worthy battle against a seemingly omnipotent foe? Do my patients not cry out in great numbers in the fields, or across the vast waves for merciful Oncology to save them from the sweeping fury of cancer?

Of course they do. It's just that as deities go, we oncologists are far from divine in our ability to answer the prayers of our suppliants. Our therapies don't work all the time - often not even half the time, compared to a surgeon given the task of amputating a limb - hard to imagine that not coming off all right, eh? Perhaps that is one reason why our fellow healers, when grabbed by the sleeve to hear us prattle about the latest improvements in the treatment of melanoma, give us the same look used to silence the family dog.

I suspect the other reason we get the glare is because of the drubbing we give our patients - the toxicities of chemotherapy. Who would not look askance at a doctor who eschewed the scalpel for a bag of poison? Is this anyway to be kind to people in need?

Until we come up with a bona fide cure for the cursed disease, we oncologists will always have a self-esteem problem. We may dream about sitting on the highest throne in the pantheon, but by Jove, some of our colleagues believe our place is by the ashes of the hearth.

Many strides of course have been made in the search for the cure for cancer, but in the world of the gods it is not enough to show progress. We must show a complete elimination of the disease, or perhaps a metamorphosis - changing breast cancer into a lowing calf, for example, would be a sublime myth to pass on to the generations. Until that day occurs, oncology has been hereby relegated to a minor constellation in the starry night.

I didn't always feel like this. In fact, when I started my training I was on cloud nine, running morning rounds with the team, seeing patients in the clinic, attending lectures purported to be fascinating. As I recall, it was only three months into my fellowship when innocence was shattered. I was musing at the nurses' station one afternoon when a sharp voice cried out over the hospital loudspeaker: "Dr. Hildreth report to the Emergency Room, STAT!"

I leaped from my chair like a wallaby in a thunderstorm and sped down the hall. As I rushed by, various helpful personnel hailed me with greetings like "Hey, don't you know they need you in the E.R.?" My mind raced with the possible scenarios that were unfolding there. What crisis awaited me, to broadcast such an alarm to the entire hospital? I pleaded for strength, wisdom, courage. It is always the oncologist who is asked to perform miracles, I thought, and began to recite the Serenity Prayer.

Blasting into the ward, I announced my presence and inquired as to the problem. A rather annoyed intern looked up from his chart and replied, "Oh, good - you're here. We need you to make the patient in room four a no-code. He has metastatic lung cancer and is going to be admitted."

Like Saul, the scales fell from my eyes and needless to say, the view from this formerly lofty perch was not inspiring. Since that day I have harbored a smallish but powerful nugget of skepticism about the prestige of the oncologist in the grand array of specialists. Nevertheless our work, our search for the cure, will continue - even to the Gotterdammerung of medicine. The final outcome will not be revealed in my lifetime nor in the lifetime of my grandchildren, but when it does occur I will wager that the legions of oncologists who spent their lives toiling against cancer will be pleased to see their names finally added to the register of heroes.

16 Comments:

At 11:52 PM, Blogger Alicia said...

"I will wager that the legions of oncologists who spent their lives toiling against cancer will be pleased to see their names finally added to the register of heroes."

As a cancer survivor and a memeber of a family that has lost 3 grandparents, several aunts and uncles, and a 6 yo cousin to cancer-your names are already on our list of heros. In fact you rank near the top, God had gifter so many men and women in this profession.

Your writtings are amazing, you have a great gift of communicating through writting. Thank you and please keep them coming.

 
At 7:03 PM, Blogger Eric said...

Superb writing.

 
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At 3:10 PM, Blogger Joe said...

You think being a MedOnc is bad try a RadOnc. Talk about low man on the totem pole! We might get to see half the patients that should, that is if the surgeons having a good day

 
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