A Christmas Carol by Charles Dickens is one of the most beloved stories of all time. It is a classic story with a theme that resonates as we end the year and commence a new one. The story revolves around the main character, Ebenezer Scrooge, examining his past, present, and future. He realizes that key events have shaped his life and turned him into the man he is. Before the story ends, Scrooge is able to make a change for the better in the present, which effectively shapes his future. Well-written novels are able to transcend time and place and I feel this story is especially relevant when it comes the life of an oncologist. It is through our patients that we are shaped and molded. These experiences are our backbone and I believe reflecting on them helps create our soul and lifeline. December is a perfect time to reflect on our patients and ourselves, with the hope that we will be able to improve our future.
I keep a memento box and journal in my office to make sure that I always honor my past patients and their families. I am blessed as an oncologist to have more intimate memories of my patients than just what is reflected in our electronic health records. Instead of previous labs, scans, and pathology reports, I have many tokens to cherish. We are lucky that our patients and their families open their hearts to us during their cancer journey. Even when they lose the battle to the cancer, patients’ families send their thanks and gratitude to me and the staff in various ways. I am humbled and moved by these gestures and hope the patients know how much it means to me that we could provide any help to mitigate the suffering towards the end of their lives.
I am also hopeful that that we were able to prolong life enough so our patients could experience special milestones in their life, even if they ultimately passed. Pictures fill my box, photos of birthdays, holidays, and weddings that a patient was determined to attend, and did. The pictures remind me that these milestones will always be cherished by their families. I also reflect on other experiences in my journal, times when I could have done better to communicate with my patient and their families and helped them more along the difficult cancer odyssey. The hope is that this reflection will make me a better oncologist in the present.
I next contemplate and reflect on my current patients who are in remission or who have completed their adjuvant therapy. I am touched by their happiness and joy as they ring the bell on the last cycle of chemotherapy. Their courage and strength remain an inspiration to me and makes the long days in clinic worthwhile. I am constantly amazed by the support the patient receives from their family and friends. For cancer care to succeed, it truly takes a village of support and love, and this is embodied by the cancer community. Another bonus is when we get to cheat on our diet when patients come to the clinic armed with donuts, bagels, cookies, and even pies to celebrate their graduation from treatment.
I try to temper this joy with cautious optimism about the future. We all know what a fickle beast cancer can be and it can unfortunately rear its head again at any time in these patients’ lives. I try to tell my patients to focus on the now and that we will deal with the future day by day. Sometimes that is easier said than done, yet serves as my motivation for coming to clinic each morning.
The final theme of the Charles Dickens classic focuses on the future. As we end the year in oncology, I am filled with promise about the way we will be treating and diagnosing cancer. Innovative research is being conducted at large academic centers and community clinics across the country and world. We are challenging our current paradigms and offering precision and personalized care to our patients. Leading-edge diagnostic tests are allowing us to detect cancer earlier so we can treat our patients sooner. We are dissecting the cancer genome, discovering new genetic markers that will enable us to develop targeted treatment tailored to individual tumors. We are learning to harness our own immune system to destroy tumor cells. We are developing care paths that enable patients at different practice settings to receive the same care and standardize the way we practice. We are challenging pharmaceutical and insurance companies to develop sustainable ways to limit rising costs of these new drugs. Palliative care and supportive care measures are moving to the forefront of our field, improving the quality of the patient experience and, in essence, patient outcomes. And finally, survivorship clinics are popping up everywhere, proving that our treatments are making a difference.
At the end of A Christmas Carol, the protagonist truly goes through a transformation from a scrooge to someone who epitomizes the true holiday spirit. I feel like every oncologist and patient should take the time at the end of the year to reflect on the past. Use this reflection to help appreciate your present state. Hopefully this will guide your internal compass to where you want to be in the future. The future will be shaped only by the experiences that you have lived, and hopefully we can learn from them. I am learning every day from my patients and their trust in me that to help them is a gift that I do humbly accept. I treasure the bond that can develop between an oncologist and their patient and always hope to provide realistic goals for the future. I also realize that I stumble sometimes and don’t get it right, and that inspires me to push beyond the status quo with my next patient.
I am thankful for the oncology care community (patients, researchers, doctors, nurses, volunteers, pharmacists, social workers, and others) who dedicate every day to making someone’s life easier while battling cancer. When you are looking at pictures, cards, gifts, or eating that holiday cookie from your patients, remember you are making a difference. Treasure the bond you have developed with your patients and realize that very few people in their job are able to capture this feeling multiple times each day.
Originally published on Cancer Doc in Evolution; reprinted with permission.