By Matthew Kurian, MD
As I reflect upon the final months of my second year of oncology fellowship, I look back at how I arrived to where I am today. My father was a nephrologist. As a teen, I spent many days in his dialysis center sitting with patients who depended on an artificial machine to survive, many of them for the rest of their lives. I saw their fatigue, their pain, and their distraught family members. I watched my father handle their symptoms and comfort them with grace. He was my prime motivation for going into medicine. As I grew older and entered the medical school, I wanted to enter a specialty that could offer more hope.
Fast forward to an oncology rotation during my fourth year of medical school. At this point in my career, I knew very little about the field. One of the first patients with cancer I cared for was a 35-year-old physician with stage IV colon cancer. I remember thinking before walking into the room that I would be the last person this guy would want to talk to—some annoying medical student here to reiterate his hospital course for the tenth time. I remember getting as far as his family medical history when he abruptly stopped me. He didn’t want to talk about his current hospitalization. We chatted about football and eventually transitioned to my future career plans. I was struck by how a stranger was asking about my future, when he was the one sitting in the hospital with an incurable cancer. I was inspired instantly. Despite his situation, he still managed to joke and smile. At the end of the encounter, I thanked him, and as I was closing the door, I remember him saying, “Keep being as calm as you are today; it’s going to be useful in your field.” I went home replaying that sentence over and over in my head. Was he right? Was oncology a good fit for me?
As an internal medicine resident, I was fortunate enough to work in a basic science laboratory studying immunotherapy in head/neck cancer. It was truly an eye-opening experience to see how things progress from benchwork to clinical application. I also learned quickly that this was not where I thrived. I missed patients, talking to their families, and being around other trainees. That is where I thrived. I worked with different oncologists and I was able to see the true hopeful world of oncology in the outpatient arena. One attending I worked with inspired me in the way he interacted with patients. As I sat alongside him in clinics and hospital rooms, he always ended the encounter with a phrase, “Let me seeing those boxing gloves,” and would do a quick double fist bump. The effect was palpable. Patients smiled, laughed, and cried. I do not think I have ever seen such varied emotion with one action. It was a simple gesture with powerful symbolism of the relationship between an oncologist and patient. I wanted to emulate that in my own career.
As a new fellow, it feels like being a new intern all over again. You know very little and you are overwhelmed by your responsibilities. You feel like a fish out of water just trying to absorb as much as you can without being overwhelmed. I was lucky to have had great mentors during my residency and fellowship—people in different phases of their career, different practice settings, and different fields. They gave me water to breathe in and built me up over time. It is not the number of hours that makes fellowship grueling, but the sheer amount of new knowledge you’re expected to learn and then combine with critical reasoning based on your experience, your mentors’ experiences, your individual patient, and a tidal wave of new literature coming out every day. It’s like being handed and expected to read a book in a language you barely know. How does anyone keep up?
I do not think I knew this coming into fellowship. Instead of calling the oncology fellow to discuss a difficult case or consult, I was the oncology fellow who was expected to be an expert on day one. I remember my first weekend on call, my first patient with leukemia being transferred to our service. My mind went blank as my attending asked what my initial plan was. I did not even know where things were in the hospital, let alone how to treat leukemia. Thankfully, my attending and senior fellows walked me through it and 8 hours later I had stabilized the patient. I was like a sponge absorbing what I could from my mentors and emulating their practice, knowledge, and skills. But slowly I began to form my own style and the way I approached patients and families. At the conclusion of my first year of fellowship I felt somewhat competent once again, as one does after your intern year.
As a second-year fellow I find I am most energized by treating my continuity clinic patients and finding time for goals-of-care discussions. It is tough amid discussing CT scans, treatment options, potential treatment failure, labs, side effects, and more. I still find it hard to balance the knowledge of many cancers based on average statistics, genetics, growing treatment options, and my own experiences with realistic hope.
My idealistic motto has always been simple: treat and speak to every patient like they were my own family member. I try to work to make sure that people feel heard. I hope that I continue to be fueled by my desire to help, to listen, to teach, and to make things, in my opinion, simple.
Dr. Kurian is a rising third-year chief hematology/oncology fellow at University Hospitals, Case Western Reserve University. An ASCO member since 2017, his interests include quality improvement and medical education; he teaches at Case Western’s medical school and is also active in the internal medicine residency programs at MetroHealth Medical Center and University Hospitals. Disclosure.