A Delicate Flower.

Pursuing oncology never once crossed my mind before medical school.

Enter stage: one of my mentors is a pediatric oncologist, a specialty I previously could only gawk at and flounder to fathom why anyone would set themselves up for such torture. Next scene: reading the words of Siddhartha Mukherjee, and realizing that cancer is the ultimate riddle. Next scene: meeting my first cancer patient, a patient with Li Fraumeni syndrome who lit up when told about my upcoming cancer research. Next scene: Today, listening to a bright-eyed, bubbling little girl with a crooked wig tell us about her leukemia.

It began just as most do: a child with fever and fatigue, and doctors waving them out the door with words of “kindergarten germs” and “it’s just a virus”. It isn’t until later when a simple drop of blood is taken from their finger that their diagnose is truly given: cancer. Her spirit lit up the entire lecture hall as we laughed at her spunk between wiping away tears. As the family told us about a night she bled out of her mouth for 24 hours and received 11 platelet transfusions, she grabbed the microphone and explained, “My doctor says I’m like a delicate flower.”

From the parents, they explained that they have come to a profound realization: the nit picky things don’t matter. If you want to wear the wackiest outfit and like something that no one else does, it doesn’t matter. Making memories and being happy is what is truly most important.

Every day, they have a word to bring them happiness. “Yesterday was ‘sisters’. Today is ‘medicine’, because we’re at the School of Medicines!” (Again, more laughter. More tears.)

The oncologist speaking with them encouraged us to absorb this family’s experience with her diagnosis. As he spoke, I could feel our class unite in silent agreement to not disregard a worried mother’s concerns: because no one knows your body or your child like you do. I soaked in my internal promise to never disregard my gut intuition about a patient, and to never live in a straight jacket of algorithms based off a scholarly journal’s statistically calculated data. The oncologist explained how every day he is surrounded by these incredibly strong, influential individuals who are battling cancer within their bodies, while we are busy worrying about tasks to finish or what others think of us. He explained that his career reminds him what’s important: to take time to live. It can become so easy to become consumed in medicine. “But you have to remember to be well, so you can be well for your patients,” he explained. He told us how it’s more than a job for him: when you’re a child’s doctor working intimately with their condition for so many years, you become like another member of that family.

You learn so much in medical school. But you learn everything from your patients.

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Without a Cure: Dripping into your Veins.

They are dipping our toes into the expansive ocean of cancer and chemotherapy.

How could I have not known all of this? I knew that cancer was due to damaged or mutated DNA, and that caused proliferation of cells which wreak havoc on the body. But how could I be so naive to only know a superficial 5% about a disease so prominent?

Do you know why most chemotherapies don’t work? They can play games with our drugs, like child’s play. Say we begin to treat a tumor with Drug X. This cancerous mass has the ability to change the physiology of the cell as it pleases, breaking every fundamental law of biology. It can ship Drug X back out of the cell, or remove the channels that allow it’s entry. It can change the protein targets that Drug X acts on so the drug no longer affects them. It can tell the cell to redistribute Drug X to a corner of the cell to block it off from acting on anything. Or, it can simply detoxify the drug and inactivate it. Say we then give Drug Y, to damage the DNA so the cell can no longer replicate. The cancer can simply tell it’s machinery to repair the DNA faster.

New oral chemotherapies cost an average of $15,000 each month. If you need the chemotherapy dripped directly into your veins, that costs an average of $40,000 each month. Many of the new IV chemotherapies developed in the last 5 years land in the range of $100,000 per month.

Can you even imagine? Sitting beside a loved one as they were handed their diagnosis and shown the image of their tumor. How are you going to deny them the chance to live if you fail to pay $300,000 for 3 months of treatment? Worse yet, imagine after 2 months of treatment, the cancer decides to simply lock your drug in a fat bubble inside the cells – rendering the entire treatment completely ineffective.

We have been working on this puzzle of curing cancer for over 70 years. And these drugs are our top-market solutions.

“We have created a multi-trillion dollar edifice for dispensing the medical equivalent of lottery tickets, and have only the rudiments of a system to prepare patients for the near certainty that those tickets will not win.”

-Atul Gawande

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Life as a Medical Student: Wool Sweaters and Long Nights.

Have you heard the analogy: “Medical school is like trying to drink from a fire hydrant”? I don’t know if I could have phrased this any more perfectly.

The first few weeks of my second semester have been eye-opening. We are finally learning diseases and medications and how to work critically through a diagnosis. I’ve studied more in the past two weeks than I thought was possible, but the material is so fascinating that I don’t even mind. How many people get to spend their days learning about why blood cells are bursting in a patient with microangiopathic hemolytic anemia, and how we can help them survive? Or racking your brain with your classmates, trying to figure out why this homeless man is showing signs of pernicious anemia with a small clue that it might be linked to metastatic cancer?

Every day, it’s something new. The human body literally has an infinite number of avenues to go wondering down, getting lost in the wonder and awe of it all.

I’m so happy here. I’m able to find more balance (by freeing up my time outside of school). I’m clearing my mind by working out every morning. Cooking and preparing food each week has been a lifesaver. But most importantly, I’m letting myself

fall shamelessly in love with medicine.

If You Only Knew.

As your eyes scan these words, 127 million neurons are firing at the back of your eyeball to transmit the information to your brain. A particle of dust floating near your eye causes you to simply blink your eye, activating another couple thousand motor neurons for a split second. There are endless sensations pummeling your body at any given moment. Take a moment to notice a few. Can you hear a car passing outside, or a furnace running? What is the temperature like in the room you are in? Can you feel your shirt touching your shoulders, or your thighs touching the chair beneath you? But you didn’t recognize any of these before. Regardless of you being aware of them or not, all of this information is continuously absorbed by millions of sensory units coating your body. At the speed of light, these little units carry their package of information to your spinal cord, zooming up like an elevator towards your brain. However, there are millions of these guys with their packages, and if they were all allowed to enter our powerful and revered conscious mind, we would die from overstimulation. So, there is a guard keeper at the top of your spinal cord, monitoring the information coming in. This guard tells most information to funnel into your subconscious mind to be processed and stored, letting only the most important information funnel into the highly protected channel to your conscious mind.

But do you want to know what I find most fascinating about this system? We have the ability to influence our guard keeper. We can tell him to let different packages enter our conscious brain or to stop letting other packages in.

Have you ever bought a new car, and suddenly began noticing the same car driving down every road you encounter? The cars were always there, mixed in with the other hundred of cars you encounter daily – you just didn’t notice. Your guard just didn’t think it was pertinent.

What opportunities and beauty and clues to your happiness are surrounding you that is being funneled into your subconscious by your guard keeper? Conversely, what negative thoughts and packages are constantly being funneled into your mind – weighing you down to the point of disappointment and exhaustion when the day is over?

Change it.

Shift your awareness.

Studies have shown that affirming a belief like “I am capable of achieving incredible things”, has the ability to influence your guard keeper to synthesize a new mindset. Changes begin to take place so that different packages make their way into your subconscious. This is the crucial secret of awareness. Suddenly, you are able to jump at a fleeting opportunity that will end up changing your life forever, instead of not even noticing it was there in the first place.

Shift your packaging. Endorphins begin to pour out as chemical proof of the shift, but it is more than that. How many great chances, great people, as well as great experiences are you willing to overlook before you begin to do something about it?

Affirm yourself.

Feel what’s around you.

Rewire.

1.jpgIsn’t it baffling, that this delicate bundle runs down your back without ever truly being noticed by any of us?

 

Quintessential Superhero.

He looked so small sitting in the chair.

The blood had drained from his face entirely, making him look pale white. He was wringing his knuckles in his lap and his larger-than-normal eyes looked like they were going to pop out of his skull if someone startled him at any moment.

He was terrified.

And who could blame him? Nearly everyone in his family had died of cancer. And here he was, called into the office by his mom, after getting a full body scan to look for tumors.

Then the physician I was shadowing entered the room, and fluidly began the most impressive encounter I have ever witnessed:

“Hey bud, what’s your name? How old are you? Oh – that’s right around the age of my own son! So have you seen the new Star Wars movie? What’d you think? What do you do when you’re not in school? What do you want to be when you grow up? Isn’t it funny how the doctors get to ask all the questions? Do you have any questions for me?”

Over the course of the next half hour, he carefully explained to the boy that he was predisposed to getting cancer – because a “superhero gene that flies around in a cape and underpants, guarding his DNA” wasn’t working quite as well as it should. Then, he showed him a picture of his brain, and the glaring white spot on the image that they had to remove. Somehow, after ingesting all of this information and realizing he needed neurosurgery, the boy was calm and curious. Drops of fear were being carefully wiped off as the doctor answered his questions and talked about his worries. He talked with the physician like they were old friends, and happily saved the doctor’s number in his cell phone to ask any questions that popped up after the visit.

I walked the boy and his mother to the primary neurosurgery unit, and listened as they explained the procedure they would be performing in a week. I couldn’t help the pride that swelled inside of me, watching the mother nod and determinedly try to remain composed, squeezing her son’s knee. She reassured his horror when discovering the scar on his head would be permanent, telling him the scar will look really cool – and earn him massive bragging rights at school.

As we were walking back, I asked him how he felt about the surgery. He thought about it for a moment, then replied with a smile, “Excited.”

 

In my opinion, any person that can break the news of having a brain tumor and the urgent need for cutting into your brain to dig it out and leaving the child feeling anything but terrified – is a superhero.

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Hi, I’m Awkward.

So at my school, they have a “big sib” program, where incoming students are paired with older students to help give advice and answer questions. I recently found out my big sib was Anish.

I have previously met Anish in passing on a few occasions, and I recognized him studying at the end of the hall one afternoon. “Hey Anish!” I called out, walking towards him. As I got closer, I realized it wasn’t Anish – but at this point, I was too close. I was committed. So I pulled up a chair and awkwardly tried to start conversation with a complete stranger, talking about school and tests and anything that could jumble out of my mouth.

Today, I saw Anish walking into the building. “Hey Anish!” I said, excitedly. “So you’re my big sib!”

He looked at me with a confused look and said, “I’m not your big sib.” Turns out, his name isn’t Anish.

To further make things painfully uncomfortable, I told him that I had awkwardly thought this OTHER kid was him, making an exacerbated point of saying this kid is ALWAYS studying on the 4th floor. I told him how I had walked up to this kid (thinking it was him), and called him Anish. I could have stopped there, but no. I continued on to tell him how I awkwardly pulled up a chair and forced myself to make conversation, because I had committed myself at that point.

This kid looks at me with a puzzled look, like I was possibly the craziest person he’s ever met, and says, “2 days ago? That was me.”

This is when, thank the dear lord, I stopped talking and just walked away in silence.

His name is Jakeeb.

And I’ve been calling him Anish.

Then after speaking with the guy I thought was Anish but is actually Jakeeb, I didn’t even realize it was Jakeeb.

So I proceeded to tell him how awkward it was to talk to him, thinking he was someone else who I actually thought was him in the first place.

 

Hi, my name is Hailey.

I’m really super awkward.

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