This last month, I’ve walked around the wards and intensive care units sporting the title of the ‘Cancer ID fellow’.
I know you have to have someone to do it but I don’t want to be that someone.
Being an infectious disease fellow following men and women with the diagnosis of cancer has been a somewhat different experience though. It allows me to follow along with the oncologists patients in phases of treatment for cancer or who have just received bone marrow transplants. In both instances these individuals have either predictable periods of almost no immune response. What we do is make sure they don’t die of infections during this particularly vulnerable period while the oncologists administer chemotherapy, giving chemo time to act on the cancer. We buy them time.
What opens up for me, then, is a period of that is rife with bewildering and often colourful spectrum of infections. The field being relatively new there is only so much of experience with these infections in such severely immunocompromised/immunosuppressed hosts. That and the fact that infections I see wouldn’t normally occur in a regular person.
Now if I were walking through the woods, I would look at mold on a fallen tree trunk and knowing that it worked to break dead wood down to return it to nature, I would then proceed to marvel at an ecosystem in harmony. Such feelings are not evoked when I see the same mold working with the same misguided fervor and intention through a 70 year old woman’s leg as she stares up at me from her hospital bed. A 70 year old woman who still teaches ballet.
Nor would I have expected to have heard of Rhizobium Radiobacter. It is not one of the common gram negative rods taught to distracted or half asleep second year medical students as they plow through microbiology. Because it is one of several previously, inconsequential bugs that are found in soil and not on humans. And thereby not a very common infection. But of course it would be found cruising, as I say, in the blood stream of a man a couple of weeks out from a stem cell transplant. Not hard to treat, as I found out later. But when you’re tailoring your antibiotic choice on the prelim micro report of a gram negative rod, this was definitely not a name I expected to pop up on final ID.
So, it’s a menagerie of weird and wonderful (is it wrong of me to say that?) infections.
But what I’ve liked even more than this is getting to know these people over the month as they ‘get sicker before they get better’. Not watching them go through it of course but being humbled to be audience and participant of so many lives.
And I have my favorites.
Because there’s no rule a doctor can’t have his or her favorite patients.
Even as I write about them, I can’t help smile!
Favourite number one is a young man with Down’s syndrome who has acute lymphoid leukemia. The poor guy’s gone through a rocky course with fevers of 40degC almost every day. Fungal pneumonias. A skin infection. A really bad skin infection. Blood clots in his lungs. A muscle abscess that needed several painful surgeries. But every day I’ve walked in to see him, no matter how rough his night was he’d still give me a thumbs up or say ‘’How are you man?’’ or give me a smile! And more recently when I talked to him about how people kept mistaking me for a Raven’s fan because of my purple shirt, he tried to win me over to support his football team.
My next favourite is another young man almost done with his consolidation cycles for acute myeloid leukemia. Who’s convinced he has to stay positive through the whole thing. We talk about how it’s ok for him to be sad once in awhile instead of channeling in to the need to exercise/workout/doing stuff. See, there’s a reason why I connect with him. And he literally bounces around his room with barely contained energy. The other thing we end up talking about is martial arts. He was wearing brazilian ji-jitsu pants when I went in the first time to see him. Suddenly the admitting intern’s note under social history in his admission paperwork that the patient worked in ‘Marshall Arts’ made more sense. He seemed surprised that I recognized his pants and I told him I did capoeira and we had the ji-jitsu guys get off the mats before we started our capoeira sessions. And so we talk about martial arts among other things when I see him every day. Him saying I should try out his class and me telling him he should really wait for his platelet level to go up before he does something like martial arts.
And there the other interesting bits that I’ve come to associate with almost every patient that I’ve had the privilege of visiting every morning.
A lady with who spent her whole neutropenic period with a rather stern face while she made these little tissue box things out of beads. For Christmas gifts. And tells me rather sternly to leave the door open as I leave.
A lovely elderly East European lady with characteristic stoicism inspite of having her intestinal mucosa shredded with chemo and a really bad case of typhlitis. Who still insisted on putting her little tea covers on her little side table. And always made sure she looked neat and presentable every morning. And who said thank you every day as we left. Inspite of how sick she felt because apparently with her generation and culture you couldn’t stop being proper and polite even when you’re barely able to sit up from how sick you are.
A Latvian gentleman who for some reason seemed enthused by the fact that I looked too young to be a doctor. And inquired very flatteringly about how I had so much energy, was so clever and so prominent. The energy I assured him was caffeine. And the clever and prominent parts were both debatable. He would then proceed to lecture me about immigrant zeal and how wonderful it was. The discussions tended to be long and tangential. Which made me resort to measures like nipping to the other corridor later in the day to avoid being waylaid again when I saw him wandering the halls.
An African American man who, unfortunately, because of a frontal lobe metastasis is disinhibited and ultra friendly. So much so, that when he sees me seated at a computer across from his room he would call out to me from his bed. And insisted on running out of his room to shake my hand. Maybe it’s wrong, but I like this friendly man even if his friendliness stems from his widely metastatic disease.
Some rooms are understandably not so positive. Not that any of them are dealing with something easy or pleasant. Everyone, rightly so, deals with their illness in different ways.
One of the rooms that I have dreaded going into is one with a lady with biliary tract cancer. I see her for liver abscesses. She sits there every morning, silver haired and blue eyed. Her eyes shine every morning with tears. Her husband sits by her, also silver haired and blue eyed. And they sit in silence. It’s always a heavy silence. And I try to be cheery and upbeat, never really knowing how far to go without being disrespectful of their emotions. But they always give me smiles through their watery eyes and thank yous as I take my leave.
And of course, the cases where you’ve done all you could but it just wasn’t enough. Because we are not gods. Nothing reminds you of that like when you see someone slip away inspite of everything. And it never becomes easier to go through that.
All in all, I’ve enjoyed this month. I like what I do. I like the people I take care of. I like the people I work with. So, yes fellowship’s been a hard transition but good nonetheless.
