It's Been A While

Fellowship is a lot of work and I've spent my out of work moments with my boys at home so I apologize for my absence from cyberspace.

I love my job. I like the people I work with. I like the patients. I like the science I am learning and the clinical medicine I am practicing. I am developing my own ways of talking to parents and patients and have received feedback that these ways are not completely dysfunctional.
I'm not terribly fond of benign hematology but I do derive a lot of satisfaction from taking care of cancer patients and their families. I am asked a lot why I chose to do this, and there is a fairly straightforward answer.
Hope.
In my experience working all over a children's hospital, there is no better environment than the pediatric cancer ward. Everyone thinks their patient population is special, but these are truly awesome kids, families, nurses, doctors, child life specialists, and social workers. I have not been anywhere else in the hospital where there is less whining, more resilience, more support and people caring for each other. Kids are kids. They aren't held down easily. They make friends with the people who take care of them week in and week out and everyone develops special relationships with their patients and their families. It's common to see a small band of children, all in crazy spunky hats roaming the halls of the clinic looking for a favorite nurse or doctor to take a picture, give a gift, or play a clever prank.
The outcomes for a lot of pediatric cancers are pretty good and we make a lot of these kids better and let them get on with their lives. Even those with the poorest outlook are treated like survivors by parents and staff. No one ever stops hoping that they get the best they possibly can.
Still, there are hard moments. Telling any parent their child has cancer. Telling a new high school grad that he'll be taking a detour on the way to his adult life. Watching a colleague suffer through the loss of a patient they have known and cared for for years. Looking at a sick little boy and just wanting to go home and hug your own baby knowing there are hours yet to go. Fearing that the karma of telling someone they will likely loose their own child will come back to bite you in the ass.
I often feel bad that I am fascinated looking at pathology slides, that I use the word cool to describe an imaging finding that will change a whole family's life forever. Still, I am here because the science fascinates me. And because the children move me.
This weekend was harder than any yet. In a sink or swim moment I sat with a family and told them that their little guy has one of our hardest to treat tumors and has a coin flip chance of being alive in two years. I did it with out the benefit of an attending physician present. Since then I have had the conversation swirling in my head trying to determine what I could have done better. I have told people before that their baby (aged 3-19y) has cancer but those babies were very likely to live to graduate from college. It's an easier conversation. This one was not.
I hated it but certainly not as much as they did.
I am humbled that the mother exclaimed "Look, E***, it's your friend Dr. Jen!" when I came back the next day.

I feel inexpressibly fortunate to have a healthy, smiling little boy.