Week 4: Regan

This week I was finally able to sort out my scheduling issues with my clinical mentors, and so I had lots of opportunities to shadow in the clinic. This week I followed around Dr. Lisa Roth in Pediatric Hematology-Oncology and Dr. Peter Martin of the Lymphoma program in Hematology-Oncology at Weill Cornell/ New York Presbyterian Hospital. Despite the fact that their specialties were both in hematology-oncology, shadowing these two physicians yielded very different learning experiences. Dr. Roth, being a pediatric oncologist, sees and treats children with hematological disorders. These can afflict children just like adults. I learned from shadowing Dr. Roth that unfortunately cancer doesn't discriminate based on age, even kids can get cancer and it can be just as horrible of an experience for them as it is for adults. Shadowing a day in the life of Dr. Roth had both highs and lows. On one hand, we had the chance to meet with a young girl who was coming to review her scans after completing all of her chemo. Dr. Roth showed her how her chest lymphoma had shrunk in the images and was no longer a threat. The room was overjoyed by the news. I found it interesting that there was still a residual mass left surrounding her esophagus, but Dr. Roth explained that all tumors have residual tissue even when they are no longer cancerous. She justified this by saying that the treatments are targeting the individual cancer cells so when those are eradicated, residual extracellular matrix from the tumor still remains. I had never thought about this before, but as a tissue engineer, this concept makes a lot of sense. So while the CT scan showed that this patient still had an abnormal mass in her chest, Dr. Roth determined that it was no longer cancerous and that the patient was now officially in remission. It would have been a good day shadowing-wise, but the next patient drastically juxtaposed the previous. Dr. Roth then had to tell preteen boy that it was highly likely that he had lymphoma. She wasn't sure because his prior work-ups were done by other health providers outside of WCM and the imaging studies conflicted the biopsy results. It was a scary moment for the boy and his family as the interpreter translated "you may have lymphoma" into Spanish but the boy took it surprisingly well. Part of that was owed to Dr. Roth's smooth delivery of the news by explaining that cancer in children is prognostically better than lymphoma in adults and that it was highly likely that he would be able to lead a healthy life after treatment for his lymphoma. Although it was a sad moment for this family, Dr. Roth left them with hope that this was not a death sentence. Her ability to deliver bad news likely has a lot to do with her own story. WCM recently published a human interest story on Dr. Roth. After her pediatrics and oncology fellowships she was suddenly diagnosed with Hodgkin's Lymphoma. She knows exactly what it is like to be given bad news and more specifically to be diagnosed with lymphoma. Dr. Roth is in complete remission now and has a beautiful family and flourishing career, and she makes sure to tell her patients that those things are not out of reach for them despite their cancer diagnosis. I found it very inspiring to shadow Dr. Roth and I look forward to more shadowing experiences with her.

Shadowing in pediatric oncology has it's challenges, but so does oncology in adults. As mentioned before, some cancers in adults are more severe and I got to see that first hand. While I didn't have to see any patients that were dying, I did visit with many patients with seriously debilitating comorbidities associated-with or not associated with their cancer. I saw patients with neuropathy, multiple sclerosis, skin ulcers, bowel obstructions, and diabetes-related amputations. These plights along with their hematological disorders contributed to making life very difficult for these patients. In my shadowing with Dr. Martin, I did make the observation at the high proportion of rituximab being prescribed to B cell malignancies of all types. It is my personal favorite biological drug on the market because it is a monoclonal antibody that targets B cell-like cells including some cancers and initiates their destruction. Dr. Martin seemed to suggest it frequently for many patients with different diagnoses. Another interesting fact about rituximab is that in one case, Dr. Martin had to discuss with a patient the cost of rituximab treatments. Even though he had Medicare, the patient was questioning if he needed the treatments so frequently in order to stretch out the exorbitant bills and payments for treatment. Dr. Martin said that the manufacturer of the popular drug will be losing the rights to the patent soon which could open up the market for competitors and bring the price down. Apparently there are already generic companies in Europe that could fill this void. It is so disappointing that these talks have to be made with patients. This man really had no other choice for relevant therapies for his condition and so it was a shame that money had to come in the way of his health. My shadowing experience with Dr. Martin made me realize how complicated paying for medical care is in the United States and how important it is that the federal government continues to provide assistance like Medicaid and Medicare for people who just want the chance to live. I think that is a basic civil right that should be shown to all Americans, and it is a right that we have earned.