Doctordenky's Blog

Do you have any idea how long we study to become doctors?  Often, doctors are already in mid-life by the time they start practicing their profession.  Guys are already going bald while women are nearing the end of their child-bearing years.

After high school, we go to college for a four or five year course which preferably should be a science or health-related course such as biology, zoology, medical technology, pharmacy, etc.  For those who are very intelligent, they can cut down this college course into 2 years if they get accepted into INTARMED (Integrated Arts and Medicine) which is only offered at the University of the Philippines (UP) College of Medicine.  I believe that there are science courses at the De La Salle University (DLSU) which can be finished in only three years.

After college, we go through four years of medical school.  In these four years, three years are spent mostly in the classroom sprinkled with a few patient encounters.  The fourth year is purely clinical clerkship where the students stay in the hospital to actually start taking care of patients.  Students graduate after four years then proceed to an additional year of internship after which they take the board exams to obtain their license to practice medicine.

After passing the board exam, the doctor can take different paths.  Majority will undergo further training to become specialists and this can last from three to five years.  They become any of the following:  paediatrician, surgeon, OB-Gyn, anaesthesiologist, internist, etc.  Thereafter, some may already start their private practice or be employed by companies, hospitals or go abroad (There was a time when so many doctors who were already practicing their profession opted to become nurses so they can go to the US.  A handful of them are already there and have brought their families with them).  Some of these specialists opt to pursue additional training to become sub-specialists which can again last from two to five years after which they begin private practice or get employed.

There are some who do not choose the “further clinical training” path and choose to go directly to employment or practice as general practitioners (I believe there are some who are working as call center agents).  There are a few to go on to pursue their real interests as some students studied medicine only to make their parents happy or simply because they did not know what to do after college.

I continued seeing patients while I pondered on my future.  However, I felt like I was in limbo.  I didn’t know whether I should continue or stop.  I felt so uncertain of my future.  I was bordering on being depressed and this translated to becoming impatient especially when talking to patients or relatives.  I became so irritable, cranky and was lacking focus.  I just wanted everyone to leave me alone.  I wanted to be on my own.  I preferred working alone.  Often, I would catch myself staring into empty space and thinking whether I have made a wrong decision in choosing this specialty.  I’d ask myself whether I should continue or leave.  One day I would feel ok about continuing then another day I would feel really bad and get at the brink of resigning.  But I would then find myself talking myself out of it and saying to stay for another day and see if maybe I try harder and take a little break, I may be able to go on.

It had already been around 9 months since I started training.  I asked around if I could transfer to another specialty training.  However, it will not be as easy as getting out of a bus and transferring to another bus.  If I transferred, I will disregard all the 9 months that I have gone through.  I will start from the beginning all over again.  I could not decide. I got depressed.

Then I had a patient who was then a thirty-something female with two very young children in the province.  They lived somewhere in Mindanao, decided to come to Manila with her husband for treatment and somehow landed at my clinic in the hospital.  She had a very treatable form of cancer (lymphoma-cancer of the blood that shows up in the lymph nodes or “kulani”).  I advised her to undergo several cycles of chemotherapy to be followed by radiation therapy.  She missed her children dearly and wanted to go home immediately.  I advised her against going back to the province without completing treatment and convinced her that she has a very good chance of survival if we proceeded.  It was a very difficult decision for her.  She was torn between wanting to see her children and choosing to sacrifice the time away from them so that she may live longer.  Eventually, she decided to go ahead with treatment.  It was a very difficult period for both of us because the treatment would take around 6 months of continuously being away from her children and everytime we would start another round of treatment, she always wanted to quit and we would go through the cycle again of convincing her to proceed.  Finally, we finished everything and she was free of disease.

On the last day of treatment, she approached me by herself and gave me a really tight hug with a shining smile on her face.  It was a kind of glow that I have never seen on her before.  She said “Thank you Doctora, I don’t know how I was able to go through with the entire ordeal but I will never ever forget you”.  That was the most sincere thank you I have ever received and suddenly, I felt that I made the right choice all along.

Doctors are expected to uphold the sanctity of life and to do no harm on their patients.  In my training in general medicine and internal medicine, our patients would usually come to us with a problem and we were expected to work our magic on them and eliminate the disease thereby making them well.  In the course of our studying to become doctors and our training to become specialists, we developed this notion that we have failed whenever we couldn’t improve our patients, when we could not eliminate the disease and most especially, when our patients die.  It has become a significant part of our identities to cure and to save lives.

“I am here to cure you and banish your cancer from your body forever and vow to make it never ever come back until the end of time.  I will use all my force, my knowledge and my time to make sure that no patient ever dies from this dreaded disease.  Cancer patients here I come to save you”.

This was my mindset when I started training in oncology.  Nowhere did I know that I was bound for major disappointment even bordering on depression and quitting.

When a patient who is previously healthy gets stricken with an ordinary to moderate illness, their natural course is to recover over time when given appropriate treatment.  A regular patient who is wheelchair or bed-bound is expected to leave the hospital walking and with more gusto after treatment.  However, such is not always the case for patients with cancer or severe illnesses.  They follow a different pattern.  These patients often do not have time on their side.  The natural course of their disease is often towards dissemination to other parts of the body or sometimes recovery but not towards their baseline or better.  They sometimes recover a little bit but perhaps not enough to get back to baseline.  The timeline though for these patients can vary from days, weeks, months, years or sometimes even decades.  A substantial number can even follow a very short-lived course.

“I did not sign up for this!!!!!”  I said to myself.  “No!  I was promised that I will save them.  Probably, it’s just because the patient was already weak when he came to me.  The next patient will be ok.  I will make sure of that”.

The next patient came and I did it.  Cancer gone.  Patient has been in remission for a very long time now.  Success!!!!  See, I told you.

Then another patient came, not as good as the second one.  “I can do it!  I can do it!”.

Then another one came and another one and another one and another one.  When I started counting, it seemed like a significant number did not turn out well.  I said no!!! This cannot be!!!!  I need to study some more and more and more.  Give more medicines and more and more and more.  This cannot be happening to me!! No! No! No!

It was exhausting.  I thought that I would get a reprieve from my toxic duties by going into oncology training.  But the situation is proving to be different.  I am not sure if I want this.  Get me out of here!!!!!!!!

When people find out that I am an oncologist (a doctor who manages cancer patients), I always get a baffled and scared look from them.  Or sometimes I hear them say “Yikes!”.  I also get questions like “Why?” or  “Isn’t it difficult ” or “How can you deal with it?”.

You probably wouldn’t believe it, but I am so grateful that I was propelled into this specialty.  My practice is the most satisfying, gratifying and fulfilling job.  Don’t get me wrong.  I don’t like hearing people being diagnosed with cancer nor having to tell them that their cancer has returned.  I feel very sad every time this happens but there is something about oncology that makes it really special.

My Story

When I was around 5 or 6 years old, I remember having mentioned innocently one time that I wanted to become a doctor.  This was brought about by my dad having episodes of chest pain and we were afraid that he might be having a heart attack.  (But now that I’m a doctor, I know that he was just malingering and just trying to get some attentionJ). 

Being the daddy’s girl that I am, of course losing my dad was the scariest thing that could ever happen and I wanted to be the one to make him well.  So I said that “when I grow up, I want to be a doctor”.  But my daddy perhaps thought that it would be a wonderful thing if his little girl will someday become a doctor. 

So in the following days, weeks, months, years, decades, he kept on repeating to everybody that I will become a doctor until one day, I really wanted to become a doctor. So I was practically brainwashed .

When I was in elementary and high school, I started telling people that “When I grow up…(I wanna be famous, I wanna be a star, I wanna be in movies….Excuse me Pussycat Dolls) I wanna be a doctor.  When I went to college, my mind was set on taking a “pre-med” course. 

After college, I did not entertain getting a job because I was bent on pursuing medicine.  Eventually, the inevitable happened and I became a doctor (So be careful what you wish for cause you just might get it, you might just get).

But Why Oncology?

This is a question I have asked myself so many times.  Often, people are inspired to become someone because of they have been touched directly by specific circumstances. 

Example, A doctor who specializes in gastroenterology (diseases of the stomach, intestines, liver, etc) became inspired to take up that specialty because his mother had stomach cancer when he was still in training.  A doctor specialized in palliative care because one of her children was diagnosed with leukemia.  In my case, it was sheer exhaustion from training.

You see, doctors have to go through more than a quarter of a century of studying to become an MD (including elementary and high school).  After obtaining our license to practice medicine, we need to devote another 5-10 years to become a specialtist or subspecialist or nowadays, a sub-sub-specialist. 

Example, there are now oncologists who specialize in breast cancer, lung cancer, lymphoma, etc.  Someday perhaps, we will be specializing in cancer of the right breast or left breast or left or right lung. That is how much information has exploded.  So it really takes a long time to grow in this profession and the journey can be quite exhausting.

“Oncall-ogist”

Doctors who go on duty or what lay people more popularly know as “on call” often stay in the hospital for 24-36 hours with very little food, rest and sleep (torture!!!!!).  They will go home to sleep (that is, if they don’t have any reports to make) and be back at the hospital on the following day at 7 am. 

I remember that when I was in training, it didn’t matter anymore what day it was.  If you’d ask me what day it is, it would take quite a while before I am able to answer because in my mind, it was either my duty day or not.  I remember back then that when watching tv, I always looked forward to the commercials than the show because the commercials were always new to me. 

I went through 5 years of those to become an internist (doctor for adults, this is the counterpart of the pediatrician). Two of those 5 years as an intern then 3 years to train as a specialist.

On my last year of training, I was chief resident (Naks!) so that on top of my responsibilities as a doctor in training, I had additional administrative responsibilities such as making sure that the newbies are not sleeping on their duties and all other stuff to carry out the torture.  Burn out was imminent but I knew I had to do subspecialty training for a better chance of attracting patients in Metro Manila.

The Clincher for Oncology

Among the subspecialties, training in cardiology (heart), pulmonology (lungs), nephrology (kidneys), etc required the same rigorous lifestyle as in internal medicine.  That meant that I had to go on excruciatingly long duties again and I felt that I could no longer keep on doing that.  In addition, there were already many of these subspecialists around so I wanted to be among the not so common. 

We had this oncologist in our hospital, Dr. Gracieux Fernando, who is so eloquent, passionate and inspiring about oncology such that when he speaks, it is as if all patients will be cured.  I was inspired by him to become an oncologist (so whenever I’m having some difficult cases, I jokingly tell him that this is all his fault) plus the fact that training in this specialty did not require such rigorously long hours in the hospital like all the other specialties.  The duties are just like any long day’s work. I didn’t mind the long days as long as I could go home sleep on my bed every night, even if not 8 hours. That was very important for me back then.  So oncologist I became.