Research Assessment #1

Date: September 15, 2017

Subject: Oncology
MLA or APA Citation: Sledge, Dr. George. “Why I became an oncologist.” CNN, Cable News
Network, 3 June 2011, thechart.blogs.cnn.com/2011/06/03/why-i-became-an-oncologist/.
Accessed 14 Sept. 2017.
Assessment:
There exist massive connections between the world of biomedical engineering and
oncology. In fact, many major linkages between the fields were showcased in my work with Dr.
Madhuranthakam last year including the subjects of radiology, treatment planning, and surgical
technology. However, there is no secret that both fields diverge widely as well. For one, pursuing
a career directly in the medical field requires a heavier educational commitment encompassing
many areas other than just lab work. Another major factor of oncology that is absent in
biomedical engineering in the need of social skills when interacting with team members during
surgeries or speaking with the patients and their families. Bioengineering requires for
cooperation among scientists, but nowhere near to the extent that oncology calls for. Due to these
differences, I was skeptical about exploring the oncology and medical fields in general. Luckily,
while researching, I came across a CNN article written by prominent oncologist Dr. George
Sledge who recounted his personal assimilation into the oncology field and the challenges he
faced.
To start off, Dr. Sledge began with a brief introduction on why doctors decide to
specialize in oncology. The first and most common one he mentioned was simply the love of
cancer science. Those who fall in love with the mysteries and possibilities the horrible disease
brings often strive to explore cancer themselves. As unusual as gaining interest in such a
malignant illness may sound, this reason is the most similar to my own decision to study
oncology this year. After spending countless hours studying tumor types and the implications of
glioblastoma, I found myself very intrigued in how cancer cells can manipulate healthy body
cells in order to survive. With unlimited cancer types and the wide spend of the disease, studying
cancer would never turn boring or routine. The next major reason for becoming an oncologist
that Dr. Sledge provided was the positive influence of teachers. Even though I have yet to study
under “professors” in college as Dr. Sledge provides, my previous ISM mentor, Dr.
Madhuranthakam served as a great role model for me. His obvious love of cancer research and
bioengineering that led me to ask him to be my mentor also allowed me to gain similar ideals.
The last reason for pursuing cancer that the article provided was a patient’s influence on their
doctor. Even though I have a while to go before experiencing the third reason, the introduction of
this article allowed me to reinforce all the reasons I decided to switch my topic from biomedical
engineering to medical oncology.
Besides the arduous education required for becoming an oncologist, the aspect of the
medical field that frightened me the most was the emotional strength required when dealing with
patients. I usually get emotional when a book or movie character dies, so I felt underprepared to
deal with the pains my patients will undergo. I was under the notion that all doctors should
naturally be strong hearted people so I was skeptical about getting involved in the medical field
myself. However, after reading this passage, I saw that even a well-renowned oncologist had
gone through the same emotions as me. The first time Dr. Sledge informed a woman that she had
cancer, he broke down crying for thirty minutes. Now, after years of practice, he believes that he
is much better at breaking the horrible news of cancer to his patients. This highlighted an
important concept to me. I learned that I don’t initially need to be emotionally strong to go into
the medical field; years of practice will develop my skills for me.
Another aspect of the oncology field that I will need to get used to is the prevalence of
patient deaths. Many cases of cancer can be solved with a talented healthcare team, but
sometimes the disease grows outside the control of the medical field. I was worried that if one of
my patients passed away while I was their doctor, I would feel personal guilt for their death.
However, to this qualm, Dr. Sledge provided an interesting perspective: as a doctor, it is almost
arrogant to believe that a patient’s death is your fault. Cancer is a powerful disease and one
person cannot stop or spread it. I was also worried about receiving the anger of the patient’s
family if a mishap occurs. Dr. Sledge’s anecdote served to relieve some of this worry. He
claimed to hold a similar anxiety when he worried that his patient Carmelita Steele’s mother
would blame him for her passing. Instead, she was thankful towards him for spending his time to
try and save her. This is a positive outlook that shows that while a death of a patient is tragic,
fear of such an event should not stop me from going into the medical field.
A jump from biomedical engineering to oncology is a big one, and I had many worries
about pursuing the medical fields. This anecdotal article by a well-known oncologist served to
highlight that I am not alone in my anxieties and that many others had the same concerns as me.
However, such concerns should not be the barrier that limits me from studying the oncology field
this year and beyond.
Why I became an oncologist
Editor's note: George Sledge, M.D., is president of the American Society of Clinical
Oncologists, the organization of America’s cancer doctors, whose annual meeting Commented [OD1]: Possible organization to ask
begins today. Treating cancer can be an extraordinarily difficult field, guiding patients on professionals about during interviews to learn about
significant oncology societies.
a roller coaster ride of fear, pain and sometimes true exhilaration. Dr. Sledge shares the
story of the patient who made him decide to become an oncologist.

Cancer doctors tend to get to their profession in one of three ways. Some are drawn in
through their love of cancer science. Cancer has always been something like a cobra to
those who study it: dangerous and beautiful and endlessly fascinating. Cancer is a
universe. One can spend an entire life exploring it without ever getting bored, for the
biology of cancer is the biology of life.
Some doctors are inspired by a great teacher. Medicine is still a profession dominated
by old-world apprenticeships, where a mentor’s passion can be transmitted to a new
generation. I have known several oncologists whose careers turned on chance
encounters with inspiring professors.
Others get there by way of their patients. I’m one of these. When I was a resident,
cancer patients were the ones who touched my heart. In fact, I can remember the very
moment I started my path to becoming an oncologist.

I was an intern at St. Louis University, a brand-new doctor, with my white coat still fresh
and creased, when I first met Carmelita Steele. Carmelita was in her early twenties,
married, with (as I recall) two young children. She came to our hospital as a transfer in
the middle of the night. She had undergone a routine dental procedure, and after her
surgery had first oozed, and then gushed blood. By the time she got to us she was
severely anemic, and had a low platelet count. There was a very real concern in those Commented [OD2]: Relating to anemia: condition of
first few hours that she would bleed to death. having less than normal count of red blood cells and
hemoglobin in blood.
We worked through the night stabilizing her. Her veins were hard to access–they had all
been used up during her time at the other hospital. In those days (the late 1970's) we Commented [OD3]: An irregular blood component that
assists in blood clotting.
lacked modern venous access devices, and I remember it taking a frighteningly long
time establishing an intravenous line. Through it all I spoke to Carmie, who was a Commented [OD4]: (IV): tube attached to body to
cheerful if appropriately anxious African-American woman, somewhat overweight, proud transport medications, fluids, and nutrients.
of her children and her loving family. We poured several units of blood into her that
night, bringing her back from the brink.
We spent the next couple of days establishing a diagnosis. She had Acute
Myelogenous Leukemia, then as now a dangerous disease requiring toxic Commented [OD5]: (AML): rapid spreading cancer of bone
chemotherapy to clear the blood and bone marrow of treacherous cells. I learned the marrow and influences many other body parts including
lymph nodes, liver, spleen, and the brain.
diagnosis shortly after morning rounds. Her staff doctor, an elderly hematologist (or so
he seemed then, though I am now about his age) would, I discovered, be off campus
until the following morning. I knew that Carmie and her family were desperate for news,
so I phoned the staff physician and asked if it was OK for me to speak to her. He
agreed.
I had never told a patient that he or she had cancer before. I sat on the edge of her bed
and told her that she had a type of leukemia, that it was very dangerous but that it was
potentially curable with chemotherapy. I told her that we would be starting treatment the
following morning, as soon as her staff physician had a chance to go over the drug
regimen with her.
Carmelita had sat quietly while I spoke, a sad look on her face. When I was through she
said, almost in a whisper, "Doctor Sledge, who will take care of my children?"
It was the last thing I was expecting, and it was thoroughly devastating. I did not know
how to answer. Today I hope I would do better, but at the time I was in my mid-twenties,
just a few years older than Carmie, and I did not know how to answer that question. I
stammered something, barely maintaining my composure, and then left her room and
hid in a stairwell for a half an hour sobbing.
The next day we started her chemotherapy regimen, full of hope. I spoke to her
regularly, and to her family. Her husband, a quiet decent man, stood by looking worried.
Her mother, a medical technician who understood leukemia, rarely left her daughter's
bedside. They were the sort of family we all should have.
For several days things went well. Then, as her blood counts plummeted in response to
the chemotherapy, she developed an infection in the area of her intravenous line,
followed by sepsis. Her blood pressure dropped, and her breathing became rapid and Commented [OD6]: Infection that develops when the
labored. She was transferred to the intensive care unit, intubated, and treated with chemicals the immune system releases into the
bloodstream to fight an infection cause inflammation
broad-spectrum antibiotics. Sometime in the middle of the night, disoriented and alone, throughout the entire body instead.
she pulled the breathing tube out of her mouth. Though she was quickly re-intubated,
things rapidly went from bad to worse, and she died the following day.
I went home that night in a furiously angry mood. I was supposed to be going out with
my girlfriend, but in my grief and guilt I simply could not think straight or act civil, so I
begged off. I relived every moment of her care: what had I missed, what could I have
done differently, what foul-up had I committed that kept a 22 year-old from taking care
of her young children? It is the arrogance of interns that they believe that acute
leukemia would turn out differently if only they had gotten a little more sleep. Commented [OD7]: Highlights important idea that some
A few weeks later I got a call from Carmelita's mother. She wanted to meet with me. I cases are out of the hands of the doctor.
agreed, with real trepidation. The wound was still too raw, and there was part of me that
feared she might hold me responsible for her daughter's passing.
But she was as gracious as I could ever have imagined. I have three sons, all in their
twenties, and if one of them died of leukemia I do not know how I would handle it.
Poorly, I suspect. But she was dignified, pleasant and grateful. She told me that Carmie,
before she had died, had told her that, come what may, she wanted to give me a gift to
thank me for my care, and for the hours I had spent with her. She then handed me $40
and told me I was to spend it on something fun. Carmie had wanted it that way.
My patients, starting with Carmelita Steele, have taught me so much about what it
means to be a good doctor and, I hope, a good person. I am an oncologist because of
her, and it is a job I have loved for three decades. But Carmelita's question still haunts
me: "who will take care of my children?"
There are some debts you can never repay.