Practical Radiation Oncology (2016) 6, 3-4
www.practicalradonc.org
Narrative Oncology
The cure for the cynical physician: Gratitude and global health Julie Greenwalt MD ⁎ Department of Radiation Oncology, University of Florida, Gainesville, Florida Received 13 January 2015; revised 4 March 2015; accepted 6 March 2015
Why did I choose my career in medicine? For me, it’s simple. Most of us, I think, in our medical school or residency applications, shared the same vision: to help people. So we chose a profession that would allow us to put others before ourselves. Often now, however, our profession can seem full of cynicism driven by increased work hours and insurance hoops. Some—perhaps many—physicians are burning out. A recent online CBS News article titled, “$1 million mistake: Becoming a doctor,” 1 describes a 2013 survey showing that, if given the opportunity to choose a career again, fewer than 50% of physicians would pursue medicine. When did insurance companies and electronic charting distance us from our core values? Simply stated, I believe we physicians need to return to our vision, our “first love.” That belief comes from faith. When a person has strayed from faith, a return to “first love” can mean—at least in my case—remembering the passion of discovering God’s unconditional love. I call on all physicians to return to our first love in medicine: helping people. To do so, for me, has required putting aside cynicism and doing something vastly different from the contemporary physician’s normal day. For me, a return to my first love in medicine has come from serving global health. I know what you are thinking: why am I, a radiation oncology resident, writing about global health? Doesn’t radiation oncology require millions of dollars for equipment and extensive technical expertise? Or maybe you wonder why, with a passion for global health, why didn’t I choose primary care, infectious disease, or obstetrics and gynecology? My answer is that my calling is to help patients through their cancer journeys while pursuing my passions for research, technology, and physics. In fact, my involvement with
global health began in medical school, but that was just a start to the journey that was about to come. It was my sixth international medical trip. I was working with an organization that mobilizes health care professionals on missions to developing countries. In the rural mountains of Nicaragua, I met David, a patient in his 50s. He seemed no different from hundreds I had helped before. His complaints weren’t uncommon for patients whom I had treated in rural regions. He reported weight loss, fatigue, and difficulty in swallowing. But when I factored in his bilateral extensive neck lymphadenopathy, I became desperate for my laryngoscope. I made do with my husband’s dental mirror. Just before I’d left for Nicaragua, one of my mentors had taught me this old technique. As I looked down into my patient’s asymmetric larynx, there it was. A large mass intruded into his airway and immobilized a vocal cord. David most likely had larynx cancer. I was still in early residency training, but having come from a large head and neck cancer center, I knew from his neck nodes, cachexia, and anorexia, that David’s cancer was probably stage IV. Typically, in Nicaragua, a local physician helps to staff a volunteer clinic. After much discussion with David, I walked over to the local physician and requested an urgent referral to Managua—Nicaragua’s capital city would be the only place, I was sure, where the patient would have even a chance at receiving the chemotherapy and radiation therapy that he needed. Managua, I quickly learned, did offer the necessary treatment, but the line for referrals was 6 to 8 months long. What medical or radiation oncologist would allow that kind of delay for such an urgent case? Was there any way to bypass the system? I begged. I pleaded. I pointed out that David would surely need an urgent tracheostomy as the mass grew to obstruct his
http://dx.doi.org/10.1016/j.prro.2015.03.003 1879-8500/© 2016 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.
4
J. Greenwalt
airway. Didn’t they want to avoid such a horrible event? “All I can do is try for you,” said the Nicaraguan physician kindly, and I knew he meant the words in his heart. At home 3 weeks later, immersed once again in the chaos of residency, I felt grateful to be practicing in a country where I could provide patients with necessary cancer care without their having to travel 10 hours by foot to see me. Nonetheless, I could not let go of my concern for David, with his 3 children and 2 grandchildren. The virtual inevitability of his dying a painful death was too much for me. I began contacting the radiation oncologists in Managua. I discovered that they had 2 cobalt machines and 3 radiation oncologists. One year after leaving Nicaragua, I returned to visit Managua’s radiation oncologists. I saw how remarkably they work to treat as many patients as possible, more than 200 per day, sometimes from 6 AM until 2 AM. Receiving one-tenth the salary of a US resident, yet dedicating their lives to treating their patients, the radiation oncologists, I thought, like many of their medical peers in Nicaragua, are true heroes. Aided by a generous department, I was soon able to arrange for a team of US physicians to return with me to Nicaragua, to offer education, equipment, and supplies. Much more, however, is needed.
Practical Radiation Oncology: January-February 2016
Opportunity exists in many medical facilities throughout the world to do what most of us set out originally to do: help people. 2,3 Many facilities, I believe, would be grateful to have a medical oncologist or other medical professional to offer training and assistance. Patients in underdeveloped countries feel honored, I have found, to see a specialist with developed-world training and experience. Political and other safety risks require great caution, but we can partner with experts who know the culture. By volunteering to serve global health, medical professionals not only can help many people in need, but also can cure themselves of modern medicine’s disease of cynicism. I challenge practitioners of all specialties to join me in returning to our “first love” by answering the call.
References 1. Kristof K. $1 million mistake: Becoming a doctor. CBS Moneywatch. Available at: http://www.cbsnews.com/news/1-millionmistake-becoming-a-doctor/. Accessed March 17, 2015. 2. International Atomic Energy Agency. Together we can do more: Reducing global cancer burden is not beyond us. Available at: https://www.iaea.org/ newscenter/news/together-we-can-do-more. Accessed March 17, 2015. 3. Radiating hope: Advancing cancer care globally. Available at: http://www. radiatinghope.org/pages/globalaccess.php. Accessed March 17, 2015.
www.practicalradonc.org
Narrative Oncology
The cure for the cynical physician: Gratitude and global health Julie Greenwalt MD ⁎ Department of Radiation Oncology, University of Florida, Gainesville, Florida Received 13 January 2015; revised 4 March 2015; accepted 6 March 2015
Why did I choose my career in medicine? For me, it’s simple. Most of us, I think, in our medical school or residency applications, shared the same vision: to help people. So we chose a profession that would allow us to put others before ourselves. Often now, however, our profession can seem full of cynicism driven by increased work hours and insurance hoops. Some—perhaps many—physicians are burning out. A recent online CBS News article titled, “$1 million mistake: Becoming a doctor,” 1 describes a 2013 survey showing that, if given the opportunity to choose a career again, fewer than 50% of physicians would pursue medicine. When did insurance companies and electronic charting distance us from our core values? Simply stated, I believe we physicians need to return to our vision, our “first love.” That belief comes from faith. When a person has strayed from faith, a return to “first love” can mean—at least in my case—remembering the passion of discovering God’s unconditional love. I call on all physicians to return to our first love in medicine: helping people. To do so, for me, has required putting aside cynicism and doing something vastly different from the contemporary physician’s normal day. For me, a return to my first love in medicine has come from serving global health. I know what you are thinking: why am I, a radiation oncology resident, writing about global health? Doesn’t radiation oncology require millions of dollars for equipment and extensive technical expertise? Or maybe you wonder why, with a passion for global health, why didn’t I choose primary care, infectious disease, or obstetrics and gynecology? My answer is that my calling is to help patients through their cancer journeys while pursuing my passions for research, technology, and physics. In fact, my involvement with
global health began in medical school, but that was just a start to the journey that was about to come. It was my sixth international medical trip. I was working with an organization that mobilizes health care professionals on missions to developing countries. In the rural mountains of Nicaragua, I met David, a patient in his 50s. He seemed no different from hundreds I had helped before. His complaints weren’t uncommon for patients whom I had treated in rural regions. He reported weight loss, fatigue, and difficulty in swallowing. But when I factored in his bilateral extensive neck lymphadenopathy, I became desperate for my laryngoscope. I made do with my husband’s dental mirror. Just before I’d left for Nicaragua, one of my mentors had taught me this old technique. As I looked down into my patient’s asymmetric larynx, there it was. A large mass intruded into his airway and immobilized a vocal cord. David most likely had larynx cancer. I was still in early residency training, but having come from a large head and neck cancer center, I knew from his neck nodes, cachexia, and anorexia, that David’s cancer was probably stage IV. Typically, in Nicaragua, a local physician helps to staff a volunteer clinic. After much discussion with David, I walked over to the local physician and requested an urgent referral to Managua—Nicaragua’s capital city would be the only place, I was sure, where the patient would have even a chance at receiving the chemotherapy and radiation therapy that he needed. Managua, I quickly learned, did offer the necessary treatment, but the line for referrals was 6 to 8 months long. What medical or radiation oncologist would allow that kind of delay for such an urgent case? Was there any way to bypass the system? I begged. I pleaded. I pointed out that David would surely need an urgent tracheostomy as the mass grew to obstruct his
http://dx.doi.org/10.1016/j.prro.2015.03.003 1879-8500/© 2016 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.
4
J. Greenwalt
airway. Didn’t they want to avoid such a horrible event? “All I can do is try for you,” said the Nicaraguan physician kindly, and I knew he meant the words in his heart. At home 3 weeks later, immersed once again in the chaos of residency, I felt grateful to be practicing in a country where I could provide patients with necessary cancer care without their having to travel 10 hours by foot to see me. Nonetheless, I could not let go of my concern for David, with his 3 children and 2 grandchildren. The virtual inevitability of his dying a painful death was too much for me. I began contacting the radiation oncologists in Managua. I discovered that they had 2 cobalt machines and 3 radiation oncologists. One year after leaving Nicaragua, I returned to visit Managua’s radiation oncologists. I saw how remarkably they work to treat as many patients as possible, more than 200 per day, sometimes from 6 AM until 2 AM. Receiving one-tenth the salary of a US resident, yet dedicating their lives to treating their patients, the radiation oncologists, I thought, like many of their medical peers in Nicaragua, are true heroes. Aided by a generous department, I was soon able to arrange for a team of US physicians to return with me to Nicaragua, to offer education, equipment, and supplies. Much more, however, is needed.
Practical Radiation Oncology: January-February 2016
Opportunity exists in many medical facilities throughout the world to do what most of us set out originally to do: help people. 2,3 Many facilities, I believe, would be grateful to have a medical oncologist or other medical professional to offer training and assistance. Patients in underdeveloped countries feel honored, I have found, to see a specialist with developed-world training and experience. Political and other safety risks require great caution, but we can partner with experts who know the culture. By volunteering to serve global health, medical professionals not only can help many people in need, but also can cure themselves of modern medicine’s disease of cynicism. I challenge practitioners of all specialties to join me in returning to our “first love” by answering the call.
References 1. Kristof K. $1 million mistake: Becoming a doctor. CBS Moneywatch. Available at: http://www.cbsnews.com/news/1-millionmistake-becoming-a-doctor/. Accessed March 17, 2015. 2. International Atomic Energy Agency. Together we can do more: Reducing global cancer burden is not beyond us. Available at: https://www.iaea.org/ newscenter/news/together-we-can-do-more. Accessed March 17, 2015. 3. Radiating hope: Advancing cancer care globally. Available at: http://www. radiatinghope.org/pages/globalaccess.php. Accessed March 17, 2015.
