Residency: A walk into the past to find the way forward

Everything that we do arises from our desires and passions. Our every action and every move are dictated by some inciting event and the rest automatically follows. My decision to become a medical oncologist stemmed from one such event. On one of my return trips home during my undergraduate medical school days at Seth GS Medical College and King Edward Memorial Hospital (Mumbai, India), I had an accidental encounter with a patient with ovarian cancer. We struck up a conversation and before long, we were discussing her experience. She shared her deep gratitude for the treating doctors at the Tata Memorial Hospital (TMH) and explained how she had come to terms with her diagnosis. She said that she was grateful for the diagnosis, as she had managed to complete the cancer treatment, and her family could complete the construction of their new home and could arrange their daughter’s marriage. They had also made provisions for their children’s future and she had learned to look at life from a different perspective after her diagnosis. I can still hear her words echoing in my ears, “I had lost all hope to live and wanted to die after hearing that I had stage IV ovarian cancer”. But after seeing the way the doctors treated her, she felt that she had been granted some extra time in her life.

Being the young impressionable doctor I was at the time, that was all that was needed to tilt me toward oncology. The rest, as they say, is history. Six years later, when it was time to choose a super specialty, that small conversation played a very big role in my decision-making. As medical students and postgraduates, we do not have much exposure to medical oncology, as we refer patients to specialized oncology centers like the Tata Memorial, or allied institutes as soon as the diagnosis of cancer is made. But I wanted to make a difference and help people and was attracted by the branch that dealt with all the systems of the body. Thus, medical oncology became my automatic undisputed choice.

So, here I was in 2019: I had completed my post-graduation in Internal Medicine and was poised to join the Tata Memorial Hospital after clearing the entrance examination, with a bubble of happiness and achievement surrounding me. Not only did that bubble burst, but I was rapidly exposed to the harsh reality of residency in oncology. The schedule was grueling, tiring, and long to say the least. We began our days at 7 am or sometimes even earlier, at 6 am with ward duties, rounds, breakfast, outpatient clinics, additional ward work, including discharges, admissions, counseling patients and relatives, and consultant rounds while occasionally managing to haphazardly squeeze in some sleep and food, whenever possible. There were days, in the beginning, when lunches became evening snacks and dinners became midnight meals. Days, weeks, and months passed unnoticed. During those calls, casualty duties, wards, and outpatient clinics, we discovered a routine and the outside world gradually became progressively more distant and blurrier.

The system at the Tata Memorial was different from that of any of the other hospitals I had worked in. All patients were welcome at any time. The outpatient clinics were kept open till the very last patient had been evaluated and treated, even if that meant staying as late as 9 pm. Phoning up to colleagues from different departments to get things done on priority for sick patients bore fruit, as they humbly and sometimes forcibly, accepted our pleas and demands. Consultants here were more dedicated than I had ever imagined and their work ethic gave us the motivation to keep working hard.

Everyone needs some way to destress or relax, and for me, I think it was the late-night walks, sometimes well past midnight. I used to just walk on the by-lanes around the hospital, trying to figure out what I was doing and where I was headed. To be frank, I never figured out the answer to that question, but those orange yellow streetlights of Mumbai, those narrow roads, which were crowded and filled with traffic even at 1 am, gave me that little boost of energy I needed to work and find peace in what I do. It not only kept me sane but also showed me the way forward and helped me gain a deeper understanding of the meaning of life: Work hard and the rest will just follow.

This was how the first few months passed. Almost all of us were just figuring out our place in the system. Then came the COVID-19 pandemic. When COVID struck and the lockdown started, as oncology residents, we initially felt a little relieved. Everyone was terrified of the disease and so were we, but the thought of even a slight reduction in work gave us a lot of relief. However, this euphoria was not long-lived, as the hospital continued to function extremely well, without any compromise on patient care, and to top it all, we were assigned additional COVID duties.

With time, the rigors of constant work and no social life started to make sense. Seeing patients leaving their homes, their families, and their work and traveling almost 2000 km for treatment made me realize the importance of what I was doing. There were many instances when I would see my patients outside the campus, living on the roadside. But despite all their struggles, the gratitude that they showed was immeasurable.

All the postings and rotations have contributed to a great learning experience, not just in terms of patient care, but also in terms of counseling skills and how to practically apply what I had read. During my medical oncology residency, I was learning about common diseases and rare tumors, learning to counsel relatives, and at the same time, learning how to arrange finances for their treatment. These 3 years not only gave me an opportunity to learn the science of oncology in detail but also helped me understand the “art” of oncology that will help me tackle problems in the future. It would be difficult to emulate the system that the Tata Memorial has, with the division of cancers into “Disease Management Groups” and ensuring smooth functioning between these groups. The multiple stages in the journey of a patient occur in a coordinated manner, from registering a file, reaching the consultation room, carrying out various investigations, discussing in multidisciplinary joint clinics, reaching the day care unit for chemotherapy, managing side effects, and completing follow-up.

Time and tide wait for none. In what felt like the blink of an eye, the DM final exams were around the corner. With the schedule that we had as the “COVID batch” (the batch of residents that spent a large portion of residency in the COVID-19 pandemic), it was difficult to find time to study, and we had to come to terms with the fact that we were going to have to appear for the exams without adequate preparation. Our teachers and seniors tried to reassure us that we would be tested only on the things we had routinely encountered in the course of our clinical duties, but the problem was that we did so many things routinely! How were we to convert the work that we did almost instinctively into words on an answer sheet? Those 2 months prior to the exams were not easy with continuing non-stop ward and outpatient clinic duties, attempts at studying, complaining about the exams, and then trying to read again!

The exams got over before we knew it, and luckily, we all got through. With crossed fingers and a smile on my face, here I am, about to start the next phase of my residency and do what I really love- Treat Patients!