The thing about July 1st is...
Before diving in, I’d like to extend a warm welcome to everyone. I appreciate how many things compete for your attention. And yet, you chose to spend a few minutes thinking about cancer. Very cool.
A bit about me: I grew up on a farm in Illinois, moved to North Carolina for college, traveled around a bit, and settled back in North Carolina. I’ve worked at large, urban cancer centers and small community hospitals. I led a growing cancer survivorship program at an NCI-designated comprehensive cancer center and cared for patients in a rural community. I recently scaled back my practice in order to work on a podcast and book about my cancer crush, Dr. Bernard Fisher.
The impetus to start Cancer Culture was after two decades in clinical practice, I realized that I was having the same conversation over and over in my exam rooms. Patients consistently expressed a gap in what they (or the people around them) expected cancer to be and what it actually was. If I was hearing this from so many patients, it was probably on the minds of more people out there.
And maybe if I brought cancer out of the shadows and into the light, I could shift the conversation from fear to understanding and even hope. For any cancer survivors or care partners, I hope these posts will ring true to your experience.
Thank you again for being here and if you like what you read, please share this post with a friend. Cancer will touch all of us, so we need as many people at this table as possible.
This week I’m sharing the first post I ever wrote. It’s especially poignant because today I’m starting a new job in a new state exactly twenty years after the first day I started work as a doctor.
Thanks for being here. I look forward to hearing from you.
Although most people mark fall as the beginning of school, medical training follows a different schedule. All new doctors start their training on July 1. Each July, hospitals and clinics across the country are filled with brand-spanking new doctors.
As I watch the interns at our hospital shrug on pristine white coats for the first time and graduating residents toss (or burn) their dirty grey ones on their way out the door, I am filled with nostalgia and empathy for these hopeful healers.
Like awkward freshmen wandering unfamiliar high school hallways, these newly empowered and untested physicians navigate hospital labyrinths to see patients awaiting their recommendations. The reality of this responsibility dawned on me like the blast of cold air escaping from sliding glass doors to the ER when I realized that it was up to me to diagnose and treat the chest pain in Room #2.
Important decisions rest on the shoulders of fresh-faced new doctors who, if they are anything like me, quickly realize the limits of book knowledge and soon appreciate that the wisdom of an experienced nurse can circumvent hours of reading. (#thankyounurses)
Due to the breadth and complexity of cancer diagnosis and treatment, medical education provides only glancing coverage of this enormous subject. Physician familiarity with cancer is so limited that a friend who writes questions for the family practice licensing exams shared with me recently that there are zero questions relating to cancer.
According to the American Board of Internal Medicine, only six per cent of the questions on their boards relate to cancer. Physicians in these specialties makeup about a quarter of our workforce and yet have little to no education about cancer. As a result, many new residents' only exposure is in training where they are charged with caring for the sickest few who are admitted for severe complications, pain control or a newly diagnosed advanced cancer resulting in a short hospitalization and death.
From the public’s perspective, research shows that people appear to be of “two minds” related to cancer, expressing an immediate sense of dread and death associated with the word followed almost immediately by a more rational understanding of the improvements in cancer care and the possibility of cure. It appears that “intellectually driven hope run[s] alongside, rather than displac[es], viscerally driven fear.”
Also thrown into the mix is institutional racism and public distrust which result in not all groups benefitting equally from significant medical advances. Public trust in science has reached an all-time low and at the same time, celebrities communicate their cancer diagnosis and treatment to millions of followers on Instagram and TikTok. With so many mixed messages, determining how we think, feel and deal with cancer is well…complicated. As an oncologist, I watch patients and families struggle with this every day
All these factors converge to form what I call “cancer culture.” From an anthropology standpoint, culture conveys our shared beliefs through spoken and unspoken norms. As people, we develop our own beliefs around cancer the first time someone we love has or dies from cancer, or perhaps the way people talk or don’t talk about a cancer diagnosis. As physicians, we learn about it from our patients AND from our personal experiences.
When I first encountered cancer patients and the team who cared for them on my 3rd-year rotation with the Heme Onc B Team, I knew I had found my people. That environment spoke to me in a way that resonated deeply and that I still love to this day. I knew I belonged, and at the end of that month, I decided oncology was the place for me.
As I start this newsletter, I invite you to think about where you first encountered cancer. What was your first experience with cancer like? Or maybe you have a distinct memory of your first week as an intern. If you feel comfortable, post in the comments below and I look forward to reading them. If not, absolutely no worries. Thanks for reading this far and please share this with a friend if you are so moved.
On My Mind:
Is it OK to laugh about cancer? I’ve been thinking about this old NYT piece a lot lately.
The Comprehensive Cancer Survivorship Act has been reintroduced. Call your congressional representatives to tell them how important it is to specifically fund cancer survivorship research and care. And then call them again. And again.
