Straight down and to the right. The receptionist was unfortunately beginning to sound like a broken record as seemingly overwhelmed residents rushed past, heeding her directions. Sitting in the patient waiting room of radiation oncology, I knew something was amiss. The time was slightly past 9 am, the set time I was supposed to meet Dr. John Ng. During one of her free moments, I then approached the receptionist and asked whether I could see Dr. John Ng, and she informed me that the department was in the middle of a “code” - the accepted slang for when a patient becomes unresponsive.
The hubbub and commotion of the residents started to make sense. Dr. Ng also later clarified that a “code” in radiation oncology is as infrequent as once or twice a year. Logically, the infrequency made sense, as a patient that is able to receive radiation treatment will not be close to coding. Dr. Ng seemed clearly glad to have handled the code well, but the excitement of the day was just beginning.
On that day, Dr. Ng was doctor of the day, or the primary physician in arm’s reach to deal with all issues. With this responsibility, surprise number 2 came shortly after the code. In the waiting room, an elderly woman suffering from lung cancer that had metastasized to her brain suddenly become extremely short of breath. As another doctor’s patient, Dr. Ng did not know the patient’s case or medical history. Still, I was amazed by his handle of the entire situation. His demeanor kept the patient and family calm, as he helped the patient get her breathing under a control through the use of a nebulizer. The patient’s granddaughter, who had just returned from college, did not know her grandma’s medical history as well and struggled with cell reception to get in touch with other family members. At the same time, Dr. Ng found himself caught in pager tag with the patient’s primary lung oncologist.
Throughout it all, he kept the granddaughter and patient calm, made a sound plan to admit the patient to the emergency room, helped figured out why the patient was short of breath (i.e. the long walk to the hospital), and even arranged for a social worker to help get the patient a wheelchair for future visits. This entire situation played out within ten minutes, frequently interrupted by pages from other patients. This experience was a bit eye-opening for me, as I did not realize the communication issues that often arise between departments. It also alarmed me that the doctors were inherently dependent on paging each other, a seemingly anachronistic technology for a place where lives are literally on the line.
Throughout the rest of the day, Dr. Ng continued to impress me with his bedside manner based on how his interactions with patients that made them feel secure in the clinical plan and comfortable throughout treatment. The theme of the day quickly became “pleasure and privilege.” Dr. Ng first said that to an elderly, optimistic patient, who he later informed me was at the stage of purely palliative, not curative treatment. Just like this patient, all of the patients addressed Dr. Ng with not only great respect but such familiarity. It sincerely struck me at how a doctor can become such an important part of the patient’s family and support structure, especially when facing cancer.
Aside from these more subtle learnings, I began to better understand the process of treatment for cancer patients from initial diagnosis to chemotherapy and radiation treatment. I got to witness the entire process including simulating treatment and actual treatment. Dr. Ng was even kind enough to walk me through the components of a linear accelerator and novel techniques to best prep the patients for these scans. At the end of the day, I even was able to see data from a clinical trial regarding the abscopal effect and speak to several researchers about the future of this research.
Outside of the clinic, I finished collecting data for my first organoid trial. I also had several meetings with members in the Cesarman and Melnick lab to plan experiments for the rest of the summer. In the coming weeks, I’m positive I will be able to complete these pieces of data and continue to shadow in both the lymphoma clinic and radiation oncology. Until then, I’m excited to see what the long weekend will bring. Happy 4th, blog readers!
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