Fall is definitely my favorite time of the year. This is a season full of contradictions, at least here in Wisconsin. Summer isn't quite gone and winter hasn't yet arrived. Some days are still full of sun and 60 degrees; others have dark, cloudy skies and freezing temperatures. Leaves appear in every beautiful fall color. Some are still stubbornly stuck to their branches, while many are in large, endless piles of fun created by my children (who are finally big enough to rake by themselves!). My current APPE rotation – an ambulatory oncology clinic – fits perfectly into this transitional season, where it seems like my heart is warmed and broken every day, and the medicine ranges from the amazingly advanced to the alarmingly primitive.
Similar to all my other rotations, I have learned an incredible amount about the practice of pharmacy; there is endless information for me to absorb about oncologic pharmacotherapy, pharmacokinetics, drug interactions, clinical trials and – of course – the ubiquitous side effects of chemotherapy. Unique to this rotation, however, is the education provided by the patients and their caregivers, namely, what it is like to manage life and battle a disease. Most of the patients I have met are just here for the day or part of the day. Their lives are changed, certainly, but they aren't put on hold like those in an inpatient unit.
I wish I could carry around a camera and capture some of the images I've witnessed, like the day I followed a couple headed toward the cancer center day hospital where one would receive a chemotherapy infusion. The early morning sunlight streamed through the windows just right, showing only their silhouettes and their clasped hands, and (at least in my mind), the hope of the day. Or the day I had the privilege of joining an oncologist in a patient exam room. At one point she was simply listening to the patient's heartbeat, but as I watched both she and the patient close their eyes and focus their entire attention on that act – quiet, still, intimate – I suddenly saw and felt the power and trust of the provider-patient relationship.
I've glimpsed the impact, both bad and good, cancer has on the patients themselves as well as on families, caregivers, friends and health care providers. It challenges everyone involved. It challenges us to rethink our luck and misfortunes, our health, what we know, and how we approach our days. Cancer is a mysterious, non-discriminating creature cloaked in the best disguise that we can’t quite yet fully understand: our own bodies. Sometimes we try and treat it with potent chemotherapies, sometimes we try to trick it, and sometimes we simply hope and pray for the best possible outcome, even if that outcome is only comfort.
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