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RESIDENT CORNER
Year : 2020  |  Volume : 3  |  Issue : 1  |  Page : 42-43

First year of residency: As the dust settles


Department of Medical Oncology, Tata Memorial Hospital; Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India

Date of Submission09-Dec-2019
Date of Acceptance24-Dec-2019
Date of Web Publication24-Feb-2020

Correspondence Address:
Kunal Jobanputra
915, Golden Jubilee Block, Tata Memorial Hospital, Jerbai Wadia Road, Mumbai - 400 012, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_114_19

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How to cite this article:
Jobanputra K. First year of residency: As the dust settles. Cancer Res Stat Treat 2020;3:42-3

How to cite this URL:
Jobanputra K. First year of residency: As the dust settles. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Apr 10];3:42-3. Available from: http://www.crstonline.com/text.asp?2020/3/1/42/279072



I began my journey to Tata Memorial Hospital (TMH) exactly a year ago. I had spent three years in Mumbai, cutting my teeth in the crowded corridors of King Edward Memorial (KEM) Hospital. Through the highs and lows of internal medicine, in exploring all its possibilities and in tailing senior consultants, arose an interest in oncology, and TMH is where I wanted to be. TMH – thronged by tens of thousands, a world of hope, pain, despair, and the triumph of the human spirit. A place teeming with patients, families, health-care personnel, researchers, social workers, and volunteers. In a small cafe in KEM, I sat buried under piles of textbooks and medical journals, looking up to see the light reflecting off the opaque windows of the Homi Bhabha Block of TMH. I had lived and worked within shouting distance of this institution, and yet knew precious little beyond the mythos a giant such as this cultivates.

After months of the deep-ingrained routine of study-exam-result, three months ago, I crossed the road and stepped into this hitherto unknown world and then, everything happened at once. Room allotted, ward duties assigned, I was introduced to TMH's formidable outpatient department (OPD). Patients huddle up outside from 6 a.m., OPD beginning at 8.30 a.m., and we see every last one until there are none. I learned to quickly wind up my ward duties before the doors opened, and then it was hours and hours of seeing patients, hearing their worries, counseling them, figuring out treatment plans, doctor and patient doing their best to pick away at our daunting opponent. The OPD queue is unrelenting; but for short breaks at mealtimes, one hardly has time to look up, and we stepped out only as night fell.

I was aware of fifteen other first-years who, like me, were finding their feet in the familiar, yet unsettling world of a busy hospital. All of us were swallowed up whole by the regimented schedules that keep TMH running smoothly like clockwork. There was a strict routine to follow – rounds, breakfast, OPD, lunch, OPD, rounds, dinner, ward, sleep, repeat. A busy schedule necessitates discipline, and with scarcely a minute to think, I found myself falling into a routine fairly quickly. It was also a dreadfully isolating experience. Sixteen of us in the same boat, but it was 2 weeks before I even met them all. This same busy schedule, however, taught me to seek warmth and light wherever I could – it was in moments of gratitude in the OPD and wards, in working with the staff, in seemingly meaningless bits of conversation that ultimately kept me going. It was, to my surprise, in Marathi – not my mother tongue, nor a language I grew up with, but in speaking with the staff and patients, it helped me find comfort and a sense of home in the detachment of those early days.

TMH was an unknown beast. I found myself visiting KEM often, feeling lucky I had a 'home' a few hundred steps away. Unbeknownst to me, however, TMH was making room for itself in my mind. I developed a fondness for the bridge connecting the main building and the annexe building, a fleeting glance into the world outside OPD walls. Dusk brought with it the promise of peace, and late into the night, we sat entering data in the waiting hall, emptied of its bustle. The easy chair in the hostel corridor beckoned me at the end of the day, where all I had to do was contemplate the skyline. Weekends made TMH feel friendlier, and I started developing camaraderie with the staff, a familiar ease with my roommates and colleagues.

Settled in, I could pay closer attention to the work I was doing. A student of internal medicine so far, I had barely skimmed the surface of oncology in my prior training. I was a novice in the principles and philosophy that guide the treatment of cancer patients. Management protocols and treatment goals differed from what I was used to, and with little time for focused study, I often wondered when I would feel confident in the subject matter. I was in awe of my seniors, who fluently quoted clinical trials, rattled off response and survival rates, interpreted graphs and P values in seconds-while I tried to memorize one set of data as another slipped out of my mind. A houseman once again, I worked more, thought less, understood lesser still.

In the midst of all of this, I fell sick. Like several Mumbaikars, in the dying days of the monsoon fever season, I fell prey to dengue. Confined to my bed, I got some unexpected time off, occasionally entertaining visits from concerned colleagues and seniors. With little to do, I took to looking out of the tall window at the end of the ward. It overlooked the waiting area of the Homi Bhabha block, and it gave me a different perspective of the OPD crowd. Rows upon rows of patients and their companions, stoically waiting their turn. Patients requiring assisted respiration, elderly patients, young patients, patients in incredible pain. We know patients line up from as early as six in the morning, some waiting till well past sundown. Some return home, some to the footpath outside. People from all over the country from all walks of life flock to TMH is a reverential truism every doctor in this country knows - TMH, the apex, the preeminent institute for cancer care-and yet, seeing the patients represented thus from my window, reinforced my admiration for the mettle, hope, and tremendous spirit shown by the cancer patient every single day.

Before long I was better, and as time for focused study was scarce, I absorbed lessons from my surroundings, from our patients. Cancer and correspondingly its treatment takes up space in patients' minds, in their time, in their relationships. With pathological courses ranging from months in some cases, to years in others, one has to consider each patient individually to chalk up treatment goals and map out therapeutic schedules. No two cases are the same, and while initially, I worried about staging and protocols and guidelines, I understood that they were mere tools in doing one's best for each patient. Day in and day out we plan, prescribe, counsel, all to vanquish the disease, but the nature of the treatment has refreshed my consideration for the toll it takes on patients, their resilience in committing to it, and the inestimable value of families and support systems in sustaining treatment.

It is now three months since I joined this institution – a short period, with a long way to go. I'm still very much the inexperienced houseman with lots to learn. The work is still challenging, but not as mechanical as it felt earlier. I don't always know what to do, but I do know where to look for information - and that help is available to those who ask. The work on my thesis is only just beginning, and with it, I hope to familiarize myself with the nature, scope, and goals of oncological research, so that I may journey deeper into the subject. TMH certainly has sunken into my skin, as have I into it. The work ethic it demands, its rigorous schedule, the emotional upheaval inherent in cancer care – every day it teaches me more and every day I hope I serve it a little better than before.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.






 

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