Rotation #12: Oncology

I was fairly certain that Oncology was going to be The Saddest Rotation Ever. Dogs and cats with cancer? All day, every day? Occasionally there are days on Internal Medicine where it seems like all our patients, whether they present for vomiting or difficulty breathing or limping, end up with a diagnosis of cancer. You can tell at the end of the day who had a "cancer day"- they're usually in the Internal Medicine conference room late, typing long discharge instructions and having long sad conversations with pet owners about prognoses and statistics and mean survival times. So, you can see why spending two whole weeks of "cancer days" made me nervous.

But then, I walked into the Oncology Service on day one and was greeted by a small herd of dogs galloping in from the chemotherapy room. During my orientation, a scruffy wirehaired terrier mix kept wedging his head between my knees asking for petting, and a lanky 3-legged lab kept trying to steal peoples' lunches from off the countertops. Oncology felt more like doggy daycare than like a hospital, except that dogs would have to stop their socializing for a few minutes to have a physical exam and blood draw in the morning, then be taken to the chemo room individually in the afternoon for the 20 or 30 minutes that it took to receive their chemotherapy. Go-home time was chaotic, with each dog knowing which leash and collar was his own and going into a wiggle-butt happy dance when they knew it was their turn.

Don't get me wrong, Oncology was not all fun and games. In animals, the goal of chemotherapy (or radiation therapy) is usually not to cure cancer, but to provide palliative care. Often, that means animals go through a course of chemo to get them from a mean survival time of, say, six months to a mean survival time of 12 months. Cancers are very rarely cured, but because we use chemo at much lower doses that in human medicine, animals usually still have a great quality of life throughout their therapy and remission time. Chemo can buy pets another Christmas, another hunting season, or one last trip up to the cabin. But even if the dogs in the chemo room are feeling well and acting like themselves, the inevitable eventually comes. We had four euthanasias during my two week rotation, and they were all more emotional than usual since owners often develop a close bond to the Oncology staff throughout the course of therapy (or even just through the diagnosis of cancer, regardless of whether they chose to pursue therapy).

Cancer makes people feel hopeless and scared, especially if they've had to deal with cancer themselves or with a human family member. Having to deal with the human psychological component of oncology requires a lot of help from Jeannine Moga, the hospital's social worker. She has rounds each week with the oncology department to talk through difficult cases, bad outcomes, or really emotional owners. She also helps out on the hardest cases, like if parents are trying to tell a young child what's happening to the family dog, or if a senior owner's pet has just been diagnosed with cancer and they want to pursue treatment even though they don't have the financial means to do so. Jeannine is a wonderful resource and makes difficult things like the diagnosis of cancer a little bit easier to handle.

So, after two full weeks of cancer days, I have to say that Oncology is not The Saddest Rotation Ever. Somehow, through terrible things like cancer, little rays of hope shine through and pet owners really treasure having that one last Christmas or one last good pain-free week with their friend.