Dual training in Oncology and Palliative MedicineJason Lambden, MD, MSPH Aug 8, 2023
The first time I met Jamie was as a resident in my primary care clinic. She had some concerning symptoms, and we were both worried she had cancer, but neither of us said it. Instead, we traded bad jokes about Chicago traffic. “Why do they call it Midway airport? Because by the time you get there, you’ll be mid-way to your final destination.” I saw her in clinic two weeks later after CT scans and biopsies, and she was reeling from her new cancer diagnosis. We talked about life, her symptoms, next steps, and I helped coordinate follow up with oncology. I saw her several more times after that, and she was always upbeat and optimistic; I visited her in the hospital after surgery, and again when she had a surgical complication. Once, I ran into her getting coffee while she was waiting for a radiation appointment. It was good to catch up. The next time I saw her was five months later in the ICU. She was dying, surrounded by family, and still telling jokes. She is one of the patients I will never forget and is a major reason that I am continuing my medical training in both palliative medicine and oncology.
Currently, I am finishing my palliative fellowship and will be starting a hematology and oncology fellowship soon. In 2023, for the first time, there are four fellowship programs offering a combined training in hematology & oncology and hospice & palliative medicine. This is one year too late for me, but the increasing support for this dual training is long overdue. The benefits are myriad. I feel far more prepared to take care of patients with advanced cancer. In the past year I have learned to:
- Gracefully navigate difficult conversations with patients and families,
- Competently manage complex symptoms like pain, nausea, fatigue and dyspnea,
- Skillfully work with patients to ensure that their cancer care is rooted in their values,
- Gently and sensitively discuss emotional and existential distress,
- Compassionately help patients transition to end-of-life care, and
- Confidently attend to my own wellness and that of my colleagues
These are invaluable skills for an oncologist, and I am incredibly grateful for the opportunity to learn from my colleagues in palliative medicine. I wish Jamie were still around so I could tell her how much she inspired me to take this path. I think she would roll her eyes, and I would laugh and take care of her the best that I could.