A letter to myself as a first year resident in medical oncology

Dear me (you),

I’m writing to you from the future—approximately ten years from where you are now. You’re a few months into your medical oncology residency, just beginning to assimilate to the flow of your daily responsibilities as a doctor committed to the diagnosis and treatment of cancer.

You hate living in upstate New York, and are dreading the upcoming winter and the associated endless piles of snow and sub-zero temperature nights guaranteed to envelope your existence over the next three-plus months.

You’re starting to refrain from feeling pure panic every time your pager goes off, but remain tethered to its incessant bleating. You constantly worry about memorizing every miniscule detail of cancer biology and metastasis.

You’re indelibly etching median survival times, remission rates and durations, and percent chance of side effects of chemotherapy drugs on the exhausted neurons of your cerebrum. You agonize over dose volume histograms and p-values and whether or not you will know the correct answers in rounds the following day.

You view your elder resident mates with awe, stunned by their experience, poise, and certainty by their career paths. You fear you came to this life by chance rather than choice. You ask yourself daily, “What kind of an oncologist do I want to be?”

You’re concerned about having enough money to pay rent and your cell phone bill, and still have a measly few dollars left over to go out to dinner once in a while. The federal government recently started knocking at your door, looking for the first of many paybacks for the thousands of dollars they so willingly lent to get you where you are.

You think you are too old and fear you will never find a husband or be able to start a family. You stare at imaginary wrinkles on your face, and contemplate what it will mean to be (gasp!) 32 years old and just starting to contribute to a retirement plan.

You spend an inordinate amount of time considering your highly anticipated “first real job,” half dreaming of the benefits associated with earning a real paycheck and mostly terrified of the thought of being in charge of complicated cancer cases all by yourself.

You stress over where you will live when you are finished, where you will purchase your first home, and whether or not your current mode of transportation, an old, but moderately reliable Honda Accord, will survive until the end of your residency.

I’m here to tell you to stop worrying.

Ten years affords me the wisdom and patience to understand that you don’t need to know it all—not during your first year of residency, or second, or third, or beyond.

I look at you with the knowledge that your stress won’t lessen with time, and your life will only become increasingly complicated. Your current concerns will be reduced to fleeting afterthoughts when you contemplate them from where I stand.

One of the most important pieces of wisdom I can pass along to you has nothing to do with your ability to accurately recite survival times or understand the molecular biology of carcinogenesis. The most valuable tool I’ve amassed over the years is the ability to say “I don’t know.”

Yes, first year resident me, you need to know a lot, but you don’t need to know it all. The patients you will meet over the years will frequently confuse you and cause you to second-guess the facts you’re agonizing over right now.

They will live longer than you ever expected and they will die from complications you couldn’t predict. They will have inconclusive biopsy reports. You won’t be able to look them up in any one of your textbooks because their signs and test results won’t match anything you’ve seen or heard of before. You will constantly second-guess yourself, your co-workers, and your patients’ owners. You will meet patients you won’t be able to save. You will see them die.

To my first year resident self, I wish you could take time to listen to my words and remember to breathe. I want you to look around and embrace the wonder of your current environment. Notice how the most esteemed medical colleagues surround you in your profession. You have instant and easy access to advanced diagnostic tools and clinical trials. You are given immense responsibility, but you always have back up. This is your time to drink it all in and savor the pure pleasure of learning.

Most of all, you have time. There’s plenty of time to study and socialize. There’s time to take a day off now and then. There’s time to find the husband and start a family. There’s time to remove even just a few pounds of the pressure you’ve placed on yourself.

Remember your friends and count on your family. Ten years will pass and you will no longer dread an endless snowy winter because you will wish time could somehow cease to continue accelerating exponentially as you age.

I know you will hear my words, but I also know you won’t listen to me. I already recognize what kind of oncologist you will become. I’m proud of you as a doctor, but I mourn the sacrifices you’ve made to become the person you are today.

…and suddenly I’m distracted by a quiet but persistent voice, whispering words I’m desperately trying to decipher. It’s the voice of someone claiming to know a bit about myself, ten years from now.

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