This article was originally presented as student remarks at the 2015 Harvard Medical School commencement.
At the end of medical school, I always return to a musing, a zen koan of sorts from Dean Jeffrey Flier. At my white coat ceremony, a close friend and current resident, Dr. Nina Gold was chatting with the dean about the heft of our newly bestowed bright white coats. He asked her, in one beautiful sentence, “Is it heavy … or is it light?”
When I started medical school five years ago — to my mother and father, I would like to note that it indeed takes five years, almost everyone does it in five years, and that these days you have to be a genius to do it in four — I was an improbable two weeks out from a year long stretch of cancer treatments. The piece de resistance was a bilateral mastectomy, performed just a week after my twenty-eighth birthday. The surgery was actually not so bad, in a very relative sense, as it had been preceded by, in order: the resection of the upper lobe of my right lung, a week in hospital because my lung would stubbornly not re-expand, and about eighteen weeks of chemotherapy, but who’s counting? After the final surgery, I packed up just the things that I would need from my tiny, railroad style New York City walk-up — or, my partner and his parents packed them for me because I couldn’t lift anything above five pounds — and moved to Boston. It was mid-August, 2010.
That spring, when I was trying to decide where to attend medical school, a major criterion was whether I would be able to defer for a year. I didn’t think my treatments would be finished in time to start. And, many people far wiser than I felt that I should take “a break” after all that had happened before embarking on the long training process. So, I dutifully asked for a deferral from Harvard Medical School, which was granted. Later, when I learned that I would have a whole two weeks after my breast surgery before medical school started, the perennial optimist, I thought, “Why defer?” It’s time to get started with these five years of medical school. “I can do this,” I thought. Or, rather, hardly being so sure, I thought, “If it turns out that I can’t do this, it won’t be the worst thing that happened to me this year.”
And so to Boston I went, bald and rail thin, feeling the very definition of a non-traditional student. I decorated my small apartment in the Fenway. I stopped wearing the hat or scarf that had covered my smooth head as I’d lost my locks to treatment. “Too quirky, too soon,” I thought. “You don’t want to be the girl with the hat,” I thought, “or worse, the girl with cancer.”
So, I abandoned the chapeau and let my smooth head be known to the world. I put on my cool earrings. I put on my best jean jacket. I tried to follow writer and comedian Mindy Kaling’s maxim: “Sometimes you just have to put on lipgloss and pretend to be psyched.” So, I pretended to belong and began to. The transformation, to my surprise, was swift and magical. I soon loved medical school. The coat was lighter than I’d thought. Learning, finally, after such a long journey, to begin to care for patients, with some of the smartest and kindest people I have ever met. Well, it was something I was grateful not to have deferred.
There have been difficult moments. The amazingly high-yield but certainly fatiguing 24 hours on, 24 hours off of the Massachusetts General Hospital emergency department always comes to mind. It is called “The Pit,” and we are called the “Pit Crew” — think NASCAR not Sisyphus. I remember telling my parents about this shift. My father said simply, “Well that sounds counterproductive.” He did not elaborate. My mother said, “I know this must be overwhelming for you, but it all sounds very exciting!”
But we have all found our way. We, the newly minted physicians, love medicine. We love it so much that we want to change it. More precisely, to make it live up to the ideals that brought us to the profession. The same ideals that will keep us here. Each of us is unique in what we what to contribute, but equal in our sincerity and our audacity. I myself have a fairly simple, self-centered story. I had cancer as a child, and cancer as an adult. I have been so lucky by the accident of my birth that these battles with illness have defined me in ways largely positive.
When I asked a research assistant that I was just starting to work with in Rwanda, Ignace Girukubonye, a man who at the time of my asking had a great deal of experience and knowledge about health research, “What do you know about cancer?” He said simply “I know that it is a fatal illness with no treatments.”
I had cancer, and I get to practice as a physician. And, one day, as a radiation oncologist. I can guarantee that there must be another young girl somewhere who could have done the same if she’d had access to the outstanding care that I have had. I have been lucky. But I am not more deserving.
I do not take my good fortune for granted, and have the dream of helping to build better health systems that address the gamut of afflictions for which treatments do exist but are not delivered. And I have the audacity to believe that these systems will include radiation; because they must. I feel unimaginable good fortune to be at this moment today. Readying myself to step into the heaviness of what a friend of mine has marked as the most meaningful year of his life: intern year or my first year as a physician. Crossing over with all of the empathy that I can muster as a patient and provider: as a survivor. How heavy it is. And, how light.
Acknowledgments: The author would like to thank Dr. Nina Gold for her inspiration for this article and her friendship. Thanks to Dr. Roshan Sethi and Dr. Timothy Williams for their careful review. Thank you to all of the mentors, family, friends, physicians and patients who have supported and encouraged, you are thankfully to many to enumerate here. No funding was received. No conflicts of interest to disclose.
Shekinah N. Elmore is a radiation oncology resident.
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