On Thursdays, the Daily Voice showcases selected Thursday Morning Memos, reflective essays about clinical experiences written by faculty, alumni, residents and students of the Department of Family Medicine & Community Health and, occasionally, contributors from other departments. Thursday Morning Memos is UMass Medical School’s homegrown version of narrative medicine, in which the authors process their experiences through writing. To learn more, visit: http://www.umassmed.edu/news/articles/2011/personal_stories.aspx.
Brianna Lyttle, MD, is an obstetrics/gynecology resident who has been spending her primary care rotation at Hahnemann Family Health Center. This is a wonderful reflection about what inspires us to do this work and how one finds their calling.—Hugh Silk, MD
The first time I felt like a doctor . . .
I’ve always been interested in breeding. When I was 5 years old, my hamster had a baby on my lap while I, not knowing she was in labor, played house with her. I was fascinated—and hooked. From then on, I bred everything—from hamsters to hedgehogs, to performing artificial insemination on my horse. I had homemade pedigrees and charts of all the dominant and recessive traits. I was—and am still—in love with the basic science of pregnancy.
Thus, I was destined to go into Ob/Gyn, and more specifically reproductive endocrinology and infertility. However, I have an even more focused specialty of interest—oncofertility.
Oncofertility is the interdisciplinary field at the intersection of oncology and reproductive medicine that expands fertility options for cancer patients. As a medical student on the pediatric oncology service, I first learned of this area. And to make a long story short, I hope to pursue it as a career.
This is where my story begins. I was holding the consult pager for my chief one day when a consult came in for a 19-year-old female who was diagnosed with a particularly aggressive pediatric cancer. The consult was for counseling of her fertility options prior to the start of her cancer therapy. I was excited—I would finally get a chance to help someone in the very specific area of interest I had become so passionate about.
To take a quick step back, when I first came to UMass, I met with a member of the pediatric oncology teams to see what educational programs were in place for counseling of the pediatric oncology population. As is the case in most of the country, most of the pediatric specialists had limited knowledge of this field and of the fertility preservation options available. Through our meetings and discussions, the knowledge of this specialty and the options for their female cancer patients have greatly improved at UMass.
Which is why I was so excited when I inadvertently received my chief’s consult. The same person I had met with in the pediatric oncology department was the one asking for the consult. After finding out it was me who answered the page, she asked if I would be involved in the consult. I was soon seeing the patient with my chief, the pediatric gynecologist and the pediatric oncologist on the children’s floor at the University campus. Her pediatric oncology team reiterated her diagnosis, and that the greatest chance she had of survival was to be as aggressive as possible up front with chemotherapy and radiation.
When I first saw the patient, she seemed to be your average teenage girl, dressed in her most comfortable grey sweats, hood on, with those white Apple iPod headphones glued to her ears and US Weekly magazine open in front of her. Both parents were in the room, and interestingly, her father was the one who was most concerned about her future fertility potential. He appeared tired but had that optimistic attitude that I imagine every parent who has a child with cancer maintains.
As he began to ask about the damage the chemotherapy drugs and radiation would have on her ability to have children in the future, I could see the patient become more engaged. She took out her headphones and diverted her eyes from the US Weekly. She listened intently as we told them the likelihood of her having her fertility intact after these toxic agents was slim. Because her diagnosis was so aggressive, her treatment needed to be started as soon as possible.
With this in mind, her options for fertility preservation were slim. In fact, she had one option. A surgical procedure that, as was explained to the family, was still experimental. I looked up as I said this, expecting to see hesitancy and doubt written on everyone’s face. Instead, I saw hope. Her father was the first to speak and he said that he had always heard his daughter talk about one day having kids. From a very young age, she would dress up babies and call them her own and often referenced, “one day when I have my own kids.” He knew how much this would mean to her in the future. I looked to the patient and asked how she felt. She firmly said she wanted to do whatever possible to give her the best chance of having children one day. She said she understood that delaying treatment had its risk, but that being able to have children was something very important to her. Everyone seemed to agree, for this patient, fertility preservation would not take backseat to her cancer therapy.
I remember having this overwhelming sense of accomplishment when I walked back in to tell the family. We had succeeded in helping a family that otherwise might not have had the opportunity to be given the information we had provided. She received her procedure within two days and a few days later could begin her cancer treatment, giving a total time of one week from consult to beginning of cancer treatment. I couldn’t have been happier.
It was in these moments, where my passion for this tiny area of medicine led to a pathway for a patient that would not otherwise have been explored, that I first felt like a physician. I felt like I had given this girl the chance to one day be able to bear children of her own, something that to some people means everything.
As you progress through medical school and into residency, sometimes you step back and wonder if you chose the right path—is medicine really for you? This experience reminded me of the excitement I had exploring pregnancy as a child. Today that excitement manifests itself in the ability to share this passion to better other people’s lives. This is why I picked this path and I can’t wait to continue to help people like my first real patient.