I wish u knew… the rewards of working in radiation oncology

Tim Hampshire

“I wish people knew that I remember all of my patients,” said Dr. Christine Hill-Kayser. She was earnest. I could see her briefly abandoning her bright smile, which is habitual and always a little sly. She slowly cocked her head side to side: “Every single one.”

“And…” she looked down and blinked once to fact-check her well-kept mental files. “…There aren’t any who make me feel sad when I think about them.”

I believed it. Dr. Hill-Kayser comes from a background of radiotherapy, specifically as it applies to breast cancer. She has recently switched to pediatric oncology and continues to be involved with Oncolink and the Roberts Proton Therapy Center. Having been immersed in fields traditionally seen as grim, she is always quick to remind her friends, colleagues, and interviewers that “many of our patients end up doing really well. I think that’s the side that’s sort of easy to forget.”

Dr. Hill-Kayser talks about working in oncology care and how her line of work can be particularly rewarding.

Why is it easy to forget? What makes people ignore the high success rates seen in pediatric oncology, and oncology in general? Why are cheerful, treble-voiced people like Dr. Hill-Kayser still seen as undertakers?

These were the questions with which we occupied the first half of the interview. According to her, “Cancer is almost like a catch phrase that evokes a sort of powerful sense of fear in people—doctors, patients, non-doctors, non-patients.” Like viruses against which we vaccinate ourselves, or sins against which we baptize ourselves, we know that there are feasible ways to combat cancer, but its presence makes us leery. Ask an octogenarian about polio. Ask a holy man about original sin. We can get rid of it, but we can’t get rid of it.

Dr. Hill-Kayser told me a story from her time as a medical intern. A woman came into the hospital with a heart arrhythmia that could be treated with a pacemaker. This woman had suffered and survived breast cancer. There was no suggestion of relapse; she was healthy but for her arrhythmia, a problem unrelated to the cancer. However, Dr. Hill-Kayser’s superiors became involved in a discussion of whether she should get her pacemaker. And why shouldn’t she? Because the breast cancer might come back, so treating her heart condition might not be worth it because she could die anyway.

What bothered me about the story is that the doctors seemed so cold. What bothered Dr. Hill-Kayser about the story is that the doctors seemed so cowardly. How could they be so terrified, so prejudiced, that they thought to turn away a patient because there had been a breast cancer in the past? The disease had been cured, yet the medical community still felt that the patient was unclean of it. Perhaps cancer carries ghosts that medical interns can’t see.

Dr. Hill-Kayser doesn’t think that her colleagues don’t know “the facts about cancer treatment—how successful it can be, and even when it’s not successful how rewarding it can be.” But she does think there is a lasting bias that grinds down hope in doctors who would otherwise approach their patients’ treatments optimistically. Interestingly, cancer treatment as intrinsically rewarding takes on the status of “fact” for Dr. Hill-Kayser. When it’s successful, the rewards are obvious. But when it isn’t successful, it has not failed to be rewarding. And this is one of “the facts about cancer treatment.” I was eager to find out why.

She told me, “I will say that I don’t find it sad or depressing at all. The patients we work with are inspiring. Even the ones that don’t survive their cancer are often in a position where we can help them with something really important, like pain control, or other things that are important for quality of life even at the end of life.” In other words, help is an activity with face value. It is rewarding to have helped a patient no matter what happens. To offer that kind of help, Dr. Hill-Kayser can’t go through her career fearing the word “cancer,” so she doesn’t. (It helps her to pronounce it as sweetly she does, like Cerberus can be tamed with a lyre.)

There is a measure of psychological intrigue to the way she approaches her specialization, pediatric oncology. “I think one of the things I enjoy about it is that it’s sort of a family predicament when a child gets cancer, and you sort of get a window into people’s lives,” she told me. To watch families huddle in the dust of despair is a peculiarly hopeful sight for her. In fact, she does not just treat the children who get cancer. She returns kids to the laps of their parents to be comforted as they were before the beams and the injections and the pills. She is a builder who finds missing keystones and puts them back in their spots with a little bit of new mortar. Tender as a dove, and hell-bent on comprehensive care, Dr. Hill-Kayser pours a lot into treating her patients and their families. And they are grateful for it.

One of the many patients who occupy her encyclopedic memory was a teenager with a relapsed cancer who wanted desperately to attend his high school prom. He was being given palliative treatments and was sent home on hospice. It was the end of his life, set cruelly to coincide with the prom. The day after the prom happened, Dr. Hill-Kayser found out that he had died. She was saddened to see that he didn’t make it to his prom until she found out that he actually did. In a wheelchair. And a tux. She’ll remember him that way even though she saw him at his worst. Something tells me that’s her secret.

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