A Day in the Life of a Military Hematology/ Oncology Fellow

Major Lindsey Graham, MD, MC

At 5:45 am, the alarm on my phone goes off. I have 20 minutes until my 2 boys wake up, which is just enough time to get ready for work and fix myself a cup of coffee. I get out of bed and walk to my bathroom, stopping at my dresser drawer to pull out a sand-colored T-shirt and green wool socks. In the large master bathroom, I flip the light on and change into the T-shirt and a pair of cargo pants in a block-like camouflage print. Stepping up to the mirror, my hands methodically pull back my hair and begin a task that they have performed nearly every day for the past 7 years. A few minutes later, the straight brown hair that falls about 2 inches below my shoulders is neatly French-braided and tucked under at the nape of my neck and secured with 4 large hair pins. My bangs, which moments ago were falling over my right eye, are now twisted off to the side and secured with their own hairpin. I then apply a very light coat of makeup to my face with just a dusting of blush for color. Most days, I don’t wear eye makeup because I do not feel as though the outfit demands it.

I walk out of my room into the kitchen at about 6:05 am. I pour water into my single-cup coffee maker and load the single-serving coffee pod and press the start button. While I am waiting, I walk to the other side of the kitchen where a stack of hematology and oncology journals and other similar publications sit neatly stacked at the edge of the shiny black kitchen island. I pick up one of the journals and flip through the pages, ripping out articles of particular interest.

As I am reading, I hear a door handle flip harshly and a door down the hall open. I then hear the familiar rapid thumping of 4 small bare feet on the hardwood floor coming toward me. A few minutes later, my husband is up. The next 50 minutes are spent in the living room wrangling a 2-year-old into his clothes and prompting my 4-year-old to dress himself, while taking breakfast orders and getting them out like a short order cook. I then sit down with them and drink my coffee while they eat their breakfast. My husband is shaving and putting on his own sand-colored T-shirt and camouflage cargo pants.

The last 10 minutes at home are spent as a family, all putting on our shoes. My husband and I pull on tan combat boots. I personally use the silky ties at the bottom of the pants to cinch them around the cuff of the boot, while my husband prefers to tuck his pants into his boots. I walk to the front door and pull a jacket-like shirt, or blouse, off the coat rack. The material and pattern match my cargo pants. I pull it on, pull up the front zipper, and secure the hook-and-loop closures over the zipper. In the middle of my chest is an embroidered gold oak leaf, symbolizing my rank, which is that of major.

I entered the Army as a second lieutenant, but never wore this rank much because I went to a civilian medical school, which is common for military doctors. Technically, I was in the Army Reserve, and spent the summer after my first year of medical school at a basic training course for medical officers. This is where I met my husband, who at the time was attending a medical school 500 miles away from mine. After graduating, I was commissioned on active duty as a captain. It is pretty standard that a doctor spends 6 years as a captain before being promoted to major. The first 3 of these years were spent in internal medicine residency at Walter Reed, which at that time was in Washington, DC. After that, I spent 2 years as an internal medicine staff physician stationed in San Antonio, Texas. I had always wanted to be an oncologist, but wanted to spend some time out of the training environment, so I didn’t apply for a fellowship right away.

Over my right upper arm is an embroidered square patch with an ivy leaf inside each corner, meant to signify the Roman numeral IV. Their stems are connected in the center by a circle. This is the insignia of the 4th Infantry Division.

Its position on my right arm indicates that this is the unit with which I deployed. Shortly after receiving orders to San Antonio, I was sent orders to deploy to Southern Iraq with the 3rd Brigade Combat Team, 4th Infantry Division. I was officially stationed in San Antonio, but was essentially “loaned out” to the unit as part of a Professional Filler System (PROFIS). It was an incredible experience—while in Iraq, I cared for the general medical needs of an Army unit. I returned to my job as a staff internist in San Antonio 10 months later. On my left upper arm is an oval patch displaying a modified caduceus with 2 snakes entwining a winged sword. This is the insignia of the Army Medical Command, worn by those serving at most hospitals, and its place on my left arm designates this as the command under which I currently serve.

My husband, my kids, and I step outside; on this September morning in San Antonio, it is already 88 degrees Fahrenheit. We then load into 2 cars, one headed directly to the hospital and the other stopping at a nursery school with the 2 boys before heading to the same hospital. My husband and I take turns with the kids depending on which one of us needs an earlier start to the workday. I exit the highway and turn onto a road leading up to a large gate with multiple lanes. At each lane is a guard checking identification. I wait my turn to enter the gate and then drive to the parking garage.

I park and then put on my camouflage patrol cap, also known as my cover. I walk through the parking garage and over a walking bridge. As I walk, active duty personnel of junior ranks walking in the opposite direction will render a salute as a gesture of recognition that we are both proud members of the US Military. I, in turn, will render a salute to senior officers— lieutenant colonels and colonels, mostly.

Once I enter the building and remove my cover, I become more of a doctor than a soldier. Nonetheless, within the hospital many of the personnel are wearing military uniforms.

I ascend the stairs to the third floor and walk down the hallway and through a door that unlocks when I swipe my badge over the detector. I walk down another hallway that contains almost all of the personal offices of both staff and fellows. The first staff office on the right is locked and will remain that way until its occupant returns from Afghanistan in January.

This morning, we have academic lectures, and I am hosting a journal club meeting. All of the fellows and staff are likely to attend. Everyone is wearing either an Army or an Air Force uniform except 1 senior staff member in a suit who spent 21 years in the Air Force before retiring and taking a job here, where he continues to be an excellent teacher and mentor.

Afterward, I head to the block of exam rooms to begin my half day of clinic. This morning’s clinic contains a new patient with suspected polycythemia vera and 4 follow-up patients: 2 retired soldiers’ wives with histories of breast cancer now taking aromatase inhibitors, 1 Air Force sergeant with Hodgkin’s lymphoma who completed ABVD chemotherapy 6 months ago, and 1 Army captain with a glioblastoma multiforme here for a toxicity check and to pick up the next 28 days of his adjuvant temozolamide. After clinic, I head back to the office that I share with a first-year fellow. She is currently on her first ward rotation and is busy writing notes and orders for the inpatients 2 floors above us. When she was an intern at this hospital, I was in my second year as a staff physician. I am now one of 2 third-year fellows. I sit down and log onto my secure computer and finish entering some of my notes. From across the narrow hallway, one of the second year fellows sitting at his desk asks, “Have you gotten food?” I reply that I haven’t and log off my computer and walk out of my office. A few other fellows join us in the hallway from their adjacent offices and we go downstairs to buy lunch.

Today is Tuesday and there is a bone marrow transplant lecture in the conference room on the fifth floor BMT/inpatient oncology ward. One of our 5 transplant staff gives us a lecture on infectious complications of bone marrow transplant. At 1 pm, I walk back downstairs and read my e-mails, including one from the pathology resident stating that we are meeting at 2 pm. I am currently on a hematopathology rotation where I sit down with the hematopathology staff and resident and go over this week’s cases. I finish my notes and work on some chemotherapy orders. At 2 pm, I walk out of our clinic and head to the middle of the hospital and walk up a flight of stairs to the labyrinth of hallways that makes up the pathology department. I briefly stop at my husband’s office to say hello before walking over to the conference room. At about 4 pm, I return to my office. I spend the rest of the workday answering patients’ telephone messages, preparing to present a patient case at a thoracic tumor board meeting on Thursday, and reviewing a few charts for a research project I’m working on.

After work, I drive through the light San Antonio work traffic to the daycare and pick up my kids. It is easily one of the best moments of my day, as it is for most working mothers, when my boys excitedly run up to me, throwing their arms around my waist. We drive home to one of the quaint neighborhoods just north of downtown where the houses are older and each one is filled with character.

I change into a T-shirt and yoga pants and simultaneously play Ninja Turtles with one boy and play trains with the other. My husband arrives a half an hour later with sandwiches from Jimmy John’s and we all eat in the dining room together. After dinner, we wrangle the kids out of their clothes and into pajamas. I sit on the couch and read books to them. I then get them to brush their teeth and coax them into their beds in the room they share. I say goodnight, and then my husband comes in to read them the poem “The Highwayman” by Alfred Noyes.

A few minutes later, my husband emerges from their room and joins me on the couch where I am on my computer checking out houses for rent in El Paso, Texas, a place we may be moving to when I finish my fellowship.

At about 7:30 pm, I head out to the detached garage where I will do sit-ups and push-ups and run on the treadmill as part of my constant preparation for a mandatory biannual physical fitness test. At around 8:30 pm I come back inside, shower, and dress for bed. At about 8:45 pm, I return to the detached garage carrying my computer and ascend the stairs to my study room above the garage. I study until about 10 pm and then return to the house. I spend about 5 minutes planning what to cook for dinner tomorrow and then my husband and I spend some time together watching an episode of a sitcom on Netflix before going to bed.

My days as a military hematology and oncology fellow are very similar to those of my civilian colleagues. I attend lectures, see patients in clinic, spend a month at a time on the various oncology training rotations, work on research, and care for a family. The main difference is that every day occurs against the backdrop of the military. I never need to worry about what to wear. After 2 pregnancies, I am in excellent physical shape from training to pass my physical fitness test. I am guaranteed a job after I graduate from my fellowship in June. Those I train with and those who train me will all continue to be my colleagues given that the military hires 100% of its graduates. Although I will not be deployed abroad during training, once I graduate, there is always the possibility that I will once again be given orders to tend to the medical needs of soldiers in a remote environment. Overall, I am proud of my job and the opportunity to serve my country.

*The ranks and genders of any patients mentioned above have been changed to respect their privacy.

The views expressed herein are those of the author and do not reflect the official policy or position of Brooke Army Medical Center, the US Army Medical Department, the US Army Office of the Surgeon General, the Department of the Army and Department of Defense, or the US Government.