(Never) A Typical Day in the Life of a Pediatric Hematologist/Oncologist

It seems the older I get, the more frequently high school students, undergraduates, medical students, or residents drop by my office to talk about career choices, inquire about shadowing, or request an interview for a school project. “Tell me about your typical day,” they’ll ask. That is a challenging question to answer, because there is no such thing as a typical day. That response usually leaves my questioner a bit frustrated. I go on to explain, however, that my inability to answer is part of the beauty of this remarkable field. For example, as I write this article, I am on an Ethiopian Airlines flight to Addis Ababa to participate in a multicountry initiative to bring pediatric oncology care to the children of Ethiopia. Just 10 years ago, I never in my wildest dreams would have imagined that such a mission would be part of my pediatric hematology/ oncology duties. So, a typical day? I don’t believe that exists, because our days are punctuated by the unexpected and our field is so diverse that we often change what we do over the course of our careers. Time alters us and our field.

Expect the Unexpected

There is no typical day because we live in an ever-morphing world. We counsel our patients to expect the unexpected, but we would be wise to tell ourselves the very same thing. Many is the day I have looked forward to quiet time in the office so that I can catch up and clear my head, but then my pager will sound and the emergency room will call. “Dave, we have a 4 year old down here with headaches and vomiting, and the head CT scan does not look good. Help!” Or a worried parent will call to talk about her 10-yearold daughter, who just finished treatment for acute lymphoblastic leukemia and now has a little knot behind her left ear. Or there is a sad meeting with a bereaved parent who just needs to talk. Or, on a more cheerful note, a chance encounter with a bushy-haired, lanky teen—a 10-year survivor of Ewing sarcoma whom you would never in a million years recognize if he didn’t have his parents with him. So, seldom is the “quiet” day quiet.

A typical day does not exist because even when things go as planned, there is so much variety in the things we do. On Monday and Tuesday I might attend on the inpatient clinic service; Wednesday might find me devoted to administration and teaching; and on Thursday and Friday I may be focused on research. Even within each day there is further variability. One patient may be here for routine follow-up for sickle cell anemia, whereas the next is a 13-year-old boy with a white blood cell count of 100,000 and an enlarged spleen. A clinical research day may run the gamut from enrolling a child in a study to filling out endless Serious Adverse Event (SAE) Report forms to conference calls on how to conduct a particular clinical trial.

A typical day does not exist because as the years go by our careers flow in different, unexpected directions, and what was typical for us 10 years ago may bear little resemblance to what is typical for us now. In my own career, 20 years ago, my days were spent juggling test tubes in the lab with time in half-day clinics that morphed into 3/4-day clinics that morphed into full-day clinics—not to mention long stretches of wearying time in the inpatient trenches. Twenty years later, I am a very happy clinician who spends most of his clinical time caring for children with brain tumors, running a pediatric palliative care program, administering a fellowship, and delving into international pediatric hematology/ oncology.

Then and Now

A typical day does not exist because not only do we change as we grow older (or shall I say, more mature ), but the times change as well. Twenty years ago, a desktop computer with Internet access was as far from standard issue as a landline is for a college student today. My typical day included very little time at the computer, because there just weren’t that many computers. Besides, there was not that much in the way of online medical information to click and scroll through, even when I had this novelty at my fingertips. So, a typical day 20 years ago in the Webless era included playing phone tag to reach referring physicians and experts in the field, calling labs for results, and reading through piles of hard-copy lab reports. Now that typical day includes many hours at the laptop, desperately trying to keep up with e-mails and trying to keep my cool in a vain attempt to decipher the bewildering electronic medical record system. Twenty years ago, a typical day might include an occasional tiff with an insurance company, whereas now our days are filled with skirmishes over prior authorizations and battles over covering the medications we know our patients need. Twenty years ago, we gave little thought to how much revenue our care and our notes would bring in. Now our typical days are filled with careful scrutiny of what we write, not just for the purposes of medical care but for the need to bill commensurate with what we document.

So, in a nutshell, there is no typical day. And I for one would not have it any other way. I love the stimulation that the unexpected brings. I love the different sorts of gratification I get from a day spent teaching, in clinic, or on service. And I love the fact that nothing is static—that we change and the times change.

That said, there can and should be constants in our careers and in this field from day to day and from year to year. Overall, my passion for the field and the privilege of being a part of it is unwavering. I believe that is a thread that connects each day and represents what is typical in the world of pediatric hematology/ oncology—not just from day to day and year to year, but from generation to generation. And perhaps the most important constant of all—at the core of all we do—is sitting at the bedside of the child with cancer and his/her family, stripped of time, technology, and the trappings of the modern era. May that relationship with child and family, and that perilous trip with them from diagnosis down whatever road it may take us, forever be a part of our typical or atypical day.