Opinion: How my cancer diagnosis changed the way I train physicians

When I teach the structure of cancer to first-year medical students, I go well beyond the causes and mechanisms of the disease. Medicine has changed since my own siloed training in pathology. Now many medical schools leap into humanism. In addition to learning about pathophysiology, cancer genetics, bloodwork, scans, and symptoms, students where I work meet a cancer patient, the patient’s family, and oncologist. They come to understand the decisions, treatments, and emotions that followed a difficult diagnosis and prognosis. The patient they learn about is me. The tumors, test results, and treatments I present? Mine. I don’t want to lose a single opportunity to make medicine very, very real for the next generation of physicians. They deserve medical training where there is a real person behind every scientific concept, and so do their future patients. Every biopsy result or slide is just a slice (sometimes literally) of a person just like me. In 2017, I was diagnosed with thymic cancer. Thymic cancer is both rare and aggressive, accounting for less than 1% of all cancer diagnoses and about 0.2% to 1.5% of all malignancies. I’m currently in treatment after a recurrence. I’ve been an intriguing, nine-year case study, almost from the moment of diagnosis. “Almost,” because I was diagnosed with a mass on a Thursday, had a biopsy on Friday, and received my diagnosis from a pathology lab on Saturday. Stunned silence filled those three days. I simply … stopped talking. I withdrew. On Monday, my wife and a friend took me to see the oncologist, who asked questions that I wouldn’t or couldn’t answer. They filled in the blanks for me as I sat, not communicating. Exasperated with my silence, my oncologist abruptly said, “David, come with me.” She took me from the office, alone, and brought me into an examining room. She asked me a few more questions that I didn’t answer. “I have cancer,” she said. “So don’t think for one second that that I don’t know how you’re feeling right now.” My catatonic state fell away, and I was able to communicate again within minutes. Something like hope crept toward me when my oncologist was vulnerable about her own health. She was not obligated to be so open, but her humility unlocked me. It allowed purpose to come into focus. From that moment, it became a no-brainer to present my own journey to medical students. But now I’d also found a co-teacher who watched me go from despondent and nonresponsive, to accepting what became a nine-year (so far) quest for understanding and healing. I, too, was not required to share my own case, but I felt doing so in class might offer future doctors a deeper level of understanding. I saw no reason for physicians-in-training to wait till residency to understand how anxious patients can become when a test is ordered or additional bloodwork is drawn, or to hear what it’s like to wait with family for results or insurance clearance. That’s why, once I’ve discussed the foundational concepts of cancer, I show students my biopsy slide, the stain used to determine the origin of the cancer I have, and my X-rays, CT scan, and MRI and PET scans. I let silence set in as the class digests the information, before I take questions that range from the diagnostic to the emotional. Two weeks later, my oncologist joins us to discuss our feelings and approach. Students’ response to this approach has been full of gratitude, curiosity, respect, and a yearning for growth professionally and personally. They’re beginning to understand the medical concepts they need to memorize as well as the very personal impact they’ll have on their own patients someday. Sharing my health challenges has been one of the most fulfilling and full-circle choices I’ve made: Students who have learned from me rotate through my oncologist’s practice, and several are my current physicians. Sidestepping an opportunity like that would have been walking past a door God had opened. Even if I don’t understand my circumstances every day, and I don’t, I accept that I’m in God’s hands. I have faith in today’s doctors-in-training, too, and feel a unique responsibility to them and the generations of patients they’ll treat throughout their careers. What I want for today’s medical students is what I hope we all seek in our doctors: to become learned and wise, to grow into compassionate educators who ensure patients understand every medical challenge as they face it and choice before they make it. One unchanged fact about the field of medicine is that practitioners need to embrace lifelong learning, whether it’s a robotic surgical technique, artificial intelligence, a new virus, or knowing when to sit with a grief-stricken patient. In those moments, we physicians draw on all our capacity to be present, and to employ fundamentally human and uniquely godly compassion. I’ve been fortunate to create a blueprint from what God has handed me, remembering as I undergo treatment that I can keep working with excellence and empathy to hopefully shape medical students’ perspectives. I hope they come to understand the value in showing up for patients and colleagues, even when life feels out of control and explanations for circumstances seem inadequate. If my experience helps future physicians care for generations of patients with deep knowledge and compassion, I’ll take it as a victory for both humanity and holiness. David Elkowitz, D.O., is a professor of pathology and laboratory medicine and science education at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. He also serves as the school’s associate dean for academic programs and educational culture and as director of the Academy of Medical Educators.