George Sledge, Jr, MD

June 3rd, 2011

Why I became an oncologist

Editor's note: George Sledge, M.D., is president of the
American Society of Clinical Oncologists, the organization of
Americas cancer doctors, whose annual meeting begins today.
Treating cancer can be an extraordinarily difficult field, guiding
patients on a roller coaster ride of fear, pain and sometimes true
exhilaration. Dr. Sledge shares the story of the patient who made
him decide to become an oncologist.

Cancer doctors tend to get to their profession in one of three

ways. Some are drawn in through their love of cancer science.
Cancer has always been something like a cobra to those who
study it: dangerous and beautiful and endlessly fascinating.
Cancer is a universe. One can spend an entire life exploring it
without ever getting bored, for the biology of cancer is the
biology of life.
Some doctors are inspired by a great teacher. Medicine is still a
profession dominated by old-world apprenticeships, where a
mentors passion can be transmitted to a new generation. I have

known several oncologists whose careers turned on chance

encounters with inspiring professors.
Others get there by way of their patients. Im one of these. When
I was a resident, cancer patients were the ones who touched my
heart. In fact, I can remember the very moment I started my
path to becoming an oncologist.

I was an intern at St. Louis University, a brand-new doctor, with

my white coat still fresh and creased, when I first met Carmelita
Steele. Carmelita was in her early twenties, married, with (as I
recall) two young children. She came to our hospital as a transfer
in the middle of the night. She had undergone a routine dental
procedure, and after her surgery had first oozed, and then
gushed blood. By the time she got to us she was severely
anemic, and had a low platelet count. There was a very real
concern in those first few hours that she would bleed to death.
We worked through the night stabilizing her. Her veins were hard
to accessthey had all been used up during her time at the other
hospital. In those days (the late 1970's) we lacked modern
venous access devices, and I remember it taking a frighteningly
long time establishing an intravenous line. Through it all I spoke
to Carmie, who was a cheerful if appropriately anxious African-

American woman, somewhat overweight, proud of her children

and her loving family. We poured several units of blood into her
that night, bringing her back from the brink.
We spent the next couple of days establishing a diagnosis. She
had Acute Myelogenous Leukemia, then as now a dangerous
disease requiring toxic chemotherapy to clear the blood and
bone marrow of treacherous cells. I learned the diagnosis shortly
after morning rounds. Her staff doctor, an elderly hematologist
(or so he seemed then, though I am now about his age) would, I
discovered, be off campus until the following morning. I knew
that Carmie and her family were desperate for news, so I phoned
the staff physician and asked if it was OK for me to speak to her.
He agreed.
I had never told a patient that he or she had cancer before. I sat
on the edge of her bed and told her that she had a type of
leukemia, that it was very dangerous but that it was potentially
curable with chemotherapy. I told her that we would be starting
treatment the following morning, as soon as her staff physician
had a chance to go over the drug regimen with her.
Carmelita had sat quietly while I spoke, a sad look on her face.
When I was through she said, almost in a whisper, "Doctor
Sledge, who will take care of my children?"

It was the last thing I was expecting, and it was thoroughly

devastating. I did not know how to answer. Today I hope I would
do better, but at the time I was in my mid-twenties, just a few
years older than Carmie, and I did not know how to answer that
question. I stammered something, barely maintaining my
composure, and then left her room and hid in a stairwell for a
half an hour sobbing.
The next day we started her chemotherapy regimen, full of hope.
I spoke to her regularly, and to her family. Her husband, a quiet
decent man, stood by looking worried. Her mother, a medical
technician who understood leukemia, rarely left her daughter's
bedside. They were the sort of family we all should have.
For several days things went well. Then, as her blood counts
plummeted in response to the chemotherapy, she developed an
infection in the area of her intravenous line, followed by sepsis.
Her blood pressure dropped, and her breathing became rapid
and labored. She was transferred to the intensive care unit,
intubated, and treated with broad-spectrum antibiotics.
Sometime in the middle of the night, disoriented and alone, she
pulled the breathing tube out of her mouth. Though she was
quickly re-intubated, things rapidly went from bad to worse, and
she died the following day.

I went home that night in a furiously angry mood. I was supposed

to be going out with my girlfriend, but in my grief and guilt I
simply could not think straight or act civil, so I begged off. I
relived every moment of her care: what had I missed, what could
I have done differently, what foul-up had I committed that kept a
22 year-old from taking care of her young children? It is the
arrogance of interns that they believe that acute leukemia would
turn out differently if only they had gotten a little more sleep.
A few weeks later I got a call from Carmelita's mother. She
wanted to meet with me. I agreed, with real trepidation. The
wound was still too raw, and there was part of me that feared
she might hold me responsible for her daughter's passing.
But she was as gracious as I could ever have imagined. I have
three sons, all in their twenties, and if one of them died of
leukemia I do not know how I would handle it. Poorly, I suspect.
But she was dignified, pleasant and grateful. She told me that
Carmie, before she had died, had told her that, come what may,
she wanted to give me a gift to thank me for my care, and for the
hours I had spent with her. She then handed me $40 and told me
I was to spend it on something fun. Carmie had wanted it that
way.
My patients, starting with Carmelita Steele, have taught me so
much about what it means to be a good doctor and, I hope, a
5

good person. I am an oncologist because of her, and it is a job I

have loved for three decades. But Carmelita's question still
haunts me: "who will take care of my children?"
There are some debts you can never repay.