I am writing this as a recently matched postgraduate year 3 internal medicine resident about to start a hematology-oncology fellowship in T minus 3 months. I hope my musings are relatable to rising fellows or reminiscent to those who felt similarly at the start of their hematologyoncology training.

As I look back, the hematology—oncology fellowship interview trail was both exhausting and exhilarating. Meeting future colleagues and hearing about the exciting advancements that medical oncology will see in the coming years gave me a sense of pride for my chosen field. I felt as if I was joining a movement that had already seen decades of momentum in research and development of novel therapeutics and care models. Needless to say, cancer therapy has changed dramatically over time. I imagined the innovations and milestones that I would see during my career and felt excited to complete internal medicine training and start my next adventure.

Soon after Match Day, my excitement was tempered by all the practical tasks ahead of me: a new state medical license, another new driver’s license, and to-do lists embedded in to-do lists. Moving across the country to a new place has punctuated every training step for me thus far. Although I enjoy exploring new cities and meeting people, it has been difficult to move away from close friends, colleagues, and the rhythm that my life had become. I also wondered about the transition to a new academic center. During residency training, you truly feel integrated in your institution, which affords familiarity with everything from where to find the stairwells to the reputations of specialists and other trainees to the culture of the place. Here I have learned how to get work done effectively and efficiently. I can only hope that I quickly establish the same familiarity at my new institution.

The Full Fellowship Experience Involves Doubts, Fears, and Understanding

Ahead of all the practicalities of moving and adjusting, I know that my new role as a hematology—oncology fellow will be the most formidable and satisfying challenge to overcome. My class of fellows and I will have to quickly rise to higher expectations for specialized knowledge and polished skills, a situation that feels reminiscent, yet more complicated, than in my early intern years. Today, I may ask for clinical advice from a fellow whose role I will be filling in a few short months. How strange and intimidating! But I remember how neat it was to transform into an autonomous, confident resident during intern year, and I can only imagine that this next transformation will be even more rewarding. This is the time when I will finally be doing what I wanted to do at the start of this journey. This time will likely shape my career trajectory more than any other segment of my training. As monstrous as it all seems, soon enough I will be reflecting on how quickly fellowship has passed as I look ahead to another transition.

I am writing this a second-year hematology— oncology fellow about to start the journey of finding that “dream” faculty position for which many of us have trained for the past 14 years. I am sharing some of my experiences during fellowship and hoping a hungry and tired fellow somewhere will know she or he is not alone.

During the interview trail, I always heard “the learning curve is steep,” but I didn’t realize it until the first day of my oncology continuity clinic. My first patient had a pleomorphic sarcoma. After I did some reading for 5 minutes, a sense of doom invaded my body. The fear of sounding “stupid” or losing my first oncology patient’s trust was overwhelming. After a long night trying to seize some basic knowledge about sarcoma, I met with 1 of our sarcoma faculty to discuss the case. He said, “There are more than 100 types of sarcoma,” and my heart skipped a beat. He took a piece of paper and kindly explained the basics about pleomorphic sarcomas. That was the moment when I realized that I was not alone, that our faculty was there to support us. Trainees’ relationships with faculty change as you advance in training. You are no longer one of the residents—you are now one of them.

Another unforgettable moment during my fellowship was the first time one of my patients passed away. We all have encountered death during our training (eg, intensive care unit rotations), but when you care for patients during their cancer journey, you develop a strong bond with them and their families. I remember receiving a message saying that “Mr M has passed away,” and immediately an incredible sense of sorrow pervaded my day. I asked myself, “Is this the right job for me?” and I questioned my decision to pursue a career in oncology. At the end of that day, I mustered the courage to call my patient’s family to offer my condolences. His wife picked up the phone and with a warm voice said, “Dr Duma, thank you for taking care of him. You two had a special connection.” A few tears rolled down my cheek, and all the fear disappeared—I had chosen the right field. After my 2 years of training in hematology-oncology, losing patients has not gotten easier, but I will always carry their memories and will continue fighting for them through my everyday clinical practice and research.

As you start your fellowship, you may feel lonely. You started with a class of 20-plus residents, and eventually you end up with a few fellows. That friend with whom you always had rotations together is no longer around. Going through a hematology-oncology fellowship is a life-changing experience that you share with only a few individuals. Over time, you will develop strong friendships with your co-fellows. They will become your confidantes, advisers, and even the future godparents of your children. James Cash Penney, founder of the retail store JCPenney, said, “Growth is never by mere chance; it is the result of forces working together.”

Lastly, ups and downs are common. One day your patient has a complete response and another day disease progression. Learning how to celebrate little victories has helped me to cope with the battles I have lost. Fellowship training has not only helped me grow as a physician but has also helped me become a better wife, daughter, friend, and teacher. I know the journey will not end after I secure a faculty position, but my experiences have taught me a lesson: We are lifelong learners, and we are not alone during this journey.

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Candace Haddox, MD, and Narjust Duma, MD, address the uncertainty, the victories, and the defeats common in oncology fellowship programs.

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