There is no such thing as a typical day for a breast surgical oncologist. Every day is different because each patient is unique—with her own disease, beliefs, fears, and hopes. Each patient has her own story.

It’s easy for us to become overwhelmed by the complexities of caring for our patients. Working every day with women who have cancer can be a challenge, but also a non-negligible privilege. Since I began my breast surgical oncology fellowship, many of my friends and relatives have questioned my abilities to handle the various associated roles and responsibilities. Many of them told me that they would never have the strength and would be too affected to pursue this type of medical practice. It is true that surgical oncology is not an easy profession. It is a tremendously demanding job that often makes one feel as though they are on an emotional roller coaster; but on the other hand, it is a job that is life-changing and abundantly rewarding.

How do we cope with the pressures we face daily at work? How do we help our patients through this journey they have been thrown into unwillingly? Throughout residency and thus far in fellowship, I’ve had opportunities to learn how to manage so many different roles from incredible staff members and my patients.

Courage is defined as the choice and willingness to confront fear, pain, danger, or uncertainty. Courage sits in your clinic every day. It resides in the lovely lady you are faced with telling that she will have to receive chemotherapy and thus lose all of her hair. It lives in the young mother, who, while you are explaining to her the uncertainties of her future, smiles back and tells you she will do everything possible to achieve cure. Or in this sweet lady with hair white as snow who is learning that she will have to be put to sleep and have her left breast removed. Our patients are great examples of courage, determination, and perseverance. They are strong fighters, ready to give all they have in the battle against their cancer. Yes, it is sometimes really hard to see your patients suffering or not doing well, but we also use treatments that help lead to cure in many patients.

During residency, I had the opportunity to pursue elective rotations at some of the best cancer centers in Canada. I met one of the most inspiring surgeons I have encountered thus far at one of these centers. On top of all of the medical knowledge he provided, he taught me some of the most powerful life lessons so far in my career.

Oncology is always evolving, with new concepts and new data frequently emerging. For this reason, patient care has to be adaptable to the new information. Our job necessitates a constant learning process, where we must incorporate the most recent studies and developments into the day-to-day care we provide. It requires passion and the ability to think outside the box, always in the best interest of our patients.

I will never forget the discussion we had on day 1 in the ward after leaving the room of a patient with a peritoneal carcinomatosis. “Give them hope.’’ Despite the stress and demands of our job, I have learned an important key to success: “Always put your heart to the patients you are taking care of.” And always instill hope in them. Facing cancer brings misunderstandings and can lead patients to feel helpless. Remind them that there are better days coming. If we lose hope, they lose hope, and then we all lose the battle.

We are very lucky to play our parts in our patients’ treatments. Let us not underestimate this. When you have a 53-year-old patient entering the operating room for her mastectomy and you realize she is frightened by the unknown, hold her hand silently because she needs comfort. Give her hope. When your 43-year-old metastatic patient, who has 3 young children at home, comes to you with disease progression, be courageous and transparent to her because that is what she wants and needs. Give her hope and remind her that you and the team are there to take care of her. She needs support, and this is where your multidisciplinary team comes in. Always remind your patient that she is not alone and yourself that you are not alone in taking care of her. Help your patient and her family to face the illness. Relieve their suffering, and listen to them. And when your lovely 65-year-old patient comes into your office for her follow-up 5 years after the completion of her surgery and chemotherapy, celebrate with her that she is disease-free. She has hope.

Unfortunately, doctors and medicine have limits. When those limits are reached, we feel like we have failed. We feel powerless and useless. Discussing those feelings of failure is often taboo in the medical profession. If we experience these feelings, we have to remind ourselves to seek help and advice, however. Talking to a colleague or our family is important.

Being a breast surgical oncology fellow offers me the privilege to help so many women. Treating patients every day has helped me realize how fragile and precious life is. One out of every 9 women will have breast cancer; breast cancer affects all women, young and old, rich and poor. Our physical health cannot be taken for granted, so let’s embrace life!

I may be helping women to change the course of their disease daily, but at the end of the day, the one who has changed the most is me.

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There is no such thing as a typical day for a breast surgical oncologist.

Dominique LeBlanc, MD

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