Childhood Cancer Awareness Month: Reflections of a pediatric oncologist
By Tamara Chang, MD
As a pediatric hematologist/oncologist, I’m often asked, “How do you do your job? How can you handle children dying from cancer? It has to be so hard. I can’t imagine what you do.”
I’ve asked myself those same questions countless times throughout my training, as a pediatric hematology/oncology fellow at St. Jude Children’s Research Hospital, as a solid tumor attending physician at St. Jude, and in the years afterward as a pediatric hematology/oncology physician at Mary Bridge Children’s Hospital, where I currently practice.
How do we do what we do as pediatric oncology providers? Why are we so drawn to this work, and what sustains us, even when we lose young people — infants, children and teenagers — who haven’t even begun their own lives, rather whose lives are cut unfairly and cruelly short?
Speak with any of us who do this work, day in and day out, and you will discover a common, deep sense of meaning and calling as we talk about what this work means to us. You will find that yes, there is profound sadness, but also tremendous and overflowing joy and love in what we do each day.
Sacredness of practicing pediatric oncology
I first fell in love with oncology as a third-year medical student during my internal medicine rotation, shadowing a hospice nurse on home visits to patients with end stage cancer. I found a deep sense of sacredness in those visits. It was a privilege to witness the special moments between hospice nurse, patient and family members.
Later, I fell in love with pediatric oncology as a fourth-year medical student on a rotation with a pediatric neurooncologist. There was something special about the interactions I witnessed between the neurooncologist and a mother as she held her little girl with a brain tumor on her lap. I knew at that moment, that this was what I needed to do.
This is how I wanted to serve
I spent the next several years completing my training as an internal medicine/pediatrics resident, then as a pediatric hematology/oncology fellow. I discovered a love of not only caring for on-therapy patients, but also pediatric cancer survivors, and creating a space to help survivors thrive in their lives after cancer. I discovered the tremendous power of cancer camp, where kids and families are empowered to recognize their own strength, and where kids whose lives have been interrupted by cancer treatment are able to just be kids. I’ve volunteered as a cancer camp doc each summer for over a decade now, and nothing brings me more joy than seeing kids, parents and siblings climb up a rock wall, scream and laugh down a zip line, and let loose on the dance floor with joy and abandon they thought could never be possible again.
Prior to the pandemic, one of my favorite things about our Mary Bridge Children’s pediatric hematology/oncology clinic was our play area in the center of our clinic. Rather than hiding in their rooms, kids receiving their chemo infusions, as well as their siblings and parents, would congregate in our play area, making arts and crafts with our awesome volunteers, playing board games, petting Olaf our facility dog, building block towers, racing Hot Wheels cars, having tea parties, and yes, playing non-stop with our minion fart-blaster. Our clinic was a symphony of the sounds of kids of all ages, and of us physicians, nurses and staff, laughing and playing together. I can’t wait for the day when we can play together in our clinic again.
Managing hard days and patient loss
As pediatric oncologists, we remember every single infant, child and teen we have lost. And their families. I’m often asked, “How do you do it? How do you stay sane and take care of yourself when you are such a large part of these families’ lives? How do you manage when you have to sit with parents and tell them there is nothing more you can do to cure their child’s cancer?”
I have come to learn so much in the years since I started caring for pediatric oncology patients. While I am 43 years old and still early in my career by medicine standards, I feel I have witnessed a lifetime of loss, grief and sorrow in my career already. Nothing rips me apart inside more than having to tell a parent their child will die. And yet, it is in these difficult moments with children and parents, that I know I am at my best as a physician and as a human being — when I am most deeply aligned with what first drew me to this work 20 years ago.
Putting my own oxygen mask on first
I have learned that to continue to do this work, we must care for ourselves first. I have to give myself the grace and the space to do the things that replenish and recharge me. I must ensure that I am taking care of myself the way I long for everyone around me to take care of themselves: taking care of my health, exercising regularly, eating healthy food, sleeping well, spending time in nature and with those who are most important to me, connecting with friends, playing the piano, and meditating each day. I have to put my own oxygen mask on first, so that I can show up as the pediatric oncologist, physician, colleague, friend, wife and human being I want to be.
I am so deeply passionate about helping and empowering other fellow providers to care for themselves, that I now split my time between my work as a pediatric hematologist/oncologist at Mary Bridge and as medical director of provider wellness for MultiCare Health System. In addition to my work with cancer patients, I get to help create programs for providers across our system to promote a culture of wellness, so that they can show up as the providers and human beings they want to be and are capable of being.
What helps me most as a pediatric oncologist to continue to do this work, is that I am an optimist at my core — I have a deep hope and empathy that permeates my interactions and relationships with children and families, and that hope and optimism does not end when there is no treatment left to offer.
One of my favorite essays is by Dr. Chris Adrian, a writer who wrote about his experience as a pediatric oncology fellow.
In his essay “The Question” he wrote, “I can return to work every day because sometimes all we have to offer is radiation and kindness. Anyone can, and most everyone does, recognize the suffering of children with cancer and of their families. But who among a world of witnesses gets to care for them? And then aren’t we the lucky ones, we who are always generating awkwardness and bringing people down at cocktail parties, we pediatric oncologists, but really, we physicians, or we anybody whose profession puts us in the way of other people’s pain?”
His words bring me peace, each and every time. And I know that I can keeping going — and keep doing this work again and again.
Dr. Chang joined Mary Bridge Children’s Hospital in 2015 as a pediatric hematologist/oncologist. She is passionate about wellness for her patients and their families, as well as her fellow clinicians. She leads provider wellness programs at MultiCare Health System and empowers female physicians through her coaching work as co-founder of Pink Coat, MD.
Mary Bridge Children’s offers comprehensive care for children facing all types of cancer. We offer the latest in technological and medical advances, including clinical trials, to help kids beat cancer and live happy, healthy lives. Learn more about Mary Bridge Children’s hematology and oncology services.
Follow along this September as we celebrate, honor and remember Mary Bridge Children’s patients who’ve bravely fought childhood cancer.
This blog was originally published in 2021 and was updated in 2024.