Advice for new graduates from a pediatric oncologist

After graduating from medical school in Taiwan 4 decades ago, I came to the U.S. to train as a pediatrician.  By pure serendipity or perhaps divine intervention, I was accepted into the residency program at St. Jude Children's Research Hospital, which was already famous for discovering a cure for acute lymphoblastic leukemia or ALL, the most common cancer in children. But back then, even at St. Jude, only 40 percent of the patients survived this cancer. During these early years, our job was tough. Many of our patients relapsed and most died, which proved heart-breaking and served to remind us to work harder to boost cure rates. What kept us going was that we were making incremental progress even with the many setbacks. The hard work eventually paid off. Today, more than 90 percent of children with ALL can look forward to a permanent cure. So, lesson two:

Experiments in the laboratory may have to be repeated many times before a study is done. Sometimes, even when you’ve got it right, your work will be rejected by several journals before it is published, because some reviewers find the result unbelievable, or just too good to be true.

If you believe in your chosen work, I urge you not to give up in the face of rejection, but to persevere until you prevail. These reminders certainly apply to us at St. Jude. We know failure can be a constant companion. Losing even a single patient is not acceptable to us, and we also urgently need to extend cures to patients who live in low- and middle-income countries where most children with ALL still die. I certainly look forward to the day we can fulfill the dream of the late founder of St. Jude — Danny Thomas — that no child should die in the dawn of life, and that eventually we can cure all children with ALL worldwide.

Taking care of children with leukemia has taught me a lot. I admire the resilience of my patients. No matter how sick they are, they amaze me with their ability to bounce back, a trait that has taught me to be stubborn and slow to give up. I can afford to take this approach because I am blessed to be working at an institution where patients are treated with the best available approaches, regardless of their ability to pay. As a result, I have seen near-miraculous recoveries from practically incurable conditions.

I recall one patient's family who had actually given up all hope for their child. The patient needed intensive chemotherapy followed by a bone marrow transplant for the treatment of relapsed leukemia. His mother was the donor. During the intensive chemotherapy, he was found to have serious liver problems that could require a liver transplant and he lost his gallbladder. After the bone marrow transplant, he needed to have his spleen removed and developed a rare complication that left him completely paralyzed and in severe pain. He required respiratory support because he was not able to breathe on his own. Worst of all, leukemia cells reappeared in his bone marrow.

It was virtually hopeless and painful to watch him suffer. I was grasping at straws trying to find new ways to manage these complications. Fortunately, the transplanted cells from his mother had begun to grow and instilled hope that they would grow strong enough to overcome the residual leukemia, and that his organs might recover with time. Besides praying, I pleaded with his parents and persuaded them to give us some more time to deal with this crisis.

Each day was a struggle for them. I could not imagine how they felt during those three long months in the intensive care unit. Today, that patient is a happy teenager who is attending high school. So, lesson three, be patient.

There is an old Chinese saying, "盡信書, 不如無書" which means, "better to have no book than to trust it blindly." My advice is to always acquire new information with skepticism.

Much so-called conventional wisdom, whether from the book or internet, will turn out to be wrong or outdated. For example, textbooks on pediatric hematology-oncology always taught us that the brain is the sanctuary for leukemia cells because chemotherapy penetrates the blood-brain barrier poorly. As a result, for decades radiation therapy to the brain was considered the treatment of choice to eradicate leukemia cells sequestered in the brain. At St. Jude, we challenged that assumption and proved that the right combination of chemotherapy agents delivered into the spinal fluid and blood, could render brain radiation unnecessary. Consequently, it has been possible to cure thousands of children with high-risk ALL while avoiding the serious side effects of radiation. So, lesson four is:

As I look back, I realize that happiness and success in life can be elusive unless we first take care of our physical, emotional and spiritual needs, as well as our families, friends, neighbors and community. For me, the key has been to keep dreaming. I constantly think of a day when leukemia cures will be easier on the patients and their families, and will be available to all children worldwide. I also look forward to the day when we can prevent at least some types of leukemia from occurring in the first place. That’s my dream. I challenge you to find your own passion and pursue it with intensity and imagination.