Medical school keeps expanding my horizons. I thought “leukemia” and “lymphoma” were two separate and complete diagnoses. I was wrong of course. If there is one thing I’ll take away from Hematology/ Oncology or “Heme/ Onc,” it is that there are more than 30 different types of these cancers, lymphomas and leukemias overlap, and there are many more types of chemotherapy drugs than cancers (and there are even more drugs to combat the side-effects of the chemotherapy drugs).
One of my cousins had lymphoma in 2008, and I now wish I had asked what type of lymphoma she had and which drugs she took. In any case, my final exam (75% about blood cancers and treatments, and 25% about blood disorders such as bleeding diseases) is coming up, so naturally this is the main thing on my mind right now.
Throughout my time in medical school, my husband generously agrees to flip through my note-cards to help me study. Recently I’ve noticed these study dates require deciphering of my own abbreviations, and subsequently long explanations. No wonder he’s starting to get bored out of his mind.
A sample dialogue as my husband reads my notecards:
Him: “Doxo-roob-eye-sin and Dawn-o-roob-eye-sin. It says M-O-A and S-E.”
I answer: “Ok, Doxorubicin and Daunorubicin. MOA is Mechanism of Action. Those are alkylating agents, a type of chemo. They basically lock the DNA in place so it can’t replicate, and it works during all the cell cycles. They also inhibit topoisomerase 2. Daunorubicin is better for liquid tumors and doxo is better for solids. You know how I remember that? Because Dawn is a liquid soap! Let’s see…the side effects are reduced bone marrow, and color-changing urine. Oh! And they are cardiotoxic… I HAVE to remember that! Ok, I think that’s all I need to know. Anything else on there?”
My husband: “Yeah, it says ‘intercalcalate DNA’ and ‘S-E down arrow cytopenias, alopecia and vein leakage.”
Me: “Ok, well ‘intercalcalating DNA’ is basically what I said before- it’s locking the DNA together, and cytopenias- that’s what I meant by ‘lowered bone marrow.’ Alopecia/ baldness, and vein leakage- alright.”
My husband: “Myelo-proliferative disorders- Chronic Myeloid disorders. CML, CNL, CEL, PV, ET, PM.”
Me: “Those are all chronic blood cancers. That means the cancer cells are mature, and all those letters stand for different types. CML is neutrophils, CNL is also neutrophils, CEL is eosinophils, PV is red blood cells (that’s not really intuitive), ET is platelets, and PM is cartilage- that one is pretty weird because cartilage isn’t really a blood cell in my book. If I had to pick one of those for us to have, I would pick ET, and the worst one is PM-primary myelofibrosis because basically we’d die pretty quickly.”
*Horrified look on my husbands face* ”Ok, that’s more than what you had on the card. You mean all those things are in blood?”
Me: “Oh yeah, there is tons of stuff in blood. Red blood cells, immune cells, clotting factors.”
At this point we get into a conversation about blood products, and my husband would like to know why they can’t just make sprays of clotting factors that you could use when you had a big cut. Interesting idea, but I don’t think it would work. Why not? Another long explanation.
Anyways, you can see how this memorization starts to feel kind of boring for my husband after you repeat it for fifty cards. By the time we get towards the end, he yawns and sighs and is so thrilled to hand the stack back to me. I see that my horizons are expanding beyond the normal realm of knowledge, and definitely off into another planet with its own language (medical terminology), abbreviations (SE is side effects naturally, and BM is bone marrow or bowel movement depending on the context), and its own values of what is fascinating (like the details of the clotting cascade and different types of blood cancers).
Posted by Liz 
