I was attracted to the field by the scientific challenge of cancer medicine. During my medical school years, I felt that the biology of cancer was fascinating; new therapies were desperately needed. I thought, perhaps I would have an opportunity to contribute in the development of one. There was always, and still is, a sense of optimism about the future and our abilities to cure many patients and to transform cancer into a manageable chronic illness.

Another important reason for me to specialize in oncology was its formal embracing of evidence-based medicine as the most important guiding principle in decision making for cancer patients. This is extremely important to protect patients from the excesses of anecdotal and alternative medicine.

Lastly, but not the least, there was also the voice of compassion to provide comfort to my patients. Cancer patients are an exceptional group. This profession provides the opportunity to care for people during times of heightened vulnerability, when doctoring is often at its finest. After all, as physicians, we cannot limit our practice to well-patient checks; somebody needs to take care of the sick people with life-threatening disease.

These themes form the basis of my choice of oncology as a career.

Cancer patients depend on their oncologists for information, guidance and support. As an oncologist, I spent many years mastering the many nuances of chemotherapy and the management of all associated toxicities, gaining confidence and comfort in dealing with treatment protocols and adverse effects.

Concurrently, I learned to explain difficult concepts, such as risks and benefits of treatment to patients, the importance of enrolling patients in investigational studies, discussion of alternative medicine and how to frame all of these with the appropriate use of statistics and evidence-based medicine in terms of tumor shrinkage and life expectancy for every individual patient.

However, knowing the most effective drug regimen for leukemia, breast cancer or any cancer for that matter is not enough to meet the emotional, psychological and spiritual needs of my patients nor assist them in adapting and choosing a treatment option. It has always been easier, and certainly more straightforward, to describe the next regimen and its adverse effects than to address the big picture, negotiate the goals of care, discuss death and end-of-life care preferences.

My patients often find themselves forced to make decisions in the midst of an overwhelming fear after a diagnosis of "cancer." They may feel willing to go through any treatment in the hope of avoiding and delaying uncertainty, chaos or death. Sometimes the emotional and psychological challenges of not being treated outweigh any conceivable physical morbidity. I have discovered that addressing the emotional issues that may cloud the process first is very helpful in allowing me to support the patient and the family, thereby facilitating their ability to progress from a position of despair to one of acceptance.

I have also learned that my patients cannot live without hope. Expectation that something good will happen in the future is the hope. This is different from wishing. It is not an escape from reality but, in a way, engaging with reality, in which there is an expectation that goals can be achieved.

The object of hope can and, at times, does change. My patients frequently move between hoping it isn't true, to hoping it can be cured, to hoping it can be put into remission, to hoping it won't grow too fast, to hoping it won't hurt, to hoping to put things in order, to hoping not to be a burden, to hoping for a good death, to hoping their families will prosper without them. Thus, while hopefulness remains, the objects of hope often change.

As an oncologist, I try to play an important role in sustaining and directing that hope. Knowing what is important to my patients, what they treasure and think is worth fighting for and how they wish to be remembered helps guide our dialogue during our clinical encounters.

To be able to provide a therapeutic presence, I need to give not just a technical opinion but also give of myself, and often this is not so easy. If I get too close to my patients and allow myself to become emotionally entangled in their suffering, every new cancer diagnosis, cancer recurrence or death feels like it is happening to a family member, paralyzing me in grief. If I attempt to preserve myself by not allowing my patients' agony to hurt me at all, then I feel abandoned by the voice needed to give comfort to my patients.

Coming to terms with the limitations of current treatments and our current medical technology's failure to salvage and rescue every patient from death can be both difficult and painful. The hopes, expectations and sometimes denial of patients and families may be a heavy cross to bear.

Fortunately, there is constant progress in our understanding and dealing with cancer. New, less toxic and more effective treatments are coming through the clinical trials and research every day. We can cure or obtain a long-term remission in many cancers by early detection. We can cure some cancers with aggressive therapies. We can turn a good number of cancers into a chronic illness.

Cancer patients are the admirable group of heroes and heroines with a lot of strength, determination, resilience and hope. The most rewarding part of my job is to see many of my patients thriving and living full lives as cancer survivors after having been through all sorts of treatments. It gives me the courage, strength and energy to keep on doing what I do every day.

Despite the altruism of oncologists, the progress of science and the requests of patients, miracles are not as many as I wish, though cheerfully accepted. Unfortunately, sometimes the disease wins. On these occasions, regardless of how the disease unfolds, my cancer team and I at St. Francis Medical Center stand with our patients in this confrontation. We assure them that we will not abandon them nor be indifferent to their outcome. We will do our best to make sure that, at the end, at least their pain is treated aggressively, and all of us at St. Francis Cancer Center as a team will keep their dignity as our first priority. This takes us beyond solidarity and enables us to see ourselves in the suffering of others.

For me, each encounter with a patient shapes not only the patient's reality but also mine. I shape and am shaped by events, and this constant molding defines me not just as a doctor but also as a person. Daily confrontation with transcendence, suffering, uncertainty and mortality occasionally creates moments of epiphany that help me redefine my values and my purpose. I question my strength, my values, my motivation and my reserve. Accepting my abilities and limitations brings healing and an opportunity for personal growth.

Including my oncology training years, I have been in the trenches battling cancer every day for 16 years now. This unique experience has taught me that beyond empathy lies engagement, that the road to self-awareness is bumpy and admits no return traffic and that my patients are my best teachers.