Why oncology?

I am not a writer and this is not my story but only a part of it. My answer to "Why oncology?" As I have lived my life, I have always been probed by myself and by others alike as to "why," why did I/you choose this, why did I/you do this and not that? If only I knew. This line of inquiry has been hurled at me since the time I could remember parts of my life (again raising the question of why we forget most of our life!), and if I had a rupee for every time someone asked me why I chose to be a doctor then I might have had at least some money today. Ever since I had planned to be a doctor nearly a decade and a half ago, many of my friends, family, and acquaintances have asked me the same question, and I realize that people, including myself, hope for a meaningful answer, a romantic answer, an answer that can give meaning to the question itself. The right answer adds validation and the right emotion to an otherwise bland question. I have never given much thought as to why I chose this path, and I remember telling everyone that I wanted to do some good and help people (you know the drill), but the truth is that it was just a very casual decision, there were no thoughts of altruism involved. I distinctly remember being at a dinner party after my high school exam and listening to someone speak about medical coaching classes and premedical tests, and I thought this seemed fine, thinking maybe I could do this. I followed through on that thought, and then the rest happened. No altruism involved, no evidence of an inner calling or higher purpose. It was just a high school kid trying to find something to do. But you see the problem with this answer is that it does not resonate with most people, try telling this at a party in response to the "why" and then see everyone sip on their drink with a dwindling smile. I wish there was some higher purpose, but this remains my truth. In the next ten years, I found that my spur-of-the-moment decision was a blessing, it turns out I quite enjoyed medicine. Fast-forward 10 years, I graduated and then completed postgraduation, and again came the question, what next? I decided to be a medical oncologist,1 and yet again, the stubborn "why" followed, only this time more vehement, in a dejected, almost pitiful mood. As more and more of my friends and colleagues learned about my choice, they became skeptical; mini- and impromptu interventions happened warning me of the futility of oncology, the hopelessness of it all, people telling me to "think about," telling me that "no one gets better," "no scope bro," "you will be depressed," and the likes. Curiously, these warnings did not bother me much. I went through a training where oncology was just "brushed under the rug." It was never discussed, never touched upon – apart from it being a differential diagnosis to tuberculosis, its history was never bothered with, and patients with even a suspicion of malignancy on radiology were told to go to some other hospital or to just do the "seva." So, to get a head start, I started reading about cancer because of my lack of understanding of it, and the more I read the more confused I became. I read wonderful science and words like 'cure,' 'advances,' and 'improved outcomes' were written in my books. I read public slogans stating cancer is curable, but I kept seeing patients being sent away, no word to us and to me as a student, it was strange and frustrating. I saw my seniors preparing for other specialties and out of 54 students, only 1 of us was considering oncology. I suppose cancer alienates its patients and its doctors from their peers alike. My curiosity helped me learn some of it on my own and later I found myself interested in the pursuit. I remember being the only person preparing for oncology with no clue in the world as to how. Fast-forward to another five years, and I am an oncologist now. When sometimes people ask me why oncology, I just smile and shrug. At this point, I think there are no grand revelations or absolute moments of clarity. There are only moments when you make up your mind, or you change your mind, and you follow through and get to wherever you are. I write all this not because of what I feel is unique but because, of late, I have been truly wondering why I chose oncology. Was it because of a sense of doing some good? Maybe, or is it that in my more euphoric moods as a young graduate, I might have thought of curing cancer? Perhaps yes, but these are not my only reasons. It is much simpler. See, I have always found myself rooting for the underdog, for the signed-off. I have always relished the wins of the weak. Where this sense comes from, I do not know. To me, the entire history of modern medicine is a history of underdogs who chose not to be signed off, of making the incurable curable, going from not being able to save one soul to saving millions altogether.2 Oncology is the modern representation of that century-old struggle. Patients, families and doctors have chosen to fight it, to make sense of it, to overcome it, to stick together. To an outsider, it is a scary, hopeless, joyless prospect, a lost battle, and I would be lying if I said that sometimes I have not felt the same way, but at the same time, I have seen some of the most hopeful patients, most resilient individuals and families choosing to fight despite the unpleasant writing on the wall. I have also seen doctors choosing to fight this goliath with their patients using science, humility, gentle and harsh words, and little lies to unbearable truths. I have also seen hope, joy, and laughter in cancer wards many times over. So, to answer my question, perhaps I became an oncologist to fight with the underdogs. To end things, I quote a character from a film called The Grey, "Once more into the fray. Into the last good fight, I'll ever know." Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.