By Tracy Jalbuena, MD
In 2012, life was great. I was a healthy 40-year-old and happily employed as an Emergency Physician at a community hospital on the Maine coast. Then one day, I noticed my ankles were swollen. Testing ensued. I had AL amyloidosis, followed by multiple myeloma.
The moment I learned I had amyloidosis, time slowed, my heart rate rose, my mouth went dry, and my thoughts were clouded with fear. I hyperventilated all the way home in the car that day, and nothing has been the same since. As emergency clinicians, we’ve all witnessed patients in that moment in which they understood nothing would ever be the same again, that their life had just veered off course into a frightening, unknown, and unwanted trajectory. Somehow we doctors imagine ourselves immune from such trials since we deal so often in other people’s tragedies. But of course, we are not.
Since 2012, I’ve had seven bone marrow biopsies and so many other tests and procedures, I don’t count them anymore. I’ve had an autologous stem cell transplant, and I’ve had almost two years of continuous chemotherapy. I, like most people with myeloma, will likely need to stay on some kind of chemotherapy for the rest of my life, resulting in significant immunosuppression. As a result, it’s not safe for me to tend to patients in a brick-and-mortar ED. At the same time, there has been a veritable revolution in myeloma treatment, with rapid fire approval of effective agents, including the new class of immunotherapies. Accordingly, the median survival for myeloma patients is quickly rising, especially for younger, healthier people like me. It’s possible I could live 10 more years, or even longer.
My illness has made my roles as mother and wife more focused and poignant, but it has threatened to steal my role as doctor from me. Being a doctor is not just what I do, it’s a integral part of who I am. Emergency Medicine is my calling. Cancer has brought me literally kicking and screaming in grief and anger to a crossroads where I cannot physically return to the ED. I am spinning away on an unknown, unwanted trajectory. Yet I still have much to contribute to medicine.
So, what’s an Emergency Physician to do?
A few months ago, I learned about Call9 – a startup telemedicine company that is reinventing 911. By connecting off- site emergency physicians with on-site paramedics in skilled nursing facilities they deliver care at the moment of a patient’s emergency, not after they are transported to a hospital. They regularly utilize point of care testing and ultrasound, administer IV fluids and antibiotics, and are preventing a majority of their patients’ hospitalizations.
Was there really a way I could practice clinical medicine while still protecting myself from infectious disease? The more I learned about Call9, the more the idea appealed to me. It felt like the sort of thing that feels inevitable – bringing emergency care to vulnerable patients instead of bringing the patient to emergency care. I decided I must try it. Besides, crying in bed gets really boring after about six months.
But in an example of stunning serendipity, Call9 turns out to be far more than simply a “replacement” job for me. It’s a new frontier in medicine. It is trailblazing new treatment paths for patients where none existed before, carving new medical domains, and creating novel ways of solving old problems. It’s flexible, growth-oriented and eager to evolve. Call9 is innovation at its best. It encourages doctors to expand their repertoire and learn new skills. What a perfect place for a doctor who is trying to create a new professional life with no established path before her, a doctor who is trailblazing on her own personal level! Call9 and I are on joint paths of creation and re-creation, experimentation and evolution, both borne of necessity.
I will never call cancer a “gift” or claim that’s it’s one of the best things that has happened to me. However, it is forcing me to evolve professionally; Call9 has been the ideal home in which to do that. Together, Call9 and I are exploring new horizons in Emergency Medicine. Contact Tracy here to find out more.
Click here to find out more about working for Call9.
Click here to find out how to submit a swab and help Tracy find a match!