Elkowitz describes teaching the structure of cancer well beyond its causes and mechanisms. Medicine has changed since his own siloed training in pathology, he writes, and many medical schools now include humanism. In addition to pathophysiology, cancer genetics, bloodwork, scans and symptoms, students where he works meet a cancer patient, the patient's family and an oncologist. They learn about the decisions, treatments and emotions that followed a difficult diagnosis and prognosis. The patient they learn about is Elkowitz. The tumors, test results and treatments he presents are his own. He says he does not want to lose a single opportunity to make medicine very real for the next generation of physicians, who deserve training where there is a real person behind every scientific concept, as do their future patients.

Thymic cancer is both rare and aggressive, accounting for less than 1% of all cancer diagnoses and about 0.2% to 1.5% of all malignancies. Elkowitz was diagnosed in 2017 and has been an intriguing nine-year case study almost from the moment of diagnosis. He was diagnosed with a mass on a Thursday, had a biopsy on Friday and received his diagnosis from a pathology lab on Saturday. Stunned silence filled those three days. He stopped talking and withdrew. On Monday, his wife and a friend took him to see the oncologist, who asked questions he would not or could not answer. They filled in the blanks for him as he sat, not communicating.

Exasperated with his silence, the oncologist abruptly said, "David, come with me." She took him from the office, alone, into an examining room and asked a few more questions he did not answer. Then she told him, "I have cancer. So don't think for one second that I don't know how you're feeling right now." His catatonic state fell away, and he was able to communicate again within minutes. Something like hope crept toward him when his oncologist was vulnerable about her own health. She was not obligated to be so open, but her humility unlocked him and allowed purpose to come into focus. From that moment, it became a no-brainer to present his own journey to medical students. He also found a co-teacher who watched him go from despondent and nonresponsive to accepting what became a nine-year, so far, quest for understanding and healing.

Elkowitz felt that sharing his own case in class might offer future doctors a deeper level of understanding. He saw no reason for physicians-in-training to wait until residency to understand how anxious patients can become when a test is ordered or additional bloodwork is drawn, or to hear what it is like to wait with family for results or insurance clearance. That is why, once he has discussed the foundational concepts of cancer, he shows students his biopsy slide, the stain used to determine the origin of the cancer he has, and his X-rays, CT scan, MRI and PET scans. He lets silence set in as the class digests the information before taking questions that range from the diagnostic to the emotional. Two weeks later, his oncologist joins the class to discuss their feelings and approach.

Students' response to this approach has been full of gratitude, curiosity, respect and a yearning for growth professionally and personally. They are beginning to understand the medical concepts they need to memorize as well as the very personal impact they will have on their own patients someday. Sharing his health challenges has been one of the most fulfilling and full-circle choices Elkowitz has made: students who have learned from him rotate through his oncologist's practice, and several are his current physicians. He says sidestepping an opportunity like that would have been walking past a door God had opened. Even if he does not understand his circumstances every day, and he does not, he accepts that he is in God's hands. He has faith in today's doctors-in-training and feels a unique responsibility to them and the generations of patients they will treat throughout their careers.

What Elkowitz wants for today's medical students is what he hopes all people seek in their doctors: to become learned and wise, to grow into compassionate educators who ensure patients understand every medical challenge as they face it and every choice before they make it. One unchanged fact about medicine, he writes, is that practitioners need to embrace lifelong learning, whether it is a robotic surgical technique, artificial intelligence, a new virus or knowing when to sit with a grief-stricken patient. In those moments, physicians draw on all their capacity to be present and to employ fundamentally human and uniquely godly compassion. He says he has been fortunate to create a blueprint from what God has handed him, remembering as he undergoes treatment that he can keep working with excellence and empathy to shape medical students' perspectives. He hopes they come to understand the value in showing up for patients and colleagues, even when life feels out of control and explanations for circumstances seem inadequate. If his experience helps future physicians care for generations of patients with deep knowledge and compassion, he will take it as a victory for both humanity and holiness.

David Elkowitz, D.O., is a professor of pathology and laboratory medicine and science education at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. He also serves as the school's associate dean for academic programs and educational culture and as director of the Academy of Medical Educators.