Cancer educates a med student
Lilienstein does not tell every patient he is a cancer survivor. Sometimes it can be a distraction. But other times, his story can offer encouragement.

He had shared his history with Nueva Espana, whose battle with breast cancer had begun in 1978, before Lilienstein was born. She had a mastectomy soon after her initial diagnosis more than three decades ago, but the cancer had recurred three to four years ago.

Nueva Espana was already in a hospital gown, and as nurses settled her onto a gurney, Dr. Stephen Sener, the cancer surgeon, arrived to explain how he and two other surgeons would remove the lump and rebuild her breast.

"It's what that medical student had: multi-disciplinary surgery," Sener said, pointing to Lilienstein as Nueva Espana beamed.

Doctors who survive cancer and return to work show a different perspective and dedication, Sener said, adding of his younger colleague: "He doesn't have to be here — he could have just curled up in a ball."

From the start, Lilienstein resisted fearing his illness. He chronicled and examined his treatment on a blog. He let his parents post photographs of his last surgery online.

"This time of illness," he said, "has been fascinating."

Still, he second-guessed himself at the start of the summer, questioning whether he should return to the demands of medical school.

"The kind of stress that I will have to endure as a medical student and a resident is something that ruins normal people's bodies and minds," he said. "As opposed to some random genetic thing that had messed with my life, this would be me making the wrong decision."

Knowing he was uninsured only added to the pressure. He already owed more than $30,000 to USC, Stanford Hospital and Memorial Sloan-Kettering Cancer Center in New York for cancer treatments and surgery. Collections agents were calling.

In the operating room, Lilienstein stood by as a thoracic surgeon sewed a protective mesh over Nueva Espana's lungs.

"Somebody hold that. Don't pull it — hold it," the surgeon ordered.

The surgeon and Sener had removed a fist-size hunk of cancerous tissue from Nueva Espana's breast and sections of two of her ribs. Lilienstein, standing across from the surgeons, helped them stitch the mesh, holding one of the threads in place with a metal clamp.

They have been on their feet for about two hours. Lilienstein was in awe of the surgery, the most radical he had seen. To him, it was both beautiful and terrible. Beautifully done, terribly painful to recover from.

Soon, Dr. Alex Wong, a plastic surgeon, arrived and took over, slicing into Nueva Espana's abdomen with the help of a resident to find the muscle he would use to rebuild her breast. Lilienstein held back surrounding tissue with a metal retractor.

"So, you're finishing your third year," Wong said. "Have you thought about what you want to do?"

Lilienstein was not sure what sort of doctor he wanted to be. He wanted to improve cancer therapies, translating advances in genomic science into new treatments. Maybe he should be a radiologist, he said, or a hematologist-oncologist.

"And I'm still recovering," he said, explaining his diagnosis of metastatic testicular cancer.

Wong took that in stride. He asked which doctors Lilienstein had seen. The medical student eagerly detailed his own case.

"The added drama is that I maxed out my health insurance, so I'm uninsured."