Kevin Gale, a first-year medical student at the University of Minnesota Medical School, can pinpoint what first led him to apply to medical school - his mother.

When his mother was first diagnosed with stage IV colon cancer, Gale left his job as a musician in Jacksonville, FL, to move home to Minnesota so he could support his mother. He admits that many of his experiences with his mother during that time changed his life, and are still helping shape his career today.

Gale recently shared his pivotal experience with JAMA Oncology. His article, “Inappropriate Celebration in the Presence of Patients With Poor Prognosis—The Cancer Center Victory Bell” was published in the journal’s series the Cancer Care Chronicles. In the article, he writes about a visit to an oncology clinic with his mom that prompted him to question a common clinical practice.

A “Victory Bell” is a large, loud bell located inside many oncology clinics which patients can ring to mark the end of their treatment

In his article Gale wrote the below excerpt about the victory bell:

Treatments in the infusion room have become commonplace for Mom - as they do for many of the patients with a terminal diagnosis. Normally Mom is keeping herself busy, grading papers (she is a math professor) or reading the daily newspaper, with quiet optimism. But today is unlike most days - today she is tearful. She just heard the Cancer Center Victory Bell ring for the first time.

“She got sad - just a natural human emotion; she was thinking: why does this person get to ring it, and why do I have to die?” remembered Gale of his mom that day. “Seeing her become sad in that setting because of a situation that could be potentially avoided, that’s when I decided I wanted to bring light to this.”

Gale left the center that day determined. He reached out to other oncology clinics to understand their practices and did some research on the tradition of the Victory Bell itself. He found it had started in 1996, and 82% of the sixty-two NCI-designated cancer centers nationwide use Victory Bells.

Many of the patients being treated in an infusion room have a terminally ill diagnosis.

According to Gale’s research, “A large minority of patients will not live past five years and will be negatively impacted by the presence of a Victory Bell.”

Some centers which wrote him back not only told him they did not carry the tradition, they explained why and what they do instead. Some now sign a card for the patient or present a certificate to celebrate the accomplishment. One center specifically said they do not have patients ring a bell because they were worried about the negative psychological repercussions it can have on terminal patients.

“I hope that oncology clinic administrations are able to read this [article] and take a second look at this tradition - whether it’s needed, whether it’s necessary, whether an alternate celebration could be used,” said Gale. “I ultimately hope clinics reconsider the use of the Victory Bell.”

These experiences continue to pave Gale’s way in the medical field. Although most medical students do not choose a specialty until their 3rd or 4th years, Gale is considering palliative care as a specialty.

“There's a need for palliative care physicians; only about 300 fellows are trained each year,” said Gale. “Because of the experiences I’ve had, right now I am thinking about a future in palliative care.”

Read the full article in JAMA Oncology here.