This week, I went with my friend, who has metastatic cancer, to his hospital appointment.
The metastases (secondary cancer deposits) in his leg, spine and lung, had doubled in size, so, eight weeks ago he'd started a new anti-cancer medicine.
Last week he had a scan to assess whether the treatment had worked.
He'd been on Red Alert 24-7 ever since, conscious that his destiny was already known to the specialists - but not to him.
His appointment was an hour late. No problem - we chatted. We'd prepared important questions - whatever the results were, we mustn't come away with unanswered concerns.
Finally the nurse called us. We put on our cheerful masks (why do Brits always do that?) and followed her.
Before we'd even sat down, the consultant told us all the tumours had shrunk. My friend let out a slow breath, Oh that's wonderful, he beamed - at me, the consultant and the nurse.
My bottom had just hit the seat and I was about to place my handbag on the floor when the doctor spoke again, 'So here are your blood test forms, we'll see you in four weeks.'
Was he serious? Was that it?At least for now, the incessant march of cancer cells colonising my friend's body had halted, even retreated. But ...
- What did it mean?
- Was this a good response?
- Would it continue? Or was it just a temporary respite?
- If the tumours started to regrow, would he be eligible for a clinical trial?
Desperately important questions, which would define how my friend would feel, live and think until his next appointment. What should he tell his children? Should he train for that next ballroom dance competition or just book an expensive holiday and order a nice gravestone?
The consultant gathered his notes and stood. I sat firm. No, I wouldn't respond to this body language. We weren't going anywhere.
In the end we extracted some answers, whilst he stood throughout, clutching my friend's notes.
I hadn't anticipated the need for a stop-watch, but I believe we were in there no more than three minutes.
As a doctor myself, I could partially understand. My out-patient schedules have frequently disintegrated. First my lunch break would disappear and then my afternoon ward round would be due to start, with still numerous patients waiting in the morning clinic. Conscious that ward staff and patients would assume my late arrival was due to poor time-keeping, I'd feel pressurised, and hungry.
Some patients simply can't be despatched within the paltry appointment window. Sometimes their illness requires more time. Some patients, oblivious of other's needs, and the time pressures on staff, may waste time with trivial conversation.
But most are so mindful of the busy clinic, that they don't even ask their burning questions for fear of bothering the doctor.
When I went through my own cancer treatment, certain staff made a mark on me, as indelible as my radiotherapy tattoos. I remember Mrs Grant, my surgeon leaning back in her chair and commenting that she had loads of time. This was a blatant lie, she worked long and hard seven days a week, but it gave me the confidence to ask important questions and relaxed me enough to absorb her answers.
Bronwen and Eileen - two nurses who I will never forget, always made me feel as if I was their only patient. They understood that every name on the appointment sheet represented a life-changing abyss for the owner.
Other staff appeared immune. Maybe repetition had jaded their sensitivity, or maybe they never had the deep empathy needed for such a role. Nurse Christine consistently forgot my important medication, disappearing out the door to lunch instead. Nurse Cheryl ignored my request to make my test results available for an important appointment with my new surgeon. Fortunately Eileen came to the rescue.
I must admit, as a doctor, I never realised exactly how much my actions and words could affect someone made vulnerable by cancer.
Most people start a career in healthcare to help people, and generally succeed. However the pressures on medical staff are horrendous. There seem to be more and more patients, but time and staff numbers do not expand accordingly. One can understand the temptation to cut short a 'routine' visit just to avoid drowning. And sometimes the doctor is left with little choice, aware that urgent cases are waiting on the ward.
The problem is that there are very few 'routine' cancer appointments. Every appointment is accompanied by fear and a need for understanding, knowledge and sympathy.
Within the huge pressure of caring for so many people with cancer, it is helpful to remember:
- Every cancer appointment has been anticipated for weeks with apprehension.
- The son/daughter sitting with the patient may have travelled hundreds of miles to learn key information. They may have given up a day's work. They expect more than just 'Everything OK? Great, see you in a few months.'
- Ignore the smiling mask, you'd be amazed at the thoughts buzzing behind it.
- People need to feel they have time to talk, and to be listened to.
- What may appear a trivial concern can be a sleep-destroying worry for the patient.
Lindsay, an oncology nurse suffering with bowel cancer has written a fabulous open letter to cancer patients. She explains how she didn't always understand ... until she became a cancer patient herself - well worth reading.
When I had cancer I realised the need for a simple guide to help patients through the system, so I wrote my book. I believe it is a useful insight to healthcare workers too.
From Both Ends of the Stethoscope - Getting Through Breast cancer From a Doctor Who Knows is available on Amazon and Kindle or through bookshops ISBN: 978-0-9935083-0-1
Thanks to The National Cancer Institute for releasing the photograph by Bill Branson into the public domain to be used without restriction.