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My Elective - Blog 1

By Josh Tulley

My Elective - Blog 1

Given the number of oncological referrals to BCH, the service is divided into: cancers causing the growth of tumours ('solid tumours'), cancers of the nervous system ('Neuro-Onc'), and blood cancers ('Haem-Onc'). During my first week at BCH's Oncology (cancer) department, I have focussed my experiences on 'solid tumours'. This is a breakdown of a day experiencing the solid tumour service.

7:30 am - Arrival

I arrived at the hospital early, after a surprisingly traffic-light commute into the city. I feel a strange sense of peace being in the hospital 'out of hours'. Taking time to appreciate the calm, to watch the sun's ray's creep into the courtyard and listen to the gentle tapping of footsteps approaching along the corridor, serves as a reset ready for the day ahead. I sat collecting my thoughts, ready to lose sense of the wider world for the day.

8:00 am - Blood transfusions teaching

An unfortunate fact about chemotherapy is that it targets all fast growing cells in the body not specifically cancer cells - most people reflexively think of hair loss as the classic example of this, but there are many others including the destruction of vital blood cells. During my first week, I saw first-hand how important the replacement of these cells is to most of our patients. I realised during this session that my knowledge of the potential side effects of administering blood products was suboptimal at best, but the small group, coupled with our fresh morning minds allowed for a great hour of discussion and learning.

9:00 am - Morning handover

Morning handover is led by the consultant 'on service' for the week - this meeting ensures that all members of the team (not just clinical staff) are updated on the status of each patient and therefore prepared for the day ahead.

Now I know the patients on the ward, and the roles of some of the previously unfamiliar faces in the room, handover has become more of learning opportunity, as staff explain the rationale for their management decisions. I have found it refreshing (but also unsurprising), how eagerly the team await updates on the patients during handover - an eagerness I have come to share.

9:30 am - Clinic

As I left handover, heading off to sit in on a solid tumour clinic, a member of the team gave me a gentle warning of the quizzing session I was heading into. During the clinic, the consultant discussed with me the histories of the patients we were about to see, before using these as a spring board for their questioning - a technique used by many consultants when teaching medical students.

However, the academic nature of this consultants work meant that these questions challenged me to recall and apply knowledge I didn't even know I had. I'm not sure who was more surprised when I gave a correct answer, but both of our smiles grew as the morning progressed.

The final family of the clinic were to receive the worst news I have ever seen be delivered. Communication skills are taught very thoroughly during medical school, often in the context of breaking bad news.

Despite this preparation, I don't think anything could have taught me how to deliver this dreadful news as eloquently as my consultant did that day. Nor could I have been prepared for the earth shattering devastation that was to be felt by the parents of our patient. Crushed, defeated and empty. The room fell into silence, whilst the family sat still, absorbing the information they had just received whilst simultaneously disbelieving its truth.

When I answer the common question of, "what do you want to specialise in", with "potentially Paediatric Oncology", my response is often met with a face grimacing with fear and a reply something along the lines of 'that must be so sad, you've got to be brave'. I disagree. Not compared to the families living their worst nightmare, unsure if the life they have seen blossom will be cruelly cut short. Not compared to the children walking around the ward with intravenous lines attaching them to the drip stands pulled alongside them.

Humbling is the only way I can describe this morning's experience. It is this emotion that fuels my pursuit of a career in this speciality, not to be called brave or even to save lives, but to share this raw emotion. To feel this humanity, and to use my training to make a difference during the most vulnerable times in the lives of these families. I hope one day to achieve this, and knowing that I might, pushes me to continue learning.

13:00 - Lunchtime seminar

A quick break before afternoon clinic, accompanied with free pizza in exchange for listening to a presentation from a pharmaceutical representative. Before I got too excited, one of the registrars was quick to point out that this wasn't a regular occurrence - however we all enjoyed the break all the same.

14:00 - Solid tumour follow-up clinic

My afternoon was an excellent demonstration of one of the draws to oncology: patient follow-up. Many branches of medicine see their patients over a number of years, but rarely as long-term as oncology. Here, the clinician affords the privilege of seeing a patient right from their first presentation, travelling with them as they tread the diagnostic path, through their treatment and monitoring them upon completion to ensure their reinstated health is maintained. It was blindingly apparent that this brought great satisfaction to the consultant I was shadowing, and the unique relationship they had with their patients and families was heart-warming to witness.

16:30 - Afternoon handover

The day finished much like it began, with members of the team filing into the conference room for the final update of the day. Plans were made for tomorrow: chasing blood results, ordering investigations and highlighting patients of concern. I get the feeling that this session provides closure for the day staff, allowing them to leave their professional worries at work knowing the night team are adequately prepared for the shift ahead. My thoughts then turned to my own evening plans, enjoying the beginnings of the summer sun and recharging before tomorrow.

This was just one day out of my first week, and I hope that I have adequately demonstrated how much I am learning, and loving this placement. A consultant once told me during my early medical school career that "you'll know you've found your speciality when you find your tribe"; it seems that I might just have found mine.

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