I knew from the first day that this week, oncology, would have the theme of perspective. In terms of my personal context, having around ten different projects alongside medicine, the pandemic, the political snowstorm (both US and UK!) and personal challenges can leave me with tunnel vision.
Online reflections
Spending the week on oncology is one way to reframe everything. As tragic and distressing it may be, there were several positives to take from the week. Most of this week was online, which makes sense given that even pre-Covid, we had to be careful sending floods of students around immunocompromised patients.
The seminars were incredibly interesting and I even discovered (through the magic of a WhatsApp neighbourhood group) that two consultant oncologists live on my street! Expect me to be trick-or-treating around their house all year round, with an empty brain to be crammed full of medical knowledge instead of sweets. In the interest of saving money, I’ll probably dress up as a clueless medical student.
Oncology, for the uninitiated, is the study of cancer. One thing you find as a medical student is how desensitised you become to words like cancer, metastasis (spread of tumours) and chemotherapy.
One interesting reflection from this week: patients who have experience with previous cancer or treatment are surprisingly well-read on these terms, and it was a strange (and morbid) comfort that I could use these words without having to skirt around them. Medicine is odd like that.
From the oncologist who led the seminars to the staff in general, my experience was that they are incredibly friendly and helpful. The patients seemed to echo this; I’ve had plenty of experience with rude or abrasive staff members and I do sometimes wonder if they started their career like that, or whether years of a poor working environment have worn them down to a dense husk. One of my major concerns with medicine is whether I’ll end up like that, but seeing consultant oncologists walk around with a smile and a joke in their back pocket makes me that tiny bit more hopeful.
Patient reflections
On the chemotherapy day unit, I was lucky enough to speak to several wonderful patients. Their stories, diagnoses and stages of treatment differed but there was an interesting connection: they had all been previously misdiagnosed.
I did my best to hear their journeys and noted some particularly thought-provoking parts: the acceptance that smoking had done this to them, the previous lives they had led, how difficult it was to open the plastic aprons (that one was from me). Their advice was always the same: consider the person beneath the illness. This is something I try to do as a doe-eyed student but the difficulty is always time, stress and human error.
That brings me to the idea of missed cancer diagnoses. On the surface, this seems unforgivable- after all, with so much public awareness, education on red flags and entire organisations dedicated to this, we surely shouldn’t be missing giant lumps poking out of people’s bodies?
The reality is, humans make mistakes. In addition, cancer can present in a huge variety of ways, often with what we call “non-specific” signs and symptoms. If you put a tired, stressed doctor in front a patient with grumbling, non-specific symptoms (like fatigue and a bit of a cough), you can start to see how cancers might be missed. We do our best to identify the “red flags” and have primary care systems in place for this, but unfortunately cancer doesn’t read the textbooks and can initially present as something else.
This week, unlike the previous two, was mainly spent in the books but I feel like I’ve got a better command of key oncology topics. Unfortunately, we barely get further experience unless we actively seek it out, so my new pro-active brain is debating whether to visit the chemotherapy day unit on a regular basis. Even just thinking about this is a win for me; the old me would have shrugged it off as putting too much pressure on myself.
Finally, I only type this now to remind myself later (if I ever come back and read these)- one very kind patient said he could tell I’d make a fantastic doctor. Compliments are not something I take well (that’s a whole other story involving family members and medical colleagues) but I hope to live up to those words.
Next week, I’ll be exploring tertiary care at Royal Papworth Hospital. Time to learn my cardiothoracic medicine!
Hardeep Lotay 