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Wilkommen to my blog - my name is Karin Purshouse, and I'm a doctor in the UK. If you're looking for ramblings on life as a cancer doctor, my attempts to dual-moonlight as a scientist and balancing all that madness with a life, you've come to the right place. I'm training to be a cancer specialist, and am currently doing a PhD in cancer stem cell biology. All original content is licensed under a Creative Commons Attribution 4.0 International License.

Saturday 29 December 2018

All That is Cancer Is Not Lost

Merry Christmas and Happy New Year, folks!  Phew, the last 4 months have been...well... crazy.  We've moved across the country, new jobs, planned a PhD (ish), moved house 3 times, bought a house, planned a wedding.... I can't necessarily recommend doing all of these things simultaneously, but equally doing so much 'adulting' in a short space of time feels like something of an achievement!

The cherry on this life cake was that I drew the short rota straw and was on call on Christmas Day - maintaining my 100% clinical Christmas working record!!  However, I really can't complain - for one thing, as ever, festive cheer was in great supply and I even met Santa :). And secondly, I was able to 'leave the building' and do the remainder of my 24 hours on call from home.  That means phone calls at 3am, but it also meant Christmas dinner courtesy of Mr KP!

A lot of being 'on call' for oncology involves being called by other doctors from essentially any clinical department for advice - A+E, GPs, any medical or surgical specialty, intensive care, etc etc.  We are often asked to give a view about prognosis and expected outcomes to help them guide their decision making. Prognosis is really hard to gauge, particularly at the end of the phone, sometimes in the middle of the night.  Clearly at my stage if it's unclear I'll seek higher wisdom.  But my main take home in the year I've been an oncology registrar is this:

  • Metastatic cancer does not mean someone is at the end of life.  In some cases, they are still curable.
  • Palliative treatment does not mean that someone is at the end of life.  
  • Palliative treatments (yes, plural, for many cancers) can significantly extend life, and quality of life.  
  • Patients with metastatic cancer on or considering palliative treatment can, in some cases, live for many years and may even die with, rather of, cancer. 

The wider world should be encouraged that oncologists are consulted on these sorts of matters, but I can't help but feel we should be doing more to spread the gospel that all that metastasises is not lost.  Of COURSE one can never give a blanket, catch-all statement about all patients with cancer - cancer is not one disease.  It's lots of different diseases really, with different biology, different molecular profiles and different treatment options. Plus patients may have other medical problems that must be taken into account.
But (for example, and broadly) - metastatic testicular cancer is often still curable.  Patients with metastatic prostate cancer have a prognosis of years at diagnosis, as do many other cancer types.  Yes, some cancers have a less positive outlook, and it's important we are up front about that too.  Also we can't predict how everyone's individual cancer will behave - sometimes they progress faster or slower than anyone can predict.  The point is that it varies HUGELY.  I sometimes wonder whether we need to change our language as oncologists.  Heart failure is a chronic disease which is generally irreversible and can be life-limiting but can be medically treated and extend life - in what way is metastatic cancer different?

So consider this blog post the start of my efforts to get the word out there.  My professional New Years Resolution is to talk more about prognosis and manage expectations for patients and medical types alike where cancer is concerned.  I am determined to be a pragmatic advocate for my patients. 

Adventures of 2018 offering inspiration to those of 2019!
2019 is going to be full of adventures, with hopefully more hill stomping, sea swimming, music playing and, now that I have a view to paint, a return to creative moments! Because if doing a job like mine doesn't teach you that the most important thing to embrace Living, I think you're probably doing it wrong.  

Saturday 25 August 2018

To Scotland we go!

I'm not sure if it's just because I've moved to sunny Scotland, but it definitely feels like Autumn is on the horizon.  In life terms, for me it's definitely 'Spring'- new job, new city, new adventure awaits!  Who says turning 30 means life gets quieter....
Scottish sunset loveliness 

The Mister and I have migrated Up North in search of that career/life utopia known as Work Life Balance - or rather, having everything we could dream of from both of our jobs with everything we could dream of for our lives (read: buzzing city, mountains, the sea and such) all on our doorstep.  My new job means I continue my Oncology specialisation training and do research all the way to Consultant-dom - exciting stuff! As anyone who has ever moved house will know, it's been rather epic - after all, the downside of being 'in one's thirties' is that a significant accumulation of 'Stuff' has happened.  Long gone are the days of fitting everything in the back of my Fiat Punto.  I've reached the stage where we have to put furniture in storage, and need not just a van but actual human help to move our belongings from A to B. Ahhh! I'm a grown up!!

A few weeks into my new job, it's all starting to slot together.  My new colleagues and department could not have been more welcoming, and the training environment feels very supportive.  We've certainly had a thorough induction which is never to be taken for granted, and always appreciated! It may surprise those who don't work in healthcare to know that there is amazingly little overlap between the day-to-day computer and information systems in different healthcare trusts.  It's amazing how many different ways there are to communicate a blood pressure, prescribe a drug or request a chest x-ray.  Purple forms (Do Not Rescuscitate forms) are now Red Forms.  Aria (chemotherapy prescribing software) is now ChemoCare.  EPR (electronic patient record) is now Trak.  Everything is different!!! Of course, that's in addition to all the newness that comes with any new job - new people, new logins x1000, new buildings (yet to work in a hospital that isn't a maze!!!).
Moving = chaos... 

I became an Oncology Registrar six whirlwind months ago and I've had the rather odd realisatisation that I may have actually learned something during that time. Becoming a specialist was incredibly daunting. I was forced to have faith in myself, and trust in what I did, and didn't, know.  I survived a steep learning curve, and by the time I moved up here, I felt like I was better than when I started (with a blimmin long way to go!).  I felt like people (the patients as much as my colleagues) trusted me, and I started to trust myself.  I felt like, to a few people at least, I might have made a positive difference.  Conversely, I felt like I had been honest and reflective when things hadn't gone so well, and, overall, I felt accepting that it was OK to still be learning and ask questions.

Reflecting on my first months as a registrar, the most useful and important thing I learned, courtesy of a superb consultant I worked for, was this - I should trust in the relationship between me and a patient. Listen to their anxieties, meet them with your own, and have faith in each other when you make decisions together.  I also remain convinced of the best baseline triad of rules for any doctor (coined by an Emergency Medicine physician I think) - don't be a d***, and be kind to yourself and others. The middle of these is the one I think many of us struggle with, and I hope an area in which I'll improve.

Leaving a place I knew was incredibly daunting, having done all of my postgraduate medical training there (2 plus 3 years), meeting some incredible mentors and making precious friends. But it's exciting to look forward and get a fresh perspective. I'm hoping to blog a bit more often about working in cancer care, and about cancer research, and I hope you'll enjoy reading along.

Turning 30 ain't so bad! 

Tuesday 6 March 2018

Registrar Reflections

Happy new year, bloggers!  Or rather, Happy Spring!  As ever, I've been a bad bean at keeping up with things.  Updates from my end:

- I'm a Medical Oncology Registrar - yikes! (i.e. the last bit of my specialist cancer doctor training)
- I'm heading back to the homeland - wowsers! (i.e. I got a Clinical Lectureship in Scotland to facilitate ongoing nerding out alongside clinical training with mountains in situ!)
- I said 'yes' to getting married - woohoo! (I'm not sure this one needs explaining...)

So it looks like 2018 is going to be a busy year.  But the first of those three things is the main thing keeping me entertained at the moment.  People say becoming a registrar is the scariest step up after qualifying from medical school in the first place.  Seems to me that makes it an important experience to reflect on, and four weeks in, here are my early thoughts on being a new registrar.

1) People are a lot nicer to you when you're a registrar than when you're an SHO.  Not that they were horrible to me before.  It's just a totally different vibe, both within and beyond your department.  Within my department, everyone has been supportive and helpful, offering help and general wisdom.  Beyond my department, people are willing to hear you out with a kinder word.  I guess it's just a general conveyance of being wanted.  Something I will definitely reflect on in my interactions with junior colleagues. 

Disproportionate excitement at having my own one of these.  

2) It actually feels like I'm being trained to be a specialist with specific skills and knowledge, rather than a bum on a seat that will learn things by osmosis.  It's really made me think about the point of middle-stage training - in my case, Core Medical Training.  I've been a doctor for nearly 6 years, but I'm pretty sure this is the first time I've started a clinical job and felt like I haven't been chucked in head first in hopes that I'll just work it out. It's also the first time I've had a desk!  And a locker!!!

3) It's quite scary that people take your word so seriously.  But that's part and parcel of getting more responsibility, right?

4) There are a lot more men than women the higher you climb up the ladder. 

5) Associated with being higher up the ladder - it does not stop you getting a lot of advice you didn't ask for.  I've been pondering if this is an issue suffered more by female professionals, because I don't recall my male colleagues ever grumbling about it.  Don't get me wrong - I am in serious need of help, wisdom, support and advice, particularly at this juncture of my professional life.  And to an extent I probably don't know what I need to know, and should listen to random nuggets of advice.  But I'm getting a little tired about being given advice about work, life, work/life balance, family life, social life etc etc... without being asked about my background in any of these areas. 
Seems apt at this point to give kudos to my last Educational Supervisor, who, three years ago, spent the first few minutes of our introductory session getting a summary of my life so far.  Meant that when he did give me advice, it felt like it meant something and was actually relevant (and it was indeed life advice I think I'll remember for a long time to come).  Again, something I will reflect on moving forward. 

6) Also I need to chill about the whole 'unwanted advice' thing.  It's always well meant.  I think.  And it's going to keep happening.  I think.  So might as well not raise my blood pressure over it. 

7) The main difference of moving from generalism to specialism is the loss of one's barometer.  I feel like in general medical situations I'm pretty ok at feeling it out - you know, 'bad' versus 'not bad', and knowing when to worry versus when to be reassured.  When you move to becoming a specialist, your barometer is not yet fully formed.  I'm sure it will, in time.  Right now I feel like I'm anxious pretty much all the time, and asking a thousand questions.  But I think it's probably better to be neurotic at this stage of things that over-relaxed. 

No #snowmaggedon will stop me getting to work...
8) I'm not terrible at this.  I did my first 7-day stint as the oncology registrar on call recently, which involved being the acute oncology ward registrar as well as taking referrals/giving advice all over the region and making admission/discharge decisions through the oncology triage unit.  It was full-on information overload, with my bleeps, mobile phone and emails all going off, often simultaneously, in addition to nurses and junior doctors coming to me with problems that needed solving.  Going home at night-time over the weekend knowing my phone could go off at anytime was a whole new experience.  I didn't do it all perfectly and there is a LOT of room for development - but I did it.  There were no tears, we even had a few laughs.  When one of the F1s said I'd been a good registrar, I wanted to hug her.  I left thinking 'I can do this'. 

There will be many nerve-wracking 'firsts' over the next few weeks, but I'm going to have to embrace the familiarity of these emotions.  I KNOW what it's like to be absolutely terrified - my first week of nights as an FY1 (= intern) I basically didn't sleep for terror, and cried after almost every shift.  I've got to take some confidence from the fact that I've come so far from those scary days.  Plus I think a lot of the nerves comes from being a perfectionist.  Not an awful quality, as long as you keep it in check...

Also high fives and hugs to Mr KP and friends who have provided important moral support.  Maybe that's the difference - it's much easier to go to work and do your thing when your house is in order (metaphorically as well as literally).  Yippee!