5 November 2007

Why cancer medicine? - The Ocker Doc

In medical school I wanted to be an Intensive Care specialist. Long way from a cancer specialist!

To be a specialist, you have to have a personality 'defect', well more of a particular personality profile. Surgeons are men of action, physicians are men of thought and learning, anaesthetists are outdoors people. This doesn't prevent them from being different, but often they run to stereotype.

What are cancer doctors' defects? There certainly is the 'cancer saviour' type. But that is, most definitely, not me.

I looked after my first cancer patients in my second year as a doctor. It was one of the horror terms - rarely less than 30 inpatients and topping out at 45. I found that I was occupied for 8 hours of the days just serving their medical needs.

I got no satisfaction from that job. So each day at 5pm I switched my pager off, finished the remaining work and then walked in to spend time with the patients. Basically I socialised after hours!

I discovered that they were all common folk with big problems. They weren't all the same. They covered the whole range of humans - married, single, divorced, professional, labourers, old, young, male, female, catholics, protestants, whites, blacks, asians, etc. Their differences were fascinating. And yet their reactions to cancer were remarkably similar.

Most people will say that they couldn't cope if they had cancer. But almost every patient seemed to cope. And not only cope, but also to find that life was getting better as a result! That is what attracted me to cancer – sorry, the people with cancer.

Of course it is one thing to find that you like working with a group of patients, you also have to think that you have something to offer them. I thought that I had two advantages. Firstly my mother had died of cancer and my father of a car accident, so I understood something of survivor guilt. Secondly I had another career before medicine that gave me a different perspective on people and their needs.

The first advantage forced me to accept that death is inevitable. The only questions are how and when. Cancer gives you just one advantage. The how and when are much more predictable. And because its CANCER, everyone knows you're going to die soon (good thing that often they are wrong). So you can prepare. But to gain this advantage the doctor must tell you what's happening early.

The second advantage gave me the skills to talk to all patients and to understand that they are all capable of understanding this cancer problem. When I wanted to know, I asked the patient. I discovered that they all want to know about their cancer problem. I say 'all' but of course there are the once-a-year patients who don't!

So here I am in cancer medicine. I still like the people I meet in work time. I still work very hard to gain their understanding.

And I still spend too long talking with them!