After falling ill while undertaking her medical training, Dr Ruth Silverton experienced what it was like to be both doctor and patient. In this blog post, she talks us through her own unique path into the world of medicine.
As I made my way through medical school, I saw doctors and patients as ‘us’ and ‘them’ respectively. Not with any disrespect or malice, but purely because I had never been a patient before, and so my purpose would be the ‘treater’, not the ‘treated’.
However, shortly before my final exams in 2011, while we dutifully palpated each other ‘just feeling for your spleen’, it became apparent that I had a lump by my umbilicus. Several appointments, scans and a biopsy later I was diagnosed with a desmoid tumour. It was deemed an ‘intermediate’ tumour due to its inability to metastasize, but due to the tumour’s aggressive growth and invasive nature, this rare disease would dictate the trajectory of my career for years to come. I would become both doctor and patient.
I started my foundation years and dutifully arranged to have no more than the maximum 20 days of sick leave, travelling from Yorkshire to the Royal Marsden to have the left side of my abdominal wall surgically removed, along with the 10x10 cm tumour that now resided within it. I returned to my job as an FY1 but the following summer the tumour had recurred, continued to grow aggressively and cause substantial pain. I balanced my FY2 GP placement alongside the hormonal treatment we decided to try, allowing me to empathise with peri-menopausal women more than I would have liked at age 29!
By the beginning of 2013 the tumour was still growing rapidly and impacting my ability to eat. It was time to start IV chemotherapy and finally relinquish my role as a doctor in order to become the patient. It wasn’t the fear of losing my hair, how I would manage the nausea, or the toll of constant chronic pain that impacted me the most; it was the way I was made to feel once I officially requested to leave the foundation programme: like a faulty cog in a machine. This was a machine I was acutely aware was being pushed to its limits, and a machine on which I was now reliant. I was consumed with guilt; there was one pathway to become a qualified, useful and senior doctor, and I was too broken to take it. I was letting the system down and I felt sure I had wasted six years preparing for a career I could no longer have. At least, that’s what I thought …
Maybe being a patient didn’t prevent me from being a doctor after all but could actually make me a better one.
6 months, several cold caps and the odd admission to hospital later and I had a stable disease. I’d started to work with Trekstock, a young persons’ cancer charity, and I took up some locum shifts at my previous hospital to get back into clinical work. I believed that this was the only alternative while I waited for the ‘training calendar year’ to begin again. Thanks to some well-informed and hugely supportive colleagues, I discovered I could complete my foundation years via an ‘alternative certificate’. Not only that, but I could do the same with core medical training. Things were starting to look up, and a new (all be it narrow, winding and uncertain) path was becoming visible.
Then returns the romantic ‘bump in the road’; the tumour started to grow again, the crippling pain returned, and my bowel was now at risk. I started a novel oral therapy, and once again relaxed into the guilt and shame of not being able to work. A couple of months into treatment, it became apparent that the side effects of the medication were tolerable, and I decided to return to work. The hospital kindly agreed to remove me from any overnight shifts, and I started a 24-month trust grade post in nephrology, with the aim of completing the alternative certificate in core medical training.
I managed the 24 months, three membership exams and the treatment, along with a wedding, two house moves with an enormous amount of support from colleagues and friends. Perhaps it wasn’t all so black and white – maybe I could carve out my own ‘greyscale’ career, allowing for my individual circumstances and using my motivation and enthusiasm to persuade those around me that it was possible. Maybe being a patient didn’t prevent me from being a doctor after all but could actually make me a better one. It took some persuading of my inner critic (an unwelcome visitor I had become all too familiar with) who sought to constantly remind me how far ‘behind’ my peers I was, how ‘difficult’ I was being and how embarrassing it would be to share my story. But by the start of 2017, I had the information, the support and the motivation I needed to quieten that voice and begin my portfolio career, without being anywhere near consultant grade (gasp)!
So, what does that look like? I have been a teaching fellow at Hull York Medical School, at UCL Medical School and for the Royal Free Group postgraduate department. I now work half the week with the UCL Medical School Postgraduate Department and facilitating for the Cambridge University Medical School professionalism course. I have worked in nephrology departments in Yorkshire, London and now Cambridge, working toward specialising in low clearance and dialysis. Following some local work in London, looking at the drivers behind the increasing number of post foundation doctors opting to work outside of a training scheme, I am also involved in work to investigate this at a national level.
The current junior doctor cohort craves flexibility.
This wasn’t a model of working I ever envisaged. It wasn’t something I thought was an option, and it certainly wasn’t an easy path to take. However, it has given the NHS a motivated clinical doctor, several universities an aggressively enthusiastic educator, and given me a fulfilling and varied working life. A working life that I hope can go some way to providing hope to anyone else who, for whatever reason, feels that they cannot keep up with the well-trodden and all too often singularly suggested path.
The current junior doctor cohort craves flexibility, a way to individualise their training to their circumstances, and the support required to facilitate that. I look forward to working with the RCP and Health Education England to move things in the right direction.