Memoir – Corpus

A career in medical oncology (ii)

15 May 2017 1 Comment

David Perez

After 40 years in oncology practice has my experience lived up to initial expectations? My answer is a big YES! On the scientific front the explosion in the understanding of genomics and the defective genes that initiate cancer growth has led to new therapies which target the defective genes and generally have fewer toxic effects than chemotherapy. These so-called targeted therapies are likely to have their main impact on suppressing cancer growth rather than eradicating the disease but prolonged suppression of cancer can be very beneficial and can be compared to the prolonged suppression of the HIV virus in AIDS. Patients with advanced cancer that will ultimately prove fatal are now living several years longer than previously due to better cancer controlling therapies. The rapid progress in the understanding of cancer genetics will ensure there will be a proliferation of new cancer interventions over the next 20 years. Other advances include the identification of defective genes that cause familial cancer which then allows preventive action including screening to be undertaken. Another recent cancer prevention strategy is the use of vaccines against viruses that can cause cancer such as cervical and liver cancers.

A woman I am

15 May 2017 2 Comments

Huberta Hellendoorn

A short extract from Huberta Hellendoorn’s recently published memoir, Astride a Fierce Wind (Mākaro Press, 2017).

A few weeks ago I realised that this ageing body could benefit from some repair work and I made an appointment to visit a specialist. Again.

I arrive at the suite of the surgeon. Soft grey-wool carpet on which are arranged deep armchairs in tonings of navy blue. Oh, how I love this luxury. I feel so warm, so pampered. Modernist paintings on the palest of blue walls, framed with just that right amount of grey and chrome.

I’m led into the surgeon’s room. After a series of perfunctory questions I’m told I’ll need a small operation to clear my medical problem. It will mean just one day in hospital. I’m told that I’ll be well looked after and that it will be a day of rest and relaxation. I feel awful. How can I disappoint him? How can I tell him that even one day is too much?

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A career in medical oncology

8 May 2017 1 Comment

David Perez

On the surface medical oncology does not seem an attractive career choice. Medical oncology refers to the treatment of cancer by drugs, including chemotherapy. This carries the connotation of patients suffering miserable side effects of treatment and ultimately treatment does not prevent death from the disease. During my training at the University of Auckland Medical School I had no particular awareness of oncology as a career choice as students were not placed on an oncology attachment. Following graduation I spent a year working in a provincial hospital, Taranaki Base Hospital in New Plymouth, then I returned to Auckland Hospital where I was assigned to work for six months on the oncology ward. Oncology wasn’t a popular attachment and I wasn’t overly happy about the prospect. Paradoxically working in oncology proved to be a positive experience and I learnt a lot that had not been highlighted in medical school. This reflected the medical school curriculum of the 1970s which taught a great deal about disease and treatment but not so much about the experience of illness and the impact on the whole person. This unplanned experience in oncology stimulated sufficient interest to consider oncology as a career choice.

Keith Macleod: radically rethinking the clinical relationship

8 May 2017 Leave a Comment

Sue Hallwright

University of Otago Medical School, Dunedin

I have strong memories of being taught by Keith Macleod when I was studying medicine at the University of Otago in the 1970s. He had a unique approach to teaching in action. I recall him, for example, discussing the profession of medicine in a tutorial. He challenged our shared view that medicine is all about curing and healing. He mooted that people are dying from the minute that they are born, that every second of every day people are treating their terminal condition by taking their next breath. Only when people fail in their self-treatment and when their friends and families are unable to help them, do people eventually seek help from doctors. On this basis, medicine is a failure-based system and ultimately all people must die, so we must fail with every single patient.

Keith Macleod: a unique and powerful teacher

1 May 2017 1 Comment

Sue Hallwright

My recollections of Keith Macleod date back to the late 1970s when I was studying medicine at the University of Otago. Keith’s views regarding the role of clinical medicine in people’s lives, his focus on patient experience and his methods of teaching all had a major impact on me. All that I learned from Keith in my early medical education has stayed with me and remained relevant over the years.

This was an era in which most doctors and patients tended to view the doctor as the ‘expert’: the person with all of the knowledge about illnesses and how to treat them. The patient’s job was to provide a good history of the condition, make themselves available for examination and investigation, and then, once diagnosed, to follow their doctor’s instructions regarding treatment. As I recall it, the importance of the patients’ expertise, the meaning of their condition in the context of their lives and the limits to medical knowledge and practice were not acknowledged within the medical school curriculum at that time.

Like playing the piano blindfold: “Life on the Spectrum”

1 May 2017 1 Comment

Sue Wootton

Musician and teacher Julie Hanify has played the piano since she was a child, but for most of her life she felt like she was “playing blindfold”. In her memoir Small Blue Thing: Life on the Spectrum, Julie writes:

I had the sense that each note was in its own world and that the next note was a total surprise, as if it were on the following page. Reading music was like leaping note to note over an abyss. I lived my life like this. I’d be in the moment with no forward thought or planning for the next.”

When she was 43, Hanify was diagnosed with attention deficit hyperactivity disorder (ADHD). The prescribed medication improved her brain’s capacity to filter and sort multiple stimuli. Now, for the first time ever, she could sight-read music. More generally, she was able to sense the present moment as having been shaped by the past and as contributing to the future. With a sense of sequence as a frame for life’s experiences, Hanify could grasp previously elusive concepts like anticipation, planning, and cause and effect. “Medication”, she writes, “changed my life”.