Dealing with Cancer as a Junior Doctor

Our founder, Dr Catherine Fernando, was diagnosed with cancer aged 23. Read on to find out about her story and how she found dealing with cancer as a junior doctor.

It was 2002 and I was 3 months into my first year working as a Senior House Officer in Medicine at Stirling Royal Infirmary.

Having already spent a transformative year in this district general hospital as a Junior House Officer, I’d grown to love the fluctuating rhythms of this hive of miracles and tragedy. My apprenticeship had already pushed me to unchartered levels of inner strength determination and stamina. Doctors are compelled to grow up fast, dealing daily with devastating traumas, heartbreak, and loss.

The key to survival is to learn to recover over and over and over again. Refresh, reboot, refocus, and move on to help the next patient. This is not a natural or easily acquired attribute. And during the process I cried many, many times. The harrowing pain of breaking bad news to patients and families of terminal illness or sudden death never lessens, no matter how many times you must do it.

In addition to personal resilience, I learned many other skills. Some of the most important of which were: to run to the cardiac arrest, instead of away from it (which is instinctively what many inexperienced juniors would prefer to do). How to wake up ready at any ungodly hour of the night. And how to dash frantically through long, dark corridors while simultaneously skimming algorithms from my “cheese & onion” clinical handbook so that I could sound like I knew what I was talking about when I got to resus.

The workload was exhausting, but it was a huge privilege to have finally earned the title of doctor. I revelled in the detective work of diagnosing and shone with satisfaction when patients responded to treatment. The camaraderie amongst my colleagues was incredible. We were all in it together – all exposed to immense stresses, responsibilities, and challenges.

Much of the time we lived on our nerves, terrified of the consultant’s questions on the ward rounds, fearful that we wouldn’t be able to convince the radiologist to do the scan we’d been asked to organise, eager to present thorough case histories and competent management plans to impress our seniors. Every day was like an examination in which we had to perform outstandingly to reach the next stage. Most of us survived, and eventually thrived. But the junior doctor years were tough.

Many intense “on-calls” later, I was gradually growing into a more confident, accomplished doctor. I was determined to become a consultant physician by the age of 30 and had begun studying in earnest for my MRCP exam. However, my life suddenly took a dramatic, most unwanted change of direction.

After casually mentioning a longstanding lymph node on the right side of my neck to one of the surgical registrars, he offered to excise it. Intrigued to finally discover its aetiology, I happily agreed.

14 days later, I was sitting in the office of a very experienced surgeon, being told that I had Nodular Sclerosing Hodgkin’s Lymphoma. It was the most awful day of my life. It was very hard for me to acknowledge or accept that I had cancer because I felt so healthy. I was working 100 hours a week but wasn’t more tired than you would expect a junior doctor to be. I hadn’t lost any weight or experienced night sweats.

Despite these objections, a dusty recollection of family history nagged at the back of my mind. My mum’s half-sister had died of Hodgkin’s Lymphoma when she was 21 years old, just after giving birth to a baby.

The night of my diagnosis I wanted to die. It’s hard to not question why this has happened to you and feel the gross injustice of fate. My life goals hung, suspended in the balance. Would I ever become a consultant? Get married? Have children? How long did I have? What would mum do? – she had only recently lost dad. In my darkest hour that night, I wondered if I could steal some morphine from the hospital and just go to sleep forever so that this terror could end.

Of course, I didn’t attempt to steal any morphine, but my mood was desperately low. The other doctors did all they could to help me. I remember one telling me that if I was going to get cancer, then this was a good one. And another, near retirement, recounting a friend of his who was diagnosed with Hodgkin’s at my age, but was now as geriatric as him!

These stories helped a little, but I knew every case was different and my story was, yet, untold.

In the following week, I underwent blood tests, an excruciating bone marrow biopsy, a CT scan, and a PET scan in Aberdeen – the only hospital in Scotland which had one at the time. Whilst awaiting the results, I escaped to Disney World to distract my pessimistic imagination, endlessly wondering how far the cancer had spread and what my prognosis would be.

Finally, I met a brilliant but frank oncologist. She told me that I had Stage IIA Hodgkins Lymphoma and that my treatment plan involved 2 months of chemotherapy and 1 month of radiotherapy. She was optimistic but also realistic. She explained the potential side effects of therapy, short and long-term, so that I could make informed consent to treatment.

These included breast cancer (from the radiotherapy), leukaemia (from the chemotherapy), and possible infertility. The stark alternative, however, was to decline a treatment for a cancer that had a proven fatality record in my family. Ultimately, it was an easy choice.

Chemotherapy was hideous. My veins burned, I wept uncontrollably at the fallen hair which covered my pillow every morning, and I felt nauseous all the time. I dreaded being hooked up to the toxic potion of chemicals that made me feel infinitely worse than the cancer.

But with every week that passed, I could feel the lump in my neck (which had swollen rebelliously to a woody mass after biopsy) gradually shrinking, and softening.

If chemotherapy was ghastly, radiotherapy was abhorrent. I took an instant dislike to the young radiographer who made a nasty, snide “ooh, get you!” sound after enquiring about what kind of work I did. I felt so vulnerable that I couldn’t cope with any insults or sarcasm. The first few sessions of radiotherapy were okay. But by the end of one week, I was utterly shattered and intolerably nauseous.

My throat was so painfully raw that no food could pass. My consultant explained the normal bell-shaped curve of responses and felt that I must be in the unusual 2 % of people who reacted severely to therapy.

However, after a heinous fortnight, someone double checked the maths. I had been receiving many multiple times the dose of intended radiotherapy and was suffering from radiation sickness. My consultant readjusted the fractions so that my total dose was correct over fewer sessions.

After a further month’s sick leave to recover after treatment – a total of 4 months since my cancer diagnosis – I returned to work. I had to get back as quickly as possible so that I could sit the first part of my MRCP. I was due to commence rotation A: Cardiology and Respiratory. Cutting edge, acute medicine was exactly where I wanted to be.

However, my educational supervisor had different ideas. He shuffled the rota and dealt me rotation C: Geriatrics. I was hurt and furious. Why was he being so patronising? Did he think that I was weak and couldn’t cope with acute medicine, or that I had lost my knowledge and skills?

However, no amount of protest would change his mind. So I was reluctantly seconded to Medicine for the Elderly. In this specialty, I was privileged to learn from some of the best physicians I have ever had the pleasure to work with. Their holistic ethos, knowledge and application of general medicine, and pragmatism are values I continue to aspire to deliver.

As it turns out, I didn’t become a consultant by the age of 30. In the following year at Stirling Royal Infirmary, I met my husband. We had a fairy-tale wedding at a Scottish Castle, and now have 4 beautiful children. Although we both completed our MRCP exams (and many others), and pursued careers in hospital medicine for some time, we both ultimately decided to become GPs. And we still love working in General Practice.

I’ve now been cancer free for 20 years and I’m working hard to make the most of life for me and my family. The fear of long-term complications never goes away. But I have learned to cope by keeping busy and taking care of my health as best I can.

Life is for living and I don’t want to waste a single day.