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I think where we live. OK, fabulous. Hi, everyone. I'm Isabel. I'm currently a foundation doctor in north London, and I'm working with W PMN to bring you a very exciting set of mine. Ours. Um, so just to introduce the series a little bit if you haven't turned into one of them before. Um, so the aim of the series really is to inspire the next generation of surgeons and to give you surgical role models that look like you. So each month, we have women from various surgical specialties across the country, and each surgeon will be talking about their journey into surgery, Um, and various aspects of their career. So far, after the talk, we'll have a Q and A with the speaker. So please do send three questions in the chat, and I will go through them after the at the end. All right. Um and so before I introduce, uh, speaker, I also want to remind you to please fill in the feedback form, which will send it to you as well at the end of the talk. So let's introduce this month speaker who we are very, very grateful and excited to have with us this evening. Um, she will be sharing her story of how she trained as a consultant for plastic breast surgeon to then age 40 full illness to the disease she has spent her life devoting to treat. She is a speaker, author, podcast, host, educator and patient advocate with improving the quality of cancer care at the heart of everything she does. So please welcome Liz. Oh, Rawdon. Thank you, Isabel. And thank you, everybody for tuning into Listen to me this evening. And we all have so many other things we could do. Um, I thought what I do is talk about how I got into breast surgery. Now, I I knew I wanted to be a surgeon from six form. When I did work experience and the first time I walked into an operating theater, I knew this was it. I wanted to wear pajamas. I wanted to be at that table, just fixing people. I was hooked, and I think from a very early age, you know, whether you want to be in an operating theater, doing whatever is in there, or it just bores the life out of you. But for me, it was all about surgery. You actually get to fix people. When I first saw a breast surgery back in the early nineties, it was literally slash and grab surgery. Put on the end of the list for the most junior doctor to do. To do. It was all about mastectomies or lumpectomies, where you cut down where the lump was. There was like a plastic surgery didn't exist. And then over my training, it changed, and it suddenly became like dressmaking. Breast surgeons were suddenly reconstructing breasts, using implants, using tissue from the muscles on the back or using fat from the stomach. I could take a large cup breast weighing a kilogram, reduce it down to a C cup breast. Take the cancer away. We were learning to cut around the nipple and tunnel up through the breast tissue to get to a cancer, so the scars were invisible and it was suddenly fun. And the general surgeons thought it was like a dark arts because they didn't understand how I could spend four hours playing with breast tissue. But I loved it. I was drawn to breast surgery as well, because there is no on call. I don't like getting up in the middle of the night to operate. I get stressed, and with breast surgery there are no really out of ours emergencies. And because I married a surgeon, it meant that I would actually see him because he does do on call. So there's no on call. I don't have any junior doctors because I don't have any patients on the ward. Um, most of my job is spent in clinic. And although people think breast surgery is boring because you're just removing a cancer from fat, there's not much anatomy unless you account removing lymph nodes in the armpit. Every breast is different, every cancer is different, and every patient can be a challenge and a joy. And that's why I love it. But it was only when I became a consultant myself that I realized exactly what I did. I signed myself up for and this is the thing. As a junior doctor, as a medical student, you don't really get how emotionally hard the job can be. You'll see cases that will make you cry and things that will make you think, Oh my goodness, but you don't have that responsibility as a consultant. I was suddenly telling 10 women a day. They had cancer, and it was up to me to absorb all. They're negative emotion. The crying, the screaming, the punching, the silence and I had double maths on a Friday Friday morning was my postop clinic, where I'd have to tell women they needed more surgery. The lymph nodes were positive. They needed chemotherapy. Then I go straight to my afternoon clinic and give women mammogram results. You've got cancer, you need surgery, and that is really emotionally taxing. We don't get any training or coaching or counseling to cope with the cancer surgeons job. It's just what you do and you get on with it. But it is really, really hard, and I didn't get that. My husband is a benign upper GI eye surgeon, which is mainly gall bladders and hernias, and he does break bad news. He tells patients they have a softer gel or duodenal cancer, and then they go to a tertiary center for surgery so he may break. He may break bad news once or twice a week, and it's upsetting, but I can do it 10 or 12 times a day, and that's really really hard, and it didn't hit me as a student. Another thing about breast cancer surgery is it's really, really oncological. You have a strong relationship with the oncologists. You have to know an awful lot about the latest trials, the latest treatments. And I like that. I like knowing why I'm treating my patients and what will happen next. But I also get to talk to my patients, and I developed relationships with them, and I see them again at a year, and I see them again at five years, and I just love having that continuity of care and knowing, hopefully that I've made a difference in their lives. I've had women flash me in a supermarket to say, Look, Doctor, I'm really pleased with my scar. And I thought as a surgeon, I was doing a great job If you couldn't see the scar around the nipple. No complications, happy smiley faces. And then in 2015, when I was aged 40 I got breast cancer myself, and I realized how little I knew about what it was like to have breast cancer despite being an expert, and I'm going to be really honest here, I never checked my breasts. I didn't think I would get breast cancer. I didn't check them, I told them my patients to And most women only check their breasts when someone famous is diagnosed or dyes. And when you're young, mammograms don't work, which is why checking your breast is really important. And overnight I went from being a fit and healthy 30 year old to a Stage three breast cancer patient, which meant I had chemotherapy. I had a mastectomy and reconstruction. I had radiotherapy, and I learned just how hard it is to go through those treatments I used to give out. Like Smarties as a student and as a junior doctor. It's very awkward to sit in a room when someone has been given bad news, and it's hard to find the time to go to all the all the other little clinics. As a consultant breast surgeon, I had never heard what my own breast care nurses told my patients when I left the room because I was seeing another patient. The same with my oncologist. I used to give patients the basics about what I thought chemo was like. You'll lose the hair on your head, you might not be able to work. You'll feel tired on to the oncologist to give you the full thing that I never heard what she said. And when I was having chemo, I knew I lost the hair on my head. I wanted to find out when, and I met a friend who had had it, and she told me where your pubic Carol fall out on Day 10. And I went, What? I didn't realize You lose all your body hair and I'm a consultant breast surgeon and a third of my patients have chemo, and I didn't know just how bad it could be. And when I had radiotherapy, I'm embarrassed to say I had never seen the machine that 80% of my patients had to lie in. I didn't realize you had to get both arms above your head, and that's why the shoulder exercise is so important. I was doing such an isolated part of the breast cancer treatment, and I had no idea what was going on and what my patients really, really needed. And it really made me think about the language that I use when I'm breaking bad news and someone's asked a question about that. So I'm just going to go in and talk about that now because this could be really important for you. The first time you hear someone breaks bad news, it feels awkward. It feels uncomfortable. You'll feel like you're intruding in a very, very private moment, and you are. It's horrible as a student, but you have to be in that room as often as you can because the more people you listen to, the better you will be because you will learn. And like that phrase God, they were awful. I never want to do it like that, and you will pick up different things. Depending on the stage of the training, you're at one of the most important things you need to do when you're doing it. And often as a junior doctor, you're told to go and give bad news on call in the middle of the night to a patient you've never met. And it's not just you've got cancer. It could be I'm sorry your scan has been canceled or your operation has been canceled because the list is overrun. That's still bad news. You need to prepare you need to make sure you know who the patient is. You've read the notes and there is a plan. If you do have to tell someone bad news clinically, make sure there's a nurse to come along and check up on them. When you've gone to pick up the pieces, make sure there is a plan because the patient is going to ask you what happens next. And if you go well, I don't know when the operation is going to be. You're almost doing more harm than good. So preparing I would physically make a show of turning my phone off and putting it down on the table. So that patient knows they have my full attention. And I was taught, asked the patient to go through what they think is going on, and as a patient, you just want someone to get straight to the point. I don't want to have to tell the fifth person today. Well, I found a lump, I had a scan, and now I'm here were told to do that, to get the patient, to say the word cancer. So you, as a doctor don't have to. But when I found out, Although I knew what it was from when I had my scan. Um, my surgeon just said, Right, it's cancer and it was like, abrupt, but she got to the point and we could start dealing with it, and it's really important that you use plain, simple terms. What most doctors do, and what I used to do is having said it's cancer. We go straight into the plan, you're going to need a mastectomy or you're going to need surgery or you're going to need to see a doctor because we know what we're going to tell them. But to the patient, whenever they hear bad news, everything you say goes in one ear and out the other. And even me as a breast consultant being told about my breast cancer experience, I couldn't remember what they said, and I went home and I went to Google and thought, Oh, my God, Now I get it. The first thing you do when you give someone bad news whatever it is, is to bite your tongue and sit on your hands and count for five, maybe 10, and it will feel like a really long and comfortable silence. But what you are doing is giving that patient the time to assimilate the information and to ask you the first thing that comes up that's really important to them. That could have a dramatic impact on what you say Next. A lot of women will say, Am I going to die? Is my hair going to fall out? Who's going to look after my disabled father, whatever it is and that can guide your consultation because if you start going down, we need to do a B C D. Those really important questions that they have, they won't ask because the doctors move on and they don't want to bother us. I am terrible at talking because I hate that gap and I've had to learn just to say it's cancer. Just sit and be quiet and let them take on the news and give them a moment. So they're then ready to go on and ask you questions if that's the one thing I can say. But when I had cancer, I had nine months of treatment chemotherapy, mastectomy, reconstruction, radiotherapy and I eventually went back to work. I found it really, really hard because when I was breaking bad news I saw the woman crumble and I saw the husband cut her hand and I was reliving my own experiences, and it was really hard to disassociate what I've been through with what they were going through. But it was the words, the language that I used to use, that I changed because when you are a doctor, we see the best and we see the worst. We've seen everything, and I kind of wanted to reassure patients that they had a small cancer. You know, it's good you won't die. It's good we caught it early. You're going to be fine. All these positive words to try and make them think it's not that bad. And I used to say, You know, we're lucky we caught it early, and it's good that it hasn't spread. But when you're a cancer patient, no one is lucky to get cancer. It's not a good thing to have, and I didn't get how triggering those words could be and how I am belittling their own experience. And yes, it may be a tiny little cancer on the tip of the nose. I can freeze off in the clinic, but it is still cancer and the patient is going, Oh my God, it's cancer! It's the end of the world and you have to realize that's what most people feel because they don't have a record of experience. And I think another great way to learn how to have difficult conversations. And I want all of you listening to promise me you'll try and do. This is to go and find the palliative care nurses in the hospital and ask if you can shadow them when they go and speak to a person who is dying because they are incredible, bringing patients and their family in and being open and honest about death and dying and how to do it beautifully. You will learn so much, I promise you, because you're going to spend a lot of time dealing with patients who aren't going to leave hospital, and the palliative care team will hold your hands and help you have those difficult conversations. So promise me back to me. After my treatment, I went back to work for about a year, during which time I had started. Blogging, mainly is the way to make my cancer diagnosis seem really, because I was in denial. I still am. Really, I can't have had cancer. Can't be happening to me. It's not really so. I started blogging, which led to me being invited to talk to patient groups and cancer charities and then, uh, TX talk and then to some higher up talks. And that led to me writing a book because I used to tell patients, Don't Google and I want each of you to think if you were diagnosed with a serious illness, whether it's asthma or arthritis or diabetes, where would you go for information? Would you go to the NHS website or the hospital website? Would you google your doctor? Or would you? Would you? Would you go to Google or Instagram? Most patients go straight to the Internet, and I tell patients, Don't Google because it's scary. It's the first place I went and I will admit, I'm embarrassed to say this. I had never been on a breast cancer charity. Four. Um, I've never read the questions my patients were asking. I didn't know what apps are available. I didn't need to know that because I'm a surgeon, but these are the That's the information my patients needed. So really get an insight into a disease you're learning about. Go and look up the relevant charities, relevant forums and see what it's like for the patients to live their illness. I discovered that women were asking, Is it safe to have sex during chemotherapy? Because I'm scared my husband's hair will fall out. They don't know who to ask this information. They don't ask me as a doctor because I'm scary. They go online and there's no guarantee they'll get good information. So I wrote a book called The Complete Guide to Breast Cancer. I should have got a picture of I'm sorry, um, to help explain all those questions that patients had, and not just about the treatment, but about diet and exercise and mental health. So much, Um, and more and more people are blogging now. A lot of people think that breast cancer and young women is really common, and it's not. It's still really rare, but your granny isn't on Tic Tac or Instagram, and I think reading about other cancer patients journeys on Instagram or Twitter is really, really eye opening to see what it's like to live their experience. You're only getting a snapshot, and some of it may be exaggerating, but it's a good way just to tip your toe in and see what is the cancer world like, What is the world of diabetes like? What is it like to be an asthmatic? All these little things and I'm going to digress here. One thing I would love all of you to make sure you talk about or you ask the doctors you're shadowing. Why they're not talking about it is sex. I know I said it. I can't remember ever talking to a patient about sex after surgery. Actually, that's a lie. When I did bowel surgery, I would go and have to tell men that they may get retrograde ejaculation and their erection may not be as strong. I didn't tell them how to fix it. I didn't think they'd want to have sex afterwards. And I remember meeting a young girl who had a colostomy, and she asked her surgeon, What do I do with the stoma on a one night stand? And he was horrified because he couldn't imagine having sex with the stoma. Why would this woman want to a lot of things we do two patients have a huge impact on their personal lives, and I never talked about it. There will be someone in every hospital who is a sex therapist. We had a sexual psychologist for cancer patients in my own hospital. I didn't know until I went back to give a talk three years later, and this woman in the audience put a hand up and said, But I'm here to talk about that with cancer patients and as a consultant, I didn't know there is no point giving someone a beautiful, neat scar. If they're miserable, they can't have sex. Their husband leaves them. It's the patient experience. It's helping them get their lives back. So if you are watching an operation on a patient, it might affect their sex life. And that could be as simple as an anal fistula or a colostomy, where there's a midline scar that you need to show someone on a date. Ask the consultant who talk to these people about how they get their sex life back afterwards, how they deal with intimacy issues. And if you're not doing it, why not? It's so important anyway. I was back at work, but I was having a lot of pain from my implant. Radiotherapy can make an implant feel like a tennis ball, and mine was moving up. My nipple was heading off towards my ear and I was prepared to go flat. And then I went to see my surgeon and she ultrasounded an area of scar tissue on my chest wall, and that turned out to be a three centimeter local recurrence on the tissue around my ribs. And that was a real shock. Um, it had come back really quickly. It meant my chance of dying from breast cancer was that much higher, and the side effects of surgery meant I couldn't use my arm properly, which meant I had to retire. So at 43 having done a PhD and a postgraduate diploma and dedicated 20 years of my life to becoming a consultant breast surgeon, I was unemployed. I had lost my job, my purpose, my identity, my income, my wardrobe because I was flat. I'm a unit goober, and I couldn't wear a prosthesis because of chronic pain and bras hurt too much, and I realized how unbalanced and toxic my life had been as a surgical trainee because I was brought up. When it is job exam, job exam, homework, audits, papers do not pass. Go. Do not go out with friends. My social life was drinking the night before I was on call with the people I work with. I couldn't do any regular hobbies because I was always doing a regular hours and I moved around so much. I had long commute and it is so hard and it's wrong. And I think more and more junior consultants are realizing that there is more to life than surgery and that having a life outside makes you a better, more well rounded doctor makes you more employable. But it's really hard to say No, I'm not going to do that audit because I won't finish it. And I have a life and my life is important to me, and I had to learn to rebuild my life and actually find people to do things within the day and find out what I like doing because I hadn't done anything apart from surgery since I was 18. And if there's one thing I could tell you, it's to try and hang onto the stuff you like doing and the friends you have because you never know what's around the corner. I can happy to come back and do a talk about how you work out who you are. Me, at my core. I just want to help people the cliche that you're not meant to say in medical school. But that's why I want to do. And I've kind of developed this new career. Um, by tweeting about my breast cancer journey, I realized I could tell patients and nurses and doctors understand what it's like and by helping doctors get onto Twitter and realize they're not going to be thrilled. And it's not scary, and we can talk to patients and patients have all these really simple, silly questions. And if I go out there and say, Ask me anything and I'll tell you it's it's the way of helping them. It's opening up a new audience, making them realize that there are safe spaces to go, and that's led to a whole new career of talking and podcasting and writing and just another way of being a doctor. It doesn't just have to be helping people in the hospital, in their home, in the community and I'm actually weirdly happier now unemployed than I ever was as a consultant surgeon, and I have a far bigger outreach than I ever did. And I would really encourage you all just to explore the world of social media. Even if you don't tweet from an educational from the networking event. There is so much information out there and you can ask anybody anything. When I was a consultant, I wanted to get access to a paper that was behind a pay wall. I thought I saw it. I found the author and I e mailed them in America. They sent me a copy. Most doctors are nice and will do anything to help you. You're going for an interview for the job, the next level up. What you do is you ask people who already have the job. If you can see they're CV, can you tell me what they ask you at the interview? It's not cheating. It's how I got my job. Someone told me, and I use that to move on, and I now pass that sorry. Pass that information down. You have to get used to sharing and being can e and using the information. You have to get the job that you want. Now, I've talked about half an hour and I can talk and talk and talk. But I'm sure you must have a load of questions that you want to ask. I'm going to stop now and see if there's anything that you'd like to ask me, Um, to start with, I'm just loading. Can you hear me? Yes. Yes. Thank you so much for a really interesting, um, insight into being a patient and a doctor. I don't think I've ever met anybody that has been in your position. Um, and your tips on breaking bad news? That was my question. Because I'm starting to see that more and have jobs coming up where I expect I'll be doing that a lot. So, um, some really practical tips first, um, So Maria would like to know, Um, do you think it is better to look at other social media things like YouTube and ticktock and Twitter as it is? A more of a lived experience? Yes, I do. Patients don't tell you what it's like when you see them because they're seeing the doctor. You don't tell your own GP. what your life is really like. It's a very false experience, the stress of waiting to be seen. So I want to apologize now any medical student I've ever sent to go and sit with a woman while she waits to have a mammogram just to get them out of clinic because I'm busy and I don't have time. Because when you are waiting to have a scan to find out if you have cancer, the last thing you want is a clueless person sat next to you trying to make polite conversation. It is just awful, I think, going and reading blogs going and finding. Just put in Twitter, bowel, cancer, asthma, whatever it is, you'll find patients go and read their blogs and read out what it is like to go through that experience, and you will get a really good idea. And if you want, please, it's all about audits and projects that you can do. The quickest thing you can do that will improve patient care. Overnight is to digitally sign post patients. I used to say, Don't go on Google. It's the first place all of you would go. So when you're in an outpatient clinic in a followup clinic. You go to patients and you say, Can you tell me what apps, websites, books, forums you found useful And you make a list and you look at them and you go to the consultants and say Right, I've looked at these. These seems safe. These seems sensible. Can we create a list that we can email out that we can give to patients to say you're going to go on Google? Because this is the thing, especially during cove ID. When you are seen by a doctor, you're If you're alone, there's only you to remember that information. You may be you and your partner, but your Children. Your mom wants to know when the patient goes home. They have to be the doctor explaining what I have told them to their family, and they can't remember it. If they could say, Go to this app. Read this book, going to go on Google. These are safe places. You will dramatically improve care overnight. Promise me you'll think about doing it. I think that's really helpful because I often find that I don't know which websites are good, which apps are good, but your tip of actually just going and finding a patient, an expert patient, maybe met in clinic and saying, What do you use is the family? I mean, I bought 20 books because I wanted to know what it was like to be a patient. I bought 20 books and a consultant breast surgeon. There's no one great book or great app. But if patients tell you what they've liked, you can then split them up between you. Go and have a look and say, right Hospital website list of resources. The patients can go there. Click. This is a good place to start. Yeah, happiness. Um, so just talking about So Motrin has said, I'm very interested to be a breast surgeon. What advice would you give in the journey of training to be to being a breast surgeon? Basically, the surgery is a competitive field, and you have to know it's hard work. For the next 10, 15, 20 years, you'll be doing audits and papers and research and homework and revising for exams into your early thirties. It is hard you, at the moment you have to do training in general surgery because they still don't believe you need to have the oncological background, which means you have to pass a general surgical exam even though you never want to look inside and abdomen again. You have to go through that training and it is competitive. So what you do is when you're a medical student, you look at what you need to have on your CV to get an F Y one to job and surgery. And then when you're F one, what do I need to do to get an ST Post when you're in ST. What do I need to do to get the next post to give yourself two or three years to take those boxes and you ask the doctors you're shadowing? Can I see your CV? Can I see your application form? Can I do an audit? You have to is ticking those boxes I need. You need to do either some form of research or medical education or management. Management is boring. Nobody wants to do it. But it's the one thing everyone will have to do As a consultant. You will become a clinical lead or a general lead. So if you can tell your consultant, I'm really interested in management. Can I follow you to the tumor board meeting? You will get huge amounts of points on your CV. You can fake it. You can lie and say, Yes, I love management. You don't give a toss and nobody else will be doing it. Nobody else will be doing it. And if you show an interest in that, it will really, really help it. Also, for most surgical specialties have national fellowships, which you do in your final year before you become a consultant, where you get expert training and there's a national on plastic fellowship where you go to one of nine centers. And again, that's competitive. So again, When you are a CT 56, you start looking at the application form for that. When does it come out? What point do I need? The job is amazing. I didn't do breast surgery until I was six months into wanting to do as a consultant. It's often it's luck. When do you get to try it? Um, but I would say Talk to breast surgeons. Talk to the registrar's, borrow everything you can from them. But remember, you're you'll do six years of hell with your own cause knowing you never have to be on call again. Yeah, I know. I hope that helps. It's a bit of a but it's competitive. And it's taking the boxes early to give yourself the best chance to get the fellowship to get the right jobs, definitely, and finding people that are doing the job that you want to do. And, yeah, so this is I. I had never done on the plastic surgery before applying for the fellowship because my consultant didn't do it and you were meant to have a years' experience. I thought, I'm not going to get it. So I rang the college tutors for breast surgery and Tansley and said, And I'm really worried. I need to get the job to learn how to do the fancy stuff, but I haven't done it. And she said, I'm on the interview panel. This is what they are going to ask you. This is how you can get around that question ring. The college tutors say I'm f Y two. I want to do a breast surgery. What should I do? Where should I go? Seriously? Yeah, yeah. Not cheating. It's being clever. Um, and so he wants to know how difficult was the kind of initial transition from being a surgeon to them. Being a speaker, author, all of these other things that you're you're doing it was incredibly hard. I spent six months seriously depressed on the sofa, thinking, Why do I get out of bed in the morning? What's the point? I have no job. I have no purpose. My one of the problems about tweeting and blogging so much is your phone takes over your life. And I wasn't doing anything for me because I was just answering all those questions for free. Writing became a form of therapy, and I was very lucky to get a book deal very quickly because my agent sister died of metastatic breast cancer. But it is very hard getting into the writing world, and everything I've done has been word of mouth. I've never gone out saying hi, me to do a talk. I did one and someone saw me and asked someone else, and they came to me and it's just been a word of mouth and it's grown, and I quite like that. I never wanted to say Please, what you pay me to talk. The hardest part is knowing what you're worth, because as doctors in the NHS, you don't really know what your hourly rate is when you know there are. There are male politicians bringing home 20 grand for a 20 minute after dinner speech. You don't know how much to charge. And that was a real learning curve, getting into a completely different world and self employed and taxes and all that kind of thing. But I love it. It's hard work, and I have to remember that I'm not a doctor for the Internet and I can't answer everybody's question instantly. And it's okay if they wait a month for me to reply, because you get that sense of I have to help you Now I don't get it for a second. Um, Maria would like to know. Is there something that you thought would be a small event during the cancer diagnosis and treatment journey that was actually a huge lived experience and vice versa. So, like there was a huge event that you thought yeah, actually was a good question opposite. So I thought I'm having a hot flash, I thought, choosing whether to have a reconstruction or not would be really easy because I spent three years counseling women about whether they want to have a reconstruction. And I realized you don't know what your breasts mean to you until you have to have one of them removed. So my cancer was 13 centimeters in size, so I had to have a mastectomy. And when you have cancer, you can't think rationally because your breast has got cancer in it. You want it gone and I'm slim. So I didn't have an option of using my tummy and my bottom of my foot. It was an implant, and I know implants can be difficult. And I'm the worst person to put an implant in because I'm slim with small breasts. And I thought, If I don't have a reconstruction, what are my patients going to think? I don't want the operation I sell? Real reason I wanted a reconstruction was because I used to wear low, swishy, long, swishy dresses with a low cut with a V neck, and I thought if you wear a prosthetic bra, it's all the way up. Here is a really full cup and that would show in my clothes and I had a vanity with the reason for choosing to have a reconstruction. And I had the luxury of five months of chemo to make that decision. My patients have to be operated on within four weeks of me giving them a diagnosis. And I had no idea how hard that is. And when I went flat, I was crying. I was traumatized. I cannot imagine being flat on one side a year later, Quite happy being a you know, but don't care. Time is a great healer, but that was a shock. I thought I'd be upset about losing my hair. And actually, I really quite liked it. I wasn't I wasn't bothered by that at all. I quite like rocking the bald head. So yeah, and I imagine different women have completely different things that they found really difficult or really easy. Yeah. The hardest thing for me was the menopause. Um, instant menopause. At 40. I thought I'd wet the bed when I felt water trickling down my butt cheek and I realized that that's a night sweat. Um, how hard it is. And again, the impact of the menopause and your sex life and how I never talk to patients about it. And I used to say, You know, six months, you'll be fine and I had no idea because I've never taken the time to listen or to research. Mm, I'm stressed. Clinics and lots of general once seen a surgeon talk to a patient about sex, ever. We don't we don't know. And if the breast if the surgeon is into the breast care nurses do no one talks about, I think it's really important, whatever your specialty and to go and else and say, How does your treatment affect a person's sex life? And who is talking to patients to help get it back? The only time I saw it happened was when I did erection dysfunction clinics in neurology. Now my maiden name was Ball B A L L. I was known as Tess as in testicle, and I was working in a hospital in the Welsh valleys, and this was before Viagra. So they had these things called Muse, which is a wax pellet, and I had to mind pushing a wax pellet down a penile shaft and warming it by rubbing the Penis between my hands to warm the wax so they would get an erection. Wasn't all that in medical school, but apart. We don't talk about it, and it's like a basic human need. So it's coated COPD. People are scared of having sex during long coated because they can't breathe. They get short of breath who talk to them about different positions. You know, it's not just cancer, so please go and talk about sex. There's a huge Twitter thing of doctors and nurses trying to make this part of normal patient care. Okay, really interesting topic. Um, Maria would like to know at the time you went back to work after your cancer diagnosis, what mechanism did you use to cope when going from empathizing to sympathizing with your patients and just add that as well? Did you, like mention going through like, did you use your personal experience in those quotations or not? Um, this is a brilliant question. So my book and my blogging and my tweeting we're done under my married name because at the time, I thought I don't want crazy patients to start me on Twitter, so I will tweet as a reardon. But I worked as a ball and I was wrong. Um, so no one none of my patients would know I've had breast cancer. And also, if you haven't had breast cancer, you're not googling for it. So you're out of that world until it's happened. And, um, I so they didn't know I had written a book, but going back in that room, I just wanted to hug them and say, Yes, it's shit and let me look after you. And the first person I had to break bad news was in her thirties. She was younger than me, and I was a bit and I had to go and cry in the toilet. I can't do this. It was so hard to be the bad guy because I'm the one that has to say, You've got cancer, you need chemo, and in time I got better, and this is really interesting. The second time, I would have told someone they had cancer. I was focusing on the patient. I was looking at her, and at the corner of my eye, I saw the breast care nurse get a box of tissues and pass it to her husband. He was in bits, and I hadn't seen that at all, and I felt so bad I hadn't seen his reaction. But she said, No, your job is the patient. I'm there to pick him up. I just had to learn to stand back, But when I went home, I was in pieces, and in some ways it was almost a relief when my cancer came back because psychologically, I was finding it really, really hard to deal with breast cancer every day when I was still dealing with my own fear of recurrence. Um, ethically. There are no rules about whether you should tell patients you've had an illness, and I did an article in the BMJ with some doctors who've been ill, and I think it comes down to gut. I would never tell a patient when they're fresh, because the first thing someone says to you when you have cancer and my aunt had that and she died, I don't want to hear about anyone else's journey. I hate the journey word until I've been through mine because I'm unique. This is all about me. But a year down the line, when I saw them in a followup clinic and they were talking about tamoxifen and I'd say, Look, I know how bad can tamoxifen can be? I try this. What about that? And then I felt my gut. Maybe I could share what I learned as a patient to help them with issues like sex. They were too uncomfortable to bring up. But I knew I could help them with, um but that can only be one patient in the room. And you have to be strong enough to deal with the consequences if you say the wrong thing. And did did you find, like, the cancer nurses were just like the best people to lean on in those situations when you were feeling difficult, like work or before I had cancer? Um, we all used. We all used to finish go home and finish clinic until the last person left her to carry the trolley of notes all the way up to the 10th floor. And I said, Look, can we stop this? We would all hang around until the end of clinic, and we would all discuss the women had made us cry. The women had made us laugh, so we had that five or 10 minutes of saying, Oh, God, because I don't know what happened when I leave the room. I need to know if a woman started crying because her mom had it two years ago and has died. That will help me the next time I see her. So we all I used to call the clinic cuddle instead of the theater huddle. We had a debrief, the end of clinic. So before I got in the car, I felt a little bit brighter. We all share that motion and a great thing. If you're having a bad day, I have a playlist of music that you just You just have to juggle, too. And I have that in the car on the way home just to try and flip from cancers to Liz. Um, that can really, really help. When I went back, there was one cancer nurse, my breast care nurse, who I went to. I was having wobble. Everyone else had to treat me as Liz surgeon because they let their job be impacted by my wobbling. But there was one nurse who could say just going to loop, and she knew what that meant, and she'd get me a cup of tea. But everyone else I had to remain professional because I can't have my team working on eggshells. Don't say that you're set this off because I had to be the boss. That's really, really quite difficult. It sounds I can't even imagine how difficult I'm just having a look, for we've got quite a few more questions. Uh, I would I would like to know if you had any males with breast cancer, and if so, how is that different? So one in eight women get breast cancer one and 350 men get breast cancer, and it's actually really common in Suffolk, where I work, possibly something to do with farmers and agriculture and what was in the fields. It does happen often. It presents as joggers. Nipple, which is actually D C. I s is is dealt exactly the same. Men tend to just have mastectomies because they don't have enough breast tissue to remove it. But what then happens is you remove the nipple. Um, the scar sticks to the pectoral muscles. They can often get a dent. So we're we're now doing, like, a feeling just to kind of refill that pectoral shape, but they're treated exactly the same with the same hormone treatment in chemotherapy. And they find it really hard because breast cancer is all about pink and you're a man sat in a room full of women. It's really, really hard. They get very angry that no one thinks about the men when it's breast Cancer Awareness Month for yeah, it's really hard and similarly for trans patients. They find it quite hard going through this because if you've had, if you're a woman who has become a man and you've had your breasts removed, you can still get breast cancer because it's impossible to remove every breast cell from underneath the skin, so they still need to know that it can happen. Yeah, that's really interesting. I've not seen any male patients or trans patients with breast cancer, but I get one or 21 or two a year, I think one or two a year. Okay, so it's not very frequent at all, Shazia says. Thank you for your talk. Any phrases you remember hearing from healthcare professionals that helped you with your own breast cancer journey? Oh, I remember I used to My my surgeon was someone who trained me, who I work with. She was a friend, and I stole a lot of her phrases when I broke bad news. And that's what you'll do. Your your cherry pick phrases that certain consultants have said, I love that I'm stealing that that will go in my book. And I had had, um, axillary node clearance. Three of my nodes were positive during chemo, so I had the rest of my lymph nodes removed. And when I went back to see her, she said, You're not allowed to lift anything heavier than a wine glass for a month. And I thought, I'm taking that. I can understand My My journey was very different because I'm a consultant breast surgeon and everyone thinks I know everything and you will. You will see colleagues, senior colleagues, consultants, nurses as patients. And it is really, really hard. When I was a junior doctor, one of the consultants came in on call with abdominal pain. At the time, every abdominal pain needed a P R. I can't p r. A consultant. I've worked with my job, and luckily, the consultant call came in and looked after him. But you you say stupid things, your your anesthetist, I don't need to talk about surgery. No, please. Promise. You ever see a health care professional as a patient role? Assume they know nothing. And you tell them I'm going to assume you know nothing. Otherwise I'll forget something and you've not been a patient before, and at the end, we can answer any other questions to go into more detail. But the moment I'm going to treat you like a normal patient and you have to help them stop being in control. Let me look after that. We can do the bit at the side, Um, because it's really hard. One thing they did ask me, though, was because everyone would recognize me. They said, Do you want to use a false name? Because people know, see, it's illegal to look at the records of another patient if you're not looking after them. But often when I was at the market and you see a celebrity and I'm just going to you're not allowed, it's illegal. But they asked if I wanted to use a false name, and the thing that came into my head was my poor star name, which is the name of your first bet your mother's maiden name and mine is Max Love I won't remember during. I can't imagine a nurse reading it out a little things like that. But it was one thing that actually made a huge difference to me. Was every time I had my operation, my consultant surgeon stayed with me and she held my hand until the anesthetic work and I went off to sleep. The normally consultant surgeon is that in the coffee room, getting the patient ready when they need to set that done. And I don't know whether she I can't remember whether she did that for every patient or just because it was me because I was a friend. But I went back and I held the hand of my first patient, and the ODP said, What the hell do you think you're doing? This is my job, and I said, No, that woman is under my care, and I want her to know that I am here when she goes to sleep, and it just it just made me feel. I was just doing something to say I've got your back little things that you pick up a huge difference, and that's why you need to see as much as possible for as many different people as possible to say, Yeah, I like that. Yeah. Yeah, because I mean going to theater. I can't even imagine like, I want to be a surgeon. But the thought of having an operation is terrifying, and I was terrified. Really? Yeah. And sometimes it can hurt like hell. The propofol. The thick white stuff can actually burn when it goes up your arm in some people. So a lot of the neatest put a bit of local anesthetic in. I was really, really scared. And actually, you just go to sleep. You don't do anything. I was singing songs from the eighties declaring and die love to my husband in the recovery room And some days let him video me and I have no memory. I love you know, memory. I was really scared. It's crazy. Anesthetists talk to the patients are scared of having an anesthetic. What was it like? Um, yeah, Surgery is the most amazing. I'm going to give you a bit of advice before we go. When I was trying to work out what surgery wanted to do, a very wise man said. You pick the body fluid. You mind the least, not who. Gooey eyeballs, monkey toenails. I just get sweaty armpits in the summer or this is a bit controversial. You're always going to see difficult patients. Most of your life as a surgeon is going to be spending clinic. I had a half day list every week, and every second week I get an extra list, so I would spend one morning a week operating as a consultant surgeon. That was it, you know, And actually you don't operate as a consultant surgeon because your training your juniors to operate the best years of your life is your final two years of training. When the consultant let you do everything, um, but there are difficult patients who will come back to clinic. What normally happens is the junior doctor sees them, doesn't know what to do, says come back in six months when I'll be gone and you're someone else's problem. There are difficult patients mean it's often chronic breast pain or irritable bowel disease. You have to like talking about the problem is the difficult patients have because you're going to say the same thing in clinic the breast pain feel 10 times a day, three times a week for the next 20 years. So you have to really like the boring bits as well. Yeah, I think that's really important when thinking about surgery, because you can do it or whatever. But you actually not that if you ask registrars even and consults, they're not, uh, enjoy talking to patients. And the disease is and you learn to love them because you're an expert in them and you know how to handle them compared to you as a junior doctor. But most of your time is going to be spent in clinic, which and you get bored. Which is why a consultant surgeon said to me is if you did colorectal surgery know if you do any surgery, you will do the same. Three operations for me. Mastectomy, Lumpectomy, sentinel node, Colorectal Could be right. Hemi left Hemi Bum work life outside of surgery or you need education or management or scuba diving to keep you interested. Um, just have a list of final questions. There's one thing I wanted to ask you about your new book. Yes, I have not forgot. So I have written I should. I'll put the link and you can send an email to everybody. Type in here. It's called I Can't I can't type. It's called Under the knife Life lessons from the Operating Theater, and you can preorder it through a company called Unbound. And it's my story as a female surgeon in a man's world, learning how to cope with the job, coping with stress and depression as a consultant, cancer surgeon going, dealing with everything I've told you and then getting cancer and then moving on. Um, yeah, it's out next year under the knife. Um, bit of therapy. In a way, I think it's a good insight into what it's like and how to cope. And you're not alone when you're feeling what you're feeling. Thank you for reminding Isabel. It's okay, Maria, Thank you for popping the link in there so we can thank you. Um, any final questions? Anybody on pre order today? You can order it now. It's very exciting. I'm going to be an author again. Fabulous. Any final questions at all put them in the chat. Now I'll give you another two minutes. But if anyone listening wants to follow up or ask me a question. Just put my name into Google. You'll find my website. I'm on Twitter Instagram. I'm happy to talk to. So yeah, it's been helpful and you will love you. Love whatever surgical career you do, whatever medical career you do because you're an expert in it and it doesn't matter if you change. When I was 24 I was going to because I trained in Cardiff. I was going to be Wales first female trauma surgeon, married with three kids by the age of 27. I love the what? That was it. I was taking liver's out and stabbings and the gunshots. That was it. And then I had to spend four years doing a PhD to get points on my CD to get a registrar job, and I realized, I don't like getting out of bed in the middle of the night. I'm one of those people who will say, Just show me again. Just show me again. I'm not one of the I'm going to be sexist. A lot of the guys I trained with, they're like, Yeah, we'll do this. I read about it last night. No, no, no, no. no, and I could do it. I didn't have that confidence. The impostor syndrome, which we all have, and breast surgery was a way of not having that stress. But it wasn't what I thought it would be. And it was very hard as a female surgical trainee moving around a lot. I was single. For seven years, I assumed I had two cats. I was a crazy single cat lady. I could go out clubbing with the juniors because I have to bolus them the next day. And yes, I did spend one night on a foam night in a night club and I thought, No, I can't do this again. It's a really hard life. I married my boss. He asked me out the day I moved hospitals. I couldn't have Children now infertile. My life has changed so much, and that's right. If you suddenly wake up and think I don't want the stress of being a consultant. I just want to be a staph grade. My ladder stops here. I don't want any more exams. Clinical. Actually, I'm quite happy just being a job in surgeon doing hernias. That's okay. Don't tell people. I said that I think that's a really good tip to finish on. It's okay. Whatever. Whatever journey you choose to take. Um, yeah. So the final Thank you so much for taking your time to speak with us on a Wednesday evening. I found it really, really interesting. I'm sure you've inspired some breast surgeons listening as well. Um, so really? Thank you so much. And I can't wait to read the book. You're welcome. Thanks, everyone. See you later. Bye, everyone.