As part of my course, I had to undertake interminably long rotations in obstetrics and surgery, among others, and found myself continually focused on the haematological parameters. I was expected to go abroad for my elective to observe medicine outside the relatively privileged western world, but I chose to stay in the UK, spending two months in the haemophilia unit of the RVI in Newcastle. It was there I first experienced the teamwork and long term relationships that haematologists develop with patients facing lifelong blood disorders.
Once qualified, I moved to Oxford to start my junior training and was lucky enough to go into a haematology/pathology rotation, where you practise medicine under the supervision of a health practitioner. I started to see the breadth of haematology and appreciate the role a haematologist plays in the hospital, not just serving patients but also supporting the medical staff. Not a day would go by without calls from surgeons concerned about clotting tests for a patient about to go in to surgery, or from GPs wanting advice on how to proceed with an unexpected test result, or a junior doctor confirming which bottle to send for a sophisticated blood test (the answer was usually the purple top).
"Over the years, I developed a softened dialogue to relay complex diagnoses in an understandable way but I can’t say that I always got it right."
My first experience of life at a bone marrow transplant unit and tertiary referral centre was during my specialist training in London and Kent. I’ve always considered doctors to be in the privileged position of having a patient’s trust and have never taken that lightly. My haematology career exposed me to the highs and lows of life and have formed my experience in a profound way. I cared for patients with illnesses that we knew would never be cured, managed existential crisis with cups of tea and long chats, cried with patients’ relatives in corridors when they couldn’t cry in front of their loved ones, and told others the fantastic news that their treatment had been successful. My career on the wards exposed me to many highs and lows which has in turn had a profound effect on my own life experience.
By nature of the longevity of treatment for blood conditions such as leukaemia, haematology is a more personal speciality than most. A lot of medics never experience the months of contact with the same patients that those in haematology consider normal. As such, I have always been acutely aware of how my words as a doctor were taken by patients. Over the years, I developed a softened dialogue to relay complex diagnoses in an understandable way but I can’t say that I always got it right. I vividly remember some very worried faces as I tried to explain cytogenetics to patients and think back with regret at how failure to get it right may have affected the early days of their treatment. As aware as doctors are of how important their role is to a patient, due to the nature of our work, we can also be tired, grumpy, and too busy to chat more than necessary. We try but we don’t always succeed.
"One young prisoner I looked after with AML needed to visualise his disease and so asked me to print out pictures of leukaemic blasts to stick on his wall to fight in his mind"
While some of my memories of haematology are fogged with great sadness for the patients I’ve cared for who are no longer with us, there are others I remember fondly for different reasons: One young prisoner I looked after with AML needed to visualise his disease and so asked me to print out pictures of leukaemic blasts to stick on his wall to fight in his mind; a man with immunodeficiency and neutropenia came in on, what felt like, every night shift I did with sepsis. Three times it turned out to be due to a food borne bacterium linked to a dodgy takeaway that he refused to give up; the patient who gave me a black eye when he panicked and punched me during a sternal bone marrow from his breast bone. And one amazing lady whose relapsed AML did not respond to the last line of therapy we had to offer asked me what she should do about the carpets in her front rooms that she didn’t like. I cried and told her she should buy the best ones she could afford and enjoy them for as long as she could.
My last two years in the NHS were spent developing a national research project in blood clotting. It was in the stillness of this research that I reflected more on what I wanted to do with my career. Coupled with the utterly baffling and sometimes obstructive processes within the NHS, even though I’d loved my time there, I felt stifled. So I began to look into options outside of clinical medicine to see if I could better place my skills in an environment which was less rigid than, say, a typical 9-5 consultants post.
It was a string of coincidences that took me to Pfizer in February 2016, and just like the patients and doctors I’d always worked with in haematology, I found an engaging and committed team who were striving to navigate the complexities of the NHS to make sure the right medicine reached the right patients. I knew this was a role I could take on. So I joined the company in April 2016 as a medical advisor with responsibility for the haematology medicines portfolio in the UK..
"I am grateful that my experience as a haematologist is being used in the right way in my new role, which will ultimately benefit a greater number of those in need than I could ever have helped before."
Whilst I no longer see patients, everything I do is patient focused, from finding and interpreting new evidence, seeing doctors to find out their needs and support their development, navigating the best way to approach government bodies such as NICE to ensure innovative medicines are available to patients with haematological disease in the UK, and working with patient advocacy groups to ensure they have a voice. My work here is just as diverse and rewarding as it was in hospital.
I often reflect on the long twelve hour shifts and miss the patients and camaraderie I experienced whilst working on the ward. But I am grateful that my experience as a haematologist is being used in the right way in my new role, which will ultimately benefit a greater number of those in need than I could ever have helped before. As a global organisation with a strong patient focus, I see evidence every day of small victories for patients and feel privileged to be a part of the changing future of both medicines and haematology.