Learning from illness
Dr Bob Grant explains how personal experience of non-Hodgkin's lymphoma and a subsequent amputation have affected him as a GP
At the age of 14 I started to develop a limp. Walking home from school became an effort and the ache in my knee that regularly woke me was unpleasant. The pain got worse, and an X-ray was followed by a biopsy of my
This revealed a non-Hodgkin's lymphoma and treatment was arranged at a
radiotherapy centre in Edinburgh. Despite my best efforts, however, I was to remain unaware of my exact diagnosis for many years.
I spent six weeks on an adult cancer ward, but eventually I was able to bear weight on my leg and I returned to school. Although I was forced to repeat the year the experience cemented my ambition to go to medical school nothing, but nothing, would have deterred me from becoming a doctor.
My experience in the adult cancer ward as a teenager also influenced the type of doctor I wanted to be.
I decided I would try to manage my patients with more compassion and understanding than I'd witnessed.
I was surprised and dismayed when growth retardation in my right leg left it three inches shorter than my left. No one had warned me about this. I had to wear specially adapted shoes and it limited the sports I could do, but other than that it had very little effect on my life.
Medical school in Aberdeen was wonderful. My general health was excellent and, as my consultant had retired, oncology review was discontinued. This lack of follow-up was to prove unfortunate.
I settled into a partnership in rural Dumfriesshire in 1974. Two years later, 15 years
after my treatment, I developed post-irradiation lymphoedema.
The limb remained stubbornly swollen and felt heavy from that time onwards. Otherwise my health remained excellent and in 1981 I moved to a practice in Markinch in Fife.
In 1988 I suddenly became very ill, due to infection in the tumour site. Next followed several years of numerous infections, anti-botics, three attempts at surgical resolution and months and months in hospital and off work.
Support provided by a permanent health policy was vital to my practice and family during this time. By 1996 the only option was to remain on antibiotics indefinitely. Despite all of these problems I managed to sustain full-time work both in the practice and also as Macmillan Cancer Support lead cancer GP for Fife.
I was coping well with the antibiotics and leading a busy, normal life. Then in February 2001 I fell on black ice and sustained a pathological fracture at the tumour site in my right femur, which did not heal. A massive distal femoral prosthesis was inserted and once again I could walk after being on crutches for seven months.
Within weeks the infection returned and I reluctantly retired early on health grounds. Just a few weeks later I was admitted to hospital with a high fever, and 10 days after my admission I requested an amputation one of the easiest decisions of my life.
I had always known that amputation was a possibility, and was psychologically prepared. The rehabilitation services in Dundee were superb and within a few weeks I was home and able to walk slowly on a prosthetic limb. Unfortunately, within a year it was confirmed that the common femoral artery was occluded and the prosthesis had to go. Since then I have relied on crutches.
Empathy with patients
My quality of life following amputation has far exceeded my expectations my life has become richer and the operation opened the door to a better life. I have relished my return to clinical work as a part-time salaried GP, work which I know has been altered as a result of my own experiences as a patient.
It has made me think much more about how the patient feels. I now empathise much more with their anxieties and frustrations. Giving teenagers and young adults more time and consideration during consultations has been another practical change.
I also now insist on greeting patients personally in the waiting room rather than using an intercom system. From the moment I
refer a patient with a probable cancer
diagnosis I make myself readily available and see them the day after their diagnostic outpatient visit.
In 2005 I was appointed chair of the Scottish Cancer Group allowing me to further my interest in cancer service development. For the first time in years it is possible to plan life without worrying about the next emergency hospital admission. Now I am living life to the full.
Bob Grant is a GP in Kirkcaldy, Fife, and chair of the Scottish Cancer Group of the Scottish Executive Health Department
What I've learned
· Knowledge of long-term effects of radiation therapy is poor outside oncology teams
· Long-term follow-up of teenagers and young adults can be difficult
· Take time with teenagers and young adults consider the possibility of a significant clinical condition
· It is best to be open and honest with teenagers and young adults about diagnoses
help for young patients with cancer
Macmillan Cancer Support has leaflets available to help discuss cancer with children and young people. To obtain these call the Macmillan CancerLine: freephone: 0808 808 2020, textphone: 0808 808 0121, e-mail: firstname.lastname@example.org, or log on to www.macmillan.org.uk
Teenagers and young adults can log on to the Why Bother? Website
The Class Action website helps health professionals discuss cancer with children and young people
Families of young cancer patients can find out financial help on 0800 500 800 or at www.macmillan.org.uk/abetterdeal