Earlier this month, Liz O’Riordan found herself once again, scalpel in hand, staring down at a woman with breast cancer. The patient was 65 years old, and had reacted to her diagnosis with stoicism. Fine, she had said. I have breast cancer. Chop it out and move on.
O’Riordan had done just that many times before, in her career as a breast-cancer surgeon. But this case was different. It would be the first operation she would do after having been treated for breast cancer herself. It would be the first time she donned a surgical mask, after years in a patient’s shoes.
In July 2015, O’Riordan discovered a lump in her breast—the fourth in five years. She wasn’t worried: All the others had turned out to be clusters of cysts. Still, at her mother’s insistence, she got the lump checked out. At a different hospital, where she used to work and her husband still does, a radiologist examined her breast with an ultrasound. “I saw the screen and said: That’s a cancer,” she says. “I just knew.”
She started chemotherapy a week later. “You think you know what it’s like to go through the treatment you’ve prescribed every week for years,” she says, “and you have no idea. You think you know how bad you are meant to feel, or how to treat side effects like constipation, but you don’t.”
Doctors face particular challenges when they become patients—challenges that they are rarely prepared for. It is hard to relinquish control and allow others to dictate the treatments that you yourself are used to doling out. It is crushing to know your own prognosis in the starkest terms—a 65 percent chance of surviving for 10 years, in O’Riordan’s case. It is awkward to see your own former patients while you’re being treated: To strike up a chat would break confidentiality.
And it is difficult to be cut off from the same supportive forums and networks that other patients use to share experiences and support; if you let slip that you’re a doctor, you become a source of information, rather than a comrade in illness. After getting her diagnosis, O’Riordan tweeted about it, and began blogging about her experiences. She was contacted privately by several people who said: I’m a doctor, and no one knows I have cancer. She ended up with a secret network of 15 such people. Two of them have since died.
After a nine-month-long triathlon of surgery, chemotherapy, and radiotherapy, O’Riordan got the all clear. The cancer was gone. She spent the better part of a year building back her energy levels, getting counseling, wrangling with hospital bureaucracy, and writing a book with another doctor-turned-patient. In April 2017, she returned to her hospital and worked part-time. At the end of the year, she started operating again.
O’Riordan still has some physical problems. Chemotherapy can famously fog the brain for years after the treatments end, so she still finds it hard to concentrate for more than half a day. When she returned to the operating room, she performed all the old procedures flawlessly, but at one point, she forgot the names of her instruments. “I was closing the skin and needed forceps to hold the tissue, but I couldn’t remember what they were called,” she says. “I was doing the action with my hand, and thankfully, with a good scrub nurse, you don’t need to ask.”
The emotional challenges are tougher. On her first day back, O’Riordan attended a multidisciplinary team meeting, where doctors of different specialties gather to plan a patient’s care. “The first patient was a woman of my age and with my details, and I heard them all say: That’s a really bad prognosis,” she recalls. “That was really hard.” She kept seeing herself reflected in the patients. She saw a woman burst into tears at her diagnosis, and suddenly, she was reliving her own treatment. She saw a patient being told that their cancer had returned, and she wondered if she was looking at her future. Her experiences on both sides of the doctor-patient divide repeatedly rose to the surface and collided.
How much, for example, should she share with her own patients? O’Riordan had blogged regularly about her cancer. She had even done a TEDx talk. But she practices medicine under her maiden name, so few people would make the connection between her online persona and her professional one. Ultimately, she decided to say nothing at first, revealing her experiences only to patients who have completed their treatments and are dealing with the side effects. It helps them, she says, to know that their doctor fully understands how hard it is to live with breast cancer. “You don’t want to compare yourself to other people,” she says. “But when they’re going through that journey, it helps to know that the doctor has, too.”
She still has to maintain professional distance. She is not there to befriend her patients. But O’Riordan firmly believes that her experiences have made her a better doctor—one who is sensitive to the needs of the people she cares for, in ways both large and small. For example, when people undergo operations, surgeons will often put tape over their eyes to keep them shut. But when O’Riordan operates on women who’ve been through chemotherapy, she now puts a little bit of gauze under the tape, so it doesn’t rip the lashes off when it’s removed.
She also takes more care with her language, and cringes at the memory of comments that were meant to be encouraging but now seem glib and unsympathetic. “I used to say: You’re lucky it hasn’t spread. No one is lucky to have cancer,” she says. “I used to ask people: Are you happy to sign this consent form? No one is happy to have cancer. As a doctor, you may give bad news 10 times a day. Until you’ve been on the other side, you don’t realize that when you get bad news, you remember every single detail of that conversation.”
After returning to work, when she first told someone that they had cancer, the woman broke down and started crying. O’Riordan tried to console her. Hearing you have cancer is horrible and it may seem like the world is about to end, she said. It’s not as bad as you think, but it’s normal for everyone to think that. “The consultant shadowing me thought it had gone really badly. We’re meant to be positive, and I’d said that cancer is horrible,” she says. “But everyone has their own style when it comes to breaking bad news, and no one ever hears you do it, apart from your patients and nurses. I realized I had to stop trying to remember what I used to say, and find a new way to do it that reflects the person I am now.”
O’Riordan hopes that more doctors who have become patients themselves will write and talk about their experiences, as the neurosurgeon Paul Kalanithi did in his best-selling book When Breath Becomes Air. And she hopes that doctors will spend more time reading what their patients are writing. “As doctors, no one tells you to read blogs or patient stories. But I think from medical students up, you need to actually take time to listen to patients. You might be a patient one day.”