How having terminal cancer has made me a better doctor: The inspirational diary of a hospital registrar transformed into desperately-ill patient
03:13 GMT, 5 June 2012
Last July, aged just 29, Dr Kate Granger was diagnosed with terminal cancer. The treatment has been arduous and unsuccessful so Kate — who’s married to Chris, a manager at Asda — has taken the brave decision to stop and, with just months to live, has returned to her job as a hospital registrar at Pinderfields Hospital, Wakefield. During her treatment, she’s kept this inspiring diary . . .
Brave: Kate Granger has made the decision to stop receiving treatment for her cancer and try to carry on with her life. She has decided to document her final months in an inspiration diary
AUGUST 17, 2011
Lying in bed at St James’s Hospital, Leeds, sobbing and scared, I’m the most vulnerable a patient could be.
A middle-aged woman breezes into my room without knocking. She declares she is the gynaecology registrar and announces her unpronounceable name, which I’ve no hope of remembering, as she doesn’t have a name badge. She continues to ask inane questions, which makes me think she’s not even read my medical notes.
It’s three weeks since I began suffering pains on the right side of my back while on holiday in the U.S. They became so bad that Chris took me to A&E. Tests revealed a huge mass in my abdomen and pelvis, some of which encased my ureters — the tubes connecting the kidneys and bladder.
The doctors told us it was likely I had ovarian cancer. Now I’m lying here waiting for the results of a magnetic resonance imaging (MRI) scan determining how extensive my cancer is.
The registrar asks why I am upset, so I tell her: ‘Because I’m 29 years old and I’ve got cancer.’
Her astonishing reply is: ‘Don’t be silly, this won’t be cancer, you’re too young. It will be something benign.’
I ask her to leave. There is no doubt I have cancer — and to have a perfect stranger tell me otherwise without taking the time even to read my medical notes makes me furious.
My day gets even worse when a young gynaecology senior house officer (SHO) arrives, clutching my scan report. When breaking bad news to a patient, we normally ‘fire a warning shot’ — where we say something like ‘I’m sorry, the news isn’t good’ — to prepare them. He nervously sits down and declares: ‘Your MRI shows evidence of spread.’
I’m so shocked by his lack of quality communication that I ask to read the report myself: the cancer has spread to my liver and bones.
As he leaves, I roll over with my back to the door and let myself go, the tears flowing.
Chris visits me a few hours later. I break the bad news to him like I would a patient — that’s my way of getting through it. I tell him, quite simply, that things are not looking good at all.
He is devastated. Lots more tears for both of us.
Just 24 hours after the day from hell, I am moved to the specialist cancer centre at the Bexley Wing and I’m amazed at the difference in the quality of both medical and nursing care.
A lovely oncologist — a cancer specialist — examines me from head to toe. I know my cancer is incurable because the MRI showed it had spread to my liver and bones and I tell him that should I suffer a cardiac arrest from something like an infection (common in cancer patients), I do not want to be resuscitated.
I’ve witnessed many brutal undignified deaths from cardiac arrest and I don’t want that for me. I ask him to fill out a ‘Do not attempt resuscitation’ form.
‘That’s a big decision to make so early on,’ he says, sounding surprised. I tell him I want to control the manner of my dying as much as I can.
I’m suddenly in excruciating pain — it’s severe kidney failure and I need an urgent nephrostomy, where a tube is inserted into the kidney through my back to relieve the pressure from the tumour on the ureter.
Devastated: Kate and her husband Chris during a California holiday before she was diagnosed with cancer. She has written of how she broke the news of her disease to him
Unfortunately, my only clinical experience of nephrostomies was watching a stoical old chap have one when I was a student. In his case it was technically difficult and he rolled around the bed in agony.
That’s in my mind as I am wheeled down to the radiology department — or as I now call it, the torture chamber.
I’m petrified. It’s not the first time I’ve wished that I could erase some of my experience of medicine.
I’ve found that older patients often don’t want to be told what treatment is ahead — they feel they cope better not knowing. I now appreciate why they feel like that.
As the consultant inserts the needle into my kidney, I let out a cry and a tear rolls down my cheek. I’d been really good at staying quiet but it’s so sore. I accept the offer of a kind female health care assistant to hold my hand. When the drainage bag is attached, I immediately pass 500ml of urine. No wonder I was in such pain.
I’m in agony, so it’s back to the torture chamber for the same procedure on my right kidney.
The consultant checks on me afterwards and breaks all infection control rules by sitting on the bed. Sometimes being closer to your patient to comfort them when they need you is far more important than bugs and germs.
A new consultant visits to say my biopsy results have thrown a curveball. I have something called ‘small round blue cell tumours’ — a rare set of cancers that usually affect children and teenagers.
The prognosis ranges from the incurable to the completely curable, depending on the actual tumour type. They need fresh tissue for a more in-depth investigation, which means yet another trip to the torture chamber.
Battle: Kate has been admitted to hospital several times since her diagnosis with infections, while also having five cycles of chemotherapy
My care is to be transferred to the Teenage and Young Adult (TYA) team, who specialise in that type of tumour.
The thought of getting to know a new set of people in my fragile mental state fills me with dread.
Also, having been married for six years and with a job with an awful lot of high-level responsibility, I feel poles apart from a teenager. So the consultant agrees I can stay put.
It’s bank holiday Monday, the hospital is quiet and I have time to myself to think. I cannot comprehend everything I’ve been through in the past few weeks.
When you are in your 20s, you feel invincible. Life was great, my career was going well, I have a lovely husband, brilliant friends and no money worries. How has all this happened to me
Occasionally, I wake up and, for a split second, I’ve forgotten all about the illness.
Then I remember, and am overwhelmed by a terrible sinking feeling.
I am incredibly worried about Chris. Every evening, we make lists of things I need from home, and he has also had to draw up a visitors’ rota as so many people want to come. This hopefully distracts him, as well as making my stay in hospital more comfortable.
The Teenage and Young Adult consultant pops by to see me. He’s much more empathetic than the last consultant and I’m impressed as he sits on the chair next to my bed instead of standing over me.
He explains about the chemo I’ll have — a reduced dose, as I’m so ill. But I’m in excruciating pain and if it wasn’t for Chris and my family, I’d give up.
I have my first dose of chemo. The vomiting kicks in 12 hours later. It takes me by surprise even though I knew to expect it.
At one point I don’t get to the bowl in time and am sick all over myself. I’ve seen this happen to patients, but now I know how completely embarrassing and devastating it feels.
The senior house officer is obsessed by my magnesium level, which plummets when I don’t eat, and prescribes massive capsules — the size of a Liquorice Allsort — which I’d struggle to swallow even if I was well.
I put my foot down. Eventually, he opts to put some magnesium sulphate in my fluids instead.
The episode reminds me of my cardiology boss when I was a junior doctor. She’d make us take commonly prescribed unpalatable remedies such as laxatives. This had a huge impact on me and meant I’d always think twice before scribbling something on a patient’s drug chart.
My consultant does his ward round with four doctors in tow. After asking how I am, he tells me my definitive diagnosis: I have a desmoplastic small round cell tumour.
Last night, I gave in to my urge to research what was going on and know that this is an extremely aggressive cancer with poor response to chemotherapy and dismal survival rates.
This news hits me hard. Everyone remains silent.
Soon I’m crying. I signal for the students to leave the room. It’s bad enough breaking down without juniors staring at me while I do.
He asks if I want more chemotherapy, given that it’s very much a palliative situation now.
Happy day: Chris and Kate married in 2005 and renewed their vows in April. She says that if it hadn't been for her husband, family and friends she would have given up long ago
He knows I think cancer doctors flog their patients, especially the young ones, with horrendous treatments until the last possible moment despite incurability.
As a specialist in geriatric care, I believe passionately that quality of life is much more important than quantity.
But I do feel obliged to give proper chemotherapy a try — more for Chris than for myself. Later, I tell Chris the diagnosis. We hug and cry.
I’m allowed home. It’s lovely to be surrounded by all my things. Chris and I get out and about, and symptom control is pretty good, too. But I’m starting to suffer back and pelvic pain, and am sick a couple of times.
I am readmitted to hospital with a kidney infection. The nurses comment I am not my usual chatty self.
This makes me well up. Despite my upbeat practical manner, I am not coping well this week mentally. I just don’t think I can survive another six cycles if I encounter these problems every time.
To top it all, my hair has started to fall out, so I ask the nurses to shave it off. I’ve now told Chris I don’t want to be resuscitated. I feel very low.
My consultant lets me read my latest MRI report. I am slightly taken aback. Everything looks better. I sigh.
I was expecting no improvement or a worsening, and was going to walk away from treatment. I don’t think my sigh is quite what the consultant was expecting. I decide to think logically. If there has been such a measurable response after relatively little chemotherapy, then surely it is worth pursuing, despite the suffering He gives me a hug.
OCTOBER 31, 2011
My 30th birthday. I’m in hospital again with an infection. I’ve been awake since 4am and feel an emotional mess. I can’t get out of my head that this is probably my last birthday.
There’s been a lot of crying. But the nurses are fabulous, bringing me cards and gifts. Chris visits with a deli buffet, a nice cake and some presents.
Transformed: Kate on her graduation day. She says that her disease has made her a better doctor
I’ve completed cycle three of chemo — the most tolerable yet. But if one thing is ruining my quality of life, it’s the drains in my back. Sometimes I think medical staff see a nice normal kidney function and think everything’s fine. But I’d give anything to be able to turn over in bed, have a bath, or share a bed with my husband again.
I’ve now managed to persuade the consultant to remove the drains and insert metal stents (tubes) to hold open my ureters. The operation is a success and for the first time in ten weeks I can go to the loo normally. It’s a strange sensation, but I am so grateful to be re-plumbed!
I’m thrilled to go back to work for a few days — I’d wanted to be a doctor since the age of eight and my job means so much to me.
I’m also beginning to return to my previously active social life. Last weekend Chris took me to Edinburgh as a belated birthday celebration and it lifted both our spirits.
Back in August I thought seeing my birthday might be pushing it, yet here I am very much alive with improving disease and no drains. I know I am still going to die. Death does not scare me; I came to terms with it months ago. But Chris has still not completely accepted the fact that I’ll be dying relatively soon and I worry about how he’ll cope.
The fifth cycle of chemo has just finished and I’ve sat at home for two days with excruciating abdominal pain.
I’m also passing blood clots and my temperature is up and down but I cannot bring myself to pick up the phone. Chris returns from work, takes one look at me and phones the hospital. I don’t want to go but he takes me anyway.
NEW YEAR’S EVE
In hospital with another infection. I’m in huge pain and can’t face any more treatment. For a while I’ve been weighing up the burdens of treatment versus the benefits. I’m crying as I realise I have finally decided to stop.
Although upset, I feel quite peaceful. I’ve got much further with the treatment than I ever expected to. Chris accepts my decision. A few friends and family have said they think I’m giving up too soon — but I’m choosing to take control of how I live. I just want my old life back, even for a couple of months.
A control freak, I’ve planned my funeral to the letter with music, poems, prayers and dress code.
I’ve written letters and cards to Chris up to his 70th birthday. I am now writing letters to other close family.
I am in pain but so pleased to be at work. If patients ask, I tell them I have cancer, otherwise I never mention it.
Having cancer has changed me. It’s made me realise how important the little things are — holding a patient’s hand, sitting down with them and not standing over them, communicating news in a compassionate way and explaining the impact on them to their families.
I wrote this diary in the dark hours of my hospital stays. I want it to be in every medical school and hope my colleagues read it and think about how they practise medicine.
Meanwhile, Chris and I are working through my bucket list — experiences I want to have while there’s still time. We renewed our wedding vows in April, had tea at The Savoy, have been to Paris and we’re going to Barcelona.
I am blessed with my life — I have a job, husband and close family who I love very much, and I hope I’ve made a difference. Yes, I’m going to die but I’ve had time to prepare for this — I’m luckier than most.
Adaptedby Sheron Boyle from The Other Side by Kate Granger. The book is available from theothersidestory.co.uk priced at 10. All profits will go to the Yorkshire Cancer Centre.