Last week, Liz Ball, an oncoplastic breast surgeon in Suffolk, United Kingdom, began work again as an attending physician for the first time since July 2015, when she was diagnosed, at age 40, with stage III breast cancer. At that time, she was treated with chemotherapy, followed by a mastectomy and radiotherapy.
She announced the back-to-work news from her Twitter account, @Liz_ORiordan, which is her married name and online identity. Ninety of her 7700-plus followers replied with a written message and 309 “liked” her tweet. They are family, friends, colleagues, collaborators, and, most prominently, other women with breast cancer.
Liz O’Riordan
Liz’s Twitter account is not what might be expected from a surgeon, often identified as among the most unemotional, dispassionate medical specialists.
She regularly posts video on Twitter from #hedgehogcam, a miniature camera that records her backyard, where two of the iconic rodents have moved into a tiny house her husband bought. She is also partial to baby animal videos because they make her laugh and “guarantee an instant smile.”
Recently, she tweeted and called attention to the need for sexy lingerie for breast cancer survivors “with one or no boobs.” At the same time, she also, in the last month, retweeted (1 of 39,000 of her retweets) about a central passion of hers, #patientcentredmedicine.
Liz knows what she likes and dislikes and is not afraid to say it emphatically, with obscenities if need be.
But it’s not always been that way, precisely, for Liz.
As satisfying as her life as a surgeon helping women with breast cancer could be, Liz suggests that something was missing or not fully present.
Having cancer is never a gift but it was a wake-up call.
“As a doctor [before her cancer diagnosis], I was the world’s most boring dinner party guest. All you do is work, eat, drink, sleep, repeat. Having cancer is never a gift but it was a wake-up call that I got at the age of 40 — instead of 60 when I retired — that prompted me to say: ‘What do I really want to do with my life?'” she said.
In the last 2 years, Liz has answered that question by following her instincts, and her life exploded with new people, projects, honors, and speaking engagements.
She has given a TEDx talk in Germany (“The Jar of Joy”), accepted a book deal and cash advance from a major US/UK publisher, been nominated for a Woman of the Year award by her online fans, and begun exploring the development of a specialty website for athletes having cancer treatment (Liz is a triathlete).
She also speaks regularly to doctors about what it is like to be a patient. For example, earlier this month, she spoke at the Royal College of Physicians Junior Doctors training day at St Luke’s Hospital in London, a portion of which can be viewed here.
But the process of transformation has been “bloody hard,” she explained.
It all started with letting go of her chief identity, Liz Ball, surgeon.
“The hardest part of being ill was losing my identity as a doctor and not being able to help people. All I ever wanted to do in life was to help people — and animals and birds and lost souls in general,” she said. Nevertheless, she surrendered to being a patient and committed herself to treatment and the life of recovery.
The hardest part of being ill was losing my identity as a doctor.
Two major events subsequently occurred and facilitated great change, allowing Liz the Patient to have an eventual reunion with Liz the Doctor.
First, she started writing her Breast Surgeon with Breast Cancer blog, bringing a unique perspective to a worldwide audience. One of the entries was the inspiration for a Medscape Medical News story on “scanxiety,” the overwhelming anxiety that accompanies imaging tests among patients with cancer.
The blog in turn led to public speaking. She was once again engaged, “which gave me that buzz back,” she said.
Liz’s perspective is much informed by her reading: “The talk I did last month to trainees in Ireland was called ‘First Rule of Fight Club,’ and I talked about something no one ever talks to young doctors about: how to cope.”
She used four books as the backbone of the talk: Paul Kalanithi’s When Breath Becomes Air (“A doctor who was diagnosed with cancer, like me.”); Matt Haig’s Reasons to Stay Alive (“How to cope with stress and mental illness by an amazing male author who’s trying to destroy the stigma attached to it.”); Sarah Knight’s The Life-Changing Magic of Not Giving a F*k (“How to prioritize yourself before everything else and learn to say no to people — work, family, friends. You only have a limited amount of time, money, and energy in life. Don’t waste them doing things out of guilt or anxiety.”); and Eric Topol’s [Medscape’s editor-in-chief] The Patient Will See You Now (“How the digital revolution is coming and how doctors can learn what it’s like to be a patient by reading blogs, online forums, and other patient accounts.”).
You only have a limited amount of time, money, and energy in life. Don’t waste them doing things out of guilt or anxiety.
Medscape Medical News caught up with Liz last month as she returned to work.
MMN: What’s it like being back on the job?
Liz: So far, I’ve not had to treat a patient who knows about my own cancer diagnosis. What is important to me is that my patient is the most important person in the room. As much as I want to say that ‘Yes, it’s really crap that you need chemo,’ or that radiotherapy is actually not that bad and give them a hug, I can’t. They need to find that out for themselves and I don’t want my own experiences to influence them. I can help them through my blog as a patient, but as their doctor, I need to maintain that professional relationship. To do that, I have to have emotionally dealt with my own breast cancer, so I can absorb the emotion of the women going through it for the first time.
MMN: Has having had cancer freed up something inside you?
Liz: I think I am a completely different person, and I think it’s changed me for the better. I didn’t work for 2 years. I wasn’t a surgeon, but I didn’t want to be just a cancer patient. I realized through Twitter that there was a whole new way of meeting and helping people. It gave me an identity, an enthusiasm, and a passion for helping people in a different way. I am stronger now in so many ways.
I am a completely different person.
MMN: Much of medicine seems to require that doctors remain staid and above the fray — what do you think about that now?
Liz: I have come to realize that junior doctors see their bosses as superheroes. You never see your boss crying in the car on the way home because they just told someone they are going to die. Or lying awake in the middle of the night worrying about a case. We’re not used to showing our emotions in public and might even see it as a sign of weakness. You are just meant to deal with it. And I think this has to change.
Doctors don’t interact enough with patients. There are very few doctors on Twitter. But I came across the amazing American breast surgeon Deanna Attai [of University of California, Los Angeles]. She leads tweet chats with other breast cancer doctors and surgeons for an hour each week. They pick a theme, and patients can ask all those silly little questions they think are too stupid to ask in person, and get an accurate reply. There is a similar tweetchat in the UK.
I have learned so much from listening to other patients, and I realized that doctors aren’t the only experts anymore. It’s okay to let patients in and share information publically. But it’s really scary the first time you do it.
MMN: Why scary?
Liz: I think a lot of doctors are afraid patients are going to stalk them. It does happen to some unlucky people. But I hope that’s the exception, not the rule. I think the medical profession needs to engage the public. It’s patients who will drive improvements in healthcare in the future.
I think the public also need to know that doctors are human, and we will, and do, make mistakes. No one can be perfect all the time.
MMN: Will you change how you engage the public on Twitter, now that you are back to work?
Liz: I hope not. In the UK, our General Medical Council has guidance about using social media, and I have always followed their advice. I do have a triple identity — Liz the surgeon, Liz the patient, and Liz the triathlete/knitter/ lover of small baby animals — and I hope I can carry on as before.
MMN: What has Twitter and blogging meant to you?
Liz: A lot of people thought I was mad to come out [as having breast cancer] on Twitter. I thought: Cancer isn’t a dirty secret. I don’t want to hide it. It was the best thing I did because I met so many amazing people. Cancer for me was very lonely. I did not meet a single person with breast cancer during my 9 months of treatment. Social media was my lifeline. It connected me to other patients all over the world, and more importantly, other doctors dealing with a cancer diagnosis — we formed our own secret tribe. The kindness of strangers really opened my eyes. That’s why I love Twitter and social media.
MMN: What is next for you?
Liz: Social media has allowed me to help people on a larger scale. I am bringing out a book on breast cancer next year with Penguin Books in collaboration with Professor Trish Greenhalgh, an academic physician who has published many books on evidence-based medicine. Trish was diagnosed with breast cancer around the same time as me, and we had chemo on the same day. It’s bizarre because she is one of my idols and her books have lined the walls of my office for years.
I have also been talking with the one of the UK’s top female triathletes, Lucy Gossage, an oncologist who also had breast cancer. She is now winning her age group in triathlons after having chemotherapy. We want to set up the first website for athletes who are having chemo to give them sensible advice on how to train during treatment.
I think doctors somehow need to find the time to ask a patient what it’s really, really like to be treated, and then really listen to what they tell you. Failing that, go and read a couple of guts-and-all patient blogs. I promise you it will dramatically change the way you practice medicine.
The last thing we do at the end of any consultation is ask the patient if they have any questions. But as a patient, I was aware that my time was up then, and I didn’t want to bother the doctor. So I said nothing, and went home, with my list unanswered. Let’s turn things on their head. The first thing we say should be, “Before we start, do you have any questions?” Let’s truly make medicine all about the patient.
Follow Medscape senior journalist Nick Mulcahy on Twitter: @MulcahyNick
For more from Medscape Oncology, follow us on Twitter: @MedscapeOnc
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