The irony of it all
Authors: Anupam Banerjee
Publication date: 31 Jul 2004
During his stint as a preregistration house officer in gastroenterology Anupam Banerjee never expected to face serious illness himself. He shares his experiences
A23 year old Asian male presents to your outpatients clinic with a three month history of changed bowel habit (alternating diarrhoea and constipation) following a two week holiday to India in March. He is eating less and has lost 15 kg of weight during this three month period. He has occasional abdominal pain, which worsened shortly before presentation. There is occasional tenesmus but never any rectal bleeding or mucus. The patient has no other symptoms or medical problems; his mother has distal ulcerative colitis. Examination proves unremarkable. Blood test results show a raised erythrocyte sedimentation rate, a slightly raised white cell count, and mild anaemia. Results of liver function tests are normal.
What would your diagnosis be at this stage? What would your next step be?
Now imagine that the patient is you. I am a 23 year old preregistration house officer (PRHO) at Hull Royal Infirmary, ironically working in gastroenterology. People may wonder why I did not present earlier, but we doctors have a well known habit of ignoring symptoms. Our variable timetable makes it difficult to gain any consistency in sleeping hours and meals, let alone seeking medical attention for initially innocuous symptoms.
Dealing with the diagnosis
A gastroenterology PRHO has to clerk endoscopy patients, and so I was familiar with the normal and abnormal appearances of bowel mucosa. As I watched the screen during my own colonoscopy, imagine my surprise when, at the rectosigmoid junction, there appeared a bulky looking mass that looked typical of colorectal adenocarcinoma (which I had seen on screen many times).
I remember little else of the colonoscopy, and awoke in the recovery room with the consultant at my bedside. The atmosphere was obviously one of great anxiety, but I remember being quite calm as we took in the news. A provisional diagnosis of adenocarcinoma was later confirmed by pathology.
I have now had chemotherapy and an operation (anterior resection and sigmoid colectomy, total mesorectal excision, and formation of a temporary ileostomy, which has recently been reversed).
The statistics are unbelievable. Under 5% of all colorectal adenocarcinomas occur in patients under 40 years of age, so for a 23 year old to get it was one in a million. It was extremely unusual for a 23 year old Asian man to get it, especially with no family history of any form of cancer.
Statistics have their place, but they go out of the window in my case as there are so few data for my age group. Each case should be marked on its own merits and not pigeon holed as a figure.
My experiences have taught me a lot. We doctors take life too seriously. Cancer has shown me that six months out or not getting the job you want just does not matter in the grand scheme of things. In my opinion, whatever you choose is right for you.
I think it is impossible to quantify just how essential the family and social support network is at times like this. I am from a Hindu family, but I have received tremendous support from people of all backgrounds. People from Hindu, Sikh, Muslim, Christian, and even atheist backgrounds have been praying for me from various pilgrimage spots around the world, as far away as India, America, and Australia.
Don't underestimate nurses
We often underestimate just how important the role of the nurses is and just how much time as an inpatient is spent with nurses in comparison with doctors.
Positive mental attitude
Having a strong and positive mental attitude is a huge bonus. On the day the diagnosis was made, my consultant told me that misfortune is around all of our corners, and it just so happens that I have run into mine now. This is certainly true, and I am a firm believer that you have to play the hand that is dealt to you and take positives from any negative situation.
One of my ways of coping was the thought that if it hadn't happened to me it could have easily been someone else close to me. These all seem like clichés, but they make sense only in a case like mine. I have also been seeing a clinical psychologist, on my surgeon's recommendation, and this has been more helpful than I ever imagined.
A year ago, I never envisaged that I would be in the position that I am in now, but after the diagnosis I could not picture myself being as far down the road to recovery as I am now. I returned to work a month ago to complete my surgical PRHO job in order to gain full registration, and I will join the Hull general practitioner vocational training scheme next month.
It is going to be a long haul and I can't predict the future, but I know that my support network will help to carry me through whatever lies ahead.
Anupam Banerjee preregistration house officer
Hull Royal Infirmary, Hull