Lorraine Gordon, Speciality Doctor in Teenage and Young Adult Cancer Care at Southampton General Hospital shares a day in her life...

I am a speciality doctor.  Most people don’t know what that means, so I will explain.

I trained in paediatrics initially and decided against being a consultant.  Instead, I chose a role where doctors can remain in one speciality without weekend or on-call work.  This gives a better work/life balance and means lots of experience on the job though sacrificing the traditional consultant career path and being more hands-on.  This benefits the patients too as there is much greater consistency.

So I spent 10 years in paediatric oncology.  I enjoyed the fact that children just get on with playing and doing what children do even on treatment, most of the time.  

However, I noticed at teenage socials that the opposite was true.  Sullen, unhappy patients were like different people away from the ward and mixing with their peers, and this made me realise that the medical environment could be failing to meet their developmental and psychosocial needs.

How being a TYAC member helped

A friend encouraged this line of thinking and suggested joining TYAC.  Through TYAC's website, I discovered a number of courses.  I took the plunge and signed up for the postgraduate certificate of TYA cancer care course.  This made me realise - firstly, how bad I am at writing essays and how poor my IT skills are, but also how much more could be done to meet the specific needs of TYA patients.

Working in a TYA unit

Imagine my joy when a 6 bedded TYA unit opened in my hospital and I got a job there!  I had to adapt to working with many 'site specific' teams as opposed to one small team in paediatrics, but my background was an advantage because I had been used to working with all disease types.

I am the only doctor based on the ward - available for people to pop in with their concerns or for a chat.  The teams come and visit on ward rounds, but I try and offer continuity from day to day.  I have got to know this small population of patients very well, which is extremely rewarding.  What a delight it is working with these funny, stroppy, vulnerable, tantrummy people! (and that’s just the haematologists....)

A typical day

So what does my day involve? Well, first thing I check my emails because teenagers will not even speak to you until midday.  I adjust meds, check obs charts, check pharmacy are OK with all the chemo, perhaps do an intrathecal mid-morning.  I attempt a ward round and spend time finding out how the inpatients are doing - many of them go stir crazy when they are in for long periods, so sitting and listening is part of that.  I try and get their discharge meds/letters ready in good time so nothing holds them up when they are ready to go, which I know is important to them.

I oversee both the ward and day ward.  They are both on the TYA unit, purpose built 18 months ago in attractive, bright decor.  The curtains are bile green but otherwise it’s a very unmedical place to be with funky furniture and a place to hang out, play pool or go on the exercise bike.  

The day care patients are given appointments to come and be reviewed and have their bloods done.  They never come when I expect them, I’ve decided to just go with it and see them when they knock on my door.

Multi-disciplinary team

Much of the rest of my time is liaising with the rest of the team - clinical nurse specialists are brilliant at knowing what's really going on in patients’ lives.  The whole team meets once a week for the MDT discussion and I learn from other professionals who are gifted in their areas.  We are currently focusing on identifying clinical trials that our patients could be eligible for, and end of treatment plans.  We have recently also met to plan an end of treatment day for young people.  This will include diet and exercise advice as well as discussions on relationships after treatment, and teaching self-advocacy skills.

The exciting thing about working in TYA care is that there are so many motivated professionals all working together to make a better service for these young people.  I have found it very rewarding.  

The only issue now is that when I say I'm a speciality doctor in TYA care I get, "You're a who? Doing what?"  But 10 years from now everyone will know about this small branch of medicine because I believe this individualised approach is the best care for all young adults regardless of diagnosis.

Author:  Lorraine Gordon