When the surgeon's scalpel is aimed at oneself, the world turns on its head. Dr. Liz O'Rearden, a former British surgeon now on a mission to educate after multiple breast cancer diagnoses, joins us to share her compelling story. In a transparent and touching narrative, Liz recounts the duality of her life as both caretaker and patient, threading through her personal experiences the pearls of wisdom that have emerged from her role reversal. Her book "Under the Knife" is more than a memoir; it's a call to action for deeper empathy and understanding in the face of illness.
The depth and breadth of cancer's impact on life's balance beam are laid bare as Liz guides us through her strategies for coping and thriving post-diagnosis. Initiatives like CancerBridges.org become lifelines in this journey, providing community support and essential tools for those navigating the treacherous waters of long-term survivorship. Liz also peels back the layers on the wheel of life concept, reminding us that self-care is not a luxury but a necessity, especially for those in high-stress professions like surgery. The conversation delves into the delicate interplay between fate and choice regarding cancer causation, urging listeners to embrace self-compassion over guilt.
In our final reflections, Liz lights the path to self-improvement and seizing joy in everyday life, urging us all to take even the smallest step toward healthier living. The message is clear: thriving, not just surviving, is the goal. Her candor and the relatable anecdotes shared throughout the episode underscore the power of resilience and the importance of cherishing life's moments. We're left with a strong sense of gratitude, both for Dr. O'Rioaden's vulnerability in sharing her story and for the community of listeners who join us in this ongoing conversation about life, health, and personal growth.
https://liz.oriordan.co.uk/
When the surgeon's scalpel is aimed at oneself, the world turns on its head. Dr. Liz O'Rearden, a former British surgeon now on a mission to educate after multiple breast cancer diagnoses, joins us to share her compelling story. In a transparent and touching narrative, Liz recounts the duality of her life as both caretaker and patient, threading through her personal experiences the pearls of wisdom that have emerged from her role reversal. Her book "Under the Knife" is more than a memoir; it's a call to action for deeper empathy and understanding in the face of illness.
The depth and breadth of cancer's impact on life's balance beam are laid bare as Liz guides us through her strategies for coping and thriving post-diagnosis. Initiatives like CancerBridges.org become lifelines in this journey, providing community support and essential tools for those navigating the treacherous waters of long-term survivorship. Liz also peels back the layers on the wheel of life concept, reminding us that self-care is not a luxury but a necessity, especially for those in high-stress professions like surgery. The conversation delves into the delicate interplay between fate and choice regarding cancer causation, urging listeners to embrace self-compassion over guilt.
In our final reflections, Liz lights the path to self-improvement and seizing joy in everyday life, urging us all to take even the smallest step toward healthier living. The message is clear: thriving, not just surviving, is the goal. Her candor and the relatable anecdotes shared throughout the episode underscore the power of resilience and the importance of cherishing life's moments. We're left with a strong sense of gratitude, both for Dr. O'Rioaden's vulnerability in sharing her story and for the community of listeners who join us in this ongoing conversation about life, health, and personal growth.
https://liz.oriordan.co.uk/
Okay, good morning everyone and welcome to Book Talk with our author, liz O'Rearden, from the UK. Thank you so much for joining us. Liz has written a book under the knife which we are going to talk about and I will turn it over to Dr Josie, who is going to introduce Liz. And if you aren't familiar with Dr Josie, she is a fabulous retired oncologist that has a wonderful community on her own right and is living with mitochondrial disease and definitely has a lot to offer us, a lot of wisdom and support and help. So I will turn it over to you, dr Josie.
G van Londen:Everybody. I see some new faces I haven't seen before, which is always good to see that. I am very fortunate this morning to be able to introduce Dr O'Riordan, who has written a book that you didn't need to have read. For these sessions we always want to make sure that you don't feel any pressure to read any of these books. I hope you will enjoy our conversation and maybe after that you feel inspired to read her book or follow her social media content, which is growing and very educational.
G van Londen:Dr O'Riordan is a medically retired British surgeon who has gone through multiple bouts of breast cancer and is now on lifelong cancer therapy, and she has found her niche I think a really beautiful niche to educate everybody she can touch, whether they're providers, patients or anybody who sits in between these two groups, including administrators, and in that sense I really like the title of her book, which is called Under the Knife, which I will start talking with her about the title of the book in a few minutes, because I think that has multiple meetings, but first I'll give the word to Dr O'Riordan to see if she would like to correct or add anything to my introduction.
Liz O'Riordan:Thank you, Josie. What a lovely introduction and lovely to meet you all. It's just a joy to talk about what I've been through and how writing has helped in exploring the world of being on both sides of the doctor's table.
G van Londen:We have multiple questions and I think this hour is going to be filled with my questions, but, at the same time, if any of you in the audience have any questions, feel free to write them in the chat, or if you wanted to just give us a sign that you want to unmute yourself and ask Dr O'Riordan yourself, whatever you feel comfortable with. This is no pressure environment. You can keep your camera on or off, whatever you feel most comfortable with. We're going with the flow. So, having said that, I would like to start with the title of your book, because I think that is a beautiful title and I keep hammering on that, and. But I keep finding more meanings and so maybe I should start by asking you.
Liz O'Riordan:I think I think the title was the very last thing that I decided on, and I think it's very hard to come up with a title, because I know why I wrote the book, but what title is going to make people buy it? And the original title was like Woman with a Scalpel Not very exciting at all, but you need something to put at the top of the page. I'm enaring and I just thought. I'm a soloist, I make my own clothes, I knit and I crochet and I quite like the idea of keeping it kind of crafty and related to all the different ways where I cut and I do things. And the biggest challenge to me was being a surgeon having surgery and not realizing what it was like for all the patients I treated to actually be under the knife yourself. So that's kind of where that came from. But, as you said, there are so many different meanings and different layers that can be put on it.
G van Londen:One of the things that keeps hanging above my head is this visual of the Damocles sword. Dr O'Riordan, would you like to expand on how you feel, what it means if you're comfortable, and how it relates to how you felt Almost, I would say, your whole life?
Liz O'Riordan:Yeah, I'm just double checking myself to remind me of the moral, but I guess it's something very bad could happen to you at any time. You're living with this fear and, as a surgeon, you're living with a fear that an operation could go wrong, you could do harm to a patient, you might make the mistake, you might kill them, and as a junior doctor, you do make mistakes and do lead to people dying. You've got this fear of am I doing the right thing? And especially when you become a senior surgeon and you're not being trained anymore, no one is looking over you, no one's watching your back, no one's checking over your shoulder, it's just you trusting that all your years of knowledge mean you're doing the right thing.
Liz O'Riordan:And then when you get and I was never going to get cancer, I never checked my breasts, I had a very unhealthy lifestyle and then when you get cancer, it suddenly is it going to come back and can I plan my life? Because tomorrow, the day it comes back, what do I do this in just this fear. And it took a good five or six years for me to actually put that fear to one side and say it is out of my control and it's going to make me ill if I spend every day worrying about what might happen.
G van Londen:But I think actually you took it a step further. I think you took control. You took the knife, a figurative knife. Now and it's my understanding that maybe I'm jumping the gun a little bit because I'm abbreviating an hour into three minutes as you take, figuratively speaking, you take the knife and you have taken it upon yourself to cut society in a figurative way, because what I think you're doing now in the book, but your mission in life is to educate society.
Liz O'Riordan:As a little girl, all I wanted to do was to help people and medicine was the only job and I loved surgery and I love breasts, because there's no body fluids and people don't die in safe and I get to explore and create and I love that. And when I got cancer, my life was taken away from me. I lost my income, my fertility, my purpose, my career, everything went. And I think when you have a major life upset, it's either the worst thing and you wallow in misery or you get through it. You somehow find a way to cope and I don't know where the inner strength comes from, because I am not that person anymore.
Liz O'Riordan:I was shy, I was introverted, I was very, very private, but I was being treated in a hospital where my husband worked and where I had worked as a junior doctor and I couldn't imagine not talking about it on social media for nine months. I was going to lose my hair, I'd be recognised and I thought cancer isn't a dirty secret. I'm a cancer surgeon. I'm not ashamed of it. I'm going to tell people, and by trying to explain what it's like in a nonsensationalised voice, because a lot of social media is a bit like TripAdvisor oh my God it's awful, oh my God it's great. I wanted to give that balance to middle of the road for you and it was a way of me understanding what was happening to me, because I was still in denial, and a way of me explaining and reaching out to people and realising that by saying I've had this, patients would come to me and I could kind of be that voice to say this is normal, this is okay.
Liz O'Riordan:But another reason I wrote the book was I had suicidal depression twice as a cancer consultant. Just the sheer pain of breaking 10 women a day, telling them they had it, and I thought I want to own the narrative and I want to say this is normal and there is help available and actually it's been really empowering to help. Millions of women know that they're not alone. But if you'd have told me 10 years ago that I'd be standing up on stage in America to a room full of thousands of people telling my story, I'd have said you're mad, there's no way. I would ever, ever, ever do that. But just writing gave me this way to help people that I didn't realise existed and one thing led to another and it just the messages I get on a daily basis of women. Thanking me for what I do just keeps me going.
G van Londen:Your book is so dense I think you could have split it up in multiple books. I think you needed to go through your life path to come where you are now, because you couldn't have done it without having been on both sides of the table. Remember, in your book you said it's amazing how little I knew about being on the other side of the table. I thought I knew everything about having breast cancer as a breast surgeon, but it wasn't until I became a patient, something along those lines. How little did I know as a surgeon? And you needed to go through that path of suffering and learning and becoming a surgeon. And then your subtitle of the book is the rise and the fall of a surgeon. I'm not sure. I would say oh, maybe evolution. You have evolved and used that life experience. Nobody can do what you do, given your background.
G van Londen:You have that unique understanding where you can make a difference.
Liz O'Riordan:And I think I wanted people to understand how hard it is to train to become a doctor, especially in a man's world the sexual harassment, the bullying, the negative criticism, the sacrifices, that hours and hours you spend away from your family. But then I realized the sacrifices my patients are going through and how hard it is for them when I say goodbye, see you in five years. And by me being honest now and saying I never talked to my patients about sex, I never told them how to cope with the symptoms of the menopause. I never realized they're desperate to know what to eat. And by being that honest I hope I can help healthcare professionals realize what their patients are really looking for.
G van Londen:But I also think I mean I don't know the British system, but the American system isn't set up for that they process these patients like a factory built and I think there's some moral or soul injury for providers who some providers really get injured that way because they feel like I can see this patient for 10 minutes and all I can do is to bear essentials and I send them on my way and I know there's so much more they need help with and some providers need to be enlightened and some providers really undergo moral injury and the system needs to be changed to allow them to be able to refer these patients to the right resource or give them more time to help their patients with all these unmet needs that you see, but you don't get your hands or tights.
Liz O'Riordan:And I think time is a huge factor. In the UK we get 10 minutes to see someone in clinic because you can't predict how many breast cancer patients you'll get each week. You don't know how many biopsies are going to be positive and sometimes you need an hour. You're always running late. We are getting busier and busier. The cases are on the rise. It is really, really hard and that's why I think the future will be digital signposting. We will say there's a load of information you need to know at some point when you're ready and I can't tell you all today. But these charities, websites, apps, forums, people to follow will have sensible information you can trust when you need it. I think that is where the future is going.
G van Londen:The right amount of information, the right type of information at the right time, and that's why I want to give a little kudos to cancer bridges, but everybody here already knows what they're about. I'm preaching to the choir with for those who stumble on this YouTube video. Cancer bridges has a very nice workshop for those who are transitioning from the acute to the long-term survivorship phase and are bumping into these issues that Dr O'Riordan just described. It's a two hour per week session that lasts for about three months, where you meet with a small group of people and you get educated on the relevant topics and you get exercise counseling along the way from a cancer certified personal trainer, and that helps many people. Not just self-help, but also that peer support that makes the difference to see from each other. Wait a minute, I'm not alone. I have the ability to reach out to experts, to peers, and we're all going to figure this out together. Something like this, in a scalable version, I think, is the way to go when people like you, dr O'Riordan, can make this happen, and so I can't praise you enough.
G van Londen:One thing I wanted to also go to, which that's okay, which is your vulnerability this book you have, like you said, used to be very shy and private, but you've gone almost overboard in describing and modeling your. But what I'm going to take from that is your coping methods. We all have different coping methods that we can utilize at different times, and there is better coping methods and there's some less healthy coping methods. And I've asked you before if you feel comfortable talking about this and you gave me permission to ask this question, otherwise I would never have done it but I want you to comment in your way, when you feel comfortable, how your coping methods have evolved over time. And you said earlier today you somehow overcame it, but you're not sure where you found strength, and that's a very interesting comment that you made. Would you be willing to expand a little bit on that?
Liz O'Riordan:So I didn't find out. I had cancer in the normal way. If you've read the book, you'll know this. Most people have a test and a biopsy and a result and a biopsy. But my mammogram is normal. My ultrasound showed a large cancer. I knew before they did the biopsy. My surgeon came in and said I don't know whether I can treat you.
Liz O'Riordan:In that split second I knew my chance of being alive in 10 years. I knew I need chemo. It was my job and part of me went into denial it's not happening. It's not happening, it can't be happening. But I needed to know how bad it could be because, although I had patients who died, I'd not seen the reality.
Liz O'Riordan:And in the first couple of weeks I spent hours Googling metastatic cancer blogs trying to find the scariest, most upsetting things I could find, because I needed to go to that very, very dark place. My husband told me not to, but it was like this a wound that you just keep picking a scab that bleeds. I just had to get that because I needed all this scary information. And then it was too much and I shut it all off and a part of me was like, even though I'm the middle of chemo, it's not happening to me. I can write about it, but my mum said it's as if you're talking about a patient, you're not talking about you. I just detached all that emotion to preserve myself through it and I think that's how I got through. Chemo. Surgery was more real when you suddenly realized you're being walked into the operating theatre and you're naked on the table and you think, oh, my goodness, I really am out of control here. And I was really emotional when I work from my mastectomy, just thinking this is the end of my life as I know it. My breast is gone, my ovaries have gone, my hair is gone. I was very much histrionic, pessimistic, cut-path, empty. And then you somehow pick yourself up and you go back to work and I started a bit of writing and I thought, well, maybe I can make a difference.
Liz O'Riordan:And then, when my cancer came back the first time, I couldn't believe it and I lost my job, I lost my career again, just rock bottom, thinking how on earth do I pick myself up? And at that time it was the little things I used when I was off with depression. It was being in nature, it was feeding the birds in the garden and trying to find moments of joy in the day, thinking cancer hasn't taken me away. It's changed my circumstances, but I'm still a woman and I'm still a wife and I'm still me deep down. And how can I find a way to be true to me? And I realized my life up until that point had just been work, exams, work, and I wasn't doing anything for charity or spirituality. And my family and friends have very low down because it was all work. So I started volunteering in a local hedgehog shelter and I started swimming in rivers and just started filling in all those other bits of my life I'd neglected. And by talking about it, it kind of it gave me a new career.
Liz O'Riordan:The thing about being a surgeon is you walk into a room and you know you're going to do something amazing and it's a bit like acting, putting on a show, and by talking it kind of scratched that itch. I said right, I can do this, I can help people. I can make a room full of men cry, which is fun by telling my story, but I know I can make every person in that room take something away that will improve patient care and that kind of gave me that purpose again when my cancer came back last year. It was actually the day before my book was launched. This isn't the book.
Liz O'Riordan:I had another local recurrence and I'm stuck to me scar. It wasn't. I wasn't upset, it was just this weird sixth sense of here we go again, and the first time I was like, right, I'm much more likely to get metastatic disease and I most people live for three years, so I can't plan anything more than three years in the future. My life is over. Now I'm like, well, it's happened and it's 50-50, whether it comes back again and it's out of my control and all I can do is carry on living my life. But it took me five years to get to that stage where the histrionics go away and I just say, well, okay, this has happened. You don't know what's going to happen in the future. It's just like this learning curve roller coaster that you're on.
G van Londen:Compound it by many things that happened in your life before the diagnosis, like it's it really builds on that. It's like everything is being magnified and it's it becomes super, super messy and somehow it forces you to deal with everything at once rather than just. It's interesting how it has this capacity to blow it all up.
Liz O'Riordan:So it's. I mean I'd been bullied at school and I'd had the psoriasis or depression. I'd been sexually harassed for most of my training that kind of goes with a job but cancer was the grief. It takes away your body image and your identity and your ability to flirt and it made me infertile and it destroyed my sex life overnight and I was left with chronic pain and I lost my career and I lost my income. It's not just cancer and I had no idea how a cancer I removed with a small operation affected every aspect of my patient's life forever.
Liz O'Riordan:The fact that you're going to die. I never talked about death with patients, which was wrong. We never took. Think you, think about all the courses you have when someone's giving birth. In the UK we have national child birth classes and the coaching and the duelists or the Lamar's classes, but for dying there's nothing, but it happens to a soul and it was only when my cancer came back the second time my husband and I actually did our wills and he accepted that I might die before him and it's been really, really positive to be able to embrace that and say we're going to die, let's get off. Funeral sorted out, let's go. Wish is sorted out now. Mom never did that. When she was dying she thought it's I'm not ready, I'll know. When it was too late, and actually it's something we should all do.
G van Londen:If you haven't read the book. It sounds like a book is is going to be all doom and gloom, but it's not. She has a very interesting way of writing that's very often put a smile on my face and sometimes even make me giggle. You're funny writer.
Liz O'Riordan:I wanted to be lighthearted and funny and full of hope and all the funny stories you have as a junior doctor me what I remember I trained under my maiden name of ball BALL and I did urology, so I was dealing with men's testicles. So they said it's Dr Ball, come to see me. And all the things that you find these funny Welsh patients I did. I used to do an erectile dysfunction clinic in this tiny little village and I went to shake the hands of a patient and he dropped his trousers and I shook his penis like, oh OK, all these funny little things to get woven through and all the lighthearted stuff that happens during cancer treatment, the joy in just finding a way to say it's not necessarily the end of the world and there is hope and the world positives and I am a happier, stronger, more fulfilled person now than I would have been if I'd carried on as a job in breast surgeon.
G van Londen:I don't know how you feel about that, but you had to go through all this to get to where you are now.
Liz O'Riordan:I think a lot of people are unhappy in their life but they haven't had that final oof to make them make a really scary decision and either change their job or move across the country or do the thing they've always wanted to do, but we're told they couldn't because we need the job to pay the bills. We can't do this. What if? What that? There's lots of things. But when it happens you're suddenly free to make those choices. I was this close to quitting breast surgery several years before. I wasn't happy. I loved the job, but I hated everything else around that life. And what would have happened if we were free to actually follow our heart and say it's OK and it's not failing if you quit the career you spent 20 years doing because actually you're a different woman and it's not right for you?
G van Londen:Not that everybody has to necessarily change their whole life overboard. Somehow you get a new appreciation for the life you have. It's interesting how your perspective changes, I guess.
Liz O'Riordan:I was thinking about quitting surgery halfway through, mainly because I was lonely. I'd been single for 10 years. I was the crazy cat lady. I was bullied. I thought I'm miserable. I'd rather work in a supermarket stacking shelves than go into work and do this job.
Liz O'Riordan:And I did some coaching to explore other careers and they introduced me to a concept called the wheel of life. Have you heard of that? It's something I use when I'm speaking to kids. You can divide your life up into seven or eight spokes, such as work, fun, friends and family, your relationship, money, health, charity all the kind of aspects you think. Well, I didn't open my credit card bills because I knew they were high, so I had no idea how much money I was spending. I rarely saw my friends because I was working so hard. What was fun? My husband and I barely saw each other because we were doing shift work. I never really did anything for charity.
Liz O'Riordan:All these aspects of my life were really, really low. And ideally the center is like one and at the outspokes of the wheel is 10 and you should all be somewhere around the outside. And most of my life wasn't. And it was a chance to say right, if I'm going to rebuild my life. I want to be having fun and I want to be calling my friends and I actually want to give something back to charity and just seeing. Life isn't all about work. And I could be selfish and say I am Monday nights for me and I'm going to choir and I don't care that my husband doesn't see me and has to cook his own meal. This is my time because it makes me joyful and taking a bit of being selfish and saying I need to do stuff for me, to nurture me, so I'm a better person when I come back to my family and friends. And I found that really hard to do, are you?
G van Londen:Yeah, yeah, very, very nice concept. Thank you for explaining that.
Liz O'Riordan:And just taking the time to read a book and not feeling guilty that I'm not spending time with my husband or my friends. This is my time for me.
G van Londen:Putting it on the calendar and making it happen. Yeah, because you are important too.
Liz O'Riordan:Yeah, and just I'm going to have a cup of tea and sit in the garden and look at the birds, and that's my mindfulness and that just reminds me that they always make me smile and it's little things. You just start to pay attention to the stuff you've been ignoring.
G van Londen:Another question, if that's okay with you, and this one we also talked about. If I can ask you because I think your take can help many other people in this group here, I wondered if you feel, what is your belief, what is your understanding of the costs your cancer? Because once you've been diagnosed with cancer, all of us are starting to wonder what costs it. Can I change it? Can I do something about it? Did I do this to myself? All these questions go through your hands. I wonder what your take on this is.
Liz O'Riordan:Especially given the news of what's happening with our royal family at the moment cancers everywhere. When it happened, I knew I had a low risk for getting breast cancer. I had no family history. I was young at the time. I was a fit, healthy triathlete. I just thought this is just really bad luck and I know what causes cancer. I'm a doctor. But then you think well, alcohol causes cancer. Alcohol causes breast cancer.
Liz O'Riordan:I drank like a fish at medical school, easily drinking 30 or 40 units a week some weeks, because that was the culture of medicine. You saw a lot of crap during the day and you drank a lot of crap at night to forget it. Did the drinking in my 20s and 30s cause my breast cancer? And I know there's no way of proving it. It may have increased the likelihood, but there's no way of saying that was the cause. We know that if you don't have children, that can increase your risk of getting breast cancer. And I didn't have kids, so is it my fault? I didn't have kids? And then you think well, there are rumours that stress and night shifts cause breast cancer and as a doctor I've had a lot of those and it's you can worry yourself silly. And I now find it really hard trying to give that public health knowledge. We know as hard as it is to hear that having increased body fatness and not exercising and drinking too much in a healthy diet increase your chance of getting breast cancer. But how do you make people who are those things not feel it's their fault? And I kind of feel it's like you need various spelling mistakes to happen and alcohol may cause two or three at a time, but there's still the bad luck that causes that third or fourth spelling mistake to make a cancer form. And although there may be things you've done in the past when you didn't know about it that contributed to it, that wasn't the only reason. So I don't blame myself. I think it's just bad luck. And if you told me when I was 20 not to drink as it can cause cancer, I didn't ignore you, because I'm a junior doctor and everybody drank.
Liz O'Riordan:I think attitudes are changing and we are becoming more aware of risk factors, but nobody can blame themselves and it's really hard to get it around your head and I think if you live without guilt, that it's your fault. You're never going to do well and I think, a lot of women. There's no proof that stress causes breast cancer and when some part of stress is good for us. But so a lot of women. We are very good at juggling the divorce, the house move, the kids leaving home, the elderly parents. We've got all these things juggling and we don't look after our health and I often see women with massive life changes coming in who would then get cancer and I wonder whether we need to help the women, the major people who look after the house, to learn to step back and look after themselves and be more selfish, just to help balance that mental, physical workload.
G van Londen:But, like your take on it, it's a buddy's, a big black box and we still don't really understand. Person is different, which is not an excuse. It just means that we have a lot more understanding to do. It's going to take many generations before we fully grasp, if we ever will, but it's a combination of nature and nurture some predisposition.
Liz O'Riordan:Also your attitude to risk. I was the first person in my family and my group of friends to get cancer. I didn't know anybody who'd had it. So if you don't know anyone, cancer isn't on your radar, so you think it's never going to happen to you. A bit like during COVID All the anti-vaxxers who didn't know anyone who had COVID didn't think it was real. But if you know people who've had cancer, you're more aware and you're more risk aware and I think that can have a big impact on how we are.
Liz O'Riordan:Writing for me was like therapy. It made it real, getting everything down on paper and who knows where all the memories came from. But just getting it down on paper was a bit like dealing with my demons. I can get it down and get angry and rant and this isn't fair. And then I can kind of step back and almost rationalize it and it's not as scary Now I've written it down and then I can tweak it and I never kept a journal or a diary through all of my life, but I just felt this urge and it was my way of accepting. You have had cancer twice for now three times, and it has happened.
G van Londen:it also is interesting how it perpetuates, because once you start a process of remembering, it triggers more memories and that can be sometimes a little confronting dealing with your demons that you've put away in a jar in the basement somewhere but now it's in the living room in daylight and the litters. Often it's a little scary and it needs to be dealt with. You need to go through it. The trick is that you learn over time and how to do that as a whole topic on its own, and that this hot potato is not something you have to throw away to somebody else. You need to get rid of it. It's the key to make this hot potato less hot, so you can hold it without it causing you burned hands, figuratively, so you can live with them, and that's how I often explain it. There's a one way to do that is dealing with it head on when you're ready and going through it instead of around it.
Liz O'Riordan:I love that.
G van Londen:I used it in clinical practice.
Liz O'Riordan:So mum died last two years ago very quickly, five months after having her arm amputated. And I used writing to cope with the grief. But I used, I wrote poems and I wrote hermit crab essays which you might not have heard of, but it was a way of contextualizing what was going through. So they say you take think of a shopping list or a recipe, a recipe to make apple pie, so the ingredients for grief or the ingredients to getting angry with my husband, whatever they are, and you write down he forgot to put the washing out, or mum died or the chemo didn't work, or the surgeon did this or was missed. And then you kind of write the instructions so I need to do this and I need to do that, and using a normal list to describe your grief or how you get over. It is a way of kind of getting it out on paper without feeling it being too raw, and the other ones. So I wrote one from. I wrote one from God to my mother saying why she wasn't allowed nine lives and she had to die. Because, sorry, that's what happened, because I was angry that she got taken away so soon. It was like a dear John letter. Dear Isabel, thank you for writing to us asking to live another life, but I'm very sorry it doesn't work like that. Look forward to seeing you up here. Bring your best golden boots.
Liz O'Riordan:Things like that are just quite an interesting way of putting a spin on trauma. So you're writing it, but it's not too personal and I think it's really hard when you have a little medical knowledge and you know what can and can't go on in that room. And I think it's much harder, and I think it's harder for doctors to treat colleagues who are patients as well, because you either treat them as if they know everything and they don't. They're scared and frightened. I think it's really hard. But I think I sometimes think of a bit like Beyonce. I turn into a character when I go on stage. This is Liz surgeon doing her thing, and then I can go away and sit in my room and read my book and it's my way of protecting myself. I am acting when I'm doing that. They're not seeing the real me.
Jen Kehm:I do have a question, liz. I'm just curious, as how do you instruct your fellow physicians, like you know, once you are your armed with this knowledge? I mean, how do you, how do you share that with them and do you think it's made an impact? Or you know what? What do you do it through lectures, or you know how does that work.
Liz O'Riordan:I do a lot of speaking tours all over the world and I do a lot of writing and it comes down to I say it's the little things that matter, it's the words you use when you break bad news. I used to say you know, you're lucky it hasn't spread and it's good we've caught early, because I've seen the worst. But no one's lucky to get cancer. No, cancer is good to have. And we like to say right, come in, sit down, it's cancer. You need to mastectomy. You need this because we know we don't shut up and count to 10 to let that news sink into the patient's head so they can come up to where we are and ask the questions that are really important.
Liz O'Riordan:I say I used to tell patients what chemo and radio was like, but I've never heard my colleagues consent for it. I've never seen the sweet. I'm clueless, I'm making it up. That was wrong. And I talk about. You need to talk about sex and intimacy and mental health issues and how they live their life, because a pretty scar isn't the quality of life and just little bits to say. I want you to think about this and you might not be able to change everything, but by working in your team. Who's talking to patients about sex? Who's telling them about the fear of recurrence? Who's talking about exercise? Who's telling them about cancer bridges? You can just see the more thinking oh okay, I can do that or I can do that. And it's these little things that just start to trickle in that can make a difference. And the feedback I've had from a doctor has been amazing and actually it changed the way my husband broke bad news to his patients, having sat next to me on the receiving end.
Jen Kehm:And I think so.
Liz O'Riordan:A lot of patients never get listened to because doctors don't want to listen to patients. At conferences, I used to leave the patient sessions and go in network, but because I'm a doctor, I somehow have this respect that they can sit in the room and listen and my job is to represent everyone who talks to me, not just my own journey.
Jen Kehm:Thank you. I think that's important work. Thank you.
G van Londen:This hour is not long enough because I have six million questions for you, but one of the things that I popped up in my head is ignorance is bliss. But that goes two ways. I think it goes two ways. I think for providers, not knowing what your, what demons your patient is struggling with is also somewhat of a bliss, Because it perpetuates your soul injury. I think the ignorance is bliss is a good thing. Up to certain level it's protective.
Liz O'Riordan:And I think it works both ways. I mean, you know as an oncologist the pain of dealing with cancer. You can't imagine what those people are coping with the chemo when they leave the door you can't get because you almost have to put your emotions on hold and become empathetic. But you can't carry their emotions with you and I think you have to switch off to enable you to keep on doing the job. And as a patient, the ignorance can be bliss, like it won't come back. I don't need to know. But now social media is full of so many people dying of cancer. It's suddenly in your face and you can't be ignorant because you can't not see it. And I wonder whether patients are being scared unnecessarily by seeing everything all at once and there's no escape.
Liz O'Riordan:It's getting the information when you are ready to learn more and your time, not when Internet's Instagram wants to tell you, and I think that's a real worry. People are seeing the good, the bad and the ugly when it can break them if it's at the wrong time.
G van Londen:I remember how you were torn by your decision about how to approach your breast surgery and how you were giving a Chinese menu, all the different ways you could be operated upon and also plastic surgery for reconstruction and the Chinese menu for that and it was as a surgeon. You knew what all these procedures are about. But even then, you had a very, very hard time, just like everybody who needs to deal with these surgical decisions about what to pick, because it's your body and this is irreversible.
Liz O'Riordan:I was lucky. I had five months of chemo to decide whether I wanted a moustache to me or a reconstruction. Most women have two to three weeks and you don't know what your breasts mean to you because you don't think about them, you don't talk about them and then suddenly they've got cancer and you cannot be rational and my brain was going if I don't have a breast reconstruction, what will my patients think? Because I'm a breast reconstruction surgeon, Surely they would expect me to do it, which is bonkers. And I used to wear quite low cut v-neck dresses at work and if you wear a prosthetic bra, it's up. Here I'll be wearing turtlenecks. I don't want to change my wardrobe.
Liz O'Riordan:I felt guilty that vanity was a reason for having an implant. Yet I told patients vanity is fine for having an implant, because I can do it to you, and just this. What's wrong, what's right? It was really really, really hard and my implant got badly affected by radiotherapy. It gave me chronic pain and now I'm happy being flat. And if I'd known now what I knew, then I'd have said just go flat in and out of hospital in a day, no radiotherapy, no post-term pain, no complications. Thank you very much, but at the time I could not have coped with being flat, and time is an incredible healer and I think patients don't understand what you want now is the time is right for you. But if that changes down the line because your experience of life has changed, that's okay. We can help.
G van Londen:I remember, as I evolved in my career, that I became different and how I made recommendations to my patients and the question is is that good or is that bad? I was wondering about that.
Liz O'Riordan:I think it's good. I think as a young surgeon I pushed complex surgery on patients because I wanted to play. You've got the perfect breast for this and I can do it, and this is fantastic. And now I realize we get we're pressured to make sure a certain percentage of women have reconstructions and our mastectomy numbers are low. We do as much as we can to save breasts. Now I don't care if every woman has a mastectomy, as long as she is properly informed and consented.
Liz O'Riordan:And when mom was being cancelled about having chemotherapy for her bone cancer, the oncologist had an hour to spend with her because it's such a rare cancer. They had that time. And just to hear someone with an experience be really, really honest and say these are the options and this is what it will mean for you and your life and what will happen if you don't and what will happen if you do, and it was like wow, I thought I was good at this, but that woman was an expert and it just made me realize when you have the time, you can give the patient that time to think what does this mean to you and how are you going to feel and is it the right choice? And it was just I think experience is a great thing just to be more open and honest and realistic.
G van Londen:Thank you. Can you please provide guidance on how to best manage with recurrence risk?
Liz O'Riordan:So, yeah, I don't have metastatic disease. I've had locals. I'm cancer-free. My worry is a lot of women think they're cured and don't realize it can come back 15, 20, 30 years, because doctors and nurses aren't very good at saying, by the way, it can come back. And these are the signs to look out for. Because you want to be positive and I think we need to know, when you're giving your post-op results, that you know what to look out for. And I think it's educating people to say, right, if you get any of these weird symptoms that you can't explain, you put it in your diary and if it's still there in two or three weeks time you go and you get it checked out because that mental bell is horrible and you make sure your doctor knows that you've had cancer and it could be related, because a lot of patients don't tell the doctor. They assume the doctor knows the doctor doesn't. He gets missed and I think it's informing them without scaring them. But they do need to know and family practitioners need to know that this could be recurrence, to bring it back in and it comes back down to.
Liz O'Riordan:We now know that if you exercise five times a week a robicon resistance, it can reduce the risk of your cancer coming back by a third. We give chemo. If there's a 5% reduction, regular exercise drops it by 30%. Cutting down on alcohol, eating a healthy plant-based diet, trying to reduce your body fatness, can all reduce the risk of recurrence and I think we need to be giving that public message be the things you can do to take control, to live as healthy as you can. It may still come back and these are what you need to look out for and I think it's just that education, that information. It's a horrible thing. It took me five years not to wake up every day thinking is this the day it comes back? And I'll still get hip pain from not stretching off to run and convince myself it's in my hips because you have that fear because it's everywhere, and I think it's a really fine balance.
Liz O'Riordan:We also in the UK we now have a lot of CBT available through cancer centers to help those women with a really bad fear of recurrence learn to deal with it and learn to process and find a way to move forwards.
G van Londen:CBT is cognitive. It's a sort of psychotherapy. It replaces one thought with another in a way that hopefully at some point becomes ingrained in your head. There's different types of psychotherapy out there. Another one that works very well for cancer patients is psychodynamic therapy, where it helps you put your whole life into the context of the current struggle that you're living with and strengthens your coping methods.
Liz O'Riordan:It helped me so much.
G van Londen:That's very visible in your book and I really, really applaud you on being so vulnerable. Two things I guess I want to clarify. Not every cancer has that late recurrence risk beyond five years, and some do. So I would recommend don't Google. If you want to know, if you're ready to know what is your recurrence risk, early and late, I would suggest write it down for you to ask your oncologist because they can give you that information. Please, don't Google it, please.
G van Londen:And the other thing that Dr O'Riordan very nicely said is all the lifestyle self help. Things give you sense of control, so it helps you physically feel better and also mentally feel better. Really, the thing I add to that is two things. One is every little bit helps. If you can't do five times a week yet, if you can't do the full blown, predominantly plant based diet, just start small, start somewhere. We're all on a never ending journey until our death to continuously learn who we are and how we can improve ourselves. That the journey means to start somewhere, start small. And secondly, if the cancer should come back, knock it off. Hopefully never.
G van Londen:I'm not sure you can, as we discussed earlier, blame yourself. You didn't do enough, you didn't try enough because, like we said, our body is one big black box and there's so many functors that play into our recurrence risk beyond lifestyle. You do your best and we we can give ourselves the illusion of control, but there's many fun to you on that that we can't can control. I don't want you to turn your lifestyle into an obsession to punish yourself, because your diet and your life are to be enjoyed. You're not supposed to survive, you're supposed to thrive. I want you to enjoy your life, dr O'Riordan, and thank you for being with us today. I always like to start and end on time and I give all of you a big, big hug for sharing and being here today and hope to see all of you soon again. Thank you everybody, thank you, thank you, bye bye thank you.