Uncertainty and resilience – a medical student’s story

Max Williamson, First year medical student

Published in JHH17.1 – Stories in medicine

I am a young cancer patient, diagnosed aged 15 with testicular cancer. For the last three-and-a-half years I have also been working in patient advocacy in health research, ranging from priority setting to clinical trial design, in groups like the National Cancer Research Institute, National Institute for Health Research and the European Society for Paediatric Oncology. In this field, my interests in particular are on survivorship, supportive care and health communication research. On the other side of this coin, I have spent the last three years at University College London studying biomedical sciences with a focus on cancer cell biology, and I have now, aged 22, moved to Oxford University to take on medical school. All being well, I will graduate 10 years after receiving my diagnosis.

I realised that what I and my family had most appreciated was the time and space that staff had made available for this compassion. Click To Tweet

My story

For me, medicine began with a lump. The diagnosis of a testicular germ cell tumour threw me into a precarious world full of immense physical and mental challenges, and relentless exposure to modern medicalisation. Suddenly, aged 15, my ‘success’ was being measured by tumour size, or ‘burden’; biological outputs like fitness, function and fertility became the tools against which my performance was measured, and I still frame myself by them. The metrics that had mattered to me before my illness – my social networks, my academic ability, and my sport – necessarily fell by the wayside.

Adjusting to normal life after two operations, three months of chemotherapy, and six months out of school, was by definition impossible: the deviation away from health into the sick role had affected all my peer relationships, and I was seen as someone ‘in recovery’. My mysterious affliction (or rather, its treatments) left me bald, pale and thin. At an impressionable time when social identity is totally paramount and totally plastic, most of my peers must have seen me as a terrifying figure, a ghost of my former self, stalking the school halls between classes. It will come as no surprise then, that at the time the thought of entering medical school was sickening. But now, as a new graduate-entry medical student at the University of Oxford – someone just beginning their journey into the medical workforce – I believe we should look to our patients as sources for resilience.

Before my illness I had dreams of leaving school and studying history of art. A fully planned life in curation was ahead of me until the uncertainty of cancer crashed through that expectation. After my illness, I felt driven to switch to science, to enter research and understand cancer biology and pharmacology. Of course at first these ideas of studying medicine were hastily swept under the ‘I’m not good enough’ rug. I felt I lacked the resilience, the compassion and the communication skills that my doctors and nurses had shown towards me. On the paediatric oncology ward I had come to know just how difficult, how truly difficult, a career in medicine could be. I had seen its best and its worst sides, and while revelling in (and benefitting from) the best of it, I felt I lacked the strength to work with the worst. But in reality, when ill we are forced to deal with existential issues, whether that be our fertility or our capacity or our mortality. So growing up ill has given me strength, and a strong sense of perspective, for in the face of these challenges I was forced to set small, achievable goals and to look for silver linings in order to work through my illness. And so for instance in sixth form, ‘go for a three kilometre walk through the village’ became ‘work for three hours on chemistry’. I have used this strategy ever since because I have found this ‘little but often’ goal-setting approach to be a helpful way of partitioning work and overcoming workload burnout.

The care I received from the doctors and nurses at my hospital was exemplary. I trusted them implicitly, and their competence and openness were essential elements in building that trust: the way they always took time to listen to me and my concerns. Time is becoming a luxury that is harder and harder to afford in the current NHS climate, yet it was exposure to this professionally caring attitude that motivated my switching to medicine. Once released from hospital I realised that what I and my family had most appreciated was the time and space that staff had made available for this compassion. I believe this willingness to hear each other’s concerns and let them improve our care should be extended to medical students. Can we create environments were students can safely and effectively express their worries and concerns without fearing that they will be inappropriately judged? Medical schools across the country are doing a better job of this than ever before, but there is still much work to be done.

During my first degree, I began to work as a patient advocate for young people with cancer. Along with this came opportunities to work with cutting edge researchers, using my experience and skillset to make a genuine difference to research strategies in a field I care so much about. But there was also a certain catharsis in being empowered to point out concerns and take part in rectifying them. These experiences have led me to conclude that, whether as students or doctors, we must begin to support one another as we navigate the many uncertainties of our careers. If we are to do so, we will need to recreate safe shared spaces: the common areas, coffee rooms and the doctors’ messes, that I imagine used to encourage reflection and to express with trusted peers our worries and concerns, as well as our triumphs and delights. lthough I recognise that structural issues in the NHS mean this will be harder than it sounds, such communal
spaces are essential to medical life, for as clinicians we hold this burden of uncertainty in common so, if we are to cultivate the resilience that a long medical career requires, we will need to find the time and space to speak to one another about the many uncertainties of our victories and inevitable defeats.

It was through my patient advocacy work that I realised medicine was the right path for me. Being ill gave me a unique perspective, and one that has prepared me (I hope) for caring for others, be they patients or other colleagues. I also had the chance to shadow doctors in many different departments, where I saw from the other side of the bed just how much integrity it takes to be a doctor. All this has given me immense hope that a career in medicine can be a rare privilege. As a medical student, I hope my exposure to uncertainty, and the resilience I have had to cultivate through illness and recovery, will help me understand and learn from patients and the colleagues I interact with. There is a long way to go until I qualify, and right now all I can be sure of is that I must continue to learn more about myself, my story and my good and bad qualities. Speaking at the September 2019 Medical Teachers’ Resilience Symposium was a great opportunity to reflect on these qualities, on my own sources of resilience and on how the many parallels between our patients’ predicaments and our own, can show us how to build a truly empathetic, compassionate health system.

See Max Williamson’s resilience symposium reflections on page 35.