Royal Marsden Work Experience (31st March and 1st April, 8th and 9th July, 6th August 2015)

Earlier this year, I was very kindly offered some work experience by an eminent ENT surgeon, Mr Peter Rhys-Evans, who works at the Royal Marsden in London. From this, I learnt much about the anatomy of the neck and development of cancer, in addition to the non-scientific skills required for medicine, such as communication and patience.

During my time there, I attended two patient meetings and a standard-based clinical audit on handwashing to minimise infection, presented by a nurse. I found the audit process interesting; after suggesting from day-to-day observations that handwashing rates could be improved, she confirmed it, outlined the criteria and standards for which to aim, and measured the existing performance level and how it compared to the standards. After doing this, the nurse suggested several improvements which could be made, and described how they could be carried out and maintained. I thought that audits such as this one seemed very useful (although I don’t know its impact on infection rates); they are crucial procedures that must take place in order to make sure that healthcare is as good as it can be. The patient meetings emphasised the meticulous organisation and care for patients by doctors, and the importance of effective communication between doctors in different fields in the hospital. Moreover, the doctors have to collaborate between the hospital’s two different sites – in Chelsea, where I was, and Sutton. Some of the patients move between the two, and are looked after by several different doctors.

I spent most of my time shadowing Mr Rhys-Evans and other doctors on ward rounds and in the clinic; this was in a way the most interesting part of my work experience at the Marsden. I encountered many mixed emotions. On one occasion, Mr Rhys-Evans was hugged by one of his patients when he saw her after his surgery which had restored her speech. I even experienced some of the satisfaction then, and it was evident to me that this was an example of medicine as a deeply rewarding career. By contrast, I also witnessed a doctor tell a patient and his family that he had about six months to live. I was impressed by how he delivered this heavy news with such empathy and composure.

In addition, I spent one afternoon in the radiotherapy clinic. All of the patients were people who had previously been operated on, and therefore most of each tumour had been removed on macroscopic level. I discovered that radiotherapy was required afterwards to get rid of cancer cells on microscopic level, to try to minimise the chances of the cancer returning. Without radiotherapy, there is a 30% chance of recurrence, but this is reduced to 10% after radiotherapy.

Mr Rhys-Evans generously let me return to the Marsden for one last day in August so that I could watch surgery in the operating theatre – this is something that I had been keen to do for many years. I watched a right lobe thyroidectomy, a total thyroidectomy, a neck dissection, and a removal of several nodules in the parietal region of the head. The practical application of science in surgery was really appealing to me, and confirmed my long-term interest in surgery that was first triggered by a trip to the Hunterian Museum many years ago. I was captivated for the whole day, despite standing for eight hours almost without break. I love using my hands, and surgery strikes me as a very satisfying and rewarding skill.

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