What lies beneath
* Dr Ian McPhee is an anaesthetist at Tweed Hospital and the head of the facilities staff medical council. Six months ago he was diagnosed with a rare form of cancer. He tells his story in his own words:
RARE can definitely be a good thing, even valuable.
Think art - a 16th century master; jewellery - a Fabergé egg; wine - a Premier Cru bordeaux, but "rare" cancer?
Suddenly there are altogether different connotations.
And this is what confronted me just over six months ago.
Years of deliberation by clinical colleagues regarding a progressive, debilitating skin condition ended with a likely diagnosis that none of us would wish to hear.
For the record, it was Sèzary Syndrome, the most advanced and sinister form of cutaneous T-cell lymphoma (CTCL).
Life changed. Perspectives on its meaning, irrevocably so.
Dr Google was immediately called on to consult.
What was this thing? What did it mean to have CTCL, now and into the future? Who, where, when for treatment?Interestingly though, never why.
A life of observing patients, many at the end of their life, with a myriad of diseases, had long ago stopped me asking this question for them, and now for myself. It just ... is.
I hope that I might be able to talk a little more about Dr Google in a future column, but suffice to say that "he" was both comforting and unsettling.
Alone with "him" there are inevitably awkward moments of silence, punctuated only by a mouse click.
Beyond the internet, I needed to seek out someone who knew something - and I would have settled for anything -
about this curious cancer.
Guided as I was by a friend and colleague, it was first to Royal North Shore Hospital.
But then a dilemma. Who had seen enough of this entity to confidently confirm the diagnosis?
Ultimately, from the cycle of testing and retesting, enough data was accumulated to mean that I was justifiably referred to the single centre in Australia with broad experience in treating Sèzary Syndrome - Melbourne's Peter Mac.
Here I found a team of committed colleagues as treating doctors, nurses and allied health professionals.
Apart from anything else, I felt proud to be in medicine. This was as I imagined care should be, but at the same time, I recognise that for many it is not always so.
There were yet more tests, just "to be sure, to be sure" - a great deal, after all, was to hang on the definitive diagnosis being arrived at and beyond the tests, extensive discussion about treatment alternatives.
21st century cancer care is so radically different to that which I experienced as a raw intern working, bug-eyed at all that I was witnessing, in the Oncology Unit at St Vincent's Hospital, Sydney, 35 years ago.
No more the "blunderbuss" approach, destroying the good as well the "bad".
In its place are targeted therapies designed to eradicate individual cell lines.
Cancer, after all, at its most basic level, is simply a cell type that has lost its genetically determined ability to control
its own life cycle. A case of uncontrolled, completely unrestrained growth: tumour formation its most obvious manifestation.
Today, while not true for all cancers, there exist therapies that are able to manipulate the very signalling that gives
cells the call to proliferate unchecked.
Some of these interventions rely on responsiveness to naturally occurring hormones, others are based on the ability to harness the powers of the immune system to mount an attack on cells that are "behaving badly".
In my own case it has been the latter that has been employed to call a halt to the proliferation of abnormal T-cells in
These mono-clonal antibodies, the mainstay of many cancer treatments, administered three times a week for eight weeks, have effectively reduced the load of abnormal cells that had not only made my days and nights uncomfortable, but had threatened my very existence.
I am not cured. I am, however, comfortable "in my skin", literally, for the first time in more than four years.
Other interventions continue at the PeterMac on a monthly basis in attempt to maintain a remission.
Ultimately, a cure may be achieved by stem cell transplant.
But that is the stuff of another story.