The Other Side
Author: Kate Granger
How does a medical doctor face the sudden diagnosis of terminal cancer? How does she navigate the health care system, from ‘the other side’, as a patient? This is the touching personal account of geriatrics trainee Kate Granger as she battles a brutal disease and its equally vicious treatment, all the while trying to live her personal and professional life to the fullest. The book is a very lucid and riveting portrayal of the course of aggressive cancer, its consequences on a young doctor.
The author’s eloquent narration starts with the niggling back pain and the CT scan which revealed ‘soft tissue masses in my abdomen and pelvis’ (page 8). She depicts the biopsy which confirmed that she had a sarcoma, and she paints the harrowing impact of the diagnosis when ‘my whole world has just collapsed around me’ (pages 3 and 8). She describes how she was ‘gently manipulated into accepting treatment’, and the support of the oncology registrar who helped her ‘come to terms with my impending mortality‘ (pages 53-63). She graphically chronicled the pain of her nephrostomy, the debilitating physical effects of chemotherapy, and the emotional impact of treatment which left her feeling like ‘a broken woman’ (page 33, 71-72, and 83). She relates the experience of losing minor comforts such as the ability to ‘to sleep on my side, to have a bath, to share a bed with my husband…’ (page 93).
The author’s key motivation for writing the book was the poor quality of her interactions with many healthcare practitioners. In many places she describes the distressing effects of what she calls the ‘minor acts’ of doctors on their patients. She says ‘its these tiny acts of either kindness or unfriendliness that completely change your experience as a patient’ (page 15). An example was how disrespected she felt when she was sent off for an MRI scan without being consulted first (page 18). She recounts more egregious acts, by both novice and expert doctors, such as the urologist who was ‘extremely brisk with his explanation’, and who acted smugly…’as if he was giving himself a virtual pat on the back for being such a great surgeon‘ (pages 8-9). The author was singularly irked by the shoddy communication skills of some doctors who broke bad news to her, describing feeling ‘quite astounded‘ by what she calls ‘how not to break bad news‘; she proceeded to outline her own way of breaking bad news, and this was nothing short of a masterclass (pages 22-23).
In a reprieve to the medical profession, the author highlighted many positive interactions with her healthcare providers, and she used these interchanges to illustrate the constituents of good doctor-patient relationships. For example, she extolled the medical registrar who was ‘very gentle and kind in her manner’; the ‘lovely medical oncology consultant’ who ‘actually examined me properly from head to toe’; and the ‘lovely health care assistant’ who welcomed her to the interventional radiology room (pages 16 and 28-29). She emphasised the importance of the ‘minor details’ with the example of the consultant who sat down rather than stand over her bed, and who explained ‘everything at just the right level with amazingly adept communication skills’ (page 50). Conversely, she criticised ‘irrational’ hospital guidelines which restrict professionals from interacting humanely with their patients. An example is the prohibition of doctors sitting on the patient’s bed, a protocol she consistently disregarded in her medical practice, admitting that ‘I certainly used to do it all the time’ because ‘being closer to your patient to comfort them when they need you is more important than microbiology‘ (page 33).
The author’s narrative style is distinctive, coming directly from the heart, and untempered by editorial niceties. She used this approach particularly when recounting her journey through the hospital system, bluntly exposing the hidden impact of the system on patients. She recounts, for example, the ‘uncomfortable experience’ of ‘being pushed around the hospital for various tests‘, and the ‘gradually trickling away’ of her dignity with repeated medical interventions (pages 28, 38, 46, 49 and 66). Her opinions of people and medical specialties were also unrestrained, perhaps even slightly provocative, such as when she said ‘I have always wondered how people working in specialties such as radiology find satisfaction in their jobs’ because they ‘probably never see many of their patients or the consequences of their work’ (page 44). Other examples are her views that ‘female consultants always seem to have a chip on their shoulders’, and her reason why oncology has so many professors ‘must be something to do with all the money from Cancer Research and the like sloshing about’ (page 89 and 110). The author had an effective knack of using only a few adjectives to capture the essence of the characters in her book, such as when she represents ‘a bustling nurse’, an ‘exceptionally dishy consultant’, or ‘a pasty looking male registrar’ (pages 4, 40 and 76).
A striking feature of the author’s personality, evident in almost every page, is her single-minded determination. Indeed the author set out to share her experience of ‘my own personal battles with control and learning how and when to relinquish it’ (page 2). Her strong-willed personality shone through when she says ‘I’m pretty good at winning arguments especially when I know I’m right‘, and when she said ‘my fierce independent spirit was not about to desert me just because I’d got cancer’ (pages 14 and 28). Her strong and controlling personality clearly influenced her attitude to coping with a devastating illness, for example when she admitted to ‘feeling surprisingly mentally strong about the cancer diagnosis’ (page 13). Her determined nature clearly influenced her brave decision to stop cancer treatment, reasoning that ‘the burden of lying in a hospital with excruciating pain is not worth the benefit the chemotherapy is giving me’ (page 115). She takes the reader through this agonising decision saying ‘once you embark on the chemotherapy path it’s like a rollercoaster with very little opportunity to disembark‘ (page 112).
This book is relevant for healthcare practitioners because it shines a light on significant shortcomings in patient care, and it is significant that these flaws appeared in the care of a medical doctor. The author was particularly brave in characterising the behaviours she witnessed…in the institution she practices. She however provided many counter-examples of excellent practice for emulation. The book is unique in not having chapters, and this is probably because it was self-published. The text was full of medical terminology, partly because it was written primarily for healthcare practitioners, but there is an extensive glossary for lay readers to look up the meanings of abbreviations. It would have been helpful to learn more about the impact of illness on the author’s family life, an aspect the author mentioned only in passing. The exclusion may however be explained by the author’s motivation to redress professional inadequacies rather than portray her illness as a personal crisis.
If ever there was a book written from the heart, then this is it. Shorn of any pretensions or complicated theorising, Dr Granger has written a book to highlight significant concerns in the art of medicine. She directs her concerns at doctors, not only pointing out what’s wrong, but setting out how to get it right. It is indeed a book every doctor must read, and I highly recommend it.
Publisher, Year: Self published, 2012
Number of Chapters: None listed
Number of Pages: 124