interview with Ranjana

Delivering the news no patient wants to hear

KUMI TAGUCHI

A glimpse into the lives of doctors who have to deliver the worst kind of news. Dr Ranjana Srivastava is an oncologist working in one of the most diverse communities in Melbourne.

For her, the seconds between looking at a patient's results and turning to tell them are excruciating. From that moment, their lives will never be the same. She spoke to 7.30 about how she makes sense of what she sees every day in the Dandenong Hospital's cancer ward. Gus Goswell produced this story.

DR RANJANA SRIVASTAVA, ONCOLOGIST: The first things that go through a patient's mind when somebody hears they have cancer is that is the end of them, and it's terrifying. And I think, as an oncologist, you have to be acutely aware of the instant brush with mortality that many people assume cancer is. Dandenong is a pretty special community. It's an incredibly multicultural community which has its joys, but also has some serious disadvantages.

My name is Ranjana, and I'm one of the cancer specialists here.

Dandenong is socioeconomically disadvantaged. Many of our patients - I would estimate up to half of our patients - don't speak any English, or speak minimal English. So obviously they need a lot more care than just cancer care or medical care. They really need whole-person care. The biopsy that they took did look OK. There was nothing to worry about, and they're quite happy just repeating an ultrasound in six months' time.

You have to show these patients how to navigate the whole system. Also, there's a lot of education that goes on, apart from the fact that you still have to look after their cancer like you do with all the other patients.

Cancer patients, especially, come to you at a particularly vulnerable time in their life. It's really unlike any other illness. Generally speaking, this treatment doesn't make you unwell. But will also give you quality of life.

Doctor Ranjana Srivastava is an oncologist working in one of the most diverse communities in Melbourne. She explains the challenges of delivering what is often the news no patient wants to hear.

As any cancer patient will tell you, treatment is more than just the drugs we prescribe.

Nancy's husband died many years ago, so she's a single mother looking after an adult child who is disabled.

So let's talk about your chemotherapy. You have two more cycles left. How do you feel about continuing?

NANCY, CANCER PATIENT: You're not going to give me the high dosage of the thing?

DR RANJANA SRIVASTAVA: No, no, the dosage I have reduced before. I haven't changed anything.

NANCY: Because I have look to after...

DR RANJANA SRIVASTAVA: I know, I know.

The chemotherapy nurses understand her situation, so we fit her in when her son is in care and just looking after all those things that are not really little - they're really significant things for her. In order to ensure that her chemotherapy experience is smooth, because as she keeps reminding us, to her, the most important thing is her son.

You're doing an amazing job looking after your son.

NANCY: Oh, I love my son so much. My God - I will be gone. I don't care.

DR RANJANA SRIVASTAVA: You're doing really well Nancy. You've done well. They're very tough circumstances.

I was unlucky enough, like a lot of women are, to lose a pregnancy. It was a twin pregnancy, fairly advanced, that I suddenly found out was not viable. And I ended up losing both the twins. The obstetrician who found out simultaneously with me that the twins were dying had tears in his eyes and he said to me that he didn't know what to tell me and how to tell me the news that he had.

And I remember thinking in that moment, "Wow, someone else shares my sorrow. This is a sorrow shared, and hence it almost feels like a sorrow divided."

How are you doing?

PAUL: I must admit I'm not keeping too well.

DR RANJANA SRIVASTAVA: Although nothing can replace the loss of a child, I felt that the humanity that was shown to me by my doctor at the time was deeply therapeutic. And it has really informed my practice of being an oncologist.

It's not surprising if you are getting some pain, because there is disease in the spine. So I think it's well worth giving you some radiotherapy to the back, which will help settle the pain. We'll have a look at your painkillers as well.

How are you going, though?

LORETTA: Just seeing Paul in pain... (CRIES)

DR RANJANA SRIVASTAVA: Yeah. OK, we'll talk about the pain. I mean, that is, something we can control.

Lots of diseases happen to whole families, but particularly cancer. I think, if you treat only the patient in the cancer clinic, then you are really not treating half of the issue.

And carers do it tough, I think like Paul's wife, Loretta, many people ignore their own health.

LORETTA: We're very blessed to have you as Paul's oncologist.

DR RANJANA SRIVASTAVA: Thank you. That's very kind of you. I think you're doing all the heavy work.

She suffers alongside him. You have to treat cancer in the context of not just what happens in this clinic, but what happens in life.

Life goes on beyond the walls of this clinic.

No matter how long you have been an oncologist, the moments of giving bad news are always difficult. And so they should be. Because we are talking about people's lives here. So, you know, I do feel my own pulse quicken sometimes and a lump in my throat when I'm about to tell someone that they have exhausted all therapies or that the disease that was believed to be surgically removed is still present, or the cancer has advanced.

How old is Mrs Cunningham?

MRS CUNNINGHAM'S SON: 80. She's also got dementia as well.

DR RANJANA SRIVASTAVA: Yes. Can you tell me what year it is?

MRS CUNNINGHAM: 1960? That's only a guess.

DR RANJANA SRIVASTAVA: Mm, yeah. We're a bit further along. It's 2017. I think it's incredibly difficult to separate yourself from the lot of these patients knowing that there isn't much, really, that separates you, apart from that person's bad luck. These are the lungs, OK?

This is one of the spots in the lung. Strictly speaking, with the lung cancer, I think it is likely to worsen over the next few months.

So one of the questions that I will routinely ask myself on the drive home is: Why? Why does this happen to people? Why did my 40-year-old patient with four young children have to die? Why do some people seem to do well, and other people don't?

We could give her, say, a single treatment with radiotherapy which would not be painful, which would not cause side effects, but could help with the pain.

MRS CUNNINGHAM'S SON: Right.

DR RANJANA SRIVASTAVA: While I don't have an answer to the injustice, I do have an answer to the experience that the patients will receive in my clinic. And I think that's really important, because you can get overwhelmed by the things that you can't control in life. But what you can always control is the kindness you demonstrate towards patients - your compassion, your humanity. That's been a really powerful lesson for me, and it's sort of imprinted in my mind every day that I come to clinic.

 

interview with Ranjana

Delivering the news no patient wants to hear

KUMI TAGUCHI A glimpse into the lives of doctors who have to deliver the worst kind of news. Dr Ranjana Srivastava is an oncologist working in one of the most diverse communities in Melbourne. For her, the seconds between looking at a patients results and turning to tell them are excruciating. From that moment, their lives will never be the same. She spoke to 7.30 about how she makes sense of what she sees every day in the Dandenong Hospitals cancer ward. Gus Goswell produced this story. DR RANJANA SRIVASTAVA, ONCOLOGIST: The first things that go through a patients mind when somebody hears they have cancer is that is the end of them, and its terrifying. And I think, as an oncologist, you have to be acutely aware of the instant brush with mortality that many people assume cancer is. Dandenong is a pretty special community. Its an incredibly multicultural community which has its joys, but also has some serious disadvantages. My name is Ranjana, and Im one of the cancer specialists here. Dandenong is socioeconomically disadvantaged. Many of our patients - I would estimate up to half of our patients - dont speak any English, or speak minimal English. So obviously they need a lot more care than just cancer care or medical care. They really need whole-person care. The biopsy that they took did look OK. There was nothing to worry about, and theyre quite happy just repeating an ultrasound in six months time. You have to show these patients how to navigate the whole system. Also, theres a lot of education that goes on, apart from the fact that you still have to look after their cancer like you do with all the other patients. Cancer patients, especially, come to you at a particularly vulnerable time in their life. Its really unlike any other illness. Generally speaking, this treatment doesnt make you unwell. But will also give you quality of life. Doctor Ranjana Srivastava is an oncologist working in one of the most diverse communities in Melbourne. She explains the challenges of delivering what is often the news no patient wants to hear. As any cancer patient will tell you, treatment is more than just the drugs we prescribe. Nancys husband died many years ago, so shes a single mother looking after an adult child who is disabled. So lets talk about your chemotherapy. You have two more cycles left. How do you feel about continuing? NANCY, CANCER PATIENT: Youre not going to give me the high dosage of the thing? DR RANJANA SRIVASTAVA: No, no, the dosage I have reduced before. I havent changed anything. NANCY: Because I have look to after... DR RANJANA SRIVASTAVA: I know, I know. The chemotherapy nurses understand her situation, so we fit her in when her son is in care and just looking after all those things that are not really little - theyre really significant things for her. In order to ensure that her chemotherapy experience is smooth, because as she keeps reminding us, to her, the most important thing is her son. Youre doing an amazing job looking after your son. NANCY: Oh, I love my son so much. My God - I will be gone. I dont care. DR RANJANA SRIVASTAVA: Youre doing really well Nancy. Youve done well. Theyre very tough circumstances. I was unlucky enough, like a lot of women are, to lose a pregnancy. It was a twin pregnancy, fairly advanced, that I suddenly found out was not viable. And I ended up losing both the twins. The obstetrician who found out simultaneously with me that the twins were dying had tears in his eyes and he said to me that he didnt know what to tell me and how to tell me the news that he had. And I remember thinking in that moment, Wow, someone else shares my sorrow. This is a sorrow shared, and hence it almost feels like a sorrow divided. How are you doing? PAUL: I must admit Im not keeping too well. DR RANJANA SRIVASTAVA: Although nothing can replace the loss of a child, I felt that the humanity that was shown to me by my doctor at the time was deeply therapeutic. And it has really informed my practice of being an oncologist. Its not surprising if you are getting some pain, because there is disease in the spine. So I think its well worth giving you some radiotherapy to the back, which will help settle the pain. Well have a look at your painkillers as well. How are you going, though? LORETTA: Just seeing Paul in pain... (CRIES) DR RANJANA SRIVASTAVA: Yeah. OK, well talk about the pain. I mean, that is, something we can control. Lots of diseases happen to whole families, but particularly cancer. I think, if you treat only the patient in the cancer clinic, then you are really not treating half of the issue. And carers do it tough, I think like Pauls wife, Loretta, many people ignore their own health. LORETTA: Were very blessed to have you as Pauls oncologist. DR RANJANA SRIVASTAVA: Thank you. Thats very kind of you. I think youre doing all the heavy work. She suffers alongside him. You have to treat cancer in the context of not just what happens in this clinic, but what happens in life. Life goes on beyond the walls of this clinic. No matter how long you have been an oncologist, the moments of giving bad news are always difficult. And so they should be. Because we are talking about peoples lives here. So, you know, I do feel my own pulse quicken sometimes and a lump in my throat when Im about to tell someone that they have exhausted all therapies or that the disease that was believed to be surgically removed is still present, or the cancer has advanced. How old is Mrs Cunningham? MRS CUNNINGHAMS SON: 80. Shes also got dementia as well. DR RANJANA SRIVASTAVA: Yes. Can you tell me what year it is? MRS CUNNINGHAM: 1960? Thats only a guess. DR RANJANA SRIVASTAVA: Mm, yeah. Were a bit further along. Its 2017. I think its incredibly difficult to separate yourself from the lot of these patients knowing that there isnt much, really, that separates you, apart from that persons bad luck. These are the lungs, OK? This is one of the spots in the lung. Strictly speaking, with the lung cancer, I think it is likely to worsen over the next few months. So one of the questions that I will routinely ask myself on the drive home is: Why? Why does this happen to people? Why did my 40-year-old patient with four young children have to die? Why do some people seem to do well, and other people dont? We could give her, say, a single treatment with radiotherapy which would not be painful, which would not cause side effects, but could help with the pain. MRS CUNNINGHAMS SON: Right. DR RANJANA SRIVASTAVA: While I dont have an answer to the injustice, I do have an answer to the experience that the patients will receive in my clinic. And I think thats really important, because you can get overwhelmed by the things that you cant control in life. But what you can always control is the kindness you demonstrate towards patients - your compassion, your humanity. Thats been a really powerful lesson for me, and its sort of imprinted in my mind every day that I come to clinic.