1:09

Okay , good morning everyone and welcome to

1:11

Book Talk with our author , liz

1:13

O'Rearden , from the UK . Thank

1:16

you so much for joining us . Liz has written

1:18

a book under the knife which we are going

1:20

to talk about and I will turn

1:22

it over to Dr Josie

1:24

, who is going to introduce Liz . And

1:27

if you aren't familiar with Dr Josie , she

1:29

is a fabulous retired oncologist

1:32

that has a wonderful community

1:34

on her own right and is living

1:37

with mitochondrial disease and definitely

1:39

has a lot to offer us , a lot of wisdom

1:42

and support and help . So I will turn

1:44

it over to you , dr Josie .

1:47

Everybody . I see some new faces I

1:49

haven't seen before , which is always

1:52

good to see that . I

1:54

am very fortunate this morning to be able to

1:56

introduce Dr O'Riordan , who

1:59

has written a book that you

2:01

didn't need to have read

2:03

. For these sessions we always want to

2:05

make sure that you don't feel

2:07

any pressure to read any of these books

2:10

. I hope you

2:12

will enjoy our conversation and maybe

2:14

after that you feel inspired to read

2:16

her book or follow her social

2:18

media content , which is

2:20

growing and very educational

2:23

. Dr O'Riordan

2:25

is a medically retired

2:28

British surgeon

2:30

who has gone through multiple

2:33

bouts of breast cancer and is

2:35

now on lifelong cancer

2:37

therapy , and she

2:40

has found her niche

2:42

I think a really beautiful

2:44

niche to educate

2:47

everybody she

2:49

can touch , whether they're providers

2:51

, patients or anybody

2:53

who sits in between these two

2:56

groups , including administrators

2:59

, and in that sense I

3:01

really like the title of her book

3:03

, which is called Under the Knife

3:05

, which I will start talking

3:08

with her about the title of the book

3:10

in a few minutes , because I think that

3:12

has multiple meetings , but

3:15

first I'll give the word

3:17

to Dr O'Riordan to see if

3:19

she would like to correct or

3:21

add anything to my introduction

3:24

.

3:25

Thank you , Josie . What a lovely introduction and

3:28

lovely to meet you all . It's

3:30

just a joy to talk

3:32

about what I've been through and how writing

3:34

has helped in exploring the

3:38

world of being on both sides of

3:40

the doctor's table .

3:41

We have multiple questions and I think this hour

3:43

is going to be filled with my questions

3:46

, but , at the same time , if

3:48

any of you in the audience have any questions

3:50

, feel free to write them

3:52

in the chat , or if you wanted

3:54

to just give us a sign that

3:57

you want to unmute yourself and

3:59

ask Dr O'Riordan yourself

4:01

, whatever you feel comfortable

4:03

with . This is no pressure environment

4:06

. You can keep your camera on or

4:08

off , whatever you feel most comfortable

4:10

with . We're going with the flow

4:12

. So

4:15

, having said that , I would like

4:17

to start with the

4:19

title of your book , because I think

4:21

that is a beautiful title and

4:23

I keep hammering on that , and . But I

4:25

keep finding more meanings and

4:27

so maybe I should start by asking you

4:36

.

4:37

I think I think the

4:39

title was the very last thing

4:41

that I decided on , and

4:44

I think it's very hard to come up with a title

4:46

, because I know why I wrote

4:48

the book , but what title

4:50

is going to make people buy it ? And

4:53

the original title was like Woman with a Scalpel

4:55

Not very exciting at all

4:58

, but you need something to put at the top of the page

5:00

. I'm enaring

5:02

and I just thought . I'm a soloist

5:05

, I make my own clothes , I knit and

5:07

I crochet and I quite like

5:09

the idea of keeping it kind of crafty

5:11

and related to all the different ways where

5:13

I cut and I do things . And

5:16

the biggest challenge to me was being a surgeon

5:18

having surgery and not realizing

5:21

what it was like for all the patients I treated

5:23

to actually be under the

5:25

knife yourself . So that's kind of

5:27

where that came from . But , as you said , there

5:29

are so many different meanings and different layers

5:31

that can be put on it .

5:33

One of the things that keeps hanging above

5:35

my head is this visual

5:38

of the Damocles sword . Dr

5:41

O'Riordan , would you like to expand on

5:46

how you feel , what

5:49

it means if you're comfortable , and how

5:51

it relates to how

5:53

you felt Almost , I

5:56

would say , your whole life ?

5:57

Yeah , I'm just double checking myself to remind

5:59

me of the moral , but I guess it's something

6:02

very bad could happen to you at any time

6:04

. You're living with this fear and

6:07

, as a surgeon , you're living with a

6:09

fear that an operation could go wrong , you

6:11

could do harm to a patient , you might make

6:13

the mistake , you might kill them , and as

6:15

a junior doctor , you do make mistakes and do

6:17

lead to people dying . You've got this fear of

6:19

am I doing the right thing ? And

6:22

especially when you become a senior surgeon

6:24

and you're not being trained anymore

6:26

, no one is looking over you , no one's watching

6:29

your back , no one's checking over your shoulder

6:31

, it's just you trusting that

6:33

all your years of knowledge mean you're doing

6:35

the right thing . And then when you

6:37

get and I was never going to get cancer

6:40

, I never checked my breasts , I had a very unhealthy

6:42

lifestyle and then when you get

6:44

cancer , it suddenly is it going

6:46

to come back and can I plan my life

6:48

? Because tomorrow , the day it comes back , what

6:50

do I do this in just this fear . And

6:53

it took a good five or six

6:55

years for me to actually put

6:57

that fear to one side and say it

7:00

is out of my control and

7:02

it's going to make me ill if I spend every day

7:04

worrying about what might happen .

7:08

But I think actually you

7:10

took it a step further . I

7:12

think you took control

7:15

. You took the

7:17

knife , a figurative knife . Now

7:19

and it's my

7:21

understanding that maybe I'm jumping the gun

7:23

a little bit because I'm

7:25

abbreviating an hour into three minutes as

7:28

you take , figuratively speaking

7:30

, you take the knife and you

7:33

have taken it upon yourself to

7:35

cut society

7:38

in a figurative way , because

7:41

what I think you're doing now

7:43

in the book , but your mission

7:46

in life is to educate

7:48

society .

7:59

As a little girl , all I wanted to do was to help people

8:01

and medicine was the only job and

8:04

I loved surgery and I love breasts , because

8:06

there's no body fluids and people don't die in

8:08

safe and I get to explore and create and

8:10

I love that . And when I got

8:13

cancer , my life was taken

8:15

away from me . I lost my

8:17

income , my fertility , my purpose

8:19

, my career , everything went . And

8:22

I think when you have a major life upset

8:24

, it's either the worst thing and

8:26

you wallow in misery or you get

8:29

through it . You somehow find a way to cope and

8:31

I don't know where the inner strength comes from , because

8:33

I am not that person anymore . I

8:35

was shy , I was introverted , I was very

8:37

, very private , but I

8:40

was being treated in a hospital where my husband

8:42

worked and where I had worked as a junior

8:44

doctor and I couldn't imagine not

8:47

talking about it on social media for nine

8:49

months . I was going to lose my hair , I'd be recognised

8:51

and I thought cancer isn't a dirty

8:53

secret . I'm a cancer surgeon . I'm not

8:55

ashamed of it . I'm going to tell people , and

8:59

by trying to explain what it's like in

9:01

a nonsensationalised voice

9:03

, because a lot of social media is a bit like TripAdvisor

9:05

oh my God it's awful , oh my

9:07

God it's great . I wanted to give that balance

9:10

to middle of the road for you and

9:12

it was a way of me understanding

9:14

what was happening to me , because I was still in denial

9:17

, and a way of me explaining

9:19

and reaching out to people and realising that

9:22

by saying I've had this , patients

9:24

would come to me and I could kind of be that voice

9:26

to say this is normal , this is okay . But

9:29

another reason I wrote the book was I had suicidal

9:32

depression twice as a cancer consultant

9:34

. Just the sheer pain of breaking

9:36

10 women a day , telling them they had it , and

9:38

I thought I want to own the narrative

9:40

and I want to say this is normal

9:42

and there is help available and actually

9:44

it's been really empowering to

9:46

help . Millions of women know that they're not alone

9:49

. But if you'd have told me 10

9:51

years ago that I'd be standing up on stage in

9:53

America to a room full of thousands of people

9:55

telling my story , I'd have said you're mad , there's

9:58

no way . I would ever , ever , ever do that . But

10:00

just writing gave

10:02

me this way to help people that I didn't

10:05

realise existed and one thing led to another

10:07

and it just the messages I get

10:09

on a daily basis of women . Thanking me for what

10:11

I do just keeps me going .

10:14

Your book is so dense I think you could have

10:16

split it up in multiple books

10:18

. I think you needed to go through

10:20

your life path to

10:23

come where you are now , because

10:26

you couldn't have done it without

10:28

having been on both sides of the table

10:30

. Remember , in your book you said it's

10:34

amazing how little I knew about

10:37

being on the other side of the table

10:39

. I thought I knew everything about

10:42

having

10:44

breast cancer as

10:46

a breast surgeon , but it wasn't until

10:48

I became a patient , something along those lines

10:51

. How little did I know

10:53

as a surgeon ? And you

10:55

needed to go through that path of

10:58

suffering and learning and becoming

11:00

a surgeon . And

11:03

then your subtitle of the book is the rise and

11:05

the fall of a surgeon

11:07

. I'm not sure

11:09

. I would say oh , maybe

11:11

evolution . You have evolved

11:14

and used that life

11:17

experience . Nobody

11:20

can do what you do

11:22

, given your background

11:25

. You have that unique understanding

11:29

where you can make a difference

11:31

.

11:33

And I think I

11:35

wanted people to understand how hard

11:37

it is to train to become

11:39

a doctor , especially

11:41

in a man's world the sexual harassment , the

11:44

bullying , the negative criticism , the sacrifices

11:47

, that hours and hours you spend away from your family

11:49

. But then I realized

11:51

the sacrifices my patients are going through

11:53

and how hard it is for them when I say goodbye

11:56

, see you in five years . And by me

11:58

being honest now and saying I never

12:00

talked to my patients about sex , I never

12:02

told them how to cope with the symptoms of the menopause

12:04

. I never realized they're desperate to know what

12:06

to eat . And by being that honest

12:09

I hope I can help healthcare professionals

12:11

realize what their patients are

12:13

really looking for .

12:16

But I also think I mean

12:18

I don't know the British system , but

12:20

the American system isn't set up for

12:22

that they

12:24

process these patients like a factory

12:27

built and I think

12:29

there's some moral or soul injury

12:31

for providers

12:34

who some providers

12:36

really get

12:38

injured that way because they feel like

12:41

I can see this patient for 10 minutes

12:43

and all I can do is to bear essentials and

12:45

I send them on my way and I know there's so

12:47

much more they need help with and

12:51

some providers need

12:53

to be enlightened and

12:55

some providers really

12:58

undergo moral injury and the

13:00

system needs to be changed to allow

13:02

them to

13:05

be able to refer these patients to the right

13:07

resource or give them more

13:09

time to help their patients with all

13:11

these unmet needs that

13:13

you see , but you don't get your hands

13:16

or tights .

13:17

And I think time is a huge factor . In

13:19

the UK we get 10 minutes to see someone

13:21

in clinic because you can't predict

13:24

how many breast cancer patients

13:26

you'll get each week . You don't know how many biopsies

13:28

are going to be positive and sometimes

13:30

you need an hour . You're always running late . We

13:33

are getting busier and busier . The cases are

13:35

on the rise . It is really , really hard

13:37

and that's why I think the future will

13:39

be digital signposting . We

13:41

will say there's a load of information you need

13:44

to know at some point when you're ready and

13:46

I can't tell you all today . But these

13:48

charities , websites , apps

13:50

, forums , people to follow will

13:53

have sensible information you can trust when you

13:55

need it . I think that is where the future is going

13:57

.

13:58

The right amount of information , the

14:01

right type of information at the right time

14:03

, and

14:05

that's why I want to give a little kudos to

14:08

cancer bridges , but everybody

14:10

here already knows what they're about . I'm

14:12

preaching to the choir with for those who

14:14

stumble on this YouTube

14:16

video . Cancer bridges

14:18

has a very nice

14:20

workshop for those who

14:22

are transitioning from the acute

14:24

to the long-term survivorship

14:26

phase and are bumping into these

14:29

issues that

14:31

Dr O'Riordan just described . It's

14:35

a two hour per week

14:37

session that lasts for about

14:39

three months , where you meet with a

14:41

small group of people and you get educated

14:44

on the relevant topics and you

14:46

get exercise counseling along the

14:48

way from a cancer certified personal

14:50

trainer , and that

14:52

helps many people . Not

14:55

just self-help , but also that peer

14:57

support that makes the difference

14:59

to see from each other . Wait a minute , I'm

15:02

not alone . I have the

15:04

ability to reach out to experts

15:07

, to peers , and we're all going

15:09

to figure this out together

15:11

. Something like this , in

15:14

a scalable version , I think , is

15:16

the way to go when people

15:18

like you , dr O'Riordan , can make

15:20

this happen , and so I can't

15:23

praise you enough . One

15:26

thing I wanted to also go to , which

15:28

that's okay , which is

15:31

your vulnerability this

15:33

book you have , like

15:35

you said , used to be very shy and private , but

15:37

you've gone almost overboard

15:40

in describing and

15:43

modeling your

15:45

. But

15:47

what I'm going to take from that is your coping

15:50

methods . We all have

15:52

different coping methods that we can

15:54

utilize at different times , and

15:56

there is better

15:58

coping methods and there's some

16:01

less healthy coping methods . And

16:03

I've asked you before if you feel comfortable

16:06

talking about this and you gave

16:09

me permission to ask this question

16:11

, otherwise I would never have done it but

16:14

I want you to comment in

16:17

your way , when you feel comfortable

16:19

, how your coping methods have

16:21

evolved over time

16:23

. And you said earlier today you

16:26

somehow overcame it , but you're

16:28

not sure where you found strength

16:31

, and that's a very

16:33

interesting comment that you made . Would

16:36

you be willing to expand a little bit

16:38

on that ?

16:40

So I didn't find out . I

16:42

had cancer in the normal way . If you've

16:44

read the book , you'll know this . Most people have

16:46

a test and a biopsy and a result and

16:48

a biopsy . But my mammogram is normal

16:50

. My ultrasound showed a large cancer

16:52

. I knew before they did the biopsy . My

16:54

surgeon came in and said I don't know whether I can treat

16:57

you . In that split second I

16:59

knew my chance of being alive in

17:01

10 years . I knew I need chemo . It was my job

17:03

and part of me went into denial

17:05

it's not happening . It's not happening , it can't

17:07

be happening . But I needed

17:09

to know how bad it could be because , although I

17:12

had patients who died , I'd not seen

17:14

the reality . And in the first couple

17:16

of weeks I spent hours Googling

17:18

metastatic cancer blogs trying

17:20

to find the scariest , most upsetting things

17:22

I could find , because I needed to go to that very

17:25

, very dark place . My husband told

17:27

me not to , but it was like this a wound that you

17:29

just keep picking a scab that bleeds . I just

17:31

had to get that because I needed all this scary

17:33

information . And then it was too much and

17:36

I shut it all off and a part of me was like

17:38

, even though I'm the middle of chemo , it's

17:40

not happening to me . I can write

17:42

about it , but my mum said it's

17:45

as if you're talking about a patient , you're

17:47

not talking about you . I just detached all

17:49

that emotion to preserve myself

17:51

through it and I think that's how I

17:53

got through . Chemo . Surgery

17:56

was more real when you suddenly realized

17:58

you're being walked into the operating theatre

18:00

and you're naked on the table and you think , oh , my

18:02

goodness , I really am out of control here

18:04

. And I was really emotional when

18:06

I work from my mastectomy , just thinking

18:09

this is the end of my life as I know it

18:11

. My breast is gone , my ovaries have gone , my hair

18:13

is gone . I was very much histrionic

18:15

, pessimistic , cut-path , empty . And

18:19

then you somehow pick yourself

18:21

up and you go back to work and I started

18:23

a bit of writing and I thought , well , maybe I can make a

18:25

difference . And then , when my cancer

18:27

came back the first time , I

18:30

couldn't believe it and

18:32

I lost my job , I lost my career

18:34

again , just rock bottom , thinking how on earth

18:36

do I pick myself up ? And at that time

18:38

it was the little things I used

18:40

when I was off with depression . It was

18:42

being in nature , it was feeding

18:45

the birds in the garden and trying to find

18:47

moments of joy in the day , thinking

18:49

cancer hasn't taken

18:51

me away . It's changed

18:53

my circumstances , but I'm still a woman

18:55

and I'm still a wife and

18:58

I'm still me deep down . And how can I find

19:00

a way to be true to me ? And

19:03

I realized my life up until that point

19:05

had just been work , exams , work , and

19:07

I wasn't doing anything for charity or

19:09

spirituality . And my family and friends have

19:11

very low down because it was all work . So

19:14

I started volunteering in a local hedgehog shelter

19:16

and I started swimming in rivers

19:18

and just started filling in all those other

19:20

bits of my life I'd neglected . And

19:24

by talking about it , it kind of it

19:27

gave me a new career . The thing about being a surgeon

19:29

is you walk into a room and you know you're

19:31

going to do something amazing and it's a bit like acting

19:34

, putting on a show , and by talking

19:36

it kind of scratched that itch . I said right , I can

19:38

do this , I can help people . I can

19:40

make a room full of men cry , which is fun by

19:43

telling my story , but I know I can make

19:45

every person in that room take

19:47

something away that will improve patient care

19:49

and that kind of gave me that purpose

19:51

again when my cancer

19:53

came back last year . It was actually the day before

19:55

my book was launched . This isn't the book . I

19:58

had another local recurrence and I'm stuck to me scar

20:00

. It wasn't . I wasn't

20:02

upset , it was just this weird sixth

20:04

sense of here we go again , and the first

20:06

time I was like , right , I'm much more

20:08

likely to get metastatic disease and I

20:11

most people live for three years , so I can't

20:13

plan anything more than three years in the future . My life

20:15

is over . Now I'm like , well , it's happened

20:17

and it's 50-50 , whether

20:19

it comes back again and it's out of my control

20:22

and all I can do is carry on living my life

20:24

. But it took me five years to

20:26

get to that stage where the histrionics go

20:29

away and I just say , well , okay , this has happened

20:31

. You don't know what's going to happen in the future

20:33

. It's just like this learning curve

20:35

roller coaster that you're on

20:37

.

20:38

Compound it by

20:40

many things that happened in

20:42

your life before

20:45

the diagnosis , like it's it really

20:47

builds on that . It's like everything

20:49

is being magnified and it's

20:52

it becomes super , super messy

20:54

and somehow

20:56

it forces you to deal with everything

20:59

at once rather than just

21:01

. It's interesting how it has this

21:03

capacity to blow

21:06

it all up .

21:08

So it's . I mean I'd been bullied

21:10

at school and I'd had the psoriasis or depression

21:12

. I'd been sexually harassed for most of my

21:14

training that kind of goes with a job but cancer

21:17

was the grief . It takes away

21:19

your body image and your identity

21:21

and your ability to flirt and

21:24

it made me infertile and

21:26

it destroyed my sex

21:28

life overnight and I was left with

21:30

chronic pain and I lost my career and

21:32

I lost my income . It's not just cancer

21:35

and I had no idea how

21:38

a cancer I removed with a small operation

21:40

affected every aspect of

21:42

my patient's life forever . The

21:46

fact that you're going to die . I

21:48

never talked about death with patients , which was wrong

21:51

. We never took . Think you , think about all the courses

21:53

you have when someone's giving birth . In the

21:55

UK we have national child birth classes

21:58

and the coaching and the duelists or the Lamar's classes

22:00

, but for dying there's nothing , but

22:03

it happens to a soul and it was only when

22:05

my cancer came back the second time my

22:07

husband and I actually did our wills and he accepted

22:09

that I might die before him and

22:13

it's been really , really positive

22:15

to be able to embrace that and say we're going to die

22:17

, let's get off . Funeral sorted out , let's go

22:19

. Wish is sorted out now . Mom

22:22

never did that . When she was dying she thought it's I'm

22:24

not ready , I'll know . When it was too late , and actually

22:26

it's something we should all do .

22:30

If you haven't read the book . It sounds like a book

22:32

is is going to be all

22:35

doom and gloom , but it's not . She has

22:37

a very interesting way of writing

22:40

that's very often put a smile on my

22:42

face and sometimes even make

22:44

me giggle . You're funny

22:46

writer .

22:47

I wanted to be lighthearted and funny

22:49

and full of hope and all the funny stories

22:52

you have as a junior doctor me what I remember

22:54

I trained under my maiden name of

22:56

ball BALL and

22:58

I did urology , so I was dealing with men's

23:00

testicles . So they said it's Dr Ball , come

23:02

to see me . And all the things that you

23:04

find these funny Welsh patients I did

23:06

. I used to do an erectile dysfunction

23:08

clinic in this tiny little village and

23:11

I went to shake the hands of a patient and he dropped

23:13

his trousers and I shook his penis like

23:15

, oh OK , all these funny

23:17

little things to get woven through and all the lighthearted

23:20

stuff that happens during cancer treatment , the

23:22

joy in just finding a way to say

23:24

it's not necessarily the

23:26

end of the world and there is hope and the world

23:28

positives and I am a happier

23:31

, stronger , more fulfilled person now

23:33

than I would have been if I'd carried on

23:35

as a job in breast surgeon .

23:37

I don't know how you feel about that , but

23:39

you had to go through all this to get to where you

23:41

are now .

23:43

I think a lot of people are unhappy

23:45

in their life but they haven't

23:47

had that final oof to make them

23:49

make a really scary decision and either

23:51

change their job or move across the country

23:54

or do the thing they've always wanted to do , but we're told they

23:56

couldn't because we need the job to

23:58

pay the bills . We can't do this . What

24:00

if ? What that ? There's lots of things

24:02

. But when it happens you're

24:05

suddenly free to make

24:07

those choices . I was this close to quitting

24:09

breast surgery several years before . I wasn't happy . I

24:12

loved the job , but I hated everything else around that life

24:14

. And what would have

24:17

happened if we were free to actually follow

24:19

our heart and say it's OK and

24:21

it's not failing if you quit the career

24:23

you spent 20 years doing because actually

24:25

you're a different woman and it's not right for

24:27

you ?

24:29

Not that everybody has to necessarily

24:32

change their whole life overboard . Somehow

24:35

you get a new appreciation for the

24:37

life you have . It's

24:41

interesting how your perspective changes

24:43

, I guess .

24:45

I was thinking about quitting surgery halfway through

24:48

, mainly because I was lonely . I'd been single for 10

24:50

years . I was the crazy

24:52

cat lady . I was bullied . I thought I'm miserable . I'd

24:55

rather work in a supermarket stacking shelves

24:57

than go into work and do this job . And

25:00

I did some coaching to explore other careers

25:02

and they introduced me to a

25:04

concept called the wheel of life . Have you

25:06

heard of that ? It's

25:08

something I use when I'm speaking to kids . You

25:11

can divide your life up into seven or eight

25:13

spokes , such as work , fun , friends

25:16

and family , your relationship

25:18

, money , health , charity all

25:21

the kind of aspects you think . Well , I

25:23

didn't open my credit card bills because I knew they were high , so

25:26

I had no idea how much money I was spending . I

25:28

rarely saw my friends because I was working

25:31

so hard . What was fun ? My

25:33

husband and I barely saw each other because we were doing shift work

25:35

. I never really did anything for charity . All

25:38

these aspects of my life were really , really low . And

25:40

ideally the center is like

25:43

one and at the outspokes of the wheel is 10 and

25:45

you should all be somewhere around the outside . And most

25:48

of my life wasn't . And it was

25:50

a chance to say right , if I'm going to rebuild my life . I

25:53

want to be having fun and I want to be calling my

25:55

friends and I actually want to give something back to charity and

25:58

just seeing . Life isn't all about

26:00

work . And

26:02

I could be selfish and say I am Monday nights for me and

26:04

I'm going to choir and I don't care that

26:07

my husband doesn't see me and has to cook his own meal . This

26:10

is my time because it makes me joyful and

26:14

taking a bit of being selfish

26:16

and saying I need to do stuff for me , to nurture me , so

26:20

I'm a better person when I come back to my family and friends . And

26:23

I found that really hard to do , are

26:27

you ?

26:27

Yeah , yeah , very

26:32

, very nice concept . Thank

26:35

you for explaining that

26:37

.

26:38

And just taking the time to read a book

26:40

and not feeling guilty that I'm not spending

26:42

time with my husband or my friends . This is

26:44

my time for me .

26:47

Putting it on the calendar and making it happen

26:49

. Yeah , because you are important

26:51

too .

26:52

Yeah , and just I'm going to have a cup of tea

26:55

and sit in the garden and look at the birds , and that's

26:57

my mindfulness and that just reminds me that

26:59

they always make me smile and it's

27:01

little things . You just

27:03

start to pay attention to the stuff you've

27:05

been ignoring .

27:07

Another question , if that's okay with

27:09

you , and this one

27:11

we also talked about . If I can ask

27:13

you because I

27:16

think your take can

27:18

help many other people

27:20

in this group here , I

27:24

wondered if you

27:27

feel , what

27:29

is your belief , what is your understanding

27:31

of the costs your

27:33

cancer ? Because once

27:35

you've been diagnosed with cancer , all of us are

27:37

starting to wonder what costs

27:40

it . Can I change it ? Can

27:42

I do something about it ? Did

27:44

I do this to myself ? All these questions

27:46

go through your hands . I

27:49

wonder what your take on this is .

27:51

Especially given the news of what's happening with our royal

27:53

family at the moment cancers everywhere . When

27:56

it happened , I knew I had a low

27:59

risk for getting breast cancer . I had no family

28:01

history . I was young at the time

28:03

. I was a fit , healthy triathlete . I just thought this

28:05

is just really bad luck and

28:08

I know what causes cancer . I'm a doctor

28:10

. But then you think well , alcohol

28:12

causes cancer . Alcohol causes breast

28:14

cancer . I drank like a fish at

28:16

medical school , easily

28:19

drinking 30 or 40 units a week some

28:21

weeks , because that was the culture of medicine . You

28:23

saw a lot of crap during the day and you drank

28:25

a lot of crap at night to forget it . Did

28:28

the drinking in my 20s and 30s cause my

28:30

breast cancer ? And

28:32

I know there's no way of proving it . It may have

28:34

increased the likelihood , but there's no way of saying

28:36

that was the cause . We know

28:38

that if you don't have children , that

28:41

can increase your risk of getting breast cancer . And

28:43

I didn't have kids , so is it my fault ? I didn't

28:45

have kids ? And then you think

28:47

well , there are rumours that stress and night

28:49

shifts cause breast cancer and as a doctor I've

28:51

had a lot of those and it's you

28:53

can worry yourself silly . And

28:55

I now find it really hard trying to give

28:58

that public health knowledge . We know as

29:00

hard as it is to hear that

29:02

having increased body fatness and not exercising

29:05

and drinking too much in a healthy diet increase

29:07

your chance of getting breast cancer . But how

29:09

do you make people who are those things not

29:11

feel it's their fault ? And

29:13

I kind of feel it's like you need

29:16

various spelling mistakes to happen

29:18

and alcohol may cause two or three at a time

29:20

, but there's still the bad luck that causes

29:22

that third or fourth spelling mistake to make a

29:24

cancer form . And

29:27

although there may be things you've done in the past when you

29:29

didn't know about it that contributed to it

29:31

, that wasn't the only reason

29:33

. So I don't

29:35

blame myself . I think it's just

29:37

bad luck . And if you told me when I was

29:39

20 not to drink as it can cause cancer , I

29:41

didn't ignore you , because I'm a junior doctor and everybody

29:44

drank . I think attitudes

29:46

are changing and we are becoming

29:48

more aware of risk factors , but nobody

29:51

can blame themselves and it's

29:53

really hard to get it around your head and I think if

29:55

you live without guilt , that it's your fault . You're

29:58

never going to do well and

30:00

I think , a lot of women . There's no

30:02

proof that stress causes breast cancer and

30:05

when some part of stress is good for us . But so a

30:07

lot of women . We are very good at juggling the

30:09

divorce , the house move , the kids leaving home

30:12

, the elderly parents . We've got all these things juggling

30:14

and we don't look after our health and

30:17

I often see women with massive life changes

30:19

coming in who would then get cancer and

30:22

I wonder whether we need to help the women

30:24

, the major people who look after the house , to

30:27

learn to step back and look after themselves and

30:29

be more selfish , just to help balance

30:31

that mental , physical workload .

30:34

But , like your take on it , it's a

30:36

buddy's , a big black box

30:39

and we still don't really understand

30:41

. Person is

30:43

different , which is not an

30:45

excuse . It just

30:48

means that we have a lot more understanding

30:50

to do . It's

30:52

going to take many generations before

30:54

we fully grasp , if

30:56

we ever will

30:58

, but it's a

31:00

combination of nature

31:03

and nurture some

31:05

predisposition .

31:07

Also your attitude to

31:09

risk . I was the first person

31:11

in my family and my group of friends to get cancer

31:13

. I didn't know anybody who'd had it . So

31:16

if you don't know anyone , cancer isn't on your radar

31:18

, so you think it's never going to happen to you . A bit like

31:20

during COVID All the anti-vaxxers who

31:23

didn't know anyone who had COVID didn't think it was real

31:25

. But if you know people who've had cancer , you're

31:27

more aware and you're more risk aware and I think that

31:30

can have a big impact on how we are . Writing

31:33

for me was like therapy . It

31:36

made it real , getting everything

31:38

down on paper and who knows where all the memories came

31:40

from . But just getting it down on paper was a

31:42

bit like dealing with my demons

31:44

. I can get it down and get

31:46

angry and rant and this isn't fair . And

31:48

then I can kind of step back and almost rationalize

31:51

it and it's not as scary Now I've written

31:53

it down and then I can tweak it and I never

31:55

kept a journal or a diary through all of my life

31:57

, but I just felt this urge and

31:59

it was my way of accepting . You have had

32:02

cancer twice for now three times , and

32:04

it has happened .

32:10

it also is interesting how it

32:12

perpetuates , because once

32:14

you start a process of remembering

32:16

, it triggers more memories

32:19

and that can be sometimes

32:21

a little confronting dealing with your

32:23

demons that you've put away in a jar

32:26

in the basement somewhere but now

32:28

it's in the living room in

32:30

daylight and the litters . Often it's

32:33

a little scary and

32:35

it needs to be dealt with

32:38

. You need to go through it . The

32:40

trick is that you learn

32:43

over time and how

32:45

to do that as a whole topic on its own , and

32:47

that this hot potato is

32:49

not something you have to throw

32:51

away to somebody else . You need to get rid of it

32:53

. It's the key to make this hot

32:55

potato less hot , so you can

32:57

hold it without

33:00

it causing you burned hands, figuratively ,

33:04

so you can live with them

33:06

, and that's how I often explain

33:08

it . There's a one way to do that is

33:10

dealing with it head

33:12

on when you're ready and going

33:14

through it instead of around it .

33:19

I love that .

33:19

I used it in clinical practice .

33:20

So mum died last two

33:22

years ago very quickly

33:24

, five months after having her arm amputated

33:26

. And I used writing to cope with the grief

33:28

. But I used , I wrote poems

33:31

and I wrote hermit crab essays which you

33:33

might not have heard of , but it was a way of contextualizing

33:36

what was going through . So they say you take think of a shopping

33:38

list or a recipe , a recipe to

33:40

make apple pie , so the ingredients

33:43

for grief or the ingredients to getting angry with my

33:45

husband , whatever they are , and you write down

33:47

he forgot to put the washing out , or mum died

33:49

or the chemo didn't work , or the surgeon did this

33:51

or was missed . And then you kind of write the instructions

33:54

so I need

33:56

to do this and I need to do that , and using

33:58

a normal list

34:01

to describe your grief or how you

34:03

get over . It is a way of kind of getting

34:05

it out on paper without feeling it being too

34:07

raw , and the other

34:09

ones . So I wrote one from

34:11

. I wrote one from

34:14

God to my mother saying why

34:16

she wasn't allowed nine lives and she had

34:18

to die . Because , sorry , that's what happened , because I was angry

34:20

that she got taken away so soon . It was like a dear John

34:22

letter . Dear Isabel

34:24

, thank you for writing to us asking to live another life , but

34:26

I'm very sorry it doesn't work like that . Look forward

34:29

to seeing you up here . Bring your best golden boots . Things

34:31

like that are just quite

34:33

an interesting way of putting a spin on trauma

34:36

. So you're writing it , but it's not too

34:38

personal and I think

34:40

it's really hard when you have a little medical

34:42

knowledge and you know what can and

34:45

can't go on in that room . And I think it's much

34:47

harder , and I think it's harder for doctors to

34:49

treat colleagues who are patients

34:51

as well , because

34:53

you either treat them as if they know everything

34:56

and they don't . They're scared and frightened

34:58

. I think it's really hard

35:00

. But I think I sometimes

35:02

think of a bit like Beyonce . I turn into a character

35:05

when I go on stage . This is Liz surgeon

35:07

doing her thing , and then I can go away and sit in my room

35:09

and read my book and it's my way

35:11

of protecting myself . I am acting

35:14

when I'm doing that . They're

35:16

not seeing the real me .

35:21

I do have a question , liz . I'm

35:24

just curious , as how do you

35:26

instruct your fellow physicians

35:28

, like you know , once you are your armed with

35:30

this knowledge ? I mean , how do you

35:32

, how do you share that with them and do

35:34

you think it's made an impact ? Or you

35:38

know what ? What do you do it through lectures

35:41

, or you know how does

35:43

that work .

35:44

I do a lot of speaking tours all

35:46

over the world and I do a lot of writing and

35:48

it comes down to I say it's the little things

35:50

that matter , it's the words

35:53

you use when you break bad news . I

35:55

used to say you know , you're lucky it hasn't spread

35:57

and it's good we've caught early , because

35:59

I've seen the worst . But no one's

36:01

lucky to get cancer . No

36:03

, cancer is good to have . And

36:05

we like to say right , come

36:08

in , sit down , it's cancer . You need to mastectomy

36:10

. You need this because we know we

36:12

don't shut up and count to 10 to

36:14

let that news sink into the patient's

36:16

head so they can come up to where we are

36:18

and ask the questions that are really important . I

36:21

say I used to tell patients what chemo

36:23

and radio was like , but I've never heard my

36:25

colleagues consent for it . I've never

36:28

seen the sweet . I'm clueless , I'm making

36:30

it up . That was wrong . And

36:32

I talk about . You need to talk about sex

36:35

and intimacy and mental health

36:37

issues and how they live their life , because a

36:39

pretty scar isn't the quality

36:41

of life and just little bits to

36:43

say . I want you to think about this and

36:45

you might not be able to change everything , but

36:48

by working in your team . Who's

36:50

talking to patients about sex ? Who's

36:52

telling them about the fear of recurrence ? Who's

36:54

talking about exercise ? Who's telling them about

36:56

cancer bridges ? You can just see

36:58

the more thinking oh okay , I

37:00

can do that or I can do that

37:03

. And it's these little things that just start

37:05

to trickle in that can make a difference . And

37:07

the feedback I've had from a doctor has been amazing

37:09

and actually it changed the way

37:11

my husband broke bad news to his

37:13

patients , having sat next to me

37:15

on the receiving end .

37:19

And I think so .

37:20

A lot of patients never

37:23

get listened to because doctors don't want to listen to

37:25

patients . At conferences , I used

37:27

to leave the patient sessions and go in network

37:30

, but because I'm a doctor

37:32

, I somehow have this respect

37:34

that they can sit in the room and listen and my job

37:36

is to represent everyone who talks

37:38

to me , not just my own journey

37:40

.

37:43

Thank you . I think that's important work . Thank

37:45

you .

37:47

This hour is not long enough because I have six

37:49

million questions for you , but one

37:51

of the things that I popped up in

37:53

my head is ignorance is bliss . But

37:55

that goes two ways . I think it

37:59

goes two ways . I think for providers

38:01

, not knowing what

38:03

your , what demons your patient

38:05

is struggling with is also somewhat

38:08

of a bliss , Because it perpetuates

38:10

your soul injury . I think the

38:13

ignorance is bliss is

38:16

a good thing . Up to certain level

38:18

it's protective .

38:21

And I think it works both ways . I mean , you

38:24

know as an oncologist the pain of dealing with

38:26

cancer . You can't imagine what

38:28

those people are coping with the chemo when they leave

38:30

the door you can't get because you

38:32

almost have to put your emotions on hold and become

38:35

empathetic . But you can't carry their

38:37

emotions with you and I think you have to

38:39

switch off to enable you to keep on doing

38:41

the job . And as a patient

38:44

, the ignorance can be bliss , like it won't

38:46

come back . I don't need to know . But

38:48

now social media is full of so many people

38:50

dying of cancer . It's suddenly in your face

38:52

and you can't be ignorant because you can't

38:54

not see it . And I wonder whether

38:56

patients are being scared unnecessarily

38:59

by seeing everything

39:01

all at once and there's no escape . It's

39:04

getting the information when

39:06

you are ready to learn

39:08

more and your time

39:10

, not when Internet's Instagram

39:12

wants to tell you , and I think that's a real

39:14

worry . People are seeing the good , the

39:16

bad and the ugly when it

39:18

can break them if it's at the wrong time .

39:20

I remember how you were torn

39:22

by your decision

39:24

about how to approach your breast surgery

39:27

and how you were giving a Chinese menu , all

39:30

the different ways you could be operated upon

39:32

and also plastic surgery for

39:34

reconstruction and the Chinese menu for

39:36

that and it was as

39:38

a surgeon . You knew what

39:42

all these procedures are about . But even then

39:44

, you had a very

39:46

, very hard time , just like everybody

39:49

who needs to deal with these surgical decisions

39:51

about what to pick

39:54

, because it's your body and this is

39:56

irreversible .

39:58

I was lucky . I had five months

40:00

of chemo to decide whether I wanted

40:02

a moustache to me or a reconstruction . Most

40:04

women have two to three weeks and

40:06

you don't know what your breasts mean to you because you don't think

40:09

about them , you don't talk about them and then suddenly they've

40:11

got cancer and you cannot be rational and

40:14

my brain was going if

40:16

I don't have a breast reconstruction , what will

40:18

my patients think ? Because I'm a breast reconstruction

40:20

surgeon , Surely they would expect me to do it

40:22

, which is bonkers . And

40:25

I used to wear quite low cut v-neck dresses

40:27

at work and if you wear

40:29

a prosthetic bra , it's up . Here I'll be

40:31

wearing turtlenecks . I don't want to change my wardrobe

40:33

. I felt guilty that vanity

40:35

was a reason for having an implant

40:38

. Yet I told patients vanity is fine

40:40

for having an implant , because I can do it to you , and

40:42

just this . What's wrong , what's right

40:44

? It was really really , really hard

40:47

and my implant got

40:49

badly affected by radiotherapy . It gave me chronic

40:51

pain and now I'm happy being

40:53

flat . And if I'd known now what I knew , then I'd

40:55

have said just go flat in

40:57

and out of hospital in a day , no radiotherapy

41:00

, no post-term pain , no complications

41:02

. Thank you very much , but at the time I

41:04

could not have coped with being flat

41:07

, and time is an incredible

41:09

healer and I think patients don't understand what

41:12

you want now is the time is right for

41:14

you . But if that changes down the

41:16

line because your experience of life

41:18

has changed , that's okay . We

41:20

can help .

41:22

I remember , as

41:25

I evolved in my

41:27

career , that I

41:29

became different

41:31

and how I made recommendations

41:34

to my patients and

41:36

the question is is that good

41:39

or is that bad ? I

41:41

was wondering about that .

41:43

I think it's good . I think

41:45

as a young surgeon I pushed complex

41:49

surgery on patients because I wanted to

41:51

play . You've got the perfect

41:53

breast for this and I can do it , and this

41:55

is fantastic . And now I realize we

41:57

get we're pressured to make sure a certain

41:59

percentage of women have reconstructions

42:02

and our mastectomy numbers are low . We

42:04

do as much as we can to save breasts . Now

42:06

I don't care if every woman has a mastectomy

42:09

, as long as she is properly informed and consented

42:11

. And when mom

42:13

was being cancelled

42:16

about having chemotherapy for her bone cancer

42:18

, the oncologist had an hour to spend with

42:21

her because it's such a rare cancer . They had that

42:23

time . And just to hear someone

42:25

with an experience be really , really honest

42:27

and say these are the options and this is what it will mean

42:29

for you and your life and

42:31

what will happen if you don't and what will happen if you

42:33

do , and it was like wow , I

42:36

thought I was good at this , but that woman was an

42:38

expert and it just made me realize when

42:40

you have the time , you can

42:42

give the patient that time to think what

42:44

does this mean to you and how

42:46

are you going to feel and is it the

42:48

right choice ? And it was just I

42:51

think experience is a great thing just

42:53

to be more open and honest and realistic

42:55

.

42:57

Thank you . Can you please provide

42:59

guidance on how to best manage with

43:01

recurrence risk ?

43:03

So , yeah , I don't have metastatic

43:05

disease . I've had locals . I'm cancer-free

43:07

. My worry is a lot of

43:09

women think they're cured and don't realize

43:11

it can come back 15 , 20 , 30

43:13

years , because doctors and nurses aren't

43:15

very good at saying , by the way , it

43:18

can come back . And these are the signs to look out

43:20

for . Because you want to be positive and I think we

43:23

need to know , when you're giving your post-op

43:25

results , that you know what to look out for

43:28

. And I think it's educating

43:30

people to say , right , if you get any

43:32

of these weird symptoms that you can't explain

43:34

, you put it in your diary and if it's still

43:36

there in two or three weeks time you go and

43:38

you get it checked out because that mental bell

43:40

is horrible and you make sure your doctor

43:43

knows that you've had cancer and it could be

43:45

related , because a lot of patients don't tell the

43:47

doctor . They assume the doctor knows the

43:49

doctor doesn't . He gets missed and I

43:51

think it's informing them without scaring

43:54

them . But they do need to know and

43:56

family practitioners need to know that this could

43:58

be recurrence , to bring it back in and

44:00

it comes back down to . We now know that if you

44:02

exercise five times a week

44:04

a robicon resistance , it can reduce the

44:06

risk of your cancer coming back by a third

44:09

. We give chemo

44:11

. If there's a 5% reduction , regular

44:13

exercise drops it by 30%

44:15

. Cutting down on alcohol , eating

44:18

a healthy plant-based diet , trying

44:20

to reduce your body fatness , can all reduce

44:22

the risk of recurrence and I think we need to be giving

44:24

that public message be the

44:26

things you can do to take control , to live

44:28

as healthy as you can . It may still

44:30

come back and these are what you need to look out for

44:32

and I think it's just that

44:35

education , that information . It's

44:37

a horrible thing . It took me five years not

44:39

to wake up every day thinking is this the

44:41

day it comes back ? And I'll still get

44:43

hip pain from not stretching off to run and convince

44:46

myself it's in my hips because you

44:48

have that fear because it's everywhere , and

44:50

I think it's a really fine balance . We

44:52

also in the UK we now have a lot of CBT

44:55

available through cancer centers to

44:57

help those women with a really bad fear of recurrence

44:59

learn to deal with it and learn

45:01

to process and find a way to move forwards

45:04

.

45:05

CBT is cognitive

45:07

. It's a sort of psychotherapy . It

45:10

replaces one thought with

45:13

another in a way

45:15

that hopefully at some point becomes ingrained

45:17

in your head . There's different

45:19

types of psychotherapy out

45:21

there . Another one that works very well for

45:23

cancer patients is psychodynamic

45:26

therapy , where

45:28

it helps you put your whole life

45:30

into the context of the current

45:32

struggle that you're living with and strengthens

45:35

your coping methods .

45:40

It helped me so much .

45:42

That's very visible in your book and I really

45:45

, really applaud you on being so vulnerable

45:47

. Two

45:49

things I guess I want to clarify . Not

45:52

every cancer has that

45:54

late recurrence risk beyond

45:57

five years , and some

45:59

do . So I would recommend don't Google . If

46:02

you want to know , if you're ready

46:04

to know what is your recurrence

46:06

risk , early and late

46:09

, I would suggest write

46:11

it down for you to ask your oncologist because

46:13

they can give you that information

46:16

. Please , don't Google it , please

46:18

. And the

46:20

other thing that Dr O'Riordan

46:23

very nicely said is all the lifestyle

46:25

self help . Things give

46:27

you sense of control , so it helps you

46:29

physically feel better and also mentally

46:32

feel better . Really

46:35

, the thing I add to

46:37

that is two things

46:40

. One is every little bit helps . If

46:42

you can't do five times a week yet , if

46:44

you can't do the full blown , predominantly

46:48

plant based diet , just start

46:50

small , start somewhere . We're

46:53

all on a never ending

46:55

journey until our

46:57

death to continuously learn

47:00

who we are and how we

47:02

can improve ourselves . That the

47:04

journey means to start somewhere , start

47:06

small . And secondly

47:08

, if the cancer should

47:11

come back , knock it off . Hopefully

47:13

never . I'm not sure

47:15

you can , as we discussed

47:17

earlier , blame yourself . You didn't do

47:20

enough , you didn't try enough because

47:23

, like we said , our body is one big

47:25

black box and there's so many

47:27

functors that play into

47:29

our recurrence risk beyond lifestyle

47:32

. You do your best and we

47:35

we can give ourselves the illusion of control

47:38

, but there's many fun to you on that

47:40

that we can't can control

47:43

. I don't want you to turn

47:45

your lifestyle into an

47:47

obsession to

47:49

punish yourself , because

47:51

your diet and your

47:53

life are to be enjoyed

47:56

. You're not supposed to survive

47:58

, you're supposed to thrive

48:01

. I want you to enjoy

48:03

your life , dr

48:05

O'Riordan , and thank you for being

48:07

with us today . I always like to start

48:09

and end on time and

48:12

I give all of you a big

48:14

, big hug for sharing

48:16

and being here today and

48:18

hope to see all of you soon

48:20

again . Thank you everybody , thank

48:23

you , thank you , bye bye

48:26

thank you .