“I, I will be king
And you, you will be queen
Though nothing will drive them away
We can beat them, just for one day
We can be heroes, just for one day"
Artist: David Bowie
Album: Heroes
Release: 1977
So I’m not usually star struck, I mean don’t get me wrong, if I ever bump into Sir David Attenborough, yes I will probably stumble my words and smile like a Chester cat, but I always believe in treating people, not for the fame they’ve made, but the way they make you feel. Not to mention I can barely recognise my own mother, so I’m most likely to walk past most famous people.
Well, today I found myself lost for words and feeling humble to be in the presence of what I would consider being a real-life superhero (without the cape 😉).
Professor Ian Smith
The Prof as he’s usually referred to is a consultant oncologist at The Royal Marsden Cancer Hospital. I met the prof on our Le Cure charity event but didn’t get to spend much time with him (he was too busy racing around those mountains). So thankfully he agreed to meet with me to discuss in more detail the work he does.
So my initial thought on meeting with the Prof was just how grateful that I was about meeting him in a coffee shop with healthy breasts! Many 100s of women have been blessed to meet him, but under more challenged and sad circumstances. #gratefulformyhealth
My next thought was just how climatised Ian was to talking about his work. This makes sense for a man who has been doing it for 43years, and he was charming and engaging. The start of our conversation in fact was focused on me where he directed the attention and I immediately felt comfortable with him and keen to chat more.
But, I decided very soon during our conversation that my initial interview approach to this was, well samey and boring, and here in front of me is an incredibly modest, humble, interesting, intelligent and slightly cheeky family-focused Scotsman who needed a little ‘this is your life’ moment.
We are all guilty of idolising superheroes, and we’ve all been reminded this year about the true heroes #keyworkers amongst us, so I’d like to do my bit, and introduce you all to the real Prof Ian Smith, ONE of a team of amazing humans saving breasts in the thousands (or at least the lives they belong too)!
So of course like all roadies do, we started on the topic of Ians Cycling career
Ians first-ever mounting of a bike was thanks to Le Cure. Back in 2013, his good friend Peter Freeman, another fellow Curista, (who worked with Tony Butler (Founder of Le Cure) click to read blog and introduced Marianne to Ian for her life-saving treatment) was the person to encourage Ian to consider joining them for a bike ride in the Alps to raise money for breast cancer.
Ian's initial thought was "only crazy people do this, but I like a challenge so I’ll give it a go”
At the time, Ian didn’t even own a bike and true to his cheeky nature, he enjoyed letting Peter research in detail, for days what was the best bikes for beginners. Once Peter bought a bike, Ian simply took 5 minutes walking into the very same bike shop and told the shop assistant “I want that one”
That was the start of their training, and many weekends were spent in the surrey hills often with lots of cuts and bruises as Ian learnt how to ride with those ‘clicky shoes’ (we’ve all had our funny stories to tell about those moments clicky shoes blog here
So whilst Ian panted up those hills, concentrating on nothing but his technique, Ian had already decided to sell his bike immediately after Le Cure and never touch a bike again. However unknown to Ian during this time, his opinion was going to rapidly change. As when Le Cure arrived, and on each mountain Ian climbed, his love for the sport grew and grew, and by the time the sunset on the last peak of the very first Le Cure event, Ian was hooked for life.
“I look forward to Le Cure every year, and now go on cycling holidays to Mallorca when I can. I get a lot of headspace from cycling, I focus on technique and safety and the sense of freedom you have, that split decision of just choosing left or right and going where you want. I love seeing the changes of the seasons, the animals and the feeling of being one with nature. When you spend 2-3 hours on a climb, it is extraordinary how the scenery changes. You start in fields, to then riding through pine forest and end up in snow-topped mountains, it's incredible”
So why choose this path of medicine?
I think the most interesting part of my conversation with Ian was actually that he never planned to be an oncologist, nor did he go into medicine for an ‘I want to heal the world ’childhood dream. I had to admire his honesty for admitting that he didn’t know what he wanted to do, and as a child to a father who supplied corner shops with fruit, he was raised with common sense and astuteness, which helped him realise that for him, an art degree whilst fun, wouldn’t have been the most lucrative career choice.
“I had no passion around literature and was never going to be a businessman so thought I’ll try medicine and that will steer my career path to where it needs to go”
(WHAT AN INCREDIBLE LIFE NUDGE)
So off Ian went to Edinburgh University, making his parents beam with pride at being the first person in the family to study medicine. His first exposure to a medical care was looking after elderly people suffering mainly from illnesses like chronic bronchitis. Working with the elderly, whilst making them more comfortable, wasn’t satisfying enough for Ian as sadly he was just making them comfortable not curing them. The younger patients who arrived into the hospital with things like leukaemia in the lymph nodes was really interesting, as he could try to help them. “elderly people have had their time, but seeing a 25yr old die is disastrous and I wanted to find ways to help”
Back then cancer medicine didn’t exist, but he heard of this hospital in London called the Royal Marsden. They were offering trainee roles and so Ian thought “why not, I had always liked the idea of experiencing London’ so after expecting to stay for just one year, Ian now sits in front of me 40 odd years later.
I couldn’t help but feel very compatible with Ian's love and appreciation for London “it’s such a tolerant place where you can be who you are and no one judges or cares and also I had a huge love for the role, trying new things, experimenting with drugs and making progress, even whilst we had the sadness of dealing with death and loss, it has always been inspiring and motivating to be part of leading-edge science that is truly making a difference in rapid time"
“In earlier days 70% of patients died, now we are down to 20%! 80% of patients survive … that’s enormous and its thanks to the work that the team do. To be part of that, the research and trials was the best career choice I ever made and it was based on a whim … funny how life works out”
Now true to my inquisitive self, I was keen to understand from Ian, how he honestly felt about managing sick people. I mean I could cry just talking about the thought, but I wanted to know how Doctors feel when breaking news like this to people.
So the first thing I learnt was that Ian has a way with patients, he communicates well and finds good ways to explain things in a way that resonates with the individual. As part of my area of expertise being able to simplify language, is quite a skill set to have, especially when you are in the depths of a subject. So I had to admire the man more for being able to converse in a way that people understood.
Now at this point, I decided to confess to Ian, that I know cancer exists, but actually, I don’t truly know what it is. So in his calm and simplistic explanation, Ian explained to me:
What is cancer?
"It is an uncontrolled growth in the body. Throughout our lives, our body is a perfectly organic substance that reproduces cells constantly. In normal circumstances, these cells are perfectly stable, however, sometimes, the cells genetically mutate and grow out of control. This is known as cancer.
The breasts, due to their monthly nature of swelling and regressing thanks to a females cycle, leaves them vulnerable for mutations happening. This becomes a cluster of cells that grow larger and lump forms.
In best cases the cells remain in the breast tissue and can easily be removed known as primary cancer, however, these cells can often escape or leak into the blood and spread into the body, this is known as a secondary.
Older methods meant treating the patient with chemo, which nuked the bad cells, but the problem here is that chemo always kills the good cells too. Thanks to modern research we discover and test more and more specific drugs that target and kill only the cancer cells, without affecting the good cells.
Its modern research that helps us determine what kind of mutation that cancer has created, we learn about the ‘inhibitor’ or connection in the gene that has mutated, and then we apply the most suitable drug that we know that either blocks or kills that inhibitor.
Thus the mutated cell dies"
So how do you tell someone that they are incurable?
"Well firstly I feel terrible, and my heart races every time telling them, trust me it never gets easier. However, I never find blurting out that there is no hope for you, isn't conducive for anyone. So I find that the best way to approach this is to explain that there is nothing else we can do for them. This never gets easier telling a person this, but thankfully it happens less and less thanks to the 80% survival rate”
How do you feel when telling a patient there is nothing else you can do for them?
"So the first thing to point out here Nic, is that I often get to know the person over years. They see me every 2-3 weeks for treatments. I meet and get to know their husbands and learn about their families. You build up a rapport with people, so then when you deliver bad news, it feels like you’re telling a friend they are going to die soon and then that’s very difficult to stomach. And yes it would be inhumane of me not to admit that it hurts.
Thankfully for me, we are a team who work together, and there is always a specialist nurse who is trained in cancers. They are fabulous and speak to the patients regularly, checking in on them, so it is fair to say that we share the burden of the emotions"
Have some particular patients stood out in your years?
"I remember and feel for all the women I’ve cared for, however, younger patients always ‘get to me more’ especially when they have young families, it’s a crueller circumstance for everyone it affects.
I once treated a lady who was an editor in a well-known newspaper. She had a weekly blog, where she spoke frequently in her articles about her diagnosis and treatments. When she passed, the week after, a journal written from her 14yr old daughter was published describing her mums' death … that was hard.
However, there are always great stories that take you breath away and help you believe in miracles.
I once had the job of delivering the news to a young woman, who was heavily pregnant (36 weeks) that she had metastases (secondary cancer). I was in the process of telling her that she had secondary and that it was not curable.
Right there and then, her husband fainted and collapsed on the floor. We put him into a suitable position with his legs elevated, but the woman asked me to carry on telling her. So here I was continuing to explain that this lady was incurable, whilst the husband was sparko on the floor lying with his legs up in the air. It was at that point that I had to stop and announce to her, that this was one of the surrealist moments in my career. We both laughed together, and I think that cleared the air and gave that moment that was needed.
Well, since that diagnosis, she tried new drugs and guess what, she was cured. What I love about that particular story is that now, every year I have a hand-drawn Xmas card from the daughter who was in her stomach at the time."
So, something I wanted to advocate since attending Le Cure and listening to exactly why we were raising money was about the research that the money is going towards.
Le Cure is very unique in the way that the charity is run, and that means that all the volunteers are 100% non-paid volunteers, and the money raised under Le Cure is ring-fenced and 100% of this money is given to the Royal Marsden research fund.
So Ian, what is the team doing with this money?
"It's fair to say, we are doing some ground-breaking research at the moment. I mentioned that cancer mutates, and its this mutation that makes it more resistant to the treatment. So a patient starts with primary cancer, this spreads into their blood, and forms mutations in all areas of their body.
For treatment to be accurately prescribed, we need to know what inhibitors make up the mutation, but these mutations are more often deep into the body, and it is hard to get a biopsy and provide suitable drugs.
In recent years we have discovered that the cancer cells shed some of the DNA into the bloodstream. With modern technology, we can now detect the mutations in the bloodstream and determine if these cells have mutated in a regular blood test. If you find these mutations you get a target, and then know how to create a drug that will block it. One of the challenges is that cancer patients relapse meaning that cancer can come back 5-10yrs later.
Currently, we don’t know why this is, so we are spending the money on a large trial that measures 100s of women that have previously had cancer and we monitor any changes in their bloodstream (looking for mutations). We hope that this will give us early detection rather than waiting for them to become ill again. We can then treat cancer in its infancy rather than when it's grown.
This is ground-breaking and could see us reduce that 20% death rate even less in years."
Click here to read more about the Research
So once you have cured cancer, what’s next for you superhero Ian?
"Well firstly, keeping fit enough to keep up at Le Cure
I enjoy working with the younger members of the research teams and whilst they have younger brains, I still feel my wisdom and knowledge is crucial. I feel responsible for them and I wish to continue to talk about the research with them, guiding and supporting them along the way.
I won't give up seeing patients anytime soon either, and until that day comes when I feel I’m losing sharpness that’s when I’ll find something else. I’m grateful that unlike a Physician, who needs their body as much, my mind will outlast my body, so I can retire later.
And let's face it, after the life I’ve currently led, its clear I’m not a planner, life will nudge me.
So when that day arrives I’ll likely to keep in touch by being part of the academic board of trustees for charity and support where I can still give experience.
Failing that, I’ll either win the tour de France or simply enjoy being surrounded by a beautiful partner, 3 kids and 6 grandkids."
So I started this blog off by saying how I don’t get star struck, well, I’m willing to confess to you all that I can no longer say this. After finishing a one hour conversation with Ian, I found myself travelling home with a sense of joy, hope and gratitude. Here I was a healthy woman with healthy breasts, meeting a regular human that many of us have probably stood next to on the tube, or sat next to at a coffee shop, and yet he has changed so many lives for the better. How lucky am I to have crossed paths with him, and hear his life stories, and not only how he has impacted others, but how they too have impacted him.
It is true … oncologist are truly Superheroes in disguise.
For more information about Le Cure visit the website: https://lecure.org/ and if you can, please donate to this wonderful cause!
pssst: always looking for more Le Curistas next year, so why not join us for 2021.