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Richard Smith, gynaecological surgeon

24 February 2017

‘There’s a crisscross between matters medical, religious, and practical’

I work as a gynaecological cancer surgeon and researcher at Hammersmith Hospital, Imperial College, and a private hospital. I see out-patients, I operate one to two days a week, and I do research and teach­ing.


Gynaecology attracted me because it’s a good mix of medicine, psychology, and surgery. More than 50 per cent of patients are cured, and the vast majority are helped by the team’s treatments using surgery, chemo, and radiotherapy. Most gyn­aecologists are women, but I per­sonally don’t believe the acquisi­tion of skills is in any way gender-dependent.


I’ve also pioneered womb trans­plants for women with no uterus who do not wish to have a baby by surrogacy. It’s important to say that the eligibility criteria are very strict. Because of the risks, it’s specifically for those who wish to have a baby. They need to have ten embryos created by IVF in storage, because that comes as close to guaranteeing success in pregnancy as you could hope for.


But the underlying desire of women for a womb transplant is very strong, even if they do not wish to have children. Many of them are born without a uterus or cervix; some have lost their uterus because of malignancy or a benign disease. They speak of feeling as if they are not a “whole person”. For people born without a uterus, it’s very diffi­cult because you don’t find out until your mid-teens, and then it’s a ter­rible shock, and it’s hard to talk about, which creates more difficult­ies still. We have hundreds of emails from people enquiring about trans­plant, but the ethics-committee approval only extends to those on an IVF programme.


I’m in the very fortunate position that we don’t lose many patients, but we do lose some. I passionately believe that, as far as possible, everybody should be helped to die in ac­­cordance with their wishes: at home, in a hospice, in a hospital bed.


When I sit with a dying patient, one of the questions I will ask is: “What would you like to happen now, given that we can’t cure you or extend your life?” Very often you get a reply that you can help with. One lady with a horrible cancer was doubly incontinent and said: “It’s bloody obvious!” I said: “Not to me. Just tell me.” “I smell of piss.” I arranged for a uro­logist to see her, and she went home, didn’t smell, could go out with her friends, and had a fantastic three weeks. Then she came back, and said: “Now I’m ready to die,” and she did, that evening.


Another lady thought I was being religious, but she said: “I’ve got a lot of papers in my loft, and I want to burn them. I can’t die in peace.” So I said: “We’ll get an ambulance and a nurse, take you home, get the papers down, and you can burn them.” And we did, and she was able return to the hospital and let go in peace.


It is most illuminating for a doctor to experience serious illness. Being a patient is a disempowering experi­ence by its very nature, and it’s anxiety-creating because you’re reli­ant on others. If they are kind to you, it makes it much easier; but if they aren’t so nice — and I’ve ex­­perienced that myself in hospital — it’s not so good. My first time as a patient was when I had been a doc­tor for ten years. I hadn’t realised till then that people’s most important experience is the nurses who look after you — not the doctors at all.


There’s a crisscross between matters medical, religious, and practical. I hope that with my own death I’ll be spiritually, psychologically at ease, not in a lot of pain, and ready to move to the other side.


There is much good news for women with cancer, and those women not cured can mostly expect good quality of life for many years.
I wrote Women’s Cancers: Pathways to living (ICP, 2015) to give accurate information about each cancer and its possible treatment, as well as chapters on spirituality and com­plementary medicine. The in­­spiration to write The Journey came from that.


It all started when I was invited to lecture to the Charing Cross Cancer Patients’ Association on how doc­tors can answer the question “How long have I got?” Most people with a cancer diagnosis presume that they have a death sentence, but, in the gynaecological world, most will survive. We categorise outcomes as “cured”, living with cancer, pre-terminal, and dying. The vast ma­­jority are not at the third or fourth stage when diagnosed, and the chance of being “cured” gets better each year you stay cancer-free.


Most people identify their emotions along the lines of Elizabeth Kübler-Ross’s “denial-anger-bargaining-depression-acceptance-hope” linear model. I think Gary Bradley’s “land­scape model” works better: it’s like a picture you buy and hang on the wall. Soon you begin to notice new things in it, and then it becomes “wallpaper” as you live with it.


I drew them a Venn diagram of spirituality, psychology, religion, in overlapping circles, and said: “We’re not meant to talk about spir­ituality and religion, but I’m going to discuss them for a few minutes, not proselytising for any religion.” At that point, people started shout­ing, and one woman said: “You and your bloody nurses — you won’t talk about this. This is what we want to talk about.” That’s why the chapter is in that book, and that’s why I wrote The Journey.


I have patients’ say that their dia­g­nosis was the most positive thing that’s happened to them, and others who are having a terrible time, terrified of the cancer coming back. The Journey’s about spirituality, repetitive prayer, and pilgrimage. It’s designed to open some doors to help those people who are strug­gling. You don’t have to be a Chris­tian to do these: there are some things in there that are secular, too.


My first experience of God was in cathedrals as a young man. This has developed through repetitive prayer and pilgrimage.


I usually go to church in Padding­ton Green and Little Venice, but I do like cathedrals. Two weeks ago, it was it was my birthday; so I went to sung mass at St Paul’s Cathedral, which was absolutely beautiful. I’m a regular churchgoer in the Anglo-Catholic tradition, with some time spent in the rest of the week in prayer and contemplation.


I think I’ve been to every cathedral in England and Scotland. They don’t need to be huge to strike you with a sense of space when you go in. St Magnus, in Orkney, is no bigger than a rich English parish church, but it has that sense of something other — as long as there’s not too many people.


I’ve made many pilgrimages: to Lin­disfarne, Canterbury, St Andrew’s, Rome, Athos; and the ones de­­scribed in the book: Patmos, Jeru­salem, Bute, Iona, Assisi. There’s a fine line between pilgrimage and tourism, but pilgrimage must at least have religious intent.


My favourite sound is Bach’s music. Bach, Baroque, and liturgical music is what I turn to for comfort.


A family dispute was what made me angry last.


I’m happiest in good company with close friends, having a good meal or at the end of long walk.


The greatest influences in my life are my parents; Fr Gary Bradley; and Shaun Hammond, who is a hypnotherapist.


Repetitive prayer is non-requesting, but I pray for family, friends, and patients in distress, as well as me in distress.


If I was locked in a church and could choose anyone as my com­panion, I’d choose St Francis. Or let’s be bold: Christ himself.


Richard Smith was talking to Terence Handley MacMath. The Journey, by J. Richard Smith, is published by DLT, £9.99 (Church Times Bookshop £8.99).

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