The Patient

Mohamed Khadra is a professor of Surgery at the University of Sydney, Australia. He has had a successful and varied career as a leader in education and medicine, internationally and in Australia. He has a degree in Medicine, a PhD and a fellowship of the Royal Australasian College of Surgeons. He also has a postgraduate degree in Computing and a Masters in Education.

His roles have included Inaugural Chair of Surgery at the Australian National University, Pro-vice Chancellor for Health, Design and Science at the University of Canberra, Professor of Surgery and Head of the School of Rural Health for the University of New South Wales. He has won several research prizes, including the Noel Newton Prize for surgical research and the Alban Gee Prize in Urology.

Mohamed is co-founder of the Institute of Technology Australia, an accredited higher-education provider that contributes to social justice by delivering accessible and affordable degrees to students in developing countries. He is also the bestselling author of
Making the Cut
.

My gratitude and warmest thanks are extended, without reservation, to my agent, Sophie Hamley, from Cameron Creswell, and to the staff at Random House Australia: my publicist, Alysha Farry, my editor, Kevin O'Brien, and my publisher, Nikki Christer.

Writing uses up time, which I borrow from my family. My eternal gratitude goes to my best friend and wife, Michelle, and to my sons, Adam and Sam.

Finally, as an author whose inspiration is drawn directly from hospital wards and operating theatres, my words are created out of the pain and anguish that I witness and that my patients endure. After the publication of
Making the Cut
, I received hundreds of communications from patients whose lives had been impacted by illness, trauma and cancer, and who had found a resonance through the shared experiences of others. In a sense, they had been comforted by knowing they had not suffered alone. I am extremely grateful for their feedback, as knowing I have been an instrument of that comfort is what has sustained me as a writer.

As surgeons, we dip in and out of our patients' lives much like a flying insect touches on a pond. The insect lands for a moment, then flies to another spot and lands again. It remains, throughout its short life, unaware of the vast and intricate complexity that lies within the pond – currents swirling this way and that, life systems building and collapsing. Surgeons, like the pond insect, keep themselves from landing too heavily on any one spot, lest they drown in that patient's sea of sorrows. For a surgeon, ignorance is not just bliss but a matter of survival.

The central character of this book, Jonathan Brewster, is a conglomerate of cancer patients whose lives I have dipped in and out of in the ongoing course of my career as a surgeon. Some I met soon after their diagnosis, some once they had already developed an advanced or terminal cancer. My path crossed these patients' paths at different points on their life journeys. I witnessed each patient reach new stages of spiritual evolution and awareness – for some, on the way to their final demise. To preserve confidentiality, I have amalgamated them into one patient and fictionalised large parts of their lives, relationships and interactions with medical staff.

This patient's interactions with me are, from time to time in the book, narrated from my point of view, as is my own experience of being a cancer patient, so I necessarily
appear in this story under my own name. I have, though, changed the names, personal details and characteristics of all other patients, doctors and medical professionals, along with the name of the hospital itself, also for reasons of confidentiality.

The principal surgeon who treats Jonathan in the book is a character who has been created to portray some of the characteristics of a bad surgeon. The events attributed to him are drawn from hearsay and public records, and his existence is designed to highlight the negative possibilities that can occur without the good governance of the Royal Australasian College of Surgeons and the various medical boards that regulate standards and review competence. It ought to go without saying that most surgeons are not like this.

It should also be noted that the episodes and encounters narrated in this book are drawn from my entire career as a surgeon to date, rather than adhering to the chronology of my CV – so those people I meet in the book who are based on people I have met during my career do not correspond to the places or times in which I actually met them.

Everything contained in these pages is nevertheless as true and accurate a reflection of what takes place in Australian hospitals every day, from both the patients' and the doctors' points of view, as I could render from my own experiences.

We understand more about the intricate anatomy of the human being since the Visible Human Project, completed by the US National Library of Medicine at the end of 1995, created three-dimensional computer models by finely slicing the bodies of two deceased donors – including a
condemned prisoner put to death by lethal injection – then scanning and digitising the resultant images. Macabre, yet useful in gaining a greater understanding of the human body. In much the same way, I have attempted to slice my patients' life stories into small segments and reconstruct them so that we may understand more about health and the health system.

The health journey is often also a spiritual journey, and you will find many of my beliefs and attitudes transplanted into Jonathan's story.

I was fortunate enough in the year 2000 to lead a team that started Australia's first rural clinical school, in Wagga Wagga, in New South Wales. In Sydney, medical students undergoing clinical training were assigned to doctors and viewed patients by peeking over the white-coated shoulder of senior clinicians. In rural south-west New South Wales, students could not have that luxury: there simply were not enough clinicians. A radical new approach to medical training had to be found. Our team's solution was to rotate the student experience by 180 degrees. Instead of assigning the students to doctors, we assigned them to consenting patients. Thereafter, whenever these patients accessed the health system, their students went with them. If the patient had an X-ray, the student was there. If he or she had an appointment with a specialist or went into hospital for an operation, the student was there as well.

The rural students gained a longitudinal view of their patients' health journey, unlike their city counterparts, who saw the small segments of their patients' lives that intersected with the doctors they were assigned to. The patient-centred rural curriculum produced medical students who had a far more mature view of the healthcare system. They saw the system from the patients' perspective and were able to appreciate the need for health-care teams to work in concert to achieve good outcomes.

In
Making the Cut
, I sought to portray the lives of patients as they interfaced with me in my capacity as a surgeon. So doing, I exposed the reader to a large number of different stories and patients.

In this book, I focus on one patient's journey. While he is one patient, with one disease, I hope the reader will forgive me if I say that he is, in some ways, all patients and all diseases. My portrayal of his journey through the health-care system is intended to reveal its shortcomings, its triumphs, its cruelty, its compassion. Just as the Wagga students followed the progress of individual patients, in this book you, the reader, will see things more from the patient's than from the doctor's point of view.

Some might criticise the darkness of this book. I should note that bladder cancer, the disease suffered by the central character, is treatable and even curable in some cases. The miracles of modern medicine have brought about cures for many of the diseases we used to regard as hopeless. There are patients who walk away from the public-hospital system satisfied with the care they received. My intention in this book is in no way to negate their good experiences. However, as a surgeon, I see much variety in disease and the cruelty it inflicts: the slow-onset disease that tortures a woman until she can bear it no longer; the murky, insidious disease that creeps up on a man without his knowledge; the lump that grows slowly in the darkness of a body crevice; the hardness of a breast that tests the ‘till death do us part' promise. If this is not the ultimate of cruelties, then what is?

Throughout human history, disease and pain have been the strongest agents of spiritual awakening. I have no idea
why, in His creation, God made human beings more likely to gain enlightenment through suffering than through good humour, health and laughter. Yet, through the annealing fire of suffering and disease, people gain insight – insight that comes at great cost.

Of course, we all have some way of rationalising the pain we suffer. The Hindus believe in reincarnation and the possibility that your next life will be better; the Muslims, including myself, that you will suffer less in the afterlife; the Christians that Jesus loves you and that faith ensures eternal life in heaven. Regardless of the wonderful spiritual writings of all the world's religions, spending night after night in the hospital caring for these patients – the beloved of God – I still believe that disease is God's cruellest creation.

Mohamed Khadra

Cover

About the Author

Title Page

Copyright

Dedication

Acknowledgements

Author's Note

Preface

Prelude

Chapter 1

Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Chapter 7

Chapter 8

Chapter 9

Chapter 10

Chapter 11

Chapter 12

Chapter 13

Chapter 14

Chapter 15

Chapter 16

Chapter 17

Chapter 18

Chapter 19

Chapter 20

Chapter 21

Chapter 22

Chapter 23

Chapter 24

Postscript

Making the Cut