Liz O'Riordan is juggling... phone calls, interviews, appointments, deadlines. Her role as inspirational writer and speaker, blogger, YouTube broadcaster and interviewee is busy, and becoming even busier.
It's far from her former life as a breast cancer surgeon, a world of operating theatres, hospital consulting rooms, medical conferences and peer reviewed journals. But in 2015, at the age of 40, Liz's life took a dramatic and unexpected turn when she received her own breast cancer diagnosis. Four years later, following a recurrence of the disease, she was forced to retire from the job she loved.
The brutal irony of it all is only too apparent; the illness she'd devoted her life to treating would now rob her of her hard-won, 20-year career. 'I loved being a surgeon,' she says. 'For as long as I can remember I wanted to help people; it's why I became a breast surgeon.' Helping women overcome pain and discomfort, as well as disease, and the ability to make a major difference to someone's life, was satisfying and rewarding beyond compare.
Now Liz makes a difference by sharing her experiences – as doctor and patient – helping others who are going through diagnosis and treatment. It's also how she makes sense of the past eight years of her life. Because another irony is that having cancer has probably given Liz a far greater understanding of the impact of the disease and treatment than she ever had as a surgeon – something she now wants to pass on to other medical professionals.
She's written two books, The Complete Guide to Breast Cancer, co-authored with Professor Trisha Geenhalgh, and Under the Knife, a frank and, at times, funny account of the highs and lows of becoming a female surgeon in a male dominated profession. She's given a TEDx talk, numerous media interviews and is now hoping to establish a YouTube channel. But when we talk at her home in Elmswell, the cancer has returned and Liz is waiting to hear what her treatment will involve. Not that it's likely to slow her down.
Liz knew she wanted to be a doctor when she was seven. She came to Suffolk after finishing her PhD at Cardiff in 2006, when she was 28, to complete the next stage of her training. She worked for six months at Addenbrookes doing breast surgery, followed by 18 months at West Suffolk Hospital in Bury St Edmunds, where she met her husband, Dermot. She did spells at Norwich, Luton, a year at the Royal Marsden doing a Fellowship in oncoplastic surgery, then in March 2013 she became a consultant at Ipswich Hospital.
In June 2015 she found a lump in her breast. It was her third; she'd already had a couple that turned out to be cysts. 'I knew what they were – I'd had a mammogram, I'd had an ultrasound, I wasn't worried. It's common to get cysts in your 30s and 40s as you get nearer to menopause,' she says. She told her mum, however, who was worried and urged her to have it checked.
'It was a cancer,' she says. For the doctor turned patient, it came as a shock. 'None of us were expecting it. And when I went back to get the results after the biopsy it was really strange because the two breast consultants were in the room, crying, and my husband was crying, and I was like, this isn't happening, it's happening to someone else.
'I was kind of living in a surreal alternative world, because I knew too much. I had a good idea of what my risk of being alive in 10 years was, and all this stuff that I knew was going to happen – I was like, I’m not going to go through this. It’s not real.'
Liz opted for treatment at West Suffolk Hospital. It was a large, 5cm cancer and she was young, so she had chemotherapy with the aim of shrinking the tumour and avoiding a mastectomy.
'I thought I knew what chemo was like,' she says. 'I used to give patients a warning shot before they saw the oncologist. You know, you’ll lose your hair and you might feel a bit sick – but I’d never had it. I was weirdly, excitedly curious to see what it was really like, but also terrified about being out of control and knowing how bad it would feel. I knew so little.
'I didn’t realise you lost all your hair – just the hair on your head. The constipation – having to swallow the tablets I’d given out to patients. Suddenly I’m taking them. Crying in the shower – sitting down because I didn’t have the energy to stand – when no one was around because I didn’t want anyone to see what it was like.
'Mouth ulcers, change of taste, sickness – I would lose three kilos every chemo week just because I wasn’t eating. I lost the feeling in my fingernails and my toes, so I couldn’t pick up a glass, and that could have been permanent, so I thought if this doesn’t go away I’ll never operate again because I can’t feel.' And there was instant menopause, being made infertile at the age of 40 because of the need to switch off the body's estrogen supply.
'I wanted to push my husband away – I said, you didn’t sign up for this when you married me. Go and find a woman with two healthy breasts and a sex drive to match because my libido is gone as well.You deserve better. And he didn’t because he loves me and he stayed, but there's that guilt of how it changes your intimate life overnight.
'A month before I was diagnosed I’d cycled up the Stelvio in Italy, one of the highest mountains, 2,000m high. I’m fit – and chemo was knackering. I thought, I give this to 60- and 70-year-olds, and I’m struggling. It was a real eye-opener.'
Chemotherapy shrank Liz's ductal cancer completely, according to the scans, but when they looked under the microscope there were still 13cms of cancer left. She also had lobular cancer. 'It's a sneaky so-and-so. It grows in sheets rather than a clump, so sometimes you can’t see it on a mammogram, and in my case you can’t see it on an MRI. My whole breast was just infiltrated with a lobular cancer that wasn’t seen – and that was a shock.'
It had also spread to her lymph nods during chemotherapy, increasing the risk of recurrence. It meant radiotherapy, Tamoxifen and because it had estrogen receptors, it meant switching off her ovaries.
'It felt like it was just piling on more and more. When is it going to stop?' Liz had a mastectomy and an implant.
She then had to work out how to go back to work. She shadowed three consultants at Addenbrookes, slowly building up to two and then three days a week.
'I found that really hard,' she says. 'The first time I saw a consultant break bad news, I saw the woman crumple in front of me and it was like PTSD. And I’d had pain after surgery so I thought, I can’t operate on women because I might cause them pain. Or when I saw someone my age who’d come back it was triggering. Could that be me?'
But she did go back to Ipswich Hospital in December 2014. Then in May 2015 she found another lump on her chest wall. 'I didn’t know what it was. I'd been planning to go flat because radiotherapy and implants are not a good combination – it can make the implant develop a hard capsule like a tennis ball. I had a lot of pain, constant spasms.'
What she thought was a nodule of tissue on the edge of her scar turned out to be a 2.5cm local recurrence. It was treatable but the disease and surgery had taken their toll on Liz emotionally and physically, and in February 2019 she decided to retire.
'The side effects of treatment – radiotherapy and surgery – mean I can’t lift my left arm,' she says, demonstrating with her 'good' arm. 'The skin’s tethered and I've lost my pectoral muscle, so I couldn’t use my arm properly to do surgery anymore.
'And psychologically, having had a recurrence, I wasn’t sure I could cope with seeing women going through it anymore.' She looked into becoming a different type of surgeon, or a GP, but it would have meant another five years of training and exams, which she wasn't strong enough to endure.
'I can’t remember my last operation – I didn’t know it was my last. I just had an operating list; then I went for the biopsy results. I wasn’t expecting it to be cancer. I’d only been a consultant for two years and it was hard suddenly being home alone, without a room full of people to do something magical in. I was the world’s most boring dinner party guest – I had no life outside of surgery. All I ever wanted to do was help people. I thought, what am I going to do for the rest of my life? How much life do I have left?'
The answer lay in the blog she had been writing since her diagnosis in 2015, encouraged by her husband. 'It was therapy, I guess, owning what was happening to me. I was getting lots of comments from doctors and nurses, saying thank you for explaining everything, and I realised I could write in lay terms.
'When I was diagnosed I told Twitter. That led to three doctors getting in touch; two now have sadly died. The third was Trish Greenhalgh, professor at Oxford. Her books got me through my surgical exams. I worshipped this woman from afar!'
Coincidentally, Trish was starting chemotherapy for breast cancer on the same day as Liz. Together they wrote the Complete Guide to Breast Cancer which led to Liz doing a TEDx talk in Stuttgart and being asked to talk to hospitals and various charities about what it’s like being on both sides of the table.
'One thing led to another and I started doing more on Twitter and Instagram, and people said thank you very much for explaining it. I thought, this is a way I can help people.'
Her fairly unique position as both doctor and patient gives her a certain authority. 'My PhD is in molecular oncology, so I'm an expert. But I do my research, everything is fact-checked. I had no idea how much nonsense is out there – you know, don’t eat sugar and eat turkey tail mushrooms. There’s so much misinformation to correct. And I had no idea patients were searching for it.'
But in other ways, says Liz, she is a typical woman. 'I never check my breasts because I thought I’m never going to get breast cancer. Most women don’t – unless someone’s diagnosed in the media or it’s a friend. It wasn’t part of my normal behaviour. I’m fit, I’m healthy.
'But actually, most breast cancers appear quite suddenly; a breast cancer has suddenly grown big enough for you to feel. It takes five to 10 years for a breast cancer to go from a cell to a lump you can feel. That’s why we do mammograms, to pick them up at a small stage before you can feel them. The size doesn’t equal how aggressive it is; it’s whether it’s spread to lymph nodes, what it’s receptors are and how quickly it’s growing.'
Her latest recurrence was on July 5, the day before Under the Knife was launched. 'I'd just been cycling in Italy – there’s something about cycling in Italy that’s bad for me! And I came out of the shower and I just saw a little nodule on my mastectomy scar and I thought that’s a local recurrence. Luckily it hasn’t spread anywhere else.'
This latest book is not so much memoir as more 'life lessons', an engaging account of her life from junior doctor to consultant, including two episodes of suicidal depression when she struggled with the emotional impact of repeatedly breaking bad news to patients. 'I could make 10 women cry a day,' she says. 'So I would do anything I could to not go to work because I just couldn't cope with that pressure. You don't get counselling, you don't get training – it's part of the job. I'd never spoken about my depression. I was terrified of patients and colleagues finding out, people not trusting me, that stigma of mental health being your fault.
'I wanted to come clean and talk about it because I know there are doctors who’ve been in my position who are too scared to talk, and I wanted to say it happens and it’s not your fault and there’s help available. I also want people to know just how hard it is to train to become a surgeon and deal with cancer. It took me 20 years from going to medical school to becoming a consultant and I want people to know about being a female surgeon in a man’s world.'
She has a collection of stories about things that happened to her while scrubbed up in the operating theatre; some of them are in the book, but taking action at the time would have been practically impossible, she says.
'Whistleblowing is hard because of the damage to your career and reputation. So you just put up with it. But I want to let people into that world.'
If, after reading this, you find yourself Googling Liz O'Riordan, you may find her latest post about getting back in the gym, or promoting the 5k Your Way in Bury, part of Park Run, on the last Saturday of every month. Anyone affected by cancer can go along, take their time to jog, walk or run 5k, have a drink, cake, and a chat afterwards. It's a way to encourage people to stay active; exercise and fitness, says Liz, have helped her hugely.
'I did no exercise at school and became a cycling widow when met husband, so got into it. I did my first triathlon about three months before I was diagnosed. I wanted to keep doing it to prove cancer's not taking everything from me and exercise was the one time I just felt like Liz. And we now know exercise reduces the symptoms, physically and mentally. It was my kind of mindfulness.'
If it's possible to be grateful for the experience of breast cancer and treatment, Liz is – for the way it's added to her knowledge and made her more able to help others.
'I'd see patients who had a very small bit of breast cancer – I'd say, it’s good, it’s only small, we’ve caught it early, we can help, what are you worried about? But now I’ve been a patient I know no cancer’s good.'
She's already talking to people with other cancers, a direction her next season podcasts will take. 'I don’t want to talk about things I don’t know as much about, but a lot of it is general information that can be shared and spread. A lot of it is about coping with treatment and getting yourself through it.'
Has her own personal battle been won? 'It took about five years not to wake up thinking, is this the day my cancer comes back? But time helps, and finally realising it’s out of my control.
'Part of me thinks it will come back again, but that’s just going to happen and all can I do is do the best I can each day. I don’t believe in bucket lists and things, I think we should all do stuff now rather than waiting. It’s exhausting living your life as if every day is the last.'
Losing her mum to osteosacrcoma was really scary, she says. 'I saw someone die of cancer and that could happen to me. But counselling really helped me come to terms with my own death – that it could be sooner than I’d like.
'It's the elephant in the room. Family tends to say you’ll be fine because they don’t want you to go. Finding people you can talk to and offload to and then come back to your family can help.'
And that's what Liz has become. ' I'm almost helping far more people in a day than I ever did as a consultant surgeon. It’s not quite the same... but it’s given me a new purpose, I guess.'
