The linchpin

Dr Rob, Judy's oncologist is like a general practitioner on steroids.

Sure, his specialist aisle is treating cancer, but from what we've seen, a great oncologist treats cancer holistically.

Holistically treating means detecting, being aware of, and most importantly understanding the root cause of any variation of any body thing that's vaguely abnormal. Blood pressure variance: why? Liver enzymes abnormal: why? Eyesight difference, mouth ulcers, red blood cell count low, shortness of breath, headache, sore back, urinary tract infection, itchy skin, wobbly legs: why? Even puffy ankle cankles.

The need to know is to understand whether a particular thing is another reason to need to fight cancer, or to modify the way that cancer is being fought. That fight is holistic, and needs to be, as any niggle may be a tell of a serious escalation. Stage four in cancer means the bastard has spread to distant sites from the original, so any change anywhere might be super important.

The list of Judy's specialists is impressive. Most times when she visits them a flow of information and analysis of that experience makes its way to Dr Rob, representing valuable tidbits, triangulation and facts to ruminate on.

Dr John looks after her lady bits.
Associate Professor John looks after her boobs.
Dr Anton and/or Dr Brent look after her eyes.
Dr Sasha looks after radiotherapy matters.
Dr Gavin, Dr Ron and Dr Jimmy are Team Neuro, and look after her beautiful brain.
Dr Karen looks after her raging youthful hormones.
Dr Ross looks after her dodgy kidney.
Dr Jill looks after her skin, and occasionally steals lump barometers.
Dr Jane peels off pre-cancerous skin things. Plus she doubles as a therapist, with appointments usually involving a bloody good chat about all sorts.
Dr Jackie wields an ultrasonographer's wand looking after her ovaries.
Dr Hayley looks after her tootsies and other podiatry matters.
Dr Howard, not talked about often, looks after her bum.

With that flow of information Dr Rob must ruminate a lot.

There's even special guest doctors like Dr Simon, who was a patient in an adjacent oncology chair to Judy on one day. He is a senior doctor who clearly takes his Hippocratic oath seriously, because at one time on overhearing a discussion about Judy's irritated eyes, he later conveyed with much gravity to Dr Anton that immediate investigation was required, and why it was. A part translation of the Hippocratic oath goes "Into whatsoever houses I enter, I will enter to help the sick". It would appear that "whatsoever" house also extends to Day Oncology and to doctors entering for treatment themselves. Amazing.

"We're both in this club, so we have to stick together."
- Dr Simon

Dr Rob has taken over the role of general holistic doctoring, because that is what is needed. Without it, Judy doesn't stand a chance.

So with such Dr Rob holism going on, Dr David, her nominated general practitioner would seem redundant these days. This is entirely down to Dr Rob being Dr wonderful.

So what does Dr David do for Judy?

Mostly, what Dr David does is to extend referrals to her specialists.

I get that there is a system of health insurance processes, procedures, rules and crap that must be followed. I get that almost all of that exists to stop folks in the system wasting or rorting^[1] our nations financial support system for health care. I get all that. But surely referrals to specialists being required repeatedly in the context of stage four cancer, a condition that with present medicine will last for the rest of Judy's life, is a fanciful waste of time and resources.

How ironic that the system protections themselves can lead to waste and rorts of the system, as for Judy and many others in similar advanced cancer circumstances their doctors waste time and resources every time they repeat a referral to specialists.

At least Dr David now offers a referrals-without-consult service (for $25 a pop) so Judy can request by phone, and avoid people coughing and spluttering all over her while waiting in the general practice waiting room for the requisite wasted hour. We now throw money at mitigating that risk, which is well worth doing.

For many others, Dr David and his general practicing kind are invaluable. But unlike Judy, those others do not have a Dr wonderful Rob as specialist and generalist in one.

We hate that we need Dr Rob, but we love that we've got him.

He knows an awful lot. An incredible lot. And if he doesn't know at any given time, he finds out. I reckon a personal philosophy of Dr Rob's is one of trying to make life easier and better for others, so him finding things out and getting generally smarter every day is an extension of that. And he knows that expanding his knowledge in the context of one patent will help many in future.

His world is a balance of effective treatment and quality of life, and he would think that Judy spends enough time at medical appointments without needing to be exposed to cough, splutter and wait at the GP. He knows Judy is in a world of hurt, and would much rather save her from any of that world of hurt.

We love that Rob doesn't send her off to a general practitioner or other specialists for things like repeat steroid eye drops, or Vagifem, or blood pressure medication, sleeping tablets, pain killers, diuretics, checking wounds, investigating itches, antihistamines or antibiotics. He only would if he thought another specialist's opinion or re-examination was required. And even then, he'd call them to talk it through first.

He's involved, almost always available, and goes well above and beyond what you'd consider excellent attention to those in his care.

This above and beyond is brilliant.

Talking about going above and beyond, Dr Rob loves to bake, and every week he bakes for others.

Most Fridays, very early in the morning he wakes, mixes a batter, slips it into the oven, then prepares for the day with shower/shave/dress, and on the way to his car unloads the oven, then heads to hospital and arrives with baked goods, still warm. These warm and tasty treats are then shared with his day oncology nursing angels.

He's a specialist bloke who truly is an holistically special bloke.

We are truly blessed to have such an extraordinary linchpin at our wheel.