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A day in the life of a WM clinician

Dima interview header
Ever wondered what a day in the life of a top Waldenstrom's macroglobulinaemia clinician is like? Dr Dima El-Sharkawi (Consultant Haematologist at the Royal Marsden) gave us insight.

What is a typical work week like for you?

I work at the Royal Marsden Hospital which is over two sites, and I manage patients with lymphoma including WM and other lymphoid cancers. Most of my work is outpatient based, and we have busy clinics running at both the Sutton site and Fulham Road site. I will also see the inpatients on consultant ward rounds and help support the registrars who manage the inpatients. The Royal Marsden and ICR also provide diagnostics for the region. When diagnosed, all patients with blood cancers will have their biopsy reviewed in a regional unit such as ours where we can look at bone marrow biopsies, and integrate the findings from these with the genetic results and clinical picture to give a final diagnosis and any information on prognosis. Part of my role is looking at blood and bone marrow samples down the microscope to report the findings and to integrate all the results together.

Although I love seeing patients, I do also enjoy looking down the microscope at all the blood cells! These are the clinical aspects to my work, but like most consultants I am also involved with projects to try and improve the service both within the Marsden and regionally. I am also involved with teaching junior doctors and presenting the latest evidence for treatment to a wide range of audiences, including at patient information days and to other doctors. Furthermore, I am involved with national groups such as those involved with discussing clinical trial development in the UK for patients with lymphoma, am a trustee for WMUK and am involved in the Rory Morrison WMUK Registry

What made you take such an interest in Waldenstrom’s macroglobulinaemia?

It is such a varied disease, and just like no two patients are the same, no two WM manifestations are the same. Thus, it is important to get experience in managing patients with this disease. It is not just about treating the disease, as the complications from WM can be as significant and so a much more nuanced approach is necessary. Sometimes, we do feel that what we can do for patients is rather protocol driven, but WM does require much more thought. I think one of the many good things that WMUK and the Rory Morrison Registry does is highlights the heterogeneity of this disease.

What do you enjoy about your work, and why?

I am very lucky and privileged as I love the job that I do. Haematology is such a fascinating speciality that is always pushing the boundaries in terms of our understanding of cancers, including lymphoma, and also the way that we can treat cancer. As well as the more academic aspect to it, it gives me the opportunity to meet so many different people from so many walks of life, and get to know them and help them through difficult times in their lives. I have a great team, both colleagues in the Marsden who I work with closely and also the wider haematology field. Haematologists are commonly accepted to be one of the nicest group of doctors (this may be my slightly biased opinion)!

What is the most challenging part of your role, and why?

There are general challenges that are not unique to doctors, such as not to keep working and switching off in the evening. I also find it difficult when patients don’t respond as well as we hoped with treatment, but I do believe that even in these situations we can still make peoples’ lives more comfortable. 

How has the COVID-19 pandemic affected your work? What changes have you had to make?

Given that the Royal Marsden Hospital is a cancer hospital, we do not have an accident and emergency and so we have not had the same kind of numbers of patients with COVID-19 as some of our neighbouring hospitals. However, all our patients are by definition in the clinically extremely vulnerable group and so we have had to change our systems almost overnight to try and avoid patients coming into hospital as much as possible. This has continued for coming up to a year, and it does rely on patients knowing that we are here if they need us, and spending more time informing patients about symptoms to look out for and to let us know about them. Furthermore, we have increased our workload to take more patients with blood cancers including patients with WM from neighbouring hospitals, to limit the impact of COVID-19 on their treatment.

As well as an impact on the “patient-facing” work, the non-patient facing work such as managerial, research and education aspects of my role have changed dramatically. We used to spend a lot of time travelling for meetings, some of which were more exotic locations than others! And now everything is virtual. There are advantages and disadvantages to this. I do think this does provide more people with access to attending conferences as you don’t have to factor in travel time or costs. This can be helpful with a young family, as there is flexibility in watching the talks as many are recorded. However, I do miss the human contact and chats that occur between the more formal talks.

I have had to get used to presenting and teaching over zoom or teams, which is different to teaching in person when you can gauge what the audience seem to be most interested in and tailor your talk accordingly. When delivering talks at home, I think I have become professional at angling the computer camera to avoid seeing the toys in the background although my children do still occasionally like to wander past!!

What advice would you have for a newly diagnosed patient?

Everyone reacts differently to the news and I think you should allow yourself time to feel sad or angry or both. However after that, you should try to accept that you are unable to change things. Remember that you are not alone; even if you don’t have your own personal support network there is the medical and nursing team to help you and also the WM community both in the UK and worldwide. The digital world does allow us to reach out to people in a way that we couldn’t do before. There are many treatments that we can give to help you live longer and hopefully improve your quality of life. I encourage my patients to take control and learn to live an active and full life with WM rather than allow it to stop them doing what they want to do. If the medical team and the WM community can help support patients in doing that, then we have done our job.

What do you enjoy doing outside of work?

I am super-lucky in that as well as having a job that I love doing, I also have an amazing supportive family who I enjoy spending time with. My two young children, husband and I enjoy playing games and watching family movies together. We are all quite active, and depending on weather and lockdown restrictions, do enjoy playing tennis, going for walks or exercising with Joe Wicks! I grew up in Swansea and still have a lot of family and friends there, so I look forward to being able to go back and seeing them all and walking along the Gower beaches.

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