Surgeon Profile – Dr. Krishna B. Clough, surgeon, oncologist and plastic surgeon
Interview in July 2018
BEING AN ONCOLOGIST
I started medicine to do basic research. I wanted to make my contribution to science and I never imagined myself dealing with patients face to face. I worked in the lab as a young student for a year, and I realized that it wasn’t like that at all, that I wanted to be in contact with the concrete things. Then, very quickly, I realized that what interested me was surgery because you have a very tactile relationship with efficiency.
And I discovered what it was like to accompany someone at a pivotal moment in their life and little by little, while I had left to take care of healthy patients since I had initially done an internship in gynecology, I became interested in this very particular moment when life turns upside down because you are told that you have cancer.
I am fortunate to be able to continue to teach, to do what we call clinical research, that is to say to develop new procedures, to test them, to publish them, in parallel with my activity as a clinician. So I am lucky enough to be able to continue to carry out a very large clinical activity within the framework of the Breast Center and a teaching activity, since we receive surgeons from all over the world, who come to spend a few weeks, sometimes a year, with us, to be trained in the techniques that we have developed and that they will then use.
In cancer surgery, you deal with the fear of death, and even though the cancer is small, the fear can be immense. So, there’s this constant relationship to fear. There is this notion that you are removing the disease, it is very particular, but symbolically it is very strong.
To come and see a patient after her operation and tell her: “You no longer have cancer”, and to see her smile in the evening when you come to visit her, even if she knows, and you know, that there is a possibility that this cancer will come back one day, to tell her: “You no longer have cancer”, is a very strong moment of relationship with the patient.
If we talk specifically about the surgical procedure, for a very long time, the surgeon talked about removal, whether it was removal of the tumor while keeping the breast, or removal of the lymph nodes or removal of the breast. In fact, what we have put in place, and once again I think we are among the most innovative teams in the world, is that the surgical consultation is a two-headed consultation: I am an oncologist and I am a plastic surgeon. We have trained hundreds of them in the world, but at the time there were none. So, in my consultation, I wear the first hat, I am an oncologist and for half an hour, I will talk about cancer surgery and cancer treatments. And then in terms of surgery, it has consequences and here, I’m going to take off my first hat and I’m going to put on my second hat, and I’m going to say: here’s what we’re going to do now in terms of after-effects, here’s how we’re going to repair your breast, here’s how we’re going to avoid removing it: and that’s what we call “oncoplastic” surgery. So now, this applies to all cancer-related repairs, whatever they are.
From the moment you explain to a patient who has breast cancer that you are also going to take care of her physical appearance, the after-effects, her silhouette, you open up a new world which is not a world of destruction, of combat, which is not a world of war against the disease, but which is to say: “Madam, we are going to take care of your “after” and moreover more often of your “during” since we are going to rebuild right away; and the fact that we take care of your “after”, it means that there will be an after”.
So yes, of course, we believe in it and we believe in it all the more because on the small tumors detected early, you are going to cure them just by surgery 90% of the women; any person could remove a breast tumor, it is not you, it is the surgical act, nevertheless it is a strong moment. The day I get cancer, I’m going to dream that it can be removed, because I know that it’s the best chance you can give someone to remove a solid tumor.
In the beginning, between 30 and 40, I was obsessed with technique. Why did I publish? Why did I do research? Because my obsession was the surgical technique, it was to improve it, it was to reduce the after-effects, it was that people would be fine, it was that people would smile at the first dressing. You removed a breast, there is no more breast, you reconstructed it, you remove the dressing the next morning, the patient smiles, yeeeeeeahhh, that’s a drug.
It’s not adrenaline, it’s a very different drug, which is the drug of feeling useful. When you have a woman who has had both her breasts removed, 9 months of chemotherapy and who comes to see you 3 years later with her baby, you say to yourself: we did well to be there…
When you are in cancer therapy, very quickly the technique, well you spend years and decades, you master it and you continue to improve it, but what you understand is that everything is played out in consultation, and that you are a sponge for stress, and you accumulate hour after hour, and now with hindsight, week after week, month after month, year after year, you accumulate all these worries that you have absorbed and then you don’t know, you don’t realize that it can affect you so much, you don’t understand that it is going to eat you up…
WHAT ADVICE SHOULD I GIVE TO A CANCER SURGEON WHO IS JUST STARTING OUT?
I will tell them: it’s hard, it’s hard… It’s heavy, it’s going to eat up part of your life and you’re going to live moments of intensity that will benefit you and I hope, I hope, those around you; I’m thinking of the patients but also of my friends, my family, at some point they must have a benefit from our madness. But there is a price.
Go see the people who do this job: the problem with our jobs is that we start out but we don’t know what life comes with it. Go and see them, go to the operating room, but this is the dancer in tutu, the operating room, it’s cool, there are people there, they put on music… Go to the consultation and above all take the person who is going to train you for a drink, and ask him how he is. He will tell you how he is. Don’t take a young person, because young people don’t realize it, take an old fart like me and ask him how he’s doing; and if everything he tells you attracts you, then you’ll do the most beautiful job in the world. But you can’t make casting errors.