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A calling to serve

Dr Lee Kim Shang became a radiation oncologist thanks to an unlikely series of events.

Can you share with us why you chose to specialise in radiation oncology?

I actually started out wanting to be a surgeon, but during my surgical posting, I found myself nursing migraines at the end of the day, possibly because of the strong lights in the operating theatre.

As a result, I had to think of alternatives. I considered various options, including family medicine. One day, by chance, I overheard a conversation between a friend of mine and one of my seniors. The term “radiation therapy” was mentioned and that sparked something inside me.

At the time, I knew very little about the discipline. There were only five lectures on it in medical school but the lecturer was so boring, I attended only the first one and skipped the rest.

Despite this, I decided to give radiation oncology a chance and tried to get a related posting. At the time, there was only one radiation centre in Singapore, at the Singapore General Hospital. When I applied for a posting there, I was told that there were no vacancies.

I would have normally left things at that, but something made me decide to try harder.

I called the head of the department, the late Dr Tan Ban Cheng, and he told me, “Why don’t you come to my clinic and sit down with me during those days you are not on shift at A&E?”

At the time, I was doing a posting at the Accident and Emergency department at Tan Tock Seng Hospital. When I was not on the morning shift, I would go down to Dr Tan’s clinic and he was kind enough to introduce radiation therapy to me.

That was how I ended up with a traineeship position in radiation therapy.

What happened after that?

I did my fellowship at St Bartholomew’s Hospital in London from 1990 to 1992 and after I returned, I worked at the National Cancer Centre (NCC) until 2003. In 2004, I came to Parkway Cancer Centre and I’ve been here ever since.

Apart from St Bartholomew’s, I also trained in my subspeciality at the neuro-oncology unit of the Royal Marsden Hospital in the United Kingdom in 1996.

The experience in the UK was very useful in preparing me for my career because there, you could see many more patients than you would in Singapore.

Also, in my early years at NCC, Dr Tan was not well at one stage and he had to take long leave. I ended up taking over his clinic and took on the responsibility of caring for his patients. That helped me gain experience very quickly.

What does your typical day look like at Parkway Cancer Centre?

I start work at 7am when I will look over treatment plans, approve them or draw up targets. That’s the best time to do it because there’s no one around and there are few distractions.

I start my clinic at 8am and it ends at about 5.30pm or 6pm. During this time, I see new consults and follow-up patients. I also see the patients who come in for treatment.

I usually grab a quick half-hour lunch where coffee is a must.

After my clinic, I will go up to check on the inpatients. Then I come back to the office to review my treatment plans before going home for the day.

Given your schedule, how do you handle work-life balance?

When I get home, and on weekends, I spend time with my wife and my three girls. As the girls are now all in their 20s, increasingly it’s just me and my wife. We just chill over coffee or watch my wife’s favourite Korean dramas together.

Sunday is usually time for church. My wife and I serve together in our church.

Doctors can establish close bonds with patients, especially when you treat them over time. But not everyone can be successfully treated. How do you cope when you lose patients?

It’s not easy to lose a patient. It’s especially hard when it’s unexpected. But I’ve learnt how to move on. I have learnt to deal with life and death because of my belief as a Christian, that there is an eternal element to this life.

Also, knowing that I am a channel for God to heal or soothe makes it a lot easier for me as well.

What does the future hold for radiation oncology?

Proton therapy treatment is going to come to Singapore in the next one to two years. That is going to be very exciting. With proton therapy, you have to be very precise in the targeting. It delivers the radiation very precisely within a specific area, but beyond that, the dose is negligible. This means you can spare normal tissue, but it also means that you have to be very accurate. It can be very unforgiving.

There are some other exciting technologies that are being developed but they are at a very early stage. There’s still a lot of work to be done but in the next five years, we will hopefully see new technologies that offer patients faster, better treatment.

Is there anything you would like patients or the public to know about radiation therapy?

There are two things: The first is that radiation therapy is safe for the people around the patient.

A lot of people think that when patients come out of the treatment room, they will glow. They think that the patients are radioactive and will be a danger to the people around them.

Radiation therapy is one of the main pillars of cancer treatment. Many of the radiation techniques used don’t endanger people around the patient.

There are exceptions: Having radioactive iodine therapy for thyroid cancer does render a person radioactive, so patients are isolated for a period of time until they are safe, but most radiation therapy treatments do not make a person radioactive.

The second thing I would like people to know is that the side effects of radiation therapy are not as great as what many people think.

A lot of people have this impression that radiation causes a lot more harm than it does. If it’s not used appropriately, it can, of course, cause a lot of permanent injury. But these days, the delivery of radiation is very safe. Many of the built-in processes will prevent any accidental exposure to radiation.

And while there are side effects, many of them are much less intense, and the serious long-term side effects such as brain injuries or nerve injuries are less common because of advanced techniques that can reduce the dose to the normal tissues.

In addition, over the last 100 years or so, the knowledge of tissue tolerance has become much better understood. That helps us to know what the safe doses are for different organs, which makes radiation therapy safer.

There are side effects, but things are much better than when I first started practising. Today, the whole process is so much more advanced and more precise. Patients need not be anxious if radiation is prescribed as part of their therapy.

Written by Jimmy Yap