White Coat to Blue Gown

Dr. Barbara Tatham used her own illness to teach others about the importance of empathy.

It was a presentation that the medical students in the audience are unlikely to ever forget. A young athletic-looking woman, just a few years older than most of them, stood at the front of the lecture hall. If she looked familiar to some of them, it is because as a third-year medical student she was featured in the McMaster- Niagara informational video that they watched when they were considering which medical school to attend. Maybe some of them had even imagined becoming friends with her if they were accepted. It would be so easy to imagine being friends with Barbara Tatham.

One of four daughters of an ENT surgeon, Barbara was the “why” child in the family, always asking her father questions about the human body. Medicine was a natural fit for her. She was an excellent student, brilliant at science. She also was confident about her interprofessional skills. She had seen her parents battle serious illnesses when she was in medical school and understood how important it was for patients to feel supported by their doctors. She received her undergraduate medical education and did her Family Medicine Residency at McMaster and then she studied emergency medicine at Queens and did an ultrasound Fellowship at Western. She was attracted to emergency medicine because she wanted to care for patients when they were at their most scared and vulnerable.

“I thought that I understood the patient experience,” she says at the beginning of her Professional Competencies presentation at the Hamilton campus of the Michael De Groote School of Medicine, where five years earlier, in 2014, she had been Valedictorian of the Faculty of Health Sciences.

 “And I thought that the skills that I learned in professional competencies were things that I was already pretty good at. I thought that I could communicate well. I thought that I could break bad news. And I thought that these skills came to me perhaps more naturally than they came to other people. But I was wrong. Because then I became a patient, and I realized how much I did not know.”

Dr. Barbara Tatham had been diagnosed with cancer 16 months earlier. “I had a sarcoma in my skull. It became metastatic and now I’m palliative. And this is not my real hair,” she said, pulling off a wig, revealing her bald head. “This is how I used to look. I used to have long brown hair and now I’ve lost my hair twice.”

Her talk was entitled “White Coat to Blue Gown,’ and over the next two hours, Barbara answered questions and spoke to the medical students about her life following the discovery of what she thought was simply a cyst on her head. She talked about her battle with sarcoma, the chemotherapy, the radiation, the four neuro and reconstructive surgeries, the infections, the metastasis to her bones and lungs, the pleural effusions, the pulmonary embolism, the bacterial meningitis and then more chemotherapy.

She laid herself bare for everyone to see just how hard it can be to be a patient, and in doing so, made all of us want to do better.

She showed her x-ray images, photos and videos of her treatments, including her surgeries. She was an adjunct professor at London Health Sciences Centre and her instincts as a natural teacher were evident. She pointed out clinical features for discussion to the students. “Now does anyone notice anything concerning about the quality of healing of these incisions? Here, on the right side, it looks a bit dusky. And dusky skin means what? Right, it suggests that is not getting the blood supply that it necessarily needs.” One could let themselves imagine, for a moment, that she was discussing a case from grand rounds, rather than describing another heartbreaking setback in the fight for her own life.

Although the presentation provided a clinical learning opportunity for the students, Barbara’s aim was to address the dynamics of the patient-physician relationship. She spoke about how the doctors who cared for her made her feel and the impact that one careless remark about the likely failure of a recent surgery had on her morale. “He took away any hope that I had in that moment,” she remembered. “He might have been having a very bad day. That is what I like to think. But it doesn’t matter if you’re having a bad day. Your patient doesn’t know that. Your patient is meeting you in that moment and so you have to be ready to be there for your patient.”

Less than four weeks after her presentation to the students, on October 16, 2019, Barbara Tatham died at the age of 32.

Dr. David McLeod was one of the faculty members who sat in on Barbara’s presentation. “She was full of warmth, humour and hope.” As he looked around the lecture hall and on the screens at the satellite sites at Niagara and Waterloo, he could see that the audience was glued to her every word.

“Barbara only got to practise medicine for one year before being struck down with this terrible sarcoma, and yet there she was — teaching, encouraging and trying to help the next generation of doctors do a better job of caring for patients and their families. She laid herself bare for everyone to see just how hard it can be to be a patient, and in doing so, made all of us want to do better,” said Dr. McLeod.

Dr. Amanda Bell, the regional assistant dean at Niagara Regional Campus of the Michael DeGroote School of Medicine, worked with Barbara as her clinical teacher and on several initiatives in adolescent medicine and mental health. She said Barbara had remained engaged with the Niagara campus and its medical program, and, when the topic arose of patient experience as part of its Professional Competencies Curriculum, Barbara was a natural fit to be able to speak from both sides of the hospital bed — that of a patient and that of a physician.

“It is so important for medical students to know more than the science of what they are doing and also to recognize and care for the humanity in each patient they encounter,” said Dr. Bell. “Barb did all of that naturally, even before she was diagnosed. Her experiences, however, both positive and negative as a patient and her understanding of the health-care system and the disease process gave her a unique vantage point and she was able to eloquently express so many important ideas that made a huge impact on our students and will make them better physicians.”

She said Barbara’s willingness to share the very human aspects of her journey — including the raw and ugly parts — was compelling. “She told us what she wished had gone differently, when physicians treated her well and not so well, when she was in pain physically or emotionally, what help she had needed and when she struggled. She was respectful yet direct and was not afraid to label the bad behaviour of others but held herself to the same high standard to which she held everyone else. Barb’s honesty about her poor prognosis was painful to hear but she had clearly confronted her own humanity and mortality in a way that few of us ever will,” said Dr. Bell.

“Barb’s honesty about her poor prognosis was painful to hear but she had clearly confronted her own humanity and mortality in a way that few of us ever will.”

Over the course of her illness, Barbara posted online updates on her health. She had asked her family, upon her death, to compile her blog posts into a book. The book, which will be available later this year, details her many setbacks, and explains, in layman terms, her disease progression.

Her blog posts were followed by a Facebook group, numbering more than 1400 supporters. And even now, almost a year since Barbara’s death, the group continues acts of kindness in her name, money raised for causes that were important to her and stories of how she continues to inspire her friends, family and admirers.

“She challenged us all, through her words and her example, to live a full life filled with love, passion and connection. She closed all of her online posts with the words “Make waves. Be kind.” I see that as her challenge and direction for us all,” said Dr. Bell.

Patients in Tanzania Benefiting from Barbara’s Resolve

Two buses collide in Killimanjaro region, Northern Tanzania. The injured passengers are taken to a small community hospital. The hospital has no CT scanner, in fact, no emergency department. But on that day, a small group of Canadian physicians working with a global health organization are just completing a course in which they were training local physicians on the use of portable ultrasound technology. As the accident victims are brought into the hospital, local Tanzanian physicians are able to immediately use the skills they had learned to identify whose injuries were most severe and triage the civilians who needed to be transferred to a trauma centre.

The not-for-profit organization visiting Tanzania on that fateful day in 2018 was Emergency Medicine Global (EM-Global) and it was founded a year earlier by Dr. Barbara Tatham and Dr. Alicia Cundall, an emergency medicine physician now working in Stratford.

They had met in 2017 at London Health Sciences Centre when Dr. Tatham was Dr. Cundall’s preceptor. Their shared enthusiasm for global health saw them become fast friends and before too long they began making specific plans for the development of an organization that would help build emergency medicine capacity in Tanzania. Dr. Cundall had spent her early childhood in Tanzania and spoke Swahili. 

Both young doctors agreed that their initiative would be about supporting, motivating and empowering the local doctors. “We did not want an organization where we would tell the local physicians how things should be done. Rather, we would work to help remove barriers to their training so that they, themselves, could lead and decide what works best for their community,” said Dr. Cundall.

They did an on-the-ground needs analysis and found that few hospitals had CT scanners and if they did exist, they were not reliable. Local physicians were keen to develop skills in bedside ultrasound that could help them better care for their patients. Once a decision was made to provide training courses to meet these needs, Dr. Cundall said her friend went into high gear, arranging collaborations with universities, striking up partnerships with portable ultrasound companies, and securing rental portable ultrasounds for bedside teaching.  

“When Barbara wanted something done, she would get it done. She was truly remarkable, really she was like nobody else,” said Dr. Cundall.

Dr. Tatham was supposed to be leading that group of Canadian physicians who helped treat the bus accident victims , but the day before she was to leave for East Africa she received the news about her skull sarcoma.

“I was in Lester B Pearson airport,” remembers Dr. Cundall, “ready to get on the plane and Barbara called me, in tears, with the news of her diagnosis. It was heart-breaking because she had put so much work into making this possible.”

Despite the shock of the diagnosis, Dr. Tatham messaged her friend constantly while she was in Tanzania, and contributed to the success of the trainings.  

“We all felt her spirit, even though she could not be there with us on that trip,” said Dr. Cundall.

Her friend’s death in October 2019 has only deepened the resolve of everyone working with EM-Global to live up to Dr. Tatham’s ideals of creating meaningful social action. “She was such a part of this, this was her dream too. We want her to have been proud with what we are accomplishing,” said Dr. Cundall.

Dr. Tatham would likely be very pleased. Although COVID-19 ruined plans for a return trip in 2020, there is another portable ultrasound training program in the works for 2021, and a pediatric emergency training course at a later date. And in addition to providing skills training, EM-Global also provides sponsorship for local Tanzanian physicians to obtain residency programs in emergency medicine at Muhimbili Teaching Hospital in Dar Es Salaam. Currently, through fundraising, they have sponsored a Tanzanian physician to go through residency training. He is just the 60th physician to achieve residency in emergency medicine in a country of 59 million.

EM-Global is now directed by a close-knit group of physicians who share the original vision. Dr. Cundall is joined by Dr. Taft Micks, Dr Eli Jaffa, and Dr. Tarek Loubani. Their Tanzanian partners include Dr Francis Sakita, who is head of the KCMC Hospital’s ER department in Kilimanjaro. Dr. Tatham, through her original contributions and indomitable spirit, will forever be a part of the team.

If you have an interest in supporting EM-Global or getting involved, check out EMglobal.ca.