Interview with Professor Anthony Chalmers
We talked to Professor Chalmers in January 2013, about the Navigations 'residency' being undertaken by artists Alec Finlay and Iain Gardner at the Beatson West of Scotland Cancer Centre, Glasgow.
Navigations is supported by a Wellcome Trust Arts Award and is a collaboration between Animate Projects, Paintings in Hospitals, and Professor Anthony Chalmers and his teams at Beatson West of Scotland Cancer Centre and Beatson Institute for Cancer Research.
What’s your job?
I’m Professor of Clinical Oncology at the University of Glasgow. The job has two main parts - one is seeing patients with brain tumours and looking after them, with radiotherapy, chemotherapy and palliative, supportive care, and the other part is running research programmes aimed at improving treatments for patients with brain tumours.
I’m employed by the University of Glasgow, but I see patients as part of the NHS, so I have an honorary consultant contract at the Beatson West of Scotland Cancer Centre. There are overlaps, as some of the research involves patients and imaging and clinical trials. Some of it is in the lab with no patient involvement at all.
How does your time split?
Every week is different. I see patients one or two mornings a week. I am in the lab one day a week. And the rest of the time is quite difficult to quantify - writing grants, writing papers, having meetings, reviewing other people’s grant applications, papers, I’m on committees, all that kind of stuff.
Your team specifically deals with brain tumours?
Yes - there are teams covering all the different types of cancers, except paediatric. We don’t do any children’s cancer treatment here, although there’s some radiotherapy for children. The Beatson West of Scotland Cancer Centre looks after cancer patients from the whole of the West of Scotland. We have in-patients but a lot of the care is given on an outpatient basis.
Brain tumours are relatively rare, thank goodness, so the numbers of patients that our team sees is much smaller than many of the others, but the work can be more intense or the patients can have more complicated needs. Because you don’t just have cancer - you’ve got something that’s in your brain that’s causing disability, physical, mental, emotional, psychological disability, as well as the fact that it’s probably going to kill you. So it is more complex often than tumours that affect other parts of the body.
How did you come to specialise in brain tumours - or cancer at all?
My first job after qualifying was as a house officer working for a breast surgeon, and a lot of his work was with women with breast cancer. At that time it was the house officer - the most junior doctor - who did all the breaking bad news and all that kind of stuff. I wouldn’t say I enjoyed it, but I felt it was rewarding. I felt I did it quite well. I thought it was intriguing, challenging.
In my specialising period I chose the rotation that had oncology in it and that I did enjoy. I thought, “Right this is what I want to do.” During my training as an oncologist I’d done a couple of jobs that included brain tumour work. I became aware that not only was this very interesting, but also that these patients were also horrendously under-served, because at that time there was really very little treatment available to them.
That had two bad effects. There was not much to offer the patients. And the doctors dealing with brain tumours were not very motivated to become highly specialised because there wasn’t much to offer the patients anyway. So it disillusioned the doctors as well as being terrible for the patients.
There is a small group of us, all a similar age oddly enough, in different UK centres, who have subsequently established brain tumours as our specific interest. Over that period new treatments have become available, so you’ve got more to offer; it’s become less nihilistic, less soul destroying than it used to be.
Are brain tumours themselves different to other kinds of tumours?
The most common brain tumour, which is the most aggressive form as well, is very resistant to treatment anyway because of its biology. But also, the fact that it’s sitting in the brain makes it very difficult to treat, because you don’t have any margin for error. Well, not even error, that’s not the right word. In other parts of the body you can remove the tumour and some of the normal tissue as well and the patient will be alright. But in the brain you can’t do that. You are very limited in what you can do to that part of the body without causing unacceptable side effects.
Who are the team?
There’s me and two other consultant oncologists, Allan James and Brian Clark, who see patients. Mairi MacKinnon, a specialist nurse, is dedicated to brain tumour patients, and does an extraordinary job co-ordinating their care both in and outside the hospital. Then we have a radiographer specialist, Aoife Williamson, who deals with the planning and execution of the radiotherapy treatment. Those are the direct members of the team.
We also work with neurosurgeons, who do the operations, and there’s a nurse specialist based in that team. Then there are neuropathologists, who make the diagnosis, neuroradiologists who do the imaging. It’s a big team.
What’s the team at the research centre?
My own research group is myself, and the lab manager Lesley, who really runs the show. She’s a scientist by training and continues to do science but also manages the infrastructure in the lab. There are the three postdoctoral scientists who are working on individual research projects and I’ve currently got one clinical fellow who’s doing a PhD, and we have another technician.
I wondered why you thought that this was an appropriate context in which to put artists? Why on earth!
I had a previous encounter, if you like, with an artist! When I was at the Sussex Cancer Centre in Brighton we had an artist in residence for nearly a year. Many of us found that an unexpectedly rewarding process, and that gave me a very positive experience of having artistic projects embedded within a cancer centre.
In what ways was it rewarding?
He engaged brilliantly with the department - made such observations about us and came to lectures, sat in with patients at clinics. He seemed to have such a deep understanding of what we were doing. I think we were all very impressed and a little humbled by it and he created some interesting, challenging work. A lot of us didn’t necessarily like all the work, but certainly it was very powerful, very thought provoking, and just added another dimension to the department.
Do brain tumours affect personality?
We’re very aware that the care of these patients and the experience they have is not just medical. There’s a huge emotional, psychological, spiritual aspect of this illness.
That’s what makes it constantly challenging and rewarding to look after these patients. The actual treatment we give is fairly regimented. It’s protocol driven. It’s quite repetitive, “This is what we give to this type of person… this is what we give to that type…” But the fact is that every single person is so different and has such an extraordinary array of symptoms and level of understanding and challenges. A big part of our job is very, very personal. And I think art is a very good way of exploring that.
In brain tumour practice I think you have to incorporate psychology, psychiatry, counselling, storytelling, listening. Probably to a higher degree than you do in many medical specialities. But every medical specialty will have elements of that; it’s not unique to brain tumours.
What must be unique is the idea of a brain tumour for the patient - how it must affect one’s sense of identity?
I think every patient would have a different response to that. Some find it deeply, psychologically traumatic to know that there’s a tumour in their brain. Others just take it in their stride and don’t seem to bat an eyelid about that side of it. I think it’s wrong to make generalisations about it, but in general there’s more scope for the psychological, emotional components of the disease to be important.
Alec is working more with the care of the patients, and Iain with the research and science lab. They’re not quite halfway through their ‘residency’ period, but how is it working? Do you have a different sense of what it might be or what it is that you anticipated at the beginning? It’s nearly two years since we first talked about doing a project with you.
And in the research world that’s totally normal - you discuss, you have ideas for research, and it can take years or decades for them to come to fruition. So that fits quite nicely with the pace of events that I’m used to in research! I would say that our early meetings, with the team and with both artists, were somewhat uncomfortable - or challenging - because people were coming at this from so many different angles.
I had had a bit of experience with the artist in residence. And I’ve got friends who work in the arts, so maybe felt a bit more comfortable with some of the ways of talking about art. But for some of my colleagues, this was the first time they’ve ever had an encounter with an artist.
I thought they coped very well.
There was still a kind of “What the hell is going on?” kind of thing, “What are they talking about? But, yes, I think everyone coped quite well with that and managed to bash through the necessary things to arrive at something that I’m sure will be productive.
And once the artists had chosen their quite different approaches, we were able to start having meetings or discussions in smaller groups, and the more focused it became, the more progress was made much more quickly. People felt a lot more comfortable.
That initial, general discussion - with one artist clearly interested in certain aspects and another clearly interested in totally different ones - was quite hard, because we were trying to explore two totally different things at the same time in the same conversation. It’s become much easier.
From a curating point of view, I thought those meetings went very well. My fear was that artists can have a very particular way of looking at things and dealing with things. Personally, as well, it was extraordinary meeting the team, because they seemed so thoroughly engaged with what they’re doing, and willing to discuss what couldn’t be a more fundamentally serious occupation. However much respect I have for art, it’s not fundamentally serious in the same way. And I think Alec and Iain have approached it in that way as well; they’re both completely aware of what they’re dealing with.
Yes. They’ve shown a huge amount of respect always. Sometimes it can be almost a bit frustrating for us who do that every day - it’s just normal, so it doesn’t always help to have people say “Oh but it’s so amazing what you do.” It is, but it’s just what we do.
Taking too much care about something?
Having too much respect for it so that it becomes a barrier.
We’ve called them ‘residency commissions’ and the intention is that there will be some work at the end of it - animated works and 2D images, and that they’ll be appropriate for exhibition in healthcare sites.
That was an issue with the previous project - quite a lot of the paintings were works that we couldn’t show in patient areas.
But given that we have an idea and the artists have been instructed and commissioned to deliver something, a lot of what’s happening seems to be much more about process and procedure and things. We called it Navigations - are navigations what is happening? We’re not at the end, but do you have a sense that our ambition for discussion and conversation about different perspectives is happening?
Yes, totally. And I actually wish the artists were here more often really. It’s really great to have a conversation about something you do every day just in a totally different way. The last discussion we had with Alec, when we really finalised what he was going to be doing - when he left, the few of us who had been part of that discussion noted that it had been almost therapeutic for us. You can’t really hope for more than that can you?
It was totally unexpected as well because, in fact, I think we’d all been a bit anxious about how we were going to do it -
“Where is this person going to sit?” “How are the patients going to come into contact with him?” “What health and safety do we need to worry about?” All those kind of things which we’d been focusing on which are important. But then the conversation was just so different really. We did deal with those issues. That I guess enabled us to focus on the artistic part.
They’re easier to deal with. In a way it might be a way of avoiding giving yourself expectations that you might be disappointed in.
I think for us as non-artists we’ve found it very, very difficult. Certainly I didn’t really, at any point, have any expectations about the product being important. I still don’t really.
No. I’m very pleased is that it’s been more than a process of facilitation.
Yes. I think that’s absolutely true. And I think the lab people are now sufficiently intrigued – because they weren’t included in the original discussion, which I think has held that back a little bit. But I think they’re now sufficiently intrigued. To just see how this can turn into a piece of art - Iain just sent something I think he’d done quite quickly to us to look at and that was really, really helpful. “Ah this is the kind of thing that can happen.” For a non-artist you’ve just got no idea. When you just see anything that transforms what you’ve been working with into what clearly is a piece of art then suddenly it’s like, “Ah now I understand it.”
What’s the benefit of the art?
I haven’t got a clue. But I know that the process is intriguing and enriching for us.
There’s a different perspective, viewing the materials and things that you work with on a day-to-day level in just a totally different way. But having to talk about your work with somebody who comes from a totally different angle is helpful I think whatever you do, because you have to explain it in different words and think about it in other ways. So that’s important I think.
I guess that’s not like your explaining it to other scientists or even to patients.
No, not at all. It’s more similar to explaining it to patients. But then with patients you have a whole set of sensibilities that you have to be very aware of as well. So yes, it’s different and enriching for that reason.
Anything else you want to say?
Having said that it’s all on the same timescales as we’re used to, I do have a certain sense of impatience at really, really wanting things to move now to the next level. I feel that we’ve done some really good work. Well certainly the artists have done most of it. But we’ve helped with what should the project be. I think I’m itching now to actually do it.
What do you think this project should be?
Two different things. With Alec’s project I’m looking forward to seeing how the patients respond. Much more than what’s the output going to be, that’s what I’m looking forward to. With Iain and the Lab, we’ve had a little taste of what kind of things could be generated from our raw material. I want to see where that goes. So in that one I think I probably am more interested in the outputs, the traditional outputs. But also interested to see how the people working in the lab respond to the whole project, because I almost feel like I almost imposed that on them a little bit, whereas the clinical team were involved right from the beginning.