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Interview with Sister Gill Hebbar - A day in a life

Clinical Nurse Specialist Sister Gill Hebbar has worked in ophthalmic nursing for 30 years and been a staff member of St Paul’s Eye Unit for the last decade. She now works within the Liverpool Ocular Oncology Centre at St Paul's and is dedicated entirely to caring for patients with eye cancer. St Paul’s is a national ‘Super Regional Centre’ for eye tumour diagnosis and treatment  Sister Hebbar explains the challenges and rewards that come with a career in ocular oncology.

Sister Gill Hebbar“I am usually at my desk by 7.30am. The day begins with a cup of tea whilst I prepare to deal with what is usually a fairly full email inbox and a long list of answerphone messages from my patients.

Our patients come from all over the UK and abroad so it’s not always possible to communicate face-to-face. Many have questions about their treatment or are dealing with a recent diagnosis so it’s important I allocate the time necessary to address any issues they have and respond to them in detail to give them all the information they need.

On Mondays we run our ‘New’ patient clinic. This starts at 8.00 am, we will expect 20 patients to attend clinic and all are advised to bring a relative or friend. All are here because they have been referred to us with a suspicion of cancer. This is obviously an extremely worrying time for anyone awaiting the diagnosis. The treatment options for melanomas here in Liverpool include radiotherapy and surgery. As our patients travel from all over the country and even overseas, surgery is offered the next day. We therefore need to carry out a pre-operative assessment to ensure that the patient is medically fit for surgery.  For those visiting us from outside Liverpool we arrange an overnight stay in a local hotel, which does help to take further, unnecessary stress away from patients and their family.

The word ‘cancer’ can be terrifying. There is a great deal of information for patients to digest whilst coming to terms with their diagnosis. Because of this, we give the patients a CD recording of their whole consultation. This helps them to further digest and understand everything about their diagnosis, treatment and prognosis and all the patients are so grateful for this recording.  My role as Key Worker is to be present throughout the consultation with the Professor, which gives me the opportunity to answer any queries the patients may have. If a diagnosis of ocular cancer is made then it’s vital that we act quickly but sympathetically.  We need to ensure patients are given the right level of time to come to terms with the diagnosis and all are offered counselling and support. Following the consultation and diagnosis, I will sit with the patient and relatives, for as long as they need, to offer support, reassurance and guidance. 

Ocular cancer is rare, has no known cause and can affect anyone. In Liverpool we have seen patients ranging from the age of eight to ninety plus. Last year over 600 patients attended the centre with about 300 of these patients being diagnosed with choroidal melanoma.

The good news is that, in most cases of eye cancer, if it is caught early it can be successfully treated. Unfortunately there is a 50% risk that the cancer can spread to the liver and, if this happens, the prognosis is usually poor. Here in Liverpool we perform a biopsy of the melanoma, which will give the patients a personalised prognostication of their risk of developing liver disease. This is a result of decades of research and collaboration with other world leading institutions. 

The two main types of radiotherapy used are Brachytherapy and Proton beam radiotherapy.  Brachytherapy involves an operation where a small radioactive disc called a plaque, is attached to the wall of the eye, directly over the tumour. The patient is admitted into hospital for this treatment as the plaque is left in place for a few days until the right amount of radiation has been given. There is then another short operation to remove the plaque. 

Proton beam therapy is used to treat tumours not suitable for treatment with a plaque.  The proton beam is given in the Cyclotron Unit in Clatterbridge, which is the only centre of its kind in England. The proton beam is aimed directly at the tumour and is delivered over five consecutive days.

Transscleral Local Resection, is a surgical procedure which involves the surgeon cutting a ‘trap door’ into the wall of the eye and removing the tumour. This is a long procedure and can take several hours to perform.  A further technique called an endoresection involves a ‘hoovering’ of the tumour within the eye. Basically the tumour is cut into fragments, which are then removed.

Our aim is to preserve vision and preserve the eye but sometimes the melanoma will be too large and preservation will not be possible, the only available option for the patient then is to remove the eye.

The surgical treatments have been pioneered by the oncology team at St Paul’s. We know we are giving our patients access to the very latest technologies and they are reassured knowing they are being looked after in a world leading centre of ophthalmic excellence. 

"We all share the same commitment in that we always go the extra mile. We take the smallest problems seriously. We want to do absolutely everything possible to make our patients’ lives a bit better."

After the clinic we have a multi-disciplinary team (MDT) meeting. This is where we get together with other professionals from different specialities to discuss patients’ treatments and needs and share opinions and expertise. The day goes incredibly quickly and lunch is often a quick sandwich on the go. We are a very close-knit team. There are nine members of the team, all with differing roles and responsibilities.  Everyone has a great sense of humour which is important and there is a real family atmosphere.

We all share the same commitment in that we always go the extra mile. We take the smallest problems seriously. We want to do absolutely everything possible to make our patients’ lives a bit better. Our philosophy is that nothing is too much trouble.

For some patients loss of central field of vision will be inevitable and some patients encounter visual hallucinations which can be very traumatic. In these circumstances there may be a lot of practical considerations for the individual. They may be   worried about their job, loss of income and how they and their family will cope. We have to take a holistic approach to their emotional and physical wellbeing and we are trained to deal with every  situation. We work closely with our health psychologist and Macmillan cancer support. Many patients call and write to us to thank us for the care and support they have received and it is very rewarding to know how much they value what we do for them.

Seeing a patient treated successfully is fantastic. Ocular cancer can be identified through a routine eye test. We can’t emphasise strongly enough the importance of regular eye tests as early diagnosis can preserve sight and lead to a full recovery.

I usually leave work at about 6.30pm.Whilst I might feel tired, I am always fulfilled. No day is ever the same at St Paul’s. I am constantly learning. I would highly recommend a career in ophthalmic nursing as it is both fascinating and rewarding. I love my job and am extremely proud of being part of such a talented and inspiring team. Knowing that we are delivering the highest quality care and treatments to our patients is the most important thing to us.”

Sister Hebbar unwinds spending time with her husband who is an ophthalmologist. She is kept busy with her five children, three of which are still living at home. Her young grandson Archie also takes up much of her spare time and between them all, they help her switch off from her busy day.