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My first day of Oncology I was introduced to my lovely team, Dr Nick Refalo the consultant and Dr Etienne Paris the registrar (or higher specialty trainee as they are known in Malta). I felt welcomed and included from the very first moment I was there.

I had varied and ranging clinical activities. My weekly schedule was:

1. Monday: prostate cancer review clinic (~60 patients) and ward rounds (~10 patients)
2. Tuesday: radiotherapy review clinic (~10 patients) and ward rounds (~10 patients)
3. Wednesday: new patient clinics (~5 patients) and ward rounds (~10 patients)
4. Thursday: review clinic (~40 patients) and ward rounds (~10 patients)
5. Friday: radiotherapy planning and watching patients receive radiotherapy

The doctors mainly spoke to the patients in Maltese as they were often talking about difficult subject matters and patients preferred to speak in their first language.

I did not ever feel bored or left out as it gave me the opportunity to really watch a patient’s body language and even though I could not understand verbally what was going on, I could gauge a relative understanding from just watching the patient and often family members they were with.

There are some particularly memorable patients that I will always remember.

• A 70-year old lady who came with one of her four sons to the new cases clinic. She had been hospitalised recently and an incidental finding was a massive hepatic adenocarcinoma that had destroyed almost all of the patient’s liver. The thing I will remember most about this case was that the patient seemed to understand that there was no treatment that would help (her performance status was too low to receive chemotherapy, radiotherapy and surgery were also not options). However, her son would not accept that and kept pushing for something to be done, eventually leaving and stating he would get an opinion elsewhere. I could gauge most of this just by body language and tone of voice, but was debriefed after by the doctors who filled me in on what happened.

• A 75-year old extremely cachectic man with pancreatic cancer who was an inpatient on the ward. He was receiving chemotherapy and was having a great biochemical response with tumour markers decreasing. However clinically he was very unwell, and was getting recurrent ascites requiring ascetic taps to drain the fluid. It showed me the importance of distinguishing a biochemical response and a clinical response and how they often do not go hand-in-hand. He was told that there was nothing more that could be done and that he could go home and spend his remaining time with his family. He died that same day when he got home.

I saw a lot of sad things on the oncology ward (very young people dying, very sick people), very rare presentations (ciliary body melanoma for example) but also many people who had survived for long periods of time following their diagnosis.

Because primary care is generally not available in Malta, the specialists follow-up people for long periods of time, so many people were coming back 10+ years following completion of treatment and living normal lives.

Oncologists in Malta are also both medical and radiation oncologists, meaning I got to experience both rather than having them as separate specialties.

I saw such varied cases (over 25 different cancers) which definitely enhanced my learning experience.

Another particular thing I noticed about Malta is that the rates of smoking are incredibly high and was seeing a lot of young people (~50 years old) with metastatic lung cancer or laryngeal cancer which I thought was very sad.

I feel I had a very valuable learning experience which fostered my love of oncology. The doctors and the nurses were lovely, the patients were all friendly, and I managed to pick up on quite a lot of Maltese just by listening (which I am unashamedly proud of!).

Definitely a fantastic learning experience and one I will remember for the rest of my life.