Series 2 episode 2 - “I don’t think medicine is for you”: Kade Flowers on fainting his way into clinical science

For National Pathology Week, Kade talks about running a myeloma screening service, teaching in the lecture hall where he once sat as a student, and why a piece of lab kit could have saved the crew in the film Sunshine a trip to the sun.

Megan Thomas Welcome to this special edition of Life in the Lab, brought to you by BD and the Association for Laboratory Medicine. I'm Megan Thomas, Medical Affairs Manager NW Europe for BD. In this series, we bring you inspiring stories of clinical scientists and medics working in laboratories in the UK and around the world. And to mark National Pathology Week, we're looking at some particularly fascinating career journeys. Kade Flowers is a clinical biochemist working in the NHS in Brighton. His job is all about helping doctors make sense of test results and supporting decisions about patient care. But his journey into clinical science began with a childhood fascination with science fiction and a dream of exploring the universe. Kade Flowers Ever since I was a really young kid, I've been absolutely obsessed with science fiction. Everything from Adrian Tchaikovsky to loved The Hitchhiker's Guide to the Galaxy. And actually I used to want to be an astronomer. I'm absolutely obsessed with space. But I don't think I was actually clever enough to do astrophysics. So, luckily, I also had a real love for medicine, and I was obsessed with all of the medical shows. I used to spend many evenings watching Holby City with my nan, who absolutely loved it. So, ever since I was really young, I knew that I wanted to do something related to science and medicine, a combination of the two or one or the other, really. Megan Thomas At just 16, Kade had the chance to experience medicine first-hand, with a placement in an oral and maxillofacial surgery department. But his first encounter with surgery didn’t quite go as he’d imagined. Kade Flowers I was super interested watching the surgery. And then as soon as they actually cut into this patient's face, I passed out, completely went whitewashed in the face, lost my memory for about 10 seconds, and quite literally woke up to the surgeon standing over me saying, "Oh, dear chap, I don't think medicine is for you indeed." And I think at that point, I probably agreed with him that medicine possibly wasn't for me if I'm quite squeamish. So I was so upset to be honest. I went running back to my careers advisor at college, and I was like, "Oh, no, this has happened. I don't think medicine's for me, and I'm so lost now." And at that point, my careers advisor said, "Oh, well, have you considered medical science and being a biomedical scientist?" So I was like, "Oh, no. I didn't even know that was a thing." And thought, "Do you know what? That is such a great blend of my interest in science and medicine that I was surprised I didn't think of it sooner." It's just not as commonly well known, as obviously being a nurse or a doctor is. So, yeah, the rest is history from after that, really. Megan Thomas It was at university that Kade really understood the varying roles of scientists in the NHS. Biomedical scientists run laboratory tests and make sure results are accurate. Clinical scientists interpret these results and advise healthcare professionals. For Kade, that close connection between science and patient care made his career choice clear. Kade Flowers If you were to walk into any biochemistry lab in the country, the overwhelming majority of the scientists working there would be biomedical scientists because they are the scientists that run the tests. They make sure that the results get produced and that those results are correct. A clinical scientist's role is slightly different. We are expected to offer clinical advice to service users. So the day-to-day of a clinical scientist isn't necessarily in the laboratory. It can be a little bit more office-based, for example, but you do have to have a lot more clinical knowledge to be able to deal with clinical queries as and when they come in. So, don't get me wrong, I loved being a biomedical scientist, but I knew that I wanted to go down the clinical scientist pathway. They had a lot more engagement with service users and really acted as that bridge between the laboratory and the doctors and nurses requesting our tests. Megan Thomas So, what does being a clinical biochemist actually involve? From blood cancer screening to supporting patients on hospital wards, Kade’s work brings together scientific problem-solving and real-time clinical decision-making. Kade Flowers My current role as a clinical biochemist is very, very varied. No two days are the same, for sure. So about once a week, I'll be something that's called the duty biochemist, and it's the duty biochemist's job to deal with any urgent clinical queries that come in from doctors or nurses. So let's say they've got a patient who actually may be acutely unwell and they're not, not sure how to deal with unexpected test results, or they need some help further investigating a patient who's very unwell. It is the duty of a biochemist’s job to take those calls and to actually help those service users. And sometimes that means actually going up onto wards. And so that's about one day a week and many of the other days a week, I spend a lot of time just interpreting the routine work that comes in. So for example, we're a laboratory that does blood cancer screening for a condition called myeloma. So I basically help to run that service, and it's very interpretive. It can be quite complex. So I spend a lot of mornings going through all of the electrophoresis patterns… Megan Thomas These show how proteins in a blood sample separate, which helps to spot abnormalities that may indicate myeloma. Kade Flowers … and also, every day there's general issues with the laboratory that the biomedical scientists highlight to you as a clinical scientist because they're worried that some ongoing issues may actually directly affect patients. So when that happens, they bring that to my attention, and I'll spend a good amount of time investigating those things and trying to put things in place to protect patients as well. And other projects are constantly coming up and down. But no two days are the same. That's definitely the summary of that. Megan Thomas Clinical science takes more than scientific knowledge alone. Decisions can have a direct impact on patients, and the role brings its own unique challenges. Kade Flowers The skills that are required to be a clinical scientist really vary actually. Some of the skills are really obvious, and some of them are definitely less obvious. You must be able to multitask. There are constantly about 10 different things going on in a real NHS laboratory that you have to be juggling at the same time. And apparently, all of those 10 things are urgent and require immediate attention. So you have to be able to multitask and prioritize what it is that you're dealing with because nobody tells you what it is you have to do. You have to make those decisions on what to prioritize as an independent professional. And another obvious one is attention to detail. For example, the myeloma screening as I've been talking about, requires very high attention to detail because there are quite a few patient cases that are not usually what you expect, and you must be able to pick them up properly, because if you don't, then patients could be misdiagnosed, and their treatments can be delayed, that's devastating for patients. So, yeah, you really have to have attention to detail for sure. Some less obvious ones, though, is actually leadership skills. Again, you think, "Why does a scientist need leadership skills? They're just in the lab pipetting all day." But, actually, as a clinical scientist, you are a senior member of staff in the laboratory, and when there are clinical incidences that you are having to deal with, you must be able to appropriately manage a whole bunch of different types of staff to be able to deal with that issue, and that's really important. People often struggle with change. Even if it's good change, people get a little bit uncomfortable. So the skill of being able to actually persuade somebody over to your way of thinking is absolutely invaluable in getting anything done. Megan Thomas Kade recently achieved a major milestone: passing the Fellowship of the Royal College of Pathologists exams, known as FRCPath. This opens the door to the next stage of his career. Kade Flowers The FRCPath exams are really hard because anything about anything in biochemistry can come up. Biochemistry covers all of the major organ systems. So for example, hematology, it's not as simple as this, but it's just a bit of an example, it's limited to blood for the most part, whereas in biochemistry, you must know the physiology of the heart, the liver, the kidneys, the brain. You have to know it all because biochemistry covers any fluid or anything that comes out of the body, so you really have to kind of know this stuff. And the exams can ask anything about anything. So, I was wading through huge textbooks for about three months before these exams. And there is a viva part of it as well, which is absolutely daunting. It's where you sit in front of two or three very experienced consultant doctors or scientists, and they grill you for about forty-five minutes, again, about anything. I remember, I think again, I almost passed out about ten minutes before I went into the viva exam 'cause I was so nerv... You can see there's a common theme between me and just passing out, can't you really, to be honest! But yeah, they were very difficult, but passing them, it's been one of the best achievements I think I've done. I'm very, very proud of that actually, to be honest. And one day I do hope to become a consultant and be clinical lead of a laboratory, and now I can. Megan Thomas Clinical scientists don’t just interpret results; they also look for ways to make lab services better. Sometimes, that means spotting where a test could be misleading or helping doctors make more informed decisions. Kade has been involved in many projects that have improved patient care. Kade Flowers One of the changes that was made was, pretty recently, a brand new drug for myeloma patients, which is the blood cancer, was approved and loads of patients started being given this drug. It's a really, really good drug that has improved survival of myeloma massively. But the drug actually interferes with the electrophoresis that we do as part of the myeloma screening. And for a good few months, this went undetected in our lab. We were reporting the interference of the drug as another cancer marker. It's not necessarily our fault. But one of the changes that I've been able to make is to implement systems to identify when patients are on these drugs and actually not report them as a tumor marker. And that's been really, really positive to be able to separate the patients who are doing well from the patients who aren't doing as well and may need some changes in their treatment. Another very recent change is changes to our renal stone analysis. So, our laboratory gets sent patients, the stones from patients who have passed urine stones themselves or stones that are removed during surgery, and they need to know what those stones are made up of because there's lots of different possible mixtures of minerals that they could be. And depending on what they're made up of will depend entirely how they're treated. So, it's important to get that right. And we've recently expanded our repertoire of all the different things that we can identify within these renal stones, which means that they can better find out what these stones are made of as well. That's been another very good change that we've been able to make recently. Megan Thomas For Kade, one of the most rewarding parts of clinical science is sharing what he’s learned. And teaching isn’t just about passing knowledge on. It’s also an opportunity to keep learning yourself. Kade Flowers Training is one of my favorite parts about the job. I love to get involved in anything to do with training. For quite a few years, I've been involved in something called the Gifford Cases, and for anybody who is revising for their consultant-level FRCPath exams, they'll be familiar with these. We have over one hundred and thirty real patient cases that we have pulled together and done commentary on. And they get circulated every single month to, I think, over two thousand people now around the world who are actively revising for these exams. And even I learn, and I love doing them because sometimes I see these cases, and I do lots of research, and I'm like: "Wow, I didn't know that. How cool is that?" And I also am fortunate enough to be a recurring guest lecturer at the University of Brighton. So every year, I teach second and third year biomedical science students calcium and bone. So I've got quite a particular interest in the physiology of bone and calcium, and measuring calcium in the laboratory because it sounds dull, but actually, it's super interesting, the limitations behind measuring calcium. And I've just developed a bit of a niche and just love it. And funny enough, I go back into the same big lecture hall every single year that I was there about... Well, what's a year now? Twelve years ago as a student. And it's surreal walking in there every time. The first time I walked in there, I kind of went down as if I was, like, watching a lecture, and I was like: "No, no, no. I am the lecturer. What? How did this happen? Who allowed this to happen?" Love it and I will do that for hopefully the rest of my career. Megan Thomas If you’re interested in clinical science, working out where to begin can feel daunting. Kade’s advice? Kade Flowers One of the things that I've realized, and I look back actually, and laugh about in a way now, is basically the misconceptions that are flying around in the public's eye about what an NHS laboratory scientist does and what the day-to-day roles are. Do as much research as you possibly can. I can guarantee you it is not what you think it is, and it involves elements that you didn't think were involved. And also try and reach out to any existing NHS scientists. Um, a really good way to do that is on LinkedIn. When you do message people, expect to not get many replies because, you know, people are busy or people don't use it. But all it takes is for one person to reply and agree to speak to you for half an hour, and it can entirely change your whole perception of the career. And if you can get into a lab, even better, because you'll know pretty quickly, having a look around the lab, if it is for you or not. But, yeah, do as much research as you can and get as much exposure as you can as well. Megan Thomas Kade can’t resist drawing comparisons between his childhood love of science fiction and his career in the NHS. Some of those comparisons are more unexpected than others. Kade Flowers Well, many of Adrian Tchaikovsky's novels are about survival on a long lost planet with complete lack of staff and lack of funding. So, do I need to say any more about that? I'm somewhat joking about that. Um, it can be like that and feel like that in some parts, but probably not for the most part. The much more interesting comparison of the NHS with science fiction is there is a film that I think was released in two thousand and seven called Sunshine with Cillian Murphy, and in the film, they get into a spaceship and fly off to the sun because they actually need to put a bomb in the sun to reignite the sun because it's dying. And I remember seeing this film, and I was like, we have a piece of equipment called an inductively coupled plasma mass spectrometer, or ICP-MS for short, and this piece of equipment measures copper and zinc in blood. It blows my mind every time I see it. It uses a very hot torch to basically vaporize a blood sample to actually split up the sample into individual atoms that we can count by mass spectrometry. It is absolutely fascinating. The torch in the ICP-MS that we literally have at work is hotter than the surface of the sun, which is a crazy, absolutely crazy comparison. And I just laughed to myself 'cause I realized that actually the whole film could have been shortened if they just threw one of our ICP-MSs into the sun. I think that would have done the job by kick-starting it back up again. So, yeah. That' s always my favorite fact to share when I tell people how cool biochemistry is. I'm in a very fortunate position to actually find my particular job incredibly fulfilling. I cannot think of a different career that is such a great blend of scientific elements and real medicine patient impact elements together all in one career. And being able to go to work every day and do things that do actually have impacts on real people is incredibly fulfilling. And I, you know, don't regret it for a second. It has its problems, don't get me wrong. Nothing's perfect. But as a whole, it just, it really fulfills me knowing I get to have fun every day doing medicine and science whilst also helping people. I mean, it's the best triad you could possibly think of. Megan Thomas For a transcript of this episode or for more about Kade and his work, visit our website at www.labmed.org.uk/podcasts. This podcast is brought to you by BD and the Association for Laboratory Medicine. Produced and edited by Caroline Bacle, sound mixed by Daniel Fletcher. Special thanks to everyone in the BD and LabMed teams. And we’ll be back next time for more stories of Life in the Lab.