Coping as an oncology secretary I am a mature medical student and while waiting to take up my place at medical school I worked as a temporary medical secretary. For six months I worked in an oncology and palliative care department, and it was here that I learnt a great deal about the hassle that secretaries endure at the hands of consultants and patients.

While the consultants were sympathetic and approachable, the severity of the problems were such that any mistakes by the secretary were potentially hazardous, making my work in this department more stressful than in others.

This was apparent as soon as the phone started to ring on my first day - the phone quickly becoming an instrument to be feared and avoided. Relatives at the end of the line were desperate for comfort, reassurance, and threads of hope.

Because of the demand on the doctors the secretaries had to shield and screen calls, but each patient with cancer was under. standably scared and emotional.

Waiting times for appointments to discuss such fears compounded their anxieties, and with time being a recognised factor in the chances of recovery, the news of can. celled clinics and delays in receiving results caused anger, frustration, and tears. So abuse was often hurled at the holder of the telephone receiver. I soon learnt how to be a sympathetic listener. Furthermore, I could not take the abuse personally and I am sure that my exposure to this unleashed understandable frustration will prove a useful insight in the future.

Another skill was the need to be tactful and diplomatic when organising appointments directly with patients. Many were visiting the consultant to hear the results of tests, and some. times we would have these in front of us. It was imperative that we gave nothing away, until they received proper medical opinion and explanations. Soothing words, understanding, and sympathy were all that I could offer. This was hard to carry out in the face of bad news, particularly when the patient asked questions and was distressed, but patience and stoicism were all part of the job.

Another part of the job was to take referrals on behalf of the Macmillan nursing service. Inevitably, each of the stories were tragic and I spent many hours listening in disbelief and horror to case histories, which were narrated in detail from diagnosis to the point at which their fate had been sealed. I then passed the information through the appropriate channels, and though I never met the patients I could not help but conjure up vivid images of them as individuals. Soon the number of conversations about individual patients declined and their names shifted from the ``non.urgent list" to the "urgent list" with the staff doing daily visits and frantically organising adequate pain relief and hospice placements.

The nursing staff needed support and encouragement from their colleagues during these difficult times, especially if several patients were seriously ill at the same time. Finally, I would see the patients' names move on to the "deceased" list, and tearful relatives would start to telephone, and I had to make arrangements for hospital equipment to be returned along with other administrative tasks.

As the secretary my involvement in the process had been crucial but minor in comparison with that of the direct carers. However, I felt sad about each patient.

At one time there were two very ill patients, both of whom I had seen through from their referral. Disturbingly, I found myself dreaming about them and their stories. Knowing so much about them and having talked with them and their families on the phone on so many occasions, I felt very close to them even though we had never met.

I was cross with myself for indulging in these feelings of sadness. Looking back, however, acknowledging these feelings made me feel less like the "departmental robot."

Although everyone in my department was friendly and supportive and there was good team work, I often got very depressed. I dreaded the start of my day's work and the isolation I felt in the face of such ceaseless heartache. As a secretary the patients rarely thanked me for any services provided - all thanks rightfully went to the doctors and nurses. While they fully deserved such praise, it meant that the secretaries got only complaints, tears, and abuse. So the job lacked even the rare moments of warmth felt by others.

I hope that this experience will help me and others to remember that we are part of a huge team in hospitals. Each member deserves consideration, and everyone should make an effort to understand the roles of others.