Many people know him as the accidental star of RPA, the TV series that documented the everyday workings of the Royal Prince Alfred hospital in Sydney. Compassionate and warm, head and neck surgeon and cancer specialist Chris O’Brien won the hearts of viewers all over the country.
When the news came that the man who had dedicated his life to treating cancer had himself been diagnosed with an aggressive brain tumour, there was a public outpouring of sympathy.
In an interview with Sky News just months before his death in 2009, Chris details his decision to harness that diagnosis for good, transforming it into an opportunity to realise his long-running dream: an all-in-one centre that treated cancer as an illness of the whole person.
With characteristic determination, the surgeon launched his efforts into a campaign that would ultimately prove successful: in April 2009, then Prime Minister Kevin Rudd pledged $150 million in federal funding towards the hospital. Chris’s dream was set in motion, but he wasn’t to see it come to fruition.
On 4 June 2009, Chris O’Brien passed away, six months before his wife turned the first sod on the new site of the Chris O’Brien Lifehouse at RPA (later shortened to Chris O’Brien Lifehouse).
Together with a legacy that lives on in the patients and families whose lives he touched, Chris left behind him a team of doctors, nurses, and committed staff who would rally together to bring the dream to life.
Five years on, members of that original team look back on just how far they’ve come, and what it really took to bring such a colossal project – a working, self-sustaining hospital – into being.
The Big Idea
Newly appointed director of the Sydney Cancer Centre at RPA, Chris O’Brien invited Associate Professor Chris Milross to apply as Head of Radiation Oncology in 2004. They’d worked together for a decade before that, and the relationship that had developed was one of mutual respect.
“Chris was the archetypal clinician scientist, seeing patients but also learning from what he saw and applying that data to analysis and finding better outcomes for his patients,” says Professor Milross.
By 2004, the idea for Lifehouse was bubbling away in the background, born a year earlier in a conversation between Chris and his wife, Gail.
As Director, Chris was tasked with renovating Gloucester House, the Cancer Centre’s aging home. Discussing the logistics of adding a new floor on an old building, Chris and Gail quickly realised that this wouldn’t solve the underlying issue. What Australia really needed was something new – a comprehensive cancer centre.
The comprehensive cancer centre model, pioneered in the cancer centres of North America, would combine diagnosis, treatment, supportive care and research under one roof.
Having spent a large part of his early career working in these centres, Chris saw first-hand their benefits. By concentrating talent and resources in one place, the comprehensive cancer centre produced some of the most exciting research in the field. For patients, it meant every part of their treatment would happen in one place, with one dedicated team from diagnosis through to follow-up care.
It was unlike anything in Australia at the time.
“There were, and there still are, an enormous number of great cancer departments in teaching hospitals in New South Wales and all around the country,” says Professor Milross. “But what there are not are standalone cancer hospitals. What we were trying to do was different, and it still is.”
For Professor Milross, who had himself spent time working at the MD Anderson cancer centre in Texas, the idea made sense. From the larger medical community, however, they faced some criticism. Some believed the centre would become exclusive and elitist, and others thought it just couldn’t be done.
“There were some huge challenges in trying to convince other people that it was a good thing to do,” says Professor Milross.
Add to that the logistics of building a hospital – staff, equipment, ordering processes, record keeping systems and any number of other moving parts must be made to work together seamlessly – and you start to get an idea of the monumental size of the task ahead.
A new home
Clinical Nurse Consultant Ann Carrigy’s memory of opening day at Chris O’Brien Lifehouse is a pragmatic one. Alongside the excitement and nervousness of moving into the new building, one thing stands out – nobody knew how to work the phones.
It was only a short move – the new location was literally across the road from Gloucester House – but for Ann and many of the other staff who came across, the transition was made with some trepidation.
“It was exciting, and it was also very scary. Many of us had worked at RPA for a very long time, and we didn’t quite know what to expect,” she says.
The building had been several years in the making, the design fine-tuned over a number of iterations. A high central atrium would provide sunlight, proven to increase patient health and wellbeing. On the first floor, patients would undergo chemotherapy in private booths, a feature which Chris advocated for during his own treatment.
“Chemotherapy is a difficult time, when you need privacy and comfort most of all,” says Cancer Nurse Practitioner Keith Cox. Now retired, Keith boasts over 40 years’ experience in cancer care, and was by Chris side as he received chemotherapy in the open-plan wards at RPA.
“We would sit and make plans about how the new facilities would look, and we were very much on the same page about having individual rooms,” he says. When the new centre opened, it was with 44 chemotherapy suites – comfortable, quiet, and filled with light.
On 18 November 2013 – it was a Monday, recalls Ann – the staff got their first glimpse of the building that was to become their new home. It was a flurry of activity as they got everything ready – and learned how to use the phones – before the centre opened to outpatients one day later.
“The fact that, for the patients that came across the next day, we managed to make that transition fairly seamless, was something that I’m proud of,” she says. “For them to walk into this beautiful, light-filled building and see many of the same familiar faces, I think that really reassured people.”
A dream realised, without Chris here to see it
For those who had worked closely with Chris, the opening represented a bittersweet milestone.
Nowhere was this more true than in his own head and neck department.
“We almost couldn’t believe it was actually happening,” says head and neck cancer nurse practitioner Justine Oates. “Our connection with Chris made it extra special, but at the same time it was sad that he wasn’t there.”
Justine and fellow nurse practitioner Sarah Davies met while working on the wards at RPA. It was Chris who gained the funding that allowed them to specialise as head and neck cancer nurses.
“Chris was incredibly supportive,” says Sarah. “He valued every member of the team, everyone from the cleaner up. Even though he had so little time, he could make you feel included and important in the daily care of the head and neck patient.”
Now, Justine and Sarah have a hand in training the new generation of nurses to perform the incredibly complex tasks involved in head and neck patient care.
“We’re very proud of the group of nurses we have. Going forward, we hope to be able to support them to become nurse practitioners, in the same way that Chris supported us,” says Justine.
Success, but still not finished
Five years after opening, the hospital supports four busy wards, a day surgery unit, and several theatres. It’s a success, says Professor Milross, but there’s still a long way to go.
“We can’t get complacent, and I don’t think Chris would have either.”
But would he be proud of what the hospital has become? Director of Head & Neck Surgery, Professor Carsten Palme, thinks so.
Chris had a strong influence on Carsten’s own career. After the surgeon passed away, a travelling fellowship was set up in his name. Professor Palme was its inaugural recipient.
“It’s been about three years since we started operating here, and we now treat the highest numbers of complex head and neck cancers in New South Wales. We train many fellows from around the world on an annual basis, and our research output would be second to none,” he says.
“I’m incredibly appreciative of all my colleagues, and I think we’ve achieved a lot, but that doesn’t mean that we need to rest.”
Director of research Professor Lisa Horvath agrees.
“In research everything is always moving. If you stand still in research you’re toast,” she says.
“It’s always about anticipating the next challenges, the next technologies, the next drugs. What is the new frontier and how do we make it happen?”
With the five year celebrations behind them, it’s time to look towards the future.
Over the past few months, the hospital has established a number of outreach clinics in rural New South Wales.
“The aim is to bring our cancer care philosophy and our expertise to rural areas, and to assist with local health care infrastructure,” says Carsten.
In day-to-day care, the drive to improve patient outcomes and provide the best possible treatment is ever-present.
“In five years’ time, we should be busier, we should have increased the breadth of cancer specialties that are handled within Lifehouse, and we should have increased our research and training capacity,” says Professor Milross.
“In five years, I hope that Lifehouse will be the place where young trainees want to come to get the best education in cancer care, and I hope that they can take that knowledge out into the world with them.”