Very good morning. It is Friday 30th of April and it's the last trading day of the week and the month and Just before I begin to talk you through what's been going on in terms of the overnight and what to expect for the day ahead Don't forget. We've got the latest market watch podcast from us and myself and head of trading appears current It's going to go out in a few hours time a bit later today Actually, we're going to talk a little bit more about kind of psychology around trading Gonna kind of interview Pierce to a certain extent about kind of his Times in his career and he's stumbled upon a real challenging time or a big loss that he can recall That was kind of tough to to mentally handle and how he went about addressing that and also on the upside as well You know the kind of the euphoric nature of a payoff when you've had a really unexpectedly large trade And how do you manage that process? So it's going to be a really useful one I think in terms of practical tips on the mindset side So do check that out if you go on to any of the major podcast platforms like Apple podcast or Spotify Just search from market watch Follow and then you'll get an alert every time a new episode goes out every Friday All right. Well, look, let's get straight into it and talk about what's been going on And we actually closed positive on Wall Street gains ranging from around a half to seven tenths of 1% across the major three indices Really seesaw day yesterday for those who are in markets will obviously be aware. It's almost like a perfect V shape here in the S&P 500 after we saw some quite Aggressive selling pressure coming out of the gate only to be counteracted then shortly after the exit of European Traders to come all the way back up and then we've just drifted back down again during the Asia Pacific session My take here is still one Generally from a technical perspective I think of a degree of Consolidation at this point if you look on the daily chart, I think yesterday Was quite key just generally for the week We were kind of knocking on the door of this previous high that had been restricting price action throughout the entire week Which was the prior weeks high at around forty one eighty three and a half in the S&P We closed firmly above that yesterday and we pulled back a little bit here today So I'd still on the higher time frames look at forty one eighty three and a half as a key area for the weekly close Can we close above that? Which will you know, perhaps see consolidation again between that kind of eighty to forty two hundred level While we just kind of see how things play out going further forward into into next week Otherwise other charts just while we're on it to have a look at oil has had a really great week We're a little bit negative so far as the session is concerned right now We've drifted south during the Asia pack session But just putting my my indicator on here if we look at where we were from the low, we obviously respected Technically this this low at around 60 66 in front month futures, which was the low going back to last Thursday I've had three tests on that level So that's a really strong point on the low of this recent trend But going from the low to high we have Risen the best part of 8% in fact. We've gone from 60 66 up to highs of around 6547 so a little bit just coming off the top here I think is absolutely no cause for concern or alarm at this point and doesn't really surprise me We have broken through that That kind of trend line that was in play through the course of this rise that we've had really throughout the week And just zooming in on the price action a little closer here In terms of the setup for today, so that area there We've already respected has been good level of support Which I've marked up which was the high that we had back on the 20th in the prior week And we had the failed push through that back mid-week on Wednesday Then it's acted as bit of a fairly rough But a zone of support around 64 38 which is just holding price on that downward move seen in the Asia pack session On the upside if we continue to push up you've got the pivot seen at 66 69 as well was some of the Asia pack Respect briefly on the support and resistance side of things So I'd be looking at that on the upside if we continue to recover Any further pullback in price would be looking down at these levels at 64 handle 96 Just below you've got this area of support that came into play during the early hours of this time yesterday And then beyond that of the s1 then you go further down to 63 63 so Generally oil going to finish higher for the week Irrespective if we have any pullbacks certainly I don't think we're going to get anywhere near down the lower zone of this today Certainly not from a scheduled fundamental point of view. There's nothing to really prompt that move At this point in time barring anything unexpected, of course Otherwise elsewhere tea notes I've just marked this up with a trend line following the downward move that we've had Throughout the week. We've had a little bit of volatility. Of course that this was the brief Pop in prices that we had on the back of Jerome Powell, but this is exactly really what I was talking about the briefing yesterday I don't think Powell what he did this Wednesday was anything new at all He just reiterated really what the Fed have been telling us as a marketplace It's just that market participants were kind of misaligned and you're not buying into the Fed rhetoric And that was a function that of market pricing rather than a fundamental change in the Fed strategy And so that move faded throughout yesterday all Thursday session, which I think was absolutely to be expected We then had a bit of a pullback obviously as the equity market was was was pulling off a little bit at that point and then We've kind of held it at the moment So technically speaking any further push up I'd just be keeping an eye on this upper side of the trend mine at 31 Which was around the the high you've just tested around this morning We're just hugging the pivot for the time being So generally speaking though yields a touch higher as far as the the weakest concern, but only moderately so Irrespective of course of the good numbers that we've had, you know, whether you're looking at consumer confidence whether you're looking at GDP whether you're looking at Jobless claims all of these numbers indicative of that general more constructive Narrative going forward for growth in the US economy In the currency markets, the dollar index as far as it's trading right now is up fractionally Just short of 1 cent to 1% Just keeping on the major pairs as far as cable is concerned here Just getting a little squeezed in recent price action over the last 24 hours So worst keeping an eye on the downside here You've got the high that we printed on Monday Which then defines then a relative key level for for price of where we're trading at the moment the low yesterday And we're just around that level at the moment could break out some of this recent consolidation phase For for cable any downside move you've got that kind of double top going back to 39 26 The s1 residing just below there and perhaps the breakdown of there if we were to see emergence of some dollar strength With these technical levels breaching because euro dollar likewise Not quite as clean, but a fairly similar set up you know if you're looking At these at these highs that we were printing back on Monday, and then this kind of near-term Support area that we have had over the course of the last two two or three days And so if that does trade heavy obviously would be targeting down and around 21 130 here in the euro and if that all comes into to play technically on the bridge with cable as well And some just prevailing down the strength and that could see some some nice downward Directional moves there short-term again nothing to Take more medium-term positions just from an intraday perspective. All right. Well, let's just get into some Some headlines so as you can see though, you know despite the recovery that we had Late in the US session in that kind of v-shape move in the US equities particularly for the S&P not quite so for the Nasdaq Generally futures have drifted south during the Asia-Pac session Asian equities were lower overnight albeit fairly modest Chinese regulators have imposed wide-ranging restrictions on financial divisions of 13 companies Including some of the the big guns like Tencent also bike dance in a broadening effort to rein in the nation's tech giants as a reminder, obviously, it's a bank holiday in the UK on Monday, so I'll probably look to get out a look ahead for the week on Sunday and I'll publish that But also for the Asia-Pac region It's an extended weekend in Japan for Golden Week in China for Labor Day Who will remain closed through to Wednesday? Just say away aware in that region overnight. We did have the Chinese manufacturing PMI for April What did that look like? Well? Here's a chart so you can see So you've got the white line manufacturing PMI the purples non-manufacturing PMI So manufacturing of April came in at 51.1 just slightly below expectations of 51.7 Non-manufacturing 54.9 versus expected 56.1 The K-Shin manufacturing was a slight beat that 51.9 against 50.8 expected all in all No real read across though into for the European Open this morning. We did add off the market earnings last night Despite conversation mean peers had some of the speculation at the beginning of the week No stock split coming by way of Amazon But their shares trading up about 2.4 percent in aftermarket trade last night. So by the numbers their revenues 108.5 billion dollars, you heard me, right Versus expected 104.56 so a beat and obviously a phenomenally large number earnings per share $15 79 cents against $9.69 expected Online online store net sales were stronger quarterly income was up and they see Q2 net sales in a range of 110 to 116 billion the previous estimate was for around 108.35 billion so a positive forward guidance as well upgrading what they see for Q2 net sales So their shares were up Higher more than 3% at some point, but up around 2.4 percent at the close of aftermarket Twitter though the opposite down 11 and a half percent for Twitter They have been bid into the release Lot of the expectation was that the advertising revenue kind of bump that we saw in some of the other Related advertisers like alphabet Google and Facebook Facebook really had a good session yesterday Twitter didn't didn't quite stack up with the numbers. They did have a Surgeon digital spending But actually one of the things that people were looking at was that the they missed user growth expectations User growth was up. It just wasn't up as aggressive that some were looking for Also, they see Q2 revenues 980 million to 1.08 billion previous expectations were for 1.05 billion So a little bit extension on the low end of that forecast and the average Monetizable daily active users DA use came in at 199 million which are basically in line with expectations But that in itself was seen as a disappointment. So they got hit quite hard in aftermarket trade On the earning side of things you've got Exxon mobile chevron I kind of big ones to look out for pre-market in UK and Europe You've got Astro Barclays coming out the FTSE BBVA in Europe BMP Paribas coming out in France E&I another firm to look out for as well with the earnings today Otherwise one of the other stories just briefly to mention Haven't really talked about coven and vaccine too much really this week And obviously there's still a really serious situation developing in the lives of India and some other hot spots around the world But from a global markets point of view still looking beyond that at the moment and relative stability seen as far as on that Subject for for major asset classes US denominated But one thing on the vaccine side that I saw yesterday was AstraZeneca executives have struggled to pull together the full data necessary To apply for US approval of its COVID-19 shot according to people familiar with the matter That further delays then the efforts to secure the FDA's go-ahead The company Astra reportedly told US officials it might need until mid-May to finish its application Previously the company has said it only needed up till mid-April so overall Astra's really gone through the mill with the actual vaccine in itself when it's associated with blood clots to its submission and validity of its data and So I guess they're just playing on the side of prudency here trying to give the full data set to the FDA But just goes some way to show the struggles of which they even counted on this particular Front which seems to be a little bit more unique to them than perhaps some of the other companies the other pharmaceutical companies I don't think this really is a big negative. I don't think this is something to get too worried about I just wanted to make you aware of it Far as the day is concerned Just looking forward Few things for sure that you need to just clock on your radar from the German data That we've already just had We just update my my newsfeed so I can I can bring you those latest numbers because we just shooting this We have gone through seven o'clock now And I think my calendar is incorrect here in terms of the German figures But nonetheless we do have the eurozone is the main focus is the CPI flash year-on-year April Figure and that is expected to come in at 1.6 percent Which is a higher number a fairly substantial increase in the previous 1.3 But as noted by by analysts, this is largely attributable To the widely flagged year-on-year base effects if you think about the slump in energy prices last April It doesn't really come as much as surprised the fact that on the year-on-year basis that number is going to be much higher And actually if you look at the year-on-year ex food and energy It's a much lower figure and it's expected to be absolutely unchanged at 1 percent On the GDP side of things In actuality, we're going to print negative 2 percent year-on-years expectations quarter corner minus 0.8 technically speaking this is going to be Consecutive quarters of negative growth, which is classified as a technical recession However, I don't necessarily think that that's going to particularly spook the market neither would an increase in inflation Because of those aforementioned reasons I think with the inflation side is to be expected as discussed I think on the growth side, although it's not a great state It's negative compared to the figure that we saw obviously that was very high in the US yesterday The point being is is that I think everyone is accustomed to the idea that going forward things are only going to improve From here on out, you know all things being equal of course So I think people are aware that the reopening in the likes of Germany France Italy and so on as the vaccinations continue Will improve and are willing to look beyond this short-term q1 negativity that we've had with the technical recession that we're about to see So I wouldn't over interpret it in a negative way, I guess is my summary late one this afternoon You've got to call PCE price index coming out of the states. You've also got Chicago PMI as well coming out this afternoon Expected to still be very elevated albeit Slightly softening from the prior number the Michigan numbers are final reading so nothing to get too worried about And then the earnings we've we've already covered. So that is it I'm going to let you get on with your with your trading day Don't forget to check out the podcast if you're watching this delayed on YouTube Don't forget to subscribe to the channel and as they say we won't be active so much on Monday for the UK holiday But I'll try my best to get a briefing out for the week ahead on Sunday at some point. All right Take care guys and have a lovely weekend


Everybody forced here upping 21-22 immaculate basketball hobby five-box full-case number 37 tiered random teams There's a result one more time for you. Let's see what we got. Good luck everybody only two positions on the entire football field that The Cowboys Need to do well right now is the quarterback in the kicker It's so weird Everywhere else. They're just playing better so far and it's a tie game It's crazy man who thinks Niners are winning. I'm up in the air right now I'm up in the air right now. I mean Can the Cowboys is not beat themselves That's all it is big return right there. It's like a 50 yard return. All right. Good luck everybody Nick's RJ Barrett 16 of 25 Yeah, not a not a great camera angle at all Go Nick's Pacers jumbo jersey miles Turner number to 54 and 99 Illegal how confident are you in the Eagles beating either of these teams right now? Like if I was an Eagles fan, I'd be like, oh, we're like Where can I work? I buy the NFC champion shirt like where can I buy that at? Not that anybody should be buying NFC championship gear Rookie team logo patch 15 at 25 Corey Kiskwards You go Wizards, very nice logo patch And again, these teams are both better than the Giants by by good margin Even with how both of them are playing right now. You got Armani Brooks premium patch auto Armani Brooks Has he only been on one team? No, right? It's not bad. It's a close game. It is just it's very weird like it's not Super exciting in the traditional sense. I don't really know it is Armani Brooks Raptors, okay Armani Brooks Raptors at a shadow box auto Kobe whites for the Bulls 71 of 99 has Armani Brooks play for anybody else in the Raptors It's the only reason I looked it up buddy might have could be white Bulls and legends auto sonics going to the Thunder Ray Allen 37 to 49 beautiful hit a very defensive game Yeah, I'll say it's a little boring for sure Like unless you're like invested it's a little boring Just cuz it's nine to nine, but like it's still it's too interesting to look away from I'm telling you It's like the one of the weirdest games I've ever seen God rookie 32 out of 99 Davion Mitchell Kings Brandon Boston, Jr. Rookie Jersey 91 of 99 Clippers Who was the who was the one Cowboys touchdown? I Already forgot That Rookie patch card Grizzly Zaire Williams 15 to 25 a lack of touchdowns is why it's been boring specifically redemption James Weisman patch auto for the Warriors Shultz gotcha gotcha warriors You know Celtics patch auto Al Horford 25 of 42 the name here is not a Little bit of the foil missing on the name part for Horford Nice hit sees it's gonna be game worn patch. I mean this one's entertaining Taylor. I'm not saying that just a very different type of entertainment First one had scoring for sure and it was snow snowing so it's always makes the games look cooler and a Larry bird auto 13 of 25 You go seas. That's awesome man. Great hit on the bird Celtics back-to-back hits All right 23 to go on the mixer now another spot came in Yeah, like that bill's game would have been like cool at first Like to be a loss no game AFC divisional round two great quarterbacks yada yada yada I don't know that I feel like I feel like after and being in the elements like that for a couple hours You're like this this kind of sucks if your team's not winning you're like this is not worth it Pacers Tyrese Halliburton 799 you're rooting for the Niners because you have pretty card It's like everybody that's been by a very recently Jersey card Marcus smart Celtic 70 of 99 Dual Jersey spurs Tim Duncan 37 to 75.  He goes spurs nice Tim Duncan So there's some damage on the on the on the fire. I've seen this a few times on these Not every time but a few times Tim Duncan. There's some damage on the The frame of the five on the swatch It's gotta be on That was an insane catch. I I Mean that That's all I can only say about that. I was incredible right there. I was a I was freaking a monster play to they were like their own 10 Passing present signatures wizards Karan Butler 14 to 25 Yeah, I got you Taylor. Yeah, I was I don't know how he caught that that was He's getting like tackled and passing present signatures or rockets Kevin Porter jr. 82 of 99 Yeah, under thrown he just adjusted so well to it CD is that dude Redemption and maculate rookie introduction Scotty Barnes Raptors Grats Raptors There you go, that'll be 1099 on card rookie Otto Scotty Barnes nice lot of spots just came in for all the breaks 22 to go now in the football mixer Down to 22 12 to go mosaic choice number 10 Three to go in a peckable random teams and two to go in a peckable random divisions Yeah, everything spots came in for every single break left right there in the first like five minutes of this one big third down Now the Niners need to stop guys Cortes is going through it right now She is going through it right now with the playoffs 21 of 49 you honest on to the Goonbow Bucks You almost had that too. There's a stop right there. I guess punth coming up Jumbo Jersey Siakam Raptors 49 of 99 Raptors game war in Siakam It's good covered by Warner That's a linebacker in coverage y'all Fred Warner so good He's still somehow almost caught that somehow. Oh, they're going for it. That's right. Let's go Oh Herbert Jones rookie team logo patch 1 of 25 for the Pelicans. I Always getting aggressive Yeah, they're playing good defense, I mean both teams should be willing to punch right now and play field position because Both defenses are playing really well Trennan Watford inaugural ink rookie out of 1099 Blazers. I don't know. Maybe they're backing it up to get Maher out there to Kick a field goal. You know what this guy needs to do. He needs to hit a 60 yarder. That'll that'll get him, right? Shadowbox signatures Mavericks Jalen Brunson 35 and 99 and a magic red RPA Jalen Suggs 10 of 49 four color patch You go magic big congrats on that one Chayuti wad with the magic. I don't know. You never know with Mike McCarthy. You never really know. All right last box We got football for the rest of the night 15 of 99 Raptors Pascal Siakam rookie jersey card for the Bulls. I would assume move 62 of 99. Oh, there's a there's like a indent right here So there's damage on this Bulls card Just a crease box wrapper out to the Bulls Jersey number rookie patch Franz Wagner That's our guy right there 19 of 50 Orlando killed it Chayuti Watts. What was that part of magic Herald and signatures Pacers Roy Hibbert 2049 a day on sharp Jersey number paralleled RPA 12 out of 20 Cortes is a Cowboys fan. I'm not I'm just rooting for him. So at the end of the day Whoever wins whoever wins this game. I'm I'm I'm going for the Eagles but Nice they were on sharp won't mag that Jersey never paralleled RPA And on the back scores club Hawks auto Dominique Wilkins 31 to 49 Let's do a recap Sunday fun days down to 22 I think still there was an older where I saw come in. Yeah, 22 still Thanks again ever for filling up the break so far tonight. We just got football for the rest of the night Relics now miles Turner Brandon Boston, Jr. Xair Williams Marcus smart Tim Duncan Pascal Siakam, Iota soon moon Corey Kispert Herbert Jones And our money Brooks premium patch auto redemption for the Raptors Kobe white Bulls shadow box auto legends auto Ray Allen Sonice going to the Thunder James wise and patch auto warriors redemption Al Horford patch on the 42 Celtics a Quran Butler wizards auto Kevin Porter, Jr. Rockets Trend and Watford trailblazers Jalen Brunson Mavericks Roy Hibbert Pacers scores club Dominique Wilkins for the Hawks That's right trash. That's right rookie Jersey number patch Frans Wagner to 50 magic RPA to 20 day run sharp nets a Larry Bird auto for the Celtics a 25 crazy catch right there. I caught a glimpse of that. Oh my god That was dangerous that could have gotten intercepted that a lot of bad things could have happened there, but you see he's The concentration was insane. Oh my god Raptors Scotty Barnes immaculate rookie introductions redemption.  Thanks again everybody football is coming up


Dr. Ranjana Shrivastava, Ranjana is a medical oncologist and internist for Melbourne, Australia, who graduated from Monash University and did our internship residency in specialty training at various Melbourne hospitals. In 2004, Ranjana won a Fulbright award, which she completed at the University of Chicago. In 2014, Ranjana was recognized by Monash University as their distinguished alumnus of the year. Ranjana is the author of a number of books. Her most recent book, A Cancer Companion and Oncologist Advice on Diagnosis Treatment and Recovery, was brought out this year by the University of Chicago Press. Ranjana is also a regular columnist for The Guardian newspaper, and in that regard reaches hundreds of thousands of people where she writes on humanity and ethics in medicine. Ranjana presents a regular health segment on Australian television. We'll be returning to the University of Chicago to work with us in the summer intensive program in July of 2016. Today, Ranjana will speak on the topic on making a difference one paragraph at a time from oncologist to guardian columnist, Ranjana Shrestha. Good afternoon. Thank you for staying and curbing your appetite for lunch. I'll try to entertain you. A very different tone from some of the talks that have followed. In fact, sometimes I do wonder what I'm doing here amongst all you intellectual heavyweights, but Mark asked me to talk about my writing, and I thought I would take you on a journey of oncology to writing, and I continue to be an oncologist, but sort of a potted history to how I got to become a writer and what I make of it and what I see. Picture to familiarize you. I'm from Melbourne, Australia. Australian tennis open. Sydney Opera House. If you ever come to Australia, look me up. When I was a medical student, in fact, when I was a resident, an oncology resident, I should preface this by saying that I feel like my whole life I've been stumbling upon things and my life, my career certainly hasn't been the kind of deliberate consequential career that that is the envy of many people, including my own. So when I was a medical student and following that an oncology fellow, I took some time out from my training and I went to India, which was a place where I had grown up. In fact, I grew up in Patna, Bihar, which is Peter Singer showed some slides of. And I went there to work with Mother Teresa's Missionaries of Charity. I had sort of stumbled upon them as a volunteer organization where I could go. And I worked with them on the street side clinics of Calcutta. And it was one of those experiences I think that would have a really remarkable effect on me. But at the time, I didn't necessarily make as much of it as I do now, 20 years or 15 years later. Followed by that, through my training, I took some, in fact, during my oncology training, I, this is, sorry, this is a picture of the hospice at the Missionaries of Charity. As you can see, very basic, run by volunteers, and a most moving and life changing experience really for me and for many other people who work there. I came back from Calcutta and I found myself volunteering at the Asylum Seeker Resource Center when I was an oncology fellow and we got a few hours off every week. This center had just opened. I can't for the life of me remember how I, how I stumbled upon it. I certainly wasn't necessarily looking to work with refugees. And very soon found this most extraordinary sort of place, which was about 20 minutes from a first world world-class hospital looking after a vulnerable population right there in Melbourne, Australia. And the juxtaposition was just incredible. You know, back at my hospital, which I worked at during the week, I could literally spend hundreds and thousands, even millions of dollars on cancer therapies and drugs without people looking over my shoulder too much. And at this Asylum Seeker Center, I would struggle to find anti-hypertensives. I would struggle to give someone an asthma pump. A little child broke his, broke his bone once on a playground and Australia at the time had very restrictive policies that refugees and Asylum Seekers were not allowed access to Medicare, which is our universal healthcare system. And I struggle to find this little boy a place to go to get an x-ray, to get emergency treatment. And I think those things, you know, you, perhaps you expect them in another world, in a third world country, but you don't expect them in, in Melbourne. You don't expect them in Australia. And I found that very confronting. And I was, I was a, I was a young fellow at the time and, and so continued to work there. So something very interesting happened and I think it kind of, this is where my non-academic career probably started. So as an oncology fellow, sorry, I should go back. So this is, this is another picture of the, of the refugees, refugees and asylum seekers in Australia, although many of them have Medicare rights now. They're detained under very severe circumstances. And, and, and that, and I'll talk, talk a little bit more to that later on, but it's very troubling. It's troubling to a lot of people, including doctors who sometimes treat these children when they're, or I don't treat children personally, who are brought to hospital and then taken back to detention. Well, all this started a very interesting conversation with my then bosses who kind of asked me, you know, where my career was heading. And you know, I worked, I worked at a, at an academic institution much like, much like this one. And I, and I said to several people that, you know, I'd been working at the asylum seeker center and found the whole issue very confronting. And, and I said to, to a fairly eminent academic, I said, I think I'm going to write about the refugees. And he looks at me and his entire expression changes. He says, what?  I'm going to write about the stuff we see. You know, look at this, it doesn't make sense to have so much inequality within several kilometers of where we work. And I'll never forget, he said, well, that's not going to get you published in the New England Journal of Medicine. And I thought, well, there I go. You know, I have failed even before I started. So, you know, isn't that the holy grail of medicine, you know, to publish in the New England Journal. So I started my career as an oncologist, sort of knowing that I wasn't heading down the academic track, knowing that I would never publish in the New England Journal of Medicine and kind of on my own wanting to become a writer, but very much loving medicine. And I'm very passionate about medicine. I love what I do. So then I finished my oncology training and came to another sort of crossroad. Do you do further training? Do you do a PhD?  Or do you sort of follow your heart and see what happens? So although I have, so essentially, you know, how do you get, are there different ways of getting to the same point? And the point, I suppose, if we all remember those of us who went to medical school and you attend an interview and people say, well, why do you want to study medicine? And I guess inevitably in some way or the other, we all say to make a difference. Well, how does one make a difference? I mean, obviously, you make difference through basic research, through clinical research, through looking after patients. But are there other ways of making a difference? I didn't really know. I sort of knew that what I saw I admired in an academic hospital, but I didn't necessarily want to do that. And somehow I was getting the sense that already I wasn't following the rules and that I was supposed to be a certain kind of a doctor. And I wasn't playing by the rules. So then I ended up in Chicago. Now I have no financial disclosures of interest, but I must make a public disclosure. And you know, Mark was appalled, I think, and dismayed when I said to him, Mark, my decision to come to the McLean Center 10 years ago was was very sort of undeliberate. I stumbled upon your site and thought, yeah, this looks like a good idea. And and you know, now when I hear people about how hard they have thought about doing a fellowship at the McLean Center and et cetera, et cetera, and how they've interviewed and prepared, I sort of think should never have let me in. But the truth is that my husband was coming to Chicago to do an MBA. I had just finished my oncology training. I wasn't quite sure what to do was sort of looking around for something to do in the in Chicago that wouldn't require an American medical license, which I don't possess, literally stumbled on the site, thought, this sounds fantastic. It sounds just up my up my alley. And then decided that in order to live in Chicago, I would need some money. So figured out, well, how do I get some funding? So stumbled upon the Fulbright Scholarship Fulbright Awards and thought, this sounds like a good idea. I'll apply for one. All my life has been completely unplanned, I feel, got a Fulbright. So I thought, okay, well, I have an institution to go to, I have money to live there off I go. And as it turned out, this most casual of decisions really to accompany my husband and to spend a year somewhere else and figure out what it was that I was going to do, turned out into the most transformative decision of my life. And I really do use that word seriously. I think that being in Chicago for a year, being amongst people like you, many of whom are still here today, which is so fantastic to see, really gave me an opportunity to reflect, to reflect on what I could bring to the world, what I could bring to the world of medicine. It was also the first place where I heard from people who were writers and who were doctors as well that that I could write and people thought and many people said to me, you know, we think there's a writer in you and we think you should you could write a book. And that was incredibly, you know, when you're sort of young and trying to figure out your way, it's really important for somebody to be able to say that. So back I went to Australia and I thought quite seriously about writing and although I haven't mentioned it here, my first piece of writing, the New England Journal in fact put out a notice for looking for writers on medicine and society. And I decided to enter that the speech that I had had many years ago about never being able to write for the New England burning in my mind. So the New England wrote back and said, you're not quite what we're looking for, but we like your writing. So would you like to write for us? So that's began a very long and continuing relationship with the New England. And so if you see my piece in forthcoming piece in a couple of weeks time in the perspective section, you'll know the backstory. So anyway, so I fulfilled it had never been my dream to write for the New England, but I got in and you know, have published many pieces since and it's just such a delight. So then I wrote my first book and the first book is Tell Me the Truth. And it's really a book about sort of some of the moral and ethical dilemmas of being an oncologist, what it feels like to sit on the other side of the desk to give bad news, to constantly give bad news, to deal with that whole dilemma of not extinguishing hope while trying to prolong life or trying to tell the truth in fact. And it was quite an honor in fact to be shortlisted for a literary prize that was won by a former prime minister of Australia for his biography that he had written with another author, Malcolm Fraser was a prime minister. And so he sort of won the prize on the night and I said to Malcolm Fraser, I said, you don't need the publicity, I do. And he was very apologetic, lovely man who just died recently. But publishing that book made me sort of made me realize that I could do it. It was it was an achievement that was that was important to me because I'd never quite realized until then how to quite encapsulate my ambition and make something of it. So it was important from a very personal perspective for me to get a book out. My second book a couple of years later was a was this one dying for a chat, which was really it's a little penguin special. I don't know whether you have them here. They're like 80 pages. They're supposed to be read on a bus or a tram or a train, one time read. And they're they're they're really kind of cute books. And this book is essentially about better end of life, achieving better end of life care by having advanced care directives in place. And it explains so it describes the story of a woman that I looked after she was 90 years old. And in a story that will be very familiar to you. She sort of went through the labyrinth of the hospital system because nobody ever stopped to say, What would you like? What are your wishes? Not not so much. What would you like or what we can give you? But but how can we make this work for you? And she died in intensive care. And I made the point that when she died and she was actually my patient. So there's a lot of me a culprit in this. I make the point that what we lost the patient, the family was incredibly dissatisfied and couldn't believe disbelieving that she had died. The bureaucrats came after us, you know, we had spent months in hospital at great cost, just like it is here. The nurses were angry with the doctors, because the nurses felt that we should never have given her the kind of care that we did. And so I make and you know, and it left a bad taste in our mouth because we had lost a patient. So I made the point, well, who's happy? You know, here we have a world class system. We have spent hundreds and thousands of dollars, if not more, the best medicine in the world. And there is not a single person who's happy. And so that was dying for a chat and incredibly, even to this day, um, it won it won an award called the Human Rights Human Rights Literature Prize. It's it's an Australian Human Rights Commission, the Commission that that gives out prizes for for writing. And it was it was quite interesting, because you know, if you ever look at their website, you'll see the kind of books that they had their award prizes to, often to do with things like anything ranging from domestic violence to refugee asylum seeker sort of writing. And I thought, wow, I didn't think I would see a day so soon, we're talking about end of life care and good doctor patient communication, which lies at the heart of this could actually be considered a human right and something that is worth awarding a human rights award to. So that was a really that was a really nice acknowledgement I felt for us as a profession, for the kind of work that that we are trying to do. Very quickly, these are my these are my other two books. The cancer companion just came out last month by the UFC Press, which was which was really lovely and and and so humbling. I'm talking a little bit about my writing career. So after my first book came out, I got a call on Christmas Eve from from the editor of the Melbourne magazine, which is which used to be it's now defunct, a really glossy lovely magazine, lots of beautiful advertising and a couple of meaningful articles hidden in there. And the editor says to me, he says, I'll come clean with you, I haven't read your book, but my wife has and she thinks it's great and she thinks I should hire you. So the power of a spouse who reads. So I was hired. So, you know, I thought it was a joke and the Melbourne magazine was my first sort of big time exposure to to writing, to writing for a public audience. And so all of a sudden, after having written for the New England Journal and in the perspective section for all for many years now, I had to figure out, okay, well, how do I write for a general audience? And one of my greatest fears when writing, when taking on this job was that I was also a practicing oncologist in Melbourne and I kept thinking that people would write to me for second opinions, people would ask me, you know, whether their colleague was treating them correctly, etc, etc, and it would just be a minefield. In all the time I wrote for them, I think it was nearly two years, it didn't happen once. What did happen was hundreds and hundreds of people wrote in, they wrote handwritten letters, spidery handwriting from 80 year olds who wrote to share their story and to say, the column you wrote reminded me of the time when I was ill or my dad was ill or my husband was ill and this is what happened to me. And I was struck, I had never ever thought that reading a column could be so cathartic to other people. You know, when you write you're always thinking about what you can bring to, you know, how you can do a good job, but you don't, I mean at least I never thought about the kind of response it would trigger in the public and it was quite moving and humbling and, you know, people wrote in with practically every kind of experience, you know, pages and pages worth of letters and emails. It was lovely and I made sure that I responded to every single one of them because I felt that people had taken a lot of time writing to me. So then along came the Guardian in 2013 and the Guardian would used to be the Manchester Guardian and then it became the Guardian. Now it's published in Australia, UK, the US has a Guardian edition. So the Guardian came to Australia and I decided that I would try my hand at writing for the Guardian or at least that was my wish because by that time the Melbourne magazine had folded and so the Guardian kind of was establishing itself in Melbourne there in Australia and you know for a while it's actually really difficult to get in anywhere as a writer and one of the things I learned is that a doctor badge can get you in many places but it's a little bit difficult trying to get into mainstream media to write especially for a prominent publication. So I kept haranguing the Guardian. I put a notice on my calendar and so every few weeks I would ask can I write for you, can I write for you. So eventually I think they're just tired of me and they said well why don't you submit a piece why don't you pitch us something. So I did and they published it and then I a month later so then I had to be I began looking out for cues because you know a newspaper thinks what's in it for me you know how will I get more readers. So I've always been a very curious person about the world and so you know I would pick out something from a newspaper from the headlines or you know something about perhaps emergency department waits becoming longer and getting longer in the public hospital system oh my god everything is falling apart and I would say to the Guardian let me give you my perspective on why that's happening and that's how initially you know I would always be very tentative around them thinking well I don't want them to I want them to say yes but I can't ask them too often so you had to figure out a time where you wouldn't be forgotten but you weren't being a nuisance. That time roughly was about four to six weeks I think. So then Christmas is a good time for me so one day before Christmas the Guardian said to me we're going to take you on because we get good feedback from your columns it's something different and I took a great deal of care in writing about things that matter to ordinary people and you know I've had a very strong sense that we do such great work and if you look at what we have talked about in the past couple of days it's wonderful and we have great intentions there are smart ideas but unless we bring patients along if people along even before they become patients that's how we're going to make change. So then I started writing for the Guardian a couple of years ago now and these are some samples of kind of the the sort of things that I picked up on and that I and that I write about. So this one is from June 2015 so just this year so what happened was if there's any oncology so you may have heard anywhere along the lines some melanoma drugs came out and they came out with a great deal of fanfare because for the first time we were seeing that we could not only treat melanoma but potentially improve people's survival. Now that is unprecedented in melanoma which is which is a nasty disease. So a couple of articles had come out while I was here other people had written them sort of celebrating what a miracle drug this had been. The problem one of the problems with this miracle with these miracle drugs was that it didn't work in many people and in those in whom it worked there was some progression free survival benefit sometimes there was a small overall survival benefit too and the cost one of the drugs was about on a per gram basis something like 400 times more expensive than pure gold. So we're talking about seriously expensive drugs that don't prolong survival for a very long time and so this whole issue of societal cost. So I was at ASCO in Chicago and I get I get some desperate calls from the Guardian to say can you write a balanced article can you write a piece on this and I said I can write a piece on this but I won't be celebrating the miracle in the same way as you know there was breathless press around around these drugs and I said well hang on we just need to take a step back and think about whether it's even affordable for example in the third world and you know in India in most places there is no morphine there is no morphine available for palliative care. How do we reconcile drug availability here in the first world people are queuing up to you know to want to get this melanoma drug approved in somewhere like Australia. How do we reconcile this with global equality etc etc. So I wrote a piece about you know as you can see why I won't be rushing to tell my cancer patients there's a cure and I brought up all these issues that I was that I was just telling you about because I think for the public it's important for people to appreciate the nuances of any drug approval process or why sometimes for example we have a we have a government funded healthcare system which is incredibly generous the envy of much of the world but it has rules and regulations around it so why is that you know why how do we reconcile how we approve drugs which drugs we used to treat which patients and so on. So this was a column that was particularly well received and I think the Guardian was quite relieved because I think that the previous columns had been slammed for being a bit too breathless in their enthusiasm. This was a particularly a column that was particularly well received and according to the Guardian who by the way interestingly so the Guardian tells you a lot of stuff a lot of data they can tell you obviously how many people click on your article so at that point where this picture was taken there were 41,070 people it can tell you how long people spend on your column so when they click on it do they spend five seconds do they spend eight seconds where did they read up to before they decided to decided to click off and so on. So this was a column that apparently wasn't only read the whole way as most of these columns are but featured as the top Guardian article all around the world for three days running and it goes it goes to show really not so much about what about my writing but about what alternative therapies do and they polarize people and so you know 2,197 comments till that day because there are people just fighting with each other about whether alternative therapies work or don't work. But I think you know it it would be very difficult to have that sort of an impact on a patient by patient basis talking about the dangers of exotic alternative therapies and of why as doctors we are so wary of people who who peddle false hope and false treatments because we are often left to pick up the pieces. This is another this is another piece so when I was leaving Chicago I was pregnant with twins unfortunately I lost them both I have three healthy children subsequently but it's obviously you know losing a pregnancy is affects you deeply on so many levels and so on the 10th anniversary of that loss I decided to deal with I decided to write a column about it it certainly wasn't planned I I sometimes share personal details about me but this is probably the most personal column that that I've ever written and it was describing the immediate sort of the experience of losing the twins and and living the experience as a patient who was also a doctor and so I talked about a few things including the fact that the obstetrician who discovered that the twins were dying he wept he he didn't know what to say and I made the point that it was the first time in my life that I had seen a doctor cry a doctor crying with the patient over some over a loss and it and you know and it changed my world as to what a difference that made to my experience as a patient and you know it doesn't mean that that we must sob and weep with every patient but it really highlighted the the power of emotion and emotion when a doctor shows it when a patient is is is suffering and I also wrote in the piece about how there is this whole industry around grieving isn't there you know when I lost when my husband and I lost the twins there was no end of well-meaning brochures and books and things that came our way you know people were sliding things under our door because everyone in the world thought that you needed counseling to get out of to get through this and I made the point that I shunned all of them and I wrote and it was cathartic and it was my way of getting over it and it's okay it's okay not to join the industry of of grieving and and not to diminish the good work that people do but I think often and especially being an oncologist I see all the time how cancer patients are meant to do certain things and there is a certain way of being a patient and of course that's not true and so trying to say to people that even I you know as as a doctor I decided not to do what the industry told me to do and I'm okay and that it's okay to take one's time over grief or whatever it is that you're going through and not live by some kind of mandatory rule so this was another very popular column for obvious reasons that the guardian editors are great at bringing at coming up with the titles I seldom do but my favorite part about this which I which I wrote to mark about was that this was so this was syndicated very widely the guardian is picked up all around the world this one was on the front page of the North Korean Times and I loved it I loved the thought of a dictator like Kim Jong-il reading this over his breakfast cereal and so being think about it so I thought that was pretty cool very quickly some other things I have done so this was a recent protest by by pediatricians these all pediatricians and nurses of the Royal Children's Hospital about refugees in detention and so slowly I think what my writing has evolved into being is talking about topics that are important that are socially important but not necessarily medical you know and one of the things that people often say is well should doctors stick to medicine but I think you know as doctors we are still citizens of the world and we have views and we have we have ethical dilemmas and we have problems when children are in detention or you know when adults are not looked after and it's okay to speak up and so I think that you know it's been a wonderful platform but also a platform of responsibility couple of other things so so this is this is a lawyer John Fane is his name he's very popular in in Melbourne and in Australia he's a great presenter and and I co-host something called a conversation hour with him which is a which is an hour on radio where there are guests now these guests are not medical in fact they're seldom medical they range from from authors and and advocates so there's a will self over there the tall gangly guy who came in with his e-cigarette he's a famous booker prize winning author talking about his book there is a former health commissioner and so talking about and so what happens is not only do you talk to these people about what they do but you also have time to talk about medical issues and and I use those 10 minutes in public advocacy so at the start of the conversation now which has been a wonderful way once again of reaching a general public this is just very interesting so this guy here is a former defense minister of Australia and I probably none of you necessarily follow Australian news but but an election was fought on the basis of the fact that the government of the day accused refugees who were coming into Australia of throwing their children overboard into the ocean in order to seek asylum in Australia a huge staggering claim that parents would dump their children in the water but by virtue of that fear mongering which happened on the eve of the election the government won by a thumping margin because you know it played to I guess you know the fear amongst many people about how asylum seekers and refugees change our way of life so I asked the defense minister a really simple question when he came in to speak on the conversation hour plugging his book and I said to him you know how did he feel because he was the one who also kind of sanctioned these claims and I said how did you feel as a parent did you feel as a parent that they stood up to this this this claim look true and to my astonishment I would probably never have asked him he got really hot under the collar and it was a more spirited discussion about about you know he didn't answer the question it was typical politician but you know defense of of the whole practice so it was very interesting very quickly this was something very dear to me so one of the other things I've done through the media is I get to do a lot of sort of facilitating and presenting this girl here is Kate Richards who if if any of you want to read an excellent book by a doctor who became a severely psychotic patient is called madness and memoir by Kate Richards so I Kate and I used to sit in a lecture theater together we were students till she became psychotic and obviously as we have heard mental illness completely upturned Kate's life she subsequently had to leave medicine and and and now she writes and so I got to interview her and it was wonderful it was a sold out audience and it was about the lived experience of mental illness but also from a doctor's perspective so it was it was a wonderful opportunity once again to tease out the nuances of things like that that I probably wouldn't get to do in in bedside medicine very quickly I'll wind up so you know this is just a picture of A.S. Rock just because you've seen so many pictures of me something to something to remind you of Australia people often ask me you know what it is what it's like to write I thought that was that was a good that pretty much sums it up before I finish in terms of you know we all worry as doctors or nurses or we all worry about making an impact in the world and it can be really difficult I think you know if you publish a journal a publisher paper in the journal you have an impact factor and you know how many times your article has been quoted and you get approached you get approached to talk at you know other academic institutions and so on and so forth and sometimes I find myself wondering you know what's what sort of impact does a column like this make or is it sheer indulgence on my part makes me happy but here is an email that I quickly want to read out to you because I think it really sums up the essence of why I do what I do Dear Dr. Srivastava I sorry it's just taking me sorry I just wanted to send you a message to thank you for your columns in the Guardian I'm a very young patient with stage 4 rectal cancer involving my liver and lungs I was highly chemo respondent but now my time is limited there's not a lot of writing on cancer that I respond to or that I think really gives me a better perspective on my cancer than I already have after many many months of living with a death sentence but your writing always moves me and teaches me something different I learn about medicine and the health care system and more importantly the act of living and the reality of dying I also really appreciate you talking about things from the medical professional side of things I have the most wonderful oncologist whom I adore and a surgeon a liver surgeon who is dedicated and focused on trying to do the impossible for me he actually operates on my horrendously screwed up liver to give me a chance there's always a feeling however as a patient that at the end of the day the kindness and the affection that your doctor show you is just a thing that they put on to make you feel like they care because that's what they've been taught at school but you've taught me that doctors are as human as they seem it must be an obvious thing to you but one that's easy to forget between the scans and the constant navigation of your body as a complicated problem rather than as a vulnerable human being I think I'll I will end there but I thought that was that was an email that was um particularly inspiring my last slide I think you know going back to talking about a difference I thought I love that slide thank you for listening to me my Twitter handle is Dr. Ranjida


I wonder if you've ever used silence as a boundary. I know it sounds strange but what I mean is when you're around people who you know do not listen to you and don't see any value in your words or your voice or opinions then silence is a great thing to choose. I don't mean silent treatment. I don't mean that reactive manipulative thing. I mean a calmly chosen silence that you choose which is saying I value my words too much to waste them on people who are determined not to hear me, not to listen to me. It's a silence that springs from self-respect. It's a silence that is saying I value my words more than I value your listening to me. It's not a silence that belittles their voice like all boundaries. This is not about anyone else but you. It is a chosen silence rather than a silence imposed on you by others.  Experiment with that today. It will get misunderstanding and so on. I know that but it will hand you back a huge sense of control and peace and empowerment around people who do not listen to you and so you create a boundary of silence to let them know that's okay. I choose silence around you rather than choose to shout over your resistance like all boundaries it empowers you. Love you guys. Hope you're okay. Speak to you soon.