Looking back, 2007 was an odd year for me. Making a career change has been inspiring and invigorating. The fact that it coincided with moving back to London, putting a year of treatment behind me and the clunky dawn of my sense of mortality and ordinariness has added to my feeling of displacement.

But with that displacement comes the opportunity to look at life from a different angle.

A month or two ago I was intensely irritated by a list in one of the Sunday supplements that described the future 500 movers and shakers. The 10 categories were art and design, business, fashion and retail, food, media, public life, science and innovation, travel and leisure, sports and entertainment and drink. Perhaps the drink category should not have been surprising, as it was sponsored by the manufacturer of an armagnac. Nevertheless, I was struck how many of these categories were related to consumption.

The survey was written as though success could not fall outside these categories. As the parent of teenagers, they seemed far from comprehensive - education, literature, health, the voluntary sector and music were all missing and yet surely they contribute to the richness of our lives more than retail or travel.

Smug (in a Groucho Marx kind of way) in the knowledge that I will never be one of the future 500, I am now feeling particularly virtuous, as I recently spent a day visiting some of the mental hospitals and homes in my organisation's portfolio. I cannot pretend that the patients and service users benefited from my presence, but it did open my eyes. Humbling stuff.

Looking back

When I was a student, I spent a summer working at a Victorian asylum. Many of the inmates did not suffer with mental illness - they may have committed some minor misdemeanour in their youth such as extra-marital sex or have been unfortunate enough to be a bit simple. Their incarceration reflected the values of the time.

The place has since closed and its remaining inhabitants have been rehoused in more suitable accommodation, as decades of being institutionalised have left them unable to cope in the real world. I found my summer job fascinating and rewarding but had only thought about these people occasionally until I took on my new role.

I was attracted to oncology nearly 25 years ago because it was intellectually stimulating while providing the emotional rawness angry young women in their 20s want to feel. A sense of engagement with people's lives for good or bad - in sickness and in health. Naive looking back but, even through the cynical lens of the retrospectoscope, meaningful.

Face forward

In the mental homes and hospitals, I found a vulnerable, marginalised section of society which I have not previously had the privilege to witness. For these people, with longstanding and often intractable mental health problems, there is not much health, only the extent to which their sickness waxes and wanes.

Some of them had a forensic history, with very serious convictions and the certain knowledge, on the part of those who care for them, that they would never function normally in the community. Others were passing through - en route between a secure unit and life in a hostel. Piecing together the flakes of their dislocated, socially excluded lives, unable to hold down a job, fending off what must be incessant boredom or a frustrated quest for autonomy.

When I asked which rooms were used when people had visitors, I was informed there were only one or two guests a year between more than 20 people. A few rooms had the smiling faces of family in picture frames and on walls but most had no evidence of belonging. I now have a flicker of sympathy for John Reed when he suggested smoking was one of the few pleasures enjoyed by the deprived population of the Gorbals.

While this is heresy for an oncologist, when somebody has been smoking for 50 years and has no prospect of leading an independent, self-determined life, is it really appropriate to subject them to smoking cessation classes, or is that a misplaced value judgement?

One of my Christmas cards this year wished me all the best in 1908 - it would have been funny but the octogenarian correspondent is becoming increasingly confused and maybe next year will no longer be in her own home. In 2007 I was taken out of my comfort zone. In 2008 I will attempt to adapt to my new location and learn from that perspective that life goes beyond Sunday supplements and their empty reverence.