Tag Archives: Health

Wow, you look well………

Wow, you look well…….

An opening gambit, a friendly utterance which if you’re lucky, promotes an instant feeling of wellbeing in your patient. 

This time, it was said with complete, genuine enthusiasm, for next through the door was Amy, a ten year old I’d known from birth, an absolute fighter who had overcome the odds and survived numerous surgeries for hypoplastic left heart syndrome. She looked beautiful, bright, bubbly and full of vigour and Mum looked on with a beatific smile on her face, whilst the child she hadn’t thought would survive, described her symptoms of a ‘routine’ illness. Reassuring normality.

How different to the last child I’d tried to help with hypoplastic left heart syndrome…….

I was a few weeks into my Obs and Gynae SHO rotation.

Mrs Knight had gone into spontaneous labour. Although she had polyhydramnios (excessive amniotic fluid), all of her pregnancy scans had been normal, so we weren’t anticipating problems. The labour went perfectly, husband in attendance, another awe-inspiring but routine delivery anticipated. Final stage, final push and out popped Charlie, a petite, perfectly formed baby boy.

Perfect, except that he wouldn’t cry or respond. Nothing too unusual or untoward. We transferred him up onto the resuscitation unit, trying to elicit a cry, rubbing his skin, then oxygen until finally he pinked up a little. Had we heard a little mewling cry? Then nothing again……..emergency bleeps, an every growing number of healthcare professionals gathered around the little bed, paediatricians called, senior obstetricians descended, attempted ventilations by first junior, then more senior colleagues. Cardiac compression, mask ventilation, another attempt at tracheal ventilation. Endless cycles. Increasing desperation on the faces and in the actions of the doctors and nurses, whilst all the time, Charlie’s parents looked on, helpless and distraught.

We couldn’t resuscitate him. For a few seconds at a time he looked as if his colour was improving when he was given oxygen, but it was never sustained and after an hour, we had to admit defeat.

We moved The Knights to another room. They couldn’t bear to be in the same room as the body of their baby son. He was so beautiful, so perfect in every way, to all intents and purposes, just sleeping peacefully. We wrapped him in the shawl that they had brought with them and laid him in a moses basket.

I went and sat with The Knights and held her hand, husband angry, pacing the room, wife shattered, speechless, motionless, numbed with grief. “Would you like to see Charlie?”. They reacted in horror. To see him would be to accept that he had died, he couldn’t be dead, they wouldn’t let him. We sat. I tried again. “He’s so beautiful, would you like me to at least bring him in so you can see him, you don’t have to hold him.”

I carried the moses basket in and put it at the foot of the bed. Gently I lifted their lovely little boy out, swaddled tightly in his shawl. He looked so peaceful, they wanted him so badly to just be asleep. I sat next to them and cradled Charlie in my arms. Stolen glances towards the bundle in my arms, then Mrs Knight could bear it no longer. “Can I hold him now?”

I left them, Charlie in his Mother’s arms and with Dad’s arms wrapped tightly round the two of them…..

Charlie, postmortem was diagnosed with Hypoplastic Left Heart Syndrome & Tracheo-oesophageal Fistula, hence the difficulties in ventilation and his momentary resuscitation improvement.

Learning and practising medicine is full of highs and lows. Some memories stay with you forever…..

 

 


Bloody Women

It’s not often that I’m speechless, but credit where credit’s due, the esteemed Professor Meirion Thomas managed to silence this gobby female this week (for a few minutes anyway). The aforementioned, brave, though some might say, foolhardy soul, was standing up, courtesy of that paragon of English journalism, the DM (like Voldemort, I dare not say its name) and was waging war on female doctors, female GPs in particular.

I won’t dignify the piece by linking it, but a few of its pertinent quotes include:

“By 2017, for the first time, there will be more female than male doctors in the United Kingdom.”

“I fear this gender imbalance is already having a negative effect on the NHS. The reason is that most female doctors end up working part-time — usually in general practice — and then retire early.”

“Given that the cost of training a doctor is at least £500,000, are taxpayers getting the best return on their investment?”

“In truth, general practice is organised for the convenience of doctors — particularly, I suspect, for female GPs — and not their patients.
No wonder many people, faced with a medical problem, ignore their local surgery and go straight to A&E — one reason why emergency medical services are at breaking point.
The problems with A&E are very much in the public eye. Not so the issue of part-time working — but it certainly should be, as it is linked.”

You can’t argue with the statistics; there are more women than men who work part-time and yes there are more women than men in General Practice, but it is for the time being a reality that women bear the children and in the main, when it comes to choice, are the ones that take a career ‘backseat’ to look after the little rug rats. Sometimes it is the woman’s choice, often I think, it is the couple’s choice and frequently it is because the woman earns less than her partner. Whatever the reason, it most certainly is a choice, perpetuated by the society we live in and thank goodness we are lucky enough, in the main, to have that choice.

What I actually took exception to, was that there are obviously still bigots in the medical profession who differentiate between male and female doctors. Doctors of both sexes work part-time. Indeed, the definition of ‘full-time’ working in medicine is one of conjecture. I would hazard a guess, that Professor Thomas’s ‘full-time’ working week has involved rather a lot of successful private practice. However, one’s achievement in the medical world shouldn’t be about gender. I consider myself a successful doctor, not a successful female doctor.

I had a rather unconventional start in medicine. I was married when I was 21 & had my first child when I was at medical school. Ok, it wasn’t a planned pregnancy, but it was no less wonderful an event for all that.
I had to take a complete year out of Medical School and on my return, first firm, Monday morning, my consultant said, “so which one of you idiot women has just had a baby?”. Let’s just say he didn’t make a similar comment again and I still got an A!

I passed finals with an eighteen month old in tow and did house jobs, working a full 1:3 rota with my young child. My husband was my rock and still is. We celebrate our 25th wedding anniversary this year. I have always worked full-time and am a mother of three; our choice, our joint effort.

I am no feminist heroine. Check out my avatar. I embrace being a woman & my sexuality, but it plays no part in me being a doctor. My ‘female characteristics’ may make me more caring and empathetic, who knows, but more importantly who cares.

At some stage, we may have to look at work force planning, taking into account likely working patterns, but I hope any discussions will be based on the reality that, for the time being women will not pop children out into vast incubating areas and immediately be forced to return to work, but rather be a considered evaluation of the needs of the NHS and patients coupled with the needs of 50% of its workforce. After all, being ‘a good doctor’ is multifaceted, but what it certainly isn’t is gender dictated………

(Perhaps the illustrious Professor should retire early….)


Man or Machine: The Downside of Empathy

Sarah was 29 years old and arrived with her mother. I’d last seen her for her postnatal check a few months before, when she attended with her new baby son, 4 year old daughter and doting husband. Mark was 35 and together they made the perfect nuclear family.

I’d seen Mark a few weeks earlier, with a worrying set of neurological symptoms and had referred him urgently to the local neurologist; I hadn’t heard back yet following his appointment.

As soon as she entered my room, Sarah collapsed into the chair and burst into tears. Her mother held her whilst she keened, like I’d only seen Muslim women do, after the loss of a loved one. Between sobs, she managed to tell me that the neurologist had told Mark that he had Motor Neurone Disease. My worst fears realized………

I held her hand as she wailed and told her that I would be there for them both, that we would get through it, that hope was not lost, that we needed to be strong for Mark. All the time I was struggling to keep my voice from breaking and keep the tears from my eyes. I had never seen such raw grief.

For the first time in a long time, I needed timeout after the consultation. A chance to regain my composure, reapply the professional veneer, time to prepare for the next ‘10 minute’ consultation.

Roll time forward 4 years………

This time the consultation was in their own home. I had come to discuss end of life care. We sat, Sarah, Mark and I, discussing the probable mechanism of his death, where he wanted to die, how he wanted to die, still a young couple, with a young family, but with no family future.

“How do you do this?” Mark asked. ‘How do you cope with these kind of conversations week on week?” It was humbling; we were discussing his death after all, not my job requirements. “Somehow you just do”, I said. “Somehow you just learn to separate your own emotions, otherwise you wouldn’t be able to do the job. There have only been two occasions in my career when I’ve not been able to hold the act together,” I said, “when the pain was too much for me too”.

Sarah looked at me. “One of those times was with me, wasn’t it?” she said. I looked at her startled. “I remember it as if it were yesterday”, she said. “I could see you struggling not to cry and I thought God if my doctor is crying, it must be bad, really bad. I needed you to be strong then, strong for me…………”