nhs, Uncategorized

Shine bright like a diamond

Happy New Year!

We haven’t exactly got off to a flying start.  To be honest the NHS is usually hit pretty hard at this time but nothing like we’ve experienced this year.   However I don’t want to waste what precious time you have talking about the flu or the so called ‘NHS crisis’.  It’s well documented and I’m pretty sure most of you are still in the midst of it.

No, what I’d like to talk about are the conversations I’ve had.  While it’s felt like working in a pressure cooker at times, it is this pressure that can turn a black situation into a gem.  You just need to see its potential.

For example, talking about death.

As a Geriatrician it comes with the territory.  However if you ask hospital doctors or nurses, most of these conversations are had with people who we know are going to die.  What do I mean by that?  Those with a cancer or a progressive chronic disease like heart failure or COPD.  It’s expected and we’re comfortable in talking about it. What we’re not so good at is when the person doesn’t fall neatly into one of those categories.

How do you tell someone they may be dying  when they’re alert, not confused and want to know why they’re not getting better?

To look someone in the eyes and tell them ‘I may not be able to make you better’ when that’s what you’ve been trained to do is hard. However I have always taken the view that I don’t want the person (or their family) to be surprised. I certainly don’t want to deny what time they might have left by not being as honest as I can.

I think it would be fair to say that as doctors we tend to shy away from these kind of conversations.  There is a gradual shift in this however as people are becoming more comfortable with being uncomfortable.

Some time after I listened to a podcast with Dr Jil Bolte talking about her book ‘My Stroke of Insight’.  In it she spoke about how she lost the power of speech and understanding due to an intracerebral haemorrhage.  The part of her brain that dealt with perception of tone, intonation was still there.  What struck a chord was the way she spoke about people including doctors needing to ‘show up’  when they came to see her.  Don’t just go through the motions but really connect for the time you’re in the room.

This may sound an obvious thing to say but working in such a pressurised environment it’s something that’s easily forgotten.  Not on purpose I might add.  Its just we become very task orientated when the place is so busy. I totally understand how that may come across but do not confuse it with not caring or not doing a good job.  It’s just sometimes there is very little left to give.  You need energy to make a connection or have an uncomfortable conversation.

On that note she spoke of being accountable for the energy you bring to the room.  So with that in mind I try hard (not always successfully) to leave whatever baggage I am dealing with at the door.

It then becomes about compartmentalising. How do you teach that?  I’m not sure you can to be honest.  Stopping to reflect is key.  Even mid ward round.  I’ll often throw out questions with no expectation of an answer. It can generate some interesting discussion though.

It was during one such conversation I was reminded by one of the FY1’s that medicine is taught as black and white but life and people are colour.  You need to allow for that.

So that’s whats made this flu crisis so interesting in some respects.  People are being forced to behave in ways they don’t like or are used to. They’ve had to not only show up for the patients but also their colleagues.

One things for sure people are having to dig deeper to find that reserve.  Let’s see if 2018 will lead to something more sustainable for the future……

2 thoughts on “Shine bright like a diamond”

  1. I agree with you re the binary nature of how medicine is taught (and sometimes regarded). In area I’ve seen it in is when patients who have a DNACPR have an unstable tachyarrhythmia – do we perform DC cardioversion or not?
    The form is regarded as a simple “treat or don’t treat” in some instances and by some members or staff, when actually there are great subtleties to it. A patient with metastatic cancer and a prognosis of 12 months may ask to be not subjected to any dramatic and futile CPR, but if they develop e.g. refractory hyperkalaemia from obstructive renal failure secondary to the tumour, then should we at least discuss filtration? If they develop third degree heart block, shouldn’t we think about pacing them? And are we involving the patients in these discussions enough?
    Thank you for your insightful post.
    (P. S. did you ever work at Crosshouse Hospital? I think I may have been your medical student there a couple of years ago. Nice to see you again!)

    Liked by 1 person

    1. Hiya! Yes I was at Crosshouse until couple years ago. Thanks for your comments – I agree its not a black or white decision. I think we don’t talk about it enough tbh. When I say we I don’t just mean people in healthcare but families and friends too. Would certainly make these difficult conversations more comfortable. Hopefully in time they might even be perceived as normal…


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