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The emotional toll of being a doctor

Junior doctors contract roadshow, St Mary's London, 16 June 2016

Doctors are human too.

It's a simple fact that can be overlooked when they are subject to impossibly high standards and intense demands.

Those who forget that doctors think, feel and react like other human beings are often doctors themselves. Experiences can be shut out, buried, or laughed off with a little black humour and a reflection that it's all in a day's work.

For some doctors, this can be an effective strategy. Others suffer, which can be compounded by outdated beliefs that they've just got to get on with it.

The BMA's Doctors for Doctors unit asked members for examples of the emotional impact of practising medicine. The case studies below aim to reduce the stigma around doctors' health issues, and help increase understanding that doctors are not alone in having to cope with the unique pressures that their vocation brings.

We are very grateful to the doctors who have contributed their experiences. They are published with permission, some with pseudonyms.

If you have been affected by any of these issues and feel you would like some support, we can help.

Contact our Doctor advisor and counselling service

 

  • My first mistake

    It was 5am on a typically busy night-shift in A&E and I'd been clerking non-stop for seven hours. Tired and grumpy, I picked up the next set of notes from the triage pile, which never seemed to grow any smaller.

    Cynthia was complaining of fatigue and flu-like symptoms. As I examined her, my mind wandered to the queue of patients still waiting to be seen, and I longed for even just five minutes of respite to make a quick cup of tea or get a glass of water. Finding nothing of note, I discharged her home with some simple self-treatment advice.

    The following evening, I opened my textbook. With my membership exam imminent, I was hoping to fit in a few hours of study before my next night-shift. 'Guillain-Barré syndrome,' the title read. Cynthia's image flashed into my mind. My stomach clenched. Oh god, how had I missed this?

    I quickly scanned the page - the contents of which I already knew by heart. The fatigue, the weakness, the diarrhoea a few weeks previously - she had Guillain-Barré syndrome.

    My heart raced. I read and re-read the page, hoping to find something that didn't fit, that would prove me wrong. But all I could see was the mother of three, who might now be critically ill or worse, thanks to my utter incompetence. She had a potentially fatal neurological condition, and I had sent her home with advice to stay in bed and take paracetamol.

    Arriving at work, I searched frantically for the on-call consultant. 'You're right', he confirmed, listening to the panicked words tumbling from my mouth. 'She came back in this afternoon, she's in HDU.'

    I felt like a lead weight had dropped into my stomach. My worst fear had been realised. I had missed an important diagnosis and my patient was now seriously ill. The guilt enveloped me, suffocating all other senses.

    As the consultant re-read my clerking note, the perfectly documented Guillain-Barré history, I could feel myself crumbling with shame. What had I been thinking? My whole vision of myself as a competent doctor lay shattered in pieces on that emergency department floor.

    Entering the HDU, there was Cynthia, sitting up in bed. 'She's doing fine,' the registrar told me. 'She'll be moving to the ward shortly'. The wave of relief was like none I had ever experienced.

    The vice-like grip around my heart loosened and I could suddenly breathe again. I sat down at her bedside. 'I'm so sorry,' I managed, mortified to voice my failure. 'Don't worry,' she smiled, 'trust me to have something so rare'. Her words were generous, her kindness overwhelming.

    The fear of making a mistake is a routine part of medical life. The gravity of dealing with human lives is so immense that this fear is not only natural, but important and instructive. It is the fear of getting it wrong that keeps me diligent and thorough, and is an inevitable consequence of caring about my patients.

    Cynthia was my first medical mistake, one over which I self-flagellated for many months, but sadly it will not be my last. Despite our characteristic perfectionism, we doctors are only human, and mistakes are inescapable sequelae of our humanity. But such mistakes are not futile, and I will never forget the lessons I learned from Cynthia, or miss a diagnosis of Guillain-Barré syndrome again.

     

    Emily Claire Vincent is a gastroenterology registrar. She writes under a pseudonym. The article refers to an experience she had as a foundation doctor.

    Read a different doctor's blog post on a similar issue

  • Haunted by a complication

    A baby I operated on had a post-op complication. I had gone back to correct a minor problem, then this unusual and unwelcome surprise.

    The child's family were understanding, so kind to me. Lucky child, to have such lovely parents.

    At the time, I was pregnant. For the first few days, I didn't think about it that much, then I started seeing flashbacks at a pregnancy yoga class when we were supposed to be visualising floating through a rainbow, then whenever I tried to relax on the sofa at home, whenever I woke up at night.

    Most expectant mothers wake often at night; I was waking in tears. I had spoiled someone else's beautiful baby. In the morning I would look down on my sunny garden out of the window and think about how I had certainly spoiled this young person's enjoyment of his life for ever, and cry again.

    Of course I had explained what had happened to the parents, but I felt they couldn't possibly understand how bad I had made it.

    I went over and over my decision-making, how I had turned a mild problem into something with much more lasting consequences. How could I have done that? What was I thinking when I decided to operate a second time? Was it hubris, subjecting a baby to another general anaesthetic and hospital admission for my desired perfect outcome?

    I went over each step of the operation again and again. What if I had done less, a smaller second procedure, would the complication still have happened? If only I had just waited. I was afraid being 'found out', of losing my job, on which my family depends; of GMC proceedings, of going to prison.

    My husband thought I was exaggerating; I really meant it. In the run-up to maternity leave, I had to hand all my patients, including this one, to my colleagues. Surely they, also, would realise I was not up to the job, and I was afraid of sharing with them.

    My patient's problem had settled by the time I delivered. I still don't know what permanent consequences there might be.

    My wonderful midwife reminded me that you can't control all outcomes, that the complication was exceptionally rare. No doubt she knows this very well. She said I was going through a grieving process. With a little more hindsight, I think that was right.

    After my own baby was born, I still thought of that family often: how awful it is to fast a young baby for a general anaesthetic, to come into hospital at all, and did I really have to make them come again? When my child reached the age at which I had treated my small patient, I felt sad, wondering whether the child would ever be as good as they perhaps might have been, had I stayed my hand.

    I still think about this baby often, though without such distress now. Perhaps only doctors know what this is like. Maybe now I will be able to help someone else.

     

    Elizabeth Melton is a consultant. She writes under a pseudonym.

  • How I got through a crisis

    I wanted to write anonymously about my experience of being referred to the GMC and calling the Doctor Support Service because, when I received the letter I genuinely thought my life would completely fall apart and that I would never be able to cope with this, but although it is a bit of a challenge, I am definitely OK.

    A bit of background - I am an SHO and I was an SHO at the time of the incident.

    I recently received a letter from the GMC. The letter related to a clinical incident that occurred over a year ago in which a patient died. I had given a statement more than a year ago to the trust I worked in at the time and heard nothing since. The letter therefore came as a shock.

    On receiving the letter I worried about being suspended or never getting a job once I had finished my training. The fact that I had been using work as an escape from personal problems did not help things. I did not know how I would deal with this as well as my personal problems.

    I had been thinking about suicide but had been fighting those thoughts for a long time. Being referred to the GMC did not help, because I was convinced that now I had failed as a doctor as well as in my personal life. I felt too ashamed to confide in friends or family.

    I had in the past been told about the Doctor Support Service. I called the number because it meant I could talk to someone I did not have to ever meet face-to-face, so I felt it would not matter as much if they judged me.

    It was very helpful for several reasons.

    Firstly, I could not face looking through the letter from the GMC again. However, the doctor at the end of the phone asked me to read through the first page. After going through it over the phone, I realised this was a preliminary investigation. The doctor explained that this case may well be closed by the GMC without even progressing to a full investigation.

    Secondly, I really couldn't think clearly; the person I spoke to convinced me that speaking to my defense union would help me feel calmer because I would start to feel in control.

    Finally I didn't feel judged when I spoke about the complaint. This was really helpful because when I went to work the next day, it was difficult to concentrate; but I felt able to tell a nursing colleague and request them to double-check prescriptions and other things with me, meaning I was safe at work.

    Two days later, I spoke to my defense organisation. They said that it may progress to a full investigation. This was difficult to hear. Again, because I was made to feel like this is not something to be ashamed of, I was able to speak to a colleague; this time a doctor who was senior to me; being able to vent my emotions again allowed me to work safely.

    With regards to the clinical incident, I had believed my actions to be appropriate at the time. Now that the GMC was involved, I started to question all my clinical decisions. I felt like I was over investigating patients and causing them and myself unnecessary anxiety. I spoke to the doctor about this and it was useful to know that this is quite normal and that it was OK to ask for a second opinion.

    After speaking about this, I felt able to speak to my educational supervisor very openly and also to my clinical supervisors because I realised it was best to ask for help with this issue. Again, people were much nicer than I expected.

    I still feel embarrassed when asking about simple clinical scenarios because I worry the doctor I am phoning must think I don't know anything; but I phrase it as: 'Sorry to bother you, it's been one of those days, I apologise for this'. I still don't like that I am not as decisive as I was, but I am hoping this will come back with time.

    As a trainee, I have always disliked writing formal reflections. My reflections were usually something like: 'I was nice to the patient. The patient was therefore happy. Learning point: Be nice. The end'.

    My educational supervisor asked me to write a formal reflection on how I would ensure I would not allow this and the personal issues to affect my fitness to practise. This was useful for two reasons, firstly, the GMC can see that I am self-aware; secondly, writing quite openly about how I would deal with this has helped me remain calm.

    I also really want to highlight two other amazing sources of support I had. There is a forum on Facebook called 'Butterfly', it's a closed group for NHS staff who have been faced with an investigation. Talking to people on there also calmed me down as I was reassured that being investigated is unlikely to stop me getting a job (as it has not stopped others) and I was reassured that no one would judge me.

    There is also a forum called 'Tea and Empathy'. It has 2,000-plus members who are mainly doctors but also other health care professionals. It's a great source of support for work related issues, life issues and health issues. You can post anonymously or ask someone and also message other people in similar situations.

    Both these forums made me feel less alone. Also, my current supervisors felt unable to comment on the clinical issues as this was not their area of expertise; using the 'Tea and Empathy' forum, I was able to talk to a senior doctor working in the specialty where the incident occurred and ask her to critically review my reflections on the incident (my thinking was, better people criticise me now so that I am self-aware and show insight if I have to talk to the GMC).

    Having talked through the GMC referral with my defense organisation and the Doctor Support Service and also receiving support from colleagues and the Facebook forums: I had realised all that was required was that I was self-aware and showed insight into what I had learnt from the investigation.

    Of course I have not heard from the GMC yet - but I am thinking, if I do not appear defensive, if I state what I have learned (even if you do not feel it is your 'fault', there is always something to learn) and if I state that I have had this in detail with people responsible for my training and taken all relevant advice from them, what could the GMC actually do? Hopefully very little.

    Of course if they do take action, at least I won't be dealing with it on my own.

    The most important thing I have learnt is a GMC referral is nothing to be ashamed of. You cannot stop someone complaining. If I am not judging myself it makes it very difficult for friends, colleagues and potential employers to start judging me.

    I hope the GMC continues to fund the Doctor Support Service. Speaking to someone helped me stay safe at work, reflect on the incident and show insight - which are all the things they want doctors to do to protect the public.

     

    Marianne Poirier is a junior doctor. She writes under a pseudonym

  • Six questions that made me cry

    I've recently had the most difficult conversation of my whole medical career.

    It was a meeting with an upset and worried relative. A relative who was overwhelmed by the enormity of the illness in his loved one. A relative who was upset and anxious about why doctors hadn't been able to heal, or cure, or provide certainty in an uncertain world. A relative who had watched his loved one transfer through four different trusts, numerous consultants and a year in hospital, yet still didn't feel that he had been spoken to or had an explanation of what was going on.

    He knocked on my office door and handed me a typed letter, outlining six questions he would like answered. This was, of course, at 5.30pm, when I was already late to pick up the kids.

    The thing is, he was a kid himself.

    A 10-year-old boy, concerned, confused and worried about his mum. Questions with impossibly hard answers. Questions I didn't have answers for, but questions he needed answers to.

    The truth was awful, the prognosis dreadful. The wider family trusted me. I had spoken to them at length.

    I had to do right by this little lad. I had to tell the truth, as this is what he was desperately seeking. I also had to ensure that this was not the moment that crushed him of all hope.

    The responsibility was huge. I was overwhelmed. My own 10-year-old was carefree, and her worst fear was not making the hockey team.

    I ran that night. My fastest ever 2km. In the dark, as my 10-year-old did hockey training. I'm not sure whether it was sweat or tears that ran down my face.

    I sought help and advice. Hospice, psychology, chaplain, the Internet, a charity and a well-known medical online forum.

    I fretted for a week. I prepared. Quiet room, props, written answers, easily understood language. Chocolate.

    There were tears. Too much chocolate was eaten.

    We made it to the end of the list of questions.

    I called his family next day to check he was OK. Caring friends texted me for the same reason. Colleagues stayed late to let me 'debrief'. A friend offered to come round with wine.

    I sought solace in yet more chocolate, a large gin and an episode of Bake Off.

    The little lad is coming to see me again this week. I hope he's not broken.

     

    Marina Platts is a consultant in rehabilitation medicine in Yorkshire and the Humber.

  • A feeling of rejection

    My husband was terminally ill. We experienced several hospitals, one of which was part of the trust that I had worked for until a hasty retirement, as he became sicker.

    The technical care from specialists was excellent, care at ward level was variable and communication between hospitals almost non-existent. But what hurt somehow was that there was no acknowledgement that I had recently been part of the trust, it felt like being rejected from home.

    I was not asking for better care for him than for anyone else, just a feeling of 'welcome back', and that after nearly 20 years as a consultant I hadn't ceased to exist.

    I realise that I was mourning my job and my husband at the same time, and may not have been quite rational. But isn't dealing with irrational emotions part of healing? And it can be done, the Macmillan team managed it!

     

    Eileen Barber is a retired sexual health consultant. She writes under a pseudonym.

  • A brave death

    The following case is without question the most shining act of selfless bravery that I have ever witnessed.

    The patient in question was a 50-year-old gentleman (Mr SS), who had suffered a C5 spinal injury in his early 20s. I met Mr SS on ICU after he had unfortunately developed a hospital acquired pneumonia. He required invasive ventilation and the subsequent long respiratory wean resulted in a tracheostomy.

    His recovery was blighted again and again with repeated respiratory infections. It soon became clear that he would never be able to successfully wean from the ventilator and surviving this admission was looking less likely by the day. Several difficult conversations followed during which Mr SS expressed his opinion that being ventilator dependant and the further anticipated gradual respiratory decline would not provide him with a satisfactory quality of life.

    Mr SS made the decision that he would like the ventilator support to be withdrawn. He also declared his desire to be an organ donor. Over the course of the next week, several more conversations ensued between Mr SS, the medical and nursing team as well as the expert input from the SNODS (specialist nurses in organ donation) team. Once capacity and consent issues had been clarified, a withdrawal and organ retrieval plan was decided and documented. Ventilatory support would be withdrawn later that day, once the organ retrieval surgical team had arrived.

    I came on for the night shift at 8pm to receive the ICU handover. There were no specifics to the plan documented, just to provide symptomatic relief post withdrawal. Slightly alarmed by this, I went to speak to Mr SS and review the 'plan'.

    Despite the tracheostomy, after such a long ICU stay, we were now able to communicate pretty clearly with each other. I was amazed at how calm, how at peace he seemed. In fact, he seemed positively jolly, definitely the happiest I had seen him since meeting two months previously. Even more surprisingly he remained in this upbeat state even after I explained my concerns to him about the 'plan'.

    I was worried about how distressing the symptoms of sudden withdrawal would be. I was also acutely aware of the thin legal line that I would be treading, premedication measures would have to ensure his own respiratory drive was maintained at the point of withdrawal. Mr SS actually ended up reassuring me about the plan.

    I noticed he had a solitary bottle of lager on his windowsill. He had been deemed 'feed at risk' by SALT, but with all things considered I thought the benefits now outweighed those risks! I offered to chill it in the staff fridge whilst I discussed my withdrawal strategy with the on-call consultant.

    Whilst waiting for the organ retrieval team, I watched from a distance as Mr SS (with help from his nurse) enjoyed his beer, surrounded by his loved ones. He was tranquility personified, despite knowing that the surgeons could arrive at any moment and then soon things would all be over. It was incredible to observe.

    At near midnight, the time finally came. Speaking to Mr SS alone I went through the plan again and gave him one last chance to change his mind. He looked me dead in the eye, smiled and mouthed to me 'get on with it'.

    Mr SS passed away 15 mins after the ventilator was withdrawn, surrounded by those he cared about most. He was strong and dignified right to his last breath. I like to think that with the pre-emptive and symptomatically administered drugs, he suffered very little, if at all. I hope so anyway. It was one of the (very rare) occasions that I momentarily wished the law permitted us more allowance to avoid unnecessary further suffering.

    Mr SS successfully donated both of his kidneys, his heart valves and his corneas, transforming the lives of several unknown, no doubt very thankful individuals. The ICU and SNODS teams were all deeply moved by Mr SS's selflessness. I felt incredibly well supported by all involved, but I am not ashamed to admit to shedding a tear or two later that night whilst in my on-call room. I did so again whilst sipping my own beer several days later, after finishing that run of shifts. Cheers Mr SS.

     

    Marc Fadden is an ACCS Anaesthetics CT3 in West Yorkshire.

  • Finding the hard but right answer

    During my first week as a foundation doctor, we found out that my dad's renal cell tumour had metastasised to his liver, lungs and bone. By the time I started my final FY1 job in respiratory, he was reaching the end of his life. I was fortunate enough to receive overwhelming support from my team and educational supervisor, enabling me to get home to spend the last two weeks of his life with him, and to help my mum care for him. I found some comfort in the fact that my dad had a peaceful death surrounded by the people he loved the most, but all too soon I was back at work, caring for other people's relatives.

    Every doctor has at least one patient whose name and face is burned into their memory.

    For me it was the 51-year-old man who came in short of breath the week after I started back at work. I stood with the registrar as she broke the bad news to him and his family. She was excellent and ticked all of the 'breaking bad news' boxes that get drummed into us during our training, but there was no disguising the facts - he had cancer, lots of it, and there was likely no curative treatment.

    Later that afternoon I had a rare moment of solitude in the usually busy doctors' office, writing discharge summaries. There was a knock on the door and my patient's 19-year-old daughter came in. She needed to talk to someone she said, she had some questions.

    With a sinking feeling I invited her to sit down, and she burst into tears. How was she going to cope without her dad, she asked me. How were here two younger siblings going to react? How would her family survive without their rock keeping them all afloat? I was (unusually) speechless. Here was this girl about to go through exactly what I was going through, but I was her dad's doctor, not her friend. How was I supposed to answer her?

    I've thought about that moment a lot since that day. Should I have immediately found someone else to talk to her and answer her questions? Or was I in fact the best placed person to provide her with the support she so desperately needed?

    As a doctor I wanted to explain that her dad needed more investigations, he needed to be seen by the oncology team and very probably the palliative care team and they would sort out what medications he needed, and provide the family with information regarding the support they needed, where to get it and when.

    As a daughter I wanted to tell her that losing her dad would be the scariest thing that had ever happened to her, but she would get through it, and she was strong enough to support her family too. To tell her to spend as much time with him as possible, not dwelling on the fact that he was unwell, but making more happy memories in the time she had left with him.

    I struggle now to remember exactly what I did say, it was a bit of a blur, but I think it was somewhat of a mixture of the above. I remember being careful not to tell her my own experience - this wasn't about me, it was about my patient and his family.

    More than two years on now, I really do believe that losing my dad has helped me become a better doctor. The concept of a 'dignified death' is easy to understand, but in reality it is harder to achieve. As a physician I pay attention to the more 'minor' symptoms of terminal illness, such as mouth ulcers and hiccups, which can be terribly debilitating, especially when a patient's oral intake is already poor. I have a much lower threshold to phone families than I used to, as I understand you would much rather have a 'false alarm' than miss being with a loved one when they are becoming more unwell or dying.

    As doctors, people place so much faith in us and our opinions. Taking the time to sit with a family and explain what is happening, why it is happening, and what to expect in the near future might make you leave work 20 minutes late but that time will be invaluable to that family, and will make their experience more bearable. To us, that is just another patient, but to them this is their parent, child, spouse or sibling, and your face may be the face that stays with them for ever.

     

    Alison Burridge is a Core Medical Trainee in Wessex.

  • There is hope after burn-out

    In July 2014 an article titled 'Resuscitation, Remedy and Respite' was published in the Voicebox section of the BMA News.

    This article was based on my personal and emotional journey over a period of years up through the medical hierarchy, to the point of burnout; after which I took a year out of programme.

    The article was written during my year out of programme, which provided an opportunity away from the clinical environment to reflect on events. As a creative person, I would say that it was written as part of the healing process after the exhaustion of the previous years. At the time, I was still in the process of coming to terms with having fallen off, albeit temporarily, the medical ladder.

    I was justifying my reasons for time out, accepting events and beginning to rebuild self-confidence as a doctor and also a human being, as for some of us our sense self has become closely tied with how we feel about ourselves as doctors.

    I attributed my exhaustion and end desire to leave medicine to a concoction of factors.

    Poor staffing levels and an inability to finish shifts on time eventually infringes on your personal life. This in turn can affect revision time and exam progress as well as time available to spend with people you love - sometimes at critical moments. In turn, this can influence how you feel about who you are and what you are achieving. Medics are high-achieving, and failing at your own self-set high expectations can also lead to disappointment.

    Currently, two years after this experience I am working on a flexible basis. Over the years I am glad to tell you I have achieved my key aims of passing membership exams, attaining a specialty registrar job in my first choice region, and now knowing the research area I wish to pursue.

    Needless to say, along the way there have been challenges; tricky events, trying people, and emotional responses. However, I have learnt to appraise my past experiences in a more positive light. I better understand my personal strengths. I accept that I have areas requiring improvement. I have understood how important a balanced outlook to life, supported by mentors, family and friends is.

    There is still a fear, which lurks inside me, a shadow of events gone, and worries about history repeating itself. But it is possible to rationalize and manage it, to implement what I have learnt, and to counteract that negativity.

    Since these experiences, I have become acutely aware of other doctors' behaviour. I pick up more readily the signs of exhaustion, irritability, and reducing enthusiasm. I hear stories of dissatisfaction, desires to change specialty, even leave the profession. This is because of my own experiences.

    I would like others to know that they are not alone or failing because of feeling that way. They should not blame themselves, or face the threat of losing their original selves. That there is a possibility of hope, rekindling interest and continuing.

     

    Alison Silver is an ST3 at London Deanery. She writes under a pseudonym.

  • A crash course in being a patient

    My first day as an anaesthetist, after the 1969 flu epidemic, I was sent to a patient having difficulty breathing. 'Just go up and let us know what you find.'

    A female apneic, hand-ventilated by the sister, a veteran of the Queen Alexandra's Imperial Military Nursing Service from the Second World War. She told me to b***** off and find a real anaesthetist.

    I was set to watch over this poor soul, intubated and tracheotomised, connected to a ventilator the size of a car. I was there, off and on, for the best part of a month, until she showed some signs of recovery. She left in a wheelchair two months later. I marked acute Guillain-Barré syndrome as something better not to get.

    One day in 1994 I was driving home when I noticed tingling in my hands and feet. By early evening it was difficult to stand up, and touching things felt like gripping barbed wire, the symptoms were in a perfect glove and stocking distribution. No need to bother the GP; no neurology at the local DGH, so I got my wife to drive me to my own hospital and arrived in A&E and called the physician, who was thrilled to hear that the Director of Anaesthesia had acute GBS.

    Within hours I had the mobility of Flipper and a strange buzzing sensation in my chest as various intercostal nerves fell out of use. In two days I only had my diaphragm and throat muscles and was scared by the discussion round the bed to choose which type of tracheostomy. They wanted to cart me off to the university where I feared I would be just another GBS. If I stayed, I knew it would be very bad form to lose the boss.

    Then a miracle occurred: they had already been filling me with gamma-globulin because I presented early with the diagnosis. Respiratory function started to improve, and by the end of the week I could flop my arms about though without proprioception.

    I was in the rehab unit for the next two weeks, and felt so sorry for the other patients who strove so hard after their strokes, whereas I was carried in at the beginning of the fortnight, and walked out with a stick at the end.

    Few ITU consultants have had a crash course in being a totally helpless patient, and come out of it completely well. I knew that GBS had a significant morbidity and mortality: this concentrates the mind and has had a lasting effect on my attitude to patients, relatives, and my colleagues: empathy and gratitude. I found, when swinging helpless and naked on a hoist, embarrassment is an unnecessary luxury.

    Strangely, although I wanted to help with the GBS society, I feel fraudulent having recovered so completely that it would be cruel to parade before patients who are permanently disabled.

    For the last 17 years of my career this single episode has contributed more to my understanding of the personal side of critical care than any other experience.

     

    Douglas Newton is a retired Clinical Director of Anaesthesia.

  • Giving bad news

    I had to explain to a patient and their relatives that the patient was dying. I led the conversation gently and explained what we thought was going on and that it was very likely that he was entering the last few hours of his life.

    His wife and daughter said: 'Thank you for being so honest'. A moment later, they told me: 'You must have the worst job in the world, you're tired, it's the middle of the night and here you are telling complete strangers that they're about to lose a loved one'.

    Then, that spell was broken, I was no longer just a doctor to them, they gave me a hug. They apologised that I'd had to come and tell them what they already knew, but didn't want to admit.

    What more compassion and empathy could you ask for, not from your doctor, but from your patient's relatives? I cried silently whilst the chaplain read the last rites. I cry again now because I can't bring the patient's name to memory.

     

    Lynne Sykes is an ST5 Medical Registrar in North West Deanery.

  • Don't be sad mummy

    I am a paediatrician and my practice involves efficient communication with both children and their parents and carers. This is a skill that I learned and am still learning.

    Quite sometime back I was an SHO in paediatric oncology at St James's Hospital in Leeds and was attending a child with an advanced stage of neuroblastoma where further treatment was considered futile. His mother was in agreement with the oncology team that palliative care was the only option left.

    I was visiting the bedside during the evening round and I heard the child telling his mother to not to feel sad and sorry as he would be there in the sky, and whenever she would miss him in the future, all she would need to do was just to look up and he would be there for her. The belief and resolve was strong, and very 'matter-of-fact'.

    His mother could barely hold her tears and came out to the corridor. As a trainee doctor I did not have enough knowledge or confidence to say anything, but I felt awful. Instinctively I followed her out of the room and just stood there by her side in silence till she said 'I am OK'.

    We both stood there just outside the ward in the corridor in silence for about 15 to 20 minutes without saying a word. I could sense her grief and I felt terribly sorry as I could do nothing to help her. I did not see the family again after I returned for the day shift. Then I received a card after many months: 'Thank you for being there on that night; though you did not say any words, I heard it all that you wanted to say'.

    On that day I learned that we are doctors by profession but human by emotion. There are situations when our human instinct takes over and just guides us through the most difficult communication where the spoken words are meaningless and silence is more powerful.

     

    Tushar Banerjee is a Paediatric Consultant in County Durham.