If you continue without changing your settings, we’ll assume you’re happy to receive all cookies from the BMA website. Find out more about cookies
When you visit any web site, it may store or retrieve information on your browser, mostly in the form of cookies. This information might be about you, your preferences or your device and is mostly used to make the site work as you expect it to. The information does not usually directly identify you, but it can give you a more personalised web experience.
Because we respect your right to privacy, you can choose not to allow some types of cookies. Click on the different category headings to find out more and change our default settings. However, blocking some types of cookies may impact your experience of the site and the services we are able to offer.
These cookies are necessary for the website to function and cannot be switched off in our systems. They are usually only set in response to actions made by you which amount to a request for services, such as setting your privacy preferences, logging in or filling in forms.
You can set your browser to block or alert you about these cookies, but some parts of the site will not then work. These cookies do not store any personally identifiable information.
These cookies are required
These cookies allow us to know which pages are the most and least popular and see how visitors move around the site. All information we collect is anonymous unless you actively provide personal information to us.
If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance.
These cookies allow a website to remember choices you make (such as your user name, language or the region you're in) and tailor the website to provide enhanced features and content for you.
For example, they can be used to remember certain log-in details, changes you've made to text size, font and other parts of pages that you can customise. They may also be used to provide services you've asked for such as watching a video or commenting on a blog. These cookies may be used to ensure that all our services and communications are relevant to you. The information these cookies collect cannot track your browsing activity on other websites.
Without these cookies, a website cannot remember choices you've previously made or personalise your browsing experience meaning you would have to reset these for every visit. In addition, some functionality may not be available if this category is switched off.
Our websites sometimes integrate with other companies’ sites. For example, we integrate with social networking sites such as Twitter and Facebook, to make it easier for you to share what you have read. These sites place their own cookies on your browser as a result of us including their icons and ‘like’ or ‘share’ buttons on our sites.
Eating is something most people take for granted. It’s true that in the life of a busy junior doctor it can sometimes be hard to find time to stop for food, and we might not always fully appreciate the virtues of lunch wolfed down in the lift on the way between the ward and afternoon clinic. But there’s usually time later to enjoy whatever we want.
Recently I’ve come into contact with a group of patients for whom eating (and drinking) is peculiarly problematic. Theirs is the weird and not-so-wonderful world of ‘intestinal failure’.
Tell-tale blue bags hang from the drip stands at their bedsides, protective covers for their parenteral nutrition. They’re hooked up to multiple tubes and machines - lines going in, drains and stomas coming out, bags and meters and pumps. Their clinical notes come in several weighty volumes. By the end of a ward round, my arms are aching.
Every patient has a different story, but they have all got to the point where they no longer have enough functioning gut to get by. Sometimes there was a single catastrophic event. More often it’s been years of inflammatory bowel disease, failed treatments and one operation after another, losing their insides bit by bit. Prognosis for these patients is measured in centimetres of bowel.
Daily progress is charted in millilitres of fluid in, millilitres out, and the millimolar variations of sodium, calcium, magnesium, phosphate. We monitor weight, renal function, markers of inflammation, make careful examination for any developing infection.
Most of the patients can actually eat and drink, but what and how much is tightly controlled. Attitudes to this vary. Some quickly begin regulating themselves with obsessive precision. Others we suspect of sneaking off to the coffee shop at any available opportunity.
Even simple foods can become something of a preoccupation. One man eulogises about a ham sandwich. A woman asks us every day about a date for her surgery, dreaming of being able to have bacon and eggs again. She is one of the luckier ones, with the prospect of rescue by a surgeon who can reconnect what’s left and restore her to something like her former self.
Others have lost so much bowel that even if you joined it all up again it wouldn’t amount to enough. These people will never be able to eat without thinking about it, share a normal meal with family, or go out for dinner to celebrate a special occasion. It’s likely that they will have multiple infections and admissions to hospital, and those blue bags will follow them around wherever they go.
‘It’s alright for you,’ one of them exclaims in exasperation, ‘you get to go home to your family and go on holidays and have a normal life.’ But in spite of it all these patients persevere, learning how to manage their own feeds, how to regulate their diet, how to make do.
Thinking about this during our coffee break, as I share an oversized muffin with one of the consultants, I realise I should be savouring every mouthful.
Follow the Secret Doctor on Twitter