NHS
Sobering realities from the Covid-19 frontline
I love the idea of a story about a detective hunting lost triangles! A man whose imagination conjures up that plot for his children has my ear!
A doctor who lets his small daughter paint his toenails lurid colours during a pandemic and leaves it on – It’s a little piece of home to take to work, a talisman to protect me and a token to remind me – gets my attention.
One who’s fearless enough to spell out unpalatable facts about our health service in the face of repeated political assurances of world-beating everything, gets my vote.
And when that medic is so incensed by the government’s spineless response to Special Advisor Dominic Cummings’ blatant disregard for instructions to the nation during lockdown, that he tweets a photo of himself in full PPE, stating that if Cummings doesn’t resign, he will, and then does so, has my heartfelt respect.
That man is Dr Dominic Pimenta, Specialist Registrar in cardiology. His story in Duty of Care begins in London in January 2020, when he becomes increasingly aware of a tsunami of disaster heading this way. It’s the stuff of his nightmares.
The book is certainly not comfortable reading. It exposes a stark picture of our country woefully lagging in health care provision:
The simple numbers are so bad they speak for themselves; at present, we have the worst A&E waiting times on record, the worst operating waiting times and the worst record on hitting targets. Even life expectancy is on the decline. We are short-staffed by a figure of around 100,000 staff, including 40,000 nurses. We also have one of the lowest number of critical care beds, general hospital beds and doctors per head of all the 37 countries in the Organisation for Economic Co-operation and Development (OECD). If we were an army, we would be a band of bedraggled, starved and exhausted soldiers. And that was all the case before any sign of coronavirus.
Now, I must confess that I personally have a lot of sympathy for our leaders trying to steer a course between many competing demands, balancing livelihoods against lives, damned if they do, damned if they don’t. It’s all too easy to criticise from the sidelines, or with hindsight. I cringe watching opposition MPs constantly carping about the decisions of government, knowing full well they aren’t going to be held accountable themselves. But this man, Dominic Pimenta, is a medical practitioner, and he had his eyes wide open from the outset. He isn’t scoring political points. So when he catalogues a litany of failings – incompetence, mendacity, lack of transparency, disregard of WHO advice – which have led to thousands of people losing their lives, thousands losing loved ones, thousands developing serious health problems, thousands having vital treatments postponed, thousands suffering serious mental ill health, then we ought to sit up and take note. These are desperately serious consequences indeed.
We could see the pandemic unfold, in high definition, live, 24/7, before our very eyes. And yet, for too long, we did nothing at all.
But in spite of his acute awareness of the true picture, shining through is his pride in the NHS: they responded magnificently to an overwhelming situation. He outlines convincing detail of their titanic struggle, their frustrations, their failures, as well as their triumphs and heroics.
With the right mindset, we are capable of incredible things.
Amen to that.
His own personal energy and determination to make a difference are exhausting to contemplate:
– writing articles spelling out the coming danger
– tweeting analysis and warnings
– publishing in the national press
– appearing on live TV shows
– campaigning for change
– garnering signatories for public appeals
– establishing a charity, HEROES, (now rebranded as Healthcare Workers’ Foundation) for the protection and support of healthcare workers
– attracting celebrity support
– designing prototypes for PPE (personal protection equipment)
– setting up a second organisation, SHIELD, to bring industry leaders and experts together in the creation of innovative solutions to meet the demand for PPE, including cutting edge ‘printing hubs’ …
all while working as a clinician way outside his own comfort zone – at the frontline in ICU – and trying to be a husband, father, brother, son, uncle, friend, in unprecedented times. His manic activity leaves one fearful for both his mental and physical health, but as he says himself, the problem was so vast, it would never feel as if any level of effort was enough.
In Duty of Care he leaves the story at the end of the first lockdown, knowing a second and possible third tsunami are coming. Since he published it, we have all entered that predicted second wave and are dealing with its consequences right now. This week the death toll in the UK passed 62,000. I feel fairly confident we’ve not heard the last from this extraordinary ma, but I leave you with his own parting shot:
So stay informed, stay safe and be kind.
The front line: then and now
Health Minister and Conservative MP, Nadine Dorries, was the first member of parliament to be diagnosed with Covid-19. This was back in early March … at a time when there were only 382 reported cases in UK, only 6 people had died. Halcyon days, huh? Less than two months later, we’ve already exceeded 26,000 deaths!
The news about Ms Dorries triggered a memory: I’d read somewhere that she was a trained nurse, and intrigued, I’d bought two of her ‘nursey’ novels in a coffee shop on my way to Wigtown, Scotland’s National Book Town a couple of years ago, stuck them on my shelves, and promptly forgotten about them – The Angels of Lovely Lane and Christmas Angels. Time, methinks, to dig them out and read them … a kind of tribute to the nurses today working so hard to care for people with the virus in a very different world.
I must confess neither the genre, nor the style of writing, are ones I’d normally go for, but there were aspects of these books that gave me pause for thought and sober reflection. These nurses were practising not long before I trained; their experiences resonated with me. Rather like BBC1’s drama, Call the Midwife.
Reading about and recalling those days made me so grateful for all that modern medicine and social care can offer today. How far we have come from those days when
– the NHS was in its infancy
– antibiotics were wonder-drugs
– women had limited career options
– smoking was the norm
– lecture notes were written on typewriters using carbon paper
– rubber tubing was boiled before being inserted into various orifices
– patients were lifted manually
– doctors were revered and all powerful
– women died or were imprisoned following illegal abortions
– ten days bedrest was de rigeur after a simple D&C; three weeks after childbirth
– nurses wore starched collars and frilly caps, always kept their hair off their face tucked inside their caps, lived in hostels with rigid rules, and were all known by their surnames
– silver buckles on petersham belts denoted qualifications
– the Irish were openly discriminated against …
Compare all that with communication, technology, medical expertise, opportunities, science, in 2020. What would have happened if the dreaded coronavirus has struck then?
In her fiction centring on Liverpool in the 1950s, Nadine Dorries has captured a world I knew, and for a few days took me away from the uncertainties and restrictions and anxieties of our present situation, to a bygone era. Memories both happy and sad. But overwhelmingly reasons to be devoutly grateful for what’s available to us today, and the amazing work our front-line staff are doing – and are able to do – to beat Covid-19.
The sad state of our NHS
A relative of mine is currently struggling with the intransigencies of a creaking NHS. I’m doing my best to find a way through that gets the patient the much-needed attention without further demoralising a team of professionals fighting fire because of impossible targets and too few resources. After all, I, more than many, appreciate both sides: I was a small cog in the healthcare machine myself for donkeys’ years, and I’ve been on the receiving end many times too. So perhaps a book by someone who buckled under the burden of working in such an environment was bound to resonate for me.
Adam Kay‘s This is Going to Hurt is absolutely brilliant. One of a family of doctors, his ‘default decision’ as a teenager was to follow in their footsteps, but nothing prepared him for the reality of life post-qualification, the life of a junior doctor.
Recording thoughts and experiences is a recommended part of ‘reflective practice’, and This is Going to Hurt is based on Adam’s diary scribbled in secret after endless days, sleepless nights and missed weekends. It’s a no-holds barred account of his time on the front line. 97-hour weeks. Life and death decisions. Ingratitude and complaint. Raw experience. Terror. Failure. Success. Innumerable objects in assorted orifices. A tsunami of bodily fluids drenching his person and his imagination. All recounted with honest brutality and a fabulous line in whacky humour.
Kay spent six years training and a further six years practising medicine, specialising in obstetrics and gynaecology. But eventually the price he was paying was simply too high. When something terrible happened on his watch, he finally crumbled. The patient suffered a torrential haemorrhage during a caesarean section – she had an undiagnosed placenta praevia. Dr Kay hadn’t been negligent and there was no suggestion otherwise; any other competent doctor in such circumstances would have done exactly what he did. But he expected more of himself. He was the most senior doctor involved and everyone was relying on him to sort out the horror. He felt overwhelmed by the tragedy.
I knew that if I’d been better – super-diligent, super-observant, super-something – I might have gone into that room an hour earlier. I might have noticed some subtle change on the CTG. I might have saved the baby’s life, saved the mother from permanent compromise. That ‘might-have’ was inescapable.
Much like the NHS itself, the book is filled with hope and despair, miracles and disasters, catastrophes and absurdities, intense sadness and riotous gallows humour. I defy anyone to read it without laughing out loud, or more importantly, without a sinking heart. It’s a damning indictment of a system that expects its practitioners to work impossible hours, assume phenomenal responsibility, compromise their health and relationships, for less pay than ‘the hospital parking meter earns’.
No wonder it won Book of the Year in the 2018 National Book Awards.
It’s difficult to avoid technical terms in such a book, so the author offers helpful footnotes –
I’ll help you out with the medical terminology and provide a bit of context about what each job involved. Unlike being a junior doctor, I won’t just drop you in the deep end and expect you to know exactly what you’re doing.
The footnotes themselves are often hilarious.
Diathermy is essentially a soldering iron – it heats up the area you touch it on and stops small blood vessels from bleeding by sealing them off. It is important not to clean the skin with alcohol-based antiseptic before the operation, otherwise diathermy sparks can set the patient on fire.
Swabs (used in surgery) are designed with a radio-opaque thread running through them as a marker, which shows up on X-rays as a line. A bit unimaginative – I’d have gone for a radio-opaque ‘WHOOPS!’
But I think my favourite one is:
I once put another of these standard dementia questions to a man in his nineties – ‘Spell WORLD backwards’. He paused and said, ‘As in “the planet” or “the past participle of ‘to whirl'”?’
Having spent years delivering babies myself as well as caring for the very sick and small ones, many of Kay’s obstetric stories rang bells for me personally. And I was moved by the care and empathy that this young doctor felt, that had him sneaking back to check patients were OK, or weeping for an hour when things went wrong. What a shame that this sensitivity cost him too dearly to remain on the giving end. We needs practitioners who really care.
Medicine’s loss is the entertainment industry’s gain. Adam Kay has gone on to become an award-winning comedian and writer for TV and film. Indeed he’s actually performing in the Edinburgh Fringe this year! But his book conveys in the best way I’ve ever seen the pain and the joy of working alongside disease, despair and death. And finding the humour and words and humility to share the emotional costs. It’s already been a No 1 best-seller, attracted over 6,500 reviews on Amazon. I devoutly hope it’s on the essential reading list for the new Secretary of State/Cabinet Secretary for Health and Social Care/Welfare. Changes have been made since Adam Kay was practising, but not enough. Not nearly enough.
NHS successes and failures
Last week I had yet another full examination by a consultant as part of my follow-up cancer care. Meticulous head to toe inspection. I’m overwhelmed by the efficiency, skill and compassion I’ve experienced at first hand in the years since I had the primary tumour removed. It could not be bettered.
And who could fail to be awed by the detailed reporting by the BBC this week of the Pakistani conjoined twins, Safa and Marwa Ullah. Two years old and recently separated.
Vast teams of top ranking practitioners working to give those two little girls as good a future as possible. The sight of the grateful mother, a widow with seven other children, kissing the hands of the surgeons said it all.
But I’ve also seen things go pear-shaped – for relatives and friends as well as those I’ve read about. And according to the media, a new publication, the NHS Resolution report, provides a worrying picture of the rise in claims for compensation. In England alone, in 2018-19,10,678 new claims were made for clinical negligence. The costs in payouts increased by £137 million to almost £2.4 billion! (NB. this includes legal costs not just the money paid to the claimants.) Mind blowing statistics, aren’t they? Furthermore some 10% of those claims related to perceived deficiencies in maternity care but, because these are extra costly, they represent a disproportionately high percentage of the total costs.
As the CEO of the Medical Defence Union said, this amount of money could have funded over 15 million MRI scans or 112,000 liver transplants. What a sobering reality check.
I feel a mixture of emotions: regret for those people whose care has fallen short certainly but also anxiety for those whose practice is called into question as well as for the NHS as a whole. Every example of negligence exacts a toll from the patients and families concerned. But the spiralling costs of compensating dissatisfied clients affects us all. Our world renowned health care system is buckling under the strain. Something has to give.
One of my ongoing files for a possible future novel is labelled RESOURCE ISSUES. My life-long aversion/allergy to numbers has kept it low down in the pile, but it might yet become a front runner if this state of affairs continues to escalate.
The miracles of modern medicine
Two days ago I experienced a miracle at first hand. Please indulge me this week if this post is entirely personal.
For the past six months my heart has been chaotic. In physical rather than medical terms I’ve been dizzy, sick, fainting, tired beyond belief, dependent on powerful medication to give even a pretence at normal functioning.
Two days ago I was lying in a special lab/theatre watching a rather shy, self-effacing man (known in the medical world as a consultant electrophysiologist) thread a catheter directly into that said heart, fire things at it, burn bits of it, provoke it in mysterious ways, and then calmly tell me he had successfully treated the malfunctions. Yep, there and then.
Here’s the written evidence in his own hand:
Six hours later I WALKED out of the hospital at night unaided (yes, of course, with medical approval!). Three days of recuperation and I should be back to my original self – but hopefully wiser, more appreciative, more tolerant … well, miracles do happen! The only slight caveat is the heart might just have been stunned into silence and not actually cured, but that we should know within two weeks.
Words can’t express my personal gratitude for this transformation, but let’s hear it for our brilliant NHS and all who play a part within it. I met with nothing but kindness, professionalism, friendliness and support at all levels in a clean and well-ordered hospital. God bless them all.
Off now for the prescribed ‘rest’ surrounded by the evidence of huge support from family and friends. Thank you all more than I can say. I am officially off the worry list.
PS. For those who have a highly developed curiosity gene or are interested in all things medical, you can watch a video of what an ablation involves here.