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When being a doctor doesn’t make choosing easier

By Mindo - 10th Oct 2019

doctor talking to her male patient at office

The dotMD conference led me to some personal reflection

I missed the first day of dotMD. Instead, I drove two hours in the opposite direction to a funeral. Just 24 hours after a death, hundreds of us were summoned by phone, text and to sympathise with the family by an open coffin.

I was almost glad I wasn’t in Galway. On the dotMD conference app, everyone seemed so enthusiastic; too happy-clappy for me. It didn’t help that, yet again, someone I care about was stuck on a trolley — after being resuscitated by ambulance paramedics.

And sometimes I get a sort of alienation syndrome, so I just wasn’t in the mood.

I’d like to have been there for the talk on kindness. Kindness has become part of my personal manifesto. After many years as a consultant, watching the botched changes in the health system, and the rise in public anger and blame, it dawned on me that healthcare is a game of chance.

I can do everything right. Brilliant diagnosis and exemplary treatment, confident of a good outcome: The patient dies. Another case goes wrong through mishap or oversight, but the patient goes home fit and well.

In either case, the family may be deeply appreciative, or very upset, at my care. But the one thing they never forget is kindness. I don’t mean hugs and tears. I mean how you make them feel; whether, at some level, you care.

After the funeral, I joined the dotMD crowd at the BBQ: A motley crew revelling in a different kind of conference. A doctor commented that it was great not to be at the usual “careers fair” conference, and said maybe that’s why so many women spoke out from the floor. Another said this emotional stuff is hungry (and thirsty) work.

As well as an unusual array of speakers, there was a great variety of people attending. Doctors — old and young, senior and junior, medical and surgical. Hmm, let’s check this out: GPs, NCHDs, public health, consultants? Non-medics too? Yes, all present.

Aha! Maybe that’s why I gradually thawed out and felt more at home, the alienation fading. This is why I enjoy the IMO AGM: A broad church, unusual talks, and definitely not a career fairs.

Day two had a lot of raw personal experience and some talks about death.

A US nurse/cartoonist spoke of the value of cartoons and graphic novels in explaining dying and death. A UK palliative care consultant asked who among us had been present when someone drew their last breath. A forest of hands went up. Ten deaths? A hundred deaths? Yes, many of us. She said it’s not true for a lay audience, who get their warped knowledge of death from TV soaps.

Both speakers wanted more conversations about death and dying. There was talk of living wills, and advance care directives.

I found myself increasingly uncomfortable.

Marie Cassidy said it right — the Irish are obsessed with death. I think we often do it rather well. My friends who watched as their relative drew his last breath spoke of the unending kindness of the hospital staff.

I have a personal problem with advanced care directives.

This summer, my little black dog died. She collapsed with seizures, was found to be hypoglycaemic, and ended up in the Dublin Vet College. A very competent young vet assured me the diagnosis was insulinoma. This was a great comfort to me; I thought she ate poison, and it was my fault for not keeping her in the garden.

I hated having ‘the conversation’ about what to do if doggy ICU care failed, and being told (twice) that my little pet could be brain-damaged. Those harsh words and images lingered. I already knew what I had to do; maybe it’s because I’m a doctor.

But I hadn’t a clue what to do when I had ‘the conversation’ about my beloved husband. There were three consultant colleagues with me in the room. I knew they cared; I could feel the kindness.

The question was whether to do a tracheostomy. I said yes, because I thought that was what they were suggesting for Tom. By the reaction in the room, I knew this was the wrong answer. So I said no. I’m a hospital consultant. I’ve done these conversations. I’ve been there at the deaths. This time, I was just Tom’s wife and I hadn’t a clue.

Over the years, I’ve watched as more and more doctors expect families to make these impossible choices. I wonder if it’s because the doctors can’t bear to choose.

As these emotions flooded around me, I looked at my wedding ring. Maybe I’m hiding behind it, allowing bereavement and widowhood to alienate me. In the privacy of darkness, I put it on my other hand. It looks okay there.

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