Time to Live

Last night I watched Time to Live from BBC2’s Life Stories series. Twelve people who have a terminal diagnosis share what they have learned about themselves and about life, knowing that it is short. They are people of all ages who have managed to find positives in their terminal prognosis and are making the most of the time they have left.

It is a fascinating, beautiful and uplifting, but also heartbreaking film. We can all learn something from these twelve people who live life with an intensity few of us experience, and who appreciate and celebrate the life they have. They have accepted themselves with all their quirks and flaws, have cut out things that are not important to them, and spend time and energy on things that matter. What this looks like is different for each person. Some go vegan and teetotal, some drink more alcohol and eat more steak. Some travel, dance, or paint. Some quit work, others throw themselves into it. Some reaffirm their faith, some lose it. Some reconnect with estranged family or friends, some leave their husbands.

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Relationship status update

I wrote the following as an entry for the Royal College of Physicians Teale Essay Prize 2017. The essay title was: How do trainees engage with the RCP and vice versa? – is this a case of a long distance relationship – how can we make this marriage work better? I did not win, but I am sharing here as a provocation. What should postgraduate education look like, and how do we get there?

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Death Cafe Euston

Join me for an evening of discussion on death, dying, life and living at 1 Lancing Street next to Euston station. There will be tea. There will be cake. There will be time and space to talk about death, dying, grief, funerals, and the fragility of life.

Death Cafes provide an opportunity ‘to increase awareness of death with a view to helping people make the most of their (finite) lives‘. They are group directed discussions with no agenda, objectives or themes. They are discussion groups rather than grief support or counselling sessions. They are generally life-affirming events, but sensitive discussions are of course possible so please bear this in mind. For more information please see www.deathcafe.com.

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Drawing myself back together

I wrote the blog below as part of a series curated by the London Arts in Health Forum, on art and culture, health and wellbeing. I and the other Trustees are already excited about 2017’s Creativity and Wellbeing Festival which will take place 12-18th June. Excitingly, an edited version of my blog was picked up by The Guardian, who have published it as part of their #BloodSweatTears series. You can read the article on The Guardian website.

The original blog follows.

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More doctors should engage with arts and health

An article I co-wrote “More doctors should engage with arts in health” was recently published in BMJ careers. A longer version is below. Many healthcare professionals are interested in the arts, as part of their own wellbeing as well as their patients. It may not be clear how to align this interest with day to day work, and arts in health practice can therefore seem inaccessible to clinicians. We hope to bridge this gap with an introductory training event, the first of which will be on 30th June at the UCL Macmillan Cancer Centre, and has been approved for 3 RCP CPD points. Read more about it on the LAHF website, and book tickets via EventBrite.

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What is good health?

Doctors spend their professional lives trying to help their patients achieve good health. Although many start medical school with an idealised image of medicine as cure, most rapidly realise that despite phenomenal advances in science, cure is seldom possible. This is partly due to the nature of disease and the inevitable frailty of the human body, and partly due to the fact that none of us exist in a vacuum, and our potions and pills do nothing to change individual patients’ contexts or experience of illness. In fact ‘illness’ is almost impossible to define, as we medicalise more and more natural life processes and events. How can medicine address modern day phenomena of socioeconomic inequalities, lack of housing, poverty, loneliness, ageing, grief, disengagement from society, struggles with sexuality, or finding meaning in life? Should it? The role of the doctor has historically been to promote, maintain and restore health where possible, and to relieve suffering, and offer comfort to all. In this context, wellbeing as a concept that extends beyond a narrow definition of health becomes increasingly important. The WHO definition of health acknowledges this, and states that health is “a complete state of physical, mental and social wellbeing, and not merely the absence of disease or infirmity.”[1]

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An ever deferred death

“…just as we know our walking to be only a constantly prevented falling, so is the life of our body only a constantly prevented dying, an ever deferred death.”  Schopenhauer

I first read these words two years after I had qualified as a doctor. On reading them I felt a jolt: a reawakening of a feeling that I had buried. A feeling that I ran and hid from as I spent my days, and many nights, beside people on the brink of death. Schopenhauer’s words forced me to confront the fact that I felt threatened, fearful, temporary. I felt mortal.

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Those of us who work in hospitals are witnesses to ‘a constantly prevented dying’. We react in different ways, and we rarely talk about it, but I have recognised more than once after a cardiac arrest call that has ended in death, a fleeting flash in the eyes of a colleague that screams “that could be us, we all die!’

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Finding the words

Making and documenting good decisions about CPR (cardiopulmonary resuscitation) and treatment escalation plans, that are truly shared decisions, is a challenge. I find that the challenge comes from a number of factors: intrinsic difficulties of talking about the possibility of death in a largely death-denying culture; the great diversity of beliefs, wishes, and level of preparation for such decisions amongst patients; difficulties in facing my own mortality and the ways in which personal situations may affect my professional abilities; navigating tensions between hope and acceptance; and additional complexities that stem from having such conversations in the context of an emergency hospital admission. In the midst of a busy shift, faced with distressed people who are in pain, sometimes it is hard to find the words.

A number of recent cases have highlighted concerns about the process of resuscitation decision making and documentation. In particular, people have been distressed by the fact that DNACPR (do not attempt cardiopulmonary resuscitation) orders have being placed in their records without an explicit discussion with either them or their family. The High Court Ruling on R (David Tracey) vs 1) Cambridge University Hospitals 2) Secretary of State for Health forced the medical profession to face up to residual paternalism in this area of practice, and to make changes. It prompted some important reflections amongst individuals, teams and institutions and I have seen a noticeable difference in practice since the ruling, which reinforced the legal duty to discuss decisions about care with patients, particularly DNACPR decisions.

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