Last week was particularly stressful; marked by staff shortages, anguished relatives, conflict over complex discharge processes, and pressure to create beds. The amount of time I spent with each patient on my ward rounds was less that what I, or they, would have wanted but despite coming in early and leaving late there are only so many hours in a day. In weeks like these I often feel guilty as I leave work that I am unable to give more time to those patients and relatives facing the end of life.
More than many other people I know, I am acutely aware of the fragility of life.
Posted in Death
Tagged C. S. Lewis, compassion, death, doctor, empathy, grief, health, life, medicine, patient, sympathy, time
I arrive at work, and quickly check my emails on my phone before I enter the signal black hole that is the hospital where I spend my working life. The SHO is not in yet, so I persuade the ward clerk to briefly give up one of only 3 functional computers on the ward and update the patient list with the details of the 2 new patients, whose names are scrawled onto the whiteboard. I skim through their notes, and cast my eyes over them to make sure nothing urgent is required. I leave a note for the SHO requesting her to arrange some tests, before I go to the secretaries’ office to hunt for a working dictaphone and a spare tape.
At a party this week I got talking to a friend of a friend who quickly discovered I was a doctor. The conversation changed from which tube lines were running and who had made the delicious chocolate brownies, to the NHS: specifically its failings. I become, not for the first time, an embodiment not only of the medical profession, but of the entire health and social care system. I was charged with defending the lack of care shown by GPs, the apparent willingness of doctors to prescribe pills for anything and everything but never to listen, the lack of a nutritional perspective from NHS practitioners and the poor funding of mental health services.
The NHS is not perfect. I have heard many stories from dissatisfied individuals, and wouldn’t for a moment dismiss their grievances. I have even been known on occasion to spend an entire dinner party lambasting its’ deficiencies. But conversations like this make me wonder about the expectations of the public of this institution of which I am extremely proud. What do they think the NHS is for?
I had just told Mr George* that his end-stage heart failure had become refractory to treatment, and I thought it likely he would not survive this hospital admission. He looked at me carefully and said, “Well that’s it then. Can’t you just give me something…end it for me?”
This is not the first time a patient has asked me such a question, and will not be the last. Often the question is more ambiguous, and it is unclear exactly what they are asking for: “can you just put me to sleep?” could be interpreted as a plea to end their life, but could equally be a request for a break from their symptoms or thoughts, with the hope of a more energised remaining time afterwards. It is a constant challenge to interpret such questions appropriately and personalise support and treatment for the needs of the individual.