Your Life In My Hands--a Junior Doctor's Story

by Rachel Clarke

  In military circles, morale – or a unit’s ‘esprit de corps’ – is often defined as the capacity of a group’s members to maintain their belief in an institution or goal, particularly in the face of opposition or hardship. If a unit’s morale is depleted, they are at risk of cracking and surrendering. A Pulitzer prize-winning American military journalist, writing during the Second World War, gave a stirring definition of high morale as being when ‘a soldier thinks his army is the best in the world, his regiment the best in the army, his company the best in the regiment, his squad the best in the company, and that he himself is the best blankety-blank soldier man in the outfit’.44

  How does that compare to the NHS? My army (my health service) is crumbling around me. Year on year, the government’s underfunding undermines the collective efforts of my colleagues and me to provide the public with exemplary care. Waiting lists balloon. My inpatients suffer the perils of rota gaps – arising where doctors have either fled the NHS or been signed off sick, leaving the remaining staff to carry their workloads. My regiment (my hospital) is in deficit. My squad (my fellow junior doctors) was recently reduced by sick leave from three to two. And me? I’m too tired to believe in much these days: it takes all my efforts to be safe and competent.

  Recently, I witnessed a stark example of the caustic effects of understaffing on morale. My team and I were discussing our patients prior to setting off on our morning ward round when a house officer walked into the doctors’ mess looking so broken and stunned he was almost staggering. We stopped our conversation in alarm. ‘I know him,’ I said to my consultant. ‘I’ll have a chat and find out what’s wrong.’

  Samir had just completed a night on call, attending to the emergency needs of a hundred or so medical inpatients. We sat side by side on a stinking sofa and I pressed a hot coffee into his hands. After a while, tears began to trickle down his cheeks and I could see how much he hated being seen to cry. At age twenty-four, he was two or three months into his career as a doctor.

  ‘I just couldn’t do it,’ he eventually muttered. ‘There was too much to do and I tried to ask the med reg for help but she was flat out in A&E and she couldn’t leave the sick patients.’

  ‘Did you have sickies?’ I asked him, this being the code for patients so unwell you fear their illness might end up being life-threatening. Silently, he nodded, the tears flowing.

  ‘I know it wasn’t her fault,’ he continued. ‘She wanted to help me but she had all the new admissions in A&E to sort out and they were sick too.’

  I knew precisely what he had been through. The feeling of abandonment, through no fault of his senior doctor, who herself had spent a night fighting fire in an equally overrun part of the hospital. The fear – a deep-seated foreboding that someone that night was going to die on your watch.

  ‘I don’t know if I can do it any more,’ he told me. ‘I don’t even know if I want to.’

  I assured him that it was not that he was slow or incompetent or feeble or useless, that he had been defeated all night by an impossible workload, that if I had worked his shift I’d be feeling just as he did, that the law of nights meant that after this shocker he’d earn at least one gentle shift before the week was out. I could see he did not believe a word of it, but he smiled half-heartedly, appreciating my efforts, and hauled himself off to bed.

  It cannot be right that, only a couple of months after six years dedicated to learning how to be a doctor, a young medic is left sobbing on a sofa. It was not Samir’s proximity to suffering that broke him that night, but his responsibility for too many patients. It was not that he lacked resilience, but that the workload to which he had been subjected had been unsafe, unfair and inhumane. The remedy, on this occasion, was glaringly obvious. Not a tick-box course designed to toughen him up, just another doctor on the rota.

  After his dismal set of nights, Samir managed to rally and move on. But not every young doctor is so lucky. Some quit the profession before their first year is out, others end up lost beneath the feeling that life is no longer tolerable.

  In February 2016, the day after Jeremy Hunt announced the imposition of his contract, Rose Polge, a junior doctor only six months out of medical school, took her own life. Her job and its workload had become too much to bear. As her mother, Heather, put it, Rose, ‘became overwhelmed with acute anxiety about the expectations, demands and responsibilities of her job. This broke her spirit.’45 When news of her suicide broke in the media, junior doctors nationally were horrified. Every one of us at one time or another has either felt sheer desperation ourselves or known another young doctor who has. I thought of Samir and his shame at his tears. Of another doctor friend who called me once to tell me he was going to hang himself. The near misses, the prevalence of desperate distress. Rose could have been any of us.

  It emerged that Rose had been midway through a shift at her hospital when she vanished one Friday afternoon, leaving a suicide note in the glove compartment of her car, then walking into the sea and drowning herself. The note mentioned Jeremy Hunt. During the inquest into her death, her boyfriend described how, the night before her disappearance, Rose had talked about quitting medicine and, finding sleep impossible, had walked alone on the beach where, the next day, she took her own life. Her online history showed she had visited suicide sites.

  At her inquest, Rose’s family called for action to address the crisis in the health service precipitated by doctors’ fatigue and punishing workloads. The words Rose’s mother would later write about her daughter’s death struck a painful chord with us all:

  Exhaustion due to long hours, work related anxiety, despair at her future in medicine and the news of the imposition of the new contract on junior doctors were definite contributors to this awful and final decision. The hours that some junior doctors have to work are, in my opinion, terribly cruel and inhumane. Rose was working 12–14 hours a day for up to 12 days, often without breaks and staying late to get the work done. Leaving little time to get home, sleep, eat and shower before the next day began. This type of existence is seen by many as a right of passage for young doctors and takes a terrible toll on them, their families and loved ones. Until this state of affairs changes significantly, more doctors will be mentally broken and leave the profession, the country or life itself. The importance of caring for those who work so hard to provide care for others seems so neglected. We have paid the ultimate price in the loss of our wonderful Rose.45

  I thought back to my time on the understaffed Surgical Emergency Unit, tears dripping onto my young son as I tried to shake away the toll of a hundred-hour week and be a semblance of the mother I wanted to be; I wondered whether, without him and my husband to love me, it might have been horribly different. And I could not shake the thought from my head of the beautiful twenty-five-year-old woman who beamed radiance and life from the photos in the press, yet placed her clothes in a pile on wet sand and walked away her life in the spray.

  CHAPTER 11

  INSURRECTION

  You know events have taken a surreal turn when a Canadian pop star with more Twitter followers than the entire UK population decides to campaign publicly for the NHS.

  Just before Christmas 2015, Justin Bieber – one of the most successful musicians in the history of pop music, a 23-year-old with four times as many Twitter followers as even the tweeting US president, Donald Trump – became the most improbable player in the junior doctor dispute.

  A couple of months earlier, a young doctor called Harriet Nerva had started a campaign on Facebook to try to get an NHS choir to the coveted Christmas Number One spot in the charts. Her online post won nearly 100,000 fans in a week, captivating the imagination of NHS staff and the public alike. ‘I qualified 15 months ago,’ Harriet explained to the press, ‘and I love the NHS, I’m very proud of it. And I feel getting it to number one would bring to the public’s eye the fantastic service it provides in very challenging times. Junior doctors in particular feel very let down this winter by this government. They’re the
backbone of the NHS and they will continue to fight for a contract that’s safe and fair.’46

  The choir in question, London’s Lewisham and Greenwich NHS Trust Choir, had originally recorded their single, a reworking of Coldplay’s ‘Fix You’ and Simon and Garfunkel’s ‘Bridge Over Troubled Water’, for a BBC Two documentary series in 2012. Their song, ‘A Bridge Over You’, featured a moving video of the doctors, nurses, physiotherapists, midwives and other healthcare professionals who made up the choir both singing and also carrying out their everyday work tending patients in the hospital, from newborn babies to frail great-grandparents. The footage encapsulated the tenderness and compassion that define, for so many members of NHS staff and the public alike, the essence of our health service.

  Although not overtly political or allied to the junior doctors’ cause, the video ended with a powerful quotation from Aneurin Bevan, the politician who founded the NHS, stating that, ‘The NHS will last as long as there are folk left with faith to fight for it.’ Junior doctors, already campaigning furiously against a contract we perceived to fundamentally threaten our ability to provide safe care, were captivated by the challenge of getting the NHS to number one and threw all our energies behind the cause. ‘It’s a proper charts battle,’ enthused Katie Rogerson, a trainee paediatrician and member of the Lewisham choir. ‘It’s just ridiculous that it’s the NHS versus Justin Bieber, but that’s all in the jolliness of it.’47

  It was indeed completely ludicrous. Only in feel-good fantasies do small NHS choirs defeat global megastars. But, with ferociously campaigning junior doctors, overwhelming public support and an enormous amount of media attention in the run-up to Christmas, ‘A Bridge Over You’ trailed Bieber’s single by only a few thousand sales. Still, it looked as if he would just win out. Until, that is, someone managed to communicate to the superstar how much this unlikeliest of battles mattered to the British public. When Bieber discovered whom he was up against, he graciously tweeted a series of messages to his fanbase urging them not to back his own single, but instead to buy the NHS choir’s: ‘I’m hearing this UK Christmas race is close,’ he wrote, ‘but the NHS choir single is for charity. So for one week it’s OK not to be number one. Let’s do the right thing and help them win. It’s Christmas. This is what it’s all about. Merry Christmas.’48

  On Christmas Day, I quietly crept away from the mountainous lunch Dave and I had cooked for our family to put on Top of the Pops for the live Christmas Number One announcement. Like every junior doctor I knew, I was desperate for the choir to win. Somehow it felt totemic. If doctors like Harriet and Katie, among so many others, could propel the NHS to chart-topping success, then it felt as if we were capable of anything, including enabling the government to see the folly of promising the public a new seven-day NHS without funding it. Tucked away by myself on the sofa, I held my breath. You could put it down to seasonal fizz but, when ‘A Bridge Over You’ was announced as Christmas Number One, I could not stop crying. The video expertly tugged at the heartstrings – the cannula in an infant’s hand, a tiny wrist encased in plaster of Paris, an emaciated, elderly gentleman hesitantly walking with the help of a frame and encouraging smiles from his physiotherapist. But it also encapsulated why I had become a doctor. This was what I both ached for and had already lost. Conditions of work that allowed me to care. And I was damned if I would let the government denigrate them any further without a fight.

  Just after dawn on 12 January 2016, I slowly walked towards a hospital picket line with too many questions dragging me down. Was I doing the right thing? Or, as some of the newspapers believed, were we really stroppy, selfish, naïve little upstarts, willing to sacrifice our patients to get our own way? As the first strike by junior doctors in over forty years began in subzero temperatures, I thought of my patients, whom I had chosen – though it felt less a choice than an act of desperation – to abandon in order to stand outside the hospital. Shame mingled with relief and pride that we were finally standing up for what we believed in. It was bitterly cold. I imagined a more experienced industrial activist would have known to bolster flimsy hospital scrubs with a pair of decent thermal long johns.

  We were an awkward bunch. Initially, we were positioned by the entrance to the hospital, but a senior manager promptly kicked us off the premises, forcing us to trail uncertainly with our homemade placards to the edge of the hospital site, a windswept mini-roundabout. I took mild satisfaction from the fact that our curt ejection was filmed from the roundabout by a fortuitously positioned BBC film crew. A picket line was unnerving territory and none of us really knew what to expect. We were, I suppose, thirty or forty doctors, but the group swelled in size as various local trade-union representatives arrived, armed with professional banners and essential striking kit such as a megaphone for effective chanting.

  ‘You have to chant,’ said one of them. ‘You must know some chants.’

  ‘Chants?’ We hastily discussed this among ourselves, amateurs who were new to this game. ‘What chants do we know? Come on, guys. What rhymes with NHS?’

  It felt like militancy for dummies. Faintly embarrassed, we started shouting loudly about the future of the health service. On the plus side, chanting kept us warm. The traffic streaming by tooted its support, sometimes so enthusiastically the horns were deafening. The irony was not lost on me that the passing public seemed to know what to do in a strike far more intuitively than we did. Every time an ambulance drove in or out of the hospital, the paramedics blasted their sirens in solidarity, to cheers of delight from the crowd.

  Even more heartening were the members of the public who travelled to our picket line to support us in person. We knew in theory that the public backed us – in polls, there was 66 per cent support for our strike – but, when this translated into a beaming grandmother pressing steaming hot coffees into our hands, or a preschool tot proudly presenting homemade biscuits to us all, the human touch meant everything. I couldn’t feel my feet, my legs would not stop shivering, but the public radiated warmth.

  My profound discomfort at striking – the tug of the patients I had left in other doctors’ hands – was somewhat assuaged when, to my great surprise, one of those patients appeared on the picket line beside me. Sammy Rogerson, a frail young man trapped in a wheelchair after infection had ravaged his legs, was determined to defy the freezing temperatures to stand beside his doctors. Despite the best efforts of his nurses, fearful of his ability to withstand the arctic winds, he had refused to stay on the ward, so they had protectively mummified him in NHS blankets, some of which now trailed like banners behind his wheelchair. The television crews clustered around him, eager for commentary from an NHS inpatient so defiantly committed to his doctors’ cause.

  ‘Sammy,’ I said. ‘I can’t believe you came. Can I take you back to the ward? You must be absolutely freezing.’

  ‘No. No way,’ he replied. ‘I’ve been in this hospital for six months and I know how hard you all work. I want to be here with you.’

  Throughout the day, the government spin machine was in overdrive. Jeremy Hunt, speaking on BBC Radio 4, described terrifying increases in hospital mortality at weekends – deaths from strokes rising by 20 per cent, from emergency surgery by 11 per cent, and deaths of newborn babies by 7 per cent. All these data were contentious and had been challenged by some of the country’s leading academics, but on air they sounded indefensible, as Hunt had known they would. To perpetuate these thousands of avoidable deaths by clinging to our weekend ‘overtime’ was, he insisted, wholly unreasonable:

  We recognise that if doctors are too tired they are not going to be able to give safe care to patients. Right now what happens is when a junior doctor is asked to work at weekends, which they do a lot, they go into an A&E department where there will be half as many consultants working on a Sunday compared to a weekday despite it being one of the busiest days. It is a pretty exhausting day. You wouldn’t, as a pilot, like to turn up at Heathrow airport and be told: ‘I’m really sorry but because
it is a Sunday you don’t get a co-pilot but off you go to New York.’49

  Aside from the fact that the number of consultants on call at weekends had nothing to do with junior doctors’ contracts, Hunt was again ignoring the real barrier to improving weekend services: the finite number of doctors, not to mention all the other staff – nurses, porters, radiographers, administrators – required for extra weekend activity. Not once had he addressed how – in the absence of any additional doctors – safer weekends could be engineered without removing us from our patients from Monday to Friday. Nor had he produced any actual evidence to corroborate his claim that additional junior doctors at weekends would increase patient safety. Perhaps most frustratingly of all, the alarmist analogy he drew between jumbo jets missing pilots and hospitals missing doctors was precisely what was already happening in hospitals up and down the country, a fact he chose to ignore. Rota gaps were commonplace – each one analogous to a plane without a co-pilot – yet Hunt still wanted to stretch junior doctors more thinly. It was fantasy politics.

  As the first strike drew to a close, patients remained caught in the political crossfire. Though stop-start talks between the government and the BMA continued fitfully, they failed to avert a further seven days of strikes, each of them causing thousands more cancelled operations. Throughout it all, Hunt insisted his ‘door [was] always open’ to junior doctors, yet took exquisite care not to meet or debate a single one of us in public. Shortly after announcing to the House of Commons that, in the absence of agreement with the BMA, he would impose his contract upon juniors, Hunt happened to arrive at London’s Millbank Studios just as Dagan Lonsdale, a speciality registrar in intensive-care medicine, finished an interview there with Sky TV. The breakdown in communication between the Health Secretary and junior doctors was starkly illustrated as the Sky News crew filmed what happened next.