We treated Sally with the most aggressive antiviral drugs on the market, but all, apparently, to no avail. If anything, she continued to deteriorate, lurching between distressed, vacant and virtually comatose, sometimes all in the space of a day. The Sally we had come to love sank further and further away from us, leaving behind a husband who continued to dote upon her smallest need while refusing to mourn the loss of the wife who seemed submerged for ever.
‘There’s a chance she’ll get better, isn’t there, Rachel?’ Ron would ask me, eyes wide and beseeching. I ached to keep his hope alive, to give him reasons to believe, but in truth the wisest consultants in my team were by now profoundly pessimistic. ‘The longer she stays like this, the more likely the brain damage is permanent,’ my boss had said in the early days. Now we were many weeks down the line and none of us believed Sally would recover. Hope existed only in Ron, and even in him it was rapidly dwindling.
Then, early in the morning of my Sunday on-call shift, everything changed. When a healthcare assistant had arrived to check the patients’ observations, Sally had asked her with perfect lucidity what day of the week it was. Astonished, the nurses rushed straight to Sally’s bedside. She dumbfounded them all by asking, quite clearly, for breakfast. They hastily called Ron at home and urged him to come straight to the hospital.
And so it was that when I entered Sally’s room some hours later, feeling giddy myself with hope and intrigue, this quiet, unassuming, devoted husband almost fell into my arms, beaming and crying and scarcely making sense of the miracle of his wife being back.
‘Oh, Ron,’ chided his wife affectionately. ‘You are a silly one, aren’t you? Pull yourself together.’
‘Hello, Sally,’ I said, smiling incredulously. ‘How are you feeling this morning?’
‘Well, I’m all right,’ she said. ‘I just don’t know what’s wrong with this husband of mine.’ The virus had obliterated several months of memory. She had no recollection of being in hospital or even of receiving a diagnosis of leukaemia, but Sally the person was intact.
None of us could explain it. Medicine drew a blank. Every once in a while, a patient confounds all their doctors’ worst fears while fulfilling their loved ones’ greatest hopes. ‘It was like someone had switched on a light switch,’ Ron said to me later, still shaking his head in disbelief. ‘Flick and there she was again. It’s a miracle, just a miracle.’
Early on at medical school, I was taught to take a sceptical attitude towards misplaced certainty. ‘Never’ and ‘always’ are two words that doctors use at their peril. Exceptions, I swiftly learned, are everywhere, with patients and their diseases rarely conforming to the textbook descriptions I committed so carefully to memory. Yet, in the muddy, uncertain, imperfect, unpredictable world of my hospital, its activity revolves around certain fixed axes.
Pivotal to our health service are the instincts driving its staff. By and large, most of my colleagues have been propelled towards the NHS by a keenness to improve the lives of those of us unlucky enough to experience sickness. We try our best to help our patients through their journeys with illness, even if sometimes we do not get it right. Our primary motivation is helping others, not our own enrichment. Our patients inspire us every day. We have the privilege of routinely observing in those patients and their families more of what is good in people – strength, dignity, love, compassion – than I ever fully appreciated before becoming a doctor. We bear witness to the best and the worst of life, the cruellest blows, the unlikeliest recoveries. We do our bit to assist, if we possibly can. And there is always, even when medicine is exhausted, our touch or voice or smile. It can hurt. It can thrill. It can take your breath away. Painful, bittersweet, overwhelming, magnificent medicine. For me, no other job could come close.
EPILOGUE
Shortly after my temporary departure from medicine, my father rang me one afternoon as I set out on the school run. He had just been told he had cancer. The nasty, aggressive sort. The news you hope never to have to break to your patients. The air felt punched from my lungs and my hands began to tremble. I pulled over. As we talked data, statistics, doctor to doctor, I was dimly aware of the daughter, the father, hovering on the outskirts of our brief, professional, calm conversation. They remained there, disconnected, but afterwards, on the roadside, phone flung in the footwell, like anyone who learns the life of someone they love is in jeopardy, I crouched over the steering wheel in tears, unable to move for the force of the refrain, ‘Don’t die. Don’t die. Dad, don’t have cancer. Please don’t die.’
For years I have looked after patients with cancer. Spent innumerable hours talking with them and their families, believing I had sufficient insight and empathy to understand the cataclysm through which they were living. As so often, it turns out I was wrong. Until it is felt, I am not sure cancer is truly understood, even by the most seasoned oncologist. The world of scans, procedures, surgeries, chemotherapies is saturated with more hope and fear than I ever knew possible, even after years of medicine. Every nuance of every conversation with the doctors is scrutinised feverishly – the exhausting, endless vigilance. You try logic, research, blind faith, cold reason, every mental power you possess to stave off the worst-case scenarios. You ache with longing to take away the diagnosis, to protect your dad from the hand fate has dealt him. Your medical degree is bloody useless.
Throughout it all, this impotence and anguish as your loved one submits to the indignities of major illness, there has been one overwhelming positive. Thank God, I have thought, so many times over, thank God we do not have to worry about how we will ever pay for Dad’s treatment. No demands for his credit card on arrival in hospital, no bills for eye-watering sums landing later on the doormat, no agonising over whether to remortgage the house to fund the next round of chemo.
That I live in a country that chooses, through our taxes, to provide healthcare without charge to those in need has never made me more proud or grateful. And the thanks and tubs of chocolates my family shower effusively on the staff dispensing the toxic treatments, compassion and kindness to my dad should really be flung wide. For right now, in a sense, like that of every NHS patient, his life is in the hands not of one doctor but of the nation – all of us who pay the taxes without which the NHS would crumble. His oncologists, his nurses, his hospital bed, it is ultimately thanks to the British people that they exist at all.
Reading headlines about the latest winter crisis in the NHS – patients dying in hospital corridors, life-saving cancer operations being cancelled – is not easy when someone you love requires hospital treatment. What if Dad takes ill? What if there are no beds? How will we make sure he is safe, not abandoned on a trolley for hours on end? But the hardest thing for me – both as a doctor and as a daughter – has been the Prime Minister’s denial of the problems.
For the stark truth, one of which she simply cannot be unaware, is that after six years of shrinking the share of GDP it spends on health, the government’s shoestring has snapped. The NHS no longer has the funds to keep up with rising demand. Hospitals have run out of beds. GPs are rationing appointments. There are not enough nurses. There are not enough doctors. Babies with suspected meningitis are lying on makeshift beds on plastic chairs in A&E. The NHS is falling apart before our eyes and staff are screaming that patients are unsafe. Another Mid Staffs – the scandal David Cameron vowed would never be repeated – is not looming: it is already here. Yet the government is choosing to turn a blind eye.
As winter unfurled into spring, the NHS crisis only deepened. In late March, the CEO of NHS England, Simon Stevens, announced the grim news that, in order to try to balance the books, he was effectively dumping the commitment – enshrined in the NHS constitution no less – to treat at least 92 per cent of patients in England needing non-urgent surgery within eighteen weeks.87 The move was necessary, he claimed, so that hospitals could concentrate on more urgent priorities such as A&E overstretch and improved cancer care. But the ten-year-old 92 per cent target had been in
troduced to prevent the misery of patients enduring agonising waits for seemingly humdrum yet potentially life-transforming operations such as hip and knee replacements and cataract surgeries. Its abandonment spelled potential misery for tens of thousands of patients, particularly the elderly.
Barely weeks after Stevens’s announcement, news broke that areas of London were banning cataract surgery in all but ‘exceptional’ circumstances.88 The Royal National Institute of Blind People (RNIB) immediately condemned the move, with Fazilet Hadi, director of engagement at RNIB, stating, ‘All patients should be given access to cataract treatment without delay and based on their clinical need. When a cataract begins to affect a person’s sight their vision will continue to deteriorate until it’s removed. Patients with severe cataracts are at risk of social isolation, depression and fall-related injuries such as hip fractures.’
I thought once more of my father, whose own cataract operations a few years earlier had turned a bleak future of disablement and blindness into one of radiant Technicolor. The simplest, speediest surgeries. The most radical, life-affirming results. Were we really willing to condemn our elderly to a fate of entirely avoidable blindness, I asked myself, unless they were rich enough to pay?
The NHS is not perfect and could undoubtedly benefit from innovation and reform. Money is not everything. But, unless it is adequately funded, our health service is clearly destined to fail. And, if that happens, presumably the NHS would be replaced or augmented by a non-tax-funded, privately delivered alternative. That might, I suppose, be what the public want (though the polls uniformly say otherwise) but at the moment we are not being given the unspun facts and information upon which to make an informed opinion. It is Theresa May’s right as Prime Minister to decide that the country cannot afford the additional public spending required to maintain our current standards of healthcare. But, if she does, she owes it to the public to be honest about the reduced level of healthcare we can expect from now on – to come clean on what the NHS will no longer provide – and face the political consequences of doing so.
In the end, I fear that the greatest threat to the longevity of the NHS may not be the current incumbent in Downing Street but, paradoxically, one of the things that make all of us so resilient: the boundless capacity of the human spirit to live life in denial of suffering and death. Cancer, heart attacks, car crashes, brain damage – we know the bolts from the blue are out there, we just never believe it is us they will strike. Perhaps it is only when you or your family are smitten that you fully appreciate – with relief and gratitude – that the NHS is there, ready and waiting to scoop up your loved one and put them back together again, without a punitive bill attached.
But, as a hospital doctor, I see lives ripped apart by illness every day. Catastrophes are my daily bread. It could be me, my children, or you tomorrow. Yet, if it is, the NHS will be there, holding, helping, comforting, soothing. For me, there is nothing in Britain that better represents the decency, humanity and generosity of spirit of the country to which I belong. The patient whose status gives me the greatest concern today is the NHS itself, and ultimately its fate rests not in my hands but in yours.
ACKNOWLEDGEMENTS
I never believed I could really write a book until receiving a tweet, of all things, from Lauren Gardner at Bell Lomax Moreton, from which this book began. Thank you so much, Lauren, for being the most supportive, encouraging and inspiring agent a new author could ever hope for. You have expertly guided me every step of the way, and it was your faith in me that made me believe in myself.
Huge thanks to James Hodgkinson, my fantastic editor at John Blake Books, who was willing to take a risk with a junior doctor activist, and whose unwavering belief in the importance of the book kept me going. All your wise observations on the writing (not to mention your emergency GIFs, when required!) helped me no end. Thanks too to Emma Stokes at John Blake, and Lizzie Dorney-Kingdom, September Withers and everyone else at Bonnier Publishing for your help and expertise.
Thanks to Taryn Youngstein, Denis Campbell, Tim Littlewood, John Reynolds, David Oliver, Jane Grundy and Rebecca Inglis for your incredibly helpful comments on the manuscript. I really appreciated you taking the time to read it and help shape its finished form.
The government’s dispute with junior doctors galvanised not only us juniors but also our consultant, GP, nursing and other NHS colleagues. Thank you so much to all those NHS staff who stood by us. It meant so much to us that you showed us solidarity. Thank you, Johann Malawana, for bringing juniors together, inspiring us to take a stand. Thanks to Neena Modi, Jane Dacre, Simon Wessely, Taj Hassan, Philippa Whitford, Partha Kar, Stella Vig, Rob Galloway, Trish Greenhalgh and Alistair Hall for your particular support of juniors. Phil Hammond, you were so kind and supportive throughout. Most of all, thanks to all those members of the public who backed us in person, in the media and out on the picket lines. It wasn’t easy reading anti-doctor spin most weeks in the press – and your support genuinely helped us keep going.
One of the great positives of what was, at root, a profoundly demoralising and destructive dispute was forming new and enduring friendships with so many other impromptu junior doctor activists. Marie, Nadia M, Ben W, Amar and Fran – the five indefatigable junior doctors who organised the most successful crowd-funded case in UK legal history, taking on Jeremy Hunt in the High Court – and Paola, Lolly, Amrita, Ruhe, Aislinn, Azra, Mei, Reena, Aoife, Ben D, Nadia R, Matteo, Roshana, Zoe, Hoong-Wei, Jeeves and Matt: it has been my privilege to campaign with you and come to call you friends. In particular, Taryn and Dagan, the intelligence, passion and commitment with which you fought for what you believed in has been a constant source of inspiration. Dagan, special thanks for those two memorable nights we shared – on the Department of Health’s doorstep.
Huge thanks to my Mum, an NHS nurse and health visitor, and my Dad, an NHS doctor, who raised me to believe that working hard, trying your best, being kind and looking out for others were the things that really mattered. Every day, I see your qualities writ large across the NHS – they are both commonplace and priceless. Dad, I have always tried to emulate the doctor you were to your patients – I hope I’ve managed to come close.
Finn and Abbey, I am sorry your mum spent two years so distracted by something as baffling and dull as domestic politics. One day, I like to believe you too will stand up for what you believe is right, but for now, my sincere apologies.
Above all, Dave, my heartfelt thanks. Your love, support, patience and encouragement have meant so much to me, every step of the way. Thank you for always believing in me.
REFERENCES
1 Health at a Glance 2015. OECD, 2015 (Paris: OECD Publishing), available at http://dx.doi.org/10.1787/health_glance-2015-en.
2 ‘Making healthcare more human-centred and not system-centred’, Jeremy Hunt, 16.07.15, available at https://www.gov.uk/government/speeches/making-healthcare-more-human-centred-and-not-system-centred.
3 ‘Jeremy Hunt: “We have 6,000 avoidable deaths every year”’, BBC News, 16.07.15, available at http://www.bbc.co.uk/news/health-33546800
4 ‘“I'm in work Jeremy… are you?”: Angry doctors take to Twitter to post pictures of themselves on duty after Jeremy Hunt claimed medics weren’t doing enough weekend shifts’, Lydia Willgress, Mail Online, 18.07.15, available at http://www.dailymail.co.uk/news/article-3166330/ImInWorkJeremy-Doctors-Twitter-post-pictures-work-Jeremy-Hunt-claimed-medics-weren-t-doing-weekend-shifts.html#ixzz4f5I8KrEG.
5 Jeremy Hunt, Twitter account, 18.05.15, available at https://twitter.com/jeremy_hunt/status/622398974478155776
6 Lauren Nicole Jones, Twitter account, 18.07.15, available at https://twitter.com/Lauren_SLT/status/622402426843340800?ref_src=twsrc%5Etfw&ref_url=https%3A%2F%2Fwww.theguardian.com%2Fpolitics%2F2015%2Fjul%2F18%2Fjeremy-hunt-provokes-anger-on-twitter-for-breaking-patient-confidentiality.
7 ‘These four words that may offend you… may also just save you’, Louis Profeta, Linkedin, 01.11.16, available at ht
tps://www.linkedin.com/pulse/those-four-words-may-offend-you-also-just-save-louis-m-profeta-md.
8 Press statement. Robert Francis, The Mid Staffordshire NHS Foundation Trust Public Inquiry, 06.02.13, available at http://webarchive.nationalarchives.gov.uk/20150407084003/http://www.midstaffspublicinquiry.com/sites/default/files/report/Chairman%27s%20statement.pdf.
9 ‘Independent Inquiry into care provided by Mid Staffordshire NHS Foundation Trust, January 2005 – March 2009, Volume I’, The Mid Staffordshire NHS Foundation Trust Public Inquiry, 24.02.10, available at http://webarchive.nationalarchives.gov.uk/20150407084003/http://www.midstaffspublicinquiry.com/sites/default/files/First_Inquiry_report_volume_1_0.pdf
10 ‘Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. Executive Summary’, Sir Robert Francis, The Mid Staffordshire NHS Foundation Trust Public Inquiry, 05.02.13, available at http://webarchive.nationalarchives.gov.uk/20150407084003/http://www.midstaffspublicinquiry.com/sites/default/files/report/Executive%20summary.pdf.
11 ‘Thousands of NHS nursing and doctor posts lie vacant’, Dominic Hughes and Vanessa Clarke, BBC News, 29.02.16, available at http://www.bbc.co.uk/news/health-35667939
12 ‘Rapid Response Re: Government’s own documents question “seven day NHS” feasibility’, Tom Hines and Rachel Clarke, British Medical Journal, 24.08.16, available at http://www.bmj.com/rapid-responses?sort_by=field_highwire_a_epubdate_value_1&sort_order=ASC&items_per_page=5&page=21697
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