Month: September 2023

Conversations

Just a collection of snippets of conversations I have had with my patients over the years. My favourite part of my job is that I get to speak to people, laugh with them, smile with them, connect with them. And be there when they’re sometimes at their lowest. Sometimes I even have the honour of being there when they leave this world.

A very frail elderly man:

“I’m 92 and I want to go be with my wife.”

“Where is she?”

“With God.”

A middle-aged COPD patient:

“Oh! That’s a Buddha in a box! Where did you get that?”

“My son’s girlfriend got it for me. She’s into these kinds of things.”

A young man:

“Can you come next week for your prescription?”

“No, I’ll be busy.”

“Oh okay. It is important. Why can’t you come?”

“I’m going to a week long Chemsex event…”

An elderly lady who tried to set me up:

“Oh. Have you got a husband, dear?”

“No. I haven’t.”

“well. Do you want to marry my grandson?”

“…er…no…thanks,”

A middle-aged man with acute psychosis

“Can I tell you a secret?”

“Yes ?”

“I know where it is buried.”

A middle aged man with cardiac problems

“I bring my own coffee because the stuff here is terrible!”

An elderly man with end stage renal disease who I saw reading a fantasy novel:

“Oh I didn’t take you for a reader of the fantasy genre,”

“No it isn’t really my taste. I’m only reading it because my grand-daughter wrote it!”

A car mechanic who couldn’t walk:

“My legs don’t work but I have strong hands,”

“Yeh?”

“I’ll show you…”

He then proceeded to squeeze my hand so hard I had to ask him to stop!

The son of an elderly woman with dementia:

“Does your mum have any hearing problems?”

“No doctor, she’s just incredibly stubborn and deliberately won’t answer.”

A woman with a condition affecting her ability to do her work:

“What do you do for work?”

“I’m a chef at the insert famous local restaurant

“Oh really! Is that your business? I’ve had food from there!”

A patient:

“How should I call you? It says your title is Duchess!

“Yes my husband was a Duke. But you can call me ABC”

An elderly woman with the strongest Irish accent I ever heard:

“Sometimes when I close my eyes, I think I’m a young girl in Ireland again.”  

-V-

Cardiac arrest

Part 9 of the Death Series

From Grey’s anatomy to famous sports personalities needing CPR and to the song ‘Stayin Alive’...almost everyone knows what cardiac arrest means. For the general public it is the epitome of medical miracles.

“Bring me back to life,”

“Re-start my heart.”

“Bring me back from the dead,”

That’s often how cardiopulmonary resuscitation is sold to the media and to the public. Cardiac arrest is not ‘permanent’. It is 2023, we can bring back a dead person, no?

No.

Cardiac arrest is defined by the British Medical Journal as ‘a sudden state of circulatory loss due to a loss of cardiac systolic function.’

Cardiopulmonary arrest is defined by the National Institute of Health as: ‘sudden cessation of cardiac and respiratory function and results in death without reversal.”

Cardiopulmonary resuscitation (CPR) which can be lifesaving is usually only effective in certain individuals, with certain reasons for being in ‘arrest.’ And the longer it takes to start chest compressions the less chances of survival.

CPR can and does save lives. And I personally think becoming a first aider is one of the most important life skills you can acquire. However equally important and perhaps more challenging is deciding when CPR is not in someone’s best interest.

In the UK the decision to provide CPR in the event of cardiopulmonary arrest is a clinical decision because it is a form of treatment. Doctors in the UK reserve the right to withhold this treatment if they do not think that CPR would be in the patient’s best interest. It is critically important however for the patient or the patient’s next of kin to be informed of this decision prior to signing any forms.

There are multiple and extensive reasons why CPR may not be appropriate for people. The common reasons are:

  • the patient themselves don’t want to undergo cardiopulmonary resucitation
  • the patient may be facing a terminal illness which is non-reversible and therefore the natural progression for their disease is death. In this case performing CPR would be futile.
  • The patient has multiple or ongoing co-morbidities which would mean that performing CPR would be unsucessful or have limited success and may leave them with permanent disabilities or undue harm as a consequence of surviving CPR but needing more ongoing intensive treatments.

Importantly and perhaps the bit that causes the biggest misunderstanding is that a ‘Do not attempt Cardiopulmonary Resuscitation’ forms only kick in or become valid when the patient is in cardiopulmonary arrest – i.e their heart and lungs have stopped and they have died. Every step before that requires treatment and management and does not change the level or amount of medical care a patient receives. DNACPR does not stop patients from being ventilated, intubated, receiving intravenous treatments, surgeries, pain relief or any other type of treatment.

In the hospital, my job often involved talking to unwell patients and their families and discussing with them what their views on death is if things got worse. Often patients and their families actually do have views and opinions on this. After all death is in inevitable consequence of living.

I strongly believe that having discussions about CPR, cardiac arrest and death when people are stable and well saves trauma and distress when we are forced to face their realities when people become unwell.

I have attended many cardiac arrests. Some have resulted in achieving return of spontaneous circulation (ROSC) and a lot of have resulted in death. However, pretty much all of them have been traumatic for us as clinicians, the families involved and ofcourse the patient.

Cardiac arrest is often a natural consequence of disease progression. And sometimes it is not. Being prepared to have these conversations with your loved ones and knowing how to provide basic life support is to me the most important aspect of healthcare.

For more information:

Basic life support and Advance Life support guidelines: https://www.resus.org.uk/library/2021-resuscitation-guidelines/adult-basic-life-support-guidelines

Songs to help you get the pace of CPR right:

-V-

Part 8 https://medibites.wordpress.com/2023/04/15/part-8-telling-the-family/

Thirty

Being 30 doesn’t really mean much yet. I still feel the same I did last year, or the year before , even ten years ago. 

I still have the same dreams and aspirations just the tangible goals have changed. 

Last year I was determined to make my last year of my twenties count. I gave my best to my job, to my friends and to my family. 

But 30? Well. I don’t know what it means to be in my 30s yet. 

Uncertainty is a part of life. And I’ve changed many a school, hospital , home to know that change is the only constant in life without which we stagnate. 

Fear is another emotion we often shy away from but it only exists because we’ve experienced love, happiness, excitement and comfort. Fear comes from knowing this could change but doesn’t that mean we’ve experienced it? 

Hope- this is one I’ve always believed in. A new decade with uncharted territory, no immediate expectations, no specific goals yet set. 

And so if you combine uncertainty, fear and hope I think I might have just put a recipe for success together. 

30s will be scary and difficult. But also fun and exciting. There will be a lot of the predictable and a whole lot more of the uncertain. Above all, I want to embrace this and being 30 only means I can refine the things I know work for me and explore the world and all it has to offer with the same dreams and aspiration of a younger me but the confidence that being a 30 year old brings. 

-V-