· heart attack,patient,bad day,medicine,only human

Working as a doctor, like with all professions, some days are tougher than others. But when I say I’ve had a bad day I mean it. I know some people throw this phrase around to the extent it loses all meaning and value. But for me, when I’ve had a bad day, it tends to make people stop and listen.

There haven’t been many but I remember them all. The day the hospital was on lock-down as there was a bomb in it. The night-shift pressing a patient’s inferior vena cava against her spine as all theatre staff wore her circulating blood volume, including the one holding her new baby. The major incident after a train derailment, telling a 14 year old her best friend who was sitting next to her, had died. Trying to intubate a newborn with undiagnosed tracheal atresia.

Thankfully they are few and far between.

But what happens when you are on the other side? When you are the patient yourself or a relative? You sure don’t want to be a part of a doctor’s bad day. But being on the other side, that is a truly heinous day for someone.

I was on the train between Edinburgh and Glasgow when I got the call.

He’s having a heart attack. Go back to him. Now!” I must have said this louder than I intended as the whole carriage went quiet. I was several hundred miles away when my sister called describing our Dad looking pale, sweaty and having a pain in his neck. Our fit, athletic, healthy Dad aged 57. Our Dad of normal BMI, who had never smoked, played competitive sports all his life and looked after himself; having a normal BP and perfect cholesterol level despite his penchant for cheese and chocolate.

She described him sitting in the living room with the curtains drawn. Not knowing what was going on, but knowing something was clearly not right, she drove away and left him, calling me for advice, several hundred miles away on a packed commuter train.

I got my first speeding ticket that day driving down to the hospital.

Before reading further I feel you should know, my Dad is fine. He turns 70 next year, he’s currently renovating my childhood home and plays cricket weekly in the Summer months, even though it now takes the entire week for his joints and muscles to recover before the next onslaught!

Arriving at the hospital, for a short time anyway, my parents made an attempt to be parents. Protecting me from what was happening and making jokes, appearing overly cheerful despite their eyes telling a different story.

He’d had a heart attack, three in fact. What was apparent was that he was not going home without intervention, be it angioplasty or coronary artery bypass graft.

As a doctor I’ve done a cardiology rotation. I’ve seen quite literally hundreds of patients who have had heart attacks, who have had successful interventions. I’ve also been to my fair share of cardiac arrests on the cardiac wards.

As a relative, regardless of any prior medical knowledge, I was terrified. Going to the lift with my Dad, lying on the hospital bed, being taken down for his diagnostic angiogram and watching the doors shut behind him reduced me to tears. Waiting at his bedside whilst the consultant came to tell us the results the most nerve-wracking moment of my life. He was in bed space 5, the curtains thin, so we had heard him speak to others and deliver their news. The man in bed 3, younger than my Dad, needed a triple heart bypass. Convinced this was his fate too we couldn’t have been any happier to hear stents would suffice.

The reason I’m sharing this story is because being on the other side was a bad day unlike any other I’d experienced. I remember each health professional we interacted with, I remember each patient in that 6-bedded bay with him. This was a hospital stay of several days where my Dad went in with a problem which was quickly diagnosed, an intervention was performed to fix it and he was discharged home. Albeit broken emotionally for some time after, but physically he was in a far better place than when he went in.

How many patients do we see where there is no obvious answer, no quick fix? Patients who get worse despite interventions, have incurable diseases, chronic illnesses and we have no answers.

Being on the other side changed the way I consulted and interacted with patients and their families. I wanted to be told things straight, black and white with none of this wrapping things up in flowery non-descript terms which made you question your own left from right. I wanted to be clear what was happening. Even though I could understand medical jargon I asked to be treated as though I didn’t, spell it out to me and check I’ve got it. And this is how I treat my patients. Cancer is cancer, not a shadow on the lung, a lump or a lesion. I don’t refer people to “get checked”, I refer people because I’m worried they have cancer, Crohn’s disease, multiple sclerosis or I can’t effectively manage to control their symptoms myself. I tell them that I treat them as I would want to be treated myself, I do what I would for my family, for those I love. I look after them.

When my Dad had his heart attack I was working as a paediatric registrar, adult medicine was several years in my past and I wasn’t up-to-speed with all the changes, medications and interventions. This was one of the reasons I changed career path to be a GP. As the only doctor in the family I knew I needed to change the story, know the questions before they were asked and have the answers.

We all have bad days, some worse than others, but it’s what we take from these, how it changes us, how we re-write the story is key. We may not always be able to change the ending but we can make the journey easier.

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