Month: June 2016

Introduction to ‘A Hand In The River’


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This is the fourth collection of posts from Illusions of Autonomy, and possibly the last. From now on posts will be intermittent and far less frequent.


During my medical training I observed many situations that led me to reflect on how I, or my colleagues, had reacted. It was only after two years working as a medical consultant that I felt entitled and empowered to write about those reflections. While explaining the reasons and justifications for my decisions to nursing staff and trainees, I realised that it might be helpful to set those thought processes out in black and white. Recognising that I was personally accountable for the clinical decisions, judgment calls and interactions that took place in my name reinforced the sense that yes, my opinion mattered. No more than any other doctor’s of course, but the satisfaction I derived from recreating difficult situations in a creative way meant that instead of letting those lessons pass by in the endless river of human experience that is a hospital, I dipped my hand and examined the essence of those problems before they slipped out of my palm.


Some subjects had nothing to do with my day to day work, but I was driven to write about them from conviction – for example assisted dying. The media driven uproar about care of dying patients and the Liverpool Care Pathway stimulated another stream of articles, from the perspective of doctors whose actions had, I felt, been impugned. The thrill of seeing articles out in the blogosphere led me to broaden my research into other subjects too… hence the wide range of topics in the early days.


The process of posting an article, Tweeting the link and seeing it catch fire was massively stimulating. To see the Re-Tweets and ‘hits’ accumulate over a weekend… was addictive. Sometimes posts did not catch fire, and instead spilled from my laptop with a leaden thud. Like all writers, I soon learnt to put these to the back of my mind while I considered the next topic. During the blog’s peak I wrote every week – the most posts I wrote was five in a month. One consequence of moving on to different subjects quickly was that I did not spend much time replying to comments left on the blog – although I think that is an essential part of maintaining a living forum of ideas (this is a tip for any aspiring bloggers – you need to make time to reciprocate). Recently I have scarcely managed one article per month, reflecting the fact that my focus has shifted.


So why stop?


It may be because I have explored many issues to my satisfaction, and have run out of novel observations. I think a large part of a writer’s drive comes from a desire to marshal their thoughts, much as an adolescent might discuss religion until he or she decides what to believe and want not to believe. Through the blog I went some way to achieving that with regard to medical futility, resuscitation, escalation, assisted dying and candour. However, thinking about things too much can also muddy the waters and leave you in an unresolved soup of ideas… There are no absolutes.


Or it may be because my decision to move away from general medicine has separated me from the front line, or the ‘coal face’, where so many complex and demanding clinical scenarios arise. The patients I see now (as a specialist in a tertiary centre) are sometimes medically more complex, but younger, less frail, and generally further from death. The pressure to see huge numbers of medical patients has given way to a different kind of pressure, that of working out how to help a selected, smaller group. Giving up general medicine has allowed me to focus on the areas that I most enjoy, but the price to pay for that may be a diminished entitlement to comment on situations that continue to challenge colleagues on the general wards.


Whatever the reason, I look back on those four years of blogging with pride, and gratitude to those who gave me positive feedback. There is a deep well of generosity out there, 99% of it in colleagues I have never met but who came across the posts via social media and took the trouble to read and comment. The most critical comment I received was ‘more navel gazing from Dr Berry…’ That is so true! Everything on this blog came from examining other people’s misfortune through the prism of my own emotions and responses, while hoping that the ideas I recorded would chime with a wider audience. Generally, they did.

three covers

Collected posts volumes 1-3