The limits of kindness: a patient with ‘pseudo’ seizures

Twelve years ago. A hospital at night. 9PM, and the night shift has started. My raggedy handover list contains many jobs; patients to review, “sickies” to keep an eye on, a chest drain to perform. At 9.30PM the bleep goes off - ‘fast’ bleep. Not a full crash call, but I need to rush. The... Continue Reading →

Resilience – from within or without?

  I have been confused about resilience. To me, it always seemed very sensible to focus on it, this ability to 'bounce back from tough times, or even triumph in the face of adversity'. It surely is part of the ‘hidden curriculum’, as Horne and Peters refer to it in their BMJ article, ‘Ensuring our... Continue Reading →

Wrecker

On this blog I have explored the challenges involved for doctors who engage patients in conversations about resuscitation. I have written about the emotional energy consumed in initiating them, and in The Hill, a series of 7 episodes, I described the spectrum of reactions seen in patients and relatives. Recently I gave a lecture that... Continue Reading →

Fear and medicine – friend, foe, natural bedfellow?

Juliet entered the ward expecting a normal, busy day. But the face of her colleague Nethmi who met her by the nurses’ station told her that something was up. “What?” asked Juliet, responding to Nethmi's wordless warning. “Mr Peterson. Bed 19. They took his vascath out last night.” “So?” “Did you tell the nurse to... Continue Reading →

Death eclipsed

  Finding the right balance between active treatment, which may include surgical or semi-surgical interventions, and palliative care, can be difficult. The two can go on in parallel, of course, but often a full palliative care assessment and plan takes place when the primary medical or surgical team have drawn a line under their management.... Continue Reading →

Checklist mentality

  The case for checklists has been made so well – see this fantastic article by Atul Gawande – yet those responsible for embedding them struggle. They are an effort, an obstacle, an apparently petty imposition. I know it’s the right patient! I know they’re not on Warfarin! I know what equipment we need to... Continue Reading →

Dodging shadows: the mysterious art of detachment

  I watched a patient die before Christmas. He was surrounded by the full crash team, which nowadays is a fairly large group. As the attempt was abandoned, and another consultant ‘called it’, I withdrew into the background. There was nothing I could do to help. I walked away to prepare my departure for the... Continue Reading →

Signature

  What explanation can there be for a surgeon to write his initials on a patient’s liver? It sounds bizarre and disrespectful. This almost surreal, alleged event is sub judice, and I know nothing of the people involved or any details beyond what was in the papers, but perhaps it exposes some interesting psychology. In... Continue Reading →

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