“Being there”

Dr Graham Ellis works at NHS Health Care Improvement Scotland as National Clinical Lead for Older People and as a Consultant Geriatrician for NHS Lanarkshire. He tweets @grahamellis247

There is a story told of a man walking along a beach. A big storm the night before had thrown up thousands upon thousands of starfish. A small boy was bending down and repeatedly picking up a stranded starfish and throwing them back into the surf. The man approached the boy and said: “Why are you bothering - there are too many to save here. You can never save them all.” While the man talked, the boy quietly bent down and picked one up. Splash. Without looking up he replied, “It made a difference to that one.”

I confess I hate that story. I would want to recruit helpers, dig irrigation channels, organise human chains and explore systems to look at more efficient ways to reach even more starfish.

Sometimes the everyday numbers are overwhelming. Nearly every clinical day of work I have to tell someone they are approaching the end of the road. That there is relatively little we can do for them. No cure. We can discuss what matters to them and what we can do to meet those needs. We can discuss their goals of care and start planning for that, but the emotional burden for doctors is huge.

As I get older I think I prescribe less and listen more. I talk more and investigate less. I must admit I even read less scientific journals and more philosophical books. As doctors are we there just to take away pain? Or are we to be there with the patient when they are in pain. After all, not all types of pain can be cured by morphine. The ‘why’ and the ‘what’ can wait for another day but ‘how’ we do things matters hugely. They say people seldom remember what we tell our patients but they remember how we made them feel.

I sat on a stool opposite her and leaned across the bedside table to face her. I put the sats probe on her finger and took off her nasal cannula. She shook from benign essential tremor and titubation that she had never had diagnosed or explained. She was self-conscious of it and apologised saying “Look I am just a stupid old woman - but doctor please let me go back to the home.” Her eyes filled up as she told me that her husband had died four weeks earlier and she had not long moved into the care home. I sympathised with her that she had faced so many losses in such a short time. How could I even begin to help her?

She told me the care home was “not too bad”. Faint praise indeed. She asked me again if she could go back. She was desperate and hated hospitals. I glanced at the saturation monitor. It had been reading a steady 97% the whole time we had been chatting. I had so little that I could help her with. Her chest infection was a small problem compared to her personal losses and fears. I was helpless to change them.

“Yes you can”, I said. “You will be able to sleep in your own bed tonight.” (Not a particularly risky or clever decision on my part.) “That’s wonderful!” she said as her eyes filled up again and she thanked me profusely.

A nurse was listening in as I pulled back the curtains. “Well, you’ve certainly made her day!” she said. Perhaps it made a difference to that one.