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The human factor

A young man was admitted to an intensive care unit with severe chest sepsis and sarcoidosis.

For several days great efforts had been made to treat him and improve his oxygenation, but he deteriorated very rapidly. As soon as I arrived on the unit, I could see that the situation was grave. He was blue and gasping for breath, surrounded by frightened nurses and the relentless, menacing beeps from the monitors. We had run out of other options and the decision was made quickly to intubate him to try to save his life.

Distressed and dangerously hypoxic, he listened as I explained to him that we would have to put him to sleep and give him a rest from the work of breathing.

Most of us, as doctors, have seen that look in a patient’s eyes when they know they are about to die. As I held his hand, watching him make gargantuan efforts to move any air in and out of his lungs, he looked me in the eyes and simply said ‘thank you’ over and over again. I saw that stomach-churning look of fear and recognition mingling with the beads of sweat running down his face, and tried to ignore the tight knot that was growing inside my chest.

When the senior registrar was ready to intubate, my hands were needed to administer anaesthetic agents and give cricoid pressure. Fortunately, we also had one of the more junior doctors present so I asked her to hold the patient’s hand in my place while he went off to sleep. At first she looked confused and didn’t understand what I had said. I asked her again. She then offered a limp hand to him and held on to a couple of his fingers before rapidly letting go and giving me a quizzical look.

The glaring contrast between her reluctance to hold a dying man’s hand and his bravery in being able to thank us for trying, even though he knew he was dying, touched me deeply. His wife and three young children were in the next room and he was thanking us for trying, unsuccessfully as it turned out, to save his life.

There might not always be anything we can do to cure our patients. We can, however, always hold the hands of people who are in pain or distressed. We can always move the water jug to a place where the patient can reach it. We can fluff the pillows of people who are uncomfortable. We can go to the linen cupboard and get someone an extra blanket.

These might not be skills taught at medical school but these are the things that make me proud to be a doctor.

So, this week, ladies and gentlemen, as you go about your business, please remember to hold your patients’ hands. Sometimes it is the smallest things that make the biggest difference.

Emma Casely is a core medical trainee 2 in anaesthetics in London