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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

Posted in:  Education and training Communication skills

Tags:  emergency medicine junior doctors medical education and training

Comments

  • Dr Niroshan Sivathasan

    9 August 2012

    A touching recollection of events, with a good 'take-home message'.  
    Sadly, I suspect that there shall be some 'infection control nurse consultant' (or such with a similar self-bestowed title of importance) somewhere, ‘tutting’ at the thought of this.  In fact, I have even heard one such 'specialist nurse' remark that doctors should never touch patients or patients' possessions, unless necessary examinations need to be undertaken.
    The N.H.S. is full of bureaucratic algorithms and is increasingly devoid of common-sense.  Concepts around infection-control potentially related to staff-spreading are, in some hospitals, irrational, ignorant, and nearing on bonkers.  This encompasses considering the needs of patients too.
    Virtually every staff-nurse that I know complains that s/he cannot care for patients anymore, as most of the working time is spent completing forms and 'adhering' to (nonsensical) protocol.  
    I hope that this situation doesn't continue to erode the practice of being a doctor or a nurse ('the power of touch') and simple humane gestures, in hospitals.

  • Dr Pete Sudbury

    13 August 2012

    I think many of us recognise the evidence, both from inquiries / inspections and, most tellingly, from our own personal experience, that the NHS often leaves the "care" out of "healthcare", or does it very, very badly. I'm glad at least doctors still come out of training remembering that every clinical case is a human being first and foremost.

  • Kevin Jones

    23 August 2012

    A very good account of the events Emma. I appreciate being able to read about doctors that still have a heart and aren't afraid to use it.

    There is this assumption that doctors should be detached from the population that they serve, but I beg to disagree. It is your heart that drives your motivation, not only as a doctor caring for the sick and dying, but also as an academic trying desprately to improve clinical practice.

    You do what you can to hopefully reduce suffering of your fellow human beings, even if it's holding the hand of a dying man. Shame on that doctor who didn't have the faintest hint of empathy to understand the importance of your request.

  • Lovie Poe

    21 September 2012

    A very touching story. You know, I'm thinking if what could happen if it has been recovered months earlier with the help of virtual doctors. It has been a big help now and situations like sudden ear ache can be cured by this.

  • Lovie Poe

    21 September 2012

    A very touching story. You know, I'm thinking if what could happen if it has been recovered months earlier with the help of virtual doctors. It has been a big help now and situations like sudden ear ache can be cured by this.

  • osvnieph

    3 February 2014

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