Monthly Archives: October 2015

The Expiry Date

Source: The Expiry Date

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The Expiry Date

This morning I read drkategranger’s blog regarding her expiry date (she is a doctor with terminal cancer who talks about death so candidly, it inspires. I would absolutely recommend!!!). The blog and some of the responses to it got me to thinking about death. I have already written about dying and the fact that I fear it not so much. As a Muslim, I tend to see death as just one of those certainties of life so I treat it quite matter-of-factly. This blog is will be further musings about my experiences of death. I will start with a quote from Hadith (Islamic teachings) which summarises how I generally see life and death:

Al-Hasan Al-Basrî said:
‘The life of this world is made up of three days: yesterday has gone with all that was done; tomorrow, you may never reach; but today is for you so do what you should do today.’ Al-Bayhaqî, Al-Zuhd Al-Kabîr p197

I am generally an optimist or more accurately an optimistic realist so I try not to be morbid and I am generally not one to dwell on death. However, I have had times in my life where the thought of dying has crossed my mind. Last winter was a pretty bad time for me. I was working in the hospital that inspired me to become a paediatrician (which still inspires me) but I was in a job with a particularly toxic individual who succeeded in poisoning the atmosphere. I became depressed after 6 weeks of this. So much so that I hated waking up every morning I was scheduled to work. It got to a point that I would lie in bed, sleepless and think ‘would it be that bad if I didn’t wake up in the morning?’ As soon as the thought came to my mind, I would feel guilty and terrible. Guilty because I knew that my life really wasn’t that bad and that there was so much for me to be grateful for. Terrible because I knew my death, although insignificant in the grand scheme of things, would be horrible for my nearest and dearest. My mama especially. I got through those 4 months because my husband was there and would not let me sink into the depths of depression that kept pulling at me. Thank you George!

I am now back to my normal sunny self despite some current work horrors. As a newly-qualified doctor back in 2009, I dealt with death day in, day out especially on my first job on gastroenterology at a busy inner-city hospital. After the initial shock, I got used to it. Not that I didn’t care or it didn’t bother me but I dealt ok with it. There are 2 patient deaths from those days that have stayed with me. Both died of alcoholic liver disease. Both men in their 40s.

The first patient died slowly from hepatorenal syndrome (HRS). Basically with chronic liver failure, if your kidneys too fail, you will die soon because that means 2 of your 4 vital organs are dead or dying, unless you get brand new organs (i.e. transplants). As things currently stand, you cannot be put on the transplant list for a new liver if you are still abusing alcohol because the new liver will get damaged just the same and it is considered a waste of an organ that is in high demand but short in supply. So with my first patient, who I will call Patient A, when his kidney function tests declined rapidly and nothing we could do medically fixed it, we diagnosed HRS and my registrars and consultants had a meeting with his wife to inform her of the diagnosis and what that meant for the patient. He too was told in due time but because of his liver failure, he was confused and did not fully grasp the fact that his condition was terminal.

He deteriorated slowly over a few weeks but in the meantime, he would ask me daily when he could go home and travel to India to be blessed in the Ganges River. I would mutter something non-committal and beat a hasty retreat out of his side room. Initially, it was clear that his wife knew his death was near. But even she began to belief he would miraculously recover from his liver and kidney failure. Every week, she would say something that made us worry we hadn’t prepared her for the inevitable. Every week we would remind her gently that although she couldn’t see it, he was in actual fact deteriorating judging from his biochemistry lab results and worsening oliguria (he was weeing less and less).

In the week of his death, he suddenly looked well again. If I wasn’t the doctor patiently doing bloods on alternate days and chasing those results and noting the relentless rise in his urea and creatinine, I too would have started to believe in miracles. His wife upon seeing the light return to his eyes and his demeanour brighten plunged headlong into denial and joined him in planning their trip to India to the Holy Ganges River. Less than 24 hours before his eventual expiry date, it was devastating for me to watch her grief as the light in his eyes faded rapidly and he shrunk back into himself. Within 12 hours of his final illness beginning, his strength was gone and his mind with it. His utterings became incomprehensible and he became completely disorientated. The look on her face said it all when we came in to see him on our ward round that morning. We returned the look and she ran out of the room to sob in the corner. He was anuric by then (had stopped weeing completely) with a creatinine of over 400 (in other words, his kidneys had packed up). His liver function tests painted an equally damning picture. We completed his end of life paperwork that morning and when we left work that evening, he was hanging on by the tips of his fingers. We came in the next morning to the news that he had died before the end of the day before. The side room he had occupied for many weeks stood empty, awaiting its deep clean before the next customer.

Patient B was a young alcoholic who had developed liver cirrhosis in the months before I started the job. He had just turned 40 and I don’t think had any idea how serious the consequences of regular alcohol binges could be. Reality hit when another patient who was his ‘neighbour’ on our ward developed HRS and died rather quickly. All of our words of warning had somehow not sunk but with this other patient’s death, his mortality was clear to him. He called me over urgently that afternoon and said ‘Doc, I am ready to change’. I was pleased and felt a sense of accomplishment when I referred him to the rehabilitation programme. His wife found me the next day before they were discharged home to thank me for getting through to him. I was honest to say it wasn’t anything I did.

Unfortunately, he came in a few weeks later unwell with an infection which caused his liver function to deteriorate badly. I was encouraged to hear that he had no touched a drop of alcohol since his last admission. He developed litres of fluid in his tummy and I had to put in a tube into the side of his tummy to drain out all that fluid. He was in a lot of discomfort and fearful for his life and he asked me ‘Doc, am I going to die?’ I hesitated over the words I used but in the end I made no promises. Just that I would do everything I could to help him get through this. At first, it looked like the drain and intravenous antibiotics were effectively doing the job and the next day, the fear was gone from his eyes. I was encouraged by his blood results and left having ordered some more routine bloods for the next morning. Coincidentally, at I was securing his abdominal drain, I carelessly dropped the needle I was using to suture and when I went to retrieve it, gave myself a needle-stick injury. I had to get a co-doctor to inform him and take blood samples off him to check that he didn’t have any blood borne infections I could catch. He apologised every day after the event like it was his fault I had stuck myself with a contaminated needle. He asked me about those results daily – he seemed genuinely to care for my welfare. This went on for over 2 weeks as he slowly improved.

I was doing the ward round alone one morning when I was called urgently to his side. He was in a great deal of pain and was writhing in his bed with his abdomen larger than before we drained him. He was pale and clammy and his eyes looked like a man staring down the barrel of a gun. I could barely make sense of his words and as I changed his prescriptions, called the blood bank for blood products and prepared to get a new drain inserted. I could see the life begin to ebb out of his eyes. In a panic, I called my registrars and told them I needed them on the ward ASAP because patient B had taken a turn for worse and nothing I was doing was making a difference. The registrar told me to leave the drain for the meantime and focus on reassuring the patient. After I asked the nurses to call his wife in, I went to him and I held his cold hand. I looked into those eyes and I knew in that instant that he was not long for this world. I remember saying a mental prayer that he could hang on for his wife to be by his side.

‘Doc!’ he cried. I squeezed his hand and responded ‘Yes B?’

‘I am dying aren’t I?’ he asked. I looked down and swallowed the lump in my throat. ‘I am here for you B and I will do everything I can to help you. Your Mrs is on her way in.’

‘Stay with me,’ he entreated fearfully. I nodded and again I had to look away because the fear in his eyes was too powerful for me to take in. The rest of it was a blur. His wife made it in before he died but not in time for him to know she was there. He was delirious by the time she got to the ward and as he was slipping away before our very eyes, there was little time to have ‘that conversation’ with his wife. The consultant whisked her away and broke the news to her. She could see that treatment was futile by then and knew that he was on maximal available medical treatment. We had no more to offer. She signed the DNAR (do not attempt resuscitation) forms and we set about making him less agitated. When we finally called it a day, he was less distressed, still mumbling incoherently and his eyes had started to take on that distant look I now associate with death. I came in the next morning to a request to come to the morgue to complete his death certificate and Crem forms so that his wife could lay him to rest. I got a call 3 days after his death to say his blood tests for blood borne infections had come back negative so I was in the clear. I cried in the staff toilets. He would have been relieved not to have put me at risk I think.

What did patients A and B teach me about death and dying? Firstly that when it is your time to go, it is your time to go. Life unfortunately doesn’t usually give you a clearly labelled package with an expiry date on it. Secondly, although death is scary for the person dying, it is actually worse for the person who loves them who has to watch them lose their battle to live and battle their fear of the unknown. Who has to go home and face life without them and rebuild their lives around the hole left by the dead loved one. Who for a very long time will think about their dear departed every morning when they wake up and every night before they fall asleep. Lastly, every human is unique. Despite having the same disease and modifying your risk factors, your body will do its own thing. We doctors can try to influence outcome but whether we succeed or not is not within our power to control. That is beyond science and medicine. That is life. That is God. That is reality. May we all depart this world in the easiest swiftest way possible. Amen

Listen to Granddad

My grandad by everyone’s standards is a legend. He has seen and done so much in his lifetime and he continues to do so today at the age of 85. Look him up. Ahmed Joda is his name. I won’t bother to write about his many achievements because so many have done so over his many years of service. I want to write about the man beneath it all. My grandad who I call Baba. We all do, his children and grandchildren alike. Because before I realised what other people thought of him, through my young eyes, all I saw was an ‘old’ man who was my mama’s dear father. My only grandfather. The patriarch of the family who was also the main father figure in my life.

The first thing we all know about Baba is that he is a stickler for punctuality. Now this might not sound significant to you but coming from Nigeria, it so is. Have you ever heard of the concept ‘African time’? Did you know ‘Nigerian time’ constitutes even worse ‘lateness’? So a Nigerian who is always on time is as rare as hen’s teeth. His most precious possession is his watch. He looks at it every few minutes even when he has absolutely nothing to do. It’s like a nervous tick. And God forbid he forgets his watch at home, he will drive us all mad asking for the time every 5 minutes.

When Baba asks you to meet at 5pm, at 5:01pm he will be on the phone asking where you are if you are not there. If you make plans to go somewhere with him, be sure to get there on time because I kid you not, if you are more than a couple of minutes late, he will go without you. Whoever you are and wherever you were meant to go with him. I think I wrote a blog about how he invited his friend from Abuja to come to Yola (9 hour road trip) to join us all on a trip to Gembu (6 hour road trip). We waited for 20 minutes and despite the fact that it was 6am and we would get there by lunchtime, he declined to wait and left without them. Lord knows what they went through to find Gembu because Nigerian roads outside of Abuja and Lagos are poorly signposted especially places like Gembu and they didn’t turn up until the next morning! We in the immediate family are no strangers to his bark of ‘come on!’ which when I was little used to make me cry because it sounded so scary. Over time, I have learnt not to react so emotionally to it but still, when that bark comes because we are more than a minute late to leave for some engagement, my heart skips a beat.

I once asked Baba why being punctual was so important even when no one else (Nigerian) cared and why we had to be the first ones at every event. He explained and although I cannot remember exactly how he phrased it, the message is reflected in the following quote:

‘Know the true value of time; snatch, seize, and enjoy every moment of it. No idleness, no delay, no procrastination; never put off till tomorrow what you can do today.’

Lord Chesterfield

He certainly lives by that rule and as I have said before, he has achieved more than most people would in 3 or 4 lifetimes. Perhaps he is still going so strong at 85 because he is mindful of seizing every moment he has been blessed with. I certainly want to emulate that when I grow up.

So many things I love about Baba but one of them is easily how much he has empowered us all to speak our minds. He has never been of the school that children should be seen and not heard. From a very early age, he would ask our opinions on topics most adults would never broach with children and he would give your answer his undivided attention and take it on board. Many years later, he would repeat your words to you especially if you had learnt from experience that things were not black and white and he would invite you to explain why the change in opinion. This means that in the Joda household, we are all prolific debaters and will put across our arguments without fair of censure as long as we were being honest. Active debate is encourage actively and even the youngest gets heard as long as they want to contribute. I think what keeps Baba so young at heart and full of zest is that he surrounds himself with the young and he sees life through our eyes. That way, his ideas are always in date and he can converse about whatever you choose to discuss.

Somehow, Baba never asked me what I wanted to be when I grew up until I was 13 years old. I brought the topic up because when I was choosing my optional subjects for SS1, my mother expressed surprise that I didn’t want to do Economics. My response was one of surprise too because although I was good with figures and mathematics, I was always more into my science than finance. Turns out Baba thought I would make a great economist. Next time we sat around the dining table, I asked him why he thought I would make a great economist. I can’t remember his reasons but I promptly told him I was going to be a doctor and that there was no way economics would even feature in any options I would take for a career path. He expressed his disappointment that that was the path I had chosen but of course it was up to me. I was going to be the first doctor in the Joda lineage and thought he would appreciate my individuality.

It wasn’t until I was qualified and he sought my opinion on some of his medications that I felt he was proud of the career path I have chosen. So was I right not to listen to Baba? I thought so until the recent NHS upheaval which might mean me changing career tracks this late in the game. He is almost always right my grandad after all. Maybe what he foresaw was that being an economist would be a better quality of life for the grand-daughter who was feisty and named after his beloved wife. Perhaps he knew that my hard work and talents would not shine the brightest as a doctor. Perhaps he even predicted that I would end up working in the NHS whose main shortcoming is its poor economics. Who knows? As of now, I think I chose the right profession. I knew I wanted to be a doctor before I even know what a doctor really does. I love the job itself now, more than I ever thought I would. However, the politics of the NHS now means I am questioning whether my love for the job justifies my continuing on in the career when it means me risking my health, my social wellbeing and happiness and giving up so many of my dreams. Watch this space!

Neglect Has A Lasting Legacy

I was 5 years old when my sister and I went on a road trip with Baba, our Grandad, up North in Nigeria. It was not normal for just the two of us to go with him. There was usually my grandma too or maybe my mama. However, this time we got to go solo with him. I suspect it is because we begged and it was the holidays and my mother was busy at work with no better plans to entertain us. Whatever the case, we got to go and I remember my sister and I getting bored quite quickly (probably an hour into the 6.5 hour journey). Plus my grandad had taken to listening to boring traditional Hausa music (Mamman Shata and the like). So we sang every nursery rhyme and Disney song we knew. We sang for hours until our throats were sore. Must have driven my grandad and the driver mad but they bore with us.

When we got to the town we were staying the night in, my grandad took us straight to my ‘aunt’s’ home. I say ‘aunt’ because this is not my mother’s sister, my favourite aunty in the whole world aunty Bilky. No, this is someone who grew up with my mum and her siblings and is therefore considered a ‘sister’. I will call this aunty ‘Auntie’ henceforth for easy reference. Now, we had spent quite a few holidays with Auntie and her many daughters in the past so we knew them well enough and were quite happy to be taken to hers. One of her daughters is very close in age to my sister and the youngest was a year older than I was but we usually got on pretty well. I couldn’t tell you if there were any special circumstances at the time we visited but I think not because we would have known. My mama was always upfront if anything major was going on especially if she was going to let us visit. Anyway, out of the car we tumbled, tired and excited. It was well after lunch but not dinner time yet but we were already feeling the first pangs of hunger having had a late breakfast on the road but not stopped for lunch. We were all shown into a living room in their sprawling home and someone showed us to the ‘bedroom’. I use the term ‘bedroom’ loosely because although the large room had beds (I think it was 3 single beds), most of it was clearly a dumping ground for dirty laundry and other clutter and it looked like no one had slept in there for a long time. My grandad left whilst we checked out our lodgings.

My sister and I waited for what seemed like ages for someone to come and tell us what to do with all the mess if we were actually going to be staying in that room. We also waited in vain for someone to offer us a drink or give us a snack. Nothing happened so we eventually picked one bed and cleared it and the area around it. We lay on the bed listening to the noises of muted conversation until all we could hear was our tummies rumbling. The sun began to set and we were soon left in darkness. One of us hunted for the light switch and we resumed our waiting game. We might have dozed off or maybe just lay around in a hungry tired trance but eventually I remember saying to my sister that I needed something to drink. That spurred her into action and she led me hesitantly out of the room and we wandered down the corridors of the seemingly empty house, most of the lights off. We found a kitchen but our hunt turned up nothing to eat. We had some water and sadly found our way back to the bedroom and eventually slept on empty stomachs.

We awoke to the sound of voices outside, going about their morning chores. We could smell breakfast frying…I am not sure now what it was (because we didn’t get any) whether it was fried yam, potatoes or bean cakes (kosei) but the smell was right under our noses and we were so famished we looked at each other in hope. No one came to get us and being nice Fulani girls, we stayed put. I remember asking my sister if she thought they had forgotten we were there. ‘How is that possible?’ She replied so we waited and waited. We waited some more as all the noise died down and the house fell silent again. Had they all gone out without so much as a word to us? Were we home alone in this house we didn’t know, in a town we had maybe visited a couple of times before? We finally ventured out and explored the section of the house we were in. No one was there. We returned to the kitchen, probably assuming that they might have saved us some breakfast. We found evidence of breakfast in the dirty dishes in the sink but not a bite left for us.

At this stage, I thought I was going to die of hunger. It was getting close to 24 hours since we had breakfast on the road with Baba and there was no adult to be seen. We went back to the room and my sister rummaged desperately in the backpack we had brought with us. ‘Look’ she cried excitedly after searching for a while. She brandished a N5 note. N5 (five naira) in those days (around 1990) was actually worth something. We could certainly have breakfast on the street with that. Remember this was a town we were not very familiar with so it was with trepidation that we ventured out of Auntie’s house and into the busy street. Thankfully there was no one out to cause mischief and we were left alone. We followed the smell of kosei to a street corner nearby and found a lady frying the delicious bean cakes seated on a stool by the fire over which she was frying. We gave her the N5 and asked for kosei. ‘All of it?’ she asked and we nodded hungrily. She scooped the freshly fried kosei out into the traditional newspaper wrap, sprinkled on a generous helping of the chilli powder that comes with it and handed it to us. We walked a few metres away before we gave in to the hunger in our bellies and we tucked in. After a few mouthfuls, we felt good enough to continue walking and we ate as we walked back to the house. The portion was decent and we gobbled it all up within minutes. Finally satiated, we chucked the paper in the bin and went in to have a quick wash and get dressed.

When my grandad came for us around lunchtime, we were happy again. Still left to our own devices but happy because my sister had fed us. We looked clean and my grandad was none the wiser. Lunch was served with my grandad so of course we got fed. I remember picking at the food because I was still stuffed from our late breakfast and also because I was so disappointed my Auntie had been so mean. But we said nothing. Just very happily jumped back into the car for the 3 hour trip to Kaduna where we knew we would be treated by my aunty Nafisa like princesses. I was not disappointed!

For many years after that, I did not forget or forgive that episode. The daughters I didn’t blame so much because half of them were young like us. But the 2 older girls were certainly old enough to know that young children visiting should at the very least be given a drink and food. Auntie should certainly have known better. I made up my mind that she was no longer my auntie but only my sister knew this for the next decade or so. I found every excuse not to go back there and mostly, I didn’t.

The next time I went was unavoidable. My mama and I were on the way to Kaduna and from there were to catch a flight back to Lagos where I went to boarding school. I wasn’t really given a choice of itinerary because she wanted to say hi to her ‘sister’. I knew anyway that I would be treated well because my mama was there but the hypocrisy grated. I clenched my teeth and said not a word. The visit was ok-ish. It turned out her daughter was getting married and we had been invited but my mother neglected to mention it. I had nothing to wear for any occasion as I was on my way back to boarding school and being a teenager, it mattered to me. Bearing that in mind, the youngest daughter and her cousin/half-sister on night 2 were in the same room as I was but I was lying on the bed, my head buried in a book as I was usually found in those days. They were whispering loudly about the pre-wedding party they were going to the next night and how much fun it was going to be etc. Being close in age to them, I would have expected them to have the courtesy either to invite me or not to talk about it in front of me. They did not have the courtesy to extend an invitation to me. Party night came and they snuck out when it was time despite being chummy with me all day. What sort of a fool did they think I was? The morning after, they were giggling over events at the party but would fall silent if I walked in a room or turned in their general direction. What grated wasn’t that I didn’t go because to be honest, I wasn’t one for parties at that age and I certainly did not have anything to wear. What sucked was their meanness of spirit and being treated like a fool.

Since that visit, I have stayed well away from most of that family. Although I have forgiven them their neglect and meanness, I doubt I will ever forget. That amongst other things are major character flaws I really wish not to be associated with. I have not considered Auntie my aunty for very many years to my mama’s consternation. I have since told my mama about that episode and several other incidents not talked about in this blog. I know she was dismayed and even sad but perhaps a small part of her is hoping that me and my sister’s account of that incident is overly-dramatized as remembered by our young immature brains. Regardless, I sincerely believe that if we had been her actual nieces, she would not have treated us so carelessly when we were so young. And she would not have allowed that mean spirit to rub off on her daughters.

When I think of her, I think of two quotes:

“When someone would mistreat, misinform, misuse, misguide, mishandle, mislead… or any other “mis”… to others, they’re obviously missing something from their lives.”
― Donald L. HicksLook into the stillness

“I know it’s painful growing,
I bet the changes was painful too.
But nothing is as painful as being somewhere you don’t belong.
Obviously.”
― Touaxia Vang

What does a Junior Doctor Do Exactly?

A letter written to Jeremy Hunt by a consultant currently working in England.
An excellent illustration of how indispensible ‘junior’ doctors are to the NHS and the public as a whole. I couldn’t have put it better myself so I haven’t tried to 😀

…………………………..

Dear Mr Hunt,

My name is Philip, and I am a consultant physician. Not so long ago, I was a junior doctor and like many others I am outraged and angry about what you propose to do with ‪#‎juniordoctors‬ and their ‪#‎juniorcontracts‬.

I thought that maybe, given you have not worked in healthcare, you might not understand what it is that doctors do (much like if I was made, say, head of Network Rail) so I thought maybe I can help you by shining a light on what I used to a few years ago as a medical registrar.

The medical registrar is the most senior medical doctor in the hospital out of hours. In explaining to my friends what we do, I tell them everyone who doesn’t need an operation right away, or doesn’t have a baby falling out of them, above the age of 16, is our business (and often we have to look after those too). We were the ubiquitous shirehorses that carried the hospitals medical workload day and night. And here’s a typical night shift I did at a general hospital. (all details changed and adapted from real cases to protect patient confidentiality).

I arrive at 8:50 PM for a 9:00 PM handover. It’s been a busy day and the emergency department is full. The outgoing medical registrar tells me there are no beds in the hospital. There are 10 patients waiting in A&E for the medical team, and a lot of patients need reviewing on the wards. He’s already admitted 36 patients during the day, and the consultant is still there seeing some of them with the daytime doctors. I wave hello at her as I head into the fray. I know the consultant and she’s not seen her kids since her on call week started. She waves back wearily.

My first patient for review was a young man with abdominal pain. My first thought as I walked into his cubicle, he looks sick. This is a skill you develop after years of training, when you look at someone and know that they are minutes from death. He’s grey, clammy and shocked. I immediately set about treating his shock and assessing why this has happened. Does he have a bad infection? Is he bleeding? Does he have a blood clot on his lungs? A quick bedside test confirms he’s bleeding badly, likely internally, and my surgical colleague (another junior doctor) and I urgently arrange for an operation. He hurriedly talks to his parents and completes a inacapacitated patient consent form as his condition deteriorates. I leave him in theatres with the anesthetists and surgeons as I have other patients to see.

The next patient was an elderly woman who has fallen. Although she has no hip fracture, she’s unable to walk and needs admission for painkillers and rehabilitation. I reassure her as best I can and stop many of her medicines potentially making her fall. There are no beds for her on the assessment unit or the elderly care ward, so the A&E sister arranges for a pressure support mattress and bed for her in the department overnight. She was lonely and depressed, and I spend some time talking to her about her worries and fears but after a while I needed to move on. She squeezes my hand and smiles, thanks me and settles for the night.

Next is a resus patient with an asthma attack. He is drunk and abusive verbally, though he’s too breathless to be too abusive. A blood test show his attack is life threatening and he he fights off attempts to treat him by myself and the A&E team, pulling off his nebuliser mask and oxygen. As I read out the blood test result to the intensive care registrar (another junior doctor) the man goes blue in the face, gasps and stops breathing. I drop the phone, run over and take over his breathing with a manual ventilator. He has had a respiratory arrest. Alarms blare, help comes running, we inject him with various medicines to help relax his airways and the intensive care doctor slips a tube into his windpipe to help him breathe. The consultant physician, still there, helps with what she could, running blood tests and helping to scribe in the notes. After a nervous period, he stabilises and we take him to intensive care.

It’s now midnight.

In the meantime I have reviewed five more patients, seen by the twilight team, and also my night SHO has discussed some patients with me. The consultant finally got home around 11PM. I’m now on the wards, a liver patient with severe cirrhosis is unrousable. I read through the notes. He has cirrhosis and is not suitable for a transplant. The team has tried everything. I sit and talk with his family, telling them I’m very sorry but there’s nothing more to be done. They cry, one of them screams at me that I’ve killed him, but I accept this as part of my job. With more assurance they’re calmer and I reassure them he’ll be kept comfortable.

My bleep goes off as I write in the notes. Is that the medical reg? The hospital is now totally full, can you please choose some patients to send to our sister hospital down the road? I groan, although I understand the necessity patients understandably hate it. I pick four stable patients and liaise with the registrar down the road.

2AM. I send my SHO off for a quick break as I review some more patients. A confused elderly man who might have a urine infection, a young man with severe headache, a diabetic patient with a very high blood sugar, a lady withdrawing from alcohol and hallucinating. The A&E sister makes me a coffee, lots of milk, lots of sugar.

3AM. I’m with a man in resus again, he is vomiting bright red blood in large volumes. He is jaundiced and looks unwell, very unwell. As the A&E team arranges for a massive transfusion to be set up, I ring the intensive care doctors and the gastroenterology consultant. He listens and says “I’ll be coming in”. I then slip a line into his neck under local anaesthetic, a practiced skill that’s hard at 3AM when you’re tired, but fortunately successful. We pour blood, clotting products, medications and antibiotics into him to halt the bleeding. The gastro consultant arrives at 3:40 and he’s taken to theatres where he performs a life saving procedure. The patient goes to ITU.

4AM. A brief moment to sit down for a quick break. I have reviewed three more of the SHO’s patients. This is the first time we’ve had a chance to sit down together, a quick chat and a cup of tea was interrupted by a cardiac arrest bleep. We run to the cardiac ward. A 54 year old gentleman admitted with chest pain by the day team has had a sudden cardiac arrest. The excellent CCU nurses are doing CPR and attaching a monitor. I ask them to stop as it’s attached, the rhythm is ventricular fibrillation.

“Back on the chest please, charge defib to 150, charging. OK, off the chest, stand clear, top middle bottom myself, oxygen away, SHOCKING.” The patient jolts. “Back on the chest please.” I heard myself say.

Two minutes later he has a pulse. We repeat an ECG, he’s had a full heart attack. I call the cardiologist at the heart attack centre 10 miles away. He’s accepted and an ambulance crew transfers him for an emergency angioplasty. I send my SHO back to A&E as I write a transfer note.

5AM. The resus doors burst open. Another patient, an elderly woman with breathlessness. The A&E F2 listens to the chest, pulmonary oedema. She’s given the emergency treatment but it’s not working. I decide to start her on positive pressure oxygen. Strapped to her face was a tight mask blowing oxygen to inflate her lungs, buying time for the medicines to work. The plan works and pints of dilute urine fills her catheter bag, her breathing improves and she says thank you through the mask. Despite the fatigue I smile and give the F2 a fist bump for a job well done.

7AM. Four more reviews. a patient with kidney failure due to medications, a depressed young man who took an overdose, an elderly nursing home resident with pneumonia, and an elderly man with a broken hip whom I assess with the orthopaedic surgeon. I start to round up the patients for the ward round. 18 patients overnight, five transfers out, one death. A relatively quiet night. I check with the clinical site manager and SHO that we’ve not missed anyone and click save on the list. No one is waiting to be seen, a good feeling.

8AM. The consultant from last night arrives, she looks tired but asks us how we’re doing. OK we said. We start in A&E as most of our patients are still there, the site manager is worried as some of the patients from last night are coming up to 12 hours in A&E. We review each patient’s story and tests, and talk to them about their condition. We visit ITU for the two new transfers there.

11AM. The ward round of the night patients are done, and I have completed a death certificate for a patient overnight. I climb into my car and listen to the breakfast show as I drive home, an hour away. I’ll be in bed by 1PM , and back for the night shift after 6 hours sleep. A relative luxury from a relatively quiet night.

This would be a relatively quiet night for a junior doctor and I am sure many registrars would laugh at how easy I’ve had it! But the people doing this work are junior doctors, who show dedication, commitment and goodwill beyond belief. They do lifesaving work up and down the country, working hard without complaining and sacrificing time with their families.

Please, I beseech you, treat them fairly and with the compassion they treat others daily. The new contract is not fair, and the extended hours it’ll cause is not safe. ‪#‎notfairnotsafe‬

I hope this little story will give you some insight into the vital work junior doctors and the NHS do. If you like, please come and spend a night at our hospital, I’ll come in with you and show you around. Please talk to my junior colleagues and listen to them, you may be surprised what you’ll learn.

Best wishes,

Dr Philip Lee

My Very Own UN

My sister is (or should that be was) a social butterfly. She always had more than friends than she knew what to do with and she never had issues making new ones. A classic extrovert. I considered myself an introvert for most of my youth. Now with more self-awareness, I know I am more of an extrovert than an introvert but I am pickier than my sister, the true extrovert. Because I have been so picky, I think I have ended up with the best friends in the world.

Some of the people I am talking about might not realise how much I value their friendship or indeed that I am talking about them but I hope when I describe how fabulous they are, they will realise how great and valued their friendship is to me. When I was little and my mama was my only role model, one of the things I thought was absolutely amazing about her and her life was her array of friends. They were young and old, some local, many from far afield (and being in Yola that is quite something I tell you). Some Muslim, some Christians. Some skinny, some fat. Some beautiful, some not so beautiful. Some quiet, some loud. Many feminists like my mama. All sorts. The one unifying thing about them was that they were kind and caring, they spoke to me like I mattered and they were passionate. If she ever needed anything around the world, all she had to do was pick up the phone or send an email and the cavalry would arrive. Subconsciously, as I grew up, I think I looked for all those things in my would-be friends. I think I succeeded in developing my very own passionate, kind, caring, loving, helpful and loyal circle of friends. The inner circle is a small one compared to my mother’s but I happen to believe the best things come in small packages. I will talk about my current inner circle in no particular order as I value them all fairly equally. I won’t mention my mama and my sister but they are my best friends and are the core circle.

First one is my Ethiopian friend who I met in 2001 who I shall call Lizzie. We were in the same tutor group in Gladesmore Community School (10AH massive) and we both joined in year 10 so we had common group but our big unifier was where lived and that we had to get 2 buses to get to school. So, earlier than the other pupils, we were up and out, dragging sleepy bodies onto the 144 which I caught at the first stop in Muswell Hill and Lizzie would hop on 4 or 5 stops later in Hornsey. We were normally quiet in the 144 but by the time we got on the 41, we were awake enough to chat. It was on the 41 that I got to know Lizzie’s life story and about her very grown up relationships. At this stage, I had never had a proper boyfriend and despite having a crush at school, I wasn’t really interested in a relationship. So I lived vicariously through her. We also bonded over our love of heels (low enough to wear to school and get away from censure) and long braids. Also I have been mistaken for Ethiopian so we had a similar slim innocent look. We have remained friends over the years, closer after school than in school, through her babies and marriage, through my medical school. Lizzie was a bridesmaid at my wedding and she regularly makes the drive up to Birmingham from London to visit. Even though we had periods were we got too busy with our lives, she has remained a constant. We may drift (although not so much now) through complacency but we never fight and we are there to listen. So here is to my yummy mummy Landan friend. For being constant and loyal and inspiring me to be more glamorous and feminine.

Next is my Northern Nigerian friend who I shall call Halima. We met in 1996 in Queen’s College, Yaba Lagos and we were friends from the very beginning. It was the Hausa lessons that cemented the friendship and as we were both boarders, prep times and dinner times were there for us to foster the relationships. In another blog, I have mentioned Na’ima and I was close to a couple of other girls, 2 of whom were boarders. Halima was in a ‘House’ located all the way across the quadrangle which thinking about now wasn’t so far but during those years was enough to make visiting her during weekends a significant event. She was responsible for the one and only time I had periwinkles (the hairstyle) for Sports day in JSS2 (see blog on that). Those periwinkles make an appearance on my first ever British passport and my husband loves the photo so much he keeps it by his bedside. She was one of the only girls whose homes I would visit outside school too and I knew her family so that made her more special than many others. Post-QC, she is certainly the one who would always make an effort to come and see me whenever I went to Nigeria. I knew about her wedding as soon as she had a date in mind because she wanted me to be able to jiggle my doctor on-call to make it there.  I am so glad I did. We shared her pregnancy from across the distance too. In all these years, I do not remember ever fighting with Halima. She is probably one of the gentlest and sweetest women I know and her son and husband are so lucky she is theirs. Despite being many thousands of miles apart and despite our other friends from that era being on social media and living in close vicinity to her, Halima is the one of all that I would be able to count on today if I needed a friend in Abuja. What a sweetheart!

Then there is my Southern Nigerian friend, let’s call her Tolu. I met her through NLI which is a (NGO) Nigerian initiative to promote young accomplished Nigerians living at home and abroad to be the champions that make Nigeria great once again. NLI was in 2010, or was it 2009? I came from here and she came from the US. We bonded over our passionate pitches and speeches. Never before had I met a young woman who seemed so like me. She exuded integrity and honesty and passion. When I told my husband about her, the words I used were ‘Tolu motivates me to be a better person. I wish she lived nearby so I could be in her presence regularly’. Being next to her or chatting with her on the phone or on social media never fails to give me a positive boost. Tolu to me is everything a young Nigerian should be and she makes me so proud to be in the same circle as hers. If I could choose anyone for my baby to be like, it would be Tolu. She went through a very harrowing time a couple of years ago and being so positive and so strong, she didn’t say anything for a long time because she is that type of a person who will be everyone’s shoulder but have no shoulder to lean on herself. She has come through all of that in a way that is no less than heroic. She is generous and kind. She is a wonderful listener. She is passionate about life and justice and selfless in her outlook. Maybe I don’t want my baby girl to be like her, maybe I want to be like Tolu. Anyway, if you are reading this my love, I might not have said in so many words but your strength, honesty, passion and selflessness makes you wonder woman in my eyes and I could not be prouder of you. I hope your dreams for Nigeria and the world come through because this world is so much better for having you in it.

Following on neatly is my only fellow Iro-Nigerian, who I call Irish anyway. She is Irish in all the best ways possible except she lacks an accent being southern England-bred (sadly but she can put on a pretty good one). We went to medical school together and once again it was fate that brought us together because we met in student halls in 2004. Being the only two medics in the flat of 6, naturally we became close pretty quickly as we were together pretty much all day every day for the first 2 years of our medical school. We were up ridiculously early and gone all day. We couldn’t party any night of the week like a certain somebody we lived with. We had plenty of work and exams to keep us busy. The first thing about Irish is that she is a morning person. I am most definitely not. She would wake up at dawn even on weekends and whistle cheerfully. She had these dryer sheets that smelled of fresh laundry…even today, that lovely fresh scent equates to Irish to me. She has tremendous boobs (sorry Irish but I feel they need to be celebrated) and the loveliest bouncy hair which is NOT mousy brown as she used to claim. She is one of those friends I have never fallen out with. It’s strange to think but we don’t have fights at all. Perhaps it is because she doesn’t tend to get dragged into one of my deep philosophical conversations because she is quite squeamish with deep emotional stuff and would rather the happier topics. That is not to say that she won’t indulge me if I need to offload. She makes the best butter icing cupcakes and has managed to teach me to bake a couple of things. She loves sunflowers. That is in a nutshell Irish to me. She is little Ms Sunshine with a spine of steel underneath all the Gaelic charm. She will stand up for what she believes in and will call you out if you do something wrong but all with the sweetness of honey. She has dealt with family issues that would faze many but she remains unfazed and strong. She also has lovely blue eyes and dimples which I would give my little toes for. Oh and she gives the best hugs ever! If Tolu is the girl I want my daughter to grown up to be, Irish is the woman I want to be for my children. I want to be all sunshine and sweetness and quiet strength and I want to be charming just like her when I grow up.

Then there is my Indian friend who around birth was inadvertently called One on some documentation and that is my name for her which I shall stick to. She is the only one of my friends who is younger than I am. We met whilst I was out doing clinical experience in SEWA rural, Jhagadia – a village in Gujarat State, India. She was out there too doing field research and being the only other single girl resident in the flats on hospital grounds, we instantly gravitated to each other and became fast friends. She is a biomedical scientist. We quickly found common love in tea and laughter and feminism. We quickly fell into a routine. She would come over after ‘work’ to put her water in my fridge and we would go over to hers for tea. I would usually drape myself all over her bed and even occasionally on the cool floor for it was pregnant with heat during my 3 months there. My friendship with her is very similar to the one I have with Safa except the age difference and my having a bit more life experience. And our life stories seem to mirror each other down to meeting the ‘wrong’ boy as defined culturally but actually believing them to be our Mr Right. Unlike Safa though, she is the only one of my friends who is shorter than I am so I feel refreshing normal size next to her. One is rather fearless I think and having lived in remote Jhagadia for a whole year, she then applied for a post-graduate course in the US and off she went to live in NY. Now she is in Malawi, again independently sourced job and seems to be flourishing. What makes her so special goes beyond her fabulous tea, her wicked sense of humour and independent spirit. She is also very honest and open, kind and supportive, generous and when she loves, she gives it her all. One is going to be great someday soon. Mark my words!

Last but not least is my youngest adopted mama, Farah for today. I met her in 2009 as a lowly FY1 doctor in the crazy world of City Hospital (Birmingham). She was soon to be medical registrar and had a reputation for being brutally honest and fierce. Did that put me off? No! I love my women fierce and fearless so we became friends in the mess when I was on surgery and actually had time to go to the mess every day. I loved her unconventional ways and I think she liked me because though small and ‘quiet’ on the face of it, I gave as good as she gave and never seemed to take it personally when that sharp tongue was pointed my way. Despite the difference in years, in the hierarchical world of medicine, we remained friends over the years and have grown closer since we stopped working together. She is another one from a Muslim background who was born into the religion and though respects me for practicing, is not of the same opinions about it. I respect that despite being from a middle-eastern background, she is honest enough to say this is how ‘I’ feel about religion and all that comes with it. I love that despite that prickly first impression she gives out, she is a big old softie with a heart that is good as gold. She is loyal and supportive and she is always there for me if I need her. She wore a polka dot dress to my wedding – if for nothing else, I will love her forever. What a woman! Farah I salute you. You are one of my heroes.

There you are dear readers, my wonderful array of close companions without whom I would be less of the woman I am today. I will take this opportunity to say that for the reasons I have mentioned above and for many more that I cannot put into words, I feel privileged to have met and befriended you all. Thank you for all the love and support. I love you all.

Appreciating the Small Things in Life

I don’t know if I mentioned that I got married last year in April. I must have somewhere. We have made it through the first year baptism and we have grown as a couple so much. Of course it hasn’t been smooth sailing but I would not have expected that being that we are both passionate about what we care about, both rather opinionated and both not the types to shy away from an argument. My post is not to pretend it is all paradise, a fairy tale. Perfection. It is in fact about the opposite. About how it doesn’t have to be perfect but you can be perfectly happy especially if you stop sweating the small stuff and instead start appreciating the little things that make the relationship great.

My husband from time to time gets a little insecure (particularly after a few days of me getting increasingly irate when he is not doing his boring chores) and asks if there is anything I think is good about him. I always react with a bit of disappointment because I know what I am like and when anyone does even the littlest thing that makes me smile or happy or proud, I am the first to say it, usually using the word ‘amazing’. So this here post is to tell you about the little things the husband says and does that makes me go all  mushy inside and makes me forgive him when he does the big things that make me want to cry in anger or in frustration.

I will start with a little thing he does which always sets my day up nicely. He makes me a cup of tea or if I am lucky a sandwich for work. I will admit now I am not usually a morning person so finding that he has made time for me in the morning and so saved me some time makes me go all warm first thing in the morning. It just used to be tea in my travel mug to drink on the way to work or on weekends in a nice mug by my bedside. Today, he presented me with the flask pictured above. Not only has he made me tea, he has gone out and bought a little flask to keep it warm knowing how slowly I drink tea and how it goes cold before I get to the last drop. And the flask is in a colour I love and the writing on it is paying me a compliment. What better way to start the day I ask you? I look outside right now and it is a grey rainy Monday morning but my heart and soul are smiling like the sun is up and shining Yola-style.

The other day, he went out and came home in the early hours to find me in bed. I was curled up on my side, tensed up waiting to see if his hands were cold from being outside. Imagine the relief when he placed his warm hands on the small of my back. Better yet, his hands were covered in oil and he gave me the loveliest backrub I could have asked for. I drifted back to sleep and it was the best night’s sleep I had for over a month. That’s #2 of the small things he does. He gives me impromptu massages, backrubs, foot rub, head massage when I need them the most. When I come home after a 14-hour day at work and collapse in a heap and I am so tired I cannot muster up the energy to take off my shoes or eat dinner. In the same vein, he will also fetch my dinner and a drink and make me eat it all then when I start to doze off with my plate still in my hands, he takes it all away and even carries me up to bed. How could I help but love him?

He pays me compliments all the time. I am quite a low maintenance girl if I say so myself and I have a healthy appreciation of myself. I don’t have any great hang ups and my self-image is good. I do not need compliments but I do appreciate them. Who doesn’t? Like the compliment on the pictured flask, 4 years and counting since we met and I know he thinks I am hot. Let me be honest, I do not see myself as hot. I know some people think I am pretty, my mama and sister certainly say I am beautiful and so do my closest friends but I sort of take it for granted that they see the beauty within as well as without. I know I am not ugly and even strangers have paid the odd compliment to me. Omosede Ighile even called me beautiful many years ago when no one outside my family had ever and I won’t ever forget that compliment because those days, I was a little less self-confident and it meant a great deal. Anyway, I digress. Sorry. Some days I look in the mirror and think ‘niiiiiiice’. Some pictures I think ‘wow wee’ maybe he is right I am hot but mostly I don’t remember to look at myself because honestly I do not care how I look most of the time. He does though and what I think is too skinny to be womanly, he loves. He looks at me like I would expect a guy to look at Shakira, Jennifer Lopez or Halle Berry. He gives me a smile that I know means he thinks I am sexy and you know what, it feels damn good. Because I know with many men, after that initial honeymoon phase, they stop seeing your beauty and it all becomes boring routine. Not for my hubby. He sees my beauty even when I am at my scruffiest, usually post night shifts wreck and he tells me verbally and with his eyes. Aren’t I a lucky girl?

Linked to his complements is that he is proud of me. Not only does he think I am hot, he also thinks my brains are hot. I mean, I can’t pretend not to know I have been blessed academically. It’s all on paper from the time I was like 2. So yeah, I know I am no slouch in the intellectual department. However, being a doctor and surrounded by lots of doctors who are not just intelligent but many are in the genius sphere (unlike me), I do not feel as special as I did say back in primary school when I was the school’s big brain. But when I am around my husband or when I hear him talk about me to his friends, I go back to that happy place where my mama was bursting with pride at her baby’s academic achievements. When my sister used to tell everyone who would listen how much of a Brainiac her little sister was. He is so convinced of my intellectual prowess that he would rather listen to me prattle on about religion, nature, culture, psychology and even art than consult Professor Google or people in those fields. What is best is that despite not being medical in any way, shape or form, he swears I am the best paediatrician ever. Even after I was facing my first ever exam failure (post-grad paediatric specialisation exam, 1B). I laugh but really, I am delighted that someone has so much belief in me that even when I doubt myself, he is there to shake me back into believing and therefore being great again.

Following on from there, he likes to hold hands. Small thing #5. He is so proud to be my husband. He was proudly proclaiming that even before I agreed to be his wife. My sister and I used to try to curb his enthusiasm and point out he wasn’t even my fiancé at the time but he was irrepressible. It was ‘my wife’ this and ‘my wife’ that within the first year of our courtship. Silly man! I got used to it eventually but it took a while. Now he will get upset if I fail to hold his hand or kiss him long enough in public. I know he takes it seriously so I try but I am a shy Fulani girl. Public displays of affection (PDAs) do not come naturally. Particularly when it goes beyond a quick kiss. I still get embarrassed. Not because I am not proud of him but because I have been brought up a certain way and PDAs are a no-no in Yola. The attention it draws is just a little embarrassing for this Fulani girl. But I am working on it.

Last small thing in this post because I will be late for work otherwise. He will dance with me whenever I give the slightest sign that I am in the mood for it. As soon as I start singing a song or I start nodding my head to music, he will duet with me and he will want me to get up and do a dance. Unfortunately for him, I don’t have the energy he does after work (it is physically and mentally draining being a doctor if you are not one). So I will usually bow out after one dance but he will happily dance for me whilst I cheer him on. His energy and enthusiasm, whilst in need to curbing most of the time is an amazing quality and I might not say this to him often, it is what stops it being boring round ours and we are always up to something or the other. Keeps it all fresh and turbulent and exciting. Much better than boring which I have a very low threshold for. Might explain why I am a paediatrician. It’s a lot of things but so very rarely boring.

So there you are dear husband and dear readers. I have told you all today about some of the reasons why I love my husband so much and why despite all the big faults, I love him to bits. Tell me what little things you love about your husband/partner/lover/wife/girlfriend/fiancée too. I would love to hear it!

p.s this paragon of ‘small’ virtues is called George. My Georgey boo 😀

Can You Miss What You Don’t Know or Have?

This one is a hard topic for me. If you have been following my posts, you will know by now that my mama was a single mother for a large part of my life. I also had a step-dad for a good chunk of my childhood. I do not know if I have mentioned my biological father at all. I probably haven’t because there isn’t much to say. I can summarise what there is to say about him. He was my mother’s boyfriend in University and despite a lot of reservation from third parties, my mother married him soon after graduation. He is from Malumfashi in Katsina State (Nigeria) and is academically gifted. His family has royal links (small fry I understand). He is still alive and working in Katsina. He is tall and considered good-looking. He is married with several children.

That last point is the one thing of all that does bother me a little. Because of the way I was brought up and my closeness with my immediate family, I sometimes feel sad that I have siblings that I could be supporting but do not. I have siblings (majority female I hear) who I could be a role model to. I could make a difference to their lives but I am unable to because I do not exist to them. I do wonder if they even know about my sister and me. If they do, do they care?

My mama got a divorce when she was 5 months pregnant with me so I was born outside of that relationship. I have no strong feelings over him. I have met him. Twice in my life. First when I was 4 or 5 and then again when I was 7 years old. I also met a couple of his brothers when I was 8 or 9 years old. To be honest, I remember more what we ate when we had lunch with him and where that meeting took place. I remember feeling somewhat conflicted and wondering how I was meant to feel. I also worried that if I liked him, would I be disloyal to my mama who was the love of my life? My mama, amazing woman that she is, hid her upset quite well but with hindsight, I know she was upset that it took him so long to turn up and that he was putting us through emotional turmoil. I recall her sitting my sister and me down after he had turned up unannounced the first time and confirming that he was indeed our biological father. She gave us a choice about going to spend the afternoon with him and said we could decide to go or not.

My sister had a vague recollection of him and was excited to see him so I didn’t object. Off we trundled to Yola International Hotel to his suite. We each had a chapman (love that drink, bright red fizzy non-alcoholic cocktail still popular in Nigeria) and I think I had a meat-pie because they made them nice and I was a fan. He must have tried to talk to us but I really don’t remember what was said. I remember saying that ‘everyone at home calls me Diya not Aisha’ when he kept calling me Aisha. I think he felt rebuffed. My sister and I soon got bored and we went off to play with the lifts and got up to mischief. He left the next day and life returned to normal. The only evidence was that he gave us some money which we promptly deposited into our savings accounts and forgot about.

The second visit was only slightly less awkward and I remember thinking ‘what does this all mean anyway?’ I mean, after the first visit, he made no effort to promote any kind of relationship. I firmly believe he would never have visited again if he had no business bringing him to Yola. Since then, I have not seen or heard from him. My sister got a couple more visits to her boarding school and then nothing since. It has been over 20 years since I have heard a peep out of him. I do not think I ever met my grandmother but we did hear that she was still alive about a decade ago. A friend of my sister’s sister-in-law last week got word to my sister through the sister-in-law to say that our grandmother had died. Our reaction was lackadaisical to say the least. First, we thought ‘erm yes our grandma died about 12 years ago in two days’ (October 6th). Then we clarified that this was our paternal grandma. We mentioned it to each other in passing and no more was said. We went to sleep that night without a second thought and honestly, I can’t say I feel like I have lost anything.

This brings me to the question I wanted to address here. When we were little, and some people still say this, we were told that despite not knowing our father and his relatives, we would regret it if we let him die without trying to get to know him. Apparently (somewhat mystically) we would feel his death and be deeply saddened. Well, my grandma has just died and it made not a dent on my life. I felt the same as I would for any of my patient’s relatives dying. Sad for a moment then life goes on.

So will I be sad if my father dies today and I have no relationship with him? I suspect not. Would I be sad if my siblings died and I know nothing of them? Probably a little. Would I be sad if I found out that they are oppressed and in need of assistance I could provide? Yes quite sad. Would I be sad if I could save them from some desperate need like donate bone marrow or a kidney to save a life and I did not because no one thought to approach me? Yes definitely. Of course I wish I could be a sister to my sisters and brother. I wish things had worked out differently and that my mama’s love had not been misplaced. I wish she had seen through her loyalty and love and chosen a different man who would have treated her and her child better. I wish she had never fallen in love with this particular man but she did. It would be a waste of my time to dwell on what ifs on behalf of my mama. She has moved on. So will I. Such is life.

Shoes Glorious Shoes

My earliest memory of falling in love with pair of shoes was when I was about 7 or 8 years old. The shoes belonged the original Aisha Joda, my late maternal grandmother who we all called Mamie. They were dainty slippers, skinny wedges with black skinny and some stonework round the front. Beautiful classic shoes, kind of understated in their elegance. Mamie had the most beautiful small feet. A size 3 to 3.5. At 7-8, my feet were that size so I would sneak into her dressing room and put them on and stare at them in fascination. I think she or my mama caught me once or twice. She must have realised how much I loved them because when I turned 10, she gifted them to me. I was so thrilled. I wore them every chance I got (unfortunately not enough as I didn’t have many occasions to dress up back then). It was with deep sadness when I came home at the age of 12 to find my feet had outgrown those shoes.

My love for shoes grew slowly and steadily. I found a bargain faux leather black boots in 2001, just below the knees and for the first time, they fit perfectly around my skinny calves. I felt much like Julia Robert’s character in Pretty Woman and that meant I felt fabulous because it was my favourite movie and still ranks in my top 10. I wore those boots everywhere anytime. For two years, aged 15 and 16. Sadly, they were not of the best quality so after a lot of miles walked in them, I reluctantly stuck them in the charity bin.

My first really lovely grown-up pair was bought by my sister. They were a classic black suede stiletto pair with 4 inch heels. It took a bit of getting used to with the height of the heels but once I broke them in, I loved them to bits. I had them for nearly a decade and had dozens of pairs of shoes by then but parting was still difficult. I gave them to a sister because I knew she would love them much as I did.

I will mention two other significant shoes. I love polka dots in any shape or form. I even had a polka dot wedding cake and have bonded with many a parent at work over their polka dot top/skirt/tights. 2 years ago, I found a beautiful pair of black with white spots polka dot high heels by Rocket Dog. They are absolutely stunning and I wear them every chance I get because even if things are going pear-shaped, I look down and my feet clad in polka dots never fail to lift my heart. My husband loves shoes and he is a generous soul so if I let him, he would buy me shoes costing hundreds of £££. I am of those who believe that if I have hundreds to spare, I would rather go on holiday than buy a pair of shoes I am too busy to wear out anyway. For my last birthday, my husband gifted me my first pair of Jimmy Choo’s. Black knee length pure leather boots with a gorgeous soft lining that caresses my foot. A bit like my first pair of boots but more grown up and of better quality. I still feel like Julia Roberts but a classier one.

I shan’t go on about every pair of shoes I own but suffice it to say, there are quite a few and I keep running out of display space. One day, my husband and I hope to build our own home reminiscent of some of the inspiring Grand Designs homes we have seen. My one wish is to have a decent sized dressing room adjoining the master bedroom. The main reason being, I would like to be able to display all of my shoes in a beautiful setting, like Carrie in Sex and the City. Mmmm….

Save Our NHS!

Sharing this from a doctor’s facebook wall with permission because she says it better than I could express through the mounting frustration and despair I feel.

“I would like to tell you what the NHS means to me. It means that as a doctor. I get to think about what my patients need, and what is best for them. I get to think about that, above all else. Because my patients are someone’s daughter, someone’s wife, someone’s mother, someone’s mentor, someone’s shoulder to cry on, someone’s friend. I get to value their life over all else.

I love that. I love that when I’m driving down a busy street at rush hour, and an ambulance with blue lights and sirens wailing, presents itself to this mass of people on the road – people with jobs to get to, meetings to attend, events to arrive at, exams to sit – not one of them stops in the middle of the road and refuses to let the ambulance pass.
Not one of them thinks their schedule is more important than the stranger in the back of the ambulance, fighting for their life. They, the general public, the person on the street, the people of Britain, value a stranger’s life above everything else at that moment. I love that. I love the humanity.

Jeremy Hunt says, he wants us to provide a 24 hour NHS. I think thats fantastic. I am pretty sure I have already worked every hour of every conceivable day to make up the 24/7 ideal. I work bank holidays and public holidays and religious holidays. I work often right up until I need to leave to catch a train to a graduation or a wedding. Sometimes I have an Emergnecy and I work past that. And I send my apologies and I lose my tickets. Because the person I am working on matters. Because I value their life over all else at that moment in time.

I think a 24/7 service is wonderful. It’s the dream. It’s like dubai at night. Or New York always. The service that never sleeps. I mean. I never sleep. Not on call. But, yes, sure, things can be delayed. It takes longer for one doctor to see 80 patients at night, than it does for a team of 4 to see them during the day. It takes longer for one lab technician to process 80 blood samples vs a team of 5 during the day. It takes longer for one radiographer to image 80 patients overnight than a team of 3 during the day.

The hospital is not just made up of doctors. We cannot work without our colleagues. Nurses, phlebotomists, pharmacists, radiographers, porters, health care assistants, scrub nurses, physicians assistants, and anaesthetics techs.
We all work together as a team. At all hours of the day and night. Because we value the life of the person we are seeing.
We would love a 24/7 service. But you cannot achieve it by taking the same doctor, spreading him or her thinner to cover the gaps they are already covering regularly – and then tell them that’s what they ought to have been doing all along so let’s slash your meagre pay by 1/3 for good measure.

To achieve the sort of dreamlike 24/7 service Mr hunt is selling and we all want to buy. The answer is simple. Create more training posts. Hire more doctors. Twice the current amount. Hire more nurses. I’m tired just watching them scramble night after night, running between rooms taking care of double their normal case load. Hire more ancillary workers. If you really wanted a fully functioning service, where 3am on a Sunday looks the same as 10am on a Tuesday, that’s the solution.
Don’t fillet and tenderise your already overstretched team to plug the gaps. And don’t turn the public against them because they have said that it’s not right.

What happens to our value as human beings? As care givers? As people who place others first? Where is the logic, in destroying one of the greatest legacies of modern history? In order to reappropriate the money as bonuses for management consultants who “told us what was wrong”.

I never finished my story about what the NHS means to me. When I’m done with my job. And that isn’t dictated by the clock but by when my patients are all stable. When I’m done I go home to my mother, who is terminally ill. Sometimes she is very unwell. And at those times I return to the hospital. This time not as a doctor, but as patient and family. I cannot begin to explain the relief in knowing that our arrival isn’t heralded by piles of paperwork to determine how much money we have to pay for treatment. They wouldn’t find much. I’m always overdrawn. I once laughed when I lost my wallet, because there wasn’t any point in cancelling my bank cards. They would find nothing in the account. I am 34 years old and a “junior” doctor that has been working for 10 years. But I have nothing worth stealing. That’s because I usually just get paid enough to cover my rent and bills. And when I need to do exams or get a wedding gift or live without relying on a credit card I would pick up extra shifts, working even more weekends and holidays than I normally would, which was already a lot.

Then, like a lot of my colleagues. I volunteer. I volunteer my services to local communities. I voluntarily sit on charitable boards where I help develop plans to help the most vulnerable in society. I travel to refugee camps to help those that unlike me, cannot make ends meet, have been forced out of their homes through no fault of their own, and now have no one to care for them. Very few people value them at all, these proud, resilient, insightful people in camps and on journeys – let alone above all else.

So I am grateful for the NHS. Because as a terminal cancer patient. My mum and I show up at our A&e a lot. And often at the most inconvenient times. 3am. 7pm. Weeknight. Weekday. The tumor doesn’t care. But you know who does? NHS staff. They care. They value her life over all else when she walks through the door – even if she may not have very much life left to live. They always smile. They always listen. They are always patient and kind. They are cheerful most of the time, even as their pagers bleep mercilessly through every conversation they have, alerting them to another patient in need of being valued.

They trundle away regardless of the time, tucking my mum into bed, helping her to the bathroom, taking her blood despite the fact that her veins disappeared under the influence of chemotherapy long ago. Patiently searching for those life giving green threads in her hands and arms. Listening to her chest. Poring over her substantial medical history to make sure they understand everything. Discussing the minutiae that may unveil what the cancer is doing this time and how they can best hold it at bay. There are no shortcuts even at 3am. They value their patients and the families above all else. And I love them for that.

That’s what the NHS means to me. Service that comes full circle.

I treated someone’s mum like they were the only person in the world that mattered right then. And later on that night, some other kindly fatigued uniformed intelligent gentle soul did the same for my mum. And sometime during those 24 hours someone was late to pick their kids up from school or collect their dry cleaning – because an ambulance with the most valuable person to someone else, closed off the road they were on as it whizzed past.
That. is Healthcare delivered as a right, not a privilege. That is humanity. So the only question, Mr. Hunt. (And anyone else who backs the sham of making an understaffed workforce doing the best it can to work twice as long for two thirds of the pay, and ensuring that women who have families and researchers who seek to cure terminal conditions like my mother’s can’t do their job, which is what they value – ) the only question is – What do you value above all else? Money? The bottom line? The shareholders? Your mates who run companies that want private contracts? A shot at being PM?

None of that will matter to you when you are ill, Mr. Hunt. I promise you. At that moment in time. You will value your health above all else.

More than that, you will want a team of dedicated well trained NHS employees to value you above all else.
Value.your.health.service.”