You know how some people make a huge impact in your life…You could have only known them for some time..few days may be..and yet you could have learnt a life’s lesson or two.
This was early this year..I was a wee bit late to start..I was’nt very impressed by myself and yet I was trying to sneak into the Stroke and rehabilitation unit at Worcester Park Royal Hospital.Trying to create the impression that I had got there five minutes earlier.I was going to be working as a house officer for 3 weeks and I was quite looking forward to it… Just then rushed past a tall fair bloke typical English attire..the long scarfs..I think European men carry it off the best.
By the time I found the front desk of the unit I was going to be working in..I met a similar looking…no I met the same guy who just brushed past me..Hmm so he was trying to create the impression of being there forever too..He was my immediate superior….We were both late on a Monday morning..Good..I liked the start.
After formal introductions..he showed me around.The 65 bedded unit , all old age, all going to die at some point, nurse led unit, we are just their pawns, we dont see all patients everyday,we dont do acute medicine because there is not point, dont even break your head over it;leave your ethics out of the door and what have you…
Ok so I wasnt sure about the patients but Toby definitely needed help here.We went about the days business and then he showed me the canteen and food shops and then took me to the library where he introduced me to the world of cheese and pickle sandwitches.So if anyone of you has had one of those sandwitches you know that the salty disposition of the cheese and the sweetness of that I dont know why they call it a pickle..is not the most complimentary to an Indian die hard fan of bedekar acchaar.That day was odd.
Next morning I was there early.I had the lists of all the patients and all of their profiles.I made my own list and added all the details we would need to make a plan of action.Of course Toby would have to lead the way..but I would be calling the shots.I didnt approve of his attitude, his frustration was not going to rub off on me.I was there to do a job and I would..come what may.
Toby challanged me at the task I had undertaken…I love challenges ..they drive me to work hard..and harder.I did accomplish what I had started out to do..But in only half of the patients by 6 in the evening…I had been there for 9 hours and I was only able to see one unit….I couldnt even think about the next.I hadnt had lunch.The nurses were very helpful.They kept telling me that only women care and can be true doctors.That it was fanatstic to see the compassion in me.That some of the patients hadnt been seen in like 15 days..That the notes were not complete,the plans werent enacted..that I was in a mess and I wanted to to go home.Toby just kept trouble shooting..asked me if I wanted coffee and…
He then took me aside..he knew I was on the verge of tears..he knew I had got more that I had bargained for and he..didnt want to help me..he had had enough of that system…
And then talked to me..I could see why he was frustrated.There was a lax in the attitude..the environment ..was given up and damn didnt I want to get out of there….Toby said he had tried but he didnt have the strentgh no more..he had no support.
I questioned his morality, his attitude, his authority. Boy did I know then how wrong I was about Toby.He sat down with me and asked me what I felt after day one.We discussed the shortcomings,the limitations. I tried to understand and take all that in.All the patients were end stage stroke patients who probably had no quality of life;either the families had given up or we had…. But the patients had’nt…couldnt Toby see that..I questioned him and he said he knew that he should be more proactive..but he could’ntt beat the system.
Coming from where I come from..we always have to beat the system…From then on began my questioning and urging and his complying…We decided to break our work load.I was his attitude and back up he was the brain storm.We started compartmentalising the patients..sickes vs stable..need to be seen..can say hi to…I started questioning the para medical staff in the hospital and started gearing up plans for all our patients.By day 5 both of us had seen all the patients, we had concrete plans for all of them, the OT Physio were mobilised, the jobs in the nurses books were all delt with and I think we had a working plan.Toby was pleased, I was ecstatic.
The consultants came for their rounds said hullo to all the patients,but some where I realised that there was a lot of politics in all of that.We werent just working against a bad system we were battling a war ..I cant even name the warriors of the war or the factions of it all..for want of political correctness….
But in all that..did Toby really stop caring, really stop doing what he believes he should have been doing as a good doctor….No..I will be so wrong to think that of him.
I will never forget that evening..One of our patients..John*..was getting bad to worse.He had come in for severe bacterial infection of his blood.The long immobility led him to have ulcers in his skin, he had had a stroke while in hospital and now his swallowing was going bad.His sister I think refused to have anything to do with him.The Gastro team..in view of his co-morbidity didnt think inserting tubes directly into his stomach was a good idea and he was getting grossly malnourished. We were losing his veins..couldnt get one to put a line in..he was so dry.What he needed was a tube down his nose directly into his stomach.We could give him water food medicine..Get him back to life.He had become so weak that his smile was just a twitch.
After all the so called experts had failed to insert a tube in, we were beckoned to do the honours.Its always funny when all else fails it becomes the responsibilty of the (that too junior most) doctor to make things right.Toby said I could have a go..but after seeing all the damage that had been done..I volunteered to help instead.My job was to help John* to swallow little bits of thickened water while Toby put the tube down the nose into John’s* stomach.I could see, 14 tubes and three hours later..Toby wasnt going to give up.But I did see his tears swelling up his eyes…I dont think he will agree to that…I do think the emotion was because Toby had seen John* during his good days.And in all that time Toby had been talking to John*, reminding him that he was a fighter, that he could do this and chatting with me about John* as though John* was just fine..We both knew he wasnt..But Toby wouldnt give up.He didnt want to fail me or himself but most of all he didnt want to fail John*.
We did succeed…John* was most patient…But that success didnt last very long.John gave up a few days later.And we lost him.I understood Toby’s mood swings that whole day.I think he even snapped at one of the nurses.You know how we tell that doctors should not get emotionally involved.I think thats crap.We all get involved.We just get good at pretending that we dont.I did ask Toby, why he had put in so much effort in John* when he knew the prognosis was rather poor.
He reminded me that..As long as the patient hasnt given up there is always hope to make them better,even if you have nothing to work with, there is always hope.Dont ever deny anyone of that.
I started spending more time talking to Toby, questioning his rationale about treatments, plans annd Medicine..I realised that being a doctor isnt just about knowing all the names of your patients on ur fingertips, having
good lists, being very organised, knowing the text book in out center.Its about attitude, confidence, confidentiality, morality trust.Its about being human.Its about doing what you can to the best of your ability,and not aspiring to do what you think you should, but cant.
When I was leaving he told me that I would make a good doctor and it meant a lot coming from him.He said I had what it took to be one.What he didnt realise is that just being around him for those few days I knew my life was enriched forever…Whenever I feel low or feel defeated..I often think of Toby..He made me realise that inspite of everything some where..there is hope….Thanks Toby!
*John: name of the patient has been changed to maintain confidentiality .