It’s a specialty where a patient may have only a 2 per cent chance of survival ‘but if we don’t have enough hope that we can see the 2 per cent, then what is intensive care for?’
Finding joy in small advances, or hope in a patient’s outcome, you might think they were the two easiest chapters to write.
But they weren’t, for both have a certain baggage. Moments of joy, as with Rose, might be fleeting. It’s a nuanced happiness, ‘for very specific reasons, and you know what happens in the end, and the patient is still chronically ill’.
And as for hope, Shakespeare might have been right that ‘the miserable have no other medicine’ but Dr Abbey speaks of a slightly treacherous commodity where doctors might have it but fear sharing it in case they raise false expectations. It’s where Herculean effort is put into helping the 2, or however many, per cent to live, and those people then say they ‘defied’ their doctors by surviving, as if it were some kind of battle.
Anger, meanwhile, was easier to write – but raises different questions. Is it ever OK to be angry at work? ‘There is a tendency to vilify anger,’ she says. ‘If you say that you are angry, people will assume that you have an anger-management problem.’ Such moments rarely come across well in print, especially in the environment of constant monitoring which junior doctors, especially, face.
Dr Abbey smiles: ‘I can be quite fierce. For me, I think it’s for a good reason. I am trying to hold to a standard. If you can’t get angry about certain things, how else do you know what needs changing? Maybe anger isn’t even the right word, maybe it’s just passion, or a sense of what’s right and wrong.’
If you want to make Dr Abbey angry, try being a prison guard who brings in an intubated patient and insists on remaining chained to him when the exasperated doctor explains that he might need shocking and he ‘literally can’t even breathe’.
You might remember that story from the Secret Doctor blog, and it’s good to see some old friends not just given greater context but related to the chapter headings in sometimes unexpected ways. Another, Dr Abbey’s best-read blog about her taking ownership of a clinical error, is filed under ‘grief’. It gives a sense of the weight she continues to carry, even though the error, a misreading of an X-ray, did not result in patient harm.
‘Doctors are often presented as a unified mass’
It seemed to resonate with doctors because of Dr Abbey’s insistence that for all the entirely correct emphasis there is on failures being systemic rather than personal, for all the fact that doctors have to learn and they will always make mistakes, she wanted to confront what she had done.
She says there is an ‘inherent discrepancy’ between the doctor’s perspective of an experience which they might repeat many times, sometimes successfully, sometimes not, and all part of a learning curve, and the patient for whom ‘it is their D-Day’. And while she is, from this incident, an embodiment of an open culture where doctors confront their errors, she recognises the pressures heaped on them by a highly litigious, blame-ridden climate.
This was an issue on which every doctor seemed to have a view, and there is something about Dr Abbey’s style which invites them to do so. The question, ‘what would you have done?’ is always implicit. Her approach is always as much about asking and telling.
So rooted is this approach that she had a verbal exam recently and had to be gently reminded that, if those were her answers, she shouldn’t make each one sound like a question.
The book is a big deal. Extracts have been serialised in a national newspaper, there will be interviews, promotional appearances. An actor – Irish as it happens, like Dr Abbey – has read it for an audio version. Is she ready for its reception?