How does it feel? How many emotions do you get through in a working day? Former Secret Doctor Aoife Abbey has chosen seven, for a major new book in which she recounts her life as an intensive care trainee. Neil Hallows reports

The Secret Doctors reveal everything except who they are. You know them through the situations in which they have struggled, the colleagues with whom they have battled, the patients who have inspired or infuriated. You get a strong sense of what drives them, of what they would be like to work with – but you don’t know their names or where they practise. That’s how it works.

So, Aoife Abbey’s decision last year to ‘out’ herself and stop writing the blog provoked mixed emotions. There was sadness – the ‘mouthpiece of my subconscious’ as one of her doctor readers put it – was the BMA’s most successful blogger of all time (we were fortunate to find a first-rate successor). However, there was also huge pride and excitement at the very specific reason for her coming out of the shadows.

That reason was an invitation by Vintage – which publishes such classics as When Breath Becomes Air – to the Coventry specialty trainee 6 to share her writing with an even wider audience. Her book (pictured above) – Seven Signs of Life: Stories from an Intensive Care Doctor – was published on 7 February.

For a doctor who had started her writing career a few years earlier by sending some blogs to the BMA website, it was a huge but daunting opportunity. She had no shortage of vivid experiences on which to draw, and was clearly a gifted storyteller but what was the best way to get these across?

‘The question, “what would you have done?” is always implicit’

She considered presenting them in the form of a diary but then came up with something far more novel. She has written a book of seven chapters and each covers an emotion. There is fear, grief, joy, hope, anger, disgust and distraction. Under the umbrella of these chapter headings are experiences profound, exposing and often unexpected in terms of the emotions they provoke.

It’s a love letter to her specialty, or perhaps more an anniversary card between a couple who have learned each other’s failings but love nonetheless.

Chess game

Intensive care can seem a quietly mesmerising place to outsiders. There is a Monty Python sketch where doctors are in diagnostic reverence of the ‘machine that goes ping’. Screen after screen, tube after tube. Staff can feel, in the recent words of an intensive care consultant, like they are playing a long game of chess with the readings and the patient can seem slightly lost in this complexity, rarely conscious, a collection of indications.

One of Dr Abbey’s achievements in her writing is to never lose sight of the patient among the pings.

‘There is a huge amount of effort trying to “line up the numbers” in an intensive-care patient,’ she says. ‘But I think you have to balance that with the more normal things, with thinking about who your patient is.’

‘There is a tendency to vilify anger’

Sometimes patients present themselves, quite unexpectedly. She tells a story reminiscent of Oliver Sacks’s Awakenings about a woman called Rose who sometimes sang or shouted in short bursts but was completely unresponsive to questions. Then she suddenly asks for a crossword and answers every clue. The next day she has returned to her previous state.

‘I sometimes think this might be the most exhilarating, joyous and yet simultaneously sad memory that I have of medicine,’ she writes.

Picture prompt

Rose may have briefly revealed her personality, but this being a specialty where the patients are often unconscious, doctors can need some help in contextualising them. Dr Abbey says she makes a conscious effort to find out about their lives from family members, to make a better connection with them. Even a photograph of normal times can help.

‘One of the things I really love is when patients have their pictures in frames on their lockers. A lot of time the patients can’t see them because they’re not awake or conscious, but you can see it, and you look at it and think oh, that’s them. You can tell who they are.’

‘The intention is to reflect what is happening in my life right now’

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.’

'Can't breathe'

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.

Under scrutiny

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?

‘Maybe it’s just passion, or a sense of what’s right and wrong’

She is better prepared than most for being judged. Some of the blog comments were fairly harsh: she was too optimistic, too pessimistic. Too quick to anger, or too much of a push-over. Dr Abbey, as the Secret Doctor, would sometimes remind them firmly on Twitter that while their views were welcome, she was just a doctor like them telling a story or expressing an opinion.

But, so far, everyone who knows her has been positive about her writing the book, and she’ll no doubt take the reviews in her stride.

Personal preference

Dr Abbey stresses that, if she is to be judged, it should be a judgement on her rather than the profession.

‘Doctors are often presented as a unified mass,’ she says. For Dr Abbey, ‘the intention is to reflect what is happening in my life right now’ – at a particular point in her career and perceptions. Nothing more, nothing less. She doesn’t doubt that if she looked back over the same experiences in 30 years’ time, some of her judgements will be different.

While Dr Abbey insists she does not want to speak for the profession, she will become a doctor who some readers feel they ‘know’ better than any other, unless they happen to have one in the family. Whether they wish to or not, these authors, like real and fictional TV doctors, become a kind of key which people use to understand, define and measure the profession.

She’s just one doctor but there’s a parallel with the blogs at which she excels. You don’t capture people’s imagination with generalities. Instead you pick a single, bright example and that – rightly or wrongly – is held to illustrate a wider truth.

Dr Abbey is a single, bright example. She doesn’t mean or want to embody the profession but if, despite her protestations, her readers decide that’s what a doctor is, then – and I admit my bias as her former editor – I think they’ve chosen rather well.


Edward Moss

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