I was asked at my last appraisal ever for a word to sum up my career. The instant and obvious answer was a “privilege”. I’m fully aware of how cheesy and insubstantial it sounds, yet it remains the truth.
I think I was the first registrar on a regional children’s cancer unit, paid for by charity monies. My partner Suzanne and I used to pick up checks for the fund from local working men’s clubs with Alex, our first child in the pushchair, only to come home with extra silver coins in the pushchair “for good luck.”
This was my first time as a registrar, and it remains my favourite job, a wonderful team, superb morale, challenging but beautiful patients and parents. I was never really clever enough, but I could put a line in, talk to the kids and their families and fill out long and complex chemotherapy prescriptions with considerable help from Ian, a highly specialist and very patient pharmacist.
Within weeks, or indeed days, of any child presenting we knew everything about them and their families. All the family secrets. We pre-empted every question they might have, every change in plan. “Expert Patients” or indeed “Expert Families” are a great educational tool, teaching communication, honesty and humility. I would recommend them to all clinicians especially those in training and my beloved Orthopaedic brethren.
So, one Sunday morning around 06:30 I rang Suzanne from the ward, crying. A young boy - possibly with Acute Myeloid Leukaemia, but memory fades - was having a bone marrow transplant. It was going horribly wrong, with severe graft versus host disease, especially involving his lungs and he was drowning in his own blood. But that wasn’t why I was crying.
Whilst we couldn’t fix his disease, relieving his symptoms was relatively easy, anxiolytics and opiates are pretty powerful in the correct doses.
No, he wasn’t why I was crying. His Mum was unusually unsupported, with no close relatives around, no partner and despite knowing her for weeks, in a pleasant social way, none of us had managed to get close to her. That was why I was crying; how could we reach her, to support her through this appalling thing happening to her son.
I’m an atheist, though I used to be a Catholic, and would you believe I said a prayer that early Sunday morning. Now I really don’t believe anyone was listening, but less than an hour later there was a child in a bed lying back between his mother's legs. She was on a narrow nightingale bed and the ward sister and I were on either side of her as her son died.
It was a privilege simply to be with her.
Great clinical learning? Not much maybe, but even if there is nothing you can apparently do, there is always something you can do, be present, don’t invade, don’t presume but be available and share the truth of your experience.
Stephen Cronin is a Sunderland lad who fell into paediatrics. He retired in 2018 but returned to emergency medicine for COVID and will be retiring again very soon. He has three wonderful grandchildren, and set up the first Durham Fringe Festival.