![]() ![]() In the throes of that doughnut-induced sugar-high, I fell to musing on how it could be that the relatives of a man we had served so poorly could be so pitiably grateful. The surgery went well, hence the card (and doughnuts). However, after four odds-defying weeks on our ICU, during which time he was supported with dialysis and an artificial heart-lung machine, and had to undergo emergency abdominal surgery, we reached the point of being able to undertake the surgery for which Mr X had originally sought medical attention almost a year before. I needed nevertheless to prove that the system that had let him down so grievously, the system of which I am a part, had not abandoned him completely. In truth, I did not expect him to survive. In the end, the reasoned unemotional argument that “he is 44-years-old, for f-’s sake, a husband, a father to young children” prevailed. There then followed a discussion between me, the intensive care consultant in the referring hospital and his counterpart in my own hospital as to whether we had already missed the boat for surgery: was it reasonable to use a scarce ICU bed for someone who would quite likely not survive surgery and risk denying that chance to someone else would he even survive the 30-mile journey to our hospital? This is the utilitarian stuff of our daily work, as it should be: resources are finite and demand seemingly infinite no one in the NHS expects a blank cheque. The reason that the schedulers had been unable to reach Mr X by phone was that he was somewhat indisposed. The local ICU team had done a heroic job in keeping him alive and wanted to transfer him to our hospital for further management. The reason for his elusiveness became clear that afternoon when, as duty consultant, I received a call from the intensive care unit of a nearby hospital: a young man awaiting heart surgery had been admitted to their care in extremis having collapsed with heart, liver and kidney failure. I followed up with the schedulers the next day they had been trying to call Mr X, but he wasn’t picking up. ![]() Struck both by his clinical condition and the fact that this poor man had spent an entire year crawling through the Kafka-esque obstacle course required to get to the top of an NHS waiting list, I asked our redoubtable scheduling team to list him for surgery the following week, something which would inevitably result in other patients’ operations being rescheduled. ![]() Mr X first came to see me in early June, needing triple heart-valve surgery, major surgery by anyone’s definition and, before the cynics give their two-pennies’ worth, not a self-inflicted illness, just rotten bad luck. It is one of the gallows-humour aphorisms of my profession that it is the patients we have served least well who are the most grateful and, while I am delighted that this gentleman’s surgery has gone well and that he is now well on the way to recovery, he is someone who has most definitely not been well-served by our NHS. This one touched me to the quick, and not just because it was accompanied by a gigantic box of diabetes-inducing doughnuts. I receive dozens of such messages every year, it is one of the joys of my job. We all know that “claps don’t pay the bills” but, in common with all my colleagues, I am always touched by the generosity of our patients and the ways in which they express their gratitude for what we do. Yesterday, we (the surgical team in the hospital in which I work) received a “thank you” card from the family of a 44-year-old man on whom we had operated the previous day. ![]()
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