Wednesday 19 July 2023

Trauma is as trauma does

I mentioned Chris Luke's A Life in Trauma: Memoirs of An Emergency Physician because it offered a tip about better comms when dealing with stressed or distracted people: write it down for them so they can recall it later. There is, clearly, a difference between turning up to Accident & Emergency or our local library for service; but there is common ground in communication between two people.

Chris Luke was born in Dublin but out of wedlock a few years after me.He spent some time dumped in an orphanage because in Ireland in the 50s and 60s the sins of the father were for sure laid upon the children. But through a heroic effort effort of compassion and solidarity, the boy was retrieved and brought up by his mother and raised by a village of her friends including the wife of his birth-father. Not everyone in those days was a priggish judgemental hypocrite. And the boy done good, getting a good Leaving Cert and going on to study Medicine at UCD.

He argues that, as a vocational emergency physician, witnessing and experiencing trauma in an orphanage set him up to helping those who were suffering acutely later on.  This might be true. My bestie from teen years was blessed with an older sister who was mentally disabled as a child by a rare tropical infection. Caring for this sister led her to think that she should care for people in general which led her to a career in nursing. By her early 30s my pal was burned out: some old sick anxious people do not have good boundaries and can be cruel in their complaints. But Dr Luke makes the mistake of believing that all / most other successful workers in emergency medicine are recruited through trauma. I suspect a deal of confirmation bias is at play here.

In Feb 2011, Chris Luke was - again - on Pat Kenny's national radio programme and said some shouty things about a) GPs who referred "inappropriate" patients to A&E b) bean-counters and management in the HSE who were failing to staff or resource A&E departments adequately c) some [foreign and/or young] A&E doctors who didn't seem to do very much. He was then called away to a genuine emergency - plane crash at the nearest airport - before he could temper his remarks in the subsequent debate, and counter push-back from Kenny and the other guests. With hindsight, he shouldn't have said those things especially so LOUD and indeed he shouldn't have been in a radio studio during the working day. There was an indignant shit-storm from GPs, politicians, colleagues, management, the press and social media. At last everyone had something / someone to pile on . . . rather than solving the trolley problem of over-crowding in hospital intakes. A previous Health Minister Brian Cowen had referred to the Health portfolio as Angola because of the prevalence of land-mines.

Luke carried on for several more years but the vilification, the stress and the always on call caught up with him and he took early retirement as he turned 60. One of the outcomes of retirement is this memoir telling us where he'd served [Dublin, Edinburgh, Liverpool, Cork, Oz] and the friends he's made along the way. One of his more actionable suggestions is that Emergency Medicine is a young person's gig. Doctors, nurses and Advanced Nurse Practitioner ANPs need to be resilient - immune to sleep deficit for starters - and old ones are not really up for the front-line. There is a sweet-spot in your 30s when you've the experience of having processed your 10,000 patients and from that can make rapid [successful] decisions most of the time. 

Bummer is that those peak years are when MDs, RNs and ANPs are also raising families on their own account. It is one of the many irreconcilable conundrums that make Health Care systems so hard to get right. Certain-sure is that national health strategy is not solvable by sound-byte . . . or memoir. The memoir is fine on it's own merits: read by the author who has a life-time's experience writing about himself and medicine in the press; so the prose don't clunk either.

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