Thursday 5 July 2018

Happy Birthday NHS

Much is being written about the NHS this week as we pass the 70th anniversary of the creation of it.
Here is my contribution. This maybe cathartic, maybe therapeutic, and chances are that the published version won't be as eloquent as others, and will have been edited and self-censored.

I've been alive for just over half of the time that the NHS has been around, and yet my memories of initial interactions are all a bit blurred - the GP who gave you a smartie as you left after an appointment, an Xray of my hands to check my growth was within normal range, dental checkups with Garfield on the ceiling.

And yet other memories are really quite vivid - 15th December 1996 in particular. Just after my 15th birthday. But to put it in context I need to explain some background.

I am the 3rd of 4 kids, the oldest died at 4 hours old back in the days when 'special care' was in big central hospitals, not in small hospitals. The second, my older brother Adam, was born just over a year later. At 6 months old he was noticed not to be developing 'normally' and was eventually diagnosed with a rare autosomal recessive disorder, Canavan's disease. When I came along 2 years later it was apparently a relief.

Even now trying to place it into medical terminology and describe his condition feels strange because he was Adam, his condition was part of him. In summary the condition affects nerve signal transmission, and thus he had a large head, and very limited muscle mass, with some scoliosis and contractures. Thus he was dependent. He could 'chew' minced up food, and swallow it but not a great deal more. However he had a wicked sense of humour, and any telling off that my sister or I received would set him off laughing.

It was only at school really that I discovered that this wasn't 'normal' - having suction machines under the bed to clear secretions; passing an NG when he was unwell, doing the litmus paper test, then pouring dilute dioralyte into a 50ml syringe barrel and watching it drain into him; even getting calpol from a 5ml syringe (in the days before they packed one in the box).

So Adam was 'given' a life expectancy of 5 but either he hadn't heard properly or the stubborn gene lives strong in the family, and with the help of the kindly Consultant neurologist, whose waiting room my sister and I sat and squabbled in on several occasions and the GP who was happy to be called day or night and did extra house calls on his way home from the surgery if mum had 'sounded worried on the phone', and who told his junior colleagues to ring him if they were concerned, Adam had done well. Without making it sound like a utopia, the NHS provided this back up, the drugs, the physios, the health visitors etc and at no point presented a bill, at no point suggested that Adam's condition wouldn't be treated and at no point asked my parents to pay for his care. It truly was free at the point of delivery, according to need not ability to pay.

In saying this, I have to pay tribute to my mum. carrying a teenager, even one who 'only weighs' 3-4stones, up and down stairs, in and out the car and into and out of various wheelchairs and buggies, and being a 24/7 carer, along with dragging up my sister and I and supporting Dad and running home was no small task.

So anyway, 15th December 1996, Adam was 17and 3 months - we had been out to family friends for lunch and were coming home at around 5.30pm. As we got home, Adam seemed to be making a funny noise in his car seat. Mum got him out the seat and took him into the house then upstairs to the room he and I shared. The next bit is a blur in my head but I vividly recall the ambulance arriving, and the crew bringing bags of stuff into the house and upstairs. There was calm tones but urgent from upstairs, the front door was wide open and the winter weather was blowing into the hallway.

After 20 minutes or so, they and mum carried Adam out and into the ambulance, calmly, and set off without the blue lights on. Dad took my sister and I up to the hospital in the car and we sat in the waiting room for what felt like hours. Eventually Mum came and got Dad and walked through a set of doors, telling us they'd be back soon. She hadn't looked that upset, so maybe things weren't as bad as I think I thought.

My next image is of being in a relatives room and a nurse explaining to us that Adam had died. She may have used nicer language but the meaning was clear. We all got up and walked into the resus area where Adam was. The lights over the other bays were off, leaving him in the middle of a room, lit up with darkness all around.  I don't remember what he looked like at that stage though from what I found at home that night, at least 2 of his teeth had been broken. The whole scene felt like something from Holby City or Casualty - the rest of the room fading to darkness, the bed illuminated - harsh bright unforgiving fluorescent tube light.

Since then there have been many family interactions with the NHS - my nieces being born, grandparents being unwell and receiving end of life care, my own visit to ED when a tree branch landed on my head, and of course my exposure to it when training and now practicing medicine.

I'm not sure what role it played in my deciding to do Medicine - I knew I wasn't going to hit the high flyer exam results at 16 or 18, and so I ended up doing Biology at Uni, completing my Medicine as a postgrad. But I didn't really think much about this episode that December evening until I was a CT1 doing my Emergency Medicine and had to walk into Resus with the lights mostly off and only one set of harsh fluoresecent tubes on, above one bed. I didn't like it and still don't - resus when it is busy, noisy, full of activity is great, but when it is empty and still......