The King Is Dead! Long Live The King!

Last night, news of Michael Jackson's death broke out. It was reported that he had a "cardiac arrest" & that doctors had spent over an hour resuscitating him.

I have been team leader for countless resucitation attempts over the years & have a unique insight into what goes on behind the scenes. It is nothing like what is portrayed on TV programmes like ER, House or Holby City.

My heart sank once I heard that Michael Jackson had suffered a "cardiac arrest". It means that MJ's heart had stopped beating & if it not restarted within a few minutes, then permanent brain damage sets in. CPR or "cardiac massage" will buy you a little more time but the longer the resuscitation attempt goes on, the less likely it will succeed.

Statistically, only about 5% of patients that have a cardiac arrest out of hospital are ever successfull revived. Resuscitation in such cases are a desperate, last ditch attempt & every member of the resucitation team knows that.

For many doctors, the hardest part is about resuscitation is deciding when to stop & "throw in the towel". Instinctively, doctors & nurses find it difficult to stop treatment. But sometimes, it is the best decisison. Resuscitation over an hour as in Michael Jackson's case is considered to be a prolonged attempt & it suggests that the doctors had tried everything. Usually, resuscitation lasts no longer than 30 minutes & resuscitation longer than that is very unlikely to succeed.

From personal experience, over half of patients that have been successfully resuscitated have experienced some brain damage. This could manifest as personality change, permanent memory loss, paralysis & even a vegetative state. Even if resuscitation on MJ was successful, it is unlikely he would have been able to perform as he once did.

Michael Jackson was part of my childhood & rebellious teenage years. The controversy over his plastic surgery & child molestation charges have become irrelevant with his demise. Like a falling star, Michael Jackson's life was short. But his star shone brightly & it changed the world of music forever. His music has touched the heart of millions throughout the world. His life is over but his music live will live on forever.

Grumpy Old Man- My consultant

"Doctor, this patient wants to be seen by you". I was in the middle of clinic when the nurse barged in & dumped a giant set of notes on my desk. "Mrs Cook does not want to see the consultant". My consultant, nicknamed "Grumps", short for "Grumpy Old Man". He is not the most friendly of characters, to put it diplomatically.

When I saw Mrs Cooks said, "I don't want to be seen by the consultant, because the last time I saw him, he hardly spoke to me". Mrs Cooks fumed, "He never asked me what I wanted & didn't listen when I told him I did not want to be investigated any further. I was examined & sent for 5 different tests including X-Rays, ultrasounds, blood tests & ECGs. I was here nearly 5 hours last time."

I was not surprised by what I was hearing. I have seen how Grumps interacts with his patients. They are made to sit in the corner in silence whilst he pours through the notes. The atmosphere would be similar to a naughty pupil sitting in the headmaster's office. After a long deafening silence, he would instruct the patient to undress for examination. Without further explanation, the patient would then be sent on his or her way for an exhaustive battery of tests taking up to several hours.

After all the results are back, the patient would then be summoned back to Grump's room where he would pronounce his verdict & treatment plan. If the patient dared to as so much question him, he would give them a patronising look, simply repeat his verdict & treament plan without elaborating any further. At the end of the consultation, the patient would be dismissed with the phrase, "that will be all".

Its absolutely embarassing to watch this display. I can't believe how little he communicates to the patient. Until then, I didn't realise that doctors like this existed anywhere except on television as caricatures.

Grumps unfortunately, is a relic from a bygone era where patients were talked at, not talked to. He is an excellent, knowledgable clinician & even has many patients that adore him. But his clinical practice fails on the communication skills side. He gives doctors a bad name & lets patients down. Even to his fellow doctors, Grumps remains a poor communicator, in particular those junior to him. He is capable of communicating well with fellow consultants, so its because of a lack of will rather than a lack of ability. Grumps has been working in the same hospital for over 30 years. He is head of department & has many powerful allies.

It will not be easy to change him. Suggestions anyone?

"Live not one's life as though one had a thousand years,

but live each day as the last"

Marcus Aurelius

As a doctor, death is no stranger for me. But even for me, every so often, something touches me & I am reminded of the frailty of life. Recently, an elderly lady who I will call Mabel was found unconscious on the floor by her husband. He immediately dialled 999 & an ambulance brought her to the Emergency Department. I was on duty that day & was responsible for Mabel's care. According to her husband, Mabel had never been ill in her life & it had been many years since she had needed to see a doctor. The day before however, she developed a severe headache. A head scan confirmed our worst suspicions, major internal bleeding in the brain. There was little we could do & Mabel passed away minutes after arriving in hospital.

The worst job I have ever had was breaking the bad news to Mabel's husband who was in a separate room. He knew his wife was ill, but he was still hoping for the best. I took him aside to the small visitor's room in the Emergency department.

"I am sorry, but your wife has just passed away". He was broke down in tears. Although, I had many more patients to tend to, it didn't feel right walking off & leaving him alone. So I stayed with him a little longer to keep him company.

"60 years we have been married together. We fell in love when we were teenagers & have always been in love with each other since". He looked at me with tears in his eyes, "It was only last month that we celebrated our 60th wedding anniversary. It was such a lovely day."

After a brief silence he said, "Please doctor, could I see my wife?". I took him over to the treatment room where her body lay. He took her hand & started talking to her tenderly like she was still there. That's when I could not take anymore.

What is the point?

A waste of a life, a waste of time & a waste of resources. That's how I would describe one of my patients, Paul.

Paul is a 32 year-old drug addict living in the rough. He has injected heroin through his veins everyday for the last 12 years. Last year, he was admitted to hospital as an emergency, with a life-threatening infection. A bug called Staphylococcus aureus grew spread to the bone of his left foot, a condition called osteomyelitis. Staphylococcus aureus commonly grows on the skin & in his case was most likely introduced into the bloodstream by injecting with dirty needles.

Paul needed an partial foot amputation, 4 days on Intensive Care & 34 days on a hospital ward. In addition to the surgeon, he received care from paramedics, nurses, physiotherapists, physicians, orthotics, dieticians & psychiatrists. On discharge, he was referred to the local heroin addiction centre & social services.

A few months later, Paul returned to hospital with pneumonia. Paul was still injecting heroin. Again, the same bug Staphylococcus aureus had grown in his lungs. This time, Paul was an inpatient for 2 weeks. Again on discharge, he was referred to for counselling & rehabilitation for his drug abuse.

Today, Paul is my patient once again. He was admitted with an infection of his heart valve called endocarditis caused by Staphylococcus aureus. Paul had continued to inject heroin. This time, he has been an inpatient for 6 weeks. In the last 18 months, Paul has cost the NHS ten of thousands of pounds.

When we eventually discharge Paul, I know it won't be long before I see him again. How long do we keep repeating this futile cycle? When do we put an end to his misery & the waste of precious NHS resources? Paul is not alone. Every year, thousand of intravenous drug abusers & alcoholic are admitted with self-induced illness.

I feel truly sorry for Paul, but he is responsible for his actions. My personal opinion is that drug addicts & alcoholics that fall ill should be given at least one chance & offered treatment. We should also them provide full support with their addiction. If they do fall ill again as a result of their addiction, I might be persuaded to give them a second chance. But in I opinion, we should follow a policy of "three strikes & you are out". That means, no to any further treatment of any self-induced illness.

Paul has taken up a bed which could have been used by dozens of other patients. We have spent resources on him which could have paid for hip replacement, cancer drugs or antibiotics. Resources in the NHS are finite & must be managed carefully. Money saved from such a policy could be redirected to much nelgected parts of the NHS like improving drug addiction services & care for the elderly.

I realise my views are controversial, but I believe that we have a duty to be fair to all of our patients.