The best medicine? Pink gin and lemonade | Rachel Clarke | TEDxNHSSalon

[Music] so i'd like to introduce you to john it's fair to say i've never met another 94 year old quite like him i'm sharing his story with his permission in fact he pretty much ordered me to tell as many people as possible when john was 93 years old he was diagnosed with cancer at the base of his tongue when the tumor blocked his airway the only way he could breathe was by having an emergency tracheostomy a tube surgically inserted in his throat despite his age and despite his tracheostomy and despite the fact that in oxford his hometown there are a lot of hills john used to insist on cycling to every single one of his oncology appointments once he was even knocked off his bike by the wind on route to the hospital and this led his oncologist to write in his letter afterwards that john was clearly a tough chap because he simply brushed himself down and carried on again i met john for the first time in the hospice where i work as a palliative care doctor he had arrived the evening before and the nurses told me he had had an incredibly torrid time overnight he had been bleeding profusely from his tumor hemorrhaging and no one expected him to survive the day so i prepared myself to see a patient likely to be very very close to the end of life perhaps he wouldn't even be conscious in fact when i walked into his room john was sitting bolt upright in bed looking both very animated and immensely displeased he couldn't speak but he was gesticulating wildly there was clearly something he was desperate to convey to his doctor he was given a pen and paper and i thought to myself well maybe he's going to write a final message some very important profound message that he wants me to convey to his loved ones when he handed me the piece of paper and i'd managed to decipher his spidery scroll i saw that in fact what he had written down was the sentence where the hell is my whiskey okay i thought not what i was expecting uh the hospice has a very well stocked drinks trolley and it turned out that the night before john had been offered a whiskey just before he'd started bleeding but he wasn't interested in what had happened to him overnight he just wanted to know where his drink was later when john was able to speak he told me that in fact his drink of choice was pink gin and lemonade so we scoured the hospice to see if we could find a bottle of pink gin this being on the basis that strong spirits might not be able to save life but they can definitely restore it john didn't die in fact from that moment on he went from strength to strength he quickly captivated all of us in the hospice with his energy and his enthusiasm he was just the kind of person who obviously loved people he learned all our names the doctors the nurses the cleaners the porters the health care assistants and sometimes on our ward rounds we'd almost be fighting to be the doctor who got to see him that day sometimes when i had time i'd sit down with john and we would talk as he sat there savouring his pink gin and he'd talk about his philosophy of life he used to tell me that this could be boiled down to two words transmit love nothing else matters just transmit love i have thought of those two words of john's so many times over the course of the last year it's really difficult to exaggerate just how challenging it can be to provide any kind of humane or compassionate presence at a patient's bedside in the midst of a global pandemic how do you transmit anything at all except perhaps covet itself when you yourself are barricaded behind layers of masks and plastic gowns and gloves everything about ppe is completely dehumanizing i remember early on in the first wave i realized to my horror one day that for all our patients who are dying from coronavirus in hospital from the very moment they set foot inside hospital doors they were destined never to see another human face again no lips no cheeks no smiles just masks and pairs of eyes behind visors i quickly concluded that this for me is the absolute greatest cruelty of coronavirus it's the way in which it separates us from each other at precisely the times when we need each other we need human contact the most the virus spreads through speech and touch and these are the means through which usually we convey our warmth and our tenderness to each other and coronavirus just intrudes upon all of that there was one occasion in the first wave when i had to sit down with a father and two little girls who had come to visit the hospital so that they could say goodbye to their mother who was dying of covet and i had to explain to the two little sisters that mummy was very very sick and she probably wasn't going to look as they expected her to they had worn their party dresses to look nice for mummy and of course we had to cover up those dresses i had to kneel down on the ground and i had to help them into their own gowns their own masks and when i watched them setting off down the corridor with their father towards their mother's room i could see the plastic aprons trailing on the ground behind them because nobody makes ppe for children and i thought to myself that's a sight that nobody should have to see because it shouldn't exist and no child should have to endure barriers like that covid has made them necessary and it continues to make them necessary and it's why for a great many of us in healthcare at the moment going to work these days often feels heartbreaking palliative care is often the exact opposite of that it's all about breaking down barriers and taboos and fears when your patients have a terminal illness and there's no prospective cure then every moment counts and the only things that matter are the really important things so that means our job is so much more than simply alleviating physical symptoms we need to find ways to bring moments of joy and beauty and meaning into dying patients lives sometimes patients experience a kind of anguish that no amount of morphine or other drugs can alleviate and and that's the pang of knowing that every single thing every person they love in the world is slipping through their grasp and it's our job to help with that and to do so if that means breaking the rules sometimes then so be it i think basically in palliative medicine being a good doctor very often requires a little bit of creativity so in john's case for instance pink gin was the best medicine we literally transmitted the way that we cared about him through the medium of 37 alcohol there was another occasion when the most important medicine came in the form of livestock we were caring for a patient who happened to be a farmer he was very very unwell very close to the end of life and very low in spirits so we sat down with his wife and asked him what she thought we could do to try and bring joy into his final days she didn't hesitate in answering uh in fact she said the thing that we needed to bring to the hospital was a creature that he probably loved more than he loved her it was a bull a prize-winning bull and apparently our farmer was devoted to it so it may have been the case that a number of hospital health and safety rules may have been broken so that we could arrange for a tractor pulling a trailer upon which there was a large and frankly absolutely terrifying animal with a ring through its nose through the hospital car parks all the way into the hospice gardens nobody ever tells you at medical school that sometimes being a good doctor involves scooping up copious quantities of cow pets but for a smile like that on a patient's face it's definitely worth it sometimes people when i tell them i'm a palliative care doctor they they find that hard to understand and i always think that's a reasonable response after all why would a doctor someone who is trained has spent all those laborious years of study learning how to do incredible things like restart hearts when they stop or cure cancers or transplant faces why would they choose to surround themselves by death and dying what on earth is the reward in that and for me part of the answer is the fact that out of all the different groups of patients those close to the end of life are often particularly vulnerable so if you're if you have a terminal illness you're often too exhausted or too ill to advocate effectively um for yourself and and often you can be overlooked or even neglected in very chaotic hospital environments but it's more than that for me what i love about palliative medicine is the fact that pretty much nothing is out of bounds the most important thing always is trying to find what helps your patient feel human i've noticed that more generally in medicine there are certain words that sometimes can be bandied around so often so frequently they can almost have the meanings sucked out of them and at the moment words like love and kindness and compassion are very much in vogue so staff are often told we must be kind to ourselves we must think about our well-being we must try and strive for compassionate excellence in the way we care for our patients and all of this is despite the fact that everybody knows the one thing that's guaranteed to batter the compassion out of a doctor or a nurse is conditions at work where there's horrendous understaffing and and overwhelming workloads as a palliative care doctor who has seen enough death and dying in the last year frankly to last a lifetime i want to take a stand and reclaim the word love for what it really means in healthcare transmitting genuine love at our patients bedsides showing them through our actions that we care is absolutely not easy or glib or effortless or reducible to some kind of hashtag it just isn't any of those things and the pandemic could not have made that plainer it takes real tenacity real courage to behave with kindness if if you take the pandemic over the course of the last year the nhs collectively absolutely has carried on transmitting love to our patients despite all of those barriers that covid has put in place but only through real effort of will so we have been there with the patients when the families haven't been able to we have sat down and read words that have been written by a husband or a wife who just longs to be there themselves in person we've sat down on the ground with a child and helped them into her ppe we have sat with a man dying of covid and produced the packet of cigarettes that he hid in his socks before he came into hospital because the one thing he wants to do before he dies is taste a final illicit taste of tobacco and doing all of those things takes real guts it would be far far easier not to go the extra mile just to keep your head down to hope that you can surrender to how exhausted you are and maybe just leave the hospital as quickly as possible but the nhs hasn't done it nhs staff have carried on going the extra mile i think that for me this is absolutely the greatest challenge in medicine it's how do you operate in conditions that are chaotic exhausting grueling overwhelming and yet still find a way to behave lovingly to return to john for a moment john didn't die in the hospice in fact he was discharged and he went to live in a local nursing home and he stayed there for another six months still drinking pink gin still holding court and i have absolutely no doubt still keeping the staff on their toes there just like he did with us i think that john identified something absolutely fundamental about the heart of good medicine he recognized that for all patients from their first day to their last day it's human connection that's the really vital medicine if you are scared or vulnerable or in pain a patient in other words then it's other people who make the difference and that for me is the essence of what love really means in medicine it is going the extra mile so i'd like to ask you how you propose to transmit love in medicine might you consider breaking the rules if the circumstances require it might you be willing to think creatively maybe outlandishly about what could bring joy to your patients it might be a matter of i don't know bringing a stereo into a patient's room or maybe smuggling in their pet or perhaps wheeling a hospital bed outside into the hospital gardens so that a patient can feel sunshine on their cheek or taste snowflakes on their tongue or maybe it's simply a matter of doing this pouring out a pink gin and lemonade i think there is something exceptionally beautiful about a 94 year old man no longer with us still transmitting a living legacy from beyond his grave and i'd like to end with a toast here's to nhs love real tenacious nhs love and here's to you john carbrey

Channel: TEDx Talks

Views: 4,014

Keywords: Compassion, Creativity, Death, English, Health, Love, Medicine, Society, TEDxTalks

Id: IQ-XsMVY4DQ

Length: 18min 0sec (1080 seconds)

Published: Wed Apr 28 2021