Clare Gerada: As the “covid-cohort” start clinical practice, I wish them luck

We have just begun that time of the year when newly qualified doctors start their first year in clinical practice. I wish this “covid-cohort” luck and congratulate them on entering a profession which I have enjoyed for nearly 40 years. 

I reserve special congratulations to one young man whom I now have the pleasure of referring to by his new title “Doctor” and someone I have known since his first days at primary school.

Peter. 

Seven years ago, when a 1st year clinical medical student he suffered severe head trauma following an assault. He staggered back home. His flat mate (a medical student), instead of thinking he had had a few pints whilst waiting for his kebab, noticed he was behaving oddly. Recognising the seriousness she called 999, an action which later provided to have saved his life.  

Due to the assault he suffered from severe injury to his brain.  

His vital signs when he arrived in hospital were extremely worrying. With a Glasgow Coma Scale of 4—(which is almost as bad as it gets) his doctors urgently relayed the bad news to his parents, that he was very close to death and even if he survived his outlook was grim.

They rushed the hundreds of miles to be by his bed side.

A series of fortunate events (his flat mate ringing 999, the quick response of the ambulance crew, the skills of the attending team, the presence of an on-call neurosurgeon) meant that he was operated on within a few hours of his injury and the pressure on his brain was relieved. 

He survived his first night.

His friends and family organised a rota for people to be by his bed side at all times; massaging his hands, stroking his face, reading and singing him his favourite songs, all in an effort to wake his brain and reconnect damaged neurones. 

Nurses turned him and physiotherapists made sure his limbs kept moving and his lungs remained clear of fluid. Doctors assessed him and kept his bodily systems as stable as possible. Tubes and machines replaced what his vital organs couldn’t do.

Days passed and gradually doctors took him out of his medically induced coma.

We waited to see what lay ahead. 

Slowly, so slowly over the course of many days he woke, first raising a finger in response to commands. Then opening one eye; grunting to instructions; sucking fluid from a straw; then articulating a few words and then recognition of loved ones.

Such joy and we rejoiced. 

He was back.

Nevertheless, enough damage had been done to leave Peter with substantial damage to his speech and language centres, the nerves which controlled eye movement, his ability to concentrate and control his emotions and he was also paralyzed on the left side of his body.

What followed was remarkable in terms of fortitude, bravery and plain hard work. 

From being a top student, winning prizes at school, and sailing through his scholastic achievements, he had to start again and relearn what had been laid down during babyhood and infancy. 

Unlike most cells in the body the brain neurones do not repair themselves. This does not mean that repair is impossible. The brain (especially those of younger people) is able to compensate in other ways. Undamaged areas can take over activities of the damaged parts and new nerve pathways are established. But the process is slow and unpredictable.

A year of rehabilitation involving surgeons, occupational therapists, physiotherapists, speech and language therapists and psychologists was followed by another focusing on his higher, cognitive functioning—re-learning essential skills of concentration, dealing with pressure, and abstract thinking. He returned to university, this time to do an intercalated degree in Neuroscience (what else!) and obtained a BSc. 

But medicine was still in his sights. 

Peter had wanted to be a doctor from as long as he remembered. Drawn to the profession as its mix of scientific endeavour combined with the act of caring fitted his personality, interests and intelligence. 

His medical school took him back and he restarted and completed the year he had left due to the head injury. However, being back full time and immersed in the pressure of clinical practice was exhausting—mentally, physically and psychologically and he struggled with the fourth year and failed his end of year exams. Undeterred he spent a year as a hospital ward clerk, and he was determined to return and finish his training. The medical school agreed, and Peter passed his final examinations this spring, due to start his first job in August. 

Of course, Peter has had to have adjustments made to his training—you try running for a cardiac arrest when you have a hemiparesis. He also needs more time to do written examinations and practical procedures can be challenging.

But where no adjustments will have been made is in the higher order functions. In his ability to focus, interpret new information, make judgements, problem solve, show empathy. All vital skills for a doctor and where no second best can be accepted. Peter has all of these skills: all innate but some having to be reawakened after his trauma. 

We often talk about doctors needing resilience—that is the ability to bounce back after a period of adversity. Peter has shown enormous resilience from being on death’s door seven years ago to now as he starts his first job as a doctor. It won’t be easy, but I know he will succeed. 

Peter is a pseudonym and a few details have been changed to retain confidentiality. Permission for this piece has been given by Peter.

Clare Gerada is a GP, medical director of NHS Practitioner Health, and chair Doctors in Distress,a registered charity.

Competing interests: None declared

 

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Source: blogs.bmj.com

Clare Gerada: As the “covid-cohort” start clinical practice, I wish them luck