Looking out for each other

TGreenhalgh_picTrisha Greenhalgh is Professor of Primary Health Care and Dean for Research Impact at Barts and the London School of Medicine and Dentistry, London, UK

The Professor of Trauma Surgery texted me: “Can I come and see you today please?”

I had started work at 8 am and it was already 4.30 pm. I had four more meetings in my diary. But he had never asked before, so I decided it must be important. I texted back: “6.30 in my office, if you’re still around.”

He was early. I buzzed him in, and asked wearily, “How can I help?”. We overlapped on a committee so I assumed he wanted to talk business.

“Actually, I came to ask about you,” he said

“Huh? I’m fine.”

“I had a tip-off that you weren’t fine.”

“Who told you that?”

“I saw X today. He said he’d seen you at a conference and you looked terrible. He was worried you might be depressed.”

It was exactly two months since I had come off my bicycle at high speed, sustaining three fractures, a dislocation and concussion. I had had emergency surgery and spent a month at home, helpless as a baby with two broken arms and requiring strong opiates for pain relief. I developed complications – chiefly thrombophlebitis and a urinary tract infection.

My memory of the accident was unclear but its nature had raised suspicions that my cycle may have been sabotaged. The only thing I remember was hitting the hard ground with a sickening crack – a split-second experience that recurred nightly in flashbacks and sometimes made me cry out in my sleep.

I took a deep breath. “Thanks. Thanks a lot. Yes I’ve been depressed. But I’m getting better. I am better. Nearly.”

He sat and waited. There was a short silence, then I told him the full story. Not the story of the accident (I can’t do that yet) but the story of how hard it had been to return to work, still in pain, to find a month’s backlog of work including twelve staff appraisals (all past their deadline) and various ‘needy’ mentees. I had found these human interactions particularly hard.

I told him of how I had come to work in a taxi for a crucial external review meeting, left early because I was in too much pain to concentrate, and found myself sitting on the pavement in floods of tears when my taxi didn’t arrive.

I told him how my body image and self-esteem had been damaged along with the physical injuries. I have always been ‘sporty’ and well co-ordinated. Now, one arm didn’t straighten properly and the other didn’t bend properly. My muscles were so wasted you could see the – now deformed – bones through the skin. Ugly pieces of metal were visible and palpable from one joint. “I call this my cripple arm,” I said, showing him the more mis-shapen one. He touched it, gently.

Even worse, my arms didn’t work. I couldn’t carry anything. I dropped cutlery on the floor in the canteen, and everyone looked round to see the idiot who’d done it. I couldn’t open doors. I needed help getting in and out of the bath. I couldn’t go swimming because it hurt, and because when I tried to swim the metal bolts seemed to come loose. All this made me angry.

He listened. And he did so with the ear of someone who knows about trauma.

I told him how the opioids had made me chronically constipated, and I was fucking fed up with being constipated. “Constipation is an old lady’s disease. I don’t want to be a constipated cripple. And my arms hurt. They hurt like hell. And it’s two months and I ought to be better by now.”

He asked why I had returned to work so soon.

“I was off for ages. I was bored. I couldn’t keep drawing a salary without coming in. I’d done everything I could do working from home, writing up papers and stuff. I had all these appraisals to do.”

“Doctors never take sufficient time off after trauma,” he said.

I paused. “No.”

He asked if there was anything more he could do.

“No I don’t think so. I’m seeing someone next week for a second opinion on the metalwork. But thanks. Thanks for hearing the story.”

Next day, I texted him to thank him again, and said if he ever needed me to return the favour he must let me know immediately.

He texted back, “I will, of course. We doctors have to look out for each other.”

ICPH14

* This blog is part of a series that @CMAJBlogs is publishing in the run up to the International Conference on Physician Health #ICPH2014 to be hosted by the British Medical Association September 15-17 in London, UK

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