Thursday 27 June 2019

Dublin doctor giving voice to the realities of life and death

Memoir: Seven Signs of Life

Aoife Abbey

Vintage, €13.99

Aoife Abbey had written an anonymous blog about life as an NHS doctor before embarking on her debut in Seven Signs of Life
Aoife Abbey had written an anonymous blog about life as an NHS doctor before embarking on her debut in Seven Signs of Life
Seven Signs of Life

Hilary A White

The Secret Doctor is a blog launched by the British Medical Association in 2016 in order to shine a light on the realities of working in the profession. The purpose was not to spy on practitioners or blow whistles but to get a conversation going about things that matter to those at the coalface. Charged with the task was Aoife Abbey, a bookish Dubliner who had been working in the NHS after graduating from biological sciences in Edinburgh and then Warwick University Medical School. Anonymously but with a perceptive knack for finding the nub of a theme, Abbey covered everything from negotiating a patient's tricky relatives to the blurring of lines in doctor-patient interaction.

The quality of her writing wasn't lost on Penguin, who approached her to put her voice into something longform. It is important to mention peripheral players such as the BMA and Abbey's publishers so that, should the need ever arise, they can be thanked for their role in midwifing this effortlessly absorbing and illuminating memoir.

As debate rages on in this country about the cost of building a children's hospital as well as a nurses' strike that (at the time of writing) doesn't show any signs of making a breakthrough, Seven Signs of Life offers a prismatic set of arguments for a truth that we too often forget: doctors, nurses and consultants are human too. This fact does not belittle their job and the demands it incurs - it makes it even more remarkable.

For those working in it, intensive care, Abbey's typical area of expertise, is just that. Fear, grief, joy, distraction, anger, disgust and hope are the spectrum of sensations that, while common enough to all of us, can be felt by a medical professional in the space of an hour or two.

Each gets a chapter in which Abbey ruminates through past experiences, threading together something gently intricate that manages to relate specialist medical detail in the arena of a perspective that feels like new territory. Medical dramas, your Grey's Anatomys, Casualties and whatnot, have traded on depicting personal lives in the trenches of life-saving. They haven't scratched the surface, it turns out.

All the years of study and all the oaths taken; the doctor lives and breathes by the mantra that they are there to be what their patient needs them to be, and only after that to be what the patient's loved ones need them to be.

But in the white heat of an emergency or an unreasonable family member, amid exhaustion and irritability, revulsion and cold fear, a constant tempering is systematically taking place that allows for clear thought and doing right by the patient. Measured out in Abbey's crystalline, personable voice, it occurs to you that this is a somewhat Herculean feat.

It attests to a level of self-examination we are not used to considering from those whom we only deal with a handful of times in our lives, if we are lucky. The internal rift when being called a murderer by angry relations, or having to stifle your rage when treating a child that has been injured by an abusive parent. The gingerly directness needed when handing difficult prognoses to patients and relatives, and the self-flagellation when a colleague highlights something you've missed, a detail on an X-ray or a dosage measurement.

In essence, the straight-faced facade we associate with doctors is what makes them so important but it is not something we should ever take for granted, even as ministers, quantity surveyors and administrators botch things up. Hope, the theme of Abbey's closing chapter here, hovers quietly, even if it is "dangerous" for a doctor to expose themselves to anything equating to emotional investment and, inevitably, grief.

"When you stand beside your relative," this brave writer shares, "with your hand resting on theirs and tell yourself, 'I hope they pull through - I know they'll pull through', I hope that too. Often, I am simply hoping that in another room."

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