The other Tubs - Professor Niall Tubridy on dealing with terminal patients and having a famous brother
Neurologist Niall Tubridy speaks to Donal Lynch about how he deals with terminal patients, having a famous brother, and how they dealt with their parents' split
Professor Niall Tubridy knows the look all too well. After all, it only happens "every hour or so". He'll be in the middle of explaining a treatment plan to a patient when they'll begin to observe him in a slightly glazed way. And, when he's finished talking, the first question will be: "Any chance of tickets to the show?"
That's The Late Late Show. For Niall, in case you hadn't spotted the resemblance, is the brother of that other Tubs. And however much respect the former commands as a neurologist at St Vincent's Hospital in Dublin and one of the foremost national experts on multiple sclerosis (MS), it's hard in this celebrity obsessed era, not to be defined in relation to his famous sibling.
"It's mostly funny," Niall says. "It is a constant source of good stories. Initially your ego might make you want to bring it back to yourself but you get over it very quickly. I've found it can actually help. I work with that potential issue (the connection with Ryan) rather than against it.
He works with it so much in fact that he thought of calling his new book, on unusual cases he's dealt with over the course of his career, Any Chancers. In the end he settled on another title - Just One More Question: Stories From A Life In Neurology - and in the book he discusses situations which the lay person might not even guess were related to neurology, such as the chef who goes for his usual morning walk, and loses his memory for the next six hours; the painter who believes her left hand is her guardian angel; and the eager young lover whose head 'explodes' every time he orgasms.
The accounts are interlinked with descriptions of Tubridy's family life and his slow progression from the surety and blinkered focus of youth to the uncertainty and empathy of middle age.
It's a compelling account - almost certain to induce a mild hypochondria - which is fitting since Tubridy broadly describes the cases in his book as instances of people "thinking they are losing their mind". The detective work of diagnosis described in the book reveals the surprising overlap between neurology and psychiatry, something to which Tubridy says both patients and the medical community are somewhat resistant. "Psychiatry and neurology were quite far apart once upon a time, but the gap has closed," he explains. "We don't know what's wrong with around 30-40pc of patients who present around the world with neurological-type symptoms. That type of patient will either have a psychosomatic illness or a psychiatric illness, which is probably causing them anxiety and now their anxiety is worse because they think there is something physical wrong with them as well."
The stigma around mental health issues and addiction hangs over his diagnoses of these colourful symptoms. Many of his patients protest that they have not been drinking. "They push back against psychiatric diagnoses. It's also a particularly Irish thing to suspect drinking: so and so's on the sauce or whatever."
Tubridy says the psychiatric implications arise by a process of elimination in his work. "From the doctor's perspective, when there isn't somewhere to focus with a brain scan or the wires are working, then you have to look at option three: is the brain under stress to the extent that it's not working at the automatic level. When that seems to be the case you go into the psychological hinterland of, perhaps, looking at Cognitive Behavioural Therapy - people still have to live. So regardless of why they're sick you still have to help them to have a good life."
At times in the book Tubridy draws elements of social work, psychology and anthropology into his broad understanding of patients and their motivations. "This is the brain we're talking about, so the contributory facts will be legion," he explains. "Your relationship, your kids, your previous experiences; they all come into it."
Tubridy's own experience and family have clearly shaped him. He grew up in Dublin, the eldest of four children. It was a family with a galaxy of political and media connections. His father, Patrick, who died in January 2013, was a doctor and the only son of the Fianna Fail TD Sean Tubridy. Niall's grandfather on the other side of the family, Todd Andrews, was a close associate of Eamon de Valera. And among his uncles were a government minister, David Andrews, and an MEP, Niall Andrews. The comedian David McSavage is a first cousin.
When Tubridy was in his teens he went off the rails a bit, drinking and smoking and hanging out with older boys. Around this time his parents' marriage also began to fall apart. "It was very upsetting for everyone, not least because of the social embarrassment that separated families suffered in early-1980s Ireland," he admits in the book. "It was still an unusual event in those years and, while undoubtedly the best thing for all concerned in the long run, it made us feel somewhat 'other' for a few years. As a result, my siblings and I are incredibly close and have all made our own ways fairly independently since our teenage years. It is remarkable now to reflect on how my parents, like so many of their generation, married and settled down so young."
"It was not fine, it was traumatic for all involved, of course it was, he explains to me. "But strangely we all got on fairly well, at least we did afterwards. I'm not going to paint a Pollyanna picture, but it wasn't as bad as other people seem to have had it. In the greater scheme of things it was the right thing to happen."
Unusually, given the presumptions in family law at that time, he went to live with his father, while his younger siblings stayed with their mother. "I was 17, so I had a choice," Niall explains. "I was heading into medicine, so it seemed right to be near him and we didn't want him to be on his own after (the split)."
His medical training took him all over, first the country, then the world. He went to the Royal College of Surgeons in Dublin, before spending a few years in Beaumont. After that he went for six months to the Adelaide for neurology training. Stints in London, Paris and finally Australia followed, before he came home to take up his current post in St Vincent's Hospital in Dublin. During all those years he never felt tempted to marry or have children. I wonder why was that.
"I didn't really want to settle down, I met some amazing women but somehow I never crossed that last line," he explains. "It was mainly to do with me. Being single you spend more time on your own; it depends on if you call that a cost, or a perk. I spend a lot of time reading and going for walks. I'm not afraid of my own company."
His specialisation within neurology is the treatment of and research into MS but he also deals with patients who have other neurological illnesses, like Parkinson's disease and motor neurone disease (MND). I wonder how he handles having to tell some unlucky individuals that they are probably going to die?
"I think it takes a toll but not as deleterious as you might think," he explains. "You value life more, you make sure you have a bit of fun when you can, you don't take yourself too seriously. You've got one turn at the proverbial merry-go-around. If you've told someone they're going to die, it stays with you that night. If you tell four or five people in the same day it can stay for you for weeks or even years."
When he was starting out in medicine other doctors warned him off neurology because of how little could be done for patients in those years. While treatments have advanced hugely there are still some patients who can't be helped. He writes in the book of his own father, who specialised in dealing with people with alcoholism, being wary of being confronted by former patients.
Does Niall ever encounter anger towards him from those individuals who can't be helped?
"Any doctor who says they haven't dealt with that has buried their head in the sand," he responds. "You're dealing with people who are facing their own mortality and if that doesn't make you angry I don't know what will. I don't think it's always necessarily directed at the doctor so much as the situation. If they perceive you are not going to be helpful any more, as is sometimes the case, they can get angry. Of course I'd find it strange if they didn't get angry."
In the book he recounts a case of a man who has apparently fallen under the spell of a quack. When Tubridy tries to reason with him the man produces a photo with a picture of his four children, explaining that he has to try "something" for the sake of his family. Tubridy clearly has sympathy for such a viewpoint, but, given that cancer quackery has recently been made illegal in Ireland, does he think the same kinds of laws should apply to those who offer desperate neurological patients unproven therapies?
"I wouldn't stop people from accessing whatever therapies they want because in my experience when you try to do that you alienate people," he says. "If there is evidence for stem cell treatment we should have it in Ireland. We send people over to London who are unresponsive to other treatments for MS. It's a very 'end of the line' type treatment. If it was someone close to me I'd prefer it done in an organised fashion through us, rather than, say, someone having a fundraiser and going off and doing their own thing. It needs to be done here and be regulated but I wouldn't stop people."
He says that some patients are more challenging than others - middle aged men particularly seem eager to reassert their "alphaness" by going overboard with whatever advice he dishes out. "If I say go for a light walk after dinner they'll run 26 miles and then develop knee problems to go with whatever other issues they have," Tubridy smiles.
To what does he attribute the creeping mistrust of doctors, the conspiracy theories that they might be in the pockets of big pharma?
"It's a more generalised mistrust of politicians, the church and other pillars of society," he explains. "You have British politicians saying people are sick of experts - but when you have a complex problem you need an expert. People can be desperate if they're not getting better and they'll try to regain control. Sometimes I'll ask people to give me the list of advice they've gotten from friends and family and they'll say to me 'have you got a couple of hours?'"
As someone at the coal face in the health service, does he think meaningful reform will ever be possible?
"If I could answer that I'd be a politician," he responds. "Anyone can identify the problems but the real question is can we find the solutions. There are good and bad areas but most people just have one or two soundbites in terms of how they think about the health service - long waiting lists and trolleys for instance. Our team reduced waiting lists for neurology from two or three years to 12-14 weeks but once people cotton on to that they try to get into your queue and somehow the waiting lists go up again."
What does he think when he hears criticisms, such as the perennial one that consultants are overpaid?
"Well, you could hold that view but we are making life and death decisions. And you don't always leave the work at home, it's demanding. You train for a long time. It's not an easy path."
It seems so far away from the continual reinvention and 'winging it' nature of journalism, and yet, in the colourful, thoughtful descriptions in his book, you sense that there is a frustrated journalist in this Tubs, too.
Does he ever wonder what it would be like to deal with the renown of his younger sibling?
"For me, his level of fame would be too much, but he loves it," he replies. "We are similar in many ways, but not that one. He has endless time for people when they come up to him. He doesn't get irritated, and most of the time he enjoys it. For me, it would be a prison."
'Just One More Question: Stories From A Life In Neurology' is published by Penguin, priced €12.99
Prof Tubridy's most unusual cases
* Not tonight darling…
A young couple went to see Prof Tubridy, and the man told the doctor that he was getting splitting headaches after sex, which they were nevertheless having quite a lot of.
The man turned out to be suffering from coital cephalalgia, or, predictably, 'sex headache'. It can be a result of tension or, more seriously, a haemorrhage, Tubridy explains.
His patient's problem was alleviated when he stopped using a nitrate spray he'd bought which was supposed to induce sexual performance but instead gave him that age old excuse to get out of sex.
* Angel lies…
A young woman with the bohemian aura of Helena Bonham Carter arrived at Tubridy's clinic in Melbourne. She had lost contact with her family, but preferred not to talk about that. She claimed to be receiving messages through one of her hands, which was her "guardian angel". She seemed perfectly sane in every other respect. Tubridy arranged psychotherapy for this patient but she never kept the appointments and he points out her case to medical students to show the limitations of advice.
A Canadian chef living in Dublin was taken to hospital by his wife, to whom he was asking the same question over and over again: "Where am I?"
The man turned out to be suffering from Transient Global Amnesia.
"The unfortunate individual loses their short-term memory and the ability to lay down new memories for up to 24 hours," Tubridy explains. "It can be provoked by immersion in water (hot or cold) or extremes of exertion and excitement."
Luckily, the man made a full recovery.