BMJ 2001; 322 doi: (Published 09 June 2001) Cite this as: BMJ 2001;322:1409
  1. Perry Board, consultant anaesthetist
  1. Crewe

    As usual I was in a hurry. Hospital corridors at lunchtime are always full of slow moving patients and relatives. Blocking my path was a young woman in a wheelchair being pushed by her mother. I managed to squeeze past and was just about to stride out again when I heard my name. Startled, I turned round to find the two women beaming at me, recognition on their faces. I racked my brains trying to remember where I knew them from. Patients recognise doctors instantly, but it's never the same the other way round. They look so different when they're better.

    Ah yes, that was it. The young woman had been on the intensive care unit recently. The person who I saw now did not match my memory of her at all. I remembered her as being dependent on a ventilator, bloated with excess fluid, and too weak to even lift her hands off the bed. Weaning her from ventilation had been a lengthy process, and at times progress had been imperceptibly slow. Now all the oedema had gone; she was smartly dressed and looked bright and happy. She still had a tracheostomy but was able to talk through a speaking valve. Her mother bubbled over enthusiastically with tales of her progress.

    They both seemed extremely grateful, yet I felt I had done very little. She was a young woman with acute porphyria and severe peripheral neuropathy. In the past two years she had spent about 10 months in intensive care. At times I had felt helpless. All we were doing was ventilating her, giving methadone for painful exacerbations, and providing nursing care. I felt embarrassed when I went to see her in intensive care because I had little to offer medically. But I made an effort. I was always impressed with how calm and upbeat she remained in such difficult circumstances. She never gave up battling and finally made it out of the unit. Afterwards, as so often happens, I lost track of her.

    Now here she was in front of me: proud and happy to be alive and grateful for the medical interventions that I had felt were so inadequate. Suddenly my urgency did not seem so great. I stayed and chatted. I heard how she was learning to walk again and had taken her first few steps. I heard how she regularly took trips out in her wheelchair, including making visits to the pub. I heard about a life that was full of meaning and quality.

    I felt uplifted for the rest of the day. Completely out of the blue I had had some positive feedback from a patient whom I had thought I hadn't treated particularly well—this was the value of a chance encounter in the corridor. My raison d'être on intensive care was restored in one fell swoop.

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