Great Ormond Street: great expectations

Sophie Cook eloquently reviewed the three part “Great Ormond Street”
documentary, which pulled at the heartstrings of the BBC viewers.1 The
production team wanted to capture a documentary with a different feel, in
which they not only highlighted the state-of-the-art medicine, but also
showed the complex and delicate ethical dilemmas we are often faced with
at Great Ormond Street Hospital for Children NHS Trust (GOSH).

The documentaries were harrowing to some but honest and real in
tackling the most complex and challenging cases managed by passionate and
dedicated clinicians. However, despite that we cannot always perform
miracles but I think that it should be emphasised that we would not be
able to perform our jobs if all cases were like this snapshot of our
professional careers.

Cook describes one televised patient with end-stage renal failure
(ESRF) on haemodialysis after “multiple unsuccessful renal
transplantations”. In fact, she was pre-emptively transplanted before she
required dialysis when she was 2.5 years of age and had almost ten years
of renal transplant function from two transplants not necessitating
dialysis as renal replacement therapy again until she was 14 years of age.
The programme also touched on one other patient who has successfully
received a living-related renal transplantation, which thankfully is the
majority of cases with half of the kidneys transplanted today lasting at
least 15 years. As clinical lead for renal transplantation of a team
which manages 150 children with renal transplants at GOSH, I see the
excellent quality of life this can offer children without the difficulties
and cardiovascular morbidity of dialysis, although all the patients will
require some form of renal replacement therapy for the rest of their
lives.

Cook questioned if we can switch off from our day jobs and although I
admit that our job is a vocation and we do get involved with the children
and their families, we all strive for a good work-life balance: working
hard and playing hard ! Cook says that she briefly entertained the idea
of a career in paediatrics but that the documentaries made her very glad
that she opted for general practice. I hope that her words do not
discourage a future generation of paediatricians as working with children
and their families is a humbling and rewarding vocation. I have the
utmost respect for parents who cope with children in ESRF, but there is no
greater satisfaction than seeing the quality of life kidney
transplantation offers children, and although is more commonplace
nowadays, when successful, is still a miracle to the child and family in
2010.

1. Cook S. “Great Ormond Street: great expectations.” BMJ 2010; 340
(7751): 870; c1934.

Competing interests:
None declared