The best medicine Pink gin and lemonade

[Music]

so

i’d like to introduce you to john

it’s fair to say i’ve never met another

94 year old quite like him

i’m sharing his story with his

permission

in fact he pretty much ordered me to

tell as many people as possible

when john was 93 years old he was

diagnosed with

cancer at the base of his tongue

when the tumor blocked his airway

the only way he could breathe was by

having an emergency tracheostomy

a tube surgically inserted in his throat

despite his age and despite his

tracheostomy

and despite the fact that in oxford his

hometown

there are a lot of hills john used to

insist on

cycling to every single one of his

oncology appointments

once he was even knocked off his bike by

the wind on route to the hospital

and this led his oncologist to write in

his letter

afterwards that john was clearly a tough

chap

because he simply brushed himself down

and carried on again

i met john for the first time in the

hospice where i work as a palliative

care doctor

he had arrived the evening before and

the nurses told me he had had

an incredibly torrid time overnight

he had been bleeding profusely from his

tumor hemorrhaging

and no one expected him to survive the

day

so i prepared myself to see a patient

likely to be very very close to the end

of life perhaps

he wouldn’t even be conscious

in fact when i walked into his room john

was sitting

bolt upright in bed looking both very

animated

and immensely displeased he couldn’t

speak but he was gesticulating wildly

there was clearly something he was

desperate to convey to his doctor

he was given a pen and paper and i

thought to myself well

maybe he’s going to write a final

message

some very important profound

message that he wants me to convey to

his loved ones

when he handed me the piece of paper and

i’d managed to decipher his spidery

scroll

i saw that in fact what he had written

down

was the sentence where the hell is my

whiskey

okay i thought not what i was expecting

uh the hospice has a very well stocked

drinks trolley

and it turned out that the night before

john had been offered a whiskey just

before he’d started bleeding

but he wasn’t interested in what had

happened to him overnight he just wanted

to know where his drink was

later when john was able to speak he

told me

that in fact his drink of choice was

pink gin and lemonade so we

scoured the hospice to see if we could

find a bottle of pink gin

this being on the basis that strong

spirits might not be able to save life

but they can

definitely restore it

john didn’t die in fact from that moment

on he went from strength to strength

he quickly captivated all of us in the

hospice with his energy

and his enthusiasm he was just the kind

of person who obviously

loved people he learned all our names

the doctors the nurses the cleaners the

porters the health care assistants

and sometimes on our ward rounds we’d

almost be fighting to be the doctor who

got to see him that day

sometimes when i had time i’d sit down

with john

and we would talk as he sat there

savouring his pink gin and he’d talk

about his philosophy of life

he used to tell me that this could be

boiled down to two words

transmit love nothing else matters

just transmit love

i have thought of those two words of

john’s

so many times over the course of the

last year

it’s really difficult to exaggerate

just how challenging it can be to

provide any kind of humane or

compassionate presence

at a patient’s bedside in the midst of a

global pandemic

how do you transmit anything at all

except perhaps covet itself

when you yourself are barricaded behind

layers of

masks and plastic gowns and gloves

everything about ppe is completely

dehumanizing

i remember early on in the first wave

i realized to my horror one day that for

all our patients who are dying from

coronavirus in hospital

from the very moment they set foot

inside hospital doors

they were destined never to see another

human face

again no lips no cheeks

no smiles just masks and pairs of eyes

behind

visors i

quickly concluded that this

for me is the absolute greatest cruelty

of coronavirus it’s the way in which it

separates us from each other

at precisely the times when we need each

other we need human contact

the most the virus spreads through

speech and touch and these are the means

through which usually

we convey our warmth and our tenderness

to each other

and coronavirus just intrudes upon all

of that

there was one occasion in the first wave

when i had to sit down

with a father and two little girls

who had come to visit the hospital so

that they could say goodbye

to their mother who was dying of covet

and i had to explain to the

two little sisters that mummy was very

very sick

and she probably wasn’t going to look as

they expected her to

they had worn their party dresses to

look nice for mummy

and of course we had to cover up those

dresses i had to kneel down on the

ground

and i had to help them into their own

gowns

their own masks and when i watched them

setting off down the corridor with their

father

towards their mother’s room i could see

the plastic aprons trailing on the

ground behind them

because nobody makes ppe for children

and i thought to myself that’s a sight

that nobody should have to see

because it shouldn’t exist and no child

should have to endure barriers like that

covid has made them necessary and it

continues to make them necessary

and it’s why for a great many of us in

healthcare at the moment

going to work these days often feels

heartbreaking

palliative care is often the exact

opposite

of that it’s all about breaking down

barriers

and taboos and fears

when your patients have a terminal

illness and there’s no prospective cure

then every moment counts and the only

things that matter

are the really important things

so that means our job is so much

more than simply alleviating physical

symptoms

we need to find ways to bring

moments of joy and beauty and meaning

into dying patients lives sometimes

patients experience a kind of anguish

that no amount of morphine or other

drugs can alleviate

and and that’s the pang of knowing

that every single thing every person

they love in the world is slipping

through their grasp

and it’s our job to help with that

and to do so if that means breaking the

rules sometimes then so be it

i think basically in palliative medicine

being a good doctor very often requires

a little bit of creativity

so in john’s case for instance pink gin

was the best medicine we literally

transmitted

the way that we cared about him through

the medium of 37

alcohol there was another occasion

when the most important medicine came in

the form

of livestock we were caring for a

patient

who happened to be a farmer he was very

very unwell

very close to the end of life and very

low in spirits

so we sat down with his wife and asked

him what she thought we could do to try

and bring joy

into his final days she didn’t hesitate

in answering

uh in fact she said the thing that we

needed to bring

to the hospital was a creature that he

probably loved more than he loved her

it was a bull a prize-winning bull

and apparently our farmer was devoted to

it

so it may have been the case

that a number of hospital health and

safety rules

may have been broken so that we could

arrange for a tractor pulling a trailer

upon which there was a large and frankly

absolutely

terrifying animal with a ring through

its nose

through the hospital car parks all the

way into the hospice gardens

nobody ever tells you at medical school

that

sometimes being a good doctor involves

scooping up

copious quantities of cow pets

but for a smile like that on a patient’s

face

it’s definitely worth it

sometimes people when i tell them i’m a

palliative care doctor

they they find that hard to understand

and

i always think that’s a reasonable

response after all

why would a doctor someone who

is trained has spent all those laborious

years of study learning

how to do incredible things like restart

hearts when they stop or cure cancers or

transplant faces

why would they choose to surround

themselves by death

and dying what on earth is the reward in

that

and for me part of the answer is the

fact that out of all the different

groups of patients

those close to the end of life are often

particularly vulnerable so if you’re

if you have a terminal illness you’re

often too exhausted or too

ill to advocate effectively um

for yourself and and often you can be

overlooked or

even neglected in very chaotic hospital

environments

but it’s more than that for me what i

love about palliative medicine

is the fact that pretty much nothing is

out of bounds the most important thing

always is trying to find what helps your

patient

feel human i’ve noticed

that more generally in medicine

there are certain words that sometimes

can be bandied around so often so

frequently they can almost have the

meanings sucked out of them

and at the moment words like love and

kindness

and compassion are very much in vogue

so staff are often told we must be kind

to ourselves we must

think about our well-being we must try

and strive

for compassionate excellence in the way

we care for our patients

and all of this is despite the fact that

everybody knows the one thing that’s

guaranteed

to batter the compassion out of a doctor

or a nurse is conditions at work where

there’s horrendous understaffing and and

overwhelming workloads

as a palliative care doctor who has seen

enough death and dying in the last year

frankly to last a lifetime

i want to take a stand and reclaim

the word love for what it really means

in healthcare

transmitting genuine love at our

patients bedsides

showing them through our actions that we

care

is absolutely not easy or glib

or effortless or reducible to some kind

of hashtag

it just isn’t any of those things and

the pandemic could not have made that

plainer

it takes real tenacity real

courage to behave with kindness

if if you take the pandemic over the

course of the last year the nhs

collectively

absolutely has carried on transmitting

love to our patients

despite all of those barriers that covid

has

put in place but only through real

effort

of will so we have been there

with the patients when the families

haven’t been able to we have sat down

and read words that have been written by

a husband or a wife who just longs to be

there themselves in person

we’ve sat down on the ground with a

child

and helped them into her ppe

we have sat with a man dying of

covid and produced the packet of

cigarettes that he hid in his socks

before he came into hospital

because the one thing he wants to do

before he dies

is taste a final illicit taste

of tobacco and

doing all of those things takes real

guts

it would be far far easier not to go the

extra mile just to keep your head down

to hope that you can surrender to how

exhausted you are

and maybe just leave the hospital as

quickly as possible

but the nhs hasn’t done it nhs staff

have carried on going the extra mile

i think that for me

this is absolutely the greatest

challenge in medicine

it’s how do you operate in conditions

that

are chaotic exhausting grueling

overwhelming

and yet still find a way to behave

lovingly

to return to john for a moment

john didn’t die in the hospice in fact

he was discharged and

he went to live in a local nursing home

and he stayed there

for another six months still drinking

pink gin

still holding court and i have

absolutely no doubt still keeping the

staff on their toes there just like he

did with us

i think that john identified something

absolutely fundamental about the heart

of good medicine

he recognized that for all patients

from their first day to their last day

it’s

human connection that’s the really vital

medicine if you are scared or vulnerable

or in pain

a patient in other words then it’s other

people who make the difference

and that for me is the essence

of what love really means in medicine it

is going the extra mile

so i’d like to ask you

how you propose to transmit love

in medicine might you consider breaking

the rules

if the circumstances require it might

you

be willing to think creatively maybe

outlandishly

about what could bring joy to your

patients

it might be a matter of i don’t know

bringing a stereo into a patient’s room

or maybe

smuggling in their pet or perhaps

wheeling

a hospital bed outside into the hospital

gardens so that a patient can feel

sunshine on their cheek or taste

snowflakes on their tongue

or maybe it’s simply

a matter of doing this pouring out

a pink gin

and lemonade

i think there is something exceptionally

beautiful

about a 94 year old man no longer with

us

still transmitting a living legacy

from beyond his grave

and i’d like to end with a toast

here’s to nhs love real

tenacious nhs love

and here’s to you john carbrey