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