Our Nuha

 https://www.c-span.org/video/?181127-1/baghdad-diaries-womans-chronicle-war-exile&fbclid=IwAR12p6uuxWRCx_M78PgbUUZkigzIQSK9GW7KCNxlW9bTqWgH9YfYCK-OLM4

Shared by her sister in law and copied here 

How long ago this was 17 years already 

There is something so very different about a video a recording of the voice the intonation the send of humour even in the darkness 

Ah Nuha..... rest in peace 

All medical advances since Spanish flu pandemic wiped out by COVID-19

There is an eerie silence about the world.

I love the clear sound of birdsong without the noisy cars and planes

But hate the distancing we all have to practice

I have for the past five weeks been repeatedly reminded of a different time, a different place
Of the 1980s war the silence after the sirens went off as we waited for the sounds of the fighter planes overhead

Of the months spent at home when university was closed during a particularly hideous battle and all male students where drafted in and taken to training camps

Of Dhuha my very first patient with acute leukaemia, trying my best to treat her during a war, under-treating because to give full dose would render her so ill and we didn't have what we needed to support her through, two months of directed transfusions from staff and family fresh blood when platelets were not available, taking her into the office in "isolation" every day when the hospital became full of visitors to protect her from catching an infection

I am on the face of it coping better than my peers I feel that I have been through this before and know that somehow we will find the inner strength to overcome

Other younger colleagues are in a state of shock at how quickly the world has changes
At how fragile our existence and all we take for granted really is

It will take many months to recover I say to them....
It is going to get a lot worse, before it gets better.....
It is best that we stay in the hospital for a week at a time and alternate rather than all be here at the same time....

We have like every other hospital lost around half of our staff through prior ill health meaning people are at risk of working, through illness, or the illness of someone in their family.

We have discovered the joys of zoom meetings (and got to see other people in their kitchens and what art people have on their walls)

We have brought in a temporary mortuary, ours has even been in the news after the team from podiatry were redeployed and had the duty of moving 40 patients into the new premises after a particularly bad weekend and published details online

We have wards that you can only enter after you have donned goggles, mask, full gown and gloves, and where everyone looks the same and it is difficult to speak, or be heard

We have five times as many ITU beds as we used to, with ventilators in surgical wards, in cardiac wards and in theatres

We have at last count 200+ COVID patients, nearly 60 in ITU

We have daily meetings where a team go through the list of thirty or so admissions from the day before and assign for or not for ventilation decisions based on risk factors (age over 65, diabetes, high blood pressure, prior lung disease, smoking, obesity) if you end up being ventilated and you have these risk factors there is a 70% chance you will never wake up, and when ventilators are scarce and patients stay on them for weeks a decision is made on admission that ITU will not be called even if you deteriorate

We have rows of patients all with the same disease, pale, hot sweaty with purple lips gasping for air in bays of six beds separated now from the corridors and nurses' areas by rapidly constructed temporary walls of plywood and plastic windows

We have patients ventilated on their stomachs losing blood from somewhere who cannot be investigated

We have patients going into cardiac arrest on the ward and a five to ten minute wait for the team to don the PPE before they can attend

But what we do not have is people with heart attacks, people with strokes, people with a whole long list of other conditions, they are staying away from hospital for fear of being a burden and for fear of becoming infected

What we don't have is the ability to treat patients with appropriate treatments

Patients with heart attacks no longer have emergency angioplasty, instead they are having bedside thrombolysis, something I remember doing in the 1980s

Patients with cancer have their treatment stopped or not started if their life expectancy is less than one year, they have their treatment delayed if their life expectancy is five years

The only cancers being treated are those with >50% chance of cure, and even then they are being treated with reduced doses, less frequent courses and with everyone wondering if they will survive until their next course or if they will succumb to pneumonia, there is of course no ventilation for cancer patients

And if they get admitted for any other reason they die of COVID in hospital possibly from someone else or from one of us untested doctors or nurses who might have a very mild or symptom free disease

This also will pass

After nearly thirty years
Wars
Separation
Exile
Struggle
Loss
Exhaustion
Elation
And two amazing gifts

We are entangled despite the silence you maintain
Linked despite the barriers you put up

Your second fall into this darkness
Memories of all of mine

You cannot work
So I work for both of us
You cannot plan
So I plan for both of us
You cannot talk
So I talk for both of us
You cannot cry
So I cry for both of us
You cannot hug
So I hug for both of us

This also will pass

Fractions of a minute

My patients are sick and the funds scarce
My twins sit ten GCSE's each
My mother waiting for cardiac surgery cannot walk and talk at the same time
My father waiting for cardiac investigations cannot remember when his last bout of pain was
My husband facing disciplinary proceedings and dismissal, delayed so far by an eighteen month legal battle that has cost us and our extended family £180,000, third court appearance due in two weeks, defeat will mean certain repossession of the family home.

For the majority of my waking moments my face is tense, my mind spinning and chest tight

But regardless of how few hours ago I eventually drifted into a nightmare filled mentally spent sleep

There are a few seconds of every morning
Sandwiched between the second my eyes open, and the second my brain logs on to the mountains I need to climb
When I have an empty clear head

For those calm fractions of a minute every day I am grateful

Dementia

Average survival predicted ten years and you have early stage....that was four years ago

My sixteen year old daughter summed it up nicely

The great thing about Jido is every time we see him it is like groundhog day, he asks exactly the same questions, and you get the chance to answer them ever so slightly differently until you find the answer that makes him happiest

Belated knowledge

Not my usual day I must be honest

I received the email last week, and couldn't really argue; it was true the patient was a lot closer to us than to he hospital that had been advising on her blood results recently, yes of course we could take over, this was expected to be a short-term situation until the patient could be moved closer home.

The patient was non-resident, she had arrived by plane, taken a train to central London and then presented to accident and emergency and had been in one hospital or another for the past four week.

I had planned on seeing her on the ward round, yesterday frantic emails about deterioration etc made things more pressing and so this afternoon with my trustee trainees we went on a visit.

Just across the road from our "home" hospital, across the car park and into the two storey building.

I guess I should have picked up the cues but just thought it odd that we had to be buzzed in, not only the main entrance but at every step of the way, through reception one door closing before the other opened, up one flight of stairs to another locked door and then we had arrived.
Corridors with a faint urinal smell, a hush broken by the young woman in pink leisure suit with headphones cursing loudly

After an initial stutter we explained who we were and who we had come to see, a nurse said she would find her for us

A tall skinny woman a few months my senior, dressed in a loose top and tight skirt, her long hair tied into a loose bun falling slightly off centre came walking down towards us.
Introductions followed a detailed history in the corridor, the history was longer than I had appreciated, I expect she had had several years of treatment interrupted probably several times, she told me she had started but not completed medical school, and clearly had the vocabulary, mostly she seemed coherent, with the exception of some almost obsessive repetition of what she felt had caused her leukaemia; namely the food and pollution, well a fair number of people do believe that, so far so regular, she understood about targeted therapy, and transfusion triggers, but was cagy when asked about where she had been staying in London, and who was back home.

Can I examine you? I ask, of course she responds and we traipse back down the corridor to her room, she unlocks the door and invites us in, my trainee stands at the door, I am not sure that is necessary but she insists
I examine her lungs which are clear, her legs swollen and tense, her spleen about 7cm below her rib edge.

We continue talking, and she is now repeating herself, we are talking about minerals and fluids, and diet and snippets of history it is becoming a little less regular as she describes the ambulance personal as white faced with hair that changed on route, and empty eye sockets.

She reaches out to my arm and declares You are human, you know not everyone here is.
I extract myself and bump into a nurse passing by, are you alright she asks? I think so I respond, but your patient is talking about feeling suicidal if she is kept locked up.

The nurse escorts us back to reception and after closing the door asks, do you have self defence training? No? did you have an escort? No? do have alarms on you? No?. This is becoming stranger by the minute.

Apparently our patient with leukaemia has a history of physical violence against staff and is approached with care.....we must ask for an escort in future....and never enter the room alone!

Weekly ward rounds are suddenly so much more interesting

Downhill 30 years a doctor

Well in the summer of 2018 it will be 30 years since I graduated.

Strange how entire weeks and months of our lives merge into sludge, but certain minutes or hours are seared into memory. I remember the day still, walking to the university in light purple sandals, and a dusky pink skirt. The mass of people in the deanery trying to find names on the paper lists pinned to the dusty cloth behind the glass screen. Someone congratulating me before I had reached close enough to see, then another and finally seeing for myself, my name at the very top of the list of graduates for the year.

I was walking on a cloud, and didn't really want to go home as I basked in the warmth of the sun and of my success.

Many miles away in a war-torn city my father was distributing fruit squash and sweets.

That evening my mother took me out to a smart part of town and I remember thinking I have done it I have won.

I am clearing out the loft conversion into which we moved, when my sick mother came to stay just before her surgery, and this week I have at last discarded the graduation photo, it was creased and in one corner torn, but the final decision to discard it was made easier as I looked through the faces trying to remember more than a handful of names.....

As we go through the third round of "should I go or should I stay" as both my husband's and my hospitals are both being reshaped by the financially more secure / militarily supported establishment that took them over, and the original team are pushed ever so not gently out of the way, I start to update my CV, thirty years a doctor, fifteen of which I have spent here, and what do I have to show for it? very little it would seem. Fifteen years of gradual decline, gradual loss of specialism and with that expert staff, and a shift from numerous conditions treated, several trials open, and shared care that means we provided some of it in house, to a second rate general dumping lot for conditions other aren't interested in, a median patient age of 75, and I find myself trying to figure out how to publish experience that isn't even really my speciality it is so generic.

I guess the only consolation is that with a cohort of over 400 graduates distributes over every continent in the world, there are never any reunions.