Survivor blog: Helpful Conversations

Helpful Conversations

Somewhere in an Intensive Care Unit in Yorkshire, September 2002:

‘Hello, Mr Sheridan, I'm Dr Ross^(a)  How are you feeling?’

‘I feel like I've been run over by a lorry.’ 

I had.

Dr Ross sits down beside my bed in the Intensive Care Unit.

‘Yes, you certainly have had a very nasty accident. What would you like me to call you?’

‘Just call me Phil or Philip.’

Everything hurts, even my eyes hurt. I can't even begin to describe just how much I hurt. I can hear bleeping machines around me.

‘I'm sorry to hear that Philip. It's good you're awake and talking. You've been through a lot. We've got in touch with your mum and dad and your work colleagues, they know what has happened to you and where you are.’

‘Thank you.’

‘Can you remember what happened to you Philip?’

‘I hit a lorry. Not good... not good.’

‘That's right, you had a collision with a lorry. What else do you remember?’

‘I remember laying on the road for a long time, the Police came, then the ambulance... I thought I was dying... but I'm not... you saved my leg?’

‘What do you do for a job?’

‘I'm a therapist and manager in a special unit for abused children.’

‘Sounds like an interesting job, but not an easy one.’

‘Yes, it's interesting, it can be very tough.’

‘What do you like to do when you have time off?’

‘I like to get outdoors, go for a run or walk on the moors. I play five-a-side football,  and like to go out with friends on a weekend to bars and clubs in Leeds.’

‘So you're fit and active then... Leeds, is that where you live?’

‘No, I live in a town called Ilkley, it's a lovely place.’

‘Ah yes, I've been there, it is in a beautiful location beside the river. That explains the moors, you like to run or walk on Ilkley moor?’

‘Yes, that's right.’

‘You're single at the moment?’

‘Yes... My work takes up a lot of time. All shift work and over-nights. Can be really stressful... Not good for relationships.’

‘Sounds like working in A and E.’

‘Can I have some water please, I'm so thirsty?’

‘Just a little, your nurse explained why we need to monitor your water for a while after such a long time in surgery.’

‘Yes.’

He holds a small paper cup with a straw to my lips to let me take a sip of water.

‘How old are you Philip?’

‘I'm 39... I think, yes. 40 in November.’

‘We're not that far a part, I'm 38, I like to get outdoors too.  And you mentioned your leg. Can I tell you what we found in surgery. Would that be OK?’

‘Yes, that's OK, I know I've broken my leg really badly, what else?’

‘Yes, that's right you do have a broken leg and some other things I need to talk about too. The good news is most of it will get better with time and physiotherapy.  Shall I tell you what we found?’

‘Yes, start with the good news.’

‘Well, you've got fractures and dislocations, you know what I mean by those terms?’

‘Yes.’

‘Yes, you've broken and dislocated bones and joints in your hand and wrist, and in your right shoulder. All should get better with a bit of work and physiotherapy. You also took a very nasty knock to your head, but we haven't found any fractures to your skull. Your neck, spine and pelvis have all remarkably escaped any serious damage from what we can see. We'll recommend that you be monitored for a while just to make sure you're OK with that head of yours. The reason you hurt so much is you have very serious bruising all over your body. We'll do our best to keep you comfortable. Like you said, you have some really very serious fractures to your right leg, above your knee and below your knee. We have had to put a plate onto your right thigh bone, or femur, but it should heal OK but it may take a while, you have a very complicated break there. Below the knee is not so good I'm afraid. Are you OK so far?’

‘Yes, go on.’

‘You said you would prefer us to save your leg, do you remember saying that when you came into the accident room?’

‘Yes, I remember.’

‘Well, it's really not good Phil... We've saved your leg but as you can see, we have had to use an external clamp to hold everything together, see?’

I could see a large tubular clamp encasing the whole of my lower leg right with just my toes peeking out, looking black and blue.

‘I'll be honest with you Phil. There's really not very much left that we think can be saved. There's no bone left to speak of and the soft tissue damage to your muscles, blood vessels and nerves is about as bad as it can get. I'm very sorry... You could go on for several years trying to save your leg Phil, but in the meantime you'll likely not be able to walk and probably be in severe pain too...’

With tears welling in my painful eyes I think I know where we're going and it feels OK. This guy is trying to explain something that for most people is unimaginable.

‘...You're an active guy like me Phil, you like to get outdoors, play sport, and like to get out with your friends, yes?’

‘Yes.’

‘I'm not saying make a decision now but with today's prosthetic legs and feet I'd recommend you seriously think about it. I think you'd get better quicker and have a far better quality of life with a prosthetic leg than if you try to to hang on to that leg of yours. I'm really sorry to say this. What do you think... How does that feel?’

‘I feel OK... I hear what you're saying... You think I'd be better off having my leg amputated... below the knee?’

‘Yes, that's what we think Phil. We're looking to transfer you to St James's Hospital in Leeds as they have far better facilities than we do here. Your nurse will accompany you in the ambulance. It's a conversation you can pick up with the consultant when you get there, how does that sound?’

‘Sounds OK.’

‘OK Phil, I have to go soon. Do you have any questions you want to ask me before I go.’

‘No... thank you for talking with me.’

He placed his hand gently on my right arm.

‘That's fine Phil. You're going to be OK. You've survived a very nasty accident and that's great, but it's going to take a little while before you feel better. I wish you good luck Phil. I have to go now, good bye.’

The whole conversation took no more than 10 minutes. Then Dr Ross walked away never to be seen again. Yet, in that short space of time he had connected and engaged with me as an individual human being.

In my previous blog I described the importance of health care professionals having the skills to explore the hopes, ideas, concerns and expectations the patient has about the kind of quality of life they wish for themselves. To enable the realisation of their aspirations while balanced with the reality of their individual health needs.

Atul Gawande explores the very same idea through the personal journey of his father and other patient stories in Being Mortal. He suggests that for healthcare to truly be patient-centred and compassionate requires an approach from health care professionals that asks the patient some fundamental questions about what is important to the patient. Although focused on end of life care Atul stresses in the epilogue that these questions can be asked at any point in a life journey – ‘...all along the way’ – as he says.

My conversation with Dr Ross proved the first of many such conversations that I had with health care professionals on my patient journey. One I continue to this day. They have proved the most important conversations I have had. Not easy ones by any stretch of the imagination but the most essential and helpful conversations to have.

These quality of life questions have become a part of my role teaching communication skills to student doctors. These quality of life questions have become a part of my role when talking with clinical leaders about the future of healthcare services.

Perhaps most importantly, these quality of life questions have become a part of my everyday life and conversation in my relationships with my partner, family and friends, and with myself when things get tough, as they can sometimes, when living after trauma.

1. Names of health care professionals anonymised for this article.

1. Gawande A. Being mortal: Illness, Medicine and What Matters in the End. Profile Books, London; 2014.

Philip Sheridan

Poet, tutor in medical education, writer, workshop facilitator, and fly fishing guide.

Patron to VX Global - a new dynamic and inclusive sport with an aim on the Olympics.

Website: www.philip-sheridan.com

Website: www.yorkshireflyfishing.com

Twitter: @madeofbeauty

LinkedIn: www.linkedin.com/in/philipsheridan888

Published 21st March 2016

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