Anyone for fizz and chips?
From a grieving father, a howl of rage at the dangerous conditions new medics endure to help save the lives of so many
ONCE reserved for the finest occasions, it’s now recommended that champagne be served at a barbecue, or even with fish and chips. At least, that’s what one major champagne house claims. Try a dry pink champagne, such as LaurentPerrier Cuvée Rosé (£69.95, champagne direct.co.uk) with lamb? Or La Cuvee Grand Cru with a burger? Even fish and chips can be lifted with a little Grand Siècle fizz.
FrIdaY night and I sat down for a meal with my wife and our daughter, Lauren, 23, who lived with us. We ate early, at 6pm, because Lauren, a newly qualified doctor, was about to set off for her first night shift at Inverclyde royal Hospital near Glasgow.
She was her usual cheerful self, gently winding up her mum and joking with us, but I could see that underneath it all, she was nervous about the unfamiliar night ahead of her.
about an hour later she set off, full of anticipation. We never saw her again.
When Lauren started working at the hospital, she’d agreed she would always call when she was about to start her journey home. These calls let us know when to expect her back. That Saturday she rang at 8.30am to say she’d had a good night and was about to leave work.
It’s a 45-minute drive home, so when she still hadn’t appeared by 10am, we started to worry. We called once, then again and again, but every time her phone rang out. We thought maybe she was taking a nap in her car, or had chosen to sleep at the hospital, so we decided we would drive there and pick her up.
We set off down the m8 and, 18 miles from home, something on the other side of the barrier caught my eye. Police activity around a blue car. Lauren had a blue car. I had a horrible thought. my wife and I didn’t say anything. I pulled off the motorway, turned around, and began to head back in the other direction.
The police had blocked the carriageway but I went up to the nearest officer and explained who I was. Somehow I remained calm, even though I had a sinking feeling in my stomach. I asked whether the car was a blue Corsa and gave him the registration number. The officer said he ‘couldn’t tell me anything’, but he then walked a short distance away and spoke into his walkie-talkie. I was frantic. I knew deep down that Lauren was the person in that car.
We were asked to wait, and for an hour we stood there, numb. I can’t remember what we did during those interminable minutes: everything was a blur. Eventually, the traffic police appeared: they had gone to our empty house to break the news to us. I don’t recall the officer’s words exactly, but he said Lauren had died at the scene.
Later, based on witness statements, road conditions and the fact that no other car was involved, police told us they believed she had fallen asleep at the wheel.
Arandom tragedy? no, I believe it’s more than that. Her death was avoidable. She was the victim of a system that’s putting thousands of lives at risk — and not just those of doctors, but their patients, too.
Because in the weeks leading up to her accident, Lauren had at one point worked ten consecutive days totalling 91-and-a-half hours, and for another stretch of 12 consecutive days totalling 107-and-a-half hours. one junior doctor colleague later said: ‘If she had gone into law, architecture or accountancy — anything but medicine — she would still be alive today.’
This month, hospitals will have welcomed the latest intake of junior doctors. Young people like Lauren who, after years of study, will find themselves under pressure to perform in some of the most stressful situations imaginable. and while there have been some changes to regulations since Lauren’s death in September 2011, these doctors are still working dangerously long hours, with serious implications for their safety — and the safety of us, their patients.
only another parent who has lost a child could understand the physical pain of the heartache, the visceral emptiness, and the incomprehension that follows the knowledge that you will never see your child again.
all the certainties of life exploded into a million pieces of chaos that day when we returned home without Lauren. I tried to rationalise it — and failed.
Lauren’s funeral was held the day after what would have been her 24th birthday. Though it was all a blur, I was aware of a church full of family, colleagues and friends. all devastated because everyone loved Lauren.
She was such a happy child. She always liked people and had a wonderful smile and, as she got older, a raucous and infectious laugh.
after doing well at school, she decided to aim for medicine. To her mother and me this felt ambitious: Lauren had always been a hard worker, but she didn’t stand out academically. However, she got a conditional offer from Glasgow University to read medicine and got the grades with ease. I remember her calling to tell me. The joy in her voice was irresistible. I was so proud.
Lauren and her mother went to buy books and a stethoscope. We agreed she would live at home, since her university was close to us in East Kilbride. over the six years of her training, Lauren
worked hard, all the time. It was a demanding course and she was often locked in her bedroom, or the library.
In February 2011, Lauren qualified as a doctor. She knew making a success of it would be tough, but she was ready for anything. She danced with delight.
Her first job started that august, in the orthopaedics department of the Inverclyde royal. although we all knew long hours went with the territory, when her rota came, we were surprised to see she was timetabled to work more than 90 hours over ten consecutive days.
and that was just the start of it. It soon became apparent Lauren was working even longer than the 12-hour shifts in her timetable. She stayed longer to attend to patients who weren’t well and ‘finish things off’ — routine tasks such as taking blood and chasing up results — because if she didn’t, she told us, the patient wouldn’t be able to have their operation the next day.
almost immediately, we noticed how tired she was. Lauren would come home, have dinner, and go to bed. all she did was work, eat and sleep — and sometimes not even that. Her mother would make her a packed lunch, which went unopened. She had no time to eat.
on one occasion, Lauren was scheduled to work a 12-hour shift. We normally expected her home around 10pm, but at 11 we received a phone call: 13 hours after she clocked on, she had just finished. ‘Can you come and pick me up?’ she asked. ‘I’m too tired to drive.’
a few weeks in, we sat her down. ‘This cannot go on,’ we said. ‘You are going to burn out.’
LaUrEninsisted everything was fine. ‘If I don’t finish all the work, someone from the next shift will have to do it,’ she said. It was the same for all her medic friends, although some lived closer to the hospitals they worked at, meaning their commutes were shorter.
doctors are not super-human. We demand heroic efforts from them, and think they are immune to sleep deprivation. We’re not and neither are they.
It took a few months before I was able to ask: why had Lauren died? The Procurator Fiscal (public prosecutor) had decided there would be no ‘fatal accident’ inquiry into Lauren’s death as she ‘had made the decision to drive’.
So I started to read about junior doctors’ hours and the effect it has on them. It was then I found the guidance for new doctors in Lauren’s medical careers handbook. ‘Be prepared to be exhausted for your first month working,’ it said. ‘You will work, eat (little) and sleep. Be prepared for dehydration and hunger. You will often feel
mistreated, unjustly accused, everyone’s dogsbody.’ But there was a cheerful ending. ‘Don’t worry, this is only for one year!’ Lauren never made it to the end of that year. Seeing those words I swore in fury.
Here was the NHS acknowledging junior doctors will become exhausted by their work. This was not advice but a warning from the very people who should be safeguarding these young people.
Because everybody knows young medics are subject to these untenable pressures.
Annual surveys of more than 50,000 junior doctors in England since 2012 show that more than half worked beyond their rostered hours, and almost a quarter were sleep- deprived when at work. Why should it be ok for young doctors to work ten and 12 days in a row, regularly in excess of 100 hours, without as much as a weekend or even a day off? How can the so- called ‘caring profession’ let this happen to its most inexperienced members?
In 2000, junior doctors’ working hours came within the scope of the 1998 Working Time Directive, which initially limited them to 56 hours a week, and then to 48 hours a week from 2009.
The problem is health boards can average out the hours over 26 weeks and balance multiple periods of long working hours by shorter periods. But it is during these peaks of activity that sleep deprivation accumulates and fatigued doctors are most at risk from accidents. Even worse, their time sheets are open to manipulation. Junior doctors have long reported pressure being applied to them to get the ‘right’ result. Many are routinely working beyond their timetabled hours — with tragic consequences.
Lauren’s accident was not an isolated incident. In August 2016 Dr Ronak Patel, 33, a trainee anaesthetist from Suffolk died after his car hit a lorry. He was also on his way home from a night shift. According to his wife, Helen, ‘we had been singing [on a hands- free phone] to keep him awake’. A police investigator confirmed the most likely explanation — that he fell asleep at the wheel.
These cases are obviously tragic events for the families. But it is a national scandal that is relevant to anyone who has occasion to see a hospital doctor. We want to be treated by well-rested doctors, not by the victims of a system which tires them out.
A survey from Manchester University last year showed that doctors with burnout are twice as likely to make mistakes, such as incorrect diagnoses or wrong prescriptions. Preventable harmful errors occur in one in 20 patients according to a recent report. Do you really want a doctor who’s had insufficient sleep taking a scalpel to you? Prescribing you drugs? Making life or death decisions? My objectives are to see proper implementation of the Working Time Directive, so doctors aren’t on shifts for more than 48 hours in any five - day period, and that working periods are followed by two days off. I also want to see their actual hours recorded, rather than a timetable which is never adhered to. I have spent the time since Lauren’s accident campaigning for these changes and have had some successes in Scotland. The Scottish government has reduced consecutive night shifts from seven to four, and no junior doctor now works more than seven days in a row. This month, new rules came into force that will guarantee trainee medics a minimum rest period of 46 hours following a string of night shifts.
The Scottish government has committed to work towards the goal of a 48-hour maximum week, and an expert working group will report in December on how to achieve this. Will the rest of the Uk follow suit or will junior doctors there continue to suffer from burnout and fatigue?
Eight years have now passed since my daughter’s death. Every day presents the challenge of adapting to our lives without her, but this is impossible. I am no longer angry, just determined to see my campaign through to a successful conclusion.
No junior doctor should be too tired to function at work or drive home. We must not reward their commitment and dedication with exhaustion. We must take better care of the young people who work so hard to take care of us.
I don’t want what happened to Lauren to happen to one more junior doctor. or for one other family to go though what we have been through.