Saving lives and losing faith: confessions of a junior doctor

Four generations of her family have worked as doctors – but Rachel Clarke is the first to have lost faith in the British medical system. Here, she argues that the NHS is losing the team spirit that once held it together

I’m running alone down a long, empty corridor, trainers squeaking on hospital linoleum, stethoscope clenched in my fist. It’s a crash call. We’re told never to run to these – junior doctors who are themselves gasping for air don’t exactly inspire confidence. But someone in the distance might be dying. Strolling to their bedside doesn’t feel like an option. So I’m panting and cursing that the cardiology ward is located so far away from the rest of the hospital. It’s 4am and I haven’t done this many times before. Slamming through the swing doors, I head towards the flimsy NHS curtains, drawn shut like a veil on a patient, from where the hubbub of voices is panicky and too loud. I steady myself, then draw back the curtain. Three or four nurses surround a young man whose face is so stricken with fear that he stops me dead in my tracks. His eyes, glazed with panic, briefly meet mine. To my relief, the rest of the crash team arrives and together we set about trying to save his life. Despite the expertise of the ITU consultant, the electric shocks, the chest compressions so brutal we hear the crunch of breaking ribs, nothing we do is enough. After an hour of futile CPR – losing a teenager is desperate – we trudge, shoulders bowed, back down the corridor, and disperse our separate ways into the night. His dying face will haunt me for some time.

Some things never change. When they were junior doctors before me, my father, grandfather and great-grandfather also fought their hardest to restart the hearts of patients who’d arrested. Between us, we’ve been doctoring for over a century. Same patients, same diseases, same distress at the bad deaths – yet to my grandad, today’s NHS would be unrecognisable. In his day, junior doctors didn’t go on strike, defibrillators didn’t exist, and work-life balance hadn’t been invented. Nor, even, had the NHS. As a young doctor, Gramps lived and breathed his 1930s private hospital, barely setting foot outside its grounds. Although he was almost permanently on call, a butler would bring meals on a tray to his on-call room, and wake him up in the mornings with a cup of Earl Grey. His doctors’ mess was a grand affair, modelled on a military officers’ mess, complete with its own private bar and waiters.

Even my dad, an NHS junior doctor in the 1960s, had his 120-hour weeks on call sweetened by free hospital

accommodation and meals in his mess. Both he and Gramps would be aghast at modern medical squalor. Dinner is often crisps and a Coke from a vending machine. I’ve known doctors’ messes where rats inspect the doctors through cracks in the ceiling, and cockroaches hide behind the walls. The Government has long since done away with free accommodation, which may be why, periodically, stories break in the press about young doctors falling asleep at the wheel, killing themselves after long nights on call.

You don’t need to be House M.D. to diagnose something gravely amiss with today’s NHS. Every major target is being missed, patients are dying on trolleys in corridors, and the mood among staff sometimes feels near mutinous. Funding restrictions are invariably blamed for this – and from my front-line perspective, rightly so. But seen through four generations of my family, there is more going wrong than finances alone.

In Dad’s day, hospitals were populated with tight-knit teams of staff. “I worked the long hours, far more than you do,” he told me, “but the difference is, we were all in it together. The doctors, the nurses, everyone mucked in together. We were pressured, but everyone supported everyone else.” Dad occupied the lowest rung of his traditional medical “firm” – a small team comprising one consultant, one registrar, an SHO and himself, the lowly house officer. Back then, in the Swinging Sixties, when the junior doctors ended their night shifts in Barts hospital in London, they would pile into the White Hart, the pub round the corner, to join the butchers streaming in from nearby Smithfield’s meat market. Blood, beer, sweat, sawdust – “and a fry-up afterwards if you wanted it”, Dad told me. His recollections remind me of a soldier’s, upon return from a deployment overseas. The job could be brutal, ugly, overwhelming – but your comrades-in-arms got you through.

These days, that ethos is at risk. Junior doctors feel increasingly like shift workers. A clock-in, clock-out mentality is creeping into hospitals as we are rostered to random runs of twilights, days, weekends and nights. In a pressured, unforgiving hospital environment in which no one really knows you, and you don’t know them, it’s easy for young doctors to feel cut adrift. “Where are your teams?” Dad asks. “You all seem as though you’re just going from one crisis to another.” He’s right.

“The medical student in me felt shame at the way my grandfather was treated. The granddaughter burned with anger”

The concept of medicine as a decade-long apprenticeship in which seniors gladly trained up the juniors on their firm is at risk of becoming a historical artefact, made obsolete by a top-down culture of NHS “targets”. The dedication and selflessness that once glued the NHS together is at risk, I fear, of evaporating.

Never was this more apparent than during my grandfather’s final visit to hospital, the one which, arguably, killed him. In his 90s, admitted for an irregular heartbeat, he spent the night increasingly desperate to pass urine. He buzzed for a nurse multiple times, but no one came. Frail and well aware of his high risk of falling, he faced a stark choice: endure a humiliating night on soiled sheets, or risk the short but precarious walk to the bathroom. He chose jeopardy above indignity. The next morning, my father and I arrived to find Gramps groggy and bruised, his neck trussed up in a surgical collar. He’d been found, collapsed, on the floor beside his bed. His neck was broken, and two days later he died. The medical student in me felt shame at his treatment at NHS hands – the granddaughter burned with anger.

Perhaps the staff that night were simply too overstretched to answer their patients’ call bells. Perhaps, like staff at the infamous Mid Staffs hospital, where a culture of indifference infected the wards, they had become inured to their patients’ indignities. Mercifully, these attitudes remain rare. In spite of a top-down, tick-box culture and the constant drive to shave budgets, today’s front-line staff are still, overwhelmingly, only too willing to go the extra mile for our patients. We love and believe in the NHS and everything it stands for. But take away the bonds between the front-line staff and that ethos begins to fray.

My late grandad’s beaten-up doctor’s bag, still laden with ancient vials and instruments, sits in pride of place in my house. He, like my dad, was thrilled when I told him I was going to medical school. I fear he would turn in his grave if he knew that last summer, burned out by my gruelling shift worker’s existence – compounded by a dismal year of junior doctor strikes – I quit my NHS training. My son, aged ten, and daughter, six, were thrilled with their new hands-on mother. But I couldn’t shake the feeling of abandoning my patients and, more fundamentally, I missed them. So, after a six-month break, I returned to a new, kinder and more tight-knit speciality: palliative care. In the NHS hospice in which I now work, the doctors and nurses function as a team, supporting and learning from each other.

Today’s NHS needs more than an injection of cash. Unless doctors’ rosters are designed to rekindle that sense of belonging and team spirit, today’s young doctors are at risk of feeling rootless. Without this – and to my intense sadness – the prospect of my own children following me into medicine fills me less with pride than trepidation. And that speaks volumes about the need for profound cultural change in a health service that is slowly battering teams of staff into resigned and weary individuals.

This article appeared in The Daily Telegraph © Rachel Clarke/ Telegraph Media Group Ltd. Your Life in My Hands by Rachel Clarke (extracted below) is published by John Blake Publishing.