Robert 0:00

The alarms are going off, showing the blood pressure's low, the heart rates really low. This guy looked like his heart was going to stop. And actually it didn't stop. I thought God have killed him.

Alex Melia 0:14

Welcome to stories of men beneath the surface. I'm Alex melia. Join me as we discover what it means to be a man in the modern era.

This episode is about what happens when a split second decision, and a life or death moment led to the worst possible outcome. Back when Robert was started out as a young doctor, he was working in an intensive care unit in North London. He was responsible for up to 40 patients at a time. But there was one patient who stood out and his memory, a man will call Daniel. Daniel had been visiting the UK when he fell extremely ill with pancreatitis. That's an inflammation of the pancreas, which led to Daniel needing to be put on a ventilator.

Robert 1:08

Went to see Daniel and Daniel had a fluid on his left lung that was stopping oxygen getting through or at least hindering it. So it was decided that I will put a tube into his left lung to try and drain the fluid. So I put the drain in and drain went in and fluid came out into the bank. So that's good news. Then seeing our other patients having cup of tea talking about them, a massive alarm bell rang, I mean, not metaphorical, a real alarm. And when an alarm goes off, you're really in intensive care. And we will call it urgently to see Daniel and we bombed it down the corridor ran into the room, a few of us. And we could see there was a load of blood suddenly come into the bag. The alarms were going off, showing the blood pressure's low, the heart rates really low. This guy looked like his heart was gonna stop. And actually it did stop a minute later. It just showed a flatline on ECG and is hard to stop. As Oh, God have killed him. What a disaster for him. And of course, in a moment, you're also petrified for yourself. So then, of course, everyone piles in, it's like a scene from er, we made a hole, we put our finger in his chest, a load of blood came out, we had to get loads of blood, we then get urgent ultrasound. So the radiologist, the X ray person comes up, who happened to be one of my ex girlfriends, which just added sort of embarrassment, I suppose you could say although it was much more than embarrassment, because she was kind of helping sawed up this clinical mess that I felt I had created. And of course, there's this wife standing outside thinking What the hell's going on. We give some drugs to try and reduce the clotting. We give a load of blood, of course, and his heart starts beating again. But of course, he has a time in which there's no no blood. Well, no blood with oxygen to his brain. Disaster, disaster, absolute disaster. I was ashamed and sort of hit a bit. Loads of people were taking care of him. So kind of on a minute to minute thing that didn't matter that I was not there. But I was just ashamed. And I felt a bit proud as well. I kind of felt that people were laughing to me. Of course, they weren't laughing at me not for one minute. Over the ensuing days or months, he has an MRI of his brain which shows badness in some core areas. I not much functioning, this pancreatitis get better. So he's left with someone who's got a brain injury, and the other stuff has got better. My main feeling is feeling like a fraud. I felt fake basically, I think coming to work and embarrassed on myself of causing this terrible thing. And why did we notice it? Could we have seen it earlier? Could we have done anything differently not bargaining in my head visiting him after this terrible episode. Those times are terrible coming to see the patient couple days wife with her. Obviously she's She's devastated. You know, she's she's one more time to my husband. Key was on a life support machine, not capable of breathing himself. But obviously his wife wants them back in the homeland. So he doesn't wake up. He is transported by plane back to wherever wherever he was born and passes away there.

Alex Melia 4:50

You been particularly hard on yourself, or would this have just happened anyways, anything else you could have done? Because it sounds like that it was kind of out of your hands but you took it really hard

Robert 5:00

I think it probably was out of my hands. I think it was someone who's really unwell. And if and people obviously will have complications, if they've, if they're really unwell, the chances of becoming even more than well, are much bigger. So I kind of think of it now, as in the medical students that I teach asked me, you know, about complication surgery code, I guess, I sort of think that I was hard on too hard on myself.

Alex Melia 5:27

What made this one different, where you kind of took responsibility in some way? I guess

Robert 5:32

I feel because of me i to put the drain in which caused the bleeding, which then caused the lack of blood from the heart to the brain, which triggered obviously his his brain injury. So, yeah, so so. So that's why a bit like a surgeon. I'm not certain, but it's a bit like a surgeon. Yeah, the patient's Well, the patient wasn't? Well, to be fair, they were on all sorts of drugs, including blood thinners, which made it easier for him to bleed. But so I am sympathetic, and I guess it's informed how I am now, if there are complications, you know, of patients.

Alex Melia 6:17

What was that like for you, as a man as a male doctor having that sort of responsibility, not just with this particular patient, Daniel, but with all people in general, I mean, especially as a young doctor at the time, and obviously, as more experienced doctor now. I guess, as a

Robert 6:31

young doctor, I protected actually, by the sort of older ones, I started having an umbrella above me to some extent of niceness and calling people who covered for me is the wrong word. But they said, Hey, let's have this as a plan. So I just had to do the plan. And that's how I learned, I guess, partly from them. I think that they were incredibly accessible. And they were blokes actually, mostly, the senior doctors were very easy to call, they would don't take just call me call me on the phone, obviously, no mobile phones. So they would respond. Okay, just do this, this this. So I felt I felt a privilege. I know, it's really cheesy, isn't it, but it's, and it remains for me even. That's the bit I really, really liked. Now. I'm 53. I've just had a week, literally a week, just now, last week. This is my first day off of being on call for a whole week for our surgical intensive care. And I love it, because it's about people. It's about how can I help you? How can I help you? I know this is grim. But my job is to make it the least grim for you. Whether it's sort of trying to buy a newspaper, there's a guy who was having a terrible time I bought a newspaper for you wanted to meet the mirror. So I bought him the mirror from a newspaper from a newsagent. But actually more medical stuff. Of course, it's about how can we get rid of the pain? How can I give you energy? How can I help you? Yeah, how can I give you love and energy? That's how I feel really about transference of energy. How can I give you some positive energy, not lying, of course, if someone's in a serious way, and they may pass away, we'd have a different type of conversation. It wouldn't be. But it's very important not to lie, of course, for obvious reasons. But I would still be positive and kind, how you doing, and so on.

Alex Melia 8:33

It takes a real sense of character to be able to do what you do, because like you say, it's all about people. And I agree, I do something in the medical field, well, that have done for about nine years, my business, we teach doctors and nurses from overseas to pass an English exam, so they can work in the NHS. Now that's about people. And it's about care and, and hopefully we're helping more and more doctors and nurses to come over to the UK. But that's what I do is very different to what you do. I don't think I could be you know, be able to save someone's life, literally speaking. So what is it about your character that you don't become overwhelmed by the pressure of it all?

Robert 9:08

Weirdly, I'm really like my dad, I've only started to realize that my dad was a guy born before the before the Second War, he was too young to fight yet in the Second World War. And then he really wanted to be a doctor after of course, he couldn't have been a doctor. Not of course, but they were giving priority to people who thought and he was quite eccentric guy, but became a hospital biochemist. i He was running a biochem lab. He was the only person in the biochem biochemistry lab. And when I used to go to the school holidays because obviously we didn't have extra childcare I had just hanging out with him. He just was ridiculously enthusiastic and walking around and waving to people and i i Sometimes catch myself and I think I am my dad, basically. So I would say that I do have quite a lot of energy, and I don't get overwhelmed I think if it was my realm To be slightly different, one of my colleagues had a serious thing. She had a baby and some complications. And I went to see her the next day. And I froze. And I realized that I could no way, look after her in No, I couldn't make any judgments about her medical facts, because I was, it was an emotional response that way, it was totally impossible. And I was genuinely scared for her life, I do realize that it's very different. If it's your relative, it's just a total, total gamechanger. It's, it's not the same as me looking after your son or your daughter or your mom with that. At all, it's and that's where my dad had his bypass graft, I went to the toilet, and I prayed pretty much for 48 hours, bargaining with God, pleased that my dad live, and I was about 11 or 12. So I don't need to stay on the toilet for 48 hours. That will be a bit curious. But I was I was praying on and off like saying, Please, you know, I'll be a good person if my dad lives. And he did live about 30 years. So I think it's very difficult. People say, I don't know how to do a job, it's very different. Because it's not your relatives, either, I would say, and most of the time, you can be positive and kind. And that's an amazing thing to be able to be. And people sense that

I see what you're saying. But it must be incredibly difficult for you to go home after a tough day at work and just be able to switch off. I mean, how did you recover from the situation with Daniel? Because clearly it takes it takes a mental toll on you? How many days? How many weeks? Did it take you to recover from that?

I would say the mental things that have happened as a result of medicine. But Daniel, particularly, let's say, the big resolution was when we had to go and see the lawyers, the lawyers interviewed us. My consultants went to me, the registrar, the middle grade doctor, and the myself and probably one or two other verses. And it was a huge, I guess it was a huge relief that we didn't have to go to court. I guess they settled out of court for some money, I guess, how many

weeks and months after was Did this happen?

Three years, two years?

I mean, quite a long, long time. Wow. So that mental toll for that two to three year period must have been difficult for you.

Yeah, it just crossed my mind back, I think it was on my mind it. Of course, as time went on, it was less on my mind. But then it reared its head again, when we had to go and see the VirusTotal. And then she just quizzed us about a few things. And then we left. So actually, that bid was relatively painless. And I was relieved that it was kind of ending at some level. For me, actually, COVID was the the next really, really big thing that is looking after 70 or wasn't me on my own nurses, colleagues, medical students, doctors, loads of us looking after really ill people, one of the terrible things about people who are well enough to need intensive care and COVID, they were on a ventilator, they couldn't communicate with you, and the relatives couldn't care for them, and he couldn't chat with the relatives. And for me, that would have been utterly unbearable, you know, to think of my mom or my dad in there. So I totally get how people are angry. And I'll get very upset when they when whatever reason. They are thinking again, of their relatives who we had to be the relatives, we have to whisper the current things, we had to show the patient's love and you know niceness as a surrogate marker, the relatives because all the COVID rules and stuff then. And the other thing about COVID for me was that I teach medical students a third of my job is that and all of a sudden, we had to kind of look after them. And so I went into overdrive making online stuff for them and became property tired and fatigued. So I think it took me about a year and a half, maybe not even now to get over that. You know, so those are the other sort of similar episodes of work situations really affecting me.

Unfortunately, during COVID, a lot of the medical students who even first years had to be pulled in to actually help out the hospital. And some of them came back completely traumatized by it. What was your experience in working with them like and and how did you help them through that time? Because obviously, even though you didn't go through, like a pandemic 20 odd years ago, when you were starting out, you did go through some difficult times. So how did you help them with your experience?

Or weirdly, I was in charge or one of the people in charge of the UCL students going to my hospital, which is uch we had about 250 in total medical students come there's about 350 and the we did this thing called townhall meetings a bit like lots of multiple zooms so we so they know me, the students kind of know me from other from early years teaching, so I was a sort of trusted figure. They all had my mobile I was on their WhatsApp, there was a group WhatsApp. And I got some of our psychologists to write a little piece on taking care of yourself, because they felt really deflated. They thought, well, we're not learning anything. Now, of course, they were learning so much, so much. And to hear some of their stories, they've learned loads. We had debriefs, and they knew that they could call on a few people, if some particularly traumatic thing, then some of them had trauma, trauma, and weren't able to walk didn't feel able to reach out, maybe they felt embarrassed, or something. I know, personally, some of them saw patients dying and, and work sort of prepared for that. Of course, I think a lot of them had amazing experiences, though. I mean, of finding that nurses are incredible people, finding that the simple things are the most important things. It's not the technical things. It's talking to the relative. It's not about knowing this complicated diagnosis. And that's what I would say to them, as well. And they were incredible. I mean, incredible medical students were just amazing. One of the nurses said, if the future doctors are like this, I've got a lot of faith. And that for me, that was that was moving. You know, just to hear that. I thought, yeah, well done them. Well done.

Rob, I wanted to ask you about the male female dynamic, because you did mention before how your ex girlfriend who was working as part of the hospital staff was around when you were going through this difficult situation with Daniel, can you talk about how you were feeling at that time and what your interactions were like with her?

Yeah, so we've split up. She's a really good person, she's still a doctor, and working in a different hospital again. So I was just embarrassed that she's had to sort of be part of this, I guess, and ashamed again, I just felt shame that it was her. I kind of had to come and bail us out almost or hasn't he helped bail us out?

Did you feel a sense of extra pressure for the fact your ex girlfriend was observing what was going on? Because I think about my self in situations where I've been through difficulties, or I've been through something where you feel like you're under pressure, and your girlfriend or someone you're seeing is around? It could even be something small, like trying to find directions to the hotel you're supposed to stay in and you feel like, Oh, my girlfriend is is judging me right now.

I guess it just made me feel incompetent, basically. That's right. And the fact that she was she was smiling to her friends now. That's fine. She should smile to her friends. But it just felt, as I say, I felt slightly paranoid that was being talked about

smile to friends, what do you mean, in what context?

She came with her some colleagues of hers? Who were her mates, therefore, their colleagues and friends who are in the same job to have a look at the patient? And, again, that's perfectly correct. And is normal. And so when she talked to them, we're sort of smiling or laughing, not laughing at the patient, of course, already. clinical situation, but just normal chat. I felt that a bit paranoid that it was evincing I really did feel paranoid that they must be laughing at me. Of course it was they were they weren't talking about me at all.

I kind of get what you're saying. Because emotionally, you're thinking, Oh, well, she's laughing at me, but logically thinking that can't possibly be the case. I know her. She Why would she be laughing about something like this, but there's sometimes a bit of a an incongruence between the two and then you immediately think you can't get out of your mind. Is that the emotional side of things? Yeah,

I'm sure she wasn't talking about me or laughing about me. But But I at the time, I remember thinking, just feeling that sense. Again, shame. Like I was just, I had sort of really mucked up, I felt. And it was much worse that it was heard that had had to kind of bail us out. Yeah, no, that definitely made it much worse.

As I said before, I can't possibly imagine what it's like to be a doctor and be in the kinds of situations that you're in where you're trying to save people's lives. And unfortunately, you do have situations where you lose people. How have you changed as a man since that situation happened?

I could answer that in a few levels. I try and write down stuff much more. That's not being defensive. That's just if someone looks at me, then and again, that's not as a man, of course. Any other doctor would would do that as well. I guess I'm a bit more cautious about that specific thing. Let's say the specific what do we do if we have to chest rating sometimes other than these, this the alarm bells goes, you rushing and trying to help someone because they've pulled the alarm because there's a crisis. I'm really wary of how I look then in that situation, as in, I go, Hey, John, whatever. Anita, how can I help you? How can I help you? And I try and just make sure that my I attitude is how can I help? Just be aware that people might be feeling utterly terrible, hopeless and confused? In fact, sometimes, if something happens, suddenly serious, you're you just got you can't cope with it. So you pull the alarm. And then sometimes someone else has to take, take control. And that's fine. We all recognize that. So I think if I go to an emergency, I'm really weary of how I appear with other people. I work with surgeons, they have complications. And I'm really wary of how I speak with them, you know, with compassion, basically. And just hate that. It's really difficult. I've been in that situation, I might, that might be the first thing I would say to them. Hey, I've been in this situation. It's very hard that we're about it. Let's park this. Let's deal with the emergency chat later. You do really? Well. I might say that. And there we go. Yes, I would say something positive. You're doing really well.

So feels like you might you're leaning more into your feminine the nurturing the caring. The positive encouragement?

Yeah. Yeah. Although, is that happening? Or is it basking today?

Well, that's that's the interesting question, isn't it? Yeah. Is it? I mean, traditionally, it probably would be seen as feminine. But I definitely think it's, it's something that a lot of men, a lot of masculine men can use and utilize at their disposal to become more of a man, I think,

yeah. So yeah, I would try and actively be kind in that situation. And then maybe try and debrief them with kindness and just say, hey, that's really difficult, really difficult. What happened there? Don't worry, I'd be in the same situation. Let's chat. So I think I think that is true. And I'm also trying to talk with my medical students about how to mentally cope with complications or problems that happen, how are you going to do that? How are we going to do that? It's really hard. If you harm someone, ultimately, you know, of course, then, and I'm also filled with compassion, a bit more compassion. Now for surgeons, gosh, what it is, someone's chatting, they come into hospital to have an operation, a complication curves, and the surgeon has caused that in the sense that the problem wouldn't happen if they hadn't had surgery. And mentally, that's very hard for them very hard. So I'm very sympathetic to surgeons. And as I get Hold on, I'm sympathetic to the mental difficulties of being a surgeon, how you kind of get around that without being callous, saying, Oh, well, whatever, doesn't matter. Well, that's, that's not true. Or, well, I'm never gonna do that operation again, to either, you know, so how you negotiate that with someone, and I guess I see my role as being the fittest as someone who can help them while down doing really well, or you okay, you know, just a few choice kind words, across the, across the sheet

after that situation happened. And the court case was over? How did you approach your job? And also, how did you view yourself as a man? And how did you operate as a man? Did you become more more nervous, more, more cautious of, of what you were doing on a day to day basis? Or did it kind of serve as a kind of challenge for you or something to spur you on to drive you to be better,

essentially, is that I think I didn't. I was really lucky. It didn't sort of destroy me. I know, some people are destroyed by single things. And who knows? I'm 53. Are they yet? You know, they're by the grace of God and all that. But I do know, people that have had individual serious things, and they've, it's consumed them. And maybe I was a bit protected beforehand, in that I wasn't that introspective. Essentially, I am capable of reflection, but I wasn't. I didn't have ridiculous, high aims for my to have never making any mistakes ever. And I see that in some of my colleagues when they they make a single small error that has no consequence it, let's say, and they give themselves a terribly, terribly hard time. And that doesn't help anyone. So I think I I didn't veer me away, or actually I don't do that speciality, particularly now that intensive care, the non surgical intensive care. I do, of course, I still am in that specialty. So it hasn't been their way. Totally. I guess that it's made me want to be more honest with patients in a certain way, not in a stream of consciousness. Here's a list of things doesn't help anyone. It's made me realize that having their confidence, he was unconscious. He could know us, obviously, because he's asleep. But patients who like to see before surgery, then they have their own set. And I want them to feel that I have listened to them. And that they can tell me stuff if they need to tell me stuff. And I've, I've considered them as people as well as a medical problem if you like. And of course, then they're much more likely to see any error on my part as well. He did his best. I don't mean that cynically, but that's just life. If someone kind if you have a load of experiences, someone cried, and then they do something they, you know, whatever, forget to do the dishes and something you don't think Oh, bloody hell, you think, Oh, just do the dishes? You know, I know that on a medical scale.

You mentioned about mistakes. And I find that's quite that's a well a really interesting topic. Because I speak to men all the time, who sometimes allow the mistakes can consume them. And they have this sort of success and failure and think, Well, I've made a mistake. So that means I'm a failure, rather than I've just made a mistake. And that's what men do. And that's what seems successful people do. And they can kind of label themselves as that. How did you deal with this mistake in your mind? And how did you learn from it? I'm just curious about something outside of being a doctor something, something in your day to day life could be family life, it could be personal. I'm just curious about that side of things.

So I guess I Yeah, so got got three kids. I'm married, I've really learned from my wife to sort of loosen my control of the kids. Not that I ever had any control on them anyway, let's be honest. But loosen any perceived control I was trying to have. I think the problems have come while I've tried to be a bit more authoritarian to just have one word. You know, they'll just go whatever. I think so I think that that's definitely true. And I've learned from my wife, definitely. And she's quite wise in that respect. And but even if I don't agree with it all the time, that's not the point. It's, she is good at that. And she's got great communication with with the kids. I should say that too, because the stepkids one is my own. So that is an interesting little twist, if you like, and I love all of the kids. And I think they'd love me back or I mean, the boy might not say that, of course. But, you know, we have we have a great relationship.

What's interesting you say, of course,

that's right. He's 15. What can I say, you know, and actually, I have thought, but you're right. But also, I would want to create, I think with stepkids, I don't want to create that all contribute to that concept of they have a dad, that have a dad, and a stop me. I mean, I would say I'm a dad figure, but you know, don't want to push that in their face, because they have a dad. And otherwise, there's a kind of internal war. If they think too, I imagine if I think to warbling me, then then that may create conflict in that well, what about my other data? That will be confusing to them, I think. But I've had a really beautiful Father's Day cards for one of the kids, one of the stepkids, which which I've kept that I bought a two sided frame, so I can frame it and see both sides, because it's so moving to me, because I think it can be quite hard to be stepped out. I think, you know, stepmom, can this be sort of step parents stepped down? Yeah, it can be I think, and also not in a man way, not too would never speak badly about their dad to them ever. But also not to try and I find it a dilemma. If I, if one of the kids is doing something I send a photo to him, then would he feel I'm kind of trumping the dad thing.

Robert seemed to hold on to the guilt. And as a young man, he just didn't have the tools at his disposal to let go of that guilt. It makes me think, as a patient, as we're all patients, at some point, should we expect doctors to be perfect to never make mistakes, because sometimes those mistakes can ultimately lead to someone losing their life. Sometimes for me, when I'm holding on to guilt about something, it's just those thoughts replaying in my mind again, and again. Those kind of fear pangs in my stomach and in my chest, and that guilty feeling that rests in your stomach. It's not healthy for any of us. And it makes me think about how much time I've wasted over the years. I can't imagine how difficult it must have been for Robert to operate in front of his ex girlfriend. And it made me think did he need to consciously or subconsciously prove something to her? What a great doctor he was, what a great money is. What are capable money is it must have been so difficult for Robert to wait over two years. To find out a verdict on potential malpractice, and having to live with that day by day, I've got so much respect for doctors, nurses, medical professionals, who are dealing with these life and death scenarios on a day to day basis. Even thinking about how difficult it must be to separate your personal and professional life. As soon as you leave the hospital, going home, how do you switch off? How do you let go of scenarios that have come up throughout the day, the highs and the lows and everything in between? I think sometimes we've all been a bit frustrated or angry in the hospital. But thinking about what those doctors and nurses and medical professionals are doing when they go home. Perhaps we don't think about that sometimes perhaps we don't think about how our words and how our anger and frustration can upset them. To have someone die under your care must be the worst fear that a potential doctor in training must be thinking about even a doctor who's already qualified. What guilty you holding on to right now that you can let go of or do something about.