‘The little boy in the incubator had been fighting for his life for days. He had Down’s syndrome and had also contracted a severe infection several days after being born. He was on a ventilator, and we gave him heart medication to keep his blood pressure stable, as well as antibiotics to fight the infection. Every day we ramped up the treatment, boosting the technical artillery around that fragile little body, so much so that I wondered whether we were doing the right thing. None of it seemed to make any difference, and his condition got worse and worse with each passing day. On day five, when I ended my shift at eleven o’clock, I went to his incubator specially to say goodbye. This is it, I thought, tomorrow you’ll be gone, I’ll never see you again. But when I returned the following morning, there he was. His condition had suddenly improved over the course of the night.
A few years later, on a Sunday afternoon, a four-year-old boy was brought into intensive care. A happy, healthy young lad who had fallen into the pond while playing in his grandparents’ backyard. He’d been underwater for quite some time, but they managed to resuscitate him in the ambulance on the way to the hospital. His heart was beating again, but he was in a coma. We spent all afternoon on him, put him on the ventilator, gave him cardiac massage and lots of medication. I feared he wouldn’t make it, but to my great surprise and relief, he recovered. He opened his eyes and came off the ventilator. That evening, too, I went to stand at his bedside. My shift was over, and I had popped in to say a quick hello. And then, before my very eyes, his heart stopped. We did all we could, but to no avail – he died right there in front of us.
To me, these two boys together are what constitute my “one patient”: two children whose stories are still with me thirty years on, because they so clearly represent the extremes that doctors have to deal with. I was still in training when they crossed my path, and they have formed the guideposts in my career ever since. They taught me a lot about my role as a doctor.
Newcomers to the profession often believe they can transform the lives of the sick; that treatments, pills and operations can make a difference and that your actions matter. But eventually the realisation will come that you’re not all-powerful, that you can’t just dictate the course of events, that you are helpless sometimes. With that first boy we did all we could, though it all seemed pointless, and he survived. With the second we worked just as hard but saw the opposite outcome. That’s the reality that doctors face. We have all this technical whiz-bangery to help patients, and it can certainly get us a long way. But the reality is that sometimes life holds on unexpectedly, while other times it slips through our fingers. It’s impossible to know where the chips will fall.
New doctors need to realise that medicine only has limited power over life. These two children have served as my reference points in that regard. Those boys put me in my place, proving to me that God has the final say over life and death and that we should be humble about the potential contribution we can make.’