I did a bad thing. I bought a present for a patient. In my defence it was the early noughties and we did things differently there. In addition, I was a Specialist Registrar who was 鈥榓 bit of a character鈥. To all my trainers over the years, I can only apologise.
Katie* had Cystic Fibrosis. She always looked cold and slight and when I think about it, I can鈥檛 recall her parents ever being there. She鈥檇 say she really really liked tigers and The Spice Girls. So out of worry for her warmth and with a grip on professional boundaries that could only be described as slippery, I bought her a tiger hat for Christmas. It was one of those fun fur ones with cute little ears and long side bits you could wrap round like a scarf. Highly flammable and very Girl Power. No one else knew.
Late January, Katie was on the ward again with pneumonia.听 As always, she was up at the nurses鈥 station, swinging her legs on the wobbly chair shrieking with a shattered Lucozade bottle laugh until Sister shooed her back to her room. That Friday she was to be discharged into a brittle Lewisham night. She promised me she鈥檇 keep warm. She loved the way the hat felt over her ears and she did really really like tigers. If she came in again, the plan was for her to go to the adult respiratory ward. Months had gone into behind the scenes transition plans and she was all set. She waved goodbye and her bare head bobbled off down the corridor.
By Monday morning ward round, there was Katie again. Turns out that on Sunday night she鈥檇 pitched up grumbling and coughing into adult ED for the first time. They鈥檇 seen her quickly and the Senior House Officer took the history. 鈥淪o鈥 he said, rubbing his tired eyes and peering at his blank history sheet 鈥淗ow long have you had Cystic Fibrosis?鈥. Katie鈥檚 jaw fell open and her tiger eyes flashed. Before he鈥檇 had a chance to correct himself, she鈥檇 grabbed her bag, spun on her heels and banged her way through the double doors, stomping across the lino into paediatric ED. 鈥淚鈥檓 never going there again. They鈥檙e idiots鈥 she said, plonking down in the nurse鈥檚 bubble. Except she didn鈥檛 say idiots and there were more adjectives.
Katie clearly didn鈥檛 feel safe. The belief of 鈥榦ut of your comfort zone鈥 birthing creativity is fair enough but can feel very threatening if you鈥檝e been exposed to trauma.听 I have anxiety and 25 years ago, a work event caused PTSD which nearly finished off my career.听 My brain is spectacularly good at scouting for risk, ready to fire up my adrenal glands so I can book it out of any threatening situation; out of fight, flight or freeze I鈥檓 a runner. Katie was a world class panic sprinter. But you don鈥檛 have to have PTSD for an event to knock you off your equilibrium. An aggressive parent, an overbooked clinic, a meeting not prepared for. That feeling of your heart in your mouth, hair standing up on the back of your neck and your stomach dropping are primal physical signs that we feel unsafe. The good news is that the strong connection between our bodies and minds works both ways. Getting that 鈥榯op down鈥 control gets better with effort. We can distract ourselves with non-threatening tasks, a movement break or the doctor鈥檚 favourite: dark coffee and darker humour. Mindfulness and exercise help too. Whatever works for you. I鈥檓 still practising.
The more I thought about it, I realised that Katie wasn鈥檛 so much caught by surprise, more that she didn鈥檛 want to accept the inevitability of change. The paediatrics ward had been her safe place for so long. She鈥檇 now have to put her trust into the new. Sometimes, even with the best preparation, you have to take that leap into the unknown. And to trust people who are there to care professionally and personally.
But for now, after a long South London Monday I piled on my coat and headed out the ward. Katie would be transferred to adults the next day. She鈥檇 be ok. She had her new hat after all. I tossed my chewing gum wrapper into the full bin. It landed on something soft. Poking out the top of the rubbish was a bundle of stripy, fun fur. Katie鈥檚 hat. Was this her accepting a transition? Was this anger at rejection from the ward? I suspected she鈥檇 been placating me and never wanted the cheap thing in the first place. But either way, we鈥檇 both walked through those doors and into another day and for me, a new job. A new chance to trust.
Katie didn鈥檛 come back.
听
Serena Haywood FRCPCH MA has been a Consultant Paediatrician since 2003 and specialises in behavioural neurodevelopment at St Georges in London. She is also a Medical Examiner, Guardian of Safe Working Hours, Peer Supporter with BMA Wellbeing, GMC Associate Assessor and playwright. Listen to Unmasked, her dramatised podcast about the first COVID-19 wave.
*Names and other information that could identify someone has been changed