Left in the dark
by Josephine Mooney

Reflection

I was shocked when Caitlin* burst into tears in front of me. Her body language indicated that she had experienced something traumatic, she sat curled up in the corner of the sofa with her arms wrapped tightly around her knees. Before encountering this young woman, I had heard of mishaps and mistakes made by doctors, but her experiences made me step back and realise that things can very easily go wrong in our healthcare system. Caitlin’s story inspired me to create my piece ‘Left in the Dark’

Caitlin had suffered throughout her life with an undiagnosed condition which had caused her bone density to decrease on a yearly basis. Unfortunately, pregnancy only made the condition worse. This resulted in her breaking a vertebra bone from simply picking up her newborn child. This was not only physically harmful, but the emotional impact was very apparent to me as she explained how distressed and inadequate she felt by not being able to fully care for her baby. Caitlin found it very difficult to cope with watching her family cuddle her child ‘when I could not even lift her up to breast feed’. Caitlin was not much older than I am now when she had her baby - at nineteen years old I could not imagine having to deal with these events. Now in her early twenties, Caitlin has the bone density of a woman in her seventies.

During the visit, I heard about Caitlin’s experience in hospital after she was admitted for breaking a vertebra. It had left her feeling vulnerable and upset, but also frustrated at the lack of communication between clinicians themselves, and also with their patients.

In one instance a hospital clinician ward examined her, and with out realising how fragile she was, applied pressure with his hands on her back during the medical examination. This caused her to scream out in pain. The doctor then left her without saying anything, for reasons unknown. She said this had a profound effect on her. In the dimly lit room she felt frightened and stranded. She explained how she could not reach the buzzer to call a nurse, was paralysed with the pain, scared and alone. She was left traumatised, in the dark about her condition and frustrated. A subsequent MRI scan the next day revealed a second break in a vertebra.

Caitlin now worries about routine appointments with consultants and withdraws from any back examinations. For a while she would not even except hugs from her family. This made me think about how important it is to communicate with a patient, to give reassurance, and to remember that a hospital is an alien environment to those who don’t see it everyday.

My piece is a reflection of how I thought Caitlin must be feeling after going through this traumatic experience. The black box is to represent the room where Caitlin was abandoned by the doctor - containing all her feelings of isolation, panic and pain. The box is also an embodiment of the patient as a whole, and only by looking inside do you truly understand how Caitlin is feeling. Feeling unable to lodge an official complaint about her experience in hospital, I imagine that Caitlin felt extremely trapped. I have used wire to express the patient’s whirl-wind of emotions, most of which were very negative. Metal is a cold, harsh material that I feel represents these feelings well. The vertebra are made of wood in order to represent a material that is softer and weaker. This is to portray both the fragility of her bones, but also the broken state of her emotional wellbeing following the examination. I have tried to show some of the emotions Caitlin described feeling trapped in the situation - the feelings of anger against the doctor who caused her so much physical pain, frustration that she did not feel she could make any complaint, and the fear she felt when left alone in the room. I used the colour red to represent the passion she showed when telling the story - demonstrating how much this experience had affected her and how much she wanted this pain to stop. The green compliments the red, indicating the freedom of expression that I feel she longs for- both to let her story be heard and to be able to let go of her anxieties when medics want to examine her back. Visiting Caitlin has affected my feelings about healthcare and really made me think about how important positive, healthy doctor- patient relationships are. Taking a holistic view, careful, caring communication is as vital as the treatment in many cases. Patients must feel they still have a voice even when they are at their most vulnerable. It has also made me consider my own vulnerabilities as a doctor. Decisions I make in the future and how I behave will impact on people’s lives. This experience has led to Caitlin not trusting anyone to touch her back. I can only try to empathise with the fears that Caitlin suffers from. It is a sad thought indeed when I realise that this situation was down to the actions of just one doctor. I will always remember this encounter and remind myself that all my actions as a doctor with every patient, although they may not seem significant to me, can make a world of difference to a patient.

* name changed to ensure patient confidentiality

Josephine Mooney, Year One, GP Attachment, 2013

Extract from academic assignment. Highly Commended in the annual GP Assignment awards