Past, present & future

Past, present & future

Thank you to the Royal College, especially Dr Fiona Donald for having me here and allowing me to speak in a personal capacity and as an anaesthetist in training. Congratulations to every one of you sitting there today, what you have achieved is remarkable. This is a day to celebrate your journey and acknowledge what it has taken you to get to this far.

This time last year I was sat in the audience where you are collecting my FRCA. It was particularly significant for me as 24 years earlier exactly to that day I made the decision to become an anaesthetist. I know that, as it was the birthday of my oldest child. Inconveniently I decided to become a doctor when I become pregnant while working in my previous career. During labour I had an epidural. I went from the worst pain in my life to no pain at all. This was like magic and there and then I decided whatever that job was I wanted to do it. But it took many years and challenges. I’ll be honest with you; it has not been easy.

I am 25 years into this journey now. I graduated medical school aged 40, starting anaesthetic training aged 44 nearly 10 years ago, I will be 53 when I CCT. I know that each one of you will have had a unique journey of challenges, ups and downs. So, days such as these prompt reflection. The practice of anaesthesia, critical care and pain medicine is changing, and we are in the midst of it.

Past

I realise that you come from different specialities, not just anaesthesia, but bear with me as I share some stories of the past, present and hopes for the future.

In my current hospital there is a wooden plaque with beautifully painted names of surgeons and anaesthetists of days past. It’s around 50 years old. One night, I started to look up many of these doctors to find that most of them had died. Many were pioneers and leaders in their field, leaving legacies that impact us today.

There were 5 consultant anaesthetists on the board. Our department now has around 100 consultant anaesthetists for comparison. Of the five, one was still alive. Dr James Mulvein. I tracked him down and spent some time talking to him listening to his oral history. He is 84 years old, and he and I chatted like colleagues in the coffee room. It was extremely rewarding.

He started as an SHO in 1960, having been told not to do radiology as there was too much physics in it! Soon discovering there was physics in anaesthesia as well. There was no formal training program, he had taken both the fellowship and diploma in anaesthetics (the original anaesthetic exam). Then there were around 3 registrars, 1 SHO and a few consultants. Much like today’s training, he spent 3-6 months being closely supervised, learning the art of anaesthesia. After a year or so he was deemed competent enough to join the Maternity Flying Squad.

I’d never heard of these squads. Back then most births occurred at home. If complications arose these women often died on their way to hospital. The ambulance service was patchy, and they had not been properly resuscitated. A Prof at the time decided that taking the medical team to the home of the mother was safer. So, Dr Mulvein with obstetric registrar, midwife and sometimes other assistants would borrow the blood transfusion van (as it had a blue light on it) and ‘hare off to the home’. He’d preoxygenate and give them a general anaesthetic with suxamethonium and thiopentone right there. Then having made them all better he said, ‘we’d had a cup of tea and go home’. No this sounded really quite scary compared to today’s training, how brave he must have been. Nationally, these squads saved many lives.

He also shared how there were no anaesthetic charts, you hand bagged, you took the patient’s blood pressure manually, needles were blunt from autoclaving and multiple use, and glass syringes were the norm. He would find our use of plastic quite shocking, I’m sure.

He told me about the day that the first man walked on the moon.  They stopped the afternoon list to watch it. Watching it he thought ‘how is it that we can put a man on the moon but we can’t monitor blood pressure properly. For him, the most groundbreaking innovations were monitoring and record keeping. For example, there’d been one ECG machine to share between 5 theatres.

He told me how he introduced the elective section list at our hospital and was one of the epiduralist/spinalists. This anaesthetic technique had not been popular and required some persuasion. Some people had serious neurological complications because of the way the trays were prepared. Formalin had leaked into hairline cracks on the percaine ampoules causing serious complications.

Talking to him reminded me how sharing our stories contributes to our collective practice in each of our specialities. By talking, we support each other. He said that this most important thing of all was to be friendly to each other and to talk to each other. This is what really matters. This is what makes great departments. His goal of providing the best evidence-based care and his love of caring for patients is what we share today.

Present

Today, the practice of anaesthesia, critical care and pain is somewhat different. But what an amazing and unbelievable job we have.

A few months ago, I was on a night shift. I spent the last few moments with an organ donor who gave the greatest gift you can to others, giving them a future. I took the patient from ICU to theatre for the retrieval. I turned off the ventilator that gave him his last breath. I had a quiet moment to myself, thanked the patient and walked out of the theatre. This as you imagine, is somewhat uncomfortable.

Moments later with little time to take this in, I was quickly bleeped to obstetrics where 15 minutes later I was present as a tiny newborn took its first breath and the new parents cried tears of joy and relief. For that is our job, one where you see birth and death alongside each other. You see pain, you see heartbreak, but you also see joy.

Now, I am down to the final months of my training journey. And this long journey does not stop then. It continues on paths unknown, some treacherous, some smooth! We are always focused on the next goal, the next challenge but it is about the whole journey not just the destination. Sometimes we may feel alone on our journey but look around us now, you will see that we are not alone.

It’s who is alongside us, the friends and colleagues. All those who helped and supported us.

But this journey has also been borne by our family and friends, and our children.

To every proud family member here and those watching at home this would not have been possible without you and your support. You are kind, you are patient.  So, this day is also about you.

Future

Now what about the future. For as we all know our career and lives are intertwined. It is also the beginning of the next steps in your career and in your life. You achieved this goal while working in a demanding job, studying at night, at weekends, giving up special occasions, family time, or through illness, life events, lockdowns and so much more. There will have been times when you wondered if you could do it. But you have.

Let’s pause and think about the collective strength and knowledge in this room. Between us how many hours of study have we done, how many patients we have cared for. How many lives saved and how many we have not saved. There is considerable experience in here and that is a formidable power.

As we all know the medical speciality is in a bit of turmoil of late. Strikes, uncertainty and a changing landscape of medical practice. Hopefully my stories of Dr James Mulvein illustrate how our work has changed and that we are adaptable. And we have always advocated for the best standards of patient care.

But one thing is certain, you are a doctor. You are an anaesthetist, an intensivist, a pain specialist. You have earned one of the hardest and most highly regarded qualifications in the world, and no one can take that away from you.

You will be the person in resus intubating the critically ill, you will be the one leading ward rounds in intensive care, running theatre lists or helping people live with persistent pain. You are the ones who will be called to manage the difficult airway or reassure frightened children. You will communicate with people at some of the most memorable times of their lives.

You are highly trained and respected. I truly believe it is the most rewarding job in the world. And we get to do it. As Dr Mulvein said look out for each other, talk to each other and learn from each other. Who knows fifty years on we may be sharing our stories with future generations. Congratulations to you all, the future is in now our all of our hands!