hieroplasty

I was standing by the hoagies smoking a joint when I noticed him. There wasn't much light. It was late afternoon. He looked bald and unassuming, the way I had heard him described. I looked around at the crowds making their way back to their cars. What on earth was he doing here?

The late afternoon lights made the park look sad the way Christmas trees look sad after the new year.

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late Middle English: via Old French and medieval Latin from Greek hierarkhia, from hierarkhēs ‘sacred ruler’ (see hierarch). The earliest sense was ‘system of orders of angels and heavenly beings’; the other senses date from the 17th century.


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Quill found Grace on the couch in the mess, wiping the tears from her tired eyes. 'Oh hi!' She said, with a forced gaiety.

"Hey Grace, how are you feeling?"

"Oh... just tired." She chuckled apologetically.

He nodded. "It's been a long night for you." He said, sitting on the couch opposite.

A pregnant pause filled the air. Grace was just about to excuse herself when Quill started speaking.

"Hey Grace, did I ever tell you about this patient I saw in A&E? He was an elderly gentleman, came in with pretty straightforward COPD exacerbation. He had had some nebs and the regular treatment in the ambulance, so I went up to him and he seemed pretty well on oxygen. Then an hour later when I walked past he was slumped over, chin on his chest, not really responding. I thought to myself, he's probably just tired from all the huffing and puffing. I didn't want to disturb him, so I had a quick listen to his chest and there wasn't any wheezing, so I was reassured that he must be okay. Ten minutes later my registrar Rob bursts into Resus with my man and as he brushes past me, he says 'this man has a very tight chest,' and he starts organising Aminophylline and NIV to correct his profound acidosis. All the while I was stunned. I wanted to help but all I could do was think about my mistake. I had missed something serious, something potentially fatal. It was the worst feeling in the world. I felt like I had absolutely failed as a doctor.

When I went home that day I just wanted to crawl underground and stay there. The feeling only went away once I stopped beating myself up and started trying to understand what had happened - and what I could do to prevent it. So I went to my Oxford Handbook and I looked up COPD and silent chest and respiratory acidosis and the whole thing, and I was super crazy careful about the next few COPD patients I saw. But what I'm trying to say is that - because of that experience, I was able to recognise what was going on tonight with that lady, and that's how I knew what to do. I could have looked at that mistake and took it as a sign that I wasn't meant to be a doctor, that I just don't have what it takes. But instead I decided to believe in myself - that I could still be a good doctor and move past it, and learn from it. And that mistake... prepared me for tonight. If I hadn't made that mistake then, I wouldn't have known what to do tonight. And the thing is - when I went in the next day, Rob didn't blame me. He didn't scold me. He still trusted me - which made me believe I could still trust myself. And I made sure to ask him or someone else for help whenever I was struggling or out of my depth. And the more I did, the more I got feedback on whether I was doing the right thing or not, the more confidence I had in what I was doing. This happened relatively late on, by the way. Not as an F1 - but I wish it had. I wish I had learned these things earlier - because that's when I started to realise... that everyone, literally everyone - consultants, registrars - has felt out of their depth, unsure of what to do, wanting to call for help and not knowing whether or not they should. Everyone has felt at some point that they have let themselves and the patient down. Even Rob - who was at that point to me basically superman and could do no wrong - against all odds, he must have felt like me at one point. After that day, I learned to beat myself up less and ask for help more. That was the important lesson that took me a long time to learn."

They both said nothing for a while.

"Anyway, I'm gonna bugger off now - it's way past my bedtime. You've worked really hard tonight. Take it easy and get home safe, okay?" He said, getting up to leave.

"Quill?"

He turned around.

"Thank you... for everything."

He shrugged. "Just doing my job."