0:02

Hi, I'm John. I'm an

0:02

emergency physician. And I'm

0:05

here to talk about the impact of

0:05

the loss of a patient on me as a

0:09

doctor.

0:10

Hi, I'm Catherine,

0:10

and I'm here to share my story

0:13

following the loss of my father

0:13

to a misdiagnosed aortic

0:16

dissection, and how over the

0:16

years I've turned my pain into a

0:20

passion.

0:24

Welcome to The Silent

0:24

Why a podcast on a mission to

0:27

explore 101 different types of

0:27

permanent loss, and to hear from

0:30

those who have experienced each

0:30

one. I'm Claire.

0:33

I'm Chris and in this

0:33

episode, we're doing something a

0:35

bit different. We're exploring

0:35

two sides of one story of loss.

0:40

When someone dies after

0:40

emergency surgery to save their

0:43

life, what's it like for the

0:43

family trying to get there, but

0:46

also what's it like for those

0:46

responsible in the Emergency

0:49

Room, (or A&E or Emergency

0:49

Department, depending on where

0:52

you are in the world). Tim Fleming was sadly one of

0:53

those who didn't. He died in

0:53

We kicked off this

0:53

conversation by asking Catherine

1:01

February 2015. In a hospital in

1:01

Dublin. One of our guests in

1:17

this episode is his daughter,

1:17

Catherine Fowler, who was

1:20

enroute with family to fly over

1:20

from England to be with him. But

1:26

sadly, Tim died before they

1:26

reached the hospital.

1:28

It was just very,

1:28

very difficult to hear and

1:31

didn't feel real. Just trying to

1:31

do simple things like getting

1:35

through the departures. I

1:35

couldn't get anything to work, I

1:37

just lost all ability to

1:37

physically function and to think

1:43

properly. And my mum couldn't

1:43

really take in the news at all.

1:47

I mean, her shock, I could

1:47

recognise was beyond mine.

2:18

and John to introduce themselves.

3:19

My name is Catherine

3:19

Fowler, I, a mother of two

3:24

beautiful children. I'm also

3:24

wife to Keith. I work in the

3:28

energy industry full time

3:28

leading a team of fantastic

3:33

people and also really enjoy

3:33

being involved in leadership

3:38

development as well. So that's

3:38

kind of like my my day to day

3:42

job in my spare time, which I

3:42

don't really have much of spare

3:47

time anymore. I volunteer for

3:47

NHS England as a public patient

3:52

voice. And I support their

3:52

cardiac clinical reference group

3:56

and also their clinical policy

3:56

group. And in 2020, I was a co

4:03

founder of the first charity

4:03

that focuses on aortic

4:07

dissection, so The Aortic

4:07

Dissection Charitable Trust, and

4:11

in the summer of 2022, I was

4:11

really proud to receive an

4:16

honour in Westminster for my

4:16

voluntary work and surfaces to

4:20

health care in Great Britain so

4:20

kids parents work, voluntary

4:24

life, life is very full and very

4:24

busy.

4:28

John Cronin's my name I'm

4:28

a Consultant in Emergency

4:30

Medicine in Dublin and based at

4:30

St. Vincent's University

4:32

Hospital, and I trained partly

4:32

in Australia and partly here in

4:37

Ireland on our national training

4:37

programme and part of that

4:40

towards the last year of my

4:40

training programme was in

4:42

Tallaght University Hospital

4:42

where my paths crossed with

4:45

Catherine's. My working week

4:45

varies from day to day. I tend

4:50

to do about three days of

4:50

clinical work on the floor, busy

4:54

seeing patients in the emergency

4:54

department, and then have one or

4:56

two days where I do other non

4:56

clinical stuff. I'm interested

5:00

in research and in education

5:00

through simulation. So I spent a

5:04

lot of time doing that. Also, as

5:04

an emergency physician, because

5:07

we see a lot of different

5:07

things, you end up developing to

5:10

many other areas of interest. I

5:10

have an interest in road safety.

5:13

And I kind of sit on the board

5:13

of our Road Safety Authority,

5:16

which are our national

5:16

organisation looking at road

5:18

safety and of interest. Another

5:18

in the theory is very much in

5:21

aortic dissection, as well. And

5:21

I'm Father, I'm married to

5:25

Eilish who's also a doctor and

5:25

with three girls. So life's very

5:30

busy in that

5:32

As a physician, what does

5:32

that practically look like? Is

5:35

that more about seeing patients

5:35

face to face administering care,

5:40

treatment, drugs? What sort of

5:40

doctoring do you do?

5:43

I'm an emergency

5:43

physician. So if you take any

5:45

average class of medical

5:45

students who become doctors,

5:48

about 60 to 70% of them will

5:48

become GPS. And then people tend

5:52

to specialise in other areas. So

5:52

we will leave medicine do other

5:54

things business or whatever. But

5:54

people specialise in in other

5:57

areas. So surgery is one that

5:57

there's no different areas of

6:00

surgery, or there's vascular or

6:00

general surgery or

6:03

cardiothoracic x, then you've

6:03

become physicians, and you can

6:07

specialise in anything from

6:07

being altered liver to

6:09

respiratory whenever, while I

6:09

specialises in emergency

6:13

medicine. So we've a training

6:13

programme, which is a long

6:16

training programme to become a

6:16

qualified emergency physician,

6:19

which is what I am and then you

6:19

become a consultant in emergency

6:22

medicine. So basically, I work

6:22

in an emergency department. So

6:26

our role like emergency

6:26

departments are very busy

6:29

places. So in our emergency

6:29

department, it's busy urban

6:33

slash suburban University

6:33

Teaching Hospital, so we'll see

6:36

about 200 patients a day. And

6:36

that's pretty consistent, you

6:38

know, even though emergency work

6:38

is is unscheduled, it's fairly

6:42

predictable, the numbers that

6:42

come through, so we see about

6:44

200 patients a day. So you just

6:44

got to sort them. So we'll, as

6:47

the consultant is the kind of

6:47

person often in charge, you will

6:51

have a team of doctors of

6:51

various grades under you, some

6:55

who are at a senior level and

6:55

are able to work independently,

6:58

many of those junior level don't

6:58

need to consult with you about

7:01

their patients. And then I'll

7:01

see patients myself so as a, I

7:05

guess, consultant, various departments have some days where I'm on the for seeing patients,

7:07

and I've other days where I'm

7:09

the consultant in charge, the

7:09

one thing I can maybe compare it

7:12

to is like being an air traffic

7:12

controller, at an airport, you

7:15

fly over 200 flights going in

7:15

and out today, and you can't get

7:18

out and fly all those planes or

7:18

land all those planes. But you

7:21

need someone who's who's has an

7:21

eye over the flow flow is a big

7:26

thing that we talked about

7:26

diversity departments because to

7:28

what our patients are coming in

7:28

tomorrow, guaranteed might be

7:31

180, might be 220. But they will

7:31

come tomorrow. So today's

7:35

patients how to be sorted and

7:35

have to be moved on have to be

7:37

either discharged or forwarded

7:37

to the care or cured or are told

7:42

there's nothing wrong with your

7:42

arm or whatever it is. So yeah,

7:46

that's roughly the size of it.

7:46

So some of it is kind of flow,

7:49

that sort of management. Then

7:49

when you're physically seeing

7:51

patients, you can be seeing

7:51

anything from somebody stubbed

7:54

their toe to somebody who has

7:54

any kind of massively complex

7:58

trauma and you're doing very

7:58

complex procedures on them. In

8:02

everything in between.

8:04

Catherine, let's focus a

8:04

bit on the event that ultimately

8:07

led to you and John coming into

8:07

contact. Take us back to what

8:10

happened with your dad.

8:12

My dad, Tim Fleming

8:12

youth was a lovely, lovely man.

8:16

He was 69 years young. He was a

8:16

husband father. He was a

8:19

grandfather. Hugely engaged,

8:19

very active in life. I grew up

8:23

in Ireland, he moved to London

8:23

in the 60s, where he met my mum,

8:27

an Irish couple met in London,

8:27

and settled in London. So dad

8:31

was living in London, but he was

8:31

on a short trip to Dublin. So it

8:36

was a three day trip. It was on

8:36

the morning that he was due to

8:40

fly home, I had received a call

8:40

from a doctor from Dublin's

8:44

largest a&e department. It was

8:44

6am in the morning, so it was

8:48

quite unusual time to receive a

8:48

call as well. And it was

8:51

explained to me that my dad was

8:51

very unwell, that he was

8:55

suffering from either

8:55

indigestion or something that

8:59

was called an aortic dissection.

8:59

So I had never really heard of

9:03

that condition before. And that

9:03

made me uncomfortable in itself.

9:07

I had lots and lots of

9:07

questions. And the doctor

9:10

explained to me the role of the

9:10

aorta, and the body now has a

9:14

very important role. It brings

9:14

blood around to all of the major

9:18

organs, and that when a

9:18

dissection happens, it's when

9:22

there's a tear in the aorta. And

9:22

that's kind of as far as the

9:26

description went at that point.

9:26

And I had lots of questions

9:30

around, I suppose the

9:30

seriousness of the condition. So

9:33

what kind of danger might that

9:33

be in? Is it something that

9:37

could be treated? The

9:37

information at that point was

9:41

was pretty light. It was

9:41

explained that there was more

9:44

investigations that were to take

9:44

place and that he'd call me back

9:49

in a few hours. So he explained

9:49

they needed to do to CT scan, I

9:53

asked, Could I talk to my dad.

9:53

And sadly, that was declined.

9:57

The doctor explained that dad

9:57

had been administered with a lot

10:01

of morphine. And so he may not

10:01

either be able to understand

10:05

what I was saying or wouldn't be

10:05

able to communicate back to me.

10:09

And I think at that point, for

10:09

me, I knew it was something

10:13

very, very serious. And I

10:13

remember saying, I don't think

10:17

it is indigestion that my dad

10:17

has, I think it must be that

10:20

other thing, that aortic thing

10:20

that you mentioned. But he

10:24

reassured me that they needed to

10:24

go off and do their

10:28

investigations, he was very

10:28

clear and not upsetting my

10:31

mother, have not not putting the

10:31

family into any kind of

10:35

distress. So he would call back

10:35

in a few hours, I advised I was

10:39

going to book a flight to

10:39

Dublin, given that dad was due

10:43

to come back that evening, I

10:43

thought, if it's something like

10:47

indigestion, like I'd be sitting

10:47

on the plane, take him back home

10:51

to London, if it's something

10:51

more serious than absolutely, a

10:55

family member should be with

10:55

dad. So kind of went against his

10:59

advice, he was saying there was

10:59

no need at that stage. And

11:03

conversation was kind of left

11:03

there, I found around the

11:07

family. And clearly everyone was

11:07

quite shocked. Dad was a very,

11:11

very healthy man. And then it

11:11

was a few hours later, I

11:14

received another call from the

11:14

same doctor. And it was clear

11:18

that he was really distressed.

11:18

And he said, you know, things

11:22

are looking pretty serious. Your

11:22

dad has had an aortic

11:26

dissection, which has ruptured,

11:26

but we've managed to resuscitate

11:30

him, he needs to be taken to

11:30

another hospital, and he

11:34

requires surgery, bring your

11:34

mother to Dublin, as soon as

11:37

possible, you're probably likely

11:37

to be staying in Dublin for a

11:42

while, surgery like this takes a

11:42

long time to recover. So kind of

11:46

pack your bags and make your way

11:46

over. I had received a call in

11:50

between those two calls from

11:50

somebody who had been travelling

11:54

with my dad as well. And they

11:54

had explained that dad had in

11:58

fact been taken to a&e the

11:58

previous day. So he had been

12:02

discharged at 2am in the morning

12:02

with a diagnosis of indigestion.

12:06

And I think the test on whether

12:06

he could whether he should go

12:10

home was whether he could

12:10

tolerate tea and toast, which he

12:14

did. And he went back to his

12:14

hotel. But clearly things didn't

12:18

settle. And he came back to the

12:18

hospital. And that's when we got

12:22

the call at six to say that

12:22

things clearly need to be

12:26

investigated further. So

12:26

immediately, I was kind of,

12:29

well, I suppose more than upset

12:29

by hadn't heard this information

12:33

up front in that dad had had

12:33

previous admission. And I had

12:37

lots of questions about how her

12:37

dad been discharged. What were

12:41

the tests that were done at the

12:41

point of discharge? So I was

12:45

really highly emotional, very,

12:45

very worried. What are his

12:49

chances? And the response was,

12:49

you know, your dad's really

12:53

sick, man, you need to get to

12:53

Dublin as soon as possible. You

12:57

need to bring your mother with

12:57

you. Here's the switchboard

13:01

number of the hospital that your

13:01

father's going to that was a bit

13:05

of a trigger for me, I was

13:05

thinking we're just going to get

13:09

lost in the system. How am I

13:09

going to stay connected, I'm

13:13

going to be on a flight. So it

13:13

was very, very distressing. But

13:17

nonetheless phoned round my

13:17

family spoke to my brother and

13:21

asked to bring them on to the

13:21

airport that would meet at

13:24

Gatwick. And we need to make our

13:24

way to Dublin because things

13:29

were looking pretty serious. No

13:29

one in the family knew what an

13:33

aortic dissection was, I met my

13:33

brother and my mum at the

13:36

airport, and we were sitting,

13:36

having a coffee before we

13:40

entered into the departures

13:40

lounge, just trying to get our

13:44

head around what was going on.

13:44

So I was kind of sitting quite

13:48

calmly and just trying to

13:48

explain to my brother and an

13:52

equally to my mum that things

13:52

are pretty serious that it was a

13:56

big operation. I remember my

13:56

brother, he had it in his head,

14:00

and I suppose I kind of had in

14:00

my head. There's no way this is

14:04

Dad's moment to die. You know,

14:04

he was so healthy, so fit. And

14:08

as we were having this

14:08

discussion, my mobile rang and

14:11

it was an Irish number. And to

14:11

me, I kind of thought there's

14:15

only one place that can be

14:15

calling right now. But it's

14:19

really the wrong time for the

14:19

call. We hadn't arrived in

14:23

Dublin, the surgery wouldn't

14:23

have been completed. I knew it

14:27

was too soon to receive any kind

14:27

of call. So I kind of stepped

14:31

away. And it was a call from

14:31

somebody who travelled with my

14:35

father and told me that my dad

14:35

didn't make it and my dad had

14:39

had died. Which was Yeah, just a

14:39

real I don't know, shock isn't

14:43

the word. It was just real

14:43

disbelief. It was like an out of

14:47

body experience. And I'm just

14:47

kind of about to end the call

14:51

and is there anybody there from

14:51

the hospital who I can just talk

14:55

to to try and understand like

14:55

what's actually happened and

14:59

there was so a lady came to the

14:59

phone and in her words she said

15:03

you know, your your dad lied on

15:03

the table. You need to get to

15:07

Dublin as soon as possible. You

15:07

need to come to Ireland and

15:11

identify his body. So we were

15:11

you know, we were kind of From

15:15

her perspective, kicking into a

15:15

bit of a process, and it was

15:19

just very, very difficult to

15:19

hear and didn't feel real, it

15:23

was probably the hardest

15:23

conversation I've ever had have

15:26

with my mom and my brother. And

15:26

sharing the news with my

15:30

siblings as well. And yeah, just

15:30

trying to take that journey

15:34

making I'm just trying to do

15:34

simple things like getting

15:38

through the departures, I

15:38

couldn't, I couldn't get

15:41

anything to work, I just lost

15:41

all ability to physically

15:45

function and to think properly.

15:45

And my mom couldn't really take

15:49

in the news at all, like, it

15:49

just was not making any sense to

15:53

her. It was just, I mean, her

15:53

shock I could recognise was

15:57

beyond mine, her ability to

15:57

function was really lost. And,

16:00

straightaway kind of confused as

16:00

to what we were doing and why we

16:05

were going to Dublin, but we

16:05

made our way. And we've been met

16:09

at the airport by some family

16:09

members. So we've got lots of

16:13

relations in Ireland, and a

16:13

couple of the gentleman who had

16:17

been travelling Out With Dad and

16:17

dad's belongings were being

16:21

handed over dad's wedding ring.

16:21

And I was also given a

16:24

Dictaphone that was in a meeting

16:24

when he became unwell. So

16:28

everything that kind of unfolded

16:28

there had been recorded. The

16:32

gentleman was saying, you know,

16:32

very important hold on to this.

16:36

So we travelled on to the

16:36

hospital, to see dad, and

16:40

everything felt like it was

16:40

pretty unreal. When we arrived

16:43

at the hospital, they had had an

16:43

outbreak of flu. So this was way

16:48

before COVID times, this was

16:48

February 2015. And so the

16:51

hospital was on lockdown. And

16:51

there's, you know, all of the

16:55

high veers everything. And the

16:55

we were very used to seeing in

16:59

COVID. But it for me, it was

16:59

like something out of a movie.

17:03

Very, very strange. But there

17:03

was a nurse waiting in the foyer

17:07

in the lobby, and she was

17:07

expecting us. So she kind of you

17:11

know, walked us through. But

17:11

before we walked into the room

17:15

kind of held the nurses hand,

17:15

and I said just when we walk

17:19

around the store, is that just

17:19

going to be there? But what are

17:23

we going to see? Does dad look

17:23

like his sleeping? Like, what

17:27

what should we be getting ready

17:27

to, to expect? She said on all

17:31

my years of nursing, she said,

17:31

I've never I've never seen a

17:35

corpse like this. And I

17:35

immediately stopped her before

17:39

she went any further and, you

17:39

know, just said this is my mom's

17:43

husband of over 40 years, it's

17:43

my dad, you know, he's a person

17:47

smaller, it's not a corpse. And

17:47

just every moment made

17:50

everything so much harder,

17:50

though, there wasn't kind of

17:54

any, like empathy coming from

17:54

the team who were, I suppose,

17:58

guiding us through that process.

17:58

And that was really hard. I

18:02

remembers talking to mum, just

18:02

saying, Look, you know, you

18:06

don't need to do this, I can go

18:06

in and formally identify dad,

18:10

and maybe it's better for you to

18:10

remember, you know, dad in life

18:14

rather than dad in in death. And

18:14

mom's mothering instincts really

18:18

kicked in then she was like, you

18:18

know, well, maybe that's

18:22

something that you shouldn't be

18:22

exposed to. She said, I'm happy

18:26

to, to do that. And I said,

18:26

Okay, well, let's do it

18:30

together, then. And we'll

18:30

support each other and, and so

18:34

we went through, and it was

18:34

really hard, you know, Dad was

18:37

still warm, you know, wanted to

18:37

touch him, and I could still

18:41

smell dad's in his hair. But he

18:41

was very much, you know, he had

18:46

all of the medical kind of

18:46

equipment still there, it

18:49

couldn't be removed, because of

18:49

the suddenness of his death or

18:53

need to be investigated with

18:53

regards to a post mortem. So he

18:57

kind of remained untouched from

18:57

the surgery. And we were waiting

19:01

for a while for the Garda which

19:01

is the police to come and do the

19:06

formality identifying dad. So we

19:06

spent a lot of time which in a

19:10

strange way, I don't know

19:10

whether it was comforting or

19:13

not. But it made everything of

19:13

course very real. I think up

19:17

until that point, all those

19:17

hours, everything just felt so

19:21

surreal. And so not how you

19:21

would met Imagine getting the

19:25

news of losing a loved one

19:25

someone being so well then

19:28

having that news and then all of

19:28

the all of the events of that

19:32

day just were never how I would

19:32

imagine an experience of a loss.

19:37

So having that time with dad and

19:37

I suppose allowing that reality

19:41

to kind of kick in. I don't know

19:41

whether it helped a bit but I

19:45

felt like I needed to be there.

19:45

I didn't feel like I wanted to

19:49

to leave or to be anywhere else.

19:49

That surgeon came in, explained

19:53

a little about the condition. I

19:53

know he was really trying to

19:57

reassure me and it's always

19:57

stuck with me give a saying you

20:01

know at some point in time

20:01

Catherine, he said you will take

20:05

comfort that your dad passed

20:05

away like this because the

20:09

condition He arrived to surgery

20:09

was not the best, which meant

20:13

that his outcome had he

20:13

survived, probably wouldn't have

20:17

looked so good. He was certain

20:17

that dad would have had suffered

20:21

a stroke. And he thought it was

20:21

a very high chance that dad

20:25

would have been left paraplegic,

20:25

which of course, I don't think

20:29

that dad would have enjoyed or

20:29

coped well, with a life like

20:33

that after that illness. But it

20:33

did trigger a series of

20:36

questions for me immediately

20:36

around the condition that dad

20:40

arrived in to surgery. Because I

20:40

was made aware earlier that

20:44

morning, that dad was in the day

20:44

before that he had been

20:48

discharged, he'd come back. And

20:48

so a lot of time was lost. I

20:52

just wanted to understand a bit

20:52

more about the condition in that

20:56

if Dad had arrived sooner, and

20:56

if the diagnosis had been made,

21:00

and transferred, being made, and

21:00

he'd had a perfect pathway, what

21:05

would have happened, then? Would

21:05

we be having this conversation?

21:09

You know, I explained to him was

21:09

like, my dad's such a fit and

21:13

healthy man. And if you were in

21:13

my shoes, you'd be asking

21:17

questions to all I'm trying to

21:17

do is to get information and

21:21

just understand how this has

21:21

happened. And could things have

21:25

been different. And then later

21:25

that night, gardener came along,

21:29

and we went through the process

21:29

of formal identification. And he

21:33

explained that there would be an

21:33

inquest, just to do with the

21:37

timing of dad's passing, that he

21:37

was in hospital for such a short

21:41

period of time, that the coroner

21:41

would want to understand what

21:46

had happened. And for me, I

21:46

thought, well, at least there is

21:49

a place for, you know, the

21:49

questions to be answered. And

21:53

maybe now isn't the right time

21:53

to try and understand all of

21:57

that. I found it very hard to

21:57

leave dad that night. And in

22:01

fact, it was probably the early

22:01

hours of the morning. And we

22:05

went and stayed with my cousin.

22:05

Sadly, for months, we found out

22:09

you know, months down the line,

22:09

it triggered an accelerated

22:13

onset for outside months, which

22:13

months still lives with today.

22:17

So the whole experience was just

22:17

hugely shocking and catastrophic

22:21

for mum, she's my superhero,

22:21

really, you know, she's so

22:25

strong. With her child, you can

22:25

watch his lift with since then.

22:29

So yeah, it was a very, very

22:29

difficult time. We had lots of

22:33

questions for the emergency

22:33

department. And my sister met

22:37

with the team. And they had a

22:37

long meeting, and it was

22:41

explained that aortic dissection

22:41

was a hopeless condition was

22:45

really the way that they

22:45

explained it to us, in that

22:48

people just don't get diagnosed.

22:48

And if you get diagnosed, you

22:52

don't have great outcomes. And,

22:52

you know, really, you should see

22:56

it, you know, along the lines,

22:56

that it was really your dad's

23:00

fate. And that was, it was hard

23:00

to hear. And we felt there was a

23:05

lot of unanswered questions in

23:05

those very, very early days, the

23:09

day after dad's funeral, dad's

23:09

sister suffered an aortic

23:13

dissection. So we failed to tell

23:13

the emergency team what had just

23:17

happened to her brother, and

23:17

that he had lost his life, but a

23:21

fair play to them. They

23:21

suspected that's what was

23:24

happening. And she had a CT

23:24

scan, and her dissection was

23:28

diagnosed, and she had her

23:28

emergency set surgery, which

23:32

saved her life. But you know,

23:32

her life was never, never the

23:35

same again. And, for me, that

23:35

was a real moment of awareness,

23:39

I suppose, in that aortic

23:39

dissection cannot be a hopeless

23:43

condition. How did this happen?

23:43

So really opened a lot more

23:47

questions for us. And we

23:47

understood that aortic

23:50

dissection is a condition that

23:50

can be detected, it can be

23:54

treated, and that people can

23:54

survive it. And for me, that,

23:58

and my family, you know, that

23:58

that really changed everything.

24:02

My dad was always a campaigner

24:02

in his life, and he had been

24:06

sharing with my older sister,

24:06

those changed org campaigns. And

24:10

so we decided that would be, I

24:10

suppose a bit of a vehicle to

24:14

share what had happened, and to

24:14

call for change, we knew that it

24:18

was a condition that could be

24:18

detected and treated. And we

24:22

started a petition that we were

24:22

hoping would go viral. And we

24:26

would be able to make a case for

24:26

change to the Secretary of State

24:30

for Health in the UK and equally

24:30

for the HSE in Ireland. It

24:34

didn't go viral. We in the

24:34

campaign is still live now. And

24:38

it has 10,000 signatures, people

24:38

who are living with a condition

24:42

and and families like ours who

24:42

have lost a loved one and I

24:46

suppose that was kind of, I

24:46

suppose our first kind of step

24:50

into trying to amplify the voice

24:50

of others. And I suppose an act

24:54

I don't know how active the

24:54

decision was at that point. But

24:58

really trying to You've

24:58

harnessed pain and grief and put

25:02

it in a place into something

25:02

that could be more positive, and

25:06

to try and drive to try and

25:06

drive change.

25:09

John, listening to all of

25:09

that, because in your work,

25:13

you've mentioned numbers of how

25:13

many people you see through the

25:15

emergency department. You know,

25:15

for many years, you'll have

25:19

dealt with many individuals

25:19

without knowing all of the

25:22

stories, the family setups, all

25:22

the background, the before the

25:25

during the after. What's it like

25:25

listening to Catherine talk, and

25:28

just getting all of that colour

25:28

all of that context?

25:31

Yeah, I mean, it's quite

25:31

emotional. And you're hearing

25:35

that personal side of it. Yeah,

25:35

definitely. Home. And I've heard

25:39

Catherine talk before been at a

25:39

few conferences. So I've heard

25:45

heard the story that maybe

25:45

you've added more personal

25:49

detail there. I think I said,

25:49

when you're working in emergency

25:53

departments, and you feel a

25:53

couple 100 patients coming in a

25:55

day, particularly if you're in

25:55

charge, you need that flow, you

25:57

need to go through it because

25:57

the appropriate places and your

26:01

mind is very much on safety and

26:01

making sure you're not missing

26:04

things. And sometimes you can

26:04

lose that personal touch. When

26:07

you're, you're when you have the

26:07

bird's eye view like that. Now,

26:12

when you workmanship, nursing

26:12

individual patients, you always

26:14

try to use try to make that a

26:14

personal bond with them. But if

26:20

you united clinical shift, the

26:20

last two days, I was working

26:23

with voi, yesterday, and the day

26:23

before us, if you asked me to

26:25

describe each patient and where

26:25

they're from, that I saw, or

26:28

even to recall all of them, I'd

26:28

struggle. But if I asked you,

26:32

when when were you last in an

26:32

emergency department, you

26:35

remember, I remember when I was an emergency problem for another 10 or whatever. So when you go

26:37

to emergency participation,

26:40

suffering a bit of an index

26:40

event in your life, even if you

26:43

just sprained ankle, you always

26:43

remember us and you'll probably

26:45

remember the doctrine, the

26:45

passions. I was the guy or girl

26:49

I saw in the hospital. But you

26:49

have someone who I saw yesterday

26:53

could walk past me and I

26:53

wouldn't remember them. So when

26:57

you're kind of dealing with that

26:57

fine when you do them day by

26:59

day, it just becomes part of

26:59

your job. But then, you know,

27:04

there are one or two patients

27:04

that you see during your career

27:08

or during every maybe six months

27:08

or a year that really kind of

27:11

stay with you and certainly

27:11

catheter story. And Tim story

27:14

was one that definitely stayed

27:14

with me.

27:17

Tell us what your what

27:17

it was like on the other side of

27:20

that story then because obviously you're on the other side. Catherine's looking for

27:21

questions, you probably know

27:24

some of the answers. What was

27:24

your experience of that day in

27:26

that shift?

27:27

So yeah, I was a senior I

27:27

was what you call an SPR so

27:30

specialist registrar. So it was

27:30

kind of on the, I guess maybe

27:33

the final furlong of my training

27:33

to becoming fully qualified a

27:36

mercy physician, I'd take up a

27:36

consultant post later that year,

27:40

and a different hospital. But I

27:40

was working in that hospital in

27:43

the final year of my training.

27:43

So let's say it was kind of

27:46

February 2015. I also had my

27:46

kind of final exams around that

27:49

time of year. So it's very kind

27:49

of busy time for me. And it was

27:53

it was a busy hospital and very

27:53

busy department. That particular

27:57

day I was working in evening

27:57

shifts, which end of day,

27:59

evening and night shifts, I was

27:59

working in the evenings shift.

28:01

So it's kind of 4pm Till, till

28:01

midnight. And when you were 14

28:05

midnight, you're ready to go out

28:05

at midnight, you know, the one

28:07

or two in the morning you'd be

28:07

kind of getting home and then

28:09

trying to relax and try and at

28:09

some stage to get some sleep and

28:12

get ready for the next day. And

28:12

the evening shifts often tends

28:15

to be the most busy time because

28:15

people the people presenting all

28:18

during the day, we're in the

28:18

department getting the best to

28:21

get to get treatment. And then

28:21

there's kind of a busy time

28:23

during the evening when patients

28:23

tend to come in. So the big

28:27

volume of people coming through.

28:27

Also that particular department

28:31

and most many many merge

28:31

departments are very

28:33

overcrowded. So all your base to

28:33

see patients will be full. And

28:37

there are patients out in the corridors some patients who had missing waiting for a bed for

28:39

hours or sometimes even days

28:42

where they're in the corridor.

28:42

So it very much crunched your

28:45

working conditions. We're also

28:45

adding short staff but I say

28:49

that we were chronically short

28:49

staffed. So there was the

28:53

registrar on the four to

28:53

midnight shift they'll always be

28:56

to register there was another registrar on the 14th midnight shift the other registrar was

28:58

less experienced to say we were

29:01

short staffed so he was a locum

29:01

so maybe wasn't as familiar with

29:04

the place wasn't as far along in

29:04

his training as I was so

29:08

definitely was the more senior

29:08

person but nevertheless, he was

29:11

he was a registrar but sometimes

29:11

I need to as well as keeping an

29:13

eye on the juniors and seeing my

29:13

own seeing my own patients and

29:17

sorting out my own patients or

29:17

being behind the juniors and

29:20

aware that maybe the person who

29:20

was on with maybe wouldn't be as

29:27

quick or experienced as capable

29:27

as me so I guess you want to put

29:32

it that it is a fairly stressed

29:32

working environment. But it's

29:37

kind of chronically like that so

29:37

you could get used to to that

29:41

kind of chronic stress and

29:41

shortage of space and resources.

29:49

And remember work in that

29:49

particular evening in in in any

29:53

emergency department you have

29:53

resuscitation area where the

29:56

sickest patients go and in that

29:56

heart and that farm there or six

30:00

resource base. So those are the

30:00

sickest patients would be the

30:04

new majors cubicles and the

30:04

miners cubicles where, you know,

30:07

the the other piece patients I

30:07

will be but the resuscitation

30:13

basically what were the sick

30:13

sickest ones would be. And

30:15

remember, five of the five of

30:15

the six resuscitation bays were

30:18

under me is always going to,

30:18

there are different stages of

30:20

being sorted out either you're

30:20

being treated and referred out

30:23

to other teams and that sort of

30:23

stuff. And I was also trying to

30:27

keep an eye on the general flow

30:27

of the department, I was aware

30:31

that there was a gentleman there

30:31

with, with chest pain, who one

30:34

of my other colleagues who's on

30:34

the J shift Woods had seen

30:36

initially, and had handed over

30:36

to my colleague, you know, often

30:41

when you're finishing your

30:41

shift, you'd be nice of all your

30:44

patients are sorted. But often

30:44

as you're when you're in an

30:47

emergency department, and you're

30:47

waiting on blood tests, or X

30:50

rays or whatever or treatment,

30:50

you know, there comes a time

30:54

when the handed over to a

30:54

colleague in the emergency

30:56

department or refer the patient

30:56

on to a specialist team or

30:59

whatever. So your he he Tim was

30:59

being seen by a colleague who

31:07

then handed his care over with a

31:07

plan to the other registrar who

31:13

was on the phone for some a nice

31:13

shift. So as I was aware, you

31:17

can certainly in hindsight,

31:17

after everything that happened,

31:19

I remember being aware that that

31:19

patient was there. So I was

31:26

quite busy and and when you get

31:26

to the last hour of your shift,

31:29

you start realising Okay, I need

31:29

to start wrapping things up

31:31

here, I'm not the person on the go, I need to sort these patients out, I need to make

31:33

sure when I hand over to the

31:36

people coming on nights that I'm handing off something reasonable, and that I've either

31:38

discharged my patients or I have

31:41

to plan for all of them sort of

31:41

thing. So I was I was doing all

31:44

that. And I remember actually

31:44

one there was one particular

31:46

young patient who was in who had

31:46

your kind of family had a number

31:54

of questions about their care

31:54

and their were well enough to go

31:56

home and found rock concert. And

31:56

the last trying to deal with

31:59

that that was kind of stressful.

31:59

So that does get them stuck the

32:02

big ticket item on my head that

32:02

evening and need to sort out

32:05

this young person and speak to

32:05

their family and get everybody

32:08

on the same page and and get

32:08

them discharged rather than

32:11

pulling them over needlessly to

32:11

age on ice from for nothing. And

32:15

so that so that was I

32:15

specifically remember that being

32:19

a thing I had to sort out as

32:19

well as the other sick patients

32:21

and resource. And then on stage wasn't the

32:24

last hour of my shift. I

32:27

remember walking past and this

32:27

gentleman, Tim, as it turned out

32:30

was not looking right and was

32:30

having quite bad pain at that

32:34

stage having been fine. Your for

32:34

a period earlier. And that's the

32:37

nature of aortic dissection. It

32:37

goes absolutely severe pain, the

32:41

worst pain ever. But as the tear

32:41

stops tearing patient, it's

32:45

better to be sitting up reading

32:45

the paper. If it starts tearing,

32:48

again, severe pain comes back.

32:48

And that's actually a classic

32:52

sign that you can get with the

32:52

with the aortic dissection. And

32:55

I was also aware, I told you

32:55

about flow and emergency

32:58

departments because there are

32:58

always more patients coming

33:02

through you need a plan. And you

33:02

can't just leave someone

33:05

wallowing in an emergency

33:05

department you need a pond or

33:08

the water to go where they need

33:08

or the threat of specialist

33:11

care. Who knows where this

33:11

patient already been handover

33:15

from will not the doctor. So we

33:15

need to come up with a plan. So

33:18

I've just done obviously not to

33:18

get involved or to not be

33:21

picking up more patients.

33:21

Because when you come towards

33:25

the end of your shift, you start

33:25

picking up more patients, you're

33:28

not going to get them sorted or

33:28

you have to hand them off to

33:32

someone else. But nevertheless,

33:32

if there's a time credit, their

33:35

mercy be there you need to help.

33:35

Remember walking past and asking

33:39

my colleague I was kind of

33:39

what's the plan, it was clear

33:42

that there wasn't a very clear

33:42

working diagnosis, when you see

33:46

someone you need to come up with

33:46

what we call a differential

33:49

diagnosis. This could be one of

33:49

these three things, one, this,

33:53

this or this, or maybe it's just

33:53

this or maybe we want to five

33:56

things and we need to do all

33:56

these investigations to figure

34:00

that figure it out. So you need

34:00

to work with your differential

34:03

diagnosis. And then based on

34:03

that you you come up with a plan

34:07

as to why you're going to do

34:07

again, it is easier seeing this

34:10

something in hindsight, but we

34:10

weren't sure what's going on. I

34:14

knew we needed a plan. And I

34:14

remember part of me didn't want

34:17

to be involved because I had my

34:17

own head spinning. But there's

34:21

clearly no plan here I need to

34:21

stick my head in. And so I did.

34:24

And I remember speaking with him

34:24

prepare, I'm just going over the

34:28

history and stuff and having a

34:28

look at the various things, I

34:31

think the blood tests and the X

34:31

rays. And you're there, there

34:35

wasn't too much to find on an

34:35

examination. And there wasn't

34:38

too much to find on the blood

34:38

tests or the X ray, which again

34:42

is typical of aortic dissection.

34:42

But it is there's something

34:45

going on here I thought of a few

34:45

things going on, one of which

34:49

was in the organisation couldn't

34:49

be this, but then I thought

34:52

actually, it's more likely to be

34:52

something else that got the

34:56

schema got which has some

34:56

crossover that again, you're

34:59

losing blood supply to the gods

34:59

just of where his pain was at

35:02

that stage, which was known as

35:02

Tommy, when he had come in first

35:06

one my colleague had seen was in

35:06

his chest again, that's a

35:09

classic thing with dissection

35:09

can start in the chest and

35:12

travel down. I'm gonna stick him

35:12

in the spirit and there must be

35:16

a problem with the blood supply

35:16

to the Gulf here. We need

35:19

surgical specialists to come in

35:19

and see This man and orderlies

35:23

scans at the time and the

35:23

hospitals slightly difficult for

35:26

us in emergency to get

35:26

specialist scans or CTS stuff

35:29

beyond X rays, our colleagues

35:29

were quite keen that it was a

35:33

specialist who ordered them, I

35:33

think they were maybe have the

35:36

impression that, you know, if we

35:36

were ordering them that we'd be

35:40

ordering it on and on every

35:40

single patient. I guess that was

35:43

kind of the culture, you're in

35:43

the place, which maybe you kind

35:47

of rubbed off on our decisions.

35:47

Anyway, I said to my colleagues

35:50

in the assertion down here to

35:50

see this, this person does

35:53

demand supply needs to happen

35:53

with different strong

35:56

painkillers because he or she

35:56

probably needs some imaging,

36:00

make that happen sort of thing.

36:00

So I go back fix one boiler bits

36:03

and pieces, I was talking to

36:03

another family, etc. It came

36:07

towards the end of my shift

36:07

again was well after being at

36:10

the station, I spoke to the guy

36:10

who was on nights and I told him

36:14

I don't my patients when he

36:14

didn't handover, but control the

36:17

nurse in charge. And I might

36:17

have two guys on ISIS by the

36:20

small chap over there. My

36:20

colleague is referring to

36:23

surgeons don't ever need to come

36:23

down see him when he just got

36:27

done. That's why I'm leaving. I

36:27

do actually remember late that

36:30

night and they can go to this.

36:30

They're lucky I'm here sorting

36:34

everything out. You know,

36:34

they're not quite I'm not I'm

36:37

not an arrogant person from far

36:37

more among each other Elba Just

36:41

one second, you know, sort of

36:41

this good, you know, walk out of

36:44

the place. And my colleague

36:44

Corbin on English. If I'd asked

36:47

him in the time since I was

36:47

talking to him, maybe 10 An hour

36:51

half an hour ago. Did you get

36:51

hold of surgeons? He was like,

36:54

Yeah, I can see is it Yeah, it

36:54

was a grace, you know, we are

36:58

planned for everybody on the

36:58

way. So yeah, that kind of

37:01

describes the end of an average

37:01

shift. Really. The next morning,

37:05

I was in with a teaching

37:05

session. And I was in and we

37:08

were kind of sitting around

37:08

talking the teacher session

37:11

where they're kind of

37:11

registrar's pencils, and the

37:14

different doctors, we all kind

37:14

of get together. And usually the

37:17

people are giving a presentation

37:17

on the topic of the week or

37:21

whatever. And before we're kind

37:21

of sitting around there talking

37:24

to them, we're talking about a

37:24

patient who's come in during the

37:28

mice who had to be transferred

37:28

out all of a sudden, and I was

37:31

really paying too much

37:31

attention. You know, people

37:34

always talk about whatever

37:34

interesting case had been in the

37:38

previous day or the previous

37:38

week, or whenever they're

37:41

talking about words or

37:41

channelling sounds like, the man

37:44

is formed by her come on

37:44

Thursday. Oh, he came in June.

37:47

And I was like, no, he's injured

37:47

the day yesterday, I was like,

37:51

you know, just wasn't making

37:51

sense. But there's as like,

37:54

maybe it's somebody else more

37:54

than chocolate. I was like, No,

37:57

hang on a sec. And so I started

37:57

asking questions and it turns

38:01

out he was sort of did come to

38:01

see him at later stage probably

38:04

during those phases where the

38:04

pain at ease and gone away and

38:08

had sent him home with you know,

38:08

in hindsight, a proper diagnosis

38:12

then you came back in during the

38:12

ice and as obviously things have

38:15

progressed and is obviously far

38:15

more unwell. And then obviously

38:19

when he came back into the night

38:19

there was obviously another

38:22

episode of care and he has been

38:22

seen by different doctors and

38:26

getting the scan and then

38:26

needing to transfer it out

38:29

ourselves where they're doing

38:29

all that part of his care by

38:32

serving Angelica I didn't

38:32

remember how she gets at home

38:35

okay, I just remember thinking

38:35

about you know, and so I said I

38:39

said to my boss, I was I just

38:39

you know, I did swing by and he

38:42

wasn't my patient he wasn't on

38:42

my list of agents My name wasn't

38:46

actually against him you know,

38:46

we have ID systems in the barn.

38:50

So if you actually go in I

38:50

remember watching er before

38:53

those big whiteboard patients as

38:53

we have progressed to more IT

38:56

systems so your name would be

38:56

against the patient in your

38:59

notes would be written in there

38:59

or whatever. But my name wasn't

39:03

against him because it swung by

39:03

to give kind of senior opinion

39:07

if you like, and I took my

39:07

muscles so then I didn't feel

39:10

quite right with Da Vinci said

39:10

look, shoot shoot me an email

39:13

she was gonna go onto the for

39:13

shoot me an email right in the

39:17

middle and sort of thing so I

39:17

did that. And at that stage that

39:20

was kind of it from that point

39:20

of view. I you know, back to my

39:24

other colleague good banana said

39:24

did you get surgeons from 97

39:27

chromaticity Did you know when

39:27

high tide was a more junior

39:31

surgeon that he'd called you

39:31

know, so on in the nurses were

39:34

very upset, who had been on you

39:34

know, they're they're kind of

39:37

very upset and Lucan angry about

39:37

us and, but really, that was

39:41

kind of ish, at that stage. And

39:41

for us as healthcare providers,

39:45

that's not a it's not a nice way

39:45

to end because you know, there's

39:48

a process that's going to happen

39:48

now. There's going to be

39:52

questions asked, it's going to

39:52

be statements and so we have a

39:55

kind of Catherine moves to a

39:55

kind of coroner's inquest, where

39:59

or any death in hospitals report

39:59

to the coroner. Sometimes

40:02

they're explained death people

40:02

die in hospitals by the nature

40:05

of people who are unwell, they

40:05

come to hospital and stuff, and

40:09

sometimes it's very clearly

40:09

explained Death and everything

40:12

probably was done. But in cases

40:12

where it's unexplained or it's

40:16

very sudden and or there was

40:16

delay or some of the sent home

40:19

goes back in and the home dies,

40:19

the coroner's will do,

40:22

obviously, there'll be an

40:22

autopsy and the coroner's will

40:25

will have an inquest. That

40:25

process could take a very long

40:29

time. So Tim's inquest was 18

40:29

months or later, under that

40:32

time, then you're asked for

40:32

statements and you're asked for

40:35

your the taken and you're taken

40:35

on board what had happened, and

40:39

then you're aware that you're

40:39

gonna be going to the coroner's

40:42

inquest on, you're gonna be

40:42

facing the family who will be

40:46

there. The coroner's inquest is

40:46

it's not supposed to be

40:49

adversarial, let's say like a

40:49

courtroom. But nevertheless, it

40:52

is in a court, and people will

40:52

bring along their legal

40:55

representation, you will get

40:55

cross examine. So it is very

40:59

much a fear for doctors. And

40:59

that's very much defensive kind

41:02

of first sort of thing. But it's

41:02

not supposed to be adversarial,

41:06

it's just supposed to be kind of

41:06

fact finding, let's all together

41:10

come to a judgement maybe the

41:10

wrong word or a decision as to

41:13

what the cause was locked out

41:13

to. Here, but it can be a very,

41:16

very stressful sort of thing. So

41:16

because that took so long,

41:20

again, I was busy. So in terms

41:20

of my life, I got more done. I

41:23

kind of forgot about I remember,

41:23

upside away, and we kind of

41:27

discussed about it a good bit

41:27

afterwards. But you kind of go

41:30

on and busy exams, and it was

41:30

moving jobs or just getting a

41:34

consulting job sort of thing.

41:34

And, but eventually, you know,

41:37

you're going to get the email,

41:37

asking for your your statement,

41:41

and you get an email saying,

41:41

there's a date set for the

41:44

Coroner's Court, then you can

41:44

meet the team in advance of that

41:47

and legal people and becomes

41:47

very kind of stressful and kind

41:51

of all consuming. Yeah.

41:51

Sometimes when there's coroner's

41:54

inquest, it, it's okay that, you

41:54

know, it's, it's normal to, you

41:58

know, nothing bad has happened,

41:58

and everything was done

42:01

appropriately. And so not all

42:01

current requests are like that,

42:04

they can be fine, or they could

42:04

be a good experience for

42:07

everyone just to get clarity on

42:07

what happened, but we knew that

42:11

this would be a stressful

42:11

experience. So then that can

42:14

that can, that can be that can

42:14

weigh heavily on you.

42:18

Facing that kind of

42:18

loss through your job. That's

42:20

obviously something that you'd

42:20

have faced a few many times, I

42:24

don't know what the numbers

42:24

would be on that. How do you

42:27

process that and, and work

42:27

through that kind of loss when

42:31

it's sort of stay detached. But

42:31

like you said, you don't know

42:34

the history of all these people,

42:34

you're dealing with things in

42:36

the minute. So it's not like a

42:36

personal grief, where you know,

42:39

the whole story, you have to

42:39

move on to the next shift, the

42:42

next patient needs you quite

42:42

quickly. So are you taught how

42:45

to handle that? Or is that something you've had to learn for yourself?

42:49

That's probably in

42:49

college, you are taught

42:51

'breaking bad news'. So you're

42:51

taught how to break bad news to

42:55

someone and there is a way to do

42:55

things not to say that it seems

42:57

that you do have to say when

42:57

you're breaking bad news to

43:01

someone. So we are taught how to

43:01

give that bad news in a clear,

43:06

empathetic and clear way. That

43:06

is something even back when I

43:10

was in college, and I'm on about

43:10

20 years now. But there was some

43:13

there was even done back then.

43:13

I'd say there's more of an

43:16

awareness of it now. But only

43:16

when I qualified. No, there was

43:19

no worries. This is how you deal

43:19

with something obsession that

43:22

happens or something unexpected.

43:22

There wasn't there was none of

43:26

that. Your but people are more

43:26

aware of it. Now we do have

43:29

debriefs, you know, sometimes

43:29

it's where you try to get

43:33

together afterwards and discuss

43:33

what happens and then anyone can

43:38

talk about kind of how they're

43:38

feeling. So you're after a

43:41

challenging case or a different

43:41

case or very interesting case,

43:43

he may you'll have a teaching

43:43

session or learning session

43:46

about it afterwards. Okay. This is what the nature of this conditions is what the

43:48

investigations you should do this is you know, the things to

43:50

watch out for. But then you also

43:53

have the debrief of the

43:53

emotional debrief events set by

43:56

ashore, pretty stressed after

43:56

assertion thing. That's

44:00

something we're often not as

44:00

good at, you know, sometimes we

44:02

call them hush debriefs.

44:02

Initially, if you do it

44:04

straightaway after if there's

44:04

been a difficult resuscitation

44:07

or a difficult event, you know,

44:07

we have to do it before you do

44:11

straight away afterwards. One of

44:11

the reasons for that is because

44:15

it's often never the same team on when you're working in emergency department. There's a

44:16

number of different doctrines, there's a number of different

44:18

nurses, everyone's on the different shift rotation. So

44:20

there's different team though

44:22

you work together, I know all the nurse I work with, I know roughly all the doctors so even

44:24

though they rotate every six

44:26

months, and every three months, you get to know them fairly quickly. But there'll be

44:28

different combination people on

44:31

every shift. So if there's six

44:31

or seven new doctors, nurses

44:34

have been working on one

44:34

patient, the six or seven, you

44:36

may not be on a shift together

44:36

again, and then you call people

44:39

in from home and then I work in

44:39

to have a debrief. So after we

44:42

we tried to do an immediate

44:42

debrief, but then also that can

44:46

have its weaknesses because

44:46

people need time to process

44:49

particularly something bad

44:49

happened or if someone dies or

44:51

there is an unexpected death. I

44:51

mean in terms of dealing with us

44:55

as an emergency doctor because

44:55

often we see our patients for a

44:57

short very short period of time.

44:57

So off, but we do see death

45:02

regularly, unfortunately. Well,

45:02

those common ways we see it is

45:06

when someone has what we call an

45:06

out of hospital cardiac arrest.

45:09

So when they've collapsed out of

45:09

hospital, they've had a heart

45:12

attack or whatever the

45:12

paramedics are, are great. Now

45:15

they're experts or resuscitating

45:15

patients, and they'll bring the

45:19

patients to us with ongoing

45:19

resuscitation, will continue

45:22

resuscitation. And often you can

45:22

get patients back and you'll get

45:26

them to a cardiologist, if that's what they need, or whatever it is they need. But

45:28

with an out of hospital cardiac

45:30

arrest, actually, this five ratio is fairly low, particularly someone's head of

45:32

downtime if they haven't been

45:35

discovered, and someone hasn't

45:35

started CPR straightaway. So

45:38

we'd regularly see our ask her

45:38

address and address, which

45:41

often, and oftentimes you don't

45:41

get the patient back at all. And

45:44

then you've a family come in,

45:44

who you're breaking the news to,

45:49

I would say that's a routine part of our work, but it's something that you see very

45:51

regularly and need to ask, you

45:56

need to give that time, you

45:56

know, it was a break from the

45:59

news to the family and kind of

45:59

speaking with them. But from our

46:02

personal point of view, because that's something we see regularly it can be, what can be

46:04

more difficult to deal with is

46:07

when you have a patient who's in

46:07

under you, and you're seeing

46:10

them, they're talking away to

46:10

you and you're doing stuff with

46:12

them and maybe ordered tests or

46:12

you're also seeing other

46:15

patients and suddenly something

46:15

happens they take a turn or

46:19

become worse and and they have a

46:19

cardiac arrest. Because you

46:24

already been involved in their care, you've spoke to them, you've done some sort of rapport

46:25

with, and your if something

46:29

happens with them, and they they

46:29

die, that can be a harder one to

46:33

register a particular thing for

46:33

younger doctors. And then

46:37

they'll always be the thing or

46:37

clerked on some definitely could

46:39

have done something earlier. And

46:39

then almost no matter what

46:42

anyone says she still register

46:42

yourself on that. And it can

46:46

very much knock people's

46:46

confidence in the job.

46:49

So just tell us how you

46:49

met Catherine then because at

46:52

the moment, we've got, obviously

46:52

you involved in the case, but

46:55

sort of somewhat distant and

46:55

you've got Catherine on the

46:57

other side of it. So how did you

46:57

how did your paths actually cross?

47:00

Well, we didn't see each

47:00

other until the coroner's

47:04

inquest, there's... Catherine,

47:04

you probably heard from me in

47:08

terms of well, what are my

47:08

statement and stuff before I

47:11

heard from you,

47:12

It was through the

47:12

inquest that actually a lot more

47:15

information was revealed. And

47:15

there was only one person of all

47:19

of the statements that were

47:19

submitted through the process

47:23

that mentioned aortic

47:23

dissection, and that was very

47:26

out of step with the hospital's

47:26

original position. So the first

47:30

kind of statement that we came

47:30

across to say, actually, there

47:34

was someone in the room that

47:34

suspected this could have been

47:38

one of those differential

47:38

diagnosis. And that statement

47:42

came from a man called John

47:42

Cronin so that was the first

47:45

time I heard of John. His

47:45

statement gave me a huge amount

47:50

of hope that we had an

47:50

opportunity to learn. The first

47:53

time I met John, and a number of

47:53

the team from the hospital was

47:57

at the inquest itself, and the

47:57

outcome of the inquest was a

48:02

booting of medical misadventure.

48:02

So, the term negligence isn't a

48:07

term that's accepted or

48:07

recognised in Irish Coroner's

48:11

Court. And medical misadventure

48:11

means that it's an unintended

48:17

outcome from an intended action.

48:17

So basically, no one intends

48:22

harm. In essence, it was an act.

48:22

And there were a number of

48:26

recommendations that were made

48:26

from that inquest. But I had

48:29

learned that those

48:29

recommendations didn't need to

48:32

be taken forward. And for me,

48:32

that was a big catalyst to say,

48:35

okay, where this was something

48:35

that we'd put I put a lot of

48:39

energy into, and was really

48:39

disappointed to learn so late

48:42

into that process, that it

48:42

wasn't going to be a driver for

48:46

change. So started to really try

48:46

and work through what other

48:51

opportunities if that's the

48:51

right word, how else can we make

48:55

dad's life and his death count

48:55

for something and enact some

48:59

change within this hospital and

48:59

ideally, further afield as well.

49:04

So I started meeting with the

49:04

leadership team of the hospital,

49:07

but also started well through

49:07

invitation attending medical

49:11

conferences. So sharing my dad's

49:11

story and my aunt story and just

49:17

highlighting the issue around

49:17

aortic dissection, because what

49:20

happened in my family is

49:20

actually a reflection of what

49:23

happens in the UK and Ireland

49:23

every year. 4000 people have

49:27

this condition 2000 People die,

49:27

so half live, and a third of

49:32

that is down to misdiagnosis.

49:32

And so that was a real trigger

49:35

to do something about it. And it

49:35

was at one of these conferences

49:40

in Galway. I was looking at the

49:40

poster section of the

49:44

conference. And somebody had

49:44

done a study on the number of

49:50

diagnosed aortic dissections in

49:50

Dublin. And the author of this

49:55

research was a Dr. John Cronin.

49:55

So mine has just stood up on the

50:02

end. I was like, very emotional.

50:02

And I don't know how but I had

50:07

your I had your email address at

50:07

that point, John. And I remember

50:11

emailing you saying, I'm at this

50:11

conference, standing in front of

50:15

this poster, got a few

50:15

questions. Are you at this

50:18

conference? Is this your work?

50:18

And was this work inspired by

50:23

what happened to my father, and

50:23

John came back, say he wasn't at

50:27

the conference, but it was his

50:27

work. And it was inspired by

50:31

what had happened to dad that

50:31

night. And I quickly got back to

50:35

John to say, I'm actively

50:35

campaigning, I'm actively

50:38

wanting to work with hospitals

50:38

to work with the medical

50:42

community to try and drive

50:42

change. And I'm really pleased

50:45

that he is also doing the same

50:45

and that I would be open to

50:48

doing something together. And at

50:48

that point, I don't think we

50:51

really knew what that something

50:51

was. So we arranged to meet at

50:55

an awareness conference in

50:55

Liverpool. But it was quite a

50:59

foggy flight in, and I think you

50:59

were dropped off somewhere else

51:03

in the UK and had a coach

51:03

journey to make to Liverpool. So

51:07

we, we didn't meet that year.

51:07

And there was a, there was

51:11

another conference the following

51:11

year in London. And that's where

51:15

John and I, I suppose met in

51:15

person outside of any kind of

51:19

inquest, or, or formal setting.

51:19

My sister was with me too. And I

51:24

think we probably spent most of

51:24

the time crying, John, myself

51:27

and my sister, it was hugely,

51:27

hugely emotional. But we were

51:31

really inspired by a lot of what

51:31

we saw that day and saw that

51:34

there was an opportunity to take

51:34

some good practice back to

51:37

Dublin, and, you know, made a

51:37

commitment in the room that we

51:40

were going to do something

51:40

together. And then I think it

51:43

was the following year, another

51:43

meeting in Dublin, thank you,

51:47

we're late to the dinner for all

51:47

of the faculty speakers, there

51:50

was only one seat left in the

51:50

room, which was next to me. And,

51:55

you know, it was really nice to

51:55

just connect in a very different

51:59

setting, talk about our

51:59

experiences and share what we

52:03

what we might do together. But

52:03

it was the following evening, I

52:06

think I met your wife, and we

52:06

were wearing the same dress,

52:10

which was a bit of a moment. For

52:10

us both, she was so warm, and so

52:15

empathetic. And we both cried,

52:15

as well, actually, when we met,

52:19

and she was you know, so sorry

52:19

for what happened, you know,

52:22

very sorry for your loss and for

52:22

your family lost. And we were

52:25

talking a little bit and she

52:25

said something that really

52:28

changed my whole outlook. And

52:28

and in fact, the charity that we

52:32

formed how that charity has put

52:32

together, because she just asked

52:37

if I had thought about the

52:37

impact that it might have had on

52:41

on John and John's family, when

52:41

I said I have thought about it,

52:47

but I hadn't given it a great

52:47

deal of thought. Because I've I

52:51

completely accept and understand

52:51

everyone goes into medicine to

52:54

do good and not to do harm. But

52:54

equally think it is something

52:59

locked is something you're

52:59

exposed to, and that you might

53:02

not always have control over

53:02

when you're working in a medical

53:05

setting to. And clearly,

53:05

sometimes mistakes are made like

53:09

in with ads case. But it was a

53:09

real eye opener, you know, she

53:13

shared from her perspective, the

53:13

stress, the strain, the grief,

53:17

although it was a different type

53:17

of grief. And for me, it opened

53:22

my mind to how I wanted to work

53:22

in this space in a completely

53:27

different way. That yes, then

53:27

John and I have gone on to do

53:30

some great work together. In the

53:30

COVID times we held an education

53:35

day completely dedicated to

53:35

aortic dissection. We have a

53:39

community of over 200 medical

53:39

professionals from all over

53:43

Ireland. We have faculty attend

53:43

from America, to share their

53:47

knowledge and experience and

53:47

we've gone on to run face to

53:51

face events together for the

53:51

emergency medicine community and

53:56

the surgeons themselves as well.

53:56

And I suppose from all of those

54:00

interactions that happened with

54:00

the hospital directly after the

54:04

inquest, they did go on to drive

54:04

a lot of change. They conducted

54:09

their own internal

54:09

investigation, which led to 14

54:13

recommendations to change. One

54:13

of those was around having a

54:17

robust guideline for aortic

54:17

dissection, diagnosis, its

54:21

detection and how it's managed.

54:21

And that went on to form a

54:25

National Guideline in Ireland,

54:25

which I hadn't appreciated until

54:29

John had invited some of the

54:29

team to present at a conference

54:33

that we had organised together.

54:33

And they were sharing that the

54:37

results of all of that work of

54:37

the last seven years and the

54:42

impact that Dad's experience has

54:42

had on the team there. It's an

54:48

interesting relationship that we

54:48

have in the sense of the work

54:52

that we do together because I

54:52

think it surprises a lot of the

54:55

medical community. Work with

54:55

lots of medical professionals

54:59

but I I've introduced John, on a

54:59

few occasions, as you know, John

55:03

was part of my dad's team. And

55:03

that's how we initially crossed

55:06

paths. And I think people do

55:06

find it surprising from on the

55:10

medical side. And I think

55:10

equally, you know, family

55:13

members who have lost a loved

55:13

one, equally find it very, very

55:17

unusual how we have got

55:17

ourselves into a space where I

55:20

suppose we can, you know,

55:20

respect each other's loss and

55:23

grief and come together and try

55:23

and make something really,

55:26

really positive from that. And

55:26

not only try now we are

55:29

succeeding, and we are

55:29

delivering some great work in

55:32

the educational space together.

55:33

When you shared, I asked

55:33

John about you know what it was

55:36

like listening. So when you then

55:36

hear John talking through his

55:41

side of things, that won't be the first time you've talked through about, but could you

55:43

just sort of summarise what sort

55:45

of impact has it had on you and

55:45

your journey with bereavement

55:49

with with grieving the loss of

55:49

your father? How is your journey

55:52

of grief been different? If it's

55:52

been different, by having more

55:57

of an understanding of what goes

55:57

on behind the scenes of a

55:59

hospital?

55:59

I mean, I think

55:59

that's a really great question,

56:02

Chris. And I think if you'd

56:02

asked me across the timeline of

56:06

the eight years, it's really

56:06

changed. So I think, initially,

56:12

you know, the very early days of

56:12

losing dad, I had a really had a

56:16

very low tolerance, I suppose

56:16

for kind of empathy. And I felt

56:19

really angry about what

56:19

happened. And I had, although I

56:24

didn't have all of the facts,

56:24

you know, I suspected that that

56:27

could have had a very different

56:27

outcome. And so it was very hard

56:31

to connect on an empathetic,

56:31

empathetic level. For me, I

56:36

think, I mean, I really wanted

56:36

to, and I think for every

56:39

individual and every family, and

56:39

even within families, it's very

56:44

People have different views,

56:44

whether they even want to step

56:46

into a space of an inquest, or

56:46

whether they want to step in and

56:50

have a meeting at the hospital

56:50

to find out the facts. Because,

56:55

you know, sometimes I do reflect

56:55

and think, oh, that could have

56:58

been easier maybe to think,

56:58

well, this just was dad's fate,

57:01

and it could have just been

57:01

left. But I did want to continue

57:05

to ask, why and how and what and

57:05

so I was really, I really wanted

57:10

more information. Sometimes that

57:10

made the grief more difficult,

57:15

because you don't always like

57:15

what you find and what you hear.

57:19

I know very much that I'm

57:19

keeping my grief realised

57:22

through the work that I do, not

57:22

only sharing my own personal

57:26

experience, but I often meet no

57:26

families, or the bereaved

57:30

families or people who are

57:30

living with their own loss

57:33

through the condition in that

57:33

they're living a very different

57:35

life. And equally, I have met

57:35

medical professionals who have

57:39

decided to step out, because a

57:39

life has been lost due to a

57:43

misdiagnosis or a missed aortic

57:43

dissection. And for them, that

57:48

has been the red line in their

57:48

career and not one that they've

57:51

wanted to step over. So I'm

57:51

definitely an individual who

57:55

wants to know the facts, who

57:55

wants to understand why things

58:00

have happened. And we'll think

58:00

even without information, how

58:03

things could have been

58:03

different, I'm definitely a

58:06

scenario thinker. So it's the

58:06

only way I could have walked my

58:11

journey of grief, I think, is a

58:11

hunger for understanding what

58:14

happened. And a little along the

58:14

way, understanding that we

58:20

weren't alone. And that was

58:20

equally a trigger. For me

58:22

understanding that so many other

58:22

families go through loss to this

58:27

particular condition, more

58:27

people die of this condition in

58:31

the UK and Ireland and people

58:31

who died in road traffic

58:34

accidents. It's, it's a huge

58:34

loss of life. And that was

58:39

equally a decision to what can

58:39

you use that energy for, because

58:44

although there is a huge loss

58:44

and sadness and pain that comes

58:48

with grief, for me, there has

58:48

been a point in time to decide

58:53

to use that energy, which is

58:53

great, because there's nothing

58:56

else that you can call it, it's

58:56

huge pain, but use that energy

59:00

to put it into something good.

59:00

And sometimes I find that hugely

59:04

helpful when I can see that it's

59:04

improving and driving outcomes

59:08

and opening doors for change or

59:08

helping an individual family.

59:12

And sometimes it just brings it

59:12

all back. And it's it's really

59:17

hard. But actually, I think it's

59:17

something that my mom said to

59:20

me. She said that if your dad

59:20

had known what was to come

59:25

following his death, I think he

59:25

would have gladly laid down his

59:29

licence. He knew that it would

59:29

save so many others will have

59:33

the potential in the future. So

59:33

many others and that sort of

59:36

thing. I don't know whether

59:36

that's really how how I feel I

59:40

don't know if that really is how

59:40

he would have felt he was a very

59:44

giving man. But the fact is, he

59:44

has lost his life. And I really

59:49

want his life and his death to

59:49

count for something. Oh, yeah,

59:53

it's it changes and I'm sure it

59:53

will change again, Chris, it's,

59:57

you know, you meet so many

59:57

different people. On the way,

1:00:00

and it's been hugely inspiring,

1:00:00

I think the amount of people

1:00:04

that want to step forward and

1:00:04

support. It was interesting

1:00:09

listening to John, particularly,

1:00:09

you know, kind of describing

1:00:13

whose name was on the board,

1:00:13

who's accountable for the

1:00:16

patient, the culture of the

1:00:16

court, the Coroner's Court,

1:00:21

we're actually it is not

1:00:21

supposed to be adversarial. And

1:00:25

in Ireland, there is certainly

1:00:25

negligence does not isn't, you

1:00:30

know, linked to any individual

1:00:30

or any hospital. But yet, that

1:00:35

setting creates a culture of, I

1:00:35

believe, and I might have it

1:00:39

wrong, John, but my perception,

1:00:39

I think it does create a bit of

1:00:42

fear. And I think that maybe

1:00:42

that fear then creates a culture

1:00:47

of locking honesty, and really

1:00:47

be able to sit down and share

1:00:52

with a family what really

1:00:52

happened. And and that's what,

1:00:55

in my experience, I can't speak

1:00:55

for families that for me, I just

1:00:59

wanted to know, it was about

1:00:59

inflammation wasn't about, it

1:01:03

wasn't about blame, it was just

1:01:03

about understanding that I could

1:01:06

feel the guards were up. And we

1:01:06

should use failure as an

1:01:13

opportunity for learning, even

1:01:13

if that failure is the ultimate

1:01:16

loss. And it's death. It's so

1:01:16

sad for that to be lost and

1:01:20

turned into blame. That's not

1:01:20

helpful for anybody, you know.

1:01:25

And you can hear John describing

1:01:25

the setting of a very busy

1:01:29

department and all of the

1:01:29

challenges. And I'm sure John

1:01:32

would love the silver bullets in

1:01:32

his working environment, as much

1:01:35

as I would love those silver

1:01:35

bullets too. So I think it's

1:01:38

uniting around, change together,

1:01:41

I could speak to that fear

1:01:41

a little bit that comes with

1:01:44

coming up to the corners. thing,

1:01:44

because I mentioned that after

1:01:48

the case, because there's such a

1:01:48

delay with it happening,

1:01:51

sometimes it goes to the back of

1:01:51

your mind, you know, it's there

1:01:54

somewhere, it's going to come up

1:01:54

down the road. And then when it

1:01:58

did come up, and you had the

1:01:58

days coming up, you start

1:02:01

reflecting because you're

1:02:01

fearful of this process that

1:02:04

you're going into and you fear

1:02:04

the worst, you know, you kind of

1:02:07

fear of his family are going to

1:02:07

try and get me or either get

1:02:11

your to see I'm going to be the

1:02:11

paper or someone's going to

1:02:14

report you to the Medical

1:02:14

Council or try to take your

1:02:17

licence and you start this

1:02:17

disaster thinking because of

1:02:20

this terrible event that that's

1:02:20

happened. And I guess maybe one

1:02:23

phase of it is kind of anger.

1:02:23

And maybe that's kind of that

1:02:26

phase of grief as well. I

1:02:26

started thinking about why so

1:02:29

fair that I had to work in this

1:02:29

system that was overstressed was

1:02:33

unfair that I had to work. Or I

1:02:33

have to work in the department

1:02:36

that was crowded and hampered

1:02:36

the way I could do my job and

1:02:40

the way the department works,

1:02:40

you know, and why wasn't it

1:02:43

easier for me for us to get

1:02:43

scans? Or why why wasn't? Why

1:02:46

didn't a different specialist

1:02:46

calm? Or why didn't I have a

1:02:49

better colleague on or, and you

1:02:49

start looking outwards, and

1:02:52

getting defensive and a bit

1:02:52

angry. And it was actually a

1:02:55

member when we went in to meet

1:02:55

the kind of Legal Medicine

1:02:58

person was representing the

1:02:58

hospital. And I remember him

1:03:02

saying he was like, you know,

1:03:02

because people were talking a

1:03:05

little bit defensively and he

1:03:05

said, Look, if there's something

1:03:08

you feel you could have done

1:03:08

differently, or something you

1:03:11

feel it was right, just say it

1:03:11

and own it, and represent it to

1:03:15

own it. Because I think it's

1:03:15

clear to everybody and you know,

1:03:18

yourself internally, if you're

1:03:18

trying to cover something up or

1:03:22

saying well, I did everything

1:03:22

right and was the system's

1:03:25

bottom or is that other

1:03:25

departments problem, you know,

1:03:28

these are older, if you feel you

1:03:28

could have done something

1:03:31

differently, I could have, I

1:03:31

could have done things

1:03:34

differently, there are different

1:03:34

things I could have done was

1:03:37

important just to, to to own

1:03:37

that. When you when you know

1:03:40

it's true. But as Catherine says

1:03:40

in the the maybe the way

1:03:43

medicine is we are a little bit

1:03:43

defensive. And if we don't

1:03:46

always own up to those things,

1:03:46

which men, then maybe it doesn't

1:03:50

allow for the learning or the

1:03:50

improvements or the changes to

1:03:53

happen, both for yourself as an

1:03:53

individual and for departments

1:03:56

and for specialties. And, you

1:03:56

know, I think positive change

1:04:00

has happened. I mean, Catherine

1:04:00

mentioned about the work we've

1:04:03

done together, I should say

1:04:03

Catherine's done most of the

1:04:06

work. And it's only happened

1:04:06

because of her passion and her

1:04:09

drive, which is quite

1:04:09

remarkable. And it's certainly

1:04:12

changed the way I approach

1:04:12

patients who possibly have

1:04:15

aortic dissection. But I would

1:04:15

say that for it's changed the

1:04:19

approach of every department in

1:04:19

Ireland and probably across the

1:04:22

UK, the awareness that she's

1:04:22

brought to the condition as a

1:04:25

result of her father's passing,

1:04:25

you'll struggle to be the only

1:04:29

doctor and in an emergency

1:04:29

departments or in the relevant

1:04:32

specialties who wouldn't be

1:04:32

aware of it and who hasn't been

1:04:35

impacted by it. Because whether

1:04:35

they know or not they happen.

1:04:38

It's interesting, because one of the questions we ask all our guests is Do you

1:04:40

ever ask the question why? But

1:04:43

you've kind of covered that because you have asked the questions. Catherine has been

1:04:45

searching for answers through

1:04:48

through her routes and through

1:04:48

the medical system. And why did

1:04:51

this happen? And you just listed

1:04:51

a whole load of why questions

1:04:53

there you ask. So it's

1:04:53

interesting how you've both had

1:04:56

to wrestle with that question

1:04:56

and sort of found ways to sort

1:04:59

of live with it. We'll get those

1:04:59

answers. John, do you feel like

1:05:02

that's something that comes up a

1:05:02

lot in your job? Is the why

1:05:05

question something that you have

1:05:05

to sort of make peace with

1:05:08

sometimes because you don't get the answers that you want.

1:05:10

Yeah, you do feel like

1:05:10

sometimes you're in the wrong

1:05:13

place at the wrong time. There's

1:05:13

a real randomness, I suppose

1:05:17

there's randomness to life in

1:05:17

the same way, you can just

1:05:19

randomly meet someone that you

1:05:19

might have met. Otherwise, he

1:05:23

goes through that sliding doors.

1:05:23

And I know sliding doors has

1:05:26

been a theme of three, Catherine

1:05:26

has done some of her talks,

1:05:29

these are kind of sliding doors.

1:05:29

Moments, your father may not

1:05:32

have been in Dublin that day,

1:05:32

you know, he may have gone to a

1:05:35

different department, he may

1:05:35

have made a different doctor, I

1:05:37

could come on my shift at the

1:05:37

same time as another doctor. And

1:05:41

we go and both go to pick a

1:05:41

patient and he just happens to

1:05:44

be the first one to like pick

1:05:44

the second one, or vice versa.

1:05:47

And that patient could get a

1:05:47

totally different experience,

1:05:50

which is we like things to be

1:05:50

systematised and guidelines and

1:05:54

protocols, that person could be

1:05:54

could have totally different

1:05:58

experience with that doctor

1:05:58

versus me and vice versa. So

1:06:04

there's real randomness to

1:06:04

working in, in an emergency

1:06:09

department. And you have people

1:06:09

call emergency departments a and

1:06:13

E's act and emergencies, but

1:06:13

it's stuff that also stands for

1:06:16

anything and everything. And the

1:06:16

next person, you could say you

1:06:19

could be the most nondescript,

1:06:19

you know, stubbed their toe,

1:06:24

easy thing, or it could be the

1:06:24

case that you'll remember when

1:06:28

you retire more than any other.

1:06:28

And you just get to accept that

1:06:33

there is a a randomness, and

1:06:33

anything can happen, because

1:06:38

initially can be a real Oh, why

1:06:38

did I have to pick up that

1:06:40

burden? Or what why was I there?

1:06:40

Or why did that happen on my

1:06:43

ship? So you just need to kind

1:06:43

of make peace with with that.

1:06:47

Let's end with our final

1:06:47

question. John, while you're

1:06:50

warmed up, through all of this,

1:06:50

what's your Herman?

1:06:54

I think my Herman, the

1:06:54

game changer on this has been

1:06:57

working and engaging with family

1:06:57

members, and loved ones of

1:07:03

patients and involving patients.

1:07:03

Because as medics, we tend to

1:07:07

meet as medics, and we have our

1:07:07

meetings and our education

1:07:10

meetings just with medics, and

1:07:10

just for the doctors there, and

1:07:13

sometimes just with only doctors

1:07:13

of your own specialty, and we

1:07:16

meet in silos, you know, aortic

1:07:16

dissection doesn't respect those

1:07:19

silos. A big change for me has

1:07:19

been not having a fear of

1:07:25

working with patients, families,

1:07:25

and loved ones, particularly if

1:07:30

things haven't gone to plan.

1:07:30

There is a defence of culture in

1:07:34

medicine, where sometimes we

1:07:34

worry about what people will

1:07:38

think of us or mistakes we've

1:07:38

made or, or lack of knowledge or

1:07:42

understanding that we might

1:07:42

have. But there is just no way

1:07:46

that we would have made the

1:07:46

progress on aortic dissection

1:07:49

had it been just us as a bunch

1:07:49

of emergency physicians or as a

1:07:52

bunch of doctors, compared to

1:07:52

wash Katherina has done so in

1:07:57

any large project that I'm

1:07:57

involved in. Now, whether it's

1:08:00

research, or whatever it is,

1:08:00

we'll look at ways in which we

1:08:04

can involve patients or

1:08:04

relatives who may be involved or

1:08:09

affected by that area. And most

1:08:09

funding bodies who fund research

1:08:12

want patient involvement at some

1:08:12

level. So this experience and

1:08:18

Tim's loss, that's the change

1:08:18

it's made to me.

1:08:20

Catherine. Yep. As John

1:08:20

said, it was your dad that you

1:08:23

lost so much good has come out

1:08:23

of that. But through the years

1:08:26

of grieving of working, what's

1:08:26

your Herman?

1:08:29

Maybe one of the

1:08:29

hardest questions to answer this

1:08:32

year, there's been so many

1:08:32

Hermans, and I hope that there's

1:08:35

going to be many more, but for

1:08:35

me, really, my permission is

1:08:40

heightened awareness that can

1:08:40

get a handle on your grief, you

1:08:44

can turn it into something quite

1:08:44

powerful if you're willing to

1:08:48

take yourself there and keep

1:08:48

your grief allies. And it's been

1:08:54

and will continue to be, I

1:08:54

think, a journey of grief, but

1:08:58

harnessing it as a passion for

1:08:58

change, and being able to

1:09:03

amplify the voice for others,

1:09:03

and equally, enhancing a

1:09:07

community being able to find

1:09:07

empathy for others grief along

1:09:12

the way. And that was a little

1:09:12

unexpected. At the beginning of

1:09:15

my journey. I couldn't see

1:09:15

myself having a levels of

1:09:19

empathy that I had with members

1:09:19

from the medical community. And

1:09:24

I think that's quite a powerful

1:09:24

thing. And yeah, for me, I think

1:09:27

it's an ability to harness grief

1:09:27

and use it for something

1:09:30

positive for yourself and

1:09:30

equally to help others.

1:09:40

What a lovely couple of

1:09:40

Herman's. Both speak into the

1:09:43

power of involving others to

1:09:43

create something special that

1:09:46

then helps others in their

1:09:46

grief. Their work reminds me of

1:09:49

the Jana Stanfield quote, 'I

1:09:49

cannot do all the good the world

1:09:52

needs, but the world needs all

1:09:52

the good that I can do'. And

1:09:56

often that involves a level of

1:09:56

sacrifice when you have to keep

1:09:59

facing your own pain in the

1:09:59

process. So thank you to

1:10:02

everyone that has taken their

1:10:02

grief and turned it into

1:10:04

something to help others.

1:10:06

A huge thank you to

1:10:06

Catherine and John for chatting

1:10:08

with us. And to find out more

1:10:08

about The Aortic Dissection

1:10:11

Charity or to contact them visit

1:10:11

their website,

1:10:14

www.aorticdissectioncharitabletrust.org,

1:10:14

or you can find them on social

1:10:18

media, and we'll put all the links in the show notes.

1:10:20

We also did another

1:10:20

episode early on in the podcast,

1:10:23

which originally connected us to

1:10:23

Catherine and John, with author

1:10:26

and psychotherapist Sasha Bates,

1:10:26

who lost her husband very

1:10:29

suddenly through aortic

1:10:29

dissection, and she shares her

1:10:32

experience in Lost 23. And

1:10:32

again, I'll put a link in the

1:10:35

show notes.

1:10:35

Now for more about us

1:10:35

visit www.thesilentwhy.com or on

1:10:39

social media at

1:10:39

@thesilentwhypod. You can also

1:10:42

now visit www.theHermanCompany.com. - that's where you can buy or see

1:10:44

Claire's newly launched Hermans,

1:10:47

which are the perfect gift to

1:10:47

send someone who's going through

1:10:49

a rough time when you're

1:10:49

struggling to know what to say.

1:10:52

And if you'd like to

1:10:52

support my work on the podcast

1:10:54

and now producing Hermans

1:10:54

there's a link in the bio where

1:10:57

you can either buy me a fancy tea (www.buymeacoffee.com/thesilentwhy)

1:10:58

because I'm more of a tea

1:11:01

drinker, or support the podcast

1:11:01

monthly or send a Herman to

1:11:04

someone you know, or even buy

1:11:04

one for yourself. You can also

1:11:07

sign up to my mailing list,

1:11:07

which I use when I have exciting

1:11:09

news to share. And all these

1:11:09

links are in the show notes.

1:11:12

We're finishing this

1:11:12

episode with a quote from Thomas

1:11:14

S. Monson, which speaks into

1:11:14

what we believe Catherine and

1:11:18

John and all the others involved

1:11:18

with the charity are doing with

1:11:20

their important work.

1:11:23

"Along your pathway of

1:11:23

life, you will observe that you

1:11:25

are not the only traveller,

1:11:25

there are others who need your

1:11:29

help. There are feet to steady,

1:11:29

hands to grasp, minds to

1:11:33

encourage, hearts to inspire,

1:11:33

and souls to save."

1:11:38

Or in the case of the aortic

1:11:38

dissection charitable trust, you

1:11:42

could almost say 'souls to

1:11:42

inspire and hearts to save'.