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The secret thoughts of an intensive care doctor

Aoife Abbey’s account of the emotional highs and lows of her profession is a compelling and candid read, says Hilary A Whiteand

Honest treatment: Aoife Abbey provides valuable insight into life on the wards
Honest treatment: Aoife Abbey provides valuable insight into life on the wards

The Secret Doctor is a blog launched by the British Medical Association in 2016 in order to shine a light on the realities of working in the profession. The purpose was not to spy on practitioners or blow whistles but to get a conversation going about things that matter to those at the coalface.

Charged with the task was Aoife Abbey, a bookish Dubliner who had been working in the NHS after graduating from biological sciences in Edinburgh and then Warwick University Medical School. Anonymously but with a perceptive knack for finding the nub of a theme, Abbey covered everything from negotiating a patient's tricky relatives to the blurring of lines in doctor-patient interaction.

The quality of her writing wasn't lost on Penguin, who approached her to put her voice into something longform. It is important to mention peripheral players such as the BMA and Abbey's publishers so that, should the need ever arise, they can be thanked for their role in midwifing this effortlessly absorbing and illuminating memoir.

Seven Signs of Life offers a prismatic set of arguments for a truth that we too often forget: doctors, nurses and consultants are human, too. This fact does not belittle their job and the demands it incurs - it makes it even more remarkable.

For those working in it, intensive care, Abbey's typical area of expertise, is just that. Fear, grief, joy, distraction, anger, disgust and hope are the spectrum of sensations that, while common enough to all of us, can be felt by a medical professional in the space of an hour or two.

Each gets a chapter in which Abbey ruminates through past experiences, threading together something gently intricate that manages to relate specialist medical detail in the arena of a perspective that feels like new territory. Medical dramas, your Grey's Anatomys, Casualties and whatnot, have traded on depicting personal lives in the trenches of life-saving. They haven't scratched the surface, it turns out.

All the years of study and all the oaths taken; the doctor lives and breathes by the mantra that they are there to be what their patient needs them to be, and only after that to be what the patient's loved ones need them to be.

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But in the white heat of an emergency or an unreasonable family member, amid exhaustion and irritability, revulsion and cold fear, a constant tempering is systematically taking place that allows for clear thought and doing right by the patient. Measured out in Abbey's crystalline, personable voice, it occurs to you that this is a somewhat Herculean feat.

It attests to a level of self-examination we are not used to considering from those whom we only deal with a handful of times in our lives, if we are lucky. The internal rift when being called a murderer by angry relations, or having to stifle your rage when treating a child that has been injured by an abusive parent. The gingerly directness needed when handing difficult prognoses to patients and relatives, and the self-flagellation when a colleague highlights something you've missed, a detail on an X-ray or a dosage measurement.

In essence, the straight-faced facade we associate with doctors is what makes them so important but it is not something we should ever take for granted, even as ministers, quantity surveyors and administrators botch things up. Hope, the theme of Abbey's closing chapter, hovers quietly, even if it is "dangerous" for a doctor to expose themselves to anything equating to emotional investment and, inevitably, grief.

"When you stand beside your relative," this brave writer shares, "with your hand resting on theirs and tell yourself, 'I hope they pull through - I know they'll pull through', I hope that too. Often, I am simply hoping that in another room."

Seven Signs of Life by Aoife Abbey, Vintage £12.99

what the doctor ordered: Aoife picks her cultural favourites

Film: Inside I'm Dancing - This is the first mainstream movie I know which came close to portraying disability in a way I'm familiar with. My brother, a wheelchair user, was passionate about the independent living movement and though this movie isn't perfect and received some criticism for a lack of disabled actors in the cast, it was so positive to see those issues highlighted. Everyone deserves to feel like they are represented in media, to see themselves occasionally. I'll never forget my brother laughing as the central character, Rory, joked about writing a letter to Dublin City Council to lament a lack of accessible bridges, from which he could throw himself.

Design: The Library of Birmingham - The Library of Birmingham is a fascinating building and the book rotunda is an incredible space. It feels a bit lofty, for me, to refer to something as 'a space' but truly this is one. The rotunda is an expansive five storeys of curved, book-lined walls. Gliding through it on the escalator with its blue-lit handrails, it's hard not to feel like you've entered some sort of temple.

TV: Call The Midwife - Shows like this are what Sunday nights are made for - beautiful looking drama with fascinating history. That's probably the geek in me: never one to pass up an opportunity to make learning fun. Thankfully I'm old enough now not to have to feel apologetic about it. The costumes are superb.


Art: Almond Blossom, Van Gogh - This painting caught my eye in the Van Gogh Museum in Amsterdam, I think because the striking blue and delicate pale pink seemed unexpected, contrasted against all those bolder coloured pieces. I am lucky to live near a beautiful park and standing beneath a tree, looking up, is the sort of 'art' I try to keep in my life. This painting reminds me of the hours of springtime I frequently try and claw back between consecutive night shifts, with a quick walk in the park.


Author: Eimear McBride - Eimear McBride uses words in a way that makes you want to stand back from the page and just stare at them, like looking at a painting, or a tree that's caught the light in a certain way. She moulds sentences into art - and this is before you even consider that they're also telling a story. I think it seems strange that somebody can use words like this and yet the end result is something that is ultimately very familiar; as if she's figured out the language that your insides speak. Her description of death in A Girl is a Half-formed Thing is unapologetic and probably the most accurate one I have ever read.

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