NIKKI ALEXANDER – DR PERFECT?

This week has seen me relieved of a burden that was becoming too hard to bear – that of watching ‘Silent Witness’. Of late it has been a show I have been watching more out of a misplaced sense of loyalty, more in appreciative memory of when it was entertaining, than because I was still genuinely enjoying it. Of course the programme has always been ridiculous – nothing has changed from that point of view. Now, it’s not that there is anything wrong, for the sake of entertainment in having pathologists, in their attempt to single handedly make all our lives safer, straying from their natural habitat of the post mortem room and running around the countryside on the trail of anyone involved in the many nefarious practices which result in bodies ending up on the dissection table. For an hours distraction, I can forgive such nonsense. But what I found difficult to swallow in the last story in the most recent series, was Dr Nikki Alexander’s constant maintaining that she was perfect, her repeatedly insisting that ‘I did not make a mistake’ – a position taken, not so much because of the details of the particular case in question, but rather, it seemed to me, because she could not conceive that she might sometimes get things wrong.

Now for some time I have felt that Dr Alexander has been close to the edge. And if she fails to accept the normality of her ordinariness, if she admits no possibility of her own fallibility and insists that only personal perfection is acceptable, it’ll surely not be long before she topples over it.

And the same will be true for us.

I wonder how many mistakes I have made this week. Thankfully most won’t have mattered all that much but, inevitably, over a career, there will be those which do. Human error is a reality – not necessarily because we are negligent, lazy, or lacking in knowledge, but simply because we are human, and all of us are flawed. Atul Gawande speaking of what he calls our ‘necessary fallibility’ is reassuring. If the Professor of Surgery at Harvard knows he’s fallible, then I guess I shouldn’t be too surprised that I am too! And knowing it’s normal to be less than perfect helps me in a small way to live with the fact – and the sometimes painful emotional consequences.

As less than perfect people in a less than perfect world, difficulty and disappointment is to be expected. We should not be surprised by it. That is not to say we should fatalistically accept it. On the contrary, as doctors we should try to change what we can for the better, both in others and indeed within ourselves. Sometimes that will be possible be that by the prescribing of an antibiotic, the administration of an injection or the simple offering of a comforting word. But oftentimes we won’t be able to help as much as would like and may have to be content to share some of the sadness that our patients feel. Such sadness, does not necessarily mean there is something wrong with us, though it might if we are the cause of the sadness, which sometimes we will be. On the contrary, sadness in ourselves more commonly will indicate that there is something very right in us – that we have a degree of compassion for those who suffer.

But unlike Dr Nicky Alexander we need also to be realistic of our real limitations because of both the enormity of the problems we are trying to help and our own personal frailties which inevitably make us a part of the problem too. Rather than wearing ourselves out trying to convince ourselves and others that we are without fault, we must accept the sadness of our own inadequacy. Demanding of ourselves perfection is unhelpful for our patients who will thus be encouraged to have unrealistic expectations of what we can do for them and thereby find that their trust in medicine is all too frequently misplaced. And demanding perfection of ourselves is unhelpful for us too, leading as it will to a sense of overwhelming despondency, an excessive self criticism and a constant fear of reproach from others which will ultimately deprive us of any joy and satisfaction in the good we do achieve in our work.

Mistakes are part of life. And when they are made, what is needed is an abundance of kindness. When we make mistakes, rather than others demanding of us their pound of flesh, we will be glad if others are kind to us, forgiving us of our errors and accepting us as we are – warts and all. Sometimes, if we are to last the course, we will need to show ourselves such kindness and, when we know we have reached our limit, demand of ourselves no more.

And when we are those who are affected by the mistakes of others, when we are disappointed and frustrated by our patients, our colleagues and even total strangers, we would do well to try and be understanding of, and equally kind to, those who, having reached their limit and can ask no more of themselves, ask of us instead – even, sometimes, on those occasions when we are unreasonably put upon and the kindness is undeserved. To be kind in such circumstances is hard, very hard – it costs us something be it our time, our energy or our emotions. But true kindness makes a difference, because when done with no expectation of a returning of the favour, it changes what has gone before, allowing past mistakes to be left behind.

That sort of kindness eases burdens, lightens loads – it pays a debt without creating another.

Kindness like that is something we, and all who fall short of perfect, need far more of.

Kindness like that will allow us to keep on keeping on.

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