The Great Queue: A British Tale of Patience and Perseverance

ONCALL

I stepped into the delivery suite to watch the fetal heartrate trace during labour. The babys cardiogram was perfectly normal. As I followed the looping line on the monitor, I thought of the midwife whose patient had fallen seriously ill and whom I had sent home. Now I needed to arrange cover with another obstetrics midwife to keep the reception ward running smoothly.

Is everything that bad? Please tell me, the anxious expectant mother looked straight into my eyes. Is there something wrong on the monitor? You look so focused.

The hardest part of being a doctor is learning to keep a steady face. All our conscious life is spent learninglearning to diagnose, to piece together fragments until the whole picture emerges. We learn to observe, to wait patiently, to intervene only when necessary, and to make instant, correct decisions. We are never taught the art of acting.

That skill becomes vital after a grueling operation at night, when Ive just splashed icy water over my eyes, barely had a breath to wipe the blood that seeped through the sole of my shoes, and must descend to the ward and greet a new patient with a calm, friendly smile. The key is to meet a frightened, bewildered personbrought in by the ambulancewith genuine reassurance that they are safe, that people care for them, and that help is on the way to ease their pain and heal them.

We were never taught that illness is terrifying. No matter how skilled we become, no matter how we handle the toughest crises, we must keep our faces composed, because fear distorts realityboth our own and others. Beyond the hospital doors, a fathers health declines, children lose their keys and sit on the stairs waiting for someone, a pregnant woman in intensive care refuses to stabilise, and the operatingroom nurse suffers a hypertensive crisis. All this swirls in our minds, yet somewhere above our own expression lies the need to stay calm.

Keeping a steady face is especially hard when you realise you are only fifteen minutes from disaster. You must conquer your own fear, give clear orders, calmly explain to the patient why we are rushing, soothe her and her relatives, obtain consent for surgery, and sprint to the theatrestripping off your coat on the waywhile still keeping your composure. Then, after the procedure, you retreat offstage to the back rooms, still holding that calm.

The hardest moment comes after the catastrophe has already struck. Even then you must keep your face, ignore the cold in your chest, and keep talkingtalking to patients, to their families, to strangers, to yourself, to God, to your lingering thoughts, to your boss, to the families again, and to the stillbreathing you inside. Only when you finally release the sharp pain in your chest and take a full breath do you realise that the shift has etched a new line on your heart.

An hour later, descending to see a new patient, you still hold that mask, rubbing gently under your left clavicle as if to soothe yourself. Because doctors make mistakes. Every single one. Even those who claim theyre called by God. Theyre human. Errors only belong to those who never work. Even the most precise machines fail, for they are built by people, and people are prone to error.

The most frightening part is recognising that youve erred. Your mind keeps replaying the moment you could have acted differently, yet you can never know how the outcome would have changed. You stare at a perfectly normal cardiogram with eyes clouded by fatigueyour eyes have grown accustomed to endless tiredness. You overlook a completely normal test that no one else would have noticed. You calculate drug dosages exactly as the protocol dictates. You arrive a minute too early or too late. You read an Xray and miss the crucial detail, or see something that isnt there. Your vision is the same as yesterday, a month ago, a year ago.

You accidentally slip the scalpel, and a clamp flies from a vesselwhy didnt it happen yesterday, the day before, or a year ago? Perhaps because six oncalls in two weeks is a lot, especially when your own mother lies at home recovering from a stroke. In medicine time is a relative concept, while your loved ones have long occupied the honoured place at the end of the table.

The worst is not understanding what exactly went wrong, because then the mistake may repeat. How many more books must be read, training sessions endured, sleepless nights endured before it stops happening? No one can answer. And how do you push away the thought that statistics are on your side?

Cold, impersonal statistics tell us that out of a thousand births, surgeries, or procedures, three, five, ten complications will occur worldwideevery day, every month, every year. Someones life, someones health, someones tragedy. It becomes personal when you, as a doctor, find yourself in that statistic. You stand before grieving families and say, Here I am, the one who caused this. Can anyone truly imagine themselves in that position? When countless unhappy lives lie before you, you become the sole source of their anguish. This is me, you say, feeling as if you must destroy yourself.

Why, when a doctor makes a single error, are the countless times he was right erased? Doctors err because they are human. Gods do not err. That is their world, their creation, their statistics. The more I work, the more I realise that only the chosen may ever grasp the purpose behind those numbers. We are not chosen. We are ordinary people, ordinary doctors.

The lesson, then, is simple: we must carry our faces forward, accept our humanity, learn from every slip, and remember that compassion, even when imperfect, is the true remedy for both patient and practitioner.