NHS frontline staff watch children die, but managers tell us to keep it to ourselves

It was fitting that I received my NHS information governance questionnaire on the same day that a little girl died. It was distributed by management at work, so I dutifully worked through the multiple choice questions that checked whether I knew to not share my computer passwords or look at my workmate’s blood results.

The last question stopped me in my tracks, and paints a comedic picture of the distance between NHS frontline staff and middle management. “You’ve had a very difficult shift with a very unwell patient and your partner asks how your day was. What do you tell them?” Clearly the correct answer would have been “nothing”.

These questionnaires are compiled by the NHS Trust that I work for. They accompany the guidelines we’re issued, which outline a number of elements, including the need for retaining confidentiality of our patients, which is of course crucial. However, on this occasion it suggested that even discussing our day in the vaguest of terms could constitute a problem. This is not the first time I’ve been faced with NHS guidance that makes me question the management priorities at play.

I doubt any of the data governance managers were in the A&E resuscitation room when the four-year-old girl arrived. A number of my intensive care and emergency colleagues were, however.

She had fallen from a great height in a tragic accident. An air ambulance doctor and paramedics tried desperately to treat her injuries at her home, but it was clear that little could be done when she arrived lifeless to our hospital. Further desperate attempts were made to save her life until finally, an hour and a half after the accident that would change many people’s lives forever, the team took the decision to stop.

I’m glad I wasn’t there. During seven years spent predominantly in intensive care and emergency departments, I’ve seen awful things happen to adults that I can rationalise and desensitise myself from, but I have yet to master the art of hiding behind the uniform when it comes to children.

Seeing a child or baby die suddenly is horrendous. You can try your hardest to regard them as just another patient, but seeing them lying there in their toddler clothes, or a mum and dad coming to say goodbye and restarting CPR in their desperation, threatens to tear you apart there and then.

Afterwards, in thick silence, the team slowly evaporates, and you disappear to a quiet corner with a cup of tea to pull yourself together before seeing the next patient as if nothing has happened.

So I find it slightly naive that a data manager tells me that, having kept a stiff upper lip at work for the remainder of an awful shift, I cannot tell the person closest to me a bit about my day. Of course, I would never allude to a patient’s name, occupation, or anything whatsoever that threatens to reveal their identity – this is deeply ingrained into my being since my first day in a medical school lecture theatre.

I hope that my colleagues who dealt with that awful incident did go home and if they wanted to, felt able to tell their partners or families they had an awful day because they failed to save the life of a little girl who was involved in a terrible accident.

Working in today’s NHS is becoming more and more intense, and there is less and less time to decompress and reflect with our colleagues. Screwing down the release valve of our support networks outside work is absurd, and has nothing to do with confidentiality. It threatens our own mental health and our personal relationships. Had I wanted to be involved with remarkable work, see awful things and maintain an impermeable code of silence with those close to me, I would have joined MI6, not become a doctor.

In my incredulity, I read the information sheet which came with my governance questionnaire to see the official line on finding support. It recommended that clinical staff arrange a meeting with their line manager to discuss difficult issues stemming from work.

There certainly is a role for discussion and reflection with colleagues following traumatic events, but even these sessions are not protected from the onslaught of work. My intensive care colleagues involved in the death of this little girl participated immediately afterwards in a “hot debriefing”, the current protocol for a paediatric death.

However, they had to leave halfway through due to another cardiac arrest call on an adult ward. The irony was lost on nobody, and I know from my own experience of kids dying that debriefing sessions are arranged with the best of intentions, but we are often too snowed under with clinical commitments to even attend.

While I present a florid example, such prescriptive and shortsighted guidance is released almost daily from on high. While it is, ostensibly, well-meaning, it can be difficult for those who have never laid their hands on patient to criticise in a way that is sympathetically understood. Likewise, we trudge knee-deep through paperwork and safety questionnaires; a battle-worn army of frontline clinical staff who have become overburdened by administrative departments which are increasingly a means to their own end.

My colleagues continued their day with admirable professionalism, both the consultants with their own young children, and the juniors who were inexperienced in such tragedy. I know it will have dug away at them all day however, even though, like me, they would have felt a ridiculous embarrassment in admitting it.

In hospital medicine the show just goes on, and putting tragedy to one side until you get home is part of the required professionalism. Bottling up such terrible events is not, and this clueless guidance tells you everything you need to know about the growing disconnect between frontline NHS staff and the politicised managers cast above us.

If only confidentiality would allow it, I would ask them to join me to see life and death playing out daily on our intensive care unit. I wonder, then, if they could manage to live behind their own wall of silence.