Kind & Sensible

When medicine can’t save someone, what should a doctor do?

Society has changed a lot in the last fifty years. We are now less willing to accept adversity, more likely to look for someone to blame when things do not go well, less deferential to authorities and less trusting of others in general. Along with many marvellous technical developments the way that medicine is practised has altered to accommodate these societal changes, sometimes for the better and sometimes for the worse.

The story

This story is about an ‘old school’ doctor, Jonathan Barber, who could not adapt as times changed. What he regards as a very mundane decision, keeping an elderly demented woman who is terminally ill comfortable and allowing her to die, leads to a court case, a hearing with the medical regulator and a disciplinary process in his own hospital, the stress of which leads to him taking early retirement.

Following his wife’s death his estranged daughter, Margaret, unsettled in her own life, returns home for the first time in many years. She and her father both feel a need to get to know each other, which they never did when she was a child or adolescent because – like many doctors of his generation - he was always working, and to do this she has to understand what happened to him and to her mother. This leads her into a series of discussions with her father, David Old (a doctor who was an expert witness at the medical regulator’s hearing), Shirley (a long-standing friend who works as a nurse in a busy Emergency Department) and Malcolm (a wise ex-colleague and friend of her father’s) which explore what’s changed in society and medicine and why.

The heart of the matter

The nub is that at an individual and collective level it has become very difficult to have honest conversations. Patients and their families are increasingly likely to push back against the inevitable realities of illnesses and mortality, with the consequence that doctors are more and more reluctant to talk frankly about them, leading to many protracted, miserable and expensive deaths. Why would a doctor embark on difficult discussions if all they get is grief? At a societal level the same mindset leads politicians to keep searching for and promising delivery of improbable benefits from medical advances: they cannot do otherwise if they want to be re-elected. And why would a biomedical scientist or someone running a drug company be honest and say, ‘this might help a bit, but it isn’t truly a game-changer’, if those responsible for funding are desperate for breakthroughs and good news?

How can this state of affairs be changed? The key argument is that this will depend on restoration of trust between patients and doctors to allow the truthful conversations at individual and societal level that are now fraught with danger. As Margaret explores these issues she begins to find a way through her mid-life crisis.

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Main characters

Kind & Sensible is told through the interwoven lives of a small cast — doctors, patients and their families, whose paths cross in and out of hospital. Here is a brief introduction to the people at the heart of the story.

Margaret Barber

is the only child of Jonathan and Joan. She does not have a good relationship with them and leaves home after school / university, maintaining very limited contact as she pursues a successful career in management consultancy for about 20 years. Her mother’s death coincides with her having a mid-life crisis, uncertain about her aims at work and in relationships. After returning home for the funeral she discovers what happened to her father and is very disturbed by her findings, also about his description of the circumstances of her mother’s death. This leads her into a series of conversations with her father, David Old (a doctor who was involved in her father’s hearing with the medical regulator) and Malcolm (a hospital colleague of her father’s) that touch on fundamental issues including how decisions to offer or deny medical treatments are made and should be made, and why it is so difficult to have honest conversations about what medicine can and cannot deliver at both individual and societal levels. During these conversations she begins to see and plot a way through her own mid-life crisis.

Jonathan Barber

is a consultant physician responsible for the care of an elderly demented woman who is very ill. He decides to keep her comfortable and allow her to die, leading to a train of events in which he is involved in a court case, a hearing with the medical regulator, and subsequently a disciplinary process in his own hospital. Stress precipitates his early retirement. A few years later his wife (Joan) dies of cancer, causing their estranged daughter (Margaret) to return home for the first time in many years. She and her father both feel a need to get to know each other, resulting in conversations about what happened to him at work and the circumstances of his wife’s death.

Joan Barber

is a nurse who became Jonathan’s wife. Early in their marriage she behaved in a subservient way, but at some point this changed and when Margaret returns home after her mother’s death she hears very different accounts of her relationship with her husband.

David Old

is a consultant physician with a significant management role in the hospital where he works. He is asked by the medical regulator to be an expert witness at Jonathan Barber’s fitness to practise hearing, which he agrees to do because he thinks the issues under consideration are of fundamental importance. Margaret tracks him down and initiates a series of meetings that draw them together.

Malcolm

is a consultant colleague and friend of Jonathan’s, regarded by him and others in the hospital as a wise opinion. Many seek his advice and counsel to good effect, as does Margaret.

Shirley

a friend of Margaret’s who works as a nurse in a busy Emergency Department, someone who calls a spade a spade.

Who would be interested in reading Kind & Sensible?

Anyone who

Wants to know what’s likely to happen to them and their loved ones if they get old and frail
Worries that more medicine doesn’t mean better medicine
Worries that medicine often prolongs dying
Is interested in the Assisted Dying debate
Enjoyed reading Henry Marsh’s Do No Harm, Atul Gawande’s Being Mortal, Paul Kalanithi’s When Breath Becomes Air

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