The last lecture

I remember the book,

Randy Pausch.

The Last Lecture.

He was an American Computer Scientist.

the book

discussed his final years,

and his parting lecture with students

before he died from pancreatic cancer, age 47,

Fortunately,

The circumstances of my last lecture are not so bad.

I just fell-out,

grew apart.

A flaky relationship.

Over the years, I have been teaching medical students.

It is central to the role of being a doctor.

You treat and care and you teach.

Some might focus on the data or study the numbers.

That’s not me.

This lecture, I have been giving since 2004. That is, almost 20 years of students. The majority of whom have now progressed to becoming doctors, consultants, GPs, and academics.

Most will not remember even a scintilla of my lecture.

The neural connectome will have died before they leave their seats.

Poof. Lost in a race to memorise facts and figures, to cram adequate information to pass the next test or assessment.

Over the years the students have changed.

Yes, I have changed too, although they more than I.

At the beginning, there were no computers.

Now, most sit looking not at me, instead at their laptops.

(I am a visual thinker and lecturer – I rely on pictures rather than words).

I don’t know what they see; it is perhaps the PowerPoint I am projecting on the wall, it might be Wordle or the Guardian Crossword (unlikely, aren’t they Boomer pastimes?). They might be Googling ‘hospitalisation’ or one of my other catchphrases although most of what I teach is not very sophisticated.

On Monday I began with the tale of Hillel the Elder, who, to paraphrase, sometime around the year 1 AD/CE was approached by a Roman who asked, ‘Explain to me the Torah standing on one leg and I will become a Jew’ (or words to that effect; (Why one leg?) The aspiration I imagine was deprecation).

Hillel replied, ‘Treat others as you would have them treat you, that is the Torah, the rest is commentary; go and study.’

I thought this was a risky start (?too Jewish) although I prefaced it with an allusion to the Golden Rule which most children are taught in Primary School and encompasses Judaism, Islam, Christianity, Hinduism and other mainstream beliefs (not Nazism, Mr Sunak). It is the truism that maintains peaceable societies. (It is also the be-all and end-all of my approach to medicine and healthcare – see here).

I couldn’t tell if there was a connection.

A couple of students in the front row, two young men, one with a curly bob were animatedly talking throughout my introduction.

I flashed-forward a decade and imagined them strutting around a hospital wards, missing the point as they seemed to miss it now.

When I asked them to not talk, they stopped although one started to furiously type on his keyboard.

This year I felt a disconnect like no other.

Previously, there was something, eye contact, smirks, grimaces, or laughter at my jokes.

It felt like talking to a wall.

Like Zoom when everyone has their cameras switched-off. Only, I was standing in a sweaty hall.

My lectures or talks are always bound with interaction, questions and answers, discussion.

Nada.

It was hard to determine whether they were not interested or didn’t care.

I rambled.

At one point I started coughing.

The air was so dry, it was blocking my throat.

I hadn’t brought a drink (All the lecturers bring drinks, my son, later told me).

I was struggling to speak.

Cough. Cough.

‘Does anyone have a drink?’

I asked.

Again, blank faces.

A void.

I coughed more, was struggling to talk.

‘OK, I will see how far I can go,’ I added.

Eventually a young woman brought me a drink.

A smidgen of compassion.

Do unto others…

I continued.

I took the students through definitions and explanations of age and ageing, of falls, frailty, dementia and delirium, person-centred care, hospital admission avoidance and the harms of hospitalisation.

I described my patient who had waited almost three hours, lying on the ground outside her house waiting for an ambulance; she developed hypothermia in addition to her broken hip.

I shared my experiences of staff mis-naming patients, getting them wrong, misconstruing their preferences, what matters.

I showed my photo of M’s room in the care home (below), the quintessence of person-centred care (see here)

More emptiness.

Hollow.

I left feeling empty.

At the start, following Hillel, I even explained to the students that my iCloud had disappeared and I had created the whole lecture from scratch over the preceding weekend.

An image flashed of my lying on the ground, choking perhaps on a Ronald Reagan peanut and the crowd watching me turn blue.

Yes, I have changed; the students have changed more.

And this is not their doing.

This is me and the rest of our society.

When millennials think of the future, and they perceive our worries, our woes, our existential dread that is worse than the Cold Ward nuclear threat I experienced at their age.

They are faced with a selfish self-serving government, a society that allows the minority to flourish and everyone else to sink, that prices them out of the housing market, that has removed retirement and replaced it with zero-hours Deliveroo.

On Thursday night I watched the Channel 4 documentary Undercover Ambulance. You might call it a tragedy of the NHS. In which a young Ambulance Medical Technician, undercover, revealed the breaks, the people like my patient who waited so long they died, the patients lining the hospital corridors, the collapse of a world-leader.

The film ended with his resignation.

I wonder what he is doing now.

A few weeks ago, I asked the young doctor working with me, ‘Did you imagine it would be like this in the UK?’ ‘No’, he replied. I don’t know if he grew-up in an India that still romanticises the UK or he personally chose to focus on other things.

I haven’t given-up on teaching.

I’ll continue one-to-one.

I have already approached the Ambulance Service.

No one wants to read negativity.

Apologies.

What can you expect from a blog called ‘The last lecture’?

It isn’t all doom and gloom.

The chaos has created opportunities for working and caring in different ways (Check-out our Virtual Ward) although I suspect it is the majority, the mainstream that remains tangled.

And this is the uncertainty into which these young are developing, moving towards; not the naïve idealism of ‘wanting to help people’ that was (and is) my motto.

‘What do you want?’ I should have asked.

‘An interesting lecture,’ they might have replied.

Post-blog caveat.

Sitting in Kwik Fit.

The valve of my car tyre is broken*. Hissing air, only inflated by the twiddly cap.

Young guy, fiddling with phone.

Old man, walking stick, struggling with door.

Young guy helps older guy.

No question.

Just active, respectful, do unto others.

I wonder.

*Valve fixed.