WHAT SEEMS TO BE PROBLEM EB

Dr Laura Marshall-Andrews

• Publisher: HQ
• Year: 2022
• Print ISBN: 9780008490591
• eBook ISBN: 9780008445034
• Topic: Medicine
• Subtopic: Medicine Biographies

'Compelling and essential . . . will appeal to everyone who enjoyed Adam Kay's This Is Going to Hurt' Philippa Perry

In this powerful and deeply personal memoir, award-winning GP Dr Laura Marshall-Andrews introduces us to the patients who have shaped her radical approach to medicine.

Over the course of a decade spent on the frontline of the NHS, Dr Laura witnessed lives being adversely affected by one-size-fits-all treatments. Determined to create change, she began to envisage a new way to care that prioritised the lived experience of her patients.

Created with the help of doctors, artists and complementary health practitioners, Dr Laura's pioneering holistic approach was revelatory. From those whose lives were changed by 'ineffective' drugs, to those for whom alternative therapies, kindness and trust proved transformative, her patients began to flourish.

What Seems To Be The Problem? is a heartfelt story of hope, and an urgent call for change in our NHS at a time when it is most in need.

Part 1

Beginning our journey

Chapter 1

Dreams

In the early 2000s, I was working as a GP in a practice in Brighton, Sussex. It was quite small, and run by just two of us, me and another GP, Jonathan. Jonathan was fun. He was a larger-than-life character, and I liked him. He had large frizzy hair and large features in his large face. We worked well together, but I found him rather old school. He held the views he held, and what he said went.

Still, I loved my patients, and knew how lucky I was that my work gave me real satisfaction. It also allowed me to balance my professional life with my family – my husband and our three kids, who were still quite young back then. I recognised how fortunate I was to have this sense of balance, considering how hard it is for so many people to find. We had a routine that worked for us all.

I’d always wanted to be a doctor. After years of rigorous studying, my peers and I had been spewed out of med school with the values and opinions of our time. We worshipped the gods of mass trial data and clinical evidence. We knew that our scientific knowledge was king.

And then, so slowly that I hardly noticed it at first, my ideas about medicine began to shift and change. I observed more and more instances where patients responded unexpectedly to treatments. I would start them on a medication that, according to the textbooks and literature, was supposed to take two weeks to offer any improvement in symptoms. It was baffling to me that a good percentage of people would come back immediately better and some would show no improvement for weeks and weeks, if at all.

People, I realised, are not textbooks. They are much more complicated than that – and far more interesting. Maybe, I thought, we don’t know everything about what causes illness and wellness. Maybe things are happening in medicine that we don’t yet fully understand.

I didn’t say anything to Jonathan about what was running through my mind. I suspected that he wouldn’t agree with me about any of it. But what, I started to wonder, was really going on?

I met the result of Julie’s blood test before I met the woman herself. It was a worrying introduction. ‘Hb 4.4’ was phoned through from the lab. We needed to get hold of her as soon as possible.

Hb 4.4 is a dangerously low haemoglobin reading. Haemoglobin is an iron-based molecule that carries oxygen in the blood. When you have too little haemoglobin in your system you have a blood disorder called anaemia; patients often feel tired or breathless as their organs aren’t receiving enough oxygen to function properly. The normal range in women is usually over 11, so Julie was severely anaemic. The most common cause of anaemia is bleeding. For obvious reasons, most people know if they are bleeding, but if you bleed into your bowel, it can be relatively silent. In this situation, you may slowly lose blood into your gut. The main symptoms of anaemia, tiredness and breathlessness, may present themselves, but if they gradually materialise over a few months you may not really notice it. Your body compensates.

This is what had happened to Julie.

It was clearly an emergency. With a reading like this, Julie could become acutely ill at any time. I phoned her mobile and her landline, but both of them rang and rang with no reply.

‘I’ll have to go round there,’ I said to Jonathan. He nodded at once. I jumped in my car and drove to Julie’s house. The curtains were drawn back and no lights had been left on. Everything seemed normal. I rang the doorbell, then rang again. No reply.

I quickly called the surgery’s main reception desk.

‘Look,’ I said, ‘she isn’t answering. I need to get inside – she could be lying on the floor unconscious right now.’

‘You’re right, Laura. Call the police.’

A situation like this presents a real dilemma. If the police come for a welfare check, there’s a very strong chance they’ll end up forcing entry to the house.

‘But if she’s just gone away and she’s fine, she won’t appreciate coming home to find her front door off its hinges. Is there any other phone number on her record?’ I asked.

‘Wait a minute,’ our receptionist said. ‘I’ve had an idea. I think her mum’s a patient here too – and if she is, we’ll have her number.’

She was right. When I spoke to Julie’s mother, she told me that Julie was away on a retreat and hadn’t taken her mobile. She would be back the next day.

Julie was 54 years old and worked in a small niche bookshop nearby. She came into the practice to see me the following afternoon. I explained that her blood test showed a worrying result and that we needed to do some more checks on her.

‘Is that really necessary?’ said Julie. She seemed to be intelligent and calm. ‘Don’t worry if I look a bit pale. I’m always pale. I’m sure there’s not a problem. I’m only here because I was trying to give blood. When they gave me the iron test, I failed it and they told me to see you. I don’t often visit the doctor.’

‘I understand,’ I told her, trying to keep the anxiety out of my voice. I didn’t want to scare her, but she had to understand that this was serious. ‘But I really think we should find out what’s going on.’

It is rare, nowadays, to meet people who are very ill but believe that they are well. It’s usually the other way around. But this was Julie’s situation.

‘Dr Marshall-Andrews,’ she said clearly. ‘With no disrespect to you at all, I don’t like to follow Western medicine. It only treats the symptoms, not the underlying causes of disease. My sister is a homeopath, and normally if I am feeling under the weather, she prescribes a remedy for me.’

A homeopath? Really? I didn’t want to be dismissive, but I didn’t think that this was helpful at all. I tried hard to keep a neutral expression on my face.

‘I’m sorry, Julie,’ I said, ‘but this is urgent. I think that your results may be telling us something important. I’d really like to send you for tests.’

Not surprisingly, Julie wasn’t happy with the tests I was proposing. Who would want to have one camera pushed down their throat into their stomach and another one inserted through their anus into their colon? But she agreed to be urgently referred for both these procedures.

A large tumour was found at the base of her oesophagus, the tube which extends from the mouth to the stomach. It must have been there for a while, curling around her gullet and oozing blood into her stomach. The word ‘cancer’ comes from the Greek for ‘crab’ or ‘creeping ulcer’, and it is easy to see why this was chosen as a name so long ago.

For Julie, the news kept getting worse. A more detailed scan revealed that the cancer had spread into the liver and lymphatics in her chest. Gently, the oncologist – a specialist in cancer – explained her prognosis. This thoughtful, interesting woman had only months left to live. Her care was handed back to us and the Palliative Care Team. They look after patients approaching the end of their lives.

But when I next saw her, Julie was remarkably upbeat.

‘I’d stopped noticing how tired I was feeling,’ she said to me. ‘I thought it was just my time of life. But those blood transfusions in the hospital made such a difference.’

Julie had been transfused several units of rich, dark blood. As a result, her haemoglobin levels were much higher. In herself, she was actually feeling much better than she had for a long time. I noticed another difference too – it was as though the sudden defining of her life expectancy had given her a clarity and purpose she had not had before. She reduced her hours at work and spent more time with her friends. One weekend a friend drove her to Bristol.

The next time I saw her for an appointment, she was very excited.

‘While we were down there, we found the Penny Brohn cancer unit,’ she explained. ‘I went inside and talked to them – and they were so lovely. They inspired me.’

I looked at her. She was obviously tired and not well, but the energy and enthusiasm in her voice were mirrored in her eyes. Something very nurturing for her had clearly happened in Bristol.

‘What did they say?’ I asked.

‘They understood how I was feeling. They listened. They knew I don’t just want to take medicines – that people with this illness need so much more than that.’

Penny Brohn was diagnosed with breast cancer in 1979. She recognised the importance of caring not just for a patient’s body but for their ‘mind, spirit, emotions, heart and soul’. She and a great friend, Pat Pilkington, got together with a group of volunteers and therapists and founded her centre. Theirs was one of the first instances of Integrated Medicine – a way of caring for patients that sees them as unique individuals, not just as cases, and sets out to meet their emotional needs and those of their families.

Penny Brohn didn’t oppose Western medicine. She was an advocate for all the advances it offers, but she also understood the importance of supporting the person themselves, not just focusing on the tumour growing within them. It was clear straight away from the response to her work how many people agreed with her. Her new centre was a big success. Its ethos was later developed and expanded by a woman on her own cancer journey called Margaret Keswick Jenks – the founder of Maggie’s centres.

Maggie Jenks was diagnosed with advanced breast cancer in 1993. When she received the diagnosis, she was sitting with her husband in a dingy room in the Western General Hospital in Edinburgh. Her abiding reflections on that moment were that at this most shocking and important time of her life, there was nowhere to collect her thoughts, nowhere to cry and be comforted. And if she felt this way, Maggie realised, so must thousands of others.

So she set about creating and designing a cancer centre where patients could go and be supported, have a cup of tea and a chat, get a massage or some acupuncture. She, like Penny Brohn, wanted to create a gentle, nurturing place that could help heal and restore the damage not just to patients’ bodies, but also to their minds, souls and hearts. Maggie died in 1995; over the years more Maggie’s centres have emerged alongside other major hospitals that care for patients in this way in the country.

For Julie and for me, the discovery of Integrated Medicine was to be life-changing.

When I was a medical student in Southampton, I made the decision that paediatrics – children’s medicine – was the path I wanted to take.

I had set my sights set on the lofty heights of becoming a consultant paediatrician at Great Ormond Street Children’s Hospital. Working with sick children – sometimes extremely sick, or with life-limiting conditions – sounds draining but in truth can be inspiring and even uplifting; to feel that you can make a difference to people’s lives at times of real crisis is a great privilege. Scientifically, the work was fascinating too; I saw cutting-edge research and remarkable advances in children’s medicine and felt like I was part of the advance of science in its war on suffering and disease. I attacked my professional goals with energy and passion, achieving membership of the Royal College of Paediatrics and Child Health in record time. I landed a job at the Chelsea and Westminster Hospital and a young, dynamic consultant there took me under his wing. I was on course – I could feel it. I made connections at Great Ormond Street. I started to draw closer and closer to my dream.

And then I had a baby and my whole world changed.

I found that my hunger for the job had died. There was something else that mattered more: a tiny, wriggling, never-sleeping thing – Josh. I struggled on for a few months, stretched between the career I had committed my life to and my new-found love. But I could no longer stay at work until the job was done. I felt the guilt of having to leave while my colleagues carried on, only to arrive late at the nursery and collect the last remaining baby. It was as though I was failing everywhere – I couldn’t be the doctor that I wanted to be, or the mother that I wanted to be either. This feeling broke my heart. I knew my life had to change.

So I left the dynamic, high-flying buzz of hospital medicine and began a reluctant conversion to general practice. I secured a training post at a GP practice in Sompting, a small town just outside Brighton. Here, at least, I would only have to work two or three days a week and could get home at a reasonable hour.

I found myself driving through the streets of Sompting to start my first day as a GP trainee early one autumn morning in 2002, and was instantly afraid that I had paid a heavy price for my change in career. Sompting consists chiefly of bungalows – and to my eyes, that morning, they were all grey. The sky was grey, the sea was grey, the houses were grey and the people who moved slowly outside them were also grey.

All of a sudden, it hit me that I had undoubtedly made the biggest mistake of my life. There was absolutely nothing cutting-edge about Sompting. I had walked away from the greatest sense of professional purpose that I had ever known. What was I doing? I started to cry. I could barely see the entrance to the practice, which was to be my workplace for the next one and a half year, but what I could see of it was also pretty grey.

I pulled myself together, composed my face and walked inside. An elderly lady sat behind the desk. She barely looked up as I entered, but motioned me to sit in a chair that looked like it had been the silent repository for every form of bodily fluid and hot beverage known to man. I remained standing and waited for my trainer to emerge. After a short time, the side door opened and a man in his fifties with unruly hair and physics-teacher shoes appeared. His face crumpled into a smile. He looked like he had completely given up on any attempt at smartness. I glanced down at the smooth lines of my Westwood suit. I did not belong there. This was not my place.

My trainer, Dr Benson – Harry – led me to my room.

On the desk, I saw a long box of notes belonging to the patients who were booked in to the morning’s clinic. An old computer sat on the corner ...

Table of contents

• Cover
• Title Page
• Author’s Note
• Copyright
• Note to Readers
• Dedication
• Contents
• Epigraph
• Introduction
• Part 1: Beginning our journey
• Part 2: Caring
• Part 3: Fighting for survival
• Part 4: Pandemic
• Epilogue
• Acknowledgements
• About the Publisher