Loss 49/101: Loss of life in an Emergency Department: John Cronin & Catherine Fowler

#097. When someone dies in hospital there's the loss of a patient, but there's also the grief of the family, so how does dealing with that grief differ, depending which side you're on?

This is The Silent Why, a podcast on a mission to open up conversations around grief, to see if hope can be found in 101 different types of loss.

Loss #49 of 101: Loss in an Emergency Department

In this episode, you'll meet two guests, each telling their side of the story about the death of a patient after emergency surgery.

Our first guest is Catherine Fowler, the daughter of Tim Fleming, who died of an aortic dissection in 2015 after being admitted to the Emergency Department in Dublin (where he was visiting on a work trip).

We’re also joined by John Cronin, a consultant in Emergency Medicine, who was on duty the day Tim was admitted, and aware of colleagues’ attempts to diagnose his condition.

However, our guests' paths didn't cross the day Tim died, they met much later as they both searched for answers about how aortic dissection is diagnosed and treated.

Seventy adults, of all ages, every week in the UK & Ireland, suffer an aortic dissection (when the aorta, the major artery in the body that carries blood from the heart, starts to tear). And sadly, only around half of these people survive.
 
What Catherine, John, and many others at The Aortic Dissection Charitable Trust have been working on since Tim's death is something we should all be thankful for, because it has massively changed the approach to diagnosing aortic dissection.

For more on The Aortic Dissection Charitable Trust, visit:
https://aorticdissectioncharitabletrust.org/
https://www.facebook.com/AorticDissectCT
https://www.instagram.com/aorticdissectct
https://twitter.com/AorticDissectCT
https://www.linkedin.com/company/the-aortic-dissection-charitable-trust/

Sasha Bates episode mentioned: Loss 23/101:
https://www.thesilentwhy.com/podcast/episode/7bb3198e/loss-23101-loss-of-a-husband-and-best-friend-sasha-bates

Transcript

John: 0:02

Hi, I'm John. I'm an emergency physician. And I'm here to talk about the impact of the loss of a patient on me as a doctor.

Catherine: 0:10

Hi, I'm Catherine, and I'm here to share my story following the loss of my father to a misdiagnosed aortic dissection, and how over the years I've turned my pain into a passion.

Claire : 0:24

Welcome to The Silent Why a podcast on a mission to explore 101 different types of permanent loss, and to hear from those who have experienced each one. I'm Claire.

Chris: 0:33

I'm Chris and in this episode, we're doing something a bit different. We're exploring two sides of one story of loss. When someone dies after emergency surgery to save their life, what's it like for the family trying to get there, but also what's it like for those responsible in the Emergency Room, (or A&E or Emergency Department, depending on where you are in the world). Tim Fleming was sadly one of those who didn't. He died in We kicked off this conversation by asking Catherine February 2015. In a hospital in Dublin. One of our guests in this episode is his daughter, Catherine Fowler, who was enroute with family to fly over from England to be with him. But sadly, Tim died before they reached the hospital.

Catherine: 1:28

It was just very, very difficult to hear and didn't feel real. Just trying to do simple things like getting through the departures. I couldn't get anything to work, I just lost all ability to physically function and to think properly. And my mum couldn't really take in the news at all. I mean, her shock, I could recognise was beyond mine. and John to introduce themselves.

Unknown: 3:19

My name is Catherine Fowler, I, a mother of two beautiful children. I'm also wife to Keith. I work in the energy industry full time leading a team of fantastic people and also really enjoy being involved in leadership development as well. So that's kind of like my my day to day job in my spare time, which I don't really have much of spare time anymore. I volunteer for NHS England as a public patient voice. And I support their cardiac clinical reference group and also their clinical policy group. And in 2020, I was a co founder of the first charity that focuses on aortic dissection, so The Aortic Dissection Charitable Trust, and in the summer of 2022, I was really proud to receive an honour in Westminster for my voluntary work and surfaces to health care in Great Britain so kids parents work, voluntary life, life is very full and very busy.

John: 4:28

John Cronin's my name I'm a Consultant in Emergency Medicine in Dublin and based at St. Vincent's University Hospital, and I trained partly in Australia and partly here in Ireland on our national training programme and part of that towards the last year of my training programme was in Tallaght University Hospital where my paths crossed with Catherine's. My working week varies from day to day. I tend to do about three days of clinical work on the floor, busy seeing patients in the emergency department, and then have one or two days where I do other non clinical stuff. I'm interested in research and in education through simulation. So I spent a lot of time doing that. Also, as an emergency physician, because we see a lot of different things, you end up developing to many other areas of interest. I have an interest in road safety. And I kind of sit on the board of our Road Safety Authority, which are our national organisation looking at road safety and of interest. Another in the theory is very much in aortic dissection, as well. And I'm Father, I'm married to Eilish who's also a doctor and with three girls. So life's very busy in that

Chris: 5:32

As a physician, what does that practically look like? Is that more about seeing patients face to face administering care, treatment, drugs? What sort of doctoring do you do?

John: 5:43

I'm an emergency physician. So if you take any average class of medical students who become doctors, about 60 to 70% of them will become GPS. And then people tend to specialise in other areas. So we will leave medicine do other things business or whatever. But people specialise in in other areas. So surgery is one that there's no different areas of surgery, or there's vascular or general surgery or cardiothoracic x, then you've become physicians, and you can specialise in anything from being altered liver to respiratory whenever, while I specialises in emergency medicine. So we've a training programme, which is a long training programme to become a qualified emergency physician, which is what I am and then you become a consultant in emergency medicine. So basically, I work in an emergency department. So our role like emergency departments are very busy places. So in our emergency department, it's busy urban slash suburban University Teaching Hospital, so we'll see about 200 patients a day. And that's pretty consistent, you know, even though emergency work is is unscheduled, it's fairly predictable, the numbers that come through, so we see about 200 patients a day. So you just got to sort them. So we'll, as the consultant is the kind of person often in charge, you will have a team of doctors of various grades under you, some who are at a senior level and are able to work independently, many of those junior level don't need to consult with you about their patients. And then I'll see patients myself so as a, I guess, consultant, various departments have some days where I'm on the for seeing patients, and I've other days where I'm the consultant in charge, the one thing I can maybe compare it to is like being an air traffic controller, at an airport, you fly over 200 flights going in and out today, and you can't get out and fly all those planes or land all those planes. But you need someone who's who's has an eye over the flow flow is a big thing that we talked about diversity departments because to what our patients are coming in tomorrow, guaranteed might be 180, might be 220. But they will come tomorrow. So today's patients how to be sorted and have to be moved on have to be either discharged or forwarded to the care or cured or are told there's nothing wrong with your arm or whatever it is. So yeah, that's roughly the size of it. So some of it is kind of flow, that sort of management. Then when you're physically seeing patients, you can be seeing anything from somebody stubbed their toe to somebody who has any kind of massively complex trauma and you're doing very complex procedures on them. In everything in between.

Chris: 8:04

Catherine, let's focus a bit on the event that ultimately led to you and John coming into contact. Take us back to what happened with your dad.

Catherine: 8:12

My dad, Tim Fleming youth was a lovely, lovely man. He was 69 years young. He was a husband father. He was a grandfather. Hugely engaged, very active in life. I grew up in Ireland, he moved to London in the 60s, where he met my mum, an Irish couple met in London, and settled in London. So dad was living in London, but he was on a short trip to Dublin. So it was a three day trip. It was on the morning that he was due to fly home, I had received a call from a doctor from Dublin's largest a&e department. It was 6am in the morning, so it was quite unusual time to receive a call as well. And it was explained to me that my dad was very unwell, that he was suffering from either indigestion or something that was called an aortic dissection. So I had never really heard of that condition before. And that made me uncomfortable in itself. I had lots and lots of questions. And the doctor explained to me the role of the aorta, and the body now has a very important role. It brings blood around to all of the major organs, and that when a dissection happens, it's when there's a tear in the aorta. And that's kind of as far as the description went at that point. And I had lots of questions around, I suppose the seriousness of the condition. So what kind of danger might that be in? Is it something that could be treated? The information at that point was was pretty light. It was explained that there was more investigations that were to take place and that he'd call me back in a few hours. So he explained they needed to do to CT scan, I asked, Could I talk to my dad. And sadly, that was declined. The doctor explained that dad had been administered with a lot of morphine. And so he may not either be able to understand what I was saying or wouldn't be able to communicate back to me. And I think at that point, for me, I knew it was something very, very serious. And I remember saying, I don't think it is indigestion that my dad has, I think it must be that other thing, that aortic thing that you mentioned. But he reassured me that they needed to go off and do their investigations, he was very clear and not upsetting my mother, have not not putting the family into any kind of distress. So he would call back in a few hours, I advised I was going to book a flight to Dublin, given that dad was due to come back that evening, I thought, if it's something like indigestion, like I'd be sitting on the plane, take him back home to London, if it's something more serious than absolutely, a family member should be with dad. So kind of went against his advice, he was saying there was no need at that stage. And conversation was kind of left there, I found around the family. And clearly everyone was quite shocked. Dad was a very, very healthy man. And then it was a few hours later, I received another call from the same doctor. And it was clear that he was really distressed. And he said, you know, things are looking pretty serious. Your dad has had an aortic dissection, which has ruptured, but we've managed to resuscitate him, he needs to be taken to another hospital, and he requires surgery, bring your mother to Dublin, as soon as possible, you're probably likely to be staying in Dublin for a while, surgery like this takes a long time to recover. So kind of pack your bags and make your way over. I had received a call in between those two calls from somebody who had been travelling with my dad as well. And they had explained that dad had in fact been taken to a&e the previous day. So he had been discharged at 2am in the morning with a diagnosis of indigestion. And I think the test on whether he could whether he should go home was whether he could tolerate tea and toast, which he did. And he went back to his hotel. But clearly things didn't settle. And he came back to the hospital. And that's when we got the call at six to say that things clearly need to be investigated further. So immediately, I was kind of, well, I suppose more than upset by hadn't heard this information up front in that dad had had previous admission. And I had lots of questions about how her dad been discharged. What were the tests that were done at the point of discharge? So I was really highly emotional, very, very worried. What are his chances? And the response was, you know, your dad's really sick, man, you need to get to Dublin as soon as possible. You need to bring your mother with you. Here's the switchboard number of the hospital that your father's going to that was a bit of a trigger for me, I was thinking we're just going to get lost in the system. How am I going to stay connected, I'm going to be on a flight. So it was very, very distressing. But nonetheless phoned round my family spoke to my brother and asked to bring them on to the airport that would meet at Gatwick. And we need to make our way to Dublin because things were looking pretty serious. No one in the family knew what an aortic dissection was, I met my brother and my mum at the airport, and we were sitting, having a coffee before we entered into the departures lounge, just trying to get our head around what was going on. So I was kind of sitting quite calmly and just trying to explain to my brother and an equally to my mum that things are pretty serious that it was a big operation. I remember my brother, he had it in his head, and I suppose I kind of had in my head. There's no way this is Dad's moment to die. You know, he was so healthy, so fit. And as we were having this discussion, my mobile rang and it was an Irish number. And to me, I kind of thought there's only one place that can be calling right now. But it's really the wrong time for the call. We hadn't arrived in Dublin, the surgery wouldn't have been completed. I knew it was too soon to receive any kind of call. So I kind of stepped away. And it was a call from somebody who travelled with my father and told me that my dad didn't make it and my dad had had died. Which was Yeah, just a real I don't know, shock isn't the word. It was just real disbelief. It was like an out of body experience. And I'm just kind of about to end the call and is there anybody there from the hospital who I can just talk to to try and understand like what's actually happened and there was so a lady came to the phone and in her words she said you know, your your dad lied on the table. You need to get to Dublin as soon as possible. You need to come to Ireland and identify his body. So we were you know, we were kind of From her perspective, kicking into a bit of a process, and it was just very, very difficult to hear and didn't feel real, it was probably the hardest conversation I've ever had have with my mom and my brother. And sharing the news with my siblings as well. And yeah, just trying to take that journey making I'm just trying to do simple things like getting through the departures, I couldn't, I couldn't get anything to work, I just lost all ability to physically function and to think properly. And my mom couldn't really take in the news at all, like, it just was not making any sense to her. It was just, I mean, her shock I could recognise was beyond mine, her ability to function was really lost. And, straightaway kind of confused as to what we were doing and why we were going to Dublin, but we made our way. And we've been met at the airport by some family members. So we've got lots of relations in Ireland, and a couple of the gentleman who had been travelling Out With Dad and dad's belongings were being handed over dad's wedding ring. And I was also given a Dictaphone that was in a meeting when he became unwell. So everything that kind of unfolded there had been recorded. The gentleman was saying, you know, very important hold on to this. So we travelled on to the hospital, to see dad, and everything felt like it was pretty unreal. When we arrived at the hospital, they had had an outbreak of flu. So this was way before COVID times, this was February 2015. And so the hospital was on lockdown. And there's, you know, all of the high veers everything. And the we were very used to seeing in COVID. But it for me, it was like something out of a movie. Very, very strange. But there was a nurse waiting in the foyer in the lobby, and she was expecting us. So she kind of you know, walked us through. But before we walked into the room kind of held the nurses hand, and I said just when we walk around the store, is that just going to be there? But what are we going to see? Does dad look like his sleeping? Like, what what should we be getting ready to, to expect? She said on all my years of nursing, she said, I've never I've never seen a corpse like this. And I immediately stopped her before she went any further and, you know, just said this is my mom's husband of over 40 years, it's my dad, you know, he's a person smaller, it's not a corpse. And just every moment made everything so much harder, though, there wasn't kind of any, like empathy coming from the team who were, I suppose, guiding us through that process. And that was really hard. I remembers talking to mum, just saying, Look, you know, you don't need to do this, I can go in and formally identify dad, and maybe it's better for you to remember, you know, dad in life rather than dad in in death. And mom's mothering instincts really kicked in then she was like, you know, well, maybe that's something that you shouldn't be exposed to. She said, I'm happy to, to do that. And I said, Okay, well, let's do it together, then. And we'll support each other and, and so we went through, and it was really hard, you know, Dad was still warm, you know, wanted to touch him, and I could still smell dad's in his hair. But he was very much, you know, he had all of the medical kind of equipment still there, it couldn't be removed, because of the suddenness of his death or need to be investigated with regards to a post mortem. So he kind of remained untouched from the surgery. And we were waiting for a while for the Garda which is the police to come and do the formality identifying dad. So we spent a lot of time which in a strange way, I don't know whether it was comforting or not. But it made everything of course very real. I think up until that point, all those hours, everything just felt so surreal. And so not how you would met Imagine getting the news of losing a loved one someone being so well then having that news and then all of the all of the events of that day just were never how I would imagine an experience of a loss. So having that time with dad and I suppose allowing that reality to kind of kick in. I don't know whether it helped a bit but I felt like I needed to be there. I didn't feel like I wanted to to leave or to be anywhere else. That surgeon came in, explained a little about the condition. I know he was really trying to reassure me and it's always stuck with me give a saying you know at some point in time Catherine, he said you will take comfort that your dad passed away like this because the condition He arrived to surgery was not the best, which meant that his outcome had he survived, probably wouldn't have looked so good. He was certain that dad would have had suffered a stroke. And he thought it was a very high chance that dad would have been left paraplegic, which of course, I don't think that dad would have enjoyed or coped well, with a life like that after that illness. But it did trigger a series of questions for me immediately around the condition that dad arrived in to surgery. Because I was made aware earlier that morning, that dad was in the day before that he had been discharged, he'd come back. And so a lot of time was lost. I just wanted to understand a bit more about the condition in that if Dad had arrived sooner, and if the diagnosis had been made, and transferred, being made, and he'd had a perfect pathway, what would have happened, then? Would we be having this conversation? You know, I explained to him was like, my dad's such a fit and healthy man. And if you were in my shoes, you'd be asking questions to all I'm trying to do is to get information and just understand how this has happened. And could things have been different. And then later that night, gardener came along, and we went through the process of formal identification. And he explained that there would be an inquest, just to do with the timing of dad's passing, that he was in hospital for such a short period of time, that the coroner would want to understand what had happened. And for me, I thought, well, at least there is a place for, you know, the questions to be answered. And maybe now isn't the right time to try and understand all of that. I found it very hard to leave dad that night. And in fact, it was probably the early hours of the morning. And we went and stayed with my cousin. Sadly, for months, we found out you know, months down the line, it triggered an accelerated onset for outside months, which months still lives with today. So the whole experience was just hugely shocking and catastrophic for mum, she's my superhero, really, you know, she's so strong. With her child, you can watch his lift with since then. So yeah, it was a very, very difficult time. We had lots of questions for the emergency department. And my sister met with the team. And they had a long meeting, and it was explained that aortic dissection was a hopeless condition was really the way that they explained it to us, in that people just don't get diagnosed. And if you get diagnosed, you don't have great outcomes. And, you know, really, you should see it, you know, along the lines, that it was really your dad's fate. And that was, it was hard to hear. And we felt there was a lot of unanswered questions in those very, very early days, the day after dad's funeral, dad's sister suffered an aortic dissection. So we failed to tell the emergency team what had just happened to her brother, and that he had lost his life, but a fair play to them. They suspected that's what was happening. And she had a CT scan, and her dissection was diagnosed, and she had her emergency set surgery, which saved her life. But you know, her life was never, never the same again. And, for me, that was a real moment of awareness, I suppose, in that aortic dissection cannot be a hopeless condition. How did this happen? So really opened a lot more questions for us. And we understood that aortic dissection is a condition that can be detected, it can be treated, and that people can survive it. And for me, that, and my family, you know, that that really changed everything. My dad was always a campaigner in his life, and he had been sharing with my older sister, those changed org campaigns. And so we decided that would be, I suppose a bit of a vehicle to share what had happened, and to call for change, we knew that it was a condition that could be detected and treated. And we started a petition that we were hoping would go viral. And we would be able to make a case for change to the Secretary of State for Health in the UK and equally for the HSE in Ireland. It didn't go viral. We in the campaign is still live now. And it has 10,000 signatures, people who are living with a condition and and families like ours who have lost a loved one and I suppose that was kind of, I suppose our first kind of step into trying to amplify the voice of others. And I suppose an act I don't know how active the decision was at that point. But really trying to You've harnessed pain and grief and put it in a place into something that could be more positive, and to try and drive to try and drive change.

Chris: 25:09

John, listening to all of that, because in your work, you've mentioned numbers of how many people you see through the emergency department. You know, for many years, you'll have dealt with many individuals without knowing all of the stories, the family setups, all the background, the before the during the after. What's it like listening to Catherine talk, and just getting all of that colour all of that context?

John: 25:31

Yeah, I mean, it's quite emotional. And you're hearing that personal side of it. Yeah, definitely. Home. And I've heard Catherine talk before been at a few conferences. So I've heard heard the story that maybe you've added more personal detail there. I think I said, when you're working in emergency departments, and you feel a couple 100 patients coming in a day, particularly if you're in charge, you need that flow, you need to go through it because the appropriate places and your mind is very much on safety and making sure you're not missing things. And sometimes you can lose that personal touch. When you're, you're when you have the bird's eye view like that. Now, when you workmanship, nursing individual patients, you always try to use try to make that a personal bond with them. But if you united clinical shift, the last two days, I was working with voi, yesterday, and the day before us, if you asked me to describe each patient and where they're from, that I saw, or even to recall all of them, I'd struggle. But if I asked you, when when were you last in an emergency department, you remember, I remember when I was an emergency problem for another 10 or whatever. So when you go to emergency participation, suffering a bit of an index event in your life, even if you just sprained ankle, you always remember us and you'll probably remember the doctrine, the passions. I was the guy or girl I saw in the hospital. But you have someone who I saw yesterday could walk past me and I wouldn't remember them. So when you're kind of dealing with that fine when you do them day by day, it just becomes part of your job. But then, you know, there are one or two patients that you see during your career or during every maybe six months or a year that really kind of stay with you and certainly catheter story. And Tim story was one that definitely stayed with me.

Claire : 27:17

Tell us what your what it was like on the other side of that story then because obviously you're on the other side. Catherine's looking for questions, you probably know some of the answers. What was your experience of that day in that shift?

John: 27:27

So yeah, I was a senior I was what you call an SPR so specialist registrar. So it was kind of on the, I guess maybe the final furlong of my training to becoming fully qualified a mercy physician, I'd take up a consultant post later that year, and a different hospital. But I was working in that hospital in the final year of my training. So let's say it was kind of February 2015. I also had my kind of final exams around that time of year. So it's very kind of busy time for me. And it was it was a busy hospital and very busy department. That particular day I was working in evening shifts, which end of day, evening and night shifts, I was working in the evenings shift. So it's kind of 4pm Till, till midnight. And when you were 14 midnight, you're ready to go out at midnight, you know, the one or two in the morning you'd be kind of getting home and then trying to relax and try and at some stage to get some sleep and get ready for the next day. And the evening shifts often tends to be the most busy time because people the people presenting all during the day, we're in the department getting the best to get to get treatment. And then there's kind of a busy time during the evening when patients tend to come in. So the big volume of people coming through. Also that particular department and most many many merge departments are very overcrowded. So all your base to see patients will be full. And there are patients out in the corridors some patients who had missing waiting for a bed for hours or sometimes even days where they're in the corridor. So it very much crunched your working conditions. We're also adding short staff but I say that we were chronically short staffed. So there was the registrar on the four to midnight shift they'll always be to register there was another registrar on the 14th midnight shift the other registrar was less experienced to say we were short staffed so he was a locum so maybe wasn't as familiar with the place wasn't as far along in his training as I was so definitely was the more senior person but nevertheless, he was he was a registrar but sometimes I need to as well as keeping an eye on the juniors and seeing my own seeing my own patients and sorting out my own patients or being behind the juniors and aware that maybe the person who was on with maybe wouldn't be as quick or experienced as capable as me so I guess you want to put it that it is a fairly stressed working environment. But it's kind of chronically like that so you could get used to to that kind of chronic stress and shortage of space and resources. And remember work in that particular evening in in in any emergency department you have resuscitation area where the sickest patients go and in that heart and that farm there or six resource base. So those are the sickest patients would be the new majors cubicles and the miners cubicles where, you know, the the other piece patients I will be but the resuscitation basically what were the sick sickest ones would be. And remember, five of the five of the six resuscitation bays were under me is always going to, there are different stages of being sorted out either you're being treated and referred out to other teams and that sort of stuff. And I was also trying to keep an eye on the general flow of the department, I was aware that there was a gentleman there with, with chest pain, who one of my other colleagues who's on the J shift Woods had seen initially, and had handed over to my colleague, you know, often when you're finishing your shift, you'd be nice of all your patients are sorted. But often as you're when you're in an emergency department, and you're waiting on blood tests, or X rays or whatever or treatment, you know, there comes a time when the handed over to a colleague in the emergency department or refer the patient on to a specialist team or whatever. So your he he Tim was being seen by a colleague who then handed his care over with a plan to the other registrar who was on the phone for some a nice shift. So as I was aware, you can certainly in hindsight, after everything that happened, I remember being aware that that patient was there. So I was quite busy and and when you get to the last hour of your shift, you start realising Okay, I need to start wrapping things up here, I'm not the person on the go, I need to sort these patients out, I need to make sure when I hand over to the people coming on nights that I'm handing off something reasonable, and that I've either discharged my patients or I have to plan for all of them sort of thing. So I was I was doing all that. And I remember actually one there was one particular young patient who was in who had your kind of family had a number of questions about their care and their were well enough to go home and found rock concert. And the last trying to deal with that that was kind of stressful. So that does get them stuck the big ticket item on my head that evening and need to sort out this young person and speak to their family and get everybody on the same page and and get them discharged rather than pulling them over needlessly to age on ice from for nothing. And so that so that was I specifically remember that being a thing I had to sort out as well as the other sick patients and resource. And then on stage wasn't the last hour of my shift. I remember walking past and this gentleman, Tim, as it turned out was not looking right and was having quite bad pain at that stage having been fine. Your for a period earlier. And that's the nature of aortic dissection. It goes absolutely severe pain, the worst pain ever. But as the tear stops tearing patient, it's better to be sitting up reading the paper. If it starts tearing, again, severe pain comes back. And that's actually a classic sign that you can get with the with the aortic dissection. And I was also aware, I told you about flow and emergency departments because there are always more patients coming through you need a plan. And you can't just leave someone wallowing in an emergency department you need a pond or the water to go where they need or the threat of specialist care. Who knows where this patient already been handover from will not the doctor. So we need to come up with a plan. So I've just done obviously not to get involved or to not be picking up more patients. Because when you come towards the end of your shift, you start picking up more patients, you're not going to get them sorted or you have to hand them off to someone else. But nevertheless, if there's a time credit, their mercy be there you need to help. Remember walking past and asking my colleague I was kind of what's the plan, it was clear that there wasn't a very clear working diagnosis, when you see someone you need to come up with what we call a differential diagnosis. This could be one of these three things, one, this, this or this, or maybe it's just this or maybe we want to five things and we need to do all these investigations to figure that figure it out. So you need to work with your differential diagnosis. And then based on that you you come up with a plan as to why you're going to do again, it is easier seeing this something in hindsight, but we weren't sure what's going on. I knew we needed a plan. And I remember part of me didn't want to be involved because I had my own head spinning. But there's clearly no plan here I need to stick my head in. And so I did. And I remember speaking with him prepare, I'm just going over the history and stuff and having a look at the various things, I think the blood tests and the X rays. And you're there, there wasn't too much to find on an examination. And there wasn't too much to find on the blood tests or the X ray, which again is typical of aortic dissection. But it is there's something going on here I thought of a few things going on, one of which was in the organisation couldn't be this, but then I thought actually, it's more likely to be something else that got the schema got which has some crossover that again, you're losing blood supply to the gods just of where his pain was at that stage, which was known as Tommy, when he had come in first one my colleague had seen was in his chest again, that's a classic thing with dissection can start in the chest and travel down. I'm gonna stick him in the spirit and there must be a problem with the blood supply to the Gulf here. We need surgical specialists to come in and see This man and orderlies scans at the time and the hospitals slightly difficult for us in emergency to get specialist scans or CTS stuff beyond X rays, our colleagues were quite keen that it was a specialist who ordered them, I think they were maybe have the impression that, you know, if we were ordering them that we'd be ordering it on and on every single patient. I guess that was kind of the culture, you're in the place, which maybe you kind of rubbed off on our decisions. Anyway, I said to my colleagues in the assertion down here to see this, this person does demand supply needs to happen with different strong painkillers because he or she probably needs some imaging, make that happen sort of thing. So I go back fix one boiler bits and pieces, I was talking to another family, etc. It came towards the end of my shift again was well after being at the station, I spoke to the guy who was on nights and I told him I don't my patients when he didn't handover, but control the nurse in charge. And I might have two guys on ISIS by the small chap over there. My colleague is referring to surgeons don't ever need to come down see him when he just got done. That's why I'm leaving. I do actually remember late that night and they can go to this. They're lucky I'm here sorting everything out. You know, they're not quite I'm not I'm not an arrogant person from far more among each other Elba Just one second, you know, sort of this good, you know, walk out of the place. And my colleague Corbin on English. If I'd asked him in the time since I was talking to him, maybe 10 An hour half an hour ago. Did you get hold of surgeons? He was like, Yeah, I can see is it Yeah, it was a grace, you know, we are planned for everybody on the way. So yeah, that kind of describes the end of an average shift. Really. The next morning, I was in with a teaching session. And I was in and we were kind of sitting around talking the teacher session where they're kind of registrar's pencils, and the different doctors, we all kind of get together. And usually the people are giving a presentation on the topic of the week or whatever. And before we're kind of sitting around there talking to them, we're talking about a patient who's come in during the mice who had to be transferred out all of a sudden, and I was really paying too much attention. You know, people always talk about whatever interesting case had been in the previous day or the previous week, or whenever they're talking about words or channelling sounds like, the man is formed by her come on Thursday. Oh, he came in June. And I was like, no, he's injured the day yesterday, I was like, you know, just wasn't making sense. But there's as like, maybe it's somebody else more than chocolate. I was like, No, hang on a sec. And so I started asking questions and it turns out he was sort of did come to see him at later stage probably during those phases where the pain at ease and gone away and had sent him home with you know, in hindsight, a proper diagnosis then you came back in during the ice and as obviously things have progressed and is obviously far more unwell. And then obviously when he came back into the night there was obviously another episode of care and he has been seen by different doctors and getting the scan and then needing to transfer it out ourselves where they're doing all that part of his care by serving Angelica I didn't remember how she gets at home okay, I just remember thinking about you know, and so I said I said to my boss, I was I just you know, I did swing by and he wasn't my patient he wasn't on my list of agents My name wasn't actually against him you know, we have ID systems in the barn. So if you actually go in I remember watching er before those big whiteboard patients as we have progressed to more IT systems so your name would be against the patient in your notes would be written in there or whatever. But my name wasn't against him because it swung by to give kind of senior opinion if you like, and I took my muscles so then I didn't feel quite right with Da Vinci said look, shoot shoot me an email she was gonna go onto the for shoot me an email right in the middle and sort of thing so I did that. And at that stage that was kind of it from that point of view. I you know, back to my other colleague good banana said did you get surgeons from 97 chromaticity Did you know when high tide was a more junior surgeon that he'd called you know, so on in the nurses were very upset, who had been on you know, they're they're kind of very upset and Lucan angry about us and, but really, that was kind of ish, at that stage. And for us as healthcare providers, that's not a it's not a nice way to end because you know, there's a process that's going to happen now. There's going to be questions asked, it's going to be statements and so we have a kind of Catherine moves to a kind of coroner's inquest, where or any death in hospitals report to the coroner. Sometimes they're explained death people die in hospitals by the nature of people who are unwell, they come to hospital and stuff, and sometimes it's very clearly explained Death and everything probably was done. But in cases where it's unexplained or it's very sudden and or there was delay or some of the sent home goes back in and the home dies, the coroner's will do, obviously, there'll be an autopsy and the coroner's will will have an inquest. That process could take a very long time. So Tim's inquest was 18 months or later, under that time, then you're asked for statements and you're asked for your the taken and you're taken on board what had happened, and then you're aware that you're gonna be going to the coroner's inquest on, you're gonna be facing the family who will be there. The coroner's inquest is it's not supposed to be adversarial, let's say like a courtroom. But nevertheless, it is in a court, and people will bring along their legal representation, you will get cross examine. So it is very much a fear for doctors. And that's very much defensive kind of first sort of thing. But it's not supposed to be adversarial, it's just supposed to be kind of fact finding, let's all together come to a judgement maybe the wrong word or a decision as to what the cause was locked out to. Here, but it can be a very, very stressful sort of thing. So because that took so long, again, I was busy. So in terms of my life, I got more done. I kind of forgot about I remember, upside away, and we kind of discussed about it a good bit afterwards. But you kind of go on and busy exams, and it was moving jobs or just getting a consulting job sort of thing. And, but eventually, you know, you're going to get the email, asking for your your statement, and you get an email saying, there's a date set for the Coroner's Court, then you can meet the team in advance of that and legal people and becomes very kind of stressful and kind of all consuming. Yeah. Sometimes when there's coroner's inquest, it, it's okay that, you know, it's, it's normal to, you know, nothing bad has happened, and everything was done appropriately. And so not all current requests are like that, they can be fine, or they could be a good experience for everyone just to get clarity on what happened, but we knew that this would be a stressful experience. So then that can that can, that can be that can weigh heavily on you.

Claire : 42:18

Facing that kind of loss through your job. That's obviously something that you'd have faced a few many times, I don't know what the numbers would be on that. How do you process that and, and work through that kind of loss when it's sort of stay detached. But like you said, you don't know the history of all these people, you're dealing with things in the minute. So it's not like a personal grief, where you know, the whole story, you have to move on to the next shift, the next patient needs you quite quickly. So are you taught how to handle that? Or is that something you've had to learn for yourself?

John: 42:49

That's probably in college, you are taught'breaking bad news'. So you're taught how to break bad news to someone and there is a way to do things not to say that it seems that you do have to say when you're breaking bad news to someone. So we are taught how to give that bad news in a clear, empathetic and clear way. That is something even back when I was in college, and I'm on about 20 years now. But there was some there was even done back then. I'd say there's more of an awareness of it now. But only when I qualified. No, there was no worries. This is how you deal with something obsession that happens or something unexpected. There wasn't there was none of that. Your but people are more aware of it. Now we do have debriefs, you know, sometimes it's where you try to get together afterwards and discuss what happens and then anyone can talk about kind of how they're feeling. So you're after a challenging case or a different case or very interesting case, he may you'll have a teaching session or learning session about it afterwards. Okay. This is what the nature of this conditions is what the investigations you should do this is you know, the things to watch out for. But then you also have the debrief of the emotional debrief events set by ashore, pretty stressed after assertion thing. That's something we're often not as good at, you know, sometimes we call them hush debriefs. Initially, if you do it straightaway after if there's been a difficult resuscitation or a difficult event, you know, we have to do it before you do straight away afterwards. One of the reasons for that is because it's often never the same team on when you're working in emergency department. There's a number of different doctrines, there's a number of different nurses, everyone's on the different shift rotation. So there's different team though you work together, I know all the nurse I work with, I know roughly all the doctors so even though they rotate every six months, and every three months, you get to know them fairly quickly. But there'll be different combination people on every shift. So if there's six or seven new doctors, nurses have been working on one patient, the six or seven, you may not be on a shift together again, and then you call people in from home and then I work in to have a debrief. So after we we tried to do an immediate debrief, but then also that can have its weaknesses because people need time to process particularly something bad happened or if someone dies or there is an unexpected death. I mean in terms of dealing with us as an emergency doctor because often we see our patients for a short very short period of time. So off, but we do see death regularly, unfortunately. Well, those common ways we see it is when someone has what we call an out of hospital cardiac arrest. So when they've collapsed out of hospital, they've had a heart attack or whatever the paramedics are, are great. Now they're experts or resuscitating patients, and they'll bring the patients to us with ongoing resuscitation, will continue resuscitation. And often you can get patients back and you'll get them to a cardiologist, if that's what they need, or whatever it is they need. But with an out of hospital cardiac arrest, actually, this five ratio is fairly low, particularly someone's head of downtime if they haven't been discovered, and someone hasn't started CPR straightaway. So we'd regularly see our ask her address and address, which often, and oftentimes you don't get the patient back at all. And then you've a family come in, who you're breaking the news to, I would say that's a routine part of our work, but it's something that you see very regularly and need to ask, you need to give that time, you know, it was a break from the news to the family and kind of speaking with them. But from our personal point of view, because that's something we see regularly it can be, what can be more difficult to deal with is when you have a patient who's in under you, and you're seeing them, they're talking away to you and you're doing stuff with them and maybe ordered tests or you're also seeing other patients and suddenly something happens they take a turn or become worse and and they have a cardiac arrest. Because you already been involved in their care, you've spoke to them, you've done some sort of rapport with, and your if something happens with them, and they they die, that can be a harder one to register a particular thing for younger doctors. And then they'll always be the thing or clerked on some definitely could have done something earlier. And then almost no matter what anyone says she still register yourself on that. And it can very much knock people's confidence in the job.

Claire : 46:49

So just tell us how you met Catherine then because at the moment, we've got, obviously you involved in the case, but sort of somewhat distant and you've got Catherine on the other side of it. So how did you how did your paths actually cross?

John: 47:00

Well, we didn't see each other until the coroner's inquest, there's... Catherine, you probably heard from me in terms of well, what are my statement and stuff before I heard from you,

Catherine: 47:12

It was through the inquest that actually a lot more information was revealed. And there was only one person of all of the statements that were submitted through the process that mentioned aortic dissection, and that was very out of step with the hospital's original position. So the first kind of statement that we came across to say, actually, there was someone in the room that suspected this could have been one of those differential diagnosis. And that statement came from a man called John Cronin so that was the first time I heard of John. His statement gave me a huge amount of hope that we had an opportunity to learn. The first time I met John, and a number of the team from the hospital was at the inquest itself, and the outcome of the inquest was a booting of medical misadventure. So, the term negligence isn't a term that's accepted or recognised in Irish Coroner's Court. And medical misadventure means that it's an unintended outcome from an intended action. So basically, no one intends harm. In essence, it was an act. And there were a number of recommendations that were made from that inquest. But I had learned that those recommendations didn't need to be taken forward. And for me, that was a big catalyst to say, okay, where this was something that we'd put I put a lot of energy into, and was really disappointed to learn so late into that process, that it wasn't going to be a driver for change. So started to really try and work through what other opportunities if that's the right word, how else can we make dad's life and his death count for something and enact some change within this hospital and ideally, further afield as well. So I started meeting with the leadership team of the hospital, but also started well through invitation attending medical conferences. So sharing my dad's story and my aunt story and just highlighting the issue around aortic dissection, because what happened in my family is actually a reflection of what happens in the UK and Ireland every year. 4000 people have this condition 2000 People die, so half live, and a third of that is down to misdiagnosis. And so that was a real trigger to do something about it. And it was at one of these conferences in Galway. I was looking at the poster section of the conference. And somebody had done a study on the number of diagnosed aortic dissections in Dublin. And the author of this research was a Dr. John Cronin. So mine has just stood up on the end. I was like, very emotional. And I don't know how but I had your I had your email address at that point, John. And I remember emailing you saying, I'm at this conference, standing in front of this poster, got a few questions. Are you at this conference? Is this your work? And was this work inspired by what happened to my father, and John came back, say he wasn't at the conference, but it was his work. And it was inspired by what had happened to dad that night. And I quickly got back to John to say, I'm actively campaigning, I'm actively wanting to work with hospitals to work with the medical community to try and drive change. And I'm really pleased that he is also doing the same and that I would be open to doing something together. And at that point, I don't think we really knew what that something was. So we arranged to meet at an awareness conference in Liverpool. But it was quite a foggy flight in, and I think you were dropped off somewhere else in the UK and had a coach journey to make to Liverpool. So we, we didn't meet that year. And there was a, there was another conference the following year in London. And that's where John and I, I suppose met in person outside of any kind of inquest, or, or formal setting. My sister was with me too. And I think we probably spent most of the time crying, John, myself and my sister, it was hugely, hugely emotional. But we were really inspired by a lot of what we saw that day and saw that there was an opportunity to take some good practice back to Dublin, and, you know, made a commitment in the room that we were going to do something together. And then I think it was the following year, another meeting in Dublin, thank you, we're late to the dinner for all of the faculty speakers, there was only one seat left in the room, which was next to me. And, you know, it was really nice to just connect in a very different setting, talk about our experiences and share what we what we might do together. But it was the following evening, I think I met your wife, and we were wearing the same dress, which was a bit of a moment. For us both, she was so warm, and so empathetic. And we both cried, as well, actually, when we met, and she was you know, so sorry for what happened, you know, very sorry for your loss and for your family lost. And we were talking a little bit and she said something that really changed my whole outlook. And and in fact, the charity that we formed how that charity has put together, because she just asked if I had thought about the impact that it might have had on on John and John's family, when I said I have thought about it, but I hadn't given it a great deal of thought. Because I've I completely accept and understand everyone goes into medicine to do good and not to do harm. But equally think it is something locked is something you're exposed to, and that you might not always have control over when you're working in a medical setting to. And clearly, sometimes mistakes are made like in with ads case. But it was a real eye opener, you know, she shared from her perspective, the stress, the strain, the grief, although it was a different type of grief. And for me, it opened my mind to how I wanted to work in this space in a completely different way. That yes, then John and I have gone on to do some great work together. In the COVID times we held an education day completely dedicated to aortic dissection. We have a community of over 200 medical professionals from all over Ireland. We have faculty attend from America, to share their knowledge and experience and we've gone on to run face to face events together for the emergency medicine community and the surgeons themselves as well. And I suppose from all of those interactions that happened with the hospital directly after the inquest, they did go on to drive a lot of change. They conducted their own internal investigation, which led to 14 recommendations to change. One of those was around having a robust guideline for aortic dissection, diagnosis, its detection and how it's managed. And that went on to form a National Guideline in Ireland, which I hadn't appreciated until John had invited some of the team to present at a conference that we had organised together. And they were sharing that the results of all of that work of the last seven years and the impact that Dad's experience has had on the team there. It's an interesting relationship that we have in the sense of the work that we do together because I think it surprises a lot of the medical community. Work with lots of medical professionals but I I've introduced John, on a few occasions, as you know, John was part of my dad's team. And that's how we initially crossed paths. And I think people do find it surprising from on the medical side. And I think equally, you know, family members who have lost a loved one, equally find it very, very unusual how we have got ourselves into a space where I suppose we can, you know, respect each other's loss and grief and come together and try and make something really, really positive from that. And not only try now we are succeeding, and we are delivering some great work in the educational space together.

Chris: 55:33

When you shared, I asked John about you know what it was like listening. So when you then hear John talking through his side of things, that won't be the first time you've talked through about, but could you just sort of summarise what sort of impact has it had on you and your journey with bereavement with with grieving the loss of your father? How is your journey of grief been different? If it's been different, by having more of an understanding of what goes on behind the scenes of a hospital?

Catherine: 55:59

I mean, I think that's a really great question, Chris. And I think if you'd asked me across the timeline of the eight years, it's really changed. So I think, initially, you know, the very early days of losing dad, I had a really had a very low tolerance, I suppose for kind of empathy. And I felt really angry about what happened. And I had, although I didn't have all of the facts, you know, I suspected that that could have had a very different outcome. And so it was very hard to connect on an empathetic, empathetic level. For me, I think, I mean, I really wanted to, and I think for every individual and every family, and even within families, it's very People have different views, whether they even want to step into a space of an inquest, or whether they want to step in and have a meeting at the hospital to find out the facts. Because, you know, sometimes I do reflect and think, oh, that could have been easier maybe to think, well, this just was dad's fate, and it could have just been left. But I did want to continue to ask, why and how and what and so I was really, I really wanted more information. Sometimes that made the grief more difficult, because you don't always like what you find and what you hear. I know very much that I'm keeping my grief realised through the work that I do, not only sharing my own personal experience, but I often meet no families, or the bereaved families or people who are living with their own loss through the condition in that they're living a very different life. And equally, I have met medical professionals who have decided to step out, because a life has been lost due to a misdiagnosis or a missed aortic dissection. And for them, that has been the red line in their career and not one that they've wanted to step over. So I'm definitely an individual who wants to know the facts, who wants to understand why things have happened. And we'll think even without information, how things could have been different, I'm definitely a scenario thinker. So it's the only way I could have walked my journey of grief, I think, is a hunger for understanding what happened. And a little along the way, understanding that we weren't alone. And that was equally a trigger. For me understanding that so many other families go through loss to this particular condition, more people die of this condition in the UK and Ireland and people who died in road traffic accidents. It's, it's a huge loss of life. And that was equally a decision to what can you use that energy for, because although there is a huge loss and sadness and pain that comes with grief, for me, there has been a point in time to decide to use that energy, which is great, because there's nothing else that you can call it, it's huge pain, but use that energy to put it into something good. And sometimes I find that hugely helpful when I can see that it's improving and driving outcomes and opening doors for change or helping an individual family. And sometimes it just brings it all back. And it's it's really hard. But actually, I think it's something that my mom said to me. She said that if your dad had known what was to come following his death, I think he would have gladly laid down his licence. He knew that it would save so many others will have the potential in the future. So many others and that sort of thing. I don't know whether that's really how how I feel I don't know if that really is how he would have felt he was a very giving man. But the fact is, he has lost his life. And I really want his life and his death to count for something. Oh, yeah, it's it changes and I'm sure it will change again, Chris, it's, you know, you meet so many different people. On the way, and it's been hugely inspiring, I think the amount of people that want to step forward and support. It was interesting listening to John, particularly, you know, kind of describing whose name was on the board, who's accountable for the patient, the culture of the court, the Coroner's Court, we're actually it is not supposed to be adversarial. And in Ireland, there is certainly negligence does not isn't, you know, linked to any individual or any hospital. But yet, that setting creates a culture of, I believe, and I might have it wrong, John, but my perception, I think it does create a bit of fear. And I think that maybe that fear then creates a culture of locking honesty, and really be able to sit down and share with a family what really happened. And and that's what, in my experience, I can't speak for families that for me, I just wanted to know, it was about inflammation wasn't about, it wasn't about blame, it was just about understanding that I could feel the guards were up. And we should use failure as an opportunity for learning, even if that failure is the ultimate loss. And it's death. It's so sad for that to be lost and turned into blame. That's not helpful for anybody, you know. And you can hear John describing the setting of a very busy department and all of the challenges. And I'm sure John would love the silver bullets in his working environment, as much as I would love those silver bullets too. So I think it's uniting around, change together,

John: 1:01:41

I could speak to that fear a little bit that comes with coming up to the corners. thing, because I mentioned that after the case, because there's such a delay with it happening, sometimes it goes to the back of your mind, you know, it's there somewhere, it's going to come up down the road. And then when it did come up, and you had the days coming up, you start reflecting because you're fearful of this process that you're going into and you fear the worst, you know, you kind of fear of his family are going to try and get me or either get your to see I'm going to be the paper or someone's going to report you to the Medical Council or try to take your licence and you start this disaster thinking because of this terrible event that that's happened. And I guess maybe one phase of it is kind of anger. And maybe that's kind of that phase of grief as well. I started thinking about why so fair that I had to work in this system that was overstressed was unfair that I had to work. Or I have to work in the department that was crowded and hampered the way I could do my job and the way the department works, you know, and why wasn't it easier for me for us to get scans? Or why why wasn't? Why didn't a different specialist calm? Or why didn't I have a better colleague on or, and you start looking outwards, and getting defensive and a bit angry. And it was actually a member when we went in to meet the kind of Legal Medicine person was representing the hospital. And I remember him saying he was like, you know, because people were talking a little bit defensively and he said, Look, if there's something you feel you could have done differently, or something you feel it was right, just say it and own it, and represent it to own it. Because I think it's clear to everybody and you know, yourself internally, if you're trying to cover something up or saying well, I did everything right and was the system's bottom or is that other departments problem, you know, these are older, if you feel you could have done something differently, I could have, I could have done things differently, there are different things I could have done was important just to, to to own that. When you when you know it's true. But as Catherine says in the the maybe the way medicine is we are a little bit defensive. And if we don't always own up to those things, which men, then maybe it doesn't allow for the learning or the improvements or the changes to happen, both for yourself as an individual and for departments and for specialties. And, you know, I think positive change has happened. I mean, Catherine mentioned about the work we've done together, I should say Catherine's done most of the work. And it's only happened because of her passion and her drive, which is quite remarkable. And it's certainly changed the way I approach patients who possibly have aortic dissection. But I would say that for it's changed the approach of every department in Ireland and probably across the UK, the awareness that she's brought to the condition as a result of her father's passing, you'll struggle to be the only doctor and in an emergency departments or in the relevant specialties who wouldn't be aware of it and who hasn't been impacted by it. Because whether they know or not they happen.

Claire : 1:04:38

It's interesting, because one of the questions we ask all our guests is Do you ever ask the question why? But you've kind of covered that because you have asked the questions. Catherine has been searching for answers through through her routes and through the medical system. And why did this happen? And you just listed a whole load of why questions there you ask. So it's interesting how you've both had to wrestle with that question and sort of found ways to sort of live with it. We'll get those answers. John, do you feel like that's something that comes up a lot in your job? Is the why question something that you have to sort of make peace with sometimes because you don't get the answers that you want.

John: 1:05:10

Yeah, you do feel like sometimes you're in the wrong place at the wrong time. There's a real randomness, I suppose there's randomness to life in the same way, you can just randomly meet someone that you might have met. Otherwise, he goes through that sliding doors. And I know sliding doors has been a theme of three, Catherine has done some of her talks, these are kind of sliding doors. Moments, your father may not have been in Dublin that day, you know, he may have gone to a different department, he may have made a different doctor, I could come on my shift at the same time as another doctor. And we go and both go to pick a patient and he just happens to be the first one to like pick the second one, or vice versa. And that patient could get a totally different experience, which is we like things to be systematised and guidelines and protocols, that person could be could have totally different experience with that doctor versus me and vice versa. So there's real randomness to working in, in an emergency department. And you have people call emergency departments a and E's act and emergencies, but it's stuff that also stands for anything and everything. And the next person, you could say you could be the most nondescript, you know, stubbed their toe, easy thing, or it could be the case that you'll remember when you retire more than any other. And you just get to accept that there is a a randomness, and anything can happen, because initially can be a real Oh, why did I have to pick up that burden? Or what why was I there? Or why did that happen on my ship? So you just need to kind of make peace with with that.

Chris: 1:06:47

Let's end with our final question. John, while you're warmed up, through all of this, what's your Herman?

John: 1:06:54

I think my Herman, the game changer on this has been working and engaging with family members, and loved ones of patients and involving patients. Because as medics, we tend to meet as medics, and we have our meetings and our education meetings just with medics, and just for the doctors there, and sometimes just with only doctors of your own specialty, and we meet in silos, you know, aortic dissection doesn't respect those silos. A big change for me has been not having a fear of working with patients, families, and loved ones, particularly if things haven't gone to plan. There is a defence of culture in medicine, where sometimes we worry about what people will think of us or mistakes we've made or, or lack of knowledge or understanding that we might have. But there is just no way that we would have made the progress on aortic dissection had it been just us as a bunch of emergency physicians or as a bunch of doctors, compared to wash Katherina has done so in any large project that I'm involved in. Now, whether it's research, or whatever it is, we'll look at ways in which we can involve patients or relatives who may be involved or affected by that area. And most funding bodies who fund research want patient involvement at some level. So this experience and Tim's loss, that's the change it's made to me.

Chris: 1:08:20

Catherine. Yep. As John said, it was your dad that you lost so much good has come out of that. But through the years of grieving of working, what's your Herman?

Catherine: 1:08:29

Maybe one of the hardest questions to answer this year, there's been so many Hermans, and I hope that there's going to be many more, but for me, really, my permission is heightened awareness that can get a handle on your grief, you can turn it into something quite powerful if you're willing to take yourself there and keep your grief allies. And it's been and will continue to be, I think, a journey of grief, but harnessing it as a passion for change, and being able to amplify the voice for others, and equally, enhancing a community being able to find empathy for others grief along the way. And that was a little unexpected. At the beginning of my journey. I couldn't see myself having a levels of empathy that I had with members from the medical community. And I think that's quite a powerful thing. And yeah, for me, I think it's an ability to harness grief and use it for something positive for yourself and equally to help others.

Claire : 1:09:40

What a lovely couple of Herman's. Both speak into the power of involving others to create something special that then helps others in their grief. Their work reminds me of the Jana Stanfield quote, 'I cannot do all the good the world needs, but the world needs all the good that I can do'. And often that involves a level of sacrifice when you have to keep facing your own pain in the process. So thank you to everyone that has taken their grief and turned it into something to help others.

Chris: 1:10:06

A huge thank you to Catherine and John for chatting with us. And to find out more about The Aortic Dissection Charity or to contact them visit their website, www.aorticdissectioncharitabletrust.org, or you can find them on social media, and we'll put all the links in the show notes.

Claire : 1:10:20

We also did another episode early on in the podcast, which originally connected us to Catherine and John, with author and psychotherapist Sasha Bates, who lost her husband very suddenly through aortic dissection, and she shares her experience in Lost 23. And again, I'll put a link in the show notes.

Chris: 1:10:35

Now for more about us visit www.thesilentwhy.com or on social media at@thesilentwhypod. You can also now visit www.theHermanCompany.com. - that's where you can buy or see Claire's newly launched Hermans, which are the perfect gift to send someone who's going through a rough time when you're struggling to know what to say.

Claire : 1:10:52

And if you'd like to support my work on the podcast and now producing Hermans there's a link in the bio where you can either buy me a fancy tea(www.buymeacoffee.com/thesilentwhy) because I'm more of a tea drinker, or support the podcast monthly or send a Herman to someone you know, or even buy one for yourself. You can also sign up to my mailing list, which I use when I have exciting news to share. And all these links are in the show notes.

Chris: 1:11:12

We're finishing this episode with a quote from Thomas S. Monson, which speaks into what we believe Catherine and John and all the others involved with the charity are doing with their important work.

Claire : 1:11:23

"Along your pathway of life, you will observe that you are not the only traveller, there are others who need your help. There are feet to steady, hands to grasp, minds to encourage, hearts to inspire, and souls to save." Or in the case of the aortic dissection charitable trust, you could almost say 'souls to inspire and hearts to save'.