A change of heart leads to endless possibilities! | Association of Anaesthetists

A change of heart leads to endless possibilities!

Box 1.

My top tips for returning to work after illness

  1. Communicate: communicate with all involved people and organisations. 
  2. Occupational health: create a bespoke return-to work schedule that addresses your needs.
  3. Your health: optimise whatever you can. 
  4. Return to work course: attend one. 
  5. Induction: ensure you are given a departmental/ Trust induction. 
  6. Shadow: spend time shadowing a peer. 
  7. Moderate: manage your hours/ workload, and resist the temptation to push too hard. 
  8. Wellbeing: be mindful of fatigue, care for yourself. 
  9. Progress: do not hesitate to stay at a given level for longer, or step back if you feel the need. 
  10. Journey to work: avoid long commutes. 
  11. Debrief and re-evaluate: Seek open and honest feedback from family, colleagues and your doctors - they may notice something you don’t. 
  12. Look after yourself.

A change of heart leads to endless possibilities!

My wife and I moved to England during the gorgeous summer of 2005. We moved from Bahrain where I had helped to set up the anaesthetic and intensive care service at Bahrain Specialist Hospital. It had been an excellent three years, but I was looking for new challenges, including the opportunity to sit the infamous FRCA. My wife was also looking for new horizons, and the opportunity to further her career in microbiology in England.

I started as an anaesthetic SHO in Harlow, Essex, and we settled in really well. The weather was at times a challenge, but I thought we managed our first cold winter well! However, in May 2006 I became ill and was diagnosed with severe heart failure and dilated cardiomyopathy secondary to viral myocarditis. Of course, I was shocked. My initial ejection fraction was 10-12%. At first there was denial, then a process of acceptance, a consideration of my life priorities, and the best way to move forward.

Snehashish Guha and his wife

My life was in complete upheaval. I was unable to work, and reliant on my wife, family and friends for support. I received only one month’s full pay and two months’ half pay as I had been in the job for less than a year. We moved in with a friend to enable my wife to get back to her training job. I focused on how I could improve my health and wellbeing, but I knew that my heart failure was worsening. This was my nadir, my rock bottom.

I referred myself to Dr Jayan Parmeshwar, the transplant cardiologist at Papworth. He and the transplant team took me into their care. I was asked to attend urgently, when they explained the various treatment options and I had the workup for transplantation. They encouraged me and gave me tremendous hope, confidence and optimism for the future. The initial plan was medical optimisation and follow-up every three months. I will remember this as the most important phone call of my life.

My confidence began to grow. I wanted to return to work so long as I could do so safely for myself and my patients, and began a phased return to work in March 2007, 10 months after my diagnosis. Work was hard with heart failure, interrupted by the insertion of an Implantable Cardioverter Defibrillator for non-sustained VT in June 2007, but I was very happy to be back working as an anaesthetist. In February 2008, I had built up my hours and restarted night shifts. I passed the Primary FRCA MCQ in January 2009, but failed the Primary Structured Oral Examination for the fourth time in October 2010. I had struggled with my memory and stamina, and kept falling just short. I suppose my awful cardiac output was not helping either. To add to my struggles, I was informed I could make no further attempts. I was so disappointed.

I gained great solace from the fact I had some control over my destiny.

Shortly after the exam, in November 2010, I decompensated. I returned to Papworth and was deemed non-transplantable because of pulmonary hypertension. I was offered a Left Ventricular Assist Device, but knew that this would not be compatible with the life I wanted to live, and I would be unable to give anaesthetics and help other people anymore.

I had a cunning plan! Stop work, relax, socialise, and prioritise my health and wellbeing. We bought and moved into our beautiful new home. In March 2011, I was feeling much better and was deemed in the transplantable range and therefore listed for an urgent heart transplant. 

I gained great solace from the fact I had some control over my destiny. I returned to work while on the waiting list, doing some daytime elective work at reduced hours with agreement from the transplant team, my department and the Occupational Health Department. I have always felt happy to be at work, meeting and interacting with patients, colleagues and friends - this is part of who I am. It kept me occupied and fit.

My transplant went ahead on the second attempt on 31 May 2012. I had put my affairs in order, my family were there to support me, and I was ready. I was transferred to the operating theatre at 14:00 and extubated at 20:00. I had made it. I was pain free and discharged from ICU the following morning, physically exhausted. As a small gesture of our immense gratitude, we bought pizzas for the staff in theatres, ICU, the transplant team and the ward.

On this journey I have lost my fear of failure, which has enabled me to step out of my comfort zone and believe in myself. 

I returned to work on 1 September 2012, 12 weeks after my heart transplant. I started slowly, which was crucial. I re-sat and passed the Primary theory and viva sections after a change of regulations allowed me another attempt. I continued as a Staff Grade until August 2016, when I started an ST3 post in the East Midlands. I continue to work 80% less-than-full-time through choice. In December 2017 I passed the Final, and became a Fellow of the RCoA! This summer, I commence my final academic year of UK anaesthetic training.

Organ donation

Organ donation changes lives. It is a tremendous gift. I try to encourage people to talk about, and document, their wishes regarding organ donation while they are in good health. I have spoken at various forums, undertaken numerous awareness campaigns, and conducted fund raising activities to promote organ donation in BAME communities.

I would like to be a regular, real-life reminder of what transplantation can do. I hope to stimulate people within the medical community to champion transplantation as the life-changing and life-saving gift that it is. It has given me the opportunity to continue to be a contributing member of society, to be the best I can be, and to continue to help others along the way.

On this journey I have lost my fear of failure, which has enabled me to step out of my comfort zone and believe in myself. After years of uncertainty and little progress, I would like to finish with a quotation from Winston Churchill:

“Success is not final, failure is not fatal. It is the courage to continue that counts.”

Snehashish Guha
ST6 in Anaesthesia
East Midlands School of Anaesthesia

Read the new special collection on organ donation from Anaesthesia.

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