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• Seven Signs of Life: Stories from an Intensive Care Doctor Arcade Publishing (New York, NY), 2019

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  Aoife Abbey grew up in Dublin, Ireland. She completed an undergraduate degree in Biological Sciences at the University of Edinburgh, before graduating in 2011 from medical school at Warwick University. She is a member of the Royal College of Physicians, Fellow of the Faculty of Intensive Care Medicine and council member at The Intensive Care Society UK. From September 2016, Aoife wrote a blog under the guise of the British Medical Association's 'The Secret Doctor'. 'Seven signs of life' is her first book.

  You can follow her on twitter @whistlingdixie4

• SMACC website - https://smacc.net.au/speaker/aoife-abbey/

  Aoife Abbey is a specialist trainee in intensive care medicine. She is from Dublin, although trains and works in the West Midlands UK. Aoife is chair elect of the UK Intensive Care Society’s trainee committee and also active on the State of the Art meeting organising committee. She enjoys creating hand drawn infographics.
  Aoife also has an interest in medical humanities; she wrote for two years as the BMA’s ‘secret doctor’ and her first book ‘seven signs of life’ will be published in February 2019.

• Sue Leonard - http://www.suejleonard.com/articles/aoife-abbey/

  QUOTE:
  "You say these things when you’re a child; that you’re going to be a doctor, a fireman or a nurse, but you don’t think what that will be like," Abbey told Sue Leonard on that journalist's website. "I didn’t, but I knew it was what I was going to be."
  Aoife Abbey has always wanted to be a doctor – it was a decision she took as a small child growing up in Dublin, but until she entered medical school in Warwick, and went on to be a junior doctor in England, she had never thought what the job entailed.
  “You say these things when you’re a child; that you’re going to be a doctor, a fireman or a nurse, but you don’t think what that will be like. I didn’t, but I knew it was what I was going to be.”
  Now that she’s on the career ladder – and, as a registrar in Intensive Care, will soon be able to apply for a consultancy role, people are constantly asking her questions. And in particular they want to know how it feels to be a doctor.
  “They’ve been asking me for the past seven or eight years, but I could not explain it in a sentence, and I guess part of me wanted to do it justice – to explain it all.”
  She first started to write about her job when she was newly qualified – and sent an article to the British Medical Council. It was published, she sent another, and after publishing three or four over four years, the editor, Neil Hallows asked her if she would be interested in taking over a blog called The Secret Doctor. This was aimed at fellow professionals, but the book, which came from the blog is for a much wider audience.
  “Over time the blog got shared on twitter, and expanded into the public domain. I decided it should be accessible and understandable to anybody who has ever said, ‘What is your job like? What do you do?’ I wanted everybody to get something out of it, and certainly anybody interested in Intensive Care.”
  And now she has. Her book, seven signs of life, tells stories of Aoife’s day to day encounters with patients – of the stresses, and all the ups and downs of life as a junior doctor in intensive care. She divides the book into chapters headed, Fear, Grief, Joy, Distraction, Anger, Disgust and Hope, and in each, she describes how each emotion affects both the patients and the medics. Not that the emotions can be so easily divided.
  “We all slide from one of these feelings to another in a moment,” she says.
  It makes for enlightening, if sometimes traumatic reading. We learn of good, and bad deaths – of the tension of making these life and death decisions, and of the difficulties in performing well when you’re beyond exhausted. But Aoife’s passion, empathy, and deep understanding for all that she does comes shining through. But why did she choose such an intense specialisation?
  “In intensive care you have a really broad scope of knowledge,” she says. “You have a hand in lots of different organs and pathologies and diseases.”
  She loved the necessity to consider all the ethical questions.
  “And, working with a whole disciplinary team, you get close to a very rich group of nurses, physiotherapists, and dieticians – and with a whole load of specialities. That really appeals to me.”
  It’s clear that Aoife has real empathy, yet once she’d left medical school there was no training for that.
  “What you get depends on your seniors, and whether you are brave enough to bring it up. As a junior doctor I was able to massage someone’s feet to get them through an MRI, and hold someone’s hand whilst they died. You aim to be the kind of doctor you would like to have looking after your relatives, but nobody teaches you how to do that; you have to work out what that is yourself.”
  Most of us are a little afraid of death, and would hope for a ‘good’ one. But that’s not always possible.
  “There are a whole cohort of people who are able to have a say in how they die, but that’s not the reality for the majority of people. People come in unconscious and never wake up – they don’t get to control their death.”
  And if it’s difficult dealing with the dying, it’s can be complicated working with their relatives.
  “I work with families who are going through hell. They are in that horrible condition, and you have to feel comfortable saying certain things. You have to think of yourself as facilitating someone else’s journey rather than necessarily being seen as intrinsically good, or be seen as fixing the situation. It’s about becoming more comfortable with yourself more than anything.”
  Aoife was once called a murderer, when she explained to a relative, that she would be removing a tracheal tube from a patient with irreversible brain damage.
  “They would not survive and that had been explained to the relatives,” she says. “But as a doctor, you don’t get to behave as though you’ve been accused of an unspeakable act. This isn’t about you. You are there to be what your patient needs you to be and what the people whom that patient love need you to be.”
  There are many heartrending stories where Aoife has to accept that she can’t save someone, and when they’re young, that can be particularly hard to take, but she was equally moved by the situation of an elderly man, who had lived independently, but after a fall, had to face that everything in his life had changed utterly.
  “Hospital is often lamented as no place for the old; it is often not a friend to those who fight to remain fit.” And whilst, hearing his age, some of Aoife’s colleagues felt inclined to write him off, she understood his dilemma. “We see it an awful lot. The concept of a fall as a significant event in someone’s life is hugely underestimated. They often cope well until something very small happens. Losing their independence is frightening for them, and often family support just isn’t there.”
  We hear of Aoife’s uncertainties, especially at the start of her career, when she was unclear whether she should ask for help in certain situations. Fortunately, most of her colleagues, lending support, praised her for the decisions she made.
  Perhaps inevitably, though, there are times she makes a mistake. She recounts one occasion, when, looking for signs of pneumonia on a chest X-ray, she failed to notice a perforation of the bowel. Was that hard to admit in print?
  “It was important to put that in,” she says, “but I had to veer against the temptation to put a lot of justification in my account – that was difficult.”
  What’s the most challenging aspect of her job?
  “So much of what we do in intensive care is uncertain. It’s hard knowing, when you make a decision for patients, that it may be something that leads to their death. Patients are so vulnerable in Intensive Care. And you need to remain attuned to your own weaknesses, but also learn that the patient is depending on you.”
  There have recently been several books published by medics, documenting their experiences, but most were written by those who had already left the medical profession.
  “Or, they write them when they are very eminent and respected. I was writing this contemporaneously, so I can capture the uncertainty and how it was at the time. I’m showing my vulnerability for a reason. I already know that my career will not ultimately be defined by heroic procedures or clever diagnoses. My seniority will be defined by my ability to think ethically, to communicate well, and to put my patient at the centre of every decision I make.”

• The Journal - https://www.thejournal.ie/aoife-abbey-interview-seven-signs-of-life-4523790-Apr2019/

  QUOTE:
  "In the book [Abbey] details very tender and emotional moments, such as when a dying man asks her to lift his head up so he can talk to her properly. It’s those intimate moments that leave an impact on her." Regarding this moment, Abbey told the contributor: "There’s things you get exposed to but I guess in the moment it’s so much about what that person is feeling, you do feel a little bit humbled by the fact that you’re able to give them anything."

  'People have been frightened for me to tell their loved one they're dying, in case they die quicker'
  An intensive care doctor has written an honest book about her experiences.
  Apr 7th 2019, 7:31 PM 61,327 Views 8 Comments
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  NONE OF US want to end up in intensive care. But if we do, we should hope we end up with a doctor like Aoife Abbey.
  The UK-based Irish doctor has written a book about what it is like being an intensive care doctor, exploring the emotional moments she has experienced. It’s a book that might just change how you think about death – and how you talk to your family about it.
  After reading the book, Seven Signs of Life, you’ll want to sit down with your nearest and dearest to discuss what might happen to you should end up needing intensive care. Talking about death or serious illness is a taboo that still persists, but Dublin-born Abbey – who is in her mid-thirties – wants us to confront it.
  “I appreciate people need to talk about death more because what I often say is, people come into intensive care, they don’t know they’re going to be there – it’s a surprise to everybody, they’ve had an accident or something,” she explains. “And you say to their family ‘what do you think they would have wanted?’ And the answer is ‘God, I don’t know. We haven’t talked about it.’ Why would you?”
  This avoidance can lead to big questions being unanswered. “How would the patient feel about risking being alive and not being able to talk, how would they feel about organ donation? There’s lots of things people don’t discuss, and I think we need to discuss them more,” says Abbey, who graduated from the University of Warwick in 2011.
  She advises people to have those difficult conversations with loved ones. “But what I would say is that it can often be difficult to imagine yourself in situations, so people might say ‘oh I would hate to have dementia. I’d rather just drop off.’,” she cautions. “When actually they don’t know that it’s true, because they’re not in that situation. So I think we have to be careful when we have conversations about life and death and what you’d like, in that we’re having general conversations and that we’re still not trying to pigeonhole people into certain decisions.”
  Because often people will say ‘I would hate to live this way’ but actually then find an amount of joy and contentment living that way in the end because they have no other option. It is a difficult conversation.
  “I guess in Ireland there’s always that thing of people say ‘don’t tempt fate’,” she says. Abbey and her family have had to deal with serious illness themselves. Her brother, Aaron, was a disability rights campaigner and died in October 2018. He was in and out of hospital a lot while the siblings were growing up.
  “I’ve certainly had encounters where people have been frightened for me to tell their loved one that they are dying. And not just because they were worried that it would upset them emotionally, which is a very valid worry and I would worry the same thing,” says Abbey.
  Because they would feel like that would mean they would die quicker. That crops up quite a lot, people say don’t tell them, because they’ll just give up.
  ‘It’s routine… until it isn’t’

  The book was inspired by anonymous columns Abbey wrote for the British Medical Association, and the stories of the patients in the book are anonymised and amalgamated.
  “I always loved intensive care and I loved it because there’s a lot of science there, you get to be specific, you get to care about the numbers,” says Abbey. “You have a lot of facilities, you know the nursing to patient ratio is one to one or one to two, you have all the numbers in front of you, everything is quite scientific.”

  At the same time, this is juxtaposed against “the massive uncertainty of not knowing what somebody’s outcome is going to be”.
  The level of pressure and responsibility builds the longer you work in intensive care.
  There’s always an opportunity to ask for help. You learn as you go along and that’s how we do it, so it was never the case where I had to walk into an ICU and make loads of decisions.
  She says that like everything in medicine, “all of this stuff is routine until it isn’t”. Indeed, in the book she details times when things did not go to plan. “If you intubate 100 patients and 99 of them are perfect, easy … it’s the one that’s difficult that’s the issue. So most things are routine, there’s always the potential for it not to be.”
  When it comes to errors, the onus is on the doctor to make sure they learn from it.
  “There’s nothing that makes you learn more than making a mistake,” she says. “You’re unlikely to ever do it again.”
  The main thing is there is a culture, and it’s the right culture, where we don’t blame people when they make mistakes. And we’re supposed to recognise it’s a systems failure, and there’s lots of different explanations for why things go wrong, and it’s rarely one person’s issue; one person’s fault. But at the same time you have to figure out ways as a doctor to still accept and be OK with the fact also that you did make a mistake.
  She includes in the book an incident where she missed something on a chest x-ray. It must have been nerve-wracking to write about when she first included it in a Secret Doctor blog post.
  “It is still in numbers their most read blog. So it’s … I’m not going to say vindicated but there’s a need for that kind of discussion and people clearly had an interest or it struck a chord with them.”
  She has never worked with the HSE, and describes the NHS as something that’s very much woven into national identity in the UK. “You have this service that’s free at the point of care, and people are very proud of it. It’s a very emotive topic,” she says, noting that “it doesn’t matter how angry the media is with the NHS at a given point, patients that I see behave the same. Most of them they are grateful, they’re frightened, they’re scared – they are just people, they are separate from political issues.”
  Speaking of political issues, the big one for NHS workers and Irish emigrants like Abbey is Brexit. “If I wasn’t from Ireland I would have a huge amount of uncertainty and I’d be very worried,” she says. “You don’t really know what’s going on. You take so much for granted.”
  But it’s not something that she lets take over her work. “I think you just learn to be very focused on what you’re doing. You have to let things in in the moment or else you’re not human, and you can’t engage with someone who’s being very emotional with you with a wall in front of you, because it’s not human and it’s not very nice for them either.”
  She has learned to talk to her colleagues and friends about things that affect her, and not keep it bottled up. This is her eighth year in training, and in August 2020 she’ll be able to pursue a consultant job.
  In the book she details very tender and emotional moments, such as when a dying man asks her to lift his head up so he can talk to her properly. It’s those intimate moments that leave an impact on her.
  “There’s things you get exposed to but I guess in the moment it’s so much about what that person is feeling, you do feel a little bit humbled by the fact that you’re able to give them anything,” she says.
  Because they’re going through something that is horrible. And you put it aside until you get home, or until you close the door of the room.
  Seven Signs of Life is out now, published by Penguin Random House.

• Irish Times - https://www.irishtimes.com/life-and-style/people/secrets-of-an-intensive-care-doctor-i-ve-been-called-a-murderer-1.3769179

  QUOTE:
  "I would like anyone to be able to pick it up and understand more about the work I do,” she noted in an Irish Times interview with Rosita Boland. “I wrote this book knowing I was unfinished, and only seven years into a very long career. It’s a record of where I am now, faults and all."

  Secrets of an intensive care doctor: 'I've been called a murderer'
  How do you tell someone they’ve less than a 6% chance of survival?
  Sat, Feb 2, 2019, 06:00

  Rosita Boland

  Aoife Abbey: author of Seven Signs of Life. Photograph: Dara Mac Dónaill

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  There are few jobs that place you on the frontiers of human existence: midwives see lives into the world, undertakers oversee their departure. In between these beginnings and endings, surgeons, doctors and nurses interact with people at varying stages of illness, and often witness people at their most vulnerable.
  Dublin-born Aoife Abbey is part of this cohort of people. An intensive-care doctor at University Hospital Coventry, in England, the 35-year-old will come into contact with more critically ill people in a month than most of us will in our whole lives.
  For almost two years, she blogged about her work experiences as the anonymous “Secret Doctor” for the British Medical Association (BMA). Abbey was the second such practising junior doctor to hold the role. “The idea was a bit like the Secret Footballer,” she says, over coffee in a Dublin hotel. “To give people an insight into the daily goings-on of the medical world.
  As the BMA explains on its website, there was nothing new about medical professionals writing anonymously about their experiences, but social media meant that the reach of these pieces gave a much wider readership than ever before. Abbey’s blog posts were read by tens of thousands of people. “I could write anything I wanted, as long as there was no gratuitous black humour.”
  A woman her own age had “the worse possible kind” of brain tumour: fatal with a five-year survival rate of less than 6%
  The piece she acutely remembers writing was about breaking the news to a woman her own age that she had “the worse possible kind” of brain tumour: fatal with a five-year survival rate of less than 6 per cent. But how to break this harrowing news? Abbey writes in Seven Signs of Life: Stories from an Intensive Care Doctor, a book she has written about her experiences: “Why had she not asked the oncology team? For some reason she had chosen to ask me instead, and now I was sitting in a room with her; with her fear and mine.” The young woman subsequently lived for less than two years.

  volume is 80%volume is gedempt

  A publishing company came to her last year with an offer to write the book from these short online reflections on the many challenges facing an intensive- care doctor. When she agreed to write it, she had to surrender her anonymity and give up the Secret Doctor role.
  The book is divided into seven sections, which Abbey considers best reflects the range of the work she does: “Fear”, “Grief”, “Joy”, “Distraction”, “Anger”, “Disgust” and “Hope”. (The story about the young woman with the fatal brain tumour is in the section called “Fear”.)
  “I would like anyone to be able to pick it up and understand more about the work I do,” she says.“ I wrote this book knowing I was unfinished, and only seven years into a very long career. It’s a record of where I am now, faults and all,” she explains, aware that some people may think she is still short on experience to write a book about working in intensive care.

  Aoife Abbey, author of Seven Signs of Life. Photograph: Dara Mac Dónaill
  Abbey grew up in a household where hospital work helped pay the bills: her mother is an emergency-department nurse. She also learned a lot about people’s attitudes to disability. Her brother Aaron, who died last year, was an activist for disability rights and a campaigner for the Independent Living Movement. “From him, I learned the difference between medical disability and social ability. It gave me exposure to things you don’t necessarily get taught in medical school,” she says drily.
  Abbey always wanted to be a doctor but, like many people, worried she would not get the points for medicine. When she failed to get them first time, she repeated her Leaving Cert, missing out on medicine by just five points. Instead of giving up, she went to Edinburgh University for four years to study biological science, and then went on to Warwick Medical School for another four, graduating in 2011.
  An intensive -care doctor carries out medical procedures that most of us, given a choice, would prefer to remain in blissful ignorance of. Every day, they are intubating and ventilating patients; examining X-rays that reveal horrible truths; operating and then hypothesising the quality of life the patient will have after the operation. How does one begin to practise such skilled and delicate physical procedures?
  What television dramas don’t capture is the huge uncertainty that comes with working in intensive care
  “The saying is, watch one, do one, teach one,” she says. Student doctors in intensive care watch first. When they attempt something for the first time, they are supervised closely. (And yes, Abbey says that patients are sometimes told it is the first time the junior doctor is doing this particular procedure.)
  She admits to being nervous when she carried out her first tracheotomy, even after having watching it being done some four or five times previously. “You could accidentally puncture someone’s lung,” she says matter-of-factly. “But it is easy to concentrate. You are just focusing on the moment. The deal is that we speak to each other in the team. You get to be very specific about the bit you are doing.”
  Medical and surgical procedures are one thing, but communicating bad news to patients and their families requires an entirely different set of skills. “It is not like the way hospital emergencies are portrayed in TV dramas. They focus on the emotional drama. They have patients who have undergone CPR, who are up and awake next day,” Abbey says. “What television dramas don’t capture is the huge uncertainty that comes with working in intensive care.

  “If our patients don’t die, they often have a long road of recovery ahead of them, with many long-term implications down the line. Most of our patients do survive, but what they face afterwards is often difficult. And I have to say to families, ‘The person is still alive, but I don’t know what alive is going to look like in the long term.’”

  Emergency room: “It is not like the way hospital emergencies are portrayed in TV dramas,” says Aoife Abbey. Programmes like Grey’s Anatomy (above) “focus on the emotional drama”
  Medical practitioners cannot effectively function if they become emotionally engaged with their patients – people who are, in fact, total strangers to them. But doctors are not robots, and breaking dreadful news to people, no matter how often you do it, is possibly the least enviable job in existence. “Intensive care is a hotbed for delirium,” Abbey notes, in the “Anger” section of the book.
  Over the course of her career, she has watched countless people die. 'I've been called a murderer,' writes adding she has been spat at, hit, insulted and challenged, both by her patients and by members of their families. She writes about all of these things in the book, and acknowledges the burnout that can affect those working in such highly pressured scenarios. “I hope medical students might read the book too,” she says. “It might help people to talk about things; to deal with the issue of burnout that is prevalent in the profession at the moment.”
  Abbey has witnessed burnout herself in the most visceral way possible for an intensive-care doctor: by attending a trauma patient who turned out to be a doctor from a neighbouring hospital, known to the staff in the room. He had made a suicide attempt. “Standing over his head that morning, I felt panic like I had never felt beside a patient before,” she writes. This was one of her own.
  It’s among the most memorable passages in a thoughtful and necessary book about a world all of us might inhabit at some point in our lives.
  Seven Signs of Life: Stories from an Intensive Care Doctor, by Aoife Abbey, is published by Vintage

• London Guardian - https://www.theguardian.com/books/2019/feb/03/aoife-abbey-secret-doctor-seven-signs-of-life-interview

  QUOTE:
  "chronicles the emotional highs and lows of her life as an intensive care doctor." Abbey told O’Kelly that she uses these seven emotions as the book's divisions because "juggling these kinds of feelings is an everyday part of being a doctor." Abbey went on to comment: "As far as the stories I had to tell were concerned, what they had in common was that they all made me feel something very strongly and I realised that the only way I could organise them in a book was according to how they made me feel."

  The New Review Q&A Autobiography and memoir
  Interview
  Aoife Abbey: ‘Being a doctor is not like in the movies’
  Lisa O'Kelly
  The intensive care specialist who used to blog as the Secret Doctor on her candid new book about her experiences as a young trainee
  Sun 3 Feb 2019 07.00 GMT

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  Aoife Abbey: ‘Burnout is a massive fear.’ Photograph: Rebecca Knowles
  A
  oife Abbey’s book, Seven Signs of Life, chronicles the emotional highs and lows of her life as an intensive care doctor. The daughter of a nurse, she grew up in Dublin and graduated from medical school at the University of Warwick in 2011. Now 35, she was until recently the anonymous author of a blog, The Secret Doctor, for the British Medical Association, which was read fortnightly by more than half a million people. She is now working in a hospital in Coventry.
  Did you always want to be a doctor?
  Yes, although I find it hard to say exactly why. I suppose the most obvious link to my childhood is that my older brother, Aaron [who died last October], was often unwell when we were growing up so I spent a lot of time in hospitals. Being exposed at such a young age to the lives and work of doctors must have had a big influence on me.
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  What inspired you to start writing?
  I’d been qualified just over a year when I had an encounter with a patient, a young girl who was the same age as me, who had a brain tumour. She asked me if it was going to shorten her life and I felt I had to give her an honest answer, which was yes. I was deeply affected by that conversation and couldn’t stop ruminating on it, so I decided to write it all down. I sent what I wrote into the BMA magazine and they published it. Not long after, they asked me if I wanted to take over as The Secret Doctor.
  What did you get out of writing?
  There were lots of situations – relationships, human encounters – that I was experiencing in my work that required much more from me than purely medical expertise. Writing about them helped me to figure out what they meant and made me feel. Doctors don’t really discuss these things among themselves or with the public in an open way.

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  Why did you decide to tell the stories in the book through seven emotions: distraction, fear, grief, joy, hope, anger and disgust?
  Because juggling these kinds of feelings is an everyday part of being a doctor. As far as the stories I had to tell were concerned, what they had in common was that they all made me feel something very strongly and I realised that the only way I could organise them in a book was according to how they made me feel.
  You certainly don’t portray yourself as a saint. You are often angry, crabby, annoyed, indecisive. Was this deliberate?
  Absolutely. I wanted to be honest. In a way the book is in direct contrast to some wonderful memoirs by older and wiser doctors like Henry Marsh [Do No Harm] and Paul Kalanithi [When Breath Becomes Air], who are looking back. I was trying to chronicle the real experiences of a doctor at the beginning of her working life. If I don’t look back on it in 10 years’ time and say, actually, I would behave differently now, I know better now, then I probably haven’t done it right. I felt like it was important to get the stories down while they were fresh. I wrote a lot of them the very same day.
  Your chapter headings convey more negative than positive emotions. Joy and hope are present but they are outweighed by grief, anger, disgust, fear. Does that balance reflect your feelings about the work?
  Being a doctor is not like in the movies. The situations you find yourself in are very complex and give rise to multiple emotions. In the course of an afternoon I might feel raw fear at having to intubate an obese patient who’s had a myocardial infarction [heart attack]; or have to overcome disgust at caring for a convicted rapist; or I could feel exhilarated and sad at the same time when a patient with dementia who’s normally silent confesses to being lonely. So, yes, I have a job where I encounter difficult situations, but the emotions it stirs up are neither positive nor negative, they are just part of being alive, I think. I try to appreciate every situation I find myself in as an opportunity to learn more about what it means to be human.
  What’s the best thing about being an intensive care doctor?
  You can always make a difference to somebody. It might just be something small, like listening to them. It might be taking into consideration the kind of death that they want, if you can’t save their life.
  You quote widely from literature, from WB Yeats and TS Eliot to Raymond Carver. Is reading poetry and fiction a source of solace for you?
  Oh yes, absolutely. I have always loved reading, whether it is classics or contemporary novels by Eimear McBride, Sally Rooney, Julian Barnes, Max Porter. When I’m writing I so often think of the way my favourite writers express themselves. There are a lot of beautiful writers out there who can help you explain how you feel.
  How else do you wind down?
  I take a lot of baths.
  Can you see yourself in the job in 10 years’ time?
  Yes. I see this as my career for the long term. Burnout is a massive fear, though. There is a growing need for doctors to appreciate that wellness is a construct they have to embrace. We need to find ways to do our job as well as we are able while also being kind to ourselves.
  How hard have the austerity years hit you and your colleagues in the NHS?
  There are a lot of issues today, all of them related to funding. In critical care there is a huge need for more beds, more nurses and pay and conditions that reflect the hard work nurses and other medical professionals are doing.
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  What single thing would improve the quality of your life as a doctor?
  For about the first 10 years of your career you move around a lot. That can be quite hard. I guess part of me thinks that if I didn’t have to move so much then it would be easier to have relationships that you can keep going. Having more beds for more patients would help, too.
  Seven Signs of Life by Aoife Abbey is published by Vintage (£12.99). To order a copy for £11.43 go to guardianbookshop.com or call 0330 333 6846. Free UK p&p over £10, online orders only. Phone orders min p&p of £1.99

QUOTE:
"Abbey's account is warm and accessible, leaving readers with a feeling of relief that such thoughtful doctors exist and the hope that if one is ever in need of critical care, a wise and caring doctor like her will be by the bedside."

Abbey, Aoife SEVEN SIGNS OF LIFE Arcade (Adult Nonfiction) $24.99 11, 1 ISBN: 978-1-948924-82-5
Compelling encounters between a young Irish doctor and patients in intensive care.
Abbey, a fellow of the Faculty of Intensive Care Medicine and council member at the Intensive Care Society U.K., writes that her world as a doctor is centered on emotions, and she tells of her experiences through seven emotions that are vital elements of being human: fear, grief, joy, distraction, anger, disgust, and hope. Throughout the book, the author writes with honesty and compassion about her relationships with patients. Each of the seven chapters opens with a relevant quotation from writers such as T.S. Eliot, Ralph Waldo Emerson, and C.S. Lewis, selections indicating that Abbey is a reader as well as a writer. As an intensive care doctor, she cares for many patients who may be dying or may be in some undetermined state between life and death. Abbey explores the strategies for talking to these patients as well as to their families. "Of course ongoing academic achievement and the acquisition of hard skills are paramount to a doctor's development, but they are not the whole story," she writes. "Many of the pivotal moments in any doctor's story are about learning how to talk to people, to understand them and to make yourself understood. Competence is not simply about knowing what is possible, but also about understanding what is right. It is about feeling and, more importantly, about knowing what to do with a feeling." A text filled with a doctor's bedside experiences with dozens of vulnerable patients may sound like grim reading, but this is not the case. Abbey's account is warm and accessible, leaving readers with a feeling of relief that such thoughtful doctors exist and the hope that if one is ever in need of critical care, a wise and caring doctor like her will be by the bedside.
Merits a spot on a list of required reading for medical students.
Copyright: COPYRIGHT 2019 Kirkus Media LLC
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Source Citation
Source Citation (MLA 8th Edition)
"Abbey, Aoife: SEVEN SIGNS OF LIFE." Kirkus Reviews, 15 Sept. 2019. Gale General OneFile, https://link.gale.com/apps/doc/A599964335/ITOF?u=schlager&sid=ITOF&xid=85fd8d41. Accessed 5 Oct. 2019.
Gale Document Number: GALE|A599964335

• RTÉ
  https://www.rte.ie/culture/2019/0131/1026779-reviewed-seven-signs-of-life-by-aoife-abbey/
  Word count: 894

  QUOTE:
  : "This is a book with a warm heart, but also does not shy from honesty. ... The book is worthy of a place on the medical school curriculum."

  Reviewed: Seven Signs Of Life by Aoife Abbey
  Updated / Monday, 4 Feb 2019 10:08

  Compelling and compassionate account -Dr Aoife Abbey (Pic: Rebecca Knowles)

  Reviewer score

  Audience score

  3 Votes

  Publisher
  Vintage, Hardback

  Aoife Abbey's Seven Signs Of Life is an honest, compelling and compassionate insight from an intensive care doctor from Dublin and the book is worthy of a place on the medical school curriculum, writes RTÉ's Health Correspondent Fergal Bowers.
  Aoife Abbey's Seven Signs Of Life is an honest, compelling and compassionate insight from an intensive care doctor from Dublin, and the book is worthy of a place on the medical school curriculum.
  This is not a book from a consultant in intensive care, hardened by years at the coalface of medicine.
  Here, Dr Aoife Abbey details her experiences in over 10 hospitals in Britain, having qualified there in 2011.
  She tells of her experiences through seven emotions - fear, grief, joy, distraction, anger, disgust and hope.
  The account charts her encounters with many patients, living and dying, and her work as an intensive care specialist registrar on the road, hopefully, to becoming a consultant one day.
  Dr Abbey is the type of doctor most people I think would want to find at the side of their bed if they were critically ill.
  This is a book with a warm heart, but also does not shy from honesty. The relationship between doctor and patient is not equal. Dr Abbey rightly notes that every meeting she has with a patient will almost invariably be more significant to them than it is to her.
  As a doctor, she says you should never promise anything to a patient that is not yours to promise. When breaking bad news, you are actually breaking something. Patients are also now much better informed through the internet, and can easily find out what the long-term prognosis for a cancer may be.
  The nature of her work is different to a GP, or many other specialists, who may have a long term medical relationship with a patient. Some of her patients may only see her fleetingly, or not at all, as she works to resuscitate them, or verify them as dead.
  This is not a grim read. It's beautifully written, with valuable insights about how different patients and their families want different things from her and it is fascinating.

  The huge scope of things an intensive care doctor needs to deal with conditions them to take many things in their stride.
  Dr Abbey explains the importance of talking to patients and understanding them, away from high-tech equipment and advanced treatments. She says it's a strange thing to go through something so significant, with a critically ill patient, and yet to share no real relationship at all.
  But there are real people within the chapters of this book, some screaming, asking if they are going to die. Others are family members stricken by grief over a loved one and calling her a murderer.
  She observes that patients under the pressure of unexpected illness are often not the person they would recognise as themselves. That the world around them can become unfamiliar, and during this time they are reliant on strangers, doctors and nurses they do not know.
  In an intensive care environment, the doctor and patient both can't succumb to fear, otherwise the outcome won't be good.
  While a certain detachment is needed to do the job, the doctor also has to connect with the patient and their family.

  Fergal Bowers
  Little of what Dr Abbey learned in medical school prepared her for breaking bad news - which she compares to throwing a grenade into a room where a family has gathered in fear.
  The pressures of the job are a challenge, and mistakes occur. She tells the story of how she missed something crucial on viewing a scan. But she also makes the important point that nobody goes to work to do a bad job. In a world of trolleys, packed wards and bed pressures, she cites a now-famous phrase - the standard you walk past is the standard you accept.
  The book chronicles how a patient's world can change in seconds. Dr Abbey may have minutes to explain to a patient that they are about to die, and what is going to be done to ease that death. If you want to live, you have to die and this thought permeates the pages of this thoughtful book. There's the story of a patient who is undergoing a fairly straightforward procedure and needs a general anaesthetic. He has an unexpected heart attack while 'under' and never wakes up.
  Dr Abbey sums up the ethos of being a good doctor well, saying the fear of standing over a patient, with their life in your hands, becomes the push you need to work to a standard where you can always look back and know that you did your best.
  Fergal Bowers is the RTÉ Health Correspondent.

• Irish Times
  https://www.irishtimes.com/culture/books/seven-signs-of-life-review-bold-courageous-and-most-welcome-1.3777886
  Word count: 897

  QUOTE:
  "bold, courageous, and most welcome." D'Alton further dubbed the book " frank, heartfelt and unself-conscious window into the inner world of a junior doctor," and a book that "gives voice to the complexity of what it means to be a human being."

  Seven Signs of Life review: Bold, courageous and most welcome
  Aoife Abbey gives voice to the complexity of what it means to be a human being

  Author Aoife Abbey does not shy away from personal vulnerability in her window into the inner world of a junior doctor. Photograph: Dara Mac Dónaill
  Paul D’Alton
  Sat, Feb 9, 2019, 06:00

  First published:
  Sat, Feb 9, 2019, 06:00

  Buy Now

  Book Title:
  Seven Signs of Life
  ISBN-13:
  978-1784709457
  Author:
  Aoife Abbey
  Publisher:
  Vintage
  Guideline Price:
  £12.99
  Over the past number of years a genre in literature referred to as medical-literature has evolved. This evolution is in part a response to people’s curiosity concerning medicine, but it’s more than that. There seems to be a curiosity concerning the emotional life of people who work in medicine.
  Aoife Abbey’s Seven Signs of Life is the story of the emotional life of a young medical doctor who is training in intensive care. It is a frank, heartfelt and unself-conscious window into the inner world of a junior doctor.
  In the course of Seven Signs of Life, Abbey is described as a “lion” by one of her colleagues. Her honesty, determination and forthrightness are indeed lion-hearted. The lion-hearted Abbey is a woman in a traditionally male-dominated world. In such a context she gives voice to the complexity of what it means to be a human being. Such an articulation is bold, courageous and most welcome.
  Abbey skilfully demonstrates that our internal emotional world is anything but linear
  Abbey does not shy away from her personal vulnerability, which is in stark contrast to the sometimes macho medical world of which she is part. She does this by inhabiting a paradoxical innocence and bravery and, in doing so, offers a different way to exist in an sometimes brutal world. She skilfully demonstrates that our internal emotional world is anything but linear.
  Each of the seven chapters that make up Seven Signs of Life has an emotion as its title. There are times when this structure is a little clunky and seems to restrict rather than enhance the narrative. Nonetheless, Abbey dexterously describes a range of emotions common to all humans: fear, grief, joy, distraction, anger, disgust and hope. She then unpacks them in a somewhat confessional poetic style chapter by chapter.
  In many ways what Abbey does in Seven Signs of Life with great sensitivity and ease is to convey the great and simple psychological truth that we do not experience discrete, neat emotions. We tend to experience a multitude of emotions at any one time.

  Abbey imparts a wisdom concerning human emotional life that is sophisticated, and also simple and poignant. She describes being “ambushed by grief” following the death of a patient and says “life didn’t follow the rules of whatever vague, illogical structure we use to hold together our shaky universe. It is because they remind us of how little we can really control.”
  Abbey touchingly describes the first time she verified the death of a patient and how she was “all grown up” but still needed to phone her mam and cry. Such an unguarded and age-appropriate response is an endearing glimpse into the youthfulness of the author.
  A youthfulness that is juxtaposed by an almost disconcerting wisdom when, for example, she describes breaking bad news to patients and gets to the metaphysical underpinning of such a task when she says: “Sometimes I think that part of the trick to breaking bad news well might be having the strength to accept that you are actually breaking something.”
  Many of us working in healthcare come face to face with the darker, distressing and sometimes violent aspect of humanity at a relatively young age. This coming face to face with such realities in the early stages of one’s career can seem at times to be too much too soon.
  Abbey is brave; she is lion-hearted in her no-holes-barred account of what it is like to care for a living
  Abbey is no exception. She walks the reader through her emotional reaction when treating a convicted rapist for example. She recounts the eye contact that happens with terminally ill people with an almost disturbing precision. It will be fascinating to see how she writes, and I hope she does, about such events as her career matures.
  Abbey is brave; she is lion-hearted in her no-holes-barred account of what it is like to care for a living. In Seven Signs of Life she courageously embodies a young doctor in touch with her vulnerability and her strength. If she is representative of an emerging generation of healthcare professionals, there is reason to be optimistic for the future of healthcare.
  Dr Paul D’Alton is principal clinical psychologist at St Vincent’s University Hospital and associate professor at the School Of Psychology UCD.

  Sat, Feb 9, 2019, 06:00

  First published:
  Sat, Feb 9, 2019, 06:00