Life & Culture

Wise words about life and death

What every doctor and patient should know about being in hospital


In 1902, Leah and Morris Franker and their three small children fled from Poland with Morris’s brother and his family. They decided one brother should stay in Belgium and the other continue to Britain, so if one encountered difficulties, the other could help. Their fate was decided by tossing a coin. Morris came to Britain and his brother’s family stayed in Belgium — and eventually returned to Poland and the concentration camps.

If this toss of the coin had gone differently, Michael Wise, Leah’s grandson, would never have been born. And in January 2009, Wise experienced his own flip of fate. As the year began he was at the peak of his profession, a world-renowned specialist in oral surgery and restorative dentistry. By the 21st of the month, he was almost dead.

A strong runner and skier, Wise was felled in a few hours by a streptococcal blood infection that led to toxic shock, causing all his organs to shut down. Such infections claim up to 40,000 lives a year in the UK and admission to hospital with severe sepsis places one’s risk of death at six to 10 times greater than with an acute heart attack.

The infection left Wise with acute kidney injury — and a profound insight into the life of the seriously ill, which he chronicles vividly in On the Toss of a Coin (Matador, £9.99). If you want to completely understand what it is like to be in intensive care, dependent on others to keep not only you but your will to live alive, or what it is like to be a long-term hospital patient, trying to politely assert yourself as an individual human being; if you are facing an arduous journey back to health, or supporting someone in this situation, or are a medical professional or training to be one, On a Toss of the Coin is a must-read.

Wise wanted “to give the medical profession an insight into what it is like to be seriously ill”. He uses a helpful “wellness index”, a score out of 100 a patient can use to express how they feel. He also conveys “the importance of little things that people say and do — a smile, touching your hand, sitting down with you. In hospital, they’re towering above you when standing at the end of the bed — I appreciate it’s difficult for consultants to sit down but it’s intimidating.”

When he was in intensive care, he heard himself (erroneously) diagnosed with a stroke, which sent him into despair until the edict was reversed: “It is easy to take away the will to live and not difficult to make [a patient] try their hardest.

“A lot of people have described the book as a love story,” says Wise, “between myself and my wife, with my family and also a love story for the NHS. The NHS has been wonderful and I get angry when I hear people knocking it.

“I wrote the book to give people an interesting read about life and to give them hope in difficult situations,” he adds. “And if I could motivate just one person to become an organ donor after their death it would be worthwhile — and if they did so while alive, that would be an amazing thing.”

The book considers some of the new options available to those needing a donated kidney, including a four-/six-way swap, in which donors who are not a good match for their proposed recipient are cross-matched with another donor-recipient pair (or two more pairs) so everyone receives the kidney they need. In Wise’s case, a family friend proved a good match for him and donated a kidney for the transplant that restored Wise to health. Organ donation while alive is permitted by Judaism; after death it becomes more controversial.

One organisation with which Wise is involved is Think Kidneys, which promotes kidney injury prevention. “Acute kidney injury is a serious condition: 100,000 deaths a year in hospital are associated with it and 30 per cent can be prevented. The main causes are dehydration, especially in the elderly; some drugs; infections; things that cause blockages to kidneys, blood pressure problems and severe blood loss.”

Incidence could be reduced with better hydration practices in care homes, as well as close management of those on medication that might affect the kidneys, such as advising them to pause a drug regime if they develop a dehydrating illness such as vomiting.

Now 70, Wise is retired and loves to spend time with his five grandchildren and pursuing his passion for music, walking and Spurs. He is learning the piano, a long-held wish: “It’s when you have regrets that you have problems — it’s important that you live your life so your regrets aren’t so massive that they eat up your life.”

“During my childhood and adolescence I thought of becoming orthodox rabbi but I had lots of questions,” says Wise. His research left him “a non-believer in the deity [although appreciating that faith may help others] but involved in the Jewish community”. He is an active member of Alyth (Finchley Reform) synagogue. When he came to write the book, it was a natural choice to allude to his mother’s story of their family’s survival. “It’s always made me very aware how life is fragile and can change on something as simple as the toss of a coin.”

Wise’s coping strategies

There are many more in the book.

l You may not be able to change what has happened but you do have the ability to take control of your mind and use it positively.

l Take one step at a time up the mountain and focus only on doing that. Once that has passed, it doesn’t have to be repeated.

l Recognise that you have something to live for.

l Do not be a passive victim. Be proactive but not aggressive if you feel something isn’t right.

l Ensure that as far as possible you are living your life today as you want to. There is no point spending the first part of your life looking to the future and the second part looking back on the past but never enjoying today.

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