We are looking for enthusiastic GP’s with new innovation ideas for primary care to pitch an idea to our “Dragon’s Den” competition at the RCGP annual conference. This was really good fun last year and got some awesome publicity for some of the ideas pitched! Click here for details. Deadline 15th September.

Mutiny

In the 1770s, a famous naval commander, Captain Bligh was trying to get bread fruit from the South Pacific to the Caribbean. He was really strict and his voyage was beset by disasters. Eventually, the lower members of his crew mutinied against him but, instead of killing him, they put him and his loyal men into a 20-foot boat with measly supplies, a barrel of water, a bottle of rum and a bottle of white wine and left him to die. He was such an incredible seafarer that he sailed 4000 miles to safety all the way from Tonga to Indonesia. This journey is one of the most famous maritime survival stories so the programme questioned  whether modern man could recreate this voyage”

Luke, who I had interviewed with his involvement with the Ebola crisis response, also had another experience up his sleeve. He had spent two months as the ship’s surgeon on the Channel 4 programme Mutiny. My impression of reality TV stars is usually not very good, and like many TV-watchers, find the attention-grabbing desperation for fame rather grating. So I knew this was going to be another interesting conversation because that’s not my impression of Luke at all. Now I know you’re wondering why I’m blogging about this and what does it have to do with global health? I’m not entirely sure either but something did capture my attention about this adventure. It’s a story about a young GP-in-training using medical skills with no resources in the South Pacific. I’ll leave it there.

I watched Mutiny (all in the name of research obviously) after the interview to write this blog post. And despite having spoken to Luke only a few days ago, I’m still on the edge of my seat wondering if they’re going to make it (honestly, it’s a reality TV show, why wouldn’t they?!). It wasn’t as sensationalist as I was expecting although there was the usual splattering of corny one liners totally in-keeping with this genre. However, having heard Luke’s side of the story first, I don’t think the show really really depicts the true extent of the danger.

So why did he apply? “I really like the rush, the extreme environment. My mind focuses and I’m so productive and I realised that I function really well in high stress environments.” What’s interesting is that, from watching the programme, it seems like the total opposite to my impression of his Ebola experience. In Sierra Leone, Luke talks about being wary of trusting everyone else due to the high-stress environment, but Mutiny feels like there is a real bonding in the team from the experience. They have to trust each other in order to navigate the high seas. Even after only three weeks, the men are reduced to tears when one member has to leave. That has to be a pretty insane three weeks to feel that close to someone.

So what was the application process? “I remember it so well. I was on the picket line for the junior doctors contract protest and was going through my emails when I got home and saw the advert. It was something like ‘Do you want to sail? Are you a doctor? Apply for this.’ So then I sent off an application form and within three hours had a call. I then had  lots of phone calls and Skype interviews with the producers. It was really intense. I really wanted this so I told myself to be creative. I told myself that I had over-egged it and thought that my application was ridiculous but I guess that’s what they wanted – they read it for two seconds and then make a decision. Thousands of doctors applied and I made the cut! ”

Why didn’t they choose an expedition doctor? They’d be better qualified, no?  “They wanted amateurs, the reason why they chose a GP trainee is because they didn’t want an expedition doctor or an A&E consultant. They respected me as a doctor but they wanted someone who would be out of their comfort zone.”

What was the prep for the show like? “So we had selection weekend which was horrific as they wanted to see if you could deal with stress. We had to do an open swim in the sea off Plymouth in March which was insanely cold. It wasn’t far – only 20m and then we had to tread water for 10 minutes. It was 12 degrees! Loads of people failed this hilariously. I thought ‘You’re applying to sail 4000 miles and you can’t swim?!’ And then they put you in a wet suit, drove you in a boat and put you in a life raft that was half deflated so it was half full of water and left you in Plymouth harbour. They then drove off without telling you when they were coming back. They just left you cramped up with 12 random people who all want to be reality TV stars. It was horrific. They came to pick us up at 9am so it was more than 12 hours. It was awful. We tried to sleep. We tried to look after the one who was having a panic attack and the one who was vomiting everywhere. I loved it!”

That sounds horrific. Why would they do that? “With anything TV, there’s always people who just want to be famous. So essentially they wanted to weed people out. So it had to be a stressful project. I always like to think of it as a project first and that it happened to be on TV. It was not like a normal reality show. You had to weed out people who just wanted to be on TV.”

“There were other medics at that selection weekend which was very awkward obviously. And it was funny because you could see that they had chosen him because he was incredibly good looking and they had chosen him because he was the grumpy man. It was really fascinating to see the process of how to make a TV show. It was quite weird to think of myself as a series of boxes.”

So, tell me about the actual expedition. “There were nine people in the boat – one doctor, two cameramen who had to live the same conditions as us, one captain and three sub sailors, and another guy (we didn’t know what he did so we put him in charge of food and drink) and a carpenter. The journey was two months and there was some training beforehand and recuperation afterwards. We only had rations for 400 calories a day and I lost 30kg. I was about 95kg at the beginning. After it finished, we were eating 10,000 calories a day.”

“It was horrendously nerve-wracking before I went especially I was going as the doctor. I had responsibility for  everyone’s health and safety so I was going through all the possible scenarios so it was getting more and more stressful. I had a medical kit and it contained things like military grade tourniquets, hacks and I had to learn about venomous snakes of Northern Australia. And I was getting more and more stressed. But luckily it was all ok. It was all wounds, dehydration, and mental health.”

“We had a paramedic on the main ship because the whole idea was that I would be compromised because I had 400 calories a day and there was only a tiny amount of water. I wouldn’t be able to make rational decisions and  I wouldn’t be able to cope with it. And they made me sign this weird thing “I, Dr Luke Kane, am not responsible for the health of anyone on the boat” but then I was expected to look after them as their doctor so it was a bit of a pointless contract.”

That’s a good point. What happened with your indemnity? “There was weeks of emails back and forth [with indemnity] and eventually I had to speak to this Professor of Legal Medicine who said I couldn’t go. I wasn’t asking her if I could go because of course her default would be that, but my question was ‘are you going to indemnify me and how much is it?’ The production company was going to pay. I know it’s risky but I wanted to do it. Eventually they just charged us £16 a day which didn’t feel like much money. They could have charged thousands!”

How do you feel now that the show has been on TV? “One of the reasons I wanted to do it is because I love that bonding in a group. I think it’s a great feeling being part of a team so that was hands down that was the best feeling. When you go through something where you think you’re going to die, if something is going to give you a tight bond, it’s going to be that. I’m in touch with all of them. I was really pleased with how respectful they [the production company] were and when they were editing. If they were putting anything that might upset you, they would call you. They were really kind. Such a positive experience. One of the guys really struggled though. He ended up leaving early and was hated by the public. There were weird articles in the Daily Mail and lots of abuse on twitter so it was a bit harsh of some people. It was pretty nasty stuff.”

“My story arc was ‘scared GP conquers his fears’ which was a little bit embarrassing but if that was the only thing that was embarrassing then that’s fine. It was scary, I almost died. I’m not ashamed of that!”

How did you feel representing the profession? “That was a really strong consideration for me. I spoke to the production company about the vibe and the tone of the show especially as it was straight after the junior doctors contract. I trusted them but I did explore that with them because essentially you are putting yourself on the line for your profession. I also reflected on myself and I thought about it long and hard. I thought that I would back myself because I’m not going to be out there and be a racist weirdo because that’s not the kind of person I am. So I thought what was the worst that could happen? But it obviously can be an issue which was very interesting. We had a lot of time to think about stuff and I really discussed with one of the cameramen about the things that I would love to talk about on TV so things like the junior doctors contract, Sierra Leone, discussion about health care work and how to improve systems and things like healthcare access which I thought would be cool to have on the show. The cameraman said that he would film me talking about it and if they use it great but if they don’t there’s nothing we could do. You are given a huge platform, and I did try and utilise that. None of the specific stuff I was talking about came up but I think the great thing was that I am a junior doctor GP doing that sort of thing so hopefully people would watch that and think I want to be a GP. The London deanery were really supportive about this as well. I thought ‘this is ridiculous, they will never sign this off again’. But they were like ‘sounds great, when’s it going to be on TV?’ I hope I did everyone justice.”

What opportunities has come your way since? “I met Simon Stevens, the Chief Executive of the NHS, he saw me on TV and asked to meet me to discuss how to get more doctors to become GPs. I’ve been asked to talk at events so there’s lots of these great opportunities so I’m really glad I did it. One of the producers/cameramen and I are going to go back and do a project on the people that we treated in Sierra Leone and see what was the effect of the response.”

What was it like coming back to the NHS from such an intense experience? “It was really hard coming back after both experiences [Ebola response mission and Mutiny] because they are so intense and you’re sitting in your GP room alone talking to the woman with a sore knee. Some of them [the patients] knew I was going away but I think not as many people as you think would recognise me. I think quite often the patient doesn’t want to talk about their GP, they want to talk about themselves.”

“My VTS are probably really sick of me doing talks of TV shows and Ebola. ‘Can we just have some teaching on breastfeeding?’ We have a really nice VTS so they think is funny.”

In the last episode, Luke has to make a call on whether to call the emergency boat for one of his comrades who is severely dehydrated. The implication of this would be that the mission would not be true to the original voyage as they would have been given donations of drinking water. This was hugely unpopular with the team who were so close to completing the project. It made me think of the decisions that we make every day, sometimes difficult, sometimes unpopular, most just on clinical acumen. Not just that but, as GP’s, we spend a lot of time making judgements and decisions about people, their social situation, their interaction with others. I whole-heartedly agree with Luke when he says “As a doctor, we all hang out with other doctors, so we don’t realise what an amazing thing we have – in terms of specific skills and how we interact with people and how we analyse situations. That is valuable in so many situations.” 

As we part ways after the interview, I reflect on the afternoon just spent talking about Luke’s experiences. What I like about him is his passion for general practice and his dynamic enthusiasm for others to share his love. I also really admire his can-do attitude and positivity and the way he talks about learning to ‘back himself’. The sailors on the boat talk about relearning how to sail using navigation equipment from the 18th century, a far cry from the modern technology and GPS they’re used to today. And it makes me think of how far even I have come in the two years since leaving hospital in trusting my instincts. As GPs, we have an extraordinary skill in being able to manage patients with only what we find in the consultation room and with resourceful use of investigations. And I feel this skill opens up our opportunities compared to many other specialities.  Undoubtedly this experience would have given Luke skills that would be impossible to learn in the consultation room but, likewise, he would have brought invaluable skills to both missions.