News, Culture & Society

DR MAX THE MIND DOCTOR: What can we all learn from the Thai coach lost in a cave?

Hollywood producers and A-list actors are battling to acquire the film rights to the story of the rescue of 12 young Thai boys and their football coach trapped in a flooded underground cave system.

And no wonder! It’s an incredible tale that’s captivated us all, as experts from around the world rushed to help the Thai military find the boys and then launch the incredibly dangerous evacuation mission in which one diver tragically lost his life.

One of the last to be brought out on Tuesday was Ekapol Chanthawong, the 25-year-old coach of the Wild Boars team. While he’s faced harsh criticism from some for leading the boys into the cave, to many Thais — not least the parents — Chanthawong is no less a hero than the rescuers.

In good spirits: Some of the trapped Wild Boards football team during their ordeal

Nine long days elapsed before British divers located the youngsters, two and a half miles inside the cave system, perched on a shelf above the waters.

Imagine how the boys must have felt, trapped in pitch black darkness, forced to lick moisture off rocky walls, increasingly hungry and weak. The sense of claustrophobia and terror must have been overwhelming. Was anyone even looking for them?

The mental torment would have been a far greater challenge for them than the physical deprivations. Indeed, it is an individual’s mental resilience that is a bigger factor than their physical health in determining how they will fare in a perilous situation.

This is where coach Chanthawong came into his own. By a fortuitous twist of fate, he’d spent a decade as a Buddhist monk and practised meditation regularly for up to an hour a day.

His aunt has told journalists that he taught the technique to the boys to help them stay focused, calm and positive. This claim is backed up by one of the rescuers, who praised the group’s strength, saying the coach had discussed with the boys ‘staying strong, having the will to live, the will to survive’.

All 12 boys and their football coach were freed from the cave complex in Chiang Rai after an arduous mission

All 12 boys and their football coach were freed from the cave complex in Chiang Rai after an arduous mission

Meditation is, basically, mindfulness, which has become very fashionable of late. It involves the psychological process of learning to focus attention on the present moment and shutting out all the background chatter in the brain.

I have reservations about mindfulness being the panacea that some advocates would have us believe. But there is no doubt that, along with other types of psychotherapy such as Cognitive Behavioural Therapy (CBT), it can be hugely beneficial for people in distress or difficulty.

In a threatening environment, that monk turned football coach has shown just how valuable it can be.

But he also teaches us a lesson about the importance of being prepared — and this, I believe, is particularly relevant for anyone who has a history of depression, anxiety or other mental health issue.

I often see patients who are in a crisis. In addition to the immediate support we give, they are usually put on a waiting list for psychotherapy. Yet so often, by the time their name comes up, they are feeling better. ‘Oh, don’t worry,’ they tell me. ‘I’m OK now — I don’t need it’.

I always respond in the same way: ‘Actually, this is precisely the time you should be having psychotherapy.’

The best time to learn the techniques of mindfulness / CBT etc is not when you’re in the middle of a crisis, but when you feel relatively well. That’s when you can really concentrate and hone the skill, because you’re not also battling the symptoms of mental illness.

So if you’re prone to stress, low mood or anxiety, don’t wait until things get bad. Make sure you have a good grasp of CBT or mindfulness now. Talk to your GP or research these techniques on the internet — and practise them even when you’re feeling good.

Chanthawong could never have imagined the desperate situation he and a dozen youngsters would find themselves in. But he had the psychological tools he needed and was able to bring calm to a terrifying experience. I think he’s more than vindicated himself.

Farewell to Jeremy Hunt, our longest-serving Health Secretary and one of the best — though few NHS staff will agree with me. 

After six years, most are delighted to see him go to the Foreign Office. 

Many in the NHS will be happy to see Jeremy Hunt go

Many in the NHS will be happy to see Jeremy Hunt go

But I was hugely impressed by his dedication to the health service and his passionate advocacy for patients. 

The job wasn’t simply a stepping-stone on his political career — Hunt wanted to ‘fix’ the health service. I think the NHS will be the poorer without him.

The near miss with a patient that still haunts me

I came across a report this week that brought memories I’d sooner forget flooding back.

According to a survey, more than half of junior doctors have had an accident or near-miss on the way home after a night shift.

Even more worrying is how tiredness affects judgment.

As a recently qualified doctor, I was covering several wards. Around midnight, I got a call to say that a patient’s oxygen levels were low. I was frantically busy, so told them to ‘sit her up and give her a bit of oxygen’.

An hour later, the ward called again. I went to see the patient, an elderly woman who was breathing heavily.

‘She doesn’t look right and her stomach hurts,’ a nurse told me.

Another ward beeped me. A patient was having a heart attack, so I rushed off — but popped back later to check on her again. I was told she’d been constipated, so I prescribed a laxative.

Four hours later, after running back and forth between wards, increasingly exhausted, I realised she was dying in front of me. But why, my befuddled brain asked, she’s only constipated?

She wasn’t: she had a blood clot on the lung. It’s one of the most basic medical emergencies and I’d missed the telltale symptoms. Too tired to think straight, I’d failed to properly assess her. The patient was sent to intensive care. Thankfully, she survived.

The 1993 European Working Time Directive, which said that no one should work more than 48 hours a week, was supposed to transform the gruelling regime that young doctors traditionally had to endure.

As the new survey shows, little has changed. Doctors work the same long hours — and, as I know too well, the consequences can be catastrophic.

Firing this NHS doctor is sinister 

What is this new age of tyranny when it comes to lesbian, gay, bisexual and transgender (LGBT) issues? I don’t like it — and I say that as a gay man.

Take Dr David Mackereth, an NHS doctor with 26 years’ experience who was training to be a disability assessor for the Department of Work and Pensions.

His contract has been terminated because he refused to agree to identify patients by their ‘preferred gender’. Dr Mackereth explained that, as a devout Christian, he believed gender is determined at birth by biology and genetics, and that God makes people male or female.

Now, I don’t agree with Dr Mackereth. I know from my work that the feeling of being in the wrong body can be incredibly distressing for trans people. But it seems an incredible overreaction to fire him.

If truth be told, he’s expressing a view that millions share. No one should be browbeaten, threatened or coerced into thinking a certain way. I find that sinister.

Being sacked won’t change his view. Far better that he gets to meet trans people in person. He might then realise it’s just courtesy to use the terminology they prefer. 

We know that even moderate drinking can cause brain damage, but figures showing that two people are hospitalised every day because of alcohol-related dementia are profoundly shocking.

As doctors, we need to tell our patients more about this aspect of alcohol — the chronic, disabling conditions linked to it. We tend to over-emphasise how drinking (and smoking) will shorten their lives, and all-too-often the jocular response from patients is: ‘Well, doctor, you’ve got to die of something!’

It’s an example of what psychologists call a ‘cognitive error’ — a way of thinking that alleviates a concern, but is based on flawed logic.

Because while it’s true that smoking or drinking to excess might not kill you outright, some of the consequences of continuing such habits are, arguably, far worse than death: stroke, disability, dementia, cancer — conditions that you may have to live with for years.

Yes, we’ve all got to die of something, but I’d rather not spend my declining years in a wheelchair in a nursing home with no memory, wondering what was happening to me.