Obituary Claire Epstein (1977-2009) by ggy86211


                                                                                                                             May 2009
       Emergency Medicine Journal

Obituary: Claire Epstein (1977–2009)
The death of Claire Epstein, at the age of
31, from bowel cancer, has shocked and
devastated her family and friends, and left
a significant gap in the medical commu-
nity in which she was so highly valued.
   Claire Hazel Epstein was born in
Newcastle on 10 November 1977. The
middle child of three, she remained at the
centre of her close family throughout
childhood and adulthood. She was edu-
cated at Durham High School, where her
enormous popularity with both students
and teachers made her the obvious choice
for Head Girl, a role she undertook with
just the right combination of humour and
seriousness. Despite what her mother,
Barbara, described as ‘‘an alarming lack
of rhythm’’, Claire worked hard to over-
come this to be involved in school plays
and musicals. This determination was to
become one of Claire’s hallmarks in her
chosen career of medicine.
   Although Claire would have excelled in
the Arts, of which she was very fond
(especially History), her decision to spe-
cialise in science, in order to go to medical
school, came as no surprise to her family.
With their father, Howard, an orthopae-
dic surgeon, it was expected that at least
one of the three siblings would follow in       to work in various hospitals in Brighton     intoxication, anger issues and poor
his footsteps and become a doctor.              and North East London, and at the time       hygiene while her colleagues hid in the
Claire’s younger brother, Michael, eluci-       of her death was a Specialist Registrar at   tea room. She delivered first-class health
dated at the funeral that the lot fell to       The Royal London Hospital, where she         care to all, and did so with the wide smile
Claire after a tense game of ‘‘rock, paper,     had impressed the staff there (as every-     on her face that became a trademark to all
scissors’’.                                     where else) with her energy, quick wit,      who knew her.
   Claire’s genuine desire to help people,      brilliant clinical acumen and fantastic         Despite having a specialist interest in
along with her keen scientific mind, made       interpersonal skills.                        acute medicine, consultants at RLH were
her an excellent student at The Royal             Always the champion of the underdog,       quick to identify that Claire’s first-rate
London and St Bartholomew’s Medical             Claire never shied away from unpopular       clinical skills along with her attributes as a
School, where she graduated with hon-           patients, and would frequently see more      true team player would make her an
ours in paediatrics in 2000. She went on        than her fair share of those with alcohol    excellent addition to the HEMS team,
    EMJ Supplement

and they had asked her to apply.                   for hours, shop for days, babysit at the                   sorry, I haven’t cleaned my teeth’’. It is
Similarly, departments that she had pre-           drop of a bottle of gripe water, cover                     also no surprise that after her death on 12
viously worked in were also already                shifts, offer practical advice (served with                February, her family found thank you
starting to ‘‘court’’ Claire and tempt her         cake and Earl Grey tea) and cancel her                     cards for the staff who had cared for her,
into a consultancy post with them.                 own plans for any of these friends. She                    written several days previously.
   Although Claire was extremely well              was spectacularly generous with her time,                     Nowhere was the love, admiration and
liked by everyone she came into contact            and also had a knack for buying the                        respect for Claire so apparent as at her
with, she was no pushover at work.                 perfect gift at just the right moment for                  funeral, at Rosslyn Hill Unitarian Chapel
Despite listing ‘‘sleeping’’ as her only           those she loved. For those friends, and her                in Hampstead, on 28 February. It was so
hobby on her Facebook profile, Claire              boyfriend David, Claire is simply irre-                    well attended—by school and university
was always punctual and was easily riled           placeable.                                                 friends and teachers; colleagues from
by colleagues’ poor timekeeping. She                  Claire was diagnosed with an extremely                  every hospital Claire had ever worked in,
would often say, as people sauntered into          aggressive form of bowel cancer at the end                 and friends and family—that many had to
work late, ‘‘I realise that everyone is            of January, and died just over two weeks                   stand at the back in order to say their
unavoidably late once in a while, but              after diagnosis. Throughout her illness,                   goodbyes to this exceptional young
would you please have the good manners             she retained the humour, dignity, deter-                   woman.
to run the last couple of hundred yards so         mination and selflessness that had come                       Claire Epstein is survived by her par-
that you at least look a bit flushed and           to define her. Even in the last days of her                ents, Howard and Barbara Epstein, and
out of breath?’’                                   life, her priority was to make sure that                   her two brothers, Simon and Michael. She
   Her sharp wit was balanced by her               everyone else was ok. It is no surprise that               is buried at Highgate Cemetery.
unfailing loyalty and generosity to those          Claire’s last words (to the anaesthetist
she counted as friends. Claire would drive         who came to intubate her) were ‘‘I’m                                    Helen Parker, Deborah Finding

Consultant appointments March 2009
The information for the consultant appointments is provided by the College and any errors should be notified to them and not the journal
Name                                    Hospital                                                                           Previous post

Dr Robin Perry                          North West Wales NHS Trust                                                         Locum Consultant
Dr Thomas Hughes                        John Radcliffe Hospital, Oxford                                                    Consultant
Dr Simon Smith                          John Radcliffe Hospital, Oxford                                                    Consultant
Dr Jane Terris                          John Radcliffe Hospital, Oxford                                                    Consultant
Dr Abdul Jabbar                         Nottingham University Hospitals
Dr Gaynor Creaby                        James Cook University Hospital                                                     SpR
Dr Patrick Dissman                      James Cook University Hospital                                                     Locum Consultant
Mr Alex Johnston                        James Cook University Hospital                                                     SpR
Dr David Snow                           Southport & Ormskirk Hospital NHS Trust                                            SpR
Dr Simon McKay                          Southport & Ormskirk Hospital NHS Trust                                            Locum Consultant
Dr Peter Martin                         West Suffolk Hospitals NHS Trust                                                   SpR
Dr Lucy Glanfield                       York Hospitals NHS Foundation Trust (taking up post after maternity leave)         SpR
Dr Mitesh V Davda                       Princess Royal University Hospital                                                 Locum Consultant
Mr Khalid Bashir                        Bronglais General Hospital (Hywel Dda NHS Trust)
Dr Paul Hill                            Cumberland Infirmary (North Cumbria Acute Hospitals NHS Trust)                     SpR
Miss Lisa Jane Lang                     Warrington and Halton Hospitals NHS Foundation Trust                               SpR
Dr Joanna E Scott                       Leighton Hospital                                                                  Locum Consultant
Dr S Satchithan                         Leighton Hospital                                                                  SpR
Dr Benjamin Loryman                     Pilgrim Hospital, Boston                                                           Locum Consultant
Dr Ian Levett                           Worcestershire Royal Hospital                                                      SpR
Dr J Acheson                            Leicester Royal Infirmary
Dr Paul Jennings                        Airedale General Hospital                                                          SpR
Dr Simon Binks                          Gloucestershire Royal Hospital                                                     SpR
Dr H Hollis                             Royal Lancaster Infirmary
Mr David Martin                         Ipswich Hospital                                                                   SpR
Dr Haidar Reza Samiei                   Doncaster Royal Infirmary
Miss Kay Jeanette Stenton               Doncaster Royal Infirmary
Dr James Crampton                       Stafford Hospital                                                                  Locum Consultant

                                                                                                                       EMJ Supplement

Pres blog                                                                                          casemix and activity are made by those
                                                                                                   distant to our EDs. In turn, it is perhaps a
                                                                                                   fraction more understandable that urgent
I write this at the end of a busy week          we all know that sustaining the 98% level          care centres and other otherwise evidence-
which has included the College response         has proved difficult and I have received a         free evolutions should be suggested.
to the report regarding Stafford Hospital,      number of reports, particularly in recent             We all need to recognise this and act
an excellent meeting at the College on          months, regarding sustainability. This is a        immediately. The key steps are:
Information, funding and workforce, and         product of inexorable patient demand, both
the March Council meeting of College.           in terms of numbers and acuity, together           c   Please do whatever it takes to max-
   The Healthcare Commission Report             with still a significant shortfall in the              imise coding compliance and accuracy
regarding the problems at the Stafford          number of EM Consultants/Senior Middle                 within your ED—I know this is
Hospital in previous years understandably       Grade doctors in post in most departments,             difficult but the importance cannot
attracted major media attention. It is          combined with limited inhospital capacity.             be overstated.
important to note, however, that the            This mismatch means that our managers,             c   Please liaise in person with your local
comments reflected concerns regarding           and then we ourselves, remain under                    Information Officer or similar who is
the standard of care provided throughout        significant pressure to comply. This can               responsible for returning data regard-
the entire hospital, not just the Emergency     inevitably lead to premature/precipitate               ing ED activity. I understand that
Department. We were pleased to note that        moving of patients from the ED, not always             there is a requirement for these
there has recently been tangible, significant   in the patients’ best clinical interests. We           individuals to liaise with the Lead
support and investment in the ED which          have always indicated that a target of 95%             Consultant in the ED before data are
now has four consultants in post. At the        would allow a degree of flexibility, still             returned to the Centre to ensure
Information meeting, one of the most            ensure that focus/investment occurred in               accuracy and reliability. However,
recent appointees was able to describe the      order to sustain a service but would be                my understanding is that this rarely,
current state of play at the Mid                achievable without unacceptable pressure               if ever, actually occurs. I know that
Staffordshire Hospital and it is clear that     on clinicians, ‘‘creative management’’ and             many IT systems are non-compliant
                                                                                                       but our position in rejecting assump-
there is absolute commitment by the ED          inappropriate patient relocation.
                                                                                                       tions about the ‘‘Primary Care’’ com-
consultant team to provide the highest             On 18 March, the College hosted an
                                                                                                       ponent of our department activity is
standards of care. In turn, I indicated that    excellent meeting on Information, funding
                                                                                                       undermined in the absence of reliable
colleagues in Stafford have the full support    and workforce with outstanding presenta-               data. Interestingly, however, discus-
of the College in delivering this care and      tions by Nigel Brayley, Tony Shannon,                  sions with colleagues from around the
that the College will help in any way           Chris Moulton, Simon Eccles and Don                    UK at the meeting on 18 March
required in the future. I also took the         MacKechnie. The lecture theatre at the                 indicated that the experience of a
opportunity to write to the Editor of the       College was full, with an audience which               range of Primary Care/Urgent Care
local newspaper to reassure the public in       included emergency medicine colleagues,                Centre models was that the average
Stafford regarding the transformation           managers and commissioners. Many key                   number of patients who would satisfy
which has occurred and that they should         points but the absolute crucial message is the         an inclusion in this group is in the
have confidence in their local ED in            issue of data returns reflecting activity in our       order of 10–15%—that is, the small
providing care when required.                   EDs. The simple fact is that up to 50% of our          minority of overall ED attendances
   The issue highlighted continuing pro-        ED attendances arrive as blank or unclassifi-          and absolutely nowhere near the 50–
blems regarding the 4-hour target which I       able returns. Crucially, this is information           60% number still repeatedly quoted by
had the opportunity to describe on the          which PCT commissioners, the SHAs and                  those in very powerful positions of
Today programme, Five Live and Talk Sport       the Department of Health use to inform                 influence, albeit at vast distance from
(?!). In many ways, the 4-hour target has       strategy and funding decisions. It is perhaps,         the real world of our EDs.
been a good thing, attracting focus and long    therefore, less surprising that misguided and
overdue investment in our EDs. However,         incorrect assumptions regarding the ED                                         John Heyworth

                    Contacting the editors

                    This supplement is edited by Mike Beckett (West Middlesex Hospital), Diana Hulbert (Southampton
                    General Hospital) and Lisa Somers (Newham General). To contact the editors, please email:
    EMJ Supplement

Simulation goes forth
Since our last article in June 2008 the        Developing an accurate map of
College has developed a strategy for           established capacity and capability
simulation with emergency medicine and         A further survey of each school is being
this article is to give you an idea of what    conducted so that the requirements for
you can expect. Within the context of this     and capacity to deliver simulation training
article simulation refers to the use of full   can be assessed. Once this is completed
body manikins with a fully immersive           we will be able to direct support to those
setting often with the use of audio-visual     regions that require it.
   An initial survey run on the college        Developing regional simulation groups
website got 115 responses distributed          based around schools
nationwide according to the map.               These will be developed from the infor-
   This showed that the speciality has a       mation gathered with the schools survey
number of individuals with a lot of experi-    but please don’t wait for this process.
ence of simulation and a wider number          Contact your school head and offer to set
expressing interest in its use. From this, a   up your school group and complete your
meeting was held at the College in October     school survey.
where 24 people attended. This group then                                                      Developing a simulation committee
developed the College simulation strategy                                                      The simulation committee structure is
described in this article                      ED faculty development
                                                                                               developing. We are still looking for a ST1–
   The group recommended the use of            This is being led by Adrian Boyle (adrian.
                                                                                               3 representative and have yet to appoint
simulation to teach a variety of skills at and his group
                                                                                               regional representatives. If you are inter-
different levels of training:                  have developed a specialty-specific faculty
                                                                                               ested please contact Peter Jaye (peter.
                                               course, the first one of which will be run at
c   Common scenarios with established          the Guy’s Hospital in London on 16 April
                                                                                                 We are also aware that in the rush to
    algorithms or guidelines (ST1–2)           2009. We also want those members of the
                                                                                               get moving with this project we have
c   Rare but life-threatening presenta-        college who are already working as simula-
                                                                                               missed some people with great simulation
    tions (ST 3–4)                             tion faculty to contact him so that we can
                                                                                               skills. Please accept our apologies and
c   Non-technical skills/human factors         map our resource and also validate you as a
                                                                                               contact Peter Jaye. There is still an
    (ST 5–6)                                   CEM simulation trainer.
                                                                                               enormous amount of work to do and we
   It was felt that non-technical skills                                                       need you!
                                               Creating a bank of simulation scenarios
should be taught at all years but the
                                               using a standard template
focus of training would increase in later
                                               This work has been split into two parts.        WHERE WILL WE BE IN 5 YEARS?
years of training. These skills will be
                                               The development of a standard template          We hope that all trainees will be exposed
outlined in a further article to follow
                                               for scenarios is being led by Iain Lennon       to College-endorsed simulation teaching
later in the year. It was not recom-
                                               ( This will allow the       incorporating non-technical skills by
mended for simulation to replace estab-
                                               College to hold a bank of scenarios for all     2012.
lished life support courses
                                               College members to access that can be             There will be an established, integrated
   The group did support the future use
                                               used on any type of simulator.                  simulation curriculum with an embedded
of simulation for assessment once it is
                                                  Steve Barden (steve.barden@bsuh.             research programme that will be on-going.
established in the curriculum. This
                                      is the lead for the simulation            A concrete regional structure with
clearly cannot occur until sufficient
                                               editorial board. They are developing a          capability and capacity to deliver training
capacity for training is developed so that
                                               group of College certified scenarios and he     will be established. The development of
all trainees will have experienced simula-
                                               is keen to be sent scenarios that you have      simulation use for CPD will be ongoing.
tion training at least three times prior to
                                               already developed locally. This group           Lastly, simulation OSCEs will be intro-
their CCST.
                                               plans to quality assure these and then          duced into MCEM/FCEM.
                                               develop a scenario bank as an internet
SO WHAT IS OCCURRING NOW?                      resource.
c Development of an accurate map of                                                            CONCLUSION
   established capacity and capability                                                         We hope this gives you an idea of the
                                               Creating an internet resource for
c Development of regional simulation                                                           work that has been done so far and that
   groups based around schools                                                                 you can expect to see developing. We are
                                               Andy Parfitt (
c Development of an ED faculty in
                                                                                               still keen for volunteers so please either
                                               is developing a webpage to be hosted on
   simulation                                                                                  contact Peter Jaye or your head of school
                                               CEM site with resources and discussion
                                                                                               and get simulation training going in your
c Creating a bank of simulation scenar-        group. This will allow College-approved
   ios using a standard template                                                               region.
                                               scenarios to be downloaded. This will be
c Creating an internet resource for            linked with the e-learning project with
   simulation                                  modules linked to scenarios.                                     Peter Jaye, Abigail Millett


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