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I did a bad thing. I bought a present for a patient. In my defence it was the early noughties and we did things differently there. In addition, I was a Specialist Registrar who was ‘a bit of a character’. To all my trainers over the years, I can only apologise.

Katie* had Cystic Fibrosis. She always looked cold and slight and when I think about it, I can’t recall her parents ever being there. She’d say she really really liked tigers and The Spice Girls. So out of worry for her warmth and with a grip on professional boundaries that could only be described as slippery, I bought her a tiger hat for Christmas. It was one of those fun fur ones with cute little ears and long side bits you could wrap round like a scarf. Highly flammable and very Girl Power. No one else knew.

Late January, Katie was on the ward again with pneumonia.  As always, she was up at the nurses’ station, swinging her legs on the wobbly chair shrieking with a shattered Lucozade bottle laugh until Sister shooed her back to her room. That Friday she was to be discharged into a brittle Lewisham night. She promised me she’d keep warm. She loved the way the hat felt over her ears and she did really really like tigers. If she came in again, the plan was for her to go to the adult respiratory ward. Months had gone into behind the scenes transition plans and she was all set. She waved goodbye and her bare head bobbled off down the corridor.

By Monday morning ward round, there was Katie again. Turns out that on Sunday night she’d pitched up grumbling and coughing into adult ED for the first time. They’d seen her quickly and the Senior House Officer took the history. “So” he said, rubbing his tired eyes and peering at his blank history sheet “How long have you had Cystic Fibrosis?”. Katie’s jaw fell open and her tiger eyes flashed. Before he’d had a chance to correct himself, she’d grabbed her bag, spun on her heels and banged her way through the double doors, stomping across the lino into paediatric ED. “I’m never going there again. They’re idiots” she said, plonking down in the nurse’s bubble. Except she didn’t say idiots and there were more adjectives.

Katie clearly didn’t feel safe. The belief of ‘out of your comfort zone’ birthing creativity is fair enough but can feel very threatening if you’ve been exposed to trauma.  I have anxiety and 25 years ago, a work event caused PTSD which nearly finished off my career.  My brain is spectacularly good at scouting for risk, ready to fire up my adrenal glands so I can book it out of any threatening situation; out of fight, flight or freeze I’m a runner. Katie was a world class panic sprinter. But you don’t have to have PTSD for an event to knock you off your equilibrium. An aggressive parent, an overbooked clinic, a meeting not prepared for. That feeling of your heart in your mouth, hair standing up on the back of your neck and your stomach dropping are primal physical signs that we feel unsafe. The good news is that the strong connection between our bodies and minds works both ways. Getting that ‘top down’ control gets better with effort. We can distract ourselves with non-threatening tasks, a movement break or the doctor’s favourite: dark coffee and darker humour. Mindfulness and exercise help too. Whatever works for you. I’m still practising.

The more I thought about it, I realised that Katie wasn’t so much caught by surprise, more that she didn’t want to accept the inevitability of change. The paediatrics ward had been her safe place for so long. She’d now have to put her trust into the new. Sometimes, even with the best preparation, you have to take that leap into the unknown. And to trust people who are there to care professionally and personally.

But for now, after a long South London Monday I piled on my coat and headed out the ward. Katie would be transferred to adults the next day. She’d be ok. She had her new hat after all. I tossed my chewing gum wrapper into the full bin. It landed on something soft. Poking out the top of the rubbish was a bundle of stripy, fun fur. Katie’s hat. Was this her accepting a transition? Was this anger at rejection from the ward? I suspected she’d been placating me and never wanted the cheap thing in the first place. But either way, we’d both walked through those doors and into another day and for me, a new job. A new chance to trust.

Katie didn’t come back.

Serena Haywood F�������� MA has been a Consultant Paediatrician since 2003 and specialises in behavioural neurodevelopment at St Georges in London. She is also a Medical Examiner, Guardian of Safe Working Hours, Peer Supporter with BMA Wellbeing, GMC Associate Assessor and playwright. Listen to Unmasked, her dramatised podcast about the first COVID-19 wave.

*Names and other information that could identify someone has been changed