Dr Chris Luke, the emergency physician who became known during his 35 years on the frontline of medicine for his frequent and lively media warnings on everything from overcrowding in emergency departments to addiction, has written a memoir. It is called A Life in Trauma. If there's a follow-up volume with all the really juicy bits he left out, he jokes, he will call it "A Life in Trouble".
In truth, A Life in Trauma is short on neither trouble nor juicy bits. He describes the book as "a sort of apology and an explanation of where it all went wrong". I don't think he means this ironically, so I ask him about how he can possibly see a three-decade career in emergency medicine in Edinburgh, Liverpool and Cork, as well as stints teaching, training and researching on toxicology, as having gone wrong.
“I suppose there’s an element of the perfectionist in me as well, who feels that you know, nothing is ever good enough,” he says.
My daughter said, 'Daddy, if you're going to be vulnerable, you got to commit.' And I had that at the forefront of my mind throughout writing
For a long time, he felt ashamed that he left frontline medicine earlier than he would have wished to in 2018, after debilitating shoulder and hand pain that made it increasingly difficult to do his job. I ask him to elaborate on the shame.
“At one point, I was flying, you know,” he says. When he was working in emergency medicine in Liverpool in his 30s, newly married to Victoria and starting a family, “I just was in my element, I knew I was inspiring youngsters all around me. There seemed to be a forward progression . . . I was ashamed because I left prematurely. I was humiliated that I had to, and I was humiliated that in the last few years, I didn’t have that popularity, that friendliness with more young people I worked with.”
These are surprising admissions from someone who simultaneously managed three emergency departments, and was known for his charisma and likeability. But the man who emerges in the pages of Luke’s book – and the one I meet over Zoom on a Friday morning in early October – is surprising.
He is as far from the caricature of the medical consultant with a complex of quasi-papal infallibility as it is possible to imagine. Instead, the figure he paints is of a flawed, unusually sensitive, highly intelligent and witty person, whose own difficult start in life blighted him with feelings of being an outsider.
When he talked to his daughter about the book, she “said, ‘Daddy, if you’re going to be vulnerable, you got to commit.’ And I had that at the forefront of my mind throughout writing this.” He took the advice to heart.
The memoir reveals that he spent his first six years in an orphanage, St Philomena’s in Dublin. The details of this experience are mostly lost, other than occasional flashes of memory of the metal bars on his cot or “the hairy legs of a young nun sitting on a table reading to a gaggle of small children”. Mostly what remains is a lingering sense of deep trauma.
But unlike the other children, he was not an orphan. He was the child of an "illicit love affair" between two co-workers, the very much married Leslie Luke and his unmarried colleague Colette Redmond. When the young Chris Luke was six or seven, for reasons that are not clear, he left the orphanage and joined his mother – or his aunt, as she explained the sudden arrival of the little boy to the neighbours.
For the rest of her life, she refused to talk about either his time in St Philomena’s or his father, leaving him to piece together what he could from snatches of knowing conversation among adults. The bond with his mother – and the huge, unacknowledged river of admiration, grief and love that separated them and drew them together until her death at 99 – is one of the defining narratives of his life and the book.
I only realised at the end that she just couldn't discuss my father. Ever. I realised that she'd had this kind of unresolved grief reaction for decades
Chris Luke has no memories of his father, who died young in 1963 after an operation. The other main presence in the book is, I suggest, actually the absence of Leslie. “Trying to know about my father was the only bone of contention between myself and my mother; the fact that she couldn’t, literally couldn’t, tell me more about [him] was a source of all the frustration.
“Because I genuinely thought that it was deliberate. And I only realised at the end that . . . she just couldn’t discuss my father. Ever. She would say, I mean, one liners at most – ‘you’re so like him’, or whatever. I realised at the end of it, that she’d had this kind of unresolved grief reaction for decades.”
These experiences left him with a fear of failure, an unhappy sense of being on the fringes of everything and a need to be liked. He was an "insanely difficult teenager" who "spun out of control" and travelled around Europe "sleeping in phone boxes on park benches". A bad LSD trip in Amsterdam the summer after he did his Leaving Cert led to a life-long interest and pioneering research in the area of substance misuse.
All of this helps to explain, too, why the incident with which he opens the book proved so calamitous.
It was February 10th, 2011, and he had agreed to appear on Pat Kenny’s RTE radio programme to talk about the trolley crisis in Cork’s emergency departments. That morning, he would later learn, a 19-seater Manx2 commuter plane flying from Belfast had crashed near runway 17 at Cork Airport, killing two pilots and four passengers instantly. But as he prepared to go on air, the news was only that an “incident” had been declared at Cork Airport. He knew he needed to get back to work, and that he was exhausted after months in a “noxious fug of anguish, despair and hostility, with patients on trolleys as far as the eye could see”.
As a result of the pressures he was under, he did not choose his words wisely. He let loose at the handful of general practitioners who kept referring non-emergency patients to the emergency department. He worried about the “productivity” of some locums staffing emergency departments, and compared them unfavourably to his own generation.
He referred to first-year doctors as “baby doctors”, a term he says they use “all the time”.
He wanted to make a point, which he still believes, that the State should be entitled to expect some reciprocal service from medical graduates after providing them with an education. “I have never met a civilian – in inverted commas – whether it’s a journalist, a commentator, a pundit, a political analyst or a healthcare analyst who doesn’t agree with me 100 per cent. But that, by the way, is the idea for which I’m most hated.”
The timing, to say the least, was catastrophic. To some, it looked as though he had strolled out of the emergency department, virtually past the trolleys holding plane crash survivors, to go on radio and complain about his medical colleagues – the fact that he didn’t yet know about the plane crash got lost in the outrage.
The aftermath was immediate and devastating. He was the victim of what is now widely recognised as an online pile-on. He went through a disciplinary process. But worst of all, he says, is how he was treated by some colleagues. Even 10 years on, there’s pain in his voice as he talks about the weeks afterwards, when he had to take unplanned leave from work and retreat to a friend’s holiday home in west Cork.
I was wracked with terrible disappointment at my disintegrating career. Worst of all, I was subjecting my family to increasingly frequent, thoughtless and unjustifiable angry outbursts
“I was afraid to say hello to doctors in shops, cars and streets in case they would awfully humiliate me,” he says. The “level of spite” he encountered still “grieves me and staggers me”.
He thinks now that the event unleashed his childhood vulnerabilities. In any case, it precipitated a mental health crisis that had been quietly bubbling away. He had been showing the first signs of burnout since he left a promising career in Liverpool to come back and take on a job that many of his friends and colleagues warned him would be impossible – managing three emergency departments in three different hospitals in Cork.
The years afterwards were very bleak. “It was the family kept me going” – he credits Victoria with making him laugh every day – “It was friendship.”
He found himself relying on alcohol as a crutch. “One of the really important messages in the book is that burnout is not just an internal combustion. It’s an external manifestation of the internal combustion. You become really angry, you become negative, really cynical. You become really difficult. Because difficulty makes people difficult. You become half the man, half the father, half the husband – or less than half – that you used to be.”
He writes: “I wasn’t smoking weed, I wasn’t snorting lines and I wasn’t chasing women, but I was spending more and more of my off-duty time slumped on the sofa, nursing a glass of claret. And I was wracked with terrible disappointment at my disintegrating career. Worst of all, I was subjecting my family to increasingly frequent, thoughtless and unjustifiable angry outbursts.”
Finally, it was an intervention that prompted him to stop drinking. “My daughter said, ‘You know, you’re not a great person to be around, Daddy. You need to change. Something needs to stop.’ So I stopped. And, I mean, I am a party animal. I like to drink as much as the next five people.”
He misses that aspect of it, but he paraphrases a quote from jazz singer George Melly on finding himself impotent at 70: "It was like being unshackled from a maniac. I genuinely say I am a sinner serving other sinners. And if I wasn't a sinner, I wouldn't be a great lecturer on party medicine."
These days, he’s in a far better place. Now teaching young medics and giving talks in schools, he suffers occasional bouts of despair at the state of the health service, and there are days when Vickie, as he calls her, has to tell him to stop talking about the HSE. But he has rediscovered his mojo.
Finally, he has come to see how being an outsider was an advantage in medicine. “I worry that medicine has become a terribly, terribly middle-class [career],” he says.
He is middle-class, he acknowledges; so is his daughter, who is pursuing a career in emergency medicine. So his concerns are not based on abstract notions about class.
“There’s a very difficult thing that I want to say now. I worry that too many doctors’ back stories now are uneventful and comfortable. Because I am absolutely convinced that because I had this difficult, unsteady childhood experience . . . where I had a fear of being found out the whole time and this kind of embarrassment or shame hanging over me”, it left him with a greater capacity for empathy.
“I think a difficult backstory makes people much more capable of empathy. I worry that there are not enough lunatics, eccentrics, mavericks and outsiders like me who’ve had a difficult background.”
A Life In Trauma: Memoirs of an Emergency Physician by Dr Chris Luke is published by Gill
