A breakthrough from the heart

In 2016 Catherine Fowler attended one of our workshops at work. Now she’s using Breakthrough Thinking to transform healthcare in her spare time and get patients and medics to Think Aorta!

Aortic dissection is a severe life-threatening medical emergency which affects 4,000 people in the UK every year. It occurs when the main artery that takes blood from your heart to the rest of your body (the aorta) tears. It’s a treatable condition with a 90% survival rate when diagnosed and managed appropriately. But survival requires a rapid diagnosis and immediate repair, because, if left, blood will burst through the outer wall of your aorta causing fatal damage, with 50% of patients dying within 48 hours.

It is the most common cardiac emergency that requires surgery, can just as easily affect younger people of working age as it can older people. And, according to Deborah Harrington, a consultant cardiac and aortic surgeon from Liverpool Heart and Chest Hospital, “we know that [without intervention] the survival of untreated type A aortic dissection is really quite abysmal and most patients will be dead at about a month.”

Despite this, as Catherine Fowler tragically discovered in 2015, the awareness and ability to successfully and speedily diagnose the condition by the medical profession is shockingly low. And so began a heartfelt campaign by Catherine to break through barriers, both personally and in the medical community, to increase the profile of aortic dissection in the UK, Ireland and across Europe and achieve life-saving breakthrough results.

What if…

We all wonder “what if??”….”What if I did x?”, “what if I didn’t do y?”, “what if I hadn’t met z?” etc, etc. But, unlike Gwyenth Paltrow’s character in Sliding Doors, we rarely get to see how the choice we didn’t make or the route we didn’t take would have worked out. But in 2015 Catherine and her family were confronted with two starkly different realities that played out in an almost parallel timeframe. Only 7 days separate her dad Tim’s story from her Aunty Maura’s (Tim’s sister’s) story. The difference between the two stories clearly demonstrates how the variation in timely diagnosis and management for patients with aortic dissection is the difference between life and death.

Tim

Catherine’s beloved father died suddenly at 69 years young. Before this he was full of life with no history of serious health complications.

“Whilst away from home on a short trip to Dublin, Dad suddenly became very unwell. He presented all the documented classic symptoms of aortic dissection: thunderclap pain, severe and sudden onset, in his back, chest and abdomen. As a man, over 65 years – Dad also had the classic patient profile for the condition.

However, within 20 hours of being brought to hospital, Dad was dead. Tragically, although aortic dissection featured as one of the initial differential diagnosis, this was neither documented nor effectively communicated.  And apart from the initial differential, sadly the wider emergency team didn’t consider the possibility of aortic dissection in his final hours.

The correct diagnosis was not made and my father paid the ultimate price with his life.”

For Catherine and her family, this became the first of their many what ifs:

• What if Dad’s initial differential diagnosis had been documented or communicated effectively?
• What if Dad hadn’t been discharged with gastritis at 2am and then readmitted later that morning?
• What if the team responded effectively to the double lumen that featured on his FAST scan?
• What if the emergency department had policy, training and guidelines to ensure they considered aortic dissection?

“As a family, sadly we know we are not unique - there are many families who have lost a loved one to this condition and left with their own heart-breaking what if’s.”

Maura

Back in London, 7 days following his death, Tim’s sister was struck by aortic dissection and brought to what would have been Tim’s nearest emergency department to home.

“You really couldn’t make it up.

Maura’s experience was the polar opposite. All credit is due to the emergency team where she was admitted. Our family was in complete turmoil following Dad’s unexpected death and they had not been notified of his aortic dissection. Maura’s symptoms were immediately identified, effectively communicated and urgent arrangements were made to transfer her to a facility, where emergency cardiac surgical services were on hand. This ensured she was treated by surgeons with the appropriate experience and expertise.”

Maura’s life was saved and it was down to the emergency team who considered the possibility of aortic dissection and their effective actions after confirming the diagnosis that saved her life.

“Maura was lucky, but can you imagine?

• What if the emergency team did not think Aortic Dissection?
• What if there had been a delay or an issue in ordering a CT scan?
• What if there was an inexperienced surgeon on rota that day?”

In a morbid and tragic real-life version of sliding doors, Tim & Maura’s contrasting experiences clearly shows how rapid detection and appropriate management of aortic dissection can save lives.

Catherine

In 2016 Catherine, who works in innovation at EDF Energy, attended one of our Breakthrough Thinking & Performance workshops we had been commission to run as part of a wider culture transformation project. At a team meal the evening before the workshop kicked-off, Sara Moore, our Senior Partner running the session, was chatting with Catherine giving her an outline of the Breakthrough Thinking content they would cover the next day. Catherine was instantly intrigued and saw huge links with breakthroughs she was trying to achieve not only at work but also in her personal life following her dad’s passing.

“I had learnt that my father suffered considerably before he passed away. As a result of my father’s suffering and unnecessary loss of life, my fire had been lit.”

Since losing her father in 2015 Catherine has been fundraising and campaigning tirelessly to raise awareness of aortic dissection and to give it the profile it needs in an emergency medicine setting. Her aim is for the condition to be consistently considered as a differential diagnosis when a patient comes to an emergency department with unexplained severe pain. And to ensure the correct diagnostic method is then routinely used. CT Scans are proven to be the only way to safeguard a definitive diagnosis. Other measures such as chest x-ray, ECG, ultrasound & blood tests can be normal and won’t necessarily pick it up.

Think Aorta

Following months of hard work, Catherine found a way to join forces with Professor Rick Body at The Royal College of Emergency Medicine and Deborah Harrington, a Consultant Cardiac and Aortic Surgeon to launch the Think Aorta campaign in 2018. Together they are creating a set of learning tools about Aortic Dissection for emergency medicine professionals and the results so far are extraordinary.

The campaign has gone viral in all the right places…3,000 posters have been dispatched to every emergency department across the UK & Ireland, 4,700 individual downloads of learning resources including a podcast about patient stories have been made from the Royal College of Emergency Medicines online learning portal. Additionally, an online petition requesting 4 integral changes for the NHS and the HSE (the national independent regulator for health and safety in the workplace) has received over 4,300 signatures in support of Think Aorta’s initiatives.

Breakthrough Thinking

At Achieve Breakthrough we are incredibly proud to have crossed paths with Catherine. In our work, we are blessed to be able to meet many inspiring and courageous individuals. And Catherine is the perfect example of one of those people. As Sara told her when they first met, she is “epitome of what our work is all about. Making a bold commitment, declaring it and working tirelessly to achieve it, even when others think it’s impossible.”

Catherine turned up to our workshop with a breakthrough mindset of ambition, possibility and transformation firmly in place. But we are humbled to have been able to help her in a small capacity on her journey. The Breakthrough Thinking tools we have worked with Catherine and her team on at work have benefitted both her day job at EDF and have also given extra texture to her ability to shift minds and change behaviours for the better in the medical community when it comes to dealing with aortic dissection.

“I understand that change within the NHS may not be easy, but this does not mean it’s impossible, even under a climate of austerity.”

Last month Catherine delivered a powerful, engaging and emotive speech to 2000 emergency medics from across Europe, promoting the Think Aorta campaign. Catherine was understandably nervous about speaking in public to such a large and influential audience, but she said:

“As I looked out across the room I knew I was connecting with 2,000 emergency physicians across Europe, and every single one of them has an amazing gift.

Every person in the room could influence change where they work whether it’s in their local village clinic, the emergency departments they work in, in their town, or in their city. They each held the power to change the ‘what if’.”

As part of our commitment to regularly pay it forward in the communities we touch at Achieve Breakthrough, we provided Catherine with free extra consulting hours working with Wayne Alexander, our in-house public speaking coach, to support her in preparing to deliver her impactful talk. Catherine was a committed learner and, despite her nerves, never wavered from her commitment to the outcome.

Standing in the result

A beautifully simple approach we use with clients when they are trying to realise a bold ambition, is we encourage them to act from the future and stand in the result of the outcome they want to achieve. By this, we mean imagine you are there and ask yourself “what does it look like” and “how did we get here?”

To sign off from her speech, Catherine asked the audience to do just that:

Stand with me in the future and just imagine the possibility – what if every emergency department represented here across Europe inspires their teams to ‘Think Aorta.’

• What if in 3 month’s time you have developed your ED policy & guideline for AD?
• What if you have used our podcast & learning materials to accelerate and extended learning in your ED?
• What if you consistently and routinely CT scan to detect and diagnose AD?
• What if you have adopted the best practice?

Dad

Catherine is proof that if we can wholly commit to a breakthrough vision, even when we don’t know exactly our plan forward for achieving it, the seemingly impossible can become possible.

“The secret of change is to focus all of your energy, not on fighting the old, but on building the new.”– Socrates

“I don’t want my father’s death to be in vain. What if Dad’s loss of life, and indeed all of those who have lost their life to a misdiagnosed aortic dissection can accelerate change for others who find themselves in a critical condition within all emergency departments? Then something very positive will come out of the pain.

Everyone is deserving of their chance to survive a treatable condition, and have their chance to live and to remove all those heartbreaking ‘what if’s’.

As my father would say to me ‘The grass is not greener on the other side… the grass is greener where you water it!’”

We couldn’t agree more.

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For more information on aortic dissection and the campaign Catherine is supporting visit the Think Aorta website.

Click here to watch Catherine's conference speech to 2000 emergency medicine physicians