Denial of Right to Live
There has been much pain, both physical and mental, since then. She still cannot remember when she learned her husband, also a GP, was dead. As well as coping with her loss and severe injuries, she has had to support and comfort three deeply traumatized children, who were in the back of the car when tragedy struck.
But her recovery has been remarkable, given the gloomy forecasts of those who predicted she would never emerge from her coma. Even though her sight and mobility were badly impaired, she has managed to raise her children alone, at the family home in Dundee, Scotland.
Her struggle for full health and fitness has some way to run, but she is determined to return one day to work. At the moment, however, her mind is set on a fight she considers more important than the personal one. It is with the Tayside Universities Hospital Trust, whose doctors, she says, wrote her off. She firmly believes her right to life was denied by those charged with her care. “If my family had been less well informed, I'm certain I would not be here today,” she says.
Dr. Smith and members of her family maintain that doctors in Dundee were hasty in diagnosing that she was in a persistent vegetative state (PVS), and that they initiated debate on the merits of withdrawing food and fluids to let nature take its course.
Specialists argue the diagnosis was never made, that her family was told only that she was in a vegetative state that was likely to be persistent, and that any talk of withdrawing feeding was intended to prepare them for the difficult choices in the future.
The differences might appear so subtle as to be almost irrelevant but it looks increasingly likely that the matter will be settled in the civil courts. Dr. Smith campaigned long and hard against the Adults with Incapacity (Scotland) Act. Along with other pro-lifers, she feared the act was preparing the way for euthanasia.
Her campaign was futile, as ministers refused to accept amendments proposed by the Roman Catholic Church and other pro-life groups to protect especially vulnerable patients, such as coma victims who cannot speak for themselves.
But now the Right to Life Campaign may use Dr. Smith's experience to bring a test case in the European Court.
On July 10, 1995 — Finola's 12th birthday — the Smiths were on a family holiday in France. Driving through Tours, Dr. Smith stopped at a busy junction and asked her husband to look to his side to help her judge when it would be safe to pull out. “Jim didn't have his glasses on and hadn't been sleeping so well. It's a bit of a blank, but I suppose he misjudged the speed of the lorry that was coming. It hit us at his side.”
Trapped and injured in the back of the car, Finola, now 19, and her brothers, Dom, 21, and Kevin, 14, knew their father was dead. Rescue workers believed their mother was dead too and were anxious to get the children out, especially Dom who had a broken ankle. But the children thought their mother was still breathing and pleaded with them to handle her gently.
By chance, Tours is a centre of excellence for neurology. Doctors there did not underplay the severity of the injuries to her brain when they discussed the matter with her brother, Raymond, and her husband's twin sister, Veronica, who had flown to France to cope with the appalling aftermath of the accident. But specialists maintained that with proper care she would regain consciousness. They even predicted correctly her awakening after three or four months.
The hopeful prognosis made it all the more devastating for the family when they were told a few weeks later by experts at Dundee Royal Infirmary, following transfer home by air ambulance that Dr. Smith was in a vegetative state with little or no hope of recovery.
Deflated by the apparent downturn in her condition, the family was further alarmed when Douglas Gentleman, the consultant in charge of her care, began discussing the prospect of having to decide whether to continue life support.
Just two months after her accident, and bearing in mind the opinion of the French experts, Dr. Smith's family felt her chances had been written off too easily. They had her moved to St Mary's Hospital in Lanark, run since 1872 by the Daughters of Charity of St Vincent de Paul.
The hospital is famed for its holistic approach and Dr. Smith's relatives say they noticed an immediate improvement in her care.
She was given far more stimulation than they had observed at the DRI, including physiotherapy three times a day. She was raised from her bed and dressed daily and carried through to a television lounge. Less than three weeks after the transfer, she regained consciousness.
Many months of painful rehabilitation followed and it was not until June 1996, 11 months after the accident, that she was fit to return home. For the next four years, Dr. Smith concentrated on her recovery. “For more than a year, I was full of hate and I made everyone around me miserable,” she says. “I was without hope and I rejected God because I couldn't understand why he had allowed this to happen to a family with faith.”
Fight for Justice
Gradually, she did make sense of it all. Her husband had been a more devout Catholic than she, but as her faith returned it became the central pillar of her recovery. Until Labour's support for the Adults with Incapacity (Scotland) Act, she was also a dedicated member of the party. She wrote to Donald Dewar and Cardinal Thomas Winning, and although she writes to their successors, as well as to Tony Blair, she has resigned her party membership.
As soon as she was able to absorb the details of her treatment, both at the DRI and at St Mary's, she was satisfied that the NHS had failed her. Five years passed before she felt well enough to tackle the Tayside Trust about her care. Two years ago, she instructed a solicitor to make a formal complaint.
Initially, she had no intention of issuing a writ. She said she wasn't after an apology. All she wanted was an acknowledgement that mistakes had been made and an assurance that in future coma victims would be given every chance. “I still feel I was not given that chance,” she says. “I wouldn't be here if it weren't for my family.”
The trust set up a review panel. Their response left her deeply dissatisfied and provoked a change in her stance. She felt that, once again, she was being dismissed too lightly and concluded that the only way forward was to sue. A £100,000 writ is being prepared by her lawyer.
Dr. Smith cannot help but shudder at what might have been. “I have three children, two of them already at university. All three have their lives ahead of them. They might marry and have children. There will be graduations and other major events in their lives.
“There will also be times of sorrow when they need comfort and support. I truly feel that if my family had not been so well informed and so confident about challenging the views of the medics that I might not be here to share whatever comes with them.”
“On a personal front, that makes me angry, but the bigger issue here is the fact that in years to come, other patients will be as vulnerable as I was. They might not have any family, or their family might be in awe of doctors and feel that they cannot be challenged. I want to make sure they do everything they can for those patients because I don't believe they did it for me.”
As she approaches her 47th birthday next month, Dr. Smith's short, stiff steps look like the gait of a much older woman and she attributes this to a lack of therapeutic care in the early stages of her trauma. Typically, for such a remarkable fighter, she has made great progress in recent months and has recaptured some of her lost mobility thanks to regular sessions in a hyperbaric oxygen chamber. The treatment is increasingly common in tackling sporting injuries; David Beckham's recovery from his broken metatarsal before the World Cup was speeded by similar sessions.
Despite the injury to her brain, her mind is razor sharp and her memory, with the exception of the accident and the days lost in coma, is as good as ever. One of the most persistent and troubling symptoms of her injuries is the fact that her eyes are permanently dry. Behind them, she feels a constant vale of tears, but she has not yet been able to unleash the flood. “I feel it's coming,” she says. “It's one more hurdle to cross. When I do finally cry I might fill a bucket, but then I'll move on because there are things to be done.”
Her birthday falls on October 28, the feast day of St Simon and St Jude, the latter being the patron saint of hopeless cases. “I came out of the coma feeling lost,” she says.
“Jim had been taken, I was angry with God and I couldn't see hope for the future. Now, I feel Jim all around us and I've made my peace with God.
I'm no longer without hope, and I'm determined to continue the fight for justice.”