This being human is a guest house. Every morning a new arrival.
A joy, a depression, a meanness, some momentary awareness comes as an unexpected visitor.
Welcome and entertain them all! Even if they’re a crowd of sorrows, who violently sweep your house empty of its furniture, still, treat each guest honorably. He may be clearing you out for some new delight.
The dark thought, the shame, the malice, meet them at the door laughing, and invite them in.
Be grateful for whoever comes, because each has been sent as a guide from beyond.
On the 9th of March, I reached Melbourne for the second leg of the Churchill Fellowship. I had been looking forward to it for ages and just couldn’t wait to get started. I had the taken the whole month off. Despite the long journey I didn’t feel any fatigue. My AirBnB was homely and comfortable. After a good night’s sleep, I was ready for work.
The Beyond Blue Office was easy to find. After a brief introduction to the team, we all went out to get coffee together. I was already one of them and the coffee was great. The following days flew past with meetings, interviews, presentations and briefings. A trip to Headspace. Despite some background murmurings of a virus, I was having the best time, learning and exchanging thoughts and ideas. Then Australia closed its borders. Meetings and conferences started getting cancelled.
On the 16th, I took a return flight to London. My trip shrank from 3 weeks down to one. I had to miss Sydney altogether. Now, I am back here with a blank diary for 2 weeks and I am loving it. I have volunteered myself to work and I am on standby.
I can now research and look up things I’ve been meaning to for a long time. I can clear out one cupboard every day and get rid of stuff I don’t need or use or get joy from. Unclutter and create space in my house and my head. I can go to bed without setting an alarm. That pile of unread books that’s been sitting atop my table, feeling ignored and giving me dirty looks, can now be tackled.
Part of me is rushing in to fill the time with a list of a hundred things to do but I am consciously slowing down. Having an easy routine. Fitting in things I love doing, like arranging flowers. Making time for friends. Cooking. Walking. Not getting hooked to the media but keeping an eye. Writing hand-written letters to loved ones. Sitting still. Enjoying our home. Truly appreciating the weirdness of our cat, Milkshake. Cherishing having breakfast, lunch and dinner with Si as he works from home.
12 days ago I left my home and husband with a strange sense of ‘last-ness’. Si and I are familiar with that uncomfortable feeling. We know that the whole world can change in one second. 12 days is a long time.
Melbourne, Australia, was my final destination when I left home to complete my Churchill fellowship. On the way, I broke my journey for a week in India. I find it impossible to fly over India to go to other places without stopping. There, I watched in horror how much India’s centre has moved to the right. It has gone so far that the words ‘liberal’ and ‘secular’ are now bad words. My closest friend there is a Muslim gentleman whom I have known for the last 23 years and have never thought of him as a Muslim. But now I fear for his safety. I fear for the safety of all my family as I know that when there is fire, some are damaged by flames but many more by smoke.
So, here I am, in Melboune, at a house, rented through AirBnB and so much has happened in these 12 days. I have never understood the need for 24-hour News Channels as they endlessly repeat themselves, induce panic and heighten pre-existing anxieties. Many people are petrified. They are understandably worried about themselves and their loved ones. The restrictions being imposed are causing more isolation and angst. Italian prison scenario is a very sad example.
This is a good time to observe the effect news has on you, pay attention to your feelings and take a break when you need to, from the constant ranting of various media. I am doing that. I am keeping myself informed, connected and calm. I am not willing to allow the situation to affect my mind too much. I am taking all the precautions as advised and that is the best I can do. WHO sensibly says let’s look after our bodies and minds.
I suspect that death rates from this virus are being hugely exaggerated. They are based on projections from those who have been tested, but many people, all over the world have had a cold or flu over Jan and Feb and have not been tested. So, where does the truth lie?
He was 15 when his Hungarian parents thought it would be best for him to come to live in the UK with another family. His parents were refugees in Paris and he in London. World War 2 had ended a few years prior. The times were turbulent and many people were having to make difficult decisions.
This boy did not speak English. He landed up amongst strangers, completely inhibited, unable to do well in school. He was teased and taunted by his contemporaries and no one understood him. At 16, he became seriously suicidal. He had a plan. One day a neighbour noticed that he didn’t look great and encouraged him to speak to someone at the Anna Freud National Centre for children and families.
“The therapist who saw me could see beyond the struggles and see another person, see they had certain competencies and capacities, and that, if you removed some of the inhibitions, the self-defeating behaviours, and got access to my more positive side then I could do quite well,” he remembers.
Prof Peter Fonagy is now a leading contemporary psychoanalyst who has propounded and researched the theory and practise of ‘Mentalization Based Therapy’ (MBT). He is also Chief Executive of the Anna Freud Centre for Children and families. In simple words, mentalization is the effort an individual makes to understand someone else’s thoughts, feelings, hopes, beliefs, desires and behaviours. It is the ability to mind other minds, to understand misunderstandings, to see the impact of our behaviour on others, to see oneself from the outside and others from the inside. MBT is said to be especially helpful in the management of Borderline Personality Disorders.
The things that block mentalization are, firstly, the strong feelings of anger, shame and fear. And secondly, defensiveness, not wanting to know what’s going on in another person’s mind.
I can see how mentalization could make each and every relationship work. Not just the ones we have with others, but also the most important one, the one we have with ourselves.
I had taken the day off work. The nurturing, peaceful, green lap of Amaravati Buddhist Monastery at Hemel Hampsted was where I wanted to be. It was a day of rest, solitude, silent contemplation and meditation. Autumn was at its prettiest best and despite everything, it was time to receive beauty. Receive time.
It was the fourth anniversary of Saagar’s passing. The most difficult day of the year, despite my belief that time means absolutely nothing. But this day always stares at me like the enemy. A wretched, horrid, cruel, ugly thing. A brown sludge that I have no choice but to drag myself through.
Slowly, slowly … most of the day drew itself behind me. I returned home, gazing at the sky from the train window, still looking for answers. Still nothing. Just the unbearable pain of longing.
Switched myself back into practical mode, as the next day I was meant to be working. Opened my inbox and found an e-mail from someone called Dan.
“I hope you don’t mind me contacting you out of the blue like this, my name is Dan, I’m a third year medic at Aberdeen University and also the Vice President of the Anaesthetics Society.
I actually attended your talk at the AAGBI conference this summer. I hope you don’t mind me saying, but I found it incredibly moving. The very day before I attended I had been diagnosed with Bipolar Disorder and was worried about how this would indeed impact on my studies and working career as a Doctor.
After your talk, I met with one of the Consultants who was offering a ‘mentoring’ session where I discussed the recent diagnosis. She spoke to me about what I need to do to stay well, one of the things was accepting treatment, which initially I admit I was not that open to doing.
Anyways, I find myself rambling on, I suppose I just wanted to email and introduce myself. If you have any advice for someone with Bipolar who is wishing to pursue a career in Anaesthesia then I would love to hear it!
I just saw an email which was saying that you are giving a talk in Aberdeen next week about this particular topic, which I certainly hope to attend! If you would be about afterwards and free for a coffee I would certainly love to meet you!
Best Wishes and sorry again for emailing like this out the blue!
Another green moment – tears mixed with joyful smiles. What a way to end the day. What perfect timing.
We met in Aberdeen a few days later. He was all smiles. Friendly, generous and sensitive. We got on instantly. Had a nice long chat. He dropped me in his little red car to the airport. I told him I was hoping to write a book at some stage. He offered to help me with the research that might be needed.
Last week, I was back there in Aberdeen at Dan’s request, to run a 2 hour-long Mental Health Workshop for a bunch of medical students, junior doctors and researchers. It was a good day. I had to smile when Dan talked about Saagar as if he was an old friend.
When I speak with gatherings of doctors, I often start with asking them to shout out whether they think the statements below are True or False. What do you think?
Sick doctors know when they are sick.
Doctors are good at asking for help and following advice.
Doctors take good care of themselves.
Doctors have strong support networks.
Doctors are kind to each other.
Irrespective of which country I am in, without fail the auditoria flood up with a big resounding ‘FALSE’ for each of the above, accompanied with some sniggering. Isn’t it shocking? One would expect that people who work in ‘healthcare’ would know a thing or two about their own health as individuals and as a community.
These are the highlights of a survey conducted by the Royal College of Anaesthetists in 2016-17:
The NHS Sickness statistics consistently show that NHS hospital doctors have the lowest rate of sick leave as compared to any other staff group. Here is a list of personality traits of doctors (a broad generalization, of course) that might explain this:
Perfectionism (I must do this right!)
Narcissism (I am good at what I do.)
Compulsiveness (I can’t give up till I finish.)
Denigration of vulnerabilities (If I need help, I am weak.)
Martyrdom (I care for my patients more than myself. Their needs come before mine.)
The very traits that make us good doctors are the ones that may not be very good for us. But our seniors have not been aware of this and hence they have not been able to help us understand ourselves. This tradition has been going on for generations of doctors. There is a nobility associated with such self-sacrifice, which we all have bought into. The fact is that if your own cup is empty, you cannot serve others well.
Things add up – a dysfunctional department, work pressures, lack of support outside work, ill-health, emotional burden of the job, a traumatic adverse incident, lack of sleep, fatigue, a complaint made against you, poor diet and no time to exercise or pursue hobbies, impaired judgement of one’s own symptoms, fear of letting others down, difficulty in admitting that they have a problem.
Burnout among medics is not unusual. It looks much like depression and sometimes ends in devastating tragedies. But help is available. Sadly, unlike other illnesses, for mental health issues, the onus of getting help lies with the sufferer. It takes courage to acknowledge one needs help and seek it out in good time. It might be the best thing a doctor can do for themselves and their patients.
Paramedics and trainee paramedics rotate through our Department of Anaesthesia to learn to manage airways safely. A few weeks ago, I had a young man in his mid-thirties, a trainee paramedic with me, learning about airway management. Out of curiosity I asked him, “What is the most annoying part of your job?” He was straight-up, “When people inflict injuries on themselves, I think it’s such a waste of time. It takes away from others with real problems, who really need our attention.” I just smiled. I wasn’t surprised. I know full well that paramedics do a great job of looking after all kinds of people in all kinds of trouble. But attitudes can only be changed through education.
A professor of Psychiatry tweeted today “Twice in the last week I’ve been told of cruel comments by health staff to people who had self-harmed. I really believe this is unusual now but it shows there is something deep-rooted that we have to eradicate.” A classic example of ignorance within medicine of attitudes within medicine.
No training of first responders is complete till someone
with lived experience of a mental illness has spoken with them, be it a police
academy, social workers, fire fighters, nursing or medical students or
ambulance crew. Lived
experience includes suicide attempt survivors, others who have experienced a
suicidal crisis and those who have lost a loved one to suicide. Sharing by
these individuals can be a powerful agent for challenging prejudice and
generating hope for people at risk. It enriches the participant’s understanding
of how people with these serious disorders cope with their symptoms, recover
and lead productive lives with hope, meaning and dignity. The program also
empowers those who are faced with mental illness and provides living proof that
recovery is an ongoing reality. Presenters gain confidence and self-esteem
while serving as role models for the community.
focus on research and clinical expertise too frequently fails to see the person
at the centre of a crisis as well as their loved ones who ride the wave of
terror of suicidal behaviour. This needs to change and with urgency.
Lived Experience is an underutilised and underappreciated resource in the UK.
Roses in the ocean, a charity in Australia is an excellent example of harnessing this invaluable resource and making a huge difference.