London calling.

I applied for the London job only because I was sure I wouldn’t get it. In 2006, I had finished seven years of post-graduate training in Northern Ireland and it was time to look for a Consultant post. There weren’t any openings locally so I looked at vacancies on the ‘mainland’. If nothing else, it would be an opportunity to practice my interview skills. Halfheartedly, I applied for a job in London and kept absolutely mum about it. When I was short-listed, I was a bit miffed as my only free weekend that month would be spent preparing for an interview the outcome of which I didn’t really care for. But I didn’t want to look like a complete fool so I did prepare.

I also went shopping for a black pencil skirt with a smart white and black jacket. Why not? I already had a nice white top and black shoes to match.
“Will we have to move to London?” Saagar asked. He was 12.
‘I don’t think so. Unlikely. Let’s see.’

Early one Wednesday morning I checked into my flight at the then brand new Belfast City Airport. As I was saying bye to Saagar’s father, I asked him, “What shall I do if they offer me the job?”
Take it, he said.
The Big Ben spooked me as it peered through the window of the office where I was waiting for my turn. What am I doing here? The panel seemed friendly. I felt relaxed and shared my thoughts freely, to the point of being quite blunt about the unrefined appraisal process and such like.
Why did you apply for this job? They asked.
I had been looking at your job adverts for a while and finally they stopped asking for ‘a female doctor from ethnic minorities’. That’s when I applied.
Why do you think you are right for this job?
Because I have trained twice for it – once in India and then in Belfast.

I found myself smiling as I left the room. I had enjoyed the conversation but there was no reason for them to offer me a job. I was sure London had its own candidates, like Northern Ireland had its own.

That afternoon, I was waiting for my return flight at Heathrow when the phone rang. I flipped the silver Vodaphone open.
“Hello. Is that Dr Mahajan?”
‘Yes. Hello.’
“I am Dr Cunningham from St Thomas’. We met at the interview this morning.”
‘Oh yes. How are you?’
“I am well. I am ringing to offer you the position of a Consultant Anaesthetist at our Trust.”
‘Oh. Are you sure you have the correct number?’
“Ha. Ha. Yes. I am.”
‘Right. Wow. Thank you.’
“Would you be willing to accept the post?”
‘Yes. Thank you.’
“Great. The HR department will soon be in touch with you. Good luck.”
‘Thank you. Bye.’

I said yes only because I couldn’t say no. My ego was on an all time high. Of all the people in the world, one of the most prestigious teaching hospitals in London wanted me. Why in the world would I ever say no?

When I shared this exciting news with a senior colleague in Belfast, he said, “So, from being a rich doctor in Belfast you will be a poor nobody in London?” Another said, “Oh! We might find you swanning around the Royal College in a saree?” I smiled. May be this was a lucky escape.

Working in London was one thing but living in that city was quite another.
On our first day we parked our car in front of our rental flat. While we were waiting for our truck to arrive with our household stuff, we kept an eye on the car, expecting it to be stolen within minutes. When we came down to the car an hour later, an orange plastic envelope was stuck to the front wind-shield. It was a parking ticket. A big lady in uniform stood there with her hands on her hips, “Yo’ front wheels’ half on top’o da pavement. I don’t make the rules. Innit?”
Welcome to London!

From a detached three bed-room house in a friendly, modern development to a random three bedroom flat on a random Chestnut road. From having a front and back garden, a driveway and a double garage to no gardens and parking on the street. From a safe and quiet neighbourhood of friends and acquaintances, to a nameless road-side flat in one of the fastest metropolis, with no friends or family. Once again we were going to make a start with ‘just us’.

Resource: At present, more people than ever live in a country other than the one where they were born.

Evidence for suicide prevention strategies with populations in displacement: a systematic review

Wrap-around?

“What can we do to offer wrap-around care to our patients?”

In the live Q&A at the end of the NCISH conference yesterday, this question was asked of the panel. The Chairperson directed it towards me. I can’t remember what I said. This morning I woke up with what I would have liked to say.

For wrapping, we need two things. One, the fabric which we are going to use to wrap and the person we want to wrap. Let’s discuss them one by one.

  1. The fabric

The fabric of Suicide prevention in Health-Care is made up of two things – people and systems. Let’s look at them a bit closely.

  1. People

What are the beliefs of the people?

I know of an ENT surgeon from another country who wanted to move to the UK and the only job he could find was in Psychiatry. So, he is now training to be a Psychiatrist. Is he interested in suicide prevention? Do Health-care professionals believe that suicides are preventable? Are they content that simply by treating mental illness they are doing their job?

What are the attitudes and abilities of the people?

When the Emergency department calls to say there is a suicidal individual waiting to be seen, how do they feel? Are they excited to have an opportunity to make a difference? Or is it a drain on the limited time and energy they have? Do they know how to build a compassionate connection with someone who has lost all hope? Have they received any training in Suicide Prevention? Do they have enough self-compassion to look after someone else well?

Do they have the resources and the knowledge to do a good job?

Do they have access to their past history? Do they have beds on the ward? Can they ask a colleague for a second opinion if they have a doubt about how to involve family or friends in their care? Do they know of other resources, like charities, activities and people that may help this person? Do they have comprehensive and informative leaflet they can share with them? Do they have the means to follow them up?

b. Systems

Does the system have capacity? Are the various parts of the system effective and joint-up enough to be able to hold the person they are trying to wrap or are there big holes in this part of the fabric? Do the various parts of the system share the same mental model, a shared knowledge, pre-suppositions, and beliefs that can be used to help achieve mutual goals? Are their practices evidence- based? Do they investigate deaths with a view to learn lessons and implement change? Do they look after the well-being and emotional health of their employees? Do they hold themselves accountable when things go wrong?

2. The person

Allowing space for them to express themselves. Help maintain their sense of agency. Inform them it is safer for them to involve other people who care for them. Equip them with resources. Give them the support they need. Ask them what would help them? Listen. Sit with their despair. Acknowledge it. Keep them connected with their life as they know it. Keep hope alive for them.

Know that the person at the centre of the wrapping is of great value.

Information is useful if it becomes knowledge. Knowledge is useful when it becomes wisdom. So, let us not stop at information.

Ref:

Reaching common ground: The role of shared mental models in patient safety : https://journals.sagepub.com/doi/full/10.1177/2516043518805326

A hundred shining circles

“The longer I live, the more deeply I learn that love — whether we call it friendship or family or romance — is the work of mirroring and magnifying each other’s light. Gentle work. Steadfast work. Life-saving work in those moments when life and shame and sorrow occlude our own light from our view, but there is still a clear-eyed loving person to beam it back. In our best moments, we are that person for another.” – Maria Popova.

We have been those mirrors for each other for the last hundred fortnights. A few days ago, the Saturday group of the Circle of Remembrance met for the 100th time. It was a celebration of the love, the love we have for our children and for each other. Love that shows up as mutual support, respect and friendship. While many people have come and gone, some have stayed right from the start. We’ve walked together for four years. What a privilege that’s been. Such unique and intimate conversations, exploring the human condition through words like ‘home’, ‘freedom’ and ‘Grace’.

I wish I had reliable and wise friends like these in the Before. I wish I could listen with understanding that could penetrate any mask. I wish I had the ability for this kind of sterling emotional engagement. It does save lives. It has saved mine.

Earlier I believed that lives were saved mainly by highly trained professionals in well-equipped resuscitation rooms in big Emergency Departments and in Operating Theatres. Now I know that each day ordinary people save lives simply by being a 100% present, with everything they have.

The longer I live, the more deeply I know that love is gentle work.

Resource: Circle of Remembrance (online peer-support for bereaved parents): http://www.core-community.com

Are you listening?

‘I was sent away to live with my granny when my youngest sister was to be born. I was three and a half then. I stayed with my grandma till I was 6. When I moved back to my family, I wasn’t quite sure who they were. That time of my life shows up as murky grey when I think about it.’

Well, everyone has gone through something or another.”

Those days life was hard. There were no washing machines and dish-washers. So, I can understand how hard it must have been to look after three under-fives.”

At least you were re-united with your family within a few years and you were safe.”

“I am sure your grand-ma cuddled you and loved you very much.”

At least you were in the care of your grand-mother and not some random stranger. I was brought up by nannies.”

“It clearly did you no harm. Look at you.”

Wow! Not one person sitting around that table listened.

Did they have any curiosity? Any fascination?

Do we allow our listening to connect us with something fragile, deep within us?

Does it forge understanding and connection with another?

Do we allow ourselves to sit with someone else’s shadow?

Does our listening ease a burden?

Am I listening?

Are you really listening?

(Resource: In CORe community, we listen.)

Your suffering is a bridge.

He described himself not as a revolutionary writer but one born into a revolutionary situation. He was born out of wedlock in the USA a hundred years ago – black, poor, despised by his adoptive father, the eldest of nine siblings and to top it all, a homosexual. His name was James Baldwin. He knew the meaning of suffering and could talk and write about it with striking beauty.

“I can only tell you about yourself, as much as I can face about myself.

As it happens to everybody who’s tried to live. You go through your life for a long time and you think that no one has ever suffered the way I’ve suffered. My God! My God!  Then you read something, you hear something and you realise that your suffering does not isolate you.

Your suffering is your bridge. It tells you that many people have suffered before you, that many people are suffering around you and always will.

All you can do is hopefully bring a little light into that suffering. Enough light so the person who is suffering can begin to comprehend his suffering. Begin to live with it and begin to change it.

We don’t change anything. All we can do is invest people with the morale to change it for themselves.”

Indeed. We can and we do. Thank you for your light, James Baldwin. Happy centenary.

[ CORe: Bringing light to those who have been unfortunate enough to lose a child.]