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.

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.

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

Posted by kidsaregifts20

“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 100^th 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?

Posted by kidsaregifts20

‘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.

Posted by kidsaregifts20

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.]

The Office Guy

Posted by kidsaregifts20

Once upon a time, trains in London used to be stuffed with people. Every now and then one found one’s head in some random person’s armpit. That Friday evening, my train was not too full. Every other seat was taken and a few people stood by the door.

He boarded at London Bridge and sat opposite me. We sat facing each other at either end of the long rectangular window, looking out at the dusk, in the typical way Londoners show consideration and give space to one another. I was on my way home after work. The skies were moody. I was glad to be released from the hospital after a long windowless day.

As my gaze shifted from the sunset outside the window to the seat across from me, I saw the young office guy with his neat brown hair, parted on the left side. Crisp white shirt and well-pressed grey trousers. Tense jawline. Fixed steely eyes staring through glass panes. Two vertical frown lines just above the bridge of his nose on a smooth white forehead. He looked sharp, a tense energy encompassed him like a taut canvas. It was palpable. He was, as if a statue with serious internal whirings.

The train was on the move now. My station was six stops away. I had noticed something I couldn’t ignore.

I wasn’t sure if I should do something. If yes, what?

If I did nothing would I regret it? Yes.

Could I fully trust my instinct? I wasn’t sure but probably.

Did it matter if I made a fool of myself by saying something? No.

He could get off the train at any moment so I had to make up my mind pretty quick.

Two stops had now gone by and he was still there. This was my chance. I leant in, my head closer to his, caught his gaze in mine and softly said – ‘Whatever it is, it will pass. I promise. It will.’

I went back to admiring the sunset as if nothing happened.

I didn’t look for a response in anyone. Nothing.

I left it there, feeling like a crazy old woman on the train who talks to strangers, my heart beating in my ears.

One stop later, from the corner of my eye I saw him get up to leave. I brought my eyes back into the coach and chanced looking at him as he stood by the doors. He met my gaze and gave me an acknowledging nod, his frown lines gone. I could have cried. I think I smiled and nodded back.

I was finally learning to trust myself to do the right thing.