Thank you for noticing.

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She was listed for a minor surgical procedure on my list. I called out her name in the waiting area and escorted this pleasant, middle aged lady into a cubicle for her pre-anaesthetic check-up. We both sat down at right angles to each other. She had an unmissable racoon’s eye on the right side of her face. I looked again. Just to be sure. It was there in its fading pinky-blueness. She was in hospital for a totally unrelated reason but I ventured into asking, “What happened here?” pointing to the eye.

‘Oh. I had a run-in. Couple of weeks ago.’

“A run-in with what?”

‘You know … It’s okay. I don’t want to talk about it.’

“Have you spoken to anyone about it?”

‘Yes. I am okay. I really don’t wish to speak about it.’

“That’s fine. How are you doing today?”

We went ahead, staying focused on preparing her for the upcoming procedure.

I took a moment to call the Safeguarding department of the hospital. They said that it was normal for people suffering abuse, to not talk about it for a long time. They advised us to signpost her verbally. A written set of resources might make her more vulnerable, if discovered by the wrong set of hands.

Two women are killed by a partner or former partner every week in England and Wales.

One in five people suffering domestic violence will plan or attempt to take their own lives.

One in eight of all female suicides and attempts in the UK are due to domestic violence and abuse. This equates to 200 women taking their own lives and 10,000 attempting to do so due to domestic abuse every year in the UK. That’s nearly 30 women attempting to complete suicide every single day.

Men endure domestic abuse too. This can include physical violence, as well as emotional and psychological bullying, sexual violence or financial control and abuse.

It is living hell. An invisible prison. Isolating, with no one to confide in.

It takes great courage to speak. It’s often ignored. Many suffer in silence.

Survivors do come in contact with health and social services but disclosure is difficult.

If done right, it is life changing. Appropriate response is invaluable.

Front-line staff must recognise signs and highlight issues.

It is important to ask and act.

After her procedure, I went to see her in the Recovery room.

“Have a nice evening.” She said. “Thank you for noticing.”

Resources:

https://www.rcn.org.uk/clinical-topics/domestic-violence-and-abuse/general-resources-and-support

https://uksaysnomore.org/get-involved/ask-for-ani/

https://www.mankind.org.uk/help-for-victims/types-of-domestic-abuse/

Patients first.

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Credit: Mario Sanchez Nevado (www.aegis-strife.net)

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.

Sources of support:

https://www.bma.org.uk/advice/work-life-support/your-wellbeing/sources-of-support
Doctors in Distress, a charity set up by Amandip Sidhu in memory of his brother Dr Jagdip Sidhu who was an eminent cardiologist and tragically died by suicide on 27th November 2018.

Feathers etc.

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10 weeks back I was surprised to find an all-day course in ‘Mindful Self-Compassion’ for Health Professionals advertised on the Trust intranet. It sounded great and it was for free. Wow! We are recognising the pressures on health care professionals and moving slowly but surely in the right direction. To organise a course like this and make it available to all staff at no cost is nothing less than super-fantastic.

I enrolled instantly and waited patiently for the day to arrive. The day arrived. I entered the room to find all these items scattered neatly around the room: a bowl of smooth tactile pebbles in purple, maroon, white and yellow, little bottles of lavender and vanilla extracts, fantastical eye-catching postcards, maracas and manjiras, a white rosary in a tiny wooden box, sketch pads with charcoal tree sticks, a bunch of sea shells, sprigs of fresh rosemary and mint, a dried corn on the cob, a few white and brown feathers, a spongy red ball and a spiky yellow plastic one, a tiny hand-crank music box and an hour-glass with pink sand. These things were for us to appreciate, touch, feel, smell and listen to.

Two gentle young women led the day taking great care of everyone in the room and in complete harmony with each other. We started with a ‘soft landing’ – becoming aware of our feet on the floor, bum on chair, our breath and our finger tips. They called these short snatches of peace, the ‘green moments’. We were encouraged to create/access these green moments to transition from seeing one patient to the next or from work to home mode and vice versa.

The word ‘discernment’ was brought into my awareness. While the dictionary meaning of it is “the ability to judge well”, we were encouraged to scan our thoughts and ‘notice what’s not helpful’. It was a useful concept. It helped me locate stuff that was unnecessarily cluttering up my mind and blocking light from entering this sacred space.

I remembered that as a teenager I had a big scrap book filled with my collection of feathers of all kinds, my favourite being the peacock feather. Where did that dreamy girl with 2 pig-tails go?

For a while I could hold the little girl in me lovingly in my arms and marvel at her innocence and beauty, appreciate her child-like sense of wonder and creativity. This sweet girl is me. Perfect and complete in every way. All she needed was to be seen. By me.

It is all a dream.

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Dream

When I stood in front of all those people, my arms were branches of an old oak flailing in a wild wind, my throat was shouting out commands like a drill sargeant at the top of his voice, my eyes were wide open and desperate to get through to everyone in the room. My chest was an erupting volcano and my feet had thrown deep roots into the ground. I invited Saagar and all my angels to help me as I felt exposed. The ‘normal’ part of me wanted to protect Saagar and me from people’s judgements. I am sure some were being made as I spoke. That is ‘normal’ too. But the mother in me stood like a warrior, absolutely disregarding any consequence, complete in the conviction that this was the right thing to do. It was difficult but it was worth doing.

Three times this week. Three times I got to show Saagar off to a bunch of doctors – 250 and 18 and 9. So, 277. They saw the light in his eyes. They now know that many suicides are preventable. They know the stigma and silence of mental illness and suicide. They know that every mention of suicidal thoughts should be taken seriously. That if they notice a colleague, a friend or a family member behaving strangely, they can ask them ‘Are you ok?’ And whatever the answer, they can deal with it. They know that it’s ok to go as far as asking, “Are you thinking of ending your life?” It’s difficult but worth doing. It might save a life. That no one is immune. That everybody can make a difference. That many doctors are lay people when it comes to suicide and believe in popular myths. That doctors, dentists and vets are very high risk groups and need to take good care of themselves and each other. That the medical curriculum is all about physical illnesses. That Mental Health services are broken in this country and we all need to educate ourselves and strongly advocate for our near and dear ones if, God forbid, the need arises. That charities like Papyrus do a great job of helping young people. That when it comes to suicide, there is only prevention. No cure. They now know when, where and how to find help.

Later on, a young lady chatted with me about how useful she found the content of my presentation and how it helped that it was delivered in such a calm and composed manner. Really? Was she talking about me?

Ref: Art of Conversation (NHS Scotland) :
http://www.healthscotland.com/documents/2842.aspx

Green Tara

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green-tara-sttue

Once again, I found myself in Swansea. The meeting was planned weeks in advance and I had travelled 4 hours to be there. I, a practising doctor, once again, seeking light in the realm of the unexplained. Why was I there? Because I wanted to write a book and I wanted to know what Saagar thought. Does that make sense? Like hell it does. That’s why I had trudged all the way there and would be changing trains for the rest of the day to get back home.

One whole wall in the waiting room was teaming with thank-you cards, mostly from women who believed they had had babies as a result of Acupuncture or other therapies received at the centre. It was a modest space with a tired fawn carpet and upright wooden chairs with plastic, foam maroon coverings. Like all waiting-room-chairs all over the country.

Her big smile snatched my gaze away from the wall and welcomed me into her space. She guided me up the stairs into the same consultation room where we had met more than a year ago. The familiar potted palm, the large window and the same arrangement of the 2 comfy sofas by the fire-place, facing each other with a small wooden table placed in between. Déjà vu, all over again.

I sat facing her and the window. She sat facing me and the door. We started with a brief catch-up and then she connected with Saagar. She said he’s happy. He’s growing his hair and following the cricket. She thinks she can hear him speak French. Is he saying something about Guy’s hospital? He says he enjoyed his time and friendships at Dulwich. He mentioned a particularly close ‘black’ friend. I am sure he means the one coming home to lunch tomorrow. He says he loved the large window by his bed with the great view of the London cityscape.

He felt there was a place for him at the wedding. It was fun, especially the bit by the river in the early morning hours. He must have meant the photo-shoot of Si and I in our normal clothes. It shows us in our ‘natural habitat’. The camera loved the early morning sun. So, we complied. ‘Natural’ and ‘photos’ don’t belong in the same sentence. We tried our damnedest best, seeking inspiration from Hollywood and Bollywood combined, getting confused and dramatic and giving rise to some cracking moments. He was there.

He offers me a Green Tara through her. A Buddhist manifestation of active compassion, Tara is the saviouress, the one who reaches out and responds freely to all who suffer. She is fearless and boundless. He wants me to have a jade statue of Tara. He knows my heart and mind. We walk in the same light.

She says the book will happen. A book of beauty and joy that was him. Of his continued presence. Of hope.

( A 20 minute video of an awareness raising presentation for trainee anaesthetists at a national conference in Glasgow from earlier this month: Being Human)

[E-mail address for Moya O’Dwyer, the medium: moyairishmagix@yahoo.com]

Day 952

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A surgeon’s wife writes

The Dark side of Doctoring is an insightful blog written by a surgeon.
The common themes that push doctors into dark despair are:

1.Loss of control.
2. Loss of support. 6am. Repeat.
3. Loss of meaning.

One would think that those who look after other people would know how to look after themselves and their colleagues. Not so at all.

Thank you Dr Eric Levi.