education

Day 828

Posted by

2

Kimberley Hiatt was 50, a nurse for 24 years, she worked in the Cardiac Intensive Care Unit at Seattle Children’s Hospital. In September 2010 she accidentally overdosed an 8-month-old infant with calcium chloride as a result of a mathematical error. Ms Hiatt, immediately reported the event to colleagues. Unfortunately, the child didn’t survive the error. The hospital put Hiatt on administrative leave and soon dismissed her. It broke her heart when she was dismissed, not just because she lost her job but also because she lost a child. In the following months, she battled to keep her nursing license in the hope of continuing the work she loved. Six months after the event, Ms Hiatt died by suicide.

The suffering of caregivers in the face of a serious medical error has been termed the ‘second victim’ phenomenon.  These individuals feel personally responsible for the patient outcome. Many feel as though they have failed the patient, seriously doubting their clinical skills and knowledge base. They may suffer from extreme fatigue, sleep disturbances, increased Blood Pressure, muscle tension, frustration, decreased job satisfaction, difficulty concentrating, flashbacks, loss of confidence and grief or remorse.

The risk factors for suicide among health professionals, including doctors, are similar to those found in the general population. However, there are some additional risks among doctors such as their unwillingness to seek timely help, access to potent drugs and the skills to self-medicate. Other risk factors include exclusion from work, poor support networks, ongoing investigations, complaints, court cases, inquests and multiple jeopardy from having a complaint considered by a range of bodies including employers and the GMC.

Scott’s 3-tiered interventional model of support for Second Victims is well recognised (Ref: https://www.muhealth.org/app/files/public/1405/Scotts_Three_Tier_Support.pdf)

It’s too late for Kimberly, but her story can serve as a catalyst for a much needed change in healthcare – support for second victims of errors.

“People make errors, which lead to accidents. Accidents lead to deaths. The standard solution is to blame the people involved. If we find out who made the errors and punish them, we solve the problem, right? Wrong. The problem is seldom the fault of an individual; it is the fault of the system. Change the people without changing the system and the problems will continue.”

  • Don Norman Author, the Design of Everyday Things

Dedicated training for all medical students and GPs in suicide prevention must be made mandatory in the NHS and all over the world as prevention of harm means prevention of first and second victims. However, as long as humans are a part of any system, errors will occur. To err is human.

 

 

 

Day 814

Posted by

4

A bereaved mum’s lament: Went out for dinner with friends. What could go wrong? All went well until there was talk of an acquaintance of one of the guests who is suffering from a debilitating mental illness. They had tried to take their life but survived. The guest herself is a breast cancer survivor. She said that she had visited the person and said “did they not realise how hard she had fought to live and there they were throwing away their life”. Its a shame she didn’t appreciate just how hard the other person was fighting to stay alive … my son lost that fight. When will they realise Depression is as dangerous and potentially fatal as cancer. You know when you are stuck in a situation when its just not appropriate to make a fuss but you want to scream “How ignorant are you ???”

From the individual level, right through the media, the regulatory bodies and up to the government, we are all ignorant. Mrs May speaks of parity between physical and mental illnesses, ie. both being given the same importance. Many others have talked about it before her but we are miles away from it.

The Ebola Outbreak in West Africa was a public health emergency of international concern and we heard about it everyday, non-stop on the radio and TV from 2014-2016. 1 person was infected with the virus in the UK and fortunately there were no deaths from it. 1 person dies every 2 hours by suicide but it is not mentioned in the media. Public health England are not particularly concerned. Suicide claims 4 young lives every day but it’s no big deal.

Imagine a middle aged man presenting to his doctor with severe chest pain and being sent home with pills that take 3 weeks to work. I am sure the GMC would have something to say about that. A young man presents to his doctor with debilitating depression together with a strong desire to end his life and he is sent home with pills that can potentially make suicidal ideation worse and the benefit, if any might be seen in 3 weeks. The GMC finds that acceptable practice.

1 in 4 patients present with a mental illness to the NHS and only 10-12 % of the NHS budget is spent on mental health.

Survivors of physical illnesses proudly claim bravery and wear their survival as a badge of honour whereas those surviving mental illness hide in corners feeling ashamed.

The acceptable faces of mental illness are Dementia and Alzheimer’s disease. This is apparent from the t-shirts worn at charity events, walks and runs. I hardly see anyone running in support of Bipolar Disorder research or British Schizophrenia Foundation or Borderline Personality Disorder Charity. 

Things most resistant to change are cultures and mindsets.
Parity of esteem?
We have aeons to go!!!

Day 813

Posted by

1

Short stories have always intrigued me. Of late my attention span has become so short that those are the only kind of stories I can relate with and appreciate.

Here’s an abridged version of ‘Grief’ by one of the greatest writers of short fiction, Anton Chekov.

‘Grief’

It is twilight. Large flakes of snow are falling. A cab-driver, Iona, waits for a customer. He sits in his cab with his body bent as double as a living body can, immobilized by misery. ‘To whom shall I tell my grief?’

At last an officer arrives. Iona sets off in his cab with the officer at the back. He turns around to speak to him.
“My son…er…my son died this week, Sir.”
‘Hm. What did he die of?’
“It was a fever.”
Silence. Iona turns around again to find the officer nodding off.

As the evening progresses, Iona attempts to talk to someone three times. He tries to tell the story of his son’s death again and again. The second passenger, a high browed businessman interrupts Iona and says, ”We all must die one day.” Another man simply gets out of the sleigh. Later Iona tries to speak with a house porter but he brusquely tells him to drive on. Still later Iona offers one of his fellow drivers a drink but the young man promptly falls asleep. Just as the young man has been thirsty for water, Iona thirsts for speech. There is so much he needs to share.

“One must tell it slowly and carefully; how his son fell ill, how he suffered, what he said before he died, how he died. One must describe every detail of the funeral and the journey to the hospital to fetch the defunct’s clothes. His daughter Anisya remained in the village – one must talk about her too. Was it nothing he had to tell? Surely the listener would gasp and sigh and sympathise with him?”

Finally at the end of the working day, Iona returns to the stables. He starts to speak to his horse, “Now let’s say you had a foal, you were that foal’s mother and suddenly, let’s say that foal went away and left you to live after him. It would be sad. Wouldn’t it?”

The mare munches hay and breathes on her master’s hands. She doesn’t close her eyes, nor walks away, nor interrupts with her own wisdom on the matter. And it’s enough. Iona tells her everything.

At the risk of repeating myself, I tell the story I need to tell:

https://www.youtube.com/watch?v=ij8Mp_zOh7Y

(Special thanks to Diane Morrow and her book: One Year of Writing and Healing)

Day 811

Posted by

0

Her Voice – a short story

‘I hear her. Her voice is in my head’ says Joe.
“How long has the voice been there?” asks the trainee psychiatrist.
‘Since I was 12.’
“And you are now 18.”
‘Yes.’
“Is it really upsetting for you?”
‘Yes. Distressing. I feel terrible.’
“What does the voice say?”
‘Different things. Often cries desperately.’
“How often does this happen?”
‘At least 3-4 times every day. It’s painful.’
“Hmmm. Let me speak to my senior and come back to you in a few minutes.”

A few minutes later.

“We think you might have Schizophrenia. Let’s start you on Quetiapine and see how it goes.”
‘Okay.’

Joe waits at the pharmacy to collect his medication. A trainee nurse is also waiting there to collect some meds for a patient on the ward. They talk. He tells her why he’s there. She asks him who is ‘she’? Whose voice does he hear?

‘She is my little sister. When we were kids we shared a bedroom. At night, my mum’s boy friend would come into our room and trouble my little sister behind a curtain. She cried. I could hear her but I was powerless. I could hear her then. I can hear her now.’

‘Do you think these pills will work?’

Day 808

Posted by

3

Yesterday our Prime Minister put Mental health at the top of the national agenda. Great to have these focussed conversations in prominent places with special emphasis on schools and work places being equipped to intervene early for children and young people with difficulties. These announcements are welcome but are also met with a slow applause as this government does not have a great track record with the NHS.

Relevant tweets:

“Schools will be linked to local NHS #mentalhealth services to support early intervention for Children and Young People” in PM speech.

“You can make the promises, but you need the workforce to deliver them.”

“Biggest challenge PM faces -getting funding to the front line. Services over-pressed, under-staffed + facing even more demands.” – President of the Royal College of Psychiatrists.

In my opinion, as long as we stick strictly to the medical model of mental illness we will never get it right as it does not put enough emphasis on prevention. We need to start with educating young parents about the family, environmental, individual and social factors that contribute to the mental well being of a child.

Thereafter the schools need to be aware that if a child is happy, he or she is more likely to perform well. Hence putting them under academic pressure can be counterproductive. Bullying policies must be strictly implemented. Kids must be allowed to fail sometimes. There is grace and learning in defeat.

By no means do I claim to have all the answers but this would be a good start. Prevention is better than cure.