If not now, when?

‘This is difficult.’

‘What I need is absolution.’

‘I don’t deserve it. I failed to be a good parent to my son.’

The subject of our meeting last evening was self-compassion, one of the recurring themes in the Circle of Remembrance. It was an opportunity to revisit the ways in which we can be our own best friend. As we have been encouraging the practice of self-compassion in the group for as long as we’ve existed, I assumed it would be an everyday practice for most of our members.

I was surprised to hear the above responses coming forth. The jaws of the beast of guilt must’ve loosened their grip on me.

Three years after Saagar’s death, I heard of ’Self-compassion’ for the very first time. My innate belief was that the only way to progress was to work hard, like the coachman whipping his horses to move forward. Finally, after having lost my marriage, my child and all pride in my professional achievements, I was learning.

Dissecting events from the past and looking at them under a microscope seemed pointless and silly. Still, I was doing it all the time. I had spent most of my life doing the things that I thought I had to do as opposed to the things that I wanted to. And it was never enough. There was always more that could be done. I was always inadequate.

When Saagar was six, I was working full time and studying for exams. When I returned from my Part 1 Fellowship exam, Saagar looked up from his toy helicopter and asked me, “Mamma, did you win?” I was unable to see this was a game, and I needed to enjoy it a little bit. In the middle of all the working and doing, I completely forgot to relax and look after me. I was unable to stop and reevaluate my priorities. This was normal. Everyone around me seemed to be in the same situation.

Through years of therapy, I learnt that I had been the unconscious creator of the jinn that kept me spinning, leaving little time to sit down, relax and have a heart-to-heart. I was invincible and so should everyone else be. Until now, the art of conversation was oblivious to me. I had never witnessed good listening, except in films. I listened to fix as that is what I was trained to do. Sitting around talking was not as credible as being busy, doing important things. That’s what I had seen and here I was, on repeat. But all these hours of sitting with the gift of my therapist’s listening had helped me turn to myself with empathy. Working through various threads of my life had loosened a tight knot. I was able to tease each thread apart and see it for what it was.

I learnt that I was my tyrant and my slave, pushed by the whip of time and pulled by the notion of success. Despite being determined to not become my ancestors, they were more present in me than I was.

Underneath that jumble, sat my grief, patiently waiting. As the thick oil-slick of self-ignorance thinned and washed away, I was able to grieve properly for the suffering and death of my child. A hundred tonnes fell off my shoulders and I bawled with relief – I was perhaps not entirely responsible. I was simply living by what I knew then.

I was worthy of my own kindness.

I deserved to be held gently by me.

In time, I might even forgive myself.

Possibly, even have compassion for me.

For all these years I had been trying my best to serve my patients and family from a punch bowl that had been empty. I couldn’t see this emptiness as I didn’t know what a full one looked like. In my home and work settings, self-sacrificing mothers and doctors were nobility. These ideals had seeped into me while I wasn’t looking.

But now, thankfully, I could see that my bowl was empty.

I was going to polish it and replenish it gently.

If not now, when?

Day 794

Posted by kidsaregifts20

Spending a few days in the countryside has brought out some stark differences from London.

No one walks with head/ear phones on in the countryside.
People greet others even if they don’t know them.
Even though people live far away from each other, they feel connected.
The abundance of nature allows for a free flow of energy as opposed to the rigid urban boxed-in compartmentalisation leading to desperate loneliness and isolation.

Last month I heard that as a man stood in despair at the edge of a tall building contemplating a jump, onlookers egged him on, poised with their cameras. Once I got over the initial shock of the implications of this fact, I began to wonder whether people had truly lost their compassion and empathy or whether they were unable to differentiate between real and virtual worlds. Are the lines between these two worlds too blurred for some of us? Do screens dominate our lives to the extent that unless it’s happening on a screen, it’s not happening? And if it’s happening on a screen it’s not real anyway?

“The Matrix is a system, Neo, and that system is our enemy. When you are inside, you look around, what do you see? Businessmen, teachers, lawyers, carpenters, the very minds we are trying to save. Until we do, these people are part of that system and that makes them our enemies. You have to understand that most of these people are not ready to be unplugged and many are so hopelessly dependent on the system, they will fight to protect it. The Matrix is everywhere. It is all around us. Even in this very room. You can see it when you look out your window or when you turn on your television. You can feel it when you go to work, when you go to church, when you pay your taxes. It is the world that has been pulled over your eyes to blind you from the truth.”

– Morpheus, in the movie, “The Matrix”

Day 787

Posted by kidsaregifts20

The Francis report concluded that patients were routinely neglected by a trust that was preoccupied with cost cutting, targets and processes and lost sight of its fundamental responsibility to provide safe care. An estimated 400 to 1,200 people could have died unnecessarily there between 2005 and 2008. In addition, the inquiry heard that receptionists in the accident and emergency department had regularly triaged patients

The public inquiry heard common themes of call bells going unanswered, patients left lying in their own urine or excrement, or with food and drink out of reach. Patient falls were also concealed from relatives. An inward looking organisation, with a low staff turnover, the trust suffered from a lack of new ideas and a negative culture that became entrenched. Extremely poor nursing care was at the heart of this enquiry bringing into question ‘empathy’ in health care professionals.

Studies have shown that physician empathy is significantly associated with desirable clinical outcomes for patients with diabetes mellitus and should be considered an important component of clinical competence. ( Source: http://www.forcedo.org/wp-content/uploads/2013/03/The_Relationship_Between_Physician_Empathy_and.26.pdf)

A qualitative study of empathy in 3^rd year medical students showed that inhibitors of empathy may originate in the hidden curriculum creating a greater distance between patients and physicians. Cynicism as a coping strategy, primary importance of technical knowledge, emotional control, becoming and being a professional hence keeping a professional distance from patients reinforced lack of empathy. One student explained that exploring a patient’s true feelings is not permitted. She noted that she explored and discussed patients’ emotions less than before because she felt that it is not accepted within the medical educational environment.(Source: http://bmcmededuc.biomedcentral.com/articles/10.1186/1472-6920-14-165)

Good bedside manner is nothing but a practical demonstration of empathy. Can it be taught and learnt?

While at one level it is possible to ‘understand’ how another person might be feeling (cognitive empathy), not everyone is capable of feeling how the other person might be feeling (emotional empathy). Both are essential for people in caring roles.

In all my years as a practicing doctor, I have learnt that patients are not just a source of inspiration for me but a primary source of learning. Books can only teach you so much. Most valuable lessons come from patients and from observing the attitudes and behaviour of senior colleagues.

Considering the fact that GP training in the UK is the shortest amongst all European countries, patients must be treated with greater respect as sources of learning. In my specialist training of 7 years duration, I learnt a lot about Anaesthesia. GPs are expected to learn a fair amount about everything in 3 years. (http://www.rcgp.org.uk/news/2016/october/mental-health-is-key-in-the-gp-training-curriculum-says-rcgp.aspx)

Am I optimistic? Yes. The government is waking up. There is hope.

Day 734

Posted by kidsaregifts20

2 months ago I made a presentation entitled ‘Understanding Resilience’ to a group of roughly 30 people in their twenties. It was well received and the feedback was encouraging. Here is the quantitative analysis, marked out of 5.

Content: 4.39

Presentation: 4.38

Relevence to me: 4.13

Overall: 4.38

It was interesting to see that the lowest score was to do with relevance. It means that while most of them liked the content and had an overall good impression of it, many of them thought it didn’t apply to them.

Perhaps it reflects the fact that at present they feel strong. Great! Long may it stay that way! If I had attended a presentation like that a few years ago, I would have thought the same. But I do hope that if any of their friends, colleagues or family is in a vulnerable place they will be able to spot that and reach out to them. I also hope that if they see a distressed stranger, they will be sensitive to that and offer support.

The low score could also indicate an inability of some of us to acknowledge our own fragility.

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Day 700

Posted by kidsaregifts20

When our GP heard of Saagar’s death, the first phone call he made was to the Medical Defence Union and they advised him not to call us. Despite having known us for more than 7 years and seeing Saagar every 2 weeks with us for the last few months of his life, he did not call us on his death.

A qualitative study of GPs’ experiences of dealing with parents bereaved by suicide by Emily Foggin et al was published last month in the British Journal of General Practise.

It acknowledged that bereavement by suicide is a risk factor for suicide but the needs of those bereaved by suicide have not been addressed and little is known about how GPs support these patients, and how they deal with this aspect of their work. 13 GPs in the UK were interviewed in a semi-structured format. It explored experiences of dealing with suicide and bereavement.

GPs disclosed low confidence in dealing with suicide and an unpreparedness to face parents bereaved by suicide. Some GPs described guilt surrounding the suicide, and a reluctance to initiate contact with the bereaved parents. GPs talked of their duty to care for the bereaved patients, but admitted difficulties in knowing what to do, particularly in the perceived absence of other services. GPs reflected on the impact of the suicide on themselves and described a lack of support or supervision.

It concluded that GPs need to feel confident and competent to support parents bereaved by suicide. Although this may be facilitated through training initiatives, and accessible services to refer parents to, GPs also require formal support and supervision, particularly around significant events such as suicide. Results from this qualitative study have informed the development of evidence-based suicide bereavement training for health professionals.

Ref : http://bjgp.org/content/early/2016/08/15/bjgp16X686605

This evening a vigil was held by SOBS (Survivors Of Bereavement by Suicide) at Hyde Park to remember those lost through suicide. Some of the people there had lost a brother 25 years ago or a sister 5 years ago or a friend 1 year ago and so on. Some of the families had not been able to speak about it for many years. Others had kept quiet as they were not sure if anyone would understand. But in that space, we sat together on the brownish-green grass with the pictures of our loved ones and lit candles in their memory and we opened our hearts. For about 2 hours we claimed that space and made it our own knowing full well that we are being listened to and perfectly well understood. What a rare gift that is!

When it comes to suicide, post-vention is pre-vention.