How we do it is important.

Posted by kidsaregifts20

They said that Saagar was discharged from the Mental health services because he wanted to return to his education. His parents wanted the same. Correct.

The Home Treatment Team decided it was the best thing. Great. They handed over his care to his GP.

After his death, carelessness was found to be the root of the problem. His Discharge Summary did not name Saagar’s illness. The person who wrote it had never met Saagar. He was carrying out a formality without understanding its significance. He didn’t quite grasp his role in the business of keeping a person alive.

His GP, on the basis of the information he had received went on to treat Saagar for an illness he did not have with medications positively dangerous for young people. He believed he was doing his best by maintaining Saagar’s confidentiality and not sharing his para-suicidal status with us while expecting us to look after him at home. He did his job but his patient died.

They all did what they thought right but how they did it determined the outcome, which was tragic.

The same applies to small things. I can request someone to stop smoking in my space but how I do it matters. I can ask someone to pick up their litter, take their shoes off the train seat and use ear-phones while watching videos on their cell-phone.

Multitasking is not to be glorified.

Doing one thing at a time and doing it well is of much more value than doing five things simultaneously and all shoddy. For instance, being a 100% present during a conversation without checking my phone once. Leaving it on silent mode in the other room with the door shut is my secret for getting into the flow of writing. Being fully present to the page and the pen and the soft scratchy sound that the tip of my pen makes as it moves in a squiggly line from left to right. Letting everything disappear except the ink freeing itself into the world.

Visiting my adolescence

Posted by kidsaregifts20

Innkeeper's wife

(The mean, very mean wife of the inn-keeper. Nativity play 1983. CMC Ludhiana. India.)

Once upon a time I used to be a kid. A bright and happy kid. I nearly forgot that girl. She used to be fun. She loved singing, dancing and play-acting. She had thick black, unusually curly, short hair. She laughed easily and played harmless pranks. She listened to music on the radio with such ardour that her day was planned around the timings of her favourite programmes on the Urdu service of All India Radio. The last few pages of all her notebooks were filled with scribbled lyrics of songs written at speed to keep pace with them as they played on the old Murphy which was a part of her mother’s dowry. Then she neatly transcribed the messy song-words from the back pages of her notebooks onto a special red diary which was her treasure.

A few months back I accepted an invitation from my alma mater, Christian Medical College, Ludhiana, India. This is where I trained to be a doctor and an anaesthetist, nearly 30 years ago. They requested me to run a Mental Health workshop for about 70 medical students and make a Keynote address at the World Junior Medical Congress they were hosting in early April.

While preparing my lecture, I dug up a few old pictures. They flew me back in time. I saw what I looked like when I was Saagar’s age. It was a strange juxtaposition. So much had changed. Oh, that heart-breaking innocence! The stars in my eyes shone so bright, they nearly blinded me. Who was this lovely girl? Where is she now? She has walked a long way and formed a big circle. She is back where she started, working with what she has – her Love, her Grief and her Self.

MH Workshop

The workshop was four and a half hours long. The sharing was powerful, the enthusiasm infectious. The learning for all of us was invaluable. It was fun! We sang and we danced. We worked and we played. It was just like the old times. Saagar was there. He was smiling his crooked smile.

“There is nothing in the world, I venture to say, that would so effectively help one to survive even the worst conditions as the knowledge that there is a meaning in one’s life.” – Victor Frankl.

Andy’s dilemma. Errm … decision.

Posted by kidsaregifts20

2830

On Friday, the first thing I heard on radio was Andy in tears. It was also the last thing on TV before going to bed. A proud Scotsman, 31 years of age, Andy announces his retirement after a scintillating career in tennis and a long fight with an injury to his right hip. Tall and athletic, in a deep blue t-shirt, seated in front of a dark grey screen covered in contrasting logos, he faced the press. Eyes lowered. Head bent. His left hand trying to cover his face in the guise of adjusting the brim of his baseball cap.
“Ermm. Not great.” (Nods, looks sideways, down and to his right. Nods twice to himself. Big sigh.)
“Ermm…”(Comes close to breaking down and leaves his seat. Walks off with head steeply bent forward.)
Comes back. Sits down. Starts again.
“Sorry.” (Small cough)
“Ermm. Yeah. So, not … not feeling good.
Obviously been struggling, been struggling for a long time.
I can still play to a level. Not a level I’m happy playing at. But also, it’s not just that the pain is … too much really. I don’t want to keep playing that way. You know, I spoke to my team and I told them that, you know, I can’t … I can’t keep doing this and I needed to have an endpoint. I told my team that I needed to get through this till Wimbledon. That’s where … where I’d like to stop.
Ermm … stop playing. (Visibly steels himself as he says this).
Ermm … but also not certain I’m able to do that. (Shakes his head and bends it further forward)
Ya. Ya. I think there’s a chance of that for sure. (Rubs his right eye. Purses his lips.)
Ermm. Ya. There’s … sure, because like I said I am not sure … not sure I’m able to … to play through the pain you know. For another 4-5 months. Ermm. I have an option to, you know, have another operation which you know is … you know a little bit more … more kind of severe than what I’ve had before and having my hip resurfaced will allow me to have a better quality of life and be out of pain and that’s something I’m seriously considering right now. There’s obviously no guarantees. The reason for having an operation like that is not to return to professional sport. It’s just for a better quality of life. Yeah. For myself mainly. (Pulls the brim of his hat forward). There’s lots of little things. I mean, you guys see me running around the tennis court and walking around in between points and it obviously doesn’t look good and doesn’t look comfortable but you know there’s little things like day to day, that are also a struggle, and ya, it’d be nice to be able to do them without any pain. Putting your shoes on, socks on – things like that. Having the limitations and the pain is not allowing me to enjoy competing or training or any of the stuff that (shrugs) I love about tennis.
Nothing helps. You’re in lots and lots of pain. You can’t do what you want to do, what you love doing. I can do it but it’s not fun. I’m not enjoying doing it. So … I mean. That’s what I’ve done. Tried to deal with it, talk about it. Ermm. But none of that makes my hip feel better unfortunately. I wish it did, cause if it did, I’d be feeling brilliant just now but it doesn’t. So…” (Gets up and leaves.)

His deep sense of loss, confusion, pain and vulnerability came across clearly. It’s probably one of the hardest decisions of his life. I visualise a society, our society, creating space for such expression, not just for physical but also emotional pain. It’s going to be a tricky transition. I am sure he has the required support network in place. Good luck Andy!

Ref: https://www.theguardian.com/sport/2019/jan/13/andy-murray-tennis-retirement

The Cats

Posted by kidsaregifts20

(Merry Christmas from Milkshake)

The Intensive Care Unit (ICU) at the City Hospital was a circus. A different clown (read Consultant) was in-charge everyday. What was right on a Monday was completely wrong on a Tuesday. The same action would be pronounced as ‘perfect’ by one clown and ‘abhorrent’ by another. To make things better, they didn’t talk to each other. The flunkies (read junior doctors) were the in-betweeners that got lammed from both sides as their shifts crossed over time-territories. They were the pawns on the frontline that took over the running of the unit from one clown at the beginning of a shift and handed over to the other at the end. They were the ones dodging the arrows of conflict over phones, in hospital corridors and at handovers. They were the ones that stayed up all night working hard, only to be abused and criticised the next morning. They were the buckets into which bile was poured, the bile of bitterness that the clowns didn’t have the guts to express to each other.

In 2004, I was one of those flunkies. After about 8 months of this non-sense, I was done. I was loosing my sense of self, my confidence in making decisions and most importantly, pride in my job. It was time to stop and take stock. After a nasty night shift, I was handing over the patients to the day team. I am sure at one point I heard the Consultant taking over suggest to me ‘you need your head examined’. That did it for me. Bleary-eyed and broken, I couldn’t bear to go home only to come back to this toxic work environment yet again that night. I planted myself in Psychiatry Outpatient Department and demanded to be seen by someone. Dr Ingram was a handsome, young psychiatrist with kind eyes and a small beer belly, well couched in his grey suit. He understood. I was given 6 weeks of work-related-stress leave and started on Fluoxetine. I was also seen by an occupational therapist once every fortnight. She suggested getting a cat.

At the local Animal rescue home, we found an enchanting black and white, one year old feline. It was her eyes that got me – talking and smiling eyes. We were told it was a girl. We decided to call her Bella. We were advised to keep her strictly indoors for at least 6 weeks, till she got used to the smells in the house. She found her way to the strangest of places – on top of kitchen cabinets and radiator covers, squeezed behind and underneath beds, chairs and sofas, inside shoes and boxes. The only place she didn’t like was her soft furry blanketed bed.

On our first trip to the vet for a basic check-up and vaccinations, we found out that the she-cat was in fact a he-cat. After much consultation, he was christened ‘Mr Bronx’, the old faithful. He soon became a source of great joy, comfort and hilarity for the family. We had him go crazy playing with balls of wool, soft toys with tiny in-built bells and laser beams. He was pure entertainment from a distance at the beginning but slowly he allowed us to stroke and cuddle him. Within a month we were having full-fledged conversations with him.

The Fluoxetine made me feel frozen. Hollow. No joy. No pain. No love. It was dehumanising and unbearable at times. It was proof that pills alone cannot make you happy. After 6 weeks, it was time to go back to work. I did. A cunning plan was put into place so that I didn’t spend too much time at the ICU. It worked.

9 years later, Saagar was home from University and I got a phone call from him at work. He said he’d found a cat on ‘Gumtree’ and he would love to get it. That evening we went over to a tiny flat in Sydenham occupied by a family of 4 – mum and 3 kids. On a window sill lounged another family of 4, a grey mother-cat with her three grey kittens, 6 weeks old. One of the malnourished kids was about 3. He handled the kittens like rags. He didn’t care if he lifted them by their ears or tails or bellies. He let them go from various heights above the floor, cornered and held them with a lot of force. He told us all about what the cats ate. We picked the cutest little kitten who resembled a mini-punk, got it properly accessorised and brought “Milkshake” home. He was Saagar’s baby that summer.

Not once did it occur to me that there might be a connection between the circumstances under which we got the first cat and the second.

Ref: https://www.cats.org.uk/news/purring-the-blues-away

you is kind. you is smart. you is important.

Posted by kidsaregifts20

images-1

My laptop claims to have at least 8 films on it but for some strange reason, on a train from Birmingham to London, it agreed to play just one, called, ‘The Help’. It’s about the writing of a book compiling the stories of African American maids working in white households in Jackson, Mississippi in the early 1960s. A book about an open ugly secret. About the courage of a few to start talking about it as a mark of protest. About the collective impact of small actions in bringing about big changes.

Yesterday was World Mental Health day and the UK became the first country in the world to announce a minister for Suicide Prevention. The day before yesterday, I learnt that Health Education England are very keen to put measures in place to prevent suicides within medical practitioners. Having been a part of the Suicide Prevention Community for the last 4 years, the one profession that is most conspicuous by its absence is Psychiatrists.

At 2 different meetings, I happened to meet 2 different Consultant Psychiatrists. On hearing Saagar’s story, one of them said he was very sorry but ‘this has been happening for 30 years’. I went blank. I just looked at him. I wonder what the public’s reaction would be if a surgeon would publicly admit that his surgical team has been making the same errors, that have been costing people their lives for 30 years. Yes. These are systemic errors. They are difficult to tackle. But, even today, youngsters like Saagar are dying because of lack of leadership within the specialty of Psychiatry, like they have been for the past 30 years.

The other, extremely prominent and respected Consultant Psychiatrist completely rubbished Mindfulness, Yoga and Meditation, without having tried any of them. He said that all these interventions have side effects. He believed that a Psychiatrist is only meant to attend to the most extreme cases. Their role comes into play only after these 5 have been called upon – parents, schools, GPs, CAMHS and Talking therapies. I am sure he knows that many youngsters die while on the waiting list, without ever getting to see a proper Psychiatrist, once. I am also sure he knows the side effects of psychiatric medications that are offered generously to all and sundry by non-psychiatrists. Lastly, I am sure he also knows how unsupported the GPs feel when faced with patients who are severely mentally unwell due to slow and inefficient response from the secondary services. And, I am sure it’s all down to poor funding. The same excuse that we’ve had for decades gone by and will have for decades to come. How about some imaginative leadership?

As parents, let’s start by saying to our kids in words and actions –
‘You is kind. You is smart. You is important.’
To me, I say – ‘I is kind. I is smart. I is important.’
You could too.