Green Tara

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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]

Community is the answer.

“…the lonelier a person gets, the less adept they become at navigating social currents. Loneliness grows around them, like mould or fur, a prophylactic that inhibits contact, no matter how badly contact is desired. Loneliness is accretive, extending and perpetuating itself. Once it becomes impacted, it is by no means easy to dislodge.” – By Olivia Laing, The Lonely City.

In the summer of 1999 I moved from New Delhi to a little place called Antrim in Northern Ireland. I lived in a tiny room in the accommodation for junior doctors on hospital grounds. I didn’t know a soul there. Slowly I made a few friends at work. Unlike now, there were no mobile phones, whatsapp, skype, facetime or facebook then. Telephone calls costed a bomb.  People were friendly but everyone was a stranger. Initially I didn’t get their sense of humour at all. I felt foolish. I longed to speak my own language with someone. Anyone. But there was no one who would understand.

One evening I went to buy some chocolates to a nearby petrol station. There were 2 cashiers but only one of them had a long queue of people waiting their turn. I didn’t understand why. I went up to the cashier without a queue and made my payment. I didn’t get the meaning of the looks on people’s faces. It didn’t help that I was the only coloured person for miles. From some face expressions it was obvious that they had never ever seen a coloured person outside of the television. I felt alone. Very alone.

Urban loneliness is a common phenomenon.  Isolation causes inflammation. Inflammation can cause further isolation and depression. The cytokines released as a result suppress the immune system giving rise to more illness.

Frome is a historical town in Somerset. It is known as one of the best places to live in the UK. Dr Helen Kingston, a GP, kept encountering patients who seemed defeated by the medicalisation of their lives. They were treated like a cluster of symptoms rather than a human being with health problems. Staff at her practice were stressed and dejected by what she calls “silo working”.

With the help of the local council and Health connections Mendip, she launched a community initiative in 2013. It main intervention was to create a stronger community. They identified and filled gaps in communications and support in the community. They employed ‘health connectors’ and trained up volunteers to be ‘community connectors’.  They helped people with handling debt or housing problems, sometimes joining choirs or lunch clubs or exercise groups or writing workshops or men’s sheds (where men make and mend things together). The aim was to break a familiar cycle of misery.

In the three years that followed, emergency hospital admissions rose by 29% across the whole of Somerset. In Frome they fell by 17%.

No other intervention, drug or procedure on record has reduced emergency admissions across a population.

 

 

 

 

 

 

 

Rule 12: Pet a cat when you encounter one in the street

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In difficult times, it’s important to hold on to something sustaining, like a sparkling crystal in the darkness, like the sweetness of stroking a cat or a dog. Take every opportunity to make life easier, lighter.

Let a tragedy be only tragic and not absolute hell. There is a big gap between the two. Like the difference between someone lying on their death bed and someone lying on their death bed surrounded by their family yelling and screaming at each other. If we didn’t make worse the terrible things that there are, if we could just put up with the terrible things that exist, maybe we could make the world a better place.

The motivational speaker and Clinical Psychologist, Jordan B. Peterson speaks about his latest book – “12 rules for life. An antidote to chaos.”  He says he wrote it for himself as much as for anyone else.

“You set an ideal and find that there is a long way to go. It is a constant readjustment. There is also something positive about that. It’s not that there isn’t such a thing as a good person. Our idea of what constitutes good isn’t right because a good person is one who is trying to get better. The real goodness is in the attempt to get better. It’s in the process, to use an old cliché.

The central figure of western culture is Christ. He is the dying and resurrecting hero. What does that mean psychologically? Well, it means that you learn things painfully. And when you learn something painfully, a part of you has to die. That’s the pain. When a dream is shattered for example. A huge part of you has to be stripped away and burnt. And so, life is a constant process of death and rebirth and to participate in that fully is to allow yourself to be redeemed by it. So, the good in you is that process of death and rebirth, voluntarily undertaken. You are not as good as you could be. So, you let that part of you die. If someone comes along and says, there’s some dead wood here. It needs to be burned off. You might think, well that’s still got a little bit of life. When that burns it’s gonna hurt. Yes. Well, no kidding. Maybe the thing that emerges in its place is something better and I think this is the secret of human beings. It’s what we’re like. Unlike any other creature, we can let our old selves die and let our new selves be born. That’s what we should do.”

When asked if he falls short anywhere in his book, he says,
“Until the entire world is redeemed, we all fall short.”

Source: Synopsis of the book: https://www.nateliason.com/lessons/12-rules-for-life-jordan-peterson/

Let’s play Politics!

National Confidential Inquiry into suicide and homicide in people with mental illnesses 2016:

In-patient suicides:

Suicide by mental health in-patients continues to fall, most clearly in England where the decrease has been around 60% during 2004-14. This fall began with the removal of ligature points to prevent deaths by hanging but has been seen in suicides on and off the ward and by all methods. Despite this success, there were 76 suicides by in-patients in the UK in 2014, including 62 in England.

Suicides after discharge:

The first three months after hospital discharge continue to be a period of high suicide risk. In England the number of deaths rose to 200 in 2014 after a fall in the previous year. Risk is highest in the first two weeks post-discharge: in a previous study we have shown that these deaths are associated with preceding admissions lasting less than 7 days and lack of care planning. There has been a fall in post-discharge deaths occurring before first service contact, suggesting recognition of the need for early follow-up. In all there were around 460 patient suicides in acute care settings – in-patient and post-discharge care and crisis teams – in the UK in 2014.

First of all I want to say that every suicide is a huge tragedy and must be prevented at all costs. Behind each of these numbers are precious lives and beautiful people. I don’t allow myself to forget that even when I am angry. This blog is a mere observation on how I have seen politics being played in front of my eyes in the last week. In light of the above findings, in consultation with his expert advisors and in all his wisdom, Mr Jeremy Hunt has decided to focus his attention on in-patient deaths – a group that is manned by the most highly trained professionals in a very controlled environment, a group that is on the list of ‘never-events’, a group that has already shown a decrease by 60%, a group where even a small reduction in numbers will amount to a big percentage and will make him look good.

With all good intentions, he has converted a healthy aspiration of Zero-suicide in the community to an unhealthy target for in-patients creating huge anxieties. Last week at the NSPA conference I heard Mr Hunt speak in the most self-congratulatory of tones about how wonderful it is that UK is the first country to legislate for ‘Parity of Esteem’. I am sorry Sir, that means nothing on the ground. The workforce coming in contact with the majority of suicidal people in the UK is largely untrained. They don’t even know how to talk with them, let alone ‘look-after’ them. The massive funding cuts focus on mental health which in turn results in poor training of junior doctors. When questioned directly about ‘parity of training’, he masterfully slips and slides away.

In my eyes you don’t look good Mr Hunt.

 

 

 

Bad doctor!!!

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Despite check-lists, protocols and guidelines, mistakes happen. As long as human beings carry out jobs, mistakes will happen. To err is human. Safety is an outcome of a person’s attitudes and actions within a given environment. Both, the person and the environment have a strong impact on each other and the outcomes. The bad mood of one person affects the whole team. Similarly, a stressful milieu for any reason such as lack of time and resources has a direct impact on the performance of each person in it.

In my 19 years in the NHS, the working conditions and morale amongst the staff have gradually worsened.  When things go wrong, clinicians, being visible on the frontline are expected and often willing to take responsibility. Holes in the system and staff morale are hidden. Only on a closer look are they clearly seen.

I sit in a unique position where I work for the same organisation that is at least partly, if not fully responsible for the fact that my son is not in this world any more. Yet, I know and see many doctors and nurses work way beyond their call of duty. However, our very own GMC took the case of a paediatric registrar, Dr Bawa-Garba to the High Court, supposedly in the best interest of the public. She had looked after 6 year old Jack Adcock before he tragically died of severe sepsis under her care. Her Counsel summerised:

“The events leading to [Dr Barwa-Garba’s] conviction did not take place in isolation, but rather in combination with failings of other staff, including the nurses and consultants working in the CAU that day, and in the context of multiple systemic failures which were identified in a Trust investigation.”

Yet, the high court convicted her of ‘manslaughter by gross negligence’.

A blog by concerned UK paediatric consultants stated that:

“On this day: Dr Bawa-Garba did the work or three doctors including her own duties all day and in the afternoon the work of four doctors.
On this day: Neither Dr Bawa-Garba (due to crash bleep) nor the consultant (due to rosta) were able to attend morning handover, familiarise themselves with departmental patient load and plan the day’s work.
On this day: Dr Bawa-Garba, a trainee paediatrician, who had not undergone Trust induction, was looking after six wards, spanning  4 floors, undertaking paediatric input to surgical wards 10 and 11, giving advice to midwives and taking GP calls.
On this day: Even when the computer system was back on line, the results alerting system did not flag up abnormal results.
On this day: A patient who had shown a degree of clinical and metabolic recovery due to Dr Bawa-Garba’s entirely appropriate treatment of oxygen, fluids and antibiotics was given a dangerous blood pressure lowering medication (enalapril) which may have  precipitated an arrest.”

The case has now been put to the Court of Appeal.

So, whose fault is it? No handover, no induction, no senior support, temporary nursing staff, poor IT services, shortage of doctors … whose fault is it? Obviously the doctor’s. Why this huge disparity in the way in which hospital doctors are treated as opposed to the others? It’s not ok for the sickest of patients to die in a hospital whereas fit and healthy young men and women are allowed to die in the community with not an eye-brow raised.

Parity of esteem? Bollocks!

 

It’s become a ‘thing’.

For a thousand days I wrote every day. It wasn’t a ‘thing’. That’s just what I did. I didn’t worry about who read it and why. It didn’t matter how good or bad it was. I just did it. Then I slowed down to writing roughly once a week.

Now, I think about writing. I talk about writing. I look up ‘writing’ on the internet. I consider on-line courses. I buy books on writing. I worry about writing well. I listen to podcasts of interviews with famous writers. I am on the lookout for writing tips in newspapers and magazines. I wonder what it must feel like to write properly every day. I envy those who can. What I do very little of, is write. I believe I repeat myself endlessly. I say the same things again and again. I forget things that are important. I hardly know any juicy big words. Why would anyone be interested in what I have to say? English is my second language and I can’t fully express myself in it anyway. My imagination is limited. I haven’t read enough books. I have no writing qualifications. Ms Confidence has evaporated and Mr Self Doubt has surreptitiously crept into her space in the vacant apartment of my psyche.

One ‘expert’ on you-tube suggested the way forward is to just write 3 full A4 sheets every day. She said,”… best not to think too much. Just put down on paper whatever comes to mind”. She called it a ‘brain dump’. She promised that over time it would start to make sense. It would become a story in your voice.

Maybe it’s time to go back to writing everyday. Maybe it’s time to start  my “big fat” book 🙂

PS: My favourite book on writing is ‘On Writing Well‘ by William Zinsser.

 

Treatment versus Care

In her entry to this year’s BMA News Writing Competition, a consultant psychiatrist relates the experience of her postpartum psychosis and explains that, although grateful for her treatment, something was missing from the care she received.

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The Human Factor

I am a consultant psychiatrist. Two years ago, I had a taste of my own medicine.

Three sleepless nights after the birth of my daughter, I became acutely ill. I slowly realised I couldn’t sleep — something strange was happening. Within six hours, I was experiencing a kaleidoscope of symptoms — elation, fear, heightened senses, delusions. I wanted to kill myself and my daughter.

Postpartum psychosis is a medical emergency and a consultant perinatal psychiatrist was at my house within the hour. I literally ran to her ward in my socks, my mum running behind, having forgotten her shoes too.

My first night was terrifying, but the staff were fantastic. As I rode an emotional rollercoaster, they reassured me, calmed me, gave me the sedation I desperately needed. Soon, I settled into a mild mania. Though at times it was very scary, I was fascinated. I noted with curiosity how my brain behaved. I felt great love for my daughter, and beneficence for my fellow man. I enjoyed all the activities the ward had to offer.

Five weeks later I was happily home. But what goes up, must come down. Gradually, I became unsettled, filled with self-doubt. I became convinced my baby was autistic. The anxiety became intense, and I considered suicide. My consultant coaxed me into hospital again. ‘It will only be two weeks,’ she promised. ‘I think you need to start lithium.’

You cannot breastfeed on lithium. One day I was connected with my baby, the next she fed from a bottle. My heart broke as my breasts filled to burst. It was a symbolic change, from wonderful to awful. She smelled wrong, artificial. I began a tiresome regimen of sterilising, preparing and cooling bottles, when all the while my baby yelled, to my great shame. As if in protest, she vomited spectacularly after every feed.

This time, the ward seemed an unfriendly place; swelteringly hot, noisy, tedious, excessively rule-bound. The other patients seemed uninteresting and depressing. My eldest son was bewildered: he wasn’t allowed on the ward. Why wasn’t mummy coming home? He became rejecting and oppositional. My heart broke some more.

I begged for leave but developed extreme insomnia and could not get well. I remember one night getting up, sitting down, and getting up again for seven hours, unable to decide whether to wake my baby for a change. A burly nurse was recruited to force me unceremoniously to move to a room near the nurses. I was told I would be sectioned if I tried to leave. An informal patient, I was allowed out for only half an hour each day.

I told my consultant I wasn’t depressed, her ward was the problem. ‘You’re depressed’ she repeated, implacably, and brought in a second-opinion doctor. I was desperate to leave as soon as I arrived, yet those two weeks became two months.

Having a mental illness is one of the most disturbing and frightening experiences one can ever have. The rug is truly pulled out from under your feet. Suddenly you are somehow lesser, rendered powerless. I was one of the lucky ones. I knew what was happening, and was more able than most to speak up for myself. I got treated very quickly. Many don’t.

My consultant was a former colleague of mine, a peer. She was kind but paternalistic, and my care became a battle of wills. She believed her plan was faultless and that her ward was entirely beneficial. She conducted her ward rounds like job interviews and treated me like an adolescent. I watched helplessly as she pathologised my normal behaviour and denied promises to get me to comply.

We were fragile mothers, but were often shamed like naughty children for not ‘doing the right thing’, sometimes berated across the ward for all to hear by opinionated nursery nurses with little sensitivity to our mental state. Mothering a screaming baby during an intense crisis of confidence was a tortuous task, yet it was rarely considered that our babies were exacerbating the problem. Scared and disturbed women were managed by intimidating rapid response teams.

I lost trust in them, I hid symptoms. One night I nearly killed myself but never told.

I now can understand how my patients feel when they say they no longer want to go back to ‘that place’. How lack of insight guides them away from reminders of restraint, coercion, scrutiny and endless questions. How it is difficult to trust people who don’t treat you as fully human.

Despite all the positives and the expertise in my care, an important element was missing. Care needs to be more than medication, therapies and keeping people safe. Now I’ve had a taste of my own medicine, I always ask: ‘What is this like for you, what do you really need to help you get well?’

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