Visiting my adolescence

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.

Green Tara

Posted by kidsaregifts20

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]

Community is the answer.

Posted by kidsaregifts20

“…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

Posted by kidsaregifts20

download

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!

Posted by kidsaregifts20

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!!!

Posted by kidsaregifts20

Screen Shot 2018-01-28 at 21.23.13

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’.

Posted by kidsaregifts20

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.