Day 828

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 824

What brings you enjoyment?

This was on the list of questions being asked of young doctors at an interview skills practice session for their upcoming promotions.

One of the young women enthusiastically told me not only how much she enjoyed her work but also the stories behind how the interest started and developed and then narrowed itself down to a specialist area, the places her aspirations took her to and the inspiring people she met along the way. Her eyes shone like sparkling diamonds as she spoke and her smile beamed. Towards the end of her answer, there was a brief mention of tennis, friends and cycling.

90% of her answer was her work. Her honesty was clear.

That was me. My work has brought me great joy over the years. I have spent far too many hours at work. It gave me self-esteem. It was something I could hide behind. It gave me meaning and purpose. It made me look and feel successful. It was fulfilling and satisfying and everyday was challenging and exciting. I loved it.

It took away all my energy and I came home spent. It took up a lot of space in my head for many long years. It made me loose my balance. It sucked me in so completely that I couldn’t see the aspects of it that were draining me dry. It deprived me of sleep for years and it drove me crazy. Yet, I loved it.

If I could go back and change what it meant to me, would I?
No.
But I would cut the number of evenings and weekends I spent away from home. I would conserve more energy for home. I would say ‘NO’ more often. I would claim some of my life back.

Day 820

One of the French companies worst affected by suicides has been the telecommunications giant, France Télécom/Orange, where 12 employees took their own life in 2008, nineteen in 2009, 27 in 2010 and 11 in 2011. Despite a new agreement on workplace conditions negotiated with the trade unions, there has been a renewal of suicides in recent years with eleven cases in 2013 and ten suicides in 2014.

Suicides took place at a time when the company was restructuring, including a plan to cut 22,000 jobs in three years. Suicidal individuals shared a similar profile: these were typically skilled male engineers or technicians in their fifties who had been forcibly redeployed into low-skilled roles, often in call-centres.

On 17 January 2014, a 42-year old employee dealing with business customers at a France Télécom/Orange office in Paris, threw himself under a suburban train on his way to work. His sister, who is pursuing a claim against the company, contends that her brother had repeatedly complained to his bosses that he was a victim of bullying by his manager. Occupational doctors had also reported a deterioration of working conditions at the agency where he worked, with a rise of workplace stress as a result of company restructuring. Prior to his suicide, the victim had sent e-mails to family members complaining of an unmanageable workload and of constant surveillance and he referred to “humiliation”, “intimidation” and “bullying”. He held several meetings with senior management where he complained of harassment by his manager. Five days before his suicide, he sent an e-mail to his head of service in which he reiterated his request to change teams. These e-mail exchanges are being used as evidence in the investigation by the public authorities into his suicide.

Whilst in France work place suicides are an urgent public health phenomenon, in the UK, despite severe deterioration in working conditions, workplace suicide is not recognised in legislation and there are no specific official mechanisms for data collection. Even when it takes place in the workplace, suicide is presumed to be an individual and voluntary act and according to Health and Safety Executive (2016) legislation: “All deaths to workers and non-workers, with the exception of suicides, must be reported if they arise from a work-related accident.”

(Source: When work kills : http://www.emeraldinsight.com/doi/abs/10.1108/JPMH-06-2016-0026?mobileUi=0&journalCode=jpmh)

Day 816

Health and social care, care of the elderly, care homes, care in the community, child care, nursing care, residential care, respite care … The word ‘care’ is used everywhere but what does it mean?

The Cambridge Dictionary defines it as ‘the process of protecting someone or something and providing what that person or thing needs’ and ‘serious attention, especially to the details of a situation or thing’.

Synonyms: caution, attentiveness, alertness, vigilance, observance, responsibility, forethought, mindfulness, regard.

Medicine and nursing are caring vocations. Yet, they are jobs like any other. They pay a salary for a service rendered. The care element can potentially become optional as long as all the boxes are ticked.

‘Continuity of care’ is particularly tricky in mental health as relationships are based on trust and every time a new person takes over a caring role, all the facts need to be repeated and trust re-established, starting from scratch.

Now that I belong to a network of mothers and fathers who have lost their children to suicide, one common theme emerges: “It seems that our sons and daughters didn’t need more resources, more GP’s or more psychiatrists or more nurses. They just needed more care…”

Let’s not use the word carelessly. 

Day 815

photo

(A sculpture by Ruth M, who lived with Bipolar Disorder, expressing her depression)

In the 1940s, mental hospitals were places of isolation and confinement, probably closer to prison than hospital. Netherne, in Surrey was seen as a progressive asylum at the forefront of waves of reform and development for nearly 50 years, till the eventual closure of the British asylums. They enthusiastically adopted physical treatments, now viewed as barbaric- insulin coma therapy, electroconvulsive therapy and lobotomy, then seen as optimistic approaches to treatment.

Edward Adamson (1911-1996) was a pioneer of British Art Therapy. He encouraged and collected the paintings, drawings and sculptures by people compelled to live in Netherne Hospital between 1946 and 1981. He describes that many people who came to his first lecture there had shaved or bandaged heads, bruised faces and black eyes, following brain surgery.

Adamson started collecting art during his early visits when a man on a locked ward gave him the first of his several drawings done on toilet paper with a charred matchstick. He later met other people on the wards who would have had no personal possessions, working with whatever materials they could find to create something for themselves.

The Adamson Collection has 6,000 of these works of an estimated 100,000 when he retired. The collection is seen as unique in the history of art therapy of the reforming psychiatry of the 1950s and 60s, collected by an artist rather than a psychiatrist, with a strong representation of works by women. Above all it is a memorial to all those who suffered in the asylums and to the human need to express.

“Edward Adamson practiced art as healing before there were ever terms or labels like ‘Art Therapist’. Being with him for anyone was therapy and yet he didn’t play at clinician, but rather served so sweetly as a supreme friend, ‘there’ for those who had none other. There were for Edward no patients. I think that is why so many lost people in his care found their way back to themselves. Adamson’s was an alchemy of the highest sort.”

– Rebecca Alban Hoffberger, Founder/Director American Visionary Art Museum, 2011

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Ref: http://www.adamsoncollectiontrust.org/wp-content/uploads/2016/09/2-2011.-DOF-Raw-Vision-for-EAF.pdf

Day 813

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:

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

Day 809

Recently I came face to face with my own subconscious biases. They came as a surprise but were interesting to watch once I became aware of them. I was faced with a series of people who were to be evaluated as objectively as possible by a colleague and I. They walked into the room and talked to us one by one. Some men, some women, some from abroad, some very well dressed, some with an accent, some with facial hair, some suave, some with a lot of hand movements, some hiding their nerves behind an overconfident exterior…

We made evaluations and discussed the interviewees. It was apparent that those who presented themselves well and appeared relaxed made a good impression. We reminded ourselves that even if someone spoke well, our focus must be on the content rather than the delivery. We picked up on body language clues like a mild trembling of the fingers and periodic clearing of the throat.

Couldn’t help thinking back. Saagar spoke well. He had an endearing and calm demeanor. He was clever. He was also a good mimic and actor. He could have easily made his assessors believe whatever he wanted them to, unless they were aware of their own biases and could read his non-verbal language – things that come with years of practice and experience!