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[recalibr8]

How to talk with Covid deniers. A guide for doctors in training.

Compassion is an unstable emotion. It needs to be translated into action, or it withers. The question of what to do with the feelings that have been aroused, the knowledge that has been communicated. If one feels that there is nothing 'we' can do -- but who is that 'we'? -- and nothing 'they' can do either -- and who are 'they' -- then one starts to get bored, cynical, apathetic.

Susan Sontag, Regarding the Pain of Others

Thursday, I helped out with the vaccinations. Joe (not his real name or identifiable history) was worried. His brother had driven him to Georges and pushed him into cubicle two, and slunk back the the waiting room, arms folded. Joe wanted the vaccination because he’d been shielding since March but all his friends had told him not to. “I dunno, I THINK it’s all real, but it’s hard to know who to trust. They’re laughing at me, in my block. I shut them out but, this vaccine isn’t, you know, gonna do anything weird to me, is it?”. I told him I was getting mine the week after so it better bloody not.

Joe had bern shouted at in person and online. Doctors hurry past crowds yelling ‘covid is a hoax’ on their way onto a shift

https://www.standard.co.uk/news/london/doctor-covid-hoax-crowd-outside-st-thomas-hospital-b633377.html?amp

and amateur sleuths film empty outpatients on weekends claiming fake news and hysterical media https://www.reuters.com/article/uk-factcheck-hospital/fact-check-video-does-not-show-uk-hospital-with-empty-ae-department-and-does-not-provide-proof-that-the-pandemic-is-a-hoax-idUSKBN29E0O7 And all the while we work, worry, sleep, regroup and head back into the teeth of the second surge. But what do you do when confronted online, in a family Zoom or in person by a Covid denier? The Tea and Empathy peer support page for health workers https://www.facebook.com/groups/1215686978446877/?ref=share has posted this question over again. It’s worrying us all because it might be fueling higher infection rates. We also get asked online questions all the time and frankly, it’s energy sapping.

Do we need to ‘do’ anything at all? In Susan Sontag’s book, Regarding the Pain of Others in which she asks us to look at those finally confronted with the graphic photographic imagery of war suggests that ‘it is passivity that dulls feeling’. And we know all to well what dulled feelings represent. Burn out. The fact we care and get angry for ourselves, our patients and the wider population means we are functioning as good human beings and good doctors. But being a good doctor means we can’t go to wars on the more egregious of the deniers. We are bound by Good Medical Practice not to bring the name of the profession into disrepute and of course although it’s tempting to video our ITU, post online and say SEE! Regard the Pain of Others! We’d not only break confidentiality but be told we are deep faking, lying, virtue signalling. It seems unfair that we can’t shake shoulders and change the narrative by showing people what we do every day. But we can’t.

So why does COVID denial exist? There’s a colossal gap between, questioning, bar stool opinions of which we all indulge and denialism. We all need to question. Doctors after all are notoriously impossible to influence: that and the public trust thing means that when revolutions happen, doctors are often on the front line or first to the gulag. But analysing everything doesn’t mean everything is wrong. And that is a problem with denialists; they are often also absolutists. For every rebuttal, there is another argument. We’re seeing it now in the US where in some quarters, anyone but the actual Capital insurrectionists are being blamed for their day of terror. Some are excited by puzzles, loving to see connections without taking responsibility for their conclusions, some hate any sort of authority, some are mischievous, some malevolent, some outright dangerous. So what do we do? Like it or not, doctors hold influential power. Someone messages you to show you Plandemic (again), someone quotes a struck off doctor who had strong views about 5G, a protestor gives you a leaflet....This. In this order.

1. We prioritise our own wellbeing because we’re responsible for the lives and wellbeing of others. Whatever we do within the rules we have to follow, we don’t get sick arguing with people who will delight in our discomfort and using up our energy. Whatever we chose to do, we can stop at any time we feel overtired or unwell.

2. Doing nothing is absolutely and totally an option. It’s unlikely (see above) but unquestionably valid.

3. Be kind to your friends and relatives who are questioning, have strong views about lockdowns or might be cross and tired. They might be right about some things too. Listen, ask them how they are, tell them to look after themselves and if you’re getting stressed, don’t be afraid to say “We need to stop here. Let’s agree to disagree. Love you, see you soon”. Leave things open for another day.

4. In random online conversations don’t feel you have to quote facts as were in time where truths and evidence are questioned. Quote sources if you do (leave it to other people to yell ‘do your research’) but remember that people often engage with the person, not the argument. Even if that person isn’t that nice. It’s about influence which is hard to pin down. But don’t appeal to people’s worst nature; it’s an easy win to ‘punch down’ about vulnerable people for example. If you feel guilty about what you’re about to say probably don’t say it. But if yiu can stick in someone’s mind as that kind, listening person, what you say next or even 6 months later might stick.

5. Don’t be afraid to say SOMETHING, if you’re in the mood. It’s easy sometimes to ignore comments, push through clinical decisions by being detached and blocking but just one thing you say in kindness, calmness and thoughtfulness might influence not the person shouting, but the person standing next to them or reading a post. Things can be polarised but a lot of people are just confused. We’re not trying to ‘convert’ people, we just want people to be safe, kind and make sensible health choices. Shouting is not going to get yiu there. You don’t have to be an exhausted martyr to facts, but a gentle nudge is all some people need. Most WANT to trust doctors because they know we care in the main. And if that person hates doctors, there’s not much you can do to change that view, but you might reinforce the views of their friend who has had mostly good experiences. And that might change the world.

Joe got his vaccine. His brother sloped back in and wheeled them away. I hope he’ll pass on his good experience.

There will be more confrontational conversations as the vaccine roll out becomes more intense. There’s more that connects humanity than divides us, so try not to judge people to harshly but don’t be afraid to walk away from conflict. Processes are in place to make sure everyone has the opportunities to be treated in their best interests. But please, do look after yourselves.

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Burgess Hill cinema was known as the Flea Pit. I’m sure it was grateful for the generous complement. Don’t look at the floor or the toilets was sage advice. Anyway, it was local and 32 years ago my dad took me to see Watership Down as a pre Xmas treat. He’d read the book so knew what he was in for. I didn’t. I was nine and several rabbits die in gruesome ways. Sorry if that’s a spoiler. Somewhat surprisingly I wasn’t freaked out and developed a life long love of folk horror stories and John Hurt. But out with my dog yesterday I couldn’t recall what my dad said when he left the film and really needed to know. Was he cross that it was grim, laughing because it was like the book or tetchy because he wanted a pint? Probably that. I know! I’ll ask him at Christmas. But then I remembered he died 11 years ago. And I stopped dead in my tracks and cried. Because I had to frame shift from a December that existed in my head for a fraction of a second. Trips to the Sussex Universiry panto, stealing beer from my parent’s friends in glistening suburban house parties and clung to by the smell of cigarettes. And then it was now again. But for so many people ‘now’ is very different this year. There’s a big rush to get Christmas cracking, whatever your beliefs. A winter festival of some sort. A marking of the end of a horrible year. Or the hope of a better one. But with this there have been so many losses. And those jolts and jumps in time will be really raw. Our expectations are being rearranged with every news report and it’s hard not to feel angry and displaced. That’s when our coping mechanisms gear up. Most will be good but some not so much. My need to work to bring me peace of mind has got way out of control recently and I’m having to make positive choices to stop. I bought a puzzle. A puzzle. It’s a Cold War Steve though. But please, be kind to yourself and others. It’s hard to find time now for good stuff whilst oddly, there’s more time to ourselves. Time feels fractured. Do you, whatever that means at this time of year. I’ve decided after a long time of feeling scroogish about Christmas that I celebrate Yule because it’s very old and has cool things like fire and logs. And it’s very folk legend. Like mangey old Watership Down. I’m sure my dad would think that was ridiculous, just the sort of thing ‘queer cousin Trim’ would say and then pour himself a pint. Yes, that’s definitely how it went. And time falls into place once more.

[recalibr8]

The New Normal

Do you like change? I do. But this can all just please settle down a bit now.

Even the father of change had bad days. Charles Darwin writing to Charles Lyell in 1861 said ‘I am very poorly today and very stupid and hate everybody and everything’. He had an undiagnosed debilitating condition for much of his adult life and also suffered extraordinary self-doubt which leads him retreating into his happy place which was barnacles. He’s also one of history’s most renowned medical student failures, dropping out of Edinburgh after 2 years. But he is most famous for his book, On The Origin of Species published in 1859 where he looks at successful adaptation of species through generational natural selection. Essentially, changing is winning. But in this case, very very slowly.

We’ve all had to do a lot of changing of late. And it’s all still happening. And it’s unsettling. Predictably, airports are full of books called ‘Advance or Die’, ‘The Developmental Paradigm’ and ‘Who Moved My Cheese?’ (only one of these is real, answer at the end). And so the business success websites suggest that acceptance of change is part cognitive, part emotional, part dispositional. Thus, if you are generally optimistic, good at varying your emotions and can use different strategies you’ll be better at it when things shift around you. Of course, most of these sites are for leaders trying to ‘help’ staff get on with the new bit of thinking they help will solve their problems and often involves changing job title or desk. https://www.ccl.org/articles/leading-effectively-articles/adaptability-1-idea-3-facts-5-tips/ . But the problem with the covid is that we’ve had to ride this big reactive roller coaster. The NHS rose to the challenge like a beast from the depths ad although not perfect; I think we can all say that we did incredibly well. It’s going to take a time to process and there will be some haunting memories for many of us ( I do include myself in this). But, with a bit of prediction, a bit of learning from the experience of other countries, there has still had to be unpredictable events in terms of how work has been, our lives, our loves. And that has been weird. And that’s made us feel weird.

A however an exciting change to come out of this time crystallised by the catastrophic death of George Floyd is the advancement of the Black Lives Matter movement and the promise of real positive change after centuries of repression and violence against Black people.

Change can bring out elation, fear, panic, laziness…all the humanity humans have to muster. Doctors have a great urge to ‘do’, to improve things for others and ourselves. Having a mixture of stasis plus unpredictable events that affect us out of control might make us want to impose ourselves on situations. When we can’t do that it can get frustrating and lead to bad tempers, illness or despondency. We might look for ways to make things make sense which is why conspiracy theories take hold. That can be secretly pointing fingers in departments through to burning down 5G towers. Or just feeling a bit cross and tired. All this is normal. Except burning down the towers, don’t do that. We can get some solace from the knowledge that we are not alone in feeling like this. We can try and make some positive changes in our environment such as writing up that audit (yay!), planning a project or booking some leave. We can try avoiding the things that blur out the uncertainty such as drugs, overwork and the medics favourite, booze. But most of all, we can look after each other. And that means maybe less finger pointing although we all love that index digit workout. And supporting positive change whether it’s for our Black colleagues who have been especially vulnerable during Covid or struggling families we know. And think what normal means to us anyway. I took the personally very threatening step to cut back on a bit of work as I realised that charging through life like a steam train wasn’t doing me any good. I’ve used my remote access more, like most of the country has been forced to do. I can now cook, load the dishwasher and do a MDT at the same time. But that’s a good new normal.

I’ve also decided it’s a good idea not to hate everybody. Mostly. Most of the time. And try to find personal empowerment where I can even if its sending my shielding mum increasingly baroque parcels of make-up samples (‘it’s got THREE layers, darling’). And not spend the next 20 years watching change unfold feeling ill and writing about barnacles.

It was the cheese book

[recalibr8]

Imposter syndrome; part 36

I’m in Ulster at a neurology conference and am running low on juice. I’ve been going to this conference since 1995 when I was an ambitious paediatric neurologist in training. This was before conferences had apps and gene therapy. But there were more men in blazers.

I ask the lady at the desk in the poster room if I can use the plug. She laughs, it’s not her desk, she’s just updating her references in case of tricky questions about her poster. Then someone rushes in, a bit late for the start, and asks us both where the conference hall is. I point her politely upstairs and we both laugh. Does this happen to her a lot? Me too. I’ve got what my mum calls a ‘can I help you?’ face. She made that her carer as a stewardess, I get asked where things are in shops a lot. My top tip is if this happens to you, keep your coat on at all times. It cuts the questions down to about 50%.

This was my desk buddy’s first trip on this conference merry go round. Neurology conferences can be a bit intimidating. People are super duper smart and never says things like super duper smart. She was scared she’d get asked difficult questions. My advice was to make the person who asked them feel extra specially clever, because they probably are but also, they were probably intimidated by HER. After she gulped that’s down a bit, she wondered if that might be true. It was an exciting bit of neuroradiology after all. And then I realised, I’d already copied her abstract and sent it to a neonatologist! Who said it was good. And that’s how conferences work. And that was so cool! She was delighted. And then we pointed a nice bloke down the stairs to the left to the gents.

When I was a SpR, I was terrified but ready to put the work in, academically and politically to be a neurology consultant. I sat on movement disorders committees, was the trainee rep for neurodisability and helped write the first competencies for neurodisability grid trainees (SCOD! Those were the acronyms).

Then I had a massive crisis of confidence. Like a heart sinking catastrophe of a crisis. I realised I wasn’t going to make it in this career. I’d done everything I could but somehow the families, the stories absorbed me so much I lost track of all the investigations and academic cut and thrust. I found myself chatting with the families, sitting on the beds on the wards learning about their histories and having coffee with my colleagues when I should have been doing extra clinics. And that was noticed to my shame. I felt increasingly like I just wasn’t good enough. So I decided finally and devastatingly in my exit interview. That wasn’t the best experience for me or the interviewers I’d imagine. Six months being away from a subspecialist and decided I loved the families, the medications, the people but not the career. But also that I wasn’t worthy. So in bravery and cowardice I diverted.

And now I’m a disability and neurobehavioral paediatrician. And I bloody love it. And I watch my colleagues’ careers bloom and I’m so proud of them.

The fallout? My dad stopped talking to me for two months. The disappointment in him was like a sickness. A sickness he tried to drown in vodka. I don’t think he ever really forgave me. And I never felt part of the neurology family I’d got to know and cared about. And felt like an idiot. And every year I go to the same conference and sit in my coat avoiding questions about lunch because I look like I work at the conference venue.

But what I do know after years is how to enjoy the evening drinks and the amazing venues and entertainment they put in every year. And how dearly departed colleagues played the piano, elegant professors dance and how to enjoy the delight of that . My desk buddy was relieved to hear that as she wasn’t sure whether to go out to the events. I do hope she went.

But after about 20 years of going, this year I’m finally content. I know my corner of medicine very well. I get approached to do research. I love my hilarious colleagues, my patients, my job. I don’t feel inadequate any more sitting amongst the posters. And I have writing and arts in my life now. I know just how important that is to me and the country right now let’s be up front about that.

So I went to a handful of talks some of which I almost understood. And downloaded lots of abstracts, read them over coffee and sent them to colleagues and have a great to-do list that I hope will help my patients.

As my phone charged, I suddenly remembered my favourite conference story from about 20 years ago. About not being ‘good enough’. Prof Dubowitz, muscle impresario and his wife, highly published and arguably cleverer. He was arguing the toss on stage about a point in a plenary. And I think it’s telling I can’t remember what the point actually was. He got a bit shirty and said “Well, if you don’t want to learn, you might as well leave now and do the city tour with the wives”.

Just then, I decided I wanted to see the Shankill Road, the tinder box of so much of The Troubles. So I said goodbye to my desk mate and told her it’s ok, that feeling she has do go away. More or less. Probably quicker than mine.

...Then we laughed our heads off to that poor bewildered neurologist who then asked us if it was OK to take her lunch early . We said, yes, it was OK.

I’m good here. Wives, here I come.

[recalibr8]

The Mot Just-ice

“You are quite political, aren’t you”

I think I’d been ranting for a few minutes between patients, medical notes in one hand, Mrs Potato Head in the other. My trainee was being politely nervous. Again. Packing up the wax crayons, I reflected it might not be her but might be me. And this election. I decided to diffuse and find something to be outraged about on Facebook. I found this.

‘NHS bosses accused of gagging staff during election campaign:

Staff say some trusts have gone too far in applying rules on political impartiality. Health workers have been told not to get involved in any political debates on social media during the campaign. NHS organisations have also banned staff from appearing in uniform or featuring any of their equipment, such as an ambulance, in their online posts or profiles’

https://amp.theguardian.com/society/2019/nov/17/nhs-bosses-accused-of-gagging-staff-during-election-campaign

Turns out the NHS guidance on communication standards during the election is out and Trusts have personalised their guidance. https://www.england.nhs.uk/wp-content/uploads/2019/11/general-election-guidance-letter-001254.pdf

You’ll see the introduction actually uses the word ‘Purdah’. Anyway, these are the highlights.

‘-the day to day operations of the NHS must continue unimpeded;

- as always, the NHS must act and be seen to act with political impartiality, and its resources must not be used for party political purposes; and

- during the election period, democratic debate between candidates and parties should not be overshadowed by public controversy originating from NHS bodies themselves

You should ensure your organisation and staff behave impartially towards all candidates and political parties, and do not influence the election outcomes, whether inadvertently or intentionally.’

In fairness, given this I can see why Trusts put out some draconian guidance.

And there’s this...

‘Social media and web: Nothing contentious should be posted on your website or social media accounts. Updates/posts, including blogs, should only convey essential factual information.’

Gulp.

Ok, that night Maria Condo’d my social media. Salted it. Bonfire of the inanities. Took ages. Turns out I AM political.

But then I read a bit further...

‘Staff activism: NHS employees are free to undertake political activism in a personal capacity but should not involve their organisation or create the impression of their organisation’s involvement.’

Confused, I went out to friends and it turns out one isn’t just a good bloke and fellow Doctor Who obsessive but is the Digital Communications Manager at NHS England and NHS Improvement. Alright! So who better to guide us through this because frankly being Neutral Janet on Facebook is driving me back to drink. https://thegoodplace.fandom.com/wiki/Neutral_Janet

So what are we all asking? Here are some questions from a range of doctors. Being doctors, some are statements. Obviously!

1. Basically if you ever relate a broader political point to your personal experience as a doctor, I.e. talking about knowing that waiting times are going up because this is the data or your experience from your workplace, does this count as "criticism of your local organisation" that would get you into trouble? If we are not allowed to use our personal experience it effectively gags us, and also removes one of the most effective campaigning tools we have. Most people don't care about data, but they will be swayed by a personal story (even the daily mail suddenly got briefly sympathetic to immigrants once they had some photos of people washed up on a beach).

2. For me, never before has the role of doctor been more important as 'activist'. Let's call it 'doctorvist'. At a time when the Home Secretary tells us angrily that child poverty has nothing to do with her (https://www.independent.co.uk/news/uk/politics/priti-patel-poverty-government-blame-austerity-general-election-tories-a9211741.html), political problems become medical in the end - childhood poverty has a medical consequence that affects an individual's life course. We see this first hand don’t we have a duty to share?

3. I have a sneaky interest in public health and most of what really needs to be done is at broader policy / political level . The FPH website is full of this sort of thing . I never see why we can't share objective data to highlight issues pertaining to health . Wasn't that also part of the message of the last State of Child Health?

4. My question is: if we want to use social media to share personal opinion or for doctor activism, how far can we go with what we post or share? At the moment I’m not even sure whether it’s ‘allowed’ to share a published opinion piece. Can we comment on political posts that we disagree with?

5. ...there are organisations with a vested interest in keeping NHS staff quiet...is there?

6. Having worked for an NHS trust on comms, the answer is totally dependent on the individual trust and its policies and levels of conservatism. Why?

And here, are the answers. As far as anyone can.

“Hi Serena,

So, basically, of course you can be an activist for Labour (or any other political party), as long as in a personal capacity).Doctors are all over Labour campaign materials. As long as everything is related to your personal experience, then that's fine.

And of course you can use data. That's all in the public domain anyway, so if you say, 'I've seen waiting times go up etc etc, therefore I'm voting Labour, no one can have a problem with that.

That problem would come if you said, every doctor I know is voting Labour because waiting times went up, or if you claimed that was the view of your trust or hospital.

I would add the caveat, that your own employer may have issued different guidance, I can only speak for the national guidance sent out by NHSE and NHSI.

*TOP TIPS TOP TIPS TOP TIPS*

1. Be yourself.

2. Use active and engaging language.

3. Make content accessible (we work in healthcare after all), so use alt text on photos, subtitles on videos etc.

4. Don't get into arguments online. No one has ever changed their mind in a twitter argument, so you're just wasting your breath.

5. Share best practice in your trust. We need to spread good work across trusts, and the more that happens, the better for patients, basically.

In summary, you do you, follow the GMC guidance obviously (don’t defame, don’t identify patients or staff, talk only as yourself not your Trust and bottom line, don’t put the trust people have in doctors in danger https://www.gmc-uk.org/-/media/documents/personal-beliefs-and-medical-practice_pdf-58833376.pdf?la=en&hash=BD5B72478B48DBC6A09E4787EC7C525F6050B62E)

Please, stay in touch with me about your adventures. I’d love to publish your media journeys. It’s could be fun. It’s could be surprising and beware subliminal messaging. Very obviously, tell everyone lots about benefits or unfortunate results.

Serena x

‘

[recalibr8]

Take Yo’ Praise

Gather at my knee, children. Snuggle close, listen keenly with shiny upturned faces as I tell you takes of the old world, of castles, princesses and heroes. Look, there, treasures are just beyond your grasp. But step with care along my path, my dears, for here be dragons. Hold each other close. Are you ready?

Yup, I’m a fifty year old doctor and I have opened the dusty book of anecdotage and am living my life slowly backwards for everyone else’s benefit. Back in the day. When consultants lived up beanstalks, phones were just phones and nurses wore hats indoors.

But I’m going to suggest a heretical concept. Enjoying the journey before the destination (I’m writing this delayed on the Dublin tarmac so that’s very literal). Stopping to pat yourself on the back even if that is not what you are used to doing.

Last week, I told one of my brilliant student tutees that finally I’d paid off most of the big debts, had a plan for money (bar that NHS pensions thing, grrr) and could step out of the Lidl queues and regularly shop in Sainsbury’s. But not Waitrose. I don’t do private work. This wasn’t an opener by the way, we were talking about money in training and beyond. She paused, looked my haggard, storytelling face and said. Urgh, does it take THAT long then?

She was right. She’d calculated the debts she had to pay and the ones she could let lie. The money she had to blag and the money she could earn. Her impressive intellect had calculated career long into the future and it was going to be OK. Probably. And then she could relax. It’s a heck of a long wait.

We’re all so goal orientated. Which is a good thing. But eyes on the prize means you can miss all the gold stars you’ve gathered along the way. That’s what appraisals and portfolios and work place assessments are meant to be of course. A happy little record of what we’ve done to proudly clutch to our bosom as we fall asleep. But actually, we worry about the one thing we didn’t do, the one thing we didn’t achieve and forget about the good things we did.

I think we are in danger of doing too much. In blog-inception, here is a story I’ve written as an &me ambassador for the truly wonderful Doctors Support Network, reducing the stigma of mental health difficulties in doctors and vets. Please, please read the stories. So much humanity. https://www.dsn.org.uk/dr-serena-haywood-me-anti-stigma-campaign TL:DR, I do too much in order to keep my depression at bay. It shuts up my inner voice (OK, it’s my dad) telling me I’m lazy and a disappointment if I do just one more thing. Then I can rest. It’s quite tiring and at times I’ve been quite not right. I’m always happy to chat if you’re the same.

So celebrate the things you’ve done. Play with all your toys now, not when you’re too old and gassy to enjoy them. Doctors used to be seen as insufferably big headed but still adorable. I don’t think there’s enough big headedness any more. Of course, never at anyone’s expense and never be boring. But be proud. Sit down and go, I’m doing alright. I didn’t think I’d be able to do x and now I am. If she can do y, good for her but LOOK AT MY X. My x is pretty good.

I blame the 80’s and 90’s when lunch was for wimps and only complete turnips took two bottles into a shower. Now we can’t stop. Ok, I’m the one blogging on a plane that’s finally taken off. But pretty darn pleased I went to a conference and met good people who wanted to talk to me. That I’m proud of.

So maybe be happy with less. And I don’t just mean food and plastic. But because your less is pretty damn good. Believe me when I say there’s work out there for you. It’s a buyers market right now, babes. Do a course or an exam because you want to; it’s more fun that way and you’ll learn better because dopamine. Get everything signed off, obvs, but be very proud. My 15 year old self would be impressed I think. And I dress the same so it’s all good.

Ok, my delightful breakfast had arrived and I’m celebrating my achievements via the medium of horizontal milk sachets and a Stoats bar.

May you days be filled with clingfilmed pastries, listeners. You deserve it x

[recalibr8]

The mEtOHd in my madness

I’d been out with my teen lads on a Friday. We got off the train and there was a young, crumpled woman sat on the platform, fat tears splashing into a puddle of sick on her trench coated lap. I offered her some tissues; I’m a mum, it come with the membership card. After a few sorries she asked “where did you stop?”. It took us a while to realise she meant, ‘where are we?’ She was out by 2 stations which on the face of it wasn’t bad. We pointed her onto the next train, gave her a mint (gold membership benefits) and my youngest shouted “take care of yourself” as we trudged up the platform. We agreed it was probably work drinks getting out of bounds and she’d be ok now she had tissues. But I kept thinking, “where did you stop?”. Where did I stop? Because I’m now AF af.

AF af. That’s alcohol free and doing pretty darn ruddy brilliant. Three months ago I upgraded my BrewDog to NannyState, went Becks Blue and am thinking in an offhand way about brewing Kombucha. I’ve teamed this up with going plasticlite, veganish and kimchi curious. So far, so middle class virtual signalling. But where did I stop?

I’ve been drinking since I was 5. I’d adorably finish up the beer in my parents’ guests glasses and well, kept going. Not in a Drew, Carrie or Liza rehab by 13 sense but I think I’ve probably had my fair share. I’m well aware that I knew, know and don’t know but suspect people who I love who have significant alcohol use problems and this is blog is in no way trying to say my needs are greater than theirs. I know a lot of highly creative endeavours and friendships were found in a gin bottle but also unforgivable abuses. And I know friends whose acts are based around the camaraderie of drinking. And I’d never tell anyone what they *should* do. But like all ex anybodies, I’m annoying about my sobriety journey right now. Bear with me.

But it’s not just me though. I see booze everywhere. For a dose related lethal toxin that’s very effective marketing. There’s a giant ad on Toots Broadway station entreating me to Go Bottomless and every other Facebook ad is for a spirit that promises to make evenings round the back of Catford Lidl magical. And many of these are aimed at women. A recent industry survey found ‘only’ 17% of women drank beer and this needed sorting out. Look out for more lady drinking adverts, they’re coming.

But I wasn’t alcoholic. Was I? Are you? You’re only an alcoholic if you have one more drink than you doctor. I’m

a doctor ... so let’s take a look.

*I’m really low on the alcoholic check list*

I’ve never drank alcohol in the morning, blacked out, been told by others I have a problem, had to apologise...

Ah, I have had to apologise once or twice. Nothing major, just ‘sorry, I was a bit wobbly/silly/rude/loud/insulting/gave you my shoes as a gift’. I once lost my credit and oyster card at the bar of a immersive theatre event though. I don’t know how I got home. I had to find the site manager the next day and he definitely had other things to do. Not long after my bag was stolen in SoHo because I was distracted. Not sure how I got home then either. Friends put me in an Uber after my MA showcase because I wasn’t walking very straight. Or being very nice. So I definitely remember getting home then.

These were all Thursdays or weekends. I’ve always been careful not to have any chance of affecting my work. But yeah, how clear headed was I for my family, myself? And much of this was stress drinking after a week of being a clever doctor. Just loosened up the joints a bit. Particularly if your slightly socially awkward. But I wasn’t a drunk, no. Maybe just a binge drinker. And that’s ok, isn’t it?

*Hangovers are just a thing*.

With only drinking at the end of the week, I was careful not to be hungover at work. But I had a Friday at home hangover where I didn’t get out of bed for the day. I claimed I’d been poisoned. I’d just had one too many Jaegerbombs. I vomited in the taxi. I’ve vomited in several taxis. That’s not a good look at any age. Hangovers are a funny meme, a cartoon of a dog in sunglasses, office banter. It’s your liver crying and your brain folding it’s arms in judgment. It’s not bad wine, it’s bad choices.

*Get kids used to drinking. Like the French. Then they won’t binge*.

My 13 year old buys old vodka bottles from charity shops. Wearing a furry hat, his comedy drunk Russian is not bad I used to have the deepest voice of my friends at 14 so it was my job to buy the booze for house parties. My mother always told me drink a pint of milk before you go out to soak up the booze. At 14. I had a few sexual assaults along the way but if I blame myself that’s victim blaming and I don’t want to be a bad feminist on top of everything. Med school in the 80’s/90’s was all over the drink. Freshers’ week was a booze insurance test. The circle line pub crawl, the Clint Eastwood Appreciation Society, the Med School pub crawl...end at Barts because Smithfield’s liscence meant you’d keep going all night.

*Booze always cheers you up*.

I’ve got to confess, my life has got a lot quieter. I’m going out much less, I leave early, I’m not champagne Charlie any more. I’m always, well, me. My dad was a depressed alcoholic, so was his dad (he ran a tobacconist and offie so that didn’t help) and his dad before him. And I have depression and PTSD. My moods are now not so high, but they are also not so low. This is very strange. I’m hoping this is a good thing. I’ve heard it is. This, this is the mEtOHd in my madness. The mood stabilisation. That’s the plan.

*Being a doctor is just one of those boozey jobs*

Fun quiz! Who do you think drinks the most? Enough to have a problem. Oooh, were good at guessing this in ED. Writers must be bad, farmers, journalists! yes, they’re always drunk, private invsestigators (?), airline pilots (like my dad, I saw what those guys put away). Ok...it’s.

Lawyers - reporting 33% with problematic drinking

Construction workers- 16.5%

Miners -17.5%

Then it’s Healthcare workers, especially doctors (oh no). A. 2012 study of American surgeons published in JAMA Surgery found 15.4 percent had an alcohol use disorder. Female surgeons (25.6 percent) were more likely than male surgeons (13.9 percent) to exhibit symptoms of alcohol addiction. Healthcare professionals in general it’s 10%

https://www.drugrehab.com/addiction/common-professions/

Performing artists and writers - 11.5%

Catering/hospitality -11%

So no pilots then? I think there’s something they’re not telling us or things are much better since the 80’s. 


 A 1998 study of junior doctors in Newcastle-upon-Tyne reported that:

* 60% exceeded the recommended safe limits for alcohol consumption

* 36% of males and 20% of females used cannabis 

The Sick Doctors Trust says “Since our working lives are spent helping others, it is easy to push aside our own problems, in addition to which, denial is quite common in medical staff. This is not deliberate, but a part of the whole illness of addiction. That addiction is a chronic illness which therefore requires treatment as for any other condition, is now well-established but there is still a tendency to feel that it is a sign of weakness, and that maybe things aren't 'that bad'.’

That some individuals are more prone to developing addiction is generally agreed. There is no single determining factor, but usually a combination of biological, psychosocial and environmental factors - a mixture of nature and nurture. There is now much evidence implicating dysfunction in the Dopamine transmitter system & it’s involvement in craving. There is also evidence to suggest that the effect alcohol has on an individual’s brain is genetically determined. A family history is present in many alcoholics- those having direct family affected being more at risk...

*Its a family affair*

I went to Adult Children of Alcoholics once. It wasn’t for me but what they said made total sense. I take responsibility for everyone, I’m primed for betrayal and disaster and I totally thrive in emotional drama. My dad wasn’t a nice drunk. He made my mum drink when pregnant ‘to keep him company’. She in turn gave babies a tot of brandy to keep them quiet as a stewardess and I can’t imagine my permanently shouting parents wouldn’t have liked us to be quiet babies too. So I’ve got pre and postnatal form. But I don’t have to fix them now. Particularly dad. It’s quite hard to fix dead people.

https://adultchildren.org/

*Booze: the solution AND cause of all of life’s difficulties*

Sick Doctors again “ Alcohol is the commonest substance of abuse in all doctors. Drinking will surprisingly continue despite negative consequences such as job difficulties, relationship breakdowns, financial problems, loss of driving licence; the alcoholic is driven by an irrational compulsion to continue, and frequently results in despair to the point of suicide. Fortunately, the depression associated with active alcoholism often abates when sober.”

http://sick-doctors-trust.co.uk/page/addiction

*I’m not an alcoholic*

and you probably aren’t either. But you might have problematic drinking. I did a survey as part of an UCLH research project. You can too. I lied a bit on it and still came out drinking more than 97% of women my age. Now an icon opens up on my phone every day to that says ‘DRINK LESS’. I stopped leaving my phone on meetings tables.

Drink Less. by Robert West

https://apps.apple.com/gb/app/drink-less/id1020579244

If you are thinking about getting help for problematic drinking or any other addictions including workaholism or have any burnout symptoms for more than 3 weeks, you can of course get staff support and occupational health. But/And there is the amazing NHS Practitioner Health Programme where doctors with any addictions are supported https://php.nhs.uk/ DocHealth is another equally good programme https://www.dochealth.org.uk/. I used the latter when it was MedNet.

So, do I feel amazing? Had I got amazing skin, lost weight, feel energised and hopeful. Urg, not really. I feel a bit scared actually. I’ve lost my social crutch and I’ve stopped going out. I’m worried I’m boring and people will think I’m weird. But....I can get up earlier to walk the dog, I’m moderately less tired and although I’m not skipping down the road happy, the depressive moment I had in spring could have been a lot worse. I think that’s actually amazing. And that’s why I’m doing this. I want to face the world honestly and openly. I want to enjoy my kids before they leave home which is frighteningly soon and weirdly, I want to know my liver replaced itself in a year so I’m literally a new person (don’t google Theseus’ Boat Paradox, life is complicated enough). Oddly compelling, that. So where did I stop? I stopped here. In a weird waiting room in my head. But with the promise of a new adventure through the next door.

But don’t stop doing you, babes. Keep telling me your booze bantz. They are hilarious. Any story that starts or ends with Baileys is only going one way. This clearly isn’t a lecture. Most people can do moderation. And do could I, mostly. And it’s the mostly that’s not good enough. Not for me. Not any more.

Online support - https://www.facebook.com/groups/joinclubsoda/?ref=share

Samaritans- https://www.samaritans.org/

BMA wellbeing including 24 hour support - https://www.bma.org.uk/advice/work-life-support/your-wellbeing

Tea and Empathy for doctors’ online support - https://www.facebook.com/groups/1215686978446877/?ref=share

Al Anon for children of alcoholics https://adultchildren.org/

https://www.alcoholics-anonymous.org.uk/

Dedicated to my husband who gave up the wine w*nker 6 years ago without any of this mid life crisis fuss. But I gave up meat and caffeine first so I still win.

[recalibr8]

Not Waving and the Benjamin Franklin Effect.

Not Waving But Drowning

 Nobody heard him, the dead man,

But still he lay moaning:

I was much further out than you thought

And not waving but drowning.

 Poor chap, he always loved larking

And now he's dead

It must have been too cold for him his heart gave way,

They said.

 Oh, no no no, it was too cold always

(Still the dead one lay moaning)

I was much too far out all my life

And not waving but drowning.

Stevie Smith (20 September 1902 – 7 March 1971 / Kingston upon Hull)

 Wait. That’s awful and beautiful. I’d forgotten. I’m going to take another moment…

But its also wrong. Because as we know, people who are drowning don’t wave. They silently slip beneath the water. One minute they are there. The next, gone. I watched my youngest son do just that in a crowded Isle of Wight swimming pool right next to me. His dad plunged his arm in and hauled out our wet puppy and he was fine but it was so quick. We didn’t know that 3 year old smiley boy was actually exhausted. He wasn’t going to ask to get out because water has always been his favourite thing…which other mum has had to organise every family holiday around hot tub availability…? But he was there and then he wasn’t.

How do you ask for help? I generally don’t. The worst worst worst thing I can possibly be apart from a Nazi is needy. I’m not alone. I had tea with an ED F2 back in the day when I was a Paed ST1. She was nursing a bloody nose and laughing after one of those naloxone events..you know the ones. The recipient really didn’t appreciate his loss of his intravenous investment and the antidote in his best interests and her face was nearest. She kept going. She didn’t even ask for a tissue. “Well, I’m not going to be the first to blub” she said. So I did for her. Never knowingly undercriedTM.

And last week my depression hit again after a decently long break. I won’t go into details but its not a laugh riot is all I can say. Losing an hour in clinic because I lost track of time was one of the most frightening things I’ve experienced professionally. I only realised as I had a cross patient in the waiting room. I’m never 10 minutes late let alone 60. They wished physical bodily harm on me but I wasn’t going to blub. Nope. Ok, I lied. I sobbed right onto a big orange set of notes. And a friend came round and I sent her away with distress on her face. Because I’m an arse. But I wont be needy, or a Nazi (bears repeating). So I went home to bed. Work, eat, work, sleep, repeat. I skipped therapy, I skipped a couple of showers. And I made a couple of friends cry themselves because I wasn’t going to get help let alone ask.  And sometimes its hard just to breathe when you’re low.

And slowly I crawled out of my hole.

And then I asked for help.

And washed.

Lots of people say I’m rather happy for a mental (my words). And yeah. There’s a lot of larking. But sometimes drowning. And I didn’t realise how much was piling up on me until the two complaints in a week just did for me. You know, like back pain isn’t picking up the fallen pencil it’s the month of abusing your spine that’s done the damage.

So I need to ask for help. Remind me.

There’s a thing called the Benajmin Franklin Effect; people like you more if you ask them to do more for you. https://www.brainpickings.org/2014/02/20/the-benjamin-franklin-effect-mcraney/. At the base this is to do with visualisation; if we ask people to do things for us, they not only then visualise themselves as good people but you as worthy of their help. Everyone benefits. So if you need motivation, asking for help makes everyone happy. 

But more importantly, they might be a stronger swimmer than you.

We are all strong independent women as my youngest son would say. And we’ve all got here by hard work and accountability above and beyond. This is upped by a factor of several thousand if you are, in order, indeed identify as woman (trans double points again)  and/or BAME (and especially from overseas) and/or working class.  So if YOU can ask for help, that is the bravest of all.

Just keep swimming.

But don’t do as I do, do as I say.

Needs are not needy. Mostly. OK, I still have work to do on that.

[recalibr8]

My PHP journey. By guest blogger, Ola Abdelhadi

“I am quitting paediatrics.” I said to myself. I could no longer cope with my ongoing health struggles on top of a busy neonatal rota and keep up with my paediatric training requirements. I had just finished ST1 and now spending my first day of induction in ST2 in a new hospital. I had spent the weekend in bed crippled with abdominal pain and I was struggling to listen to induction due to a mixture of physical symptoms and uncertainty about my future.

I have struggled with physical symptoms for the past 3 years Abdominal pain, diarrhoea, bloating and vomiting became my new ‘normal’ and I was finally diagnosed after numerous investigations with a malabsorption requiring enzyme replacement every time I ate. I used to get abdominal pain nearly on a daily basis with a visit to the Emergency department every 2 months when my symptoms were at their worst. I was even wheeled down in a wheel chair to A&E on a busy night shift after having a severe exacerbation of my symptoms. My symptoms were unpredictable and sometimes I would avoid eating on a long shift so that I would not have to deal with the pain.  This fuelled my anxiety around eating and around my condition.

I have always been a perfectionist and describe myself as having type 1 personality (as most paediatricians probably do). I have always felt stressed however; I feel that I perform better under pressure. However, I was beginning to crack. The stress of a busy paediatric rota, dealing and managing sick babies and children as well as coming to terms with the lifelong nature of my health condition as well as the physical aspects was becoming overwhelming and I could feel myself drowning. 

I was worried about what my colleagues would think of me. I worried about the number of sick days I had taken off and if that would affect my training or the way people thought of my dependability. I was worried about the babies on the postnatal ward, had I missed something on the baby check. I worried every morning if I would have severe abdominal pain that day. I was worried that my physical symptoms were affecting my mental well being.  I was worried what my medical family would think if I decided to quit.

I managed to attend the first day of induction but by lunch time I was dreading the thought of a another training year. I had used all my physical and mental strength to finish ST1 in one piece. One of the speakers at induction was Dr Simon Broughton, the one of many doctors that I will forever be grateful to for helping me. He mentioned that he was the Paediatric TPD and that if we had any concerns we could go to our educational supervisors or speak directly to him. I decided it was time to say something and at lunch I approached him. He kindly took me to his office where I told him about my past year and my health struggles.  He was extremely empathetic advised I take some time to recover from my physical symptoms and arranged a support meeting with the London Deanery and advised I refer myself to PHP.

I met with Dr Camila Kingdon, the Head of the School of Paediatrics, and another doctor at the support meeting not long after. They supported me to take some time out of my training to get better and supported my decision to get help from PHP. PHP stands for the Physician Health Programme/GP health service which is a confidential self-referral NHS service for doctors and dentists struggling with their mental wellbeing. Doctors or Dentists living in London or training in London can self-refer themselves and those outside of London can be referred by their GP.

Referring myself to PHP was the best decision that I have made in my life so far (second to marrying my husband).  It was an easy process to refer myself with an online form followed by a telephone consultation for a further assessment.  I met Dr Eleanor Cole, a Consultant Psychiatrist, a few weeks later and my journey to recover began. I had an initial consultation and she thought that I might benefit with CBT for my anxiety. I commenced CBT with Simon Lyne and had 6 sessions of CBT in total with some follow ups with Dr Cole to check my progress. I went back to work the next rotation and continued my CBT and follow ups with PHP.   I also had regular emails with Dr Kingdon checking on my progress and another support meeting when I returned to work. 

CBT has helped me process the challenges that my life has thrown at me and to change the way I worry about things. I was also given tasks to do in between CBT sessions and was advised to some mindfulness on the ‘Calm’ app to help as well.  I was able to go back to training in a much better mind frame, complete my membership exams and successfully apply for an academic clinical genetics post.  I am forever indebted to all the people that have encouraged me to get help and take time off.  I would like to thank Dr Broughton, Dr Kingdon, Dr Cole and Simon Lyne for the time that they have given me to help me as well as my husband, my family and friends and the Paediatric teams at King’s College and St George’s Hospital who supported my return to work. My one regret during this whole process was not going to PHP prior to my final burn out and I hope this long account of my story will help another trainee seek advice or help sooner. You have to be well to your treat patients, so treat yourself first. 

https://php.nhs.uk/

[recalibr8]

The Kindness Initiative

TL:DR Do one kind thing for you and one kind thing for someone else today. Tell someone about it. Because, that might just change the world.

This post was going to be about the kind things people have done for me at work. It still can be....the cup of tea at 4am, the nurse who scooped me out of the child protection meeting I was sobbing in, the post-it gin and tonic plonked onto my keyboard because the clinic was still going. But then this morning, there was the New Zealand atrocity. My first thoughts were for the people, then their families and finally the perpetrator. How detached from humanity could he be with his manifesto of victimhood and hatred? How detached is he, how much depersonalisation is he carrying, what black hole of kindness is in his soul?

I looked for articles on workplace kindness and doctors. There are quite a few. The best are small and personal, the worst point people besieged by complaints to seek comfort in their duties. Nothing inspired me enough to share with you.

Then there’s this. This works.

“Winning? Is that what you think it’s about? I’m not trying to win. I’m not doing this because I want to beat someone, or because I hate someone, or because I want to blame someone. It’s not because it’s fun. God knows it’s not because it’s easy. It’s not even because it works because it hardly ever does.. I DO WHAT I DO BECAUSE IT’S RIGHT! Because it’s decent! And above all, it’s kind! It’s just that.. Just kind. If I run away today, good people will die. If I stand and fight, some of them might live. Maybe not many, maybe not for long. Hey, you know, maybe there’s no point to any of this at all. But it’s the best I can do. So I’m going to do it. And I will stand here doing it until it kills me. And you’re going to die too! Some day.. And how will that be? Have you thought about it? What would you die for? Who I am is where I stand.. Where I stand is where I fall. Stand with me. These people are terrified. Maybe we can help a little. Why not, just at the end, just be kind?” — The Doctor

Kind to ourselves. Kind to others. There’s lots of talk about ‘ripples’ today. Why not a kindness one? Ok, am I a kind person? I don’t know. I know I’m a level 3 do-gooder (I pick up cold, wet dog poo left by other owners) that’s for sure. But kind? I didn’t return the kindnesses of the people above. I’m too concerned with finishing my work and am clumsy with peoples feelings. What can I do? I’m starting a peer-peer prize completion for trainees called The Guardian’s Angels (being a GOSWH) where I’ll judge nominations for acts of kindness. So I’m hoping to learn what others do. For myself, I’m going to stop feeding my screeching work emails like they were hungry baby birds and not shoving to get off the train at Balham every morning. It’s a start. Send help if I’m walking from Clapham Junction on Monday.

We’re practical people. So let’s DO something. Consciously and conspicuously. We get a chance to make people’s lives better every day yet things seem to be getting worse everywhere. But if there’s the sound of kindness, kindness kindness, it might just drown out the hate. Because what else is there? “Maybe we can help a little. Why not, just at the end, just be kind”...

[recalibr8]

What do YOU want to be when you grow up?

I always ask my tiddly patients about their dream job. This is to help them find a focus for school. But mostly because their ideas are brilliant. This week I’ve met the next generation of gamers, premiership footballers, underwater engineers and a 7 year old who wants to develop a home security system that detects the heart beat of invaders then knocks them out with a laser and calls the police. And an otter. I like her thinking.

But how do you know what you want to be? I’ve heard:

1. Chose the sort of patients you want to be looking after for 30 years or

2. Choose the thing you’re left with after you’ve rejected everything you don’t like or

3. Look at the people doing the job you like and decide if you want to share an office with them for 30 years.

I really really wanted to be a paediatric neurologist. But I’m not. That ‘failure’ sometimes tugs at my sleeve like hungry children. I liked kids, I liked brains and spent a happy year in Australia taking one apart for medical students so I figured it was ideal. I also liked and still like paediatric neurologists who are urbane, funny, kind, sarcastic and brilliant. Also The specialty is filled with words like Opsoclonus Myoclonus, subacute sclerosing panenephalitis and Levetiracetam which you have to be able to say in order to finish your training. They check.

So when I began, I jumped in as a trainee rep for everything, published and presented. My face was everywhere. But over the years I developed a creeping feeling that something wasn’t quite right. Then suddenly, I ground to a halt. Don’t get me wrong, I was still working hard (small hiatus in extra clinic attendance when falling in love and simultaneously doing an evidence based Paeds MSc which was noted, I’m sorry, I was crap). In fact I was working HARDER. I introduced a solo ITU round to troubleshoot which had mixed results but was great learning. I went to every conference. I mentored junior trainees I’m still in touch with. But something was missing and I couldn’t work out why. Working harder didn’t fix it. I have theories that I enjoyed the patient narrative more than the fascinating pathology but I’m not sure. But within 6 months of subspecialty completion I stopped my training. I diverted into neurorehab where I hunkered down for 10 irreplaceable years, got my Paeds liscence and made babies. I was happy but my dad was so upset with my decision he didn’t talk to me for 2 months and came back with a relationship with adult half sister I didn’t know I had. I take from this that everything, even familial disappointment can lead to unexpected reconciliations.

But now I’m doing brains, pharmacology and narrative paediatrics with the fascinating neurodevelopment/behaviour and despite the odd reflection on that decision, I couldn’t be happier. I still hang out with Paeds neurologists from time to time and they are still hilarious and have great hair. Seriously, sit at the back of a neurology lecture and look down. I think it’s a neuroectodermal thing: all that cerebral activity feeding the follicles.

Anyway, I’m signing off a magnificent trainee this week. Watching her career decision making process is a thing of beauty. But she can change her mind. Anyone can. If you’re feeling a creeping sense you’re in the wrong speciality you might be. Or it might be your colleagues or you might just need a holiday. I use lots of neurology as a bedrock to my assessments (although, woah am I out of date) so despite my career redirection, nothing is ever wasted. Talk to a friendly mentor type and I can bet you they’ve been through a horrible career self doubt at some stage. Maybe the switched direction. Maybe they had some biscuits and that fixed it. But there’s no shame. There are lots of famous job changers (Charles Darwin, Graham’s Chapman, Harry Hill etc). I’ve reconciled that I’m not going to have a condition named after me or frankly publish anything any more. But that’s ok. I do other stuff. And medicine is made up by a zillion different things that people do that influence other people that are all equally important even if they don’t look grand. We’re one big spider’s web. And if you’re not going to be a hot subspecialty influencer, tertiary clever clogs or author, that’s totally fine.

This isn’t failure, it’s personal evolution. And the up side is that if you’re really really good at evolution, you might find yourself becoming furry, fierce and cute whilst eating fish....neurologist OR otter then.

[recalibr8]

Dashboard Warning

This time last year all 4 of us got the noro one after another. My youngest was the last. Shouting down the stairs, “daddymummy! I have some sick on my foot”. I dragged up my drained body and sure enough, he had a little splodge on his toes but just beyond that, a whole gastric volume of chocolate and red grapes everywhere else. We’d been watching a Jack the Ripper film and it looked like a dark day for Whitechapel all over the landing.

So this year, no noro but endless colds, a touch of labyrinthitis (this page is hard to pin down right now) and even my greyhound is wearing the cone of shame due to a stitched up paw (not the stitched up poor, that’s a Tory policy). Anyone else sick? It always happens on holiday doesn’t it. Why is that?

It’s so common it has a name. Leisure sickness. Why? Its probably multifactorial (the classic membership answer - let’s call an MDT). It’s the transition from work to leisure. Possibly as our adrenaline levels falls as we turn on our of office or de-scrub, the cortisol levels that have been bobbling along high and suppressing our immunity then peak leaving us open to infection. Also, we are more aware of symptoms we have been suppressing as we’ve battled on. Like everyone coughing during a boring bit in a play, when our attention is captured we don’t notice the little aches and pains. Travelling itself also makes you ill. Airports/planes in particular are filth buckets. Plus people. Being in close quarters with the filth bucket public makes you ill (I’m a filth bucket and proud). But the good news is that as you get older you have more antibodies, allegedly. Here’s an article.

http://www.bbc.com/future/story/20150216-the-truth-about-holiday-illnesses

The trickier bit is what to do with long term symptoms such as fatigue or mental health problems or insomnia. I’ve got one of those. I won’t say what it is. But the long holiday period has made it worse. It’s a bloody nuscience. Makes me lose my rag, too used to making myself Carrie on I guess. Anyway, it’s taken a lot of nagging for me to seek advice. Maybe your New Year res might be to listen to your body when it keeps telling you something. But like we all great at doing our workplace based assessments etc in a timely fashion (lol) maybe checking in with health stuff now when there might be a bit of time to think is a good thing. If you’ve been working all Christmas I’m sorry, I hope you get a break soon. But take that little warning light on your dashboard seriously. Because warnings are there for a reason, and doing something about a false alarms is a bit annoying at the very worst.

Happy New Year, resilience warriors. I know 2019 is going to be brilliant.

[recalibr8]

Put the soup down and walk away, Debra

She wasn’t happy. I couldn’t hear what she was saying but I could feel the volume across the room. S was getting an earful and a half and it wasn’t his fault. Her loved one had died and she was lashing out with the f bomb, the s bomb and a c bomb megaton warhead. He’s not a clinician. He wasn’t responsible. He was calm, polite and put the phone down walked away mid rant. He wasn’t going to tell me what it was about because he was done with it. Sure enough, she rang back....

So much emotion at work this week from colleagues, patients and rellies. Lots of raw anger, petulant tantrums and heartfelt pain. My response in clinic is to run to the sink and get hand towel, apologise for the crunchiness and try to make whoever it is feel better. I do that with my logical descriptions of the situation, my professional experience and as much empathy as I can muster. I try to do this quickly though; appointments are only 30 minutes and we’ve got to keep going. That bit doesn’t make me feel too good. And sometimes it doesn’t do the trick at all and I’ve been called all sorts. Worst is the passive aggressive, ‘thanks anyway’ which I was going to call my autobiography (Thanks Anyway by You People). I then try to think how they must feel. I give them time. And sometimes pointers to counselling or mental health services if needed. But I try not to carry with it with me for the rest of the day and impact on others. And that’s tricky.

But we are all human. And carrying peoples’ anger and sadness along with our own is a big weight. I’ve had cause to remind lots of people this week what we do is emotionally stressful. We forget. But going from bad news, to feeling overwhelmed, to a death to a grumpy colleague who has had all of the above too, it’s a big weight. The fact we’re not all wrecks all the time I think is a credit to our resilience even if we think ours is a bit wobbly.

So do you cry at work? I do. I’m a bit of a emo all round though. One parent always sets me off (but he says he manages do do that to a lot of professionals - he’s just such a diamond). Have I wept with frustration and exhaustion? Yes and yes. Was it professional suicide? No. Once or twice a bit awks but mostly I’m bought a coffee. Do I advise people cry at work. Oh yes. But not the full Niagara, you know that. Shoving it down inside is a short term solution. You know it’s coming back somehow.

All BIG emotions cycle through the familiar stages. I know this has been superseded but it works for sadness, anger, fear as well as grief. Try it.

1. Denial: The initial stage: “It can’t be happening.”

2. Anger: “Why me? It’s not fair.”

3. Bargaining: “Just let me live to see my children graduate.”

4. Depression: “I’m so sad, why bother with anything?”

5. Acceptance: “It’s going to be OK.”

This can happen within a five minute period or a lifetime (I’m still stuck at anger with one of my educational supervisors from 20 years ago...yeah, I know it’s probably time to let it go). And everyone is different but recognising these phases is a start.

For more reading https://positivesharing.com/2008/01/how-to-deal-with-anger-at-work/

But again, don’t forget everyone feels this at various times every day. As long as you don’t act it all out in a big way you’re entitled to your feelings. It’s what makes you, you. The advice about anger I heard once was that it’s like making someone you’re angry with a bowl of poisoned soup and then insisting on drinking it for weeks. Put the soup down and walk away, Debra.

So cut yourself some slack. And others around you, not just the ones you have a professional responsibility for. Because you can’t push the hang up icon on everything. The phone will buzz again sooner or later.

And on that note, there will be fewer of my blog posts as I’m now appointed as Guardian of Safe Working for my Trust. Equally excited and bricking it. So resilience stuff is going to take on a very practical form. My lot, I’ve got you.

Love and kindness; Strength and courage (that’s not Trust values, it’s a Lemon Jelly lyric and very nearly was a tattoo. Now then, there’s another blog...)

[recalibr8]

Three Things

Names three things you love to do...

1. Eat pizza. My teen son is having his birthday party sleepover tonight. He’s grown up enough to order but not old enough to pay. I’m still trying to use that excuse to be fair. I was going to wait until they finished and have any leftovers, but no, I like pizza. I strolled over and brazenly had one (ok three) slices. It was, well, average tbh. But I think I’d put off eating pizza long enough. They are now playing the drumkit so it’s going to be a long night.

We forget to do the things we want. This is because we’re too busy, we think we don’t deserve them and we plain forget what we like. When I do events such as the Health and Wellbeing (or Webbing as my autocorrect keeps making it) Day at our Trust a couple of weeks ago, I give people post-its and ask them that question. Most people panic especially if I’m watching them. But then they get thinking...

2. New pyjamas. I had to buy ‘a unicorn onesie or pink morph suit please mum’ on 5 o’clock on Thursday for breast cancer awareness pink day at school. His response to my reply was ‘you sound a bit angry’. I found a unicorn top and leggings and because I was very pleased with myself in Cath Kidson, pj bottoms featuring otters playing trumpet and fox on sax. Of course. Because pyjamas are soft trousers you can wear in bed! That’s brilliant. The boys are now shouting something something about gaming something.

We had amazing responses from walking, holidays, howling with a dog to gay (best response to a doing question ever). I chat to lots of different professionals but the unifying theme is one of regret. I love watching people remembering what they like to do and if only they could do it more if they had the time. Two caterers reminded each other how much they enjoyed knitting, a group of pharmacy students agreed to go on a museum trip together, a surgeon told me how much she used to love to dance but her son was too small to allow her the time to go out. Some people were sad they were no longer well or young enough to do sports, one was angry that I was reminding them of what they had lost. Some talked about caring for others as the thing they liked doing and found it tricky to think selfishly. And thought hard, remembering the things they loved doing when they finally got home and everyone else they cared for was sorted out for the night.

3. Watching videos of Queen in concert. Oh wow. How could I forget how good they were. He was. Dear Freddie. A lifetime of inspiration. The boys are amazing. They can just sit around and chat now. This means I can legit go to the fridge now and eat his cake.

Just because your job comes with a title doesn’t mean you are always that function. Three things, only three things. Don’t overthink what it is that makes you happy. Life is short. You go back to work better if you’ve been able to see yourself as a whole again.

Ah, they’re playing Cards Against Humanity. I’m opening the fun sized chocolates.

[recalibr8]

Doctors Supporters

Hey everyone, here is my face talking about what we do at Doctors Supporters at BMA. You’re not alone if the GMC comes calling.

Take care of yourselves x

https://www.bma.org.uk/advice/work-life-support/your-wellbeing/doctor-support-service

https://mobile.twitter.com/TheBMA/status/1050068832059047936/video/1

[recalibr8]

Fish Poo

I regularly try to sack my therapist. It’s usually after the summer break because I’ve done alright for a month and then just before Christmas because Christmas. Come September, I swear she stirs up my psychological murk, so she can fix me again. It’s like matter lurking at the bottom of a mildly neglected aquarium. It looks ok. The fish don’t seem to mind. But if you swoosh it around a bit, things get cloudy for a while. I grump because she reminds me I not only need this for my mental health journey, but I need her. Needing people is difficult. 

But I’ve also been stirring this week. It’s beginning of term and I’m asked to do inductions and lunchtime chats on resilience locally and offsite. I am also asked to talk about child death.  Its always a pleasure and completely different each time. I talk from my own experience, throw in some evidence and look to the future using my BMA, Doctor Supporter training.  I’m aware that there may be elements that are upsetting. I know some things can be very difficult indeed to hear. I hope the take home message is hope, kindness and optimism win the day, every day. But I know everyone is going to hear something different.  I leave lots of opportunities to talk during, after and have a weekly drop in session if anyone wants to just chat knowing that an off the record doctor gives a completely different perspective from other professionals.

There have been several brave people wanting to talk this week. I like to think this means that generally clinicians (and non-clinicians too) have felt enabled to chat which is fantastic progress. Doctors don’t want to be seen to be stressed, letting the side down, failing. So, if the conversation about mental health is getting out there and if someone seeks help through this process, that is amazing. I accept recently I might have been bringing a little more than usual earnestness to the presentations too. That’s what makes all teaching so interesting; its not just the material, it’s the person giving it, the place they are in in their heads and the audience. A lot like theatre.

I have PTSD and the word ‘triggering’ is now unfortunately tagged to aggressive social media commentary. Anybody declaring an empathetic interest in something is defensively labelled as a weeping snowflake. I blame 2016. But of course, triggering is absolutely a real thing and dormant memories, moods and traumas can be brought to the surface if we work in the environment that caused the event leading you to feel unsafe. Here is some helpful information on how to recognise common conditions in yourself and others and how to help.

https://www.mind.org.uk/information-support/types-of-mental-health-problems/

I anyone comes to me with stirred up memories and feelings, I will absolutely always suggest that they get professional advice. There is a list of organisations at the top of this page. Don’t forget http://www.dochealth.org.uk/ which is supported by the British Medical Association (BMA) and the Royal Medical Benevolent Fund (RMBF). Its been a tough autumn for a lot of people. But their strength, humour and kindness never stops astounding me. You are all brilliant.

Sometimes stirring is good though. It can make you think of a situation with a different perspective. And we all have a journey. But have someone or there to catch you even if it is on a phone or messenger. I’m a big fan of pets for this too. Greyhound update; my girl is doing fantastically well after her traumatic journey. We have a therapeutic howl together at the end of each day. And more rescue chickens arriving on Sunday. Updates soon. Pets are great. But with my cavalier attitude to aquariums, I probably should never own fish though.

[recalibr8]

Come Back Mrs. Bishop, All is Forgiven

I was uncharacteristically early for the first trial-by-crisps school

event of the year so went out for a quick gin with one of the dads. He

is the financial director of an international bank. Let’s call it

Floyds. His father was an anaesthetist, now long retired. He worked in the

era of the demonstrably dramatic surgeon (throwing scalpels), the

reduced working week (golf on a Wednesday) and silver service in the

senior dining room (this is so unfair isn’t it? I was promised these things!). And Mrs. Bishop. Mrs. Bishop was employed to make

sure that doctors (seniors first, obvs) had enough to eat throughout

the day. She would stick her head round the theatre door, take a

sandwich order and make it up in the staff room. Presumably this was

just before golf on Wednesdays. Bonkers. But also, nice. Mrs Bishop

used to get quite shirty if the doctor did not stop to eat. The poor

woman would go nuts trying to get any of us to sit down and eat now. I had

a Reeces Pieces chocolate cup for lunch on Wednesday then made up for

it 5pm Thursday by eating a whole packet of Colin the Caterpillar (the veggie one with his girlfriend on the packet so it doesn’t count). But a proper lunch? That’s what going to conferences is for, right?

What happened? Did the 1980’s just do for lunches seeing as they

were for wimps? Was it seen as a frippery by public servants, the sort Daily Mail

readers get off on and so therefore banned by management? Or is it

that we just stopped looking after ourselves because we are too busy

looking after other people. A bit of everything I guess. Are doctors

unique? Absolutely not. Do we voluntarily come in at six and leave at

9 ‘just to get this thing done’ day after day. Uhuh. Does this do us any good? Given the state of a lot of us here this week, that’s a hard nope.

OK, so there are days there’s no time and yes, downing tools mid

delivery of twins to eat chipotle is generally frowned upon. But

sometimes we can be Mrs Bishop for our colleagues and bring in a pizza and days we can be

Mrs Bishop for ourselves. Make a positive decision to stop. Because

literally what harm will that do (mostly).

And Mrs Bishop? Who was looking after her. Believe me, I have made up

a lot of interesting ways that she passed her spare time in my

head…but I hope she had someone to make her a sandwich too. A mini Mrs Bishop following her around making sandwiches. Because when the people who constantly and effortlessly absorb the blindsides life brings, when the people who are the invisible threads become unravelled everything can slip away. Care for carers, everyone. Look carefully around, you’ll spot them. Maybe it’s not someone you’ve thought of much before but I bet they’ve thought about you.

Ok. Bit of reflection. I got asked this week whether this resilience

teaching and all this talking me and others do ‘works’. This followed

a lecture I give (I talk about addictions, the epidemic of suicide in

men and how young women are catching up and how we are too ashamed to

ask for help) where as I was leaving, the chair said “Well, enough of

this nonsense, lets get on with real work”. He was about 20% joking I

think.  Well, if one person somewhere stops to have a sandwich, if one

person makes another person a sandwich and if one person decides it IS a all worth it, job done. Because that person might be someone else’s Mrs. Bishop, spider gently spinning and connecting an organisation together even if they themselves don’t know it yet.

I fancy a sandwich now...