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Archive for July, 2011

This is a bit rambly – sorry!

I’ve had a lovely weekend, after getting my result back, and my younger brother and his girlfriend came to stay as my brother turned 21 yesterday. It’s been lovely, catching up and laughing together, and hearing stories from his work at the camp I’ve been involved with for two years, but couldn’t work this year due to starting 5th year. He’s looking after some of the campers I cared for, and love a lot, so I kind of still feel part of it, through him.

I’ve been thinking about validation this weekend as, after getting the all clear with the research project (TAKE THAT, DEPRESSION!), I feel so much calmer, as though I’ve finally proved that I deserve to be in my final year with everyone else, as though the barrier between me has been brought down. I’m no longer marching to a different drum, or doing things in tandem – I’m back on track. For the past few weeks, I’ve  felt like a fraud, still waiting to hear if I’d ticked every box for 4th year, or is I was going to be hauled up again and find myself working out of synch to make it up, again. I feel more validated now, as though I have a right to be where I am.

Seeking and needing validation is tricky territory – very ‘of the world’ as the apostles would say. Since becoming a Christian, this is certainly something I struggle with, when at times, there’s a constant sense of only being as good as your last exam mark or assessment, and I don’t always manage to separate out my requirements as a medical student to hoop-jump and satisfy criteria, with my requirements as a person under God, who needs no other validation or title. Academics are an easy bolt hole in a lot of ways – when I was a teenager, maintaining perfect grades was a good way of convincing myself that things were fine – as long as I could do calculus, what did it matter if my dad had been sat in the ER overnight again, sobering up? I was ostensibly fine. I could differentiate with the best of them. And that stayed with me through university – it took a long time to even start getting away from thinking that God uses a grading system too, or that he lines us up according to ability or worth, with the runts confined to the broom cupboard. My confidence in academics and medical school has certainly taken a dive recently, as has my confidence in most things – so I’m trying hard this week to remember that I don’t need any other paperwork or confirmation, or validation or proof, than that which I get from God. Depression built itself a lovely wall between me and my faith – it’s going to take a while to get all those bricks down again and back to baseline, before moving forward in faith once again.

Feeling on equal footing to everyone else as a Christian has been something I’ve struggled a lot with – one memorable moment was at one of my first services, listening to someone read from Isaiah 40, and panicking as at that time, no, I didn’t really know, I hadn’t really heard and I didn’t have a clue what I was doing, aside from following a pull I couldn’t describe. I sat there feeling like a fraud for not knowing about Jesus and not knowing about God, and wondering if I’d get thrown out if anyone knew just how clueless I was. As someone who came to faith late, I don’t have the stories about sunday school and church holiday camps. I wasn’t raised saying grace before meals or praying before bed. I don’t know a lot of Bible history and I get a bit confused between all the Simons and Peters and Simon-Peters, and all the Johns too. I don’t know the words to the songs the children sing, have no contemporary Christian music on my ipod, don’t really know what to say when I receive communion and get a bit stuck when I’m in a prayer circle and can see that it’s my turn to give something up. I usually feel like I’m running a completely different race, bowling with the bumpers up, cycling with training wheels, swimming with armbands – separated out by a lack of history and a whole lot of uncertainty. It took a long time to realise that if and when I’m standing outside Heaven, St Peter is probably not going to whap out a Bible and say ‘you have ten seconds to find Habbukuk – GO‘ – and that if he does, that’s probably a lot easier than the whole judging of my life etc. Note to self: start preparation for End Times.

This last year gave my self-worth a heart kick in the teeth, to be honest. This week, I got my validation from the medical school and thus can more freely move on and get on, with my last year. Tackling other insecurities isn’t quite as straightforward – it’s not as if I’m going to get an email that says ‘just to let you know, you scored an 88 on being a child of God – above average, but room for improvement. Formal feedback sheets available from the college office’. I’m not entirely sure how I’m going to tackle this, aside from getting back into my Bible and seeking out those verses that tell me that I’m not as unworthy and not as much of an after-thought as I often feel. Psalm 139/Ephesians 1/John 3, here I come…..

One of the first Christian books I read was by AW Tozer  and I remember being completely bemused when he wrote about a mild, meek man who was nothing out of the ordinary, who didn’t break records or the glass ceiling, who didn’t kill himself striving and trying – but who was completely firm in his value, every day, no matter what, due to his inheritance from God. At the time, I didn’t get it – I didn’t understand that our value to God has no bearing on our position in the stock market, our mortgage, our children’s IQ’s or our climbing careers. This is something I am gradually getting to grips with, though breaking a life-long habit of using my CV as my yardstick for worth, is hard. According to my counsellor, I’m pretty typical for someone ‘growing up alcoholically’ (her words, not mine) – in that I was raised with mixed messages and changing promises, with love used as a tool for bartering and being with-held when someone stepped out of line. Without wanting to get too Philip Larkin, those early relationships both mould and marr. Early patterns are hard to break.

So – now that I can stop focussing on ‘worldly validation’ from the likes of the medical school, I’m going to focus the next few weeks on sorting out my own stumbles in seeking validation from God. Let’s see how it goes. Any tips/ideas/maps always greatly appreciated.

In other news – I’ve got a week left on care of the elderly before moving off to GPland for a month. If you’re a praying person, please pray for elderly patients and the staff caring for them – there’s a lot of tough stuff going on for some of them and if it was up to me, I’d take them all home with me and set up a nursing home in my living room. However, as this is somewhat socially contraindicated, prayers from you, and (attempted) attention from me, will have to do.

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YIPPEEE!

I got the results from my research project back today – and I got 88 (which in medical school, is a high B). I am over the moon – I really thought I would be scoring just a pass (60) and that my academic average would be really affected, meaning that getting the job I want next year might have been less likely- now, it seems that I’m still on track. It wasn’t the project I wanted it to be, but, all things covered, I’m pretty pleased – I got through the last year, I got through depression, and now, I don’t have to carry last year with me as I start applying for my first doctoring job. I can breathe easy. I can start to move on.

Thanks to everyone who has encouraged me so much over these last few months, you’ve been fantastic!

Today really is a HALLELUJAH day!

Have a fabulous weekend people!

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I have a lovely friend who has just finished their first full year as a doctor. He is one of my biggest role models – he’s truly kind, very calm, and practically, a brilliant doctor for his stage. We met for a drink earlier and it’s really perked me up. One thing we talked about was the (grim) topic of declaring and certifying patient deaths, which is a task that often falls to junior doctors. At present, doctors get a small additional payment for every certificate they fill in – a small perk for doing a miserable task.

My friend donates all the payment he gets from filling in death certificates to charity.

Other people might go and buy a new handbag (though not my friend!), or put it towards a holiday or a car. He gives it away. He uses the benefit he gains from someone else’s passing, to help someone else.

He is one of my every day heroes.

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I’ve had a bit of a grumpy weekend as I didn’t quite get everything done that I wanted, and last week was just long and tiring, so by the end of it, the last thing I wanted to do was get up at the crack of dawn on Saturday and Sunday to write assignments. At church on Sunday night, I was listening to a sermon on kindness – which is always one of those topics we all think we have covered but are usually more in need of guidance on, than anything. I know I often think, I’ve got kindness down – not patience, never patience – but kindness, surely that’s something I’m pretty ok at?  The crux of it was about showing that you value people by investing time, and effort, and any other resources you might have in them, but for me, this isn’t entirely accurate – in some ways, the people I ‘invest’ my time in give me the most back – I spend an hour visiting a patient with no family, and invest that hour, but the joy I get is worth it. Also, I don’t like the word ‘invest’ – it’s so full of economic suggestion, as though you can chose to invest more in one person whom you value more, than another, and that you expect something concrete in return. I want to be someone who values everyone. I don’t want to invest. I just want to give.

At the end of the day, the faith I follow teaches that we can never repay God for the gifts He gives us – we can never repay it, and He knows that. It’s ok. Breathe a sigh of relief.  When I think of people I would say have ‘invested’ in me this year, they certainly haven’t gained much back, except for the fact that without them, I probably wouldn’t be here to write this. I’ve had a group of people who have got themselves around me when I needed it, who have written encouraging letters and kept me going, who have sat over me and made me eat and waited for me outside doctors appointments and medical school meetings. They’ve listened to me ranting about counselling and hugged me as I cried, and when things got worse, stopped crying altogether, with depression. They invested their time and I can’t repay that. I don’t want to be someone who expects payment when I am someone who needs grace every day, more, every day.

I was speaking with a consultant this week about his view on the assisted suicide bill (don’t even get me started on that) that is once again being brought before Parliament and what he said greatly fitted in with this. He was talking about how you can judge a society on how it treats its weakest and most vulnerable, and I believe this is true, at both a national level, and smaller – I love my church, for how it reaches out to the vulnerable groups in our community, but Britain doesn’t always bring home the bacon when it comes to caring. The best example I’ve seen of ‘Christianity in action’ is my learning disabled small group, where each person is truly valued for who they are, and where I was welcomed, regardless of not knowing the words, or the parables, or the structure.  So often, society places value on those who contribute, who push boundaries and speak out, and leaves those who cannot do this. We enforce our own definition of value on them, and box them in, when really, who are we to weigh and measure each other? This doctor said, ‘ask yourself every day how you value your patients’. I want to value them. I want to care for them. I want to be someone who enables and does not disable, who reaches out and does not hem in. I want the extra mile to be the mile I do every day. I want the extra mile to be the one I am known for.

I have my issues with father figures, as you’ll know, if you’ve read this for a while – but as much as I struggle to accept it in my heart, my faith tells me that we are all children of God, and the egalitarianism was something I fell in love with in the Bible early on – if you can’t sacrifice a bull, a pidgeon is fine, if you can’t bring a pidgeon, some grain is fine.  We are all equally loved, the Jews, the Gentiles, the lame, the blind, the greedy, the lusty, the faith-ful and the faith-less. And as much as we have our value and inheritance in sonship, we also have our burden in sin, equally tarred, equally stained, equally, terribly, in need of redemption. We are equally sinful – the Jews, the Gentiles, the lame, the blind, the greedy, the lusty, the faith-ful and the faith-less. In the teachings I follow, I need Jesus as much as you do, as much as I did yesterday, today, tomorrow and after. I deserve Jesus, as much as you do, as much as we all do and did and will do. Who am I, to give and take value when my own value comes from above?

I’m in counselling again tomorrow. It’s been a bit of a jolt, really as I wasn’t due back in till next week but some timetable issue meant I was put down for tomorrow, which actually works better for me although it’s thrown me a little. I’ve had a month off and it’s been nice, not to have it marking my week, not having to rule out the evening of the day I go as I just won’t be up to much and will be feeling pretty blue. It’s so hard. I’m not looking forward to it. An hour of bravery is sometimes a little tricky to find.

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I’ve done a week and a half on my medicine of the elderly placement so far, and, after a bit of a wobbly start, am loving it. Now that the junior doctor on the ward has realised that I’m actually very willing to do jobs and help her out, she’s become a lot friendlier, and I’m learning a lot on the practical side of things. This is the first attachment in so long where I’ve felt like myself, and it’s good to feel useful too. I finally feel back on track – as though after months of just going through the motions, I’m finally flying again. I’ve been thinking a lot about what it means to be old this week, and in particular, how it is that the majority of people say things like ‘when I go, I want to go quickly‘ and ‘I can’t imagine anything else than gradually declining for years‘ and ‘I can’t imagine anything worse than dementia‘ – and the list goes on – and yet, this is what awaits so many of us. Very few have the fortune of being fully functional to a great age, and then slipping away peacefully without a long slide downhill. These specialist elderly wards are somewhere a lot of us will end up, in the years to come, and where our parents will go before that. These patients are my, your, our, future. Something that’s struck me a lot is that although my generation is often criticised for jumping from one relationship to another, and as a population, it’s got to the stage where more marriages seem to end in divorce than those that make it through, in some ways, this will be a good thing when we’re old – so many of my patients never spent a night alone after they married, often at a young age, and then suddenly, had this huge gap in their lives when their spouse died, and are left, completely asunder, completely bereft, torn in two. They go from having a constant companion, to being terribly alone. It’s hard, being old. I want to help make it less hard. I want to make it easier, better, kinder for them.

I’ve also been thinking a lot on patience this week, after it was covered in the sermon on Sunday. I know that when it comes to myself, and my prayer life, I don’t have much patience – I spent a lot of time when my depression was at its worst stamping my feet (quite literally, and somewhat misguidedly as we live on the second floor – oops) and telling God how fed up of it I was, how I was ready to give in, how I had nothing more to give, or say, or bleed out, and that if things weren’t going to improve – which at the time seemed so unlikely – I just wanted it to stop, dead, myself, dead. Not a lot of patience. Similarly, now, the need to pace myself makes me want to rattle the bars – how long will I need to adhere to all these rules to keep depression at bay? How long will I need to censor everything I’m thinking of doing and ask myself if it’s really in my best interest, or if it will tip me backwards? How long do I have, until I slip back down, how long until the colour starts to fade again and I am lost to the cold of it, once again? I wrote a while back about that feeling of running to keep away from the shadows cast by a setting sun, and that feeling stays with me, as I try and keep in front of depression, on the right side of the horizon, afraid that one day it will overtake me once again. I am thankful every day, that God got me through the worst months, to where I am now, that He gave me back that elusive shard of hope, gone so long, and now, lays a promise of a future at my feet. I am thankful. Hope doesn’t do so well, without patience. I am grateful for days without crying and nights where I fall asleep with ease. I am learning, slowly, to be still. I am learning, slowly, to truly know God.

However, this week has also reminded me that patience towards others is something I am good at, and always has been. I’m good when it comes to working with patients with communication disorders, or cognitive impairment. One of my favourite memories of the SEN camp I worked two years ago (and which my younger brother is working this year – slightly strange) was when I spent an entire day with a participant none of the other staff could manage due to his demanding behaviour – we went on some dodgems a total of 25 times in a row and had a four hour conversation about lego. I still meet up with him regularly, and although I come back exhausted, I love it. I like being with people who just need a bit of extra time – it helps slow me down. I felt quite emotional earlier this week when one of our gentlemen told me that I was the first person to really listen to him (he’s got a lot of speech problems after nerve damage following major head/neck surgery, and is very deaf) as it reminded me that I can do this, and that I have my role and part to play. I’ve still got so much to learn – but it’s good to know that I’m not on the very bottom rung of the ladder.

I’m speaking again at the church group for adults with learning disabilities in two weeks time so am trying to prepare that over the weekend after finishing a case report due on Thursday. I’ve only done the main talk at a meeting once before, so am a bit nervous about it – I’m never quite convinced by the whole ‘anyone can preach the gospel’ thing! I’m trusting that I’ll have a Jeremiah moment and find the right words at the right time, though, and as I’m preaching on Zaccheus and have been offered an 8-foot wooden tree as a prop (apparently the Sunday school in the building we use have fairly regular use for such things….intriguing (or – inTREEging – sorry, couldn’t resist)), what could possibly go wrong?

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This is my first full week on my medicine of the elderly ward (MOE) and to be honest, it’s been a bit hit and miss. The consultant I’m assigned to is never in, there’s a lot of staff changeovers, and the junior doctor on my ward is in her own words ‘not a big fan of keeping an eye on students’ – so to be honest, I was feeling quite demoralised, at a loose end, and not really able to learn much. Half of my marks for this module come from ‘continuous assessment’, which is a bit problematic when no one is taking an interest. I’ve also realised just how big a hit my confidence has taken when it comes to medicine (and frankly, everything)- and I know, that this is irrational, as I’ve passed everything, well,  have been working at this hospital as a volunteer for two years,  have worked with people with communication difficulties most summers since I was sixteen, and am generally a good student – but I still feel as though I can’t do it, as though everything I was and did before my depression is invalid and counts for nothing. I felt a lot more emotionally labile yesterday than I have in quite a while, and it doesn’t help that every time I feel weepy, I start wondering if the depression is coming back, so soon after I finally got rid of it. It’s this horrible feeling of vulnerability, of the ability to be grievously wounded, of being open to being bruised at the core, that I so hate, that seems to be coming a lot at the moment. I’m a bit more hedgehog and a bit less lion, at the moment. I was quite excited about today as I was scheduled to sit in with my consultant in his clinic at the other end of town – but when I got there this morning, he’d cancelled it, so back across town I went, back to the ward, still not having met him. Grrrrrr.

However, I know that much of the success of this placement is down to me, and my attitudes, and in a way, the lack of guidance is good training for my first years as a junior doctor. After traipsing back this morning, I went to different wards until I found someone who didn’t mind me tagging along, did all of the paperwork the doctor had that I could do myself (lots of re-writing drug cards), and then offered to do all of the cognitive examinations that the consultant had requested, which are a bit of a pain to do as they take ages and can upset patients. I feel a lot better now, having been useful, and know that I’m just going to have to push through this, and that with time, my confidence will return, my skills will improve, and I’ll stop wanting to hid in the broom cupboard. Literally.

I’ve also been thinking a lot about my patients – I want to be a positive presence for them, someone who goes the extra mile to make sure they’re ok. It’s tough at times – yesterday I had quite a few patients die, and then found myself comforting one of the ladies’ daughters, feeling fairly out of depth – and I look at the patients I test, who are still aware enough to realise that they’re slipping away, and hate it, and are scared of what the future holds for them, and I so wish I could fix it. There’s so many men on the ward who, after years of being fairly active and caring for a wife, completely went to pieces when she died, started neglecting themselves, drinking too much, not eating, wasting away, after being left, completely bereft and alone, for the first time in half a century. It’s not easy, being old. Those golden years have so much heartache of their own.

I’ve also had some lovely surprises in the last few days – a friend I worked with in America at a special needs summer camp is coming to visit in November, which I am already (probably far too) excited about – she’s awesome to the extreme. The supervisor from my (fairly awful) research project also asked if I want to submit an abstract for a conference, which was a nice surprise as firstly, I thought that they would never want to contact me again (they were bad enough at keeping in touch when I was doing the work), and secondly, as I never thought the project was worth the paper it was printed on, let alone anything else. It feels good to be looking forward – last year, I didn’t really think more than a day in advance, as getting through that day was all I could ask myself to do. Suddenly finding myself looking three months ahead, and seeing a future there, feels good.

After a Psalm-40ish year (minus the patience but with a lot of trying to be still), I’m feeling pretty blessed at the moment – at the moment, I feel as though I’m finally on the same page as God, speaking the same language, painting inside the lines, by the right number. I feel like my faith suddenly has a bit more direction – I’ve come through my first dark night of the soul, and emerged, a new song in my mouth, still standing. I found a branch to hold on to. I’m not floundering in the dark, quite as much as I used to. I’m not saying it’ll be easy – but the sense of being on a map, being on track, is comforting.  Let’s see where it goes.

*PMA stands for Positive Mental Attitude!

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I met one of my church friends for coffee yesterday. She’s just back from her first mission trip to Belaruss, and is pretty fired up. She’s also one of the first friends I made at church, and the only good friend who stayed in the right place and didn’t move somewhere else fairly soon after the friendship was cemented – and for this reason, I really value the time I spend with her. She’s pretty different to me as she’s an art student, and is a minister’s daughter so has never had the same anxiety I’ve had with respect to church culture, or being new to faith, but I think our differences are why we get on so well. We were talking about how our church sometimes uses its size as an excuse not to be welcoming – as though there are so many obstacles in the way that they just don’t always bother too much. It took both of us well over a year to settle in, and certainly my own experience hasn’t always been that positive, which if you’ve read this for a while, you’ll know. We’ve put some ideas together about how to improve this, and it’s going to take  little time, a bit more confidence, and a lot of trust in God – but more about that another day.

We also had a fairly in depth conversation about depression, which was a bit unexpected –  her flatmates are a year behind me in Medical school, and are on their psychiatry block at the moment, and, like all of us do, find it difficult. It was a bit surreal, as there are so few people who know about my own depression – usually, if I need to explain why I’ve been ill, the excuse I’ve used has been glandular fever as this accounts for my tiredness, weight-loss, and is much more accepted and less susceptible to the rumour mill which is rife amongst students, than depression is. I’m not always proud of the lie – but certainly at the time, it seemed the best option, and did make things easier. The other students and doctors I was on placement with last year weren’t always that understanding or accepting of patient with mental health problems, so I didn’t really want to fly the flag for myself, and after the fairly disastrous result of confiding in someone I thought I could trust at church about my depression, there was no way I was going to be honest about it with other people there. I’ve got closer to K, this friend, through this year though, and she is someone who, had my illness been starting up now, I think I would have trusted with it – and she’s one of the few people I truly feel awful about lying to, and very aware that there’s a very obvious solution to that.

Talking with K made me think a lot – she talked about being afraid of mental illness, as, quite rightly, you lose a sense of self, and your usual coping mechanisms, and can’t do much to improve it, aside from follow doctors’ advice, and promise that you’ll get through the day, every day. My greatest fear now is that if it comes back, I won’t be able to beat it again – I won’t have the ability, or the energy, or the trust that I’ll get through again. I set this blog up mostly for myself, to give me space to get things out of my head, and down on paper (so to speak), but it’s also for people in the same boat, who need to know they’re not as alone as depression tends to make you feel – but it seems that I could be doing this in ‘real life’ as well, by being honest about my experience, and knowing that there might be someone at the back listening who’s out of their depth and out on a limb. I have a horrible, niggling feeling that God is wanting me to use my experiences and speak out – if not straight away, then in the future. It’s true that I’ve always been interested in student welfare in particular, and I have a CV to prove it – but using myself as an example, as a poster girl, is pretty different to what I’ve done before. I don’t want to think that there’s someone sitting at church in front of me in real time and six months behind me in terms of depression, who’s going home crying as I was, who’s convinced that their faith is no more than a coat-hanger for their rapidly diminishing hope, as I was, but statistics suggest that there probably is someone like that, in a church that size. And I have a choice, whether to speak truthfully, when the right situation presents itself (and they always do) – or keep quiet, and know that by being silent, I am just reinforcing the walls around someone else, instead of breaking them down.

Part of me wonders how the conversation would have gone, if I had said, ‘that post viral thing I had, wasn’t post viral at all, it was depression, but I came through it, as most people do‘. Stereotypes only change when they’re challenged and taboos only diminish when they’re discussed. Being a Christian with depression is tough. I want to be part of the solution. Depression is now part of my history, part of my faith, a scar on my skin, a mark on my map. I thank God every day for keeping me alive through it – but as James’ book says (I love James), what good are words or faith without actions? I’ve got a choice now, as to whether I paint over the last year, or actively use it as a testimony to God’s hand in my life. Faith without action is a dead faith. Seems the choice is a clear one.

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