Archive for July, 2011

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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After three days of lectures, I’ve now started my medicine of the elderly placement on the ward I’ll be based on for the next four weeks. I think it’s going to be a bit mixed – I know that I’m going to like spending time with patients, and medically, it’s going to be very useful as they’ve all got about fifteen different diseases and are on a shedload of medications, so I’m learning a lot, but it’s also made me think about the doctor I will be, fairly soon. The team I’m attached to are lovely, they really are – but they are also very pragmatic in their approach to some of the more cognitively impaired patients. I know that when you’re rushed off your feet, there’s not much time to tell someone for the thousandth time that no, they’re not going home, or no, they’re not in Florida, they’re in the hospital – but it’s not that busy a unit, there’s a lot of coffee breaks and long lunchtimes, and when they just whip past someone, I find myself questionning it.

I’ve done more than enough volunteering on MOE wards, in this specific hospital, that I know how difficult and frustrating it can be to have circular conversations with folk that don’t go anywhere – but I don’t want to be someone who just walks by because they think explaining yet again is a waste of time. I want to be someone who makes time. I want to be someone who never forgets that every patient here is a mother, a wife, a sister, a father, a grandparent. My grandparents received atrocious care in the hospital they both died in; if the staff couldn’t be bothered to spot overwhelming sepsis, I very much doubt they took the time to sit and talk to my grandparents when they were in there. None of the staff when we visited knew their names, let alone who we were. Sometimes I think that it’s only by prioritising the little things that you will remember to do them – a little bit ‘look after the pennies and the pounds will look after themselves’, as my gran used to say. I don’t want to be someone who shuts the door of the doctors room for a bit of peace and quiet, I don’t want to be someone who passes a patient by because they are confused enough that they won’t remember the conversation. I want to be a doctor who knows the names of their grandchildren and how they met their husband or wife, who takes the time to say, every time, over and over, that they aren’t going home just yet, and why. I want to be the doctor who obviously knows them, when I talk to the family, and isn’t scrambling for their name, or diagnosis. I want to be a doctor who is known for compassion. I don’t want to forget.

So – what have I done so far? I’ve done an MMSE (test of memory) on pretty much every patient with pretty variable results, had three of the old men ask for my hand in marriage (respectfully declined), and as I didn’t have anything timetabled this afternoon, spent it watching Jeremy Kyle with a lady of 96 (her choice, not mine, classic comment ‘in my day, marriage was for life and intercourse was for marriage, what do they think they’re doing?’). My heart breaks for some of them – the ones who are so very desperate to go back to their own homes, but will never get that as they’re too ill and too confused, the lady who asks repeatedly for her husband, who died 20 years ago, the man who cries as he can’t write a sentence anymore, after a massive stroke – they are our future, our family. It makes me so angry that there are so many cuts to services for the elderly – it takes about four weeks for a referral to social services to come through, and after that, a similar amount of time to get care packages in place so that they can leave hospital. We should be honouring them, we should be proud to lighten their load and care for the generation that brought us peace and freedom, and then kept it. I, as a young woman training to be a professional, owe a lot to these older generations.

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