Archive for September, 2011

I’ve got a few posts kicking around in my head but thought I’d start with a more personal, less gungo-ho theology one for now. I headed home for a visit this weekend as it’s unlikely I’ll be back before Christmas, to collect my winter coat and check in with my parents and brother. It’s been a really busy week on my attachment, with a lot of 12 hour days without breaks- but also really good and I’ve learned a lot, and have got to scrub in on a lot of surgeries too, which is always fun – but I was pretty knackered by the time I was on the four hour journey South.

Home as always, is strange. There is so much that my family don’t know about me, that sometimes it really does feel like I’m playing to the crowds, and after a fairly painful discussion about family stuff in counselling last week (is it ever, not painful?), I was dreading it and feeling pretty vulnerable. On Friday night once everyone had gone to bed, I was in my childhood bedroom, looking out at the night sky from a darkened room, as I did so often when I was younger, wondering how it was that the sky was so peaceful, when inside our walls, everything was chaotically falling to pieces. I feel so empty, so two-dimensional, when I am here. My old room in many ways is a catalogue of who I was – the list of grades needed for every medical school in the UK, which I pinned up three years in advance to spur me on, is still there, and now, a year from qualifying, it’s odd to look and realise that I’m so close to my childhood dream. The photos of the first learning disabilities respite camp I worked, age 16, are still there – and I’m still involved with similar things. The stack of thank-you cards from the Brownie unit I helped to lead, and used as an escape, is still there. The photos from the sixthform ball, me awkward in a balldress and heels, are there, despite the fact that the evening ended in tears when I ended up, as usual, being the ‘responsible’ one calling the parents of people who drank too much and were sick in the floor, further fuelling a complete fear of alcohol that would tar the future years with uncertainty and mistrust. The books on the shelf suggest that even then, I was painfully searching for answers, something to explain what I was seeing and thinking and feeling, something to help me get over and get through. Jostein Gaarder, my fifteen-year-old self owes you a debt. My old room almost feels as though it’s in mourning for something I can’t quite place.  Being back reminds me of how much I hated those last years at home, of how desperate I was, for such a long time. It reminds me of how young, and vulnerable, and afraid I was, how lost and alone and bruised, I was and to some extent, still am.

It’s pretty much five years to the day since I moved up to University and every year around this time, I think back to what that meant. For me, the thought of escaping and starting over, was intoxicating. I’d been ticking off the months till I was predicted to leave, for three years. I couldn’t wait to get away from it and find people ‘like me’ who wanted to change the world and change it whilst sober. The reality was a little different; my first week in medical school landed me in a horrific tutorial on alcoholism met with (probably fairly typical) bad attitudes from the other students and I literally was like a rabbit in the headlights, running away, so needing to find somewhere, anywhere, that alcohol and its damage couldn’t get me. I was so upset I ended up catching the first train I could, regardless of destination, and spent a day wandering around a city I didn’t know, just trying to get some peace and sort my head out before realising that I was truly on my own, not knowing anyone, and that I had no choice but to pull myself together and head back. I returned, headed out with a group from my halls, and churlishly drank more than I ever had (not hard, as I’d not really touched it at all before then), and ever will, to try and push through. If you can’t beat them, join them, after all. It was awful. My medical career did not get off to a sparkling start. Fortunately, it got better.

Now, I am five years on, stronger, older, wiser, though often, it doesn’t really seem that way. I don’t want the next decade to be as hard as this one has been. I don’t want to lose more time. I don’t want to still feel so caught and tethered by the things that bring me down. At twenty-three, there is still plenty of room for life to throw things at me that will knock and hurt me; if I’m going to manage, I want to be free of the weights my family life hung about my shoulders. Going home still wears me down and makes me feel fainter about the edges, as though if I’m not careful, I’ll fade into the wallpaper and cease to exist. It still makes me feel masked and costumed, concealed and false. When I was eighteen, the thought of being stuck in a room talking about my issues scared the daylights out of me. It still does, but I do it.I’m learning. I just hope that I’m learning enough.

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I’m on a general surgery attachment this month, and am with the emergency team this week so have been spending long days clerking patients and following surgeons as they charge round the hospital. As ever, I’ve had a high volume of patients with serious problems induced by alcohol, which longterm readers will know is something I struggle a lot with. This time, however, I’ve literally been the first person to assess them before I’ve handed over to my seniors, and there’s a responsibility, and opportunity, that comes with that.

Something I’ve noticed is that ‘problem drinkers’ tend to fall into one of two categories; they either are completely adament that they are ‘not an alcoholic‘, that they can stop when they want, and that this somehow makes them ‘better’ than others they see labelled in that way – or, as soon as you meet them, they tell you that they are an alcoholic, in this defeated way that suggests that they kind of know that not much is going to be done, aside from patching them up and shipping them home again. It’s as though the second group think that if they own up, we’ll tar them with a coat of hopelessness, and give up on them. We won’t fight for them. We’ll leave them be to carry on, which is probably a lot easier and less scary, than sorting their problems out. Sadly, this is often what happens; most healthcare workers only see the problem of the ‘revolving door’ patient, who comes in again and again, and never seems to change, regardless of whether it’s an issue of access to help, or ability to ask for it. I want to be someone who has time.

The interesting thing is that often these patients, in either group, don’t have the right label for themselves, at all – dependancy, afterall, is a syndrome, characterised by both physical (such as withdrawal symptoms) and more psychological aspects (such as narrowed repertoire, and salience of alcohol over other substances and past-times). I ended up having a long conversations with two of my patients, one of which lead to him realising that he does in fact have a dependancy on alcohol, and is quite a long way past the ‘social drinker’ he had classed himself as – and the other with someone who is a longstanding ‘known alcoholic’, trying to get to the bottom of what else could be done to help, and work out why it is that he’s got such a poor view of himself that he didn’t think anyone would bother to help him sort his drinking out in the first place. I guess a learning point here is that often we don’t have accurate views of ourselves, whether by lack of awareness, denial, or selfloathing. We sometimes need another perspective to get things straight. We all do this to some extent.

As always, I found talking to these patients hard to do, – and as always, every time I speak with a person with substance misuse issues, I think of my dad, and the years we all lost to his drinking, and all the hang-ups I’ve garnered from them – but I was also glad to be there, as someone  supernummary who has a bit of extra time to spend with patients, and doesn’t just fob them off as a no-hope case. I was glad to be there, getting the story out in the open, listening to the reasons they had drank more than usual, and being able to answer honestly, about what they were doing to their health. I was glad to be there to stick up for them when I reported back, as I like to think someone might have stuck up for my dad when he was at his illest, and not just stuck him in a corner to sober up. If we don’t stick up for them, they will never get the help they need. If we don’t stick up for them, they’ll keep that revolving door swinging until one day, they die before their time. I know that it’s so easy to get ‘compassion fatigue’ when you’re working in a busy unit with a high turnover, and are always on the go, but I want to help combat this.  My dad probably wouldn’t be alive today, if someone hadn’t help us get him into rehab, when they did. He’s alive because someone had the time to help and the time to care. I don’t want to find one day that I have someone’s blood on my hands (figuratively, but possibly literally given my line of work) – because I didn’t care enough. I want to make sure other people get another chance. As a Christian, I’m only too aware of how much we all need second chances. The God I follow, is a God of second, and third, and seventy-seventh chances. If I’m going to follow, I need to be a person who gives these chances too, as well as receiving them.

I know that it’s likely I may always have shaky moments when I’m managing these sorts of patients. I know that sometimes, when I’m already fraught and tired and emotional, it may break me a little, for a while, and make me cry in a corner somewhere, for a while. It’s one of my struggles, one of my wounds. We all have them. It reminded me of this post here. But I also know that I’m learning, all the time. I’m learning. And sometimes, I think that’s the best we can hope for, the best we can aim for. As long as I keep learning, I’ll be fine.

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I sing in a girls voice choir. More specifically, I sing in a non-auditioning choir that I personally founded, together with  a music teacher friend who in his own words ‘likes a challenge’. In the last two years,  it’s grown from being a madcap idea, to a firm university fixture, with biannual concerts, over a hundred students singing, and sell-out concerts. Choir is something I am so proud of, and I’ve loved leading it for the last two years. Now, I’ve handed it over and am no longer involved in choosing music, arranging socials, or sorting the finance – and it’s been a bit of a wrench. I’m someone who, for better or worse, needs projects. I’d decided to really try and let the new committee do it their way, and not stick my oar in – but I also really miss it. I miss being in the loop and being at the forefront of decisions. It’s been a great community – there’s something about single-gender groups that you just don’t get when you mix, much as I love my male friends.

Anyway, I bumped into the new president this week, and was asking how all the arranging’s going and if everything’s in place for when the new term starts. She asked me if I was coming to the committee meeting, and I said that I didn’t want to step on any toes or get in the way (which realistically, I may well do, as I care about it so much) – when she said –

‘but we WANT you there! We will always WANT you there – there is a Char-shaped space in choir that will never go away! And you are the only one who fits in that space. We want you there.’

Sometimes I think the most powerful words we have, are things like this. Everyone needs to hear those words – I want you, there, I want you, here, I need, we need, you to be with us. There is a job, a role, a space, a void, that only you can fill. When you’re not here, we are not who we were. We are not who we should be. We are not complete.

This was something I hadn’t realised I needed to hear – this last year, I’ve had to step back from a lot of things (choir was the only thing I kept up exactly as I had before), and at times, I’ve felt replaceable, and un-missed, and unimportant. Depression made me feel completely missable – that if I lost to it and gave up, no one would notice and nothing would be changed. It made me feel pretty worthless, and stuff like that takes a while to shift. Slow-grow.  I don’t always feel like I have a firm place in my different communities, whether it’s the medical school, my church, or the other groups I’m involved with – I don’t always feel that they miss me when I’m not there, or that God put me in there for a reason, for a task that no one else is quite suited for.

To be clear, it’s not about achievement, either – it’s just about knowing that your voice counts, that your hands have a task and your personality is there to make a difference. I guess it’s about having enough self-awareness, or self-love, or whatever you want to call it, to realise that you’ve got a part to play in this whole vendetta of living, that your name is in a book somewhere, written on a wall somewhere, etched on someones heart, somewhere.  It’s about knowing that there’s a little bit of land, a space, a gap, just for you, a perfect fit, that no one else can fill.

This reminded me firstly that God has me where I am for a reason, even if sometimes I don’t see it, but also that if we’re going to encourage others, the place to start is where we tell them how much we need them and want them there alongside us. To bring up Lord Kitchener again, it’s all about the YOU being the biggest word there – we need YOU. We want YOU here. Not the person to your right, not the person to your left, not the taller one, the smaller one, the cleverer one, the funnier one. You. It doesn’t matter, that I’ve spent two years ending emails to choir with a statement that every voice is wanted and needed. I needed to hear it myself. Once again, I am not ‘practising what I preach’. Room for improvement. I’m learning.

If you’re reading this, someone wants you here, too.

And just to round off, here is my favourite song we’ve sang so far  (it’s not us in the video obviously, it’s some mixed group, but it’s still beautiful)

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This week I had a ‘first’ in my life as a medic. I had a young woman come to see me in my ‘student surgery at the GP’s last week with a first presentation of depression. I’d taken a history, done the questionnaire etc, and suggested some medication (and referred for psychotherapy), checked everything with the GP, who agreed, and we asked her to come back in ten days to see if she improved. Because my allocated psychiatry block was with an intensive home team, and how my other placements have happened to fall, I’ve never actually seen someone with mental health problems improve in a clinical setting. When she came in again on Friday, it was like seeing a completely different person. It really did seem like a miracle. Antidepressants, when you get the right one, for the right person, at the right dose, really are life-changing. She wasn’t crying, she wasn’t thinking about killing herself, she was sleeping and eating better, all round, it was so good to see. Such a difference to how she was before. Incredible. She was also really thankful that we’d managed to sort her symptoms out; I felt like I’d been part of making a difference. It’s a good feeling. Obviously, this person will still have a long way to go before she’s fully back to ‘normal’ – but hopefully she’ll get there a bit sooner than I did!

This made me think about two things:

1) I sometimes let my own experience of antidepressants colour my view of them – seeing a clear case where they actually significantly helped someone, has sort of renewed my faith in them as options that actually can work. I get a bit cross when they’re handed out like sweets as an easy option, but it’s good to remember that there is an evidence base behind them, they do work, and they do make a difference, and it’s not just that other options are more expensive to deliver. If I am going to give hope to my patients, I need to have hope myself that these drugs will work for them, some of them, anyway.

2) I gave up on antidepressants. I clearly wasn’t given the right one for me, and had a horrific six months of putting the dose up, and up, and then stopping it myself as it completely accelerated my dangerous thinking and gave me a tremor that frankly scared me senseless. The second time it was increased, I didn’t eat anything at all for four days and only realised that when I fainted and was asked when I’d last eaten- that’s how out of synch it made me. I wasn’t fortunate enough, like so many are not, to get put on the right one. And when I lost faith in fluoxetine, I lost faith in all of them. I was afraid to try another one in case it also pushed me close to the edge. I was too scared to use something else psychoactive. Sometimes, I wish I had been braver – I was not brave. I was more scared than I’ve ever been. Sometimes, I wonder if this whole episode would have lasted the full year it has, had I been put on citalopram or sertraline from the word ‘go’ – I’ll never know that. I only know that doing it cold, was tough – but I didn’t really have anyone encouraging me to try it another way.

People ask me sometimes how I manage being ‘hard core into science’, and a Christian. I love science; I love being involved in research and finding new things out. My specialist areas are across neurodegeneration, plasticity, and molecular genetics, and I love learning about how our bodies work on the most intricate level. I love that someone worked out what’s going wrong in a disease, and someone else engineered a drug to target that mistake. These things only strengthen my faith; when I see someone improve as I did this week, it’s as though I’m seeing the tools God has given us to start to put right all the stuff that’s wrong, all that’s not ‘good’. God so often gives us the keys we need to set things right. For me, science is a big part of that. Medicines, are a big part of that. I’m not saying they’re the only solution, at all – but it’s been good to remember this week that often they are a big part, of a solution. When science works, it’s pretty cool.

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