Archive for October, 2011

I’m coming to the end of my stint in Accident and Emergency, and although it’s been hectic, frantic, difficult, and I’ve not had much time at all to stop and think, let alone pray, I’ve actually felt quite close to God these last few days. I was working the nightshift over the weekend, and was aware that it was going to challenge me as, at the end of the day, our Friday night culture is pretty focussed on binge-drinking, and the ER is where they all end up, being assessed by people like me, with a white coat flapping round my knees, stethoscope poking out of a back pocket.

After a pretty labile week, I was dreading these shifts a great deal. I prayed on my way in that God would show me how to best use my hands, and be of use.On my way in, I found myself praying that whatever came through the door, God would show me how to use my hands and be of use. I prayed for strength to get through, and compassion to help treat my patients as well as possible. That prayer was answered. Although my head found certain things difficult, my hands never stopped helping.

My nights didn’t get off to the best start; within ten minutes, I’d been projectile vomited on by a woman I was trying to mop up a bit, leading to a change of scrubs and coat and derision from the nurses, and pretty much the minute I stepped back into the ER, I got covered in blood after trying to put a drip in someone on bloodthinners, as they jerked their arm halfway through. After changing once again (surgeon en route saying ‘weren’t you covered in a different bodily fluid like….ten minutes ago…are you going for some kind of record…?’), I managed to keep my white coat clean till morning, and the hours passed in a blur of seizures, overdoses, falls from heights, heart attacks, and of course, the angry, drunken, injured masses, bleeding on floors, shouting at staff, and dozing in corners. My hands were kept busy, though at times, my heart was heavy.

When I think of practising medicine, I think of doing it with my hands – percussing chests, feeling pulses, testing coordination. I think of my hands getting method-memory at how to position IV lines, feeling bellies, and test joint stability. Obviously, medicine is also about listening, and speaking, and hearing – but so often, it’s the palm on a shoulder that patients are comforted by. It’s the fingers that push pain meds through their line, that quiets them. It’s the hands that compress their chest, that keep them alive. It’s a practical profession.

These are the hands that stitched up bleeding heads, sampled a lot of blood gases, and put in more cannulas (drips) than I could count. These are the hands that held the hands of an old man whose wife lay dying. These are the hands that were squeezed in solidarity as a broken leg was straightened. These are the hands I use to learn my trade. These are the hands God gives me, to love my patients. These are my hands.

I have moments, sometimes, where I look at what I’m doing, and wonder if it’s been worth six years to get my basic medical degree, and at least another ten, before I am near the top of whatever training scheme I chose – I spent two hours peeling a dressing off an infected leg yesterday, which to be honest, is a job anyone with a strong stomach, could do.  Then, however, come the rare moments,  that remind me that I am exactly where I want to be, in both the good, speak-easy weeks, and the ones which challenge and threaten to break me down. It’s those rare but beautiful moments of true connection, of one hand on one shoulder, of one person comforting another, that make me love the path I have chosen more than anything. It’s those fleeting experiences where I can put all of my knowledge and training into practise, to help someone, whether it’s by explaining a bit about chemotherapy, or how a chest drain works, or just listening to their story, that remind me that being in medical school is the best gift I’ve ever been given. These are my hands. These are God’s, hands.

When I am working with my hands, my head is less busy and less chaotic; it focusses on the task, and blinds everything else out. Last week, with its triggers and tempers, I benefitted from being able to switch off, though as always, there’s only so long I can go before I start to crack a little. Now, I just need to get through my next exam on Friday, before I really collapse. By my calculation, this is then 29th exam I have sat since starting medical school and not including my year out to do a BSc. No wonder I’m tired….

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First off, my ‘date’ yesterday afternoon was really rather nice. I think I’d like to see him again.  I’ll stop before this gets too schmalzy.

Some things this week have been tough, though. I know I am prone to a lot of introspection, but I think that this week with all the other things going on (job application: finally submitted!) has led to me thinking more than ever about mental health, and my own path through it. More specifically, after seeing pretty quickly that 30% of beds on accident/emergency are perpetually filled by overdoses, self-injurers and suicide attempts, it’s made me question what made me, to put it bluntly, manage to hold on when I was at my lowest. I don’t always know the answer to that. I don’t know what separates me, from the people who come in to the ER and sadly never leave. I don’t know why I was brought out, and they were not. I do not know. Sometimes, I think it’s mostly because I was too scared that if I tried anything, I’d end up being treated in this same ER, with my peers on placement peeking at me round a curtain. It was the potential for shame, that kept me alive.

But on the other hand, I’m kind of struggling with having a flatmate (and best friend) who is now being started on treatment for mid-grade depression. I encouraged her to go back to the doctor’s this week for follow-up and afterwards,  and was trying to explain that she shouldn’t assume that her medication won’t work just because mine didn’t, but just ended up frustrated. I think part of it is that when I really really needed someone to hold my hand through things, there was no one quite up to the job. I know I asked her, at one point, to phone and make an appointment with the psychiatrist I’d been referred to for me, as I just couldn’t face it, and I needed her to go and fetch the number, and do it, there and then and take that task from me. I needed her to do it and give me a date and a time, and make sure I went. I couldn’t face it myself. No one rang for me, and so I never went. No one encouraged me to go back and see another doctor, or keep taking medication. With depression, you sometimes need someone to take charge and just force your hand; I think they were unsure or afraid or doing that; perhaps it seemed too difficult. I fought my way out of last year without medication or psychiatric input, or anything much, really, and am still reeling from it. I’m still not back to where I was. I don’t know if I’ll ever get there.

And I want so badly for this first, low dose to work for her. I want her to be one of the ‘miracle cures’. I’m praying for it. But I also am just so bogged down with wondering why it did not work for me, why I was less worthy, or deserving, or able of mending myself. I ended up on three times the starting dose, and it was never right. I’m helping guide her through it, but that small part of me is angry that I had no-one who knew enough, or was confident enough, to tell me, show me, how to get through depression. My flatmates were not medical and did not know. I know it doesn’t mean at all that they didn’t care – but sometimes, caring isn’t quite enough. Sometimes you need action and motion. It’s hard. Sometimes, I feel like I’m always leading the way or teaching from my experiences, but having to learn the hard way myself – and I know that’s partly because I hardly make things easy, but by the same token, last year, there were all these people I was having to go and talk to, and to be honest, none of them really did much for me. They didn’t return my emails, or check in. They didn’t chase me up or ask my tutors to keep an eye out. They just looked awkward when I cried at them and promptly forgot me.

And it makes me angry when she says things about counselling not ‘being for her’, as though you have to be a bit self-indulgent or attention-seeking to benefit from it. It makes me feel fobbed off – I’m not sure anyone who has not ‘done counselling’ knows how hard it is, or how much effort and courage it takes to go, every single week. I’m not sure she realises that it’s no easy option. It’s been the most painful experience of my life. Perhaps it’s my fault for never telling anyone that I get there fifteen minutes early so I have time to coax myself through the door, or that it still makes me cry myself to sleep every single week, and leaves me drained – but I don’t appreciate feeling as though I’m a weakling for trying it. I’m a stoic, in many ways. Counselling has gone against all of my instincts and taken away any feeling of safety and privacy I had. It’s not for the faint-hearted.

I guess, in ‘mental health’ terms, this week has just been ‘extremely triggering’. I’m not sure I’d really appreciated stuff like triggers before. I’m on the nightshift this weekend, and spending twelve hours at a time surrounded by drunk people, is wearing me down. However, this time in a week I will have a week’s holiday to look forward to, and I really can’t wait to have a few days away from the city and medicine, where I don’t have to think about all of this.

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Mixed experiences

This post has two parts: a light-hearted part, and a pretty heavy part. Here goes.

I am working in my city’s accident/emergency department at the moment. It’s great, as I’m getting to do lots of skills (I am the ‘cannula monkey’, apparently), and see lots of things – but I also had a shock this week, on my first day, when I was called to the resus room over the tanoy, and then asked if I could start chest compressions on an elderly man whilst the team got stuff ready to shock him.

I’ve done CPR once before, as a very green 16 year old lifeguard, when to be honest, it was such a shock to have to drag someone out of the pool that we were all on autopilot. Then, it was a fifty year old man with an unexpected heart attack – it made sense to try. This time, however, was different. He was 87, with three previous strokes, and a previous heart attack. We stopped after about ten minutes of compressions from me, then a further stint using the automatic compressor (which is officially the most horrific thing I’ve ever seen), and I could hear his ribs breaking. He was brought in so quickly, and the ambulance staff left so quickly, that none of the doctors knew his name. He should have been allowed to die at home, peacefully, but instead, ended up bruised and naked, in the ER. He was allowed to die, at last, whilst we watched his heart trace finally flatline. I held his hand. Not the good death, we are supposed to aim for. CPR is actually much less effective than most people know. Only around 5% are brought back – and of those, many end up dying in ITU, or similar. I ‘m not saying it’s not a wonderful thing – for some patients, it’s a true miracle. However, for most, it’s futile, and barbaric.

This was the first of what I know will be so many deaths I will face as a doctor – but unlike my first successful cannula, or blood gas, or intubation, this is one first I did not look forward to, at all. Sometimes, I think that so much is wrong with how we approach these things – GP’s have targets for managing so many symptoms, yet don’t have to make sure that appropriate patients have DNAR orders. This man probably did not want the treatment we gave him; his wife certainly didn’t. I want to be a doctor who protects rights to a good death, as much as rights to a good life. I want to help my patients die where they want, surrounded by family. I don’t want them to end up cold and broken after a trainee cracks their ribs. I want better for them. As I was doing CPR, my eyes drifted to the clock on the wall, and it was midday – which is when, according to my church’s current project, we are all supposed to pray. And at first, all I wanted was for him to open his eyes and start breathing. All I wanted was a heartbeat. But then, I realised that I truly wanted what was best for him, and that is what I prayed for. I believe, that God delivered on that. I believe he heard me.

Since then, I’ve been a little shaken up; long hours, and particularly bad sleep at the moment make me short tempered and tearful. Counselling on Monday was harder than it’s been for quite a while. I’m a bit overstretched. I’m partly mourning, for a man I did not know.

On a lighter note……..

My other ‘first’ is that tomorrow I am going on an official, real-life, bonafide date. With a boy (or more specifically, a young man who teached maths at the same school the former conductor of my choir also teaches at). I know – who’d have thought, eh? We met at my conductor’s wedding celebration on Saturday, and after a lovely chat, agreed to meet again.

I have never done this before. ‘Terrified’ doesn’t quite cut it, to be honest. My only other ‘serious’ relationship started after I’d known the guy for eighteen months – we didn’t need to do the whole dating, sit down and talk about music and childhood nicknames thing. We knew each other. This, is so different, so strange. Part of me wonders if it’s a good idea – I’m still so wobbly, and have so many ups and downs, that even the scent of a relationship seems badly placed. But on the other hand, it’s nice to be asked – I’m not the sort of girl who turns heads and gets a lot of interest from lads. Most of the ones my age, are a bit intimidated by me. I’m a hopeless romantic, but also often wonder if I’ll ever find someone who matches me, challenges me, but will love me for all my discrepancies and hidden issues. I’m often not that convinced he exists. And being faced with a possibility, no matter how slim, no matter that this is informal and friendly – is a bit scary. I’m not sure how ‘good’ at dating I will be. I’m not sure how ‘good’ I want to be. Here goes.

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First of all, this is apparently my hundreth post – I never thought I’d have enough to say to fill that many! Thanks for sticking with me guys. Let’s see if I’m still writing when I get to the seventy-times-seventh post. I had some thoughts about what my centenary should be about – but then, what follows came up and I felt quite convicted by it, so here we go!

As you will know, I’m a student. I do many student things; I eat dodgy combinations of left-overs, walk three miles to get somewhere to save bus-fare and have a definite penchant for fancy-dress, preferably involving facepaint. My time here at medschool has been shaped mostly by the clubs and societies I’ve been in, lead, and founded, in addition to my studies. Last night was the annual society fundraiser at the union, where every club and society who have people going, are given some money. Now, I’m not a massive fan of clubbing, as so often, it’s dominated by people drinking enough to make me uncomfortable (let alone themselves), and stereotypically, lads who think that drinking five pints gives them a right to grope you (NB it doesn’t). This night is different however, because it’s held for the people with the greatest passion for what they do, the people who hold the fabric of the university together and make our student experience the terrific thing it is. Band geeks and history buffs don’t tend to attempt the drunken grope. They are too busy being dressed as tenor horns and Henry VIII.

I was there last night with my girls voice choir (complete with painted treble clefs on our faces) and have also gone in the past with my patient visiting group (dressed as an old person) and windband (dressed as a clarinet, using some imagination). Although everyone is dressed more than a little ludicrously, I actually love it – it’s about saying, this is what I do with my time, what I love. This is what I think is important. This is what I will encourage you to get involved with. This is my identity, my clan, my family.

I find it interesting when older people say things like ‘I still feel twenty-one’ – when what I think they really mean, is that they still feel passionate, they still feel alive. When you are actually twenty-one, you’re usually still finding your way and working out where you fit with things, and have not yet got the confidence and stability that comes with maturity. It’s actually quite painful, or was, and to some extent still is, for me. But often, we in our early adult lives, are also full of passion and excitement. We are the can-do generation, unladen with children and their ballet classes, mortgages, or elderly parents. We have the freedom to try to change things. We have the freedom to spend three days a week visiting patients in hospital, or to run a concert band. Our lack of ties, whilst sometimes isolating, is also the essence of our abilities. I know that when, or if, I have children, I will chose my son’s football matches over my choir practises, and my daughter’s piano lessons over whatever charity I’m involved with. And this is how I would want it to be – but is also means that now, before that phase, is my chance to make my mark and make a difference.

So often, churches talk about the apathy of the people and how we’ve lost the meaning of the message in between a culture of wanting, and the pull of consumerism. I hear preaching on getting off the treadmill and getting out of our bubble and getting in to our communities.  Last night however, all I could think was that I was in a room full of passionate people intent on making a difference somewhere, whether it’s in running the lacrosse team, raising funds for wells in Africa, reaching out to international students, or publishing the university newspaper. It’s always  inspiring, being in a room of people with conviction, big dreams, and action plans.

I had a ‘Christian first’ recently as I bought the new Tim Hughes album, my first foray into having Christian music on my ipod. The track I’ve posted is a good one for early mornings, but it’s also kind of flawed in labelling current Christians as ‘the freedom generation’; we’ve been the freedom generation since Cavalry. We’ve been free, since the man we follow and sing to and cry to, died on a cross. We are not the freedom generation. We’re a part of the freedom genealogy, the freedom family tree. It’s not about being a twentysomething with little to tie them down and no shackles from taxes and pension plans. It’s about following our hearts and keeping that conviction, that passion to change and better and fix, alive, as we go through the valleys and mountains of our years. I don’t want to lose my can-do spirit or my indefatiguable love of pushing boundaries. I want our freedom family tree to extend until it includes absolutely everyone. I don’t want change to be a task for one generation. I want it to be a task for one, enormous, family.

What are you passionate about?

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