Helping people breathe

Life is pretty busy at the moment – I’m doing anaesthetics this week so working for as long as there’s operations going on, essentially, and trying to sort my job application at the same time. Anaesthetics isn’t for me – I’d rather be the surgeon doing the cutting than the anaesthetist enabling them to operate – but it is interesting. I intubated my first patient this week, and am enjoying getting to learn more and more practical skills – I feel like I’m finally really learning the ‘tools of the trade’. And I’m not going to lie – helping them put a tracheostomy tube in was pretty AWESOME. I’ve written before that I love medicine, but it’s things like this that really make me rejoice and thank God for guiding clever clogs through the centuries – we can keep someone alive. We can breathe for someone. When you need it, someone will literally breathe for you. That’s pretty amazing.

Counselling on Monday was pretty rough; she’d not had time to read back through everything so I didn’t get feedback, despite being a complete bag of nerves all week over it. So, I have another week to wait. Part of it is that although she’s pretty much duty-bound to do the whole unconditional positive approach or whatever, I don’t really believe it. I’m still, even now, as ever, set to this stance of incredible negativity, which only gets worse when I’m a bit emotional as I am at the moment. I’m half expecting her to tell me I’m a hopeless case and that I’ll never achieve that all elusive balance. I’m half expecting her to tell me I’m wasting everyone’s time and just need to get over myself.

I’m so tired at the moment, which is not that surprising as I’m doing long hospital days, followed by a few hours of studying, and then repeating ad infinitum, but I am just feeling so very drained. It’s tough with F and her pathway through possible depression at the moment, particularly as I’m the only student on my block and literally go all day without seeing any peers, and then come home to a fairly grim flat. I’m feeling a bit shut off at the moment. I’ve just got too much in my head at the moment. Between my job application (due in a week on Friday) and everything else, I’m just feeling stretched. I’m also feeling a lot more anxious than usual which is starting to worry me (ironically) – whether it’s just that I’ve had some pretty harsh clinical tutors recently who have really dinted my confidence is hard to say, but I’m not enjoying the whole racing heart, light-headed thing. I need to be working at the top of my game. Strangely, I’m very good in actual high stress situations – I can get cannulas in quickly and helped resuscitate someone today – it’s just there in the background, more of a confidence in the small things problem, as when I actually really need to step up, I can. I’m putting it down to a stressful few weeks, and am hoping that once my application is done, I’ll breathe easy again.

One thing I’ve thought about this last week is that my prayer journal has changed in the last while, for the better. Every Sunday, I write at the top of my notes things that I’ve done that week, and things I need to pray for in the coming week. For most of last year, there were big lists of bad things that were happening, and long lists of stuff I was worried or scared of, and not very many positives. Now, although I still worry about counselling and don’t enjoy the meetings at the med school I have to go to, finally the list is becoming more positive, more reflective of who I am. This week, a student going to Londond for next year asked if he could start a branch of my visiting programme down there, which is fantastic, and tonight is the AGM for the neurology interest group I chair, which has done a good job this last year. I’m advertising the medical school mentoring scheme, which is my new pet project, tomorrow to the second years, and have a wedding to go to on Saturday; all good things that remind me that although I lost a great deal last year, I am slowly regaining it back and am still the person I always was. It’s good to feel that the balance is finally tipping back to normal, even though I know I still have a few miles to go. These things keep me going. They keep me breathing.

I’ve written before that I struggle with keeping my ‘busy-ness at bay’ – but sometimes, I am so grateful for it, as it reminds me that I make a difference and make a change to how things are around me. I need that anchoring at times. It helps me focus on what I’m doing and why. When I spend a Sunday visiting one of my old folks in hospital, part of the joy is that I know their family is feeling that bit easier as they aren’t spending another day alone. They breathe easier. Similarly, my mentoring scheme will help younger students who are battling with academics and their own issues – it will help them breathe easier. This is all what I want to do – as a medic, I want to, obviously, ventilate with the best of them and get people through crippling illnesses. But as a Christian, my goal is more simple. I want to lighten loads and lend a hand and find solutions. I want the world to breathe a little easier. I want things to hurt a little less.

We all need help to breathe, sometimes.

 

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Tales from the ITU

I’ve been on the intensive care unit this last week. It’s been a mixed experience as I’ve enjoyed learning about the specialty, and am always amazed with what medicine can do, even after studying it for six years. It also reminds me of God, as despite years of geniuses beavering away, science has still not fully worked out how to do as good a job as our kidneys, hearts and lungs so of keeping us all alive. Technology is no match for divine design – but it does come in handy when things go wrong!

It’s also been hard, as by pure coincidence, all of the patients I was allocated to died – which although is obviously quite a common outcome, was still just bad luck, really. This too, is a part of life and a part of the profession I am entering, but it doesn’t make it any easier to listen to the sound of pure grieving from behind a curtain once the machines have been turned off and the chaplain has left the family to mourn. I was listening and thinking that there are certain sounds you know that by choice, you would never hear again, and the sound of a mother crying for her dead (adult) child, is definitely one of them – but this is something I am going to be a part of for the rest of my working life. It was the sound of a heart breaking, of hope, breaking. It was the sound of a life changing. It was the sound of something coming to a close.

ITU is a great equaliser, in many ways. Humans are bloody fragile. We may be marvellous products of creation and evolution, but that doesn’t change the fact that when you’re sedated, intubated, ventilated, and dialysed, there is something so vulnerable about every last one of us. I never got to speak with any of my charges this week as they were all incapable of communicating, whether due to sedation or ventilation – but I felt like I got to know them, nonetheless. I met their families. I occasionally caught their facial expressions and eyes. It makes me sad when at times it seemed they were being treated like  a pile of failing organs, not a person – but I can also understand that at the end of the day, this is probably what long-term staff must do, in order to do their jobs. When my patients died, the process of turning off everything and removing all the tubes seemed like a strange ritual, brutal, final. I found myself mourning people I had never truly met. I found myself crying (in the changing rooms, anyway) for men and women I did not know and never would. It’s been an emotional week. I’m looking forward to getting back to a specialty where I actually get to talk to my patients; I’ve missed it, this week.

When I got my first offer of a place at medical school, aged seventeen, I went to a bookstore and used some hard-earned babysitting money to buy some medical books. The ones that stand out are the memoirs of a junior doctor which at the time scared the living daylights out of me, and a medical history book about the most significant advances of the last century. One of these was the invention of manual ventilation, which was first trialled in a big group in Copenhagen in the 1930’s, when there was a huge polio epidemic that pretty much wiped out the cities children. Medical students from all over Europe travelled there to sit at a child’s bedside and manually ventilate them with a bag and mask, for days on end, until their respiratory muscles recovered enough to let them breathe on their own. How amazing is that? At the time, the thought that someone not far from my stage, had sat and squeezed a bag to save a life, made a huge impact. It’s still one of my favourite ‘medical anecdotes’.  I love the fact that we can keep people alive who even twenty years ago, would have died. I love that we can give another chance and get people through to recovery. I feel so priviledged that I get the chance to learn how to do things like this. Even if I was a little bit terrified when they asked me to fiddle with the ventilator settings.

Tomorrow I’ve got counselling and will be getting the feedback from L about how I’m doing and what I need to focus on to ‘move forward’. Frankly, I’m pretty scared. I had keyed myself up for asking for a quick run-down last week, but not quite anticipated an indepth analysis that I’d have to wait a week for. I have a feeling it’s going to be pretty painful. I’m feeling fragile enough right now that I’m not sure how I’ll cope with it, to be honest. Tomorrow is also the day my job application opens so I’ve got two weeks of misery until it’s submitted. I’m still a bit sore that I didn’t get the chance for an academic job due to last year, and am  really feeling the stress at the moment, between placement, impending exams, problems with my flatmate (see last post), counselling, church stuff and ongoing issues with student finance (who have got to be the most annoying organisation in history). All in all, I’m feeling pretty fragile. Last week was the first one where I’ve cried every day, for quite a while. I’m just a bit drained at the moment. But, in three weeks, my job application will be done and so will my exams. Two more hurdles over.

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The unwelcome visitor

Things in my flat have been quite stressful recently. In the last few weeks it’s become increasingly clear that my flatmate F, who is one of my best friends, may be clinically depressed as opposed to just grumpy after a difficult internship. It’s been pretty hard, seeing her struggle and we finally had a big talk this week about what we’ll do about it. It’s been hard, these last few weeks; while my personal brand of depression just had me emotionally labile and dangerously introspective, F gets grumpier and angrier by the day. I kind of feel like I’m taking the blows for it. She’s my main ‘person’ – I don’t have family members I can phone after a hard day, really. When she’s off with me, I’m off with myself. Such is the nature of true friendship.

I guess this is where my ‘patient experience’ comes into its own. Most of our conversation revolved around her not wanting to go to the GP (to which I say, what do you have to lose? And – no one LIKES going to the doctors. It’s not a playground, after all), or wanting to wait a bit (to which I say, what do you gain from waiting? There’s a reason that they use a 2-week cut-off for treatment, as once you’ve been low for a fortnight, you’re unlikely to perk up without a boost from somewhere else. The drugs, if that’s the right option, take a few weeks to work – what do you gain from waiting?). I understand all of this – I understand not wanting to go, I understand wanting to just wait it out, to ‘man-up’. Depression isn’t about manning up, however, and thinking you can just get a stiffer upper lip and be fine, is an insult to anyone who’s ever been there. As Sylvia Plath wrote, I have seen the bottom and I know it. I’ve said before that I’m not sure I could last another year like this one. But neither could I bear to see F go through that either. It drove me crazy at times that neither of my flatmates really understood what having depression is like (the perennial, ‘can’t you just cheer up’ line was infuriating to the extreme), but now, I’m desperate that it stays that way. I don’t want her, to know what it’s like. I don’t want her to know what it is to feel disconnected and blank, to feel alone and beyond reach and under water. I don’t want her to hurt the way it made me hurt.

This has thrown me a bit; on the one hand, I’m glad I’m here to insist she gets help if she needs it, but I’m also worried, or a little bereft, that just as my own depression finally seemed to fade, it’s wormed its way back into my life in full force once again. Part of me is also, secretly, a little angry – I never had anyone pushing me to go and get help until I was so far gone that I gave even a seasoned GP a bit of a shock. I never had anyone who really knew how to manage someone with depression to make sure I was on track and who knew how to check in properly. Like the patient at the GP’s, once again I’m thinking about why it was that my own ‘journey’ took so long, why the drugs didn’t work despite all the praying and the crying and the changing. Was I less deserving of recovery? Was I in need of so great a lesson that it would take twelve months to learn? Am I less of a priority, more of a liability?

Ahh, depression, you are such an unwelcome visitor in my home! Like a stubborn houseguest that wreaks havoc with your thermostat settings and leaves trails of crumbs for the mice to follow, it turns our lives upside down. It permeates the air and dampens our spirits. It sands us down to fragments of what we were. This is no smoothing of rough edges or honing of souls; it just destroys. It moved in and now won’t let me move its feet from under the table. It’s made me feel quite emotional, these last few days – not quite wringing hands and yelling ‘WHY GOD, WHY?’ but also not desperately far from that. Although I know that this is not really something I am ‘in charge’ of, it still kind of feels like that. It just makes me feel a bit vulnerable. I know that life is all about the mountains and the canyons and the highs and the lows and whatever – but at the moment, I’d be willing to give up a few mountains, just to be on an even keel (or, by extension, a prairie) for a while. I’ve had a year now of feeling tied to depression, quite literally – tied down, tied out of, tied up – and this kind of makes me think it’s never going to stop. It’s always going to be stuck to my shadow. It’s always going to be under my roof. It’s one pernicious, unwelcome visitor.

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Stuff I’m scared to say

I’ve got counselling again on Monday. It kind of feels like it’s getting to crunchtime in a way. And there’s still some stuff I haven’t really talked about, because I don’t know how to. I don’t know how to begin. So I’m going to give it a trial run, here. I’ve also got to change my tack and course pretty quickly as it’s become clearer and clearer in the last few weeks that my flatmate needs a lot of attention at the moment, but more about that another time.

I think part of it is that I want to know what L (counsellor) thinks about me but at the same time, I’m terrified of this. I want to know if she thinks I’ll actually get over and through all this, or if I’m going to be one of those people who get caught in mental health services and diagnoses, and never leave. I don’t want to be walking with a label for the rest of my life. I want this year to be a blip on the radar, not the start of a whole lot of crazy. I’m scared to know what she says. I have to know what she says.

Sometimes I can’t decide if I’m incredibly self-centred, or incredibly other-centred. My first (disastrous) counsellor told me that I was so codependant I would never have a ‘normal’ relationship (yup, she said that). The blog however sometimes feels self-indulgent, and this last year has certainly made me re-evaluate how I often don’t value my own health and needs against those of others. I don’t know whether it’s better to run around after other people until I collapse, which is how the last few weeks have felt, or to stand and guard my heart and put myself first, as I’m learning, occasionally, to do. For some reason, I just can never seem to get the right balance. It’s as though I was born with a weight on one shoe, or something. I’m always off-kilter. I’m always left of the middle.

Despite the fact I’m seeing a church-based, Christian counsellor, and have a blog where I basically write about either depression or God, L and I never talk about faith. In many ways, I am a hushed sort of evangelist, a bit of a fraud. I’m pretty eloquent on paper, but tend to stumble if I try to speak about what I believe. My faith is so close to my core, and so close to the heart of my depression; I don’t know how to explain or describe how painful it was to feel so separated, both from God, and from everyone. I sort of think I need to cover this; if I’m going to grow in faith, if I’m ever going to have any sort of leading role in the church, I need to be ok at talking about it. Counselling sounds like an obvious place to sort that. And yet, I’m afraid. I don’t quite trust her, with that layer of myself. I’ve sort of realised recently that my ‘spiritual needs’ aren’t that well met; although I have some wonderful supporters on this blog (who probably don’t realise just how much their prayers mean to me), I don’t get much ‘in real life’; since my trust was spectacularly broken last year, it’s taken a while to trust the church again.

Last Sunday, I was praying with my head down and feeling pretty crowded out, when a women I didn’t know, who was just visiting for the evening, asked if she could pray for me. I’m afraid of prayer from others, sometimes; I’ve had too many experiences of people thinking they can say something hurtful just because they’ve put a ‘God-stamp’ on it. In the two years I’ve been at my church, no one has ever asked if they can pray for me. For most of those two years, I’ve also been too afraid, or depressed, to ask.

But last week, it reminded me so strongly of why it is that the Bible says that when there’s more than two of you together, He’s also there. It’s that kind of synergistic energy you suddenly feel when someone has a hand on your back and prays you back on track. It’s that kind of triangulation between you, another person and God, that helps you work out where you stand and where you’re going. It’s that need we all have for someone to ask for the things we can’t ask for ourselves. I think I need this. Faith, any faith, isn’t just a personal thing; it’s a remoulding, a remodelling of who you are. As it deepens, you start to tesselate with people on the same path; there’s a space for you, a space only, for you. And if you’re not slotting in, you’re just a shape on your own, outwith the big picture, not quite fitting into your surroundings.

I’m feeling a bit overwhelmed at the moment, between job applications, family stuff, flatmate stuff, placement stuff and God stuff – despite lots of attempts to find some peace and quiet, it’s just not really working at the moment; I’m going by the still waters but am not really feeling that restored. Hopefully this will pass. Love, char48.

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