Posts Tagged ‘alcohol’

The gift of a child

I’m just back from a week at home.

Christmas has previously been one of the hardest times of year for me as despite my dad’s current sobriety, of which I am very proud, much of our family gatherings still seem to revolve around alcohol, who’s drinking it, who’s not and why, and an unhealthy dose of finger-pointing. At home, I feel blurred at the edges, out of focus, faded. I’m not myself. It sucks something out of me.

This year however, was so much better than I expected. My older sister (who is working in Australia at the moment) brought over both her current partner, and his six year old daughter, to meet us. Different? Yes, you bet. This child seemed to realign everything, she seemed to shift the focus from the tangled adults, back to her own needs and place in the family. I love children and spent a lot of time with her, convenient for the boyfriend as he was so jetlagged, and my sister who isn’t that maternal.  I already love her. One little Australian girl in a fairy outfit, singing ‘six white boomers’ (officially the most adorable thing I’ve ever seen) refocussed our entire family from anger and disputes, to something altogether kinder. It also gave me something to focus on rather than revision, or medication side effects, or depression so was a blessing in more ways than one.

I think we were more cemented than we’ve been for years. It was the first Christmas day where no one cried, or collapsed, or felt dangerously wooden. It was the first Christmas day where I felt as though there could be a hope for me and my dysfunctional family. It was the first week I’ve had at home in years, where I was a little sad to go.

Here’s a photo of me and my almost-niece:

Of course, this all reminded me of the child who really did change everything for us; as my family are pretty anti-religion, my faith can get a bit drowned out at Christmas; Jesus doesn’t come into this time of year anymore than he does any other period, so I am left trying to keep my mind focussed on what the holiday means, whilst surrounded by a more consumer driven approach. This is my third Christmas as a Christian, and in many ways, the most stable. The first one, when I was just a month into faith, was a pretty confusing time. Last year, I was sick on my first trial of medication and so depressed I thought it was going to be my last Christmas. This year, I am finally more stable on medication, sleeping better, feeling a bit better, and crucially, my faith is still strong, and as always, I think of that baby in a manger and am amazed by the promise he was delivering. I think of the nativity story, and as always, am amazed that most of the people guided to the birth of Christ were pretty run-of-the-mill, normal people; what hope it gives me, as a run-of-the-mill person, that I can also follow on.

I’ll be writing the obligatory new year post at some point in the next few days but in the meantime, I hope you had a wonderful Christmas and wish you every blessing for the coming year.

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I am just back from a lovely break up North, which was all the more wonderful as I’ve been hosting an American friend, and her grandmother, for the week. My friend S is one of those people who seem to have a tattoo across their forehead that says ‘world-changer’. We met working at an American summer camp for people with special needs, four years ago. She is awesome. Sorry for being off the radar, but we’ve not had internet since heading off on Wednesday. This is a little rambly – sorry!

They arrived last Sunday and after getting them settled in, S and I went for icecream (I like that this is the most American thing I have done in living memory) and talked. One of the things I love about her, is that unlike the vast majority of people I know, she has absolutely no fear of the word ‘depression’. She uses it where it should be used. She does not dress is up and make it tapdance so it seems less threatening. She does not brush it off. She does not refer to it as a habit I fell into, or a path I mistakenly went down, or a series of bad judgements. And, in doing this, she makes me feel more separate from depression than I have for so long; often, I think my close friends still mentally prefix me as ‘depressed-Char’, or see it as part of who I am, a part that is here to stay. In naming it so frankly, S called it out. She gave it parameters and borders and drew a line, where depression starts and I began. This is crucial, as for so long, depression made me think that it was indeed, here to stay, that the chapters without it in my life had ended, and that my future was just one bad, sad day after another. It’s taken so long to feel as though I’ve ‘come back’, and returned from wherever depression banished all of my drive and passions and sense of self.

She is also much more frank, and direct than any of my other friends, who know about this year. Not one of my close friends has ever asked me where I’m standing with alcohol when I pass over the wine bottle, or turn in early from yet another party. No one has ever had the courage, or gumption, or wherewithal, to ask where and how I am. In being direct, S made me feel a little less like a modern-day leper, turning away from societal norms. She made me feel like just another person with just another set of issues, rather than someone standing out from the crowd due to everyone else giving a wide berth and ignoring the elephant in the room. S was pretty much riding that elephant, metaphorically speaking. She made me feel less like a problem, and more like a person, with a problem. I am grateful for this. S has been reading this blog, and came halfway across the world to check in with me. If that’s not an expression of friendship, I don’t know what is. So often, depression (and recovery) leaves me feeling alone and bereft, and despised. Friendships like these, are the antidote to that. I’m not sure you can get through depression, or any mental health problem, without a cheer squad.

Depression causes so many problems as we all have our brand of misery, and people who have not met it personally, struggle so greatly to grasp that depression isn’t just a bad day, or even a bad week; it casts a false impression as, afterall, we have all been sad, have we not? We have all cried, and surely, depression isn’t too different from that? And yet, this feeling of false understanding is often the most damaging to people living with it, as we cannot explain how it hurts and scars and takes an age to heal. It’s not just a bad day or a bad week. It’s so much more. My flatmates and close friends are brilliant, but didn’t know how to approach my depression, and as a result, didn’t know how to approach me when I had it. Because of this, I was ashamed, and took to hiding. Having someone who understands that I am separate from it was invaluable. Having someone who understands what it means, helped me begin to heal.

As a firm lover of period dramas, I am still fairly convinced that I truly belong in the eighteenth century, dancing with men in regimentals and doing charitable works in whatever time isn’t spent making jam and embroidering cushions, but I also love that I am living in an age where I can have a friend on the other side of the world, and see them every now and then. I love that I live in a time where ‘goodbye’ rarely means forever, and au revoirs are entirely possible. In just under a year, I will (fingers crossed etc) finally be earning and out of student-dom forever. I’m looking forward to being able to bring home the bacon on some au-revoirs.

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Being the change

So – I’ve got a post about the visit of a dear friend from the special needs camp I worked four years ago, who is visiting from America (with her grandma – and it’s been AMAZING!), but this is just a short one in the meantime.

I had a good meeting with staff today about the medical student mentoring scheme I’m setting up, so am feeling pretty positive. I’m really excited to be a part of improving the experience of struggling students at my university. I love new projects, and am starting the learn that one of my strengths is in moving and shaking things – I love seeing gaps, and filling them. It’s kind of like God gave me a passion for real-life tetris.

However, I’ve also taken a leap of faith this week. After being in accident/emergency, I really felt like I needed to come to a decision about how I will approach alcohol, and patients with related issues, when I practise. In short, this comes down to the ‘man or mouse’ approach – will I run from it and avoid it, or will I look it in the eye, and apply my strengths to making a difference? I want so badly to be a part of the solution, not the problem. I want so badly, for there to be a reduction in alcohol related harm in my city. I want so badly, to get people off the long road of dependancy, before they can’t get off it at all. I know that this choice may strike some as a little foolhardy, and I certainly know that I may find it hard at times – but at the end of the day, I cannot be a doctor who does not manage alcohol, as it affects such a huge proportion of people. And because of that caveat, I am choosing to actively seek opportunities to help change things. I may be part hedgehog, but there will be no mouse in me from now on.

So – I emailed one of the A/E docs whom I have an incredible amount of respect for, and have also had quite a bit of contact with as I’m a medschool rep so have to email staff fairly regularly. I asked if she knew of any focus groups for alcohol issues, and whether they’d welcome a junior member of staff, at some stage.

She replied, copying me into the head of the most appropriate group, and in this email, described me as ‘a truly excellent student’. This actually made me cry a little, as it feels as though I’ve finally got away from the horrors of last year, and after a rocky and unconfident start to fifth year, I am back on track. I am a good student, and someone has recognised that. I am a student who cares, and someone has seen that in me. Last year gave any of my already unsteady self-esteem enough of a kick to the teeth that most of the time, it’s like my radio’s set to a station where the only song playing is ‘I’m not good enough and I can’t do this’, over and over again. That description, which I imagine this doctor didn’t remotely think would mean so much to me, feels like an affirmation. I can do this. I can be part of a change. I can be part of a solution.

I am so thankful to this woman and her unconscious encouragement – but I am also so very thankful to you, my readers, who encourage me every single day. Thanks for sticking with me. I love all of you a lot.

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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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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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