It’s all about the PMA

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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Shepherds and valleys

Last Sunday was the first time I’d been to church in about six weeks, the longest I’ve been away since I started going there two years ago. Having some space has been good for me, but being back also felt right, and as it was the first service that’s not reduced me to tears for about a year, I think both the break, and the return, were well timed.

The pastor was preaching on Psalm 23, which must be the most famous, and beloved, passage of the entire Bible. It’s a psalm we learn as children, a psalm we grow up with, either in church communities, or on film and in books, as it’s the passage so often fished out for both the joyous, and the not-so-joyous occasions. It’s about the shepherd-God, the King who takes a position reserved for the most lowly, the poorest boys who have no option but to chase their flock over mountains and valleys, no option but to sleep in the open and cook over a campfire, no pay, except the wools and skins from the animals so tenderly cared for. It’s about the tireless worker, guiding his charges, binding sore feet, and counting, counting, counting their number to make sure none have gone astray.

One thing he said was that it’s when we find ourselves in the valley of the shadow of death (or, VOTSOD) as I always think of it, never underestimate the power of a good abbreviation etc) – that we feel God most closely guiding us.

I  don’t really agree with this.

In my experience, and if you’ve read previous posts, you’ll know that I don’t believe that the distance between us and God changes at all – it’s out perception that does, our interpretation that always comes up wanting. When I was, quite literally, walking with the shadow of death, I was desperately trying to find God, any God, any where, in the mess I was in thanks to a hefty bout of depression. I was scouring the horizons and praying for hours, and searching, searching, for this shepherd who was supposed to be guiding me, and yet, the skies just seemed completely empty. There was no-one there beside me. There was no footprint next to mine, in the valley. There was no shadow up front to guide my way. My faith turned to one dependant on hope – surely, one day, all those promises would find their way to me and I’d find a bundle of hope with my name on it just when it was needed, surely, this elusive God I’d madcaply tried to follow would turn towards me and gather me, as a lost sheep into his arms. Surely, surely, one day, that day, would come. Depression cuts you off so acutely from the world; it convinces you that you have no part in it, it severs any connections to people and places, it steals hopes and dreams and aspirations and leaves you with nothing except an angry energy that won’t sit still, a nervy desire to get out of your own head, out of your skin, at all costs. I felt cut off. I felt alone and abandoned, in the valley.

It’s now that I am (hopefully, gratefully) coming out of the other side of this year, that I realise that the shepherd was there all along, though I could not see him, through all my panicking. It’s now that I’m on steadier ground, that the promises and gifts of God come into focus, that I see clearly, that He IS faithful, and WAS faithful, and WILL BE faithful. I am, that I am. It’s now that I am out of danger that I understand that Psalm 23 is both antero-, and retro-spective, in my opinion – it may be the truth, but it’s not about the experience of the VOTSOD. It may be what you believe will be the case before the tough times hit you, and it may be what you realise afterwards, but in the eye of the storm, you still feel on your own.

I guess what all this comes back to is that the inconstancies are all on our side; God’s distance never falters, his presence never falters, but our perceptions do – and they are what follow through each day. As the writer of the book of Hebrews put it, ‘faith is the substance of things hoped for, the evidence of things unseen’. Its foundations on human weakness and tendency to wander make it fragile and malleable but its focus on God, who is strong and unchanging, make it beautiful. Psalm 23 is a passage that has relevance to me before, during and after those hard times. The image of the shepherd is one of my favourites in the Bible. This is a flock I am happy to be in.

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The Journey of a thousand miles….

…..begins with a single step, according to Lau tzu. It’s been a busy few days, and reader, now that my exams are a fortnight away, and my hand-in for my research project a week later, you will need to prepare yourself for a broken-record sort of blog for a while.

On Wednesday I went to a clinic to hand out some questionnaires for my project. My supervisors (who volunteer to have students, by the way) have discouraged me from doing clinic work since the start, mainly, as far as I can see, because they couldn’t be bothered to show me the ropes. As I’ve been feeling generally ill and run down this week, I was dreading it – I’ve come to hate this project and deadline, that has really ruled me for the last few months, and caused so much stress. However, I was pleasantly surprised, as the specialist nurse was lovely and very helpful, and most of the patients were keen to fill out my questionnaire, and as it’s not a department that get many medical students (it’s a very specific subspecialty), a lot of them were really interested in talking to me, and hearing what I had to say. It’s given me a real boost – which seems daft, as all I did was explain my project and send them off with stamped envelopes to post them back to me, but it reminded me that actually, I’m quite good at what I’m learning to do, I’m good at connecting with people and I truly want to be a doctor who makes a difference. This project has a long way to go until it’s finished, but at least this week, there was something positive that came out of it, which certainly hasn’t been the case for a while.

Now that I’m in exam-mode again, it’s easier to see that I have come a long way since my last set at the beginning of February; I can actually sit and concentrate for a couple of hours, and retain something, whereas back then, I wasn’t taking in anything at all, and was just sitting and either staring into space, or crying. I’m still not sure how I passed as well as I did. Whether it’s because I’m doing specialties that interest me a lot at the moment, or just that my mood is finally lifting a little, I’m enjoying learning again, even though after putting in about twelve hours most days, I’m ready to put down the books and sleep. I love learning, and when I just couldn’t do it, I couldn’t quite handle it, as so much of my identity revolves around studying and applying knowledge. It’s good to find the thirst for it again, even if I still have quite a lot of wobbles.

It’s pretty much a full year now, since I started sliding into depression, and though sometimes, I resent the time that has been stolen from me, I know that I need to look forward and not back. I’ve lost a year, so far, and I don’t want to lose more if I can help it. I want to enter my final year of medical school with a clean slate, without anything hanging over me. Feeling strongly enough to want something, also seems like a breakthrough. I still have my apathetic days, but just knowing that behind it all, I’ve still got that glimmer of what I was before this, a glimpse of what makes me who I am, is a relief. It’s good to be feeling 3D again after being flat for so long.

I’ve been in counselling for about eight weeks now, I think – I’ve managed to stick it out longer than the first time I tried, three years ago, and it’s strange how it’s become a part of my week – not precisely a welcome part, but there regardless. Sometimes I think it’s strange that it’s so much harder talking about something than living through it – it’s so much harder revisiting it, than being up against it in real time. And though I’ll never be a fan of pop psychology, I am learning from it, slowly, painfully but learning nonetheless.

So – it’s been an ‘ok’ few days, which I’m grateful for – here’s just hoping I get everything I’ve set myself to do, completed by the end of the weekend. The even keel is a nice place to be, even just for a little while.

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In the middle of the night, two hearts beat

I had another night shift on the labour ward on Friday night, and it was quite surreal. I assisted with a c-section on a mum-to-be who had laboured for 24 hours, saw a ‘normal’ delivery with another couple, and then spent six hours with a couple as they progressed from early labour, to prolonged labour, to a terrifying emergency situation where, as the midwife ran to get the medical team, I was left holding the hand of this mother, hoping and praying that her baby would make it through. After a lot of intervention, her baby was born, and there was a horrible, silent fifteen seconds or so where he didn’t cry, and just lay there, blue and still. From now on, hearing a baby cry means so much more to me. I don’t think I’ve ever thanked God quite so much. It shook me up a bit, to be honest.

In the gap between the two, I went up to the post-natal ward to check in on some of the mums and babies I’ve helped with earlier in the week. One of the midwives asked me to feed a baby for her, so I had an hour or so with a total cutie in my arms, just the two of us, together. His mother is a methadone and heroin user, (and he will be taken into care) so this little lad was born premature and with all the extra problems of being dependant on drugs. He was so small, just over five pounds, his feet dwarfed by the feet of his orange baby-grow that just highlighted his jaundice all the more. He lay against me and snuggled in, suckled on a syringe full of ‘first feed’ and then fell asleep gripping my finger in both tiny hands. I don’t think I’ve ever felt so protective of something. When you are holding a baby, you are holding something more valuable than the greatest of riches. When you are holding a baby, you are letting them know that they are not alone, that someone’s heart is beating right there, close to theirs. This little man has a tough life ahead of him; from the day of his birth, the odds are already stacked against him. He lay against me sleeping, not knowing the adversity he will be up against, but I do hope that somehow, someday, he might know that for that hour we spent together, someone loved him from the moment they saw him. I hope he knows, if and when things get hard, that there are people around him who will pitch in and help him over the hurdles. It’s things like this that I so want to change – I want all children to be born with an equal footing, I want them to grow up nurtured and wanted and treasured, I want them to have someone there when they fall, and cry, and ache. I think I need to be some form paediatrician, in all honestly, or heavily involved in child welfare some other way!

Psalm 139 is one of my, and most other Christians, favourites. I thought of it last night as I held him, about how God has known us since we were babes in the womb, how he is with us, alongside us, every step of the way. He knew me, and you, when we had little hair on our heads, the smallest of fingernails, and eyes that couldn’t help but stare at the strange world around us. He knew what we would grow to be, and what we would struggle with. He knew where we would cross paths with each other, and fall away. I thought about how small we are compared to God, how defenseless and uncertain.I thought of the Israelites depending on God each day for Manna, as babies depend on their mothers for milk. I thought about how this little lad slept, not knowing that it would have taken little persuasion for me to actually carry him off home (don’t worry, I really will not ever turn to kidnapping, no matter how tempting), how he nestled against me, not knowing that for that hour, I could feel myself loving him, could see myself forgiving him anything, could imagine putting myself inbetween him and anything the world could throw at us. Our hearts were there, beating against each other.  So many of us are like this with God in that we don’t know, or accept, or remember his love. He loves us as children of his own, which is probably a lot more strongly than the love  a young medical student has for a baby in the middle of the night on a quiet hospital ward. He loves us, from our first and weakest breaths, through the growing pains and rebellions, the dirt and the dust. Near or far from him, he loves us. His heart beats with ours, it beats for ours. Loving – so easy sometimes, isn’t it? Yet when we find it hard to love, it is so hard to change that feeling. If only all loving were easy.

I see L again (counsellor) tomorrow and have thought of it a lot today. I decided to write something and read it, to try and get over the fact that once I get inside that room, words just seem to fail me a lot of the time. I’ve never written something with a view for a particular person to read it, with the exception of letters to over-seas friends, and this is different. I’ve certainly never read anything I’ve written aloud. When I write, the words just seem to flow in a way they never will verbally. I am, as usual, anxious about going. Sometimes, I feel like God is revealing things I need to learn so frequently – he puts all these people in my way, he gives me babies to hold that remind me of Psalms and homeless men to feed who remind me of Hebrews – but sometimes I wonder if I’m acting on all of these things, or just thinking on them. I want to be an actions-not-just-words person. I want to be a faith-by-example person. It’s difficult to live up to expectations, sometimes. I know that, no matter how hard it feels, that He must be in this whole counselling thing too, and that there are probably a lot of messages from Him I’m ignoring by choice. I want to get through this, but learning, as always, is hard.

I’ve been blogging about a month now, and am so glad I took the plunge and started. Some of the comments I’ve had have really built me up, and it’s been so good to stumble across people who have walked a similar path to mine, and come through. The world feels smaller, somehow. I feel really blessed. I hope that if you’ve been reading this a while, that you’re getting something from it, because knowing that you’ve stopped by, is such a gift to me. Love, Char48.

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