Why I like toddlers with tantrums

Alongside all the up-in-the-airness of the last few weeks, paediatrics has been really quite lovely. I love children. A baby can get me smiling when frankly, little else will. I had a nice week on neonates, essentially following a doctor and sticking my pinky in babies’ mouths to comfort them whilst they got prodded and poked – and loved it. The hard side of paeds, is, of course, when children get exposed to things they shouldn’t be, whether that’s a serious illness, family hardship and disputes, or more sinister things like abuse. We see all of this – and nothing makes me question those big questions about life and fairness and morality, quite like an abandoned, disabled baby with a history of neglect, does, and such complex needs that few fosterparents will consider them. Some people just are not born with fair chances. I hate that.

One of the things people associate with toddlers and small children are the temper tantrums over trivial things – but for me, this is a good thing. Firstly because I’m patient and young enough that screaming children don’t put me off and don’t make me love them less – but also because when a child is crying because they didn’t get their choice of ice-cream, or DVD, or jumper, or whatever – it means they’re still shielded from the worse parts of the world. It means they are still innocent from the badness and hardship that happens to everyone, eventually. When a child doesn’t cry at those things, because they are frequently  beaten, or hurt, or demeaned, and used to real pain, that’s so much worse. When they stop crying when you take blood because they’ve been through so many painful procedures, it’s so much worse than when they do. It’s difficult, seeing these babies with what the professionals call ‘frozen watchfullness’, before they’ve learned to smile. It’s hard, hearing the sound of a baby withdrawing from methadone, which is the most heartbreaking thing I’ve ever heard. It’s hard, seeing the photographs and hearing the stories about the depths to which human cruelty can reach.

We all ‘grow up’ at some point. When I was at school, I remember being jealous of all the other kids who didn’t have a father that drank himself silly or was always on the cusp of violence. I envied their freedom and security. The petty disputes meant less to me, as I had so much more to handle. The arguments over boys, meant less, when I was spending evenings visiting in rehab, or hiding the whisky bottles, or making sure my younger brother was ok. I sometimes think that I grew up far too quickly, and missed a lot of milestones due to my families difficulties, and then started going backwards once I hit 21, and tried to see if drinking the same as everyone else would make me feel less different. It didn’t make me feel less different. It made me feel more alone, as no one else struggled with it as I did. Both drinking and not-drinking isolated me for a long time. My early experiences coloured everything and made me see things in a different light.

I have a happy-ish medium now, in that I am confident in choosing not to drink when I don’t want to, but can also enjoy a glass of wine occasionally without starting to panic about following in family footsteps. This has probably been the single best thing that’s happened this year, as having a healthier attitude towards drinking makes so many things easier. And yes, my early experiences do mean that sometimes I find it harder than others, and that I’m not comfortable around people who have drank a lot, and am actually quite scared of them – but I get by. I’ve found a vague balance.

I was back at the GP’s today, and she really is a good, lovely doctor. She asked me if I’d had bouts of depression before, and now, it’s easier to see that I have had periods of low mood, probably since I was sixteen, if not longer. And when she asked why I hadn’t seen anyone, all I could say was that my family was preoccupied with other things, and no one noticed that I was fading into the background. No one noticed at all. As for me, I thought it was normal, and it wasn’t until recently that I read my old journals, that I realised just how sad and lost I was, so determined to escape. It wasn’t until I came away that I realised just how hard my family life is.

I don’t remotely suggest that my own childhood even comes close to some of the things unfortunate children go through – but I do mourn, when I see that something has stolen their childhood from them irreparably, I do mourn, when I see that they are forced to grow up too soon and act in ways beyond their age. I wish that all every child had to cry about, was the wrong sort of icecream. I wish that all every teenager had to worry about, was whether some boy knew their name. We don’t live in a world of fair chances.

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When the drugs actually work….

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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Work in Progress

Today I went on a home visit with one of the GP’s to see a very old man, in his nursing home. Before we got out of the car, the GP turned to me and said, the picture of nonchalence, ‘by the way – he might ask us to euthanise him – just so you know. He asks every time we visit him.‘

Sure enough, this man, who is over a hundred, with no living family, no friends to visit him, and incredibly frail health, started asking about what it means to die, and when it would come, and could we, please, please doctor, help him, now, right now? And of course, we sat and told him that we couldn’t do that, and that we didn’t know when death would come, but that when it did, we hoped it would be peaceful.  And he talked, for a long time, about what lay behind in his youth, and what lay ahead, in his dying, and the loneliness in the room was so heavy it felt like we were sitting in thick fog. Then, the time came for us to go and move on to another patient, and it made me wish, as I do so many days, that I was training to be a magician, rather than a doctor. There’s just aren’t enough magic wands in medicine. I wish there were more.

It’s things like this that remind me how good the church, or any similar group, for that matter, can be. Now that our communities lack the cohesiveness and closeness of the past, it falls to groups like the church to come in and reach out, and keep people connected. I’d like to think that if this man was a member of my church, that someone would be going to see him, taking him Communion, dedicating time to those questions that are still for him, so painfully unanswered. Patients in hospital have access to chaplains and ministers; it’s when they leave, that they so often are left lonelier than ever. I’ve been so proud to see the student charity I founded two years ago grow, to be able to provide regular visitors to elderly patients across three hospitals, if they don’t have family to come and see them – but there are so many older people alone in their homes, that we can’t reach. It’s painful. I want to do more. I want it to be better. There are so many gaps in society that I want to help fill. I know that I can’t fill them all. None of us, can fill them all.

 It’s things like today that make me want to go and shout from the rooftops that until we have a society that has a place for every person in it, we have no society at all. We talk about the community of church, so often, and yes, it’s fantastic, the things that happen when a group of people get under a steepled roof and lift up their hands and cast upwards their eyes, but does any of it matter, if we’re not taking it to those places that need it the most? Does any of it matter, if there’s still an old man, lonely, or a young mother, not managing, or dare I say, a student, dropping off the edge of depression? The people most on the outside are the ones most in need, and hardest to reach. There are so many places that just need someone alongside someone else. There are so many places that just need a hand ontop of a hand, a heart beating next to a heart.

We all know that according to Genesis, one day, God looked at this world and said that simply, it was ‘good’. For now, I’ll pass over God’s extensive use of the understatement.

Now – forgive me if, thanks to my hazy knowledge of the Bible, I’m off the mark here, but from what I know, God’s not said that, since. Our world is not being looked at and passed as ‘ok’. Can you imagine what the world would look like if God still thought it was ‘good’? I’m not sure I can. It’s so far away, from what I have seen. And I know, that Jesus changed everything and set the wheels in motion for it being ok, more than ok even – perfect – I know, that before Jesus we were living in a spiritual cemetery, and without Jesus, we’re still sitting amongst the gravestones – but our world is still not good. We, are still not good. No matter what you believe, we can do better. We need to do better. We need to sort this stuff out. We need to figure out how to stay connected. We need to figure out, how to get our hand on top of the hand that is shaking. We need to figure out, how to get our heart beating next to the heart that is failing.

Let’s all try and figure out, how we can do better. We’re all works in progress.

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Leadership lessons

On Monday, I met my friend E for a drink and a chat, but came away with a little more than I’d bargained for. E is a few years behind me in medical school and we first met through the university windband, when he joined as a first year three years ago, the year I was band’s president. After that, we crossed paths again when we both started at the same church at around the same time, and with a similar amount of uncertainty (ie a lot), and this was when we got to know each other more on a par, as with band, I’d always been ‘in charge’ and leading things, and he’d always been following. We’re very different in some ways, and after a hard year for both of us (he is resitting a year after failing a lot of exams before finally being diagnosed with dyslexia) I really value his friendship.

We were discussing what we’ve been doing in the last few months and I was talking about the mentoring scheme I’m heading up and what’s happening with the choir and hospital volunteer scheme I founded two years ago, and he asked me why I’ve not ended up ‘in charge’ of anything at church when I seem to fall into leadership in most other things I do. And I replied that I’ve never really thought that I’m able to lead, or gifted in leadership, or however you want to put it – in ‘church life’ – that I’m always a bit unsure of what part I’m supposed to play, what space I’m supposed to stand in.

This lead to what I’m going to call ‘affectionately being completely shot down.’

E basically asked me if I honestly thought that God’s gifts were different depending on whether I was standing in church or somewhere ‘secular’, and then (somewhat amusingly) went a bit Lord Kitchener on me (your church needs YOU! Your God needs YOU!) and told me to step up and stop drawing a line in the sand, so to speak, between the parts of my life that are lived in church, and the rest of my time, where my faith is perhaps not quite as much on show.

All I could really say was ‘oh’. The phrase ‘you got told’ comes to mind.

He’s right in a lot of ways. I do have a tendancy to separate things out and think that I’m not really that useful to any church and that I don’t have any gifts, that in the world of 1 Corinthians, I’m one of the less vital, more silent, body parts, whereas it’s fairly true that outwith that, I feel confident in leadership roles (I even got an award from the university for it once) and like filling gaps I see and changing things I think need changing. I’m a project person – I’ve always got some scheme on the way, whether it’s getting the patient library together, or currently, this mentoring thing. It just doesn’t always carry over to who I am ‘at church’. Sometimes I fall back into thinking that I’m just kind of gatecrashing the party – that everyone else has an invite and a reason to be there, whereas I’ve just snuck in through the back door, and am listening in the dark at the back, and God can’t be bothered to chuck me out.

Part of this is probably down to the last year, when standing at the back of a service was as much as (and sometimes more than) I could handle, and I’ve been conscious as I recover that I shouldn’t overfill my time or take on too much (not that I’m managing this well at all). Another obstacle is that until this year, I just wasn’t stable enough in my faith to feel as though I could really be that involved, or active in things – as Ulysses Grant once said, you can’t blow an uncertain trumpet. I didn’t really comfortable spreading a gospel I wasn’t that sure of. I didn’t really want to infect anyone else with my perpetual, and often consuming, doubt. I didn’t feel ‘qualified’ or ‘capable’ or ‘allowed’ to be an active Christian – I had too many hours still to spend working things out. I thought I was better suited to sitting quietly at the back and trying not to lose my place in the hymnbook. My trumpet was certainly uncertain for quite a while.

Now however, talking with E made me remember that everything I am comes from God, and that I need to step up more and contribute my share to the kingdom we’re all trying to build. I’ve been thinking a lot recently about where I fit and what I feel called to change, so this conversation was certainly timely. I’ve got a feeling that the Bible study some friends and I are starting might be the start of a more well defined path for me, but only time will tell, at the end of the day.

And in other news, the GP let me stitch someone’s head cut today. Sorry if you’re squeamish, but it was AWESOME. The things that make me happy…..

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