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Posts Tagged ‘Medicine’

I possibly did something a little foolhardy last week. I’d been thinking a great deal on the last interaction I had with the person from my church whom I (misguidedly) confided in, when I was at my illest last year year, who subsequently broke my confidence (apparently I was suicidal enough to justify that, whilst leaving me alone, knowing that she was going to do that was absolutely fine…..cue dangerous situation) and made it incredibly difficult to both access the help I needed, and also go back to my church at all. We haven’t spoken since – although I sent thank-you emails after a sermon she gave to the students, she didn’t reply. It’s been pretty awkward. I don’t feel bitter or angry about it (though some of my friends would still quite happily lynch her) – but it felt so unclosed that I needed to do something.

So – I wrote her a letter, basically apologising for putting her in a difficult situation, but also asking that if she finds herself confronted with someone in a similar situation again, that she acts differently, as if someone is serious enough that you need to get someone else involved – they shouldn’t be left alone, and also that if she’s going to volunteer for being a pastoral support to someone, that she honours that by answering emails and actually getting back to them when they need it. We’re all learning – I am learning, you, reader, are learning, and she is learning – but there are some places where acting incorrectly puts someone else in danger, and I think people need to know where they’ve gone wrong so they can do better the next time. Last year was a mess, and no one knows that more than myself. To move forward though, we have to repair what’s gone before as best we can, we have to put the protections in place to prevent history repeating itself. We are all learning. I also said that I still pray for her, and that I am sure God will use her and her faith.

I’m not sure at all what I expected back – maybe just a short note saying that next time, she would better know what to do when faced with someone in crisis, maybe even an apology if I’m perfectly honest. I got a one-line email informing she’d received the letter and no other comment. Harsh? Possibly. There’s not much grace, there.

In some ways, this demonstrates well that I am better off with her having absolutely no involvement in my life, faith, illness, or recovery. It also shows that as I knew, we are very different people, and that I am glad for that, because I wouldn’t want to be like she is. When I first met her, I thought she had such a good faith and was such a ‘good Christian’. Now, I am not so sure. I’m nowhere near perfect, but I am not short on compassion (possibly over-imbued with it, at times) and I am not ashamed to admit mistakes and learn from them. Her reaction says a lot about her, I think. I hope that she does learn something, from our encounter – and sometimes I think that maybe that was God’s plan from it, that something good could come from my deep despair, that someone could benefit from my deep depression.

In other news, I saw the GP again on Tuesday and after hearing (and seeing my panda eyes) that I’ve literally not slept since starting the sertraline, she gave me some zopiclone (non-addictive sleeping tablets) to try. I was pretty wary of them, but after trying one, slept so much better and felt so much more alert the next day, that I think it’s ok to use them to get me through the adjustment period on the new medication. I’m still feeling very nauseous and am generally very flat, but I’m hoping that if I sleep  better (ie at all), things will improve.

I also met with the organiser of the paeds module this week as mostly due to said lack of sleep, I’ve just not been performing that well and have struggled to get everything ticked off. He was so lovely it took me by surprise – everyone else from the medical school has made me feel like a slacker, or a problem, or a weakling, but he was so kind, and knowing that I don’t need to panic quite so much about everything makes a huge difference. Hearing someone say ‘it’s not your fault, well done for getting things in place, and let’s see what we can do to make this easier’ was something I needed to hear. I’m so thankful for him.

So – it’s been a mixed week of blessings (at last, a lovely GP who listens and acts), the paeds guy, and some of my friends, who have been wonderful – and this not-quite-closure of the letter and its response. I feel like I did right though, by writing, even if the response wasn’t quite what I expected.

thanks, guys.

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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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Glimmers of hope

I’ve done five days on the new drug now, and the good news is that although I’m feeling continually nauseous and extremely jittery (I literally startle at every sudden noise in the vicinity)  it’s not making me as dangerously unwell, as my first drug trial did. This gives me hope that this might be a solution.

On Wednesday, we got the scores back for our junior doctor job applications (in a nutshell, you get scored across various domains including ability to write 200 word answers to questions about team work/communication etc, and then choose job options depending on score, with higher ranking candidates getting preference. Jobs which include paediatrics, emergency medicine, neurosurgery are higher ranking, as are jobs in popular hospitals). I’d panicked a bit about this as I dropped some academic marks due to last year – but I got a high enough score that I can essentially apply for whatever I like and be likely to get it, as my score is above the minimum needed for every job in my area. I’m so excited about this – looking at the options and realising that in a year, one of them will be mine, is amazing. It means I can go for programmes with neurosurgery and paeds, it means I can avoid jobs I don’t really want to do in the first year (vascular surgery, urology – urgh) and it means I can stay in my city, where my roots are, for another two years. It kind of feels like a sign that after everything, I’ve come through. It was a good week, to hear this, with all the anxiety over medication.

It’s been quite a rough week as I’ve felt so ill, but also rather lovely as I’ve been on the neonates unit, and despite feeling pretty unconnected to a lot of things at the moment, small, sick babies make me remember why I’m in medical school. I want to look after them. And it reminds me how amazing medicine is, that a baby born at 24 weeks (four months early), can survive, sometimes with minimal problems (though sadly often not). It reminds me of my faith, as Jesus was not so different to the newborns I checked over this week, dependant on his mother, just as we are supposed to be dependant on God. It reminds me of hope, imaging what these babies will grow up to be – the leaders of out future, the workers who will improve the world.

There’s still a lot I need to sort out, as although I’ve managed to physically go to placement, getting everything signed off has been a bit much when I’m feeling jittery and unwell enough that I’m not really that on the ball. This could prove problematic with el medical school. Despite feeding back about my GP app as instructed, the Dragon also hasn’t replied – though she often doesn’t, it still annoys me when that’s her job, and I have questions I need answers to. My mood is still very low, and the sertraline is messing with my sleep a lot so I’m continually exhausted, and not able to do more than an hour or so of anything academic before getting fatigued. I think the best description is that I feel ‘sickly’ – weak, wobbly, and queasy. There’s also a lot of small print stuff to sort for my elective – but I am feeling that little bit better, now that there’s more of an action plan in place.

Sometimes, it’s so easy to feel as though God, in whatever guise you find him, has turned from you. It’s so easy to feel adrift and off the rails, and misguided. This week I’ve really felt that inspite of how difficult these last few weeks have been, both in terms of how I’ve been feeling, but also interms of long-term decisions and fallout, that God has come through for me – I have a high score that will get me a job I love (hopefully), I have a plan to get me through the next few weeks, and I have some brilliant friends who drop their own lives for me when I need them. I would like to feel a bit more on the ball, though!

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Still

The last few days have felt both frighteningly familiar, and brand-new, all at once. On the one hand, it seems like every day brings more confirmation that I’m ill again, and yes, I am afraid of being back here, of falling down again. I am afraid.

However, now that I’ve accepted my lapse, and done the practical things (doctors app, seeing ‘the dragon’ today), I’m in a bit of a stalemate  now. Unlike this time last year, when I wasn’t really willing to accept just how bad I was, this time, I’m putting things in place. It’s almost out of my hands now – until I’ve seen the doctor and talked things through, all I can do is keep going and hope for the best. That’s not saying I’m giving up and spending a week with my head under a blanket – but just that there’s not much more I can actively do, now, aside from try to keep things ticking over.

I met L after meeting the dragon today (the phrase ‘glutton for punishment’, comes to mind) and am feeling pretty bulldozered by it. She seemed to start panicking when I told her I knew I was going downhill again, and said maybe I should see someone else – which is ridiculous as I’ve only got a few more weeks till we break for Christmas, after which I’m going to Nepal – and I didn’t really know what to say to that, apart from feeling pretty cross and upset as I wasn’t quite expecting that reaction. I sort of rely on her to NOT panic and be calm – and it threw me off. It’s the first time I’ve felt angry with her. And then she started going on about church healing rooms and suggesting I think about it – which also confused me as I’m really not one for asking for people I know to pray for me, let alone strangers, and to be honest, it sounded like a last resort – as though I’m in need of a last resort. It’s nothing to do with my faith in God not being strong enough, to find healing in these places – it’s that (as she knows) people have inflicted quite a lot of damage by using prayer to say things they had no right or reason to say, and I don’t trust other people with my faith, especially when I’m vulnerable. Not at the moment. And what I needed was for someone who has heard my reasons for fearing medication, to encourage me and tell me that I’ve done right in making these appointments and gearing myself up to try them again. I didn’t need that decision glossing over and marginalising. Her suggestion was so completely out of my range that it makes me wonder if she’s been listening at all, these last few months. Feeling like a lost cause, is never a good thing.

And yes, it’s just this latest drop that making me feel as though the rest of my life is going to characterised by many more troughs than peaks, and yes, it’s just this depression that makes me feel so relentlessly unable to fathom how I’ll manage that – but it’s how I feel, today. It’s how I was feeling after seeing the dragon and being up since 6am after a sleepless night. It’s how I was feeling after finding church on Sunday more painful than its been for such a long time. It’s how I was feeling, as I realised how much I’m playing for at the moment.

I know, that mulling over things isn’t going to help and that there is no gain in regretting past decisions or thinking over mistakes I made – but if I can’t rock up at counselling after a crap week with a pretty big realisation, and cry and say that I don’t know where to go from here, and how I’ll get through another period as black as last year if it comes my way, where can I say that? I have acted to sort this out as quickly as possible, but that doesn’t mean that my mood hasn’t plummeted, and it doesn’t mean that I’m not devastated at the moment by this latest change.

I’m not sure what I’ll do next week. Part of me doesn’t want to see L again. Part of knows that I probably need someone keeping an eye one me. It’s hard, sometimes.

Thanks to all who’ve been thinking and praying for me. It helps.

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So – I’ve now got a doctor’s appointment but it’s not till Dec 6th which is a bit annoying – I’m not a good one for waiting, particularly when it’s something I’m already anxious about. I’ve decided to see a different GP this time too, as I didn’t feel like the man I saw last year was really listening to me – so also have that issue to think about.

I’ve also emailed ‘the dragon’, at the medical school, which was difficult, but am meeting her next week. This is probably sensible, as I know, if I’m honest, that my working ability isn’t great right now – the apathy is coming back with avengance, and it has nothing to do with paeds, which I love – but it’s still there. I can’t sit and concentrate. I can’t work my way down a to-do list, which is pretty big at the moment. The paeds department make you tick off a lot of things on attachment, just because we haven’t had much exposure to the specialty yet, so there’s a lot of stress to get assessed regularly, and be proactive. On a community attachment, whe’re I’m in a different part of the city, with a different team who to be honest don’t really notice if I’m there or not, every single day, it’s quite hard to keep keen as you never integrate and never feel valued.

Once again, things feel ironic – this time last year, was when I was running seminars for the first year medics on ‘coping at university’ – whilst falling apart. On Monday, the medical school mentoring team I have set up and chair, met with members of the pastoral care team, which includes a psychiatrist who was consulted (without my consent) about my lack of compliance with medication. I feel like I have one foot in two very different camps. Having met these members of staff essentially as an equal, also makes me keen not to have to plug in to medschool services, myself. I don’t want to have to flag myself up to them, and lose face. Sometimes, if not most of the time, I almost hate being someone who is driven, and builds projects, and follows up ideas. It complicates everything. It muddies the waters. And yes, I love the mentoring scheme – but at the moment, I feel like a fraud again. How far I am from the person who should be leading that sort of venture, how changed.

Going back on medication seems like a huge and daunting decision – the endless GP appointments, the endless checking in, the  constant reminder of needing something external to control my soul and quieten my thoughts. And even though I’ve personally told people that a bad response to one drug doesn’t mean another will be the same, and I know that it’s unlikely – I’m terrified. I’m scared that I’ll give meds another go, and before I know it, I’ll be low enough that I’ll once again be itching to get out of my skin and out of my life in order to stop the thoughts flooding in. I’m scared that if I sink low enough, there won’t be anything holding me back. I’m scared that I’ll lose any sense or hold on reality and certainty, and that I’ll lose everything I fought so hard for last year. And that’s not easy to say to a GP who doesn’t know you. It’s not easy to say to anyone. I’m not usually the panicker – I’m always the one leading and chairing and organising. But now, I’m panicking. I don’t know if this is a good idea. I’m tying myself to a minimum of 18 months on treatment, which is a long time. I hate being a patient. I would literally rather gouge out my own eyes, than be in the patient role. And I wish that there had been someone there six months ago chasing me up and making me take medication and keeping an eye on me – so that this relapse might not have happened and I wouldn’t be back beyond square one again, with all of these decisions to make anew.

And again, I look back and realise I’ve not been singing or talking or praying, as I should be. Again, I feel pretty tarred and marked by this, a stain that is never going to leave me. And I wonder what it is that draws me towards this state and the reason for it – but there is no reason, which makes it all the harder. There is no reason, apart from bad genes and bad luck. There is no answer lurking behind this. This is just the hand I’ve been dealt. I don’t want to play it.

 

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I realise I’ve not written too much about my counselling with L of late – mostly just because other things seem to have subsumed them, or my posts haven’t gone up soon after a session.

It still seems odd as the longer I know (as much as you can ‘know’ your counsellor, anyway), the more it seems that if we’d met in other circumstances, we’d probably have got on very well. It’s like that Thomas Hardy poem, ‘the man he killed’ – except unlike in the Boer war, bloodshed is very much frowned upon in therapeutic circles…. The concept is the same though – in other times, in other places, on different terms, our relationship might have been more equal, more balanced. I’ve thought a bit this week about how I’m now past the mid-point in counselling as once I leave for two months in a Nepalese hospital in January, L and I will probably never meet again. I also had an email this week from an old teacher at school, which has also made me think a great deal, as she was the first person I ever told about my dad’s drinking, after I came into school one morning after sitting overnight in A and E, and just completely broke down. She was the first person who listened to me – and when I refused point blank to try any form of counselling, she didn’t push me, and supported me through my final years of school by giving me books (she was a very stoic English teacher and very much subscribed to ‘reading through the pain’ – as do I) and generally being lovely. She also never breathed a word to my parents, which must have been a hard decision to make, but one I am eternally grateful for.

I was sixteen, then. It took another seven years for me to get myself into a counsellors office and capable of staying there. Growing up in a substance misusing household changes your perception of risk, gain, and potential for harm. For me, the risks of opening up were just to great, for too long. I’d lived under the shadow of a tabboo topic and couldn’t break it. There was too much at stake, and too many ways that it threatened to push me over the edge. By the time I had no choice but to go, I was already as far over that edge, that I could go. And it’s taken more courage, each week, every week, than I can often describe.

Yesterday, I hadn’t been thinking too much about what to talk about, but then had an extra half hour to waste as I headed over as I got away early from the childrens hospital, and as I was walking, realised that I’ve felt pretty flat recently. And yes, I’ve been busy and harrassed, and busy again – but I’ve also been a little numb, a little flat, in a way that being busy and somewhat misguidedly listening to the latest deathcab for cutie album,  just doesn’t quite explain (everyone has a band they should have outgrown, but never will – deathcab are mine). I was already crying, by the time I got there. I was already crying, and wasn’t even that sure why. It’s that feeling of mourning something, that I can’t quite shake off, that feeling of being without something, of being tired out and work out and desperate for some relief from the heavy days and all of their requests. I can cry in front of L, now. It does get easier.

Part of it is that I’m over-reacting a bit about a meeting I’m chairing next week for the medical school mentoring scheme that I set up (it’s going very well, which is nice) – and asked for a member of the medical school’s pastoral care counsel to come along to speak to us. The person they allocated is a psychiatrist that the student support person (aka ‘the dragon’, for longterm readers) told about my depression, without my consent, when I took myself off medication and went more than a bit haywire. And although I should be able to say that he’s a psychiatrist and this is what he does for a living, and that he probably won’t remember me by name alone anyway, I’m also terrified that he will and will say something, and I’ll start crying. I’m fed up of feeling as though every single time I feel like I’m getting past all of this stuff, something jerks me back. I’m fed up of feeling like I’m tattooed for life. I’m fed up of feeling as though I will always be judged first on my history of depression, before anything else comes into play.

L was pretty good about all of this, and I do find that I trust her opinion, which after six months, is a good thing. Counselling still leaves me exhausted though – it’s not as simple as being a release, or an outlet. It wears me out. Sometimes everything just feels so dramatic and difficult. Simplicity is a wonderful, enviable thing.

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Elegy to autumn

Now, I’m pretty used to be analytical, and most of medicine is about comparison, either with ‘the norm’, or the other side of the body. To find a pleural effusion, you’re looking at how one lung base sounds compared to the same spot on the other side. To work out if a knee is swollen, you look at the uninjured one. To assess a child’s development, you compare them against what a child of their age and experience ought to be doing.

Perhaps this is why I find myself referring to last year constantly at the moment. This run up to Christmas was the hardest time, in many ways, of all of my time with depression. There were a lot of painful moments, this time last year. I was pretty deadened. The changing leaves didn’t make me look closer for their beauty, but for their relationship to dying, as that was all I was thinking about. Everything was empty. Now, after a week of 9-5 lectures, I appreciate being able to concentrate in a way I couldn’t do for months, last year. I appreciate waking up and feeling exhausted, but not wishing I’d not woken at all. In the last month or so, I’ve got my ‘medical mojo’ back – I can approach patients and speak with them, and examine, without feeling like I’m having a panic attack or that I’m distinctly substandard. When my depression was both in its early, middle and late stages, I had real problems with that – as though patients could see my diagnosis and would assume I was useless, or that I was useless, and would never ever be a good doctor. You have to have a certain level of confidence to go and talk to someone with terminal cancer, or a sick child, or ask to do a pelvic examination. Medicine is no place for wallflowers, and my confidence is taking a long time to come back.

This time of year always makes me nostalgic, probably because it has so much packed in that a lot of my childhood memories are of walking home from school in the twilight, or waving sparklers, or carving pumpkins, or picking apples from the garden to make crumbles. The cold, clear autumn days are my favourites of all the year. They remind me that change isn’t always bad, or forever, and that all phases and stages, both good and painful, end at some time. We move on. We grow.

It was early autumn 2003 when my dad went to rehab for the first time, and deep winter when he came out. When we picked him up, we had to bring his winter jacket as he’d gone in with just a jumper. It was autumn 2005 when I applied to medical school, had my first set of interviews, and felt like my chance of escape was growing closer. It was autumn 2006 when I started medical school, which really was my lifeline, and what had got me through the previous three years at home. In 2007, I lost my last grandparent as the leaves were falling, spoke at a funeral for the first time, and mourned the loss of a generation. This week two years ago in 2009 marks my change, at last, after months of questionning and wondering and fear, from plaintive agnostic, to quiet, startled Christian (this is a post in itself). This week, last year, marks the anniversary of the day one conversation with a person I misguidedly trusted, led me closer to death than I hope to be again until I am old and worn and ready.

The autumn for me is a time of heartsome remembrance, an elegy to what has changed, and what starkly refuses to alter. This year, I am two years into faith and those two years have hardly been easy or straightforward. I remember the wounds of last year, and carry them with me. Those autumn days where my mood was hibernating, marked me. However, my years of faith have marked me more. My faith has survived, my prayers are still stumbling, my heart is still learning. Eight seasons on, I am still singing. Eight seasons on, I still see God when I look at the changing leaves and see the death of the year beginning, in all its glory. Eight seasons on, I can see how much ground I’ve covered, and am able to look forward and wonder where I will be in another eight seasons. This is my favourite time of year.

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