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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Magic Eye mountains

I was thinking about Psalm 121 this morning. Something I find interesting about the Psalms is that they were often written in specific circumstances or for specific purposes, and yet, we in modern times still turn to them when our experiences are markedly different; few of us have hidden in a cave and pretended to be insane like David, after all. Psalm 121 is noted as a ‘song of ascents’, and although this is purely speculation, I always imagine it being sung by a group embarking on a vast journey over huge distances, in the steps of their forefathers, weighed down with animals and possessions, small and fretful children in arms, the sun beating down and the end nowhere in sight. Nowadays, certainly in the developed world, it is rare that we are forced to do arduous journeys for any aim other than travelling in its own right;  people run marathons and do cross-country cycles, but there is no sense of journeying away from a physical threat, and knowing that the end of the journey signifies not only personal satisfaction, but also safety, which may have been missing before (although obviously, there is unfortunately still plenty of places where emigration for safety is still a frequent occurance). In Psalm 121, I imagine that the singers were looking down the trail, towards whatever oppression they were escaping, and then upwards, to both salvation and safety, and thinking how far away it seemed and how the distance just didn’t seem to shorten, how the sun was burning them, and the dust of the trail making it hard to breathe.

We often talk of life being ‘a journey’, and usually, this focusses on the uphill, difficult stints – not many people find themselves contemplating the ease of a downhill pace, where no effort is required to move forward. Similarly, in terms of depression, we talk of ‘slipping’ and ‘getting lower’, yet it’s unusual to have a few days where we think about climbing moods and soaring spirits – in all areas of life, the easy times pass by, unnoticed, yet the hard times tip us into contemplation.

I’ve been thinking about what the ‘top of my ascent’ really is, recently; whether it’s a point where I truly feel I have waved goodbye (or more likely, flipped the bird) to my depression for good, or whether it’s reaching a place where I am more able to manage it, and feel less consumed by it. At the moment, the peak I’m aiming for is when I have finished all the extra bits I’m having to do, and once again, only have the standard commitments of medical school to worry about, like everyone else; no more ongoing projects, no more extra meetings, no more counselling. My peak is one of normality.

This Psalm also reminds me what I should be focussing on too; when I’m looking ahead to the challenges I’m anticipating, it can seem so bleak at times, just one chance to fall, to fail, after another, and I wonder how I will ever manage to reach solid, high ground, when at times, my resources seem so low, and my  heart so heavy. This song of ascents is pretty clear on this; my help comes from the Lord, the maker of Heaven and Earth. He created the literal mountains being climbed by the psalmist, he created the metaphorical mountains I am scaling. He knows the easiest routes and the paths to avoid. It’s a long way up, but God is guiding us over the rocks. It’s a long way up, but God is behind us, stopping us stumbling. I know that as I keep moving upwards, the vantage point on the last few months will keep changing and I will gain new perspective. I’m looking forward to reaching this next peak and being able to lay this year to rest, and move on, and lose the sense that I’m on borrowed time, and will always be playing catch-up. I’m looking forward to packing this year away, and forgetting about it’s power and pull for a little while.

In some ways, the path ahead of me is like one of those Magic Eye paintings; at first glance, all I see is the trouble, and the challenges, and the fear of falling. All I see is the pattern that went before, of gaining a little ground, and then, oh so quickly, losing it, and falling even further back. All I see is a future stretch of never-ending depression, of never-ending torment, and the possability of unchanging, unstoppable strife is more than I can bear.

But then, I remember a section from the Bible, or have a thoughtful conversation with someone, or see something that reminds me that the world isn’t quite as bleak as I sometimes think it is, and I am pushed  to look from a different angle, to refocus, and I see that behind and amongst that bleakest of patterns, that highest of mountains, is God, clear as crystal, hard as iron, and  I can’t believe I didn’t see Him there before. I can’t believe that all I needed to do, was take a step back, or forward, in order to see His footprint on the ground ahead and behind me. I can’t believe that He has been there all along, in plain sight, the focus of the painting, the thing we are trying to see. The pattern around Him means nothing. The superficial challenges, mean nothing; it’s all about the hidden layer of truth that we sometimes forget, or refuse to see. The pattern is just the top of the river reflecting the light; God is the undercurrent that guides it to the sea.

So, if you’re reading this, and feeling far from God keep an eye peeled (sorry) for those ‘Magic Eye mountains’, I hope you find one.

I’m back in counselling tomorrow – feeling quite anxious about it after last week and not entirely sure how to play it. This week, I also have a lot of bedside teaching from my head of year, whom is mentioned here; the only time he has met me hasn’t really been that encouraging, and I was in floods of tears at the time – not exactly conducive to convincing him that I’m a good student. It’s going to be an uphill week, so hopefully I’ll remember this Magic Eye thing myself.

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Do as I say, not as I do…..

Lesson of the day: never think “I don’t have anything to write or think about today”.

I started today planning to meet one of my best friends for lunch, spend time sorting out my research project, then meeting another friend for a drink in the evening – in other words, a relaxed, fairly academic day.

Then on the way back from lunch I ran into a rather distressed friend G. She is a girl who started first year of medical school with me, then has had quite a few years out doing various non-medicine things, currently a completely unrelated degree. We only see each other once a year or so, and became friends in first year.  She is a book lover, like me, and loves debating the  ‘deep and meaningful’ questions, so chatting is always interesting, particularly since I became a Christian. Seeing her  gave me some real food for thought.

In a nutshell, and without saying too much, after talking for quite a while, it became very clear that she’s unknowingly possibly become depressed, somewhere between ‘moderate and severe’ in intensity if I were to stake a guess (which is all I can do as a student).

What started out as a friendly catch-up quickly turned into a pretty heavy conversation, and me feeling really quite concerned. She’s agreed to go to the GP, and actually asked if I’d go with her – not really a possibility, as her GP is also the man I have seen for my depression (honestly – what are the odds….), which she knows nothing about. We had a long conversation about maybe trying counselling, making sure she’s eating, sorting sleep patterns, alerting her DoS, exercising, antidepressants, all those things I can reel off at the drop of a hat, but struggle to do myself. It took me roughly four months of feeling completely awful to get myself to the GP, and then, it was only at the insistence of my flatmates. Even after that, it took me four more months to gather enough courage to get myself through a counsellors door, and even now, I struggle with eating enough each day, concentrating, and have such disordered sleep  that I look permanently like either a racoon, a zombie, or some terrifying combination of the two. Tackling depression takes courage and you have to be ready for it.

When I am feeling positive, I am glad for the heart God has given me to care. I like sitting down and seeing if I can help someone find a solution. Over the last few years, I’ve gathered quite a string of surrogate little sisters and have loved playing big sister to them, in a way I always sort of wished my own big sister had done with me.  My favourite jobs by a long way have been as a carer for people with learning disabilities, or physical impairments. But sometimes, I wonder if this urge I have to care is even a good thing in the long run, or something that actually harms me. My common sense tells me I have more than enough on my plate without worrying about G too – indeed, it would probably be fair to say, I’m in a worse boat than she is, just now. Without trying to be precious (and probably sounding even more unhinged than usual), it’s caring that keeps me going – when my depression was at its worst, it wasn’t the darkest thoughts about myself that were driving me closest to the edge, but the feeling of extreme apathy, and inability to care anymore, for anything or anyone. I felt like a huge part of me had died and was never coming back. I thought that I’d never be able to be a doctor as I just didn’t have the ability or energy to care, when the world seemed so bleak and full of unvanquishable heartache. I stopped visiting patients at the hospital as I just couldn’t find a hint of positive conversation for them. I started writing about how medicine is futile as, in the end, we all have to die somehow. I had run bone dry. When I’m unable to care, I lose my sense of self. When I lose my connection to others, I feel lost.

I would like to say that I believe God stuck me in G’s way today to be a source of comfort, someone able to advise on depression from inside the medical mindset, and someone to give her a hug and keep an eye out – that I believe He used me as a tool to help her.  I think though, I also need to question if God is actually teaching me that I need to protect myself at the moment, testing my ability to say ‘no’. Or on a more clear-cut level, maybe God is just pointing out that I need to follow my own advice and stop being so afraid. Get thee to counselling, Ophelia! I felt like a complete fraud, standing there, after quite a rough week, still bogged down so much by this mood of mine, advising someone else about mental health. Irony feels like a second shadow at times!

I suppose, (God being frequently classed as omnipotent etc) that both of these could have been on the agenda. Who knows? The last time I tried counselling, the woman I saw made a big deal about my supposed co-dependant tendencies. It annoyed me then, and still stings now – I don’t think I am co-dependant in any way to be honest. I don’t rely on being needed, but sometimes I just seem to fall into it. Perhaps it’s my face – I got told twice this week by mums with babies that I look like a paediatician. Perhaps it’s because having been through rough patches, I’m more aware to the signs that someone else is fibbing when they say they are ok. I don’t want to start feeling negative about something which sometimes feels like my only positive attribute. I don’t want this depression to steal that, too.

I tend to think that although some people talk about being ‘prodded and poked’ into action, that when it comes to me, God whips out a huge stick and just starts whacking. I am stubborn and obtuse and will do my hardest to pretend I didn’t see all but the most ridiculously obvious signs. I dig in my heels and champ at the bit. I think about covering my eyes and employing the classic ‘if I can’t see you, you can’t see me’ stance that toddlers all seem to innately know. I am learning to be grateful for these spiritual bruises, and know that I need teaching (Job 5:7 springs to mind here – I was certainly born with a good dose of mischief). I am really quite unable to take my own advice at times. After hearing myself talking to G today, I know I need to keep asking for help and keep going with this. No one should need to list their thoughts as one of their greatest threats. No one with depression should start thinking that maybe, just maybe, this is how their mind is going to behave from now on. No one should convince themselves, as I sometimes come so close to doing, that they will never ever come out the other side and remember what it is to smile. Tackling depression takes courage.

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Turnabout Prayers

It’s true that this blog is mostly about working out my own path at the moment – but, although all of us need to be inward focussed sometimes, there’s also moments when it becomes so apparent that we are such small parts of a whole, and that just maybe, our prayer life, or inner life, should reflect this, at least for a moment.  I mentally call these ‘turnabout prayers’ – because often, it’s when I’m thinking deeply about something going on in my own life, that I become aware of context and that there are an awful lot of people in much direr situations than I am in.

I wrote about storm imagery yesterday and have been continuing to think about psalm 46 (be still, Char, be still!)- and today, realised that although there is a place for metaphor, unfortunately, some people don’t even need the imagery as they have the real thing to deal with. Christians bang on a lot about spiritual journeys, hardships, persecution, and battle, and I think in between all those analogies that aim to ground our experiences in something concrete everyone can identify with, we forget that across our world, people are experiencing all these things in heartbreaking reality. Comparing the persecution of Christians in this country for example, falls more than a bit flat when we compare it to the situation in the Middle East or Asia, or the persecution of other faiths and groups in so many countries. This is what I mean by a turnabout prayer – something that stops you in your tracks going inward, and refocusses you outwards on the big picture. Something that makes you think ‘WHOAH’ and swings you round by 180 degrees so you see things cast in a different light and from a different angle. We have these moments in both spiritual and secular life – we’ve all experienced something catching on our heart and forcing us to re-evaluate our current preoccupations and stance.

The people of Japan are facing pretty real and dangerous storms at the moment. Some of them no doubt will have actually fallen into the sea. Many have lost their lives. Psalm 46 to them, at this moment, is not an expression of God keeping us safe in the storms of everyday life – it’s reality, and they have every reason to be afraid. As I write this, it’s true that my mood is low, my heart is aching, and I am anxious about the next few weeks. But it is also true that I am safe and dry, warm and sheltered. My family and friends are safe. A lot of Japan are facing problems with those things thanks to the earthquakes and tsunamis. My heart is hurting for them, and I’m praying for them – please pray, too.

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