An Interesting Idea

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I’ve been interested to follow the progress of the ‘Sunday Assemblies’ over the last few months. For those who’ve missed it, it’s an atheist gathering which was started by two comedians, and meets monthly, with a service featuring uplifting music, a talk on something moral or otherwise worthy, and an encouragement to community involvement.

In other words, it’s what a lot of us know as ‘church’ – but without the central character. It’s the congregation without the main player. It’s the morals, without the message.

I think this is a great thing, in a lot of ways. There’s often a bit of a clash between the secular and religious communities on issues such as community work – churches (that’s where my experience lies) have a long history of alms, and outreach, and aid, helped by ample finances and deep pockets on a Sunday morning – but are often met with suspicion by others, sometimes exacerbated (as always) by a difficult few people (West Borough Baptist, I’m looking at you), outspoken and  in main sight.

Christians are generally a do-gooding bunch – and for a variety of reasons. I’ve said before that unlike many twenty-something church goers, I’m no arms-waving evangelist, and indeed, evangelism is something I struggle with, as for me, faith is such a personal thing that I don’t think anyone has a right to muscle in where their input is unwanted. I don’t think faith happens after someone with a sandwhich board shouts at you. I think it happens after deep thought and conversation. I believe strongly in being open and honest and accountable to my beliefs, and am always ready to explain them – but I’m not into pushing them on others, and find those who do extremely uncomfortable. For this reason, I dislike community work (and workers) where the main push is conversion and bringing of faith.  On the other hand, I love community work where someone has seen a gap and tried to fill it. I love the fact that my church is so socially active, and every night of the week there are groups of people getting stuck in, helping run soup kitchens, youth groups, visiting the elderly (as I do), making space for the learning disabled, befriending those in debt. It’s a vast, long, deep mesh of yearning to improve the society we live in. For most, I think it’s driven equally by the whole ‘the Bible (and vicar) says I should do this sort of stuff’ and pure, decent, passionate ‘this situation needs to change’ motives. The church is big on social justice – which is often glossed over by the scandals and less savoury aspects.

When you join a church, it’s not long before you’re sucked into helping with something – and I think that’s a positive thing. When I look at my close friends, more of the ‘religious’ are involved in regular voluntary activities than the secular, though all are equally lovely. Part of that has to be down to having so many opportunities waved at you on a regular basis, an attitude that says that all hands are needed, and being surrounded by people doing similar things and saying ‘come along with me, and give it a go’.

Although this new Assembly is (I assume) going to be lacking in the assets that the church has had so long to build up – I think it is a great thing. After all, there are many lessons I get from sermons that aren’t directly ‘jesus’ related – wisdom on being a good friend, a wise head, a firm shoulder. I hear examples of how to live the sort of life I want to live – full of giving, love, peace, and kindness, and without the consumerism and disconnect that often surrounds us. A lot of this will be just as well (if not better) delivered by a secular group. A content life, I think, is about connection. A difficult one is surrounded by the opposite.

I really hope that this group gets stuck in and keeps moulding themselves on the church model – I hope that with time, there’s another group of folk who gather round when someone’s in hospital, or help at their community centre, or cooks a meal for a new mother struggling to manage. I’m glad that the organisers have recognised something special about church, and its community, and I hope local churches open their doors and show them how they organise things en masse, so regularly. I’m glad people are yearning for the sense of connection that being part of a congregation brings. I think both groups could learn from each other. We need a few more do-gooders. There’s more than enough work to go round. There’s more than enough isolation to remedy. I’m looking forward to keeping an eye (and a prayer) on it and seeing how it goes.

After the interview…..

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….here is an update. It is a bit rambly. Sorry.

I set up a time to meet the people running this alcohol harm reduction programme and had filled in all the neccessary paperwork in preparation. One thing I hadn’t been sure about was whether to mention my family history or not – in the end I did, but just as a cursory sentence in-between all the other stuff, like working in acute medicine, and being interested in social aspects of health, and doing Nightline as a student, and all the other things you whip out to prove you’re worth the time spent interviewing. I went along this morning, feeling anxious, with a lot of questions to ask and a lot of feelings to balance.

The interview went well –  it’s a small project, so they seem to really know their volunteers, and there’s a lot of supervision involved too, which is good as it’s solo community work. Having a medical background and an understanding of alcohol issues definitely helped, as did the fact that (unlike some applicants, it would seem), I obviously don’t think all drinkers are violent, unstable wifebeaters. So far, so good.

What was lovely was that they even seemed keen to have me get as involved as I like in the future, when I’m settled, with things like training – after three years as a Nightline trainer, it’s good to know all that practice at teaching active listening won’t go to waste. It felt good – they seem to really value both the clients and their volunteers. I had a pretty long list of questions to make sure it fitted with what I needed it to be – and so far, it looks good. It’s well organised, but not anally retentive.  It’s realistic, but terribly kind. It is overwhelmingly hopeful. I will overlook the fact that one of the interviewers was such a hipster that he could have walked onto a Mumford and Sons set with no issue. There is no judgement here.

I came out of the interview feeling very positive and good – excited, even, which I’d not expected. I feel like this is something I need to do. The Pollyanna in me won’t be silenced. Folks, I am back on track to being an insufferable do-gooder (acting by stealth – not quite as overt as the glad game, fortunately), and I love it. It feels good, to have a passion about something again. I’m really looking forward to it now – and actually, didn’t feel vulnerable at all, during the interview, though admittedly, that’s a pretty ‘safe’ situation. My first few visits might be different.

I’ve thought about this so much, that the decision seems right. I’ve spoke to three good friends, and although my best friend (and flatmate) looked pretty stricken at first (she’s done a lot of scraping me up over the years, as I have with her, and is honestly so protective of my wellbeing that it’s a bit scary at times – don’t cross her. ) – she’s come round too.  A wise friend on the other side of the pond gave me the encouragement I needed whilst reminding me that it’s one step at a time, and that even if it gets tough, there’s an exit. A lovely church friend gave me the prayers I needed, and the acceptance I craved, to trust my faith’s instinct.  And twitter, of course, were lovely as ever!

All in all, this feels positive – I’m excited. One step closer to sorting out all of the health concerns of the country, one disease and patient group at a time! The future is in the community, people. If I can get stuck in, you can too.

 

 

A push in the right direction

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A few weeks ago, I had one of those moments were something is put in your lap that at once scares you senseless, and also fits perfectly with something that’s been preying on your mind. Call it serendipity, call it a chance, a coincidence, a fluke, and flawed thought, and you’d be right on all counts. We’ve all been there, at some point.

If you’ve read this blog you may remember this post here – which speaks about some of the bigger obstacles I’ve had in the last few years. Growing up through to adulthood with an alcohol dependent parent is undoubtably hard – it has its own 12 step program, after all. Growing up and then being in a job where you come into clear, crystal contact with alcohol misuse every single day, presents its own challenges. Medical school was very much spent sinking under the weight of it. Fortunately, FY1 made me feel like I was (mostly) flying through it – wielding as my weapons vials of pabrinex, and a sense of empathy that just wouldn’t leave. Like any chronic illness, if you’ve been through it, you connect differently with patients than those who have had contact only through books, and experience with other patients.  It’s taken a long time to get to the stage where I come out of a conversation feeling drained, but pleased with my efforts, and not needing to find a small, dark corner to have a small, dark cry before moving on to the next person in the next bed. It’s become both manageable, and rewarding, as opposed to semi-destructive.

We all know that alcohol (and drugs, of course) cause a lot of problems. We know this from the agendas of our leaders, the labelling in supermarkets, the street scenes on a Friday night, the empty bottles in a front garden. This is an issue I care about, both in terms of harm reduction, but also in terms of families, who so desperately need a culture of support, rather than dismissal.

A few weeks ago, I was sent an invitation to interview for a charity in my city that pairs volunteers with a family with a persistent drinker, for befriending and support. I’d been looking into something similar for a while, feeling slightly desperate to feel like I was doing something useful. My job is wonderful, but it’s also my job – and for me, if you feel strongly about something, you should be willing to give that thing your time outside of work. This chance fell into my lap. It feels right. It feels scary. It fits. It’s a serendipitous opportunity. It’s an answer to prayer.

I think a sign I’ve grown up a bit over the last couple of years is probably that rather than diving right in, signing the forms, and getting going, I’ve taken time in the last few weeks to really think it over, and to seek advice from a few of my more sage friends (if anyone in their 20’s is really sage….), who know me, and my past, and therefore the risks. It’s been good practice. Obviously, I don’t want to be knocked back into difficulty with this, when otherwise things are pretty stable. I’m a bit less hot headed now, a bit less gung-ho. It’s been good to get the thoughts of a few people who definitely have a bit more wisdom than I do. Asking for help and a second opinion is well recommended for a reason, it would seem.

So – off I go next week to interview, filled with determination, passion and more than a dash of nerves. This feels like something I need to do – for the clients, but also by a small measure, for myself. I want to be part of a culture change. I want to be part of the care system for people who don’t get much care. I want to be in on the action for the things that move me, and get off the sidelines. I want to stop the stigma and the isolation. We’ll see how it goes. It’s slow progress, this life. Sometimes, you just have to lay on a line and go for it. Good things come, from leaps of faith.

Rookie year draws to a close…..

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In less than a week I’ll be an SHO. I’ve spent this week training up the new FY1s, who all look at me like I’m some sort of cowboy crossed with a superhero, wielding a stethoscope. It feels odd to know that I’m now on the not-quite-bottom rung, that the new FY1s will be looking to me for advice and assistance, and I’ll be expected to provide it. As with most of this year, that thought makes me wonder if I’m old enough, or wise enough, or smart enough, for this next level of responsibility.

I’ve loved my first year of work, and in some ways wouldn’t mind FY1ing for a bit longer – I like that every day is a learning day, every patient brings something I’ve not seen before, every situation is a chance to grow, and try to be the clinician I so want to be. It’s been a year of firsts – witnessing my first death and certifying many more, speaking to families where there is domestic abuse, drug addiction, child protection problems, family feuds, grief, and much more- and being part of the team that works to help, even if my part has been so small. I’ve learned new skills and enhanced old ones. I’ve got my hands into research and teaching. I know the sort of doctor I want to be, more than ever – as good at end of life care as emergency care, as good at teaching as learning for exams, as good at inspiring, as being inspired. I want to be a doctor who holds hands to comfort their owner, not just to diagnose their illness. I want to be the doctor who knows the families, not just the bedspace. I want to be good at ethics, and quick decisions.

I’m aware this might all take some time. Probably more time than I have, in fairness.

I’m also more balanced than I’ve been in a long while. After a rocky final two years of medical school (that’s another blog post) ending in what I lovingly refer to as ‘THE LONG DAYS OF ABJECT MISERY (also known as finals), I started FY1 pretty drained – stoked, jittery, enthusiastic -but drained. I was unsure about how to take up this new and strange mantle. I was unsure how to fit a life in around my work, or my work was meant to be my life, and I my work. I didn’t know how I’d manage patients with stories I knew would be difficult, jarring with my own past and checkered issues. I wondered if I’d be soaring by the close of the year, or drowning in a vat of saline somewhere. I didn’t know whether my strengths would be enough to match my many, varied weaknesses. I didn’t know if my heart would be brave enough to see the heartache, and not fall to pieces on the way home. I was prepared and expecting to cock up and plunge everything into total chaos. I was not overly optimistic.

At the close of the year, I certainly don’t have all the answers. PASTEST will certainly back me on that one. I do feel more at home in my doctorly skin, though, my ‘grown-up’ skin, and my ‘still don’t have all the answers’ one too. I’m excited for what this year will bring. It’s been a year of firsts, of settling down, of finding the middle ground and trying to stay there. It’s been a good year.

For all the new FY1s out there, know that this year will teach you more than you ever realised you had to learn. Grab it with both hands. Don’t be afraid to get stuck in, and don’t be afraid to ask for help. We’ve all done it. We’ve all survived it. You will, too.

 

A few thoughts on faith

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I’ve been pretty pensieve recently, even more so than usual. Whether you have it or not, spirituality and faith are funny things. I’ve been a pretty committed Christian for several years, and much of my thinking time revolves around what this means to me. It’s taken a while to drop the idea of competitive faith – that although actions are louder than words, none of us are measured against another. Faith is enough, for better or worse.

When I started working, although I often didn’t make it to church, it didn’t bother me too much – I felt as though I was working with my faith, with my hands. I felt as though there was that quiet presence, pushing at an elbow when I needed it, giving me a boost when I felt like hiding in a broom cupboard and throwing my bleep (and sometimes myself) out of a window. At night, when I’d head to the sanctuary to grab some peaceful minutes to myself, I’d sit and flick through the book there (are you allowed to do that? not sure….) and be comforted by the faith on the pages, the many faiths, the words coming upwards and outwards, covering the walls and floors with some small glimmer of hope that medicine can’t come close to honouring. I felt my God there – in the quiet minutes spent with dying patients, in the conversations I went into feeling unprepared, in the resus situations and pain, and suffering that came up behind us every day.

At some point, with some things, that changed. It’s like you oscillate between finding simple faith enough of an answer to the ‘big questions’ we all have – and no where near enough. Why is there suffering, of good people, of children, of the demented and confused who cannot rationalise it? Why are there horrific child protection cases, domestic violence cases, drugs and alcohol dependents, sex trade victims, suicides, all of the other things that you can probably block out if you don’t work in the public sector, but are confronted with daily, if you’re at the coal face of the NHS?

I don’t know that answers to those questions. At times, my faith is a comfort. At others, the amount of chattering it brings to my thoughts makes it a burden. I’ve already learned that much as I’d like to, I can’t solve all of the problems I encounter alone. I have to trust that now, early on in my career, with little expertise or responsability, that I am still being used in some way, and that the things that bruise me a bit now, will give me the experience and grace I need to handle situations in the future, when I am further up the ladder. I also try to remember that as both a doctor and a Christian (and arguably a human being) I am meant and programmed to feel terrible about injustice and inequality, and to feel driven to be a part of changing how our society works with and treats its most vulnerable.

At times, I think my job means I don’t have as joyful a faith as others – faith is easy, when it’s plainsailing, after all. It’s when you hit hard times, or are surrounded by those people, that it’s most challenged. I’m certainly not a hands-in-the-air person, a cheerful evangelist, or a roof top proclaimer. My faith is more melancholic, more elegiac. It’s more that quiet noise that adds the sweet to the bitter, the salt to the earth. It’s that feeling of being small in a big world, or being led when lost. Perhaps its a caveat, more than an explanation. It shifts, almost daily. It waxes and wanes. Either way, I’m glad it’s there. Perhaps one day we will have answers and an end to hardship. For now, we have the pipedream. Sometimes, that’s enough.

A bittersweet realisation

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I’m halfway through my time in paeds now and it’s an odd mixture of loving the job – it’s well staffed, there’s less direct responsability, it’s varied, and the children are lovely (when I’m not sticking things in them) – to the realisation that although I love it, its not for me.

This was a bit of a surprise – through medical school, paeds was the one constant in a stream of passions. For a while, it was paeds or psych, then paeds or neurosurgery, then paeds or neuro, the paeds or MOE (aware that’s an odd list…). I spent a lot of time arguing the similarities of that last pairing, and think it does explain why I’m attracted to both – the holistic attitude, the caring for the vulnerable, the need for good communications, the frequent need to look at ethics and what’s best for a patient.

Most people assume I’m heading for paediatrics before they even talk to me – it seems that the camp counsellor attitude and sheen never leave you. Perhaps some of it was not wanting to score it off as a future, as sometimes it does feel that although paeds is seen as ‘worthy’, care of the elderly isn’t – it’s the specialty that a lot of people don’t want to do – and gets a lot of negative press. Being competitive to the core also meant that the challenge of paeds being hard and selective appealed in my early years in medical school – in the same sort of way that teachers used to say ‘you’ll have to work hard, you know, to get into medical school’ – it made me more focussed. You learn though, that the competitive paths aren’t that way because they’re better.

Much of the decision has been that although I am good with children (by FY standards!), I’m better with the elderly, and I enjoy sorting out the elderly more as well. I have endless passion and time for improving things for our vulnerable older patients – but sometimes think that in paeds, a lot of time is wasted setting up for a quick procedure in a well child who won’t remember it by the evening, let alone long term. I miss the challenge of adult medicine. I miss those moments with the confused and afraid, where putting your hand on theirs offers comfort. Children aren’t the same. I miss feeling that I’m helping, even just by sitting and talking, or explaining, or finding out about exactly how old the tins of soup in the cupboard are. It feels that in paeds, it’s not until you get very far through that you have much impact. Wrong, perhaps, but I feel like in this job, a lot less patients and families know or care about my name, compared to my medical jobs.

I had a few weeks of feeling a bit bogged down and uncertain as its the first job that although I like it, I perhaps won’t miss in the same way. Sometimes, I feel so frustrated that I have so much to learn, that I don’t know all the answers. Paeds surgery is so specialised that I feel it all the more. No matter how much extra reading I do, I’m still often clueless about anything except the bread and butter. Thanks to a few new avenues, I feel more on track again – going over an MOE audit has reminded me of how passionate about it I am. Doors close, and doors open. Sometimes, its me that shuts them, rather than anyone else. I think I’m still learning that that’s ok.

A sense of failure and frustration

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This week’s been a challenge. There’s been quite a few child protection cases in – either kids on the register, or kids coming in with suspicious injuries, either admitted to, or very much denied by care givers. There’s a few kids who have parents with serious drug and alcohol problems, who have suffered because of that inability to provide good care. There’s kids with non accidental injury. There’s a small boy who confided in a nurse and I that his dad hits him. There’s a NAS baby. I find myself worrying a lot about this kids – rightly, but also slightly obsessively. I worry that I’m getting a bit vigilante about these issues – I look at some of the cases, and to be honest, It feels like sometimes the system prioritises the right of a woman to have a child, over the right of a child to a reasonable upbringing. There are children put back into families who have already had children put in care, and then when they come back in, with suspicious injuries, all I can think is, who have we sacrificed, here? Which risks are worth taking? Every child deserves safety. I sort of think that if you wouldn’t send an unrelated child into a family, you shouldn’t keep a child in there.

I’ve said before that my personal history of coming from a family where parents have alcohol problems has made me  at times, a better doctor, if a vulnerable one. This week, all those old blues have been niggling more than usual. I find myself thinking a lot about the tough things my family went through. Sometimes, being surrounded by lots of young people makes it more clear than ever that a lot of the things we did when my father was drinking were pretty out of the ordinary. We grew up so quickly. Being a carer is hard. I’m feeling a bit war-torn this week, a bit battered and bruised. I find myself feeling desperate to be a part of changing the stories of some of these children – being part of the net that catches them early, rather than later. Being part of a world that isn’t threatening, that supports them and encourages them to grow. I want to give these kids the things we missed out on. It’s kind of like I’m trying to put fillers in the holes in these kids’ boats, to make up for mine sinking.

I like to think of myself as a good problem solver. I make list after list of things I can do to make my conscience feel like I’m acting and not standing by – getting back involved with guiding or scouting, training with childlike (after five years of nightline, I know I like telephone volunteering), finding drugs and alcohol programmes and charities in my cities that need volunteers, there are so many things I’d like to commit to. It’s driving me a bit mad that I can’t do all those things now. I cannot, hard as I would like to, solve the problem of addiction in the country, or non accidental injury, or mental health problems. I hate that, this week. I really hate it. 

I do my learning disablity group, and I do my care home visiting, and after that, with my rota, it’s tough to have a predictable evening a week off. I feel like a failure – I want to be in there, but I’m not a social worker, or even a ‘proper grown up’. I can’t foster children. I can’t commit to training several hours every week for several months for a telephone help line. I feel like my contribution isn’t enough. I hate it. I want to do more. I’m getting twitchy and itchy and irritable. I want to be helping in these situations with my whole heart, my whole mind, my whole ability, but I’m not qualified enough, in any domain. I’m a bit stuck.

I think in part I need to go and have a huge rant at someone at some point and get all the crazy-lady ideas and pent up anger out of my system, and then focus on a realistic plan. A smarter target. Possibly featuring bullet points and a star chart. I need to think of the CP successes. I need to remember my small triumphs, my small connections with patients and families that get me through the day. I need to rediscover my medical mojo. I need to remember that I have (hopefully) years to pick how I make a difference, how I use my time to help the people I want to help the most. I should be excited by that, not melancholic. We have our lives to effect change. It’s a start.