Tourist law


We queued in the midday heat, and I was secretly cursing not setting the alarm, but there are unwritten rules about “holiday”. You drink more, and wake when you want to, then suffer the consequences.

The queue snaked along the road, and on arrival the bus gulped a mass of pink and white skinned flesh. We were the last to get on, perched on the steps, faces forward, front row seats to the panoramic spectacle of mountain driving by locals versus tourists.

The bus pitched and heaved and honked its way round vertiginous coastal roads not designed for 21st century living.  Then amongst the waves of nausea and emergency breaking emerged an embryonic court of appeal and arbiter of need, a kangaroo court lurched from stop to stop.

As the doors opened and passengers did their best not to the tumble out of this metal carrier, a plea was made by the waiting.

“Ok -you can get on.”

“Eeeeeeh?” erupted from the bus

“It’s a baby – a bambino!” remonstrated the driver 

“Aaaaaaaah” replied the bus

The attractive mum holding a white shawled little girl climbed on and a passenger relinquished their seat; smiles of a peaceful child’s embrace rippled down the carriage. Next, an elderly bag lady tried to get on as the doors opened and she made a bold attempt to climb up against the wall of opposing bodies. The driver apologised and remonstrated with youth’s respect for the elderly, but beneath it all – she wasn’t a chosen one. She made hand movements to her mouth with looks of poverty and destitution, he countered with forces beyond his control and assurances time would tend to her woes. 

And with a swish and hiss of closure, we moved on to the next hearing.

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When the canary stops singing

canary

In November 2016, on a rare sunny afternoon I was driving to work. There was nothing out of the ordinary about this, until I rang my Sister and she said,

“Hi! How are you?”

The tears wouldn’t stop, and she calmly coaxed me to the roadside so I could park, and turn off the engine.

I remember repeating:

“I’m so weak. Why am I so weak?”

That was my last day of working in General Practice as a Doctor. At 43 years old, I was finally going to address a decision I made at 17 to go into Medicine. So here is the first stage of the challenges we face as a society: finding the right people to do the work of healing and caring. Unfortunately, if you want sensitive, compassionate, empathetic recruits the chances are, they won’t survive your current system. It’s simple Darwinian laws.

I was probably a bad fit for the job right from the start. “Adrian, you are too sensitive.” That’s what I grew up with ringing in my ears.

I remember the buzz in the hospital on the first day working as a qualified Doctor. The news of the first person to breakdown and cry travelled swiftly, and I was secretly relieved it wasn’t me. May be I was one of the tough ones? Recently I was involved at a Medical School as an academic mentor. Sadly, the culture hadn’t changed from my experiences in the 1990s. It is difficult to leave Undergraduate Medicine with your dignity intact. The narrative remains: “failing”, “struggling”, or “not good enough”.  Should Medicine be an Undergraduate course at all? There is argument for a Postgraduate approach, recruiting adults with more life experience, and opportunity to truly think for themselves.

Am I happier now? Six months later? I’m certainly less stressed. I don’t wake up with a knot in my stomach and a feeling of nausea. I don’t drink as much alcohol, and my husband doesn’t say, “Anyway, that’s enough talk about work”. Being a medical Doctor is a title you carry on your shoulders with its pre-conceptions and judgments of the person you ought to be. I am still having existential challenges of self, self worth, value and meaning. May be that won’t ever end, perhaps it shouldn’t.

Loneliness kills; there is evidence to support this, and it might become more important than the pills we prescribe, and the diagnostic tests we order. As a GP, I sat in a room from 8am to 7pm. I left to call patients, sign prescriptions, go to the toilet and make a drink. Sometimes I would spare 15 minutes or so for lunch, but mostly would eat at my desk. I saw 36 patients in a day, and dealt with more than double virtually- reviewing tests, correspondence, referrals, queries and urgent matters when no one else could manage.  My experience of General Practice was better than many in terms of workload, and demands. I tried to set up a coffee break. I was motivated by a Swedish custom called “Fika” all about meeting, relaxing, eating nice things and sipping a hot, refreshing drink. It didn’t work. There wasn’t the time. I felt isolated. Patients can be frightening in terms of their complexity and need. I would often drown in a tsunami of distress, desperation and confusion (and that was just me). I saw it as a weakness – my need for Professional support. When I raised my struggles with a colleague, it was suggested as an educated, well-paid professional I should be sufficiently self-organising to find what I needed. So I tried for a while….hovering in the doorways of colleagues’ consulting rooms…trying to make a connection whilst they sat at their desk, both of us aware of the third person in the room – the computer, with its unblinking demands, just there, with a steady glow drawing half an eye into it’s virtual space.

I went to a meeting over the issue of providing a 12-hour, 7 days a week GP service. A frequent comment was, “You’d have to pay a premium to get GP’s to do this.” I felt very depressed. I realised the money I earned was not a reward for service proudly provided, rather to compensate for the awfulness of the work I endured. We, like everyone else in a capitalist world believe what we earn is the key to motivate, reward, provided status, and make us happy. Yet other factors offer a tipping point in decision-making; like a GP with an interest in ophthalmology that stopped working for a hospital when it expected him to pay for parking. We think money is our only currency, but it’s a virtual reward. An environment that provides hot drinks, tasty food, and a person who has the time to ask, “How are you doing?” and is willing to listen to the real answer, remains for some, more valuable than a job that simply offers extra cash. I know for many of my middle-class friends the capitalist equation is: money=nice house + nice area + good schools. Or money = nice house + nice area + private school fees. So we become tied to crippling mortgages and/or exorbitant school fees in a form of indentured labour to ensure the next generation benefits as much as possible from our own monetary aspirations.

There are at least 10 ways to complain about your GP if you are unhappy with their service. For example, you can:

  • complain directly to the Practice,
  • post your thoughts on NHS choices and/or other web-based rating sites,
  • complain to NHS England,
  • your clinical commissioning group (CCG),
  • your MP,
  • the media,
  • the GMC,
  • the Patient Advice Liaison Service,
  • the Health Service Ombudsman,
  • or your friendly neighbourhood Solicitor.

If you don’t like the answer you receive, well, there are plenty of alternatives to keep everyone busy for a while. Anxiety was a common presentation in my job. We don’t have so many real threats anymore, like sabre-tooth tigers or life in a war zone, but we have plenty of virtual threats constantly bombarding us. Although I’ve left my Profession, I have years to wait before the threat of a complaint or litigation truly starts to dwindle. I am left wondering, what is it we want? Do we want an improved quality system to reduce future mistakes, facilitated by openness and transparency? Do we want appropriate and fair compensation for harm, or do we seek vengeance and retribution?

So where does this leave us? The toughest will survive our current NHS predicament, and the weaker will endure but at risk of destructive coping strategies such as drugs and alcohol. The toughest won’t be the most empathic, and the more sensitive burned out, so care may be delivered with a small “c”.

We need a societal conversation and public consultation on what we want our NHS to be. It is doing remarkably well within constraints we have imposed. We do need pay that is fair, but also to think beyond financial compensation or reward, to other forms of investment for longevity. This includes systemic trust, and valued time to grow emotional resilience, reduce professional isolation and facilitate supportive communities of care. They say, “Culture, eats Change, for breakfast.” A hot drink, and a smile that says, “I have time to listen”, should not cost as much as it does right now. When things go wrong, we need a rationalised, centralised system to provide fair and transparent investigation, compensation and quality improvement.

I think we all want to feel cared for when we think of the letters “NHS”.

Time

I have this wonderful gift called time. I can sit on a train and enjoy its presence. In the capitalist handbook time is considered low value, but high cost. It has no material form yet we all notice its absence. Both friend and foe, how do we flip it from enemy to ally?

What Is Your Mission?

Reading from the book of life, a chapter on “Finding your mission” provided a useful insight into creating focus and direction associated with our careers. It’s true, those of us with no plan, are distinctly disadvantaged when we come up against organised planners. The idea behind the concept is finding work purpose towards a service to humanity. It goes beyond our personal needs, but doesn’t have to be a massive and worthy cause, like finding the cure for HIV or malaria. It just needs to be something we can imagine improving the lives of others.

I think I’d like to lessen the psychic stress of individuals living in our current sensory overloaded society, and create visual imagery to remind us of our interconnectedness, vulnerability, and sensitivity in a temporal world of layered complexity.

Fusion

Following the principles of acceptance and commitment therapy (ACT) I discovered the challenges of fusion. 

In simple terms it’s when our thoughts become the only Truth. Whatever our inner voice says – we just accept. Traditional CBT encourages challenging, and over-riding our loud inner critic. ACT however, endeavours to get us to:

  1. Recognise our inner commentary 
  2. Lessen the impact through observation and acknowledgement, without automatically fusing with the narrative 

Often the biggest challenge (certainly for me) is hearing that voice. It’s become so massively fused I seem to shift through various states of being without time to recognise or cognate what is happening.

Mindfulness is excellent practice to allow time and experience of observing. Sometimes it feels 10 minutes in a day hardly balances out the remaining hours to survive; but it starts to leak out of practice periods and can give surprising STOP moments where I find myself saying: 

I HEAR YOU, AND I KNOW WHAT YOU ARE DOING

Keep going

Mental health is a curious phenomenon. I journey through the day vaguely perplexed by my physical tiredness, and overwhelming desire to crawl into bed and sleep.

It feels like a chronic or post-viral fatigue. I have to practice pacing, grading my activities to reduce flip-flopping between spikes of activity, and crashing inertia.

Sitting and staring out the window with my dog curled up on the floor at my side has become a wonderful pleasure. I hope never to lose appreciation for this experience, before guilt mobilises me into activity.