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The Winter of Discontent

The Winter of Discontent

Now is the winter of our discontent, Made glorious summer by er, Someone? Anyone? It’s really cold and everyone’s striking, and all this sounds vaguely familiar. I was born in the middle of the Winter of Discontent, the cold, bleak winter of 1978-1979. I had […]

My wonderful moustachioed man at Heathrow.

My wonderful moustachioed man at Heathrow.

When I was 16 years old my big brother went off on a gap year, backpacking around Australia. I was jealous and wanted to go too but there was a problem – I was only 16. Eventually my parents compromised, I could go, but to […]

I wasn’t expecting that – more encounters with suicide.

I wasn’t expecting that – more encounters with suicide.

I wasn’t expecting this.

I wrote about my next encounter with suicide because I needed to think through how I was feeling. It had come up with some colleagues recently and I boldly claimed that we needed to be able to talk about it more. I shouted nice and loud…. We NEED to able to talk more about suicide!

I never ever said though, that it was going to be easy.

It all started out as a simple personal reflection on being able to recognise and cope with personal biases, especially as a medic. Suddenly I found myself with a huge number of readers, many of whom shared my post so more readers came.

They didn’t come for any horrific photos, they didn’t come to hear about the gruesome or to be peeping-Toms to the misery of others. It seemed to strike a chord in another way.

The bit that seemed to hit home was when I described how I felt about my personal encounters with suicide and how I dealt with it all. Or didn’t deal with it, as it turns out. I had a lot of private messages, some saying thanks for sharing and one or two being very long and heartfelt. I haven’t yet replied  to them individually because well, I wanted to take time, to get it right. Silly me, that is the very problem!  If we wait to say what we should say, if we wait to get it right, then too much time will pass and we end up not saying anything at all. Then the next time we see those people, we feel it is too late and we still don’t say anything. That’s craziness.

I am glad people felt that they could write to me. I am glad that they shared the same feelings and I am glad that we started a conversation. It has been hard though. A couple of friends have written to me telling me their stories, things I never knew about them, or that they had gone through. I hope it helped. I feel closer to them. I think about them differently now. Strangers too felt compelled to share with me how they felt about it all. I feel differently about it all now.

This is why we need to talk about it more.

However hard it may be.

Thanks too to all those who messaged simply to ask if I was OK and to let me know that they were there even though it was never about me. That was wonderful and shows that yes, we are looking out for each other. The world of medicine/nursing/paramedicine needs more of that stuff.

I am off to make some individual replies.

Suz

What is mildly amusing is that since I wrote that post I did actually end up in a bed on my ward via ED … Didn’t jump out the window though, don’t worry!

Stuff that may help:

From EMS1:  How to save a medics life

NYTimes: Why do Doctors commit suicide?

From PHARM: Are you OK?

From Mind : Suicidal feelings

From Samaritans: Suicide

 

A rising tide floats all boats.

A rising tide floats all boats.

  I was having a discussion about disruptive technology in medical education (as you do) and in a reply one particular line stood out for me… I think the world is now mature enough to be sceptical about what we see and hear on the […]

It is your reaction that is the problem.

It is your reaction that is the problem.

I’ve been feeling a little uneasy about Scott Weingart’s opening talk from SMACC. It was an extraordinary talk, recorded live on stage for the EMCRIT podcast and it took quite a few people by surprise. He talked about meditation and negative contemplation….all good things, if they work […]

Facing personal biases and my next encounter with suicide.

Facing personal biases and my next encounter with suicide.

The Friday night school disco was always an awkward, fun, silly affair with smoke machines, rotating disco lights and the occasional shifty bottle of MD:20:20 smuggled past the headmaster. I had danced with Harry, the new boy. He was a bit different, I liked him. We had similar military family backgrounds and being fairly new to the school he was having trouble adjusting because of that. He was fun. We were 14. Nothing else mattered.

 

On Monday morning as we took our seats for the new week, with stories flying around about who got up to what, our head of year entered the classroom. He asked for our attention, he told us to sit and listen and things suddenly changed. Harry is dead, he said, there had been a terrible accident. He explained how he had been playing a trick on his little brother, pretending to hang himself with his belt, he had slipped and he couldn’t be saved. We were 14 years old.

 

It has been a while since I was 14 years old. The school has been pulled down, the tree we planted in Harry’s memory torn up to make way for new flats. A long time has past and yet I still can’t shake off this nagging feeling. I just can’t bring myself to believe that this is what really happened. You see, I think Harry killed himself and for whatever reason, we were not told the truth.

 

I have lost an alarming number of friends, acquaintances and colleagues to suicide in recent years. Shall we take a moment and get past the joke that maybe they just couldn’t stand to know me any more? Thanks…moving on…

There have been the two hangings, the two drug/whisky overdoses, the jumping in front of a train (two of those believe it or not!) and one that I think was suicide but I have never asked because, to be frank, I can’t bear to hear it confirmed. At work I have seen a few people who have taken there own lives. If you spend any time with the ambulance services it doesn’t take long before you see them. A hanging, a shot-gun to the head, an overdose.

The fact that every time it happens I really struggle to deal with it may be my biggest problem here. I haven’t ever been able to face it and so I haven’t been there for my friends. I haven’t been to funerals or memorials. I have avoided any discussions. I have been so angry about each occasion that I have refused to hear the details, I have never questioned what really happened. I don’t get upset, I don’t cry, I just get very very angry.

 

I mentioned this to a senior medical colleague recently and she seemed a bit shocked.  “You’re going to have to get your head around this” she said “to work in the emergency environment and not, you know, go nuts. Also, you can’t be seen to deal with this so badly”. She was pretty blunt. I hadn’t really thought about it like that. She might have a point. I really don’t know how my own thoughts or feelings of anger affect how I deal with family members, or how I am seen to react. I just hadn’t considered that before – how does my own almost irrational bias manifest? Do people see it in me or do I manage to hide it?  I don’t know the answer to that.

 

Doctors are more likely to kill themselves than people in other professions. We know this. It makes me angry. Female physicians are just as likely as male physicians to take thier own lives. It is only a matter of time before I have to confront this again. I hope I never have to but of course I will. I suppose we all have our own individual hang ups, our own personal biases that might make us react differently when they come through the hospital door. At least knowing what mine might be is a good start.

Right now I work on the top floor of the hospital. The emergency department is downstairs at ground level. I sometimes joke with colleagues that there’s no point in jumping out of the window here…I would only land in the ED and as we are the only ward to ever have a spare bed I would just end up back where I started. I don’t think they realise that the thought had on more than one occasion seriously crossed my mind. I have, on more than one occasion, driven home along the small winding country roads (that have a habit of claiming a lot of lives around here) at over 90mph, willing a truck or tractor to come the other way so I could just drive into it. I have been there. It was a bad time. Please don’t worry, I’m not there any more.

 

So why do I get so damn angry when others go and end their own lives? I don’t know, but I have a suspicion it may go back to Harry. It may go back to wanting to be told the truth. It may go back to knowing that, with recognition and support, any one of them might have been prevented.

At work one day I asked a friend what was wrong. I hadn’t seen him for a while. He looked tired and unhappy. He looked like crap. He shrugged and told me he had a cold and I accepted that. Why wouldn’t I? A few days later I learned he had taken his own life. I felt so so angry. I still do.

 

Tuesday: I appear to have hit a nerve or two with this post. I am replying to personal/direct messages but I am a bit poorly (D&V, will spare you more details).

Please do leave a comment below if you wish to.

 

Some more reading:

Hopkins Medicine: Why do young doctors commit suicide?

 

 

 

 

Speaking out: teams, juniors, leaders and what SmaccDUB taught me.

Speaking out: teams, juniors, leaders and what SmaccDUB taught me.

Landing on the wrong runway has left with me a story to tell for life. It probably gets more animated each time I tell it over a drink or two…but for once, I’m not the guilty party…ish. I say “..ish” because I wasn’t flying the aeroplane, I was […]

A Touch of Mountain Medicine

A Touch of Mountain Medicine

WMT’s Mountain Medicine Course You have the chance to be an expedition medic. Which group would you choose to join? A charity walk with thirty people climbing Kilimanjaro? A school trip to India with thirty 14-18 year olds? A high altitude climb with a small […]

Small town excellence

Small town excellence

Sometimes you have to turn things on their head and look at them in another way. I was made to recently by the boss…who had a slightly different (and of course far more experienced) point of view.

crackinthewall

I was grumbling to some colleagues about a subject that seems to be becoming my thing…the fact that where you live really shouldn’t determine if you live.

But it does.

Time and again I read and hear examples of this being so.

Scotland’s aeromedical service (@EMRScotland) only this evening pointed out on Twitter that London Air Ambulance (@LDNairamb) has 2 dedicated trauma teams on tonight, and Scotland has none. Northern Ireland has none. Dr John Hinds (@DocJohnHinds) regularly points out such inequalities and that trauma care in Northern Ireland is something of a lottery.

Where we live has consequences when things go wrong.

When my husband and I bought our beautiful cottage amongst the mountains we could not have been happier. For our youngest daughter, things were not so great. The day we moved in she became unwell. The bad nausea, vomiting, fever, photophobia, stiff-as-a-board type of unwell. I phoned the out of hours GP service and they sent an emergency ambulance. As Mr Edge went out into the dark to guide them to the house, I contemplated the longest time it would take to get us to hospital. I couldn’t help but question our decision to move so far from the big city.

But we chose to be rural and I know what you’re thinking. Scotland isn’t quite the outback…we aren’t relying on @ketaminh to fly us miles and miles across the land to definitive care, but none the less, where we live could have a huge part to play in whether  or not we live, should disaster strike. Distance to a local hospital might not be that great, but next stage distance to a teaching centre with ICU, neurosurgery, interventional radiology and dermatology (OK maybe not dermatology so much) being available on site must have an impact on the local population? Doesn’t it? Are there any studies?

Sure, we should strive to be centres of excellence in big cities, but we should be striving for even more than that if we are far away.

We have a brilliant District General Hospital. It is staffed by many talented,  enthusiastic and slightly eccentric but reliable and committed generalists. We are sometimes viewed by the specialists in the big city as being another ward of the Trust in which we all belong. Most of the time though we feel like the crazy Aunty that nobody wants to sit next to at a family wedding because she smells of mothballs.

Things are different here.

REBOA carried out on a London street to save the life of a young trauma victim is science fiction to us. If you suffer a traumatic cardiac arrest on the roads around here, you’ve had it. Sorry, did I use the word if? This is happening on local roads every single day just now. But I’m not just talking about the sexy trauma stuff. I’m talking about the other every day life changers: the tumours, the brain haemorrhages, the clots, the STEMIs and the time it could take to get you through the DGH system and on to definitive treatment.
Having a STEMI? The cath lab is quite far away, will thrombolysis do?
Emergency neurosurgery? Good luck with that.
Abdominal pain at night? Hi, I’m a new FY2 (seriously, that could be me you’re getting first).  I’m not really sure if DGH populations understand that? I didn’t before I came here.

The boss stepped in at that point…she stopped me in my tracks. She put it like this…

Of course it’s obvious that where we choose to live determines our chances….but our chances of what exactly?
Because of the geographical gap between us, it can make life harder to get people to the end result they might need but we do get people out the door and down the road when we need to. 
I believe that it is because we DON’T have all of their snazzy potential interventions and “things to try” at ANY cost, that we are far better at discussing and considering all the options, including death. Good old-fashioned end-of-life, death. We do palliation really bloody well. Sometimes, that’s what people really need and packing them off the big city might not be for the best. Providing a good death, with family nearby and consideration of comfort, dignity and DNACPR are as important when needed as ICU when it’s appropriate. I think we do that really well here.

She’s got a point.

The local population might not appreciate how different their care can be far from big teaching hospitals but maybe like me, they choose to live (and die) here anyway and for other reasons.

As for my daughter, after what seemed like a vey long trip, she jumped out of the ambulance, shone the pen-torch in her own eye and giggled on the long journey home with the packet of biscuits the nurses had given her. We didn’t sell up and move back to the big city. Not yet.

****

I posted this blog post about 24 hours ago. Since then I have learned the sad news that Dr John Hinds died today in a crash doing what he loved…risking his life to save others. Northern Ireland deserves the same care services as the rest of the UK.

Where you live shouldn’t determine if you live…but it does. RIP Dr Hinds.

 

 

We’ve always done it this way

We’ve always done it this way

There is not a phrase in existence that I could despise more. Please don’t get me wrong, as a junior doctor it is a phrase that has helped me out of a few sticky situations when uttered by an experienced nurse who’s watching my back. […]

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