It is your reaction that is the problem.

reaction2

 

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 for you, but still I am uneasy and here is why…

 

A few years ago I started a year-long job that was a bit of a distance from home. Far enough that I wasn’t going to be driving home after 13 hours at work only to come back again the next day. So I rented a hospital flat and was away from home for that year. On the first day, during induction, I was asked how I was going to cope being away from Mr Edge and our girls.

 

At the time, my answer was very clear. They are safe, they are well looked after, they are happy.
I was pretty chilled about it all because, and I can recall it so clearly, it was a time of horrendous fighting in Gaza and I had been watching online the devastation happening in the Middle East. The hashtag that stuck out for me was a chilling call for the International Criminal Court to deal with Israel. Now this is not a political blog post and I have nothing to say about that. Whatever the circumstances, as a human being, it was harrowing. In particular I saw a series of traumatic photographs of a broken man, walking a broken street with a plastic bag. He was picking up the pieces of his child, who had been torn apart by a bomb. The final image was shocking, it was a close-up of the contents of that bag. I think about that image often.

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Scott was getting at this… Imagining the worst case scenario will always set you free to make a leap, because it will make you realise the unlikeliness of that scenario coming true. It will give you the strength and courage to face the difficulties of your day. But do we really need to be so graphic? I think about that image a lot. Perhaps that is my own personal negative contemplation. My children are safe, they are well looked after, they are happy but it is a painful way to remind myself that this is so.

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I play along with the rhetoric and philosophy of the Stoics. I keep Marcus Aurelius at arm’s reach in my school bag. In fact the Meditations of Marcus Aurelius was the book I took with me to Dublin (did I think I was going to get a chance to read it?). Like Seneca himself I could probably be considered slightly less than stoic at times…but that’s OK, I am after all a work in progress. For a start I do not join in deliberately with any Negative Contemplation. I don’t ever deliberately visualise my girls dead in my arms. I don’t feel the need to go that far. This is something that Scott brought up in his talk, he says he does this, deliberately, daily. Understandably he was met with stunned silence in the large auditorium. He went on to explain how this and meditation helps him get through the tough stuff and how you too could make a start yourself on the path to inner peace.

In this arena full of high achievers, we all want this to work for us too. Since SMACC I have heard a few people say that they are going to start meditating. They are rushing home to give it a go. But this is a bit of a word of warning…beware that it may not bring what you’re looking for and that’s OK.

I am not being a #meditationwanker and I am not having a go at Scott Weingart, VERY far from it. We are looking now to a future where our wellbeing is considered much more important and we can discuss mental health issues more openly. This can only be a good thing. In the past this would have been unconscionable. We need people like Scott, with the reach and influence he has, to say that it is OK to seek out help like this and to suggest tools that could help. I’m just saying, personally, I struggle with the meditation that he suggests and negative contemplation feels to me like the sort of self flagellation I accidentally achieve daily anyway. As long as I channel it to positive outcomes then that’s fine and it doesn’t necessarily have to be quite so traumatic.

 

So what CAN I do?

For me it is writing. I write a lot. Only a tiny portion ever reaches publication – the rest is all shit (you might argue the published bits are shit too). I am guilty more than anyone of trying something only a couple of times before moving on when I am not suddenly representing my country or winning awards but

My point?
Do what floats your boat.

I have friends and colleagues who meditate and boy do they do go on about it. I spent a lot of time punishing myself for not finding it helpful. I did this too when I couldn’t find what I was looking for in Tai Chi…I gave it a chance but after I while I went back to kickboxing because really I just needed to punch and kick people to help me feel peaceful.

It doesn’t matter if you can’t do what Scott Weingart says. Give it a try. If you try (and like anything, you need to give it time) and it doesn’t work for you, recognise that you didn’t fail and you don’t have commitment issues. It just wasn’t your thing. Stoics see it like this – it is not the problem that’s the problem, it is your reaction to the problem that is the problem. If this doesn’t work, don’t go beating yourself up…and it is not Scott Weingart’s fault either. So,

 

Meditate
Don’t meditate
Imagine the worst case scenario
or don’t.
Write
Watch Football
Read
Run
Study

It is in the deliberate and in the mindfulness that you find your thing.

Strike your own match against whatever is going to set you on fire.

Just make sure you strike it somewhere and remember it is unlikely to be your last match and that’s OK.

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

Shetland

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 sitting there, holding on with white knuckles and a voice in my head saying “he’s the pilot, he knows what he’s doing”. I said nothing, so perhaps, I too am guilty as charged.

We had been out for a day trip. It had been a beautiful day making it slightly hazy which isn’t always the best for flying but for me it was a great view. We flew over our house and flew over my old school in the Worcestershire countryside. We waved at the tiny flecks of sheep in the fields and followed the main roads as they snaked along below us. I love flying and strangely, the bumpier the better. But all good things come to an end and we had to head home.

As we flew back to the airport I listened to control – he was telling us to land on runway 3-4. That’s definitely what I heard, he said it a few times. The problem was, as we came in to land, in an unsurprisingly windy and bumpy descent, I couldn’t see a 3 in front of me. There was, however, a giant, white number 2 painted on the runway. Something didn’t add up. This wasn’t the right runway but I wasn’t the pilot. I didn’t speak up. I just thought I must have it wrong. He knows what he’s doing after all.

It was a very bumpy ride but rather skilfully, he managed to land without incident. There were no other aircraft or obstacles to hit and we got away with it. That doesn’t mean the pilot wasn’t in trouble!

Last week I flew (as a passenger) back from SmaccDUB to Aberdeen. The lady in the seat next to me was not a happy flier. It was another bumpy one, the weather was rubbish (welcome to Scotland) – she hated it. She sat there hyperventilating and holding on to the armrest and then my arm. I was loving the turbulence but I didn’t think it was a good time to tell her my story. I did tell my colleagues who had been on the same flight as we stood waiting for our baggage – and their immediate (just back from SmaccDUB) critical care doctor’s style response – “Why the hell didn’t you speak up – have you learned nothing?”.

Well, that’s easy for them to say. I think flattening hierarchies is easier said than done. If you’re the boss, just allowing me to call you Rob at work isn’t suddenly going to make me question my judgement less or yours more. That’s a confidence issue that as a junior doctor, I’m not the only one who struggles with. There’s a lot of work to do to make the team understand your reasoning and play along.

The talks at SMACC were delivered by experienced and thoughtful bosses. There was a lot of discussion about leadership, team working and vulnerability in this line of work, about looking after each other and watching your choice of words. Will it help me develop leadership and understand team dynamics? Yes.
Will it shape the direction I go in? Probably.
Will I speak out when I need to? Well, I spent my week in Dublin surrounded by grown up doctors from my hospital. I probably didn’t contribute much because I didn’t feel I had much to contribute. I love this picture of us…and I am not stuck on the end but right in the middle. It will make life easier to have discussions when I am back at work, of course it will. They aren’t as scary as they look 😉

dubx

Would I speak up? Yes, now I would but it isn’t easy. Speaking up or calling someone out isn’t easy, whether or not they want you to “just call me James” when you’d rather say Mr Surgeon-Sir. Some of us just find it easier having rank slides. Dealing with team dynamics and leadership is not easy – wherever you fit along that flattened ladder. Some of us don’t find it easy to walk into a room of 2000 people and end up friends with everyone even if there is a free bar and Guinness is flowing. We are all different. I’m not necessarily quiet, I sometimes do say it how I see it. I sent a peace offering to someone the other day and have been met only by silence…you can’t have everything but you have to try.
These so called soft skills are anything but soft just as Liz Crowe (@lizcrowe2) told us in her fabulous talk about love in Dublin. For me, they are harder than learning renal physiology or anything anatomy related for exams. I don’t think I’m alone in that and that’s why we need conferences like SMACC. This week I have managed to keep up my life-long 100% pass rate for exams…but I think when it comes to the soft stuff, one way or another, I fail daily. SmaccDUB taught me that.

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