My wonderful moustachioed man at Heathrow.

 

My 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 visit my Uncle and Aunt in Brisbane and be back soon to start A levels.

 

I waved goodbye at departures, got through security (explaining that the cricket bat in a box was a gift for my cousin and was not a dangerous weapon, pre-9/11) and off I went on my own. I found a seat and as I sat down, tears started to form. I was emotional. I was 16.

 

There was another passenger already seated on the benches in front of me. Until that moment he had been hidden behind a large broadsheet. He slowly lowered his Financial Times and peered out at me over his glasses. Revealed was a tall, skinny man, larger than life. He was dressed in tweed with a remarkable moustache, a big bushy beard large enough to hide Basil Brush and Roland Rat and to top it all, he was wearing a wonderfully bright red turban.

 

“What are you crying for young lady?” he asked me, not accusingly, not aggressively, not patronisingly, just quietly.

 

“I’m going to Australia.” I sobbed.

 

“Mmmm, well that just sounds like there’s a wonderful adventure to be had and no reason to cry. You’re going to love it” and with that he was hidden again behind his newspaper.

 

I couldn’t help but stop crying and start laughing about at how silly I was being.

 

I never saw him again, not in person anyway. I think of him all the time though, when things start to get a little hairy and I feel like a 16 year old heading off alone to the other side of the world.

 

What a chap.

 

It is easy to fixate on the shit comments people have said to us, the ones that really stick in us like knives and do us so much harm. For some reason, remembering the helpful stuff is harder. There are plenty of chances to see the positive and be helpful and kind to those around us. If you are in a position of authority and even if you can’t match the remarkable facial hair of my wonderful moustachioed man at Heathrow, please offer up a good comment, you never know who might remember it, with fondness, 22 years from now.

 

 

Facing personal biases and my next encounter with suicide.

topfloor

 

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.

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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