Monday, January 20, 2014

How Her Majesty the Queen helped me survive these past 1.5 years.

Dedicated to every brave soul who daily choses to continue living - even if it means facing demons, hardship and heartache.  Dedicated also to the fabulous Rev Dave and CEO Lisa who together gave me the bravery to speak out and put pen to paper.

It is amazing that even in the 21st century, it still isn't very easy to speak openly about mental health issues - particularly on a personal leveMORE empathetic and compassionate rather than building walls and de-personalising our patients!  Somehow anyone within the NHS, there is a ridiculous notion that "we are professionals and shouldn't struggle on this level".  But the unspoken reality is that the NHS is wonderful because it is staffed by human beings who do go through similar problems to the patients and families we see on a daily basis.  That reality should make us

My own personal background was somewhat more complicated by the fact that I came from an extremely fundemental religious background where mental health issues were particularly disapproved of, and usually put down to "sin" on some level.  When I first went on antidepressants some 10 years ago for a time, I didn't dare tell my parents for some years - as it was seen as an admission of "failure".  I have seen my General Practioner and various Occupational Health services through work pretty regularly - and the clinical feeling is that I am not "depressed" per se - I apparently tend to struggle with "chronic anxiety".  In short - I daily seem to imagine up (I have a very vivid imagination) all sorts of fears, worries and panics about what life may bring.

The last year and a half has been particularly rock-bottom in terms of experience, health and work.  Two or three times I did in fact consider suicide and whether it really "was all worth carrying on".  Those low points were often prompted by events I read, such as the tragic account of the nurse involved with the Australian DJ scandal while Prince William and Kate were in hospital expecting Prince George.  Reading that account made me feel an affinity with the nurse - but in a ludicrous way, a rather morbid wondering if I also committed suicide whether the Chairman/Chief Executive of my workplace would make a statement to the press.  I decided they wouldn't bother - and somehow found that enabled me to "keep living" that particular low day.

But the benefit of this year has meant that I have been forced to confront some of my worst fears headon - with no support, help or alternative.  That's a story for another time - but what I found was that actually - my imagined fears were WORSE than the reality!  But what I wanted to focus on in this post was what enabled me day by day to "keep going" this year.  And that was the person and example of Her Majesty the Queen.  Before you snigger - let me explain why.

I am sure there may be psychological reasons why the Queen means so much to me personally.  I lost both my beloved Grandparents at significantly low times in my life to cancer, and both losses affected me deeply.  I guess there may be a degree to which I long for a "Grandmother" figure.  But Her Majesty's example has meant more than that this year.  It is well known and commonly cited that her life motto is;

"Duty first - self second".

When Her Majesty was 21 she made a monumental speech in South Africa where she committed her life to;

"I declare before you all that my whole life whether it be long or short shall be devoted to your service and the service of our great imperial family to which we all belong".

Her committment to duty has ruled her life and service - even if at times it has meant that her family life and personal life has been affected as a result.  Many commentators (and we never know what Her Majesty herself thinks - as she does not give interviews) suggest that call to duty is something that has remained with her, and has driven her throughout her life and reign - to the present date, her amazing 86 years of age and her now-over 60 years of reign.

Let me make it clear - I do not equate myself in ANY way to Her Majesty the Queen in ANY sense (other than to count myself fortunate to be one of Her subjects).  But what remained with me throughout this blackest of years, was initially a thought - does Her Majesty the Queen ever get down or low?  And this wondering grew into an interest that lead me to reading many of the biographies written about the Queen, and the difficulties that have beset her (especially her famous "annus horribilis" year and the year where HM lost both her beloved mother and her sister) - yet continued to perform her duty.

Her Majesty's personal difficulties are made worse by far because they are so often in the sight, criticism and debate of the press and therefore the public of both the United Kingdom and Commonwealth.  At the very least any personal problems I have, were able to be limited by myself to the people I trust and were able to depend on (and to them - a few in number - I owe them a debt of gratitude I will never be able to repay!).

While working through - day by day - the blackness, the lowness and utter desolation of the past year - at times, it was quite simply the fact of seeing Her Majesty the Queen at an official function (I follow several blogs that track and report the Court Circular) that gave me courage and conviction to try and "live the day".  At times, this was as pathetic as leaving the safety of my flat and walking to the corner shop to buy a pint of milk.  It sounds ridiculous to write this - but my mentality was;

"If Her Majesty can go to yet another engagement despite the wealth of possible aches and pains she may have as an over-80 year old, smile constantly even though she may not feel it, and shake umpteen hands even though she has done nothing but for the last over 60 years of her reign ... then surely I can put clothes on, leave the flat and do a simple task?".

That simple role-model and mentality enabled me to gradually build and grow in confidence, activities - and as a result I found my mood and outlook on life improving, my determination to work through my difficulties strengthen, and focus my goals beyond just "surviving the day".

It is for this reason I will never fail to be grateful to the unfailing example of Her Majesty the Queen.  The couple of visits I have been SO fortunate to make to Buckingham Palace only served to enhance that.  It is why I am a Royalist through and through!  I know this example will not work for everyone who suffers with anxiety, depression or any other mental health disorders.  But I do think it underlines the importance when you are struggling so hard to "keep living" - sometimes it can be the most simple or obvious of things that help keep you "living"!  It could be a family pet that needs feeding.  It could be a planned outing in a few weeks time.

The majority of the victims of suicide almost invariably state; "they ran out of hope".  So for us - as NHS professionals - one of the key responsibilities upon us is to help find that hope (and it will be individual to each person).  But we can only do our job well and effectively - if WE are honest about our struggles and experiences.  Small things such as a "thank-you" from a Chief Executive or a line manager can change the complete "mood" of a working week!  More importantly - cared-for staff give better care (it is widely acknowledged - I cite an excellent PICU Intensive Care Consultant as an example) so it is vital that if NHS staff do share mental health struggles and issues, they are supported and not vilified or patronised (as has sometimes been my experience).

Positive thinking (in my opinion and experience) is absolutely vital to "keeping on going".  For many of my 36 years of living - I thought that positivity and happiness was a reaction to the experiences that life forces upon us.  If life was going well - then I was happy!  If it was going very ill - then I was not.  But I have come to realise and understand (thanks to Twitter friends - in particular Kath Evans, Head of Patient Experience for NHS England and her friend 'Engaging Emma') - that in fact positivity and happiness come from "within" and are a state of mind that can be increasingly immune to life's changes and events!

My conclusions?

1.  Life isn't fair or just.
2.  We all have a choice - to continue and fight or opt out.
3.  We can all chose to benefit from our experiences and use them for good.
4.  There is always hope - even if it is the smallest glimmer (such as the Monarch carrying on her duties!).
5.  The night cannot last forever - the dawn does comes, even if it seems forever!

Tuesday, January 07, 2014

A View of Things That Matter

This blog post is dedicated in particular to Julie Bailey, Deb Hazeldine, James Titcombe, Liza Brady and Dr David Drew - among so many other whistleblowers.  It takes tremendous courage to speak out and "rock the boat" - courage perhaps more than I possess.  These people have suffered unbearably but want - only the best.  We need to hear from them.

It's been on my mind to write about the last year's public opinion of the NHS for some time.  The important whistleblower revelations of Mid-Staffs, Morcombe Bay and others have broken the rose-coloured fallacy that the "NHS is perfect because it gives free care to people who need it".  That is true and it is wonderful.  But the NHS is made up of imperfect human beings from the porters and domestics who enable hospitals to run, to Chief Executive Officers who lay down vision.

As is common in human behaviour, we tend to hold opinions of extremes (I hold up my hands and admit I personify this!).  If we do not love something passionately, we hate it with a vengance - particularly if wronged by it.

It particularly troubled me to see the horrendous backlash against key whistleblowers such as Julie Bailey and Deb Hazeldine, James Titcombe and Liza Brady.  For those unfamiliar, these two ladies lost their beloved parents in the most appalling failures of care and were not giveNOT just treat "the patient".  That "PERSON" comes as part of a family - and care given to them (whether good, bad, excellent or dreadful) will impact upon the closest people to them.  A caveat: I can somewhat understand why a lot of the backlash comes from the people of Stafford who face losing their hospital.  They are looking for a scapegoat, and inevitably (I suppose - however unacceptable) will look to the whistleblowers.
n the answers and reassurances they deserved - and so began to campaign.  The NHS and health professionals owe them a debt!  They are a reminder that we do

But I want to ask - does anyone mildly rationale think these two ladies - Ms Bailey and Ms Hazeldine EVER considered "becoming campaigners" or "whistleblowers" five to ten years ago?!  We must consider why fate led them to this.

1.  A Step Back and Pause for Thought:

Over this past year I have had a lot of time to think, read and consider the NHS as something incredibly important to me.  The availability of the Mid-Staffordshire Inquiry has enabled in depth reading and consideration of the mistakes and errors and lapses in communication.  In particular I wanted to read the accounts of families like Julie Bailey and Deb Hazeldine to learn and ensure that in my experience - this would NEVER happen again in my human power or sphere of capability wherever I work.  I was seized by a comment Deb Hazeldine made in her testimony to the Inquiry that I think it incredibly telling - she made it early in the complaint (point 25);

"If Martin Yeates had been up front and honest in the first place, I would have walked away.  I just wanted justice.  If he had said; "Hands up, it's bad" but could demonstrate in a robust way that it wouldn't happen again - I would have walked away secure in the knowledge that vulnerable people were not at risk".

I would hesitate a guess that virtually all families who have suffered unjustly or through human error would be actually satisfied with a swift, sincere apology and evidence of real lessons learned and proof that identical mistakes would not be made - would be enough.  I wonder if we can allow for the fact that whistleblowers have happened - because one of the human errors of the human NHS is that we collectively haven't been good at admitting error and learning from mistakes?

When I was at school (a private Christian religious school run by my parent's church) we used to have reports on our progress - both academic, but being religious, also character.  One consistent character point I scored very badly on was called; "Responds Well to Correction".  I can only assume at heart at that point I was an intensely proud and/or stubborn character as I consistently would score; "Needs Improvement".

This is an error I have somehow (I am not sure how) been keen throughout my life to remove and hope will continue to do so.

2.  Applaud the Good but Admit the Bad - and Learn and Improve from It!

There was a report in the Independent today that somewhat ignited the difference of opinion about the NHS.  Sir Mike Richards - the Chief Inspector of the NHS - wrote and commented favourably about the NHS.  He said;

Compassion in the NHS is alive and well.” And then with extra emphasis: “We’ve also seen some really excellent care.”

This surely is good news?  But on Twitter again opinion was divided.  Those desperate to see the tide of public opinion turn on the NHS highlighted the story and applauded it.  The whistleblowers still seeking "something more" were justifiably concerned - all is still NOT well in the NHS and there is a great distance still to go.  The Sir Mike article states it itself;

"It is what I hoped I would see,” he adds. “But seeing is believing.”

There is a reason that I love reading the Birmingham Children's Hospital Foundation Trust Parent and Carer Feedback page on their website that collates feedback from the instant "Feedback Application" (Award winning!).  It demonstrates so clearly that feedback and performance change.  Some days the NHS gets it very right.  Some days the NHS gets it very wrong.  We are human.  We change!  But as long as we are transparent, live, love and learn - surely there is hope?

I for one - as a proud current NHS healthcare professional - promise and pledge here and now to devote the rest of my working life (up to 70 now I believe!?) to ensuring the patients and families under my care NEVER have any cause to have to raise concerns about the standards of my care.

PEOPLE matter.  End of.  FAMILIES matter.  End of.  And it is our (my) everlasting privilidge to be able to care for some of these vulnerable people when they need it most.  That expression of trust must not be ever let down.

Wednesday, January 01, 2014

Not WHAT we do but the WAY we do it

I am having a lovely relaxed New Years Day (mainly sheltering from the West Midlands grotty rain!) but hav been "seized" again by a comment made by a patient on a programme I am currently watching.  Having been away from critical care nursing for so long - it is frustratingly agonizing to watch the various ER programmes available and long to be involved!

The programme in question this first evening of 2014 is "Kings Cross ER: St Vincents Hospital" in Sydney, Australia.  11 years in nursing doesn't stop me watching with my toes curled as the ER team treated a poor young man who got stabbed in a nightclub in Sydney.  An ultrasound revealed that the knife pierced the left ventricle and he was bleeding out into the pericardial sack.  The cardiovascular surgeon was too far away by car to be present to save his life so the ER team looked as though they were going to have to perform the life-saving procedure by mobile phone.  Fortunately the young man managed to cope until the surgeon arrived and he was taken to theatre.

The next programme showed our young man re-admitted with possible infection and shortness of breath - and it was a thrill to see he survived the trauma!  However I was fascinated to note the one comment he made about his awareness of the life-saving surgery he had.  He said this;

"I remember hearing the voice of a lady doctor.  She kept telling me I would be okay.  She sounded like she had the voice of an angel".

It struck me again as we enter 2014 - healthcare workers have a UNIQUE privilidge in what we do in caring for patients and families often at their lowest point.  And yes - our patients and their families arrive at the point of care needing something - the care they can only get often from us.  But my point is this - the WAY we deliver that needed care is something that will stick with them for ages to come - far more than the care they needed.  We need both!  From Chief Nurse Jane Cummings "6Cs" - care and compassion run hand in hand.

A good New Year's resolution for all of us who may have the privilidge to care for patients in 2014?!