Tuesday, 22 April 2014

Climbing back onto the face of the Earth

Well hey there. I'd like to preface this post with a summing up of the last year or so:

I don't think I've made this blog-writing enough of a habit yet. I guess when I feel like it it's usually to impart jolly posts about how much of a ray of sunshine I am (really I am, just...not for the last year). I have so many half finished posts on here I just wasn't in the mood to finish. I'd get started then FEELS and I'd have to stop writing.

There's been a running theme to my posts and my life for the last two years. From one painfully preventable, horrendously handled, catastrophically circumventable circumstance after another, it has been a year of hilarious tragedy. The volume of shit that went wrong was just amazing.

Hahahahaha it hurts so much I can't stop laughing. Help, the pain -
All the bullshit stars aligned perfectly, all the screw you planetary angles coincided and I'm pretty sure one or two Greek gods got involved - at least that incestuous whore, Aphrodite.

Lets go with the most blog-relevant. I failed my semester 3 exams by 0.8%.

0.8%. The pass mark was 60.8%.

Results, you funny.

It's not the failing I'm fussed about, seriously I'm not in the 90%-or-more committee. It's the reasons why I failed that are the source of the glass case of emotion. I won't go into them because god would we be here forever (refer to bullshit star alignments above) but I've discovered the amazing tag team that depression and anxiety can make when they join forces and you suck at fighting them. I'm in counselling, have been for quite a while now. In short I failed spectacularly at life and require professional help.

So proud. Much impressed.

Save for student support, the medical school has been nosy, bothering and smotheringly unhelpful. They're more panicked about the whole thing than I am, giving me all kinds of options like taking a week out (lol, no) or suspending studies for a year (lol, hell no). Consequently, I've gone back and forth about taking time out and decided this flip flopping is pretty much taking up any time I have to actually get my life back on track. So I'm sticking it out and hoping there's no damage the counselling can't help me handle and that the medical school backs off if I just quietly sod off and find ways to handle things. 

In fairness, most of last semester and a large chunk of the start of this one were spent trying desperately to get out of bed in the morning and face life. If I did make it out of bed I'd get as far as the living room and distract myself from being in my own head for roughly 5 minutes while I decided between calling someone to cushion the inevitable breakdown or curling up on the sofa to hide and ride it out. By then I'd have missed the morning lecture and was in more shreds than I could convincingly hold together. It was no one's business at university and, to make matters worse, there were people I knew would see through it and they were the last people on Earth I wanted to realise anything was wrong. So I'd stay at home where it felt less like my guts were spilling out while I scrambled to keep people from noticing. This wasn't most days, not even some days, but it was a number of days and that's bad.

Med school became a source of feelings of not being safe. My tutor would tell me 'once you start missing things we have a problem. You can't do this at work, your patients have to come first. At the hospital you can't just take time out and you need to go and do things to help yourself. If the counselling is only keeping you where you are you have to consider whether it's a good idea to continue.' etc etc. The general gist I got was 'your studies come first, get better, do it soon, or we're going to have some problems'. I get there was probably little else she could say in fairness and I wasn't informing her because I expected support. It was just to update the med school in case they accused me of being 'unsafe as a student doctor' by not notifying relevant people in authority about any issues affecting my studies.
I think she was trying the child-scaring approach with me - frighten someone enough into 'sorting their life out' and watch them do it. Spoiler alert: this does not work on depressed people who are neither 18 years old nor impressed with your affected sympathy and are legitimately doing everything they can to stay functional most days. And if you tell them to 'sort their life out' don't be surprised when they bitchslap you into empathy. For the love of god, you wouldn't say this shit to your patients, why would you say it to your colleagues?

From then on I saw her very occasionally and out of duty to cover my ass should anything happen and the med school point a finger and say I was not doing everything I could to help myself and keep them informed.

Student support was the only place within the med school I felt remotely safe. They were more help than I will ever be able to repay.

It's weird. I'd have days where this was all very funny and I'd be pretty much berating myself for being a whiny little girl and then days (mostly counselling days) where it would be nice if life could just maybe slow down a wee bit to a possible halt please.

Eh. Whatever.

I'm not sure how to sign off this one so I'll just leave it hanging.

Saturday, 25 January 2014

A Review of My Learning from the People and Disease Course

This is a reflective post on my experiences during the people and disease course. From year one, we are assigned a patient whom we visit regularly then we find our second patient ourselves and follow up their progress also, reflecting on both their experiences holistically (which means we take into account social, medical, drug and family history as well as life impact on illness and vice versa. It's very good at teaching the importance of providing support to patients from all aspects of life that can be affected by illness). 

My first year of the People and Disease course has been an illuminating and challenging one. Before studying it I understood the definition of patient autonomy and the ethos behind it but I did not understand how deeply valued it was nor how essential it was to ensuring the best care is tailored to patients as well as possible. I also had less understanding of the roles of professionals in primary and secondary care, was less aware of the usefulness of patient feedback and was extremely nervous about the idea of house visits. 

The first greatest challenge was contacting my first patient, C. C presented with blackouts and was diagnosed with schizophrenia. I was also told that she was in her sixties and lived alone. The first thing I did, out of nervousness I’m ashamed to admit, was make assumptions about her character, socioeconomic situation and educational background - almost all of which were incorrect.

Where I expected someone reclusive, incoherent, difficult to speak to and disjointed in thought I found an articulate, open, intelligent woman. My knowledge about mental illness stemmed largely from societal beliefs and an A Level in Psychology, both of which served me relatively poorly in this instance. C’s strength of character, autonomy, management of her condition and utter refusal to pity herself or accept pity from others flew in the face of all the preconceptions I had.

I was touched by her matter-of-factness, her robust progressive attitude was obvious considering the many jobs and qualifications she had attempted despite repeat break downs. She made me aware of how badly her life had been affected by her illness but it was clear she valued her independence and resilience. She also seemed extremely self aware; she recognised that she could be ‘delusional’ and it appeared she understood her condition and her behaviour when not well-managed.

During my first visit, she was kind and welcoming, quite at ease with my questions. She told me she was happy because she finally had her own place and I found a comfortable rapport developing despite my nervousness. As our conversation progressed I felt increasingly confident with her dry wit and frankness and wondered what her opinion of the social stigma regarding mental illness was. She told me she does not associate herself with ‘those people who use the label to excuse laziness’ or ‘who wore the label as a badge of exclusivity’. I was a little shocked to hear this and have learned that no matter how ingrained beliefs are about groups of patients, I should reserve judgement of individuals.

Moving on to social and medical history, I learned that C had been sexually abused since childhood into early twenties, had been homeless several times in her life and had had very negative experiences in primary and secondary care. I was happy with the way I handled the conversation, apologising for bringing up such difficult topics and telling her she could decline to answer or stop at any time she felt uncomfortable.
When I asked about her opinion of the NHS and how she feels it has benefitted her, she told me the only thing the NHS has done for her is provide her with home medication and weekly Depixol injections at the clinic. She related poor, unprofessional treatment from staff during her time as a mental health in-patient on a mixed-gender ward with sex offenders and with her previous doctor. She told me her last GP talked over her and gave her little to no autonomy, that he tried to force her to re-unite with her abusive step family, that she was not told her diagnosis but found it out from reading her file, that it was not explained to her how her illness worked back then. She was obviously angry about it. I felt awkward with the information and found myself apologising for her experience and wanting her to know how much current practise valued patient autonomy and dignity.

 She was, however, happy with her current GP, which made me believe her claims about her previous doctor may have had some weight. During seminar 3, I related some of these negative experiences to the group believing they were mostly true. I had not considered that her illness may have distorted her perceptions back then and felt a little uncomfortable when I realised this. It has made me apprehensive about how to critically treat subjective accounts of experiences by patients, since viewpoints can be distorted by expectations, previous experiences and emotional/mental state.

My second patient, K, suffers from epilepsy.  I found her more easily and faster than I expected through a consultant in an epilepsy unit. The nervousness preceding the first call was there but I felt far more in control than I did when I contacted my first patient for the first time; I was more confident in explaining our respective roles for the module and making sure the patient had all the information she needed before agreeing to meet with me.

What I was not prepared for was finding out that her mother had recently passed away, less so that she was willing to make time for me if it was urgent. In the moment, I was afraid I would say something entirely inappropriate but luckily I managed to apologise and arrange a later, more convenient meeting for her and her family. Since then, I have had to rearrange the meeting due to constraints on the family’s time.

I came into the course with many preconceptions and judgements about illnesses, patients and care and I’m glad to say almost all have been challenged and improved upon