A Tale of Guilt and Woe
June 2012. It was unseasonably miserable. Having successfully fought the battle of Neuro I was all ready for the next onslaught which manifested itself in the form of reproductive and endocrine medicine (us Bristolians have dubbed it EndoRepro which sounds more like an evil Mexican villain). I was making a trip to the library, which, at the time, was around a 30-minute walk away from my student house. This was to do some extra reading. I had my laptop in my bag along with my bags of Haribo for encouragement and when I’d stomached all I could take I began the walk back. It rained. It rained like I have never seen rain before. For 30 minutes, I walked in a torrential down pour and when I arrived at the local Sainsbury’s, they kicked me out because I was dripping that much I posed a health and safety risk on their tiled floor. It was a very miserable day.
When I had eventually gotten back into my room and put all my clothes to dry I stood there and thought – why. Why was I doing this to myself? It wasn’t even necessary and I’d put myself through a monsoon to go get some books and read ahead. The reason was because I’d have felt guilty if I hadn’t – I planned to do it, so I was doing it. Guilt is a very powerful thing and it’s something we all encounter as students on a regular basis. When I used to revise for my pre-clinical exams, if I stopped for an hour or two that meant I would have to extend my evening revision to cover the time. I should imagine everyone can relate to this (even those macho folk that profess to be invincible!). Stopping was not an option. In that rain-sodden day I learnt one thing – cut yourself some slack.
I never believed it when people used to say to me that “down time” was as important as work time. Down time was wasted time. Down time was a period when I missed that all-important sentence that answered MCQ Q22 on the upcoming exam. At the start of that unit I decided to take things differently. I always timetabled work, but this time I was only doing those timetabled slots if I thought it would be productive. If not, the time was better spent doing other things. If I started and felt like it was too much effort, I didn’t carry on in some marathon-like endurance exercise, I stopped. I refused to let the guilt set in. I turned my ears off to all of the talk in lectures about how much work everyone had or hadn’t done – I refused to let myself be intimidated.
So what was the result? I had much better sleep in that time. My head was a lot clearer and I found it about 100 times easier to get up for lectures in the morning. I spent a lot more time doing the things I enjoy which generally upped my motivation.
More to the point, I achieved the best set of results in two years in those exams.
I only wish I could go back to my fresher self and say:
“Cut yourself some slack. Don’t feel guilty. Do your own thing”.
It's been a while since I've added any thoughts to this blog. In that time I have finished my Obs/Gynae placement, I have spent a week on labour ward, and done my first week of my 4th year surgical placement. All the while cramming in revision between various activities and general staying alive measures. This, I feel, is how most people who are sitting their final written exams are spending their time, so I don't feel so alone.
I just want to bring to the attention one amazing incident that happened on my labour ward week. I was on a night shift, there wasn't a lot going on. Absolutely everyone was knackered, the registrar who'd been on nights for the past week was just chatting to me. I have never seen someone look so tired. The emergency alarm went off and a lady had a cord prolapse, which is an obstetric emergency with a high foetal mortality rate. Now I think it's amazing that the doctor went from nearly falling asleep to switched on 'surgical-mode' in an instant, successfully performed the C-section, delivering the baby in about a minute, then went back to being absolutely knackered and let the SHO close up the wound.
It just really impressed me and I felt it was something worth sharing. Actually I was incredibly surprised that I enjoyed Obs/Gynae. Women's health was a placement I was dreading, it was my last major knowledge gap and I didn't have a clue what it was going to be like. If my tutor for the block does read this, thank you for all your help and getting me involved in everything. I would encourage other students who are going into it and feeling any level of apprehension to just throw yourselves into it and give 110% effort. It is a great placement for practicing transferable skills (this is important to remember, especially if you don't have any desire to go into it you CAN transfer and practice skills from elsewhere!) and getting heavily involved in patient care.
Also I'd like to point out the Mother and Baby were fine :)
Last week in my personal blog I reflected on humility as defined by James Ryle:
God given self-assurance that eliminates the need to prove to others the worth of who you are and the rightness of what you do.
Ryle suggests, from 1 Peter 5:5-7, that central to humbling ourselves is throwing our cares on to God. Every concern, care and fear being hurled on to God who is faithful and powerful enough to handle them. When we know that we are loved by Him no matter what and that He is in control no matter what, then we remove the need to prove ourselves or protect ourselves. We become humble – secure enough to allow God to be in control and to serve others. Once our eyes are lifted from ourselves we are able to see others to love and serve them.
Just before writing the last post I was reading an article about the report by Robert Francis QC on the appalling treatment of patients at Stafford Hospital. One of the recurring comments made by many different people is that the pressure of targets and incentives increasingly displaces focus on compassion and patient care. When doctors, nurses and managers alike are bombarded with ever increasing and regularly changes hoops to jump through and targets to meet, no wonder their attention and efforts are dragged from patient care.
I’ve seen something of the effects of this in a family member who for many years worked as a Health Visitor. In their decades of service they saw an ever increasing and ever changing string of targets and goals alongside cost cutting moves that stripped resources and personnel. Their desire to be compassionate and offer the best care possible became more and more stressful until it finally proved too much. She recently changed jobs.
Now I’m not trying to attack the NHS and I am well aware that so many people receive great care. But this is not a new concern that is being bandied around with fresh vigour in the light of Stafford Hospital. What struck me is that it demonstrates on an institutional level what also seems true at a personal level. Namely, that when we are forced to operate from a place of insecurity we begin to miss the most important things. NHS services have to meet targets to receive funding to simply keep operating – there will be no patient care if there is no hospital. Oftentimes, especially as a leader, we can live with a sense that, unless we meet expectations or make people like us or recognise our worth, then we’ll have no influence to do any of the things we know we are called to do.
The secret of personal humility is to recognise that we are already loved by our Father before we even move our finger; to recognise that He is control and we can throw every care on Him. A person who can live from that place of security finds, free from the need to prove themselves or their actions, can begin to simply do what they are made and called to do. They are no longer pulled in different directions by a multiplicity of cares. What about an institution?
It strikes me that a similar solution is needed for the NHS. Is there a way to give security for doctors, nurses and caring professionals so that they are able to do what they are called to do without constantly watching their back? Obviously there is a need for accountability for the safety of patients and to ensure a good standard of care, but the constant need to prove worth and achievement cannot be helpful for those who are called to compassionate care.
I’m not a healthcare professional. I don’t know exactly what this would look like. But I recognise in the diagnosis of struggles in the NHS, God’s diagnosis of struggles in many people’s lives. The way He designed us to live with Him is often a good basis to begin to imagine a new way for every level of society to function.
So, my question is this: what would a humble NHS look like? To whom could a National Health Service throw it’s concerns and cares?
After I retired from my academic position at the University of Miami, I started working as an intermittent ob & gyn in various cultural settings in the US and abroad. In 2006 I practiced in a hospital in New Zealand.
I saw many interesting cases during my six months at Whangarei Hospital. One stands out in particular. This was a middle aged native Mauri woman who had been seeing her family doctor for several years because she was gaining too much weight, her abdomen was getting bigger, and she was constipated. Each time the family doctor saw her, he did not examine her but patted her on the back and encouraged her to eat less, eat more fruit and vegetables and be more active so that she would lose weight. When much later he finally examined her, he noticed a large tumor in her abdomen and referred her to the hospital.
To make a long story short, we operated on her and removed a large ovarian cyst weighing more than 18 kilograms (about 40 pounds). This cyst fortunately turned out to be benign and the woman did well. The operation itself was something else as we needed an extra assistant to hold the tumor in her arms while we removed it without breaking it.
Even though this large tumor was certainly not a record, we ended up publishing the case in a New Zealaned medical journal for family practice (see reference below), not so much for the nature of the tumor itself as for pointing out to family doctors (all doctors, in fact) that examining patients before giving them advice is most important.
Alison Gale, Tommy Cobb, Robert Norelli, William LeMaire. Increasing Abdominal Girth. The Importance of Clinical Examination. New Zealand Family Physician. 2006; 33 (4): 250-252