Home

Blah blah blah

August 28, 2013

I love people.  Men . Women. Children. People in general. People in particular. I start out with the notion that everyone is interesting, kind and good and I am rarely disappointed.  It is unusual for me to find people completely boring – I rather enjoy geeks and nerds – but I can find people unpleasant when they are patronising, arrogant, completely self-centred or simply unable to listen to a different opinion.

However I have spent enjoyable evenings with obnoxious twats who I find entertaining  for a short period of time even if I violently disagree with their views –  as long as they are able to navigate the give and take of discussion and understand that conversation is not the same as having to convince the opposition of your  being right. The enjoyment is in the discovery of new ways of looking at things but not necessarily being so convinced by them that they change your views completely. But they might temper them. Or inform your opinions so they are less extreme. Or just be really interesting and sit brewing in the back of your mind making you view the world in a slightly different way.  Or it may simply be a case of agreeing to differ. Conversation is not the debating society where one side has to win and the other lose. It’s just about sharing.

I probably find people with no opinions and nothing to say harder to enjoy, but often I think perhaps I just haven’t found something they want to talk about. Or shut up long enough for them to get a word in…

And I love a good party. In fact I need of a good party every so often. And luckily we have an invitation to one coming up this weekend.  Whoop! whoop! I love it. Lots of people, whether I know them or not –  all the possibilities of conversations going in a thousand different ways. New insights on life, alternative outlooks, funny tales and interesting stories.

And if one person gets tiresome you can move on to the next……… what’s not to love?

Advertisements

Breaking bad news is never easy. And comes in many guises. It’s not just about death or diagnosing a fatal disease. I gradually realised that many things qualify as ‘bad news’ to others which to me seemed relatively minor. As a student  I hadn’t understood the likely impact of my words or the preconceived ideas patients would have which meant they would interpret my breezy announcement about their condition in a way I did not predict. I would say “Mr Jones it looks like you have a condition called diverticulitis which has been causing this bleeding from your bottom” and I would expect him to be as relieved as me that it wasn’t cancer. But sometimes Mr Jones would appear to be as devastated as if I had told him he had a month to live. Because of course I stupidly didn’t realise he would have no idea what a diagnosis of diverticulitis would actually mean.  Because I hadn’t told him.

So I quickly learnt that what seemed to work for me was to be explicit upfront about the diagnosis NOT being cancer. It surprised me how many patients default to imagining they do have cancer or a serious fatal illness whatever their symptoms. Not everyone obviously, but lots of people. So I would always ask people what they thought it might be so I could be explicit and clear in my reassurance if we were able to exclude that particular problem.  It made it easier for me too as it somehow gave it a platform of being not the worst news even if it wasn’t good news. A perspective of relativity perhaps.
We had classes on giving people terminal diagnoses. What to tell them. How to tell them. How to listen. How to ask. How to remember the patient when all the family are insisting on a particular course of action.  It would often be more stressful battling with the family to treat their loved one as an intelligent adult than talking to the patient themselves. They often seemed to insist that their parent or partner would not be able to take it if they were told their diagnosis. But I had no right to withhold that information if the patient was of sound mind. And I found that patients do tend to give you pretty clear signs how much they want to know if you ask them.

As a student I had been with doctors when they were delivering bad news to patients, but there comes a time when you are the one to have to do it, not be the sympathetic bystander. Unlike nowadays, we did not have roleplays to practice our technique and responses but if I am honest I am not sure how useful roleplays are unless they use real patients who have been through it. Actors, no matter how good, are not real patients and come with their own  ideas of how they would react which is not necessarily the same as seeing it in real life.

But anyway, I’d seen it in real life before I did my first. In fact, unlike the usual medical adage of see one, do one, teach one I had seen it a few times before I was left to do it myself. I had really enjoyed my stint on the Oncology ward as I blogged here, and had seen an inspirational Consultant talk to his patients about death and dying. The best possible training. Except that this wasn’t really the same scenario…

I think it only fell to me this particular time because it was at the weekend and an emergency so the more senior doctor who had been with me trying to save the patient’s life had been called away to another patient. And the living take priority. So I was left to tell the parents and boyfriend of a seventeen year old girl that we had been unable to save her from the anaphylactic reaction she had had. Because they needed to know. They had a right to know. We couldn’t let them just wait until my more senior colleague was finished. That could have been hours. They would already have been waiting for over an hour wondering how she was doing since she’d been brought in semi-conscious. And so with pounding heart I went to find them in a small side room in Casualty.

A nurse came with me and we walked in to the room. They all instinctively stood up and looked at me expectantly.  And then the boyfriend started crying when he looked at my face. It was so hard. I had been the one who had taken the history from him to find out what had happened as by the time she arrived she was losing consciousness so couldn’t speak. Her parents didn’t arrive until later. So I already had a relationship with him. And I expect he saw it in my eyes that it was the worst news possible.

I don’t remember where the nurse was, but we all sat down. I drew my chair up so close my knees were touching the mother’s. And then I told them. I tried not to use euphemisms and said that we had done everything we could but she had died. I remember thinking I shouldn’t say things like “She’s gone” in case they might think I meant she’d gone to another hospital or just out of the building. And the father appeared stoic and supported his wife who looked shell shocked. I asked them if they had any questions and did my best to answer them. But it is often too early to have questions when you have been hit by the ten ton truck of sudden death. So in fact there were few, mostly about what she would or wouldn’t have been aware of. And whether she would have been in pain.

And they were very gracious and grateful and thanked me for all our efforts. And I felt terrible. And their niceness made me well up even more. I was trying to stay professional but I could feel the tears. The throat closing in. I wanted to leave before I crumbled completely but felt I couldn’t just get up and go abruptly. We sat and I held the mother’s hands. “I’m really sorry,” I said as I got up. The father shook my hand. The boyfriend was still as a statue looking at the floor. I touched his shoulder as I left the room. The nurse stayed to talk to them about what happens next.

And I really was sorry. This wasn’t just a trite saying. Sorry for their loss of course, But the overwhelming feeling was guilt that we had failed. Sorry we hadn’t been able to save her. And I went over and over it in my mind. Could we have done something differently? Had I done something wrong?  We are trained to save lives and make things better and it is hard to come to terms with failure, even if you have done everything possible. It was awful.

They do say relatives often remember this kind of conversation with incredible accuracy and replay it in their minds. I hope to fuck that I didn’t make things any worse for them than it already was by the way I handled it. But I’ll never know.

When people talk about stress in their work I am minded to shout that they’ve got no fucking idea what work related stress is. But I don’t of course.

Forgotten skills

August 21, 2013

In the old days, my Mum would pop in to the grocer’s with her list and leave it for them to deliver later. If she wasn’t getting too much, she would read out her list to the shopkeeper who would be standing behind his counter and he would walk to his shelves and pick off what she needed. The bacon slicer always fascinated me. Never see them cutting bacon nowadays, only cooked hams and the like. But then the bacon would be sliced to your liking, wrapped in greaseproof and then in to a brown paper bag.
We lived next door to the grocer’s. The grocer’s children were my friends and we used to play together. I loved going to the back of the shop and marvelling at all the stuff. Clutter. Things. But what I loved best was when her parents would give us a pack of the brown paper bags that would have hung next to the counter. Tied on a string loop, waiting to be plucked off one by one. Loved it. Even now I seek out the paper bags in Waitrose (mushrooms used to have them nearby but they seem to have gone, only the bread ones are left) and enjoy the frisson of pulling one off.
We would play shops as children and whip off these bags to put our customers’ purchases in. So real. So grown up. I loved it.
But the most amazing bit about the next door shop was going in to the sitting room at the back where my friends lived. And sometimes the Mum would be sitting at the table with a large ledger in front of her. There were the three columns of pounds, shillings and pence. Twelve pennies made a shilling, twenty shillings made a pound and twenty one shillings made a guinea. Obviously this is pre-decimalisation. What was so utterly fascinating and awesome to me was to watch the Mum run her pencil down the columns at the speed of light and then write the total at the bottom. She added all three columns at the same time and had no calculator. So she was dividing by twelve and then dividing by twenty instantaneously. She’d then write that total at the top of the next page and continue adding up the page until she had the total takings. It was amazing the speed she did it at. And of course, since decimalisation (not to mention the introduction of digital tills), a completely redundant skill. I wonder if it is transferable to any other walk of life.

I do so admire people doing things well. Be it an athlete, an actor, a waitress or a doctor. Anyone at the top of their particular game is inspiring.

We’ve all had bad days at work. Days when we are not at the top of our game. Days when we’ve missed stuff we should have spotted, been unneccessarily harsh, been unable to see the wood for the trees. But sometimes some people seem to have more off days tham on days. And some people don’t appear to have on days at all.
Sitting at the chef’s table in Maze a few months ago we were in the heart of the working kitchen watching people work whilst we enjoyed ourselves. Out of the corner of my eye I suddenly caught the head chef talking to one of his staff who was holding a tray of food. I do not know what the issue actually was or what had happened but what I could hear was a refreshing directness from the boss. “It’s not good enough. Exactly what have you done to sort it out?” He wasn’t shouting a la Gordon Ramsey (although it is his restaurant) but it was clear he was angry and what had happened was unacceptable and that this staff member now knew that he was utterly responsible for the cock up and had to ensure it was rectified.
During medical training there were numerous times that Consultants would indulge in ritual public humiliation when I didn’t know something or did something incorrectly. It was awful. Not all Consultants by any means, but enough. I used to feel sick in anticipation. And it made me sharpen my game. It was the last thing I wanted to happen and I knew I had to step up. Similarly, this underling in the restaurant could have been in no doubt he needed to improve if he was going to keep his job.
In contrast, I often see poor work performance allowed to pass by seemingly unnoticed. And I’m not talking in state run institutitons where people stereotypically think it is rife. No, successful private comapanies. Yet they let some people get away being shoddy and lazy. Repeatedly. Until people just shrug and say “Yes, he’s crap isn’t he?” but just accept it.
Is it because we don’t like confrontation? I do not manage anyone so don’t have these dilemmas, but I think it is often because bosses want their team to like them. I mean really like them. They don’t want to upset their team or make people think they are unreasonable or nasty. Which is commendable.
But as a boss surely you have to distinguish between being liked and being respected? Great if you can do both of course, but I think the respect is more vital to work relationships than being liked. Because whilst they are tippitoeing around the underperformer, the rest of the team are getting pissed off carrying this passenger and will start to resent the boss for not doing anything about them. It is demotivating to have a slacker as part of a team as others gradually start to question why they bother to pull their finger out if others get away with doing nothing and it becomes a vicious, lazy circle.
In contrast a high performing team engenders greater performance from each other as everyone strives not to be the weakest member. And the leader of that team will be not only be respected but worshipped for creating such a fantastic working environment.
The other possible fear that managers have is that there will be a complaint against them or the lazy worker will go off sick with stress and then sue them for unfair dismissal or somesuch. I agree complaints are stressful, but unless you have been a bully or completely unreasonable then you are likely to be able to show evidence of the incapability and poor performance. And if you cant then that reflects poorly on your capability as a manager.

Then let’s say they do sue the company. Firstly most people don’t and of those that do, many will not be found to have been unfairly dismissed. Then there is the money. I am not a lawyer but my understanding is an absolute max of about £85K. Worth it I’d’ve thouight not to have a drain on morale and performance. And if you don’t dismiss them you’ll be paying them the equivalent to do nothing well….

How could this be described as a monster?

How could this be described as a monster?

I have blogged before about the shock of becoming a parent, but the Royal Birth brings it all flooding back. especially as she looked so calm and beautiful standing outside the Lindo wing a mere 24 hours later. In contrast I still hadn’t managed to get dressed for the first three days, let alone have the confidence to hand small baby over to hubby in the glare of public spotlight. We never did that without ensuring there was a soft landing underneath for the inevitable slippage that we envisaged during the first weeks.
For the first one, I came home on Day Four feeling physically OK. Shellshocked. But OK. And brand new babies (really really new) still sleep lots so I was in what I would later realise was the initial week to ten days of a honeymoon period.
The next day I woke up and thought “Who the fuck put these boiling hot boulders in my bra?”. I looked down to see what the text books say is the milk coming in. What they don’t tell you is how bloody painful it is. Until then baby had been feeding on the protein-rich colostrum that we produce before milk starts up. But now the milk was well and truly in. I was lucky with being able to feed relatively easily, but the downside was that it seemed constant. I would let him feed until he fell off, bloated like a tick. Whereupon he would be so overstuffed he would throw up and want to start again an hour later. It was a nightmare circle that I seemed unable to get out of without my husband helpfully taking him off me and walking about with him.
I was delusional about what ‘demand feeding’ means and was gripped by the fear of him crying, my not feeding him enough and basically being an all round shit mother.

It is an exhausting and crazy time after you have your first. Especially if you are used to being in control. Suddenly this 8 pound monster is dictating your every move. So I give new mothers my

Top Ten Tips for “Feeding on Demand”

  1. Get comfortable. The best way to increase milk production and all round satisfaction is to relax. Hahaha. Easier said than done when one is as tense and stressed as its possible to be. Use pillows to prop yourself up, lay the baby on them on your lap. Whatever it takes to try to be comfortable.
  2. Stick your nipple in till you think you’ll choke them. They work the milk in to the nipple by squeezing the ducts around it rather than the nipple itself so they need to get a good gobful. You won’t smother them with the rest of your boob as they’ll roll their head back and let go if they can’t breathe. They’d have to be trapped for their to be any problem.
  3. Keep them chomping at one boob for at least 10 minutes so they get the benefit of the ‘hindmilk’ which is fattier and more satisfying than the initial milk produced which is a thirstquencher.
  4. Every squeak doesn’t mean they need feeding. Despite what all the baby books say, every time they cry doesn’t automatically mean they need feeding. It’s the only real noise they can make after all, so it’s used for everything. For hunger yes, but also for cold, heat, damp, need a poo, poked my own eye, just feeling grumpy, feeling tired, didn’t want to wake up yet, what’s happenin, and fancy a cuddle.
  5. Demand feeding allows you to make demands on the baby too – it’s not all about them having total control. So you can decide that you won’t feed more often than two hourly. Or three hourly. Or four. And that way when you do feed them they will be hungrier, suck harder, get more hindmilk and be more satisfied so sleep for longer between feeds.
  6. Some babies will always suck when given the chance. It doesn’t always mean they are hungry. they might be ‘comfort sucking’ – the equivalent of thumbsucking. they’re not interested in the milk as food, just the nipple, the warmth and the cuddle as a rather enjoyable experience. And who could blame them?
  7. Watching pap TV with your feet up and a cup of tea is actually working when you are breastfeeding as it increases milk production. The more you run around the less milk you make hence why babies are often most satisfied by their first feed of the day as it’s had  great hindmilk production overnight. Come late afternoon and mum is ragged from running about the milk is less gold top and more UHT. So don’t give yourself a hard time for watching daytime TV or reading crappy magazines – it helps.
  8. Don’t just pull baby off the breast – they have created a vacuum by sucking so hard and it will hurt like fuck if you do. So stick your finger in their mouth to ‘break the seal’ and then pull baby off.
  9. It does get easier. Sometimes my boobs would feel like they were literally going to burst and the relief of feeding was indescribable. These wild ups and downs of production do calm down with time.
  10. Getting up in the night is hard hard soul destroying stuff. Especially if, like me, you seem unable to put him back down in the cot without him bawling.  I had to learn point 4 the hard way – that every time he cried didn’t mean I had to pick him up and start again. It meant he’d rather liked where he was and didn’t fancy being on his own in the cot. Give him a few minutes with a hand on him and he would go off. Or hand him to hubby who would somehow make it miraculously happen.
  11. Don’t beat yourself up about your inadequacies. You’re tired and emotional. It’s bloody hard work. It’s relentless. But in a few weeks it will seem less poleaxing and things will start falling in to place and feeding will get easier and you will realise not having to sterilise bottles and all that crap is actually a blessing. Obviously if you have decided not to breast feed don’t beat yourself up over that either.

I really enjoyed Kim Cattrall in Private Lives, but this was a disappointment, although she was the best actor on stage as far as I could see last night. Unfortunately the chemistry between her and the beach boy she has picked up is lacking. She doesn’t really look completely spent and fading  (and what is that ridiculous wig she is wearing about?) and the whole play is more farce than tragedy. But it is not funny enough even to pull that off.

It is hard to feel anything for any of them, including  disgust for the white supremacist who just seems to shout rather than embody evil,, or pity for the ghost like Heavenly his daughter who just wanders about looking lost.  Somehow this play never ignites despite having numerous potential threads to pull at our heartstings. Two stars.

Which career? Which job?

August 1, 2013

If I had any words of advice for people setting out on their career path I would say do what you enjoy. Of course many people don’t have the luxury of being able to afford to make those decisions, but must do any work they can to feed, clothe and house themselves. I am talking here to the lucky elite in the developed world who may have done their degree and now face the prospect of the working world.
Essentially it is the world of the unknown. It is not until you enter the real world of work that you discover the hundreds of jobs and roles that are out there. The things people do that you’d never thought about. The way people have got to where they are is often not a straightforward route but full of apparently lucky breaks and opportunities. But were they just luck or was there an underlying drive to get to the top?

So, I give you my

Top Ten Tips for working life

  1. Take the time to work out what you love doing. What stimulates you, excites you, keeps you absorbed for hours? It could be anything – shopping, painting, acting, watching football, organising people, playing computer games, blogging, chatting….
  2. And then try to work out how to earn a living doing it. There are jobs to suit every love. Even if you have to start them up yourself. Honestly, people make money being personal shoppers for other people, or fashion advisors or pet groomers……… there are a myriad of things you just don’t think of as real work.
  3. Money is more likely to come when you are doing something you love because you will put more time and effort in. Although if you love it, it won’t seem like effort because you enjoy doing it. But that increased input usually means you do well and may get rewarded for it. And even if you don’t -at least it is something you love doing.
  4. Realise no job is 100% perfect 100% of the time. Every job has its downsides, but you just need to weigh up if the good times are worth the hassle of the painful bits.
  5. You can change careers. You have forty plus years of work ahead of you. Switch tack at 30 – you still have 30 more years of working life left all being well.  And when you get to 40 no one will care if you have 10 or 15 years experience as it will make no difference.
  6. If it is ‘making money’ that you choose is more important than enjoying work, then realise you will have to accept more frustration and tedium as the price you are paying for not doing something you love. So don’t moan about it.
  7. Think about yourself and what you want out of a job as much as what the company will get out of you. Loyalty is a huge asset and commendable but at the end of the day you have to put your own interests first. If you don’t ask you don’t get. Sadly this is true virtually 100% of the time. Too many people think that they will be recognised for working hard and doing a good job, but too often this really doesn’t happen unless you point it out to the company. In a nice way.
  8. Be prepared to start at the bottom – it is a great place to remember when you are at the top. If this is the industry you want to work in, put the extra time and effort in now and get yourself noticed. Make it clear what you would like the company to do. It may be offer you development opportunities, a transfer to another department, a promotion, a pay rise.  Often they will have had no idea what your aspirations are. Or forgotten them.
  9. Even if you don’t love your job, try to appreciate the better points. You may have great workmates. It may be close to home or in a great spot for easy access to wine bars. But more importantly try to find another way of making money that you will enjoy.
  10. Remember there are plenty of people who would love to have your job and advantages. You are not down a coal mine. You are not in Afghanistan. You are not starving in Ethiopia.
%d bloggers like this: