Dr. Damian Roland (@damian_roland) - #FOAMed supporter

What I learnt this week: Not revealing your grief doesn’t mean you are not hurting #WILTW

In Uncategorized on November 21, 2014 at 6:23 pm

This is the 27th #WILTW

While it might be ‘trash’ I am quite a big fan of the American TV series ‘Arrow‘. It is pretty typical rich vigilante with very troubled past trying to right wrongs kind of stuff. A previous love interest of the hero died recently; an event which hit all of Arrow’s team (including their technology specialist Felicity Smoak) hard: 

Felicity: How can you stand there being so cold and rational?

Arrow (Oliver Queen):    ‘Cause I don’t have the luxury of falling to pieces. Everyone’s looking to me to handle things, to make the right decisions. Everyone is looking to me to lead.

If I grieve, nobody else gets to…

Felicity: You’re still a human being, Oliver. You’re allowed to have feelings. I know sometimes that it’s easier to live under that hood.

Arrow: I’m not.

(From Arrow Series 3 Episode 2 “ Sara“)

Comparing a TV series to Emergency Medicine may be one of my most dire conceptual leaps so far in #WILTW but there is a similarity between a team leader needing to stay in control during stressful and emotional resuscitations and Arrow’s dilemma. I am not promoting the emotionless doctor who remains un-empathic with a grieving family (in fact I have written previously on how I have been deeply moved by another consultant bearing all with a patient). I acknowledge though the team need someone they know will continue to function however upset/challenging they are findings things. Where does this strength come from?

reflection

The death of someone known to us inevitably highlights our own mortality. When that death is unexpected it can be very challenging, and the grief reaction can be powerful, regardless of how well you know the person. In making sense of acute loss I am reminded of the poignant words of a consultant colleague, Dr. Pro Mukerjee, speaking of that moment when you hear that someone has passed away.

At first there is a pause, a look of sadness and then almost always a smile as a powerful familiar memory of the good about that person surfaces

I find this reaction invariably true and I reflect that at times of deepest sadness there is some memory we can hang on to that which provides a modicum of positivity. Unfortunately in Emergency and Acute Care there is no connection with the person who has passed away. Although health care professionals deal with death regularly, so you might expect a certain amount of tolerance and resilience, the loss of the child or unexpected collapse of a person before their time is always upsetting. How do senior staff compose themselves to ensure both families and staff receive the time, compassion and information they need? I am not sure there is a universal method but certainly experience plays a significant role. What I am sure about is that the  reaction is still there, just placed somewhere else for a temporary period, so others can have the time they need.

What have you learnt this week? #WILTW

 

After writing this post I thought I would highlight Saying Goodbye. The Saying Goodbye Services are the first national set of remembrance services for people who have lost a child at any stage of pregnancy, at birth or in infancy, whether last week or 80-years ago. There is a very good video on children and grief by Dr. Ranj Singh on their website.

What I learnt this week: The challenge of learning something new #WILTW

In #WILTW on November 14, 2014 at 9:36 pm

This is the 26th #WILTW

So this week marks the six-month anniversary of #WILTW (full list here). I get a chance to reflect on reflections I suppose!

It’s been a really interesting process which I think has definitely been worthwhile for me although recent feedback varying in its utility for others  :)

#WILTW came from a blog I wrote in the first week of being consultant. It spoke to the time honoured quote: “You never stop learning”. I thought that formalising my (perceived) learning in the form of a blog may encapsulate it. Firstly in a way that I could easily document (useful for continuing professional development) but also to help me not waste it. As a result I have discovered a few interesting things…

  • I have realised on a week-by-week basis it’s actually quite difficult to learn something completely new. Most of #WILTW is about validating what I know rather than develop any entirely new skill or mindset.
  • As a result I have sometimes struggled because reflection shouldn’t be forced. If I am honest there are a few posts which started as: “I have no idea what I am going to say this week….”
  • But being disciplined about having a regular time (usually Friday afternoon) has been incredibly useful in not letting things drift completely. Just the time to sit and think about the last week is valuable.
  • Finally when you do truly learn something new in a clinical context it can be quite difficult to discuss it in a open forum without breaching confidentiality. This was an unexpected challenge, although with some imaginative story telling, not an impossible hurdle to overcome.

For me the process has been a valuable one and something I will persist with. I am neither a Jane Austen nor a J.K.Rowling but I hope these short records will stand the test of time and at the very least give me a record of the direction my time as a consultant has taken me.

What have you learnt this week? #WILTW

 

 

What I learnt this week: Am I narcissistic in my enjoyment of emergency care? #WILTW

In #WILTW on November 7, 2014 at 12:51 pm

This is the 25th #WILTW

I spent an evening at my old school this week for a careers fair. I was hosting a stand on a ‘Career in Medicine’ and had a very enjoyable couple of hours speaking to students about admission criteria, specialty choices and whether the work is ‘really hard.’ A common question was, “Why did you choose Paediatric Emergency Medicine?”. It’s good to reflect on this as I have no idea what I said at my medical school interview about why I wanted to be a doctor and my interview to get into Paediatric Emergency Medicine Specialty Training was a car crash from the first question; so not quite sure what I said then either.

It was easy to speak about the nature of the job: I enjoy the frenetic pace, the practical element and the fact that sick kids get ill quickly but well again even faster. I was also honest about how out-patient clinics frustrated me and I tended to see them as something to ‘get through’. Given this attitude probably isn’t conducive to a great patient experience I realised it wasn’t for me.

Medical Staff Tending a Patient

But I had a nagging suspicion that there was something else as well. It’s rewarding working in Emergency Care. The feedback is very visceral and immediate. Whether it is ameliorating pain, correcting a deformity or relieving an anxiety “don’t worry, I can see why you are worried but this rash isn’t serious” a lot of what happens in urgent and emergency care is positive reinforcement of your skills. Even in the most desperate of tragedies you can avoid breaking bad news badly (I am uncomfortable about saying you can be good at breaking bad news). I ponder whether this is a benefit of Emergency Care or something that I need to happen to enjoy working there? This was a bit unsettling. Is there something about Emergency Care that satisfies an inner lack of confidence that positive feedback partially corrects? Am I rejecting in- (or out-)patient care not because I find the medicine unexciting but because I don’t find the potential feedback as fulfilling….

On a related vein do we see more emergency and critical care physicians on social media as this also provides a great deal of positive reinforcement of our self worth or place in the community? I am sure the situation is not as binary as this, but it is a thought I have not been able to shake. It is a good chance to be open about my intrinsic motivations although I am pretty sure I am not going to be leaving emergency care anytime soon :)

What did you learn this week? #WILTW

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