Finding my way in the storm….

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Distress.

This is an excellent accessible blog for everybody with so.e very useful tips and resources.

Dr Abbie writes

I have wanted to write a post specifically about mental illness for a while now and Mental Health Awareness Week has pushed me to put pen to paper (or hand to keyboard). I have started this post so many times, struggling with how to appear sincere and not clichéd but relevant. It’s ironic how anxious I have been to get this right! I want to do justice to Mental Health Awareness Week and my many patients who have inspired me. This is a small snapshot and I hope to do more blog posts on specific conditions/presentations in the future.

I haven’t suffered a mental illness but, as a GP I have witnessed the effect of mental illness on patients and their families. I cannot truly understand what it feels like to endure these distressing symptoms day by day but I can share my experience of mental illness in general practice…

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A Song to bring in the New Year……

Much as I loved Christmas and wanted the new year to herald a new start of goodness and promise, somehow the dawn of the year always felt like a damp squib – watching TV, drinking (possibly too much), and if I was very formulaic, taking in Jools Holland’s Hootenanny followed by the fireworks competition to created the biggest spectacular show around the globe.  And then that song we sing – you know, that one that only 3% of the population know the words to (and probably fewer understand their meaning)…..

It has in the past made me feel very small and insignificant and somewhat purposeless.  This year I decided to do things differently, start as I mean to go on.  We started the beginning of Christmas eve as a church family memorising the verses of Proverbs 3:5-6

Trust God from the bottom of your heart; don’t try to figure out everything on your own. Listen for God’s voice in everything you do, everywhere you go; he’s the one who will keep you on track. Don’t assume that you know it all. Run to God! Run from evil! Your body will glow with health, your very bones will vibrate with life! Honor God with everything you own; give him the first and the best. (The Message)

 

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Trust like a child

Of course I feel insignificant – I am.  In the presence of the Creator of the Universe, the big ‘I Am’, I’m tiny.  And yet I was known and loved while I was still I’m my mothers womb (Psalm 139) and I am loved with the most unimaginably huge love (John3v16).

Next I spent time lovingly wrapping belated Christmas presents for my 104 year old Nana who I lived with for a year as a child and who I know looks forward to every one of my infrequent tracks over to Lancashire.  I want to do anything I can to help improve her quality of life, so reduced by loss of sight and memory. I hope that the illuminated magnifier and photo album with large prints of family together with a CD of many of her favourite songs will do just that.

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Moving on, I decided I would reflect on the words of the wonderful Rend Collective anthem to the tune of Auld Lang Syne (see below together with the link to a thought provoking You Tube video). This led me to other videos as inevitably happened and I stumbled upon the interview with the actor, Jim Caviezel, who played Jesus in The Passion of the Christ.  I am aware that many committed Jesus followers have not yet seen the film. I forced myself to do so – twice. The second time was more heart wrenching than the first but I wanted to appreciate just what the son of God had done for me and all of us.  The interview was astonishing. I’d been aware that Jim was a believer prior to taking the role.  What I hadn’t know was just how costly this was for him, physically and emotionally – and yet it appears to have been transformative. Rarely have I heard such intensity, purpose, humility, wisdom and direct challenge from a celebrity. Playing Jesus and taking up the cross literally can’t but change a person.

 

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So I have a choice – do I ignore this and do nothing with it or do I live in trust that the most wise and powerful being imaginable wants a relationship with me?  Knowing that I have already done the latter means that I am adopted into the everlasting family of God gives me both identity and purpose.

Now 2018 gives me a new perspective.

Rend Collective – For All That You Have Done

Artist: Rend Collective

Album: Campfire Christmas, Vol. 1

Your grace will never be forgot
Your mercy all my life
Will be my source forever song
My story and my light

From mountain top to valley low
through laughter and through tears
Surely the goodness of my God
Will follow all the years

For all that You have done for us
for every battle won
We’ll raise a song to bless Your heart
For all that you have done

You know our failures and regrets
You always led us home
Redemption’s arm has raised us up
Our triumph in the storm

For all that You have done for us
For every battle won
We’ll raise a song to bless Your heart
For all that you have done

(You’re faithful through the ages)

In unity we’ll stand as one
As family we’ll go
Shoulder to shoulder
Hand in hand
Into the great unknown

For all that You have done for us
For every battle won
We’ll raise a song to bless Your heart
For all that you have done

Being Mortal – living well until the very end.

“Our ultimate goal, after all, is not a good death but a good life to the very end.”
― Atul Gawande, Being Mortal: Medicine and What Matters in the End

This quote sums up for me a key part of what I feel my job is. As both a family doctor and the local NHS End of Life clinical lead, my role is to ensure that local health services are enabled to provide quality care and support for people reaching the end of their lives.  We all would wish a good death for ourselves and our loved ones in as peaceful and in a planned way; so they maintain as much autonomy, dignity and compassion as possible.

th-11However, something has gone badly wrong with how we do things in modern medicine. Our goal has often seemed to be to try to prolong life no matter what the cost.  And the cost is great.  For the person, it may mean being subjected to a series of treatments which may cause harm, whilst distracting everyone concerned from the business of accepting the inevitable and living life to the full until death.  For the family it may mean a more complicated bereavement, with words unsaid, actions not done.  For the public services and NHS it means increased likelihood of repeated admissions and expensive and futile treatments.  Who has not known someone who has been subjected to chemotherapy (which is after all, a poison) right up until their last week of life?  Active treatments can prevent embarking with palliative and end of life care but there is no reason why these can’t run in tandem.  Children’s end of life care services have been championing this approach for many years but adults healthcare hasn’t embedded the same approach.

“Death is the enemy. But the enemy has superior forces. Eventually, it wins. And in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knows how to fight for territory that can be won and how to surrender it when it can’t, someone who understands that the damage is greatest if all you do is battle to the bitter end.”
― Atul Gawande, Being Mortal: Medicine and What Matters in the End

So, as a person coming to the end of life, as a member of that person’s family, as their doctor, what is the territory that can be won, what should be fought for and what should be acknowledged as inevitable and prepared for?  Planning ahead is everything.  Without this we are victims to circumstance, without any control.

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Westernised societies appear to have somewhat lost the plot when it comes to the end of life.  We have sought to try to extend it no matter what the cost, and the cost is considerable: people dying on a trolley in a busy A&E department, in an Ambulance whilst having futile resuscitation attempts when death took place some time earlier, family members unable to say their goodbyes because the dying process was not recognised or acknowledged, an unnecessarily long or complicated bereavement experience.  In my own family, because we did not want to own up to the fact that my father was dying, we missed vital opportunities to talk about some vitally important matters, something I will always regret.

So why have we been so poor at this in the last 50 years?  I would list the following reasons which are by no means the only ones:

  • We are less connected to rhythms of life generally, and creation.
  • New technologies have blurred the boundaries of starts and ends of life.
  • Medicine is part science, part art.  We are less good at the art bit and, lets face it, doctors and nurses are human and many are uncomfortable addressing this sort of issue despite the fact that it should be bread and butter to all of us.
  • Many people fear death or the process of dying.
  • It is a deep, emotional subject and requires great sensitivity to address.
  • Families find it more difficult generally to let go of their loved ones than the person who is dying and may attempt to prevent wholehearted preparation for death.
  • People leave these conversations far too late and may have lost capacity to do so: either because of a sudden severe event or because dementia sets in (this is soon to become the most common cause of death).
  • Increasingly it is difficult for the NHS and social care to provide the type of support that people need, when families are stretched and public resources increasingly scarce.  It may be in the ‘too hard’ box.  This ends up costing more in £s and in distress when folk end up being admitted to hospital as an ’emergency’ to die instead of peacefully making their exit in a dignified and peaceful way at home (where most people would prefer to be).YODO_poster

Asking the honest question?

We should consider asking this question of our relatives, of each other:

‘If I told you that you had just 3 months of useful life left to you, followed by death, how would you spend those 3 months?’

Ok, its a purely hypothetical question, but it does cut to the chase.  What are the most important things to us?  Are we currently spending our time most fruitfully now, living life to the full?   Have we put in place all we would wish for our loved ones should we die unexpectedly?  Have we said the things we want them to hear?  Or, have we put all those things on hold for some future date that may never arrive?

There will be a whole week of focus on these issues, with people available to guide folk on the business of planning for the end of life so that they can then go on to live life to the full, confident that should something unexpected happen, wishes are known and plans in place.

Dying Matters 2017

What are we doing?

  • Primary Schools art/poetry competition
  • Death cafe: discussion, sharing, information about services, resources.
  • Drop in sessions:  will writing, legal services e.g. power of attorney, funeral directors.
  • GP surgery resource packs
  • Opportunity to find out about the new Respect Process emergency care plan documentation.
  • Meaningful bucket lists!
  • Sharing important information with relevant organisations ‘Know About Me’.
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It is not well known by the public that those who opt for palliative care (aiming to actively manage symptoms and provide symptoms control rather than cure) actually live longer. Patients with terminal cancer taking this approach with or without chemotherapy had much better quality of life, live longer and were more likely to have their wishes met. Everybody who needs palliative care towards the end of life (most people actually) should receive it but only a small % actually do.  The Hospice movement has grown to fill much of the unmet need and excels in bring understanding, compassionate care, relief, hope, clinical expertise and respite care to carers.

Developed by Dame Cicely Saunders (a nurse, social worker, Anglican and doctor) with the founding of St Christopher’s Hospice in London in 1967, the modern hospice movement combines latest research and teaching with effective pain control and holistic care: incorporating attention to physical psychological social and spiritual needs.  Hospices are places of laughter relationship and peace.  People to choose to go to a hospice to be cared for in their final few weeks but most people receive care as day therapy guests, a temporary stay for respite care or symptom control or home care – all by expert nurses and care assistants.

 

Could knowing we are reaching the end of our life be considered a gift? An opportunity to take stock and re-order our priorities?  An opportunity for inner healing restoration and reconciliation? A chance to fulfil a dream?

Could this be an opportunity for our society to rediscover community and compassion as we support family and neighbours at this most vulnerable and poignant time of life?  When ROC (Redeeming our communities) were recently invited to facilitate a community meeting by Nottinghamshire County Council and Notts police, may of us from churches, health, social care, police and other community groups put our heads together to examine the needs for our community. Social isolation featured large.  Isn’t it about time we started a movement to address this – its everybody’s business.

As I write this, in that waiting time between Good Friday and Easter Sunday, I’m reminded that this time of sorrow and darkness culminated in great joy and victory; spiritual death defeated.  If we come to view death as a necessary transition, not to be feared, but when the time comes, to be embraced, and to celebrate lives well lived rather than ended, then we can ensure we truly live life to the full.

References & Resources.

Being Mortal, Atul Guwande.

Matters of Life and Death, John Wyatt

Joan Bakewell, Radio 4 Podcasts ‘We need to talk about death’.

Dying Matters Website and You Tube Channel

Respect Process Website

Gold Standards Framework

Advance Decision to Refuse Treatment

Hospice UK Website

Nottinghamshire End of Life Website

Milford Compassionate Community

Compassionate Communities Website

Redeeming Our Communities (ROC) website

Signs of Life…..this is personal.

I’ve been musing about new life; but then I reflected how can someone tell if I am truly alive?

Well a doctor would instantly go durrrr! Heart beat? Respiration? Activity? Or they might supply a broader definition:

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Richard Dawkins, however, in his book ‘The Selfish Gene’,  states  ‘The argument of this book is that we, and all other animals, are machines created by our genes’.

Really Richard?  Most scientists, especially those working in the healthcare profession, counsellors and psychologists would beg to differ.

But, most importantly, what does God say about life?

John 3:16New Living Translation (NLT) “For this is how God loved the world: He gave[a] his one and only Son, so that everyone who believes in him will not perish but have eternal life.”

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God reaches to us through Jesus. Artist Iain McKillop

John 14:6 [NLT]   Jesus told him, “I am the way, the truth, and the life. No one can come to the Father except through me.

John 10:10 [The Message]  Jesus told this simple story, but they had no idea what he was talking about. So he tried again. “I’ll be explicit, then. I am the Gate for the sheep. All those others are up to no good—sheep stealers, every one of them. But the sheep didn’t listen to them. I am the Gate. Anyone who goes through me will be cared for—will freely go in and out, and find pasture. A thief is only there to steal and kill and destroy. I came so they can have real and eternal life, more and better life than they ever dreamed of.

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So the Son of God is very clear real life, life to the full is found in one place only -in Him. Unfortunately many in our society listen to the ‘thieves’ and ‘sheep stealers’. ‘What worries me about religion is that it teaches people to be satisfied with not understanding the world they live in.’ Richard Dawkins

I have never yet met a faith-fuelled person of any brand of religion who could be described as being satisfied with not understanding the world. They seek truth and understanding in many ways, partly by soaking up the information around them and partly by active seeking.  In fact, one of the scientists who discovered the human genome declares “I believe that God did intend, in giving us intelligence, to give us the opportunity to investigate and appreciate the wonders of His creation. He is not threatened by our scientific adventures”. Frances Collins.

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My own journey to discover God came through a scientific examination of the historical evidence behind the Bible and the person of Jesus.  Having decided that all the evidence available pointed to a creator God and a person claiming to be the son of God who amazed all who met him, was killed by the authorities of the day and subsequently resurrected, I surrendered myself to Him.  Calling Him Father is the most wonderful thing and that decision was the best thing I have ever or will ever do.  It was having my own children that prompted the desire to know the truth about whether God existed.

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Chris tenderly strokes his newly born baby sister

As CS Lewis said (in Mere Christianity) of Jesus, “You must make your choice. Either this man was, and is, the Son of God: or else a madman or something worse. You can shut Him up for a fool, you can spit at Him and kill Him as a demon; or you can fall at His feet and call Him Lord and God. But let us not come with any patronising nonsense about His being a great human teacher. He has not left that open to us. He did not intend to”. 

So I made my choice, invited Jesus in through the door my life, and from then on, by his undeserved grace, was adopted into His family and became a new creation with a new life.

In the powerful lyrics of Philippa Hanna, in ‘New For Old’

He blows the dust from off the surface
Traces each and every line
And with Scarred and weathered fingers
Holds it up towards the light
He knows exactly what he has to do to bring it back to life
Nothing is worthless for the one who sees the gold
New for old.

My next musing will be about my adopted family – the Church.