Month: October 2016

This week I took to the skies again, no not as an astronaut but as a regular passenger on a flight to London.  Now for people who have had the misfortune to fly with me in the past, they will know I was not a good flyer.  In fact I was a terrible flyer.  I’m not really sure where it started but my family like to trace it back to my love of the Airplane films.  Hilarious but not exactly what a young impressionable mind should be watching. I was also quite late to flying having flown once when I was 15 but not again until I was in my ~20s.

I viewed flying as some kind of dark art, unnatural even.  Birds do it, bees do it, even educated fleas do it but humans – no way.  We are not designed for that!  And yes I did do physics at school.  And yes I could tell people all about the ‘forces’ that allegedly holds planes in the air (really….?Do they….?)

So what was my problem? The reality was I had a fear of flying and it made me miserable.  It wouldn’t however stop me from going places as the thought of giving into it was worse than the fear itself.  However on a flight back from St Lucia I took a panic attack.  What made it worse was the fact that I didn’t know it was a panic attack. All I knew was that I thought I was going to die.  On a plane. Somewhere over the Atlantic Ocean.  I stopped flying anywhere for a long time after that.

I did eventually manage to build myself up to fly for no more than an hour but even then I would be consumed with anxiety for a week or so leading up to it.

This went on for ~10 years until I decided I had had enough.  There was a significant birthday and anniversary coming up and we wanted to go to Disney in Florida.  A whole 9 hour flight!

I was determined we would go and having booked it the year before I had already started working myself into a bit of a state over it.  Just how much gin would I need to drink to keep me awake and vigilant but also quietly buzzed and calm?  It turns out there is no balancing this equation so I booked onto Virgin Atlantic’s ‘Flying without fear’ course instead.

So one windy day (it’s important to check the weather forecast a week in advance if flying) in March 2015 I took the train (taking no chances) to Birmingham Airport.

Yes, I was taking back control!

The course itself was brilliant!  The perfect balance of serious but fun although every single thought I had ever about flying was suddenly exposed.  It turns out I was not the only one who could will a plane to take off and stay in the air just by thought alone.  I knew the cabin crew would alert their co workers to danger by using a secret bing bong system. I also knew that cabin crew serving drinks would always signal turbulence and that this was their distraction tool.  Oh yes, I was proper crazy!  However I was not alone.

The course debunked all of my idiotic ideas and gave me the confidence to get on a specially charted flight out of Birmingham the same day.  What a flight it turned out to be.  The weather had worsened so by the time we were making our final approach to land it was raining ice, very windy and to top it off we were struck by lightening (on the wing where I happened to have a window seat!).  The plane 2 mins behind us also had to do a ‘go around’ as it was deemed to windy to land.

As I got back on the bus after dealing with a medical incident with one of the other passengers the adrenaline had started to kick in. I had flown in terrible weather in a plane that had been struck by lightning but still landed safely.  I felt amazing!  I could do anything.

Nearly two years later the adrenaline has worn off but the feeling of possibility has not.  I flew to Disney and had the most incredible holiday with my family.  I have flown several times since and now actually look forward to it.

They say ‘feel the fear but do it anyway’ I disagree.  Feel the fear, understand it and then smash it into smithereens as you fly off into a world of possibility…..

My daughter’s favourite board game at the moment is ‘The Game of Life’.  I’ve lost count how many times we’ve played it.  The idea of the game is to make decisions about how you live your life based on a variety of choices.  These start with deciding to get a job or going to college and progresses (in order) through marriage, having kids and then retiring.

You have ‘won’ if you’ve made more money than everyone else.  I’m not exactly keen on this being the take home message to be honest however I have to admit it is fun. I usually end up choosing a career as an astronaut and living in a beach front apartment.  Amazing!

I was talking about the game with friend and colleague Emma Vardy (@emmavardy) this weekend.  We got to talking about a different version of the game that would reflect more realistic choices to be made in later life.  For example when choosing a house it could include things like does it have any adaptations?  Does it have ground level entry? The family section could include discussions about power of attorney and living wills.

While this may seem a tad facetious I do think there is a conversation to be had about our life choices as we age.  I think it is something that very few people have – usually it comes late and at a time of crisis.

My on call last week reinforced this assumption.  I assessed several frail people who had had no prior discussions about treatment escalation plans.  Unfortunately all of them were so ill they could not participate in any of the discussions.  I had to speak to families that were already very distressed at seeing their loved one so unwell.

These conversations can be hard and time consuming.  While I feel it is important to have them and do them with sensitivity, I do feel that I overload people with information.  It’s a lot to process.

The new DNACPR guidelines have been released along with new forms.  The main difference is the documentation of decisions and how they are communicated to the person and their families. [1]

Resuscitation is without doubt the extreme end of the treatment spectrum but what about antibiotics, fluids, nasogastric feeding or operations for example? In 2013 it is thought 1 in 14 people over the age of 65yrs has dementia.  This is projected to increase by ~40% by 2025 [2]  We should be having these conversations much earlier.  If we truly are in control of our lives or certainly our health then surely we would want a say in what happens to us later in life?  What about when we no longer are able to process that information and our families are asked to help inform/guide/shape treatment plans in the middle of the night?

If these are conversations that seem ‘too serious’ or perhaps the response from parents is ‘och, I’m too young for that!’ then why not try playing ‘The Game of Life’.  When you get to the finish line of retirement instead of counting your money go to http://www.mypowerofattorney.org.uk and have a real conversation about your future.

Even astronauts living in beach huts will eventually need to do that….

References:

[1] http://www.gov.scot/Topics/Health/Quality-Improvement-Performance/peolc/DNACPR

[2] https://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=412

A phrase you will hear pretty much in any workplace including the NHS is ‘that’s not my job’.  This week I heard it said a lot and it began to grate.

Now to be fair most people working in healthcare will try to be as helpful as they can.  There are very few who will be deliberately rude especially towards patients and relatives.  I have though noticed a change in the way we behave to one another. When faced with:

‘No I don’t know why that abnormal result wasn’t brought to the attention of the doctor.  That’s not my job.’

Or perhaps….

‘No I don’t know why Mr X was not seen.  Maybe the referral got lost.  I could find out why but that’s not my job.’

….I have been witness to somewhat contradictory behaviours.  There is acceptance of the situation whilst at the same time a growing sense of injustice.  It is this injustice that seems to drive people to behave in exactly the same way they have been treated themselves.

‘well if it’s not your job I’m not going to be anymore helpful when I’m asked in the future’

It all leads to a sense of frustration and unhappiness.  The people who suffer the most are the patients.  If we can’t treat each other with kindness then how do we even start with our patients?

Towards the end of the week I was becoming thoroughly disillusioned and fed up.  On Thursday we had our inaugural STAT (Stroke & TIA Assessment Training) day.  To be honest I could’ve seen it far enough such were my energy levels.

The STAT program was developed by a team in Northumberland to deliver stroke education and training to nursing staff.  It had been supported in Scotland by Chest, Heart and Stroke.  I’ve delivered several STAT for nursing and ambulance staff as well as MedStat sessions for doctors during my time in NHS Ayrshire & Arran. I was very keen to bring it to Forth Valley.  After many months of rescheduled dates we finally decided to bite the bullet and get one done.

Nyree (senior charge nurse) and myself trained 3 of our nursing staff plus our registrar.  The day itself was a mixture of presentations but the main bulk of the training was done using simulation.

To make it more authentic we had a real person, Christine, be our ‘stroke survivor’.

Simulation is great!  It allows a safe environment to try out what has been learned through a series of scripted scenarios.  While there are very defined learning objectives one of the things I encourage people to do is to put themselves in the patients position.  I want to hear people offer reassurance and explain what is happening.

It was therefore fantastic to hear Nicole, our newly qualified nurse, explain to one of the others ‘it’s all about communication. That’s the foundation.  Get that right and the rest will follow’

During the more complex scenarios not once did I hear ‘that’s not my job’.  All I heard was ‘what can I do to help?’.

So while we will be faced with plenty of situations where the natural response will be ‘that’s not my job’ I would encourage people to replace the full stop at the end of the statement with one word.

‘That’s not my job but……..’

It does require effort. It may even require you to do slightly more than is in your job description but I guarantee the effort will be worth it.  You will become less defined by your job and more defined by kindness.