Seven Pounds with Will Smith: A Surprising Source of Reflection

This is a slightly impulsive blog, and since I have already blogged three times this week, you may be excused from being tired of hearing from me. However, while in the momement, I wanted to capture my thoughts on paper.

I have just watched a movie called ‘Seven Pounds’. It features Will Smith who, having caused a fatal car accident that claimed seven lives including his wife’s, sets out to find seven people to whom an organ or tissue is needed to save or dramatically improve their lives. He does this as he plans to take his own life with the express and planned decision to donate his organs to them. Along the way, he of course, falls in the love with the woman who eventually receives his heart – both literally and figurately. It’s Hollywood – of course he does.

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I will not deny it – it got to me and I did shed a tear. I am old softie at heart after-all.

As I sat afterwards over a cup of green tea (just to complete any loss of masculinity this afternoon), I thought about the film. Not, as you might think about the notion of organ donation – for that in itself is a meaty issue and not something for light reflection – but about the way in which Will Smith looked into people to see how they treated others in the face of antagonsim. He looked at how they still gave and acted as good decent people when they were themselves in desperate need of being given to.

As a doctor my job is not only to help treat patients physical and mental conditions but to treat them as a person. A person who is no doubt scared, unsure, desperate for answers and solutions, often with a team of family and friends around them. I thought how I try and be understanding and patient in the presence of these people – but it is not always possible – sad to say when I am tired and frustrated and stressed – I am not always the most patient of people – my own mother would certainly testify to that.

However then I thought again. Nick – you are being a complete idiot – the fact that you are a doctor means nothing. Being a doctor is not a dictator to the way in which I should treat people when our lives cross each other. It should be instead be about who I am as a person, as an individual – stripped back bare to before a job title or a status. As Nick, pure and simple, not as a Doctor Nick, I would like to think that I treat people well. I suppose that this film however reminded me to always try that little bit harder with people and when I can, to be kind, and generous, and supportive. Life can, afterall, be very hard at times.

This may very much sound like the ramblings of someone who is used to being very busy and that clearly has had too much time of his hands to think, but I would hope that I am making some-kind of sense – that, we need to look beyond a person’s clothes, status, job, position in society, whatever it may be and instead look at how they behave as a person – I bet you if you look around we will see a lot more good than the newspapers try and convinve us of.

If you have a chance, do what the movie, it’s very powerful – just have a box of tissues at the ready.

Have a lovely weekend all.

Nick

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The Eye of the Storm: Annual Leave

It’s 8.01am on Wednesday 26th March 2014. I am lying in bed with a cup of coffee in my favourite “Nicholas – Meaning Leader” mug that I have had since I was 16 year old streak of a teenager, the radio is on playing the latest Pharell “Happy” chart-topper, and I as I stretch out under the duvet my feet extending down into the corner of the warmer parts of the bed, I let out the deepest sigh of relaxation.

This ladies and gentleman is what heaven must be like.

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As my head lies on the pillow I think about the day ahead. It is filled with all manner of activities such as putting the television on, having a nap, going for a nice long walk all Battersea park smiling to myself in the knowledge that the rest of London sleeps. Perhaps, just perhaps, I will even cook a nice meal for my housemates (the less fanciful alternative now that the girl I was dating has decided to look elsewhere). Actually, a meal for my housemates may be a bit too much like work. Let’s scrap that.

I am on day 3 of my annual leave. It feels like a lifetime. I indeed feel like a normal human being beginning to once again re-engage with my personality and life pre-doctoring. I remember I like reading magazines, making time to see my friends in the evening (and staying awake during the process!), I recall that I DO like staying up past 10pm on a weeknight and that my facial muscles do indeed, wait for it, relax. Suddenly I look and feel 10 years younger and that spring in my step has returned. I am reborn! Well, ok, yes, a slight exaggeration but I hope you get the gist – my annual leave is serving a very important act – saving me from myself.

I take another sip of the coffee (freshly pressed I might add…because…well, I have time) and do my very best to sink a little further into the mattress and relax as many as the 642 muscles in my body as I could. I look up to the ceiling and sigh once more. Bliss.

But then it happens. I feel it happening and like a slow car crash I am helpless to not look, to take a peek at the ensuing act. It chisels its way into my mind, slowly but surely…my defences are down, my body too relaxed to fight it and then before I know it…

….I am thinking about work.

If I could, I would have shed a little tear.

“I need to do the cardiac arrest audit soon; I don’t have the papers to reference that case report yet; I have the emergencies course next weekend; when am I going to sit the first part of the Membership for the Royal College of Physicians; I have to complete the quality improvement project next week; I need to review that patient’s file….” Spiral around my head like those unrelenting charity collectors that hound the streets following you like a 12 year old boy on his first game of “kiss-chase”. I shake my head to try and knock the thoughts of work out of it but it is too late. The seeds have been sown and, heart-breakingly, within 5 minutes…

…[Click]…

The laptop powers up. I have a mirror next to my desk (not for vanity reasons I assure you, it’s just, well, there) but I daren’t look at it for I know I will see disappointment in my eyes. Disappointment that I have buckled to the ferocity of being a doctor. I spend the next few hours working away on various presentations and medical ‘development’ that is all designed to make me a better doctor apparently. The time goes by in the blink of an eye.

As I briefly tune-out of the journal article on per-operative temperature management and complications, and transiently tune into the radio I hear Pharell’s “Happy” playing again – This is a clear sign that I have been working for a while. I glance down at myself, still in the rugby shorts that I sleep in with that old hoodie on (think less ‘street corner thug’ more ‘Oxford University Triathlon Hoodie’ sort), surrounded by the darkness of the bedroom with the curtains still let to be drawn, and only the glare of the laptop screen to light the way for my fingers on the keyboard. As I pause I hear the “whirr” of its aging and burning up fan. I take a sip of that coffee…

…oh Nick, why oh why did you think that would still be hot after 4 hours….

But here lies the irony in all of this. I felt a buzz. I felt accomplished in what I had done and that, strangely, made me quite happy. Very happy in fact. I smile as I remember who I am – I am the 7 year old boy who while being read bed-time stories by my Pub Nana (I called her this as she owned a Pub with my granddad, Pub grandad), would slip out of bed and say “keep reading, nana, I’m listening” as I got out my tape-measure to measure my furniture to plan my next room ‘change’ – I am the 13 year old boy who would pull a ‘sickie’ from school only to then spend the day assessing our family garage to then present a typed-up document for a proposal for a garage conversion into a bigger bedroom. I am a do-er. I am task-orientated, and that ladies and gentlemen, as much as I fight it, as much as I dislike it at times, is who I am – and ultimately what makes me happy.

Accepting who we naturally are is as a large important part of achieving true happiness. I am happy.

Besides, I think I should at least get SOME credit for lasting 3 days of annual leave….

See you next week.

Dr Nick

Death in a Bottle.

 

Just as the year has different Seasons, each with their own set of personal characteristics, I have different sides to my personality. You may have gathered from most of my blog posts that I am a by and large a pretty relaxed guy who likes a joke. There are times though when, just like the Seasons, I see a shift in my personality. This week saw that shift and I guess to a degree, this week’s blog will reflect that. Let’s call it the Winter of my personality – slightly darker and little more severe.

Now most Friday’s after a long week at work, I like to have a whisky as I sit back, relax and reflect on the week that has just once again moved like a freight train from underneath me at breakneck speed. This week though when I got back to my flat, I just stared at the bottle of whisky and felt nothing but disgust. Right there and then, I hated alcohol.

Why?

A very good question. Well in a nutshell, in this single week in the intensive care unit I saw three young men and women die a horrible death from decompensated alcoholic liver disease. All three were under the age of 50 years. What a tragic and terrible waste of promising life.

In fact, every year over 5,000 people die in this way and over the past 30 yrs this has risen by 450%.

Let me give you a little idea of what decompensated alcohol liver disease does to the body: your liver shrivels up and stops making proteins, sugars and chemical factors that help your blood clot when you bleed, it puts pressure on your kidneys so that they stop working, it forces the massive consumption of your muscles for fuel so you literally waste away, fluid that should be kept within your blood vessels and cells actively leaks into your tissues and abdomen giving you a huge ‘ascitic’ tummy and puffy limbs, and the build-up of a break-down product called ammonia causes an encephalopathy – which basically means that you become confused and lose your sense of self.

Now imagine that you are a family member at your loved ones bedside? What do you see? Someone who certainly doesn’t resemble your loved one that’s for sure. Instead you will see someone who is utterly wasted with no muscle mass, bleeding from various orifices, with a huge bloated tense tummy, yellow skin and eyes from jaundice (the build-up of a chemical called bilirubin) and unable to any make sense to you as they are confused – that is of course if we haven’t already intubated them and are helping them breath via a ventilator as their lungs have also failed. The chances of recovery once they come into the intensive care unit with this picture of what is ultimately known as multiple organ failure is incredibly poor.

Even more heart-breaking is that fact that you discover that they continued to drink right up to their hospital admission. For them, alcohol has grabbed hold of them like a serpent slowly squeezing the life out of its prey.

So where’s the root cause of it all? Well, yes it is most definitely multifactorial – I don’t disagree with you there. But you don’t need to be too switched on to see that the relationship between society and alcohol has become increasingly promiscuous. Friday night, Saturday night, any night in fact, in any major city is an opportunity to get wasted. You could rub two five pound notes together in a bar and get you and five of your mates drunk. In essence, drinking is a national past-time now.

Now don’t get me wrong, readers, I like a drink. Indeed a small amount of alcohol within the daily recommended volumes (for men that’s less than 21 units a week with at least two days without drinking; for women that’s less than 14 units a week with at least two days without drinking), is good for you for it is thought to distress us, reduce our blood pressure and thereby reduce the risk of strokes or heart disease. Problem is, moderation is not part of the British culture when it comes to alcohol. The fall-out from this is that we see families destroyed, violence, financial trouble, social unrest and over 800,000 alcohol-related admissions to the NHS each year at a cost of over £2.5 billion.

Of course, drinking is also on a spectrum. For the vast majority of us, we sit healthily on it. It is those that sit on the extreme right of it, consuming way in excess, which see themselves in A&E and then guests in our intensive care units. But it is not just them is it. It’s the families of these people. Often strained to breaking point after having tried to rescue their little boy or little girl from the grips of what is a horrible unrelenting illness. I had to watch these families go through hell this week – the final part of their journey you might say before perhaps they can begin to rebuild their family units now that their loved ones are finally, at the very least, at peace.

And to be clear, yes, you did hear me right – I did say illness. Alcoholism, alcohol dependence, and alcohol binges, are all an addiction that destroys the body and mind. It is an illness and as such we need to support and care for people that suffer from it. I know that many people find this an unpalatable notion – especially when alcohol has the power to transform an individual from the kind, gentle and reasonable person into a monster.  I argue this to you however – if we don’t – how will it ever get better for them or their families. I bet my bottom dollar you know somebody who drinks too much. I know I do.

Alcohol and the devastating effects it produces is an issue for us all. It is the collective responsibility of individuals, families, society, governments and providers. Until we come together and tackle it with iron-clad tools to beat it and transform our relationship with alcohol, I will and many other doctors will continue to see people come to us. Sadly by then, it is just too late.

And on that note, I do hope now you may see why I didn’t feel like that whisky last Friday night.

Have a great week everyone – Spring is on it’s way.

Dr Nick

P.S. If you or anyone you know wants more support I recommend checking out the link below: http://www.nhs.uk/Livewell/alcohol/Pages/Alcoholsupport.aspx

Apparently Accident and Emergency “won’t kiss it better”…

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This folks, is my favorite NHS promotional advert of all time!

It is a sign of the times – the melting pot of strained emergency services, inappropriate use and the more robust approach emerging from the NHS.

The question is – why the confusion? Is it us – the public, being more precious and launching ourselves head first into the A&E waiting lounge from a screeching car because “little Jimmy didnt smile as much as usual today” or is it the squeeze on the service causing the NHS to start ruling with an iron fist within the velvet glove? Either way – the times are a changing.

In about half a year I will be working in Accident and Emergency. I will be curious to see the mix of patients coming in through our doors. Maybe my opening question should be….”Have you ever seen the Ronsil(TM) advert?”

Afterall…Accident and Emergency is a bit like Ronsil – it does exactly what it says on the tin.

So come back when you actually need it!

…No no I can’t do that – I pride myself of my ‘soft’ skills…[cough]

Did I just experience “Eat Pray Love”?

 

I did have something else in mind for my blog this week but I had to demote it to talk about something that, at this moment in time, has truly captured my imagination, thoughts, and to be quiet honest given me a wave of positivity.

It’s Sunday morning, so I do what I always do on a Sunday morning, I get up early-ish (but after the sun has come up – unlike my working week), have some oats and throw on my running gear, heading out to the park. Now I live in Battersea and so have the luxury of having the beautiful Battersea Park that nestles next to the river Thames as my treadmill. As I say, I do this every Saturday and Sunday. But like much of life sometimes we stop looking and instead just see without interpreting.

Today I interpreted.

The world is full of duality. There is good and evil, light and dark, happiness and sadness – you name it and there is an opposite. The way in which we decide which side of duality we want our lives to fall into is a personal one. It is also, I am sure you may agree, very easy to fall onto the side of darkness, fear, sadness and pessimism. After all the media floods our lives with fear and doubt – murder, crime, untrustworthy government, tragedy all part of our daily feel of what the world is life. This influences our choice of this duality and as such we are literally guided to a more negative state of mind. I am guilty of this sometimes. Personally, my most influencing moment was the London riots – they crushed my belief in my own city for a while and I lost hope in people. I am happy to say that this did not last but on reflection it is unbelievable who easily influenced we can be.

If we were to look to health it is no different – we are all fat, depressed, slobs according to most people you speak to or which paper you look at. We are all going to die of heart disease, strokes and suffer years of dementia as advanced medicine keeps our bodies alive as our minds deteriorate. Well I actively chose not to accept this perspective. Call me naive. Call me ignorant. It doesn’t matter. What matters is the perspective and positive mind-set that I – you – everyone has the capacity to hold. This is incredibly powerful. The more people in society that adopt it, the more power it has.

Today as I went for a run with the Spring sunshine on my face and the reflection of an (almost) inviting River Thames as London slowly woke up to another day of a million separate and personal stories that will unfold. Do you know what I saw?

Drunks? Slobs? Fights? Arguments? People looking depressed? No.

I saw every shape and size person out trying to walk or run for the first time this week, the die-hard runners breaking out their MARATHON FINISHER string vests as the temperature climbs, families having enticed their young kids away from the television or social media, dogs chasing other dogs (or rather oddly around a stationary stick…), and people smiling at other complete strangers.

As I finished my run, I usually stretch for 10-15minutes and in my head (yes I know this is sad!) run through what kind of week ahead I want to have and what I want to achieve. Today I spent over an hour because what I saw in that park, in the people there was so overwhelmingly positive, good, and uplifting in an ironically passive and non-deliberate manner that I wanted to drink it in.

Positivity is one of the best medicines we have for it frames our perspective which in turn feeds our actions. This benefits every pillar of our health: social, physical, psychological and spiritual. I for one will looking to carry this into my week.

This just leaves me to say – have a truly positive and brilliant week.

Dr Nick

#DrNickBlog

Rain Check: How Life has Changed Since Becoming a Doctor

I have found myself in the rather unique position today of having some free time. Now I am someone who, admittedly, struggles with the concept of free time. You see I simply have to fill it – and if I don’t I tend to pace, let my thoughts, doubts and insecurities surface, and question it all. It sounds dramatic but amongst my jokes, I am actually quite a deep thinker I guess.

So what I thought I would do is try and summarise, while in the state of having free time and uninterrupted mind, what life is like now and how it has changed since I started work as a doctor.

I think perhaps before I do that I should let you know what others tell you – especially other doctors. They tell you to:

(i) forget having a social life

(ii) forget about having a relationship

(iii) forget about having hobbies

(iv) forget about having sleep

(v) forget about not letting your family and friends down

(vi) forget about enjoying the job and just get on with it

I have chosen to ignore their advice. Personally I think it is rubbish. The life that you lead is ultimately controlled by you. If those factors were to have become wholly true then I would have happily walked out of a career in medicine. Life is after all, precious, and what that would have done is remove all the facets to life that make it so rich, full of joy and exploration, and hope for the future. Those people that make statements baked in half negative rhetoric are people I have no time for. If you know me, then you will know, I don’t suffer fools lightly and will happily let them exit my life (with boot helping them on the way out!).

So what have I found? Well, I have found that yes medicine does leave me more tired, less able to get to every social event, and a little bit more wary about even bothering with a relationship. However, medicine has also given me a privilege. It has given me a privilege to be party to other people’s lives. Through this I have seen every single possible emotion (in even just the 7 months as a doctor) and encountered situations that before I would have most definitely questioned how I might react. Armed with this experience now I feel lucky: my own emotions are richer and more cemented and better understood with my new perspective; my appreciation for my family and friends that much greater for I have seen what it is like for others when they lose them; and I have a much better idea of what I want out of life.

So what do I mean by “what I want out of life?” Well, I mean I want to seek out happiness, fulfilment, purpose and enjoyment. Those facets shine a little bit brighter for me since becoming a doctor. I think, on reflection it is the perspective that I have been given. I am very grateful for this – despite some of the sacrifices that have to be made. Becoming a doctor has also helped me with my identity. I mean, yes, true, it is just a job but it is a job that requires me to do something and act that requires an extension of who I am. By that I mean when I talk to a patient or a family I am not just telling them what I have been told to tell them or delivered the bad news in the way that I was  taught to in medical school – but I am doing it all weighted in my own emotion and empathy or sympathy for the person in front of me. As such I think it hard to separate the doctor, person and the job. And we are all probably aware that we see people who do it well and people who do it poorly. I just hope that I do it well and indeed continue to improve.

The bottom line is, people say that being a doctor takes its pound of flesh but I would argue that indeed for every pound it takes, it gives the doctor two pounds back as they learn continuously more about themselves through their privilege position in other people’s lives.

For now, I’ll take that happily.

Dr Nick.