OCD

Sometimes I feel like the whole mental health umbrella is getting too big and everything is being shoved under it.

Take my next patient for example. He wasn't even going to waste my time, he already had his diagnosis ready. Well, his fiancee did.

"I need to be referred to the Psychiatrist for intensive therapy to cure my OCD."

 I quick-scroll his medical records. No OCD there.

"Okay....Have you been diagnosed with OCD in the past?"

"Well, my fiancee showed me this website and it's exactly how I feel."

He passes me a printed booklet.

"And what website is this from?" I ask,  hoping to hear something like nhs.uk or even wikipedia.

He says something like intrusivethoughts.com.
(Not that I was going to start reading his seven page document anyhow. )

"With all due respect for your research, can we just keep this aside and you tell me what has been happening with you."

"I can't stop thinking that I have made the wrong decision proposing to my fiancee. I don't think that she's the right person for me, I am not ready to get married.

And I keep acting on these thoughts by letting her know how I am feeling but the thought doesn't go away. It has become obsessive. That's all I think about all day.

The website says it's when you can't stop thinking about something and my fiancee suggested I see a Psychiatrist to get rid of these thoughts."

On further history, his concerns are not completely unfounded. He has no job, cannot afford a wedding amongst other genuine concerns.

At this point, I am silently trying to process this information.

Why didn't they search for "I am having second thoughts about getting married. " instead of intrusive thoughts. I wonder.

 In fairness to my esteemed colleague Dr. Google, you will always find what you search for.

One day, when I am near retirement with no fear of getting struck off the medical register, I would be able to say what I really think.

Today I say the right thing still....I am professional like that.

"I don't think that you have OCD.

I think it would be a good idea to have some relationship counselling to get to the bottom of why you have doubts about your relationship. "

I signpost to him to a relationship counselling service.

As for the bride-to-be, by hook or by crook, can't blame a girl for trying 😂.

Choices

"I don't have a choice, do I?"

It was at that point that I lost it. I stepped out of my doctor shell and became a woman, a sister, a friend, a mother.... just another human being, and female.

Rewind.

**Caution**
Graphic content may be distressing**


I was doing a day's shift at a practice in an area with a high population of conservative ethnic and religious groups where a lot of families lived in homes and streets with extended family members within close proximity.

Within these kind of arrangements, there are often strong cultural values and practices, unlike the general English culture.

A young lady came to see me. She was around 22 years old and had a toddler with her.

Her opening statement told me that I needed my detective glasses on. The kind that tells you that they are very worried about something, but they're not going to tell you what it is. I will have to figure it out.

"Doctor, I need you to be check my insides to make sure everything is ok."

(On a side note, can I just highlight that there is no one test for everything/to check that you are well/don't have cancer etc. Believe it or not, our human body is extremely complicated and dynamic....)

Anyway, I started probing.

The short summary (we got there in the end), was that she had been bleeding vaginally following fisting by her supposed fiance on repeated occasions. He had now suggested that they progress to anal fisting and the thought terrified her.

It was an on-off relationship and it was clear that she was not comfortable in it. She hated these alternative sexual options but felt obliged to endure them because he had promised her marriage!

She was already a single mother from a brief relationship and felt that finding a man willing  to marry her would save her from the shame she was enduring within her community.

"I don't have a choice, do I?"

I will save my extended views on feminism for another day but the Chimamanda Adichie and Meghan Markle I felt at that point was palpable.

Thankfully I had recently been on a course where they taught us how to breathe. Honestly. I had not realised how handy it will come until this fateful day.

Apologies again to all the next few appointments.

I spent the next thirty minutes discussing life with this young lady.

Who are YOU? What do YOU want out of life? What do YOU believe? What standards do you want to set for your child? What do you really intend to get out of marriage?

How much are you prepared to sacrifice for this? How much of your self? Your physical and mental health,  your future, your hopes, your beliefs. And for how long?!

It's all down to YOU. And the only thing you have is CHOICE!

Please do not stay in the wrong place, job, relationship etc when you know it's bad for you. You do not have time, but you have a choice, a voice.

Unfortunately, I may never meet her again but I would like  to think that for the first time in her life, she saw herself  as a 22 year old woman and mother with a life of possibilities ahead of her. One that did not include the need to wear nappies to control leaking bowels resulting from trying to please a man.

I mean, have you ever looked at the size of a man's fist?!

My name is...

The power of language.

I had a complaint letter from a patient  (As you do in the modern era of complaining about everything.... but there's a separate story about that).

This lady had requested medication which I had refused to issue as there was no clear indication for them in her records. They also had a risk of addiction.

The tone of the letter was not very nice, to say the least.

She questioned the audacity of this foreign doctor whom she had never met, changing what her old doctor prescribed five years earlier. She decided that this doctor was a previous doctor she had encountered in a telephone consultation whom she thought had a language barrier. (Wrong assumption)
She demanded to see a proper doctor who spoke English.

Somehow, she ended up back on my list.

As it turned out, she had indeed met me before-face to face, not over the phone- but for some reason, had assumed my name to be something else like Moore or Mason. (Apparently, that was the name on the door).

I remembered her well now, seeing her again. It had been a very normal engaging consultation where she had expressed gratitude for making her feel listened to for the first time.  (There should be another story about that phrase....and others. )

This time around, it was awkward. Mostly for her really, I had my invisible resilient cloak on.

"I didn't realise it was you." She apologised. "Because it had a foreign name on the message"

Duh!!

Long story short, she wasn't getting that medication anymore. At least, not from me. She agreed.

It was one of many occasions where I have observed how language sometimes transcends ethnic name or race in how people identify and relate with one another.

I remember reading Trevor Noah's " Born A Crime ", how he used his ability to speak different languages and in different accents to gain affinity amongst various groups of people, including gang type groups in his childhood.

This incident, one of  many, brought flashbacks from many years ago, whilst applying for post-graduate training placements.

I was given advice like:
"With your name,  it will be difficult to get a job."
"Maybe you should put a picture in front of your CV so people can appreciate the kind of person you are"
"Call and speak to somebody on the phone, let them hear you speak "

All with good reason and intentions.

I was once actually advised to start watching soaps like Coronation street to improve my English....by somebody who had never really spoken to me!
I dared not inform them that some of Coronation street language would defile, degrade and befoul my spoken English. I let it slide and let them learn. I was about to start working with them.

I have come to appreciate that language should be seen for what it is. A means of effective communication, not a measure of intelligence.

Anyway I am here now, in spite of my name and in honour of it.

This is me.

Africa for beginners

AFRICA FOR BEGINNERS

Africa is the second largest and second most populous continent in the world, made up of 54 countries.

It is also the oldest, and it is thought that human species originated there.

There are over a thousand languages spoken across different countries in Africa including Swahili, French, Yoruba, Arabic and Portugese.
The most spoken language is​ English.

Most sub Saharan Africans are dark skinned but there are around 5 million white Africans in South Africa alone, mostly of European origin.

The most popular religions are Christianity, Islam and Traditional religions which vary vastly across different countries.

Traditional clothing styles are diverse but tend to be made of brightly coloured, rich textiles worn with crafted jewellery or bold natural stones such as coral.

These are usually worn for special occasions such as weddings or festivals and can be extremely glamourous and flamboyant, such as the traditional wedding guest attires amongst Yorubas in Nigeria.

Everyday dressing however is similar to clothes worn in the summer months in the UK.

Africa's economy is based largely on agriculture and trade, with some countries rich in natural resources like crude oil.

Most of the food eaten in Africa is locally sourced with very low levels of imported food. Again the variety is huge across the continent. Starchy foods alongside meats and sauces is common.

More recently, in Nigeria for example, the entertainment and fashion industries have grown significantly, gaining international recognition for their music, movies and clothes designs.

Unfortunately, the potential for economic growth in many parts of Africa has been hindered by corruption and political unrest leading to uneven distribution of wealth, with widespread lack of welfare systems creating extremes of wealth and poverty.

Recent and ongoing development in the private sector is aimed at narrowing the gap.

There is also huge disparity in levels of formal education with some countries having only 60% of school-age children in school,  whilst a country like Zimbabwe has an overall literacy of 92%. Education is still based on mostly British and American systems.

Sadly, many educated Africans migrate to western countries for better and more stable financial opportunities.

Modern technology systems and internet access is widely available in most towns and cities.

Road travel in cars and buses are the most common form of transportation. Many cities have dual carriageways  with motorways between cities. Although there are brands of cars manufactured in Africa, most vehicles are imported.

The climate in Africa varies from hot and dry in the northern desert regions, to warm and humid in the​ sub-Saharan and Southern countries. Prolonged and heavy rainfall is common in the Tropical rainforest zones. Temperatures rarely drop below 16 degrees Celsius even in the coldest months. This makes it ideal for people who want to escape the cold winters in Europe.​

Popular holiday destinations in Africa include Cape Verde, Marrakech in Morocco,​ Seychelles, Egypt, Nairobi in Kenya and Cape Town in South Africa.​

Wildlife safaris are a popular tourist attraction in some parts of Africa like Tanzania and Kenya.

Most animals are found in nature reserves and forests, not usually in dwelling areas.

Contrary to popular impression, many people I know, living in the UK, who grew up in Africa have only ever seen Giraffes and Hippopotamuses in places like Chester and London zoos.

Love for the Middle

Someone once said: "Everyone loves you when you are a little child and when you're old, in between these times, you have to take what you get and deal with it"... or something to that effect.

I hold my two hands up, guilty as charged. I love children, and more recently, have a deep admiration for the elderly.

Today however, I am speaking for "the others". The Middle.

We are the ones responsible for the dependent ones at both extremes of life. We take the blame for their crap literally.

An obese toddler running around with an over-soaked diaper and the first thing that comes to mind is "Irresponsible parent".

An elderly gentleman comes into the bank looking unkempt and smelling of urine and you think "I wonder who looks after him"

Us! Well at least most of the time.

Today, I am deciding to take a step back for a minute and just appreciate the struggles of our present age.

I mean, some children are just born annoying. They whine for everything all the time, never listen or never stop talking, eat everything they shouldn't and refuse actual food, go into places they shouldn't, and refuse to go into places they should- like into the nurses room to get their injections.
(Flashback to the day the nurse and I were trying to pull my larger than average 3.5 yr old from under her desk to get his pre-school booster).

Let's be honest, some of these "lovely old ladies" were right birches in their heyday. (Spelling error noted.) 

And I bet some of these "elderly fine gentlemen" had nothing fine or gentle about them once upon a time.

 They may tell us nice and colourful stories about the good old days, so we do not see that they were the mean boss or lazy co-worker, or the guy who sprayed graffiti over the church door or felt too pretty or too cool to get along with their neighbours. 

Where is this coming from, you ask?

Well, I had an extra appointment booked by an anxious mother whose 9 month old had not passed stool for a few days then started passing rainbow colours.  Bright green, yellow-orange and red - with photo evidence.

The child was happy as Larry, and we soon uncovered that she had eaten some beetroot the day before the red stools. Mum on the other hand, was very frazzled and needed a hug. She had clearly not had a full night's sleep in a while. This baby had the most beautiful smiles...which quickly turned into dry wailing when she sighted her mother's boobs, demanding a feed. I tried hard not to fall for the super cuteness. Today is Love-for-the-middle day!

Later on I paid a home visit to an elderly Octogenarian lady whose son was very worried about a rash on her legs. She clearly wasn't. She answered the door with: Shoes off please!, This was followed by: Can you get me a drink please love? Can you turn up the microwave for 4 minutes. Can you pass me that bag there, okay look inside for my hospital letter- 2 minutes later ...Oh its not there, can you go an look in the pile over the fireplace.

Gimme me a sec, I need the bathroom - 8 minutes later... "Well, I will tell you the full story. It started when I was a little girl....."

I mean, I was glad to be of help and did enjoy her story in the end, but I could not help but envisage her as a bossy diva in her 30s and 40s and it annoyed me a little.

So I am going to be nice to my fellow Middle-lifers today. I am going to smile at you and make funny faces for no good reason. I am going to pull your cheek and rub your hair and offer you my seat and offer to carry your heavy shopping bag. 

Do I hear you say it'll make me look creepy , crazy , desperate or suspicious?

Ok, I will just go back to loving the old and young then, deal with it!

Worry

How often do we, Christians, commit our burden to the Lord in prayer, only to subconsciously decide that we would rather bear the load ourselves, and retrieve it by worrying.

Worry leads to physical and psychological stress which in turn leads to various physical and mental health illnesses including Hypertension (raised blood pressure), Anxiety and Depression, Irritable bowel, Low self esteem,  Hair loss and Obesity amongst others.

Perhaps this analogy will paint a clearer picture:
A young woman was having a very stressful time dealing with her difficult boss at work. It was taking it's toll on her whole life and she could see no way out of keeping her job and working alongside him.

She visited her parents one weekend. They were hosting their close friends and she discovered that the company she worked for was owned by her father's friend!

She explained the difficulties she was having at work and he said to her. "Don't worry, I will sort it out."

Immediately,  she felt like a heavy sack had been physically lifted off her shoulders. Unlike previously, she enjoyed the rest of the weekend with her parents, not anxious even for a moment about the start of a new week at work. No Monday eve jitters.

That is trust. Faith. In man.

Yet, when God, whom we proclaim as the alpha and omega, tells us not to worry, we are not convinced. We need evidence. When? How?

We must learn to let go, trust God and let not our hearts be troubled.

Have a faithful and fruitful week ahead!
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