Who Cares?

My job enriches my existence, mostly by offering me a direct look into varying phases and forms of human existence and coexistence. 

I see people at the most vulnerable times in their lives:

When they are very young, fragile and unaware. 

When they have suffered trauma either by accident, foolishness or intention. 

When they are unable to pick themselves out of the doldrums of depression.

When they at the door of death. 

At these times, their quality of life often depends largely upon another person, usually a family member or a paid carer who will hopefully, try to meet their care needs. 

Sometimes however, the role of this other person becomes dubious for various reasons. 

Maybe they become overwhelmed and overburdened with their caring role.

Maybe they are simply oblivious of the detrimental effects of their actions.

Or maybe they just enjoy having a hold over another person.

My next case made me ponder all these possibilities.

Let's call her Zara.

She has come in today for a routine check for her baby usually carried out between six to eight weeks after birth, just before or alongside their first vaccination.

It is also usually an opportunity to check on the mum and see how she is coping with the challenges of looking after a newborn. 

Zara's husband attends with her. 

He points her to the chair by the door further away from me, drops the car seat with the baby in it at her feet and sits in the actual patient seat next to my table.

He tells me straightaway that she would like some sleeping pills and strong opioid medication. 

The story unfolds....

She has a long history of depression and anxiety is going through a bad spell. These controlled drugs are the only things that work for her so he has been buying them over the internet for years but now cannot afford it.

"The only time she feels well is when she is pregnant." He says 

"That is why we now have ten children. "

Yes, ten.

I am taken aback. By his brazeness, by her blaséness. 

 He goes on to explain that her oldest child has given up on college to look after her mother in between pregnancies, and to help look after her youngest siblings. 

The discussion goes around in circles, with me constantly inviting Zara back into the conversation, explaining why I would not be giving her those drugs.

I eventually insist on examining the baby, which is what the appointment was made for, I remind them.

I ask about the oth­er children. They cannot seem to agree on the ages of the last three children including baby, all under 3 years old. He dismisses it by saying "It is on your system."

I ask her partner why he has not considered a Vasectomy. 

He laughs in my face, as if I am being ridiculous. 

When he realises I am serious, he shrugs and says, "If I do that she will go and get pregnant outside. "

"But you have said she never leaves the house, has no mobile phone and does not use the Internet." 

My eyes are actually saying:

So how is she going to get pregnant outside, and how is she getting her regular supply of these drugs which she is obviously now addicted to? Who is looking after all those poor children and what the heck is going on at your house?!!!

Anyway, every service that needed to be involved were drafted in: Adult and child social services, Psychiatrist, Gynaecologist etc, all of whom were already aware of this family. 

My mind travelled to a previous case I had been involved in, with a middle aged man who was very depressed and had not stepped foot outside his front door for about two years.. 

His sister was the only person who visited him, every other day, bringing him food and alcohol. 

She had only called the doctor now as he was feeling generally lower and seemed swollen. 

I had no relevant records to go by as he had not been to the doctors for several years so I asked him to come to the surgery. He couldn't as he was too fat now to get out of the door.

I visited him in his flat. He was lying on a sofabed in the corner of the room, morbidly obese. There were bottles of alcohol in various clusters across his living room where he now slept. He was coherent and interactive. He described himself as an alcoholic.

I will skip the clinical details. 

By the next day he was dead. 

I appreciate that dealing with addiction and addictive personalities can be really difficult and sometimes one cannot do wrong for doing right. I will probably never know the intentions in these cases but my thoughts are:

I realise that sometimes the roles of respo­nsibility to others, be it as parents or carers or in other supervisory roles, can actually become a hindrance, enhancing their vulnerability and detrimental to any attempts to take responsibility for themselves. 

As a carer, one must recognise when the situation is beyond their capabilities and reach out for help early. 

When does care become cruelty?

May we not have reason to overburden others beyond their capabilities. 

May we be wisely guided in our roles of respo­nsibility, that we do not love others to their death....literally.

Xx

You Don't Say!

Marriage is a wonderful institution. 

It can bring together people of different ages, race, abilities, faith and I have now learnt, language. 

I have come to admire, albeit with deep curiosity, couples with such distinctly dissimilar backgrounds that their union, the intimacy without boundaries, is fascinating to me. 

My every day job has given me the opportunity to witness some of these wonderful unions.

Take Mr and Mrs Hill, let us call them. Mr. Hill is a large man in his mid fifties. He had lived his whole life within a three mile radius of the village in the North of England where he was born, only going away for short holidays abroad. That was until about three years ago when he married Mrs Hill whom he met on a holiday touring South East Asia.

Mrs Hill is a thirty year old petite Thai lady. She speaks no English. 

They have been married for nearly three years and go back to Thailand for a couple of weeks every year. 

Mrs. Hill books an appointment to see me. Mr. Hill will be doing the translating. The only problem is,  he doesn't speak Thai!

I only discover this after a couple of minutes of non verbal communicative gestures. 

He says something like "She's got a pain in her back."

"How long have you had the pain for?" I ask her directly. 

She smiles back and turns to her husband.

He says "Pain, pain" pointing to her back. "For how long?" he makes hand gestures.......

"I ask politely if she has hearing difficulties, apologising that I hadn't been aware. 

"Oh no, she just doesn't understand English, only Thai"

"Oh ok, do you speak Thai then." I asked, somehow thinking it was a silly question until he responded with "No"

I picked up the phone straight to the telephone interpreter. 

They smiled at each other and held hands.....

Love is a beautiful thing. Language is clearly not their "love language".

Well, that was easier than another couple. Ajay and Maria, let us call them. 

Maria is the patient. She is very hard of hearing without her hearing aids which are broken. She can read Spanish sign language. 

Ajay, her husband does not speak or understand Spanish.....or English. 

He only speaks Urdu. 

He is here with her today to translate. He tells me that he can sign, a bit.....at least that is what I think he says.

I get an urdu interpreter on the phone. 

After they have a short conversation, the interpreter tells me that she has a problem in her abdomen. I ask a few questions which she translates to him.

He then looks at his wife. 

He makes some random hand gestures. I can see her clearly signing back. 

He shakes his head and starts saying some things slowly in urdu so she can read his lips 

She doesn't understand it seems so he makes some more hand gestures. 

They burst into laughter,  shake their heads and hug each other. 

After nearly twenty minutes between myself, the interpreter on the phone and this couple, it becomes obvious that the whole consultation is in shambles. 

They will have to arrange a face to face Spanish sign-language interpreter at a later date. 

They go away smiling and holding each other as they wheel away their little baby in his pram.

I am exhausted but I learn something. Their intimacy needs no words. 

Their marriage is certainly stronger than that of my next patient.....

He is booked in as having a personal problem. 

Over the phone (because of Covid), he tells me that he has been having severe heartburn and indigestion since he got married about six months ago and his wife came to live with him from Pakistan. 

My mind is wondering how this is a personal problem. 

In my imagination, I am picturing him eating too many tasty spicy curries which have probably made him a bit fatter.

I hope he is not having marital  stresses already. 

Is she starving him of food? Are we dealing with domestic abuse here?

He spares my mind the endless rummaging by volunteering. 

"You see, since we got married we are now living together so I am not able to fart, so the air is trapped inside and now I have indigestion. "

(I must admit, there are some advantages  to remote consulting. No need for straight face, and you have a mute button. )

I never thought the day would come when my professional input would be. 

"Just fart." 

In love and marriage, there is more to intimacy than language. 

For one night only

 

I had just completed my post-graduate specialty training and was exploring different ways of working to find the best fit for my personal and family commitments.

I decided to do an overnight visiting shift with the local extended hours provider. This entails providing medical care to patients who were not sick enough to be sent to hospital, in their own homes.

As the doctor on duty, you are given a caseload of patients, a car and driver (Navigator).

The next case on my list was an elderly man who was agitated, unable to sleep and had got his medication mixed up. 

It was after midnight and his house was in a poorly lit row of terraces along an alley walk in a roughish area in the city. 

All previous night visits I had done were as a Junior doctor in the company of a senior colleague. 

I did not feel comfortable in that neighbourhood, so was glad to have the Navigator, a chunky middle aged man, with me.

I started to get more uncomfortable as we heard argumentative voices from within the house before knocking on the door. The impression I had was that he lived alone. 

The door was opened by scraggly man probably in his forties. The room appeared dark and foggy, but most of all, the stench! It was a mixture of all kinds of smoky things from marijuana to firewood, mixed with damp and cats. 

He pointed at an old man curled in a rocking chair in the opposite corner of the room and muttered some introduction in a slurred muffled voice. I gathered he was the patient's son. It was obvious that he was drunk/high/both or worse.

I made my way to the middle of the room and tried to find a standing spot amidst the clutter on the ground, holding firmly to my doctors briefcase for comfort whilst likely silently saying prayers of Saint Christopher, the saint of protection. 

There was thankfully no expression of aggression and I started to get the history of the problem with his mixed up medication. It was going to be very quick. He was alive and breathing, and I was struggling to breathe in the smoke. 

The next thing, I heard a loud bang behind me. My Navigator/bodyguard had collapsed! Much to my horror. I was in a dingy room in a rough neighbourhood with a frail old man, an intoxicated man and a semi-conscious big man in the middle of the night. 

I rushed to open the door and the fresh air must have helped him as he opened his eyes. I somehow managed to drag him to the doorway where he sat on the floor for a few moments trying to regain consciousness. 

The next few minutes were a blurr but I managed to give the patient quick advice on an alternative medication he could take immediately until the chemist opened in the morning and get Mr. Navigator into the car. 

To be fair I think the patient had temporarily forgotten about his own problems for a bit.

I drove the car back to station with my new patient reclined in the front passenger seat. My hair and clothing still pungent.

He had mostly recovered now and was apologising that his poor lungs could not withstand the condition in the house. 😏😒🙄

Anyway, that was enough adventure for me. It was some eight years ago and I have never done another overnight visiting shift since.

No, thanks. I nor do again. 

I can't breathe

I came across a comment about how people are "jumping on the bandwagon" in the UK for racism in America. 

I understand how it may be difficult to see the need to speak up for what you stand for, in a society where racism is mostly covert. 

However, the danger is that continued silence has encouraged behaviour that has slowly chipped away recognition of the value and dignity of black people within society. 

The truth is that many black migrants are not even aware of various racial connotations in their everyday interactions. Sometimes even when we are aware, as long as it does not interfere with our daily bread, we brush it aside and carry on. 

For first generation migrants coming from a society where almost everyone is black, most people have no idea what racism actually is. White foreign workers, missionaries and those who marry into families in Nigeria for example, are treated with reverence. They are never called migrants, which has somehow become a derogatory term. They are called expatriates.

In the worst case, they are assumed to have foreign currency and hence are target for theives.

Very sadly, most of the African continent does not seem to be able to recover itself to a level of independence in spite of its rich human and natural resources. 

White people are confident travelling anywhere in the world for holidays and adventures because they expect to be treated with fairness and dignity wherever they go. 

Unlike me, they will not be asked when they arrive in South Africa or Bahrain or New Zealand to work, "Was life too hard for you in your country that you had to come here?"

I have now lived most of my adult life in England. I am a British citizen. I speak English. I do not think that I look dangerous. I have a decent job, I pay my taxes and stay out of trouble. 

I continue to have experiences of direct and indirect racism. Some unintentional, some out of curiosity and many just plain ignorance.

A senior white colleague many years ago, advised me to put my photograph in front of my CV when applying for jobs and to always go into the workplace to make direct enquiries and speak to somebody. Simply sending in an application with my traditional name and undergraduate qualification from Africa will quickly send my file to the bottom of the pile.... or into the bin.

At first I thought it was just honest advice as he understood the obstacles in my path but on reflection, I realise that it was his recognition of the inherent racism within the system.

A patient walking into my clinic the day after the Brexit results to console me that he wasn't one of those that voted for "people like me" to be sent away was extremely ignorant and so daft that my next statement was something like "Can we just concentrate on these boils in your groin that I am trying to help you get rid of?"

I remember doing a home visit as a trainee in a rural practice near Burnley in the North of England. It was to a farm house down a narrow, winding downhill path with a male patient probably in his late 60s. He had poorly controlled diabetes with long standing leg ulcers that had become infected. I changed his dressing, prescribed some antibiotics and rang round to ensure that the district nurses were going to come out to replace his dressings regularly. On my way out, I noticed a sign on his door hand-written in coal. "No dogs. No Blacks or Asians allowed here".

A small part of me was annoyed with myself for not reading the sign before entering his house. It would have given me a good reason to drive away and leave him with his rotting racist leg. 

But a bigger part of me was thinking how lucky he was that I hadn't seen it. 

I looked at the sign, turned to him and shook my head, making a note to update his records to alert any future Black or Asian doctors not to visit him unaccompanied in the future. 

Another time, I was visiting a nursing home in the company of our secretary, a very lovely white lady. The nurse, a white male, led me to the patient's room. As he went in to inform the patient that the doctor had come to see him, I overhead him saying "I don't want to see any coloured doctors. Get me an English doctor. "

I turned around and walked away, telling the now embarrassed nurse to transfer him to another practice as there were no white English doctors at our practice, much to the poor secretary's awkward unease.

Of course there have been many more incidents.

Most people I meet are however not racist. They may be curious or ignorant and ask you if you know one Ola or Kanu because the person is from Africa like you. (Like asking an Englishman you meet in Mauritius about Erik from Sweden). 

Some people start to tell you stories about their visit to Kenya when you say that you are from Nigeria. (Like telling an Irishman you meet in South Africa, about your visit to Germany).

I understand that people have a right to preserve their culture and I think that is the right thing to do. I do not have any grand delusion that things will suddenly become equal and fair.

But by not addressing fundamental prejudice, we sacrifice the future of our children and their children many of whom will continue to suffer bias and bigotry in overt and covert forms not because they are migrants themselves, but because of the colour of their skin. 

We do not have to wait until someone is kneeling on our neck until we cannot breathe before we cry out.

We see. We hear. We are here. We are human. 

. 

Self Preservation

Recently, it was the anniversary of the Manchester arena terrorist bombing - a very sad day indeed. The thought of such a dreadful thing happening close so to home in an arena where I had attended concerts even with my children, was terrifying. I remember how it sparked open prejudice within the society.

There have been a few waves of discrimination of various groups of people in different societies for various reasons. Eastern Europeans during the Brexit saga and more recently, South East Asians for Covid 19. Within the American Society the atrocious blatant racism against the black society does not seem to have changed since the era of slavery- but that is beyond my remit and comprehension.

Muslims had a long spell thanks to several terrorist attacks all over the world. Personally, I have respect for the dedication to their religious practices and cultures in spite of adversities.

I remember one particularly embarrassing incident around the time of the attack which made me reflect on perceptions of prejudice.

There have been times when I have been visibly startled in the course of my work, such that I was unable to retain my professional poker face.

One time was when I attended a home visit for an elderly lady. She lived alone in a small forlorn bungalow with an overgrown front garden. I knocked and waited. After a few moments, the little old lady poked her head through the door and believe it or not, she had a small horn in the centre of her forehead. I freaked out and jumped back (probably yelled "Blood of Jesus!")...but I got my composure enough to complete the visit. I later found out it was a skin condition she had developed over time, awaiting treatment. Nothing of the devilish inclination I was thinking. (But yes, it was a horn, like a Rhino's, but much smaller)

Another time whilst working as a Junior doctor in an Urgent Care Centre many years ago, a young middle eastern man came in complaining of a skin condition on his back. I asked him to lift up his thobe (kaftan) to allow me to examine. As he did so a huge pile of scaly skin fell to the floor with a loud rustling sound. I literally jumped out of the cubicle. I thought it was a snake. As I found out later, it was a really bad case of a skin condition called Erythrodermic Psoriasis. (You know you want to "google" it).

Anyway, back to my original story....

It was a few days after the Terrorist attack when there was a heightened sense of alertness in the company of Muslims.

I called in my next patient. He was a middle aged bearded Asian man dressed in traditional kaftan.

He made brief courteous eye contact with little expression. He walked at a steady pace, and took his seat on the patient chair in front of me. As he did so, he brought out a mobile device from his pocket and placed it on the table between us, glanced at me and turned to fix a stare at the wall behind me.

Within a few seconds, his phone vibrated on my desk followed by a rather loud Muslim call to prayer. "Allahu akbar".
Before my brain had time to process what was going on, my body leapt out of the chair, out of the door, through the corridor, down the stairs and outside the building. All in about five seconds.

After a couple of minutes, (when the building did not explode), I took a moment to recollect, said a quick prayer and re-entered my office.

"I am so sorry." He apologized. "It's my prayer time alarm, I have turned it off"
I muttered some form of excuse in apology for running off like that.

It was a most embarrassing moment for me but we forged a very good doctor-patient relationship with his whole family from then on for the next few months.

I know I am not prejudiced. I would still put my personal safety on the forefront-
Self Preservation is somewhere in the Hippocratic Oath.
🧐🤓

Hero?

Hey!

How is everyone doing?

Some people will be coming up to the point of developing cabin fever within the next couple of weeks as the novelty of working from home or being off school starts to wear off.
We are realising that this is not the same thing as a holiday.

Friends cannot come to visit, and we cannot go out because there's nowhere to go! Everywhere is shut. Worse still, we have no idea how long this is going to last.

Let's look on the bright side; Our earth 🌎 is breathing again, we're saving money on petrol &snacks, and we're getting very good at online quizzes!

For those who are still going to work, some are terrified.
Every time they step into a public place they can almost feel or smell "the virus".😨

My experience has not been without its intrigues.

My usual way of working has changed, probably forever.
Overall, it has confirmed what I have always believed- that many people did not really need a face to face appointment to see a doctor.

In this "Coronial" era, we have all come to appreciate that video calling is not just a fancy fad. It is also useful for examination of rashes and swellings and even assessing breathing difficulties.

Unfortunately, there will still be people whose idea of emergency or whose confusion about the role of a doctor, (especially those without a magic wand or a crystal ball) will differ.

All the doorstep clapping at 8pm on Thursdays and constant proclamation of heroism is probably contributing to the rather high expectations.

I can understand those reacting in hysteria to the current pandemic and seeking answers from me that the World Health Organisation (WHO) and Centre for disease control  (CDC) have not been able to give. It is a very worrying time.

I am happy to Google for you or read you the latest advice as I receive it- which may be different tomorrow. For example: Does Ibuprofen increase your risk of complications from Coronavirus?
(I also seem to have missed the memo that inhalers treat Covid19- or why else is everyone requesting one, even if they have never needed one before!🤔🙄😏)

I will even entertain ten minutes of solidarity rant about the unavailability of protective equipment for frontline workers even if that is all you booked an appointment for.

What I cannot do are things like telling you where to get infant formula milk or sanitary towels or paracetamol if all the usual shops have run out. Serious as it is.

I cannot also tell you whether you can start trying for a baby now and be certain that you will not get the virus and it will not affect your unconceived baby.

I can help to manage your anxiety but if the problem is that your weed supplier has coronavirus, my input is limited.

I cannot also start prescribing you sex change hormones because the online doctor (whom you have never met in person!) that was assisting you with gender change hormone injections is no longer contactable and you are now turning back to a man.

Yes, I have had every one of these....and more.
Honestly, people are having withdrawals from make-up and routines!

It might be an idea that people staying at home should get up every morning, get dressed as usual....full make up, suit and tie and all, go into your car and switch on the engine and sit there for the length of your usual morning drive. Or take a walk if you use public transport.🤔

Maybe also use the time to reflect on the rare opportunity to appreciate just being human with basic needs. Spare a thought for the young lad at the supermarket or pharmacy till with no protective gear who is now worried as the disease is no longer an "old people problem", the carer taking the risky journey on the bus or train, to work at the care home looking after vulnerable people. They are heroes too!

My respect for everyone working in intensive care and emergency units around the world.

Hang in there on a prayer🙏

Stay safe, Stay home, Stay 2 metres away from me!
😚

Keep Calm C-19

Hey Everyone,

Many of us will be at various stages of dealing with the news about the current Covid 19 outbreak.
Some of us are just starting to gather information whilst others are in a queue for toilet roll or tomatoes. Many are already sick of hearing about it now.

Unfortunately for most of those I share this with, we still have some way to go in this tunnel before we see the light.

Whichever stage you are at, there is a heightened sense of anxiety around the world right now and there has never been a better time to look after your mental health.

Persistent states of anxiety can result in long term physical and mental illnesses including hypertension, irritable bowel syndrome,  hair loss, skin diseases like psoriasis and many more.

Here's a few suggestions that might be handy:

Try to avoid constant News updates throughout the day. 1-2 times daily updates will be enough, unless you require information for work or direct information about a loved one.

Find a reliable information source like:

 -https://www.who.int
-https://www.nhs.uk/conditions/coronavirus-covid-19/
-https://www.worldometers.info/coronavirus/
-Your local health authority.

Remember that this is a new disease. Even the experts do not have all the correct information yet.

Be mindful that children are suffering too. A lot of them are confused and very anxious. Their sense of normal has been disrupted and many face isolation from friends and family, reduced physical activity and uncertainty about their education in the immediate future.

Many will start to constantly hear words like Hospital, Death, Wartime, Quarantine  and so on, which can be quite frightening.

They are also feeding off our own anxiety.

Let us try to keep things positive for them. Engage them in household activities: DIY projects, Gardening. writing, outdoor play. Watch telly together -avoiding News of course. Many will now have an online school programme. Try to keep a routine to their day.

If you now have to stay at home or work from home, don't forget to look after your health too. There are lots of online exercise videos.

Go for walks where possible. This may be a good time to take up gardening or to tidy up that wardrobe/kitchen store/spare room!
There are many TV series available to watch on Netflix, Amazon Prime etc which can be a useful distraction.

Try to have first aid supplies at home and avoid going to any hospitals unless absolutely necessary. Paracetamol, Ibuprofen, Hayfever medicines, Anti diarrhoea medicines, plasters and multivitamins are basic essentials.

Ensure that you have ordered adequate supply of any prescription medication from your doctor.

Many doctors are now able to offer video and telephone consultations to reduce your need to attend clinics. The aim of this is to protect you from highly susceptible environments for disease transmission.

Many people also find religious faith, prayers and mindfulness practices helpful.

Remember that if you do get Covid 19, you have a high chance of survival and there's good chance that you will only get mild symptoms.

Above all, avoid all non-essential social contacts and wash your hands! ....... instead of singing happy birthday whilst washing your hands, you can sing:

"Staying Alive" by the Beegees
"Living on a Prayer " by Bon Jovi
"Scrubs" by TLC
😊

Hang in there!
Godspeed
X