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

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!
X

Charades

Consultation in General practice can sometimes feel like a game of Charades. The doctor trying to guess why the patient has actually come whilst the patient throws cues but never divulges the actual fact.

Even highly suggestive questions like: "Why have you come here today?" or "How can I help you?" can prove futile. 

This couple seemed to enjoy playing this game with me. Usually individually but today they had come as a double act.

They were a very pleasant Chinese couple in their late fifties, who obviously had no faith in western medicine. 

Today, Mrs Xu (fake name obviously) asked me to check her blood pressure....again. I noticed we had checked it more often than usual over the previous 6 month period. 

It is normal, as usual. 

Mr. Xu's blood pressure was a bit raised as usual so I ask if he had taken his blood pressure medication. I knew the answer coming. No.

"No good for me. Maybe I have 2.5mg, instead of 5mg?" He hasn't actually tried taking it. He proceeds to show me blood pressure readings done on their home monitor within the same range. 

Mrs Xu is also monitoring hers, as a control in their experiment, I suspect.

"Ah, yes. But we no like this a medicine. We have new one from China. Very good medicine"

We have had exactly the same conversation at least four times in the past 6 months. We talk about her varicose veins and hot flushes, his low vitamin D, eczema and raised cholesterol.

He collects the prescription for the lower dose but emphasises very pleasantly, that they will not be taking any prescribed medication. 

We have small chat about China, they recommend parts to visit and they present me with another tin of authentic Chinese tea.

They are very grateful.

For what? I do not know. 

Like Lazarus

I first decided to keep some sort of journal of my experiences at work, mostly to remind myself that these things actually happened and I had not just imagined them.

I preferred to remember the more light hearted, less serious episodes. 

Every now and again though, I recall some utterly bizzare but actually serious experiences. Like this one from many years ago:

I was freshly qualified, doing my mandatory housemanship year at Lagos University Teaching Hospital.

On this particular day, I was on duty in the emergency department, alongside a fellow house officer (As we were called in the first year following graduation).

Two days earlier, a lady had been rushed in unconscious following a hit-and-run car accident. The person who brought her in had no information about her identity.

Unfortunately, this was not a healthcare system where one was at liberty to save lives at any cost. Somebody had to be paying.

She remained unconscious in the Emergency department until she very sadly died from internal bleeding. Alone, on an examination couch in a busy department, unidentified.

About half an hour after she died, a group of people turned up to the department as her family.

It fell to my colleague to speak to them as he had been the last doctor in attendance. The more senior doctors were attending a trauma.

I saw them gather around him in the room and thought to myself how brave he must be to be able to break that kind of news, and right next to her body.

I carried on with my work.

A few minutes later, I heard mumbling and chanting, coming out of that room, rising above the usual ambient noise.

I looked through the glass door out of curiosity.

The family held hands in a circle around her, praying and singing. In the middle of the circle was Dr. Mycolleague. His hands were pointed over her and he was repeating in a commanding voice: "Rise up! Get up now!"

It was a most bizarre experience. I am a Christian and I am a doctor but this was next level.

I ran to get the consultant on duty.

As it turned out, it was the first time a patient  had died in front of my colleague. He had been struggling to process the experience when the family arrived. This had triggered a mental breakdown, with hysteria and confusion, and he reverted to some sort of Christ-the-healer mode. He did have underlying mental health problems.

I can only imagine the overwhelming sense of guilt, failure and helplessness he must have felt.

He was suspended for a time, whilst getting the help and support he needed.

It was a very hard way to learn the importance of separating sentiments at work especially when dealing with cases that may resonate with personal experiences.

We are humans first.
Every doctor is some other doctor's patient. 

A pig in a poke

I have come across various social media photos and posts revealing adverts so preposterous that one often doubts the authenticity of them.

I had not actually conceived the thought of the possibility that there might just be somebody out there who was reading these kind of posts with thoughtful intent to patronize them.

That was until that fateful morning when Mr. Hook (let us call him that), walked into my consulting room. He was in his mid-fifties, of average height and build. There was some discordance between his casual dress style and attitude, and the seriousness of his voice.

"I've come in for my prescription doc, and for a bit of medical advice"

I quickly scan through his regular medication records to check that they were all relevant and appropriate.  Some medicine combinations in his prescriptions suggest to me that he possibly had a recent heart attack.

8 months ago, he confirmed. This had given him a wake-up call to pursue a healthy lifestyle.

"I've stopped smoking, cut down hours in my stressful job, I am eating only healthy stuff..."

"Brilliant! Well done. "

"In fact, that's the other thing I wanted to talk about ."

He brings out an empty medicines box, with a bold label ARTERY CLEANSER.

"It's a fantastic drug," he tells me. "I found it on the internet and want to check that it's okay to take with the rest of my medication".

I look at the box. It has bright colours, instructions to take one daily and an impressive list of potentially curable conditions. It also has an expiry date. Nothing else.

No manufacturers address, no attached leaflet, no ingredients, no scientific information.

"What does it contain?" I ask.

"I thought you could tell me. It says it's a wonderful drug and can cure most of my problems, it's exactly what I need."

I apologize. I have never heard of it before and there is no information for me to go by.

Quite frankly, I am still trying to wrap my head round the mechanism by which one tablet can:
Cure Haemorrhoids, Cause weight loss, Boost libido and sex life, Cure tiredness, Supply oxygen to all your vital organs, Remove all pain and swelling, Repair all your veins and arteries, Strengthen your heart muscles, Improve memory, Banish cellulite.....

Perhaps I was being too scientific about the whole thing and my lack of wider intelligence must have shown on my face.

He looks disappointed. "Maybe you can research it and then give me a call later" he says.

I have to be honest. "I wouldn't advise you to take a tablet with unknown content, especially given your medical history and other medication, it does not sound very genuine to me." (And I am not interested in researching this obvious pig in a poke)

"That's just because you don't know about it. Here's the website." He writes it down for me.

I am too exhausted to argue so agree to look it up......AND I ACTUALLY DO! Over my small pot of olives during lunchtime at my desk, I type in the website details.

Same big colourful logo. There's a picture of a man wearing glasses and a white lab coat, and even longer list of the wonders of the tablet. 100% Guarantee.  Even bigger and brighter, there's a payment instruction.
Click here to BUY NOW! Only £59.99 for 15 tablets.
That's it.

Nothing about what it contains or how it works.

I give Mr Hook a call and tell him not to buy this tablet. He sounds a bit annoyed and says

"Well I'll just make an appointment with Dr. MyRetiringColleague to discuss it then, he has more experience"

I make a note of our conversation in his records, praying briefly that he is being sold a Multivitamin tablet as a worst-case scenario.

It's amazing how gullible people can be when trying to cling on to hopeful solutions.

It is even more amazing how many people are readily waiting to prey on vulnerability.

I go back to my olives.

Shine your eyes, mate!