A New Normal

One month after my father’s death, I went back to work. I went back to daytime hours, unsure of how I would cope with the stress of emergencies, of possibly having to break the news of death & dying. It was all too new & too raw for me to be any good to anyone else in that situation.

But, by January, I was back full time, counting down the last few months of my training, to the day when I would finally become a consultant. I’d had to postpone my FRCS graduation as it was the same week as dad’s funeral. I was supposed to be celebrating my achievement, instead of grieving.

Those 6 months were not easy. I found myself constantly apologising for being emotionally labile, always on the verge of tears, feeling I should be able to keep my emotions locked up during the working day. And so I became even more adept at putting on a brave face. In a profession that can view showing emotion as weakness, I learnt to lock away my emotions and feelings. I became increasingly afraid to let them out & confront them for fear they would consume me. I threw myself into work, using it as a distraction. I started working as a locum consultant surgeon in August 2013, 9 months after my dad’s death. How’s that for 2 stressful life events in lest than a year??

Another thing I hadn’t considered fully was how difficult it would be to get a substantive consultant position. I went to interview after interview, always being second best. I went to interview courses, kept up to date and practiced so hard but to no avail. Meanwhile I working as a consultant and doing it well. But, just after moving hospitals in the autumn of 2014, I noticed my mood was starting to slip. I was miserable, I disliked where I was working (I’ve never been great with change) and I was starting to resent my job and doubting my abilities. I had enough insight to know I needed help so I saw my GP and was started on low dose antidepressants. And this helped, for a while. But, as I took on more & more work and had further unsuccessful interviews, I had to increase my dose to feel any benefit.

And that worked again, for longer this time but it was not the full solution. At the start of 2017, things came to crisis point and I had to take some time off work. I thought I would only be off for a few weeks but ended up being off for 6 months. I don’t recognise the person I was at that time, my journal entries make for very difficult reading. But, in the space of a year, with a lot of hard work and self care, I have turned things around. I now have a permanent position in a team that I love and a house in beautiful Portstewart. I have also learnt which friends I can really turn to when things get tough.

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A life changed

Friday 9th November 2012 – the day that my life, and the life of my family, changed forever. I will never forget that evening. Even writing this now, over 5 years down the line makes me a bit shaky. I was ST8 in general surgery and was having tea with my SHO in the canteen as I was on a long day. It was my dad’s 60th birthday and I was bemoaning the fact that he was so difficult to buy presents for. Just then, my phone rang. It was my younger brother. Who never phones me. I was a phone call that I never thought I would ever get and certainly not one that my brother would ever have imagined he would have to make.

“Ali, dad’s tried to kill himself”

And that was it, my life changed in an instant. The next hour was a bit of a blur. I left work in a hurry, informing my boss and leaving my bleep with the SHO. I drove home in a slight daze, not quite believing what was happening, hoping that everything would be ok and he would survive. But, just before I reached my parents’ house, my brother-in-law phoned to tell me to meet them at their house. He was gone.

It is hard to describe how I felt at that time. It felt like a dream or, more accurately, a nightmare. This was something that happened to other families, not to ours. I felt numb. You always imagine that if something really awful happened that you would be uncontrollably upset. But it’s not like that. You are shocked, numb. In fact, I didn’t cry much in the days that followed. Shock & adrenaline get you through everything that has to be done. I remember phoning family and friends, feeling guilty for ruining their evening and upsetting them. We had to talk to the police and deal with the coroner. My sister & I had to identify his body at the mortuary before the coroner’s post mortem and then organise the funeral as my mum wasn’t up to it.

The friends who visited me in those first few days helped me more than they will know. And support comes from unexpected places in times of grief and tragedy.

But behind it all were the questions. Why? Why had he done this? How had he thought that we would be better off without him? The aftermath of a suicide is an experience that I would not wish on my worst enemy. Dad had been unwell, but we had never anticipated this. Suicide is a very permanent solution for a temporary problem. The medical side of my brain knew that he must have been in a very desperate state to do what he did and that for him this was clearly the only solution. He had listened to that voice in your head that tells you “you’re not good enough”, “they’d be better off if you weren’t here”, “nobody will miss you”. That voice lies. And I know this because not only did it lie to my daddy but several years down the line it lied to me too.

Losing someone to suicide leaves more questions than answers. It makes it difficult to come to terms with the death. And worst of all, all the good times that we had were now overshadowed by the way in which he died. It’s only now that I am able to feel comfortable sharing stories again. And it’s been a long & difficult road to get to that point.

Through this blog, I hope that my journey will give others hope that life can go on, & even be good, after tragedy.

Checking in

I haven’t shared on this site in a long time. In fact, I hadn’t realised how long it had been until I logged in 2 minutes ago! 2017 was a difficult and challenging year for me. Health problems meant 6 months off work followed by a phased return. I found it difficult to accept that I was unwell and needed to slow down. But thankfully the year finished on a better note as I started a new (permanent) position which I love.

The start of a new year is often a time for reflection and given the events of the last year I have definitely been in a elective mood. Having just finished listening to Option B by Sheryl Sandberg and Adam Grant about resilience and learning to live with (and even enjoy!) option B, I have felt compelled to start to share what has happened in my life over the last few years and how I am finally coming out the other side.

I want to share because all too often we keep these stories quiet, feeling that we need to hide our negative emotions and our struggles from others for fear of being seen as weak or unable to cope with life. This leaves us feeling ashamed and vulnerable and can lead to more serious problems down the line as we develop unhealthy coping mechanisms.

Having struggled with feelings such as these, and especially the need to put on an outward appearance that everything is fine, I have come to the conclusion that it is important to share, to know that we are not alone and to know that there is light at the ends of the tunnel. To know that it is possible to survive and even thrive after experiencing tragedy or adversity.

So, it is time to come out of hiding and show my true self, because my experiences have shaped me into the person that I am today and I am stronger for it. And even if only 1 person is helped by my story then it will be worthwhile.

A quick update

So, it’s been quite a while since my last post – so much for at least once a month…. It’s been a hectic couple of months and I’m now starting to calm down & get things sorted. May was a particularly busy month with a talk at a local primary school about a career in surgery, and attendance at my first Medical Women’s Federation conference.

 

The primary school visit came about because I had signed up with Inspiring the Future last year, where teachers can find people from all careers and walks of life to participate in careers days. I have to say I really enjoyed doing this. I spoke to every year group from P1 to P5 and even visited the nursery children! It was great to stand there as a female surgeon, as a role model for future generations and hopefully planting a seed to inspire future surgeons.

 

I have recently been elected as the NI standing council rep for the Medical Women’s Federation. This is a fantastic resource for mentorship, support & networking. The spring conference was held in Edinburgh, entitled ‘Medicine at the Margins: Creative Solutions to Healthcare Challenges’. I found this a completely inspiring day and so unlike any medical meetings I have been to before.Some of the highlights for me were the talks by Dr Christine Goodall OBE, Dr Jacqueline Andrews, Dr Phillippa Whitford and the Dame Hilda Rose Memorial Lecture given by Dr Catherine Calderwood, Chief Medical Officer for Scotland.

 

First up was Dr Christine Goodall OBE, a senior lecturer and honorary consultant oral surgeon at Glasgow University who founded the charity Medics against Violence in 2008. The education provided in primary and secondary schools, youth clubs & prisons has helped to decrease homicide and serious assault in Scotland. Treating violence as a public health issue works.

 

Dr Jacqueline Andrews spoke to us about the Leeds Female Leaders’ Network which is creating a vision for cultural change and working towards gender equality in the workplace & in leadership roles within the NHS. She reiterated the importance of role models – “you can’t be what you can’t see”.

 

In a similar vein, Dr Catherine Calderwood, Chief Medical Officer for Scotland gave a powerfully inspirational talk on “The Importance of Women”. We hear increasingly about the feminisation of the workforce and how this is becoming a major problem. The majority of female trainees and consultant work full time and bring different skills into the workplace which can only serve to enhance things. On the subject of leadership, only 32% consultants and 24% of medical directors are women. She explored the barriers to leadership including personal expectations, organisational cultures and work-life balance. I felt this was a powerful call to step up as female leaders and to support those who fly with us.

 

I came away completely inspired and energised after spending time with so many amazing & dynamic women who are dedicated to supporting and mentoring other women in medicine. As an added bonus, I also got to meet some Twitter friends! I’m excited to increase the profile & membership of MWF within Northern Ireland over the next 3 years and hope that we can serve as role models for the next generation of female leaders.

Closing the gender gap – time to fast forward

“If you don’t like the way the world is, you change it. You have an obligation to change it. You just do it one step at a time.” Marian Wright Edelman, president and founder of the Children’s Defense Fund.

 

The theme of this year’s International Women’s Day is #PledgeforParity. According to the World Economic Forum in its Global Gender Gap Report 2015, it will take approximately 117 years to achieve global gender parity. Why is this important? It has been shown that accelerating women’s advancement in the workplace and therefore creating gender-balanced teams produces better outcomes and creates prosperity. More equality means a higher GDP and more productivity. Also, more gender-balanced leadership results in better all-around performance.

So what does this mean for surgery? There have been some improvements. The number of female consultant surgeons in the UK has increased from just 3% in 1991 to 11% in 2014. Obviously we still have some way to go considering approximately 60% of graduating medical students are female. There is still a large gap between the number of women who go into surgical training & those that become consultants. One of the most important changes that we can make to improve this situation is to create an inclusive, flexible culture for everyone. It is increasingly recognised that men in surgical training want work/life balance (whatever that means for the individual) too. Those in senior positions have the opportunity to set the tone for their unit or organisation to one that is supportive, inclusive and that challenges conscious and unconscious bias. To help women and girls achieve their ambitions, visible role models are imperative . In the words of Marian Wright Edelman, “you can’t be what you can’t see”. We need to define opportunities for advancement and encourage women to put themselves forward.

 

My pledge for #IWD2016 is to help women and girls achieve their ambitions. For me, this means being a visible and positive role model for young women, reminding them that girls can do anything. The inspirational and successful #ILookLikeASurgeon and #ILookLikeAnEngineer campaigns on Twitter have gone a long way to showing girls that any career they want is within their reach.

 

If we are to achieve gender parity in the workplace we need to work together (men & women) to reinvent gender roles, challenge the norms and provide equal opportunities for all. Only then, within a supportive working environment, will all talent be allowed to flourish. So, make a decision today to be part of that change.

New year…..

So, one of my goals for this year was to try & write one blog post a month…..not doing too well on that one!! 

Last year was a bit of a whirlwind & if you had told me this time last year I would be involved in a global Twitter movement, be interviewed on local & national radio (as well as a local paper) and would have started a blog I would have thought you were crazy!

I also had the opportunity to visit the Cleveland Clinic in Ohio for a month which was a great experience. 

On the work front, I am finally starting to feel that I’m finding my feet as a consultant after 2 1/2 years. I really enjoy my job and have made some positive changes. 

On the home front, I made the decision to start looking after myself a bit better. I know that “self care” is trendy at the moment but I now firmly believe that if you don’t take to time out to look after yourself then how can you be expected to look after anyone else. For me, that means (almost) daily meditation with the Headspace app, yoga, time with my personal trainer & a sugar free diet. All of these have been helpful in improving my sleep & my mood. 

Having done the I Quit Sugar programme in October 2015 & now on board as one of their experts, I am increasingly convinced that our highly processed diet is making us sick & fat. So just giving some advance warning about many posts on this subject as I continue to research it! 

I am definitely going to try and post more regularly so stay tuned…..

#notfairnotsafe

“The NHS will last as long as there are folk left with faith to fight for it”

Aneurin Bevan

Any of you who follow me on Twitter will have seen a deluge of tweets about the junior doctor protests today (sorry about that!). All the recent coverage over the last few days has incensed me. Jeremy Hunt is claiming that 11,000 excess deaths at the weekend are caused by the fact that “financial penalties” and “excessive overtime” deter hospitals from rostering enough staff at the weekend. This is a blatant misinterpretation of a study published in the BMJ recently which stated that around 11 000 more patients die each year within 30 days from admission occurring between Friday and Monday compared with admission on the remaining days of the week. The absolute risk of death (within 30 days) after admission to hospital is 1.8% overall; the statement that you have a 15% higher chance of dying if you are admitted on a Saturday means that the absolute risk of death goes up to 1.98% – doesn’t sound quite as dramatic does it?

This weekend effect is not unique to the NHS and the causes are unclear. In this paper, the authors state that “It is not possible to ascertain the extent to which these excess deaths may be preventable; to assume that they are avoidable would be rash and misleading.” Despite this, Jeremy Hunt told his Labour opposite Heidi Alexander: “There are 11,000 excess deaths because we do not staff our hospitals properly at weekends. I think it is my job, and the Government’s job, to deal with that, and to stand up for patients.” Last month, he blamed consultants, now he’s blaming junior doctors!

There are less staff at the weekends because there is no elective service (there are between ½ and ⅔ less patients admitted at the weekend compared with during the week).  At a time when rotas are more stretched than ever, the gaps are being filled by locum doctors or by the staff already there, putting them under even more pressure and at risk of burnout.

Then this morning, Mr Hunt stated that the junior doctors are so angry because the BMA has misrepresented the Government’s plans and is misleading them. What he has failed to grasp is that junior doctors (describing anyone from a newly qualified F1 to an ST8 who is about to become a consultant) are intelligent people who have read the Dept of Health proposals and have come to their own conclusions. If they thought they were being mislead by the BMA then they would have said so & would not have felt compelled to protest today.

The numbers evident in the photos from today speak volumes. I have never witnessed such solidarity in our profession. We have been taken for granted for far too long and the time has come to say “enough is enough”. This is an attack on our professionalism and our sense of vocation. Myself and my colleagues (junior & senior) are dedicated & committed professionals with patients safety at the forefront of everything that we do. We already staff a 24/7 NHS and will continue to do so.

This proposed contract will remove the safeguards against working excessive hours & will penalise those in the specialties with the most anti-social hours. It will also deter others from entering these specialties, many of which already have a recruitment crisis. The protest is not about pay, it is about safety – for doctors and patients. The NHS is worth fighting for and we will continue to do so.

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Bullying in surgery

“The standard you walk by is the standard you accept”

Lieutenant General David Morrison

The External Advisory Group report on discrimination, bullying & sexual harassment advising the Royal Australasian College of Surgeons makes grim reading. Approximately 50% of Fellows, trainees and international medical graduates report being subjected to discrimination, bullying or sexual harassment. Of those,  39% report bullying, 18% report discrimination, 19% report workplace harassment and 7% sexual harassment. This is unacceptable in any workplace and can have wide ranging effects, not only for the trainee but also for patients.

Unfortunately, this problem is not unique to Australia. We also have a similar issue in the UK. A survey published by RCSEd in May 2014 found that 3 out of 5 surgical trainees had been victims of undermining and bullying at work, and 9 out of 10 have observed it first hand. This figure is three times higher than recorded across other healthcare professions in the NHS (BMJ 2013). The figures from the RCSEd survey are backed up by the GMC trainee survey in 2013, where surgery was found to be an outlier with respect to bullying & undermining in the workplace.

There is a reluctance to speak out about these issues for fear of reprisal, that the behaviour will actually get worse or that it could be seen as “career suicide”. In fact, only a third of those who experienced or witnessed bullying behaviour felt able to report it. But where this behaviour is experienced or witnessed but not reported, it contributes to normalising the behaviour. This means a lot of the time we laugh it off, “suck it up” and get on with things.

Surgery is seen as a macho culture, where you have to be tough to survive and unfortunately this kind of behaviour is often seen as part of the training & culture. This may be partly due to the hierarchy within the profession with there often being a parent/child approach with trainees. We should be treating our trainees as equal adults, albeit with less experience. The culture of “junior” and “senior” doctors means that you are still regarded as junior even when you are highly trained & deserve to be treated like the professional that you are. As a senior surgical registrar nearing the end of my training, It was very frustrating not be taken seriously because you are seen as “junior” and therefore are undermined. However, history shows us that we tend to emulate the behaviours of our seniors and so the cycle continues.

This is a significant issue and the RCSEd is determined to address it head on. The college has set up Professional Excellence groups to provide a safe forum to raise concerns. They have also set the Faculty of Surgical Trainers to provide a forum for accrediting surgical teaching.

But we need to do more. We need to change the culture. The days of teaching by humiliation should be long gone. Creating a toxic environment where trainees are scared to speak up can have a detrimental impact on patient safety as they are less likely to raise concerns or ask for help when they need it. It affects good communication and team working. This kind of environment also has a negative effect on the quality of training and the quality of life of the trainee who feels undermined. We need to act as positive role models for our trainees and teach appropriate behaviours.

We need to create an open culture within our organisations where people feel they can raise concerns without fear of repercussion or a lack of faith that anything will be done.
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Time to banish the Poo Taboo

Gut health

Talking about bowel habits and poo is still seen as taboo and many patients are embarrassed to talk to their doctor about these types of symptoms which can lead to considerable delay in diagnosing serious bowel conditions such as bowel cancer or inflammatory bowel disease. Equally important are disorders such as irritable bowel syndrome and faecal incontinence, both of which can have considerable impact on the patient’s life. Recent research has revealed that while over half of people in the UK suffer with a chronic or persistent gut problem, almost 60% believe that talking about poo is unthinkable.
As a colorectal surgeon, I was interested to discover the Gut Week campaign which runs this year from 31st August to 6th September. Now in its 17th year, it is part of an ongoing campaign by Love Your Gut, supported by 5 leading digestive health charities: Bowel & Cancer Research, Bowel Disease Research Foundation, Core (the Digestive Diseases Foundation), the Primary Care Society for Gastroenterology and St Mark’s Hospital Foundation. It’s aim is to raise awareness of gut symptoms and disorders, emphasising the importance of maintaining good gut health and providing resources for further information.
Initiatives like this are so important in breaking down the stigma around bowel conditions. I have had many patients suffer in silence, only coming to see a health doctor when they really can no longer cope. There are many reasons for this, but I think it is primarily because they are embarrassed or feel that it is something that they just have to put up with. I commonly see patients with incontinence or rectal prolapse who have been suffering for years.
So, how do you discuss these things with your doctor? Firstly, it is important to remember that you are not alone. Over half the population will have a gut problem and your GP, surgeon or gastroenterologist will have seen many of these things before. We appreciate that discussing poo & bowel habits can be embarrassing but we will not be embarrassed so you should try not to be. Using everyday words is fine and the more honest you can be about your symptoms the better – it’s difficult to be too graphic with a colorectal surgeon!! If examination is required, the reasons behind this will be explained and it will not be done without your consent.

Embarrassment is temporary but ignoring symptoms may lead to a more advanced diagnosis if presentation is delayed. Dealing with things at an early stage is always easier.

Over the next number of weeks, I will post more about common digestive disorders, their symptoms, investigation and management along with links to online resources for further information.

Is surgery losing its allure?

Cropped image of surgeon using scissors during surgery in operating room. Horizontal shot.

I knew from fairly early on in my medical student career that I wanted to be a surgeon. Inspired by enthusiastic and passionate teachers in my third year surgical attachment, there was no question that I was going to do anything else. I loved the mix of patient contact, challenging cases and the ability to do something very practical to impact on a patient’s health and wellbeing.

Therefore I was disheartened to see a recent BMJ Careers article about how surgery is becoming a less attractive career option. Historically surgery has been a popular specialty and is usually oversubscribed. Although the ratio of applicants to jobs has remained fairly static, the fill rate of posts after the first round of interviews is decreasing. In Northern Ireland, only 45% of core surgical training posts have been filled after the first round of recruitment. This is leading to problems with CT rotas and means that we are becoming ever more reliant on employing locums.

So, why is surgery not seen as attractive option any more? One reason may be the higher proportion of female medical graduates. Women now make up almost 60% of graduates but only 30% of core surgical trainees and 11% of general surgical consultants in the UK. A paper published in 2013 by Dr Ed Fitzgerald found that 59% of male and 68% of female medical graduates believe that surgery is not a career that welcomes women. This is partly due to the perception that there are still negative attitudes towards women in surgery. Indeed, a survey published in the The Bulletin (RCSEng) found that many students cited poor work/life balance as a reason for not choosing a surgical career. Two female respondents said that they had been directly dissuaded from a surgical career by their consultant, told that being female and wishing to have a family would only be a hindrance to their training. Poor anatomy training was the second most common reason.

There is a general dissatisfaction with surgical training as documented by the 2014 GMC trainee survey. Satisfaction ranges from 72.1% for foundation trainees to 82.5% for ST4 and upwards. These are the lowest average scores of all specialties. If foundation trainees have a poor experience then they may not pursue a surgical career.

There are obviously still many issues that need to be addressed. The first is to get rid of the perceptions of a male dominated specialty. We continue to have an image problem with the continuing stereotype of the arrogant, aggressive & misogynistic surgeon. The #ILookLikeASurgeon campaign started by Heather Logghe  on Twitter is an important step to challenging this stereotype and continues to gather momentum.

Looking at a change in working patterns to include more flexible working hours will go a long way to making surgery more accessible. Both men and women would like more balance with more than 30% consultant surgeons in the UK expressing a desire to work part-time at some point in their career (RCSEng workforce census 2011).

Those of us who already have a career in surgery have a responsibility to encourage younger generations to apply. We need to engage and support our trainees, especially those at foundation level. If we don’t do this then we will fail to recruit the best candidates for the jobs as we will be recruiting from an ever smaller pool of suitable applicants.

We also need more visible and positive role models (of both genders) to engage and inspire those considering a career in surgery. We need to positively influence attitudes of colleagues and junior staff to encourage diversity within the profession and to continue to dispel the myths and stereotypes about gender, personality & work-life balance.

Be part of the change. #challengestereotypes #ILookLikeaSurgeon