On a couple of evenings, most weeks during the summer, I go for a swim in the sea.
The first foray into the water in early June after the winter and spring layoff always comes as a shock to the system. No matter how many times I return after the break, the anticipation of the cold sea usually makes me hover at the water’s edge for a few moments, waiting for other swimmers to climb up the ladder to my launching spot to reassure me. ‘It’s just beautiful’, is the standard reply I get when I enquire about the temperature from from the hardy all year round swimmers. It’s all part of the ritual.
I usually jump straight in from the lower levels of a diving tower in Salthill known as Blackrock, so I can avoid the unpleasantness of having to immerse myself more slowly via the adjacent gently sloping beach.
The sudden cold shock of the water and the initial panic I feel as I look down into the unknown of the dark bottomless ocean, usually make me want to get straight back out again. But there are people watching and because of a little manly pride, I usually resist the temptation to escape and so I start swimming. After an initial burst fast strokes to warm up, the water no longer feels cold and within a few minutes I’m feeling good, into my rhythm and calmly pulling myself through the water a few hundred metres out to sea. Before I know it, I’m climbing out, reassuring the incoming swimmers that it’s just fine. ‘Its just beautiful’.
This week I’m back in the office after a week off and I’m getting a familiar feeling. Lets hope there’s no jellyfish…
Image of Blackrock from Flickr by Eoin Gardiner
Levels of Life by Julian Barnes. Published by Jonathan Cape (Hardback) 2013
This is a wonderful short book about ballooning, photography, love and more specifically, an attempt by its author, Julian Barnes, to come to terms with the death of his wife.
Levels of Life will be a gift to those trying to make sense of their own grief or indeed anyone who has ever loved - ‘Because every love story is a potential grief story’. In articulating his own grief, he helps us understand how love and loss behave like two sides of a balanced, inevitable equation; ‘The thing is – nature is so exact, it hurts exactly as much as it is worth, so in a way one relishes the pain, I think. If it didn’t’ matter, it wouldn’t matter.’
Although grieving is not an illness, reading this book brought me back to importance of stories and patient narratives in medicine; stories help their tellers make sense of their own world when it all goes wrong.
One of our jobs as health care professionals, according to writer and doctor Jay Baruch*, is to be ‘professional story listeners’. Bearing witness to, and acknowledging these stories forms an important part of the healing process. These stories also connect us on a very human level to our patients, and in listening we may unexpectedly receive comfort in return.
I’m happy to recommend it to anyone, particularly those trying to make sense of loss or those trying to help them.
* Dr. Jay Baruch presented ’Story-Centric: curiosity, a glass of water and other creative tools for future doctors’ as part of Millenial Medicine 2013.
‘I just can’t do it anymore doctor. I’m a wreck’.
Mary is a widowed 72 year old lady who has a bad back, sore wrists and shoulders and as a result, has difficulty sleeping and sometimes even dressing herself can be a struggle. These symptoms make her own life difficult but her main concern is not for herself. She’s afraid she’ll no longer be able to care for her 2 preschool grandsons.
She’s helping out her daughter who has had to return to work to help make ends meet now that her husband’s salary has been cut. Her daughter drops the two boys round on her way to work, 5 days a week, and picks them up on her return.
Its a long day, but Mary is glad to be able to help out. She loves the kids and enjoys spending time with them but the physical and emotional demands of feeding, changing, cleaning up and entertaining them is taking its toll. She feels that her arthritis pains are worse, finds it difficult to make time to visit her friends, exercise or to attend her hospital clinic appointments.
She’s not alone. As the financial pressure mounts on cash strapped families in this recession, grandparents are more frequently being asked to give a hand with childcare. Even during the financial boom, unpaid relatives were the main source of non-parental childcare in 11.5% of preschool children. There’s an increasing proportion of single parent families of whom 1/3 will avail of the services of an unpaid relative to help with childcare. For many Irish grandparents, there’s no escape either. In Ireland, 20% of grandparents live in the same house as their grandchildren and up to about a third live within 25 Kilometres.
Looking after small kids is hard work. I frequently see young mums (more so than young dads…) overburdened with the physical and emotional demands of raising small children in my practice. Perhaps its not surprising that older people, particularly those with a pre-existing condition such as arthritis might struggle in the same situation.
However, a 2007 study found no evidence that ‘caring for grandchildren has dramatic and widespread negative effects on grandparents’ health’. It did suggest however that likelihood of negative impact of grandparent health might be determined by the particular circumstances and ‘workload’ circumstances of the carer. For example, there might be a positive health advantage to those doing a little babysitting, but potential for problems where the grandparent is helping out in ‘skipped generation’ families (where the parents are, for whatever reason, absent), or those who provide ‘live-in’ care. It clearly depends on the circumstances.
Although there are no hard and fast rules to how to manage requests for looking after grandchildren, and I’m always cautious about offering life advice to my elders, here’s some of the advice.
1. If you enjoy looking after your grandchildren and feel up to it, keep on going! You are unlikely to do harm to your health and you are providing a great service to your children and your grandchildren.
2. In order to care effectively for grandchildren you need to look after yourself. This means making time to exercise, socialise with your friends and (if necessary) see your doctor. If you don’t have a hobby or outlet, get one. Its easier to say no when you’ve got an Art class to go to.
3. If you feel the need to set limits on your commitment, its better to do it early. Before the baby is born is ideal or at the very least, very soon after. It gives your family time to set realistic expectations and time to make alternative arrangements.
4. Don’t move in if you can help it. There’s evidence that grandparents who co-habit fare worse with their overall than those who live independently As nice as it is to spend time with your grandchildren, its nicer doing so knowing that you can give them back.
5. If you find that you are not coping physically or emotionally and don’t feel comfortable or guilty bringing it up with your own children, it can be helpful to involve your doctor. I have, for example, written letters to my patients to ‘recap’ on advice given at clinic regarding the need to pull back form childcare which they can in turn, show to a relative.
Here’s a little bit of extra advice from Ile Nastase, the veteran tennis star on the benefits of exercise and of having small children around.
Last week I attended a hospital based workshop which focused on how to manage discussions with patients in the setting of an adverse healthcare outcome.
Whereas an acknowledgment of the problem and an appropriate apology are essential, we were also reminded about the importance of encouraging patients to tell their version of events in a way makes sense to them.
Those of us who have met anyone who has been recently bereaved or who has experienced a physically or emotionally traumatic event will have noticed their compulsion to tell (often repeatedly) of their recollection of the experience. Although these stories don’t always follow a linear narrative and may include digressions and things that seem irrelevant to the listener, it is the actual telling of these stories helps people make sense of their experience. Our listening and response to those stories as health care professionals bear witness to them and plays an important part of the healing process. It takes time but is always worth the effort.
Any other time pressed doctors who are in any doubt as to the role (and power) of patient stories in healing should listen to this 12 minute witness impact statement by Ed Gavagan, a from TEDMED 2012.
Over the last couple of years I’ve been putting together a small waiting room library of books for my patients to read. I thought of the idea after visiting a restaurant where they had left cookery books lying around for patrons to look at while waiting for their food.
The challenge was choosing suitable reading material, beyond that of our usual selection of magazines, newspapers and disease specific information pamphlets. I wasn’t convinced that making gory, illustrated medical textbooks available to those waiting would be conducive to relaxation either. Although I sometimes run behind a little, things are never so bad that a patient might complete a Russian novel there’s probably time, to read a couple of poems, browse a few cartoons or even read a short story.
As a result, I started to put this little collection together and it has been a hit with my patients. There’s a couple of books of poetry for strange times, a book of photographs of bad hairstyles (not sure why a 1970′s me wasn’t included), a book including important medical facts such as ‘why men have nipples’, a collection of essays on famous hypochondriacs (which goes down better than you might expect), a hilarious book of New Yorker medical cartoons and a book on meditation (for those waiting more than 40 minutes).
As some of my patients will be coming back to see me for many years to come, I’d like to try and keep the selection fresh.
What would you like to see included?
I don’t usually get emotional listening to the proceedings of our national parliament but this week found myself overwhelmed and tearful while listening to a speech by our Taoiseach, Enda Kenny.
He was apologising, on behalf of the Irish State and its citizens, to women who had been incarcerated in a group of Catholic church run institutions, known as The Magdalen Laundries. The apology followed the publication of a recent report confirming “significant state involvement” in the incarceration of these women in these organisations, where they had been detained in inhumane and cruel conditions to provide slave labour.
Although the his speech is a good example of the effectiveness of a genuine, heartfelt apology, it was also, to my mind, a masterclass in using the power of empathy to heal.
Kenny had, in the previous few weeks visited some of the victims to listen to their stories. Many of those interviewed on radio and TV were clearly moved by the efforts he had made to listen to them. Their heartbreaking stories, which he repeated as part of his apology affected him deeply, and it shows.
For anyone in doubt of the impact of the apology on the survivors (a group of women, no doubt well attuned the insincerity of political rhetoric over the years) should have a look at this photo below of them from the LA Times. Although some form of financial redress and support will follow, I sense that the healing has already begun.
The full apology is published here
Anyone who’s been in my office in the last year or so might have noticed two little girls looking down at them from my wall.
The photo caught my eye at an exhibition by Galway photographer Joe O’Shaughnessy a few years ago so I bought it, not really knowing where to put it. Recently, in an effort to cheer up my office a bit, I decided to dust it off and hang it on my office wall.
It has been a great hit with patients. There’s something about the cheeky, defiant pose of these twins (pictured on their first day at school), that raises a smile in most who notice it. I recognise the flicker of distraction in patients eyes as they register the picture behind me, the pause, smirk and then the questions. ‘Are they your girls?’ they ask. ‘Aren’t they just great!’ ‘Are they twins?’ ‘I’ve seen that look before!’
Truth be told, the time it takes to explain how the picture came to be there, and answer questions about it slows me down and probably contributes to my running behind a little. Nonetheless, its here to stay. People seem to take strength from these two brave girls as they prepare for their journey into the unknown.
A first visit to a hospital can be intimidating, disorientating, and stressful for patients. Much like our first day at school, it may not be as bad as you think.
Thanks to Nicole and Rachel Healy and their Mum Mairead for permission to use this picture. Good luck in the Leaving Cert girls.