terrifying ignorance

I have been more or less glued to the BBC news website over the last 2 days, watching sections of our society break down with no semblance of law and order.  Normally I don't get very affected by the news, I tend to employ my doctor emotional detatchment skills (rightly or wrongly), but the riots have really upset me.  This is probably partly because I am pregnant again, and rather emotional all the time, but also it seems like the kind of thing that ought to be happening somewhere else, not in England, especially my home city of Liverpool.  It's also just so sad to see people terrified, people losing everything and people dying for no particular reason that I can fathom.  These things would almost seem more understandable if there was at least a reason, an actual protest about something that degenerates into violence is easier to understand than just sheer destruction and looting because people think they can get away with it.

The most terrifying thing about the whole situation for me has been listening to the one or two snatched interviews with "rioters" on the BBC website, found here and here.  The young people interviewed betray a shocking lack of any moral compass at all or even any logical train of thought.  Eg. "it's all about the govenment isn't it - the Conservatives whoever they are, it's all about showing the police we can do what we want."  Or the young men who claimed that young girls looting was wrong, if someone broke into their own house that would be wrong, but for them to be looting was ok - well not ok, but they were going to do it anyway, it was the government's fault because they couldn't stop them.  There was no real anger here, not even any clear idea of who they were rebelling against, no justification at all, but just a sense that if nobody would stop them, they would do whatever the hell they liked.  I found it chilling to listen and to think - has anyone ever even spent half an hour one on one with this child, teaching them about personal responsibility, or what society is, or any kind of empathy, or even how to think about something?  Or did they just decide not to listen?  I do believe that there is "a darkness in the heart of man", as Geoff blogged about here, and I do believe that those involved in the rioting should take the full consequences of their actions - any attempt to exonerate people because they come from a deprived background seems misguided, but listening to these kids made me wonder - how can so many people be growing up to think (or rather not think) like this?

The joy of complaining

My recent episode of uncharacteristic behaviour began when out shopping with mr moo (my 2 year old).  Walking past a menswear shop in our local shopping centre I noticed in the window, about 1 metre off the ground, an advert to win a "lads holiday in Ayia Napa" featuring a picture of some large and probably enhanced breasts, with strips of fabric about an inch wide covering them (no face was involved in the picture).  I saw mr moo clock the picture as well, and saw him think about it for a couple of seconds, but I don't think his vocabulary was up to framing the question in his mind.

I felt immediately angry.  Mr moo has seen breasts quite a lot of times, given that I get dressed with him around, and there are a lot of breastfeeding mums in our friendship group at the moment (and that I breastfed him until he was 14 months, but that was a very long time ago in his world).  He has recently felt the need to point out "mummy's boobies" when he sees them, but then he also likes to point out "mummy's drink, daddy's drink, my drink" at the dinner table.  I've been trying, by my actions and words to let him know that breasts are a natural part of a woman, private, but nothing to be ashamed of, and primarily designed for feeding babies (although I don't have much hope that last lesson will last him past puberty.)  I'm not ready for him to see the objectification of women, the lust and sexualisation of our culture that I'm sure will impact him all too soon.

But I kept walking, chuntering to myself in my mind about the irresponsibility of the advert and its placement.  It was on the way back that the uncharacteristic moment came to me.  Why, I wondered, was I internalising this anger and disquiet?  If everyone who was offended by this picture walked past without saying anything, it would just stay there, but it was quite likely that a quick comment to the management would make a difference.

Taking my moment of bravery/insanity/becoming my mother in both hands, and mr moo in both arms so he wouldn't make the encounter worse by running away at the crucial moment, I walked up to the middle aged man rearranging clothes on  the sale rack, and asked for the manager.  It turned out he was the manager, so I turned on my nicest smile and politest manner and explained that as a mum, I found the picture inappropriate and especially its position at children's eye level.  He was unphased, and said "oh yes, we've been told to tone it down a bit when we start getting complaints."  I thanked him and walked away, feeling encouraged that he was open to feedback, but wondering why the shop felt it best to push the boundaries of public "decency" as far as it possibly could, rather than just trying not to offend in the first place.  However, I suppose the obvious answer to that question is ... to sell stuff to men.

Today was the first time I've been back there, and, to my glee, the advert has been moved up the window, and the picture now shows three relatively clothed women, including faces!  However, I'm a bit concerned that the immediate success of my first attempt at this particular brand of complaining will seduce me gradually on down this path.   Maybe by the time mr moo is 15, I'll be the kind of toe-curlingly excruciating mother who complains loudly in public about the manners, morals and grammar of complete strangers, causing him to be traumatised for life.

negative voices

It all started this morning when a friend dropped by to lend me a baby door bouncer... My elderly next door neighbour said hello to her and her 1 year old daughter, and she mentioned that it was a lovely day for gardening. He then said pointedly to me, "Yes, did you hear that? it is a lovely day for gardening."

Now our next door neighbour is a retired man (normally really lovely), and obsessed with his garden. As far as I can tell, he spends most of every day out there, despite his fairly advanced lung disease, and it is always pristine and beautiful in every season. Our garden, on the other hand, is a little rough around the edges. It has a wild unmown section at the bottom, which is a deliberate choice to give bees etc some habitat, but I sense he's not too keen on that feature, since some weeds grow there. The beds mostly have easy care perrenials in, because that's all I had time for at the best of pre-baby times. And ok the lawns haven't been mown yet this year, and things have gone a bit "to seed" since the pelvic pain kicked in halfway through pregnancy. But in my opinion it looks presentable. Compared to two and a half years ago when we bought the house and the plot was half rubble, half bed full of weeds, it's practically an oasis.

What was really disturbing was what that simple jokey comment, (which I may have totally read too much into), did to the rest of my day. I was instantly torn between paranoia (oh no he thinks I'm a terrible neighbour and inadequate housewife, gallivanting off to baby groups all week without attending to my own back garden) and anger (doesn't he understand what it's like having a new baby to take care of and how difficult it is to even keep the house clean?). I became unable to focus on the conversation with my friend after she came into the house, even though she dismissed him as a cheeky old man, and then I began to feel bad that I was coming across as scatty and absent and not in control. We talked a little about it at the end, and she said to me as she left "You're doing a great job. Hear that." But sadly this was no use. The negative comment had sunk into my brain somehow and was blocking all positivity out.

By the time I set off for my breastfeeding support group, my brain was a storm of negative voices. I spent the pleasurable sunny walk across the park thinking about my choices as a mother, and spiralling down into self-doubt. I began thinking about what will happen when I go back to work. Currently I'm planning to complete my training working half time, and then get a permanent job with even less sessions than that, if possible. I started hearing the (mostly male) voices of my colleagues at my current practice, who already feel that a year of maternity leave is an extended holiday and that I won't remember anything when I get back. Soft option they were saying to me, don't you care about your career? don't you want your son to go to private school like our children? don't you want to be a partner? Then my paranoid version of my parents voices started, You need to give your time to your child, they grow up so fast... and Christians I have read books by if you have the means you should give up work, God intended mums to look after their children. I began to feel that I will be giving both baby blue and my work less than my best. Next I began to worry what mr me was feeling about me, and projected onto him the view that I spend all week having fun and coffee with my friends, while he slaves away at work. Then I started wondering what other mums think of me, and whether they see me as a failure because baby blue is still in disposables and still has to be cuddled to sleep for his daytime naps. Then my childless friends - do they think I've turned into an antisocial baby bore? Then my own judgements on me - I forgot to clean his tooth again this morning, maybe he'll grow up with tooth decay... I didn't realise he was hungry for half an hour of grumpiness, maybe he's not growing as well as he should be because I don't feed him enough.... You get the general idea.

Fortunately the thought bog was stopped when I got to baby cafe by an hour of chatting to fellow mums, venting my frustrations re the next door neighbour, and feeling a little more that everyone's in the same boat i.e. we're all doing our best. This evening has cheered me up even more, with some affirmation from mr me, and an 8pm decaf vanilla latte at Borders, accompanied by some Marie Claire reading while he kindly manned the baby monitor at home. However, just typing out these frustrations and insecurities and (mostly unfairly attributed) opinions of others has already put a bit of a weight back into my chest.

What really annoys me is that I am still this vulnerable and weak. I was chatting with some church friends last week and bitching about the fact that most church seminars and days for women seem to keep reinforcing the same point - that you are accepted and valued by God, you are His daughter, His princess, you don't have to worry what others think of you. I implied that I'd got that by now, I'd heard it enough times, couldn't they move on to something meatier? Not all women were seething masses of insecurity, I said. Well maybe they're not, but sadly, and mortifyingly, it seems that I still am. I still need this message to sink from my head to my heart. I know this needs more prayer. I know I also need practically to learn to let little comments bounce off me, especially as society seems to judge mums for every choice that they make. I'll never be able to do everything and please everybody. I need to learn to be happy and confident in our family choices and in doing my best. But how? Does anyone have any more tips on how to beat the guilt, insecurity and self doubt that being a mum seems to exponentially increase?

glee

On Thursday and Friday last week, I had to visit two different hospitals where I used to work. One trip was to spend time with the substance misuse liason nurse, and the other to try and finish off an audit I was supposed to be doing during my last job. The whole process filled me with glee that I am no longer working in hosipitals.

"Ha ha ha," I thought to myself, as a very loud alarm (possibly the fire alarm - who knows?) went off for five minutes for no observable reason, making conversation almost impossible, but not causing anybody to stop their work. "Hee hee hee," I gleefully mused, as I listened to a stressed looking SHO have a 15 minute row down the phone with another SHO about a rota swap. (although obviously I was sorry for the poor bloke.) "Ho ho ho," I chuckled when I had to eat some form of cardboard in the oppressively decorated canteen. "Ha ha ha ha!" I felt like saying, when a consultant from my previous job tried to give me a rollicking about the fact that there are discharge summaries piling up to be done in the junior doctors' office, without realising that I had actually left and didn't work there any more.
Felt like telling him that now I work in a place where people actually treat me as a fellow professional rather than some kind of naughty lazy student who needs to be told what's what.

And in all the quiet moments on my own, walking down the corridor, or washing my hands in the skin-stripping soap, and especially in the car on the way home with the windows down, I was singing a little song... It was the tune of "Bread of Heaven/ you're not singing/ are you scotland in disguise", and it went, "I don't work here, I don't work here, I DON'T WORK HERE ANY MORE!!! (any more) I don't work here any more!"

The Pedestal

I have had one of those periods of my life where my insecurities surface more than usual recently, for various reasons, and one of them reared its ugly head the other night when stressing to mr me at about 1am when we were in bed. This insecurity is one of the worst things about being a doctor.

Rightly or wrongly, when you tell people you are a doctor, they have a certain reaction. Normally it involves the word "wow!", and there is instantly a certain mystique about you that wasn't there before. You have seen babies born, you have seen people die, you have (hopefully) stopped a few people dying, and most people place their trust in the integrity and competence of their doctors. So they suddenly look at you in a slightly different way. Being me, I normally say "I'm a doctor," in a slightly apologetic way, as if to say, "please don't look at me differently" (although I notice I have recently started introducing myself as a doctor, instead of a junior doctor. So maybe I am getting slightly less self-deprecating)

I am getting more able to live with the pedestal that people put me on. Perhaps too much so - sometimes I try to imagine how I would feel if I wasn't a doctor any more, and I realise that I am slowly depending more and more on my career for my sense of self. I am well aware that pride lies that way, and I attempt to "consider everything a loss compared to the surpassing greatness of knowing Christ Jesus my Lord." (Phillipians 3:8) I know that I need to work more with God on finding my sense of identity in Him and not in the things I have or am here in this world.What I still find very hard to live with is the nagging fear that one day I am going to fall off the pedestal.

Medicine is a lot about the way you present your knowledge. E.g. you have a young female patient with a chest pain which sometimes occurs at rest, on breathing in, then goes away again after a few minutes. You ask a few questions and it sounds like a chest pain related to anxiety. That is your diagnosis. You know that there is probably a tiny percentage chance that it is something else. But the risk calculator instilled into your brain by practice is telling you that this tiny risk is not worth investigating for. Do you tell the patient all this? No. She is already anxious, you don't want to make her more anxious. So you tell her in your best reassuring manner to try a few simple measures to reduce her stress and that the pain is nothing serious. To safety net you maybe ask her to come back if things don't improve. For the patient to go away happy and to get better, you need to come accross confident. This "bedside manner" that doctors have to have can sometimes feel like an act. You are taking on the anxiety, so that the patient can stop thinking she is ill. But the general public often seem not to understand that the art of diagnosis is, by it's very nature, a sophisticated type of educated guessing. In many cases there will be some uncertainty. But if your educated guess later proves to be wrong, the patient may forever think you are a bad doctor, even if 9 out of 10 colleagues would have done the same thing.

Then there is the question of knowledge. The volume of medical knowledge is vast. It covers all diseases from prematurity to senility, and from every system of the human body. It is almost impossible for one person to know it all. Especially with some of the questions I get asked in my day to day life, eg "why does my tongue hurt when I drink pineapple juice?" or "is it usual for one twin to be left handed and one twin to be right handed?" But if a patient, or worse, an aquaintance who is asking you medical questions, suddenly finds that you don't know the answer, sometimes they look at you like their world is tumbling around their ears. Because doctors know everything.

Maybe some doctors know everything. Gregory House, for example - he knows everything, and that is very lucky, because he has the most statistically improbable caseload of conditions I've ever seen. I have met a few who seem to remember every footnote from medical school. But the vast majority of doctors know about the conditions we see every day in our chosen field, and for the rest we depend on remembering some of the information, knowing where to find the rest of it, and recognising when to refer to somebody else.

I find it very hard to be under the constant pressure of being expected to be some higher form of human being, who never gets things wrong or doesn't know the answer. It doesn't help that I am naturally rather ditsy, and tend to bump into things a lot. Sometimes I can see people looking at me thinking "well, at least she's not a surgeon!" after I have done something particularly dyspraxic. I am getting better at coming across confident and all-knowing at work, but in my day-to-day life, it's just not me. I'm too honest to pretend I know all the answers all the time. Sometimes I love to be somewhere where nobody knows what I do, and I'm just a girl, just another person on the street. I also regularly fantasise about being a housewife, and not bearing this responsibility that sometimes seems so heavy.

I am well aware that I tend to live my life far too much through other people's eyes, and worry constantly about what others think of me. I think for this reason I feel these pressures more than many of my colleagues. I am also aware that a lot of what I'm describing may well be me projecting my own insecurities onto others, and imagining they are mentally criticising me when in fact they are doing nothing of the kind. I don't think it helped that in my first few years of medical school, my housemates were constantly commenting "I can't believe you are going to be a doctor, you're so dozy/clumsy/I can't believe you're going to skip a lecture!" etc. I know that I am a bit scatty, always have been, and this is something I have to fight daily in order to make sure I practice safely by staying organised. I never go beyond the reach of my competence, and I am honest with patients about this. Maybe if I can deal with my inner critic, I can start to let the rest of the world think what it likes about me.

What I hate most about being a grown-up

Forms. Admin. The general hassle and stress that can be generated by pieces of paper.

Grrrr. Have just spent most of the afternoon searching through bank statements, cheque book stubs and P60s to ensure I had all the right figures to fill out my tax return online. Turns out I was missing just one - my UTR, which is a reference number they give you when they ask you to do the tax return. In fact they didn't ask me to do one, but I wanted to for various reasons, including having 3 different employers during the last tax year, who paid and taxed me at different rates, and because I'd recieved some untaxed income from report fees etc. You would have thought the Inland Revenue would be happy to hear from honest people like me who self-refer. But no, very suspicious behaviour. "why do you want to fill in a tax return?" Perhaps they suspect what I suspect - that they owe me more than I owe them. Now it turns out I may not get the essential bit of information until after the deadline where you have to work everything out yourself. This would be very Bad News given my poor head for finance. And what my dad would say to me when I asked him to help me. I suspect he might feel that i had left things a little too late. But I maintain it's all Their Fault. These are the moments when I wish I was a kid again, and my financial calculations involved mostly wondering how long it would be before I could afford another Sylvanian family.

IMGs

It is a very bad time to be an IMG in Britain. For those who don't know what this means, an IMG is an international medical graduate - someone who took their medical degree outside the EU area. Life is chaotic enough for all junior doctors at the moment with the new system called MMC, where everybody is given their jobs through a centralised computer system and there is an entirely new system of training, as I briefly ranted about before here. I am one of the few to be immune from this intensely stressful process, as the people already on a GP training scheme are able to complete it without having to apply for anything else. Click on this link to see how it's affecting someone else in the system. So there is an immense amount of uncertainty around for most people, but it is much much worse if you graduated outside the UK and Europe. In March of last year, with scarcely any warning, the Department of Health announced that it was abolishing permit-free training for doctors from overseas. In effect this means that if an applicant for a post is from the UK or EEA, and is competent for that post, the post cannot be given to a doctor from overseas.


There are many reasons for this. Historically, 30% of UK doctors have been IMGs, they could train in this country without a work permit due to our need for their skills and the shortage of UK trained doctors. In recent years the number of UK graduates has risen and the number of doctors coming in from abroad has also risen due to the popularity of the UK for training and the access to the assessment exams to work in this country. This in addition to the reorganisation of jobs for MMC has led to a lot of competition for posts. While most people agree that it is important for all UK trained doctors to be able to get a job in this country, and that the GMC should stop encouraging IMGs to come to this country by continuing to conduct the PLAB (Professional and Linguistic Assessment Board) exams, it is the effect on those doctors already here that seems deeply unfair.


Doctors from other nations who come here first have to pass the PLAB exams (which are expensive), then frequently have to work in non-training approved posts to get experience to get to the final goal - jobs approved for training which can then lead on to registrar and even consultant posts if they are very successful. Many doctors have been here for several years, moving around different SHO (senior house officer) jobs, working away from their families (especially if they are married to another doctor), moving around, living in hospital accommodation, uprooting their families and working difficult shift systems. Suddenly many of them feel that it has all been for nothing, they will not be able to get onto training posts, and many will probably have to leave the country and try to start post-graduate training again elsewhere.


I am pretty aware of these issues at the moment, as I am the only UK graduate working as an SHO in this psychiatry department at my current hospital. The other SHOs are all IMGs and they all have a very high level of stress at the moment. Some have been shortlisted for interviews, some have not. Most have spent at least some time on the internet in recent weeks looking at jobs in Australia. One is currently in Australia checking things out there. Others are chasing round gathering information for their interviews, trying to second-guess what the interview process will be like. Several have been ill. A young Pakistani doctor who was working in the UK, and involved in the legal challenge from BAPIO to the DoH's decision has recently commited suicide. It all makes me feel very guilty, both that my job is so safe because I am British and to be part of a country that would do this to people who have been helping to provide a service to our NHS for many years.