Three minutes to stop and breathe: how an app changed my working life

This blog was written for the BMA.

Exhausted, losing weight, looking miserable. This was not how I had imagined my life as a doctor.

As the F1 on acute medicine I struggled to balance treating my patients well and looking after myself. There is no shortcut to learning how to deal with a patient with severe chest pain, an angry family wanting to speak right away and a microbiology consultant on the phone, all at the same time. In the end the skills I learned – such as how to prioritise – still help me to this day. But that came at a cost to my physical and mental health.

I would bend over backwards for my patients but I wouldn’t prioritise myself, my lunch breaks or my right to hand over jobs. And long term, tired doctors aren’t in their optimum state to look after patients.

I did the best I could, but I knew this couldn’t carry on for two years. I made changes, I went to the gym more, made sure I enjoyed all my time off and started meditating.

No junior doctor gets to the end of two years without major highs and lows. It’s a learning curve, and I learnt the hard way just how important it is to look after myself. One day at the end of F2, I was doing nights, and I had to pack up my house and drive my stuff over 200 miles to my parents’ house, pack for a friend’s wedding and sort out accommodation on the opposite side of the country for my new job. I felt acutely stressed and needed something to help.

I remembered my GP teaching – we’d been recapping treatments for depression and our tutor mentioned the Headspace app, recommending we try it. In my moment of panic, I downloaded it and did a three-minute exercise: sitting on a chair and breathing. Easy, right? Well, harder than you might think actually, but that three-minute pause was what I needed. It got me out of my ‘oh my God’ state and into ‘let’s do this’. Thankfully there was no chanting, no annoying music and no great demand on my time.

It helped me when I was feeling stressed, but also when I wasn’t. ‘Prevention is better than cure’: we say this to our patients all the time, in the guise of ‘what’s your diet like?’ or ‘do you smoke?’, but the same can be said about mental health.

When I was on holiday and waiting to start working in radiology, my friend, also a doctor, found it strange that I would continue to meditate every day. But I knew that radiology and moving across the country would have its own challenges, and I wanted to keep up the habit.

I wasn’t wrong. I’m now a few months into training, working and preparing for exams. It’s both the best and worst thing about medicine: you’re never finished. And then you have life’s ups and downs too.

For me, Headspace gives me time away from all of that. Time just for me; sometimes it’s the only time I get. I use it when I can – sometimes on the park and ride into work, on my lunch break or at the end of the day. All you need is a phone and headphones. Half the time people must think I’m napping! And some days I can’t fit it in, and that’s OK too.

Everyone needs a moment to just stop and breathe. I wish I had used Headspace earlier as a doctor. On those busy crazy days, a three-minute ‘time out’ to regroup would have been really beneficial. It’s easy to be sceptical – I know meditation seems hippy and new age to some people – but my advice is, don’t knock it until you’ve tried it.

 

 

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Staying sane at Medical School: an idiot guide

It might seem like quite a basic thing but my experience is that it doesn’t come naturally to all of us and can definitely be neglected. In my first year of medicine I muddled through but with no real plan of how to look after myself and believe me, it’s just as important as getting through the degree itself!  This IS the end goal, but your health (and sanity) is a priory too!

Here’s a list of things that I do that might help you if you haven’t already got a strategy:

1- Exercise. I use to do this when I was really stressed and go running at ridiculous times of the night but these days I go as often as I can and it helps to relieve me of stress before things get bad.

2- Talk to somebody. It really helps me to talk about what I feeling am stressed about. I have been lucky to have supportive flat mates but if you want someone to talk to your university are also there to help. At Bristol you can find support at http://www.bristol.ac.uk/student-counselling/services-offered/need.html

3-Have proper breaks. For me this means going home. I use to think that this was a waste of time but now I see how important this is. There is only so much work you can do before you NEED a break. Medicine will NEVER tell you to have a break. There is always more to learn. But you need to give yourself a breather.

4- Allow yourself to question if Medicine is for you or not. In my third year of Medical school I hated clinical Medicine. So I took a year out an intercalated. It was one of the best decisions I have ever made. I missed medicine a lot and this was the confirmation that I needed that this WAS what I wanted to do. Medical School is a hard and long process and if you have doubts it’s OK. Most people I know have questioned why they are doing medicine at some point or another. Give yourself a chance to change your mind. It’s not the end of the world. I think it would be a travesty to get to 5 years of Med school and have hated it all along.

5- Get a bit of perspective. This can be hard at the time. Our work can take over our lives, but in the grand scheme of things, if your biggest problem in life is your medical school exams, you are doing ok in life. (Well, this is what I tell myself anyway!)

6- Don’t suffer in silence. People don’t write Facebook statuses saying “I failed my exam and I feel crap about life”. But they do. These things happen. A lot. And if you do fail an exam, or feel really stressed, hear me when I say YOU ARE NOT ALONE and this crappy period in your life WILL pass and you will be better for it.

7- Treat yourself. I have a mantra that I say to myself which is “gotta look after number one”. That’s you! My Mum has drilled this into me and in an all consuming emotionally, mentally and physically draining profession this is crucial. How you define this is up to you but make sure you do look after number one! Medicine is important, but at the end of the day, you should come first.

Coctail. Candles. Running. Family. Friends that became family. How I get through Medical School.
Coctail. Candles. Running. Family. Friends that became family. How I get through Medical School.

social media sabbatical

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Prevention is better than cure. We’ve all heard it. You don’t have to be a doctor or in any way related to the healthcare profession to have gotten that message. You might even be sick of it by now. All the smoking cessation adverts or the constant media scar mongering.

Some of it is a bit overboard I’ll agree but having worker as a doctor for a few years now, I’ve seen my fair share of patients with conditions that were avoidable in some sense. I don’t just mean physical conditions and the obvious culprits such as obesity I’m also talking about mental health.

Whilst I haven’t suffered depression or a mental health condition myself it has alway been something in the back of my mind that I have been conscious of. Working long hours as a junior doctor, initially in a new area with no real social network of friend or family set up for myself, I was a prime target. I use to think looking from the outside it wouldn’t be surprising if I had a patient who was in my shoes who was depressed. Especially after those exhausting on call weeks!

That’s why I’ve tried to make an effort to notice how I was feeling and how different activities made me feel. I had seen patients with depression who were really suffering and whilst I also was fortunate enough to see some at the other end of the tunnel this wasn’t the case for everyone. I didn’t want to risk it.

Oprah once said your life’s constantly talking to you and when you don’t listen that whisper turns into a ton of bricks falling down around you.

They say it’s not wisdom until you actually implement it into your life and recently I listened to the whispers in my life and a made a few changes.

I took a big step back from social media.

Going with my prevention is better than cure, I started to be more conscious of how certain things made me felt and what role they played in my life. I looked at myself as both a consumer and a part of social media. The truth was I didn’t like what I saw.

For any time I would look on Instagram I would ask myself “what value is this adding to my life”. Looking at the super rich in their amazing clothes and holidays added very little value to mine. Then there were some account which one could group as “inspirational”. In fact there are some pretty great doctors out there making pretty big waves on social media from promoting healthy ways to eat to motiving people to work out more.

But again if I was really honest with myself, how was that beneficial to my life beyond the benefit they have already had? On balance most of the stuff I end up looking at was frivolous and whilst that’s ok at times, these apps are designed to be addictive and 5 minutes here and there soon adds up and that’s time that I wouldn’t choose to use in this way. I would just end up doing so!

Everyone is so happy to show everyone the highlight reel of their life. We all know no ones life is perfect but when you look at those perfectly captures “candid pictures” with Valencia and the perfect amount of brightness and contrast, we forget. Or at least I do. And that I think can be very damaging. Because we compare our reality to someones else perfected squares.

Facebook is the same. For every engagement picture there are triple the heartbreaks and breakups I’m sure. But we don’t hear about that.

And I’m in that group too. I don’t post the crap times of my life either but posting the best bits of my life makes me feel uncomfortable too. I’m not 100% sure why. I guess a part of my feel that it’s a bit dishonest putting one side of the story. Another is I don’t want the world knowing what I’m doing. I guess I don’t find Facebook useful at the moment. I’m not interested in keep up to date with everyone else’s life.

If you’re my friend I already know. We keep in touch in other ways.

Since deactivating my Facebook and getting Instagram off my phone I feel happier. I have noticed my concentration levels have increased and my time feels like my time now. Where I would show off about doing certain thing I don’t have to spend the time to think about which picture to use or which caption. I switch off.

Your mind and your attention are so precious and I don’t want to waste them on things that don’t serve that attention.

I still have my Instagram and my Facebook is deactivated for now. I’m not against social media but I am against wasting time and continuing with old behaviour just because “everyone does it”. I still check Instagram once a day but I’ve taken a backseat to my consumption and uploader status for a while and that’s suiting me just fine.

Whatever your opinion on social media, I hope thing made you think a little. You might love it and get so much out of it in which case carry on! But if you don’t and you don’t find it to be a good thing in your life then perhaps a little sabbatical or just what you need.

Until the next post,

Salma

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Confessions Of A Junior Doctor

 

 

There are a few things that us Brits care greatly about. The great British Bake Off (and the colour of Mary’s jacket). A good cup of tea. The weather. Oh, and the NHS.

(Another) election also means potentially more shake up for the already struggle institution that we all know and love so when it came to watching the first episode of the new TV programme from Channel 4, I feel we all sat up a little straighter.

If the reaction from twitter and my non medic friends is anything to go by, the new documentary following junior doctors in Northampton General Hospital touched a nerve with everyone. For the medics it was a case of “yep, I remember that” and for the non medics it was an unfiltered eye opener.

People relate to people and for all the talk about the much contested junior doctor contract this programme wasn’t about that. It was about the people on the front line doing that thing that they loved and living with the very real consequences of a system under pressure. Like their patients helpless at times in the face of disease, these junior doctors were also visibly helpless to the pressures of the NHS. The 9-5 working day which many doctors know in reality is an ideal more than an often subscribed to reality was demonstrated by the doctors having to stay late at work.The statement of “a large part of it runs on the goodwill of the staff..without that there would be no NHS” rang particularly true.

If there is one thing keeping the NHS together it is the people. As a junior doctor myself I have had some of the hardest days of my life at work. I’ve cried. I’ve run around like a headless chicken. I’ve stayed late. Yet with all of the difficult conditions why do we all stay?

It’s a question I’ve asked to junior doctor friend before. Their confessions weren’t caught on camera but rather in my car, or the canteen, or on the way to the pathology lab because the pod system stopped working. The response comes in many forms but ultimately the answer is something like “because I care”. And that I find universally in the NHS.

For all its flaws and imperfections, it’s filled with some of the best people. People I feel lucky to have worked with. The other day I found a consultants doing a ward round at 7pm on a Friday evening. For those of you who don’t know this is quite unusual. They weren’t being paid for this. They just wanted to make sure their patients were ok. When I went to help I was told it was all in hand and there was “a system” in place (that perhaps I would have ruined!). This is one example of someone going above and beyond their “job”. Everyday I see this. I don’t even have to look hard. I meet a million unsung heroes everyday on the NHS.

If you haven’t already gathered I’m a fan of this programme. For someone who doesn’t own a TV and doesn’t watch any TV programmes regularly, I shall be tuning in again.

The long and short of it the NHS is breaking but people still care. I don’t have a solution but I do know where you can go to educate yourself about the real state of the NHS every Wednesday at 9pm on channel 4. Oh and vote wisely.

Until the next post,

Salma

perception Vs reality: death, the failure to cure

 

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Christmas at the Hospice

A wise person once told me there are only two things in life that are guaranteed. Life and death.

Out of the two, I think we have a problem with talking about one of them.

I love life as much as the next person but I think my views on death are quite different. I think there are major issues with the way we look at death. Both the general public and as doctors.

As a doctor I often get the feeling that death is seen as failure (and sometimes it is when we get avoidable things wrong). But most of the time it really isn’t. People age. Organs tire. Treatments don’t always work. It’s at this point that we have to take a step back and think about what we’re really trying to accomplish.

Our aim changes. There’s a branch of medicine that deals perfectly with this change: palliative medicine. It’s may not be everyones job to treat dying patients, but it’s everyones job and business to recognise when someone reaches this point and to do something about it.

I’ve been working in a hospice for 4 months (really not as depressing as you might be thinking) and no I didn’t spend 4 months trying to save someones life. What I did do was try to help a little. Sometimes that meant treating an infection and other times it was treating agitation at the end of life.

I’ve moved back to the hospital now and it really doesn’t take very long to come across patients who are at the end of life. Yes we can all recognise it but I really think we have big issues in being black and white about it and saying it.

I’m not saying it doesn’t get said. But I think there is often a delay in relaying what we can all see happening and communicating that to the patient and their families.

I think it’s a cultural thing. You go to medical school and you become a doctor to “save lives”. Then you’re faced with a patient with a condition you can’t cure. They may not be imminently dying but you know they will at some point. Your mantra of “save lives” suddenly becomes a bit redundant. I’ve seen a mix of reactions to this from avoidance to a feelings of hopelessness. The end result of this is things don’t always happened as quickly as they should.

If you’re patient is having a heart attack you don’t delay telling them and starting treatment if it’s appropriate. The same attitude should be applied to the dying patient.

It’s can be a difficult discussion but it’s just as important as telling someone about a heart attack. It isn’t always a failure or anyones fault. People die.

I was also one of those doctors who went around with the attitude of “I save lives” (or at least I was trying to). My effort for my patients hasn’t changed but my perspective on what I do has. I now like to think of what I do as “I try to help”. Whether my patients can be “cured” or not, I’m always trying to help them. It makes dealing with the “we’ve reached the end of what we can do to cure this illness” conversation easier and also stops death from being the enemy.

Because if I’ve learnt one thing from my 4 months at the hospice it’s this. We might not always be able to cure disease or avoid death but that doesn’t meant there still isn’t a hell of a lot we can do to give someone the time and dignity to live the time they have left in the way that they want to.

Until the next post,

Salma

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GP land: over the hills and far away

 

In case you missed it and want to have a read, here is a blog post I wrote for a GP magazine on the language we use in healthcare and the importance it might have.

Happy reading!

Salma

xxx

 

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I was a medical student and I was in a clinic with one of my favourite doctors. He had a two-eared stethoscope (the only one I have ever seen to this day), would often hand me the drug chart during bed side teaching and ask me for a differential diagnosis and he called me Faiza for a year because I once sat in Faiza’s chair. He was so nice I didn’t mind that after six months he’s still called me Faiza.

One day in clinic we were trying to contact a GP surgery to get more information for the patient who was in front of us, a confused breathless man. We called several times but the line was engaged and then no one would pick up. No luck that afternoon.

‘No response from GP land’.

 This was the first time I had heard the term and since then it’s not been an uncommon term for me to hear around the hospital.

When I first heard it, it reminded me of something akin to the telletubbies: ‘Over the hills and far away the GPs come out to play?’

Language and choice of words interest me. GP land is banded about all the time. In general conversation, in on call rooms, in multi-disciplinary team discussions, but do the words we have have an impact on how we view certain specialities?

GP land is far away from us ‘the hospital’. GP land is unrelated and like the telletubies say, over the hills and far far away. Once the patient is there they are very much someone else’s responsibility, the GP’s, there to pick up the pieces after a hospital admission at the mercy of a discharge letter for information.

The patient, who every physician will agree is at the centre of their efforts, has interactions with so many different specialities but the ‘us’ and ‘them’ attitude between doctors in every speciality still surprises me. It doesn’t help. Being a junior doctor you quickly move around specialities and you straddle the line between us and them. One day you’re ‘with the surgeons’ and the next you can be in ‘GP land’. Same patient, same you, but a different hat and different outcome even though ultimately we all want the same thing; the best outcome for the patient.

One of the hardest hats to wear is that of a GP’s in GP land. The hats there don’t have the fancy gadgets of the hospital.

In an ideal world patients would move seamlessly between primary and secondary care but as long as ‘GP land’ and the ‘big bad hospital’ attitude exists we as clinicians don’t help things. Yes there are bigger reasons behind the sometimes not so seamless primary to secondary care exchange, but sometimes something as simple as the language we use can shift attitudes a little and change thinking from ‘us’ and ‘them’ to ‘we’.

Inspirational women: The man version

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As part of my blog I have had a little long running series called inspirational women. Today I am breaking the gender restrictions. But Giles is worth the exception. You will see why if you read to the end.

I met Giles when I started out at medical school. We had tutorials together every week on society health and medicine. I still remember the first piece of work I ever did, reading a paper on the psychosocial impact of a positive diagnosis of chlamydia trachomatis in women!

I was a clueless 18 year old and just about navigating supermarket shopping on my own the washing machine and Giles was worldly. Giles rode a bike. Giles had traveled. Giles know there was more to life than studying and university. As such he was an easy figure for me to look up to. He was also ridiculously nice and had great insights in tutorial.

I intercalated and dropped back to the year below and Giles graduated before me. Recently I saw a status on Facebook that he was tagged in which mentioned a small stroke he had. I had no idea and scrolling though this Facebook feed, the marathons and general awesomeness still continue.

The man came back from a stroke, continues to work as a doctor and has only gone and written a book about his experiences.

You can see why I had to open up the inspirational section to men now can’t you.

Have a read of a little interview I had with Giles. Share his story with people who you think may benefit. We could all do with being a bit more Giles. Oh and do the right thing. Buy his book ( paperback and e-book).

For people who don’t know you, tell us a bit about your self
  
Thanks for that introduction Salma! So I’m 34 and decided to study medicine when I was 27 after various experiences of working and travelling around the world. After leaving school  I did an English Literature degree and then worked for an amazing company helping organise rural volunteering projects in places such as Peru, Ghana and Fiji.  We’d also then take the volunteers trekking to places like Macchu Pichu or on overland road trips to Timbuktu.
 
Prior to medical school I was Project Director of Vorovoro Island in Fiji, an eco tourist resort where we were trying to build an eco-village from scratch whilst living alongside the locals Growing our own food, catching rain water for drinking and living on the beach in huts made of bamboo. It was amazing.
 
Then medical school happened and I got into long distance running and cycling. By the end I had done an Iron Man triathlon and had run 100km in one day. In my early summer holidays I led groups trekking and mountaineering to Peru before taking part in mental health projects in Sierra Leone and with Syrian refuges in Lebanon.
 
Now I‘m living in Hereford as an F2, having recently got married to the amazing Amy last year and start GP training program next year.
 
So.. up until this point in my life, things were going well.
What’s it like suddenly switching roles from doctor to patient?
 
It’s bizarre. As a doctor you walk around hospital with such certainty and sense of direction. You are very much part of the place and have a sense of control about your day. Although you get on well with your patients there seems quite a defined line between them and you. Yes, you know you could get ill and be in their place, but it never seems to happen.
 
Yet crossing over the divide  is a very powerful experience. Suddenly the lines of the corridors become sharper, the echoes from the hard floor louder. Any perceived softness of the place evaporates and it begins to feel cold, functional and like a machine. Even staff having a laugh with each other as you are waiting for important tests begins to feel a little isolating.
 
I’ll never forget waiting for my MRI brain scan, sitting alone in the waiting area. At that point it could have been a brain tumour, MS or a stroke. The hospital seemed such a big, angular and scary place. I felt lonely in a way that I had never experienced before whilst the frantic pace of the department continued around me. I have sent so many patients for scans, even walked past them as they are waiting. I’m not sure I ever realised how terrified they might be.
 
Crucially what defines the change is the loss of control. As a doctor you feel like you have it all, as a patient you must surrender yourself into the hands of those (and there are many) who will then care for you. 
 
One the main things I’ve learnt from all this is actually how much less I truly empathised with my patients than I thought. I don’t mean this in a negative way; more that I was blown to bits by my stroke in a way that I had never even appreciated could be possible. While I still care (perhaps more than ever) about the well-being of my patients, it’s made me realise how hard it is to truly understand what another person goes through when they suffer. With that in mind it has me made want to simply listen more rather than offer any immediate answers. 
 
Illness and its consequences are relative to each patient, what they feel and suffer will be unique to them based on their journey to that point and what their life means to them. I hope I never forget this.
Where do you get your drive to keep pushing through from?
 
Good question! One that probably has many answers to be honest. I have a deep sense of how brief and fleeting life is. Increasingly (and now in my own life) there are just no guarantees.  I suppose in many ways I don’t want to waste a moment.
Not only that but when I was younger I didn’t have much belief or confidence in myself. It is only since my mid-twenties that I have started to believe in myself more. This has led me to state of perpetual curiosity of what life has to offer. What more is there to learn, what more am I capable of, what are the limits of mind and body? 
 
I love a challenge and the exploration and experience that come with that. Life just seems like one long wonderful chance to learn, both about oneself and the world in which we live. I suppose in many ways I fear becoming set in my ways and the inevitable stagnation that will accompany that. Being out of our comfort zones allows us to grow, even though it might not be fun at the time!
 
How did you fall into writing and how did it help you?
I did an English degree first in my early twenties which I loved as it basically involved reading books all day. I never had a passion for writing so much then though. That only started coming as I worked for Travel Company helping with their marketing and I would put together their brochures, websites and blogs. With practice I became more confident and enjoyed it.
A few years ago I started carrying a small book to write down thoughts and observations about life. I’d carry it in my bag either at Uni or travelling. It soon started filling up and I would while away long bus journeys exploring my thoughts. Then one day about 2 years ago while in India I wrote my first poem as an experiment. I really enjoyed it and wrote some more. Over time I became braver and started to send them to people, one thing led to another and I’ve self-published a couple of collections with travel photos to give to friends and family.
So when the stroke happened I found writing to be an extremely cathartic and healing way of exploring the many different facets and moments of it. In the aftermath I wrote quite a few poems as they helped me look deeper into what I was feeling and crucially try and communicate it to others. Being ill can be very lonely, and I found this helped a lot.
Eventually I had over 20 and thought it might be nice to make another collection. However rather than pictures I wondered if written reflections might go better with them. I set myself the task of writing about each poem and before I knew it I had a small 40,000 word book on my hands.
Writing Brushstrokes has been an incredibly healing and useful thing to do. Allowing me to grapple with the pain of the experience and come to terms with what has happened.  Much of how I think about the stroke and came to be at peace with it was formed in the writing of it.
Sitting still (not by choice!) yet creating something from the experience was a large part of helping me recover. It was a very useful way of exploring the muddle in my head that had replaced what was there before!
Hopefully it conveys some of the story and may be of benefit to others who find themselves having their world turned upside down.
Massive thanks to Giles for sharing his story on my blog.