Wanderlust or procrastination?

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I’m the kind of person who is naturally very reflective. To you it’s a walk to the shop and a rude person who doesn’t serve you quickly enough. To my it’s life teaching my about patience and a little reminder of what not to do.

I though I would share some thought that I’ve been having recently to the aim that it might stimulate some debate and may make you think a little.

“I love to travel”. “Wanderlust”. “I’ve got the travel bug”. If i had a pound, scrap that penny, for every time I’ve heard that recently.

Apparently, we’ve all been bitten by the same thing. We must have all eaten the same rotten fruit. Work pressures, failing relationships, debt, or maybe just the wish to see something new and learn about the world. It looks like we ALL suddenly want to travel. Everywhere. And all the time.

Now don’t get me wrong. The thing I said about wanting to see the world and everything, I buy that. I also want to see what people my age are doing half way around the world and learn from them. I want to go to the far reaches of the world just as much as the next gal.

But to my over reflective self, I also see something else going on. Procastination. “I don’t know what to do so I’ll travel”. That’s not to say that that isn’t a good use of someones time, because I really think it is, the world has many lessons to teach us all. But the bigger issue I have is how will this help you figure out that thing that you want to do? Or that decision you want to make. I’m all for taking some time out to think about things, but what I don’t agree with is wasting time.

Because time is precious. It’s why I can’t have something in my life I don’t think is good for me. I can’t do fake friends. I physically can’t tolerate it. My body shuts down. My mouth won’t open. I have nothing to say (and if you know me you know I don’t shut up and as my friend you have to tolerate me). Time is a GIFT. It will never come back. That thing you’re deciding on might not be possible in a few years. That career. That family you want. That move round the world. That visit to a family member. Whatever it is.

As one of my faviourite TED talks said “I’m not discounting 20 something exploration, but what I am discounting is 20 something exploration that’s not suppose to mean anything”.

If you read my last blog post, you already know that I’m quite an extreme person. I don’t like that TED talk I LOVE it. I come back to it time and time again. Life gets messy and that reminder can get lost. I need to remind myself first of all.

So I’m gonna just leave this post and that talk here. Think of it as life giving you a little reminder. Or you could just think of it as that Salma girl with one of her (maybe annoying) blog posts again. Whatever.

Either way, it’s here.

Have a great day.

Salma xxx

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Daring greatly: moving to the dark side

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I’m an extreme kind of person. I don’t know how to like something a bit or do a bit of something. If I’m in I’m in.

Recently I threw myself into something at full speed. My medical speciality application. I went full steam ahead chasing my dream as if nothing could stop me. I couldn’t guarantee that I would get in but I dared to try.

And I honestly think that that is half of the mental battle. In the process of applying for this job I was told so many times “oh that’s really competitive”. And the speciality I was applying for IS competitive. It’s not untrue, but the undertone of that comment was often quite negative. Discouraging even. Once I decided that this was the only thing I wanted to do, I blocked this out. If I didn’t I really think that I would have been paralysed. Too scared to even try.

Later I would choose to reply to this comment with “yes, but I’m also a competitive applicant. I make up that competitive pool too”. And it’s true. For everything that is “competitive” firstly, YOU are also part of that. Secondly, someone HAS to get the job so why wouldn’t it be you?! I put that to the side.

That wasn’t my priority because that wasn’t my decision. All I could really impact was me and how I performed on the day and the things that I could do to try my best to get my dream job. To waste mental energy on anything else is unnecessary baggage and when you’re trying to climb you gotta drop that baggage or you’ll never get anywhere.

I guess the point that I’m trying to make is nothing ventured nothing gained. To give yourself a chance you have to try and to try is to be brave.

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On the day of my interview, when my portfolio had finally come together, I cried! Not because anything awful happened but because I had even gotten this far. I was proud of myself and whatever the outcome almost didn’t matter because I had tried my best. At the end of the day that is really all that counts. Yes I would have been disappointed to not get the job I wanted but the biggest tragedy is to not try.

I’m talking about chasing a dream job here but the same rule applies to anything in life that is a bit scary to go for. That thing you want to do but you convince yourself you’re not quite good enough yet. You just have to be a bit brave and got for it. Brene Brown (if you don’t know who this is, google her, she’s amazing) introduced me to this quote below by Roosevelt. To me it’s about trying. Being brave. Daring. It’s not easy but the rewards are so sweet. When you don’t try, you don’t enter the arena and you fail yourself already. I almost did that to myself, but a mustard seed of faith and a pinch of bravery and a why the hell not me attitude, helped me get past that.

It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.”

 

I’ll be starting training in Clinical Radiology in a few months and if I didn’t dare greatly, I would be either starting nothing or starting a job I never really wanted to do. There is nothing special about me that isn’t in anyone else. I just gave myself a chance by trying and if I didn’t get in first time round, I would have given myself a chance again.

I hope this post spurs you on to think of an area in your life where you could dare greatly.

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Cheers to chasing the dream

 

Until the next post,

Salma xxx

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’.

Self-full and selfcare: how not to suck at it

 

How I keep my cup full, family, holidays with friends, weekends away…

 

We don’t know how to look after ourselves and if we know we don’t do it because we don’t see it as important.

As a doctor and in my private life I see the casualties of this phenomena. The friend engrossed in a new relationship that they forget to look after themselves. The daughter  so caught up with looking after an ill relative they doesn’t eat properly. The newly qualified doctor who never has lunch because they’re too busy doing jobs.

Lots think taking care of themselves is a luxury and pastime for others with little else to do. “When you are busy you don’t have time for that nonsense.” It’s not an uncommon attitude and I have uttered those words myself before. There is also a notion that to look after yourself is selfish. “You should always put others first right. You shouldn’t always think about yourself.” Without qualifying those statements with a healthy dose of boundaries, I can’t express to you how harmful I think this attitude is.

Being busy these days is some sort of status symbol. And being too busy to look after yourself is almost a norm. So we go on in our day to day life and yes we survive. We don’t fall apart. That doctor who missed lunch again to do the 3 discharge letters in under 15 minutes got them done.

But what happens when things go wrong? When that doctor who doesn’t know how to look after themselves makes a mistake at work and has to deal with that, how do cope then? Badly is the answer. Same for the girl in a relationship when there is a rough patch. Same for the relative when their family member gets a terminal diagnosis.

Exactly the point at which the self care elements need to be amped up, you start from ground zero and although not impossible it makes it harder.

I have a simple mind and I like simple concepts. My cup represents me. My job is to keep my cup full. I fill my cup with selfcare and all the things that make me happy. When my cup if overflowing you can have some when that’s not the case though, I have nothing to give without stealing from myself. It’s not selfish it’s self-full.

When your cup is already empty and there is a tragedy in your life no wonder you will struggle. And to be honest it doesn’t even have to be a big thing. When you’re running on empty everything can seem like a challenge.

We often confuse self care and self-full with selfish. Saying no to an evening out because you need to sleep early isn’t selfish when you’re at work the next day and you know you will be tired, it is look after yourself. Yes it’s different if it’s a friend in need calling you who is having a terrible day but generally putting yourself first is just good sense. Saying no isn’t selfish. I think a lot of people have a problem with that word.

I have no shame in saying that I put me first. I’m my number one priority. The truth is if I’m not my own number one priority then who else will priorities me? No one. Of course there are people who care deeply for me and I also care deeply for them but if I fall down and hurt myself, I feel it more than anyone else. My success and failures ultimately affect me the most. I have also seen first hand the affects of living with an empty cup. That Salma isn’t a good doctor, sister or friend. Equally it isn’t anyone else’s responsibility to fill my cup up.

 

The first step to self care and keeping your cup full and being self-full is to change the way you think about it. No it’s not a luxury. Yes we all need to practice it. No it isn’t selfish. Ultimately more people walking around with filled cups have more to give to each other. I for one say cheers to that!

Until the next post,

Salma

 

 

 

 

 

 

F1 my two cents’ worth

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Before I started my first job as a doctor which feels like ages ago (12 months ago), I was terrified. The words “do no harm” were my mantra. Being “good” was icing on the cake I thought. I looked up naturally to people who had been there and got the t-shirt to provide me with some well needed guidance and having just finished F1 I thought it was probably right that I passed the knowledge on whilst it’s still relatively fresh (kinda) in my head.

You can find the generic stuff anywhere but I’m gonna try and tell you the things people don’t tell you.

  1. You are there to do a job and help people and your patient is your first priority but you also matter too! You wouldn’t let your patient starve, ignore a mild hypo and AKI and continue so don’t let yourself get to the same state. I have done that. We all have and some days are crazy busy that you really can’t run and grab lunch but try to. Very few things can’t wait. The hospital won’t fall apart because you have lunch or you go and get some water. I use to feel guilty eating at times, how ridiculous?! Try and have food in your bag (I have multi packs in my bag, always good for a pick me up for you and your colleague) and don’t let missing lunch become a habit.
  2. Working in a hospital is like working anywhere, there are many personalities and viewpoints. You won’t get on with everyone and that’s ok. This might be your first ever job and navigating the complexities of the work dynamics will come to you. Just give it time.
  3. What goes around comes around. We all like to leave on time, but that colleague who is till there at 5pm who you can help may just be the one to help you when you’re equally stuck next time and need to catch a flight. Equally don’t dump jobs on other doctors that you can do or should have done during the day. Think how you would feel being that doctor and if you do hand something over, have a plan,”chase bloods” isn’t a plan…
  4. Playground cattiness is everywhere in the working world so don’t be surprised if it follows you onto the ward. It takes all sorts, just rise above it, focus on your patient and remember what you’re there to do.
  5. You’re “just an F1” until an important blood test isn’t checked! Don’t sell yourself short, you’ve worked hard to be where you are and you may be the most junior doctor in the hospital but you aren’t “just” anything. Equally be humble. If you make a mistake or don’t know something ASK. You do no one any favours by pretending to understand something when you don’t. It makes it unsafe and that pretending is a bigger issue than the not knowing. It’s not an exam any more. You won’t be penalised for not knowing but you will for not asking. I was sick of my own voice with all my questions but it’s what’s expected and it keeps patients safe. It’s also how you learn so ask away.
  6. Speak up. If you aren’t happy about something, feel unsuppourted or have any other concerns tell someone. The foundation team are there to support you and have been doing their job for years. You won’t be the first or the last F1 to feel depressed/tired/wanting to quit medicine. Talking to someone means issues can be adresssed before they build to bigger issues.
  7. When a lot of your friends are doctors meeting up is a logistical challenge (ahem nightmare). Get some dates set ASAP. You will be working with doctors who went to medical schools all over the country, but your uni friends will just understand you on a different level. They know how well or not so well your medical school prepared you for this F1 gig- talking is therapy!
  8. Don’t let work take over your life. I refused to which meant I was exhausted at times, I took the work hard play hard seriously but I don’t have regrets! Just remember to schedule in some actual rest time now and again 😉
  9. F1 flys by. By the end of F1 you will doing things that use to terrify you without thinking. One patient with DKA and another septic, no problem. It’s a steep learning curve, more like a cliff that you are pushed off with your degree…but we all go through it and make it. The chances are, you will too.
  10. Ultimately look after number 1 which is you because no one else will. It’s not selfish it’s self-full. When you have more to give you are a better doctor. That means sleeping, eating and resting and whatever else keeps you full. For me seeing family is a big part of that and they got me through (as always). Being off sick when you are and not feeling guilty about not going into work is also important. You are only human and you can only do your best. And yes that is good enough.

So there you have it boys and girls, my two cents worth of F1 tips.

Hope it helped someone.

Salma xxx

 

 

 

 

 

 

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.