Caring by Ren Forteath

I always say that my job is 90% pure undiluted joy. We welcome women into our unit, excited at the prospect of meeting their babies. We watch men become fathers, pride in their partner’s achievement shining in their eyes. We see generations of women bond over a new life whose growth and development they will all influence.

But the 10%; those women are engraved in our memories. They affect us perhaps more deeply than the others. Caring for them is a privilege that is heartbreaking. We pay special attention to every detail, because nothing must be missed; every precious second is treasured, every document triple checked so that they won’t need to be called back to go through it all again, every memory painstakingly catalogued. Because these are the only moments, the only memories, they will ever have.

It is not a club anyone wants to belong to. We understand that. Perhaps you knew when you walked through our door what was going to happen that day, because a scan appointment a day or two before hand had gone terribly, earth-shatteringly wrong. Perhaps you came in to the unit as excited as the next person, and it wasn’t until sometime later that your world was turned upside down. At whatever point you knew that your birth journey was going to be different, difficult, immeasurably sad, we were there with you; holding your hand, passing you a tissue, explaining, again and again because it is impossible to take in or believe.

We try to make sure that your birth is still yours, still about you meeting your baby in the way you wanted to, although it is now not in the way you would ever have wanted to; that there is still dignity and time and the opportunity to be together and to make memories, take photographs, bath and dress them, have family meet them, take them home with you if you want, stay here with them if you want.

And then you leave and we prepare them for their final journey, talking to them just as you would and being as gentle and careful with them as you would be, placing their teddy and blanket with them, their silver heart in their hand, walking them down stairs as our last offering of care to your precious little one.

Perhaps in the time that you were with us we had to pop out of the room for a moment, to fetch something. We might have been in the loo, sobbing because we couldn’t hold in our tears of sympathy any longer. We might have been in the break room, a colleague giving us a pep talk, or stealing two minutes of privacy in the sluice to breathe deeply and steel ourselves for the rest of the shift. We came back into your room dry eyed, entirely focussed on your care. When your baby was born we may have cried with you, knowing that seeing how your loss affects us means something to you; that you are not just a number to us, just another patient.

Then we go home and we take some time to care for ourselves. We each have our own way of dealing with our feelings, our sadness. Hot bath, good cry, glass of wine, chocolate bar, phone our Mum, Netflix binge, diary, prayer, hug from our partner; we each have our own process, our own way of sorting our thoughts, putting it behind us, moving on. Because it is not our pain. What has happened is tremendously sad, but we cannot dwell in it or let it overcome us in the way that it consumes you, occupies your world. Tomorrow, or the next day, or a few days after that, we will be back at work, smiling and fresh faced, ready to care for the next person, ready for the next bit of the 90% or the next bit of the 10.

But we won’t forget you or your baby. Maybe we came to your little one’s funeral. Maybe we have a little tiny notebook in the bottom of a drawer, on each page a date and an initial; our only record of each little life not lived. Maybe we light a candle every October 15^th at 7pm and think of them all. Maybe we hang a special star on our Christmas tree every year that says ‘always loved, never forgotten’ and remember. Maybe we see you at the SANDS carol service. Maybe we write, maybe we fundraise, maybe we teach our colleagues how to help you. It all helps us to keep going into the next room with a butterfly on the door, to do our best for you.

Ren Forteath is a Midwife in the Women, Children’s and Sexual Health Directorate at NHS Dumfries and Galloway

#Connecting: Getting off Mute during #AHPsDAYScot by Wendy Chambers & Claire Martin

Mid October is National #AHPsDay (Allied Health Professions) and now we’re all back from our local school break we would like to take the opportunity to #Connect with both the AHPDG workforce as well as our many colleagues across the Partnership.

#AHPsDay has 4 themes: #Celebrate   #Appreciate   #Inspire   #Connect

I was asked, by the National @AHPDementia Forum, to reflect on the theme #Connect for their blog series of this month.

I’m neither a linguist nor a speech language therapist but I’ve always been interested in the origin of words; it fascinates me. Something about the how the roots, origins and history of words help us better understand why things are as they are, and how this also correlates to us as people. The connections and the impact we make on each other and the world around us.

I looked it up; “connect” is a very old word within the English language, arriving in late 15^th century, originating from the Latin verb “conectere” meaning “join together”.

Joining together is something which we took for granted before the pandemic arrived. We could move around as we liked and choose how, where and when we connected with colleagues, family and friends.

I’ve always loved airports and travel. I’d arrive early and enjoyed the sheer pleasure of watching people coming, going, moving and connecting. People meeting up from across cities, countries, continents; the sheer turmoil and hubbub of emotions. The sights, sounds, smells – realising we connect using all of our senses; it’s so much more than words, the joining happens on many levels seen and unseen. Indeed I spent #AHPsDay this year in a ferry terminal, after visiting and #connecting with family and friends in Ireland. Noticing the masks and momentary hesitations as we all negotiate busy spaces. That things have changed but nevertheless our need to #connect superceeds and life goes on.

While the pandemic has brought us on leaps and bounds around how we #connect and meet in virtual and digital spaces I realise there is so much else that I miss about the quality of the connection. Attending a conference, webinar or meeting online is just amazing and has opened up new possibilities and opportunities. However I, like others, miss the unplanned connections and conversations over coffee, the smells and hubbub that face to face connections enable.

The Oxford dictionary definition of connect also includes comment on the quality of a connection, the notion “bringing together or into contact so that a real link is established”. Working in the diverse world of dementia care in Scotland I have been privileged to be involved in the AHP work rooted in the Connecting People Connecting Support (2017) policy document. Aptly named everything the AHP policy ambitions set out to do and all the evidenced transformative work which AHPs across Scotland have been doing, strives to create, develop and deepen connections between people and the services which can support us all to live well with dementia.

Earlier this year a wise mentor offered me some useful reflection; that it was time for me to get off the computer, switch off the digital connections and go meet people face to face again. That I needed to remember it is always a case of both/and when it comes to connecting. That both, in person real time as well as digital time, connections bring their own just deserts and positive contributions to how we work together.

As humans we thrive on and need diversity. None of us wants to arrive at a buffet and be offered only 1 type of desert. A buffet by definition consists of several dishes from which we as guests serve ourselves.  We want and need to have choice in life. We prefer, and the buffet offers us, choice and gives us control over those choices; profiteroles, baklava, pumpkin pie, gulab jamun, trifle, baked alaska. So when we feel all we want is the familiar, we can absolutely choose some apple pie every time, if that is what we want or need. The ability to choose our desert and our mode of connecting is what matters.

So, this month, in celebration of #AHPsDay & #AHPsDayScot I have connected with you all digitally and want to thank you from the bottom of my heart for being the amazing, diverse and professional group that you all are, across 14 AHP professions, 8 of which we employ in D&G. For everything you have all done in the connected world of @AHPDementia to transform the AHP offer in dementia care in Scotland.

I’m delighted to now be working alongside and #connected with Claire Martin, to continue the AHPDG journey, transforming our local offer and ensuring our AHP services across the region are dementia inclusive. And now I’m switching off the digital to go connect in real time, face to face – joining together, establishing real time links with AHP as well as non AHP colleagues.

Have fun connecting this month remembering that we all need both/and to make all of the magic happen.  #AHPsDay

Wendy Chambers is Alzheimer Scotland Dementia Consultant (AHP/OT)

Claire Martin Team is Lead Occupational Therapist Mental Health

Whistleblowing: it’s everyone’s business by Marsali Caig

In sport, it’s the referee who ultimately blows the whistle. They’re expecting the players to play by the rules of the game.

In the NHS, it’s both the players and the referee who can blow the whistle. That’s more powerful. It’s more democratic. And it respects the fact that everyone who works in or for the NHS, no matter what their role, their grade or where they work, has a stake in the culture of their organisation.

NHS Dumfries & Galloway wants to sustain a culture at work where as an employee, a student, a volunteer or as someone who delivers services on behalf of the NHS, you can speak up if you see things that negatively impact on patient & staff safety or misuse of resources such as money or equipment. We all come to work to do the best job we can, and if something is getting in the way of that, we’ve each got a responsibility to try and get that resolved.

Personal issues, such as being bullied or harassed at work, have very clear routes to take from an HR perspective. What we’re really talking about in relation to whistleblowing are issues and risks that impact on the quality and timeliness of the care and support we provide, and how we use taxpayers’ money.

Overcoming those issues and risks is best dealt with as locally to the issue as possible. This means first trying to work through it with your line manager and team by talking to them and seeing what can change. Business as usual, it’s called.

However, in some situations, the issue or risk isn’t dealt with adequately. In some situations, someone might be scared or apprehensive about approaching their line manager. When this happens, new Whistleblowing Standards for the NHS in Scotland are available to support you to determine how best to deal with your concerns.

Whistleblowing comes with a reputation. Some of the thoughts someone who is thinking about whistleblowing might include things like,

‘My voice doesn’t matter, I’m only a Band 2’

‘If I whistleblow, it’ll be me that’s punished’

‘This will be the end of my career’

‘What if everyone finds out it’s me’

‘I can’t speak up because my boss is a personal friend of the person whose actions I’m questioning’

‘My colleagues won’t want to know me’

The reality now is that the new Standards are there to protect people who formally whistleblow. They’re there to make sure Board members are assured that people who whistleblow are being supported and taken seriously. That the process of investigating the issue or risk is fair and as quick as possible.  That if you whistleblow, you’re kept up to date with what is happening and get feedback. And ultimately, that if there is a genuine issue or risk, it’s dealt with and any learning is embedded and shared with relevant parts of the organisation. There is a final stage available if things aren’t resolved via the national Independent Whistleblowing Officer (INWO) who will investigate complaints and, where needed, recommend action for the NHS organisation to take.  In addition to complaints, the INWO has a national leadership role providing support and guidance to NHS organisations, focusing on appropriate early resolution, and good practice in whistleblowing handling, recording, reporting, learning and improvement.  Their ultimate aim is to ensure that patients receive a good, safe service from a well-run NHS in Scotland.

Taking personal responsibility at work is really important in order to contribute to making a great place to work. The Policies and Standards we have to work to help ensure that. The Whistleblowing Standards are one example of a process that’s there to help you speak up and help the organisation to improve.

As Martin Luther King Jr said,

‘Our lives begin to end the day we become silent about the things that matter.’

You can find more information about the Whistleblowing Standards here:

on Beacon:   

http://hippo.citrix.dghealth.scot.nhs.uk/sorce/beacon/?pageid=Whistleblowing_Homepage

at the Independent National Whistleblowing Officer’s website:

https://inwo.spso.org.uk

Each NHS Board has a whistleblowing champion who is a non-executive director. The whistleblowing champion monitors and supports the effective delivery of the whistleblowing Standards. The whistleblowing champion seeks assurance that managers are responding to whistleblowing concerns appropriately, in accordance with the Standards.  They are also expected to raise any issues of concern with the Board in relation to the implementation of the Standards, patterns in reporting of concerns or in relation to issues emerging from cases. They do not get involved in individual cases.

NHS Dumfries and Galloway’s whistleblowing champion is:

Marsali Caig, Non Executive Board Member 

Tel: 01387 272702 

Email:  marsali.caig@nhs.scot 

#HelloYellow – World Mental Health Day 2021 by Alison Telfer

Written by Alison Telfer, alongside Erin, Alix & Rhianna, members of CAMHS Young People’s Participation Group.

Artwork produced by Alix.

We have all been impacted by COVID-19, in lots of differnet ways. I just started working within my CAMHS Participation Lead role, within the NHS just before lockdown began. No one could have predicted that we would experience two lockdowns, not being able to see loved ones, unable to socilaise, travel in the UK or abroad, have toliet roll shortage, take part in team online quiz’s, having to adjust to home schooling and working at home, building new working relationships on Teams, remembering not to be on mute! Navigate new ways of working and having to upskill ourselves within this new digital world.

During this time, Child & Adolescent Mental Health Service (CAMHS) Young People’s Participation group has been established. This is a small group of young people aged 13-25 years old, who are ‘experts by experience’ and are currently accessing services or have in the past. This group currently meets online on the first Wednesday of every month from 5pm-6pm. The young people, who participate within this group, come from all over Dumfries & Galloway, share their experiences, thoughts and ideas for how we can make positive improvements to CAMHS together. The young people involved within this group are passionate and interested in using creative arts to express themselves, tackle mental health stigma and raise awareness.

Members of the CAMHS Staff Team, wearing something yellow last October 2020, for supporting #HelloYellow.

Saying #HelloYellow this World Mental Health Day is a little thing we can all do to make a BIG difference to young people’s mental health on Friday 8^th October.  Young Minds encourage Schools, Youth Groups, Organisations and Communities, to all come together to organise activities and events and wear something YELLOW to show young people they are not alone with their mental health.

“Participation in mental health means young people taking an active role in caring for their own mental health decision making, the mental health care they receive and shaping the services they use…. Participation is all about change (Young Minds)

This year, I asked the young people how they would like to raise awareness of Young Minds #HelloYellow World Mental Health Day.  As a group, we like to use online jam board’s which is free to use, interactive and is like an online flipchart paper and this means everyone can still contribute and share their thoughts and ideas using text or post it notes. The young people decided to research and produce a Mental Health Quiz, Design Your Own Mental Health Hero giveaway, aimed at raising awareness amongst other children and young people, share their thoughts and ideas, create posts to be shared on CAMHS social media platforms. For more information:  FB: @DGCAMHS  / Instagram @CAMHSDG /  Twitter: @CAMHS_DG_NHS

This group also wanted their October meeting themed around #HelloYellow, the young people and staff all had something yellow on. They took part in Wellbeing Bingo, designed their own Mug, with a positive message / inspirational quote relating to Mental Health Awareness. Some members of the group shared why raising mental health awareness is important to them! Below are some ideas from children and young people who participate within CAMHS online Arts & Wellbeing Group, for activities to do, to prevent the bottle from overfilling or exploding. 

Sunflower Artwork produced by Rhianna

The young people within the participation group wanted the opportunity to share their ideas, advice and experiences of mental health with other children and young people. In April this group were successful in external funding from the See Me Anti-Stigma Art Fund, they have worked with a professional artist and CAMHS Participation Lead to produce the Be Kind short animation and educational booklet. Be Kind to others and to yourself is a simple but important message, they wanted to get across.

A lot of hard work, imagination, commitment, creativity, time and enthusiasm have gone into producing the animation and educational booklet, from all of the young people involved.  

The young people have designed, drawn and produced all of the characters, written the storyline, recorded the audio, designed artwork produced some of the animation, decided on the sound effects, however due to lockdown, there have been some challenges limited, face to face group meetings, and we would have liked the young people to have animated everything, this sadly has not been possible.  

If you would like to be kept up to date on our CAMHS Participation work, we will share the link for the animation and how you can gain a copy of the booklet, have a look on our CAMHS social media platforms or get in contact with Alison Telfer: alison.telfer1@nhs.scot.

Alison Telfer is CAMHS Participation Lead for the Women’s and Children’s Directorate at NHS D&G

The Empty Chair by Chris Tiplady

(This blog was originally published on the Royal College of Pathologists website and can be found here)

I notice chairs. Is that odd?

I started noticing chairs a few years ago. One particular patient I recall had advanced follicular lymphoma, a type of cancer which is incurable but often treatable for many years with intermittent courses of chemotherapy. Eventually nearly everyone will die prematurely because of the lymphoma.

She always came with her husband, every single time without exception. There were many visits and many conversations with them both about her health, the disease, the treatment and her future.

LIKE MOST PATIENTS SHE ALWAYS SAT ON THE LEFT

In my clinic room I have the room set up with two facing chairs. Like most patients she always sat on the left, her husband on the right. We saw each other like this for years. She had multiple courses of chemotherapy and did well. I got to know them both, a privilege we are fortunate to have and one I never waste. The years passed, each visit marked by a short entry in her notes, enough to help me pick up a conversation I may have started months ago. We talked about dying on some visits, not all of them but she knew what would eventually happen. Her husband and I talked about recognising when that time was getting close and how we would support him.

Then one ordinary clinic day she walked quietly into my clinic, this time on her own. There in front of me was an empty chair − the one on the right. Her husband had died of a suspected heart attack just a few days before.

THE WRONG CHAIR WAS EMPTY

An odd thought hit me − the wrong chair was empty. I always expected the left chair to be empty first. I didn’t think his death was my fault but I felt guilty even though everything was completely outside of my control. That empty chair suddenly represented missed conversations, missed opportunities, missed chances to talk about him, his health, his problems and his future.

‘That empty chair suddenly represented missed conversations, missed opportunities, missed chances to talk about him, his health, his problems and his future.’

This was several years ago and it keeps happening. The experience changed my practice. I always make sure I talk about the occupier of the chair on the right − the person who is the carer, the one who has to cope, the one who must look after themselves as well as their partner.

I SEE EMPTY CHAIRS

Sadly, over the last year the number of empty chairs has increased dramatically, I keep seeing them everywhere. But no longer does an empty chair in my clinic room suggest a death. It reflects the rules, the lockdown, the anxiety and the uncertainty. I see empty chairs in the waiting room because we do so much over the phone. I see empty chairs in the corridors because we can’t have visitors in the hospital. Bedside chairs are rarely filled by caring relatives anymore. I see empty chairs in the hospital coffee shop because families can’t come in. I see them everywhere on the way to work, through the windows of shops, libraries and cafes. The buzz has gone, the feel of people all around is missing, the world is quieter and you can’t see the carers or the people they are caring for.

‘I am in a room on my own, gazing at others in rooms on their own too. When I teach, I am enthusing into a camera but it’s not the same.’

Colleagues are ill or isolating. Busy offices are split, more people are working from home. Those with chronic illnesses have been away for months and may never come back to the same role. When I attend training, I am in a room on my own, gazing at others in rooms on their own too. When I teach, I am enthusing into a camera but it’s not the same. I miss the people filling chairs with their voices, their sounds and even their smells!

I LOVE TALKING, I LOVE LEARNING ABOUT PEOPLE

Every single person who this pandemic has affected leaves an empty chair somewhere. These empty chairs are a conversation someone wishes they had, a support that is missing or a diversion that is no longer present. I miss being diverted, it’s what I need most when there is too much to do and too many difficult things in the day. I love talking, I love learning about people and I usually love my job. It is harder with all those empty chairs.

The empty chair that means most to me though is in an airy well-lit conservatory facing north west, in a little village just outside of Carlisle. My Dad died very suddenly in that chair while looking out over fields and their beautiful garden. I hadn’t seen him properly for months because of lockdowns. Time has passed but the empty chair is there every time we go to see my Mum.

DON’T WAIT UNTIL A CHAIR IS EMPTY

Empty chairs are there as reminders to all of us. They should remind you to talk, to enquire over who should be in that chair, to have the conversations that need to be had, to recognise the relationships we all have that support us and that make our days better.

Most of all, don’t wait until a chair is empty.

Chris Tiplady is an Honorary Clinical Lecturer and Director of Undergraduate Studies at for the University of Sunderland