The man With The Tea Trolley by Alison Wren

image1Hello! My name is Alison! I work as a Clinical Psychologist in the Clinical Health Psychology Service; the final member of the team to blog this month as part of our service promotion! Part of my role within this job is to help individuals and their families manage psychological distress caused by or maintained by physical health problems. Of course as a psychologist I do this at a professional level, but do we always need to be a psychologist to provide psychological care to those who need it?

 
This is the story of a man with a tea trolley; an ordinary chap who made a big difference to me at a particular moment in my life when the chips were down. I didn’t know him and he didn’t know me. We only met once and we don’t keep in touch. He probably doesn’t even remember me. He didn’t need to do what he did; it definitely wasn’t in his job remit and he probably bent the hospital rules.

The story starts on a Saturday afternoon several years ago when my husband unfortunately had a heart attack and was admitted to our local coronary care unit. It all came as a bit of a shock as he had none of the typical risk factors. He wasn’t overweight; he didn’t have high cholesterol, and had never smoked. He drank sensibly and walked miles every week. The event itself was fairly low key; just a burning sensation from throat to stomach followed later by an aching jaw. Symptoms so low key that he still image2went off to a football match that afternoon as planned. Twelve hours later after a trip to A&E (“just to be on the safe side”) our worst fears were confirmed. I’m happy to say that after a successful angioplasty he made a great recovery, but at the time we both pretty devastated. I was beside myself with worry. My stomach churned and my thoughts raced out of control “Was he going to die?”, “Would he have another?”

“Would he be able to stay active?”, “Would he still be able to work?”

image3I felt overwhelmed. How would I help my husband to cope if I was struggling myself? I had no one to talk to and could not voice my fears to my husband who needed me to be strong. As a Clinical Psychologist with many years experience working with people who have experienced distressing life events, I knew that my thoughts and feelings were normal but I was at a loss as to how to help myself.

The coronary unit that my husband was admitted to was located in another region in the UK and has now closed. My husband received excellent medical care, but as a worried spouse I felt alone. Nurses and doctors were busy. Visiting hours were limited (I was not permitted to stay longer than an hour). I wanted to be near my husband and to feel that others understood that we were in this together. I wanted reassurance. I wanted information. I wanted someone to ask me if I was alright. I felt that I needed looking after too.

One afternoon with all this weighing heavily on my mind, the man with the tea trolley came into my life. I had seen him before on and off during my visits serving hot drinks and biscuits to the patients. He was always cheerful and took the time to have a chat with people. He bustled passed me as I sat in the visitor’s room. I guess he must have noticed my forlorn expression through the window, because he doubled back and came into the room. What he did next was a small act of kindness that changed my day, and helped me feel a little better.

image4He simply smiled, gave me a cup of tea and said, “It’s hard isn’t it? How are you doing?”

We chatted for a short while about this and that, and he listened to me as I told him what had happened. Of course he couldn’t answer my medical questions, or give me any assurances about the future. He couldn’t really do anything as such, but he was there for me at the right moment and he seemed to understand. He knew I needed a friendly ear. I never saw him again, so I didn’t get chance to thank him. So whoever you are, thank you! That cup of tea made all the difference.

image5Dr Alison Wren is a Clinical Psychologist for the Clinical Health Psychology Team at NHS Dumfries and Galloway

An Occasional Visitor to Dumfries & My ‘Scottish Heritage’ by Tarik Elhadd

(This article was written in Dumfries in August 2015)

I have always been fascinated by the Trust Weekly Blog and stemming out from my connection with Dumfries, I thought of posting this reflection, hopefully it will be deemed suitable for publication.

I first came to Dumfries in spring of 2011 several months after departure from my home country, Sudan. My re-traffic to Sudan in 2009, trying to re-uproot, make a living and help my own people, was very much dashed by several factors. Making a living there was second to impossible. Back in 2007/2008 I had an offer to join a thriving health service in the area beyond the far western Canadian prairies, in British Columbia, which encompassed both academic and service domains. Coming to Dumfries was the perfect choice as the job was still vacant. I went to British Columbia a few months earlier in a fact finding mission. Part of the Canadian recruitment process entails inviting prospective candidates and their families to come and see themselves, and then make an ‘informed decision’. Following a week in ‘Prince George’ in fall 2010 we got satisfied and decided to go for it, despite that it is in the ‘end of the world’, being 13 hours flight from UK. But for us, the Sudanese, it was ‘Safe Haven’. The prospect of working and living in the ‘New World’ proved exciting. I had just turned fifty by then, and the career prospect was still rife. I began the process of joining Prince George University Hospital of North British Columbia, but to fill the 9 month gap whilst this took place I came to Dumfries to take up a locum in Diabetes and Endocrinology. One place, one hospital and then off you go to Canada. That was the dream which proved to be elusive.

At Dumfries life was very smooth. I was embraced by everybody, from within the department and from without, as one of the team. I never felt, nor was given, the feeling of being the ‘bloody locum’, who is here to do little for ‘too much money’ and then vanishing away. I was always treated with dignity and respect and always given the feeling of being ‘one of the team’. Everyone expressed love and showed gratitude to the job I was doing. This culture you won’t see or feel in other places as a locum. At Dumfries your expertise and hard work would be appreciated and valued and, despite that I was well paid for the hours I was doing, I was never eyed as a locum and stranger by anyone save one or two people.  Weeks and months and the path to relocate to British Columbia became fraught with obstacle after obstacle. It proved to be a ‘bumpy road’, and my stay at Dumfries continued, not only for nine months but it went to one and half a years.

I left Dumfries in August 2012 pursuing the elusive Canadian dream only to come back again in December 2013 when change of heart and change of fortunes forced yet a move into the opposite direction, this time eastward. The Canadian dream been burned on the altar of destiny. I was heading towards the Arabian Gulf, another safe haven for us, the beleaguered Sudanese. I was again embraced by Dumfries with the same old love, dignity and respect. Despite that my second ‘tenure’ at Dumfries was in Acute Medicine but it was equally enjoyable and blissful. Again I was never been given the feeling of the ‘other’, or the ‘stranger’. Not only that, after over ten months, I left to Qatar with an open mandate to come back at any time if ‘things did not suit me!!! Is that not wonderful and special to be given the feeling of ‘being wanted’ and in demand? Needless to say I was even approached to consider a permanent position and a substantive post.

Back to UK after spending a full working year in Qatar, and having the demand of keeping my license and my GMC registration alive and staying close to my grownups, who were staying in Cheshire, who had all re-trafficked back to UK after completing their University education in Sudan. I was welcomed back to Dumfries. It was the same old fantastic feeling. As a trainee back in the mid and late 1990s, I began my training in diabetes in Edinburgh at the old Royal Infirmary near Edinburgh Castle & the Royal Mile, and returned to Scotland again as an MRC Research Fellow at Ninewells Hospital in Dundee. Not to miss out the two years spell I had in Ayrshire when the educational needs of my youngest son made a re-traffic to UK in 2007 a necessity. So out of over 20 years of my career I spend in UK, one third was in Scotland. I am proud to call it my ‘Scottish Heritage’. One third of this heritage belongs to Dumfries-shire.

Dr Tarik Elhadd is a Consultant in Diabetes and Endocrinology

The Pneumonia in Bed 5 by Sian Finlay

Although it is sometimes easy to forget it amongst the busyness of front line clinical duties, I am a person.  I suspect many of you are too.  Occasionally I am unwell, but I consistently find that I still remain a person during this period – I have never yet become a disease!  So why is it that when patients come into our care, we so often default to calling them by their diagnosis instead of their name?  Go onto any ward and I guarantee it will not be long before you hear someone described as ‘The Chest Pain’ or ‘The Pneumonia’.  Many handovers will include phrases such as ‘He’s a UTI’.

No, he isn’t! He’s a PERSON who has a UTI!

A common (and potentially even worse) variant of this is the ‘bed number’ name, exemplified by ‘Bed 3 needs the commode!’  Sometimes attempts are made to justify this practice with the excuse that it protects confidentiality, but let’s be honest here.  The truth is that it simply demands more mental effort to remember the patient’s name and we are taking a short cut.  All very understandable in a busy environment, and I really don’t blame anyone.  You might think it is just semantics anyway – what does it matter if we call someone ‘The GI bleeder’?  Well I argue that it does matter.   More than you think.  These patients are people, no less complex and emotional and fragile than you or me.  By depersonalising them, we are subtly starting down a path which allows us to forget this; which allows us to view them as tasks in our day rather than the individuals they are.  If you are unconvinced, try this little exercise; read these 2 sentences and see if they elicit the same emotional response in you:

Bed 5 is agitated.

Tommy is agitated.

Would you agree that the second sentence immediately makes us feel more empathy and compassion towards its subject?

Many people will be aware of the late Kate Granger, the inspirational doctor who responded to her diagnosis of terminal cancer by establishing the ‘Hello, my name is..’ campaign.  Sadly Kate died last year, but her campaign lives on and has touched many of us in the healthcare profession.  But Kate’s work didn’t begin and end with wearing a smiley badge with our name on it; it is in essence about remembering the humanity of our patients and treating them as fellow human beings.  And I can only imagine Kate’s fiery reaction if she ever overheard herself being referred to as ‘Bed 5’!!

But we are all under pressure.  What if we genuinely can’t remember the patient’s name and are just trying to communicate information quickly?  Surely that doesn’t make us uncaring?  Of course it doesn’t, but in times of acute amnesia, we could at least say ‘the man with pneumonia’ rather than ‘the pneumonia’.  And that should only be a holding measure until we can remember his actual name – surely essential for safe communication anyway!

I hope I have convinced you that words do matter.  The phrases we use set the whole tone for the level of kindness and empathy we expect in our clinical areas.  So if any of this resonates with you, I hope you will lead by example.  Look at your patients and remember they have hopes and fears and histories and personalities…and almost always names!!

Sian Finlay (aka ‘The Migraine on ward 7’) Acute Physician and Clinical Director for Medicine at NHS Dumfries and Galloway

 

 

Surviving and Thriving in a Time of Change by Dawn Allan

I have always been fascinated by human beings and why we are the way we are.

Does our cultural and family background influence us?

Why do some people believe in God and some don’t?

Why are some people able to talk about death and dying so easily?

Why do people focus on their weaknesses, what about their strengths?

How self aware are we?

Who are we when nobody is looking?

Having emigrated from Ayrshire to South Africa where I spent my childhood and early adult years, I discovered the down side of the school playground because I sounded different.  There were only so many times a 6 year old with an Ayrshire accent wanted to mandatory repeat the word ‘potato’ at the class bullies insistence, and then suffer his disparaging comments,

“…doesn’t she sound weird…say it [potato] again…oh, ja, you’re from ’SCOT-LAND’ hey…”!?!

I remember stifling back tears, wishing I sounded like my peers so he would leave me alone.  When I reflect on this childhood bullying memory, it is mainly laughable now and I quickly adapted by adopting a local accent to blend in.  Life nurtured resilience and I learned when it might be safe to confront a bully wisely, when to ignore them and when to ask for help.

This year I relocated from Shetland to live and work in a place, “Often described as “Scotland in Miniature,” South West Scotland’s Dumfries & Galloway region is characterised by its rich cultural heritage, stunning scenery, sweeping seascapes, towering cliffs, rolling agricultural land, and its wide, wild landscapes”.  Who wouldn’t want to live here?!?  So, what about the people?  I am pleased to say they too are fascinating, warm and welcoming.

The 2017 focus for NHS Dumfries & Galloway is the move for many staff from the current DGRI to the new hospital.  From what I am gathering, this process of change is daunting for some.  If communication is key to all that we offer and provide as health care professionals, part of the way we manage our expectations in preparing to move is to be aware of how we communicate with or about each other as individuals, departments and teams.  Having a person-centred approach should be our modus operandi – our behaviour and communication does not go un-noticed by patients and visitors.  Being a ‘relational person’, I believe our hospitality is as valuable as our clinical / social care, our administration skills or our financial targets.

If a holistic approach cares for the whole person, this includes acknowledging someone’s pain, providing them with pain relief and offering them a cup of tea – all spiritual ‘acts’.  We all deliver spiritual care, what I aim to define is that we as staff do not, ‘go Greek’ i.e. compartmentalise and separate a person into ‘bits’, i.e. age, gender, status, patient, service-user, client, spiritual, religious, physical, mental, psychological, emotional…When in physical pain, the whole of our being is affected.  Judeo-Christian views that –

  • every person is born with worth and dignity
  • every person has the ability to choose between doing good and doing wrong
  • every person has the responsibility to help others in need and the community

Whether the person we are caring for or working alongside has a belief / faith or not, they will have a ‘value system’.  I hope having a VBRP – Values Based Reflective Practice – approach will help all of us as we reflect and hopefully learn from the past in the present, to know how to continue or change best practice, including our communication.  Our motives are based on values we apply every day which will help or harm the people we care for, including ourselves.

To be a hopeful presence is how I sometimes describe my encounters with people.   When we are at our most fragile and vulnerable, we need others we can trust, who will listen with their eyes and ears, who can make us laugh, encourage us when we feel stressed, sick or lonely and offer compassion.  My confidential support includes staff – we are all at different stages in our professional roles and our personal lives.  Before anyone ever declares whether they have a belief / faith or not, it is what we have in common as human beings that is paramount.  Difference is a given, but negative overemphasis on difference marginalises people – companionship and inclusion build bridges.  Sometimes, ‘life happens’ and it is the sudden, unexpected occurrences that affect our health and relationships most.

One of my favourite authors C S Lewis reminds me that a man of such academic, creative gravitas was honestly transparent, he said, “I pray because I can’t help myself.  I pray because I’m helpless.  I pray because the need flows out of me all the time – waking and sleeping.  It doesn’t change God – it changes me.”

Rabbi Harold Kushner’s description speaks into my role, “When you cannot fix what is broken, you can help very profoundly by sitting down and helping someone cry.  A person who is suffering does not want explanation: the person wants consolation.  Not reasons, but reassurance.”

If we as individuals think we do not need each other, we are deluding ourselves.  My faith informs my professional practice, without imposing it on anyone.  If the Son of God relied on twelve disciples, who am I to say I can survive without the support and wise counsel of colleagues?  We are only human and we need each other to ensure NHS Dumfries & Galloway not only survives but thrives today and tomorrow.

Dawn Allan is Spiritual Care Lead Chaplain at NHS Dumfries and Galloway

Can I make a difference? by Paul Gray

It’s a big question – can I make a difference?  How does it feel to ask yourself that?  For some of us, the answer will be different on different days.  My experience suggests that your answer depends much less on what you do, than it does on how you feel.  In this blog, I’d like to offer some thoughts on making a difference.

However, some context first.  I fully recognise the challenges we face.  Health budgets are going up – but pressures on recruitment, and the demands of an aging population, are also very real.  There is also still much to do in tackling inequalities, and improving the health of the population, which NHS Scotland can’t do on its own.  And we do know that people have the best outcomes when they are treated and cared for at home, or in a homely setting.  So our current models of care are transforming to meet these demands, and to provide the most appropriate care and treatment for people, when they need it, and change brings its own challenges.

So my first suggestion is to turn the question, “Can I make a difference?” into a statement – I can make a difference.  If you start from that standpoint, you’re much more likely to succeed.  It’s easy to become pre-occupied with the things we can’t change, and the barriers and problems – I know that I fall into that trap from time to time.  But wherever I go, I see people throughout the NHS, and in our partner organisations, making a difference every day.  So ask yourself, what is the one thing I can do today that would make a difference?  And then do it!

paul-1Now, give yourself some credit – think of an example where you did something that was appreciated.  Write it down and remember it.  If you’re having a team meeting, take time to share examples of things that the team did, that were appreciated by others.  Sharing these examples will give you a bank of ideas about simple things that matter to other people.  And it also gives you something to fall back on, if times are tough.

Next – think of an example when someone did something for you, which you appreciated.  Find a way to share these examples too – if it worked for you, it might work for someone else as well.  Ask yourself when you last thanked someone for something they did well, or something you appreciated.  It’s easier to go on making a difference if others notice what you’re doing!

If you’re leading or managing a team, ask yourself how much time the team spends discussing what went well.  It’s essential to be open and transparent about problems and adverse events, but if that’s the whole focus of team discussions, we overlook a huge pool of learning, resources and ideas from all the positive actions and outcomes.  And we risk an atmosphere where making a difference is only about fixing problems, rather than about improvement.  So, as yourself and your team, what proportion of time should be spent on what went well?

Remember to ask “What Matters to You?”.  I know that the focus of this question is on patients, and that’s right because they are our priority, but it’s a good question to ask our colleagues and our teams as well.  Just asking the question makes a difference – it gives you access to someone else’s thoughts and perspectives, and is likely to lead to better outcomes.

paul-2Will any of this change the world?  Not on its own, of course.  But you could change one person’s world, by a simple act of kindness, or listening, or a word of thanks.  You can make difference!

Paul Gray is the Chief Executive Officer for NHS Scotland and the Director General for Health and Social Care at the Scottish Government

I am human by Dawn Renfrew

“I am human: I think nothing human alien to me”

dawn-1-terence-the-african

Terence the African

So wrote Terence the African, around 2000 years ago. He was a slave from Roman Africa, a dramatist, and an interpreter. He was quoted recently in the annual BBC Radio 4 Reith lectures, by Professor Kwame Anthony Appiah, professor of philosophy and law at New York University.

dawn-2-appiah-now

Appiah Now

Professor Appiah’s subject, “Mistaken Identities”, is one of the most defining issues of our age. We all have multiple identities which describe who we are. These include those suggested by our gender, age, occupation, political affiliation, nationality, race etc. The possibilities are endless when you think about it: parent, child, sibling, friend, Bake-off fan, or Queen of the South fan are just a few.

In a healthcare setting, we also have many identities, including being part of our own discipline, team, ward or service. Sometimes we are ourselves patients, and some of us are managers. Any health condition, whether physical or mental, can become part of our identity.

Appiah himself embodies many complex aspects of identity. Half-British, half-Ghanaian, he was brought up in Ghana and England, and has now adopted America as his homeland. He is the grandson of the Chancellor of the Exchequer, Sir Stafford Cripps. He is a crime novelist, and a fan of Japanese haiku. In addition, he was one of the first people to take advantage of the new gay marriage laws in New York State. He is probably ideally placed to set about unpicking assumptions which we all have about the “labels” associated with identity.

dawn-3-growing-up-in-england

Growing up in England

Appiah discusses 4 aspects of identity over 4 lectures: creed [religion], country [nationality], colour [race] and culture [Western identity vs non-Western]. These are delivered in 4 different locations: London, Glasgow, Accra [capital of Ghana] and New York. The lectures cover the great sweep of history, and examples from a range of countries across the globe. They argue that identities are more complex and fluid, than are commonly supposed. They are more a “narrative”, than an “essence”, and do not necessarily determine who we are. Everywhere you look, you can find exceptions in identities, which challenge our commonly-held assumptions about them.

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Growing up in Ghana

Identity is important for our survival. It helps give meaning to our lives, and helps us feel, and be, part of a community. Evolutionary psychologists would argue that it has been critical to our development as a species. All identities are constructed and evolve over time, but as soon as you construct an identity, you create potentially not only an “us” [those within the group], but also an “other” [those outside it]. When there is competition for resources, things can turn nasty, and the “others” may be persecuted or scapegoated. So it is important that we are relaxed and open about our identities, and that we recognise why that process of “othering” arises so easily within all of us. It’s a trap that is easy to fall into, and we need to resist it.

Appiah doesn’t mention healthcare in particular. But if we apply these ideas to the healthcare setting, we can see that a shared identity can help us pull together to meet our patient’s needs, in what are often increasingly challenging circumstances. Equally, there can be a process of “othering” which operates, whether it is towards our patients, our managers, our employees, or other agencies. Whilst understandable, “othering” can prevent us fully engaging with the “other” in a way that leads to the best outcome for all of us. This is relevant to our aims to provide person-centred care, and to integration with other agencies.

On the question of nationhood, Appiah isn’t against nationalism, so long as it is an “open, civic nationalism”. His favourite idea of nationhood, however, involves 2 concepts. The first is patriotism, defined as concern with the honour of your country [or countries]. This means feeling proud when your country does something good, and ashamed when it does something bad. The second concept is cosmopolitanism, which means being a citizen of the world. These can combine to form a “patriotic cosmopolitanism”. You can, and should, respect both “the local” and “the global”.

Identities connect the small scale, where we live our lives alongside our kith and kin [and healthcare colleagues], with larger movements, causes and concerns. Our lives must make sense at the largest of scales as well as at the smallest. We live in an era where our actions, both ideological and technological, have global effects. When it comes to the compass of our concern and compassion, humanity itself is not too broad a horizon. We live with 7 billion other humans, on a small, warming planet. The concept of cosmopolitanism has become a necessity.

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Appiah with Obama

Appiah argues for a tolerant, pluralistic, and diverse society. He says, failure to accept this is not just a failure to understand human identity, it is not in our collective self-interest. We do not need to abandon identities, but we don’t need to be divided by them either. Ultimately, the identity of “being human” ought to transcend all others.

As Scout, the young heroine in the novel about race and mental illness, To Kill a Mocking Bird, concludes: “I think there’s just one kind of folks. Folks”.

The Reith lectures are available to listen to on the Radio 4 website, indefinitely.

Dr Dawn Renfrew is a Consultant Child and Adolescent Psychiatrist for NHS Dumfries and Galloway

Oh Christmas Tree by Catherine Nesbitt

Throughout my childhood, every December we went to Newcastle to see my mother’s best friend, Paddy. Paddy’s Christmas extravaganza was the highlight of my year! First, the pantomime (we once stumbled across the cast in a side-street restaurant… It was a bizarre Newcastle1.jpgcombination of Linda Lusardi, Geoff Capes and Kenny Baker (at the time, Page-3 model, World’s Strongest Man and R2D2). From there, Fenwick’s Christmas Window (a MUST-SEE if you never have) and a local garden-centre decorated like Lapland but in Gosforth! Paddy bought armfuls of decorations there every year; my parents bought my sister and me one decoration each because they couldn’t afford more than that.

That was where I fell in love with the most beautiful Christmas tree I have ever seen; an 8ft tree with branches right to the floor. I begged to take it home with us, but no, our living room was too small.
Two years later when we moved to a house in Carlisle with 12ft ceilings, I asked again!
Again, it was denied; they just couldn’t afford a new tree.
The following year (aged 13) that 8ft tree was all I wanted for Christmas. Mum gave Dad one of “those looks” and the tree was mine; on the condition I decorated it from then on!

DEAL!

That tree and our growing collection of decorations were a perfect match and my sister and I have added decorations ourselves over the years. None of them match; there are no coordinated sets of baubles and no “theme”; some are cute, some are beautiful and some are downright bizarre!

decoration01A bear sitting on a drum and a little crate of toys marked ‘North Pole’ from our Christmas trips with Paddy (and a lovely Christmas reminder of her since she died in 2004). A clip-on peacock documents my lifelong affinity with them (‘peacock’ was my first word and aged 2, I tottered over to a particularly unfriendly one and still have a scar on my forehead for my troubles). A corduroy reindeer from when Starbucks first came to Newcastle, (my University flatmates and I agreed we would not set foot in Starbucks for the first time until it snowed to ensure the “full Starbucks experience” (i.e. as much like a movie-set in New York at Christmas as possible). But then it didn’t snow! One morning, with a few floaty snowflakes in the wind, we all ditched lectures to sit in Starbuck’s window, but the coffee machine had broken and the tables were piled high with dirty plates! It was so disappointing that we never went back but still chortle about it when we make our annual pilgrimage to see Fenwick’s window together!)

The hideous ones are mainly thanks to my sister. She worked in America as an aerospace engineer testing a new aircraft. Her first Christmas in California, the company produced commemorative decorations and she sent one home (an F35-Lightning-II in a wreath of flags) with the characteristically sarcastic message, “Because nothing says ‘Peace on earth and goodwill to all men’ quite like a 5th generation fighter aircraft!”
She later moved to Maryland and we road-tripped coast to coast collecting a haul of decorations en route: a sleigh bell from San Francisco, Santa in a reindeer rubber ring from San Diego, a “Get your kicks on Route 66” decoration from Arizona and a pottery camel made by the Mescalero Apache Tribe in New Mexico. On arriving in Maryland she sent home our most grotesque decoration: a crab-shell painted like Santa’s face!

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floodIn January 2005, only hours after taking the tree down, a flood hit Carlisle. We scooped the decorations up in a blanket and hauled them upstairs. My tree was lost, but the decorations survived. When the house was refurbished, I chose another tree which graced my parents’ living room for a decade, but only days after putting it up last year, a second flood hit Carlisle and that tree was lost too! As the water poured into their street, my parents stripped the tree of the decorations and saved them again. It sounds unlucky but earlier that year Dad decided to store the decorations in his workshop rather than back in the attic. If the tree had not been up when the flood hit, the decorations would’ve all been lost too. They are all the more precious now having survived when everything else did not.

Our tree represents our family history; where we’ve been, what we’ve done and the friends we’ve had. My parents’ frugality produced an extraordinary collection that I would totally recommend gathering for yourself. My mother even uses it to store sentimental things which have no obvious place to live. Since retiring from Nursing, she volunteers in a school and when one little girl recently left, she thanked Mum by giving her a necklace with a big elephant pendant. As Mum doesn’t wear necklaces she wasn’t sure what to do with this little gift, but exchanging the chain with a ribbon solved the problem. This year the elephant has been added to the tree.

treeCheap or expensive, ugly or beautiful, they all have a place. The collection has become an heirloom in our family and one day my sister and I will divide them between us to keep the memories alive…. She can definitely have the crab!

Dr Catherine Nesbitt is a Clinical Psychologist in the Child and Adolescent Clinical Psychology Service at NHS Dumfries and Galloway.