An Uncertain Future by Ken Donaldson

Well, that’s been an interesting few months, hasn’t it!! We all watched with fascination as Covid spread across the Globe – China first then Italy and Spain – before it hit our shores and started creeping towards Dumfries and Galloway.  Everything changed. We were told to stay at home, avoid loved ones we didn’t live with, only go out if necessary and our work was transformed. Many people had to ‘Shield’ at home and could no longer work. Those still coming in found their working day turned on its head; perhaps completely new duties or sitting in front of a screen all day. But there was one thing I am pretty sure was felt by everyone; fear.

I was terrified. Terrified of how many people were going to get sick, terrified of how many may die, terrified for our frontline staff who were putting their lives at risk. I was also terrified for my own family and loved ones and, whilst this may sound selfish, I was terrified that I would fail in my job. This felt like a big test of leadership. Was I up to the task? Was D&G at risk because I was about to fail.  Many sleepless nights followed.

However it all looks different now. We have survived the first peak of Covid and, in general, we have gotten off fairly lightly. Our colleagues in the Critical Care Unit and Care Homes may disagree as those two areas have experienced a significant impact from the disease but, as a region, the numbers were nowhere near what we expected and whilst this may be down to our rurality it also reflects how all of us have adhered to social distancing and isolation and stopped the spread.

So what happens now? Lockdown restrictions will start to ease, people will be out an about and there is the strong possibility of a second wave. However there is no doubt that we are much more prepared for that and have systems in place to deal with it should it come. But social distancing is here for some time and we all need to think how we are going to deliver our services for the people of D&G in this uncertain future.

Things have changed and one message I would like to share today is that we cannot go back to what we had before. It quite simply wasn’t working and if we have demonstrated anything in the past 3 months it is that we can deliver healthcare in 2020 in a very different and more efficient way. We don’t need face to face consultations all the time, we don’t need to admit so many people to hospital, we don’t need lots of different steps before a patient interacts with the professional they need to.

There was one other noticeable change when all this kicked off; we all pulled together like never before. Many petty differences which had prevented progress vanished. People reached out to help each other (virtually or 2m apart, of course!) and it was obvious that we genuinely cared about our colleagues. There was really no need to use the phrase ‘We are all in this together’ because we all inherently knew that was the case.

So while the dust settles and we look around at the ‘New Normal’ let us not go back to what we did before. Let us embrace new ways of working and talk to our colleagues about how we do it together. Let us do the right thing for our population.

“A crisis can create an opportunity to learn and build a better way forward. The system that will emerge on the other side of the crisis is shaped by those leaders who are able to harness the potential in the moment and galvanise others to act.”

John Sturrock 2019

Ken Donaldson is Executive Board Medical Director for NHS Dumfries and Galloway

With thanks to Charles Mackesy for the image.

 

 

 

Enough Love by Ken Donaldson

I was out for a run the other morning (yes, despite the physique I do run. I also eat) and was listening to a random music selection. An oldie by Genesis, Land of Confusion, came on. I smiled wryly as I listened to the lyrics. Lines such as ‘Too many problems’ and ‘losing control by the hour’ certainly resonated.

The past few weeks have been simply unbelievable. The initial adrenaline rush brought on by the Covid 19 crisis has started to dissipate and the realisation of what is coming and how this will affect us is sinking in. The purpose of this blog is not to discuss all the plans we are working through and what needs to happen over the next few days and weeks to make us as ready for this as we can be. The purpose of this blog is to talk about us. When I say us I was thinking NHS D&G but in reality I realise I mean everyone working together with the NHS through these difficult times; social workers, carers, police, council, fire and safety, third sector etc etc. Actually what I now realise is that I mean the People of Dumfries and Galloway. All of us.

What I have witnessed over the past few weeks has been a simply astonishing response to this impending crisis. Those in the critical areas; Primary and Community Care, Emergency Dept, Combined Assessment Unit, Critical Care Unit have stepped forward with plans to significantly alter services and ensure they can cope. Those in other areas less critical stepping forward to offer their skills and time to support services in any way they can.

All this is amazing and, I can’t deny, that when I have been feeling particularly stressed, it has made me feel emotional. But its the small things that have brought on the tears; the catering assistant when I was paying for my lunch who gently laid her hand on my arm and asked if I was ok (I know, she shouldn’t have, infection control etc but it was a lovely gesture), the colleague making a point of stopping me to ask if I was all right, another who offered a hug. I mention these for a specific reason.

Whilst I may be feeling a little stressed just now in a few weeks we are all going to be facing simply unprecedented pressures. Quite a few of us will be sick with this virus, we will have friends and family suffering and work will be relentless. We need to cling on to these small gestures. Simple acts of kindness are going to help keep us going through the dark times.

I was at a meeting with Valerie White, Interim Director of Public Health, and she said words to this effect “This is going to be really hard and we all need to work together but I can say without any shadow of a doubt that there is nowhere else I would rather face this than Dumfries and Galloway. The commitment I am seeing from everyone and the willingness to work together is amazing.” I can only echo Valerie.

Returning to that song, Land of Confusion, there was another line that stuck out; “There’s not enough love to go round”. Now this is one I totally disagree with, in Dumfries and Galloway I think there is enough love to go round, and then some.

Take care everyone. We can do this together.

Ken Donaldson is Medical Director at NHS Dumfries and Galloway

*Image taken from “The Boy, the mole, the fox and the horse” by Charlie Mackesy

Holly

This Beautiful young woman called ‘Holly Butcher’ posted her advice to the world  24 hours before she died of cancer.

This was her message for you…

“It’s a strange thing to realise and accept your mortality at 26 years young. It’s just one of those things you ignore. The days tick by and you just expect they will keep on coming; Until the unexpected happens. I always imagined myself growing old, wrinkled and grey- most likely caused by the beautiful family (lots of kiddies) I planned on building with the love of my life. I want that so bad it hurts.

That’s the thing about life; It is fragile, precious and unpredictable and each day is a gift, not a given right.

I’m 27 now. I don’t want to go. I love my life. I am happy.. I owe that to my loved ones. But the control is out of my hands.

I haven’t started this ‘note before I die’ so that death is feared – I like the fact that we are mostly ignorant to it’s inevitability.. Except when I want to talk about it and it is treated like a ‘taboo’ topic that will never happen to any of us.. That’s been a bit tough. I just want people to stop worrying so much about the small, meaningless stresses in life and try to remember that we all have the same fate after it all so do what you can to make your time feel worthy and great, minus the bullsh*t.

I have dropped lots of my thoughts below as I have had a lot of time to ponder life these last few months. Of course it’s the middle of the night when these random things pop in my head most!

1) Those times you are whinging about ridiculous things (something I have noticed so much these past few months), just think about someone who is really facing a problem. Be grateful for your minor issue and get over it. It’s okay to acknowledge that something is annoying but try not to carry on about it and negatively effect other people’s days.

2) Once you do that, get out there and take a freaking big breath of that fresh Aussie air deep in your lungs, look at how blue the sky is and how green the trees are; It is so beautiful. Think how lucky you are to be able to do just that – breathe.

3) You might have got caught in bad traffic today, or had a bad sleep because your beautiful babies kept you awake, or your hairdresser cut your hair too short. Your new fake nails might have got a chip, your boobs are too small, or you have cellulite on your arse and your belly is wobbling.

Let all that shit go.. I swear you will not be thinking of those things when it is your turn to go. It is all SO insignificant when you look at life as a whole. I’m watching my body waste away right before my eyes with nothing I can do about it and all I wish for now is that I could have just one more Birthday or Christmas with my family, or just one more day with my partner and dog. Just one more.

4) I hear people complaining about how terrible work is or about how hard it is to exercise – Be grateful you are physically able to. Work and exercise may seem like such trivial things … until your body doesn’t allow you to do either of them.

I tried to live a healthy life, in fact, that was probably my major passion. Appreciate your good health and functioning body- even if it isn’t your ideal size. Look after it and embrace how amazing it is. Move it and nourish it with fresh food. Don’t obsess over it.

5) Remember there are more aspects to good health than the physical body.. work just as hard on finding your mental, emotional and spiritual happiness too. That way you might realise just how insignificant and unimportant having this stupidly portrayed perfect social media body really is.. While on this topic, delete any account that pops up on your news feeds that gives you any sense of feeling shit about yourself. Friend or not.. Be ruthless for your own well-being.

6) Be grateful for each day you don’t have pain and even the days where you are unwell with man flu, a sore back or a sprained ankle, accept it is sh*t but be thankful it isn’t life threatening and will go away.

7) Whinge less, people! .. And help each other more.

😎 Give, give, give. It is true that you gain more happiness doing things for others than doing them for yourself. I wish I did this more. Since I have been sick, I have met the most incredibly giving and kind people and been the receiver of the most thoughtful and loving words and support from my family, friends and strangers; More than I could I ever give in return. I will never forget this and will be forever grateful to all of these people.

9) It is a weird thing having money to spend at the end.. when you’re dying. It’s not a time you go out and buy material things that you usually would, like a new dress. It makes you think how silly it is that we think it is worth spending so much money on new clothes and ‘things’ in our lives.

Buy your friend something kind instead of another dress, beauty product or jewellery for that next wedding. 1. No-one cares if you wear the same thing twice 2. It feels good. Take them out for a meal, or better yet, cook them a meal. Shout their coffee. Give/ buy them a plant, a massage or a candle and tell them you love them when you give it to them.

10) Value other people’s time. Don’t keep them waiting because you are sh*t at being on time. Get ready earlier if you are one of those people and appreciate that your friends want to share their time with you, not sit by themselves, waiting on a mate. You will gain respect too! Amen sister.

11) This year, our family agreed to do no presents and despite the tree looking rather sad and empty (I nearly cracked Christmas Eve!), it was so nice because people didn’t have the pressure of shopping and the effort went into writing a nice card for each other. Plus imagine my family trying to buy me a present knowing they would probably end up with it themselves.. strange! It might seem lame but those cards mean more to me than any impulse purchase could. Mind you, it was also easier to do in our house because we had no little kiddies there. Anyway, moral of the story- presents are not needed for a meaningful Christmas. Moving on.

12) Use your money on experiences.. Or at least don’t miss out on experiences because you spent all your money on material sh*t.

13) Put in the effort to do that day trip to the beach you keep putting off. Dip your feet in the water and dig your toes in the sand. Wet your face with salt water.

14) Get amongst nature.

15) Try just enjoying and being in moments rather than capturing them through the screen of your phone. Life isn’t meant to be lived through a screen nor is it about getting the perfect photo.. enjoy the bloody moment, people! Stop trying to capture it for everyone else.

Random rhetorical question. Are those several hours you spend doing your hair and make up each day or to go out for one night really worth it? I’ve never understood this about females

🤔.

16) Get up early sometimes and listen to the birds while you watch the beautiful colours the sun makes as it rises.

17) Listen to music.. really listen. Music is therapy. Old is best.

18) Cuddle your dog. Far out, I will miss that.

19) Talk to your friends. Put down your phone. Are they doing okay?

20) Travel if it’s your desire, don’t if it’s not.

21) Work to live, don’t live to work.

Seriously, do what makes your heart feel happy.

22) Eat the cake. Zero guilt.

23) Say no to things you really don’t want to do.

24) Don’t feel pressured to do what other people might think is a fulfilling life.. you might want a mediocre life and that is so okay.

25) Tell your loved ones you love them every time you get the chance and love them with everything you have.

26) Also, remember if something is making you miserable, you do have the power to change it – in work or love or whatever it may be. Have the guts to change. You don’t know how much time you’ve got on this earth so don’t waste it being miserable. I know that is said all the time but it couldn’t be more true.

Anyway, that’s just this one young gals life advice. Take it or leave it, I don’t mind!

Oh and one last thing, if you can, do a good deed for humanity (and myself) and start regularly donating blood. It will make you feel good with the added bonus of saving lives. I feel like it is something that is so overlooked considering every donation can save 3 lives! That is a massive impact each person can have and the process really is so simple.

Blood donation (more bags than I could keep up with counting) helped keep me alive for an extra year – a year I will be forever grateful that I got to spend it here on Earth with my family, friends and dog. A year I had some of the greatest times of my life.

..’Til we meet again.

Hol

Xoxo”

 

Innovation through Compassion by Ken Donaldson

Last week Jeff Ace introduced us to SAM, the Sustainability and Modernisation Programme, that NHS D&G are launching to address the complex and challenging landscape that faces the NHS today; increasing demand, reducing workforce and financial constraint. We started touring the region this week, meeting with teams to discuss these issues and ask them for their thoughts and ideas. It has been energising to hear from you all, there are lots of really good and simple ideas as to how we can change, but it is also apparent that there are many significant obstacles that it will take time to overcome. 

Lets be honest, working in healthcare today is really tough. We all know ‘winter is coming’  when in reality it never went away. Our recruitment challenges extend well beyond medics now with difficulty filling nursing, AHP and other professional posts. Beds are blocked, shifts cant be filled, and so on. What do we do? 

The following is a quote from a Kings Fund paper titled “Caring to Change’. 

“Only innovation can enable modern health care organisations and systems to meet the radically changing needs and expectations of the communities they serve. While adequate financial support is a necessary precondition, it is clear that more money on its own, without transformative change, will not be enough.”

Two words stick out to me, Innovation and Transformation. Both are necessary, both are hard, especially when we are busy, but both can be fun if we work together and support each other to deliver them. Done well they can make our lives less busy and our patients care safer and more person centred. But how can we achieve this? I know many people reading this will be thinking ‘Well, fill all our vacant posts and that will solve the problem’ and they may be right, but we know that is not easy and, whilst we cannot take our eye off the recruitment challenge, we need to do something else. 

There is a growing body of evidence showing that a different form of leadership can achieve cultural change and provide the environment that can lead to innovation and transformation. This leadership focuses on compassion. By compassion I don’t just mean Kindness and being nicer to each other (although I will come back to that at the end). So what do I mean?

Compassion can be understood as having four components: attending, understanding, empathising and helping.

Attending

If I am going to lead with compassion then first I must be present with you, pay attention, I have to Listen with Fascination. This may sound obvious but is not as easy or common as it may sound. Too often people listen with minimal interest. They clearly are waiting for the talker to stop so they can get their point across. Listening with fascination means giving your all to the person you are attending. Really hearing what they are saying so that you can fully understand their point of view. 

Understanding

If we truly listen to others then we can start to understand their point of view, what is causing this persons distress, angst or worry? It is only by fully understanding that you can apply the third aspect; empathy. 

Empathy

I have heard several people say that it is impossible to truly empathise, how can we feel what others feel when they are a complex mix of experiences and values that differ from our own. This may be true but if we listen and understand their problem then, at some emotional level, we can feel their distress and share their feelings. Then we will be driven to the fourth aspect, the motivation to help. 

Helping

Wishing to help doesn’t have to mean ‘give me your problem and I will sort it’ but thoughtful and intelligent action to address the individual or teams issues. More  ‘what can I do to support you, what do you need or who do you need to talk to to solve this problem?’ Providing reassurance that different ways of working, innovation & transformation, are welcome and will not be criticised and blocked or, if things don’t work, there will be no accusation or blame. 

To create a compassionate culture, one in which we can thrive and transform our services, then we all need to demonstrate these simple behaviours. I urge you to ‘Hold the Mirror up’ to yourself and consider your behaviours not others. What can you do to improve your service, not what others can do to improve theirs. 

Every interaction, every day, shapes our culture. The ‘leaders’, and by that I don’t just mean ‘management’ but all in senior positions, have a particularly powerful role in this. What they say, pay attention to, monitor and reward communicates what is valued by our organisation. As leaders if we pay attention to our teams, listen, understand,  empathise and seek to help then we are a step closer to the high performing, innovative and transformative teams that we need to get us through the difficult times. 

To quote Michael West, a founder of Compassionate Leadership….

“Virtually all NHS staff are committed to providing high quality and compassionate care. They represent probably the most motivated and skilled workforce in the whole of industry. However, we impose on them a dominant command and control style that has the effect of silencing their voices, suppressing their ideas for new and better ways of delivering patient care and suffocating their intrinsic motivation and fundamental altruism. Released, their motivation and creativity will ensure commitment to purpose and performance. 

Compassionate leadership means creating the conditions – through consistently listening, understanding, empathising and helping – to make it possible to have tough performance management and tough conversations when needed. Staff complain they only see their leaders when something goes wrong and that even if they do listen, nothing changes after the conversation. Compassionate leadership ensures a collective focus and a greater likelihood of collective responsibility for ensuring high-quality care.”

There is a lot more to Compassionate Leadership. Figures 1 and 2 demonstrate some of this which I will explore in a future blog. If you wish to find out more of this yourself you can listen to a presentation from Michael West here or read the Kings Fund paper ‘Caring to Change’ here. 

Just before I finish I would like to return to Kindness, which I mentioned earlier. Whilst Compassionate Leadership has many facets and some different ways of thinking, Kindness is at its core. If we are going to survive the next few years then we need to transform and adapt but we must not forget to be kind to each other. In the NHS we often discuss Kindness to patients but rarely do we discuss Kindness as a leadership behaviour. I am not saying that any of this is easy and I am certainly not saying that I have demonstrated Compassionate Leadership over the years, far from it. I am however willing to put my money where my mouth is and practice this way from now on. I would ask you all to do likewise.

Ken Donaldson is the Board Medical Director at NHS Dumfries and Galloway

The Patchwork Quilt by Valerie Douglas

A doctor once told me that I had a portfolio career.  As my working life as a nurse in the NHS draws to a close it seems to me more like a patchwork quilt, assembled from many knitted squares.  Beginning in a psychiatric rehabilitation ward, I moved to acute admission in the old Crichton.  I dipped in and out of that ward undertaking secondments: to the Clinical Research Department, a Lecturer/Practitioner role, Care of the Elderly, Patient Safety and Improvement.  Then full circle, I moved back to rehabilitation nursing, this time interwoven with forensic threads.  Knit one, purl one.

Recently I’ve been on a partnership working secondment, with seats on the IJB and the RCN Board.  I have needed to insert some elasticated fabric into my knitting, as this has stretched me in directions unlike anything experienced before.  

With retirement imminent it is inevitable that I reflect on the whole quilt, the completed work, and remember the dropped stitches, the unravelling I’ve seen, the piecing together, the mending.  Some squares have faded with time but others remain vivid.

The Quiet Man.  This inpatient was polite, smart, of late middle age.  He wore his depression like a waistcoat watch, well-hidden in a little pocket.  You could just catch a glint of it if you really looked.  One Friday he went home for the day.  This wasn’t unusual.  He would typically return before 9 pm.  When he didn’t appear, staff phoned him.  No answer.  They phoned his family.  No, he didn’t have plans to come home that day, he had informed them explicitly.  Alarm bells rang and rightly so.  He never returned.  He had chosen a way out of his deep, silent despair.  Our thoughts of course went out to his lovely family for their loss.  But today my thoughts are also for us, the staff who nursed him, the doctors who treated him, the domestics who cleaned his room, the ladies at medical records who received those final ward documents.  I wonder if they still mourn him like I do over twenty years later.

Miss M.  Mute, traumatised, psychotic, she hardly ate or slept.  I was on a spell of night duty and would sit by her bed, talking to her, after giving her medicine.  She would listen intently, not responding.  ‘Looks perplexed’ were the words used most often to describe her in nursing notes.  After about a week she was out of bed when I arrived for night shift.  She glided around the ward, keeping close to the walls, vigilant.  One evening I took chocolate éclair sweets in.  I gave three to the nurse and three to the nursing assistant, saying to Miss M as she passed, ‘I’m leaving these three sweets on the table for you.’  She neither slowed nor acknowledged me.  A short while later the nursing assistant bounded into the office, ‘She’s taken those sweets.’  In mental health nursing it is often not diagnostic tests that expose signs of improvement, but observation and engagement.  Nurses can usually pinpoint turning points – medication has started to work, trust has been gained – and I have never forgotten the night of the sweets.  Each Christmas I’m reminded of Miss M when I hang the tinsel angel she made for me before her discharge.

Nursing has presented me with many patterns to follow, using different weights and colours of wool, some challenging designs.  Although all secondments have been worthwhile, I’ve always chosen to return to hands on nursing, the role I rate the highest, the role I value, the one I will miss the most.  Knit one, purl one.

 Val Douglas RMN, DipN, BSc (Hons), MSc Research (nursing)

Two tins of soup by Libby Johnston

When asked to submit something for the blog quite some time ago, the suggestion was that the subject be something that readers would find moving in some way. Recent press has been highlighting the degree of loneliness some are experiencing and how it can effect wellbeing physically, mentally and isn’t always visible to others.

In the run up to Christmas festivities I went to one of the so-called Pound shops. It leans towards my frugal nature and there is nothing like a bargain. However many use such shops to survive with a limited budget.

As I wandered down the first aisle a rather frail but spritely elderly woman moved to allow me to pass and I thanked her and we exchanged pleasantries. As I made my way through the aisles and shelves she seemed on the same route and I couldn’t help but overhear her saying ‘Merry Christmas’ to virtually every person she encountered. I made my way to the checkout and there she was again in front of me in the line. As I looked at her clothes, I could see that she had many layers of threadbare jumpers and no coat on what was a cold day.

She seemed to know the person at the checkout and was asking if they were ready for the holidays and he asked her the same to which she answered yes this was her last shopping trip. On the conveyor belt were 2 tins of soup. He commented, ‘No turkey’? She shook her head, saying nothing and placed the tins of soup in her shopping bag, continuing to wish everyone around her a Merry Christmas and the same to us as she trudged out of the shop, bag in hand. My heart was full as she had shared the joy of the season with everyone she encountered in the shop and yet there was a loneliness to her life.

As a nurse and midwife (retired), it’s always been in my nature to reach out and help others in need. I desperately wanted to ask this dear lady if she was having a Christmas meal with anyone and if not invite her to share ours. I feared she might only be facing a tin of soup. However, she had disappeared from sight and I will never know.

It left me feeling a touch of sadness for her. There is much awareness about people being lonely and particularly at this time of year. Many organisations, charities are endeavouring to help those who may be lonely. There will always be those who won’t want help and soldier on like this woman who found some company, even joy in sharing festive greetings in a shop. A lesson perhaps for the less lonely to be bolder in reaching out to others not only at Christmas but in everyday life.

The government is investing in ‘loneliness’ as it is felt it has been shown to impact health and wellbeing. This is highlighted in this article in The Guardian:“UK to tackle loneliness crisis with £11.5m cash injection”

The money will help establish projects that will bring people together and in so doing reduce elements of loneliness, improving health and wellbeing.

 

“Loneliness and the feeling of being unwanted

is the most terrible poverty.”

Mother Teresa

A Yellow Wood by Gill Stanyard

The 1st June 2018 was my  last day as a  Non-Executive Director for NHS Dumfries and Galloway.  After four years of a potential eight year appointment from Scottish Government, I decided to  leave. I felt I had reached a good and fulfilling end and to stay on for another four year term would have been signing up to endure.  I made a decision I wanted to enjoy. So, I felt happy with my decision to end my time, made when swimming in a shimmering blue sea one early morning, whilst in Greece.

I made a decision. ‘Decision.’ The Latin origin of this word  literally means, “to cut off.” Making a decision is about “cutting off” choices – cutting you off from some other course of action. Now that may sound a little severe and limiting, it’s not. It is liberating. Decisions, they take us onto the next stepping stone, sometimes called  ‘The End’  – two words which tell us a story is over.

My friend made the final and shocking decision to end his life at the weekend. A fact I am still struggling to comprehend. Our last communication was a fortnight ago, with me texting him about all the different gins (24 to be exact) that were on the menu at my leaving ‘do.’  He texted me back with a  joke about Rhubarb gin. Then nothing. I didn’t think too much of it, life gets in the way. And then I received ‘The News.’  Yet I have forgotten a couple of times since then, and have gone to text him. Then, with a strange physical ‘flipflop’ stomach feeling,  I have remembered ‘The End,’ which is accompanied by much hurt and sorrow and  strangely, lines from one of my favourite poem’s. – ‘ The Road Not Taken.’ by Robert Frost:

Two roads diverged in a yellow wood,

And sorry I could not travel both

And be one traveler, long I stood

And looked down one as far as I could

To where it bent in the undergrowth;

 

Then took the other, as just as fair,

And having perhaps the better claim,

Because it was grassy and wanted wear;

Though as for that the passing there

Had worn them really about the same,

 

And both that morning equally lay

In leaves no step had trodden black.

Oh, I kept the first for another day!

Yet knowing how way leads on to way,

I doubted if I should ever come back.

 

I shall be telling this with a sigh

Somewhere ages and ages hence:

Two roads diverged in a wood, and I—

I took the one less traveled by,

And that has made all the difference.

 A single decision can transform a life. I always assumed Frost wrote this poem about himself, yet I recently read Hollis’s  biography of Welsh poet Edward Thomas, and discovered that Frost and Thomas were ‘besties.’  Frost had written the lines as a joke about Thomas’s depression induced indecision, which showed up on their long ‘walk and talk’ days together, with Thomas never being able to decide whether to take the path on the right or the left. When Frost sent the poem to Thomas, Thomas initially failed to realize that the poem was (mockingly) about him. Instead, he believed it was a serious reflection on the need for decisive action. At the age of 36, after much wrestling, Thomas felt compelled to enlist as a soldier in the Great War.

He wrote of his decision to his friend Robert Frost  “Last week I had screwed myself up to the point of believing I should come out to America & lecture if anyone wanted me to. But I have altered my mind. I am going to enlist on Wednesday if the doctor will pass me.”  On the first day of the battle at Arras, Easter Monday, 9 April 1917, Thomas was killed by a shell blast.  His poem ‘Adlestrop’ was published in the New Statesman three weeks after his death and has since become a classical favourite of British poetry.

Adlestrop

Yes, I remember Adlestrop —

The name, because one afternoon

Of heat the express-train drew up there

Unwontedly. It was late June.

 

The steam hissed. Someone cleared his throat.

No one left and no one came

On the bare platform. What I saw

Was Adlestrop — only the name

 

And willows, willow-herb, and grass,

And meadowsweet, and haycocks dry,

No whit less still and lonely fair

Than the high cloudlets in the sky.

 

And for that minute a blackbird sang

Close by, and round him, mistier,

Farther and farther, all the birds

Of Oxfordshire and Gloucestershire

Life sometimes makes decisions for us. I don’t mean to get all Dead Poet’s Society here, yet I think T.S Eliot had something when he wrote “What we call the beginning is often the end. And to make an end is to make a beginning. The end is where we start from.” (Four Quarters) We get ill and have to take time to rest and get well, and sometimes we don’t always recover, we have accidents,  we don’t get chosen for that job or by that person and we lose people and animals we love and care for.

Where possible, make a decision and choose your ending and make a new beginning, whether it be the end of an unhappy relationship and the start of a happier one with yourself,  saying No to working for extra hours, when you could be saying Yes to spending more time with your family, or your dog or your garden, standing up to a bully and choosing to start being assertive and courageous, speaking out against something which you see is wrong and thus ending corruption or collusion, stopping trying to do everything by yourself and start asking for help -(getting a mentor through NES really helped me with this)  and putting a stop to being taken for granted and drawing new boundaries that put your needs first.

I have taken a Non-Executive decision to be more accountable to myself in my life, to spend more time outside, to stop watching tv and read more poetry,  to save up to live in a place where I can have two donkeys, chickens and  another rescue dog and to track down some Rhubarb gin.

Sorry if I did not see you to say Goodbye. I wish you well in your decision making and hope that your sigh is a happy and fulfilled one.

I

What Matters by Ken Donaldson & Alastair McAlpine

I recognise that it is a bit cheeky of me to put my name to this as I haven’t written any of it. A few months back I was scrolling through Twitter and came upon this thread that really moved me. The messages are simple yet immensely powerful. I have therefore simply taken some screenshots from Twitter and published them here. As you can see this is by a Doctor called Alastair McAlpine who is a Palliative Paediatrician in Cape Town, South Africa. Read on…..

Cant Thank Everyone Enough

You don’t have to look very far these days to realise that the NHS is under significant pressure; the local bulletins, national news and local papers are all talking about ‘Winter Pressures’ and ‘Flu Outbreaks.’ This, along with staff shortages and capacity issues, would make many of us dread going in to hospital or having a loved one admitted however I recently had to witness my husband spend the festive period in the new DGRI and I was so impressed by his, and my, care that I wanted to write about it.

On the 19th of December my husband was referred up to X-Ray for a CXR. This rapidly became a CT scan and then direct admission to the Combined Assessment Unit. This itself was a massive shock for all of us and a very scary time. However the staff in X-ray were amazing and made a frightening experience a tiny bit more acceptable by their kindness and attention. Thank you to all of them.

When we arrived on CAU it was obvious that it was a very busy place. For the staff to be working under this pressure in a new environment beggars belief but they did so with equanimity and charm. The care my husband got was excellent and I wish to thank Moira and all the other nurses who were fantastic as well as the Health Care Support Workers (many cups of tea which were never too much bother) and also Drs Ali and Oates. Dr Oates your visit on Christmas Day meant a great deal to us.

After CAU we moved up to Ward B2 and the outstanding care continued. I came in at 8.30am and left at 9pm and having a single room and open visiting meant I was able to stay with my Husband at all times which meant so much to us especially during this time of uncertainty. We could cry in private and talk in a way we could never have in a 4 bedded bay. Once again the staff were amazing – all the staff nurses, HCSWs and Domestics got used to seeing me around and, despite being extremely busy over Christmas and New Year, catered to our needs. They brought blankets and cups of tea – the small things which can mean so much – without us having to ask, in fact they were so busy we would not have asked for anything. Dr Gysin listened to our moans with patience and kindness and ensured that my husband got home as soon as possible, just after New Year.

We have just started a journey which will now mean trips to Edinburgh for more tests and possible treatment. This was always going to be a hard time but the caring and compassion we experienced whilst in DGRI over the festive period has made it that little more bearable.

Thank you

The man With The Tea Trolley by Alison Wren

Hello! 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 went 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?”

I 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.

He 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.

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