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

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

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

 

 

I am human by Dawn Renfrew

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

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.

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.

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.

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.

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

Having a bad day? by @kendonaldson

Are you having a bad day? Or has the day just begun and you are struggling to face it – you know the ward is full but you have 8 admissions and no one knows where to put them. Perhaps you have 6 meetings lined up and you know that all will be challenging with little achieved. Or maybe you have a ward round then a clinic and you already have 50 unopened emails and no prospect of time to deal with them except when you get home later tonight. And on top of this your Dad is sick, or maybe your partner has just lost their job or your child is struggling in school. Sound familiar?

Very few of us come to work with absolutely no worries and even less of us find our days work problem free. We all react and behave differently to these stressors. Some thrive on them and perform even better than expected. Others struggle and this often becomes apparent from day to day. I know I struggle and often I don’t quite realise it but I do have a few ‘barometers’ that tell me things are getting bad. People say things like:

“You’re sighing a lot Ken”

“I heard you sighing from the end of the corridor”

“You’ve just arrived and you are sighing already!” (Sighing features quite a lot)

I saw you walking down the corridor and your head was low and your face was miserable. What’s up?”

“Ken, you were a bit short with them.”

And, probably most telling of all…

“Daddy, why are you so grumpy?” Sadly, sometimes said through tears.

Its when I hear phrases like these that I realise its time to take stock and focus on what really matters to me: my family, my friends and doing the job well, not rushing things and upsetting people.

I recently read a bit of advice from a psychologist. She holds a glass of water and asks her students how heavy it is. There is a range of answers but the point isn’t the absolute weight, its the fact that as she holds it longer and longer her arm begins to ache as the glass feels heavier. Ultimately her arm is almost paralysed in pain. Anxiety and stress are a bit like this. The longer you think about something the heavier it becomes until eventually you are paralysed. You need to put the glass down every now and again.

The reality is that working in the NHS is tough. We are short on doctors, nurses, beds and the patients keep on coming. Paperwork changes or the number of forms increase, new IT that seems to hamper rather than help, wards are shut due to norovirus or flu. GP numbers are so low that practices are covering ever increasing areas and more patients. The list goes on but it affects almost all of us.

So why this blog? Well it’s to ask us all to remember that it may not just be you having the bad day. It may be your colleague on the other end of the phone, or the other side of the bed or the other side of the table. They may in fact be having a worse day than you. If we remember this, are kind and considerate to each other and consider that we are actually all on the same team then it might make our day a little better. Random acts of kindness, however small, can make a difference: saying thank you, making a cup of tea, a smile.

At the end of the day it’s not just you or your colleagues who lose out. It’s also the patient and, chances are, they are having a significantly harder day than you!

Ken Donaldson is a Consultant Nephrologist and Associate Medical Director at NHS Dumfries and Galooway.

Thought provoking anniversaries by @HazelNMAHPDir

”Move him into the sun—
Gently its touch awoke him once,”

Wilfred Owen (1893-1918), British poet. Insensibility

The 100^th Anniversary of the start of World War One has stimulated a great deal of interest in seemingly forgotten history across the country. Families have been reconnecting with relatives who fought, died and survived using photographs, diaries and letters hunted down out of dusty boxes in the attic.

During the summer we visited a number of WW1 sites in northern France that were haunting in their atmosphere, magnitude and sense of sacrifice. The British monument at Thiepval near Albert and Arras (designed by Luytens; who also designed the Cenotaph) is an incredible place.

It caused me to feel thoughtful about nursing in that time – prior to any professional register, when it was viewed as ‘woman’s work’. In addition to recognised trained nurses, the VAD (Voluntary Aid Detachments) were crucial to supporting the war effort. In August 1914 there were thousands of them, whereas there were only a small number of military nurses by comparison (Queen Alexandra’s Imperial Military Nursing Services). In August 1914 they had no idea that every pair of hands was going to be needed over the next four years, as the common misconception was that the war would be over by Christmas.

The VAD system was founded in 1909 with the help of the Red Cross and Order of St John. By the summer of 1914 there were over 2,500 Voluntary Aid Detachments in Britain. Of the 74,000 VAD members in 1914, two-thirds were women and girls.

At the outbreak of the First World War VAD members eagerly offered their service to the war effort. The British Red Cross was reluctant to allow civilian women a role in overseas hospitals: most volunteers were of the middle and upper classes and unaccustomed to hardship and traditional hospital discipline. Military authorities would not accept VADs at the front line.

Katharine Furse took two VADs to France in October 1914, restricting them as canteen workers and cooks. Caught under fire in a sudden battle the VADs were pressed into emergency hospital service and acquitted themselves well. The growing shortage of trained nurses opened the door for VADs in overseas military service. Furse was appointed Commander-in-Chief of the detachments and restrictions were removed.

During four years of war 38,000 VADs worked in hospitals and served as ambulance drivers and cooks. VADs served near the Western Front and in Mesopotamia and Gallipoli. VAD hospitals were also opened in most large towns in Britain. ^]Later, VADs were also sent to the Eastern Front. They provided an invaluable source of bedside aid in the war effort. Many were decorated for distinguished service. Vera Brittain and Agatha Christie are two famous VADs; with the story of her experience captured by Vera in her book ‘Testament of Youth’.

“If the ghost that haunts the towns of Ypres and Arras and Albert is the statutory British Tommy, slogging with rifle and pack through its ruined streets to this well-documented destiny ‘up the line’, then the ghost of Boulogne and Etaples and Rouen ought to be a girl. She’s called Elsie or Gladys or Dorothy, her ankles are swollen, her feet are aching, her hands reddened and rough. She has little money, no vote, and has almost forgotten what it feels like to be really warm. She sleeps in a tent. Unless she has told a diplomatic lie about her age, she is twenty-three. She is the daughter of a clergyman, a lawyer or a prosperous businessman, and has been privately educated and groomed to be a ‘lady’. She wears the unbecoming outdoor uniform of a VAD or an army nurse. She is on active service, and as much a part of the war as Tommy Atkins.”

Lyn Macdonald, The Roses of No Man’s Land

 

 

 

Exit Strategy by Jo Beecham

This weeks blog appeared in the Spectator (www.Spectator.co.uk) on May 10th 2014. It is by Jo Beecham who was diagnosed with advanced ovarian cancer in 2011. I would like to thank both Jo and The Spectator for allowing us to re-publish this artice on dghealth and also Andrew Turner (Head of Information Assurance and Security at NHS D&G) who sought their permission and submitted the article.

“I am ready to talk about my death. Is anybody else?”

It is October 2012 and my ovarian cancer is back. As we wait to see the consultant I say to my best friend, ‘We are going to Mexico this weekend to get that stuff so I can kill myself. We’ll probably get killed by drug barons.’ My consultant says I have three years. I agree to more chemo and ask: ‘Can I go to Mexico?’ She looks baffled.

It is February 2013 and the consultant is discussing hospices. She is eight months pregnant. I don’t tell her about the Mexican barbiturate in the fridge. I do tell the nice hospice counsellor, though. She goes white. ‘The drug dealers seem to have a good reputation. She isn’t reassured. ‘It works on large animals and I’m no bigger than a small donkey or a big dog.’

She tells me that I need to have a psychiatric assessment. Apparently it’s natural to think about dying but not to plan your own death. When I see my GP I tell her that I’m thinking about killing myself and want this recorded to protect my family and friends.

‘Oh, and I also need to be referred to a psychiatrist who’ll say I’m sane, or I won’t get therapy.’ ‘What do you think of that?’ she asks. ‘Ridiculous.’

The GP calls a psychiatrist and she says it’s ridiculous. Now that I’m officially not mad the counsellor will see me again, but only with her supervisor, who tells me that in 15 years at the hospice she has never encountered someone with a plan before.

How can you talk about a good life with- out talking about a good death? I get the feeling that the hospice isn’t the best place to talk about dying.

It is June 2013 and my friend suggests we go to a Death Café. About 40 people are there. The facilitator is asking people to imagine their deaths. People mention favourite cotton sheets and listening to Bach. I try to imagine the smell of baking but can’t stop wondering whether faecal matter will come through my mouth. So I tell them I have a terminal illness and an illegal drug in the fridge. ‘How many of the group are dying, like me?’ I ask. No one raises a hand.

Late June 2013. These are my people! A hundred of us gathered to learn about peaceful methods of dying at the Exit International Workshop. As we leave, however, there are protestors. My friend calls them cowards for hiding behind skeleton masks.

One takes hers off but looks so terrified I tell her to put it back on. Another says she’s a lawyer. I ask her: ‘What right do you have to tell me how I should die from ovarian can- cer?’ She answers that her sister died from ovarian cancer and fought for her very last breath. Her face is full of grief and I suddenly feel desperately sorry for her and want to hug her instead of punching her.

“Apparently it’s natural to think about dying but not

to plan your own death”

November 2013. Whenever I am in a clinic my blood pressure shoots up. I’m on a three-weekly intravenous drug called Avastin, which is the only thing keeping me alive, but my veins are getting thinner. Today my blood pressure’s higher than ever. Eventually I’m cannulated. A nurse tells me to relax, she’ll take my blood pressure later. I know I’m too anxious. I won’t get my drug.We wait for the doctor on call to give his permission. My BP goes through the roof.

I beg a nurse to turn on the machine. I could kiss him when he says ‘OK’, but later I look at the bag and the drug isn’t being fed into my arm. All the nurses have disappeared. I wander through the wards, wheeling my Avastin on its pole. I’m crying, pressing buttons on the machine, hoping I can turn it on myself.

Eventually a nurse tells me the doctor on call instructed them not to give me the drug.

I speak to him on the phone and demand my drug. He hangs up. Just as I think I’m about to have a stroke, the nurse tells me that my consultant has a clinic that day. I can’t stop babbling when I see her.‘Have a mince pie,’ she says, ‘I’m going to give you the Avastin.’

In January this year, the cancer spread to my glands and lungs. My consultant told me there was no further point in giving me the Avastin or in my undergoing any more chemotherapy. We talked about palliative care and pain relief. I asked her what her thoughts were on assisted dying. She said that no one had asked her this question before and she needed to think about it.

Many years ago I saw a Woody Allen film where he is considering suicide but he can’t do it without killing his parents first, as his death would be so devastating for them. I think killing my parents first is an excellent idea. I could check that the barbiturate works on them before I take it. My mother, who is 88, fell over at Christmas and broke her pelvis and is only just getting over it, and my father, 91, shuffles and lurches in a way that has us all running for cover. It can only get worse.

The three of us are sitting at home. At 51, I am aware that this is the first time I feel like an adult in the company of my parents, and being an adult means keeping it together in front of my mum and dad while knowing all our hearts are breaking.

‘I’m very sick. I don’t know how long I’ve got but I promise you that I will not suffer. I have the means so that I won’t let that happen. I promise you.’

They nod that they know and that they really don’t want me to suffer. My mum is looking at me very intensely and says that I am an angel — she has often thought so — and that there is some smoked salmon in the fridge. Would I like to take some home with me?

 

Jo Beecham

A longer version of this piece is online at www.spectator.co.uk/beecham

 

Three Little Words (Make a Difference) by @weemac63 & @gbhaining

Here’s a story about 3 people, 3 days, 3 towns, 333 miles, 3 words.

We recently had the great privilege of hosting a 3 day mini tour in Dumfries and Galloway with Tommy Whitelaw. Tommy spent many years touring the world running global merchandising operations for people such as The Spice Girls, U2 and Kylie Minogue, before giving it all up to look after his mum Joan, who had dementia. Sadly his mum passed away in 2012, and Tommy has tirelessly campaigned to raise awareness of dementia and the impact on carers.

Tommy’s inspirational talks encourage people to think about dementia and how it can affect each and every one of us, professionally and personally. You can watch some of his talks and videos here on his blog. The theme of Tommy’s tour for 2014 is “You Can Make a Difference”.

In April 2014, for the Dumfries and Galloway leg of his tour, Kylie and The Spice Girls were not available, so he was forced to go on the road with two new sidekicks.

(Us! – Linda and Gladys: @weemac63 and @gbhaining)

Here are the highlights of our tour with Tommy….

Tuesday 8^th April 2014.

We headed to our Transport Department to collect our “tour bus” for the 3 days.

“Oh no!” was our first reaction, It’s a Corsa! Never mind, there are only 3 of us and Tommy will just have a wee rucksack with the essentials. So off we went to pick Tommy up at Lockerbie station via a well known supermarket as we wanted to ensure a supply of sweeties, sandwiches and drinks to keep us well nourished and hydrated over the next 3 days.

We arrived at Lockerbie station just in time to see several bags, rucksacks and packages of many shapes and sizes advancing towards us at an alarming rate down the steps of the station platform. We soon discovered the smiley face of Tommy Whitelaw peeking out from beneath one of the bags!

After enthusiastic greetings all round, we made our way to the tour bus where the “roadies” ( us!) managed to squeeze all the gear into the boot of the aforementioned Corsa, and off we set to our first gig at Stranraer!

We arrived at Waverly Medical Centre and unloaded the “gear” to start the events. A quick sound check confirmed that the technology was going to play its usual tricks on us but we soon “made do” and the audiences at the two sessions were treated to emotional and inspiring talks from Tommy.

After a brief photo call, we were back on the road, heading for our next gig at Palmerston Football Ground.

We arrived at Palmerston with a little time to spare and again Tommy delivered a very emotive, inspiring and thought provoking talk to the invited guests. We had a wide range of people from our community at the event and it was a huge success. The football ground was an ideal location as Tommy during his tour has visited many other grounds across Scotland.

 

 

 

 

 

 

 

The lack of half time Bovril was made up for by a fantastic supper provided by the girls at Palmerston (including the customary pies and sausage rolls!)

Wednesday 9th April 2014

Another busy day ahead which kicked off with two very well attended open sessions in Crichton Hall.

After navigating the “tour bus” through all the interesting road works of Dumfries, we then arrived at Alzheimer Scotland’s resource centre in Gordon Street, where the three of us were very privileged to be invited to join some of the day care service users for lunch.

Tommy was then given a tour of the resource centre meeting staff and volunteers.

In the afternoon we popped back up to Crichton Hall where Tommy presented to members of our Person Centred Care Committee.

With a busy morning and afternoon there was a little time for Tommy to return to his hotel and relax before joining a few of us for dinner. (A welcome change from the sandwiches and junk food we had been consuming over the past two days!)

Thursday 10^th April 2014.

Our final day with Tommy and we’re not letting him slow down, so the tour bus was loaded up with a plentiful supply of Lucozade (the healthy version of course!)

The first session was held in Midpark Hospital. Word had obviously got round, as it was standing room only in the packed venue. Jeff Ace our CEO even had to give up his seat in the VIP area and move to the cheap seats. Despite technical problems which left us without sound and vision, the audience were moved to tears listening to Tommy. Afterwards, he had a short visit to the dementia assessment ward to see the wonderful facilities and meet with some of the staff.

 

No time to stop (even for another sandwich!) before rushing back over to Crichton Hall for a session with the dementia champions.

We were then back in the car heading to Annan for the last session of the tour, feeling sad as the tour is coming to an end, but so happy with the positive feedback we had received along the way.

As expected, this final session was inspirational and thanks to Brian Cluckie we had no hiccups with the I.T.!!!

The final leg of our tour was soon upon us, and we headed back to Lockerbie Station to bid farewell to Tommy, who had another talk with student nurses in Glasgow later that evening. As we left Tommy at the station platform, with slightly lighter luggage, and the last of the now stale sandwiches clutched in his hand, we felt exhausted, and sad to say goodbye, but with happy hearts that so many people had the opportunity to meet Tommy and hear his message. After 3 days, 3 towns, 333 miles, 33 sandwiches, the 3 of us hoped that everyone left thinking about 3 important words:-

WE can all “make a difference”.

Throughout the three days Tommy has engaged with and shared his story with people from our community including the public, health care, social care, third sector, police, clergy, carers, care providers ,footballers and many more.

Tommy has had lots of pledges from Dumfries and Galloway and it’s not too late… You can still pledge online at http://dementiacarervoices.wordpress.com/you-can-make-a-difference/

Here are some quotes from people who attended the sessions.

 

 

 

 

 

 

 

 

 

 

 

 

 

This blog has been compiled by:-

Gladys Haining (@gbhaining gbhaining@nhs.net) and Linda Mckechnie (@weemac63 linda.mckechnie@nhs.net). Gladys is our Alzheimer Scotland Dementia Nurse Consultant and Linda is a Service Development Manager at the Mental Health Directorate both at NHS Dumfries and Galloway.

 

 

 

 

I want to see a specialist by Michael Stewart

I’ve read a number of books over the years and something stands out to me: a great number of them tell the story of travels, of lands distant and of journeys of lifetimes. From Gulliver’s Travels to Around the World in 80 Days to The Lord of The Rings, most of my favourite books seem to be telling me that great worth is to be found through travelling to far off countries and experiencing different cultures. Although they were (probably) originally written purely as a form of escapism it seems to me that the unintended effect of such stories has been to glorify Leaving to the detriment of the appreciation of Staying.

I write this to appreciate those who stay put.

Let me give a true but extreme example of an all too common mindset: when I was in my final year of uni I was speaking to a friend of mine, Laura (fake name), about how our placements were going. Laura had been in a GP surgery for 7 weeks in a rural town in Grampian where she’d spent a lot of time getting to know the GPs and the locals. She told me a story of an Old Lady in her 80s who was nearing the end of her life and still lived in the house that she’d been born in, and whilst telling me of this lady Laura, quite matter-of-factly, said, ‘what a waste of a life, there’s so much she hasn’t seen.’

Is it really a waste of a life to stay in one place? I don’t think so.

I’m going to pause now and state that I’m not arguing against the flux of peoples across borders: here’s a reason why, other than that I haven’t stayed put. I once watched a documentary about how the invention of the safety bicycle (known more commonly these days as ‘the bicycle’) changed the world by enabling travel between villages and allowing exchange of ideas and body fluids amongst previously distant peoples to bring the human race to the path of ever moving technology on which it now walks. We effectively started cross breeding to create more advanced peoples. The modern situation of travel just extends that exchange to an international level from a local or national one. And of that I thoroughly approve. To put it another way I should say that without the input of people from other nations I believe that the NHS would fall apart and/or would not progress.

Anyway, back to the point. I think to some of the staff that I’ve met in DGRI who are from these parts and how they have benefitted both patients and me in my time here. Where new ideas and different expertise may come with those from elsewhere a deep local knowledge is of immeasurable value and as important if not more so. I’ve a couple of times had patients who have been known to nursing staff and my consultation has gone that much more smoothly because of a gift piece of advice, ‘Michael, that gentleman’s wife recently died of disease X so be careful what you say’, ‘The ambulance is coming from Moffat so they’ll probably be here in about 40 minutes’. It makes my day run that bit more cleanly and lets me feel closer to my patients through a connection which I haven’t been here long enough to share.

In addition to the work-based benefit of local informants I have benefitted massively from extra-curricular hints and tips. Right back at the beginning of my time here it was the local members of staff who told me about the Lockerbie Jazz Festival and the Local Whisky Festival (drink responsibly). These little pointers have made me enjoy my time here so much more than I may otherwise have because I’ve been able to jump feet first into the regional culture and not wasted any time looking.

When my friend told me that that Old Lady had wasted her life I got to thinking: we’ve glorified GPs. It has become cool to spend a little time everywhere at the expense of truly being the specialist of the place that you live. It’s people like Laura that can refer you to a place that you may love, but it’s the people like the Old Lady who really make it worthwhile going.

Michael Stewart is a Foundation Year 1 Doctor at Dumfries and Galloway Royal Infirmary

Crabbit Old Woman by @gbhaining

This poem was written by Phyllis Mabel McCormack 30/06/1913–10/01/1994. Originally entitled “Look Closer” she wrote it in the early 1960s for publication in the Sunnyside Chronicle, which was a magazine produced by the staff of Sunnyside Royal Hospital for circulation within the hospital. She submitted it anonymously as she felt it was critical of some of her colleagues. A copy of the magazine was loaned to a patient in a nearby hospital, Ashludie near Dundee. Before returning the magazine, the old lady copied the poem out in her own handwriting and kept this copy in her bedside cabinet. When she died and the staff cleared her belongings, it was found and, as it was in her handwriting, it was assumed that she was the author.

POEM  Please take a little time to read this, also the nurses response!

I first learned of this poem whilst undertaking my mental health nurse training in the late 1980s.

This poem resonated with me, and, has stuck with me throughout my career. This led me towards “care of the elderly mentally ill nursing” as it was then called, and, ultimately to strive for the delivery of the best possible care for people with dementia, their families and carers.

Why Dementia?

Traditionally dementia has been the “business” of mental health services but if we consider the statement below, this confirms that wherever we work, whoever we are, at some point we are going to come in contact with a person who has dementia.

“Dementia is one of the foremost public health challenges worldwide. As a consequence of improved healthcare and better standards of living more people are living for longer. This means in Scotland that the number of people with dementia is expected to double between 2011 and 2031. This presents a number of challenges, most directly for the people who develop dementia and their families and carers, but also for the statutory and voluntary sector services that provide care and support. Over time we expect that a greater proportion of health and social care expenditure will focus on dementia, and there is evidence of that change already. There are no easy solutions and transformation will take time. This document sets out what we will do in the next three years.”  Scotland’s National Dementia Strategy 2013 – 2016

What was it like away back then?

 Crichton Hospital (William Burns 1834)

Well…. whilst I was training in the 1980s I had various placements with the Crichton Royal Hospital that had wards for people with dementia.

These were large institutional wards with nooks and crannies all over the place, they had nightingale dormitories and from an observational point of view were a challenge.

The wards included acute assessment and long stay and it was dependent on the stage of your illness where you were placed. There was little evidence (in my opinion) at this time of person centred care. People were well cared for but personal choices were limited.

We had charts for bathing, toileting, weighing, to name but a few.

We dished out meals of limited choice and drinks based on what we knew, however, I mostly prefer to drink coffee BUT do like to be given the option of having a cup of tea!

We had large sitting rooms where everyone was expected to congregate between getting up, mealtimes, toileting times, bath times and going to bed. The telly or some Scottish music was generally going on in the background.  

I want to stress that we didn’t think we delivering poor care, we weren’t. We were delivering the care that met the physical needs of people with dementia and had to do this because of the numbers of people we were caring for. 

So have things changed?

YES!

We no longer have large institutional wards for people with dementia. People with dementia are cared for within their local community. 

We have memory clinics where people are assessed and diagnosed early. People with dementia are supported to take control of their care and treatment including planning for their future and determining their wishes.

We have commitment from the Scottish Government to ensure that all people including people with dementia receive excellent person centred health and social care.

We have national programmes to support this including:-

• Scotland’s National Dementia Strategy            
• Older People in Acute Hospitals
• Dementia Standards
• Promoting Excellence
• People at the Centre of Health and Care

So……………….back to my point about dementia touching each and every-one of us.

Yes it will:  be it personally or professionally, be it in the work place or at home. We will all have to be prepared to care for people with dementia as our aging population grows and we all live longer.

My current role as Alzheimer Scotland Dementia Nurse Consultant is as a result of the commitment from Alzheimer Scotland, the Scottish Government and a fundraising appeal by Kay the Dowager Duchess of Hamilton.

 I am a small cog in a big wheel but I am working with my colleagues across the region and striving to make sure “we get it right for every person every time” and particularly if that person has dementia.

Gladys Haining is an Alzheimer Scotland Nurse Consultant working at the Mental Health, Learning Disability and Psychology Directorate of NHS Dumfries and Galloway.

Telephone 01387 244007 (internal: 36606)

email: ghaining@nhs.net

Dementia helpline: 0808 808 300    www.alzscot.org