The delights of committees and meetings


Monday 5 September 1664

Up and to St. James’s, and there did our business with the Duke; where all our discourse of warr in the highest measure. Prince Rupert was with us; who is fitting himself to go to sea in the Heneretta. And afterwards in White Hall I met him and Mr. Gray, and he spoke to me, and in other discourse, says he, “God damn me, I can answer but for one ship, and in that I will do my part; for it is not in that as in an army, where a man can command every thing.”

By and by to a Committee for the Fishery, the Duke of Yorke there, where, after Duke was made Secretary, we fell to name a Committee, whereof I was willing to be one, because I would have my hand in the business, to understand it and be known in doing something in it; and so, after cutting out work for the Committee, we rose…

I entered the very grand business use Holiday Inn in Filton, North Bristol. I had thought of staying over the night before but I had forgotten how expensive the rack rates are anyway.

robbery? say average £220 per night 100 rooms £154,000 pw
Quite difficult to pitch a talk to people you do not know

Today was the day when I delivered my paper. The conference was about the technicalities of trauma; the acronyms were beyond me for the most part but I got an overall picture which at least pointed me in the right direction. I saw how passionate and dedicated the staff members are and how hopelessly overloaded. They not only have to maintain an existing system but make more efficiencies for financial cuts to come.

I am ‘patient representative’ but since I am the first of the genre people are not sure how to treat me – what sort of brief and remit to give. I have indicated that without a specific brief my energies will be dissipated beyond what will be useful. I am not sure where the initiative lies. Is it the volunteer, or is it the doctors who should have some idea of the post discharge needs of the patient.

I was last on in the morning of six talks with only a brief coffee break. I made attempts to enliven a mostly over-loaded audience.

Here is the full text of my talk:

Welcome to Pandora’s box

My job as patient representative involves putting my self in the shoes of the doctors and clinicians on the one hand and in the shoes of the patient on the other. This brings about a certain benign schizophrenia which is considerably eased by a rather eccentric sense of humour which I fortunately possess.

Nine months into my post of patient representative, I still find my contribution to be largely decorative give or take a few ideas. The way the national health service functions has been the subject of a learning curve.

At the start I thought that if I had a good idea at say 10 o’clock in the morning and wrote off an e-mail describing the idea I could have a yes or no answer by 4:30 PM, five o’clock at the latest. In this I was mistaken.

My learned dissertation is entitled “my wife’s handbag”

My wife’s handbag is a mysterious object, one that I would never dare to approach let alone invade. Handbag activity is a sight to behold and for which the word ‘rummage’ was invented. I as a mere male would search methodically and coolly. My wife rummages with varying states of panic and emotion. It must be there somewhere. I have learned through long experience to refrain from drawing breath through my teeth, or making any comment sarcastic or otherwise that might indicate impatience or criticism.

Apart from the needed items such as the mobile phone and purse, the nether regions contain a mixture of redundant items, miscellaneous scribbled notes, and other objects or parts of objects that have no known use.

This analogy reminds me somewhat of the human psyche. We function within our familiar comfort zones easily enough but there are certain subjects or feelings that we have decided to shy away from or simply never explore. An insult reminds the patient temporarily but instantly of these matters.

Trauma comes without warning. In my youth I remember driving a motor car or with perhaps one or two too many drinks and out of nowhere a police car appeared behind me. All the things that I might have done wrong instantly appeared on my inner screen. The brain can work fast if it wants to. My brain scans would have been interesting.

I remember once many years ago in Ireland I was driving in the middle of nowhere and, exhausted, stopped outside the humble dwelling of a local man. The man beckoned me inside and without saying a word sat me down in his humble front room and placed a half a glass of Guinness in front of me. He nodded and left the room. That was exactly what I needed.

I recall when I was in Great Ormond Street hospital attending to my very sick child who was born with a congenital heart defect. Wife and I were sitting helplessly by the bed with tubes and blinking monitors all over the place when in came a cleaner. She was from the Caribbean. Caribbean people have the ability to smile to such an extent that the smile enters the room before they do. Without saying a word, she leant on her mop and smiled. I remember the smile going right through me and warming me from within.

Oh by the way on the topic of smiles by your profession. My advice is, avoid it. It is unfair to expect yourself when under pressure to be able to instantly symmetrise the required 26 muscles. Your well meaning efforts will be sabotaged and your intended Mona Lisa smile will inexorably morph into a grin, a smirk, a grimace, a leer or even worse – a dental display.

Take my tip – let your eyes do the smiling, there is less chance of deviation.

We all give an overarching impression of ourselves whether we like it or not 24/7. One clinician enters a room and everyone feels relaxed; another clinician can come into a room and everyone gets tense. Only a minority of who we are is expressed in our words of wisdom. The rest we could say is a field or an aura comprised of all the things we have thought, done, said or believed in. There is no hiding place.

Incidentally, I have often felt that clinicians could use diagrams to explain things instead on word streams delivered at 100 MPH this would be more productive and less ‘them and us’.

It was interesting to see how patient’s relatives in Great Ormond Street reacted to the sickness of their children. The children from well-off families especially those from the Middle East received vast bouquets of flowers and fruit, for what purpose I was unsure. The adults stood around completely impassively. On the other hand, the working-class mums had a good cry and got it over with accompanied by much hugging and commiserating.

So here you are as a clinician in the line of fire, facing an untidy cascade, a firework display of a mixture of emotions and symptoms.

As a Yorkshire friend of mine said, you have to separate the froth from the beer. If this means nodding and smiling while you buy yourself a few moments to figure out the most effective way forward then so be it.

The ability of traumatic raw material to morph into an apparently unrelated set of symptoms puts chameleons in the shade.

However, a traumatic event can have its good sides. It can be a tipping point to make the patient face events and situations as they really are, to bring people together, to make them appreciate the life and health of their kith and kin.

The word trauma is a catch-all word which can cover anything from mild shock, lack of preparedness, emotional dysfunction, a desire for attention even the waking of a dead mind. Is there such a thing as an inherent traumatic event.

Shock only becomes traumatic when it cannot be managed. I find it helpful to see trauma as dissociated emotional energy, or an emotional blood clot with nowhere to go. Or you could say that it is a condition in which time has ceased to be fluid.

If a patient stood up on their bed and sang ba ba black sheep at full volume you would more easily diagnose them as emotionally disturbed but far more difficult to read are the silences. A traumatised person will freeze a part of their memory to make life bearable, to dissipate the pain. If the memory were a jigsaw puzzle, the puzzle would have been separated into its pieces and buried in sand. So the abnormal becomes the normal.

As we know, trauma can lie in the system for years as we have seen with Japanese prisoners of war, and sexual abuse cases especially with regard to the church.

English people tend to implode which includes explosions, and that process is as about as therapeutic as having bits of shrapnel embedded in you. If some well meaning person tries to take them out, the process is resisted.

The patient needs to see that there is a problem,

they must be prepared to participate in its investigation

and then face the implications.

If the subject has no trust in anybody this is an uphill task indeed. I would no more try to talk to someone about their trauma from a standing start than I would try to cook a frozen turkey in the oven.

I think the doctor or clinician has truly arrived in the profession if they have learnt instinctive prioritisation, and a compassionate distancing which should be automatic between them and the situation of which the client is a living embodiment. In other words, if the attitude is right the distancing will look after itself.

Pragmatism is not inhumane especially when balanced with vision.

It is also desirable for doctors and nursing staff involved to be ever so slightly unhinged. Normal people should not apply. That’s a subject for another occasion.

As for the longer term, “The brain/mind/body has a great capacity to heal itself but the last thing it wants to do is to live and relive the event in a moebus strip like fashion. The situation itself needs to be transcended, viewed from above so to speak.

A props of this there is a very interesting exhibition in the Bristol Museum and Art Gallery entitled “Alternative Visions – Undiscovered Art in the South West” which runs until next Sunday. If a person has a trauma, encourage them in an artistic endeavour and the brain can do what it does best which is to resolve situations. This is particularly relevant to those who don’t not fit in to society, or who are autistic or isolated or damaged in some way. “if you can’t say it then draw it”

What of trauma within the medical profession itself?

This mostly consists of subtle slow motion torture about things that might happen, things that are happening, plus the desire for something resembling a social life not to mention recovering from plain and simple fatigue.

What is a social life I hear you say. I define this as you and your partner or friend being in the same room at the same time, awake, and talking about a subject not involving work with the mobile phones switched on silent mode. Quality time is when you can both switch your mobile phones off.

The spectre of Jeremy Hunt lurks in the background. For the most part he gives an impression of a cadavar. A besuited Hunt reminds me of someone looking out of a deep sea diving suit.

Someone who spends £44,000 on a toilet and shower for his post cycling ablutions is clearly out of touch and I wonder how many of those in power are anaesthetised to the needs of the wider community through their own personal financial fortune.

American corporates have been dying to get their hands on the NHS and Hunt is their man. I guess this process of absorption was finally completed by the time he co-wrote a report in 2005 euphemistically entitled “direct democracy: an agenda for a new model party”.

If you have ever been in the insidious position of having to read this document, it is a master of intentional obfuscation and verbosity. What a contrast to the clarity and almost missionary zeal of the Beveridge Report of 1942.

what other forms of trauma are there?

Does attending a seminar or workshop on trauma make you more traumatised

Vicarious trauma

The medical profession also suffers vicarious trauma as when the misguided parents of Charlie Gard took on the doctors of Great Ormond Street and insulted their professionalism. The couple especially the wife were proved wrong in every single instance yet they persisted with a vengeance. I cannot make up my mind whether they took advantage of a sympathetic but ignorant public or whether they were taken advantage of by the media.

Pre programming and misinformation

You might as well start conversations with some patients by saying, so according to the Gospel of the Internet what condition do you think you suffer from and what should I be doing?

Consider the muddying effect on your patient who reads in the Daily Express six different views over as many months on the claims of statins.

What about the American lady who having read that placebos work, and the placebo effect, asked her physician to prescribe double strength placebo pills because she wanted quicker results. The doctor, not wishing to disillusion her said that if she was prepared to trust the pill twice as much, I wish would be granted. She still didn’t get it. Some people will never get it but you advise and support never the less.

Being sued

The culture of suing, or sewage as I call it has spread from the Atlantic. It’s a pity you can’t sue patients for wasting your time, talking nonsense, lying or not following advice.

Over reach

Try not to be mother hen of the universe. Many patients have got into a dysfunctional state through their own neglect or deliberacy of which the presented insult is but a catalyst.

The patients have to learn the lessons. It’s not your lesson though it can be. Unless you are invited in, the suffering life sprawled before you is best approached with caution.

Remember the handbag.


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