Tuesday, July 1, 2008

Stay or go? Safest to have no choice.

It's time for me to move from my current job. I've been part of a team for the past twelve months, where I have felt welcome and valued and I have had opportunities to work with children and their families who are struggling in a variety of ways.

Limited terms and "college requirements" are one of the drawbacks of a training job. Broad experience and contact with lots of different teams is really valuable, but fitting into a team, just in time to leave it can be disappointing. What also makes me sad is the fact that the team I am leaving is bruised and broken, having lost a number of staff recently. People have moved on hurt by their time there and there has not been much effort to bring healing. Processes have been started to work out where things went wrong, but I don't know whether this will ever be able to create a better place, where people have learned and grown from the experience. Instead we let people creep away wounded, by finding another job, we don't actually offer them a process for resolution or change.

Part of me is regretful that people don't stick it out to let the process work and be part of improving and changing the place. But who am I to complain? I always knew I was only here for a season. Maybe that gives me a detachment which makes me courageous on other people's behalf? Would I stay if my job was permanent? Would I stay if had been subjected to ridicule or innuendo, or if I had been spurned when the idealisation was over? Perhaps my limited appointment is a convenient excuse which means I don't need to actually live out my principles of participating in difficult change.

Leaving to start another term gives me convenient way out, and is forcing me to look ahead to what I will be doing next. The only inconvenience is having to face those cases where I have to decide the best way to move on for the patient. Some of them are not getting better the way I planned. I am faced with my own inadequacies as therapist as a parting gift. I am having to keep my hand plastered to my chin in order to keep it up. The more I write, the more I see this is fodder for supervision tomorrow. Bring it on...

To the team I leave behind... thank you for your support and what I have learnt from you all. For the team you will become as you grow again (and I know you will), you will be in my prayers, and I know that what you have seen and endured will build you stronger.

Friday, June 6, 2008

Going to visit the nuns...

My friend Silvia took me on an adventure last week. We packed little boy into the back of the Mazda 121 and headed off to rural outer Sydney. A brief stop at the village, but the water was turned off at the local cafe so we couldn't get a coffee - leave that until later.

Down a quiet tree-lined road, horse-studs round each corner, and finally we reached our destination. Canaan of God's Comfort - the home of the Evangelical Sisterhood of Mary. http://www.marysisters.org.au/

Wearing old fashioned linen dresses and stout shoes, the nuns welcomed us quietly. They took time to smile and talk with us. We wandered along the prayer walk, through the stations of the cross, and sat for a while in the sun-dappled chapel. (Little boy made to preach his first sermon, the first time I had ever considered that one of our children may have their father's gifting.)

What a place to retreat and listen for God's voice. It made me wonder whether that is an important thing for me to do, spiritually. Some people would say we should always be busy as there's so much work to be done. Maybe I am one of them, because I've been part of churches where I felt like I just wasn't doing enough. I wonder if I encouraged other people to think that way, too?

In the middle of parenting, working, having time for people, I find it hard to take time to retreat, to listen. In theory, I know that Jesus took time to pray and left the crowds to do so. In practice, what does it mean for me? I feel a little like I am fumbling around at the moment, and the trip to the nuns has given me a glimpse of clarity. Their life of retreat and service is admirable, and I can see its value, while just wanting a brief taste of it from time to time.

The more I think about it, one thing stands out as having the movement of the spirit and the work of the Lord about it. My friend Silvia was God's message to me, her prayers for me, her desire to widen my spiritual view, to give me a space to see and hear God move. Praise God for friends, especially the ones that are an unexpected gift.

Wednesday, June 4, 2008

What do you think of a doctor who says 'I don't know?'

This week I attended training in how to deal sensitively with families of patients in mental health. We began discussing difficult questions which we sometimes get asked by families. One of the common themes that comes up is concerns about prognosis, the future for the patient and their family, and 'is full recovery possible?'.

Really important, practical questions. Extremely difficult to answer, to really answer what that family are asking. I'm not sure that giving people a list of statistics for prognosis or recovery is all that helpful. They have a place in a really comprehensive answer, but I suspect that we doctors hide behind statistics because questions like this make us uncomfortable. It is hard to tell people that not everyone recovers or that people have relapses or don't return to work.

We need to acknowledge, however, that we do not know the future. We cannot say for a particular individual what is going to happen. We can make educated guesses, based on studies of the natural history of an illness, or on experience with previous patients. But we do not know for sure. In fact, expecting to be able to answer these questions without uncertainty is unrealistic.

What became evident as we talked was a deep reluctance among my colleagues to say 'I don't know'. It was even mentioned that saying those exact words will damage the therapeutic alliance between the doctor and the patient's family, so they should never be said.

But how can we say that we have built a therapeutic alliance if we cannot even acknowledge uncertainty. I think people know that we are fudging and uncomfortable with the question. This damages their trust in us more than admitting we don't know. Saying 'I don't know' opens up a dialogue that includes fears for a bad outcome but also the possibility of a good one. Difficult, confronting questions, with answers that we do not clearly know are an opportunity to talk with the family about what has provoked the question. It gives the chance to educate them about what we do know, to support them in the uncertainty of what we do not know, to ignite in them the hope of recovery.

Where did we get the idea that we are not allowed to be uncertain or not know? I think that our empathy for and alliance with patients is strengthened by admitting that there are some things we do not know. I also suspect that we may couch our reluctance to express not knowing in delicate feelings for the patient or the therapeutic alliance but we are actually protecting ourselves. We are the ones who do not want to hear that we do not know.

Tuesday, June 3, 2008

I love Flight of the Conchords

How can two blokes called Bret and Jemaine wandering around in New York be so endearing and so funny? I wish that I had seen them live so that I could count myself a diehard fan. I can only say that I really enjoy the work of New Zealand's 4th most popular folk-comedy duo. Catch them on Sunday nights for a few more weeks.

In the true knowledge that nothing I can say will be as funny as the show, I vote you spend your time watching them rather than reading any more here today...

Monday, June 2, 2008

How do things touch my soul?

What is it that makes the difference between feeling inspired by time with my church family and the sense that it was no different to being on the train or at the shops?

This morning, playing my flute, I felt lifted by the people around me. All of my attention was on the here and now. I wasn't blushing for my mistakes, even though they were still there. I didn't think about what I might cook for dinner or over-analyse other people's behaviour. Somehow, we were all praising God together, listening, revelling in a connection with God and with each other. I know that none of us knew what anyone else was thinking, but unspoken understanding was in the air. Was I breathing it in, or did it sink through my pores? What is the part of me that is attuned to other people in that wordless way? I can't predict when it's going to be evident, but I want to listen to it more.

Is it particular people or places which bring it out in us? Do some people know the secret of connecting that way? And if they do, I'm assuming they can use it to their own advantage if they choose to.

I once knew a guy who was writing a PhD on religious experience. He looked at faith, church and God in a pretty clinical way, although I think his interest had been sparked by personal experience. By trying to understand, explain or quantify do I take away from the experience?

I could examine it from a few different angles... Is it that my pre-frontal dopamine circuits get a buzz from a particular set of circumstances? Did the way I was feeling from the weekend, and a week off work, set me up for a good experience? Were the people who were there, participating, the ones I feel the closest affinity with?

I assume that lots of things have influenced my Sunday morning experience. Maybe it depends on the language I use to describe it. Somehow, my mind, body and heart were engaged unanimously, and fully in the present. I think that can be an intoxicating experience (not necessarily wild, but deeply invigorating). Joy and peace combine for a moment bringing contentment and a touch of possibility.

This is one of the songs which lifted my heart today.

What the Lord has done in me

Let the weak say, "I am strong"
Let the poor say, "I am rich"
Let the blind say, "I can see"
It's what the Lord has done in me

Hosanna, hosanna
To the Lamb that was slain
Hosanna, hosanna
Jesus died and rose again

To the river I will wade
There my sins are washed away
From the heavens' mercy streams
Of the Savior's love for me

I will rise from waters deep
Into the saving arms of God
I will sing salvation songs
Jesus Christ has set me free

(Reuben Morgan, Hillsong)

Wednesday, May 21, 2008

Small beginning

Totally new to the world of blogging. Intrigued, a little fascinated. What is it all about? Done a bit of blog-surfing. Doctor blogs, mothering blogs, knitting blogs, probably endless configurations and microcosms of bloggers. I have decided to join in, slightly vague about my purpose but keen to try something new. Maybe I won't last long, but who knows?

Why a listening space? I would like to be a better listener. To my family, to my patients, to myself. Most of all to God.

When it comes to listening well, I have found that I like to be clever. I like to guess ahead and predict what people are going to say. Sometimes I anticipate and interrupt. Sometimes I'm right, but sometimes I don't even realise that I'm wrong. So that's what I'm doing at the moment. Trying to listen better.

Reading back, I sound preachy and a bit sad.

What I'm also enjoying is laughter with my son. He has started sleeping in a bed and can get himself in and out. I can hear him playing with his toys in the dark when he should be asleep. When I go to investigate, he peeps around the corner with the cheekiest grin and waits for me to chase him into bed. How many times could he enjoy this before falling asleep? Way too many, but somehow that smile stops me from putting on my stern and serious voice and I revel in the little arms around my neck and his lips pressed to my cheek.