The Reason For My Silence

I've been a fairly regular blogger since I started this blog in June 2008. I don't write a post every day, but there is rarely a break of more than a couple of days, but regular visitors to this blog will have noticed a long period where I haven't added anything, even about my knitting.

The reason is that I continued to go downhill and I got to the stage where I became suicidal. I couldn't find a reason to carry on with life and even though I didn't actually do anything to harm myself, it became the foremost thing in my mind. Fortunately, I was still capable of doing the sensible thing so I went to see my GP who was so concerned that he referred me to the psychiatric staff at one of the local hospitals and I ended up becoming what is laughingly called an 'informal' patient at one of our psychiatric hospitals which means that I went in voluntarily rather than being 'sectioned' under the Mental Health Act. The local Mental Health Foundation Trust has seven psychiatric hospitals and which one you end up in depends on where you live within the area that the Trust covers.

So, I have been without access to a computer at a time when I probably had more material for the blog than I could possibly use, although whether anything that I wrote during the early days of my incarceration would make any sense is somewhat debatable. Anyway, I have been granted my first bit of home leave and tonight is going to be the first night at home for a few weeks. I have to go back to the hospital for Ward Round tomorrow, when my Consultant will obviously want to know how I have coped and whether I can be allowed to spend a few more days at home without resorting to doing myself any harm.

This has been a somewhat interesting experience for me because although I have suffered from severe depression for 11 years, and I have felt suicidal at one period in the past, I have never had such intimate dealings with the mental health services offered by the NHS. During this encounter I have met some really interesting people, some nice (including a paranoid schizophrenic who was a real pleasure to be on a ward with) and some who really frightened me and who I really wouldn't want to meet on the street. One thing that I have learned is that one of the worst places for encountering discrimination towards people with mental health problems can be a psychiatric hospital, and this discrimination comes from the staff. I have encountered a few really good mental nurses and a lot who were possibly more 'mental' than the patients that they were supposed to be looking after, and I was looked after for a few hours when I was initially admitted by a doctor who was incredibly kind and compassionate at a time when I was extremely vulnerable and completely overwhelmed by everything after having been left in limbo for about nine hours while the psychiatric staff at the hospital to which I was referred by my GP seemed incapable of doing the simplest things (such as ensuring that I was fed and watered; I had nothing to eat or drink in all that time). He made me a cup of tea and got me some toast and did all he could to put me at my ease while he took a detailed history and carried out a full medical examination. If he continues to exhibit this compassion as he progresses with his training as a psychiatrist then he will make a consultant whose patients will consider themselves very fortunate to be in his care.

I need some time to get my thoughts into focus again, but once that has happened I will write a series of posts about my experience and what was good and bad about it all. One thing that I have already decided is that I want to make sure that my voice is heard and that I want to do something to help ensure that those of us with mental health problems don't get 'treated by numbers' instead of being treated as an individual with rights and feelings that need to be taken into consideration in our treatment.

Diary Of A (Mostly) Bad Week

Monday
A Bank Holiday and all that means. Feeling depressed and unable to concentrate on anything for very long. Feeling sorry for myself because another year has gone by and I am getting older and the aches and pains take longer to go away.

Tuesday
My birthday and things start to go wrong almost immediately. Mr Smiley has to cancel our lunch date, the postman doesn't bring me any birthday cards, and then There and Back lets me know that she isn't very well so won't be able to travel up to London for our day out together on Wednesday. All I can do is cry; this wasn't how I wanted my birthday to be.

Wednesday
There and Back may not be able to join me but I still go to the theatre. I walk to the bus stop, a bus arrives within a few minutes and almost immediately after boarding the bus it starts to pour with rain. I arrive at Cambridge Circus and miraculously the rain stops just as I get off the bus. I cross the road to have some lunch (it rains while I am in the restaurant) and then I head for the theatre. It's only a few minutes walk and still more about 45 minutes before the show is due to begin but there is already a queue starting to form outside the theatre.

I join the queue and after a few minutes it starts to move as the doors open and we are admitted. I quickly find my seat, get myself comfortable and look forward to watching my favourite (and the nation's) favourite musical. This is the first time that I have seen it performed at this theatre (Queen's); previously I had seen it several times at the Palace Theatre, and one thing that I notice early on is that the set is different from that which I was used to.

It didn't take me long to fall under its spell and the three hours of the show went by in a flash. As usual the performances were wonderful and the cast received a well-deserved standing ovation. Once the show was over, I put my coat on, gathered up the rest of my belongings and headed out into the street to make my way to the bus stop. I was again lucky with a bus arriving within a few minutes of me arriving at the bus stop and like my journey to the theatre, it was not long before it started to rain. When it was time for me to get off the bus the rain had stopped again and I walked the short distance home. Ten minutes later it started to rain again and continued for the next four hours.

How on earth had I managed to stay dry all day?

Thursday
Up early as I had to travel into London again, this time to attend a workshop about patients having online access to their pathology data. The workshop had been organised by the Department of Health and most of the attendees were pathologists, although there were a couple of GPs, a number of other doctors, at least one chief executive of a foundation trust and a number of senior people from the Department of Health. I was the only patient present, and while the idea of the workshop was to discuss the possibility of patients having access to their pathology data, my presentation was to show that some of us already have that capability.

Unlike all the other presentations which comprised numerous PowerPoint slides, my presentation used the internet and my medical record to show what can already be done by some patients in this country. The presentation went down well and during lunch I was asked many questions about the system that I was demonstrating and the benefits that I felt it gave me.

I met lots of lovely people at the workshop. I find that doctors are generally a lovely group of people to give presentations to and this group was no different. I met several professors who were very interested in what is already available in General Practice, and the President of one of the Royal Colleges has asked if I would give a presentation to the Royal College in the New Year.

I find this work, although I don't get paid for it, very worthwhile and even though I am a bundle of nerves before each presentation, I find that once I start talking the nerves disappear.

Thursday turned out to be a pretty good day.

Friday
I was very tired when I got home on Thursday and it did not take me long to get to sleep and once asleep that was how I wanted to stay. I slept most of Friday morning, had a nap in the afternoon and still managed to go to bed and fall asleep at a relatively early hour. I didn't achieve anything because I just didn't have the energy for it, but catching up with some sleep did make me feel a little better.

Saturday
Another day pretty much lost to sleep. I did manage to go out and do some food shopping and the walk did me some good. The afternoon and evening was spent half listening to the far off public address system at the Guides' rally at Crystal Palace and when the fireworks started I watched those that rose into the sky from my bedroom window. Having had so much sleep over the last couple of days I had problems dropping off, but eventually I managed it and slept through the night without waking up at all, a fairly unusual event.

Sunday
I've not been looking forward to today; it is the anniversary of my husband's death. Lots of tears at frequent intervals but I have managed to do a few chores and to do some knitting. My circular shawl is growing and I have only about another 30 rows to do before I start work on the border; work on it will certainly slow down then as I try to manipulate the border on two needles and join that to the shawl which is on another needle.

The 'Print O' The Wave' stitch panels are growing and the shape of the pattern is starting to become clear.

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It's not been my best week ever, but I seem to have survived it and hopefully things will start to improve a little now.

On Tenterhooks

I'm sitting at home waiting for it to be a reasonable time for me to set out to go to a medical educational establishment in London. It's not the first time that I have been there so I know how to find it, and the presentation that I am to give (three times) is one that I am very familiar with having delivered it a number of times over the last eight months. But familiarity with my subject does not stop me from being very nervous.

I have been booked to give these presentations since my first foray into talking to doctors about the benefits of patients having access to their medical records. It is not yet a year since a chance conversation with my GP led to him asking if I would be willing to talk about my experience with being able to access my medical records online, something that was pioneered by the GP practice that I am with. I described my feelings about that first experience here and here. Since then I have given several more presentations on the subject, and I even feature as a voice over on an online demonstration of what I, as a patient, can see on my medical records and the benefits that can accrue from this.

For those readers who may not have read all my previous posts, I should say at this point that giving presentations at large international conferences was something that I did regularly when I was working. And the delegates at those conferences could be pretty difficult to deal with as it was possible that I was saying things that went totally against their beliefs in the subject areas that I dealt with. But familiarity with my subjects and confidence in my analysis meant that I could deal with hostile questioning without hesitation. However, the severe depression that I suffered from, and which caused me to have to take early retirement on medical grounds, has left me with a complete lack of confidence in myself and I was very nervous about speaking in public again even though my GP reassured me that the audience of doctors would be kind to me.

On the first occasion that I gave the presentation everything that could go wrong, did. It was planned that I would do the presentation using the live system to show how easy it was to use. Unfortunately, between setting everything up for the demonstration and actually having to stand up in front of the audience of doctors, the server at my GP's surgery went down, so no live records, and it became necessary for me to make the presentation using screen shots of the system which I had only seen once and the order of which I was not altogether certain.

Since then I have developed a PowerPoint presentation that allows me to give the presentation tailored to the audience and time available to me. There are nice transitions between the slides, and some nice refinements that have been built in as a result of the sort of questions that the presentation generally elicits. I am familiar with the order of the slides, I know what I have to say about each of them, and I have a slide at the end which sums up the benefits to the patient that such access allows. I know from experience that doctors are a nice audience to make a presentation to and they are especially appreciative of the opportunity to hear the patient's view on the subject.

Yet, I still have butterflies the size of pterodactyls blundering their way about my stomach and an attack of the shakes that would make a withdrawing alcoholic look steady as a rock.

Nothing New From Sir Liam Donaldson

The BBC News website has started a new weekly column that is to allow leading clinicians and experts to outline their views on health topics. The first of these columns has been provided by Sir Liam Donaldson, the Chief Medical Officer for England. As Sir Liam probably hasn't seen a patient for a great many years (and I am sure that the many medical bloggers out there will confirm this point) I am not sure that one could really refer to him as a clinician any more because that implies someone who is practising medicine on a regular basis, and to call him an expert would probably have many doctors choking on their morning coffee for was he not one of the major architects of the MMC/MTAS fiasco?

The column that he has written seems to provide little of any significance about health or the NHS. He seems to believe that one of the ways to improve the service that the NHS provides to patients can be to mirror the service provided by shops. He sees patients as 'customers' a term that I believe many patients consider to be insulting. He highlights a case of a friend of his, who on arriving early for a GP appointment, was greeted by the receptionist saying, "you're early, I hope you don't expect to be seen early". Apparently Sir Liam's friend was "embarrassed and belittled" by being spoken to in this way in front of the other people in the waiting room. While one would perhaps be a little disgruntled at being spoken to in this way, to be embarrassed and belittled is perhaps a little over the top. It is an unfortunate fact that in many GPs surgeries these days, the reception desk is in the patient waiting area. Being used to a surgery where the reception was in a room separate from the waiting room, I found it a little awkward when I started at the GP practice that I am with now to find the reception in the waiting area. After all, who among us wants a large portion of the local population to know that you have come to make an appointment for a smear. I am sure that we have all come across the receptionist who perhaps isn't as polite as should be expected, but the way to deal with it is to have a word with the practice manager, after all there may be a reason why the receptionist hasn't been the best ambassador for the practice. Sir Liam goes on to admit that the case of the impolite receptionist was not a matter of life or death, but suggests that we wouldn't be spoken to in this way by a member of staff in John Lewis. I think that he is wrong, because I have had more problems with impolite shop staff than I have ever encountered in the NHS.

Sir Liam cites the report by Lord Darzi and talks about high quality care from the NHS which should include faster treatment, more accurate diagnoses, and better survival rates from life-threatening conditions. However, one wonders how easy this will be to achieve when there is concern within the medical profession about the lack of experience that will be the result of the changes that have been made to the training, time taken  and experience required to achieve consultant status for doctors in the future. While it is only right that junior doctors should not be expected to work the ridiculous hours that was expected in the past, this should be taken into consideration when it comes to the length of time taken to reach consultant level. There is significant concern at the level of dumbing-down that seems to have occurred in our schools and the examinations that children sit, do we really want a similar dumbing down in the medical profession because mistakes have been made in the way that doctors are trained.

As I say, there isn't anything new in what Sir Liam has to say, nor should we perhaps expect it. He has spent too long away from the coal face and has no real idea of how hard many in the NHS are working to ensure the best possible service for patients that they can. The problem is that in many cases it is the multiple layers of management within the NHS that is responsible for things not working at optimum levels. Perhaps this is the area that needs to be examined more closely and compared to that within organizations such as John Lewis.

Friday Is Doctor Day

I've written before about Friday being a day of seeing doctors.  Friday morning sees me attending my regular appointment for psychotherapy, and my first appointment of the day with a doctor. This hour of talking about myself and my feelings and thoughts about things in my life is not the easiest hour of my week, but it is helping me.  My friend, Mr Smiley, has said that he has noticed a big difference in how I am over the last few months and I know that going through the psychotherapy is a big factor in this.

I have always tried to set myself high standards to achieve, and for many years I did just that. But when I lost the support of my husband, I started to lose confidence in myself and my ability to do many of the things that I had done without thinking previously.  It wasn't just the depression that I started to suffer when my husband died, but also the harassment and discrimination that I started to encounter from some people at work.  For years I managed to keep working despite all this, but eventually it had such an effect on me that work became impossible.  During this time my mother had died very suddenly, so in addition to all the problems that I had at work and with my health, I had to keep an eye on my elderly father from a distance of almost 100 miles.  When my father died a little more than two years after my mother, work became impossible and my GP sought early retirement for me on medical grounds.

I decided to move back to London when I retired, mainly because I was not happy in the home that I had shared with my husband, but also because I felt it better to get away from the area where I was likely to see many of the people that I had worked with, and I could not face constant questioning about why I had to give up work. With the move came a change of GP, and a year ago, concerned with the depressive state that I was in, my new GP decided to refer me to the local Mental Health Trust to be assessed for psychotherapy.  I was lucky, I didn't have anywhere near as long to wait for assessment as my GP had warned me that I could expect to wait, and after being assessed as suitable for individual psychodynamic psychotherapy and warned that I would be on a waiting list for some considerable time; I started therapy three months later.  

I have been attending most Fridays since the beginning of May and the six months of 'talking therapy' have definitely made a difference to how I am feeling.  I still have periods where I fall into that black hole of depression, but I find that I can climb out of it more easily now.  And after suffering for so many years, I think that we have uncovered some of the things that caused me to be the way that I am and possibly why my depression, which originally was thought to be a grief reaction, has continued for so long.

This afternoon, I had to go and see my GP for a check on my present state.  Regular readers will know that the GP who I had been seeing when I registered at the local practice when I moved back to London retired a few months back.  I had needed to see a doctor when my GP was away at a conference, so I saw one of his partners, and finding that I got on well with this other doctor, it was decided that he would take over my care when my GP retired.  So new GP has been seeing me at fortnightly intervals since taking over my care, so that he can get familiar with me and my problems and we can develop a relationship that I will be comfortable with.

Today's appointment was the first since we had managed to get my blood pressure under control, so it really was just a case of me reporting in and saying that I felt fine. I expected it to be a five minute visit, but I was wrong. When I was called through, I got to GP's consulting room and he opened the door just as I arrived and as I was walking in told me that he had a medical student with him, and asked if I would be happy for the student to stay during the consultation. I surprised myself and my GP by saying that I was happy for him to stay.

The consultation that I expected to last just a few minutes took a little longer than that.  After getting over the shock of me agreeing to the medical student staying for the consultation, GP decided to use me for a good teaching experience.  I think I coped with it all quite well. Tears were very close on a couple of occasions, but GP kept a close grip on things so that I never went over the edge.  I hope that the medical student gained from the experience, I believe that I managed to climb another hurdle and get over it without any harm.  My psychotherapy was discussed in general terms, we discussed the strategies that I use to manage my day to day life when I am feeling depressed, and how studying has been one of my lifesavers over the last few years.

So I have seen two doctors and an almost doctor (he takes his finals next year) today, and I'm not even ill. Well, I have the last remnants of my cold, but nothing worse than that today.  Maybe my life is starting to take a turn for the better after all those years of despair.  I will obviously be susceptible to depression whenever I encounter really difficult times, but I seem to be learning how to deal with it and come out the other side without too much harm.

All Is Not What It Seems

Usually when I start to fall downhill there is a reason for it; an upcoming anniversary or something that has triggered things in my memory. But, as I fall deeper into the black hole that is depression, this time I am not aware of anything that could have caused it to happen.

Yesterday morning I went off to my psychotherapy session as usual. I was pretty anxious as I left the house and even more so by the time that I arrived at the hospital. My therapist was aware that all was not well almost immediately (I think the tremors in my hands may have been a bit of a giveaway) and decided that the session would take a slightly different path to normal. The session covered how I felt when a period of depression started, how I felt as it deepened and how I felt as I was coming out of it.

For me depression has always had a deeply physical side to it as well as the mental effects. When I am at my worst, my head and body no longer feel connected; there is a significant sensation of numbness in the area of my neck and shoulders. When I get to this stage I find it difficult to concentrate on even the simplest things, my sleep pattern gets worse as the days progress, and I start to have dark thoughts; my mind takes me to places that I really don't want to be.

For the first time ever, the session was a real two-way conversation and as a result I gained a lot from it because of the questions that my therapist was asking and the answers that I gave helped both of us to understand more about me.

Yesterday afternoon I had an appointment with my new GP. This was an appointment to go through the results of my recent blood test, to check on my blood pressure to see if the recent introduction of medication to lower it was having the desired effect, and for him to get to know a little more about me. He has requested that I book double appointments for at least the next few months so that he can get to know me as well as possible so that he can effectively monitor me.

The blood tests showed that all was well, my blood pressure has dropped to normal levels, and we had a good chat about what sort of psychotherapy I was having, about my sleep problems, and how I cope with things when my depression gets really bad. We also discussed a programme that the local council and PCT jointly run for people suffering from depression, anxiety and stress. The result of this discussion is that he has referred me to this programme and hopefully I shall soon be joining a local art class. I've never been much of an artist, but I've always wanted to be able to draw and paint, and I think that this might be a good way to help me with my lack of self-confidence, and help with dealing with social contacts. So with a bit of luck I will soon have a regular art class to form an alternative to my OU studies, and hopefully it will also help me focus on those studies a little better.

So what is this post all about? On the surface it may seem to be about me and my depression, but actually it is about something quite different. It is about two doctors; both of whom helped me on a day when I was feeling very down. Neither of them have made me feel better, but both have helped me to understand why I am the way that I am and have helped me to find ways in which to come to terms with that.

So, why is it that there are so many people in government who feel that doctors are not doing a good job and therefore it is necessary for them to interfere in the NHS? The problem is the government are not talking to the patients about how they feel about the NHS and its staff. They listen to big business, and to people who have an axe to grind. If they really want to know how to improve the NHS they should listen to more people like me; real patients with real problems, who are getting excellent support from their GP, access to treatment for mental health problems, and who appreciate all that is being done for them, and they need to listen to the the kind of doctors who are looking after me. It is always those at the coal face who know most about the business, not those who sit in offices far away and who have no idea about what really happens.