Reflections on ‘firefighting’

A thought came to me while watching the trailer for Deepwater Horizon at our local cinema recently. We use the term “firefighting” in the Emergency Department almost daily – as a way of explaining our focus on immediate shop floor crises, often at the cost of proper planning for the future. But what exactly does “fire fighting” involve ?

Certainly a team of people – we generally don’t expect a single fireman to deal with a burning house on his/her own.

It needs specialist training, and constant updates in best practice.

Finally, firefighters are inherently heroic, aware they may be called upon to sacrifice their lives every time they get called out.

Looking at EDs across the UK, and at our own, how often do we send a multidisciplinary  team of both emergency and in-hospital specialists (doctors and nurses) to deal with episodes of shop floor overcrowding and severe clinical risk  ? How often are those of us leading the response really trained in managing critical imbalances between emergency demand and available resources ? (good article by Damian Roland on unconscious incompetence at scale). How far are we ready to go in sacrificing career progression, even job security by speaking out when the situation calls ?

There are reasons why even with our best intentions, the fire in UK Emergency Departments continues to burn …

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#FEARLESS Compassion

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Friday, the 27th of May 2016, saw the launch of what was originally meant to be the first of five sessions on developing Compassion in Practice in the Emergency Department – a series we had named “Two Wings”. We had seven participants of different backgrounds, all international medical graduates, all motivated and gifted individuals. The session began with a shared lunch at restaurant close by – bringing back memories of a time when consultants would take their juniors out for a meal. We then moved on to our Post Graduate Education Centre where we watched a video and shared personal reflections on the common journey that connects us – bringing joy, relieving suffering and trusting our own music – either on a piano or in clinical practice.

I would love to have ended there but of course the journey into compassion is rarely that easy. Minutes before the session, what had been “we” (organisers) suddenly became an “I’. I won’t go into why my co-organiser got pulled – it still feels quite raw. Yet in the honesty of that rawness lies the challenge of compassion – and its strength.

Damian Roland, a respected colleague and friend, shared in a blog recently how there may not be that much for the NHS as a whole to learn from Leicester City Foxes incredible Premier League victory. For me as an individual though, it feels different. Against the odds, against conventional logic, with little money and up against the ‘big boys’ of the Premier League – a team comes out of nowhere and wins. A story to identify with – compassion in emergency care !

So my challenge for today is to uncover  #FEARLESS !

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“Are We Sure ?”

One of the best expressions I have found in my quest to develop compassion in practice is the simple question – “Are you sure ?”

This week, while setting up a teaching session for emergency floor consultants on advanced End of Life care, a colleague  challenged me quite forcefully with – “Can you please highlight what the learning objectives are … (it needs to) sit within a framework to address outcomes.”

An interesting, and all too common perspective. But are we sure it is always the right one ?

What if the learning objective is to simply be there ? To understand our colleagues’ challenges in delivering good End of Life care in an overcrowded Emergency Department and to share our own ? To acknowledge and reconcile (even if only a bit) our suffering by knowing we are not in it alone ?

Are we sure such non ‘framework’ outcomes are any less important than being updated with the latest NICE guidance and having experts teach us current best practice ? (also included in the program)

To me, it is like eating a meal. Do we need to routinely set “nutritional objectives” of how much vitamin-mineral-protein-calories to consume each time ? Or can we simply allow ourselves to connect with the refreshing, healing and nourishing elements in the food (or an educational event) and trust sometimes that may be enough.

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NHS Compassion

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I had a fascinating discussion with Jake and Geeta, two members of our educational team. Jake, who is our IT guru, was telling me how he felt the doctors and nurses frustration with the different IT systems used across the ED shopfloor. He really wished he could somehow change the software so the clinical staff “would not suffer as much”.

Recognising another person’s suffering combined with the heartfelt desire to relieve that suffering – isn’t that the very definition of compassion ?

Like many, I had not always considered hospital compassion beyond the patient- clinician interface.  Listening to Jake, I now recognise this spirit within so many people across the NHS – in very different forms and roles, clinical and ‘back office’.

How can we nurture this deep compassion ?

Well, according to Geeta, -by “putting aside our egos”.

And from Jake – sometimes “just being”.

Thank you both for such a rich sharing.

A Compassionate Christmas 

In my journey to better understand what compassion means, I spent some time in a Buddhist monastery. One of the senior monks there offered this message about a green Santa which I would like to share with you …

This season, we invite you to imagine a Santa Claus dressed in green. He bears an empty sack, with no material gifts, but only a gift of the heart, a gift of love. This Santa visits each home, not coming secretly down the chimney, but knocking overtly at the front door. He has nothing in his bag. He greets the family and embraces each child in his arms with a long hug, no matter what color their skin, or whether they live in broken-down huts or luxurious homes. He tells them that this Christmas, he is bringing them the gift of love and compassion, and not gifts wrapped in boxes, because it is this energy of love and compassion that the world is most in need of now.”

  
May each of us find this love and compassion – in and around us –  as we travel the road together  …

Relating Meaningfully

This is from an email recently shared with my Emergency Department:

here are a couple of things I’ve worked out so far…

One – for all our eccentricities, the people I work with are exceptional. Exceptional in how much they care deep inside, and exceptional in how strong they are day in day out on the outside. An amazing team I would like to relate to in a more meaningful way over time. 

And two – the conviction I had before all this – of compassion being our way forward – now shines brighter than ever. A journey we will walk together, one step at a time.

What does it mean – to relate to in a more meaningful way ? I am finding out, and for this week it’s been having the courage to accept and to give a hug to those friends at work who care about me and haven’t seen me for a while.

Dear Friends – thank you.IMG_5180