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Resilience Training

A Three Breath Traffic Light

 

traffic-lightsAs I prepare a resilience workshop, I would like to offer you a simple tool called the three breath Traffic Light.

In essence, you keep an image of a traffic light somewhere easy to find – like your phone or on your desk. Have an alarm prompt you every so often to look at this image.

The Red Light – is to remind you to just stop and breathe.

The Orange Light – to breathe and be aware you are breathing.

The Green Light – to breathe and then go.

While this may sound childishly simple, it’s power can be immense. Neurophysiologically speaking, “stopping” interrupts fear and flight or fight circuits from continuing to spread beyond their origin in the amydala. Becoming aware of the feeling of our breath, strengthens the links between the right and left sides of the brain. Finally when we breathe mindfully and “go” it restores brain function and control to the executive centres in the pre frontal cortex.

Or put simply, it gives us the power to choose how to respond, rather than be driven by subconscious lower brain impulses.

Faced with the breaking point pressures in the NHS as we have been for 3 years, it is worth remembering tools similar to this have helped rebuild inner strength and resilience in children exposed to much worse – the devastating trauma of 9/11. If it can work for them, it can work for us. Will you give it a try ?

Inner Resilience Program

Social and Emotional Learning

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Public Sharing

Einstein’s “Circle of Compassion”

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Over a coffee yesterday, my friend Saad told me about “Genius” –  a National Geographic tv series based on Walter Isaacson’s book on Einstein. An amazing story of the man within a scientist, allowing us to perhaps reflect on how a journey of sacrifice and suffering lead him to his amazing insights – insights that have fundamentally changed the trajectory of human evolution.

Yet within his scientific discoveries, we also find the insight of compassion. In his words

“A human being is a part of the whole called by us universe, a part limited in time and space. He experiences himself, his thoughts and feeling as something separated from the rest, a kind of optical delusion of his consciousness. This delusion is a kind of prison for us, restricting us to our personal desires and to affection for a few persons nearest to us. Our task must be to free ourselves from this prison by widening our circle of compassion to embrace all living creatures and the whole of nature in its beauty.”

The challenge for us – how do we “widen our circle of compassion” ? A first step might be – simply opening to what is in our immediate circle – including ourselves – with joy and gratitude …

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Personal Journal Public Sharing

Three Tests of a Humanitarian Crisis

The Red Cross says it is. The government says it isn’t. So how do we decide if the current stresses within the National Health Service are more than just seasonal pressures ? Here are three tests.

The “Duck” test: “if it looks like a duck, quacks like a duck, and swims like a duck – it probably is a duck”. How do people and patients perceive not just their own care but the care of other patients beside them in the Emergency Department corridor or Acute Ward ?

The Expert test: What do the people who work with humanitarian crises day in and day out think about the situation ? The Red Cross has spoken, how about other similarly experienced individuals and organisations – what are their views ?

The Rationing Care test: how are clinicians and managers deciding on the best use of resources ? For example when the Emergency Department is overcrowded, which patient do we move into the corridor – the one least likely to come to harm or the patient most “likely to die anyway” ?

Difficult questions that we as clinicians, hospital managers and a community need to answer honestly and together. Not out of anger, but out of understanding and compassion.

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“We who have experienced the war directly have a responsibility to share our insight and experience concerning the truth of war. We are the light at the tip of the candle.”
Vietnamese Zen Master to US War Veterans

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Personal Journal Public Sharing

“Enough”

A friend sent me this story on social media. Within it lies a deep wisdom that can heal at its roots, the current crisis in our Emergency Care system …

“Recently I overheard a father and daughter in their last moments together at the airport. They had announced the departure.

Standing near the security gate, they hugged and the father said, ‘I love you, and I wish you enough.’

The daughter replied, ‘Dad, our life together has been more than enough. Your love is all I ever needed. I wish you enough, too, Dad.’

They kissed and the daughter left. The Father walked over to the window where I was seated. Standing there I could see he wanted and needed to cry. I tried not to intrude on his privacy, but he welcomed me in by asking, ‘Did you ever say good-bye to someone knowing it would be forever?’

‘Yes, I have,’ I replied. ‘Forgive me for asking, but why is this a forever good-bye?’

‘I am old, and she lives so far away. I have challenges ahead and the reality is – the next trip back will be for my funeral,’ he said.

‘When you were saying good-bye, I heard you say, ‘I wish you enough..’ May I ask what that means?’

He began to smile. ‘That’s a wish that has been handed down from other generations. My parents used to say it to everyone…’ He paused a moment and looked up as if trying to remember it in detail, and he smiled even more. ‘When we said, ‘I wish you enough,’ we were wanting the other person to have a life filled with just enough good things to sustain them.’ Then turning toward me, he shared the following as if he were reciting it from memory.

I wish you enough sun to keep your attitude bright no matter how gray the day may appear.

I wish you enough rain to appreciate the sun even more.
I wish you enough happiness to keep your spirit alive and everlasting.

I wish you enough pain so that even the smallest of joys in life may appear bigger.

I wish you enough gain to satisfy your wanting.

I wish you enough loss to appreciate all that you possess.

I wish you enough hellos to get you through the final good-bye.

He then began to cry and walked away.”

May I wish each of us enough.img_0223

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Personal Journal

Breakfast Rounds

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Which comes first – my role as a doctor or my role as a human being ?

Recently, with clinical need exceeding inpatient bed availability, patients have been forced to spend the night boarded in their local Emergency Departments. Which brings me to my dilemma.

Imagine I come in at 8 am. I start with a “ward” round on these overnight patients. I come to patient number two and find a frail 81 year old lady who has been in ED for hours with very little to eat or drink. I look for a health care assistant or hospital volunteer who could bring my patient some breakfast. There isn’t anyone. I look for my patient’s nurse and find she is stretched between several other patients, about to start antibiotics on someone septic while simultaneously organising the urgent transfer of a patient she needs to take down to CT. (gone for another 30-40 minutes at least). So it comes down to me –  do I  stop the round and make tea and toast for this lady and other overnight stay patients myself ? Or do I delegate the task –  knowing it may be an hour or more before it gets done – and instead check whether the remaining boarded patients have serious medical problems to sort ?

I honestly don’t know. Like Australian Lieutenant General David Morrison, I believe the standard you walk past is the standard you accept. And this is a standard I can not accept.

My friend and colleague Damian Roland wrote about being the kind of consultant who answers the telephone.

Another friend (and fellow ED consultant) routinely pushes patients on trolleys to the CT scanner when a hospital porter isn’t available.

While noble and good for the individual patient concerned, I wonder if such actions might weaken the system further, putting future patients (and staff) at greater risk. (“We don’t need more reception staff / porters / health care assistants – the doctor can answer the phone / push the trolley / get breakfast…”)

I guess some of it depends on how we as doctors communicate these issues to hospital managers, and how hospital managers in turn respond.

Till then however, my dilemma remains …

 

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Personal Journal

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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Personal Journal Two Wings

#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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Personal Journal Public Sharing

Two Wings

We will be launching our five session Compassion in Practice Series – “Two Wings” tomorrow, Friday 27 May 2016.

Our Aspiration:  “Like a bird flies on two wings, may we learn to balance external activity with inner sustenance.

IMG_9141Over the coming months, I hope to post updates of our sessions for those of us who can not be there in person. I hope you will join us, even if from a distance, in this shared journey.

I am often asked “Can you actually teach someone compassion ?” I don’t know – but I do know the experience of compassion  feeds compassion – and once nourished, compassion always finds a way to manifest itself.

I look forward to flying with you, dear friends.

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Personal Journal

“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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Categories
Personal Journal

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.