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#AnotherWay

Start of a Journey #AnotherWay

It’s a little over three decades since I joined medical school and I find myself starting a new journey – exploring deep compassion in clinical practice.

I will be doing so through a Masters program “Human Factors in Patient Safety” offered by the Royal College of Surgeons of Ireland from this September. A little nervous, and very excited.

Human factors” can mean different things to different people. For me, it is about exploring how compassion influences the interdependence between human beings and clinical systems. Anyone who has experienced genuine compassion knows the effect it can have on clinical outcomes – how might it be possible to reproduce this at a “system” level ? And if we did, what kind of effect might it have ? In short – could there be #AnotherWay to how we deliver care ?

I hope to share what I discover over the coming months through this blog …

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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 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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