The straw that broke the camel’s back.

This metaphor has been coming up a lot for me recently. I am a paramedic and have recently suffered a breakdown. I am currently being treated for post traumatic stress disorder (PTSD) and depression.

This metaphor is so relevant. For me, depression crept up, one piece of straw at a time, until it became such a huge burden that I could barely get myself out of bed. When I broke it was not as the result of a big traumatic incident, it was something small. I was already carrying so much weight to begin with that one small incident was all it took to push me over the edge.

I want to dig a bit deeper into what this metaphor means and represents and how this can help us to understand things like depression a bit better.

The metaphor talks about a camel carrying straw. The camel can carry a limited amount of straw. If you keep adding tiny little pieces of straw one at a time the camel isn’t going to notice each tiny addition. However eventually you will exceed the camel’s strength and endurance and it will fail. One minute the camel will be able to support the weight of the straw. Then you will add a tiny bit more straw and you will exceed its maximum endurance and it will collapse. All you’ve done is add an insignificant amount of weight but that was all it needed. The last straw, so to speak.

People are like this. I have been told that ‘you can handle it until you can’t any more’ several times over my journey this year and this is what they mean. Each little increase in your burden is tiny; it’s insignificant on its own. But when you combine all the little insignificant additions they become too much to bear.

This is particularly relevant to health care professionals and mental health. You hear lots of different advice as a student. Experienced people tell you that for each sad/traumatic/painful thing you see you lose a piece of your soul. They advise you that if you can avoid seeing something particularly distressing, just don’t look because once you get images like that in your head you can’t erase them. I understand where they are coming from but I picture it slightly differently. Unconsciously, and without realising what was happening I took on a small portion of each of my patient’s suffering. I collected these pieces of grief one by one throughout my too short career in an effort to lessen their pain.

I picture myself as a glass. I started off mostly empty, but as I met and treated patients the glass started filling up. The glass empties somewhat when you go on holidays or take time out for yourself and fills up again in proportion to the trauma you are exposed to. Importantly this isn’t just physical trauma and gory scenes, this is mental trauma too, loneliness, hopelessness and grief. Horrific scenes may leave you feeling fine if there was room in your glass, but if you have had a run of bad cases or simply haven’t had enough time to unwind the glass may fill quicker until you end up in my situation.

We were taught how to better empathise with others at university. To listen, put ourselves in their shoes, repeat their problems back to them to make sure we are on the right track and then offer observations based on what emotions they seem to be expressing; ‘that sounds exhausting’, ‘that must be very difficult to deal with’, ‘I can’t imagine what you are going through’, ‘that sounds frustrating’.

This is a great skill to learn and I have seen first hand the relief on a persons face when someone finally listens to them and takes their concerns seriously. The problem arises when you are continually exposed to difficult, negative emotions. Over the course of a day as a paramedic I may have put myself into the shoes of an elderly lady living alone with no relatives. She is lonely and has no stimulation. She is scared of dying alone. Next I might attend a child with a serious illness. At this job I become the parents. I watch their beautiful child suffering as though it is my own. Next up is a middle aged man with chest pain. First I am him, scared I am having a heart attack and worried about what will happen to my family if something happens to me. I also become his wife and children and feel their love and fear. After that we go to a person that has been self harming. I feel their hopelessness, their anger, their feeling of no way out.

I imagine that the health care professionals who last the longest are able to display empathy without actually taking on what people are feeling. They can keep their work and their personal life largely separate. If I had known that this task was near on impossible for me perhaps I would have chosen a different career path, however it is almost impossible to tell until you try it.

If you are a health care professional, whether you are a student just starting out or a seasoned expert, do not underestimate the power of little burdens to bear. What you could handle last week may not be as easy this week and often by the time you realise it is too late. Use your family and friends to gauge how you are going as when it comes to depression the sufferer may not be able to see the forest for the trees. If your organisation offers regular mental health check ups take them. If nothing else they will provide a trend that may pick up something you miss.

Most importantly you need to take care of yourself before you can take care of anyone else. Make sure that you prioritise the things that empty your glass. Be it exercise, spending time in nature, reading, creating art or just sitting on the couch watching a movie. These are not and should not be luxuries, they are essential to your longevity and your patients will benefit in the end.

Advertisements

Grief Sponge

Depression crept up on me slowly. Incrementally. So gradual that I didn’t notice as the colour slowly faded out of my world.

It started with tummy aches that would begin halfway through 10 and 14 hour shifts. Bending over to pick up bags and treat patients caused discomfort and the cause was elusive. They were fairly mild at first but over the course of 6 months they got so bad that I’d end up driving home from work with my belt and pants undone.

At the same time as this was happening I started to get sick. Every bug that went around had me feeling lethargic, coughing and sneezing for weeks. My previously robust immune system was failing. Multiple trips to my GP provided no answers with serial blood tests revealing that I was perfectly healthy.

I would lie in bed on my days off and try and coax myself to get up and do something, but all the sparks were gone from the world. I let my veggie garden succumb to the ceaseless spread of weeds. Shriveled chillies and capsicums rotting on the ground amongst unruly and now inedible baby spinach and coriander, a constant reminder of my neglect.

I no longer had enough energy to leave the house or entertain guests in the few hours between shifts and sleep. For five days in a row I would cook-eat-clean up, cook-eat-clean up, breakfasts, lunches and dinners alone. Getting my washing done is an accomplishment and a necessity. Its completion becomes the main focus of my days off.

Prior to this I would have been the kind of person described as ‘bubbly’, ‘confident’ or ‘outgoing’. I was always doing something, always full of energy and giving my all to whatever challenge was in front of me.

When I finally broke it was like a dam wall burst. I had been collecting tiny pieces of grief, loneliness and pain from each of my patients over the course of two and a half years and it all poured out of me in a torrent of tears and hopelessness.

The most prominent feeling was an overwhelming sense of failure. When you are a paramedic you are told over and over again that ‘it takes a special person to do what you do’. What happens when you can’t do it any more?

A Creative Enema

An excellent combination of events has led to this week being probably my most productive blogging and writing week yet.

Firstly I was fortunate in that this weekend I was able to attend Catherine Deveny’s “Gunnas Writing Masterclass” that is designed to give participants the ‘creative enema’ they need to kick start their writing. Whether it be poems, novels, fiction, non-fiction, blogs, a youtube series or song writing, this masterclass certainly achieves it’s intentions. Not just for beginners, this course would suit you if you are a professional as well. It is not about how to write, or even what to write. Instead it provides a huge, and only somewhat metaphorical kick up the ass to get you headed in the direction you want to be going.

As Catherine explains, writers, whether famous or not, are all plagued by the same three things.

1) Procrastination

2) Thinking that our work isn’t any good

and

3) Worrying about what other people think.

Catherine tackles all of these in between coffee, delicious food and a considerable amount of delightful profanity. I walked out of the stylish La Luna Bistro in Carlton filled with energy, cake and enthusiasm to get started. I think I have been long plagued with Imposter Syndrome, however by the time I arrived home after the class I slowly started to realise that people like me can write books. One of the pieces of advice that eased my mind most was that you don’t have to be anything in particular to be a great author or write a book. You don’t have to have read thousands of books, you don’t have to have been winning writing competitions since you were ten and you don’t have to have an encyclopaedic knowledge of famous writers throughout history.

This bulletproof feeling has been very nicely timed to coincide with the #YourTurnChallenge, run by Winnie Kao and Seth Godin. Challengers have to ‘ship’ every day for seven days, specifically a blog post. You submit them to the challenge tumblr account and the idea is that you get started, get out of your comfort zone and that the community supports each other to stick to the challenge. For more details click the YourTurnChallenge hash tag above.

I am going to post my writing here as well. Hope to see you getting involved.

Menarche – A time for celebration

New post on The Wellness Journal about attitudes to menstruation and why it needs to change!

The Wellness Journal

After deciding to go off the pill in order to learn more about my body I began what I thought would be a brief online investigation into attitudes towards menstruation. My original goal was to uncover some of the cultural taboos around this important aspect of women’s health, but what I found was something else entirely. Article after article, galleries, websites, organisations, a museum, even a PhD thesis, all dedicated to menstruation and the impact of our cultural taboos on women. I found examples of varying religious protocols, I learned about period huts, menarche rituals that mark a girls transition into a woman, a concept called ‘The red tent’, spiritual and psychological theories and the modern concept of menarche parties. I even stumbled across an online shop where you can find period related party hats and paper plates. What I have read has made me think in a new way…

View original post 1,155 more words

A cup of tea and a chat could be more beneficial for your health than another blood test.

In June an article entitled “How stress can clog your arteries” was published by the American Association for the Advancement of Science. A group of scientists have investigated why people who are suffering from chronic stress are more likely to have increased atherosclerosis (a build-up of plaque in their artery walls that can lead to heart attack, amongst other things). Blood samples from stressed-out medical students revealed they had increased levels of immune cells in their blood. Subsequent laboratory testing successfully duplicated these findings.1 The poor stressed-out mice had increased levels of neutrophils and monocytes as well as increased incidence of risky atherosclerotic plaques at danger of rupturing and causing life threatening blockages. The findings were conclusive; stressed-out mice are at greater risk of heart disease.

This is incredible news! They found a definite link between stress and cardiovascular disease. Alternative medicine has long emphasised the importance of reducing stress but conventional medicine has not explored the possibility of a direct connection in much detail before this study. It is well recognised that stress is contributing to the majority of illnesses such as high blood pressure, Irritable Bowel Syndrome (IBS), and susceptibility to seasonal infections. Despite this, little is taught of how to reduce stress and it is rare to find a GP who would suggest mediTation to a patient before, or even in conjunction with, mediCation. That is why the results of this study are exciting. A definite link means that this very important aspect of wellness may start to be recognised as a major player in overall health in the conventional medical model.

But in true conventional medicine style, the article then mentions some possible outcomes of this research including a pharmaceutical drug to block the excess production of the offending immune cells, and then this telling quote from Alan Tall, a physician and atherosclerosis researcher at Columbia University:

“Rather than asking four questions about stress levels, we could use their [patient’s] white blood cell counts to monitor psychosocial stress,”

A blood test for stress!? Is this a step forward or a step backwards? Increased diagnostic powers can have definite advantages, and sometimes patients might not know when they are stressed, particularly if it is chronic stress but Tall specifically refers to saving time. Why talk when you can test instead? This is concerning in an age of disconnect, where people are feeling more isolated and helpless. Over the past few decades the world of medicine and pharmaceuticals has become increasingly advanced and often beyond the comprehension of most people without specialist knowledge. The result is that patients lose their agency and ability to make their own informed decisions. Complicated, multifactorial conditions such as hypertension (high blood pressure), Parkinson’s disease and cancer can require this specialist medical knowledge, but reducing stress definitely does not. A blood test for stress would ‘medicalise’ it, taking it out of patients’ hands where it belongs, and putting the responsibility on the doctors and the health care system. Research should focus on how to best communicate the importance of stress reduction to patients, and diet too while they are at it.

There is a long way to go for our health system before GP appointments can be long enough for good conversation. Regardless, the results of this study could provide a fantastic stepping-stone in the path towards involving the patient back in their own health. It would be fantastic to see these results encouraging doctors to talk to their patients again and to build relationships with them. To find out about their lives, whether they are happy or unhappy, and what stresses are impacting on them. Engage patients, educate them, and encourage them to be partners in their own healing.

Reducing chronic stress is one area of health care where the patient has the ability to prescribe and initiate their own treatment. The link between stress and atherosclerosis paves the way for GPs and cardiologists to take a look at the sources of chronic stress in their patients’ lives and start referring them to psychologists, counsellors, massage therapists, yoga and meditation classes and suggesting long baths, cups of tea, and more convenient working hours. Give the power back to the patients!

  1. Here is the full reference for the paper. Unfortunately I cannot access it as it is behind a pay wall.

Heidt T, Sager HB, Courties G, Dutta P, Iwamoto Y, Zaltsman A, von Zur Muhlen C, Bode C, Fricchione GL, Denninger J, Lin CP, Vinegoni C, Libby P, Swirski FK, Weissleder R, Nahrendorf M
Chronic variable stress activates hematopoietic stem cells
Nature Med. 2014;20(7):754-758 – PMID: 24952646 – PMCID: PMC4087061

How to Train Your Dragon 2 – A word about Valka

I had been looking forward to the release of How to train your dragon 2 and so was disappointed to read a review by The Dissolve that was critical of the portrayal of a prominent female character. The review by Tasha Robinson lamented that this very interesting female lead had amazing potential but that when it came to the crunch she didn’t do anything. She was saved by her husband in the major fight scene and then proceeded to disappear:

“…once the introductions are finally done, and the battle starts, she immediately becomes useless, both to the rest of the cast and to the rapidly moving narrative. She faces the villain (the villain she’s apparently been successfully resisting alone for years!) and she’s instantly, summarily defeated. “

The character being discussed is Valka, mother to the stories protagonist, Hiccup. We are told that dragons attacked the Viking Island of Berk when Hiccup was a baby and carried Valka away with them. For the past 20 years she has lived with the dragons in their hidden frozen island cave, learned their secrets and become their friends. It is reported that she didn’t come back to Berk once she was able because she didn’t believe she could get the Vikings to come around and trust the dragons. She is intelligent, fierce and independent, yet vulnerable and tender towards her son and husband.

After watching the movie myself I disagreed with the Dissolve reivew. Yes I suppose she was kind of interesting, being a dragon lady and all and having this fantastic relationship with and knowledge of the dragons, as well as some pretty cool armour, but the story wasn’t about her. Her very premise wasn’t the best role model anyway; she left her family because she didn’t think she could change their minds. She left her infant son without a mother. I feel that the decision to have a child is a big one and that it comes with certain responsibilities – responsibilities which Valka shirked for a life of fun with her dragons while her husband Stoick raised their son on his own. Additionally, the battle in which Valka is ‘defeated’ by the villain is quite realistic. She is fighting someone who is about four times her size, of course she needed help!!

I then read another review, this one on The Daily Dot by Aja Romano entitled “Why ‘How to Train Your Dragon 2’ is a radical feminist triumph”. It was a fantastic review and made a lot of really good points and if you don’t have a lot of time you should stop reading this and go and read that instead. This reviewer loved the way that Valka was not shamed for her choices by the narrative or her husband or son, and loved how badass she was. She says:

“…Hiccup instantly and immediately recognized that his mom’s choices were her own choices, and that they were obviously valuable and important. At no point did the narrative shame Valka for rejecting her role as a mother and a housewife.”

This is what I want to talk about.
I will admit up front that I am very new to feminism, and by this I mean I have only really been aware of what it is all about for maybe three or four months (but I am doing A LOT of reading!). I am all for women making their own choices and making them for themselves and not for everyone else. I am all for women not being expected to be mothers and housewives, and I am all for women finding their own paths and what makes them happy… however… I still don’t feel like it was fair of her to leave her family behind. Male or female, Viking or not, If you bring a new life into this world then you owe it the best chance possible to grow up happy and healthy.

Perhaps I am the one being unfair; I don’t have children and I am not a Viking woman (although I was delighted to discover that I may be descended from Vikings through my maternal grandfathers line). I am well aware that I have lived a very fortunate life thanks to my country of birth, my devoted parents and my middle class upbringing and perhaps I am missing something or I am unable to relate to this situation. If that is the case I would love to have my mind changed. Please, educate me!