It all began this winter.
The pressure was extreme, despite the mild weather.
More and more patients arriving, more people waiting to both be seen and admitted, and hanging-around even longer to get home.
‘When can I go home?’ Has become a mantra of my patients – matched by my platitudes… ‘As soon as we can organise care,’ ‘When the social worker comes,’ ‘Maybe tomorrow,’ ‘I’ll ask sister.’
The winter made me a liar.
And worse than that; it placed such unimaginable pressure on co-workers that behaviours were changed; interactions distorted.
There is a story by Shaul Tchernichovsky called ‘Boiled Dumplings’ (Levivot Mevushalot) – it is an idyll describing the process of cooking dumplings as an analogy for the experiences of students at the time (1920’s, Germany) whose lives were so constrained and pressurised, compressed within the confines of strict gymnasium life, that when exposed to the outside world, they explode with the sudden drop in pressure – become radicals, revolutionaries, (just as the dumplings burst if over-filled when dropped into boiling water).
I see my colleagues, challenged through a sort of systematic bullying that is emotionally and physically draining, who drink and smoke too much in an attempt to relieve the stress, who I see growing old before me, their faces lined by poor sleep and early waking.
Who have slipped from, Jean in the corner, retired postmistress from Fife, to bed 12;
TTO (To Take Out) & prescription ordered and form signed, tests completed and heaven-forbid you should consider changing/stopping any of the medicines at last minute; the spectre of ‘the Nomad’ (pre-packed dosette boxes), is relentless; the phone, ‘How many beds today,’ and on and on.
Fortunately, we have arrived at such a level of refinement of care, in my department at least, that the pressures have not caused a deterioration in quality – we have still managed to process the patients and avoid any significant harms (indeed, we seem to be improving all the time) – as if, ‘I work better under pressure,’ is the new normal.
And back to the rationale.
I came to the conclusion that this winter was likely to be the same as the next, and, probably everyone after, more and more compression, the workforce squeezed from coal into diamonds. The structure of our teams realigning, reforming, harder and harder.
And with this realisation, which was augmented by the announcement of the retirement age moving further away (really, does anyone of my generation believe that retirement will exist in 20 years?) – and the knowledge that my experience, my sense of wellbeing and those around me is likely to continue, accelerating towards the unsustainable reckoning of the winter months, and my need to do something about it.
Something about it.
That was my sense.
That, all is not lost; that, despite the changes, the ever-increasing complexity of systems and processes, the diminishing resources and growing need, there was a way out, a way to unravel the madness and, return compassion, caring and sympathy to the system, to embolden colleagues, bolster their emotions and create a workplace that will support decades more work.
It is all about meaning.
A few months ago, I wrote about Victor Frankl and his great book, ‘Man’s Search for Meaning,’ in which he describes the experiences which led to the creation of logo-therapy, Frankl’s meaning-based Psychoanalytic theory.
If you have a why to live, you can bear with any how.
The why is easy – helping people, easing suffering, being kind, caring, sensitive, listening, treating, empathising, supporting, leading, nurturing.
It is the how that dissembles.
How can you do all of this within a system which is under constant threat of collapse?
When people become process and individual’s numbers?
The how, was quite straightforward – developing a person-centred quality improvement programme in the organisation, to industrialise doing-better, to take the imaginings, hopes, ideas and aspirations of the thousands of our staff and provide a voice to support their solutions, to cohort their creativity and provide a translation.
Being the means to improvement, to doing better, to securing the future, was what I felt could be my how.
And that, was taken away.
That was when the system said, ‘You may have your how, but it is not our how, your how is not consistent with our principles, our values, or direction; we respect your difference, but please, take your difference someplace else.’
And that was shattering.
Without the how to see me through, without the answer to the turbulence there can be no continuing.
And this is my call.
First find meaning, and, if the meaning is diminished, is missing or fake, look elsewhere.
We become trapped in routines, imagining that our way is the only way, when in reality there are an infinity of options, of opportunities before and around us.
Meaning first, and the rest can follow.
So said Viktor and so wrote Shaul.
*This winter saw unprecedented numbers of early Painted Ladies in the UK – a reflection of our mild winter. What might a big-freeze have looked like?