Monday, 5 June 2017

paying it forward, gratitude and the NHS: how lucky we are

I am a nurse, working in an A&E. I am also a tutor of meditation and a Connected Kids™ tutor and trainer. I am a parent. I spend a lot of my life giving up time, energy, listening, helping, teaching...sometimes swearing under my breath or occasionally stamping my feet on the ground, folding my arms, scowling and grumpily declaring "Not Fair!". 
Recently I've become a patient, relying on the NHS to help me out. I have had a health scare, which involved me being fast-tracked for investigations to rule out something that may have been rather sinister. Today I got to sample the hospital where I work from the other side of the fence. I arrived an hour in advance of my appointment, because I knew it was going to be a waiting game for a parking space (If it wasn't for the fact I live 30 miles away, public transport would have been an easier option). I scampered off to the canteen for a coronation chicken sandwich and wolfed it down in the waiting room, making a jolly mess, actually. But I didn't care, because I had a paper towel and some alcohol rub to clean my hands and erase all evidence of my gorging on coronation chicken in a half-full waiting room on a rainy Monday afternoon. A sandwich where I'd been able to get a staff discount, as I'd remembered to bring my ID badge with me. Well, there have to be some perks to working for the fifth largest employer in the world, doesn't there? My appointment was 50 minutes later than scheduled. But I actually didn't mind. Why? Because I worked a night and a day shift in a quick turnaround (my choice - albeit reluctant - to make up my contracted hours to fit around the social life of my ex-husband and the subsequent parental responsibility arrangements). So I got to doze off in the waiting room. Peace, quiet, no expectations upon me to Do Anything. Just to Be. How lovely! There are only ever two things which worry me about falling asleep in a public place:

1. The snoring. It's a Thing. 
2. The drool. I have no idea how I can cure this. But it's not a good look.

But the allure of soporific background noise in amongst a slightly uncomfortable plastic-covered static chair was too much for my tired body and mind to stay awake. I was just dozing off, heading into some bizarre world where coronation chicken met the subconscious mind of underlying anxiety mixed with the familiarity of being on home turf as a patient, and where the lingering scent of alcohol hand rub was at risk of being ignited with the underlying strands of mild fear which were wrapping themselves around my consciousness, when I heard my name being called. I jumped up in a hurry, pretending that I was awake the whole time. Which I clearly was. Otherwise, how would I have heard my name (maybe it was because they called me Nichola. I always feel like I'm being told off when I'm referred to as a Nichola). 
Anyway. After a consultation, some tests in which one involved a colleague I'd never met but had signed a piece of paper saying I had passed some training to do something (it's always nice to put a face to a name, but on this occasion I felt it was not appropriate to begin a conversation in that regard), I was reassured that although I and my GP had been absolutely right to get checked, the great news is that I am perfect. Sorry - I mean, perfectly well. 
Thank Fuck For That.

(I make no apology for the swear word).

I instantly felt the stress and worry melting away. It's been a tricky 10 days of wondering and worrying, albeit mindfully accepting my fears, worries and thoughts. To be told all is well is fantastic. But I also knew that of the 4 of us who were in the waiting room and had been handed the same pre-consultation questionnaire, one in two of us will, at some point, be given a diagnosis of cancer. As I left the department I couldn't help but wonder if the other women who had been there will have had further invasive tests and an anxious wait for answers, before being given the life-changing diagnosis of cancer. 

I walked back to my car in the pouring rain, feeling drained and exhausted, but relieved. I began to feel so grateful for the NHS, marvelling at its efficiency and ability to work despite everything that is being done to systematically dismantle it (my own view, obviously). 
Then on my way home, as I experienced the gratitude,  I had this voice in my heart, asking me to pay it forward. 
So I stopped at a petrol station, checked my tyre pressures, then went into the shop. I randomly picked a petrol pump, then asked to pay for that person's fuel. The assistant was surprised but played along with me - I didn't want the man who had just filled his car to know that it was me who had paid for his fuel. I just felt so grateful: to know that I was clear of something that could have been dramatically and catastrophically life-changing for me (as a single parent I am forever aware that I have to be well, fit, healthy and able to care for my children. Being unwell is simply not an option for me). On the receipt I wrote, "Have a good day. Pay it forward. From Nikki".
The look on the man's face as I saw him pull away out of the station was a picture. I loved this: the thrill of making a difference to someone else warmed my bones. Random acts of kindness bring about physiological and psychological effects, and being kind has benefits which can be far-reaching, especially if they are paid forward. In light of the tragic events that have been happening recently, I want to encourage as many people as possible to #payitforward in order to share these feelings and experiences. I paid that person's fuel bill to help him, request that he do something to help someone else, to spread the love (oxytocin), and in gratitude of our marvellous, amazing NHS. 
T h a n k   Y o u 

Saturday, 27 May 2017

Let's Talk About Sex: Mindful Parenting

Picture, if you will, this scene: Me, in the kitchen, cooking dinner whilst sipping on a freshly-poured glass of red wine, dipping some crusty bread into a balsamic and olive oil dip (on my 8 year-old's request, who casually informed me that "Balsamic is my favourite sauce, Mum", which made me chuckle, not least because it triumphs over the discussion he had with his big sister earlier today in a cafe about the difference between dulce de leche and chocolate spread, rendering my kids painfully middle-class and me totally to blame for the whole thing). Whilst I stirred, quaffed and dipped, I was also strumming on my acoustic guitar, one leg up on a chair, trying to remember the chords to It Must Be Love by Madness, and somewhat failing.

Then, in strolls my daughter, age 12, clutching at my 24 year-old copy of the hefty hardback
Pathophysiology: The Biologic Basis For Disease in Adults and Children, which she had extracted from the bookshelf today to have a good look at. This is one of the books I would hug close to me, in the vague hope that I would somehow find the miracle of osmosis passing on information to transfer into cerebral knowledge without me having to study for hours on end, sweating over the pain of rote learning. So I felt a sense of joy at seeing my girl interested in this book, a contradiction to my utter heart-sink moments at having to read through pages and pages to try to find the answers to questions or a nugget to use in reference to an assignment during my training (oh, how different things would have been to me if the internet was in use when I was studying).

"Mum", she says, placing the book noisily on the table, as I see her biceps quiver in relief. "I have questions."
Ah! I thought. I can help here. I am fundamentally Good At Questions. "Fire away, my love" I said, stirring my bolognese with a confident gusto, enough to splash sauce over the tiles at the back of the hob. "What is it that you wish to know?"

"Well..." she began, gingerly, whist flicking through the pages of the book. "I am confused. What is going on HERE?". She pointed animatedly at the page of the reproductive system, showing foetal development of the sex organs. I suddenly begin to realise I am in interesting territory. Unperturbed, I take a sip of red wine, and continue. "Ah, OK, so you're confused about how a baby's gender is determined? Well, here it says that at 7 weeks gestation -"
"What's gestation, mum?"
"- Gestation is the term used to describe the development of the baby, called a foetus, whilst it's growing in the womb"
"Oh". I feel confident. This is going well. I take another sip of wine and a deep breath. Not at the same time though, as that would be silly.
"So," I continue, "As you can see from these very detailed diagrams, here is development at 7 weeks, but here, at 40 weeks, the gender of the baby has been determined and is fully developed. But it is of course down to DNA that decides the gender of the baby". A moment of acknowledged silence. I pause all stirring, strumming and sipping has ceased, in order to give my daughter the detail she is asking for, but wondering what is coming, next. I begin to feel just a teeny bit nervous, as she continues to flick through the pages, and chapters. Then I realise where we are heading. Oh God, I thought, taking a bigger, braver quaff of wine.
"Mum....what is this? It looks disgusting!"
"Oh, that?!" I said, loftily yet injecting an air of teacher-ness intojj the mix. Must stay on top of the situation, I thought. Must not show fear. She is pointing at a photo of a syphilis chancre on a penis.
I take another gulp of rioja. And then I take 2 mindful, grounding, deep breaths.
"That" I said, weakly, then clearing my wine-lined throat. "Is what is known as a Sexually Transmitted Infection."
Silence. For 8 seconds. 8 seconds of pondering.
"Hmm" Said my daughter. "How did that happen?"
"Well" I said, going back to my stirring of bolognese, feeling strangely relaxed. That rioja is wonderful, I mused, as I thought about how to continue the conversation.
"You see" I began, "when people decide that they want to um, have sex with each other, sometimes they don't share the right stuff, and do share the wrong things. Syphilis is one of a number of infections that can be passed on to couples when they have sex, if they choose not to use protection from infections and contraceptives". At this point, my 8 year-old son walks in. "What's contraceptive? Ugh, what's that a photo of? Ugh, it's a PENIS!" Cue giggling that would befit a Minion movie. "Ha! I just said PENIS"
I inwardly wince. Christ almighty...
"Yes, contraceptive" I continued, "Is what men and women use to stop the woman becoming pregnant. Because..." Oh God, I thought, I have landed myself in choppy waters, now. "Because...umm...sometimes, people like to have sex with each other because it feels really good - not just to have a baby." There was a silence. The bolognese sat on the hob, muttering its own nuances on the topic that was distracting the creator away from it, causing some bottom-burning on the pan. I realised just in time, that this was the cue to take me out of the discomfort that was edging from my toes, to my knees, to my chest and to my face, leading me to feel all hot and uncomfortable for the briefest of moments.
"Ugghhhhhh!" both children chime in fascinated disgust. My daughter flicks over a few pages, to look at photos of genital warts. Oh, bloody fantastic, I thought. We're on to Herpes. "Look, mum! How did that happen to him?"
"Because at some point he didn't use a condom" I reply nonchalantly, breaking spaghetti into boiling water and for a millisecond wondering why I hadn't done the same, all those 13 years ago.
"What's a condom?" My 8 year old asks. I explain. He looks at me as if I am telling him about dancing unicorns in the enchanted forests of some unknown world. "It's like a special balloon that a man puts on his penis and catches the sperm to stop it reaching the lady's egg in her womb. It also stops infections spreading between each person during sex" I explain. "Oh" He said, and I believe he understands me. I feel jubilant. I'm handling this so well. Much, much better than I thought I would. But that's because I'm a nurse and I can handle this, I reassure myself, taking another sip of wine.
"SO," I continued, in my teacher/mum voice. "One thing you need to remember, is that just because you can't see it, it doesn't mean it's not there. Like HIV" I said.
"What's that? Is that like AIDS?" My daughter asks. "No, it's not AIDS. It's a germ that can be passed from one person to another when they have sex, but wearing a condom helps to stop that from happening, as well as passing sperm on which can make a baby". Is this going well? I ask myself. "I don't know, is it?"My inner voice replies, impatiently. Apparently satisfied, both children saunter off to the lounge to watch CBBC, which at that point, means my work is done.
I realise something rather magnificent has happened, here. My biology bible, the book that gave me neck and shoulder strain as I commuted from Green Lanes to Waterloo to get to uni, all those years ago, the book that has seen 5 house moves, a marriage, two babies, a divorce and a life re-boot, has just opened up a brilliant dialect between me and my children. It has enabled open, honest, relaxed (ish) conversation about sexually transmitted infections, a subject many parents struggle with , and I have nailed it. Sort of. I know that this isn't the end of it. In fact, it's the beginning. I am happy to chat to my children about this subject. They need to know. De-mystifying it is far better than shrouding it like a confusion condom, preventing good quality, informed decision-making and correct information. I, as a parent, have a duty to teach my children about safe sex, to teach them that sex is good, fun, but to be treated reverently and with the deepest respect on all levels for it to be safe and successful, as well as for them to know that there are infections and illnesses that can cause big consequences if the wrong choices are made. I tell my children often that I am happy to answer all questions and take away that layer of mystery and fear. That is my mindful approach to parenting. I could never have imagined, however, that McCance and Huether would ever be referenced in a conversation with my children about what safe sex is.
Now, where's that rioja bottle...?

Sunday, 30 April 2017

Failing our children is failing to secure their future

I am a single mum to my 8 year-old son and 12 year-old daughter. We live in a lovely house, in a beautiful coastal town. I work hard to keep us in our home: I work part time as a nurse in A&E; I have my budding business teaching mindfulness and meditation to adults and as a Connected Kids™ tutor and trainer; and I do airbnb. In combination, I probably work around 70-80 hours a week, with the majority of those hours unpaid. 
Having experienced homelessness as a child and the effects this had on the mental health of my mother, I conscientiously  work at my connection to my children. I want to know what's happening in their lives, so in an effort to do so, we eat our meal together at the table, talking about our day. Sometimes they don't want to talk to me, as they would prefer to eat dinner in front of the TV. I indulge that in them sometimes, but I don't like it. The evening meal we share together is often the only time we get to discuss the good and the bad stuff that has happened in our day. I listen to them telling me all about their boring lessons, their exciting lessons, the current Year 7 politics (in an often surreal realm all of its own, I can assure anyone who isn't in the know); I listen and laugh at the daft jokes they learned. 
I listen to their worries and we try to problem-solve together. I tell them snippets of what I deal with in my work in A&E. They always want to know these two things:

1. Whether anyone vomited down the back of my scrub top (this is a real trauma, which I will never, ever forget)
2. Whether I saw lots of blood and gory stuff (what is it about gore with kids?!)

 They also love to hear about the work I do with my mindfulness clients. I do lots of fun stuff with kids to help teach them how to connect with their feelings and to train their minds. My kids like to hear the success stories, to hear what stuff we do. I like to tell them, because it makes me feel proud. It also teaches them that I can do the stuff I do because I believe in what I do and love to see the positive results. Having said that, I did once take my daughter along to a meditation talk with her teachers on their staff development day. Seeing her mum in work mode freaked her out. I tried not to take it personally when she told me she didn't like me in work mode.
After dinner our routine involves a bedtime read. I am proud of the fact that my 12 year-old still wants me to read to her each night, as we all snuggle up together and read a book. We take it in turns to read, nowadays: a great and privileged thing indeed. I love to hear my 8 year-old read to me, especially as up until about a year ago, to him books were "boring" and I'd be lucky to get him to read a paragraph. Now he reads pages. 
We've read and discussed all sorts - from Michael Morpurgo's Warhorse, to David Walliams' Grandpa's Great Escape; Malala Yousafsai's I am Malala; fairly soon bedtime reading is going to evolve into the evening bookclub, where I am determined to keep this up for as long as possible; or at least until the masses of homework and exam revision bleeds into that precious time we have as a family each night. 

This concerns me on three levels: 

1. As a parent - I value and treasure the little time we do have as a family. As a single parent I am often acutely reminded of how difficult family life can be: to try to manage the every day stuff can be a challenge, let alone when a curve-ball sploshes into the mix. So single-handedly helping my children with their homework and exam revision, on top of my own work and home life frankly boggles my brain. I'm not sure how I'm going to fit everything in and still have time to connect with my children on a level that doesn't involve the angst of maths, science and English, creating a 3D model of a WW2 allotment or somehow cleverly illustrating inequality in the Victorian social classes, as I navigate through the hardships of being a mother to one or two teenagers on every level, whilst  I deal with my own existential crises. Meditation is going to take on an even greater role in my life!

2. As a healthcare professional - stress, anxiety, depression, self-harm, eating disorders - mental health problems amongst children and young people is increasing. The findings of the Office for National Statistics Insights into Children's Mental Health and Well-being (October 2015) report on the most up to date, comprehensive data from 2004 showed that:
  • 1 in 10 children aged between 5-16 years had a clinically diagnosed mental health disorder, with 11% of boys and 8% of girls with a mental health diagnosis
  • the prevalence of mental health issues increased with age
  • Girls were more likely to have emotional problems
  • boys were more likely to have conduct or hyperactivity problems
  • The study also found that children with mental health disorders were more likely than those without to have time off school, including unauthorised absences, and were less likely to have close networks of friends or family
In response to this, in 2015 a new measure of children's mental health was added: the Strength and Difficulties Questionnaire (SDQ) from the UK Household Longitudinal Survey (Understanding Society) which showed that:
  • 1 in 8 children aged 10-15 who reported symptoms of mental ill-health in 2011-2012 had measured a high total SDQ
  • Children who quarrelled with their mother more than once per week were three times more likely to report a high or very high SDQ
  • One third of children who were relatively unhappy with their appearance reported a high or very high SDQ
  • Children who spent more than three hours on social media websites on a normal school night were twice as likely to report high or very high SDQ, compared with those who spent less than three hours on social websites
The conclusion, according to the well-being measures of Understanding Society survey, was that bullying and quarrelling with mothers had the strongest associations with mental ill-health. This is consistent with the findings from academic research and previous national surveys of children's mental ill-health. In my work as a nurse I frequently see the results of mental ill-health and see the constraints in managing them, particularly for access to Children and Adolescant Mental Health Services (CAMHS) which is a variable feast in terms of access to, and support from this service. According to The Lightening Review (2015) from the Children's Commissioner :
  • 28% of children were turned away from CAMHS without being offered help, although this varied across the country, suggesting that there is a postcode lottery of mental health service provision across England
  • Waiting times to be seen were widely variable - between 14 days to 200 days, again, depending on the region in England
  • 3,000 children were referred to CAMHS with a life-threatening condition, such as attempts at suicide, self-harm, anorexia and psychosis - of which:
    • 14% were not allocated any help
    • 51% went on a waiting list
    • some waited for over 112 days for access to services

3. As a mindfulness tutor for children. In my work in schools and privately, I see a vast number of children and teens with various mental health issues. I know that what I teach works - I have seen the evidence for myself and audited my work; parents and teachers report improvements in the students I work with. As an individual, I feel great that my skills are helping those I work with. On an operational level, it frustrates me, because there is so little money available for schools and organisations like the NHS to provide this level of support. 

I am so passionate about the work I do with the children I work with. I jump up and down with joy when I see a child come through a dark period in their life through using mindful activities and learning to meditate in order to manage emotions, make sense of feelings, or overcome anxiety or fear; conversely I jump up and down in frustration when I feel like I'm struggling to be seen or heard by the powers that be: too often mindfulness is still regarded as "soft" and not as effective as medicines to treat children's mental ill-health. What is it going to take to enable collaboration between these disciplines and enable a team-around-child approach to mental well-being in schools and in the NHS? 

I can promise you that I am at the front of the queue, waiting - if not chomping at the bit - to get mindfulness training into the clinical setting for paediatric staff to use as a clinical tool in delivering patient care. The Mindfulness All Party Parliamentary Group (MAPPG) found evidence that mindfulness training helps children and young people learn to regulate emotions, improve problem-solving, reasoning and memory (MAPPG Mindful Nation, p.30). As well as reduce stress and depression and improve emotional and behavioural regulation, the MAPPG recommend mindfulness training in the education sector to schools, as well as in healthcare, the workplace and in the criminal justice system.

With the education and healthcare sectors feeling the financial pinch and ever increasing need for clinical intervention combined with a lack of training for education staff in managing mental ill-health in pupils; the effects of the decreasing numbers of nurses thanks to Brexit and the scrapping of student nurse bursaries, I am concerned about how we as professionals and as parents can help children and teams work through mental health problems, let alone teach good techniques for coping strategies and life-skills for managing stress and anxiety throughout their lives. Three out of four teachers feel that they are unable to access the support to help their students manage mental health problems. 

If we fail to prepare our children, we are failing to help them secure a positively-assured future. We cannot let this happen. As parents, teachers or healthcare professionals, despite the growing problems we face in tackling this, we have to continue to fight against the grain of resistance, in order to do as much as we possibly can to help these children and teens. We have a duty to do everything we can, and it starts with making that connection with them, in whatever small way we can, and build on it from there. 

Nikki Harman, RGN, Connected Kids™ mindfulness tutor and trainer