Magic roundabout

It was raining when we left London on Monday afternoon, the cold and the pervasive greyness seemed to perfectly match my mood. I should have been feeling relief as I was finally escaping my own life, if only for a little while and heading of to Zurich. However, I was in a state of static numbness, crushed by tiredness and something else as I tried to process the previous forty-eight hours.

Saturday morning I had started in panic mode. I was booked to complete a review clinic and I was not entirely clear who was coming to the clinic. The names looked familiar but I could not quite remember diagnosis or the reason they were coming back to see me. Sometimes, time constraints mean that this is something that I am just finding out in the hour before the clinic. Or if I am super organised (rarely) I have the luxury of looking the afternoon before. Somehow for this Saturday clinic neither of those choices were a good option for me. I had left the office on Friday after seven and I was exhausted when I returned home. I cannot remember what time I dragged my weary body to bed but I woke up at five in the morning in a panic about the clinic. I did not want to get up a drive to work like I would do in the week day, it was Saturday after all. So I put my dressing gown on sat on the sofa with my laptop and went through the four case notes, working out what my last clinical impression was, what my plan was, was it carried out and anything else that had happened to them since I seen them last. I found that as I half completed my new report for each patient, my anxiety about the clinic faded. I finished just after six and then completed a few administrative tasks (yes crazy for a Saturday morning). I showered and made my way to work.

I arrived at work at eight thirty to find one of the managers and personal assistants (PAs) already seated at their desks, computers. Somehow the first I did was apologise to the manager for the flurry of tasks that I had sent her, in the absence of me not having a PA. She had asked that I send all the work to her but it was a lot of work. She commented “I’ll need to work the next three Saturday’s to finish it!” I replied “welcome to my world!”. It struck me as slightly insane that she would think the would need three whole days to complete the work that I had generated in just one day.

So I did my clinic and as ever was struck and moved by the vulnerability that walks through the door. The first and last families were especially poignant. One mother apologised to me as soon as she walked through the door. Telling me she was sorry that she was rude at the last appointment. I honestly did not remember rudeness, I remembered a mother who was struggling to cope with the fact that her daughter was presenting with features suggestive of autism and at the time it was not something she could accept. At the time, she attended the appointment with a senior member of staff from the school and we agreed to keep going to the speech therapy and input at school and review things after six months. So the NHS being what it is meant that she literally did not see a therapist. The only ones she has seen, she had had to pay for and the will charge a cool £90 per hour – something she could not afford. This mother is not English so she hired a therapist from her own country for £20 and hour, to help her child but in her mother tongue which they then translate back to English. The child has made little progress and even this new therapist had spoken to mother about the possibility of autism. The new school she was meant to start would not take her because they felt that they ‘could not meet her needs’ so the child is staying in nursery. And we as a service had not been able to offer a timely review appointment – I was doing my review 5 months after I had planned and on a Saturday morning. It all felt bad. The information that mother shared with me about her child’s progress in the past year and what I observed in the clinic room, lead to a discussion with mother about how my clinic impression was still that her child was presenting as a child with autism and that we ought to make a firm plan to complete my assessment. So I have booked a day to complete a nursery visit and in the meant time contact other professionals to complete their assessment and observations. It did not feel like we as a system had helped this child. It felt bad.

I managed to discharge one patient on Saturday morning. I’d given a diagnosis of autism and attention deficit hyperactivity disorder over a year ago and now he family and school were at a stage where they were able to understand and meet his needs, they understood better his behaviour and how he thought and acted the way he did. Life was still challenging but they felt better equipped to deal with the ups and downs.

The last family was more complicated not the child per se but the social circumstances. As was taking the history it became clear that this mother had multiple plates to spin and the bigger picture involved more that just the child that was cheerily putting train track pieces. We were able to discuss a plan of action that might help provide some short and long term support. I finished the clinic later than planned but much of the immediate administration related to the clinic is complete. I wrote to GPS, formalised prescriptions and requested investigations. When I get back I have three clinic letters and some referrals to dictate but they should not take long because the clinic preparation meant that the reports were half done, the only additional information was the history, assessment findings and management plan.

So I left the office three and speed home. I made myself a panini sandwich and the left the house again for a night out with friends. I had earlier in the week booked tickets for the Backyard Comedy club. It’s a place that I have been too on a number of occasions with my best friend and this time we went to celebrate the up and coming birthday of her very good friend. It was on the surface a lovely evening. However, although I was laughing on the outside I was crying on the inside, and in fact when my friends got up to get a drink in the interval, I was crying my eye out. I’m not sure why, I put it down to sheer exhaustion- mentally and physically. I had worked six days this past week, waking up early each morning. Perhaps I should have really stayed in on Saturday night. I never listen to myself.

Sunday morning was a bit more reasonable, I had a lie in until eleven which felt like heaven. But then we were off out to meet friends at a Middle Eastern restaurant in the centre of town. The food was amazing and the company was even better. However when I got home, I felt like I’d been hit by a sledgehammer. I went to bed weary and somewhat agitated. The agitation persisted and I ended up getting out of bed to send some work related emails for subjects that had been playing on my mind for weeks. I paid some bills on line – also gnawing at my conscious for weeks. Then at five o’clock I suddenly felt relief, like a burden had been lifted and I could finally relaxed. I crawled back into bed and slept, until seven. Then I woke up again with a racing heart thinking about all the washing up that needed doing. So I washed up and put away some dishes, emptied the bins, wiped down the counters, organised the leftover fruit and vegetables into bags to keep and take with us and those to chuck.

*. *. * * *

I only started feeling the nearest thing to normal once I buckled my seatbelt on my 16D seat on the airplane. I stopped struggling and resisting and worrying because I thought “there’s nothing more I can do now. Everything is out of my control” Which was a fine thought until we reached a patch of turbulence…

It’s now Tuesday afternoon, I have had a 12 hour sleep and I’m sitting on the sofa, in my sister seemingly effortlessly cool, stylish sun filled lounge. My husband is reading ‘Daughter of Smoke and Bone’ on his Kindle. My sister is taking a nap and I am going to thinking about how to break this cycle of stress and anxiety before it breaks me. I’ve already started this holiday physically unwell, cough, sore throat and a deep aching tiredness that seems to have seeped into my bones. I have tried to stop checking my work emails and now I have got it down to once every few hours. I am hoping that I have enough discipline to not look again until Monday morning when I’m back in the office but I’ll let you know how that goes. Something does need to change for me this year. This is now the third time I’ve been ill this year. This is the third period of annual leave that I’ve been too unwell to properly enjoy. I think I am overworking and overthinking. I need to work smarter not harder.

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