More Than A Job Part Four - You Don't Have To Be Crazy To Work Here....

I left the Accident Hospital to go to work in Mental Health. Now at the time, physiotherapy in mental health was a backwater; a nothing speciality - the domain of the unambitious, and a place where old and/or tired physiotherapists went to die.

Except at Highcroft Hospital.

Nick Rosen is the most innovative, inspirational, motivational physiotherapist I have ever worked with. His nickname was Mr Brittas, after the character from the Brittas empire, because in the same way that Brittas had a single-minded drive to bring exercise to the masses, Nick was evangelical about exercise for mental health. We had technical instructors instead of physio assistants, years before any other department. We had a computer that did our stats in the days when you had a blinking green cursor to greet you when you switched it on, and when NHS computers were generally glorified word processors that you fed information into and never EVER got anything useful back out of. They are still that now, come to think of it - but back to the story....

Highcroft was where I learned what mental health physiotherapy should be about, and what a physiotherapy manager should be about.

It was where I had my last mental breakdown.

It was also where I began learning Cognitive Behavioural Therapy, and really got cracking on the process of changing my life and my self.

Those two things are not unrelated.

Highcroft was another massive shock, because I went from being a Senior I who knew all there was to know in her field, to being a Senior I who knew bugger all about what she was doing. Oh, the physiotherapy part was fine. And the relaxation classes were fine - well, the relaxation classes weren't fine, they NEVER went to plan, they could be the highlight of the day or the nightmare scenario and you never knew which it would be, but it was the same for everyone, it wasn't just me being crap.

No, the bit that was so difficult was knowing how to deal with people so ill. Again, with the frankly psychotic people, everyone was in the same boat, and there were behaviour management programmes that everyone used, so I could deal with that. It was the anxious and depressed, the suicidal people. I felt at sea, didn't know how to deal with them, hadn't the skills the other seniors had to know what to say and when. But hey, I was more experienced now, I could deal with this, I'd been here before and I was that bit older.

Then just as I was finding my feet, just as all the reading and learning was starting to make a difference, the two other seniors both left within a short while of eachother. I found myself the most senior clinician left, and deputy to the Superintendent, and this was where things REALLY started to go tits up.

I took on anything and everything. I was determined to prove that I could do this and I tried to prove it by never saying no. I would go to work in a state of anxiety and dread. Whilst I was there, things weren't too bad - during the day I would cheer up - I was too busy to dwell on things and I was so good at putting on a smile that I could even convince myself. Then I would go home and be too exhausted to enjoy anything any more. My thoughts were focussed on my work even when I wasn't there. Nothing else in my life was of any importance compared to living up to my predecessors,  being the best I could be and helping the most people I could. I couldn't sleep, and spent the time dwelling on my own uselessness. Then it was up early again and another panic-ridden commute where I would fantasise about running away.

I remember Nick reading a book that compared problems to monkeys - about how you should only ever have your own monkeys, not other people's, and how some people will always get rid of their monkeys whilst others are monkey-collectors. He said he could see me wandering around picking up stray monkeys, even grabbing monkeys off other people who were quite happy with them, and all the time I was already staggering under the weight of a sanctuary full of the creatures.

Then one day I threw all the monkeys in the air and ran before they hit the ground.

I came into work and saw someone had booked an extra patient in my diary. I picked up my bag, left my department keys on the table, and walked out.

I bumped into Nick on the way out (I was always the first in - even though Nick was always early). 'Where are you going?'

'I resign, I'm never coming back.'

I could hear him asking me to come and talk about it, to come and have a cup of tea, but I ignored him and kept on walking. I caught the bus into Birmingham. I played the usual game of should I continue to my destination or should I hop on any old bus and run away wherever it took me. I went home.

I lay on my bed and cried. But I knew things were very wrong and I knew I needed help. I booked a GP appointment and felt so relieved to hear that 'it's not your fault, you have depression, you are ill, it's your brain chemistry.'

But that was nothing more than a comforting fiction. The pills she gave me didn't do the job. Facing the half-truths and lies in that GP's statement was how I got well.

To Be Continued...

More Than a Job Part 3 - Living the Dream

I was destined to work at Birmingham Accident Hospital. Fate took a look at me, and took a look at that little gem tucked away on Bath Row, and she knew, she just KNEW that we were meant to be together. Carlsberg doesn't do hospitals, but if it did.... If the Accident Hospital were a man, I would have married it and lived happily ever after, shagging its brains out nightly. I make no bones about it - this is the alpha and the omega of hospitals, there never has and never will be a hospital that can touch it in my eyes.

From the minute I knew I wanted to do physio permanently, I was plotting my escape back up the M6 and into the welcoming arms of the Acci. My first attempt was a dismal failure. A senior II post came up that was rotational through the trauma and orthopaedic hospitals - and one of the 6 month rotations was the the Acci. I went, I interviewed, but inexplicably (oh, ok, all too obviously due to someone being better than me) didn't get the job. I was gutted, especially as my housemate had done my tarot cards and been convinced I was leaving Wales for my dream job in the next few months. She did them again - 'no, you're definitely going, DEFINITELY.'

A month later, the Birmingham Orthopaedic Physio Big Boss phoned me to say that a job had come up and did I want it, 'but I have to warn you it isn't rotational through the hospitals, it's permanent at the Accident Hospital.' Luckily she wasn't in the room, cos her hand really wouldn't have been safe from being bitten off.

The Acci never was for everyone. Most people didn't like it for the same reasons I loved it. It was fast-moving, chaotic, no time to think, SUCH hard work - but SO interesting, so enthralling, what you were doing was the ultimate in worthwhile. Life shrank, because the Accident Hospital was work and play - it was a small hospital, we all were so bound together that we were friends instead of just colleagues, there were loads of parties in the Doctors' mess and the Nurses' Home, we'd go on hospital trips to Alton Towers, Snowdon, Carding Mill Valley. You either got it or you didn't. You either found it confusing, unstructured and frightening, or you loved the excitement and the challenge and the thrill.

I began in February 1988, and at the start I struggled, horribly, and it was especially difficult because another lassie began a couple of weeks or so after me, and she was so much better than I was. The tables had turned form Wales, and now I was the rubbish newbie. Oh, I still loved it, loved the day-to-day work, loved what I was doing: but I couldn't do it fast enough or to a high enough standard. It didn't help that two of the senior staff sort of bullied me - would follow me around criticising everything I did (and not in a constructive manner) or check up on me when I wasn't there, then accuse me of not doing things I had done, or doing things I hadn't done!

Luckily, my immediate senior was really supportive, and with her help I got through it. It didn't really help that at this time I was at a bad place in myself, on a majorly self-destructive downer - drinking too much, too often, being incredibly promiscuous, and generally seeing just how far one person could go without having a nervous breakdown or dying. Of course, I was majorly in denial about this, and remember having a right hump when on a night out someone I actually really liked goes, 'hey, Karen, I've put your song on' and it was this:

"Here you go, way too fast

Don't slow down you're gonna crash.....

.......So what do you want from me?

Got no cure for misery

And if I go around with you

You know that I'll get messed up too"

To be fair, this wasn't anywhere near as mortifying as the time a sort-of-boyfriend Acci doctor requested a DJ dedicate Pet Shop Boys 'Domino Dancing' to me, but it was along the same upsetting lines.  

But things were changing. The two pseudo-bullies left, I found my feet, and I met the nice boy M_  that I horribly cheated on . I was calming down, becoming more focussed on work, and becoming a valued member of the physio department - I was helping other people now rather than the other way around. In 1990 I became the Burns Unit Senior I - and that was where my life became about my work. I wanted to be the best Burns physio ever. I made a comprehensive pack which educated the students on placement in little sections over their three weeks with us. I read everything there was to read on the treatment of burns. I went to watch skin grafts, I went to dressing changes, I went on every ward round and answered questions the junior doctors couldn't answer (and the consultants shamelessly used this as a means to belittle them - basically saying 'oh look, even the physio knows and you don't'). I loved that job. I loved being a senior, I loved setting an example. If switchboard couldn't contact the on-call physio, they contacted me because they knew I wouldn't moan or bitch, I'd just come on in. I loved it! It felt like being on ER!

However, two years in, I knew I was feeling a bit restless. Burns physiotherapy is really quite routine - you do the same things day in, day out. The skill was in motivating people who were in pain and feeling really ill, to do exercises that hurt, or made them feel even more ill. And also in dealing with the sort of people who get burned.

Ordinary people rarely get serious burns. There would be the odd one-off accident, the rare work accident or the very occasional fireman who would get burned; but usually the serious burns, the ones who ended up as in-patients, were people with drug and/or alcohol problems, people who were homeless (you'd be surprised how many were set alight by stupid idiot yobs) or people with serious mental illnesses. This was the challenge, and this became the part of the job I liked the most - the learning how to relate to people that other people found it really hard to deal with. I was always in love with the Accident Hospital; and it was at the Accident Hospital that I began to learn to love my patients.

I remember the day I knew it was time to move on. I was in theatre and the consultant asked one of the junior doctors to correctly adjust the dermatome for harvesting the skin graft. I could see he was baffled, so I whispered, 'hold it up to the light and adjust it so you can just see a sliver of light.' I realised there was nothing left to learn. I'm pretty sure I could have done a skin graft myself - I certainly could tell at dressing changes if they had taken and I was starting to be able to recognise the different smells of different infections. Maggots under dressings in summer no longer made my skin crawl. It was time for new challenges.

Even so, I probably would never have left if the decision hadn't been made to close the Accident Hospital and move the staff first to the General and eventually to the Queen Elizabeth. We fought to stop it, but once it was confirmed and bound to happen, I couldn't stay. Seeing the closure of the Acci would have been like watching the death of a beloved relative. I was the first rat to desert.

I cried on my last day. Walking away, knowing I'd never again walk through those corridors in the still of night, never again feel the heart acceleration and the adrenalin rush that a big burn or a major trauma would bring, would never, ever be phoned again in the middle of the night to come in and help save a life.... I cried. I loved the building, I loved the atmosphere, and I loved the people, the teams, in it. Even now, if I close my eyes, I can smell the physio gym, the changing rooms, the oh-so-distinctive Burns Unit smell that would linger in your nose even when you were long gone from the Unit. I regularly dream I am back there, and I'm sad when I wake up.

Those five years, I lived the dream. I just wish I had been the physio and the person I am now, I'd have been able to give so much more. The Accident Hospital showed me my future, although that future wasn't going to be trauma, or burns.......

An Obsessive's Guide To Diet and Exercise Part 3

I don't know if I would ever have gone back to exercise if there didn't exist this thing called 'ageing'.

It is strange to me that whilst maturing mentally seems to have completely passed me by (and in fact I seem to be a mental equivalent of Benjamin Button, getting more childish by the year), my body somehow does show signs of time passing. It creeps up on you so slowly that you don't really notice it - or at least I didn't. Then one day your Son says, 'why are you doing that? Why don't you just walk properly' as you struggle to get your feet flat on the floor as you walk first thing in the morning, ankles crunching, calves niggling, hips aching.

But hey, it only lasted until I reached the bottom of the stairs, and no one could tell by looking at me that I was a crock in the morning. And EVERYONE has these aches and pains, don't they? It certainly wasn't enough to get me exercising.

You see, in my odd little brain, if you couldn't exercise for at least 40 minutes, at least five times a week, well, it wasn't worth doing it. So when I would periodically decide I 'really must do something' about exercising, it would last about a week, then I'd have a lot on and miss a couple of days, and then I would tell myself it was pointless continuing. I was just TOO BUSY to be fit.

Then one Monday last September I woke up and my left arm was numb. I thought I'd slept on it funny, but as I sat up I became simultaneously aware that my face was swollen and my left leg didn't feel like it belonged to me. I was instantly terrified - I'm a physio, I know what a stroke is like - but I couldn't believe that this could happen to me. I got out of bed and went downstairs - or tried. I couldn't lower myself with my left leg, so I had to get down two feet to one step-wise like an old person. At my living room door (on my left). When I first pushed it, I couldn't open it - had to deliberately push harder. My arm felt unco-ordinated, as though it didn't belong to me. I kept waiting for it all to go right, but it didn't. I had no headache, and no loss of visual field, so I was pretty sure this wasn't a migraine. I also thought I would probably have a headache if I'd had a stroke, and probably would have lost visual field. And my left is the side always affected by migraine (it goes numb, but never lower than my arm), so maybe it was? I was having no trouble finding words, which I always do when I have a migraine. But stroke patients paralysed on the left hardly ever have problems word-finding. This was all running through my mind, because surely it wasn't possible that I had had a stroke?

In the end, I decided I had to see a doctor. I phoned the GP, and the receptionist asked why I needed an appointment. I told her, and she didn't even refer me to the triage nurse - in a first-ever occurrence, she gave me an appointment for later that morning, no questions asked. This was not looking good.

I phoned my boss to say I wasn't going in to work, got Son off to school (he knew nothing of this drama) and headed off to the doctor. I was sort of expecting her to reassure me all was well and send me back to work. She agreed that I had good muscle power, but said I had to go to the hospital, and did I want an ambulance?!!!!

I said I didn't, I would call a taxi. I couldn't have coped with the drama of an ambulance as the whole waiting room looked on. ME! Avoiding drama! I must have felt ill.

Went home, called a taxi and wondered what the hell was going to happen to me. I got to the hospital A and E, and two stroke nurses were waiting for me. They assessed me and said I had to go to the stroke unit for tests, but that the stroke unit doctor would need to assess me first, so I waited in a cubicle while he came. The nurses came back after he had done all his tests and stuff and said I had to be admitted and would need a scan (can't remember now which one it was, MRI or CAT).

'But how long will I need to stay?'

'Well, at least overnight, but possibly longer.....'

'I CAN'T!!!! My Dad is dying and my mum has dementia and I have to go over to Wolverhampton to take her to visit him, and I have a son, and who will look after him, and....'

'Hey, hey, that will all be sorted out, we'll help you sort out child care, is there someone you can phone....'

'NO!! There's ONLY ME! I can't stay, I don't mind signing myself out, I have to go -'

At this point the doctor who had been standing at the nurses' station came in and said, 'it's alright, you won't have to stay.'

PHEW! He then went on to describe how he had been pretty sure it wasn't a stroke or TIA because my pupils were fine, as were all the cranial nerves. He asked if I had been under stress lately, and I said I had, with mum and dad and so on. He then talked about strange neurological things that could happen when you were under stress, and because he had mentioned migraine, I thought he was saying I had had a bad migraine. I didn't think this was true. But hey, I was able to leave, that was the main thing. My Dad died that night.

My leg recovered quickly, but my arm was problematic, particularly the shoulder, for over two weeks.

Several weeks later I was listening to a programme on Radio 4 discussing something called Functional Neurological Illness (previously known as Conversion Disorder) - physical symptoms with no apparent physical cause, which were associated with stress. I realised I hadn't had any problems with my arm since my father's funeral. I had suffered a Functional Illness - which is pretty ironic considering that during my time in mental health I had come across it several times and was well aware of the mind-body connection. Yet it never crossed my mind that this was what I had, and this could only be another example of the less conscious parts of the brain hiding stuff from the conscious part, cos once I heard that programme I was like 'of course'!

But the relevance of that here is that it got me thinking about my health. This was only reinforced when I had a vomiting episode whilst on holiday in October. It only lasted 24 hours, but it made me really question how run down I was, and how unhealthy I was now feeling - especially as I didn't feel right for about three weeks afterwards. It was this vomiting episode that led me to give up alcohol unless I was going out socialising. No more weekend glasses of wine to unwind. It would also mean I would save money, which was a bonus. Still exercise hadn't crossed my mind.

Then the Unforgiving Mirror across the hall from my bathroom struck  again. I rarely leave the bathroom door open, so when I do my reflection always takes me by surprise, usually by being a stone heavier and 15 years older than I am expecting. This time I was horrified to spot notice I had no bottom. Where it used to be was a sad little fold of flesh like an old lady in her 80s would have. A sad little fold of flesh with cellulite on the right hand side.

This succeeded where all else had failed - I was now motivated to exercise, because I WANTED MY BOTTOM BACK. I told myself that this time there wasn't going to be any obsession, I would fit it around my life, not the other way around, and I would stick to it because if I missed a few days it didn't matter, I would do some lunges at least, and I would Get My Bottom Back.

I started doing my old exercise DVDs and VHSs - I like Davina, Cindy Crawford and Elle McPherson. However, I knew if I was going to keep it up, I would need some new DVDs to fight the boredom.

This being the start of November, there were a few deals on Amazon and Ebay, so I bought a couple of Nell McAndrew DVDs (BIG mistake, boring as hell and v high impact so no good for those with a 30GG bust) and a four DVD box set by someone called Jillian Michaels. I had never heard of her, but she had rave reviews and seemed to be pretty difficult, and I knew I would get fit pretty quick from previous experience, so I bought them.

I mostly bought them for her 40 minute routine ones, one to boost metabolism and one to target problem areas. WELL! For the first time since I had restarted exercising, my legs and arms ACHED the next day after each of these. Oh, I have to be honest, I thought I was going to DIE whilst doing them. DEFINITELY a step up from Davina, these and the 30 minute abs DVD now became my favourites. Son would hear me and go, 'mummy, PLEASE turn that off! Why are you doing this to yourself?'

But I was now motivated by something completely different. By December I was leaping out of bed with no problem in the mornings. My stiff neck, my twingy back, the little aches and pains I had put down to getting older - they were GONE. What's not to like? I was exercising on average three times a week, and I felt GREAT.

Then came Christmas. Two very busy weeks. Here I may have fallen off the wagon and not exercised at all, but in the four-pack of Jillian Michaels DVDs was '30 Day Shred' Now I am well aware that this DVD is now all over Twitter, my timeline is full of it, but at that point I had never heard of it. I certainly didn't believe that 20 minutes of exercise would do anything by way of fitness. But I told myself that 20 minutes was better than nothing.

I didn't do it as directed because I get bored, I did a different level each time I did it. On the second week I only did it three times. When the Christmas period was over, I had every intention of never doing it again - after all, although it is intense, it's only 20 minutes - that wouldn't do anything. Would it?

First exercise DVD after going back to work, and I did the fat burn/metabolism boost Jillian. I managed it with no problem - it was hard, but I wasn't moaning and crying by the end like before Christmas. Next time, I did Davina - three of her High Energy Five - and it was TOO EASY. I was having to add weights and add in Jillian adaptations to make it hard enough. I was completely and utterly amazed. '30 Day Shred' had achieved results fast. So now I do it two or three days a week, and do other DVDs when I have days off and time for them. I have also bought another pack of Jillian DVDs - including Extreme Shed and Shred - OMG, this one is a KILLER. but I am going to persist (in a 'once every two weeks or so' kind of way!).

I am now motivated because I am stronger than I have ever been. I can do 10 press-ups - I was never able to do more than three, even when I was a crazed gym bunny. Can I brag? 30 Day Shred is easy now, aside from the occasional moves that I find hard, like moguls. I sometimes think my horrendous bingo wings are shrinking, and I definitely have a two and a half pack - I can see the top bit of a six pack, and the top of the next bit of a six-pack, but the rest is covered with my baby belly fatty skin! Which is sad, cos I'd like to show off that two and a half pack, but I don't want to clear any rooms :-)

Over Christmas I put on 6 pounds, mainly down to non-McKenna endorsed pigging on Xmas Cake and custard. Though the upside is I didn't eat any salad or other non-sweet delaying tactic crap beforehand - just ate what I wanted but forgot to be mindful and didn't stop until I felt nauseous. On more than one occasion. I am a work-in-progress still. I lost 4 of those pounds in the first week of going back to eating normally. Haven't weighed since, but will weigh on Thursday or so. Just to be sure I'm below 10st. I'm not oging to post 'progress' or anything here or on Twitter cos for me none of this is about weight (tho I've got to admit if I go over 10 stone it def IS about the weight!). It's about a new way of living - a more healthy way. I measure that in aches and pains, not inches :-)