Day of Operation: 27th February 2017

FeaturedDay of Operation: 27th February 2017

This is a series of blogs that started when I was diagnosed with an acoustic neuroma (a benign brain tumour) and if you find this blog interesting, then please do read the rest. My surgery was 4 years ago and my life has changed so much since, and then more so with COVID. Stay safe everyone!

The first thing to say about today is that it has ended well. My biggest concern was damage to my facial nerve. Of course, I listened carefully to the 20% risk of nerve injury but also to the 80% chance that there would be no long-term damage. I had read of all the possible management options depending on the degree of injury and had discussed the options to mitigate this complication with the Surgeon. I had made my choice and now I was in the hands of others.

Today started with an inability to sleep and getting up at 5.30am. I waited in bed after brushing my teeth, washing my face and taking my tablets. Wanting to have a shower, I went in search of the nurses as I needed my operating gown. The nurses were at the handover desk at the end of the ward and I had worn my brand-new slippers (and my new pyjamas and dressing gown!). The majority of patients were asleep, the ward was dark and quiet but the nurses were still busy with the patients that were unwell. Trying to stay as quiet as possible, I tiptoed through the ward, as I had learnt from my many nights on call but despite this my bed slippers were squeaky and whatever I did they did not get any quieter!

The nurses gave me my gown and two fresh NHS towels, reminded me of the need to wash in the triclorosan and to take my tablets with a little water. I showered, enjoying the hot water and the feeling that I was independent, a feeling I knew I would lose in the short-term. 

I thought how different today would be compared to the lovely family meal we had yesterday at an Oxford pub. There were so many pubs to choose from to enjoy a Sunday roast but the one that had caught my eye was the Eagle and Child. Apparently, this is where J R Tolkien and C S Lewis frequented and where my favourite books were born, The Lion, the Witch and the Wardrobe and the Hobbit. It was good to spend family time, although rushed, as I needed to be admitted at 4pm to the West Wing at the John Radcliffe. 

I got out of the shower and dried myself on the towels. To the NHS, please make your towels bigger as many of us are not a size 8!!!! I put on my gown and remembered to do it up correctly so that I maintained as much dignity as I could for as long as I could!

Having tidied the room, putting all my belongings away tidily and not being able to think of anything else to do, I got back into bed. 

My husband and kids arrived, followed closely by the duty registrar who consented me. The second anaesthetist also arrived and made sure that all was well. My Surgeon also came and reassured me that all was on track and that I should be on my way down to theatre by 8.30am. He asked if I had any further questions and I replied that I did not but I needed to get on with it! My husband was worried and the Surgeon promised that he would contact him as soon as he had finished or in between if there were any concerns. And he did what I do regularly. He took the phone number down and wrote it on the notes, as there it cannot get lost and is on hand if you are scrubbed in theatre and need someone else to find the number for you!

I kept it all together until I left my husband and kids. As soon as I laid down and started being wheeled out of my hospital room, a feeling of sheer panic overwhelmed me. I have never really experienced this before. I should know better and knew the operation was a calculated risk that was in my favour, and that doing anything else was not an option. How absurd and silly, but the panic was there as I really had lost control and there was no going back. 

I closed my eyes and went on the journey to theatres and into the holding bay. I confirmed my details and shuffled from my bed onto the theatre trolley. I was then taken into the anaesthetic room. Everyone was professional and calming. The anaesthetic team had a great balance of humour and professionalism that really did confer a sense of normality to this bizarre situation. 

An intravenous infusion of propofol (I assume) was attached and one minute I was talking normally and the next I was asleep!

I have no idea as to what happened next. I know I needed a catheter, an arterial line, a femoral line as well as other new venous cannulae. I was placed on an operating table in a park bench position (lying on my left hand side). I had holding pins to make sure that my head did not move during surgery. I am glad that this was all done when I was asleep as there was no further anxiety or concern regarding dignity from me. 

The operation apparently took 10 hours. The operation involved a craniotomy (making a hole behind the ear through the skull) and then pushing the cerebellum back to allow access to the tumour. Neurosurgery is complicated and involves changing the way the brain functions by reducing the fluid around the brain and so allowing access for the surgeons to operate as there is a very limited space within the skull. The tumour had grown into the brain, was stuck to the brainstem and was slightly different anatomically to what had been anticipated. The growth was towards the lower part of the cerebellum and brainstem so the auditory (hearing) and facial nerve were preserved as much as possible. 

The Surgeon did not phone my husband during surgery as there was no need. Apparently, my husband did get a phone call from the hospital at around three hours in and this caused him to worry. It turned out that it was the ward asking him to take all my stuff home as I would be moving ward on my return after surgery. 

I took a long time to wake up causing enough concern to send me straight to the CT scanner. The CT scan was normal and reassured the surgical team. Most of the tumour had been resected and there was a little air (as expected) and no blood or signs of a stroke to cause concern. 

I remember being wheeled across to recovery and thinking, I am glad to be alive, and then, I can hear. My back was painful and I seemed to have severe left-sided sciatica (pain from your hip to foot). The nurses in recovery were patient with me and the anaesthetic SHO who came to see me was reassuring and understanding of my concerns. 

The Surgeon came to see me and explained what he had found. He told me that my facial nerve had been preserved and I had no obvious facial dysfunction. I had been very lucky. I trusted him and did not ask for a mirror to check. He was happy with the surgery but knew I would need a night in the intensive care unit (ITU) to recover. He had already phoned my husband and the family would come and see me in ITU. 

My head was painful and I was so sleepy. I had no energy and could not wriggle or move my body to get comfortable. Smells were different and my mouth tasted weird. I was also thirsty but also so sick. Once as comfortable as possible with the pain, I was moved to ITU. 

I imagine that those first hours must be how it feels to be on drugs as the world just seemed to slow down and fact and fiction seemed to merge. I was introduced to my nurse in ITU and her name drifted in and out of my head so that I kept having to ask her to clarify her name. My husband, two boys, and brother and sister visited in pairs and were obviously relieved to have got this far without a major complication. At one point, someone’s phone rang and I remember telling them off for having it on in ITU and being told that maybe my hearing was better than I thought it might be. 

I was now very tired, my head hurt and I asked everyone to go home and get some sleep as well. It had been a long day for everyone and we had several months of convalescence to get through and everyone needed their energy. 

I tried to get comfortable and drift off to sleep but also to remember anything that might be of value for others going through this experience. 

I had been awed by the complete honesty of others who had been through this process already and who had taken time to get in touch with me. These were strangers who wrote on the blog and gave me an alternative to the despair that I read on the internet. The desire to help each other is immense and I cannot tell you how moving and deeply honest these posts and direct messages were. Other messages were from previous trainees, friends and colleagues who shared experiences of their own (aged 5 as well as older) and of family members, which again, were realistic yet full of hope.

Other messages, which are the real reason that this blog will continue to record my progress and hopefully become a resource for others, are from people about to go through this journey. If there is only one sentence that you find helpful in this sea of words, then I will feel that my blogging journey was worth it. Of those of you who offered me support via direct message, I will ask you later whether you are willing for me to share your words of wisdom with others, as they truly meant a lot to me.

All I can say for now is that I am one of the 80% who has kept full facial nerve function and so my ambition from now on is live life to the full!

PS

I have added a resource page to my blog and will continue to add resources that I have found helpful. Liz O’Riordan’s blog as well as the blog from Maureen Kenny are a great read. The late great Kate Granger’s blog is a must read. Please let me know of any others that you have found useful or interesting. Thank you.

Transforming surgery into a multiracial, multigender and multiclass profession

FeaturedTransforming surgery into a multiracial, multigender and multiclass profession

Stella Vig is a vascular and general consultant surgeon, who is a clinical director at Croydon University Hospital.

This is an interview by Womanthology. The issue is titled Women of Colour and there is an amazing podcast with special guests Dr Ambily Banerjee, Inclusion and Diversity Advocate, and Inês Santos. Worth a listen!

Stella Vig

“My pride in being Indian and Welsh, and being brought up by parents who instilled a belief that you can be whatever you want and to ignore negative vibes, has ensured that I have progressed despite all blocks hurled into my path.”

What excites you about being a Surgeon?


Surgery has been a magnet, with an exciting mix of immediate results and the application of science and anatomy, and has pulled me in since I was five. I went to the University of Wales, College of Medicine and qualified in 1991, training in Wales and London, becoming a consultant in 2005.

Although surgery involves hard work and long hours, it still allows the ability to pursue other work and personal ambitions. I have had the privilege of teaching across the professions as well as managing within and out of the NHS. I have also been married for 27 years and have two children, who now have careers of their own.

What is your working week like?


My working weeks are never the same and I enjoy a variety of roles. These include working as a surgeon with outpatients and surgery as well as on-call commitments. On other days, I am both the divisional clinical director and the training programme director for South West London core and higher surgical training. This allows the unique ability to ensure that finance, governance, education and service are combined to ensure the best for all.

My roles allow flexibility to address the needs of the Trust as well as external roles such as being on the Royal College of Surgeons of England Council.

How has COVID-19 impacted on you?


COVID has had an enormous impact on all aspects of my personal and professional life. As COVID surged, in the first wave, I was heavily involved in the planning of services and resources to ensure that patients and staff were kept safe. Surgery effectively came to a standstill with people redeployed to enable the safe care of expanded critical care services.

The NHS and its staff were amazing, coming together as a team and innovating to ensure that services were as effective as possible. This rapid change was necessary but came with a cost of mental and physical exhaustion and a need to restart at pace, and at 150%.

Going into the second wave brings challenges for the delivery of winter and COVID pressures with a battle-weary workforce. The implementation of vaccinations brings a glimmer of hope that is much needed as we go into 2021.

Stella Vig
How has a woman of colour impacted on your career?


At a young age, it never occurred to me that being female or of colour would hinder my career aspiration to be a consultant surgeon. The realisation that there were no female surgeons in Wales with children in 1991 made me reconsider my path.

Amazing mentors, and my future husband to be, supported my ambition, and I became the first female Calman registrar in Wales appointed to the surgical rotation.

But being a woman and wishing to have a family as well as being a surgeon, brought the fear of taking maternity leave. During both pregnancies, I took twelve weeks leave and went back to work full time, to ensure that being a mother did not impact on my career.

Being female and of colour has made me more determined to succeed, despite the conscious and unconscious bias that exists within society, as well as, to a lesser extent, the NHS.

The ability to ensure that I was over-prepared for the next step compensated and allowed me to progress despite not being in the right club, conversation and group that allowed others first passage.

My personal journey has embedded my desire to ensure that a surgical career is accessible to all and I will fight for this right on all levels.

What does intersectionality mean to you?


Intersectionality is a new concept and is not always understood, especially within the NHS. I am female, born and brought up in Wales in a working-class family, of Indian origin, married with two children. I am also Hindu and short.

My pride in being Indian and Welsh, and being brought up by parents who instilled a belief that you can be whatever you want and to ignore negative vibes, has ensured that I have progressed despite all blocks hurled into my path.

The inequity in the system cannot be readily understood or recognised by those who have had traditional paths into medicine and leadership, and increasing diversity will increase the understanding both for differential attainment as well as access to healthcare.

Why do organisations need to be more inclusive and welcoming to diverse talent?


Organisations will only survive and grow if they embrace and understand the power of diversity and inclusion. This is not just about colour and gender, but rather ensuring that the workplace replicates society which is important, especially in the delivery of healthcare.

Welcoming and enabling diversity is not about a tick box but rather ensuring that ambitions are understood and also discussed, so that negative unconscious bias and the imposter syndrome is dispelled at an early stage.

How do we transform surgery into a multiracial, multigender and multiclass profession?
My advice to women of colour (and anyone else who feels that they do not look like the other members of the surgical club), is to first consider whether they really want to do surgery. If the answer is ‘yes’, then we are all here to help.

It is possible and important that diversity is supported, and there is no better time than now. Surgery is having to change from a male-dominated workplace to a multiracial, multigender and multiclass profession. The structure of a surgical career is changing and will become more flexible, embracing maternal and paternal leave, carers’ responsibilities and the desire to have portfolio careers.

Work-life balance is already becoming part of a surgeon’s vocabulary as is the need to be true team players and working within a multidisciplinary team. Ignoring the negative gossip and rumour, and instead finding a mentor or supporter is important to help navigate the rules of a surgical career.

What are you looking forward to?

At present, it is difficult to consider anything than managing our lives in the context of COVID. Recently being appointed as trust clinical director of recovery has opened a new challenge for me and will no doubt lead to a journey I had not envisaged.

COVID has brought much sorrow and devastation but has also taught us to cherish life and embrace those dear to us. I look forward to spending time with family and friends, basking in the warm sun, laughing with and hugging those who are important to me.

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#TeamNHS #NHS72 #ThankyouTogether

Featured#TeamNHS #NHS72 #ThankyouTogether

The NHS turns 72 years old today and never have we needed her so much.

I have worked within the NHS for the last 30 years. It is a career that brings challenge, heartache and so much pride but anything witnessed before has recently been blown out of the water.

I am so proud of the NHS teams that I have had the privilege to work with. I am seeing surgeons, physicians, nurses, physiotherapists, managers, GPs, porters, radiographers and so many more just coming together as #TeamNHS. The support networks have been amplified with food, well wishes, hand creams, masks, scrubs and even small hearts!

We have turned wards and theatre recovery areas into intensive care units, normal wards into intensive respiratory wards and challenged our staff at every level to work harder and harder. We have seen such death and illness in a short time frame and have done our best in difficult times.

We are used to looking after ill people, it is our bread and butter. The tragedy of illness and death is interwoven with the human interaction, a squeeze of a gnarled hand, the smile of a memory and a shared laugh even when death can be the only outcome. Patients and relatives rely on the human interaction, meeting with doctors, learning how to cope and the joy of going home to loved ones. All of this has had a hard stop with COVID-19. The masks, gowns and need to physically exclude friends and families have added barriers to patient care in a way never seen before.

Healthcare professionals talk about emotional injury where we support you and relatives in illness and death, but we keep the emotions we feel, of sadness and pain, internal. This is balanced by your thank yous and the joy of discharging a patient in better health, able to resume their own lifestyle.

This mental stress that has challenged our wellbeing has been added to by the daily battle for personal protective equipment causing a fear of coming into work, especially for those from a BAME background.

COVID-19 has stripped us all of the ability to cope. We are not NHS Heros, we are normal people, trying to do an exceedingly difficult job. The emotional injury has been high as wards have dealt with heart wrenching stories that have developed often overnight. Relatives relate seeing their loved ones deteriorate rapidly, taken by ambulance to hospital and then not seen again. This has been even more difficult when these patients are one of our own and were working with us days before. The numbers of healthcare staff affected has been huge and the faces of those who have passed are remembered in the picture below. To make this time even more difficult, the solace of families and colleagues coming together for funerals has been destroyed.

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The NHS is beginning to open up services again, so that patients awaiting operations and outpatients clinics can visit safely. As the levels of COVID-19 decrease both the NHS and society can start breathing again. I hear talk of going back to normal, but we will never go back to normal.

Within the NHS, we have learnt to use technology to communicate with patients and colleagues. Rather than bringing you to an outpatient appointment at a time that maybe inconvenient to you, we can reach out whilst you are still at work, so that you do not need to take a whole day off but rather just a 15 minute break,

Rather than travel into London for a short meeting, we can Team in, and get so much more done. We have moved healthcare into communities and redefined our paternalistic view of healthcare risk. Perhaps we have finally realised that the patient knows best.

This new norm comes with societal responsibility if we hope to enjoy the freedom of social interaction, good health, travel and economic growth.  As a society, we need to realise that we have to work and care together if we wish to develop an equitable society.

The recent scenes of beaches on the south coast or in Soho and Brixton are just appalling. COVID-19 has not gone away, it is just hiding, waiting to raise its head again. The loud voices protesting that they are young and therefore invincible should remember the vulnerable (and often in ways invisible to the naked eye). It is their lives that you put at risk when travelling home or during your food shop on your way home from your day frolicking in the sun. Social distancing must be the new norm unless we have a true track and trace or a vaccine for all. Huge gatherings with no public toilets open just is too ugly to think about.

So much good has been and can be achieved. We have seen a shift change in the care of people who have become homeless. We now need to see dramatic shift changes in many other aspects of societal norm.

Organisations must address inequalities of representation within their workforce and senior boards. Historic privilege will be challenged and equity, inclusion and diversity representing those around us must be the new norm.

This is the time where kindness and doing the right thing must be the minimum standard. So many people have shielded for the last four months and are now taking tentative steps to developing a new routine. Let us support them and each other by thinking of the greater good.

Those who say that we are going through the most difficult time, need to remember that our senior generation have been through two world wars, an economic depression as well as wars such as Vietnam. They have been through rationing and the harshness of a global recession.

What are we asking society to do? To wash hands, wear a mask and keep a social distance.

Is this so hard? Let us set the standard together and challenge ourselves to protect others. This is not about COVID-19. This is also about flu, norovirus,and everything else that challenges the NHS in the winter months.

So Happy Birthday #NHS, let us raise a huge cheer for what has been achieved and for overcoming what is to come.

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These are the Hands

FeaturedThese are the Hands

These are the Hands

That wearily hold my children as I close my eyes for the last time

That washed a broken body no longer in its prime

That grasped a tarnished mirror and found no hope

That struggled to hold a sippy cup and to cope

 

That transformed to bruised and wrinkled beyond belief

That held onto the gnarled walking stick for support and relief

That shakily applied lipstick that was still an absolute must

And desperately hid the laughter lines that felt so unjust

 

That ecstatically cuddled the grandchildren as they were born

That sadly embraced parents as dementia set in, their memories worn

That patiently learnt to paint as I grew older to stay inspired

That emotionally held the short speech read out when I retired

That doggedly created a culture of which I was proud

And vigorously scribed so my voice was loud

 

That happily wrote books as a surgical trainer and educator

and enabled my career as a senior hospital director

 

That excitedly cut the cake on my 25th wedding anniversary

and gently washed my tangled hair after harsh neurosurgery

 

That hesitantly developed hobbies as illness took over

and immediately crushed the letter informing me, I had an acoustic neuroma

 

That balanced my body against the wall as I was uncontrollably dizzy

and dutifully embraced tasks as I became busy

 

That repeatedly saved lives both young and old

and meticulously recorded the diagnostic stories that I was told

 

And firmly held those dying during their last breath

That fearfully felt the carotid pulse to declare death

That miraculously stopped traumatic bleeding with compression

That incredulously held the knife as I entered the surgical profession

That confidently felt the abdomen during the night on call

That disappointingly created writing that was an unreadable scrawl

 

And furiously wrote the thesis for my vascular Masters’ Degree

That washed the never-ending dishes to pay for the University term fee

That rubbed my tired eyes as I studied for my school exam

That nervously phoned my parents when I was in a jam

 

That came together in temple and family prayer

That struggled to plait my unruly long black hair

That clutched the library books as I studiously learned

That held the fingers of my joyful parents as I was born into this world

 

These are the Hands

No one is here forever!

FeaturedNo one is here forever!

“The world is not ready for me” Interview with Dr Hannah Barham-Brown

#ChangeTheNorm Interviews Series by Miss Stella Vig for Sovereign Magazine

In this column, I will continue to highlight those individuals who are changing the world we live in for the better by challenging and changing the norm. These are individuals who are unsung heroes and heroines, who are making huge impacts whether in a small community, a profession, a national or international stage. These are the people who make small contributions at first that then snowball into legacy movements.

We are surrounded by unconscious bias which steers our decision making and assumptions every single day. This bias is often based on long held and subconsciously learnt rules which have since become fact. Girls wear pink and play with dolls; boys wear blue and play with toy soldiers. People with disabilities cannot achieve and must be looked after as they cannot be independent.

The world is changing, and individuals are slowly challenging, breaking and transcending these rules. Whether this is in the sports arena such as the Paralympics or feats of endeavour such as climbing Mount Everest, disabled people are showing the world, ‘Yes, We Can!’.

This week I interview Dr Hannah Barham-Brown, who is a Doctor and an advocate for equity both for women and those who are disabled. Her interests are wide and include medical ethics as well as medicine in the media. She regularly blogs about health and disability issues on her personal blog, ‘Wonky Medicine’; and tweets furiously @HannahPopsy.

Hannah was diagnosed as having a disability as a final year medical student and needed her wheelchair just before graduation and whilst challenging, this amazing woman has certainly risen to the challenge with humility and resilience.

She is fiercely proud of the NHS and is on the Shaw Trust Disability Power 100: a list of the most influential disabled people in the UK.

Hannah, please tell us about yourself.

I’m a GP Registrar in Leeds, and a wheelchair user. I work part time clinically and spend the rest of my time giving talks about disability and diversity as well as working with the British Medical Association. I am a member of BMA Council and Medical Ethics Committee.  I am also part of the Junior Doctors’ Committee which has just agreed the new Junior Doctors’ Contract. I am a member of the Women’s Equality Party and stood as a local Council Candidate in Leeds, and as an EU Parliamentary Candidate in London. I regularly appear in the media talking about a wide range of topics, I’ve given 2 TEDx talks, and in 2018 I entered the ‘Powerlist’ for the Shaw Disability Trust which was humbling. I’m also an Ambassador for two charities; The Eve Appeal and MyAFK.

How are you a disabled person?

I was diagnosed with Ehlers Danlos Syndrome, (a collagen disorder affecting skin, joints, gut and other things) having run a half marathon and left myself with long term injuries following some kneecap dislocations. Since then, my joints have become gradually less stable, and I now use a powerchair or sticks to get around.

What was your initial reaction to your diagnosis?

I think initially it was one of relief that there was something wrong with me, and there was a name for it. Having an undiagnosed condition is a very lonely and isolating world, with little support available. The practicalities of how my life was going to work with a disability were my major concern, as I’ve grown up with a disabled mum and so know the huge barriers disabled people still face every day.

What concerns did this raise for you as a newly qualified doctor?

Simply getting around was a major concern, having to crowdfund a wheelchair in order to do so was not how I planned to spend that year of medical school! Also, the fact that I’d never met another disabled doctor before, so I had no one to turn to for advice or reassurance initially. It turns out there are quite a few of us, but I had no idea at the time!

How would you describe your ambition and purpose for your career?

I have to be quite realistic about the future of my clinical work; my condition means I experience regular joint dislocations and other injuries, so I probably won’t be able to work as a doctor forever but I’m determined to keep going as long as I can because I really love my job! My other passion centers around making the world a better place for disabled people. I know I’m in a privileged position where I have a platform and the ability to highlight iniquities as I experience them, so I hope to continue doing so (however ‘difficult’ that makes me!). I love politics, so fully plan on developing my career in that direction.

What problems need to be solved to ensure equity for those with disabilities?

Where to start?! We live in a world designed without disabled people in mind, and as such, even the simplest tasks for other people, such as getting across London or popping to the supermarket, can be huge challenges for us. But there’s a relatively simple solution – involve us at every level!

I’ve had so many difficult experiences in terms of the most basic tasks such as train travel; I’ve been left on trains, and at some points have had to travel using my sticks rather than my wheelchair because I’m just so worried about how I’m going to manage the journey on wheels when I can only access ¼ of the tube system. This leaves me in a lot of pain, and far more vulnerable to injury, but I refuse to stop living my life simply because the world isn’t ready for me yet!

What frustrates you the most?

People speaking to me differently because I’m disabled or patronising me because my body is different. I have ten years of university behind me, I’m a doctor, and I’m an effective campaigner. I’m not ‘lesser’ because of my disability, I’m different, and, my disability has led to a range of experiences and knowledge I’d never have had without it. My disability can be an asset, so don’t pity me.

What are the challenges in making the public aware of your work?

I used to feel I had to prove myself constantly, to challenge assumptions. Part of me always will feel this way a little, but now I focus on doing what I can to make the world a better place and give a voice to people who struggle to find adequate representation in other ways. I try to keep my messages varied, to use humour and embrace a variety of media to get my work out there; but it can be hard to keep up with everyone and everything – I really need a PA!

What keeps you going?

I’ve been brought up around a sense of vocation; my father is a priest, and my mother goes above and beyond in her role as a “Vicar’s Wife”, whilst also volunteering in several roles. I’ve never been motivated by money, but more so by an altruistic desire to improve and impact change in the world. I think having lost two younger brothers, I’m very aware that no one is here forever, and what really matters is what we achieve in our time here.

Why did you choose to be an Ambassador for your chosen charities?

Well, I had the privilege of being asked by both, quite unexpectedly, and as with most of my charitable escapades, couldn’t bear to say no! They really are the perfect fits for me; MyAFK works to get young people mobility equipment they need and to support those with intellectual disabilities into work, which are both areas I am passionate about. The Eve Appeal is all about fighting the five Gynaecological cancers, improving access to smears, and encouraging education. I’ve recently been campaigning to make GP practices more accessible to disabled people for examinations, and cervical smears are a key example of where improvement is needed, so it’s great to be working with such an enthusiastic and dynamic charity on this!

What can we do to help?

Look around you. Are the 13.9 million disabled people who live in the UK represented on your board, your executive committees? If not, ask why the 1 in 5 is not represented in the room. And change this.

What key message do you want to highlight?

Disabled people bring something unique. We are Nature’s problem solvers, because we live in a world designed without us in mind. Involving us in your discussions and workplace is not about doing us a favour, but about ensuring you aren’t missing out on an exciting and different way of thinking.

Twitter: @HannahPopsy

Facebook: www.facebook.com/HannahBarhamBrown

This is the link to the original article as published by the Sovereign Magazine

No one is here forever

Happy Easter #ChangeTheNorm

FeaturedHappy Easter #ChangeTheNorm

Happy Easter to all of you.

This holiday weekend makes us reflect on religion, family and the world at large.

Yesterday, we watched an amazing programme by David Attenborough, which was a ‘call to arms’ to the world to slow down climate change. The risk of global warming within the next 30 years seems inevitable unless we change our own carbon footprints as well as those of major industries. A small rise in temperature may completely change coastal communities as well as drowning historical sites and London itself will be under threat as water levels rise.

We have seen the odd swings in local temperatures with huge surges in rainfall which overwhelm local drains. Wallington in Surrey, saw flash floods that caused chaos within a few hours.

Image result for wallington flood

London is under a greater threat and this is becoming increasingly visible.

There are a row of large lions’ heads, cast in bronze, that line the side of Victoria Embankment. They were sculpted by Timothy Butler for Sir Joseph Bazalgette’s Victorian sewage works programme in 1868-70. These are important as they allow a visual guide to the risk of flooding in London. The old rhyme states: “When the lions drink, London will sink. When it’s up to their manes, we’ll go down the drains.” The mouth of each lion holds a mooring ring and the rhyme suggests that if the lions drink the water from the Thames, London will flood. Although the lions have never been submerged to date, certainly high tides now seem to lap the heads regularly.

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This makes us all consider how we #ChangeTheNorm.

The world is changing around us. We are all living longer and expecting more from life. I want my children to enjoy their lives and look forward to their children achieving and living happily and successfully. Stratton and Scott suggest that an individual aged 20 now has a 90% chance of living to 103 in the Western World. Someone who is 7, is likely to live to 107!

Authority is being turned on its head. It is humbling that 16-year-old climate activist Greta Thunberg is leading the charge to ‘wake up the adults’ to what is threatening their future. “We had everything we could ever wish for… now we probably don’t even have a future anymore.”  She also says the planet’s future “was sold so that a small number of people could make unimaginable amounts of money”.

So what do we need to do to?

Small changes will make a difference. It is easy to order on Amazon and get a delivery today. It is convenient but does it really matter. Why can’t it wait until tomorrow? Or next month? I think back to the time when we were little. Asian food was not sold in North Wales and we would wait til the monthly trip to Manchester to buy the groceries from the Indian shops there. Now all the food from the world is available in my local superstore. Previously we would enjoy the fruits of the season and now we enjoy them all year round. But do we? How many times does fruit over ripen in the fruit basket and then get thrown out.

We all need to consider what we want from life. We have become impatient. We will watch an entire box set or chomp through a box of chocolates because there are no more boundaries on life. Rules that existed previously have been over written.

Perhaps now is time to rewrite the rules. There will have to be an exchange of values as we no longer live in an altruistic world. If we suggested that you stop buying online, it would never happen. What would be valuable is to attribute a carbon footprint cost to everything we buy.

You may have a choice to buy strawberries.  Choice should no longer just be based on cost. One carton maybe slightly more expensive but is produced locally whilst the other has been flown across the world. An understanding of the carbon footprint might alter your choice and start to change the way that we live and eat.

Are we able to repair items and make them last longer rather than throw them out and buy new? Do we really need that new phone just because it is the new release? Should Amazon offer a discount if you agree to a bulk delivery once per month rather than the delivery of an item under £5?

We all have to #ChangeTheNorm for many reasons.

I reflect back on the last few years with regard to my health.

I developed a loss of balance and tiredness nearly three years ago and struggled to understand why. I still remember the fear of the diagnosis of an acoustic neuroma and the desperation to stop being a patient and live my normal life. I remember the amazing team that looked after me in the John Radcliffe in Oxford. Mr Richard Kerr was my NeuroSurgeon and operated on me for 12 hours. The night in ITU is unforgettable and I have never felt so vulnerable and weak as in those first five days. Headaches, nausea, dizziness and sheer frustration began and have never completely resolved but are so much better than at the start.

In truth, I went back to work too early (yes, everyone was right!) and it took me eight months post-surgery to be anywhere near normal but the NHS was a great employer and my friends, family and colleagues at work supported my journey.

I have recently undergone another post-operative MRI.  This proves that there is no increase in size of the small remnant of the acoustic neuroma. Hurrah!!! No more scans for another 6 months.

Everyone was pleasantly surprised at the pace of my recovery and outwardly there is now little evidence of the surgery. Even the hair that was shaved has completely obscured my scar and I am now more comfortable putting my hair in a bun!

The improvements that I noticed post operatively that allowed me to return to normal have now all slowed down. I have gone from hearing perfectly to unilateral deafness. Voices become less distinct when there is a lot of background noise.  My brain does not switch off and my sleep is frequently interrupted. I now must make notes to ensure that I do not forget anything as my short-term memory works very differently. My balance has improved but is noticeably different when I am tired. I no longer feel that I am invincible and am more aware of my health and the need for a work life balance.

I love being back at work and being lucky enough to have had such little post-surgical complications. This carries with it a guilt for all those who had a much tougher post-operative journey. I still manage my long lists and the education and training of junior surgical colleagues. Both as a Surgeon and as a Clinical Director, the patient experience is invaluable. It infuses everything I do and on most days.

But the most important lessons are being learnt now. I will never go back to my ‘normal’ but I have had to develop a new norm. Those that know me are slowly forgetting my recent journey and I must remind them that I am deaf in one ear as they whisper to me or talk quietly in a meeting. I get tired and must pace myself and so have had to say no!

I am also learning that the world is not forgiving of disabilities. In a shop recently, a woman faced me angrily and told me she had been asking me to move out of her way, in a busy shop full of Christmas shoppers. She pushed past and walked away before I could tell her that she had been talking to my deaf side! I cannot pinpoint noise and feel like I need to wear a sign that explains that I am deaf on one side.

I have learnt to be grateful for the one life that we have, in which we must live, love and share happy times with family and friends. I have a new life, different to the one I had two years ago but one that I intend to live to the full. I want this for my children and their children too.

So Happy Easter to you. In the next few days, let us all consider what we can do to #ChangeTheNorm and make this planet, our wonderful planet, continue to be a place where we can live long and prosper.

My interview with Sovereign Magazine!

FeaturedMy interview with Sovereign Magazine!

I was delighted to be interviewed by Sovereign Magazine about my patient journey but also the wider NHS.

Stella Vig is a Consultant Vascular and General Surgeon at Croydon University Hospital, South London. Born in Bangor, North Wales, she trained at the University of Wales College of Medicine. She was appointed as a consultant in 2006.

Stella has a strong interest in training and encouraging medical students and foundation years to pursue a career in surgery. She is a champion and advocate for trainees, ensuring their voices are heard. Stella was awarded the NHS Leadership Academy London Mentor of the Year in 2015 and the Silver Scalpel Award as well as the Dr Rose Polge Award in 2018.

She developed an Acoustic Neuroma and underwent surgery in 2017.

We reached out to learn more about Stella’s story, the story of an extraordinary woman who had no choice but take the journey from being a surgeon to become a patient and survivor.

You brand yourself as an NHS Enthusiast and Survivor. What was your recent experience as a patient?

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Luckily, I had an Acoustic Neuroma, which is a benign brain tumour. I can remember realising that I had a mass as I came out of the CT scanner. There was an immense relief when I found out that it was not a cancerous growth and that there was an option for surgery.

The NHS was amazing throughout my journey. I underwent a CT scan rapidly and was given a diagnosis by a Consultant before I could blink! In fact, it was too quick, and I had to spend time catching up with my diagnosis and coming to terms with it.

I had fantastic care both at Croydon University Hospital and then at John Radcliffe Hospital in Oxford. My surgery took over 12 hours but was uneventful. My Surgeon explained that it would take 6 months to recover and though I was desperate to beat these odds, it did take me 8 months to be anywhere near normal.

The NHS is in dire crisis right now and as a healthcare professional you have experienced both sides of the NHS. Stripped of who you are as a mother, friend, wife, and NHS Professional, what has the doctor, Stella Vig, learned from being a patient?

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It took a matter of minutes to convert me from a Consultant Vascular and General Surgeon to a patient. As a professional, I am aware of the funding crisis and the increased need for NHS care which is outstripping current capacity. Whilst I knew what was going on in the background, as a patient I was shielded from this everyday chaos. I was given time to talk in my appointments, my operation took place on the day it was planned, and I had all post-operative care as needed. I never felt rushed or that I was wasting valuable clinical time. The nurses, though overstretched, made me feel as if I was the most important patient every day and the physiotherapists forced me to walk, even though I did not think I could do it!

How this experience impacted your values as a surgeon?

This experience has reaffirmed my values as a Surgeon that the patient always comes first and you must do the right thing, first time to the best of your ability. The Surgeon was fantastic and although there was a 40% chance of facial nerve injury, I managed to escape this devastating complication, due to his skill. The honest discussion during my consultations, which were frank and informative, helped develop a strong bond of trust and faith in my Surgeon and their team.

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The experience has also reinforced how vulnerable a patient feels under one’s care as well as the wider impact to the family and friends. The surgeon’s role is not just to ensure that the patient is looked after but also that the family are kept up to date with post-operative care and discharge plans.

What was apparent was that the Surgeon’s leadership was evident in the behaviour of the ward and more junior team. Being a Consultant Surgeon is not just about the surgical skill. The compassion and communication as well as leadership and development of the surrounding team, ensures excellence in patient care.

There is a lot of frustration both with communication and compassion, not only with patients but with NHS staff.  What can the NHS do to survive?

The NHS is a valuable institution and the recent survey by the Kings Fund, evidences that the public still consider this to be vital to the United Kingdom. As a member of the public, we need to ensure that the NHS is used wisely. It is sad to see patients not attending outpatient appointments, tests and operations. Each of these wasted appointments costs money but also stops another patient from using this time for their own care.

As a Clinician, we need to be aware of the cost of tests we order and practice evidence-based medicine. There is a constant need to innovate and to challenge ourselves to deliver the best care in the most efficient way possible.

The NHS has its own hierarchy, economy, and while looking at systemic flaws, we have a moral duty to acknowledge the rapid growing demands for healthcare. What are politicians missing to understand and address, what they need to know from your viewpoint as a NHS Enthusiast and Survivor? #

Politicians are aware of the crisis that is developing within the NHS, mental health and social care. The current promise of £20 billion is needed immediately to avert capacity issues but this must be spent across all the sector. The ageing population has not yet soared as the post war baby boomers are still young at 70 and intend to live well into their old age. There is now an increasing need not just for health care but social care as the family networks have disintegrated increasing the need for government aid.

The need for investment is not just cash based. The NHS has long survived on the goodwill of altruistic staff, but the removal of NHS bursaries and the Junior doctor contract discussions have developed a major chasm in the NHS culture. Investment is now needed in developing the NHS workforce of the future.

You are known for your contribution as an educator. How important is education in the work place?

Being an educator, mentor and trainer, brings huge rewards. The small daily investments in your future colleagues across the multidisciplinary field soon causes major ripples. Once one has invested in you, you feel duty bound to invest in another. This circle of kindness, care and interest in the work place creates an atmosphere that engenders innovation and a wish to try without recrimination. This is the culture that needs to permeate through the NHS but sadly is still only palpable in small pockets.

You received The Dr Rose Polge Award.  While a doctor never chooses to be ill, is anyone prepared to give them a chance whilst they are struggling with their own mental health challenges?  

Receiving the Dr Rose Polge award was humbling. Dr Polge’s death was tragic both for her family as well as the NHS. We need to look after each other and this just takes an investment of one’s time and a passion to nurture. If just one trainee reaches out, then this is worth it.

There are very few ‘Difficult Trainees’ and if one probes sensitively, there is always a back story to the trainee in difficulty. It is important that the culture supports the notion that no one comes to work to cause harm or intends to become ill. Doctors are human and have the same life challenges as everyone else. Bereavements and family circumstances may cause an individual to become the sole bread winner whilst managing a taxing career. Illness may creep up slowly without an individual realising the effect on their work. Support and understanding at this difficult time allow a doctor to return to their profession in some way that allows them to succeed. The NHS is supportive of health and well-being, but services remain stretched as the NHS becomes more and more challenged fiscally.

There is still a long way to go to eliminate not only the stigma of current mental illness among the medical profession but raising awareness for their well-being. It is a global epidemic and there are no easy answers. What does it take to change NHS attitudes towards doctors’ well-being? 

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One of the major challenges in supporting doctors is the pride and stigma of health and mental illness. There is a fear that once one is labelled, one cannot return to a normal working life. It is imperative that the work place champions the idea of asking whether one’s colleagues are okay and creating a safe place for individuals to talk if they need to. All hospitals have an occupational health department and they are fantastic at signposting to services that are available. From a personal point of view, the support I have had from colleagues has empowered my return to work with an increased loyalty to the NHS that looked after me.

Communication is the very fabric of the healthcare profession. For centuries people went to the doctor and told their story and the doctor prescribed a remedy based on what they heard. While this is a very basic definition of the patient- doctor relationship, do you think communication is utilised to our advantage at present? How can we use the power of words to communicate better as a patient and as a healthcare professional? 

The basic tenant of communication remains the story telling by the patient to the doctor. The details of the story are vital to the diagnostic abilities of the doctor but the skill of asking the right questions is still key. Underlying this is the need to develop trust to enable the story to be told without any concerns that the information will be used unwisely. As a patient, this was the key in ensuring that my treatment was a positive journey.

Consultations often carry explanations of difficult concepts and details of complex management plans. These conversations are embedded in the delivery of bad or difficult news which engenders fear, desperation and the defence mechanism of denial. It is therefore difficult to ensure what is said is what is heard, whether by the patient or the professional. Listening and checking what has been heard and understood is essential to reach a common understanding. Key to this communication is the multidisciplinary team who encompass a wide variety of skills. The specialist nurses are a fantastic resource that are not only extremely professional and knowledgeable but also approachable providing care plans in a practical and long-lasting relationship.

Please click here to see the entire magazine!

 

 

Happy Christmas!

FeaturedHappy Christmas!

Merry Christmas to all of you! I hope that you have found time to eat, drink and enjoy the company of loved ones and develop new memories to cherish forever! I am on call and treading the delicate balance of ensuring that any patient well enough can get home if they wish, especially if it is likely to be their last Christmas.

It is always a difficult time of year. We try to get patients home but sometimes home is not the cheery warm house with the open fire, a Christmas tree and presents all around. Sometimes it is a bleak place that is lonely and cold and patients choose to present to accident and emergency to be admitted and enjoy company and good food in hospital. Others would love to go home but are hampered by the need for social care which is a scarce resource. They may need mobility aids or food delivered to home or sometimes, just someone to pop in and check they are okay.

As cuts have hit, many convalescent homes have closed, which used to offer respite for patients, allowing an interim between an acute episode of care and home. The wider social network has also diminished as the societal norm of the extended family has changed with smaller family units and a desire to move to independent family homes. It seems simple that a family member could come and stay or that the patient could stay with a close relative but the interconnectivity between NHS Trusts, community and social care are so poor that it takes an age just to set up dressing changes in a different postcode location. There are therefore, patients who are desperate to go home who end up in hospital over the Christmas period despite best intentions.

The desire to get home does seem to add a miracle into the medical mix as patients summon inhumane energies to get better. I wish I could bottle this up as an everyday get well potion! There is great evidence to show that a positive attitude reduces the length of stay of patients in hospital. This seems to drive the same positive gains as the #EndPJParalysis campaign. This global social movement emphasises that having patients in their day clothes while in hospital, rather than in pyjamas (PJs) or gowns, enhances dignity, autonomy and get them home quicker!

The lead up to Christmas has been a busy one. We have celebrated the 60th wedding anniversary of  my in laws with a surprise party as well as attending the wedding of a dear friend. The 60th celebration cake was unbelievable!IMG-20181216-WA0006

It has been busy at work and we have tried to say thank you to the people we work with everyday. We wrapped up 250 Christmas socks, with chocolate coins and Christmas pens! This was a small gift to say thank you but we enjoyed spreading good cheer in the Directorate!IMG-20181220-WA0011

As we all start to celebrate, we have to ask what is Christmas? A holiday, a religious time or just a state of mind, where we all enjoy goodwill and mercy to each other? This year more than ever, has demonstrated the undercurrent present in our society, which engenders distrust, chaos and division. As we drive through the streets festooned with lights and holiday spirit in the air, society seems to be conjoined in ensuring a good time for all. And then there are glimpses into the alternative reality with the homeless on the streets and BREXIT looming.

I write today on Boxing Day. My father passed away three years ago on this day. He died peacefully at 92 having led a hard but successful life.  I am glad he is not here to see the divide that is developing in this country. He arrived in 1955 on the RMS Strathnaver and then married my Mum. Together they brought up three children and encouraged us to work and play hard! The ethos of working to improve the lives of others is embedded into all of us and we have worked hard to honour Mummy and Daddy. Daddy himself played a important role in North Wales, where as the first Asian Labour Councillor, he advocated for an investment into the fabric of Penmaenen. He has left a legacy not only in us but in Penmaenmawr. It is now hard to imagine an alternative scenario where Daddy had been refused UK entry and the three careers which add to society as well as the hopes and dreams of our children rendered null and void.

This Christmas has been quiet, with only four of us celebrating, especially with my week on call. Christmas in North Wales was full of laughter and presents and was the one time when we were all at home! To the kids dismay, I am looking forward to the time when they have families and we have young children running around again!

I hope that you all have had time to spend with family and friends and wish you good cheer!

This is a series of blogs starting from the day I was diagnosed with an acoustic neuroma. If you want to start at the beginning then please follow this link: 

https://stellavig.blog/me-and-my-acoustic-neuroma/

What is said & What is heard #NHS

FeaturedWhat is said & What is heard #NHS

This is a series of blogs starting from the day I was diagnosed with an acoustic neuroma. If you want to start at the beginning then please follow this link: 

https://stellavig.blog/me-and-my-acoustic-neuroma/

Last week a friend attended an important medical appointment and was told ‘Chemotherapy may not make a difference’. When we were discussing this later, my friend was still unsure whether this was because the prognosis was so good that it would not make a difference or because the prognosis was so poor… The consultation had lasted an hour!

Communication and language are at the heart of the healthcare professions but we seem to be losing the art of speech and compassion. Even interactions between healthcare professionals are becoming more pressured and dictatorial in the normal working environment and the healthcare professionals, who are largely altruists, are being harmed. Trainees are asking for advice with difficult conversations and often trainers need to point out that the altercation is often not about the way they behave but rather the stress of the individual they have encountered.

Losing 50% of my hearing has made me appreciate language and communication now more than ever. I watch others and find that non verbal signals fill in many gaps of a conversation as increasing background noise obscures my hearing. This observation also demonstrates the unease and dismay when hard-working professionals try their best to provide excellence within a hard pressed NHS environment but they face words used by others which clearly evidence a lack of value and respect.

A factor must be the limited funding within the NHS causing undue stress and that desperate strive to do more with less. Words used as drivers are efficiency, productivity and income. Quality, safety and excellence risk being lost and we are all responsible for ensuring that these words continue to be flagged alongside the daily conversations within the NHS at every level.

Is another factor the introduction of the electronic patient record into the NHS environment? Members of nursing staff now sit in ward bays on computers inputting patient observations and drain outputs. The laughter and banter, where staff and patients interacted, is still present but is a rarity as the pressures of the new safe staffing ratios and lack of workforce bite. Doctors work with antiquated computer hardware with software that outstrips the bandwidth in the NHS so that the system churns so so slowly. The doctors continue to do ward rounds and desperately try to enter the patient information on the ward round in the fewest words possible as there will be no time once the ward round finishes. Nursing staff are seldom on ward rounds as there are multiple specialities rounding at the same time.  Speciality wards have long since disappeared as the number of beds within the NHS have reduced in cost cutting exercises. Gone are the days (when I qualified in 1991), where Sister would send all visitors out, in preparation of the Consultant ward round, with all prescription charts and notes made available at the end of the bed especially the x-rays in brown packets! Woe betide the house person who did not find that missing x-ray packet as that would be the only one the Consultant would ask for! There are certainly many improvements with the electronic patient records as the charts and x-rays are readily available but it is at cost of patient facing time and the art of conversation.

Recently on a ward round, we approached a patient who was clearly visually impaired. As normal, I introduced myself and took her hand. I asked what she could see, as each patient has a different visual impairment. The team introduced themselves and we discussed her clinical symptoms and management plan. It was important to individualise the management plan with her due to her visual impairment. She cannot see her feet and therefore is unable to recognise the early signs of problems with her foot. In fact as her foot is insensate, all early warning signs fail. This increases her risk to sepsis with a foot infection as she is diabetic and systemic infection can take hold very quickly. The juniors asked me afterwards how I worked out that she was visually impaired so quickly as I had not met her before. To me it was obvious as she was not watching what was happening on the ward but I learnt the skill of observation and deduction from my seniors and time spent with patients. It is now very easy for the entire medical team to log on to a computer remote from the patient, review their history and clinical symptoms without even talking to the patient. A second ward round in the afternoon may assimilate blood results which completely change the direction of a clinical management plan. As this decision is taken in an office, the junior team may forget or be too busy to go back and ensure the patient and their family are aware or even more fundamentally, the nursing staff who will enact the plan. We all need to work harder in the NHS to role model the communication that you or I would wish and deserve to experience in any medical interaction.

The frustration with communication in the NHS was also exemplified when my father was in hospital. Trying to find out what had happened during the day in my father’s care was a daily battle. Working families struggle to visit in ‘normal working hours’ of the medical staff and out of hours medical staff do not have the time or knowledge to address family concerns. This year at Croydon, we will try a communication board at each patient’s bed side where both family and patients can write down any questions they wish to have answered, I will let you know how we get on but if anyone has a good idea to overcome this particular challenge, please do let me know!

The challenge of communication in the present day does not seem to be isolated just within the NHS. I was talking to a Black Cab driver recently whose father had recently been into hospital (and could not praise the NHS enough). He commented on the diversity in the NHS workforce and expressed his concerns with BREXIT looming on both morale and workforce numbers. As with most Black Cab Drivers, his communication style was interactive and that innate ability to put you at ease as soon as you got into his cab. He shocked me with the stories of abuse he had received, both verbal and physical during his hours as a cabbie. Despite innovation in technology, we seem to have lost courtesy and respect as a high value commodity. Community welfare has been exchanged for individual prosperity and development. Has the I replaced the We?

My hope is that is has not! The world has become a much smaller place. My father travelled by ship from India to the United Kingdom in the 1950s which took weeks. Letters from my father to his family would take an age as they travelled by Airmail and then he would wait even longer for the reply. Now we email, Skype and FaceTime to stay in contact with our friends and family across the world. People have migrated across the Continents, have settled and married between different cultures and created new rules by adopting the best from both. What an opportunity to respect, value and embrace cultural norms as well as differences. Would I be viewed differently at work if I wore a sari, a suit, a dress or salwar kameez? Sadly, I think I would, despite the clothing worn by the same person. How do we teach society to be tolerant and have value and respect for all cultures?

We all need to role model the behaviours that we cherish and value. We have a responsibilty to call out behaviours and words that do not attest to a society that values all. Our politicians and celebrities carry a heavy responsibility to evidence their integrity. Respect and value should be their mantra every day, every time. Society needs to make clear this is the expectation of the public. We should not ban cultural dress nor dialect but embrace and incorporate this into our multicultural world. There should be a common understanding that what is said may not be heard in the same way by others as our cultures vary. This high level communication skill should be embedded into our training programmes in all public facing services to ensure that we all hear and understand the common language. What we should all expect in return is common courtesy in an old-fashioned way.