“Don’t die with the music still in you..!”

LOST YOUR “SPOON”?????

“History teaches us that men and nations behave wisely once they have exhausted all other alternatives. ”   –  Abba Eban”

Let’s hope so…..!

Well:

To grasp the broader meaning of  “spoon” or “spoon theory” lets start to say this is sort of a disability metaphor used to explain the reduced amount of energy available for various and productive tasks.  Spoons are features of measurement. They are used to check how much energy a person has throughout a given day. We can’t live on one teaspoon sugar, so to say. Let’s agree this is very different on the spectrum of human diversity. That’s easy to understand. Energy levels are different, likewise the energy levels we can sustain.

When you are affected in your mental health either through depression, excessive anxiety or being “burnt out” of sorts, the energy available for a healthy “output” may be reduced at various degrees.

That’s what we may call in broader terms “lost spoon”.

How far your “spoon” is lost is a different story. The most important thing is that when you lose your spoon that you try to find it again.

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But mind you, there are many “lost souls” on this planet unable to find back what they lost. Damaged and living on the other side of the spectrum…Surely, I am unable to say as how to find what you lost again and certainly this is different for anyone involved in issues affecting mental health.  But.. without generalisation, it is true that even the greatest on earth did know “the battle of the mind” at times. The struggle to compose oneself and radiate a sense of normality whilst conflicting emotions and feeling low or anxious, at times, play a role at the background.

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Abraham Lincoln, together with more famous sufferers of depression like Winston Churchill and Mark Twain, used humour as an antidote to depression. To boost his spirits, Lincoln told jokes and funny stories. Lincoln once said, “If it were not for these stories—jokes—jests I should die; they give vent—they are the vents of my moods and gloom”, said Joshua Wolf Shenk (In ” Lincoln’s Melancholy: How Depression Challenged a President and Fuelled His Greatness”) He concludes that “Humour gave Lincoln protection from his mental storms. It distracted him and gave him relief and pleasure . . . Humour also gave Lincoln a way to connect with people. In addition to humour, Joshua Wolf Shenk ( the writer of above book) discovered that Lincoln utilised other major depression antidotes, including his love of poetry and a strong belief that his life had an important purpose. As you see, and without adding too many examples, many did lose their “spoon”, but some of them had also the means to help themselves. When Lincoln e.g started to speak, started to connect with people, – his often somewhat sombre face did relax into an embracing smile.

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Just one other example:

Before becoming the Buddha, he was Siddhartha Gautama. According to traditional biography, he was born into royalty, his father a king who attempted to shield Siddhartha from knowledge of human suffering by removing the sick, aged and other suffering from his view. However, Siddhartha was said to have seen an old man, a diseased man, a decaying corpse, and other suffering, and then to have become deeply depressed by these sights. And at age 29, he began his journey to seek wisdom about how to overcome suffering and despair. His spiritual journey took six years, with Siddhartha ultimately rejecting popular “treatments” of his day that included asceticism, deprivation, and self-mortification.

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Siddharta’s Antidotes: At age 35, after 49 days of meditating under the Bodhi tree, he attained Enlightenment and became known as Buddha, the “Awakened One,” and one of the world’s greatest antidotes to the suffering of depression was born. Buddhism begins with understanding truths about suffering. Specifically Buddhism’s Four Noble Truths are that (1) suffering is an inherent part of existence; (2) suffering is caused by attachment and craving, and our ignorance about this; (3) we can cut suffering by letting go of attachment and craving; and (4) this can be done by following the Noble Eightfold Path of the right understanding, thought, speech, action, livelihood, effort, mindfulness, and concentration. For the remaining 45 years of his life, Buddha travelled and taught extensively. Compassion and the truth about suffering were his major antidotes to depression and despair—antidotes for himself and for others.

It would not be wise  to romanticise all depression sufferers and to celebrate all non-medical solutions. As a medical professional myself I would be against it, however those examples give some comfort perhaps. Comfort in a sense that you may lose your “spoon” but that in compassion through suffering you may give back one way or the other. Is this wisdom?  Not so sure about this. Aeschylus once said that he who wants to learn has to suffer. For sure he did not mean the type of learning we do at school or at Uni. He meant the learning of the soul in the pains we may meet. There might be a pain we can’t forget. An agonising wordless feeling hanging as a cloud upon the mind.

What can we say about this?

He said that “the” wisdom may come from a different calming dimension. Not as an instant cure, but through a long-lasting process.

Yes, he said:” Even in our sleep pain which can’t forget falls drop by drop upon the heart, and in our own despair, against our will, comes wisdom to us through the awful grace of God”. He reflects here on the supporting dimension of God.

I think I lost 2 times in my life “my spoon”. Sort of!.. The first time was ( I don’t count my departure from being a “tropical doctor” in Africa), when I moved from Scotland to Australia.  It was a very busy and stressful time. Firstly to sort out my practice where my partner left me on my own with a cottage hospital pending to close down. For the last reason,  I could not attract a new partner because I could not promise a growing income. This seems to be important for doctors. Almost one-third of our income was generated from this hospital. There were issues with the practice building as well.

The Grampian Primary Care Trust was finally ready to take the practice over, so at least that bit was secured. They understood the predicament related with Campbell Hospital in Portsoy.

My legacy, if any, was that I was able to secure the practice with this Trust. But for various reasons I did not wish to work under them.

It would be an understatement that I worked extremely hard at the time… When they asked for a “free spirit” in South Australia – after plenty of consideration with my family – , we all went ahead and moved from Scotland to South Australia and started in a rural area some 250 km from Adelaide. I was extremely tired when we started there.

Starting in Australia, with all its charm and appeal was challenging as well. Moving from continent to continent is a job and starting a new job with a degree of exhaustion is an extra experience… And for sure my background experience working as a rural medical doctor in Scotland and longer ago in South Africa was of great help. I am still grateful for the people who provided support.

For this remote area it was helpful that there was a Flying Doctor Service to get those critical ill patients transferred  to one of the specialist hospitals in Adelaide, if needed. There was good nursing staff in Pinnaroo.  Very important when you are the solo medical practitioner.. Frictions with the EO/DON were very unhelpful then. Both her approach to the hospital owned practice and some other staff were not favourable. When they (my practice staff) arrived in tears during my holidays at our house next to the practice, as they were “bullied” by the EO/DON a somewhat worrying time started. But I had to raise vital concerns with the local Hospital Board, which I did in line with proper protocol. For sure this was taken the wrong way and before I knew, our portable family swimming pool was emptied by this EO/DON and maintenance man. It became a long eventful story with a number of challenges. The specifics of all those things are not important anymore within this context. But let it be said that for a number of people  the culture being created in this environment, with all its dynamics, was of a disruptive and unpleasant kind.

In all this, however, we need to realise that people are often far more than their expression at one stage of their lives, and that lots of goodness not always come to the surface. Being gentle therefore bears perhaps more fruit, I guess. Where the EO/DON of this place could have done things differently, my very straightforward and direct approach on “work place bullying” could have been more diplomatic perhaps. Others would say it was the right approach.  But anyhow, that’s all history!

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Finding the right balance is not always easy, but there is always  a learning curve.

At some stage, however, I had not much energy anymore at this place. Being about permanent on-call, a busy family life with counter productive dynamics at hospital management level and being more or less ongoing on the alert for at least more than one (EO/DON created) plot made us decide to move away. The Pinnaroo community was and is a great community and from this point of view it was sad to go. It proved that the higher regional management was unable to deal with a very significant and dysfunctional management pattern at local level. Coming from Europe, this was quite an “eye-opener”.

We moved in 2004 to a town close to Port Macquarie in New South Wales, where after one year I got an associate partnership.

Nice teaching practice but at some stage also somewhat dominated by not so fruitful dynamics. The youngest doctor decided to start for himself elsewhere. “He did not like her approach”. This escalated into dynamics in which I decided  not being willing to be left alone in a practice like happened in Scotland. After various options being considered within my family (and moving up to the Coolangatta area not being perceived as favourable within our small household), – I took by coincidence actually a job for the Health Service in Tailem Bend, South Australia. For various reasons then, within family context, this was the most desired direction. However, not knowing what would evolve. We moved this direction to South Australia, in part because our youngest daughter was perhaps already not too well at the time. For various reasons being relatively more close to Pinnaroo was for her more easy to accept, after exploring some places in New South Wales.

To make a long story short, years after I left Laurieton in New South Wales, the doctor who wanted to start on his own elsewhere again(despite some financial odds against him), established a very successful practice and took the Practice Manager with him (along with other practice staff). Also, the last remaining GP (who owned the building with her partner),  took a successful different direction with both courage and determination. And all that’s good…I admire this!..In a way both great people, but better evolving in different entities and different directions.

As I said, people are often very much more than their expression at one stage of their lives. And being mindful of this, bears perhaps more fruit in our response to matters or circumstances where human dynamics are involved.  That’s the reason I like what Abba Eban said about history and exhausting alternatives: “History teaches us that men and nations behave wisely once they have exhausted all other alternatives. ” It does however not always work this way, as we all know.

There are always people though, who are stubborn, thinking that they are always right and not willing to change their mind where this is at times required.

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Tailem Bend – as well – was full of adventures and endeavours. Last but not least because working with SA Health made you as a GP less in charge of choosing the doctors to work with: SA Health was fully in charge… Contracted with SA Health provided, for sure, some benefits but where it comes to “involvement” in critical GP recruitment choices, there was not much participation. The workload could be fairly unforgiving at times, with both the cover for the practice, A&E, the Acute End (of the hospital) and the Long Stay Department. For the last reason doctors more often did not stay that long. Obtaining the Royal College exam (called the FRACGP) was not rarely one of the motivations to stay for some – and then: moving on again!  The variety of doctors coming and going had their challenges for both the practice and hospital in Tailem Bend… In between, I worked often (at large)  on my own. On regular occasions lacking the required “back up” locum support.

Surely, it was not always easy to secure locum support for both the entity of cover on both the practice, hospital and A&E…. Not everybody likes this kind of work. It can be quite challenging and chaotic….But for some reason I managed to sustain with not many holiday breaks for both myself and my family. Perhaps only  in one occasion a holiday with 2 weekends  included… And then we speak about a time frame of more than eight and half years…

Long term retention for GP’s in rural areas do really need enough time to recuperate from the strains of working under totally different circumstances than city GP’s, and this failed to be secured in my case.

Besides this, with being that busy, it is not always possible to make friends as being “on-call” was a quickly occurring repetitive event.

The last doctor with SA Health in Tailem Bend ,working with me, did not get his contract extended early last year. This as due to the type of conduct not being seen as favourable for both SA Health and the Medical Board. Again, it left me with a challenging situation working very long hours, –  often on my own between the end of March 2016 until mid December 2016. Having explored all options (see last article), I left this Health Service for a practice in Aldinga.

Undeniably, this almost nine years journey in Tailem Bend had an impact on both myself and my family. Not always for the better. However…. a learning experience…For sure…

Some human encounters during this time had a lot of meaning for me in the darker moments to survive the various responsibilities.

I guess that after some months the aftermath of Tailem Bend did hit back. Not sleeping…  Feelings of despair are not strange to me and at times I learnt the hard way.

I learnt that in taking important decisions about change of working environment, one need to look at the scene and the context of the place. Not always (optimal) possible as dynamics can often change in unexpected ways. Apart from this, information being provided at the beginning may be coloured by the interest to get a rural medical practitioner to take the job. It’s an interesting ball game and “playground” with various interests at stake.

In Aldinga, working at a lower pace and variety was almost a shock for “the system” as I was not used to this, – but I do appreciate it now. However, in some ways I am further away from my original aim – when I studied Medicine in Maastricht (the Netherlands)… But looking back there has been a tremendous experience across continents and countries and I am grateful for very many positive encounters as well.

Many people made a great impression on me and in my moments of despair and extreme tiredness at times, I took often comfort in the imagination of their presence, and: the simple fact that many of us in the medical profession had to endure a certain degree of hardship.

We try to make decisions within the best context of both duty, care for family, and…”meaning” perhaps – but we do not always get what we want.

Often we have to balance on what life asks us to do in a particular set of circumstances.

The search for meaning goes on and on. It never stops and every time you need to reinvent youself, embrace life for “belonging” and change, and keep in mind what Aeschylus once said. And for sure, .. it’s all part of: > “not to die with the music still inside of  you”<.

And that it can be agonising at times may be part of life. For some more than others.

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Through the awful grace of God we may forget what lies behind us, with gratitude, and live with the music in us: to embrace this in full, for the benefit of both ourselves  and others. It is perhaps a matter of the right sense of direction, the right discipline of the mind, – and “heart over matter”.

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Yes – “heart and imagination” over matter – if we are able to allow ourselves NOT to be defeated in our own souls.. We are neither confined to one place in our mind, nor confined to any one place on earth. We are allowed to travel , broaden our mind as far and as long as we can stretch this. But in all circumstances we have to watch both the scene and the context of our activities with purpose and direction, with love at the centre of our heart.

And as such we are digging up our “spoon” again, with still:  the music at heart!

Thank you so much!
Paul Alexander Wolf
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