For the last week, therefore, I have been exposing her to repeated viewings of Christine and the Queens' 'Tilted', both in video and live performance versions; she particularly enjoys two aspects: the man who walks on his hands and the line 'I am doing my face with magic marker.' 'That's silly, Daddy', she says. She is right, which only leads me to wonder whether a magic marker is the same as a permanent marker, and how worried I should be that she will become a music-lyric-copycat, and be left with ink stains on her face that remain until she grows new skin. She's due to start school in a few weeks - it's a real concern.....
Tilted is a song that first appeared in French. Heloise Letisser (Christine is her alter ego) speaks English with the kind of thought and consideration that allowed Nabokov and Conrad to write beautiful English prose in non-native languages. Tilted in English, is, I suspect, purposefully ambiguous, and contains the delicious line 'I am actually good, I can't help it if we're tilted.'
You make of that what you will, but to me, it invited comparisons with what it is like to work in healthcare. Over my career, there have been moments when I was unable to be the conscientious, well-meaning young man that decided to be a doctor. There have been moments when I found it impossible to be as compassionate as I wanted to be, to be a considerate as I needed to be, or as patient as my patients needed me to be.
I am not alone in having set out in medicine to be expert, caring and good under pressure. I am not alone in having failed to live up to these objections. I am not alone in having felt the shame of having fallen short. Today, I wonder sometimes how I made it through my time as a medical registrar.
Feelings of inadequacy in a hospital can be insidious, and undermining. You look around at all the people who manage to be nice all the time, who seem to breeze through the day, while you wrestle with the anguish of feeling inadequate. You exhort yourself to try harder, to be better, because, well, that is how you manage problems in the NHS.
We have been fostered in an environment that talks about 'no-blame cultures', but which, through every action it actually takes, cements the perception that you are OK as long as you don't mess up. Targets are met through constant cajoling, pushing and exertion. Each day is a full throttle effort to keep up, leaving no time for colleagues to sit down and ask of each other 'Are you OK?'. There is no space to reflect, to learn, to plan different ways of working, or simply to make sense of what has happened.
It is in this environment of working that staff start to wonder whether they have the stamina to survive. Each day in an acute hospital is run as if it is a crisis. Yet a crisis response is only sustainable if you know that the crisis will end; that one day soon, you will be able to take your foot of the peddle, slow down, catch up, tidy up and recover.
The recovery time in medicine has disappeared. Recovery used to take place in the mess, in the pub, in the quiet moments of the day. The old way of team building through having the whole firm working together all the time wasn't ideal - machismo and practising on patients are no way to do healthcare, but at least there was solidarity. Now the hours have changed, but nothing has replaced the team structure. Modern working schedules do not allow firm team structures to exist in the way they used to. Without them, however, junior doctors have lost the support networks they used to have, and they have not been replaced with anything. One would have thought that with doctors switching teams so often, that the NHS would be the world leaders in team development strategies. Perhaps we might be, except that the current culture of healthcare seems to view team-building as non-essential. For confirmation, look at the number of junior doctors who started posts this August who still don't have contracts, know what they will earn and didn't get their rotas until a few days before starting.