That’s Dr Thingy to you

Saturday’s appointment with YAS (Yet Another Specialist) sparked a small and unexpected revolution in my head. It was a teeny, tiny spark, but I am beginning to think it was more significant than I realised. Let me explain. This particular specialist had earned my undying gratitude by coming in on a Saturday to give me an appointment two months earlier than his waiting list would otherwise allow. I was disposed to adore him before we met.

Nonetheless, when he opened the door, he greeted me with “Linda, is it? I’m Dr Thingy*.” I introduced my husband and we sat down in the waiting room to fill out the obligatory forms. I carefully filled in “Dr” where it asked for my title. I worked hard for that PhD, and I like to have it recognized, but it’s particularly useful in medical situations. Even though I don’t have a medical degree (and never pretend that I do), I like to establish that I am a trained scientist and I can handle technical terms. I like to be taken seriously. I shouldn’t need a PhD to be taken seriously, of course, but the truth is that it does tip the scales sometimes.

I’ve always called doctors by their titles. Well trained by my doctor father, and also of a respectful and somewhat conservative bent by nature (20 years on I still find it hard to call my school teachers by their first names), it comes more easily to me to call a doctor “Dr Thingy” than “Jess”, even though many doctors now introduce themselves by their first names.

But even the doctors who hide behind their titles and surnames like battle armour always, always call me by my first name. And it suddenly dawned on me that using surnames and titles reinforces a psychological distance and a power relationship that might not be in my best interests. As a patient I have always had an irritating tendency to want to understand my diagnosis and make decisions about my own treatment. It drove my dad nuts, but I stuck with it. It took me a while to get to this point, but now when I encounter a doctor who isn’t comfortable with me making the decisions, I dump them post haste. This is my body. This is my health. This is my responsibility. My doctor is a partner in my quest for better health, but she can never, ever be in control.

Astute regular readers may have detected a touch of the control freak in my approach to the world, but I think this attitude transcends a mere personal tendency. For too long, some health professionals have treated their patients as devices to be fixed at worst, as naive children too young and ignorant to know what’s best for them at best. Either way, patients taking charge of their own health are not a welcome development in such cases. Here the battle armour is crucial to reinforce their supremacy and control. “I’m Dr Thingy. You’re just Linda. I’m the expert. You do what I tell you.”

To be sure, sometimes there’s a fine line between making your own decisions and ignoring expert advice in favour of quackery. I’m well aware that many anti-vaxxers believe they are making informed decisions. But it is rare that any condition has only one possible treatment, and extremely rare that treatments are without complex consequences. There are always choices to be made. There is quite a lot of medical literature documenting the fact that patients who inform themselves and take equal roles in their own treatment have by far the best outcomes.

Recently while in hospital I was told I needed a test I had already had – even though I had mentioned the results of this test to 3 separate doctors during this visit. I told them again, and repeated the date of the test, and they agreed it was unnecessary. This test was going to cost me around $400, but it was harmless (if rather unpleasant). No harm would have been done if I had allowed it to proceed, except to my bank account. A few weeks later I got a letter telling me when my appointment for the test had been scheduled! Now imagine it was a drug I was on that had not made it onto my file. Or a life threatening condition. These mistakes happen. Imagine, then, if I was put onto a drug that would interact with something I was already taking, and I didn’t question it, because my godlike Dr Thingy is the expert. He knows what he’s doing. He’d be offended if I questioned him!

It happens. It nearly killed a friend of mine a few years ago, in fact. After that he got kind of stroppy and started to push his doctors to explain and justify themselves, and his healthcare improved immeasurably.

I can’t help feeling that the best and most productive doctor-patient relationship is one of mutual respect. So if my doctor calls me Dr McIver, I will happily call him Dr Thingy. But if he’s going to go with first names from the start, then I think it might be important to put myself on an equal footing, both in his head and in mine, and just call him Fred. After all, we’re in this together.

*Not Whatsit’s real name. I should also add that the real Dr Thingy’s attitude has been fabulous, and he has not exhibited any of the issues discussed in this article. :)

Slipping away

I’m not sure whether my Mum is losing me, or whether I am losing my Mum. We’ve never been close. We’ve always been complicated. But in some ways I defined myself as much by that complication as anything else. I became a set of “I will never”s as much as a set of “I will be”s.

Now dementia is rewriting that fraught relationship every day. There are upsides. Screaming paranoias that would have lasted weeks or even years now only last a few minutes. Memory loss has its charms, as it turns out.

Sadly there are hidden razor blades, too. My Mum no longer knows how many kids I have, or whether they are boys or girls. That’s not particularly new, but on Monday she went from one sentence berating me for working too hard to asking how the job hunting was going. When I told her I was happy in my job she was puzzled – how long had I been out of work? When I gently suggested she was confusing me with somebody else, she agreed that this might be so, and then, in a small voice, asked me “What do you do, again?”

That small question hit me like an out of control freight train. Being a teacher is a fundamental cornerstone of my soul. It’s who I am. So I am forced to face the fact that my Mum doesn’t know me anymore.

Whoa-oh-oh slipping away from me
Whoa-oh-oh slipping away from me
And it’s breaking me in two
Watching you slipping away
Slipping Away. Max Merritt and the Meteors.

It feels like a short step from here to her not recognising me at all, but the heartbreaking part is that we still know her. We still possess within us all the complexities, the hurts, and the misunderstandings of our lives together. For her they are washed mercifully clean, but for us they churn away in our every response to her. We remain angry and confused about things she has no memory of doing. We are still frustrated and hurt by a history she can’t even imagine.

You may argue that it’s time to let go. To dispense with emotions that are years out of date. But those experiences made us who we are, and they are not lightly or easily discarded.

My grandfather forgot us all, in the end. My personal version of that history is that he remembered me long after he forgot everyone else, but I suspect that’s a story my 13 year old self desperately wanted to believe. It’s far more likely that we all disappeared for him, much the way we are disappearing for Mum, now.

Sometimes Mum calls 6 times an hour, asking the same question, accepting the answer, and forgetting it within moments. Sometimes she doesn’t call for days. She doesn’t remember this afternoon that I saw her this morning, but she can hold onto strange things – like wondering what I have done with her bathroom mirror? (I never had it.) We’re used to the conversation repeating. We’re used to things being forgotten, and her getting muddled. But this loss of identity: this is a fresh shock.

Mum’s young for dementia. At 76 it’s unusual to be this far from your former self. At 43 it seems unusual to be facing the slow, shattering demise of the very essence of your Mum. But this is our world now. This is the future that looms, the grief that stalks us.

Family

Mothers day is always a little fraught for me. My relationship with my Mum was complicated, long before dementia kicked in and kicked over the furniture. So today I have been watching all the heartfelt declarations of love and support on Facebook and feeling a little bruised. A little battered. A little lost.

But then I started thinking about some of the extraordinary relationships in my life. My beautiful girls brought me breakfast in bed. Their handmade cards made me teary. Their hugs were heartfelt, and inevitably followed by a certain amount of coffee-endangering wrestling – don’t tell me girls don’t wrestle. They just do it at a much higher pitch. It all made me smile (once my coffee was safely out of the way).

I reflected on the wonderful people that my work has brought into my life. The amazing support staff. The fabulous teachers who have become dear friends. The researchers and activists I and my students have collaborated with. And the students themselves. That’s when it hit me. I have two children by any normal calculation. But in the 5 years since I became a high school teacher I have suddenly become Mum to every student I have ever taught.

They all have a piece of my heart, and a claim on my time, for as long as they want it (and beyond). They teach me incredible things and give me amazing gifts every time they bounce into the classroom. Every time they email me for help. Every time they find me on Facebook after they leave school. Every time they come back to help in my classroom, or just to sit up the back because they have a study period and they like the atmosphere. Every time they send me interesting snippets they think I’ll enjoy or be able to use in class.

Every time they tease me with while(True) loops and emoji variables (sorry, programming joke).

Every time we meet for coffee. Every time they ask me for career advice. Every time we stay connected. Every time we interact. Every single time. I’m so lucky to be connected to these amazing people. In a very real sense they are part of my family forever. Family is where your heart is. Happy Mothers Day!

What if we could save millions of lives?

Imagine there was a way to save millions of lives. To dramatically reduce violent crime rates. To wipe out an entire criminal industry. To rebuild communities, and reconnect people with the world. Who wouldn’t be up for that? Who could possibly stand up and say “No, I’d rather see people raped, murdered, and robbed. I’d rather see lives destroyed and whole communities living in fear.” Imagine there was a solution to all of that.

There is. It’s known. It’s been tested. It’s understood. It’s called drug legalization.

“But no,” we scream, recoiling in fear. “Drugs are dangerous. Drugs kill. Druggies will do anything for a fix. Drugs are catastrophically addictive.”

This is what the vast majority of us believe, and we don’t question the science. Which is why I was shocked to read “Chasing the Scream”, by Johann Hari. It was the first time I ever heard of the Rat Park experiments by Bruce Alexander. These experiments showed, with startling clarity, that drugs are indeed addictive to rats, if you keep rats in isolation, without any other source of stimulation. In solitary, deadingly dull confinement, rats will choose heroin over water.

But it turns out that if you keep rats in company, with things to do and plenty of food and water, rats don’t get addicted. In fact they choose not to take heroin at all, even after being forced to take it for weeks at a time – when you stop forcing them and put them back into happy, healthy surroundings, they stop taking heroin almost immediately.

This is stunning stuff that turns our understanding of drugs on its head. So it must be amazing new research, surely? Amazing yes, but new, no. This research was conducted in the 1970s. Published in 1980, and more or less buried ever since.  The results were so far outside the established dogma that funding was cut almost immediately.

In England in the 1980s and 90s, heroin was available in some areas on prescription. Crime rates fell. Addicts began to lead stable, productive lives, and many even came off heroin – all because heroin was more easily available than before. In fact in those areas total drug use went down, largely because users didn’t need to push drugs in order to be able to afford their own drugs.

According to Chasing the Scream, Dr John Marks, who prescribed heroin to his addicted patients, “expected that the news of these results would spur people across the country, and across the world, to do the same. Who would turn down a policy that saves the lives of drug users, and leads to less drug use, and causes dealers to gradually disperse?”

Instead, a conservative government shut the program down, death and crime rates shot back up, and England was back to square 1 in the drug war.

The shocking essence of the book is that it’s our increasing lack of connection that drives our relationship with psychoactive substances of all kinds. Our desperate drive for stuff fails to fill the void, and drugs, including alcohol, ease the pain. Increasing connection by providing support, care, and a place in society, decreases addiction reliably and consistently. And our war on drugs is guaranteed to sever the very relationships we need to strengthen if we’re to beat drugs.

When outcomes are measured consistently and you combine harm to users with harm to others, our easily available legal drug, alcohol, is one of the most dangerous drugs we have. Far worse than marijuana, heroin, cocaine, and even LSD. Most of the catastrophic harm that we know drugs cause is actually a direct result of prohibition rather than the drugs themselves. I won’t convince anyone of that in one short blog, but I urge you to go and read the book for yourself. Also check out Bruce Alexander’s work on the Rat Park.

Research and practical experience has shown time and again that we can win the war on drugs simply by ceasing to fight it. The monstrous enemy we believe drugs to be is entirely a construct of our political system. It bears no resemblance to objective reality. And yet here in Australia we seem unable to allow even medicinal use of cannabis.

In a sense this revelation ties in with our attitude to climate change. We have a problem that is of catastrophic proportions. The science is in. We know how to fix it. But our politicians aren’t listening to the science. They are hostage to the fearful monsters in their own heads. But the more we talk about it, the more we question the things we used to know were true, the more chance there is that the world will finally become a more compassionate and rational place.

So go read Chasing the Scream. And next time the conversation turns to drugs, drop some facts into the conversation. Who knows what you might accomplish?

Simmer until reduced

Imagine a Facebook “guess my gender” quiz.

Do you prefer:

• pink
• blue

When you pack do you:

• Carefully fold things and pack them in a specific order
• Stuff the minimum of things in any old how

A pile of dirty dishes:

• makes you twitch until you can roll up your sleeves and wash them
• what dirty dishes?

If this were to be accurately scored my result would have to come out not so much male or female as somewhere around “It’s complicated.” And I recognise that I am not normal. As a wearer of persistently odd socks, and the kind of person who winds up in the wrong room when a party splits into the girl room and the boy room, I am probably not a good person to ask what is “boy stuff” and what is “girl stuff”. But I’m quite sure I’m not the only person who feels this way.

Today I saw a meme on facebook that said “Men: if you ever wanna know what a woman’s mind feels like, imagine a browser with 2857 tabs open. All. The. Time.” and my first reaction was to laugh, because that’s totally me. But my second reaction was annoyance, because I know a lot of men who are exactly like that. It’s not a gender thing. It’s a personality thing.

We are extraordinarily good at categorization. It’s an essential survival skill. We box things fast so that we know how to react to them. This helps us stay alive when the box is labelled “man-eating-tiger-RUN”. But there’s not a lot of room for nuance and error detection in this super fast boxing. All too often it leads us to the wrong conclusion. It leaves us in a place where men are not allowed to be nurturing and women can’t be assertive. Where women can’t be strong and men can’t cry.

We’re starting to make progress with toys and demand that manufacturers ditch the “boys play with cars and girls play with dolls” marketing that is so corrosive. We’ve got a long way to go, but we’re getting there. But we seem to be much slower about tackling the adult versions of the same thing. The jokes. The funny memes.  The assumptions about the way men and women will and should behave.

People I respect, writers with a lot of intelligence and credibility, still make comments about how bad men are at cooking, and how there are things only a woman would understand. And it drives me CRAZY. (But that’s ok, because women are good at crazy.) They write articles about imposter syndrome as an exclusively female problem – and it’s not. I know men who feel this way too – but how much worse to feel this way and believe that you shouldn’t, because you’re not the right gender?

The internet is full of articles with headlines like “5 things every woman should know.” “10 things only a man would do.” I just Googled “10 things every man should” and it defaulted to “10 things every man should own.” It won’t surprise you to learn that I found lists of axes and work gloves. The first full page of results for things every woman should own was all clothes, except for one about things women should have in their purses, which began with hand sanitizer and a sewing kit. Oh, and something called “oil absorbing sheets”, because apparently there’s nothing worse than finding you have oily skin right before a meeting (words fail me). When I found a list for men’s pockets it included USB drives, multi-tools, and a hip flask. I’ll take the pockets, thanks!

Sure, taking the top few Google searches is the low hanging fruit of the internet. But it is also a key indicator of the shape of our world. Men still aren’t supposed to carry bags, and women’s clothing doesn’t have pockets. Women shave their legs and their armpits, men don’t. Women can’t be seen in public without makeup. Men barbecue, women cook in the kitchen. We may think we are equal and so much better at gender politics than we used to be, but while we are still defining ourselves and our behaviour by our reproductive organs, we are still horribly lost. Worse, we are still constraining ourselves by our gender. And it’s time we set ourselves free.

I can’t put it better than my friend Jarred did today: “It’s about time we moved on from 90s-style jokes about how men and women are sooooo different and it’s impossible to understand each other. It’s 2015, people!”

* UPDATE: A week after I wrote this I discovered there is a Facebook gender quiz, and I scored 85% male 15% female. I think it was inaccurate though. I should have scored 70% male, 10% female, and 20% None-of-these-answers-are-right-also-please-correct-the-grammar.

Filling the heart bucket

Soon after my youngest daughter started school she came home talking about her bucket. Her older sister would sometimes be accused in most peremptory tones of emptying the bucket, and when she was happy she would joyfully announce that her bucket was full to overflowing.

It took us a while to twig that this was the way they were talking about emotions in her class. They called it the heart bucket, and every day they talked as a class about the things that were emptying their buckets, and the things that filled them. The metaphor has been growing on me ever since. It works in so many ways.

Some life events don’t just drain your bucket, they punch big holes in the bottom. Some people do that, too. But others can actually strengthen, and even enlarge the bucket in the long term. But sadly we’re not always good judges of how to fill our buckets. I saw an ad yesterday for insurance, and it was a montage of images of people showing great affection for stuff. Big stuff – like cars – and little stuff, like jewellery. The implication of the ad was that stuff makes us happy. And it’s very tempting to believe that.

When we’re sad, or lonely, or dissatisfied with life, it’s so easy to believe that a new X will make us happy, for any given value of X. A new car. New clothes. A new laptop. A new phone. These things will indeed make us smile for a short while, but the thrill of acquisition quickly fades, requiring yet another acquisition to fill the new space in the bucket. Pretty soon we wind up with a house full of stuff and a startlingly empty bucket. It turns out that stuff is an utterly ephemeral contributor to the bucket. It’s like fairy gold that glitters brilliantly by night but evaporates in the sunlight of reality.

There’s been a lot of research lately on kindness and altruism and their positive effects on our health and well being, and it feels to me as though we are finally onto something big.

That big thing is that it’s up to us to fill our own buckets, and the best way to do it is to tend to the buckets of others. As a slogan, I realise that needs a little work. It’s not exactly punchy and attention grabbing. I can’t see a crowd walking around with placards that say: “how’s your bucket?”

But looking after other people, noticing their feelings and their needs, is a profound form of self-care. It takes our heads out of our own rumps and stops us wallowing in all the things that are driving us crazy. The health problems. The work stress. The people who tip us over the edge on a regular basis. If we focus on these things they will surely take us down. Looking after someone else, on the other hand, can lift us right back up again.

The good news is that we don’t have to drop everything and devote ourselves to orphans in developing countries in order to focus on filling buckets. It can be as simple as taking time out to give someone some positive feedback – whether it’s sending an email someone who made you feel good, or appreciating someone who made you a really good coffee. Or my personal favourite: telling a teacher how great they are, and how much you appreciate all their hard work. ;-)

Another great bucket filler is noticing and helping the people around you. On my way to the GP this afternoon on my bike, I passed a mum struggling with a pram on a particularly rough bit of footpath. I paused to ask if she needed a hand. She didn’t, but gosh she was pleased that I had asked. And I was pleased that she was pleased, and there was a whole lot of smiling going on.

A couple of weeks ago I wrote about how much I enjoyed Adam Hills’ comedy. I tweeted the blog to him, he tweeted a very lovely comment back, and bingo – buckets sloshing about all over the place. This is the sneaky upside to bucket filling – aside from feeling good about filling someone else’s bucket, it often results in reciprocal bucket filling that can go on for a quite remarkably long time.

So whether it’s a famous person, your local barista, or a stranger in the street, filling someone else’s bucket is a wonderful thing to do for your own mental and emotional health.

That’s what’s known as a win-win. Or perhaps we should rename it a slosh-slosh. I think maybe I have to work on my sloganeering. But bucket filling I can do.