Advocate for Your Health

Are you an advocate for your own health care?  Before you answer, I’m not going all health food guru here.  I’m the person who sits on my ass all day with my token Tai Chi and the dog walk exercise regime.  When you go into your GP, do you advocate for your health or do you allow yourself to be talked out of what’s wrong with you?

I see.

This week, another story about another woman with a sore belly and only after two years of not getting better, were tests done.  By then, the cancer had metastasised and it was too late for her.  She was in her twenties and died a few weeks after her wedding.

Oh my, did she not go to her doctor?  She did.  And that’s what I’m thinking about today.

So first, my sad tale.  No, first I want to say that I grew up in a medical family and married into one, which brings probably more than the average number of doctors into my social world.  This isn’t anti-Western medicine or NHS, although both those things contribute to the situation.  How could they not?  They ARE the situation.  That would be like saying cow’s milk had nothing to do with some people having lactose intolerance.  It’s not the milk’s fault but it is the problem.

Now back to me.  I wasn’t a pretty young thing who should be in the best of health at the time I went to my GP over a pain in my thigh.  I was American.  That was the excuse she gave me.  My expectations of the NHS were out of order.  Without doing any tests, she told me that I had arthritis (in my muscle, thinks me) and the pain wasn’t bad enough (I couldn’t sleep through the night) and I probably needed a hip replacement (how do you know without an x-ray) which I couldn’t have for fifteen more years.  Go away, girl.

A few years later, I moved and went to another GP who immediately referred me to the best orthopod in the area (according to my gasman husband) who did the x-ray and found a congenital defect in the hip socket which should have been dealt with YEARS before the anti-American GP.  So all those disturbed nights, all those New Year’s dances I sat out, all the miles of flowerbeds I weeded by scooting on my bum shouldn’t have happened. 

But I’m alive, aren’t I?  My new hip is the best thing since sliced bread.  And to be honest, having to watch my lunatic family dance during New Year’s was a hoot.  The thing is, I once listened to private stories for a living and I can tell you that my experience with the anti-American GP isn’t that unusual.

First, let’s think what a GP in the UK has to do.  See six patients an hour.  Yup, in ten minutes, greet, seat, listen, maybe examine and diagnose, turf out of the office and document a patient’s complex medical situation.  When I went to my GP because I wasn’t bouncing back after surgery, he looked surprised and said, Oh you’ve had surgery?  Then read my file.  This was the same person who busted his ass to get me the area’s best surgeon.  But that’s what he does.  Six times an hour.  He can’t remember everything.

Don’t go in all shy and hope for the best.  Go in with a concise description and perhaps your concerns.  Share whatever medical history you think is pertinent.  When we lived on base, our GP routinely verified a situation with the spouse.  Patriarchal, you think?  He did it because in his experience, people tended to underplay their suffering.  So ask the people who live or work with you how they perceive your symptoms.

GPs also have targets to meet or avoid which have financial impacts on their surgery.  So to practice medicine at the speed of light with Damocles sword over your purse, the default position is that the most common answer IS the answer.  In other words, you won’t be referred for abdominal surgery after your first complaint of a tummy ache.  If you’re young, you could have Crohns or cancer or an abscess or have eaten a dodgy take-away.  Don’t be fobbed off because you are young if the symptoms don’t go away.

If you have a history of mental illness, that will be the first stop for some GPs.  It won’t matter if the symptoms manifest physically.  You’ll be told it’s panic, anxiety, take a pill.  I have had clients with a mental health history who experienced severe allergic reactions that interfered with breathing and were told it was psychological, even when the client could identify the allergen and the attack responded to medication. 

Mental illness isn’t stupidity, and in my experience, usually not attention seeking.  Don’t be fobbed off because you’re tired of being told you’re nuts.  They’re just rude and you need proper care.  (And besides, who among us isn’t nuts?)

If you’ve suffered trauma, that does not make you a hypochondriac.  Abdominal pain?  Because you were raped.  Back ache?  Because you were raped.  In the wrong body?  Because you were raped.  No ovarian cysts, compressed discs, Gender Identity Disorder for survivors of trauma in some GP surgeries.

 Our bodies DO store our histories and emphatically store our traumas, but in my experience as a trauma therapist, conversion disorders (non-medical pain, paralysis, etc., because of trauma) aren’t as common as I’ve seen them diagnosed.

And while I’m on my soap box, trauma survivors – letting a doctor drug you up isn’t the answer.  Too many women after twenty-five years of a zombie life on medications, eventually sat across from me only to find themselves two years later, back inside their lives, medication free or greatly reduced, doing things they never thought they would do again.  GET A GOOD TRAUMA THERAPIST.  Or even a good enough one.  You never forget your trauma, but you can get back to your life.

Your doctor is not the enemy, but accept that it’s a relationship.  The anti-American GP was recommended to me by a colleague who had a great rapport with her.  If you and your GP don’t fit, ask for someone else in the practice.  Switching practices risks getting branded as a malcontent, but if that’s what it takes, be honest with the new GP. 

Your GP has limitations, only a few that I’ve listed here.  A GP isn’t a mind reader and certainly not a god.  You have to be active in your health care, even when you feel like crap.  It’s important.  You are important.  Be civil but speak up.  Ask questions if you don’t understand.  Go back.  Do not let social discomfort keep you from getting the best care.

If you are genuinely being discriminated against for any reason including race, mental health, trauma history, sexual preference, don’t ignore or accept it.  You will not get top notch medical care if you collude with the idea that you are somehow less-than.  And, you probably aren’t the only patient in that surgery experiencing that prejudice.  If you don’t have the internal resources to survive the complaints process, then move on to a GP without that prejudice.

Writers live in our heads.  When our body isn’t functioning up to snuff, we may ignore it.  If our GP doesn’t think the problem is worth exploring, we tend to believe it.  But don’t believe it if your problem doesn’t go away.  You’re creative.  And the only advocate for your body is you.  Find a way to be the best advocate for your own health care.

Places That Are Off Limits

Sense of place, even in plot driven fiction, is a deal breaker for me.  How can you write about a place you’ve never been and cannot visit?  First, a little learning theory.

We all have a dominant sensory perception as well as a weakest one, the sense we use most to process data from our environment.  Have you been asked to do that writing exercise where you give each of your senses a colour, then go through a bit of writing and highlight them accordingly?  You end up with a colour coded inventory of how you write through your senses.  

Dominant sensory perception doesn’t necessarily mean which sense is the most acute.  It means the sense through which you understand your environment.  For instance, my weakest perception is visual, although I have 20/20 vision with my specs on.  This means that if my highly visual son wants to hide a circular pan from me, he only need put a rectangular one on top and I don’t perceive the circle.  I SEE it but I don’t understand it.

I’m kinaesthetic, which means I know my environment via touch and movement.  This makes it essential that my characters are grounded in place for my own suspension of disbelief to take place.  Why, then, would I take on Afghanistan?

The story stayed with me on too many levels to let it go.  The award ceremonies, the repatriation parades, the singing wives and surprise reunions and crisp uniforms, a neat and tidy way of ignoring slaughtered children.  Someone needed to tell the truth here.  So if you’re thinking about a setting that you can’t physically be in, make sure that you’re completely invested in the story.  That’s 50% of overcoming the obstacle.

Next, get the facts about your location.  I started with photographs of Camp Bastion, floor plans of the hospital, then drew maps of how staff walked from one location to the next so I mentally made the trip from Point A to Point B, following my characters where and how they moved through their day.  

Once I knew where they were going, I needed to know what they were going through – weather, air conditioning, furniture, terrain.  If your dominant sense is something else, then that’s where you would start.  Ground yourself in the location through your dominant perception.  Watch videos, listen to sound tracks, taste the food, smell things that come from there.

To write fully in the experience, though, you’ll need stimuli for all your senses.  I initially used other people’s experiences and I did it scene by scene, rather than try to get all my information at once.  This was only possible because I have live-in access to that information, so could say over dinner, If you’re walking from the Cook House to the NAAFI, what would you see?  Ask during an ad break, If you’re awake at 0200, what would you hear?  Come out to the garden to pose, If you’re in ITU, what’s the dominant smell?  Can you give me an example of where there’d be water?

I consider place as a character in a scene.  Not surprisingly, then, I consciously choose where things happen – is this discussion better placed in an office, at the Cook House, in the Bath House, in the dark?  So if you don’t have live-in access to someone who knows your place, plan your locations in advance, then go to your informant with detailed questions.  Always, always, always use more than one informant if you can.  It diversifies your information.

My experience interviewing people for research has been positive.  I think it’s that whole thirst we all have for creativity, so other people do enjoy participating.  My interview subjects often come up with creative ways to give me the information, such as letting me smell a shamagh that had been used during dust storms or asking work mates who are doing a transport to be mindful of the smells and sounds on an aircraft so they can report back to me.  When writing about a place you can’t go, DO talk to people who’ve been there.  Always ask them to compare there with here, wherever here is for you.

However, this type of research isn’t always practical or socially appropriate.  The technique that I sometimes use to extrapolate from an interview, is the negative hallucination trick.  For instance, as I type this, I’m looking out the window into a North Yorkshire autumn.  There are the brilliant colours, the dulled light and, though I cannot feel it from here, I know the air will have a texture that’s damp and cool.  So what is here that isn’t in Afghanistan?  The most obvious thing to me is the air moisture (because I’m kinaesthetic) but you may say the colour, so let’s go with that.

I know from asking my sources that as my characters go from Point A to Point B, the world has only shades of beige, most of the people dress in camouflage, but periodically they’ll see coloured ISO containers and contract workers in faded clothing.  What would my reaction be to seeing random spots of colour? 

I once lived in Australia which has wonderful colours, but not the particular shade of green our grass had at home.  While in Australia, I didn’t notice this but when I went home, the green seemed garish.  It actually jarred something in me to look at the grass.  Use a memory of your own experience if you can because it will be authentic.

But keep this authenticity consistent with the character.  What is that person’s dominant sense?  (Will I never let that go?  Nope, not gonna do it.)  If my character is visual, then seeing bits of dull blue or green will make an impact.  If my character is auditory, they may not even notice or may not know why they notice.  Different characters taking the same route at different points in the story can have different experiences which give a fuller picture of the setting.

If you don’t have a sensory experience to help you imagine a negative hallucination method, then read about the brain and how it works.  These type articles often have specific examples to help you understand them (and to steal for your own purposes).

Now that you have your information, accept that you’re not going to use most of it.  If you describe your setting in minute detail, then you risk burying the story you wanted to tell.  Also, the more detail you give, the less believable it will be.  Use a sketch pen, not oils when conveying your setting.  Think of Degas’ work when he was losing his sight, how the vagueness itself evoked the image.  This is what you want to do, to evoke.  Ah, be evocative!  Exactly. 

Developing your craft means going beyond your comfort zone and doing what you didn’t think you could do.  Write what you don’t know.  Do it with passion.

Don't Kill the Monster

It’s been a wonderful and strange week in this world, hasn’t it?  The US government’s still shut down.  In the UK, legislation was passed to make landlords, banks and GPs participate in the xenophobic witch hunt called immigration control.  And the Spirit Moose in Canada was legally killed by non-indigenous hunters. 

Then Alice Munro won the Nobel Prize.  We chuckled over David Gilmour showing his narrow minded ass.  The White Hats win and they’re worn by women.  Canadian women.  If Munro had been gay and Chinese, I would’ve gone back to church.  Having said that, it’s here where we move a little too close to the self-destruct edge.

Let me tell you about a cat.  Stray Eddie.  A pot bellied, one eyed, scrofulous, geriatric stray with hair like an American opossum.  In other words, icky.  We very kindly brought him into our home where he promptly savaged the Butler, terrorised the much smaller females, urinated in all the wrong places, jumped up on the table during meals with the expectation he could eat from our plates.

What an ingrate.  He had to go.  The Butler rang round and was told by cat rescues that the only solution was euthanasia.  Okay, our home had been taken over by the North Yorkshire Monster, but euthanasia?  You do know what that means.  Kill the monster.  Kill.  The.  Monster. 

Kill.

We weren’t going to do that.  Fortunately, our vet explained cat behaviour to us and we realised we’d been making Stray Eddie more and more stressed out.  Here we had an elderly cat with a collar mark still in his fur who apparently had never been let outside and seems to’ve lived alone with one person who treated him like a human companion.  Now he’s been turfed out only to find shelter where he's under siege by other cats and the new humans have no manners.  On the plus side, he seemed to like the Big Nosed Dog. 

So we’ve implemented the vet’s attitude adjustment plan (to the humans) and immediately, things’ve calmed down.  The cats aren’t merrily skipping round a May Pole, but the reign of terror is over.  Stray Eddie and our calico are in the kitchen together watching birds as I write.  I’m certain they still hate each other, but you can’t have everything.

The same tactics apply to the human world.  In his interview, Jon Stewart asked Malala how she reacted to learning that she’d become a Taliban target.  She said her first thought was that she’d take a shoe and defend herself.  Then she thought, if she used violence, she’d be no different than her attackers.  She decided that she would tell them how important education was – for their children, too – and then say, ‘Now do what you want.’

http://www.youtube.com/watch?v=gjGL6YY6oMs

I doubt she had time for dialogue before she was shot.  However, even after the attempt on her life, she believes that we can only bring change through dialogue and peace.  How wow is that?

We have the power to be wow, too.  Or to be Monsters to someone else.  Writers tweet, blog, express more succinctly and thus more convincingly than most.  Therein lies the strength and the danger.  We can be the GOP holding an entire nation hostage – not just Democrats but children, cancer patients, veterans, the elderly – or we can be Malalas who put down our weapons and recognise the humanity in each other.

Today is National Coming Out Day.  Today there will be children as young as Malala and adults as old as myself who take that step, who hope they will be met with dialogue rather than weapons.  Some lives won’t survive today.  But the reason the possibility exists for a Coming Out Day is because of the belief that dialogue and communication can win out over weapons and hatred.  When they do, it takes our breath away.

My hand is up to say I’m guilty of all sorts of –isms.  I know they’re more naughty fun than being Malala.  But you and I are the communicators.  We have a huge responsibility to do no harm.  After you’ve been shot, after someone kills your Spirit Moose, after the opposition passes a bill you dislike, don’t pick up a gun, don’t shut down the government, don’t kill the monster.  Don’t deride, don’t ridicule, don’t alienate. 

Create.  Communicate.

Relation-tweeps

I broke up with a follower after less than 24 hours.  The breakup was quiet, yet it has its place in the queue for this week’s blog.  First, some other loosely connected items. 

According to The Bookseller, Jonathan Franzen feels writers are being 'coerced' into social media, and that new writers are told they won't be considered without 250 Twitter followers.

http://www.thebookseller.com/news/franzen-writers-coerced-social-media.html

Some people find this overstated, but I did hear an agent tell an audience that if he couldn’t find a link to a new writer through Google, he didn’t bother reading their submission.  

I later had a private meeting with him and, if there’s a word for people who hate writers, (mis-scribonist?), I suspect that’s what he is.  Hopefully, he's not standard agent material.  Regardless of his psychopathy (sorry, had the wrong hat on for a moment), he’s the reason I started blogging and Tweeting. 

Writers in the 21^st century aren’t in Kansas anymore and I, for one, am glad.  Electronic cut and paste alone make it all worthwhile for me.  However, virtual social engagement sometimes is devoid of virtual social graces.  If we’re truly coerced into social media, we need to consider the impact of a place without niceties.  In descending order from horrific to my experience, let’s discuss bad examples.

Lauren Mayberry (Chuvches) wrote a Guardian Music Blog about cyber abuse directed at her solely for being a woman.  In response to her previous posting, one of the trolls said he knew where she lived and would come rape her anally so she knew what rape culture really was.

http://www.theguardian.com/music/musicblog/2013/sep/30/chvrches-lauren-mayberry-online-misogyny

Then there’s Writer One who went into vocabulary meltdown on Twitter, fuck being spread fairly thick.  Why?  Because a journalist used a negative word about Writer One, a descriptor not nearly as bad as the meltdown proved to be.  The journalist had to block the writer. 

Writer Two also challenged a negative comment made by a journalist, and they had a short exchange.  The journalist stayed rational yet unwavering in the face of Writer Two’s slightly aggressive but civilised comments.  Two sane adults, right?

Although Writer Two didn’t disembowel the journalist, Writer Two RTed every one of the journalist’s comments and 60,000 followers did the job instead.  One of them reported the journalist to an employer.  In the end, Writer Two got a Tweeted apology.  I imagine it was heartfelt.  

Okay, so what about my Twitter bust up?  Not quite so sensational.  One of those situations when someone who follows someone you follow, ends up following you.  Ray, let’s call him, was unusually witty, so I followed him back.  He happened to be caught up in trans-Atlantic travel that day and kept me smiling with his funny Tweets.  And then he wrote this:

'And I'm not all that keen on Americans in America, but put 'em in an airport and I'm all like Tina, bring me the axe.'

The difference in these examples is the degree.  Each of them is an assault on the recipient's sense of inviolate well-being, and certainly out of proportion.  They come from a deadening of empathy, which is the only thing that separates you from bullies and trolls.  Once you stop feeling it, then you're on your way.

The internet, and social media especially, really let us off the empathy hook.  We live in a world that no longer gives you three chances.  You have a bad day, I have a bad day, I don’t think before I type, you don’t think before you hit ‘send’ . . . the next thing you know, what you are thinking about is an axe.  When you say it out loud, you convince yourself it’s a joke.  Because we all know how American (Black, Asian, female, disabled, poor, LGBT) people are.  They ask for it.

I have to admit that I do a very good impression of an asshole myself from time to time.  When I do, I hope to be forgiven and because of that, because Ray has good traits, I wanted to turn the other cheek.  But the thing about using aggression, even if that aggression is garbed in humour, is that people stop listening to you.  All they can think of is how to stay safe.  When we are sexist or racist or use celebrity to squash the small fry, we silence not only the other person; we silence ourselves as well. 

There are people on the other side of our cyber actions.  There are consequences.  Be kind.  When you’re not, say you’re sorry.  It isn’t rocket science, guys.  Just play nice.