From the Front Line of Story
Reflections on being the inaugural Storyteller in Residence at NHS Leadership Academy SouthWest, UK Summer 2021
“It was week one, March 2020. She coughed beside me at the NHS staff meeting, looked at me and said “Maybe I have that Covid”. Two weeks later I was in intensive care, on a ventilator fighting for my life”. The participant went on to tell us of her near-death experience as a patient with Covid in her own hospital.
“It was my first time putting in a catheter. Later he went into arrest. I realised it was because of the catheter”. She went on to say that the doctor in charge had taken her aside, reassured her that the responsibility did not fall at her feet.
“I didn’t think I had a story this morning”, said another participant. He had just finished telling us about a night at the mortuary where he worked as a manager and the body of a child neighbour that he knew had arrived. His story had us all in the palm of his hand.
Stories of mentors, forgotten patients, the story of a baby given up and a life recovered. Stories of lost partners, challenges of confronting systems that are broken, of answering calls to suicidal patients, the difficulty of standing up to a line manager and finding out what you’re made of. As the artist in residence at NHS SWLA, summer 2021, I heard the most incredible stories that showed me a glimpse of where the NHS staff are right now.
Since April 2020 I have been investigating the world of medical and clinical teams. I was given this task by Dr Preston Cline, Director of the Mission Critical Team Institute. Dr Cline concerns himself with how to keep crisis teams alive; before, during and after an event. When Preston and I spoke in the early days of the pandemic he saw the signs of what would come: PTSD, burnout and suicides of front line medical staff.
“The real damage of the pandemic,” he said, “will be seen in the medical teams one year in once the PTSD starts but the pandemic doesn’t stop. So go find out how to help them make meaning of their journey. Figure out how to make medical teams talk”.
No mean feat. But it felt good to have a task. Amid the swelling waves of uncertainty, a task gave me a much-needed focus. Could I be of use? But what did I know of the medical world and its’ struggles? I am after all “just” a storyteller.
I relied on what I always rely on: the intelligence of my community. I asked questions of everyone I knew on a medical or clinical team. I got into conversations with nurse practitioners, doctors associates, emergency physicians, chronic pain nurses, general practitioners. The story of a world emerged; a world that is time poor, where self-care is rare, silence is common and stories are not told. A world where resilience is often signposted but rarely taught.
Resilience, it turns out, is a dirty word in the UK healthcare. “Be more resilient” is a common instruction, handed down by management. This can transfer accountability unfairly onto the individual rather than expect the larger system to take responsibility for the well being of its’ staff.
Resilience is not something you can switch on because you are told to. Resilience is learned and transmitted through experience and reflection.
In conversations with managers, doctors, nurses I learned about the silence in the world of healthcare. The staff don’t generally bring their work home. They don’t want to infect their home lives with it, so the stories stay inside, unspoken. I wonder what all this silence will do to them, long-term? Untold stories often indicate unprocessed experiences. The knowledge, experience and sometimes the trauma that occurs during an experience can sit inside us like stones. These stones can often accumulate until there is a mountain.
It’s May 2020, I’m watching the news and a doctor from Hong Kong is talking about the SARS outbreak of 2012. He says that twelve months after the initial wave there was a massive rise in the numbers of death by suicide of physicians.
A shocking fact.
I thought about what makes that happen? What it would mean to go to work in a hospital during a pandemic? I imagined that when someone repeatedly witnesses death, injury, trauma, and repeatedly cannot save enough lives, cannot talk about it, has no rest, and is expected to serve society in crisis, that that human being may get ground down.
They may silently suffer from PTSD, thinking they are the only ones. They may stop sleeping, lose mental acuity, become depressed. They might lose all feelings of self-worth or value, all feelings of connection to any community or their own family.
The exhaustion of a pandemic, the lack of humane working hours, the lack of emotional processing of intense experiences. There may come a day when life simply feels too difficult.
Early on in the pandemic, there was a phrase used a lot in England: “We cannot overwhelm the NHS”, and “We must save the NHS”. I wonder if we, in our heart of hearts, believe that the NHS could be overwhelmed? Perhaps it is all too easy for us on the outside to perceive the NHS as just another organisation. A huge faceless entity. We see the institution, not the humans inside. The NHS appears to us like an enormous concrete wall saving us from the relentless waves of the sea of Covid. What we don’t see is that every day the people who make up the wall are being overwhelmed.
Over the three months of my residency, I heard more than 60 stories. From morgues to first days. Stories that arose from the direct experience of the people of the NHS: Line managers, anesthetists, data analysts, commissioners.
With each story, we, the listeners, were filled with empathy and recognition. When we witness someone else’s story, we recognise ourselves and each other. Stories are full of the universal currency of the human experience.
At every workshop I told the story from my friend Teresa Griffiths; a retired military nurse who worked at the RAF Medical Evacuation Unit in Kuwait during the Iraq War in 2003. Two 12 hour shifts a day, scud missiles flying overhead, injured soldiers arriving every 12 hours and she managed a multidisciplinary team of 30. Despite the often chaos Griffiths demanded that her entire team meet once a day to do a “check-in”. There was pushback: who had the time? If you weren’t saving lives you were sleeping.
“I don’t care what state you come to the meeting in, in pyjamas, unkempt, unwashed, but you will all be here at 4 pm”.
Every day at 4 pm her team showed up. A little reticent at first. They sat in a circle and Teresa asked how they were doing. Everyone answered. Soon it became standard, then after a few weeks, it became ritual. One sentence was enough for Teresa to know how they were really doing, their body language, their voices, their faces would tell her that. Soon she was adept at reading the subtext of who needed what.
At the end of deployment they gathered one last time. Teresa asked for three words from each of them, to reflect their deployment. From those words, she told a story of what had happened in Kuwait. She created a group story and in so doing made sense of their experience.
I told this story at every workshop during the residency because there is always a feeling in the clinical and medical world that there is never enough time. There certainly isn’t time to do a check-in. This belief in time poverty has a knock-on effect in terms of deep thinking, reflecting, sense-making, learning, adapting and, of course, the ability to cope. But if Teresa can make the time in her situation to do this, can you?
During the residency, I spent six hours with each group. They were strangers to each other, not established teams. They were all a little nervous. We jumped right into the work of story, because a story can be a place free from hierarchy. When we got to the end of our time, we had become a unit; a tiny community built on words. We remembered each other’s names, the stunning images from the stories, and the life journeys that were shared. We remembered how someone made us gasp, laugh, cry. We were bonded through the common humanity that is summoned through a story.
Resilience it seems is found inside the space between sentences. We learn about how person after person has dealt with death, loss, success, illness, suicide, failure, and how they took the next step forward. As we listen, we instinctively learned how we also could take another step forward. That’s how resilience is transmitted, not through a short instruction or a poster.
What’s more, as they tell these stories everyone realises one very simple reassuring fact: we are not alone. Our flaws, our choices, our challenges are not anomalies. We are human. Our stories outline the map of our humanity. We’ve all made mistakes; we’ve all fallen down and we have all found many ways to get back up again.
As I reflect on this residency I am touched by the amount of humanity I witnessed. I think we would be idiots to throw these people, our best beloveds of the medical and clinical world, into the wild and stormy sea of this pandemic. We would be mad to assume that because we have designated them as our “heroes” that they can somehow learn to swim through this tsunami of human crisis. We would be better off to hold them close to us, to protect them, to give them the space and time to do their work and then to give them enough time to rest and recover. Without them, as the old nursery rhyme goes, we all fall down.
