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Reflections on Retirement 9: Honourably Discharged

Six months in

 

Last week felt like a significant milestone for me: it marked six months from the day I retired; I (together with colleagues) completed and submitted our latest Triennial Review of Serious Case Reviews; I received my last payslip from the University of Warwick; and the University decided to award me an emeritus professorship.

A friend asked me what that meant exactly and I replied,

‘It means I can pretend to be old and wise, impress other people with my amazing credentials, and carry on doing what I love doing. More importantly, it means I can continue to access the university library. And it means the University can continue to get credit for any academic work I do without having to pay me, so a win-win situation for all.’

I thought, though, that perhaps I should look up what it really means, and this is what I found:

emeritus adj. honourably discharged from the performance of public duty [latin ē signifying completeness and merērī, to deserve]

professor n. one who professes [latin prō, publicly, fatērī, to confess]

 

So I am now officially (and, I trust, honourably) discharged from my former duties in the NHS and University, and free (I presume) to publicly confess whatever I like (any suggestions of what that should be will be very welcome).

So what now? Am I any different? Has my life changed either now or over the past six months?

 

It seems to me that retirement is more a process than an event, and more a transition than an ending.

Pretty soon after retiring, Lois and I headed off to Asia and New Zealand to spend time with her family and enjoy some laid back rest and relaxation – a retuning of sorts. Since returning to the UK in January, I have gradually been adjusting my routines, carrying on with a few ongoing commitments, taking on some new projects, and enjoying the freedom to be more flexible, focused and fulfilled.

I have enjoyed being able to choose each day what to do with the day. I have loved getting stuck into writing and research, with new and inspiring projects. I have valued having time to spend with Lois in the garden, going for walks, and some inspiring trips. And I have been privileged to accompany others on their spiritual journeys through retreats and ongoing spiritual direction.

So it is with a sense of ongoing fulfilment that I continue my journey into this new phase of life. And I shall look forward to waking up tomorrow morning and deciding what I’d most enjoy doing…

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Reflections on retirement 8: Losing track of time

On Tuesday this week I cycled over to the University for a meeting I’d organised with my research team. It was a nice, sunny day – unusually warm for this time of year. As I cycled I pondered the themes arising out of our research on Serious Case Reviews.

At the reception desk of the conference centre they could find no record of my booking. After a while searching, I looked up my booking reference only to find that the meeting was on Wednesday. I had booked the room for Wednesday, told the rest of the team it was on Wednesday, and written it in my diary for Wednesday. But somehow I had got it in my mind that the meeting was on Tuesday.

So I cycled home again.

And as I cycled, I pondered the themes arising out of my time management in retirement.

It isn’t the first time I’ve failed to look at my diary, or turned up for a meeting on the wrong day, or at the wrong place or time. But somehow, being retired and not having a structured routine to my week seemed to make it less surprising on this occasion.

In the run up to my retirement, a number of people pointed out to me the challenges of managing the twin demons of boredom and busyness. So far, I haven’t suffered from the first, and don’t see any realistic prospect of it haunting me too much.

The second – busyness – seems to me a much more real adversary. When I hear myself describing to others what I’m doing with my time, and the things I am committed to, I start to wonder whether this really is retirement. In the six weeks since I stepped out of paid employment I have been on a silent retreat; visited Jordan and Sweden on child death review projects; analysed data for our Serious Case Review research programme; preached in our local church; made a leaflet display stand from recycled wood; drafted my application for a PhD; seen both my children and my parents and a number of friends; cut down some trees in the garden; spent five days in London at the Department for Education; given evidence in two court cases; and read five books.

And yet it really does feel so much calmer and more relaxed than when I was working. I am loving the freedom of waking up in the mornings and wondering what to do today; of being able to spontaneously go out for a walk with Lois; of spending time in the garden; and of saying no to any requests to take on any new projects. I value the opportunity to truly focus on a small number of ongoing projects, and give my mind to them without feeling distracted by too many other competing demands. I am appreciating the peace and beauty of Breathing Space. And I’m looking forward to the eight weeks we’re about to spend in SE Asia and New Zealand.

So, demons may flee. What I think I am experiencing is a new fullness of life. And that doesn’t leave much room for either boredom or busyness.

And it does mean that I can enjoy the fresh air and exercise of a needless cycle ride, without feeling frustrated by all the things that I could have been doing instead.

 

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Reflections on retirement 7: Wholeheartedly on my bike

I cycled in to the University today – perhaps for the last time. The sun was shining, the sky was blue, the first frost of autumn was shimmering on the grass, a shadowy mist hovered over the duck ponds, and the mothers and children were skipping on their way to school. Actually, the children were grumbling and the mothers getting stressed (this was Tile Hill after all!) but I smiled cheerily at them nevertheless.

 

I had started the morning with a reflection from one of my 21st century gurus, Richard Rohr:

‘Much of a man’s life is spent going to work, running errands, cleaning house, mowing the lawn, waiting in lines, attending meetings, and tending to the necessary but endless minutiae that make up life. We know that we can’t live as if we’re in the middle of an Indiana Jones adventure. We know that much of life is rather dull and repetitive. That’s why it’s so important to be fully present to the ordinary things that keep us going: a movie, a concert, dinner with a friend. Anything you do fully gives you joy. Anything done halfheartedly will bore you. People do not tire from overwork nearly as much as from halfheartedness. Wholeheartedness requires that a person be fully present. And people who are present are most ready to experience the Presence.’ – Richard Rohr, On the threshold of transformation, p186.

 

I reflected that that has been my experience in the amazing 36 years of my career. When I have been fully present, wholeheartedly engaged in the task in hand, I have felt fulfilled, energised, inspired. When I’ve been distracted, halfheartedly engaged, my mind on other things, I’ve ended up bored or frustrated.

I guess I have been blessed by being involved in work which lends itself to fulfilment: clinics; teaching; inspiring research… But it has had its share of routine, repetitive tasks: management meetings, governance reports… Surprisingly, though, even those things which carried the potential to be tedious and uninspiring have turned out to be fulfilling when I was able to engage with them wholeheartedly. One of the most rewarding parts of my job over the past few years has been chairing our local serious cases subcommittee. I have loved this work – partly, I’m sure, because of the great team of people who have formed the committee; but also because I have been able to carve out the time to focus on the work in hand, to see its importance in terms of children’s lives, and to think creatively about how we learn from these cases.

And so, getting in to my office, I was once more privileged to be able to throw myself wholeheartedly into the tasks before me: editing some journal papers; feedback to students; supervising one of my PhD students; supporting another PhD student through her viva (successfully so – well done Jumana! A great bonus for my final week at work); and doing some final clearing out of my office.

‘That was the best defended thesis I have ever examined’ – Julie Taylor, external examiner

 

So I was feeling fulfilled and not at all tired when I closed my office door and walked out to my bike for the long cycle ride home. Only to find that some other dopey (I will give them the benefit of the doubt that it was dopiness rather than malice, or some warped attempt to keep me at the Medical School) cyclist had padlocked my bike to theirs!

Fortunately it was just through the brake cable, so an hour later, when Lois came to rescue me in the car, complete with a set of Allen keys, I was able to free my bike and get home. And the added bonus was that in the intervening time, I had managed to finish clearing my office and say goodbye to room B028 at Warwick Medical School. And while the sun was no longer shining, the sky was nevertheless crisp and clear with golden tints of an autumn evening.

 

 

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Reflections on retirement 6: Bereavement and Transition

The other day I walked through the corridors of Warwick Hospital for what may be my last time as an NHS employee. I thought back on all those days and nights – many years ago now – walking (and at times running) through similar long, pre-fab corridors as a junior house officer. Those days (and nights) are long gone now, and I can’t say that I miss them – certainly not the horrendous long hours and the relentless intrusions of the dreaded bleep – but I do look back with a bit of a sense of nostalgia.

 

Bereavement and transition

It is often said that retirement is a kind of bereavement. Looking ahead to my retirement, though, it doesn’t feel so much a bereavement as a transition. I guess I am privileged: privileged to have had a career that has been worthwhile and fulfilling; privileged to have also had meaning and worth in my life outside my work; and privileged to be retiring at a stage when I am able to look forward to all the new things I will be able to do.

But any transition also involves loss, and I recognise that for many that can be acutely painful. Particularly where retirement is accompanied by a sudden or gradual loss of significance.

So as I go through this change in my life, how do I make it a positive transition rather than a painful loss? There are three questions which I have found helpful in facing any kind of transition, which can be summarised in the three concepts of mourning, meaning and moving.

 

Mourning: How do I let go of all that has gone before?

For me, this has been a gradual process: stepping back from hospital work and nights and weekends on call; dropping my clinics to focus more on my academic and specialist work; and now leaving paid employment with the NHS entirely. As I look back there is so much I am grateful for: my colleagues; the families I have worked with; the things I have achieved in my career. I can recognise and celebrate the contributions I have made to protecting children, supporting families, and encouraging and empowering other professionals – both locally and nationally. At the same time, I can accept the things I haven’t achieved; the mistakes made; the unfulfilled dreams: the closure of our child health MSc; the doors closed on a return to Cambodia; my lack of promotion to an academic chair; my failure to establish a sustainable local team for responding to unexpected child deaths. And I can acknowledge that there will be aspects of my work that I may miss: the interaction with my colleagues, children and families; inspiring teaching sessions with motivated students; chairing our local serious cases sub-committee…

 

Meaning: how do I make sense of this transition?

In a way this, for me, is quite an easy question. And in this I recognise, again, just how privileged I am. I can look back on the journey my career has taken, and see lots of meaning and purpose in it. While at the time there were aspects which were perhaps harder to make sense of – my repeated failure to pass my MRCP exams; the traumas we faced in Cambodia; the gradual disintegration of our academic child health team; the frustrations of unsuccessful grant applications – overall, there has been a sense of purpose, of doing something worthwhile, and now, being able to move on to new opportunities. Looking back I can see how my life and work have had meaning, and how it has unfolded in a path that has brought me to where I am now, with all the skills and experience I have gained along the way. And I am blessed in now being able to take that expertise and apply it in new areas – both nationally and internationally, as well as, perhaps, developing new areas of interest and engagement.

Moving: how can I make the most of this new phase of my life?

For me retirement is a wholesome and positive moving forward. I am looking forward to the new opportunities it brings. To be able to take the skills and experience I have gained over these years and use them in new and inspiring ways. And to enter into a more gentle pace of life, one where there is no longer the pressure to achieve or be productive. There is so much I am looking forward to: being more involved in the rhythm of life at Breathing Space; working from home, looking out at the beauty of our garden; morning toast and coffee with Lois; helping create the house and garden as a place of peace and serenity; pursuing other projects here in the UK and abroad; starting a PhD; spending time with family and friends…
And, for now at least, no longer walking down long, pre-fabricated hospital corridors.

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Reflections on retirement 5. Child protection: the good, the bad, and the ugly

Child Protection

It is strange how one’s life journey doesn’t always take you on expected paths…

As a junior doctor and trainee paediatrician in the early 1990s, there were two career avenues I decided I really did not want to pursue: child protection and research. So I often wonder how it is, 28 years later, that I end up retiring from a career as an academic paediatrician specialising in child protection.

I suspect it was my time in Cambodia that set the compass leading me down this route. And perhaps, even more so, returning to this country – having seen the huge needs of children and families in such an impoverished and war-torn country – and wondering where the most vulnerable children and families in our country were, and what I could possibly do to make a difference.

I may puzzle over it, but I certainly don’t regret the career choices I have made. It has been an incredibly rewarding. Looking back, there is so much I can celebrate and feel positive about.

But it has also been a hard journey and it is perhaps only recently, with the prospect of retirement looming, that I have come to appreciate just how much of a toll it has taken. There are times when I feel tired and I look forward to no longer having to take responsibility for decision making and giving advice on individual cases – knowing that my advice can have such profound impacts on the lives of individual children and their families.

 

The good

As I look back, though, there is so much I can appreciate. Like the little girl who took me by the hand and proudly showed me round her new primary school after I’d seen her for a follow up medical after the one that led to her being taken out of the awful home situation in which she was living. Or the stressed out mum who learned to praise the good she saw in her child…

I first saw this little boy as a toddler brought to my clinic with constipation and soiling. From the moment they entered the clinic room, his mother poured out a torrent of abuse, calling him a ‘little shithead’ and ‘the child from hell’. Over the following months, with appropriate treatment, his constipation gradually improved. Each time they came to clinic, I made a point of telling the little boy something positive about himself. I also, over time, started asking the mother what she liked about him. One of the last times I saw him, they both came in beaming and his mother (now calling him ‘my little angel’) prompted him to show me his latest star chart – a gold star on every day.

Or another family where a bit of joint agency detective work led to a positive outcome for everyone…

As a newly appointed consultant I was asked to see a baby girl with rib fractures discovered on a ‘routine’ chest x-ray. There were no other injuries, the girl looked healthy and thriving and both parents seemed to be devoted to her. And yet, she had serious and unexplained injuries. Further investigations, including a home visit, revealed that the family lived in a poorly maintained first floor flat. In order to reach their home, the father, who had a disabling muscle condition which left him unsteady on his feet, would climb a narrow, unlit stairway, holding his daughter under one arm, while he held onto the bannister with the other. It became apparent that at times he had stumbled and, in doing so, gripped his daughter tightly round the chest – the likely explanation for the fractures. With a multi-agency child protection plan, rehousing to somewhere more suitable, and some parent training and support, the family were able to stay together and protect their daughter from further harm.

 

The bad

Sadly, not all the cases had such good outcomes, or such readily apparent solutions. I am sure there have been times when I have missed cases of abuse, given unhelpful advice, or simply been unable to reach any clear conclusions. I know that there have been times when decisions I’ve made have resulted in children being left in abusive environments. Equally, there have been times when my advice has ended up with children being unnecessarily removed from families. That is the hard road we walk balancing child protection and family support, where far too often, we just don’t know what route to take.

And there have been other cases where the best solution has been apparent, but we just haven’t had the resources to see it through…

I was asked to assess the baby of a couple with learning difficulties. The baby had suffered sunburn after the mother had applied after-sun lotion, not realising that it wasn’t actually sun-block. The baby had signs of neglect with poor growth and developmental delay. Both parents clearly loved their child, wanted the best for him, and would never knowingly harm him. A psychologist had assessed the parents’ capacity to take on board instructions and to be able to parent their child safely. The advice of myself, the psychologist, and the social worker was that, given enough support, these parents could look after their child. However, the levels of support that would be needed to ensure the child’s safety and wellbeing, were well beyond the resources available in the local authority, and the child was placed in care.

 

And the ugly

One of the most disturbing cases I have dealt with in my career was as a young registrar, early in my training. I was called to the emergency department to see a 2 year old who had been brought in with some minor injuries. From the moment I walked into the cubicle, the young girl, sitting on the examination couch, watched me with an intent, watchful expression. Throughout my examination she didn’t react at all – neither smiling nor crying – while her father sat stony-faced on the other side of the cubicle. I concluded that her injuries were accidental in nature and didn’t need any treatment, and I sent her home with her father. What really upset me though – and has haunted me ever since – were five words written in biro on her arm: ‘I am a little bitch’.

I have often wondered what happened to that little girl. What kind of a home did I send her back to? What kind of person did she grow up to be? Did anyone else pick up on the emotional abuse she was experiencing and act where I had failed to act?

 

Child protection does have its ugly side. Fortunately they are rare, but there are parents and others who deliberately and maliciously harm their children – physically, emotionally, and sexually. In the course of my career, I have had to deal with that. It isn’t easy seeing the pain that some children have to live with. Nor is it easy seeing the pain of parents who have their children taken away from them; of families torn apart by abuse, domestic violence, addictions. Or seeing adults carrying the pain of abuse they have suffered – from parents or partners, and sometimes just not knowing how to deal with that pain, or the stresses of life that can be so overwhelming that children end up getting caught in the middle and hurt themselves.

It isn’t easy. But it is important.

Which brings me back to the good, and one of the greatest privileges I have found through working in this field: the people. The very real and ordinary families who have shared with me some of their struggles, hopes and dreams; the amazing children, so many of whom show incredible resilience, joy and love, even in the face of such devastating adversity; and the professionals – social workers, police officers, nurses, teachers, doctors and others – all dedicated and committed to helping others, passionate about making this world a better place for children.

 

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Reflections on retirement 4

A few things I’m really looking forward to:

 

8 days’ silent retreat at Mirfield

8 weeks’ holiday in Laos and New Zealand

Being able to ‘work’ from home in our lovely annexe, looking out on the Breathing Space garden

Getting more involved in Breathing Space – retreats and quiet days, spiritual direction…

Regular mid-morning coffee, toast and marmalade with Lois

Getting stuck into some exciting new projects

No more mandatory training on manual handling, infection control and preventing deep vein thrombosis

Designing a national child death review system for Jordan

Starting a PhD

Gardening, DIY, walks in the countryside

No more appraisals

Finishing my book on Rembrandt’s Bathsheba

Painting

Just enjoying the peace and beauty of Breathing Space…

 

IMG_2549

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Reflections on retirement 3: Longing for a world where children don’t die

Last week I received an email from one of our administrative team at the medical school, reminding me that I have just over two months to fully clear my office – to shred or archive all old research papers and data, get rid of the mountain of books and files, empty my filing cabinet, clear my hard drive, and hand back all my IT and other equipment.

Once I’d got over my initial shock and the reactive ‘I can’t possibly do that, there’s far too much, and what about all that academic stuff I want to keep on?’ I realised that perhaps it wasn’t such a bad thing after all. I do need to wake up to the fact that, come October, I will no longer be a paid employee of the University with all the benefits (and responsibilities and frustrations) that brings. It is also high time I had a good clear out of all the accretions of 13 years as an academic.

 

When was the last time I opened that file of research interviews I did back in the late 1990s?

 

So, taking the bull by the horns, I started work on one of my filing cabinet drawers. After filtering through each file, I think I ended up with just two or three papers worth keeping.

This particular drawer held all my case notes from the South West Infant Sleep Scene study I did with Peter Fleming in the early 2000s. As I started shredding the interviews from those early home visits to bereaved families, I reflected on the blessing it has been to meet with, and hopefully offer some support to, so many amazing families.

 

Longing for a world where children don’t die

The dramatic drop in SIDS rates in the 1990s has been one of the most impressive successes of epidemiological research this century. I have been immensely privileged to meet and work with many of the leading researchers from around the world who contributed to this work, and in my small way, to contribute to ongoing research, teaching and practice that has seen SIDS death rates continue to fall to this day.

At times it has been truly heart-breaking to meet with families in the horrendous trauma of their child’s death. But it has also been encouraging to know that the work we did in Bristol and elsewhere has contributed to more compassionate and thorough responses to unexpected child deaths. I have, over the years, had many expressions of thanks from bereaved families who have appreciated the care and support they have received from my colleagues in health, police, and social services.

And, even more encouragingly, over the course of my career, I have seen the numbers of children’s deaths decrease.

When I started my medical training in 1982, nearly 8,000 children in England and Wales died before their fifth birthday. By the time I started work as a consultant, that figure had fallen to less than 4,500. Now, as I retire, the figure is just over 3,000. Just looking at the past two decades, that suggests there are 15,000 children and young people alive today who might not have been if our mortality rates had stayed at the 1997 level.

Has my work contributed to that fall?

Perhaps I will never know, but I like to think that, in some small way, my research and teaching and the little steps I have taken to engage with individual parents and children might have made a difference to some. And perhaps, with so many others making their small contributions, we may just be moving towards a world where children don’t die.

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Reflections on retirement 2: 35 years in the NHS

The NHS at 70

nhs70By the time I retire in September, if you include my years as a medical student and exclude my year abroad in Cambodia, I will have spent 35 years as part of the British National Health Service: exactly half the time it has been in existence.

What a privilege to have been able to serve in what I still believe to be one of the best health systems in the world. In a recent poll, readers of the BMJ voted “providing care based on need and free at the point of delivery” as the NHS’s greatest achievement in its 70 years (https://www.bmj.com/content/361/bmj.k2809). I fully agree. Having seen people in Cambodia die because they haven’t been able to access proper health care, and families go into irrecoverable debt to pay for worryingly poor hospital treatment, I am incredibly grateful for the care we receive from the nurses, doctors, cleaners, porters and all the other dedicated, hard-working staff I’ve had the privilege to work alongside.

“Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune the cost of which should be shared by the community” Aneurin Bevan. 

 

There are, of course, countless other achievements of our national health service:

  • General practice as the foundation of care
  • Limiting commercial influence on patient care
  • Pioneering evidence-based practice
  • A comprehensive childhood vaccination programme
  • Free contraception for all women

To name but a few.

As one commentator put it though, ‘perhaps the NHS’s greatest achievement is its sheer survival’. In spite of political interference, budget freezes, almost constant reorganisations, rising public demand, and media criticism, the people who make up the NHS continue to offer a great service.

 

Survival and change

In the years that I’ve known it, the NHS has changed. Gone (I trust) are those days of traipsing down a ward with my fellow medical students in the wake of an arrogant surgeon who would then proceed to humiliate both us as students and the patients under his (invariably it was a he) care. Gone are those not-so-halcyon junior doctor days of being on call for upwards of 72 hours and struggling to keep our eyes open long enough to write out a prescription or calculate the fluid requirements of one of our patients. Gone (to a large extent) are those days of treating patients according to a consultant’s whim rather than following protocols based on sound evidence.

lancelot spratt

 

But I wonder whether, with some of that, we have also lost something of the heart of the NHS? Of the camaraderie of those evenings on call, where we would linger with the nurses over a cup of hot chocolate on the children’s ward; of the small cottage hospitals where everyone called each other by their first name; of the sense of fulfilment when you had cared for a patient right through from their initial clerking in the emergency department to writing (by hand) their discharge letter as they walked out once more happy and healthy; of the art as well as the science of medicine?

Who knows?

Whatever the changes, and whatever may lie ahead for the NHS, as I retire from it, I feel incredibly proud and grateful to have been a part of what it is.