Writing about ECT, as a patient, comes round for me, again and again. Perhaps it’s not a surprise that I’m not entirely sure what I’ve said and written already – indeed, perhaps that’s the whole point. I don’t know how many treatments I’ve had. I know I had quite a lot (?20) last winter, and I’ve had a smaller number over the last couple of months. I know the plan is hopefully to reduce very soon from twice weekly to once weekly, aiming for a period of maintenance. I know I’m better than I was.
I also know that I had a treatment this morning, and the details are blurring already. But, as a result, I find myself pondering the experience of ECT – What is it like? Could it be better? I don’t know, but it’s worth thinking about, for me and for others.
Firstly and obviously – continuity of care. Having the same staff caring for me, both nursing, psychiatric, anaesthetic, is wonderful when possible. My current period of my treatment has been over the summer holidays, and is inevitably affected by this, although for me it’s been pretty good. And of course people need their holidays. I think what struck me today was that the consultant psychiatrist giving my treatment reassured me, including telling me his name. As a psychiatrist myself, I know him reasonably well, and he might have thought this unnecessary, but he didn’t, and this actually felt very important. I would have known his name anyway, but he was demonstrating that he knew this might be a problem for me. He also mentioned the sticky gel in my hair, and the reason for this (unilateral ECT) – he didn’t need to do this, but it helped. I had been slightly troubled by it, as I don’t necessarily want to have to explain to people that I’ve just had treatment, and hair washing is more immediately necessary than with bilateral treatment. I’m rather pleased I can remember this!
One of the things I have never really been sure about is whether trainees ever do my treatment. I would be more than happy if they did (they are supervised by a consultant) – but I don’t know, or can’t remember. I would like to be told if they did; and I’m aware that they might not want to treat me, if, for example they’d worked with me, or hoped to do so – although that wouldn’t necessarily exclude it.
I think the anaesthetists introduce themselves on a first meeting, but I’m not sure that they always repeat it on subsequent ones. Today’s anaesthetist was very kind and nice, but I don’t know her name. Essentially I don’t known all the staff in the ECT suite, and I wish I did. They are all kind, but I’m not sure that they always all understand this problem. I think it would help if they all routinely introduced themselves, not matter how often they had done so before. There are ways of doing this that are perfectly kind and acceptable – as happened to me today. I’m not sure whether larger and more obvious badges would help, but it’s a tense time, and I can’t recall even trying to look at name badges – I’m too nervous.
The ECT suite itself is quite nice, light and comfortable with reclining chairs, and I never have to wait too long for my treatment. It is far superior to the old ECT suite, which I am unfortunate enough to remember – or at least I have a memory of the door leading into it. I have written before that it always reminded me of the HG Wells story, ‘The door in the wall’, and that I feared and dreaded what lay beyond. Although I find the new suite far less sinister, the problems of uncertainty and memory impairment make it difficult to be sure of anything. After my last course of treatments I meant to visit the suite when well, to be sure I remembered it, both for that time and also for any future treatments. I don’t know if I did this, or if I’ll be able to do it this time – after all, I can’t do it on my own, and I’m embarrassed to ask anyone who works there. I think I know what it looks like, but I forgot from a previous set of treatments, a few years back. I have a picture in my mind from then which is quite different, and certainly not right.
One other problem, for me, are the reviews, which my psychiatrist does every couple of treatments. I am aware that this is extra work for him, as the suite is no longer close to the University Department of Psychiatry where he is based, but these are potentially tricky for someone else to do if they don’t know me as a patient – and more particularly for a trainee to do, especially without prior discussion. There also doesn’t appear to be a room in the suite to use for this, so also rather public. I could go to him, but I have a suspicion that hard copies of the forms need to be taken over, so that may not be very helpful – maybe something that can be addressed.
I have myself looked after other doctors in my job as an addiction psychiatrist, and also in my role as a GMC assessor and supervisor. It can be difficult, maintaining professionalism and confidentiality, particularly as a colleague and trainer. All that I’ve said here applies to anyone, but there can be some added issues as a doctor, and I think it’s important to take into account both the doctor being treated and those treating, giving some choice where possible.
So, I hope I’ve remembered what I’ve remembered correctly, and thank you to all those who have looked after me. And, if in any doubt – or not – please tell me your name. I may have forgotten it, and in any case, I don’t mind being told again.