Radiation therapists, workplace and culture

IMG_1754.jpg

I’m trying to write about radiation therapists. Not the tasks that we do, that’s pretty easy, although most people don’t have much of a clue. I’m trying to explain the relationships we have with each other and what our day-to-day working environment is like. I suspect both are unique. We’re not like our diagnostic radiographer colleagues who can work by themselves. We don’t do that. Our workplace culture is based on tight-knit teams—not only the doctor-physicist-therapist triad but the team that works on the treatment unit.

The closest model I can think of is an operating room. The nurses, anesthetists, surgeons have to work in a kind of dance. This dance relies on what Lorelei Lingard has called collective competence, being able to effectively work and communicate with others. Verbal interaction is key, most errors can be traced back to not talking to each other. It’s similar for radiation therapists. We have innumerable checks and balances, quality assurance steps and protocols, and many of them are verbal. But we also have to, fundamentally, have each other’s backs. It’s a dance of physical movement (moving the patient, moving the treatment couch, moving the equipment) and verbal interaction (I’m doing this now, this next, have you done that?). When we do it well, it flows seamlessly, between ourselves and the patient. When not done well it can cause friction, delays, a lack of patient care and, sometimes, errors.

There may be three of us on a treatment unit, or sometimes more. With breaks and shifts, sometimes just two at a time. If we don’t get on, talk to each other, the work gets harder. We don’t have a choice of who we work with, and we may be working with someone for months at a time. We sit close to them (the treatment consoles are small), check their work (and they check ours), lift and move patients together, and arrange our days (this patient is new, this one is finishing, we need to follow up on this, did you call about the weird noise the machine is making?) We have to trust each other, we have to know the steps.

If you work with someone like this for a few weeks, you often get to know a lot about them. What TV shows they watch, how their commute went, what they have for lunch, what their weekend plans are, their kid’s activities and their upcoming vacation plans. Between patients we chat, we get to know each other, we pass the time, we build our relationship. Our “private” and “professional” lives are not binary – they merge into each other. We need these interpersonal bonds when it gets stressful, when that patient breaks our heart a little, when we have to vent.  They can help sustain us. When we don’t get on, or when we can’t be ourselves at work, it makes what we do harder as well as less safe. The dance slows down, we stumble.

Why am I mulling this over? Because as I write my dissertation I’m remembering times when I was careful what I said at work, the religious co-worker who “didn’t approve of my lifestyle” and an older therapist who ignored my tentative coming out speech and referred to “my husband” (when he talked to me at all). I’ve had recent conversations with gay, bisexual and lesbian (GBL) therapists who have said they “keep themselves to themselves” at work, or “just don’t go there” with some people. There’s ample evidence that having to manage sexual identity at work (to monitor when it’s safe to come out) is common in healthcare, with colleagues as well as patients. GBL workers report more stress and less social support than their heterosexual peers. Covering up who they are is a reality for many, and they are less likely to talk about their partners or life outside work.

Does it matter for radiation therapists? I think it does. We’re not exempt from the same pressures that affect GBL physicians, nurses, pharmacists, other allied health care professionals and our trainees. I might argue that the way we work makes these issues more important. We need to be able to bring our full selves to work, to be able to fully join the dance.

Advertisements

A blog about a paper about a tweet chat about a paper…

Capture

A couple of years ago I was deep in a policy class at UBC as part of my EdD. My final paper was about policies in LGBTQ healthcare – from global (like the WHO resources) to local (what my department didn’t have and why). Tracing the web of policies, legislation and guidelines around LGBTQ health was fascinating and depressing. Canada is one of the best countries in the world when it comes to anti-discrimination laws and every hospital has a statement about diversity. However, there are still lesbians who avoid screening appointments because of their past experiences with healthcare, trans patients who get treated terribly in the ER and gay men with cancer who can’t find local resources that include them and their loved ones.  Polices and legislation are great, but we also need healthcare professionals who understand what the issues are, know how to work with LGBTQ patients and work towards fixing some of the systematic gaps that some of our patients fall through.

I adapted the work I’d done in the policy class and the sought the insight and lived experience of UK radiographer Sean Ralph to co-author a paper that was a kind of “LGBTQ health issues 101 (and how you can help)” for Radiography. It was packed with references and we hoped it would be used by people wanting an overview of the issue. It was the first paper about LGBTQ issues in any of the three major radiography journals. In the meantime, our Twitter journal club (MedRadJClub) was getting going. The paper that Sean and I had written was suggested for one of the monthly chats. One of the regular chat participants was Sophia Thom, a student diagnostic radiographer from the UK. We’d met in real life at a conference (UKRCO) where I’d been talking about my EdD research – and we’d gone out with Sean to Canal Street in Manchester to drink gin and talk about research, coming out in healthcare and the perils of online dating. Sophia wanted to do some research but wasn’t sure where to start. I said something like “Oh, we’re doing a MedRadJClub chat later this year about our LGBTQ paper, why don’t we use the data from that and submit it to a conference – how about UKRCO next year?”

So we did. In this case we were interested in how much education the participants had received around LGBTQ people and healthcare, and what was going on in their departments. We had 44 people join the chat and a lot of conversation. We weren’t surprised that most people hadn’t had a lot of formal education – although participants shared an amazing list of self-found resources. We co-wrote the conference abstract in the fall with Julia Watson (a MedRadJClub friend) and Kim Meeking (Kim’s research area is social media) and submitted it to UKRCO with crossed fingers. When it was accepted we analysed the chat data and Google Drive’d the poster design together complete with Sophia’s rainbow Twitter symbol! As we’d done the analysis it seemed wasteful to stop there. There’s very little in print about this – and someone, somewhere might need citeable evidence. So we wrote the paper based on the tweet chat, based on the paper based on the policy class.

I think this process illustrates a few points. Firstly, if you want to get started use the resources you have, projects, essays, people and connections – the inspiration and material for writing a paper can come from many different sources. If you’re a new researcher, reach out to people who can help. Most of us are happy to give advice, edit, cheerlead or (sometimes) collaborate with you. Finally, if you’re an established researcher and have the skills, bring a few people along for the ride next time you do a project or write a paper. There’s a lot out there to investigate and we need more people to help!

image4

 

Explosive Knowledge: Freddie Mercury and my Literature Review

freddie-mercury-700

I am deep in my literature review. Having finished (for now) my results section I made an attempt to write the discussion. It was a sad effort. My results section is my stories, written very much from the heart and from being immersed in the transcripts from my participant interviews. I got very lost in the discussion section, trying to tie the stories back to the literature review I had done for my proposal, about ten million years ago. I kept writing little notes to myself like “add a section on how cancer care is gendered” and “stick in lots more about coming out”. Then I’d get sidetracked for days reading more about cancer and gender (that stuff is interesting!) and forget what I’d been doing.

My supervisor advised me to continue with the discussion – I had the stories in my head, she said, it’s the ideal time to put them in context, relate them back to your research questions. I do have the stories in my head. It’s reassuring. I read about patients being misidentified as sisters, not partners, and I think “oh, that happened to Lisa and Alex” – as if I know them instead of having invented them as characters in a story. It wasn’t enough though – there were big gaps to fill back at the literature review section.

The part I’m building at the moment is on coming out. I originally had a couple of pages in my proposal, which looked fine to me at the time, discussing the metaphor of the closet and how coming out isn’t a one-time act. That small section has grown to many, many pages. I might know more about coming out at this point than anyone in Edmonton (in theory anyway). Watching Bohemian Rhapsody last weekend, I found myself categorising Freddie Mercury’s identity management strategies in my head. He didn’t exactly hide it, most of the time, but used a combination of non-verbal disclosure such as covering and using clues to signal affiliation with a non-heterosexual identity. He was possibly one of the most queer rock stars in history, but some of his fans didn’t pick up the clues, the social context of a rock band served to mute the effectiveness of the message. Similar to Freddie, most LGB people use a combination of methods to come out, a process which is both continual and contextual. See how much fun I am to go to the movies with?

One thing that has struck me, as I wade through my papers, is how this is still very relevant. I did wonder, starting out, if being LGB was still (sometimes) something to be managed at work, or out in the world. In the last few days my news feed has popped up stories about two women being asked to leave a concert for kissing (in EDMONTON!) and a woman in Ontario being kicked out of her church for being in a same-sex relationship. Coming out, for them, had consequences. Watching TV, Drag Race is full of coming out stories, and Transparent is a study in coming out as trans*. At one-point Maura (the lead character, a transwoman) is told not to tell Grandma Rose because it would kill her. “Hey, that’s called ‘explosive knowledge’” I told my fascinated partner, “the idea that coming out could blow up a relationship** and/or cause physical or emotional violence!”

So, the take home message is mainly that I watch a lot of gay stuff, but also that I am mentally and physically immersed in my literature review. I think it was a good decision to do this before my discussion. I hope I will have both the theory and the emotional resonance of the stories available to me when I get there. I’m certainly seeing a lot of connections and hoping I won’t have to do a lot of backfilling if and when I come across an idea or theme I hadn’t  included. Knowledge, explosive or not, that will help me get to the end of this dissertation journey.

 

*I  know, I can’t believe it has taken this long for me to watch it!

** Orne, 2011

 

 

 

 

 

Plans, progress and dinosaurs

This time last year I was in the midst of my comprehensive exams, trying to pull together my research ideas into a coherent whole, enough to convince the examiners at UBC that I had enough knowledge to move into the research phase of my doctorate.

This time last year I was in a different job, in a different province and married. Things have changed.

It’s axiomatic that doing this kind of in depth introspective work alters you. Also that you’ll smugly assume at the beginning that you are somehow exempt from that. You’re not.

This last year has reminded me that when we think we have it all figured out, life throws us a curve ball. Or as the old Yiddish proverb goes – Man plans and God laughs. Which reminds me of my all-time favourite:

Dr. Ian Malcolm, “God creates dinosaurs, God destroys dinosaurs. God creates Man, Man destroys God. Man creates dinosaurs”
Dr. Ellie Sattler, “Dinosaurs eat Man….. Woman inherits the earth” (Jurassic Park)

 Yeah, OK, not really the same but chaos theory, am I right?

This last year has also shown me the need for cheerleaders. As well as from my EdD cohort (shout out to Chickadee Nation!) I draw a lot of doctoral-type support from Twitter. The recent #ImmodestWomen tweets have got me cheering. Women with doctorates are changing their Twitter handles to ‘Dr’ to make a point that if they’ve achieved something, they should be able to be proud of itPostings from people doing doctorates can also be inspiring, encouraging and motivating. I love reading the “I finally did it” posts with the pictures of happy people in funny hats. The “OMG why did I start this” tweets can be funny or sad – depending – but usually trail a number of comments like “you got this” and “keep going!” I’d like to think if I was having a terrible day/week/month I’d get my share of cyber hugs as well. Recently my virtual buddy Janice posted about taking a break – people shared with her how hard it had been for them, and how taking a break was sensible and necessary if she needed one. It sounds trite (and I would have scoffed at this three years ago) – but sometimes it really IS about the journey. We don’t want to burn out before we get there.

So after a move to Alberta (home of many dinosaurs!) I’m unpacking my notes, downloading the reference management software on my new laptop, and getting on with it. Or starting to. Or thinking seriously about it. I’ve posted the “things I need to do to be called Dr. Bolderston” table on my wall (see pic!) and put up my “you should be writing” memes so it’s a good start.

Even though my dissertation is about 11% done* since I started my EdD I’ve developed an LGBT healthcare research niche, published, presented and changed a few things for the better. It’s hard to separate the doctoral work from my daily practice (which is the whole point of a professional doctorate – so well played UBC). As an example, I was talking to a volunteer patient last week – she generously gives her time to be “treated” by our radiation therapy students at the University of Alberta. She told me that last year she had to play a patient with prostate cancer. I said, that’s amazing! It must have been so cool for the students to learn about trans patients. She looked at me strangely and said – well, no, we just didn’t have any men volunteering! But think of the missed opportunity, I said, we could rework the whole scenario! I’m not sure if she is going to sign up for that but it’s an easy way to queer the curriculum just a little bit. Impact – right?

So whether I start on my discussion section tomorrow, or next month – graduate this fall or in 2021, I’m (89%) OK with that.  Just remind me when I post the “OMG why did I start this” tweet!

fullsizeoutput_220

*probably a generous estimate

Year three: Beyond the comps

Untitled

For many graduate level courses the comprehensive examination (“comps”) is a pass/fail checkpoint in the program (often after mandatory coursework) that assesses knowledge and work done to date. Once passed, the student can progress to their research. Comps seem to be more common in US and Canadian higher education – and Wikipedia, that rigorous source of academic information, says that “preparing for comprehensive exams is normally both stressful and time consuming!”

Our EdD comps were last weekend and preparing for them was indeed stressful and time consuming.  We wrote a 7,500 word paper on our research ideas (and questions) to date, that included a literature review and (in some cases) details of our theoretical framework.  We had to present for 20 minutes on our paper and our work so far. A panel of six UBC professors (familiar to us from our classes) then asked us questions for 40 minutes – it was pretty much open season! I am happy to report that I did get a question on Foucault. In fact, I think I managed to dodge/deflect enough to insinuate that, yes, I was intimately familiar with his groundbreaking contribution to the history of western morality – the three-volume L’Histoire de la sexualité (in the original French of course) and it was, in fact, my regular bedtime reading.

We have been together as a cohort for 2 very long years, and we are pretty familiar with each other’s areas of interest. Some of us haven’t varied much from our original idea, and many others have taken a long and winding journey to settle on something that may not have even been a consideration back in 2015. Members of the group have changed jobs, had personal and professional crises and questioned why they are doing this in the first place! There has been crying, anger, hugging and lots and lots of reflection.  Some of us have supervisors, some have a committee, a few others are still exploring. Regardless of where we are it was a significant weekend for all of us and marked the last time we will be “officially” together as a cohort.

We’re currently waiting for our results; we may have to do some extra work on our submitted papers before we move on. Next hurdle is the proposal, after which we can finally be referred to as doctoral candidates.  After a few bad academic first dates I finally have a committee – consisting of a philosopher, a poet and a physician. I am particularly thrilled with this and I am in the process of writing a “….walks into a bar” joke so please forward any suggestions you have. They haven’t got together yet, that comes after the proposal is approved by my supervisor, but I hope that happens before the end of the summer.

So – year three begins tomorrow! It’s not an overstatement to say the last two years have been life-altering, but I think that was the point. I have gone from being acutely uncomfortable speaking up about LGBTQ issues to never shutting up about them and I can’t wait to get into the rich conversations with my participants and find out what it’s like for LGB radiation therapists working today. Stay tuned!