I was so disappointed with our Community Mental Health Teams

My first placement with a CMHT

A GP might refer an out-patient but in-patients are generally allocated to a Community Mental Health Team (CMHT), prior to hospital discharge, which is normally made up of various multi-disciplinary professionals such as:

  • Community Mental Health Nurses (CMHN) and unqualified support staff
  • Social workers and Approved Social Workers (ASW’s) – Same as social workers, but ASW’s have undergone specific training in mental health law; the Mental Health Act 1983, which enables them to carry out Mental Health Act assessments with other professionals.
  • Consultant Psychiatrist, Senior Registrar and/or SHO’s (Senior House Officers) who are Doctors undergoing their six months training in a particular area of medicine. In this case, Psychiatry.

The CMHT works with a person who may get help from one or two of the above professionals, depending on their needs.

As a Mental Health Nurse student, I was allocated to Alan, a CMHN who would be my supervisor for the duration of this placement. I was five minutes early so I had a coffee and introduced myself to a few of the team while waiting for Alan. It was eight fifty-five and their overall mood matched the weather on that stormy Monday morning. Had they not been sitting at desks, behind the flexy plastic window, I might have thought they were patients waiting to be told they’re being placed on Section 3 of the Mental Health Act 1983 (1) and are due to have medication — injected into their eyes.

I smiled as the front door opened and an older gentleman walked in. He was wearing a tatty tweed jacket, a moth-eaten jumper and a shirt so old, the collar was frayed. His well-creased trousers looked as though they’d had an argument with his ankles and his black plastic slip-ons squeaked as he walked. Still, his gappy-toothed smile was welcoming and as he stuck out his hand, he pushed open the inner door with his backside and he introduced himself as Javid, a Social Worker.

Washingtonpost.com

I explained who I was and Javid took me down to what looked and felt like a fusty old storeroom. He pointed out his desk, Alan’s desk and the one opposite that I could use and off he went.

I went through my Practice Based Assessment (PBA’s), a list of evidence-based tasks to be carried out at each placement, to see which ones I might be able to meet sooner rather than later. I always liked to get a head start and not leave the PBA’s right til the end of placements.

While thumbing through a patient file, gathering information for one of my PBA’s, I happened to look up saw a rickety old bike being chained to the railings. I watched as a pair of green wellies marched up the few steps to the front door then heard them thumping down towards the basement. The office door bashed open and there Alan stood. He pulled himself up to his full six foot plus, puffed out his chest and glared at me, demanding “What do you think you’re doing?” in a broad Scottish accent. Think Billy Connolly!

“Javid said I could look through……..”

“Is Javid your supervisor? No, he’s not. I am. Javid is an ASW and you. are. a. mental health student. Are you not?”

I almost stood to attention. Instead, I raised my eyebrows and stared back at him for what seemed like an age. He turned on his heels saying “I’ll get myself a coffee and see you when I come back!”

This was the way Alan continued over the next few weeks, barking orders at me and ignoring any questions, feeding me snippets about his patients – when he saw fit.

He told me he was married and had two children and that he was an ex-police officer, something I should have guessed. Either that or the Armed Forces. He was not a nice man. Rather, he was an egoistical, belligerent and manipulative git.

Unionmedico.com

I was surprised one morning when Alan told me I was to run his Depot Clinic (2) under his supervision. Patients come to the clinic bi-weekly or four-weekly to have their antipsychotic medication via intramuscular injection. “You do know how give give injections, I presume?” he snapped “And don’t forget to check which side. I’ll countersign the medication charts when you’ve done.” I had observed several injections during my in-patient placement but I’d never actually administered one.

My first patient was due in soon so I checked her medication chart and spotted the small letter ‘L’ underneath the signature box, which I gathered meant that was the side the last injection was given. Injections sites were alternated to stop the buildup of scar tissue on one side.

Sally, my first patient, appeared sullen and I wasn’t sure I’d be able to engage her in idle chit chat before inserting the needle, something I hoped would help take the patient’s mind off the injection. However, she chatted amiably about me being a new student and asked whether I liked football. The needle was out and I told her that I was an Arsenal fan. “Blinding. Me too. I ain’t never been myself tho’, ave you?”

“Yes, I’m lucky. I’ve been to quite a few games.” I was scribbling my signature on her meds form when she turned her head to me and said “Come on, ‘urry up girl!”

“All done Sally.” Ha! I’d given my first real injection and she didn’t even notice. Her eyebrows shot up then I got a wink and a brief smile of approval as she buckled up her jeans. “You’re alright you are. She can come ‘ere again Alan.” She gave me a knowing look and glared at him as she left the clinic. Not a word from him, just another of his withering looks as I passed him the meds chart to countersign.

Irishtimes.com

A month passed and Alan continued to arrive late every day. One morning, Javid asked if I’d like to go out and visit some of his patients with him and I jumped at the chance. We arrived at Anne’s house to see her in the front garden wearing a flimsy kaftan and barefoot. She twirled around on the grass, arms outstretched and head thrown back as she sang – Julie Andrews popped into my head. In fact, as I sit here typing, the classic film, The sound of music, has just started on t.v. and every time I see it, I remember Anne.

Anne grinned when she saw Javid and waved him in with a dramatic curtsey, telling us she was calling the children in for lunch. Four skinny under-twelves trooped into the living room and hungrily snatched up huge doorstep sandwiches. They danced, skipped and jumped all over the two mismatched sofas as they munched. They sang silly songs and clapped loudly, dropping crumbs everywhere. Their likeness to the much loved Von Trapp family didn’t go unnoticed.

They were clean, wearing all manner of clothing; some too big and some to small, all bare foot, but they looked happy and were both well spoken and well mannered.

Crazyhead comics

Anne had a diagnosis of bipolar disorder which used to be known as manic-depression, where a person has episodes of depression (feeling very low and lethargic) and mania (feeling very high and overactive). Unlike simple mood swings, each extreme episode (high or low) of bipolar disorder can last for several weeks, or even longer, and some people might not experience a normal mood very often. Bipolar disorder is treated with mood stabilisers such as Lithium or Valproate, which is actually an anticonvulsant medication (also known as antiepileptic medication), which were all originally made for treating epilepsy. Epilepsy is a neurological disorder that can cause seizures.

Once we were on our own, Javid asked Anne if it was okay for me to complete a mental health assessment, done by observation and direct questions, assessing things like:

  • mood, behaviour and appearance
  • thought form for speed and coherence
  • thought content for delusions, suicide, homicidal or violent thoughts, obsessions and perception
  • cognition for orientation to time, place and person, attention and concentration

Finally, I assessed her insight to gauge whether Anne knew her incessant chatter, thought disorder and her behaviour wasn’t normal, given the weather and both her and the children’s appearance. However, she didn’t believe she was currently unwell “This is nothing.” she chirped. “You’ve seen me worse Javid.”

Javid smiled, then stood to bid our goodbyes and I couldn’t help but giggle when Anne and the children burst into song “So long, farewell, Auf Wiedersehen, adieu. Adieu, adieu. To you and you and you.”

Sitting in his car, Javid talked me through the visit and agreed that yes, he had seen Anne worse? “Really?” I asked. He nodded and chortled. However, he said he would check to see if there was a bed so that he could plan a voluntary admission over the next few days. He said that Anne would use all kinds of delaying tactics but would eventually agree to voluntary admission. “She knows she has a chronic (long-term) diagnosis and she’s well known to services. She’s aware that if she doesn’t go voluntarily, she would be admitted under Section 3 of the MHA 1983. This means patients can undergo coercive interventions, such as enforced medication, seclusion and restraint.

After a few more less-exciting home visits Javid and I returned to the CMHT, around four fifteen. We were just in time to complete our documentation and to see Alan snap his briefcase shut, throw me a look of utter disdain and head for the door. Thank God for the weekend.

Alan’s lateness carried on, his behaviour remained erratic and his lack of interest or guidance was getting me down. There were days I was in tears, despite the admin girls telling me to ignore him and making me laugh, saying he just needs a good shag!

Every day Alan was late I went out on visits with Javid or other staff who’d asked if I’d like to accompany them. I was gaining so much experience as the team were supportive and fed back to me my strengths and small areas that I could build on.

Most of my PBA’s had been completed I and was pleased with the necessary evidence I had attached, having made sure there were no names or numbers that could identify individual patients. The staff I’d worked with wrote on my PBA’s that I was really intuitive and empathic, that I had excellent communication skills, and had been proactive in achieving the high standards I’d set myself. Over all they said they were impressed. All I needed now was for Alan to sign them off as having been completed.

Lady smirking – iStock.com

The arrogant shit refused! He hadn’t seen me complete any of the tasks listed on my PBA’s so he would not sign them! He couldn’t possibly!

Long story short, I had to involve his superior who agreed that other senior staff I’d worked with could sign them off for me!

The admin girls mychieviously phoned me to ask about my results and I boasted – I only got a huge 94% for these PBA’s. Guess who they couldn’t wait to tell!

Note to self: I might have lost a battle but I certainly won the war.

(1) Section 3 allows for a person to be admitted to hospital for treatment if their mental disorder is of a nature and/or degree that requires treatment in hospital.  In addition, it must be necessary for their health, their safety or for the protection of other people that they receive treatment in hospital.  Section 3 is used where the person is already well known to psychiatric services or following an initial assessment under Section 2. 

Under a Section 3 you can be detained for up to six months in the first instance.  This could be renewed for a further six months and then for periods of one year at a time.  Section 3 can only be renewed following an assessment by the doctor responsible for your care (Responsible Clinician or RC).  Each time the Section 3 is renewed, a review of your current care and treatment is carried out by the Mental Health Act Managers.

(2) A depot injection is a slow-release, slow-acting form of medication. It isn’t a different drug – it’s the same medication as the antipsychotic taken in tablet or liquid form. But it’s administered by injection, and it is given in a carrier liquid that releases it slowly so it lasts a lot longer.

First day nerves on placement on an acute in-patient ward

My first morning on an acute in-patient ward

Staff photo board on an acute inpatient
mental health ward

Beyond the door, people were milling about in all states of undress, one lady baring her breasts as she had a hospital gown on backwards and the ties were undone. Fortunately she had knickers on, albeit they were large white paper ones, which covered her modesty. Others had hospital-issue pyjamas bottoms on, some bare-chested and barefoot while some had on what looked like their own dressing gowns, clothing and footwear.

I could see more dusky coloured walls, on the left was old artwork, curling at the edges and hanging precariously with tattered tape. A large perspex covered board with photographs of unsmiley people and nametags, who appeared to be staff, hung on the right. Alongside, was a wonky shelf with welcome leaflets and other ward related information. Looked like someone had a fallout as they’d scribbled on the perspex over one particular nurse’s face.

Which one is the nurse?

Heart thudding and having pressed the buzzer to get in I watched as this guy, who looked like an all-American Quarterback sporting a huge white smile, sauntered lazily towards the door. He unlocked it with one of the keys from a large bunch and nodded me in then he locked the door behind me. I guessed that, because he had keys dangling from his belt, he was staff.

Other than the pyjamas, it was difficult to identify who was a patient and who was staff. Man mountain was wearing jeans, a sweatshirt and trainers. He introduced himself as Adeola and pointed me toward the nurses office where, because the door was locked, I stood for a few seconds, hoping one of the three people in there would let me in.

“Hello. You must be Nancy, our new student. Come in now, come sit. Moreblessings get up and give this wee lady a seat now, will ye?” A young Northern Irish guy also in jeans, t-shirt and trainers raced on “I’m Derry, that’s Moreblessings and there’s Abimbola, Nancy. Would ye like a wee cuppa tea Nancy, would ye? Give us a wee minute and we’ll get ye one, eh”? I loved him already and despite some humphs and tuts from Moreblessings, I knew I was going to like it here.

The office was tiny. There was a rickety desk with some stacked filing drawers, a telephone and some office paraphernalia on it, and two old swivel chairs. Two battered-looking four-drawer filing cabinets stood opposite each other, a formica top stretched along one side of the office and held a fax machine, photocopier and few loose files.

Above was a couple of  flimsy shelves holding lots of precariously balanced files and some nursing books. Dressed in a neat flowery jumper, a calf length skirt with thick black tights and flat black shoes, poor Moreblessings huffed and puffed her bulk out of the chair in the far corner, between the filing cabinets, to give up her seat. Derry slid into her empty chair, leaving his for me.

The troops arrived

Just at that, the office door burst open and in bungled two others, out of breath and laughing as they attempted to get their coats off in such a small space. “Yer late again Alison, Fadhili. Come on now. Hurry up.”

“Keep your hair on, I’ll just grab some coffee.” giggled Alison as she winked at me.
“You’ll just not. Come on. Some of these folks want to go home this morning.” said Derry. “Anyway, this is Nancy, our new student.” he added. Alison smiled and Fadhili nodded at me.

The heat from the six of us steamed up the office window and I was getting a rather icky whiff of body odour, badly covered up with strong but not unpleasant cologne. However, as Alison sat her neat bum on the table edge, she was closer to me and the sweet, floral scent that she wore helped mask the other smells. She too was wearing faded jeans with a striped shirt and trainers while Fadhili had on trousers, a shirt and tie and shiny black mock croc shoes.

Derry looked towards Abimbola who started to read out names from  a large whiteboard on the wall. “Helen, slept all night, no problems. Peter, he’s okay, just waiting to go home. Isaac, restless and sat in the day area most of the night.” He went on, discussing the twenty patients on the ward that morning. This was called handover and it happened at the beginning of each shift. It was brief and didn’t give me too much information, but enough to begin with as I had to memorise the staff names first.

Finished, Abimbola snatched up his coat and heaved his large frame through everyone and left the office, waving wearily as he went. It was like a mass exodus then, as everyone else made a mad dash too.

Was it still only 8 o’clock?

“Coffee Nancy?” I heard Derry say over his shoulder as he went next door to the kitchen so I followed him and said I’d have a coffee with milk. Out came the toaster, cereal and coffee mugs, clattering onto the stainless steel worktop and I watched as some staff helped themselves to breakfast. Derry just made two coffees and handed one to me saying “Do you smoke Nancy?” As I nodded he made eyes at me to follow him and we crossed the narrow hall to the smoking room.

We walked into the stench and a dark yellow fog that you get when there’s half a dozen smokers and no ventilation. The smoke stained windows were open but only half an inch, obviously so no one can escape. Several pairs of lifeless eyes turned towards us, though many remained staring blankly, either at the grubby windows or the soiled floor which was littered with fag ends, empty crisp packets, screwed up plastic cups and old cola tins.

Derry sat on one of the chairs, inviting me to sit next to him, and I hoped my fixed smile hid my disgust at the state of the stained chairs with their cigarette burns and other unidentifiable debris.

Still, I smiled around nervously and offered my introduction “Hi, I’m Nancy and I’m a new student on the ward.”
“Alright Nancy. I like students. You got a spare fag?”
Derry interrupted “Pete, the wee lass just started today. Leave her alone.”
“No it’s okay.” I said and offered the pack to Pete then watched as others eyed the box, willing me to offer them one too. I didn’t feel I had a choice so I was five ciggies down already, and it was just gone eight o’clock.

Medication. Medication. Medication.

At that, there was a loud rattling of the kitchen hatch going up and Moreblessings was yelling “Breakfast time, breakfast……” as she loped along the hall. “Time to move.” said Derry. “I’m your mentor for this placement Nancy, but bear with me and I’ll catch you up in a wee bit. I’m coordinating the shift today. Have a wee seat, chat to a few patients and see how you get on, eh?”

Moreblessings was still yelling and now Fadhili had joined in, “Medication,” he sang and I watched as he went down the hall, knocking on bedroom doors “Medication. Breakfast. Medication………” Patients trickled out from rooms, heading in various directions, some to the hatch between the kitchen and dining room for breakfast and others towards the queue for medication. One or two just flopped on chairs in the living area and gazed at the television.

I thought I’d be best in the kitchen helping with breakfast, as there wasn’t much I could offer on the medication side, being a new student. This also aided in putting a wide barrier between me and a slightly aggressive young female who was eyeing me up and down and glaring at me. However it didn’t protect me from the stale morning breath and unwashed bodies.

There was no queue as such and patients just leant over each other to reach for cereal, milk and sugar or the hot buttered toast, some burnt and some still white. Not sure if this was a defect with the toaster or the domestic, who was also busy handing out green plastic cups of hot water so that patients could add either tea or coffee. Drinks and cereal sloshed as patients shuffled to small tables in the dining area.

Soon, vacated tables had crumbs, slops and spills so I went round the other side of my barrier to wipe some of it up, but I practically flew back when Mandy, I learned, screamed, “Fucking lesbian. Stop fucking staring. You ugly white bitch.” This was the young lady who’d earlier on, had her nightgown on back to front. “Oh, ignore Mandy. She harmless really.” said Mrs Farrell, this tiny, sweet domestic lady in her Jamaican twang “She just having a bad morning.”

Meeting the patients

Breakfast was almost over and the last of the dawdlers were still in the queue for medication. I popped into the office to see that Derry had allocated patients to the four staff on duty; two qualified mental health nurses being Derry and Alison while Moreblessings and Fadhili were the  two nursing assistants. I had Supernumerary status which means that student nurses are additional to the clinical workforce and undertake a placement in clinical practice to learn, not as members of staff.*

I asked Derry what I could do to help as I was feeling a bit like a spare part and quite out of my depth, what with Mandy following me, cursing like a sailor on a drunken holiday! Derry said to just shadow one of the staff and not to worry about Mandy; she’ll be fine after some medication. Alright for you to say,  I thought as I bumped into Mandy when I backed out of the office and turned with a wobbly smile to say “Hi, I’m Nancy, a new student here. Is there anything I can I do to help you this morning Mandy?”

“Ah, you’re a student, I thought you was one of the Doctors, I ‘ate Doctors. Ask if I can have leave, will ya? It ain’t ward round today and that’s the only time you get to ask for leave, but I’m not fucking waiting ’til Wednesday. I need some clothes, look at me in this fucking dirty ‘ospital gear.” she ranted.

I asked where her clothes were, what did she come in with and whether we could perhaps find them together. “They ain’t here. Someone nicked them in the night. Jealousy, that’s what it is. Jealous cos I’m a model and I get given good gear to wear. And that’s why they nick it. Fucking poofs and lesbian, all of them. And the staff, they’re at it too. All of ’em” she rambled. I didn’t know what to think about her clothing. I offered to help find her clothes but she wandered off, still cursing and muttering. Quieter now though.

“Go and have a wee break Nancy, you deserve it.” Derry grinned.

*Nursing & Midwifery Council, 2014

Why I became a mental health nurse

The first eighteen months of our uni course included general nursing and students, along with the aforementioned pushers and shovers, made a mad dash for the announcement boards to see where we’d be placed for the next eight weeks. I got ‘Gynaecology & Urology’. This was back in the day when we still had mixed wards, which was shocking and probably embarrassing for the mainly females, due to the nature of the ward.

I was so excited that ridiculously early Monday morning, in my new blue and white striped uniform with my upside down watch and the obligatory shiny new black DM’s. The nurses were all welcoming and there was a nice friendly male nursing assistant, Phil, in his mid thirties, who was to show me around the ward.

Phil was a bit on the cheeky side and seemed to have a good relationships with both the nurses and the patients. Nevertheless, he was lazy and would habitually try to fob menial and yukky tasks onto gullible students like me. I quickly let him know that while I don’t mind sharing the load, I was also a mature student who needed to learn certain nursing skills as well as carry out his nursing assistant tasks.

A few weeks in, Phil was grinning when told me to remove a catheter from a male patient and that he’d be back in five minute to check. On his return I told him I’d completed the task and with eyes agog, mouth agape, he paled immediately, thinking that I’d followed his instructions. As students, we all knew, you didn’t carry out such tasks on your own if you’ve never done it before – so I didn’t. Having never carried out this procedure, how would I know you had to deflate the balloon before you removed the tube from the penis?

While we were in lectures at uni, we’d learned about all the different types of poo. There’s no such thing as a perfect poo – it comes in all shapes and sizes, colours and textures. The most surprising was fecal vomiting which was one type we were told, we’d probably never come across during our mental health nursing. Fecal vomiting is serious and can happen when a person has an obstruction (usually in the small bowels).

Anna was only forty-six and had both colon and bowel cancer which had now spread to the lymph nodes and she wasn’t expected to recover. She’d called me, looking very embarrassed, asking for the commode and as she was so weak, I had to help her onto it.

No sooner had Anna sat down, she requested the sick bowl sitting nearby. Too late, she furiously projectile vomited, propelling runny poo all over the bed and down her clothes. She was mortified and kept apologising as I stood behind her rubbing her back and saying “it’s okay, not to worry. You’re okay Sweetheart” while my eyes and nostrils were stinging and I was gagging silently. I really felt for Anna, I did. My heart so went out to her and I burst into tears. I was annoyed with myself for feeling so ‘icky’ about it all.

Although urology and gynae was mostly ‘icky’, fecal vomit was definitely the worst. Yet I still feel somewhat privileged to have been able to support a patient in some small way, during probably one of the worst times in her life.

I was sad to leave this placement because the staff were so lovely, always including me in their daily chats, sharing all the chocolates and laughing at me when they saw me heave at the sight of bodily fluids. General nursing definitely wasn’t for me!

However, I’d learned how to make hospital beds, empty bedpans and clean up shit as well as making gallons of coffee whilst at the same time, remembering to document patient care in their notes, to be signed off by qualified staff.

My shiny new dm’s were tested to their limits, having ran around the wards thousands of times, at breakneck speeds. My lovely blue and white uniform got tighter as I enjoyed the sweets and chocolates gifted by patients and the daily homemade cakes I’d taken in, to ‘bribe the nurses into liking me’. My upside down watch was used often, probably more often than normal I suppose, because I had to keep re-doing BP, pulse and resps – to ensure they were correct. I was terrified I’d make a mistake and someone would die because of me, in fact, I had nightmares!

I didn’t realise how much I’d miss the patients and the relationships we built during such a short period and the times we’d laughed and cried together. I felt so humbled by this experience, when these lovely people, despite their illness, pain or suffering, shared with me their life stories and their innermost fears and secrets, some of which they’ve never been able to talk about.

Note to self: “Listen to that inner voice of yours. It’s not you, but it’s for you.”
― Kiyo Giaozhi

3 years study to become a mental health nurse

Within weeks of starting Uni, I learned just how stupid some people are! How many lack personal insight and have no idea of personal space or people skills. I was able to study my fellow students as they shoved their way through the doors I was entering and jumping ahead of me to get the seats at the front of lectures or lessons. Now, I know I was really skinny but trying to get two people through the narrow single doorways at Uni was nigh on impossible and, if they thought I wanted to bring attention to myself by sitting anywhere within a ten-foot radius of any lecturer, they were sadly mistaken. Those lardy arses who bulldozed past me, snorting, kissing their teeth or tutting were welcome to their prime seats.

Having only recently recovered from a lengthy psychotic episode, I still felt really shy, nervous even, and constantly prayed to someone who’d help me stave off the ever-impending anxiety attacks. I’d sit somewhere in the middle of the halls and quickly avert my eyes or pretend I was taking notes if I caught a whiff of a question coming my way from the attending lecturer. I was so busy monitoring my pulse and breathing, I probably missed half the lectures anyway.  Still, most of the lecturers appeared to be reading straight from books, which meant I could catch up by going through the same book or reading any handouts during breaks or at home.

What I hadn’t bargained for was the seminars and classes, which normally lasted between one or two hours and, where we were expected to work in smaller groups, normally around eighteen to twenty students. We’d be further split up to around 2-4 people, to discuss some topic or other, then complete a written task before presenting our understanding back to the group. Or, because of the sweet packet rustlers, the stupid questions and other disruptors, we often had to complete the task at home then feedback to the larger group. Oh, my word! If I’d known that I would have to stand up. In front of everyone. And speak? I would never have applied for the course.

No way was I making an absolute arse of myself. I practised for hours in front of a full-length mirror at home, where I’d present my findings calmly and with a flourish, maintaining good eye contact and waving my hands theatrically. Cracked it; I could do this. Huh! For all that, the first time I presented to the class, I dropped the acetates I was relying on to distract my peers as I spoke. Taking in huge gulps of air as I bent down to retrieve said slides, I could feel the heat rising up my neck and hear my heartbeat pulsating in my ears. Then I swayed and felt dizzy, increasing my anxiety tenfold. ‘Please do not let me have a panic attack’! Though not sure who I was asking. By now, I could see my heart leaping out beneath my clothes like Jim Carrey’s character in The Mask and felt sure everyone else could see it.

It felt like an age as I raised my head and saw my well-meaning contemporaries smiling, encouraging me, willing me to get over the finishing line, so I began. With trembling hands, a fake smile and what felt like a massive boulder in my stomach, I managed to stutter my way through my presentation and answer some easy questions. There was no theatrical waving and no calm, just relief when it was over and I was able to watch my peers presenting. Not sure I should be glad but, I could see I wasn’t the only anxious student in the room. Those following me muttered, mumbled, lacked eye contact, had hives creeping up from their chest and for some, their presentation wasn’t even relevant.

Note to self: “Today I will not stress over things I can’t control.”