“I still need that wee” – from the pressures of clinical life to having time to ‘conceptualise’

Elaine Willmore is Head of Research and Development for Therapy at Gloucestershire Hospitals NHS Foundation Trust, and has recently started her ARC West PhD with the University of Gloucestershire, looking at social prescribing. Here she reflects on her first few months developing her research question and the change in gear her new academic life has brought.

There is a situation with which nearly every NHS clinician will be familiar…the phenomena of taking 3 hours to get to the toilet. You realise that you need to go but then are too busy with patients, fielding questions, writing notes, making phone calls, requesting investigations and so on, and you forget. Then, somewhere near the end of a clinic, you find yourself muttering to a colleague “I still need that wee!”

I stepped out of clinical practice in October to start my PhD. In the first week, I had my first official meeting with my supervisory team – Professor Jane Melton and Dr Rachel Sumner – and I was pushing to nail down the research question, set my goals and plan the next three years of my life in glorious technicoloured detail. I was enrolled on two modules at the University of Gloucestershire – Research Philosophy and Research Methods – and I was assured that by the time I had finished them at the end of January, the question and methodology would emerge.

Four months felt like a frustratingly long time and how could I write the assignments when I hadn’t even narrowed down the question? If we just cracked on and decided on it there and then, I could hit the ground running and move the project forward straight away. I was probably perilously close to crossing the threshold into nagging territory when I was told, with a wry smile and a wink, “this isn’t how this works. Slow down. You need time to think and conceptualise.” I nodded, we arranged to meet again and ended the Teams call. I stared at the blank screen for about five minutes. Slow down? Conceptualise? Last week, I didn’t have time for a wee and now I am told that I need to just think. In my clinical lead job, I had a “To Do” list that was like the magic porridge pot and now I don’t know what I’m doing. And how does one begin to go about “conceptualising?” Is it even a verb?

I had literally just told my supervisors that the thing I was most worried about was the feeling of floundering. I am goal orientated, a completer-finisher, the type of person who is so scared of failure I work my socks off, taking every precaution and considering every eventuality to make sure it doesn’t happen.

At the start of the meeting, I was banging on about hitting the ground running and now I felt like I had fallen flat on my face. 11am was a bit early for a gin so I found comfort in the arms of my lifelong coping strategy…stationary. Nothing brings me more joy, or more order to my thoughts than sorting, organising, labelling and, if I can get my hands on one, a laminator. By lunchtime I had my action list (colour coded of course) and signed up for some project management software. The next day I did my first full literature search and, on the Friday, I had my first full day of lectures. I wasn’t feeling in control but I wasn’t careering out of it.

After a month, I started to get into a routine. I divided my day into sessions and tried to make sure I got out for a walk around my local woods at lunchtime. It is weird when I reach the top of the woods which brings you to Worcestershire Royal Hospital. I don’t work there but it makes me think about how different my new life is now.

I also went out for a friend’s 50^th birthday and met some people who I didn’t know. When they asked me what I did I had a sudden crisis of identity. I instinctively said that I was a physio, but then felt like I needed to qualify it as I am not seeing patients anymore. Referring to myself as a student seemed completely disingenuous, particularly being surrounded in Bristol by actual students, who I was comfortably old enough to be their mum. It threw me back into self-doubt once again – who am I and what do I actually do?

What had begun to dawn on me by this point, was that in those first weeks I had failed to realise that time is a gift. There will come a point in the not-too-distant future when I no longer have it. Over the last 12 weeks I have immersed myself in the literature – there are days where I read for hours. I have watched dozens of lectures on YouTube, spoken to anyone who will give me time, built some good early relationships with a diverse new network of people and have spent time properly thinking.

I have also begun to need to write. I don’t consider myself a creative person but I have so many ideas and so many thoughts that I am forming sentences, paragraphs and threads of narratives in my head which I need get down. I am also more at ease with the floundering. Actually, no I’m not, I still hate it but I am learning to accept it.

Doctoral level study is a process of discovery after all and no one is going to hand me any answers on a plate. So, annoyingly, like your parents when you are a teenager, Jane and Rachel were of course right. Things are starting to emerge and take shape as they sagaciously said they would. When I hear myself talking now, I can appreciate how far I have already come. I can converse semi-coherently about phenomenology. I am comfortable that epistemology isn’t the study of me and my mate Sarah after two bramble cocktails and a bottle of prosecco and I’m confident that reflexivity doesn’t require a tendon hammer.

As a keen hill walker, me and my walking buddy often joke that the hardest part of navigation is finding the right way out the car park. When using this metaphor, in our first conversation, Jane told me that I wasn’t even out the car yet. I think I am just about ready to open the door.