MONOLOGUES OF A TIRED NURSE // Theatre for Thought

Stress-related mental health problems affect one in five primary care workers. Four in five have trouble sleeping. These are the realities of working in today’s NHS, according to mental health research by Mind, and they form the backdrop to Monologues of a Tired Nurse.

Two nurses step onto the stage, one an optimistic new recruit, Emily, and the other a battle-hardened and exhausted nurse-in-charge called Sally. Among the paraphernalia and body fluids of a normal day, a harrowing story unfolds, the characters’ interconnecting soliloquies showing how the most compassionate individuals can become casualties of an undoable job.

Sally says she came into nursing with a Superman complex, but soon realised there was no time to care. She feels broken – that she isn’t good or worthy, and is angry with people who say nurses are saints.

Emily is hopeful, almost angelic, but struggles to gain professional confidence. Sally’s attempts to toughen her up only seems to make things worse. Emily blames herself for the mistakes she makes under pressure, and sees the coping mechanisms she develops as inevitable.

Monologues is written by Stephanie Silver, who worked for eight years as a paediatric nurse and plays the hardbitten Sally. Her insider’s perspective shows a health service in which shortages have a direct impact on both patients and carers, and where the scrutiny of box-ticking bosses takes priority over the humanity of staff.

It's the issue of putting a brave face on things, and continuing under grinding levels of stress, that this play really addresses. Emily, lost in issues of her past and present, eventually leaves a note for Sally and takes her own life.

Mind’s research shows that one in three healthcare workers would never talk about their stress for fear of being seen as less capable - less able to take the heat of an NHS essentially on fire. Monologues starkly shows us the future we are facing if we are not prepared to care for those who work on the frontline of caring for us.

- Rebecca Mileham

Monologues of a Tired Nurse ran at theSpace @ Surgeon's Hall until August 27th - https://tickets.edfringe.com/whats-on/monologues-of-a-tired-nurse

Mind’s 2016 survey into mental health in caring professions: http://www.mind.org.uk/news-campaigns/news/mind-finds-worrying-levels-of-stress-among-primary-care-staff/#.V8b8vqI9p8o

NHS staff cuts and reduction in care quality ‘inevitable’, say King’s Fund: https://inews.co.uk/essentials/news/health/kings-fund-nhs-staffing-cuts-care-quality/

Student bursary cut 'may worsen NHS staff shortages': http://www.bbc.co.uk/news/health-36336830

Nursing Times article on a nurse's suicide being linked to work pressures: https://www.nursingtimes.net/walsall-nurses-suicide-linked-to-work-pressures-rules-coroner/1/5076937.article?sm=5076937

TELL ME ANYTHING // David Ralfe

Tell Me Anything delivers a refreshing and profound take on the enduring discourse surrounding mental illness. The narrative focuses on performer David Ralfe and flashes back to his relationship with Kate, his girlfriend at 15 years old. Diagnosed as atypically anorexic, Kate is physically absent from the story, as we are led to believe she, and many like her, try to become physically absent from reality, by starving themselves. As 'Thinspiration' becomes a pre-pubescent lifestyle choice it’s impossible to avoid this epidemic of female self-harm. Watching the recent Netflix phenomena Stranger Things, it seemed terrifyingly unsurprising there is a Proana discussion devoted to the unnaturally thin Natalia Dyer.

David is tormented by Kate’s illness and its profound effect on their relationship. With a Dolphin strapped to his back he recites the mantra Warmth, Guidance, Gentle Nudging as a coping strategy to help him thought the lies and vomit scented snogging. Young love beset by constant struggle ultimately takes its toll on David and our honest and reliable narrator reveals his present mental health struggles.

Kate's parents are uninterested and like Joan Bakewell’s recent controversial and unhelpful statement, infer that anorexia is fundamentally narcissism. This leaves the burden of support on an increasingly unstable David: we feel his instability as he physically stumbles through a small collection of cardboard tubes. He grasps at them as they fall over and he tries to fix them, just like he is trying to fix Kate, to save her from herself.

NHS Mental Health funding is bound to suffer no matter what was written on the Brexit battle bus, there are no quick solutions to the rise of the mental health crisis brought on by years of austerity but Tell Me Anything manages to engage the audience with determination and commitment.

- Lucy Orr

Tell Me Anything is on at 17.45 at Summerhall (Venue 26) until August 28th. See venue for Accessibility information, Suitability: 14+ (Guideline). https://tickets.edfringe.com/whats-on/tell-me-anything 

NHS mental health funding is still lagging behind, says report: https://www.theguardian.com/society/2016/may/09/nhs-mental-health-funding-is-still-lagging-behind-says-report

My Battle With Anorexia | Dave Chawner | TEDxClapham: https://www.youtube.com/watch?v=lqbL-UhhyPk

Eating Disorders from the Inside Out: Laura Hill at TEDxColumbus: https://www.youtube.com/watch?v=UEysOExcwrE

Ruby Wax:What's so funny about mental illness?: https://www.ted.com/talks/ruby_wax_what_s_so_funny_about_mental_illness

STORIES TO TELL IN THE MIDDLE OF THE NIGHT // Francesca Millican-Slater

Francesca Millican-Slater's work tends to be autobiographical: Me, Myself and Miss Gibbs traced her journey across the UK in search of the recipient of an enigmatic postcard, while Forensics of a Flat unfolded the history of her peculiar home in Birmingham, a former office above a shop. The same is sort-of true of this show, but only in its starting point: as documented on the accompanying blog, she experiences chronic insomnia, and the stories she tells over the course of the hour are a reflection of the fantastical thoughts that plague her through the night.

Insomnia is a common problem – the NHS estimates that one in three people in the UK experience it regularly – and on the surface Millican-Slater's stories evoke the banal: one features a couple in a supermarket; another, a couple disturbed by the insistent loud music played by their neighbours after hours. A man in one story attempts to find friendship among his colleagues in a pork-pie factory; a man in another strikes up conversation with a cafe owner and a newspaper vendor on his early morning walks. However, each vignette quickly takes a Tales of the Unexpected detour towards the weird. The factory worker is demoted when he constructs a pastry penis; the street blares with noise as neighbours compete to play their own favoured style of music at the highest volume. The tone is more often kind than sinister, particularly in the tale of a mysterious matchmaker, a man who stalks people he knows to be single, then attempts to pair them up, functioning as an “analogue Tinder”.

Sleeplessness is a lonely and often furious place, and many of the characters in these stories are lonely and furious, too – particularly those already in couples. The overlap between insomnia and depression is suggested in an undercurrent hum of desire for meaning, or purpose, or connection, most audible in the story about the man who begins each day walking his neighbourhood, convinced that the world would fall apart if he didn't. The blue light that bathes Millican-Slater's face speaks of the computer screens that promise connection but only in isolation. Listening to her, the audience sit in isolation, too: joined together by her velveteen voice, spinning a web of strangeness.

(MC)

Stories To Tell in the Middle of the Night is on at 10.15 at Summerhall until August 28. See venue for accessibility information - https://tickets.edfringe.com/whats-on/stories-to-tell-in-the-middle-of-the-night

Basic insomnia facts: http://www.nhs.uk/Conditions/Insomnia/Pages/Introduction.aspx

On the relationship between insomnia, anxiety and depression: https://sleepfoundation.org/insomnia/content/what-causes-insomnia

On the cultural rise of lack of sleep: http://www.telegraph.co.uk/lifestyle/wellbeing/10304984/Is-there-any-way-to-cure-insomnia.html

On mindfulness as a cure for insomnia: https://www.theguardian.com/lifeandstyle/2015/jan/09/sleep-how-to-beat-insomnia

The blog accompanying the show: http://www.storiestotellinthemiddleofthenight.com/

GUSSET GRIPPERS // Elaine Miller

Some shows are best defined by their audience. This is certainly true of Gusset Grippers, which combines the previously disparate forms of stand-up comedy and incontinence physiotherapy. Incontinence affects 1 in 3 women and 1 in 9 men, so it is likely that some, if not most, of the audience had first-hand experience. Laughter can lead to leakage if you have stress incontinence so given the hilarity throughout, some of us were probably experiencing it during the show itself.

The audience effectively had an hour-long consultation with physiotherapist Elaine Miller. Not the first health professional to go into comedy, she is unusual in using her routine to do her job. Unlike Harry Hill, who left medicine to become a comic, or even Phil Hammond, who remains a GP, Miller uses this show as explicit health promotion - with the emphasis on “explicit”.

Rather than invite audience questions, as was the case in Brian Lobel’s Sex, Cancer and Cocktails, for example, Miller grants us anonymity in this clinical encounter. No one has to share their story - through experience with clients and her own incontinence following the birth of her third child, she knows what we want to ask, why we didn’t go to the doctor, and what mistakes we will make learning the most effective treatment: pelvic floor exercises.

And with an anonymous group rather than an individual client, she is free to exploit every rude joke going about our most intimate body parts and functions. That must be why there was a hen party in on the night I was there. A few years ago, a show called Incontinental avoided “all the obvious and cheap jokes” around incontinence according to a review in Exeunt; by contrast, Miller’s frank descriptions of pish, poo, sex, birth and pelvic anatomy elicited constant laughs of embarrassment and recognition. Her approach is, in many ways, vulgar - in terms of her language, yes, but her directness and practicality as well.

Also in the audience were health professionals earning credits towards their continuing professional development (CPD). CPD helps practitioners like physios and doctors keep their skills and knowledge up to date, and each year they are required to do a certain amount of learning beyond their formal qualifications in order to stay registered with the General Medical Council or the Health and Care Professions Council. Miller's show qualifies as CPD because it is rigorously evidence-based, but she is interested in another type of evidence, too: by following up with consenting audience members, she will assess whether comedy really is an effective tool for health promotion. In this case, I really think it is. (MR)

Gusset Grippers is on at 18.00 until the 28th August (not 10th, 17th, 24th) at Woodland Creatures (Venue 282). https://tickets.edfringe.com/whats-on/gusset-grippers

Find out more about Gusset Grippers and Elaine Miller online: http://www.gussetgrippers.co.uk/  

NHS Choices has somewhat drier information about incontinence: http://www.nhs.uk/conditions/incontinence-urinary/pages/introduction.aspx  

Dr Phil Hammond has two shows at the Fringe this year: http://www.drphilhammond.com/

Sex, Cancer and Cocktails, by The Sick of the Fringe’s very own Brian Lobel, is reviewed here: http://www.disabilityartsonline.org.uk/sick-festival-brian-lobel-sex-cancer-cocktails

Kazuko Hohki’s Incontinental was reviewed by Exeunt in 2012: http://exeuntmagazine.com/reviews/incontinental/

The Health and Care Professions Council explains continuing professional development (CPD) here: http://www.hcpc-uk.co.uk/registrants/cpd/

More about CPD for doctors from the Royal College of Physicians of Edinburgh: https://www.rcpe.ac.uk/education-support/cpd-scheme-guidance