on arriving, and being in the moment

At the start of something new we hold our breath, often unconsciously. Anticipation. Excitement. Fear. Often all three. But we can't hold our breath for too long; we need to start inhaling what it is that we have chosen. We need to acknowledge where we have arrived from, and sometimes grieve that which have left. Unless we do this, we don't fully enter into the entirety of what awaits us.

We have been doing a lot of breath-holding, a few gasps, and some deep, long sighs over the past weeks. We have feared that which we might lose, and that which we might gain. We have anticipated highs and lows to guard ourselves against the unexpectedness of uncomfortable emotions. Instead of being sad or lonely or disappointed in the future, why not try and imagine it now, just to convince yourself of what it feels like, right? Our wondering and wandering minds in all their awful brilliance do their dastardly best to  alleviate us of uncertainty in the future by robbing us of the certainty that is the present.

In saying goodbye we give thanks for the journey that has led us to the point of leaving, and most importantly, for the people along the way. It sounds rather utilitarian to put it like that, but of course we know that it is the relationships and the people that make the journey worth its while and give us the strength to press on.

It's a twisted truth that we have learned that one cannot solely make decisions based on relationships and people, no matter how beautiful and wonderful they are. There is a little self-protective selfishness that says, follow where you are headed; there you will be of most use not just to yourself but to others too. It has taken time to accept this, but we have learned that in leaving and coming, we have been changed by those we have left, and we will meet others whom we can, hopefully, in some small way bless again.

It maybe sounds a rather esoteric way to justify a nomadic wandering or the pursuit of something that never actually existed in the first place; if so, we will always be so deluded despite the hours, months, and years of consternation and dreaming and hoping and analysing and prayerful thought that goes into significant decision-making.

It's our way of making sense of this rather beautiful and winding and alluring and exciting and challenging and, at times, difficult and obstacle-ridden path that life consists of.

In the mean time, we are touched by and take with us, and remain changed by friendships gained along the way, and which we will work to maintain over time and distance.

Until then, we are joyful in our own sense of arrival at a point and a place which we thought might exist but were scared may not.

May you journey on despite your fears. May you say goodbye well and fully, and arrive whole-heartedly, breathing deeply and freely.

If at one moment there is comfort, peace, success, or happiness then so be it. Enjoy it but remember that will change.

Equally, if there is an experience of pain, anxiety, failure or depression then so be it. Be patient in the presence of it and remember that it will change..... 

Life is constantly trying to teach us that experiences - pleasurable and painful - come and go whether we like

them or not. 

- Craig Hassed and Stephen McKenzie

when tragedy strikes

My wife said the man's body flew through the air like a rag doll. A neighbour called an ambulance and she drove the two hundred metres back to our house and pounded on the door of the bathroom. I stumbled out the shower.

"There's a man lying on the level crossing, he's been hit by a car. He's not breathing, and there's stuff coming out his mouth."

I pulled on trousers and t-shirt, still wet, and stuffed on my shoes. Unthinkingly I grabbed my stethoscope and sprinted out the house, vaulting over the garden wall. I could see cars stopped and a crowd of people at the rail tracks in the distance. A man looked at me as I ran past.

"Someone's been hit by a car. It's real bad."

I felt annoyed with him in that split second. Did he think I always ran down the street in skinny jogging bottoms, sopping wet?

As I approached I could see the man's body and someone doing chest compressions. My neighbour was there and she motioned me over. 

I could not feel a major pulse. He was not making meaningful attempts at breathing by himself. I took over performing chest compressions, and giving mouth-to-mouth breaths.

In hospital we have nice bags and masks to assist people with their breathing in the case of cardiac arrest. Even when you practice CPR in simulated scenarios, there are hygienic plastic covers to place over the mannequin's mouth, which we then clean with antibacterial wipes. My job allows a strange degree of intimacy with complete strangers. We palpate their bodies to assess for signs of disease. We listen to their fears and concerns and worries about their life; because it usually does not stop at just their chest pain or breathlessness. This professional intimacy is where our own emotions cannot be engaged too much and are usually tightly tethered, safely away from the difficulty and pain of others' lives which we sometimes have to deal with. We cannot connect on a deeply emotional level with every patient we see, and it is not helpful for them for us to do so. How do you deal with drug and alcohol abuse and poverty and mental illness and chronic diseases and trauma and death and feel the depth of the effect that these have on people?

I have cried at work once. An elderly lady begged me to remove the feeding tube from her stomach. She and her husband held hands and cried and told me how happy they had been but that now it was time for her to die. The old lady said that the most important thing you can have in a relationship is trust, and she trusted her husband. But many scenes in my short career have burned themselves on my memory: a toddler smothered almost to death by a distraught teenage mother; a relapsed drug user who was at the end of himself; hearing the screams of a woman who hears that her husband has died in an accident which she survived; the attempted murder of a woman by her partner; telling someone they have lung cancer, with a secondary deposit to their brain. This is messy, gory, painful life, which we see and hear and feel yet protect ourselves from as best as we can. We know it happens to others, and we have inklings that it could be us. It may have been us already. 

This was a new experience however, which anyone might have to do at some point in life. Putting one's mouth over the mouth of a stranger on the road, trying to exhale some of your own respired air into their lungs with the hope that the blood you are manually pushing round their circulation soaks up some oxygen at the blood-alveolar interface. It cut through those protective processes I have erected. My reflex was to spit the moisture from his mouth which was now on mine. This somehow felt too crude, even disrespectful to the man and shocking to bystanders. There was no plastic between me and him. It was just my breath into him, my mouth over his.

It was difficult to tell whether the man was making some 'death' or agonal breaths, or whether his stomach contents was refluxing from the vigorous chest compressions. This man who had been hit from his bike by a car travelling at 50kmh and who was at high risk of having an injury to his spinal cord.

I was already aware that without monitoring of this man and intravenous access and medications, and then eventually x-ray and CT scans, the only paltry offering I could bring was effective CPR. Now there was the decision to protect his airway and to risk potential future disability. I thought he was going to vomit so I turned his head.

*******

I don't want to conjecture too much about this man, out of respect for him and his family at this time. I know nothing of him, or the grief that they are experiencing. My impression was that he was incredibly fit, late on in life. Maybe, now retired, he spent his days relaxing, cycling, enjoying his beautiful city. I wondered if, after his cycle, he would meet his wife for coffee at the beach. Maybe they had grown children, and grandchildren, their reward for long years of work and busyness. 

It feels so cruel and harsh, a dreadful, real outcome of his chosen sport and some moments of a combination of an unknown quantity of factors. I was an observer in some dreadful moments of his life, imparting some attempt at stemming the effects of a traumatic injury.

How do we remain feeling and open to the trauma that we see around us? People are beheaded in the name of revenge and for a greater cause. Missiles are fired in the name of an even greater cause. A gas explosion happens in the middle of the night, and a man waits to find out the outcome of his missing wife and baby.

It is a wonderful gift of being human that we do continue hoping and acting and working to combat tragedy. This in itself is an incredibly uniting thing. Some kind of unspoken, even divine, spark keeps us believing and not bowing to nihilism or fatalism. We keep trying to be a force for good and change, in most cases. And it is a struggle sometimes, not to relax into cynicism and an acceptance of the status quo.

May we all continue, in our little ever-expanding ripples of influence, believe in the possibility of change and rehabilitation and healing and peace. 

two years on

Two years ago, to the day, we turned up in a foreign country, in a city that we had never visited before, with a dream sketchy in its details but certain in its aim. A small daughter accompanied us, oblivious to the change that was happening in her young life. 

(The only time I shed a tear was when I closed the light blue door to our beautiful Edinburgh top-floor flat. It had massive bay windows with views of the Castle and Arthur's Seat, sitting snugly in cosy Bruntsfield. Ahhh, Bruntsfield! All Miss Jean Brodie, Alexander McCall Smith, J K Rowling, hipster, organic, second-hand clothes, French bistro, coffee-brewing, cosmopolitan, winding Bruntsfield. Bruntsfield, where students drink beer on the roofs, and travelers sleep under the Links' trees. Rich old ladies buy haute couture ruby red shoes and American visitors try to absorb Scotland through their pores. The Chocolate Tree. Le Mouton Noir. George Watson's pupils in their maroon kilts and blazers criss-cross with George Heriots' dark blues and greens. Spices from Khartoum and incense from the Indian takeaway. The Italian where my wife craved king prawns in sambuca sauce throughout pregnancy, and the Lemon Grass where we ate on a summer evening on the grass.

The wan Scottish sun sent smatterings of light through the skylight into the echoey starewell of our tenement that day, a place where we had carried our newborn up five flights of worn stone stairs only seven brief months before. In my hand I was carrying our baby in her car seat down to my parent's car taking us to the airport. So much was being risked, and there was sadness lined with excitement as we said goodbye to the incredible place where we had been gifted with this new little bundle of life. Comfort and familiarity and support were being thrown to the wind, and I did not know how our small family would sail the rough waters to come.)

From the moment we were met at the airport by a friend of a friend, we knew we were on to a good thing. She took us to our accommodation - the home of friends of hers (friends of a friend of a friend, one might say) - who blindly and trustingly gave us their house for a month whilst they were out of the country. Who knew that friends of friends, and friends of friends of friends, could become, simply, friends?

We learned that the welcoming, open hand of kindness could give a sense of home and settledness quicker than a trip to Tesco or a walk down Princes Street ever could. People even seemed happy at work, as if they were not expecting to have a breakdown imminently, or work a 100 hour week on a regular basis. How bizarre!

Wonderful people abound everywhere. We left wonderful people, and found wonderful people. We have wonderful friends in our life for short periods of time and for long periods of time. And of course, family hangs present and stable as a background to our very existence and posterity. 

And soon we will move on again. We follow the road that is unfolding before us, a little wiser, a little stronger, and always more blessed. 

Our little family has weathered it well, with some ups and downs. We feel privileged that a dream has come - and continues expanding - to fruition. Sometimes the stepping-out is the biggest and most unknowing of actions. But your foot keeps landing on solid ground. The next foot comes up, and lands again, taking you forward in ways you would never have thought.

Thank you for the friendship and fun along the way, from across the seas and around the corner.

I shall be telling this with a sigh

Somewhere ages and ages hence;

Two roads diverged in a wood, and I -

I took the ones less traveled by,

And that has made all the difference.

- Robert Frost

when patch adams dies

All of life is a coming home. Salesmen, secretaries, coal miners, beekeepers, sword swallowers, all of us. All the restless hearts of the world, all trying to find a way home. It's hard to describe what I felt like then. Picture yourself walking for days in the driving snow; you don't even know you're walking in circles. The heaviness of your legs in the drifts, your shouts disappearing into the wind. How small you can feel, and how far away home can be. Home. The dictionary defines it as both a place of origin and a goal or destination. And the storm? The storm was all in my mind. Or as the poet Dante put it: In the middle of the journey of my life, I found myself in a dark wood, for I had lost the right path. Eventually I would find the right path, but in the most unlikely place.

Robin Williams in Patch Adams

The outpouring of well-wishing and soul-baring around the suicide of Robin Williams is at once outrageously sad and refreshingly honest. I am reminded that mental illness is no respecter of success or wealth, faith or culture, personality type or background. Mental illness is undeniably complex, lurking as it does in its shades of greys and neutrals, affected by a multitude of variables...as is cancer and heart disease and our own individual reactions to the common cold viruses. But why are we so affected by this one man's death?  Is it that so many of us can empathize with deep feelings of frustration and hopelessness and self-questioning and a dank, heavy oppression that cannot be banished by logic or positive thinking or fervent prayer? Or is it that we find it shocking that someone whom we associate with a certain picture of happiness - exceedingly intelligent, popular, wealthy, hilarious - still finds no reason strong enough to motivate their existence?  

One of the devastating things for the sufferer of mental illness is the disintegrating effect it has on their personality. It's difficult to face the world - especially when you are known by a lot of people in the world - when your own personhood and image feels fractured and shattered. To be a talented actor who can portray other people with depth and humour and accuracy, yet not to be able to know what your own self looks like without this blanketing and mind-numbing depression, must be unspeakably terrible.

We are collectively sad because we realise that the confident and funny persona presented by Robin Williams was not the whole person; we are disappointed that someone was not as happy and buoyant as they appeared, and yet they could apparently hide it so well. To think that the man who acted a medical student who acted a clown to develop a new relational way of interacting with patients with mental health problems could not 'act his way out' of his own psychological morbidity, is distressing. We like to think that if we have insight into our state of mind that we can therefore overcome it. The sensation of loss of control of one's feelings and loss of integrity of one's personality, is something that can be the driver for a person to make a decisive, controlling, terminal action.

Suicide is not artistic or romantic or a freeing action. It is an action signalling a final sense of defeat of the human spirit. There is much to be said about the neurobiochemistry that is affecting someone's decision-making ability in the depths of depressive illness...but it is nothing less than deeply sad that all of us could potentially come to that point where our own judgement and insight are so severely affected by illness and circumstances that perspective is lost.

Remember that your family and friends and patients and strangers with mental illness may be uncomfortable in their own skin as part of their illness. Many have lost, and some will have forgotten, who they were or who they could have been, when their lives were not overshadowed by depression or anxiety or delusional thinking. 

May you find the right path in the most unlikely place.



Check out the work of the real Patch Adams at the Gesundheit! Institute http://patchadams.org/mission

simple silence

Trying to find words to describe what is happening in Iraq and Gaza is futile; to attempt it, from this sterile distance, feels like a further slap in the face to people who are suffering there.

And we remember Afghanistan and Syria, Mexico and Sudan, Nigeria and Somalia.

I feel horror and senselessness, but somehow I hold onto the hope of peace and healing. May we continue praying and acting, hoping and trying, so that we can maintain the integrity of our humanity.

I offer only silence.

the fear of freedom

Freedom is something I aspire to. It was always an elusive dream, a theoretical time and place where I would feel unencumbered by responsibility, constraints, expectations. I didn't have a concrete plan of how to get there; I just hoped that I would muddle along until I found myself in a wide open space where I could breathe easily and my cares would float away. But like all good things, it's hard to come by, and having cares and responsibilites are not excluded in this life I have chosen.

Summer seems so distant in the middle of winter, and as chill winds rob me of my idyll of wearing a few scraps of material and thongs (flip-flops, before you get too alarmed), I remember searing heat and the cooling sea. I feel like an orbiting planet, sometimes being obscured from the sun, wanting to beat gravity and be planted somewhere for a while, steady and sure. Rooted, yet free. Like the seasons and with the predictability of gravity, life will come and go, much of it outside my control. How do I maximise my use of the parts which I can control?

Pursuing freedom is wrought with fear, because, by definition, it means doing away with certainties. It means living with longings and aims, yet trying to be present and grateful in the present. You don't gain freedom by doing what you have always done where you have always been (unless you purely want to feel free to do that with no expectations of anything else. And good on you if you can do that.) It means sacrificing temporary comfort; 'comfort', to strengthen greatly. It is to feel weak and vulnerable, with the hope of greater fortitude gained in the long term. Yet freedom will not necessarily always correlate with feelings of strength and wholeness. It may demand a lifestyle of second-guessing, checking, self-questioning. 'Am I living in freedom? Have I sacrificed freedom for comfort? And if so, is that what I want?'

Freedom, for me, over the past months, has meant preparing to uproot again. It has meant planning to leave the familiar, putting great effort in to achieving the unfamiliar. By making choices we gain a sense of utility and potency. It is a truly great privilege to be able to make choices; it can also be the curse of our age. I am thankful for the experience I have gained of making decisions - big decisions - and seeing them turn out well. This in itself emphasises the freedom I have. We learn how to be free, and we learn that it is not a miracle which is handed us prettily wrapped. We work at freedom.

And is this freedom-seeking just a journal of personal fulfillment? If so, is that a bad thing? Or can pursuing our own ideals free us to be individuals who are more equipped to be a power for good where we are? I sincerely believe the latter, within the context of us being people who actually want to be forces for good and positive change. We are not, however, intrinsically altruistic beings. We seek our own safety and peace, and our families, and we then try to widen our circle of positive influence. Can we be more influential by maximising our own freedom, freeing us to use our gifts or love or money or time to bless others? I think so.

Don't trust financial certainty.
Test job fulfilment and security.
Trust relationship quality.
Remember that health is fickle.

And if all that means loving what you are doing, where you are now, do it wholeheartedly. This is freedom, in all its beautiful scariness. I think we will affect our world greatly if we live with an appreciation of this.

at the heart of it

"Oh, I would just like to go quietly. Peacefully, you know?" Her powdery round face in its wrinkled beauty purses its lips and continues its laboured exhalation. "My husband disagrees, though. He wants me to be resuscitated, and to go on a breathing machine." Her fast, irregular heart rate pings up and down on the cardiac monitor, and I envisage her soft, floppy heart, straining to pump blood into soggy lungs, and thereafter round stiff arteries. She grips the rails of the bed. The papery skin of her hands are pockmarked by the numerous attempts at trying to find a vein beneath her fluid-loaded tissue. She smiles, and looks unafraid, and I make a mental note about how her ongoing care wishes can be sold to a medical team. I marvel at her peacefulness as I ask her difficult questions, and I'm frustrated at the bartering that will need to take place to ensure that this lady receives the most appropriate level of care to meet her end of life expectations. Her blood results indicate she has not been taking some of her myriad medications, and I wonder if the wily old soul has been trying to expedite this moment, in a way which obfuscates her poor husband's responsibility. This husband who has probably lived with this gentle lady since somewhere between Marilyn Monroe marrying Joe DiMaggio, and the release of A Hard Day's Night. For him more than her, separation and loss are the darkest clouds on the horizon.

"Do you have any pain in your chest? Do you feel anxious about your breathlessness?" I do the doctor thing, simultaneously weighing up her symptoms, and trying to address what is actually bothering her at that moment in time. One thing I have learned in this job is that people present not with a clear list of symptoms, but a muddled collection of anxieties and worries and questions and complaints, sometimes among which lurks identifiable, concrete pathology doing its best to evade detection.



But at the heart of it is a lady in her ninth decade, probably taking a calculated decision to avoid most of her twelve or thirteen medications set out for her in a neat pack day-by-day, and seemingly with a penchant for avoiding any more trips to hospital to be needled and prodded and carted around in ambulances, to be told once again to go home and take her tablets. We recognise her wishes, and encourage her to discuss advanced directives with her husband, to help us facilitate her comfort and wish for quiet at this, the encroaching interminable advance of time.

I am not interested in commenting on the rights or wrongs of how we treat (over-treat, under-treat) in our lavishly rich medical systems. I am interested in one old lady and her clear-sighted wishes about her own ailing body. Individuals at the bottom and the top of our society, are also at the centre.