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.

the gift of time

I've just spent the last week recovering from a painful operation. I want to wax lyrical about the enlightening experience of pain and the new appreciation that it gave me for my health. But it was just shitting sore. Literally. I found myself doing what I get annoyed at patients doing: being astounded that one should suffer from such a degree of pain. It seemed almost inconceivable that this level of pain could be associated with a healing process. I found myself resorting to Dr Google in the early hours of the morning when I could not sleep, and latching onto similar stories shared by anonymous others online. I felt like the surgeon had not prepared me for this; his 'you'll be sore for a few days' did not cut it when I felt like could have passed out during a purgatorial trip to the bathroom. 

But I did learn that with pain comes the gift of time. Time slows, as we observe and experience our own suffering. We wrestle with fear that this moment will not pass, or that it will get worse. In the midst of pain, there is a realization of our spectacular human frailty, and a delineating of what we are as opposed to what we think or hope or fear that we are. We may be surprised at our resilience or shocked at our fragility.  It may not be as dramatic as spending the day in bed crying, but rather a more sinister, sabotaging of our greatest attributes upon which we pride ourselves.  We see that our patience with and tolerance of others is largely dependent on our own sense of comfort and fulfillment,  not on our altruism and sacrifice. And of course we can give ourselves slack and 'room to be human' - but our humanness is emphasized,  and its capricious nature depends so much on the stability,  peace and pleasantness of its surrounding environment. This reminds me that my resilience and capacity for goodness - whether that is being kind or patient or listening or encouraging - may largely be products of the general blessedness and beauty and luxury of my cossetted life. I cannot judge others for not displaying this trait or that trait, when often I will know little of the pressure that life is exerting on them that day.

Time was also literally gifted to me. I had to take time off work, and then had to extend that further. I was not able to play with my daughter as I usually would, and my wife carried the main burden of caring for us all. I enjoyed being forced to slow down, though. Walking slower, moving slower, being forced to be aware even of how I sit. It made me mindful of what I do. This was obviously bothersome at times, but it was good too. I could feel the pain, accept it, and then adapt what I did around that, or I could focus on it and get annoyed at it and become fearful of it.

It was, ultimately, a good learning opportunity,  and a reminder that I have little right to think that I know what someone means when they are in pain. Maybe I have a little bit more of an inkling that far and beyond a physical sensation, someone's sleep, mood, ability to think  and act as they wish, may be severely impaired. And with that comes disappointment and frustration and weariness.

If you know someone who lives with some degree of chronic pain,  or any chronic illness, or someone who is having a painful procedure, remember that their 'humanity' may be being tested, and they may be struggling to deal with what they are seeing and learning about their self. This has definitely taught me some empathy, even with the people who listed their weekly progress of bowel movements on haemmorhoidectomy discussion forums.

in the wee hours

It is in the clanging stillness and solitude of sleeplessness that we see ourselves as we are. In glaring sunshine and busyness and distraction and rushing and noise we are comforted by the absence of introspection. Worries and fears are bundled along with our daily regimes; good, comforting regimes, that root and bind us. But when sleep evades and thoughts tumble, we are asked questions by that most fearful entity: ourselves. It is a strong person who can put his arm around the shoulder of that self and say, 'Don't worry now. It will look different in the morning. You are strong and capable, even if you don't feel it at 3am.' It is a reflective person who says, 'Why do you think you are thinking about this now? Do you fear not being completely in control? Or are you just excited?'

It can be a good time, though. It is difficult not to be over-awed by the lack of sleep, and the fear of the vulnerability of reduced energy levels when children demand and jobs beckon and family dynamics need sensitivity and energy to function smoothly. See it as an opportunity for true stillness and quietness, and in that to be thankful. There is the possibility to mindfully consider that for which we are thankful, instead of spiralling down the chute of that of which we are scared or cannot change (in other words, that for which we are not thankful.) It can also be a time of reflection, if that is helpful, to consider the day or the week that was, or the situation or news that is potentially causing some kind of heightened emotional awareness. I am sitting at the end of a week which has contained a string of antisocial shifts, straight into an operation under general anaesthetic, and finishing off with a job interview by telephone as I sat somewhat in pain. A job which I got, and which is slowly starting to sink in, and for which I am thankful. But there are undercurrents of nervous energy and questions and excitement at new opportunity, and some good old pain to remind me that this body is fallible

Use these moments well. Read a book (not one preceded by Face). Write a letter. Write about something you want to do, and tell someone about it. And remember that tomorrow will come and go, whether you are tired or not, but at least you will be able to look back from the routine and commotion and remember the wee small hours and the time you had.

“Listen to yourself and in that quietude you might hear the voice of God.”

- Maya Angelou, 24/5/14

zen habits

I love this guy's blog. Simple. Profound. Blog-tastic.

http://zenhabits.net/act/

blow-your-innards-out tasty thai nom nom

Taken, roughly, from a little cookery book on our kitchen shelf by someone who took it from Thailand. Ergo, no reference. Except Thailand.

mince (100-200g per person. I eat at least 200g)
garlic clove x4
birdseye chillies x6 (+/- 2-4)
fish sauce
white sugar
water or stock
handful of basil leaves
bit of fresh coriander
one egg per person
oil to cook
jasmine rice

nice bottle of wine

side serving of chillies in fish sauce:
birdseye chillies x10
garlic clove x1
bit of lemon/lime juice
bit of fresh coriander

1. Open the bottle of wine (white/rose/red, as you please), and pour yourself a large glass.

2. Prepare the chillies in fish sauce. Chop the chillies quite small. I de-seeded them, but if you really want to blow your socks off, leave the seeds. Crush up the clove of garlic. Chop the coriander leaves. Put it all in a bowl, add a squeeze of lemon or lime juice, and add plenty of fish sauce - enough so that all the ingredients are floating in it. About a third of a soup-bowl's worth.

3. Drink.

4. Put the rice on at this point. I use an absorption method, at a rice/water ratio of 1:1.5. Boil it for 7-8 mins with the lid on, then just leave it on the hob, heat off, until you're ready to eat it. Fluff it with a fork. If it feels a bit too squishy, remove the lid and it will dry nicely by the time you're ready to eat.

5. Drink.

6. Heat up a wok real good. Put in enough oil to fry an egg. Then fry your egg. I like to have the yoke runny still. Do each person's separately, and then keep them warm on a plate in the oven.

7. Drink.

8. Add a good glug of oil to the wok. Heat it up real nice, then reduce the temp a bit. Throw in the chillies and garlic, and be prepared for the blast of smell that makes your skin tingle, your eyes water, and makes you cough. (I should add, if you're cutting up 16 birdseye chillies, you should be wearing gloves. My fingers are still tingling 24 hours later. Probably too late by now. You'll know next time. Guys, be careful which hand you use when you go to the toilet.) Shoogle for a minute. Don't let the garlic go too dark.

9. Drink.

10. Throw in the mince. Stir fry it - don't let it lie. When just about cooked, add the stock or water (c. half a mug), sugar and a generous few shakes of fish sauce. Keep stir frying. Don't let it get dry, but don't let it stew in the liquid. You don't want it getting tough.

11. Drink.

12. Throw in the basil and coriander leaves. Fry for another 30 seconds.

13. Don't drink after that, you alcoholic.

14. Nice big bowl of rice, egg on one half, mince mixture on the other half. Douse it in chillies in fish sauce as required. Be prepared for Bangkok to fall right in your lap. It's all heat and spice and tangy and sweet aromatic all at once.

the rewards of gratitude

Maintaining an attitude of thankfulness is not always easy. Being thankful is; it's looking at situations and people around ourselves and saying, 'I am thankful.' Just do it. This engenders gratitude. But maintaining that is difficult because of distractions. One of the commonest causes of my lack of thankfulness is worry. Worry has the ability to drain energy. It's a fruitless practice that I subconsciously use to maintain the illusion of being in control: if I worry enough, then I may be able to do something to stop the thing happening that I fear will. Worry is part of being human, but excessive worry may be the symptom of a more fundamental anxiety issue.

Probably one of my reasons - whether I realised it or not at the time, I can't remember - for wanting to be more thankful was to try and reduce the amount of worrying I did. Often I found that I was worrying about not feeling as happy as I would like to feel. This essentially was me being anxious that I was not doing the things that made me happy. Because I was not immediately able to change what I was doing to what I thought I would like to be doing, I concentrated on being grateful for the things that I did have and could do. Although the deliberate act of being thankful made me feel more content and fulfilled, it also made me more aware of the things that I could do which were pursuing my 'dream'. Once I was more aware of what I wanted to be doing, I was able to start doing it. For example, I realised that I was missing having a creative outlet, so I started writing. As I became thankful for writing, I did it more and enjoyed it more.

So that was 'my' part in pursuing happiness. But then divine guidance comes into play, too. I was offered a particular job for three months - something I probably would never have chosen myself - which I ended up really enjoying. As well as being an enjoyable job, it also was something that gelled with my longer term dreams (being able to spend time writing, moving somewhere specific that I had in mind). I felt unsure initially when I was offered the job opportunity, but decided that I would be thankful for some of the aspects of it that I imagined would suit me.

This job provided me with the insight into an area I really had little exposure to previously. I was bowled over with how it suited my personality and strengths, and how it enabled my other aspirations. It felt like my decision to be thankful for my current, unsatisfactory situation a few months earlier had opened doors I never expected.

Now, I have a job interview next week in this new area of medicine, situated somewhere we wanted to move to. But...with this comes the potential for new worries. Where will we live? How will our daughter settle? Will we be able to afford another big move? Will our relationships which we have established here, continue? And I am struck that, as I have further opportunity to 'follow my dreams', there is always more to worry about.

It's a great opportunity to learn, though. I see that as we pursue something which is important to us, even if it is not entirely clear how it will end up, there is risk involved. And it makes sense. No dream can be apprehended by simply staying static for forever. There are times for being static and rooted, and which require doggedness and persistence, and these are important skills and attitudes to learn too. I have watched myself going from being thankful, to being slightly amazed at the good fortune that has been allotted me, to starting to worry about what the new good fortune holds. I can smile at myself in this.

And I reiterate my desire to be thankful. A large part of my motivation is to be a father and a husband who is thankful for what he has, so that this can rub off on my family. It is wanting to be a grateful friend who can give back into relationships what is so freely given to me. It is the desire to become a caring practitioner who can use his skills to help others. I don't really believe that by me being unhappy or unfulfilled I can be the best person for others that I can be. This is a long way from my upbringing where I was surrounded by people who believed that the badge of suffering is some kind of mark of honour. I learned that personal happiness is always secondary to others' happiness; any other way is selfish. Sometimes I still feel like being unhappy or melancholy might show some kind of solidarity with the billions of people in the world who are less fortunate than I am.

Maybe I can encourage you to be thankful for where you are at. For the safe and wealthy country that you live in. For your friends and family. For a job that provides a salary. For food on your table. And maybe I can encourage you to figure out more what your dreams are, and to pursue those in an adventurous, loving and constructive way. By this, you can become the best blessing that you can be to the world around you.

If you can solve the problem, what is the need of worrying?

If you cannot solve it, then what is the use of worrying?

Do not be anxious about anything. But in everything, by prayer and with thanks,

present your requests to God. 

Playschool moments

It starts towards the end of her weetbix and berries.

'Papa, Playschool, okay?'

Okay, say I, secretly hoping for this Sunday morning quietness together.

'Papa bring coffee.'

I place my cafetiere, which she has already ritualistically plunged, and cup on the coffee table.  To her, I am now here to sit, quietly with her, for some time. Papa is not working this morning. She roots around in her small collection of DVDs, all of which she knows almost by heart, and then presses the 'open' button and waits for the little drawer to slide out smoothly. She inserts the DVD, less smoothly, and presses the appropriate button (where did she learn this?). She takes the remote control and jabs the largest button, and the screen flickers to life.

'There's a bear in there, and a chair as well.
There are people with games, and stories to tell.'

Here eyes grow wide as the balloons float across the screen, and we sing together.

It is the little moments with her that keep me rooted in the present. Sitting on the sofa, a small, warm body still in her onesie, curling into me. Wriggling feet which push into my thigh. Wild, curly hair smells sweet from yesterday's shower after the swimming pool. Teddy nestles between us, sometimes an arm or an ear held by an ever-less podgy hand. Sweet songs and bright colours parade across the screen, and for an hour, I am hooked in this peaceful, simple world. And it is to be relished. As I see her joy and wonderment at an animation of This Little Pig, she sees how to make finger prints, or an orchestra is produced from kitchen utensils, I too am swept up in simplicity. She spontaneously breaks into a dance, as she repeats the words to a nursery rhyme she doesn't yet understand.

Beauty in this simplicity. Children draw us back to that. This is one of their gifts to us.