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.

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