Posted in from the dark room, photography on September 5, 2007| 2 Comments »
Honeysuckle, originally uploaded by bobsee.
Can’t you almost smell this?
What’s your favourite scent?
I love the scent of honeysuckle. In fact, I love the scents of most flowers but lilies I can’t be near. The smell is overpowering for me. Makes me instantly nauseous. A strange thing but I’ve met several other people who share exactly the same experience.
I wonder what it is that makes some scents attractive and others disturbing?
Posted in from the consulting room, from the reading room, health, narrative on September 5, 2007| 4 Comments »
When patients consult me I begin the first consultation (after having made my introductions) with some variation along the lines of “Your doctor has sent me a referral letter which gives me some of the background information about your illness but it’s best you tell me your story yourself”. This allows the patient to set the agenda and to tell me whatever they want to tell me in their own preferred order. When they come back to see me for a follow-up appointment I tend to begin with a question like “How’s things?” – deliberately vague and open, again to let the patient tell their story their own way.
I try to write down their exact first words. How they are doing is often captured richly in those opening sentences. For example, something along the lines of “Doing well. Got back to work and really enjoying it now” or “Managed to have our first family holiday in years”, tells me that there has been a significant shift. The details follow but the essence and magnitude of the change is often right there in the first few words.
We use an “outcome scale” with our patients in Glasgow Homeopathic Hospital. “0” means no change; “1” means some improvement, but not enough to be of value in daily living; “2” means improvement of value in daily living; “3” is significant change which has brought a significant improvement in daily living; and “4” is hallelujah, I’m cured!
Whilst it’s satisfying to see that two-thirds of our patients score a 2 or more, these bare numbers really lack the richness of the actual words the patients use. What is more important really is to capture the “story” of the change. The story needn’t be a long one; the first few minutes are usually time enough the hear it because the essence of the story is conveyed literally in the first three of four sentences the patient utters.
Interesting that this issue was on my mind today as I was musing about to capture these changes more systematically, when I came across a post on Lifehack about stories. (This post, by the way is Part 6 in a series about Chip Heath and Dan Heath’s book Made to Stick: Why Some Ideas Survive and Others Die)
This phrase really struck me –
Stories, then, allow us to impart not just our conclusion, but the actual experiences by which we came to that conclusion.
That’s it! I thought. That’s it in a nutshell. Figures are so uninteresting because they present a conclusion. They are thin information. How much richer is the information conveyed in a story!
I can tell you that in all my years of practice I’ve never heard the exact same story twice. It’s by telling their stories, with their own preferred vocabulary, in their own preferred way, that patients convey the experiences of their illnesses to me. And healing is in no small measure a matter of enabling somebody to tell a different story, to start a new chapter with new vocabulary and to develop new themes – positive themes, health themes as opposed to illness ones. It’s such a treat!
Surely we must resist the current trend to do medicine by numbers where individual stories don’t matter, where individual people don’t matter!
Here’s to the richness of stories!
Posted in from the dark room, life, photography on September 4, 2007| 3 Comments »
It is impossible to understand anything in isolation. If you really want to understand something you have to consider it in its contexts or environments. I think that plants make that point beautifully. Think how a plant cannot exist all by itself. Think how it connects to other parts of nature in order to live, to grow and to reproduce.This time of year you can see an amazing diversity of strategies that plants use to spread their seeds.
Wind dispersal can carry the seeds to some pretty unusual places –
Some of those places are more useful to the plant than others –
A quite different strategy is to hook onto passing animals. I’m not sure if this is a Scottish term or not but we call these “burrs” –
These are such vivid ways of showing us the interconnectedness and interdependences of nature.
Humans are the same. We spread ideas, thoughts and even feelings. We can spread them deliberately, or randomly, but in neither case can we control where they’ll end up!
Posted in from the dark room, photography on September 4, 2007| 4 Comments »
Posted in from the dark room, from the music room, music, photography on September 3, 2007| 5 Comments »
Ben Ledi Grey and Pink, originally uploaded by bobsee.
The view from my window…….I find this very soothing.
I can’t see and a grey and pink scene like this without having one particular song play through my mind…..
Posted in from the consulting room, health, life on September 3, 2007| 5 Comments »
Wesley Fryer’s excellent Moving at the speed of creativity blog has an interesting post today on “Measuring Engagement“. Engagement is, I think, a key quality of a healthy life. But what does it mean exactly?
I think of it as being in active exchange with your environment – both consciously and unconsciously; physically, emotionally and spiritually. There are three elements to this –
Wesley Fryer’s area of interest is education. I’m primarily a physician but a significant part of my job is education so that perspective interests me too. I share his interest in web technologies and it’s a Facebook development that seems to have stimulated this particular post. Facebook has measured applications on the basis of numbers of users but is now changing that to measure “engagement” instead – by this they really mean they are measuring a number of ways users interact with an application. Jeremiah Owyang argues that this is not really “engagement” but just “interaction”. Whatever you think about the Facebook model, Wesley goes on to consider how teachers measure engagement in the classroom (as opposed to just participation).
So, all this got me thinking. If I believe that engagement is a key quality in health, how do I know how well that is functioning in a particular patient’s life? Let me explain a little further…….
When someone has chronic suffering, be it pain, breathlessness, depression, whatever, their lives can become much smaller. They can retreat from work, from social interaction, and even from the basics of life – not noticing the world around them, collapsing further and further into a deep, black, hole. As they start to become well again they begin to notice more and respond to more around them, become more active socially and their lives gradually expand. This expansion is one of greater engagement (in illness, the contraction of life is a loss of engagement).
So, here’s my query – how do you know you are more or less engaged in life? Are you aware, when your world is either shrinking or expanding, of what it is that’s changing? What does “engagement” mean to you?
Posted in from the living room, life on September 2, 2007| 3 Comments »
What are the characteristics of Life? (as opposed to those of inanimate objects and the dead?)
It’s a strange truth that if you consult a textbook of biology you probably won’t find an entry in the index for “life” (it’s equally strange that the standard medical textbooks, such as Davidson’s Principles of Medicine, don’t have an index entry for “health”)
Varela and Maturana at MIT invented a word – “autopoiesis” – for what they thought was the key characteristic of living organisms. They explain that autopoiesis means “self-making capacity” and say that only living organisms can do this.
I think Life has at least these two main characteristics –
We are continually perceiving and sensing the world and constantly responding to all the signals we are picking up. We respond to maintain our health (a function known as homeostasis describes the organism’s capacity to maintain internal stability). But we don’t just maintain an adaptive status quo……we grow.
Growth involves development, expansion, and novelty. Growth is our creative function.
Zombies don’t perceive and adapt. Heroes are consciously aware, reflective and responsive.
Zombies don’t grow. Heroes accept challenges and grow in the process.
That’s why I think our true nature is as heroes, not zombies.
Posted in from the dark room, photography on September 2, 2007| Leave a Comment »
Celtic cross headstone, originally uploaded by bobsee.
Maybe it’s because it’s part of my culture and has been familiar to me all my life but Celtic knots, and Celtic crosses are very appealing to me.
Probably one of my favourite symbols in the world is the “yin-yang” symbol but I think the Celtic Cross captures a lot of the same ideas as that Eastern design for me.
I love the circle around the cross itself which creates a very pleasing sense of something holistic but its the Celtic knots which I really love. I love tracing them with my finger, following the curves and sweeping lines, under and over each other, intricately intertwined. Such a strong sense of the inter-connectedness of everything.
I love how there are no beginnings and no endings.
And most of all I love the continuous FLOW of the lines.
Posted in from the dark room, perception, photography on September 1, 2007| 4 Comments »
Patterns in river and fields, originally uploaded by bobsee.
What caught my eye here was how the pattern in the river was so like the pattern in the field. Almost like a fractal or something. And the more I look at this, the more it pleases me.
It shows me how amazing the human brain is, especially at spotting patterns. We’re doing that all the time. They catch our eye and then we wonder “what’s that pattern about? what does it mean?”
I suppose we often don’t get the answers, or we don’t stop long enough to ponder to allow the answer to be discovered.
Here’s something to do today – what patterns do you see around you? And when you see one, could you just stop for a wee while and ponder it?
Tell me what you see
Heroes Not Zombies 