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Archive for April, 2019

Knowing we don’t know

Posted in from the dark room, from the living room on April 30, 2019| Leave a Comment »

Hey look! The hoopoe is back! See him perched up there on top of the wall just outside my window yesterday. I was born and lived most of my life in Scotland, so the hoopoe seems a very exotic bird to me. They aren’t that uncommon in this part of France. In fact, their outline is used as a symbol on the main autoroute from here, through the Charente Maritime to the coast. They are migratory birds, so they disappear from the garden as winter approaches and fly off to Africa. Yesterday was the day they returned. A pair of them. Now I’ve no way of knowing if these are the exact same birds which I saw every day last summer but chances are they are. Two of the things we do know about migratory species is that they tend to travel enormous distances every year, and that they begin and end their journeys in exactly the same locations. What we don’t know is how they do that.
It seemed quite appropriate that I read an article in Le Monde this morning about the tenth annual conference on migration hosted by the Institute of Navigation in London. The main message in that article was that although these are probably the top experts in animal migration what they came to share was what they didn’t know. Oh yes, of course, they’ve got their theories and they’ve even got the results of some experiments. But it seems those very results often throw up more questions than they provide answers. The bottom line is nobody knows how these migratory creatures do it. How do they navigate? Where are their maps? Their compasses? Their GPS units? What are they using to navigate by? The Sun, the stars, the Earth’s geomagnetic field, odours? We don’t know.

Do you find that exciting or exasperating?
I find it exciting?
I love to stumble across what I don’t know. It stimulates the dual senses of wonder and curiosity. And luckily for me, there turns out to be a lot I don’t know!

Many, many years ago I read a lead article in the British Medical Journal about Medical Education. I remember the main message. It was that the one statement which best served learning was “I don’t know”. When a medical student discovered they didn’t know something it served as the driver to find out. Of course, medical education was, sadly, not like that. Instead, when a dozen of us stood around a patient’s bed in the hospital, we all did all we could to avoid direct eye contact with the teaching consultant. Because if he (and it was almost always a “he” in my days) picked us out to ask a question we knew we’d better know the right answer or we’d be mocked and humiliated shamelessly. “Ritual humiliation always worked for me and I’m not about to change” a Professor once whispered to me during a training session in “Problem Based Learning”.

Now, I’m not advocating ignorance. It doesn’t strike me that it’s a good idea to find out what you don’t know then add to that an attitude of not caring! In fact, I’d say it was my understanding that I could never know all there was to know about anyone which made me a good doctor. It kept me humble, kept me curious, and kept me attentive. As well as supplying me with daily experiences of wonder and curiosity.
There’s an opposite, isn’t there? The one which seeks and claims certainty. We often hear people claim that they know things for sure. They might be politicians who haven’t the slightest doubts that they are the best people to make the decisions for us all. They might be journalists who splash across the front pages the news of the latest “miracle drug” which is going to save thousands of lives, or the latest food item which is either going to kill you or make you live ten years longer. They might be people who claim “the evidence shows that…..” and conclude that the evidence reveals certainty so there’s something else we don’t need to be curious about any more. You get the idea.
Again, I’m not advocating ignorance, and I’m not knocking rationalism or science. What I’m saying is that if you aren’t aware of some of the many things you don’t know, then you’re going to pass through life missing out on a whole load of wonder, amazement, curiosity and discovery.

At the end of this piece, the famous phrase of Montaigne pops back into my head. In his essays, time and time again, after describing or explaining something, he’d say “Mais que sais-je?” – “But what do I know?” I love that about Montaigne.

So here’s my recipe for today – become aware of something you don’t know, enjoy the amazement, then get curious, see what you can find out…….

 

  1. become aware of something you don’t know
  2. enjoy the amazement
  3. then get curious
  4. see what you can find out…….

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The embroidered cloths of Nature

Posted in Uncategorized on April 28, 2019| Leave a Comment »

The Botanic Gardens in Edinburgh has been a place of wonder for me for many, many years. As a student I lived within walking distance of the gardens and would take my Medical textbooks there to study. Throughout my life I’ve returned there, and although many parts are familiar it has constantly changed. I’ve never walked there without stopping several times to gaze in wonder at some astonishing plant.

I’m a great fan of “l’émerveillement du quotidien” – the wonder of the everyday – it’s one of my most favourite strategies for a happy, healthy life, and I know of nothing more likely to astonish me than Nature.

I took this photo the other day and I find it both breath-taking and entrancing, so I thought I’d share it with you.

As I gazed on this scene, this poem, by Yeats, came into my head –

Had I the heavens’ embroidered cloths,   
Enwrought with golden and silver light,   
The blue and the dim and the dark cloths   
Of night and light and the half light,   
I would spread the cloths under your feet:
But I, being poor, have only my dreams;   
I have spread my dreams under your feet;   
Tread softly because you tread on my dreams.

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Suppression of the subject

Posted in from the consulting room, from the dark room, from the living room, Uncategorized on April 7, 2019| 2 Comments »

Sometimes I find threads which connect various, apparently completely different, books. Here’s one such example.

I’m reading Alain Juppé’s “Dictionnaire amoureux de Bordeaux”, and one of his entries is about Jacques Ellul, who was a Professor of Law and wrote about sociology, philosophy and theology, amongst other topics. One of his major themes was what he termed “Technique”. I won’t go into that in any detail here. I’ll write something else about it some other time. But here’s the phrase of his which hit me between the eyes – “Suppression du sujet” – the suppression of the subject. This is what happens when we turn a blind eye to the uniqueness of each human being, or when we reduce a “subject” to an “object”. This is an issue close to my heart and I’m going to explore it more, but what immediately came to my mind when I read that phrase were a few lines in the opening paragraph of Marguerite Yourcenar’s “Memoirs of Hadrian“. Specifically, this –

It is difficult to remain an emperor in presence of a physician, and difficult even to keep one’s essential quality as a man.

When I read that two thoughts jumped into my mind. One was how I had never experienced intimidation when I consulted with a patient. No matter whether or not the person was a celebrity, a Lord, or a Professor. It wasn’t that I felt better than them, but I saw everyone as unique, wounded and suffering. But I only thought about that because this is an emperor speaking. The other thought, which I reckon is more important, was the second phrase in the sentence – “…..difficult even to keep one’s essential quality as a man” – there is something potentially de-humanising about health care. It happens when doctors and nurses refer to a patient by their diagnosis instead of by their name. Indeed, not only refer to them as “a case of X”, but treat them that way too, considering only the “data”, the “results”, as important and not the lived experience of this unique person.

When visiting my mum in hospital recently, I overheard one nurse in the corridor say to another “Have you taken the blood from Bed 14 yet?” I thought, good luck getting blood out of a bed!

Sadly it’s not uncommon to witness health care based on the “suppression of the subject”. Outcomes, targets, measurements, doses, and all the technical paraphernalia of machines, tubes and flashing lights can obscure the human being completely.

When I read the sentence in The Memoirs of Hadrian, I wrote in the margin, some lines from T S Eliot’s “The Cocktail Party” –

In consultation with the doctor and the surgeon

In going to bed in the nursing home

In talking to the matron, you are still the subject,

the centre of reality. But stretched on the table

you are a piece of furniture in a repair shop….

All there is of you is your body

and the “you” is withdrawn.

The subject as the centre of reality – is that basis of our health care? Is it the basis of our politics, our economics, our schools, our workplaces? Because if it isn’t….it should be!

This “subject” which Ellul says is suppressed, this “essential quality” of Hadrian’s, this “you” which Eliot says is withdrawn. What is it?

That’s my thought for the day – how do we get to know the subject, the “me”, the “you”, the “self”, the “person”? And how do we make that REALITY the core of our societies?

Because when we objectify human beings we lose touch with reality, and we open the door to all kinds of cruelties and suffering.

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The Power

Posted in from the dark room, from the living room on April 4, 2019| Leave a Comment »

When the water meets the rock, both are changed.
When the waves meet the cliffs, both are changed.
Nothing exists in isolation. Everything which exists constantly influences, and is influenced by, whatever it comes into contact with. And because, ultimately, everything is part of a single vast web, everything which exists manifests the power to bring about change.

I believe in my power. I know I have the power to disrupt. In fact, I want the power to disrupt. I think that’s what I brought to doctoring….intervening, bringing myself into the situation, engaging with someone who was stuck in long established ways of an illness, or suddenly becoming overwhelmed with an acute event….and in that relationship I bring my power. I shift things. I challenge. Pull or push someone into a different perspective. Open a door or two, or at least open a shutter and let some light pour in. I bring that power to my relationships. I believe people are changed, their lives are changed, when they engage with me. I have seen my power upset people, calm people, inspire people, drive some people to despair. I’ve seen my power save a life at a moment when a person hangs between life and death. I’ve seen my power bring happiness, hope, and sadness. I have the power to bring pleasure and the power to bring pain. I believe I’m here to express that power and to learn the skills of directing it towards greater happiness, better lives, a better world even. Yes, I bother about the world, and, no,
I don’t have any greater influence than everybody else,
I know we all have that power,
and I know that I probably won’t manage to bring about the changes in the world I’d like to see, because I’m just me, just only me, and I’m here to live, to experience, to reflect, to understand, to create and to express what only I can.

I believe that, at least potentially, the same is true of every human being. However, it seems to me that a lot of people have no sense of their power and subject themselves instead to the powers of others all the time, leaving them feeling like victims, hopeless, as if the world, or God, or whatever, is against them. I don’t.

I believe in a benign universe. A universe which is the best of all possible universes to enable me, and you, and everybody else to exist, no, not just exist, but to thrive. Yeah, I know. That isn’t the case for everyone and certainly not all the time. A lot of horrendous things happen in this world. A lot of suffering. But I don’t think the universe sets out deliberately to make that happen. I can’t see how Life could exist without the support of the Universe.

I suspect that the power I feel is related to the power of the universe, or maybe even better, to the “vital force”, in exactly the same way as a wave is related to the ocean. It’s not my power. It’s just the power that moves through us all.

My point is – if I have this power, or better, as this power flows through me, then that power will interfere with others – I use the word interfere thinking of waves again, of the interference patterns on water which emerge as different energies set out across a loch. Sometimes cancelling each other out, sometimes doubling each other, but always producing something new, some new, beautiful pattern of interaction, or what the physicists call interference.

Here’s the next bit. If it really is the power of the universe, the vital force, flowing through me, and if in my ordinary, everyday living, I interact with this power (as I believe I do, and everyone does, and every plant does, every life form does, every deep throbbing, heaving mineral energy in the core of the Earth does)….I interact with this power just by being alive. I can’t help it. Even my dying will have an effect. So what can I do? Should I learn to understand it? To become aware of it, to learn the patterns and influences, and develop the ability to create, consciously create with it? Or will I be like a stick floating down the stream? Does “going with the flow” mean switching off? Stopping making choices? Drifting any which way, it doesn’t matter? I don’t think it does mean that.

I think “going with the flow” is more like “not going against the grain”. It’s about learning how life works and learning to surf it, to ride it, the way the Chariot card indicates in the Major Arcana of the Tarot, learning to harness the energies and create the new as the Magician card shows us, learning to see Life uniquely as The Hanged Man card does, and, yes, learning to be the Emperor, fully aware of his power, the power to provide and protect, the energy of Mars, of the Sun, of the Father. And, you, if you are a woman, you understand all this and you are learning to be the Empress, to bring all that beautiful, wonderful feminine, nurturing and nourishing energy of Mother Earth, of the Goddess, of Venus, Aphrodite, of the Mother. Both of us find ourselves in the Lover card, forming bonds of human compassion and care, and, ultimately, we see our powerful selves in the image of the World Dancer, as portrayed in the World card. Because there’s the next part of this understanding. We aren’t split into two utterly different types of creature, one manifesting only “the male principle”, and the other, “the female principle”. Rather, we are all the result of the constant interplay of both of these fundamental forces. As we see, beautifully represented in the symbol we call the “yin yang symbol”.

I like the imagery of the classic tarot cards. They convey a rich history of symbolism which, like all great art, can provoke and inspire. There’s one more card I’d like to mention here – The Wheel of Fortune. Chance. You see, I can’t see the future. Nobody can. I have no way of knowing what paths will open up, what opportunities will emerge, which will disappear, which doors will open, which will close. All I can do is to act with Good Heart. With what some people call a Big Heart, a heart “big enough”. I can play my hand then pay attention to see what others play, wait to see what will emerge now. So sometimes, I know, I am an obstacle to others. Sometimes, I know, I am a trigger of distress. I can try not to be. But I could only really manage it if I became utterly insignificant to them. It’s like The Little Prince and the fox, isn’t it? That wise fox who warned The Little Prince that once they created a bond, they created the potential for tears, for unhappiness. We don’t miss the people who never touched us, and who we never touched. Good Heart, Big Heart, the fox’s bonds, I think they are all referring to a way of living – bringing love to the power.

It’s impossible to avoid sending out waves to the universe, waves of energy, of molecules and of information. Isn’t it better to accept this power? To get to know it a little bit more every day? To learn how to live with it, to learn how to live in it.

More than that, to learn how to bring Love to it. I think we can all do that. Fashion, shape, influence the power which constantly flows through us. Fashion, shape and influence it with Love, so that it emerges into the universe heart shaped.

One day I saw a sign in front of the wall of the Higashi Hongan-ji Fushimi Betsuin Temple in Kyoto. It said “Life is living you”. That makes you pause, and think, doesn’t it? Say it again – “Life is living you”.

I think the best thing I can do, day by day, is try to bring love to life, so that I can feel this loving life force living me.

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