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Archive for August, 2019

“one swallow doesn’t make a summer”

Yeah, I know, but, first of all I was trying to get a photo of about a dozen hyper swallows zipping and zooming this way and that above my head, but, hey, I only got one! And only just!

The fact I only got one (in the middle of a summer’s day, by the way) reminded me of that old adage about how spotting one swallow doesn’t mean that summer has arrived. Which brings me to the subject of anecdotes….

Since the rise of “Evidence Based Medicine” I’ve heard it said many times that anecdotes are not evidence, and that a whole bunch of anecdotes isn’t evidence either. Only rigorous, controlled trials, statistically analysed provide evidence. But my problem is that I spent my working life meeting, listening to, conversing with, and treating, one patient at a time. Each patient came and told me a unique story. Not a single patient told me an identical story to one I’d heard before. I tailored my treatments for each patient according to their unique story and the way things progressed from there was unique, and also unknowable.

I had no way of knowing whether or not an “evidence based” treatment would deliver the promised results in this particular patient. On the grounds of probabilities and experience, of course, I could go forward in good faith and with some confidence, but I learned that I always had to be prepared to be surprised when the patient returned. It seemed that no two patients experienced exactly identical effects of the same treatments. Didn’t matter whether I’d prescribed painkillers, antidepressants, anti-inflammatories, antibiotics (seeing a pattern here?) or whatever, the future course of an individual life was, and always will be, unique.

Unique and emergent.

Emergent – that means the future unfolds as it happens in ways which could not be wholly predicted from the knowledge of the past and the present. All living organisms display emergent properties. It’s a characteristic of all “complex adaptive systems”. 

So, whilst I could never generalise from an individual “anecdotal” experience to apply it to every other patient, the truth is, generalisations can’t be applied to every single patient either.

The tendency to dismiss individual stories as irrelevant to medical practice has always struck me as illogical. Irrational even. It might make sense in a research environment, but the individual story remains crucially important in the clinical one.

In deciding on a particular course of treatment with a patient I’d want to take into consideration what I’d learned was good practice, and what the research evidence had shown about the various different options, but, on the day, in the room, with this unique individual sitting with me, and, maybe even more importantly, when they’d return to report what had happened, THE most important thing was them – their story, their experience, their life.

I didn’t know any other way to practice – it was one patient at a time. Ultimately, the patient was always more important than any data – despite the fact a junior doctor told me, not that many years ago, that she’d been taught “Never listen to patients. They lie all the time. The only thing you can believe is the data”

Nope. That’s no way to practice Medicine!

Oh, before I finish, thinking of “one swallow at a time” reminds me of one of my most favourite books about creative writing – Anne Lamott’s “Bird by Bird”. Recommended.

 

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The Ile d’Oleron is a small island not far from where I live. I visited it a number of times. There’s a pretty village called Chateau d’Oleron with brightly coloured old fishermen’s and oyster farmers huts which are now mostly artists workshops and stores. On my most recent visit I came across this bridge with dozens of oyster shells hung on it, each one inscribed with a wish. The first thing I thought of was the padlocks fastened to the Pont Neuf in Paris which I saw many years ago.

When I looked closer to see what people were wishing for I realised that these oyster wishes were indeed very like the padlocks.

I remember seeing love wishes in Kyoto too –

In fact, most of the wishes I read were for love or happiness, and many of them weren’t really wishes at all, but, more like the padlocks, simply a public declaration of love….two names and a heart, or a date.

Not all the wishes were for love or happiness though. Some were much more specific –

“One house here”!

Which got me wondering about this whole wishing thing.

What’s it about?

Mostly, these are not requests, in the way that a prayer might be. Although some certainly are. I saw a wish for marriage “soon”, no names, just a wish to be married. I saw a wish that a particular child would remain happy forever. Or two names a a hope that their love would endure. But not all were like that.

Most were statements of love or happiness. Declarations of love or happiness. Maybe in some way these were “performative” wishes. By simply, and clearly, stating something, you bring it into being. A sort of focusing. Making love, or happiness, or wellbeing more than just a wish, but a reality, a totem of some kind.

One was even more expressive by making a drawing the centre point, instead of words.

This one says “The song of love”.

I spent quite a while browsing these shells and what, at first, seemed a bit strange, became all the more charming.

After all, don’t they say “The world’s your oyster”?

So, what would you wish for? What would you declare on a padlock, an oyster, a star, or a tree?

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It’s fascinating and inspiring to watch a bud mature into a flower.

It’s a process of unfolding and unfurling. The tightly packed young petals expanding and unwinding as they grow opening up to reveal the flower in all its glory.

From a certain perspective the flower is there already in the small green bud, it’s future path laid out before it. It’s fate, it’s destiny, to become a very particular type of flower, even if it’s individual uniqueness will be determined by an innumerable complex of factors…time, place, climate, weather events, insects and chemicals, natural and manmade in the environment, human hands…..

It’s a beautiful phenomenon. This interplay of the past, the present and the future, bringing into reality a specific creation, a unique single “actual” from the “multiplicity of singularities” of possibilities.

It’s just as beautiful in human beings. Watching the newborn child unfold his or her character, unfurl his or her body, as they grow, develop, mature into the fully expressed uniqueness they are in the universe….it’s awe inspiring.

It inspires me to open, to spread my wings, to choose growth and development, to express the uniqueness that is me.

I hope it does exactly the same for you.

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I took this photo a long time ago up at the Bracklinn Falls in Scotland. As you walk through the woods from the car park, you hear the roar of the water long before you can see it. Once you reach its banks, or stand on the bridge, the “new” bridge from 2010, the “old” one having been washed away by the power of the water in a storm some years before, you can hardly hear each other speak for the noise.

There’s a hint about the power of water in the volume of the noise. There’s another hint when you learn the history of the bridge, see the height of it, and wonder about the day the stream turned into a torrent and destroyed the old one. I’m old enough to remember standing on the old, iron, one. I never imagined it could be washed away. The new bridge, is, I think, even more beautiful than the old one.

What caught my eye in that first scene, was the shape of the rock.

It looks like there is a giant mouth opening up to swallow the water.

In fact, many of the rocks here smoothly sculpted by the power of the water. They are beautiful. The water itself does not run smoothly over this section of its path. It is never still, never quiet, and constantly breaks into foam and bubbles. It’s sort of counter-intuitive to think that water can shape rock, yet it’s obvious too because we see that all around us, whether we are looking at cliffs along a coast line, the rocks along the banks of a river, or even stones which lie at our feet.

One of the things which so delights me about these scenes is realising how the rock has become the shape I’m looking at only by interacting with the water.

It hasn’t grown to that shape all by itself.

Because it reminds me that nothing is the way it is all by itself. Everything we see, everything we are, emerges from an infinity of experiences to become the way it is today.

When I look at these beautifully fashioned rocks I see a relationship. I see a history of water and rock. I see continuous motion.

Which isn’t what you’d expect to see when you look at a rock!

Wow! We live on such a creative planet don’t we?

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What do you see when you look up at a sky like this?

The first things to catch my eye are the patterns in the clouds. I just love seeing these ripples, waves and swirls. I can delight in densities and the transparencies. I love how the blue beyond shows through and appears as lakes, streams and rivers in the white land of the cloud.

Then the next thing that happens for me is noticing that some of these patterns here look familiar. They remind me of something else, in the same way that sketches and doodles do, in the same way that paintings and photographs do. My eyes are drawn to the blue zone in the cloud which I can easily see as a pair of lungs – well, I’m sure that’s at least in part due to my working as a doctor all my life – but the idea of a pair of lungs breathing this cloud into existence delights me! Bear with me for a moment longer, because, and this comes and goes for me, I can then see what looks like a head above “the lungs” with a face looking out towards the right hand side of the image. Sometimes that looks SO clear to me that it almost spooks me out! And then I look again and I just can’t see it.

If you’ve been reading the posts on this blog for a bit, you’ll know what’s coming next……the image sets of a train of thought for me.

This time what I start to think about is creation.

I love to see clouds emerge, change, and disappear before my very eyes. So often they look like a work of art, like a piece of performance art. I see it happen and it amazes and delights me.

This, I think, is the essence of the Universe – creation.

The Universe has been creating since its beginning. As best we know, first elements, like hydrogen and helium, then clouds and densities which form into stars, those sources of all the elements we know….and so on, with the rest of the Universe Story…..right up to the creation of the Earth – as far was we know, the only planet like this in the entirety of existence – yeah, I know, people tell you that there are chances there are other Earth-like planets out there somewhere, but we haven’t found any yet.

And on this Earth, creation continues, with the elements forming into molecules, molecules combining and synthesising to create cells, and so to living organisms, no two organisms living identical lives……to the most complex of living organisms in the universe (as best we know)….human beings, no two of whom have ever been, or ever will be, identical.

And so to this day, this day which has never existed before, and will never exist again, where every event, every experience, every body, is new today.

Creation. It’s the essence of the Universe. It’s the essence of Life. The constant, never-ending, creation of novelty, of emergence, of uniqueness.

Yep, all that from a cloud…..how’s that for a creative thought?

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Sometimes when I look out over the vineyards I can see the rain coming. Like a swathe of grey chiffon dropping down from clouds in the sky to soak the green vines below, or like the wet fingers of the rain gods lightly stroking the face of the Earth.

It’s quite beautiful.

It’s like change manifesting itself, the future showing its hand.

Of course it means it’s time to take the washing in from the line, or to head indoors until it passes, but sometimes, it just appears, then disappears again. I can see it just there on the other side of the vines, then within a few minutes it’s gone, never having come this way at all.

It’s a daily reminder that the future is not predictable.

The French philosopher, Michel Serres, wrote that human beings are creatures which anticipate. He said we are always looking ahead, imagining what might be there, what might be coming our way. I think there’s a lot of truth in that. I know that if I stop to watch my thoughts for a while, some of them are memories, some are old patterns of thought passing through again. But often they are anticipations, thinking ahead to later today, to tomorrow, to next week, month or even the years ahead. None of which exists yet. None of which I can be sure of.

In fact, I’d say that even when I am practising a focus on the present I discover that much of the here and now content of my mind is anticipation – planning, expecting, wondering what if this, and what if that, anxieties or fears, hopes, desires or longings.

Isn’t it strange that we give such attention to the unknown, and unknowable, future?

Yet, isn’t that perhaps one of our greatest strengths? The one which gives us not only the ability to plan, but the power of creativity? The one which enables us to imagine another world? Isn’t that where we get our ability to be prepared, as well as our ability to be active agents of the future?

Wondering what’s coming next isn’t necessarily all about worry and fear. It can enable us to cope, to adapt. And it can allow us to manifest our own creations.

 

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I noticed this little profusion of diversity at the edge of a pavement the other day. Now that I’m reviewing the photo I see really stark contrasts between the natural and the built environments.

On the right hand side here we can see a drain cover cast in heavy iron and imprinted with regular rows and columns of slightly raised boxes. It even looks heavy. It looks rigid. Fixed. You would bet that these covers were produced in a factory. It’s likely that thousands of these almost identical objects were churned out from a production line using a template, or a mould, so that they are as similar as possible. If the factory has “quality control” it’s likely that any which are significantly different from the others will be rejected. The goal is standardisation, efficiency, same-ness.

Human beings are great at this kind of work. We take raw materials from Nature and beat them into the products which we can mass produce. These things are useful. Look at the other useful things human beings have made in this picture. The concrete poured to create kerb stones, drainage paths, and gutters. The tarmac laid and levelled to make roads. The houses built with stone, cement, wood and glass. These are just some of the things which make up our built environment.

But taking centre spot in this image is Life. Bursting out of this manmade environment is a flourishing, a profusion of colour. A tiny, micro-system of flowers. Somehow we know nobody planted them there. Nobody sowed the seeds there. They got there of their own accord, blown in the wind, dropped by animals, carried along by streams of water after a rain. Then they took their chance and growth kicked in. First of all just small green shoots, which grew quickly and diversified. Each developing according to the typical shape of a plant of its species. They look chaotic, disordered, different. You know they haven’t been manufactured.

It doesn’t take long for wild unpredictable nature to make its mark. That’s the essence of Life. That’s the underlying truth of all organisms, including we humans. We grow in unpredictable, diverse ways to create complex communities of Life.

You know, don’t you, that we need all of this. The ability to act on opportunity, the ability to adapt to changing circumstances, the ability to form complex networks of relationships, and the ability to create the environments in which we live.

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