Archive for October, 2022

More of…..?

I read a lot of messages online about overwhelmed doctors and other NHS staff, and about patients struggling to access services.

It seems pretty clear there aren’t enough doctors, aren’t enough staffed beds, aren’t enough anything really. There are also similar problems in Social Care which are impacting on the Health Service, but I’ve got another question…..

…..why is there such increased “demand”, which is another way of saying, why are so many people sick?

It’s not just a Covid issue, although that surely has made the situation worse, and will continue to do so through Long Covid and cardiovascular inflammation. The population was getting sicker before Covid. More people are living with more incurable chronic diseases.

Covid reinforced something we’ve long since known…..it hit hardest amongst the poor, those living in inadequate housing, the elderly and what the French call the “precariat” (those living the most precarious lives).

The answer to the question, why are so many people sick, lies in the social, economic and political sectors. Ok, not the whole answer because there are clearly problems with the current Medical Model, of treating diseases more than patients and trying to find “a pill for every ill”.

If we want to tackle the health crisis, we have to tackle what often seems to recede so far into the background that it becomes invisible – the circumstances, the environments, in which people are trying to live.

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Something clearly happened to this tree. Something catastrophic. But look how it has recovered in a completely different way.

It appears that it had a pretty substantial trunk but then fell over and broke in a storm. Either that or someone cut it down. But from the remaining stump and the deep hidden roots it began to grow upwards again. This time, not as a single trunk but three, even four. There are the twins following pretty much the same direction as their larger predecessor, but there are two others as well, one just beyond the twins and a fourth one forging an entirely different path off towards the right in this photo.

Living creatures have astonishing powers of recovery and resilience and their exact paths forward are unpredictable.

Many times patients told me stories of illness where their chances of recovery seemed slim, but they went on, not only to recover, but to develop along completely unpredicted lines. Many times a serious illness or accident brought about a complete reassessment of life and a patient would make big life changes….in relationships, work, housing, even in their most important values.

I don’t think anyone would advise a serious accident or illness as a means to a better life, but what I witnessed again and again was the emergence of a completely new way ahead for those who recovered from a major life threatening event.

As with this tree you just can’t predict how an individual is going to flourish differently.

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Eye to eye

Bang! Something hit the window! I looked up and saw a Robin sitting on the window frame. I took a photo, from a distance, then slowly moved closer taking more photos as I walked. I wanted to try and photograph him before he flew away. I needn’t have worried. He was stunned and recovering, so I sat down in an armchair right next to him and got some really nice close ups.

It took him a while to recover so we had about five minutes or so together, which is a long time so close to a wild creature. But the robin isn’t a timid bird. In fact he’s always flying down to see what I’m up to, whether it’s filling the wheelbarrow or getting the shopping out of the car.

I was willing him to recover. It was quite a bang and I could see he was sitting, just breathing, and looking, and waiting for the healing to complete. I thought, there’s a lesson here, one I learned and practiced many times but a good one to remember. That lesson is –

Healing occurs naturally. We living creatures have an ability, a power, to recover, to repair, to heal. All I ever did as a doctor was support that self healing. Even the most powerful drugs don’t heal. They contribute to healing….maybe a life saving contribution, often a hugely significant, important contribution….but repair and recovery is a natural process and “treatments” aren’t a substitute.

How did I support self healing? By being there, by caring, by making a connection, building a relationship, by listening attentively without judgement, by understanding, by meeting the other, eye to eye, heart to heart.

And that’s what I did with the robin. Sat close, made an eye to eye connection (how often was I taught the importance of eye contact in Medicine?), and maybe more than that….created a heart to heart connection through intention and care….I was willing him to recover.

There was a pane of glass between us, so I couldn’t do what we humans are able to do together…to touch, to hold….the power of laying on a hand. But nonetheless, it seemed to me, it was more than enough to make the connection, eye to eye, and heart to heart, his little breaths making brief mists on the glass.

Is there anything more special, more powerful, than the connection between two living beings, eye to eye, heart to heart, soul to soul?

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What is life?

And what is life? An hourglass on the run
A mist retreating from the morning sun
A busy bustling still repeated dream.
It’s length? A minute’s pause, a moment’s thought.

John Clare’s poem, What is Life? begins with an hourglass, the image of the sands of time constantly running. You can’t help thinking “running out”. A life is short, something we humans inescapably know. We know we are mortal, and we know none of us will have an expectation of more than a couple of handfuls of decades. We try not to think about that, but maybe if we do stop and think about it, maybe because we have a brush with death, we change. We change our priorities and put procrastination off until another day.

Then he describes a dawn, the mist disappearing in the face of the rising sun, because we experience life as a series of days, one after the other. Life is rhythm, cycles, seasons.

For most of us, most of the time, we fill these days with busyness, with habits and routines, rushing from morning to night on autopilot….a bustling, still repeated dream. This is the zombie state I chose for the title of my blog. It’s too easy to miss a life because we fill it with busyness, automatic, unthinking busyness.

Is the unexamined life worth living?

Clare gives us the answer by asking the question “It’s length?” and answering by getting us to focus on “a minute’s pause, a moment’s thought”. This is the “right here, right now” advice, the call to the present, the prod to wake up and become aware, to be more consciously present in this very moment.

That’s a surprising answer to the question about the length of life, but I think it’s a good one. Because the length of a life is affected by its depth.

When we wake up from our automatic zombie state to author our own, unique story, with ourselves as the hero, the main subject, then life becomes richer, more satisfying and more meaningful.

It becomes a full life, a life of constant becoming….evolving, growing, developing into maturity, into flourishing and fruition, always experienced in a present moment.

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Changing perspectives

Whatever we encounter, whatever we look at, there is always more to know, always another aspect to discover.

My work as a doctor depended on being able to understand people, and that depended on being able to hear their story.

To hear someone’s story takes time and requires attentive, non judgemental listening.

I wanted to hear what they were experiencing now, but also to hear how that experience had arisen, what were the circumstances from which this experience emerged and what sense did they, themselves, make of it all.

A very common feedback was “I’ve never told anyone what I’ve just told you. You know me better now than anyone else does”. I knew what they meant but I always thought, and often said, “I’m pleased, but we’ve only spent an hour together and one hour in a whole life is very little. I’m sure there’s a lot more to understand.”

You’re never finished understanding someone. You never have all the information or “the whole story”, because you haven’t lived the life they’ve lived. I found that even when I thought I had a good sense of someone, there was always another layer, another angle, another perspective.

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What we wish for

We all need money. Can’t live without it. And money is very unequally distributed which means some don’t have enough to live on and others have so much they don’t know what to spend it on.

My concern though is that our societies have become too money oriented. Money has become a god. It’s presented as the top priority over all else. We hear a lot these days about debt, both personal and national (although these two kinds of debt are really not alike!) and about “growth”, “wealth” and “profit”, without much detail behind these words. I even heard U.K. politicians talk about creating an “aspiration society” when they proposed reducing taxation for those earning over £150,000 a year.

Aspiration is not all about money. I worked all my life as a doctor and never aspired to earn over £150,000 a year. I don’t know any doctors, nurses, carers, teachers who do. In fact very few people in the world ever do aspire to, or expect to, earn over £150,000 a year. They have other, non-financial motives.

I’ve heard the U.K. described as “U.K. PLC” as if it’s a business. It isn’t. A country is people living together. It’s a community. We should aspire to creating a healthy community which enables individuals to flourish, to develop their talents, to thrive physically, mentally and spiritually.

Somehow we need to put money back in its rightful place – a good servant – because it’s a terrible master. Greed isn’t good. It’s destructive.

Here’s the poet, John Clare – “Poor greedy souls – what would they have/ beyond their plenty given?/ Will riches keep ‘em from the grave?/ or buy them rest in heaven?”

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I’ve started a daily habit of reading some poetry. I’m doing this for two reasons. First, because I enjoy poetry, and, second, because poetry activates the right hemisphere of the brain, and I think we all need to do something to reset the imbalance between our cerebral hemispheres.

Since moving to rural France I’ve encountered the natural world close up much, much more frequently than at any other time of my life, so it seems obvious that I should start this new practice with some nature poets. I’ve chosen William Wordsworth and John Clare.

We were exposed to a little Wordsworth at school….well, daffodils, you know, as I suspect you were too. But it didn’t click. And John Clare? I don’t think we read any of his poems at school.

In my first few days of this practice I’m immediately struck by how often Wordsworth conjures up sounds and music in poetry. Here’s an example…

Or gaze upon the moon until its light/fell like a strain of music on his soul/and seemed to sink into his very heart.

Isn’t that lovely? It conjures up an image, music, and spiritual feelings all at once.

I’m happy to just read a verse like that a let it do its work, as it, like the strain of music he describes, sinks into my “very heart”.

But I’m also struck by how he uses both “soul” and “heart” in the same phrase. They aren’t completely interchangeable terms but they both refer to something deep, and invisible, and important, within us. Something which can’t be observed from outside, which can’t be measured, but which, I would argue, is essential for a good, full life.

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Looking for meaning

Our brains are brilliant at spotting patterns. The psychiatrist and neuroscientist Dan Siegel, author of “Mindsight”, says our frontal lobes are responsible for creating three distinct types of map – “a you map, a me map, and a we map”. These maps are created from the patterns we spot, the shapes, events, habits, behaviours, feelings etc. They are how we recognise ourselves and others, how we know what to expect, and most importantly, how we make sense of life.

We are meaning seeking and meaning creating animals. We are driven to understand, to interpret our experiences and to classify and integrate them.

We weave our interpretations and understandings into the stories we tell others and ourselves.

But we have to remain a bit sceptical. We have to retain the ability to doubt, because sometimes that giant letter “A” in the forest is just three logs which landed precisely there.

That’s the problem with discerning cause and effect. We are complex adaptive organisms, open systems embedded in multiple layered and interconnected environments.

To say that “this” caused “that” is, at best, only a partial truth. There’s always more to know, there are always more factors playing a part. We never know it all.

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The light

I was about to write “What strikes me most about this scene is the light”, then I suddenly had the thought “We can’t actually see light, can we? What strikes me here is the tree and the way it is lit”.

Light travels throughout the universe but the universe remains dark. It floods the Earth but we only see it when it is reflected, and even then what we see is whatever it is that’s being reflected – in this case, a tree.

Even when we look directly at a source of light (don’t look directly at the Sun!), for example when we see a car’s headlights at night, we see the source itself lit by the light – we see the headlights, not light itself.

How can light be so bright yet remain invisible?

C S Lewis wrote about a sunbeam in his shed and compared the two experiences of seeing the beam of light as it lit the millions of dust particles in the air, and of looking along the beam itself to where the light entered into the shed. But, here, I find myself simply delighting in the phenomena of reflection and illumination, how light makes everything we can see visible, but remains invisible itself.

Some say God is like this. They say we can’t see God directly but we see God reflected in the forest, the birds, our loved ones. God illuminates, reflects, brings into existence all that is.

I’ll leave you with that thought for a Sunday morning.

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As above so below

This is one of my most favourite flowers in our garden. It’s a Petunia and it looks like the night sky.

When I look at this I see the stars stretching across the sky above me at night and I think of the old saying, as above, so below, and I think of all the complex, fractal symmetries which exist in our universe.

I pause, I wonder, I am amazed.

One little flower can deepen the joy and awe of an everyday life. It sets my mind soaring up to the heavens, down into the soil of the Earth, flying through the vast web of connections and patterns I live in. It engages me, yet again, with what is greater than me, with The Other, The Divine, with the Life Force.

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