Archive for the ‘from the consulting room’ Category

You know I think that, especially in times like this, we think of life as being incredibly fragile. It’s easy to see it as transient and fleeting, subject to being extinguished in the blink of an eye.

All that might be true, but there is an opposite equal truth.

Life is an incredible power.

Maybe life is one of the most, or even, THE most powerful force in the universe.

At one time this planet which we all share had no life on it all. Now you can find it everywhere.

Some of the most successful life forms are micro-organisms. They have spread into pretty much every single ecological niche you can think of. You find them in volcanoes. You find them on the deep sea bed. You find them under metres of ice.

There’s even a theory that single celled creatures like bacteria got together to create multicellular organisms – including, eventually human beings. Did you know that there perhaps ten times as many bacteria in your body than there are “your” own cells? Each of us is actually a symbiotic community of cells.

Astonishing (and a bit creepy too somehow!)

There are regions of the world where there is a huge diversity of plants. The Fynbos in South Africa is one of those. Periodically fire burns through that region destroying all the flowers, but the heat from the fire stimulates the germination of seeds in the soil which then spring up as flowers. Some of the species of flower which appear haven’t been seen for decades. Some were thought to have become extinct. But no, they come back to life (or maybe the were never dead?)

Albizia Julibrissin, the Persian Silk tree, taken to London in 1793 was thought to have disappeared but after the German bombing of London in 1940 its seeds germinated and it began to grow again – 147 years later!

I’m sure we’ve all lots of experiences of flowers popping up in the most unlikely places!

The photo I’ve shared at the beginning of this post, of the little flower appearing in the forest floor, reminded me of all that.

Yes, life is delicate and fragile, but it is also THE most incredible force in the universe. We would do well to remember that.

I think that’s partly why I don’t like all the war language which is being used during this pandemic. We are not at war with corona virus. We are, I hope, learning how to live with it. There are already scientists telling us these pandemics arise because we haven’t learned to live with all the life forms on this Earth, that our destruction of habitats and environments, our pollution and urbanisation, are the root causes of the emergence of this particular pandemic and will remain the cause of the future ones unless we learn to respect Life and to learn to live together, learn to adapt to life together on this little blue planet.

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This is probably one of the most familiar shapes you know. We humans evolved from a life in the trees and both individual trees and whole forests hold a lot of meaning for us. In fact, you could probably argue that these are such familiar forms that we pass them by, almost, or even completely, un-noticed.

Trees are the lungs of the Earth. They capture the carbon dioxide in the air, extract the carbon, and push oxygen out into the atmosphere. See this shape? Inside your lungs you can see pretty much the same pattern. The difference is that trees produce individual leaves along their smaller branches, but our lungs end in what look like little bunches of grapes. Both these structures are designed to present the maximum surface area to the air. This particular form maximises exchange. In the trees it maximises their ability to capture carbon dioxide and sunlight, and to send out oxygen. In humans it maximises our ability to get oxygen out of the air and into our blood, and to get carbon dioxide out of the blood and into the air. Nice symmetry, huh?

We use this same tree-like structure to organise our knowledge too. Think of genealogy, using what we even call a “family tree”. Or of any system of classification, which breaks the whole field down into ever bifurcating, diverging parts. You’ll have used that too when you make an outline to help you plan a document, each chapter divided into sections and each section divided into subsections and so on…

But there is a limitation to this model. It is based on separation. At every stage there are more and more divisions. By the time you get out onto the twig at the end of a branch it seems to be connected only by traveling back along the twig, branch and trunk, retracing the divisions to bring the flow together – just like you see as the many streams and little rivers flow together towards an estuary.

This separation is true. It’s a fundamental characteristic of reality. But there’s another form just as fundamental, which maybe we neglect.

The web of nodes and links.

In networks we see a different way of connecting. The human brain has more specialised cells (neurones) than anyone can count….it’s billions – can you imagine what billions of anything look like? It’s pretty hard. But wait, it gets even more mind boggling than that. Every single one of these neurones establishes direct connections (synapses) with thousands of others. Thousands. That means the total number of connections in the brain is in the trillions…..nope, I can’t imagine what that looks like either!

There are networks everywhere in Nature. From inside our bodies and brains, to local ecosystems, to the entire “biosphere” of planet Earth.

I’m fascinated by networks and I’ve written a few posts which gather together some of the most influential books I’ve read on this subject. Have a look at this, at this, or this.

The thing is the tree-model isn’t the only one which helps us to understand Life, the network model is needed too. I find that a lot. It’s not a matter of “either/or” it’s a matter of “and”.

That’s become my mantra – “And not Or”.

It helps me to focus on the connections, to understand what holds opposites together, and to keep returning to the perspective of the whole…..whether that is a whole, unique patient, or a whole, unique Earth.

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When I lived in Cambusbarron in Scotland I looked out of the window each day and saw Ben Ledi. I quickly realised that this mountain looked different every day, so I started taking photos of it. I took a LOT of photos.

I was constantly amazed how my usual experience was not of looking at the same scene every day, but seeing a different scene.

I know, maybe you are thinking, but it’s the same mountain. It’s just the clouds and the light which is changing….

But the mountain doesn’t exist by itself. It exists in a place and a time. I can’t see the mountain disconnected from the world in which it exists. That wouldn’t be real, would it?

I think the world is like this.

Absolutely everything is connected. Absolutely everything exists in webs of contexts and environments.

It changes moment by moment. Everything we see, hear, smell, touch and taste changes constantly as the streams of molecules, energies and information flow through, influencing, creating, disrupting.

So, today is always new.

This moment is always new.

We humans are good at doing something called “abstracting”. We isolate a part of what we are experiencing and consider it as if it is separate, disconnected, un-attached. We call these abstractions “things” or “objects”. Or we call them “outcomes” or “results”.

But we have to return our abstractions to reality eventually and then we seem them as less isolated, less fixed, less separate than we thought.

I never felt I could understand a patient by isolating their disease from their life. I never felt I could understand someone’s illness if I considered only the changes in certain cells, organs or tissues.

When we tell our stories, part of what we are doing is describing some connections…..some sequences, some consequences. We describe events, experiences and emotions, and together they combine to make every day, every moment, every place and every relationship, unique.

What did you notice today?

Was there something familiar which you experienced differently today?

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With all the “social distancing” that is going on, and being urged upon us, I thought it might help to remember this line from Saint Exupery’s “The Little Prince” –

The important things in life you cannot see with your eyes, only with your heart.

I don’t really like the term “social distancing” because I think we need each other now more than ever.

What’s important during this pandemic is to reduce the time you spend in the same physical space as other people. The more physical contacts you have, the more chance you will catch this virus and spread it to other people. A French official put it well the other day when he said – don’t think how can I avoid catching this, think how can I avoid spreading it to everyone else?

I think that’s a useful flip because people spread this virus without having any symptoms, and while, chances are if YOU get this virus then it won’t be serious, for about one in every five people it will be. Reducing your physical contacts now is the most caring thing you can do.

But that does NOT mean to minimise your relationships.

More than ever this is a good time to tell the people you love, that you love them.

Now more than ever this is a good time to share…..to share thoughts, to share feelings, to share our stories.

We humans are perhaps THE most social of all creatures. We die without social contact. So let’s pay attention to that and increase our communications. Phone more, text more, FaceTime, or Skype more, blog more, instagram more, WhatsApp more…….whatever means you have at ¬†your fingertips use them now.

Have you seen any of the video clips online of Italians or Spaniards on their balconies? Singing, cheering, banging pots and pans…….all saying “we are here, and we are in this together”.

As we minimise our physical contacts for now, let’s over-compensate for that, by increasing our “invisible” ones, the ones we can see only with our hearts.


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There’s one thing this pandemic is showing us – we all share the same world.

We all live in this Earth together. What begins in one place quickly affects all the other places.

This infection will run its course, and it will fade away, but I think it’s pretty likely there will be other episodes like this.

Modern medicine often boasts of its success in conquering bacteria. With the invention of antibiotics we had begun to focus on “non-communicable” diseases instead – heart disease, cancer and so on. But we never really had the equivalent of antibiotics for viruses. We have some (as in HIV treatment for example) but we still can’t treat the vast majority of viruses. Maybe one day we will have the treatments. But look what’s happened with antibiotics….. because we’ve been misusing antibiotics in farming and in treating viral diseases which don’t respond to antibiotics, they are losing their power. We need a different model of health care.

Is there a Health Service in the world which has enough resiliency and adaptability built in to cope with these waves of illness? It doesn’t look like it, though it was pretty amazing to see the Chinese building whole hospitals in six weeks. For most of the world these services are run on a bare minimum (or below) basis. The truth is we don’t have enough doctors, enough nurses, enough hospital beds, enough equipment. And that’s what this particular virus is revealing. Although only a small minority of people will get seriously sick with it, the actual numbers overwhelm the hospitals and services very quickly. And once they get overwhelmed then everyone who gets ill loses out.

This pandemic is revealing other things too – it’s not only health care which is threadbare and inadequate. From the globalised “supply chains” of goods, to the daily vulnerability of workers, families and small businesses, resilience and adaptability are seriously ¬†lacking.

I know that for now the priority is to try to slow the spread of this virus and to treat and care for as many of the sick as possible, but soon it will be time to ask ourselves what we can do to make a better world.

  • What are we going to have to do to adapt?
  • What can we do to be more resilient?
  • How can we look after each other better?
  • What should we change?

How about we explore these questions together in the days and weeks ahead?

Meantime……from midday today I’m in lockdown here in the Charente. France has closed all the bars, cafes, restaurants and all “non-essential” shops, and now it’s quarantined most of us in our houses. I’m not afraid but life is not going to be “normal” for a long time. So, here’s one thing I can do – share my beautiful photos, my daily “√©merveillement”, and my caring heart more often.

I’ll be posting more regularly from today.

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You know these seeds which helicopter down from the trees? Strangely one-winged and decidedly “wonky” looking?

Well, maybe humans wanting to make something which would be carried on the wind wouldn’t design it like this, but, hey, Nature’s designs are the best!

So, sometime, maybe last autumn, this little seed spirals its way from a tree, who knows which tree, and tumbles and flies and skips and zigzags its way through the air, to land here, on the forest floor. Then, a few months later, who knows how it knows, it wakes up, yawns and starts to stretch, feeling that Spring is around the corner.

And look at it now!

Out of the pod uncoils a long stem, probing down through the moss to find nutrients, and begin to grow itself into a tree!

I mean, do you ever stop and consider something like this?

Have you any idea how it happens?

We can’t even tell if an individual seed is alive or not, is viable or not, until it wakes up and begins to develop. Isn’t that incredible? That we can’t even tell if it alive or dead? Nobody can.

Then how do the cells start to divide and “differentiate”? That means start to develop into the different cells which will produce all the different parts of the tree.

One of my most favourite and most memorable lecturers at Edinburgh University was the Professor of Anatomy, Professor Romanes. He used to start a lecture with a box of coloured chalks and one of those giant rotating blackboards which gave you one screen after another. By the time he finished he’d produced what were no less than works of art showing each different kind of cell, each different kind of tissue, in a different colour. We were transfixed.

He gave a series of lectures on embryology taking us through the various stages of development of a foetus from a fertilised egg cell to a ready to be born baby. I remember thinking at the time, and those thoughts are still with me, “how on earth does that happen?”

I mean, how on earth does a single fertilised cell divide and multiply and differentiate to produce all the organs, all the tissues, all the parts of a human body, and every one of them in the “right” place?

It utterly amazed me.

It still does.


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When I left rural General Practice in Southwest Scotland to join my friend Sandy in the big city of Edinburgh I swapped villages, farms and fields, for busy streets, blocks of flats and the noise of a city life. Sandy and I had a small Practice initially which was split between two different parts of Edinburgh – Portobello and Mayfield Road. In those early years there were two distinct communities of patients, one in each area, and the ordinary everyday involved a fair bit of doing house visits in both parts of the Practice, as well as driving from the one area to the other to deliver clinics in each of our Practice premises.

There was a link between the two. Well, I know there are always many different roads to choose between any two destinations, but one of my favourite ways to travel between them was a small road looping round the base of Arthur’s Seat in Holyrood Park. It was like a small voyage through the countryside between two webs of city streets.

Arthur’s Seat is a such a presence in Edinburgh. It’s an ancient volcano and dominates the entire city. Holyrood Park, in which it sits, has several small lochs which invite you to sit by the water for a while. General Practice work is, however, busy, busy work, with plenty of demand, lots of patients to see, homes to visit, every single day. Sometimes, often in fact, I’d feel on the edge of being overwhelmed by the long list of visits to make and tasks to perform, all with an ever present pressure of time. I’d drive between the two premises via Holyrood Park and sometimes I’d see an empty park bench.

An empty park bench.

Can you imagine the feelings of longing, the huge surge of desire, the unattainable wish to stop and sit on that bench?

It could become like a life goal. “One day I’ll stop and sit on that bench and just do nothing. Just for a bit. Not forever, of course, but without a deadline, without a need to be somewhere else in a few minutes time.”

I never sat on that bench.

Years later, on holiday in France, I saw this old sign on the wall of a small village house –

“Gently in the morning, not too quickly in the evening”

I thought of that park bench when I saw that and I thought…..”one day!”

Much later an Italian friend of my mine told me about “Dolce far niente” – doing sweet nothing – and I realised it was the same thing.

How life can be so utterly full of busy-ness that there just never feels like there is time to stop, time to pause, and just be. (Ha! Ha! What sprang into my mind there was Bart Simpson saying “I’m a human being, not a human doing!”)

This is such a deep human need. I think we find it in all cultures. Although often we have to justify it to ourselves as a “time of contemplation”, “a few moments of mindfulness meditation”, or “a time to reflect”. Now, I think all those things are great too. I think they all have the power to bring quality to our lives, but they aren’t the same as slowing down to the point of taking a pause, and just….being.

We need to “Mind the Gap” – need to find those spaces between one task and another, the spaces between one breath and another, the spaces which exist between the end of one thought and the beginning of another.

I wish I’d paid more attention to that. I think it would have been good for me. But, hey, it clicked eventually, and even now when in retirement a day can fly by filled with “things to do” and “things which need done”, I remember to stop sometimes, and……


When I stop to enjoy a pause now, I don’t try to “empty my mind”, or “still my thoughts”, or “focus on my breath”, or anything like that. I just start to notice. I hear bird song, like the bird which sounds like a squeaky gate (I’ve never seen that bird but I hear it often!), or the flapping wings of a pigeon flying overhead. I hear the sound of the wind in the vines. I feel the temperature of the air on my skin. I smell the newly cut grass. I see the ever changing shapes of the clouds in the sky.

Then I carry on and do what I was intending to do next. But I’m back.

Back into the present instead of lost in the memories and imaginary futures where I was before the pause.

Back here in the real world from the world of thoughts and concerns which was filling my life before the pause.

I feel re-connected.

Who’d have thought stepping out of the flow for a spell was the best way of being in the flow?

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