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Archive for the ‘life’ Category

Do you get those experiences where something catches your eye, then when you stop to reflect on it, its significance gets deeper and deeper?

Last week I was in Paris, and on one of the rainy days was heading for a restaurant at lunch time but this scene caught my eye. Despite the fact it was raining, I stopped and took a photo. In fact, I took two….the first time my camera slipped as I pressed the shutter and I only caught the top of the scooter!

These electric scooters are everywhere in Paris just now. You can hire one using an app and drop it off anywhere you like. In fact, that’s become a bit of a problem. People are falling over them on the pavements and sustaining injuries, so the authorities are starting to consider new regulations to control them.

I took the photo because I thought it looked funny. To see this serious gentleman either looking down at the scooter somewhat disdainfully made me smile. Then I thought maybe he’s actually thinking about jumping down onto it!

When I got home, I decided to find out who this man is – turns out he is “The Marquis de Condorcet”, a leading Enlightenment thinker and writer, a mathematician and philosopher. One of his most deeply held beliefs was “progress”. He thought we humans, through learning and communicating with each other, would steadily increase our understanding of the natural, social and political worlds, continuously progressing and improving society. “However, Condorcet stressed that for this to be a possibility man must unify regardless of race, religion, culture or gender”

The wikipedia entry on him goes on to say this –

Condorcet was concerned with individual diversity; he was opposed to proto-utilitarian theories; he considered individual independence, which he described as the characteristic liberty of the moderns, to be of central political importance; and he opposed the imposition of universal and eternal principles.

He was a champion of diversity, equality and individual freedom. But he was also a champion of thinking – that progress required us to deepen our understanding of the world and of each other, comparing and reflecting on our individual experiences. He campaigned against slavery and for women’s civil rights.

So, it took an electric scooter to get my attention, but I’m glad I’ve discovered Condorcet. I think we could learn something from him about the importance of values, diversity and justice.

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I recently visited the Chateau de Clos Lucé in Amboise, in the Loire valley. This is where Leonardo da Vinci spent the last years of his life. He was invited to live there by François I in 1516. The king provided Leonardo with a place to live, 700 gold ecus a year, and financed his works, in turn for the pleasure of his company and daily discussions with him. Leonardo only lived three more years, dying in 1519, which is why, on this 500th anniversary year of his death, the chateau is hosting a major exhibition of his work. (As an aside I find it fascinating and inspiring that Leonardo was given free range “to dream and work” – what kind of society could we have if we funded creatives and academics to “dream and work” together, without goals, funding applications or publication demands?)

There are a number of Leonardo quotations around the chateau and the gardens. This one caught my eye –

You know that medicines when well used restore health to the sick: they will be well used when the doctor together with his understanding of their nature shall understand also what man is, what life is, and what constitution and health are. Know these well and you will know their opposites; and when this is the case you will know well how to devise a remedy.

After a lifetime career in Medicine, I’m less sure now that medicines do “restore health to the sick”. I think it’s biology which restores health. Human beings are complex adaptive systems, and all such organisms have both “self-healing” and “self-making” capacities. The best medicines stimulate those natural processes of healing. The next best support the processes. Many of the ones we use reduce symptoms, or reverse an imbalance in the body, both of which are reasonable goals and acts, but are they directly involved in restoring health to the sick? Do you think that’s just semantics? I don’t. I’d have a hope for the future that we’d develop the treatments which really do support and stimulate the natural processes of healing, and that’s what Leonardo says, in other language, at the end of that quotation – “when this is the case you will know well how to devise a remedy”.

When what’s the case?

Oh, yes, understand “what man is, what life is, and what constitution and health are”.

Ah! Well, there lies both the problem and the signposts to the solutions…..

A couple of years into my work as a General Practitioner I started to wonder what health is. Nobody taught us what health is at university, and the clinical training of a young doctor focuses on learning diagnostic and therapeutic techniques – identifying pathologies and treating disease states. I went back and looked at my Clinical Medicine textbooks. I searched the index for “health” – no entries. Nope, not one. That set me off on an exploration, looking for an understanding of what health is. The medical school textbooks were no help. Oh yes, there was that old World Health Organisation definition –

“a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

But all that really does is substitute the word “well-being” for “health”. It does suggest health is multidimensional – physical, mental and social – and it does suggest health is something positive, not just the absence of disease or infirmity. But does it really take us much further that irritating “Brexit means Brexit”?

While researching the issue of the absence of health in medical textbooks, I discovered there was a kind of parallel anomaly….biology textbooks didn’t have a definition of life. Really? Well, yes, it wasn’t uncommon to find a biology textbook without the word life appearing in the index.

So what is life?

One of the more satisfying descriptions I read was from Maturana and Varela’s, living organisms demonstrate a “self-making” capacity, which they termed “autopoiesis” and that lead me down the path of the complexity scientists and their definition of “complex adaptive systems”. I still find that a good starting place.

That leaves us with two more areas to explore, according to Leonardo. What is man? and What is a constitution? Remember he was writing 500 years ago, and we would probably now say “What is a human?”, rather than “what is man?”. Let’s leave constitution aside for just now, as it’s pretty embedded in the issues of what is a human and what is health?

What is a human being?

There have been a couple of books published recently which put this question centre stage again. Douglas Rushkoff’s “Team Human“, and Paul Mason’s “Clear Bright Future“. Both of these books are concerned about the impact of technology on human beings and on our societies. Rushkoff says –

being human is a team sport. We cannot be fully human, alone. Anything that brings us together fosters our humanity. Likewise, anything that separates us makes us less human, and less able to exercise our will.

In other words, he focuses on the innate sociability and need to act co-operatively in human beings. I’ve heard Paul Mason say at least two interesting definitions of what is a human – human beings “use energy to counter entropy” – in other words we are a creative species. And human beings are “co-operative, imaginative and linguistic” – the combination of which makes us a unique species.

All of these ideas are interesting to me. And I find it refreshing that these questions are coming to the fore now. Surely this is a timely and positive response to the mechanical, data and statistics driven reductionism which is so utterly de-humanising.

I continue to explore what it means to be human, and I find some of the more impressive answers in the works of philosophers, from the classical schools to Spinoza, Bergson and Deleuze (to name just a few!)

Of course, I could write about this for hours! Ha! Ha! But I’ll stop here and leave the possibility that these are questions you might like to pursue for yourself.

Let me summarise – because I think this is a lifetime project as well as potentially the basis for a whole curriculum –

  • What is Life?
  • What is a human being?
  • What is health?

The answers which appear from those studies could, possibly, give us the remedies of the future – the ones which actually do “restore health to the sick” – and, yes, more than that, allow us to create healthier societies filled with people who fulfil their potentials, creatively, co-operatively, and artistically…..can I even say “spiritually?”

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I was reading an interview with Harvard historian, Anne Harrington, who has written “Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness”.

When I was at university I was taught there were two types of depression – reactive and endogenous – the former occurring in response to specific events, and the latter seen as an illness of internal origin. It was thought that talking therapies, as they’ve come to be called, were the best way of dealing with reactive depression but that endogenous was a biological problem which required drugs. One of the main themes which emerged from that thinking was the serotonin theory of depression which was the basis for the great commercial success of Prozac, a drug which influenced the levels of serotonin in the brain.

Well, it all changed. Psychiatrists stopped distinguishing between “reactive” and “endogenous” and moved to thinking of all depression as biological and, hence, all requiring treatment with drugs.

But that didn’t last. As Anne Harrington describes, in the late 90s, “a range of of different studies increasingly seemed to suggest that these antidepressants – although they’re helping a lot of people – when compared to placebo versions of themselves, don’t seem to do much better.” As the “gold standard” of drug effect is its performance over that of placebo, and drug after drug was shown not to be that much better, it got harder and harder to bring new drugs onto the market. She says –

“But it doesn’t mean that the drugs don’t work. It just means that the placebo effect is really strong. But the logic of clinical trials is that the placebo effect is nothing, and you have to be able to better than nothing. But of course if the placebo effect isn’t just nothing, then maybe you need to rethink what it means to test a drug”

This is the same observation as Irving Kirsch made in his “Emperor’s New Drugs”. In that book he drew a graph which I found very impressive –

 

 

The point he was at pains to make was the same as Anne Harrington’s – well, actually, he was trying to emphasise that just because the drugs didn’t seem much more effective than placebo didn’t mean that doctors should stop prescribing them. But the main point, I think, is –

Placebo is not nothing

It seems crazy to me that people make decisions about whether or not a treatment should be offered to patients solely on the basis of its statistical difference to placebo if those decisions then lead to the withdrawal of treatments which were helping thousands of patients.

If the placebo effect is not the same as doing nothing (and it is clear that it is NOT the equivalent of doing nothing) then we should be exploring just what it is. That will involve moving on from the stigma of trickery, because that’s how the placebo effect has been portrayed. “Dummy pills”, “inactive pills”, “mock treatments” producing real life changes in the patients who receive them, only to reveal to them that, ha! ha! you got nothing!

I think it’s interesting that it is in the area of psychiatry that this debate has emerged. Because we know something of the power of placebo on our mental states. But as we are whole, body/mind, non-dual beings. What influences our mental states, influences our bodily functions too. Placebo effects are not restricted to changes in mental states, they are seen throughout the body, influencing organs, cells and circulating levels of natural chemicals.

Here’s the other thing – if placebo is NOT the same as doing nothing but a drug doesn’t show a substantial and significant benefit over placebo, then what else can we offer the patient? What else will be at least as powerful as placebo, but less harmful than the drug?

What about exercise, nutrition, the creation of significant social relationships, engagement with natural environments, meditation, learning how to handle our emotions for starters? And not forgetting demanding that we do something about the conditions in which more and more chronic illnesses are emerging – both mental and physical – poverty, poor housing, inequality, polluted environments, industrial, chemical methods of agriculture and food production and so on – have a look at the perspective I described in “There still aren’t enough”, and in “Inequality and health”.

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bandanaEvery day in the UK, we hear stories of ambulances waiting in queues at hospitals. Patients waiting hours to receive attention. Patients waiting hours on trolleys in hospital corridors.

What’s the problem?

Much of the media coverage focuses on the “demand”, by which they mean the sheer numbers of people coming to hospital for health care.

Let me return to the issue of demand in a minute, but let’s start with waiting times. Let’s set targets aside for a moment as well, because targets can be arbitrary and unhelpful.

Why are there queues of ambulances at hospitals?

Part of the answer is there aren’t enough doctors and nurses to attend to the patients’ needs.

There aren’t enough, because if there were, they would be able to devote all the time necessary to each patient but there wouldn’t be a huge queue.

Part of the answer is the staff can’t move patients through from A&E for inpatient care because there aren’t enough inpatient beds.

There aren’t enough inpatient beds.

There are more patients needing inpatient care than there are beds to put them in.

Beds aren’t enough.

Once a patient is in a bed, they need to be cared for….by staff to keep the ward clean, staff to make food for them and feed them, staff to care for their daily needs and staff to manage their diseases and get them well enough again to go home.

So can we fix that first?

  • Increase the numbers of beds available in the NHS to cater for the needs of sick people.
  • Increase the numbers of NHS staff to the level where there are enough of them to meet the needs of sick people.

Wasn’t that the whole point of the NHS in the first place?

To meet the needs of the sick in society.

Let’s turn to demand.

It’s going up.

And there’s absolutely not a shred of evidence to suggest it’s going to do anything other than continue to go up.

The proportions of the population over 60, over 70, over 80, and, yes, over 90 are all rising. All the evidence shows that older people have greater health needs. The demographics of the country tell us that demand will increase.

Life expectancy might be going up, but disease isn’t going down. There are more people suffering from a chronic illness every year. There are more people suffering from two or more chronic illnesses every year. This is what doctors are referring to when they talk about increases in “complex problems and needs”.

All those patients waiting on trolleys for a hospital bed have been assessed as needing the complex care of a hospital to cater for their complex needs.

Not all those patients already in the hospital need the complex care of the hospital. Some of them are elderly, and/or disabled people who are not able to look after themselves at home. They need to be looked after somewhere else.

Here’s the next item on the list.

There are not enough places available in care facilities which are not hospitals.

Places in care facilities, (nursing homes, residential homes etc), need sufficient numbers of trained and support staff to provide the care for their residents. We don’t have enough care facilities.

Let’s think about another aspect of demand. Time and again we hear that many people pitch up at A&E because they can’t get to see their local GP. They are told they have to wait several days, or even weeks, for an appointment so they go to the local hospital instead – with problems which could be, and should be, managed by GPs in the community.

Why can’t people get to see a GP in a more timely manner?

There aren’t enough GPs.

There never have been.

The scourge of General Practice is not having enough time to treat each patient as well as the doctors would like to. Were five minute appointments ever adequate? Are ten minute appointments adequate? Do they give the patient enough time to say what they want to say? Do they give the doctor enough time to listen, to examine, to diagnose, to offer treatment, to give the patient enough information to give informed consent to the treatment, to allow enough time to discuss options and alternatives?

You’ll have a hard time finding someone who can answer yes to that.

There aren’t enough GPs.

And there aren’t enough staff in the GPs’ teams either.

A healthier society

The biggest delusion suffered by those who created the NHS was that the NHS would make the population so much more healthy that eventually demand for it would shrink. That’s never happened. And it’s not likely to happen.

Health care isn’t the biggest contributor to the health of the population.

We need to address the causes of illness if we want to reduce demand. The causes of illness are primarily social, economic and environmental.

  • We need to tackle the isolation of people in our society.
  • We need to tackle poverty.
  • We need to tackle the constant stress of the “precariat” – all those without secure incomes, those on zero hour contracts, short term contracts, those employed for insufficient hours at insufficient levels of pay to meet their daily needs.
  • We need to tackle the food industry, from farming methods, to factory production of foodstuffs, to marketing and sales of food.
  • We need to tackle the chemical industry, to reduce the amount of CO2 in the atmosphere, the amount of plastic in the sea, the number of chemicals found in the blood of every newborn child, the number of chemicals found in drinking water, the number of chemicals in every household.
  • We need to tackle inequality which is rising fast and has been shown time and time again to inflict pain and suffering on millions.
  • We need to tackle conflict, to be able to direct resources towards healthy lives instead of war.
  • We need to tackle our political systems which leave so many feeling disempowered and forgotten. Democracy might be a great idea. Maybe we should try it. Not the pretend democracy of a vote every few years for someone to work in government, but real, relevant, responsive democracy which increases the engagement and autonomy of citizens.
  • We need to find different ways to live together.
  • We also need to tackle the Pharmaceutical industry. That industry which doesn’t exist to produce cures, but profits. There isn’t a drug on the market which increases health. At the very best a drug will support the body’s natural systems of repair and recovery. At worst drugs diminish symptoms without making any impact on the underlying disease.

We need a different philosophy of health care, one focused on health not taking drugs.

That’s an awful lot. Daunting perhaps. But are there better answers?

In summary

This is a toe in the water. There is no way to cover the complexity and extent of the issues in one short article. But can we make a start?

  1. We need more hospital beds, more care facilities, more GPs, more doctors, more nurses and more support and care staff.
  2. At the same time, we need to tackle the causes of the increase in demand – the social, economic and environmental causes.

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jan17

In January each year I like to make my own calendar for the coming year. Maybe it’d be a better idea to make it in December so it was ready to go in January, but that’s not what I tend to do.

The way I do it is to select twelve images from my photo library, one for each month of last year. I select them first because they are images I’m really happy with. After all, I’ll have to look at each of them for a whole month at a time for the next year. If I find I’ve more than one to choose from then what I do next is select the image which evokes the strongest memories for me. That way I’ll recall, month by month, a beautiful, wondrous, or amazing experience throughout the year. Each image evokes memories, but also inspires me.

I find this is a way of harvesting the experiences of one year to inspire the choices I’ll make this year.

It’s really easy to find and collect your own photos. Of course, you don’t need to make an actual calendar. You could simply select and collect twelve images into a separate album on your phone, your pad, or your computer. Or share them on Instagram or Facebook. You choose. Oh, one other tip – file names – as I save each image into the “2017” folder I name it “Jan17.jpg, Feb17.jpg” and so on. Makes it way easier to organise and use them in the future.

I’m a great one for “and not or”, so I make a special album/folder of the twelve images and keep that on my desktop. I use those images to make a physical calendar, browse through them from time to time, and use them on various posts and sharing platforms through the year. The service I use for the physical calendar is Redbubble. It’s not cheap, but it’s really fabulous quality and their service is fast. There are plenty of other web based services out there, or you could print your images at home and make your own calendar by hand. There are also photo print machines in various outlets but I’ve never tried any of them. Have you?

The image above is my January image. I took it one foggy morning in the vineyards which surround my house. Isn’t it gorgeous? Reminds me just how beautiful winter can be, and how amazingly wonderful trees are.

Here’s February –

Feb17

In February 2017 I spent some time with my friends who live in Capetown. We took a few trips and one of my really favourite areas was Franchhoek. It’s like a French enclave in the South African countryside. As I now live in France the unique blending of French and South African culture in Franchhoek really appealed to me.

Mar17

In March I returned to Scotland and had a day out in the Trossachs. Stopping at the side of one of the many lochs I was astonished by the brilliant reflections of the sky in the absolutely still water. This shot includes the rocks at my feet as well as the reflections of the overhanging trees and the clouds above me. It’s quite a disorienting image and that’s what I love about it. Really draws me in to work out just what I’m looking at.

Apr17

April is the time of blossom in my neck of the woods. Cherry trees, plum trees, almond trees….it’s a beautiful time of year. I can’t look at these blossoms without feeling a surge of new life and creativity. At the same time, I’m reminded of the Japanese veneration of the cherry blossom time of year. The cherry blossom doesn’t last long so it heightens our awareness of the inextricable links between beauty and transience.

May17

Last May we were blessed with an abundance of sweet peas. The previous year we sowed a number of seeds but they really didn’t come to much. This year, they were everywhere! That was a lesson. Take your time. Sow your seeds and let Nature nurture them on her own timescale.

Jun17

For my birthday in June we took a trip to Segovia in Spain. We’d visited there the previous year and loved it so much we decided to go back. It’s about an eight hour drive from our house to Segovia so we stopped off in Saint Jean de Luz just this side of the French-Spanish border on the way. Clearly one of the most astonishing things about Segovia is this Roman aqueduct which took water from the hills right into the town centre. The Romans, huh? They knew how to build structures which would last for centuries didn’t they? Long after their empire had gone anyway. I wonder how long what we build now will last…….

Jul17

One of the delights of this house is the “open outlook”. Years ago one of my Dutch friends told me how important it was for her to have “a long view”. She felt that these long views opened up your heart and your soul to the world. I think she was right. I’ve stayed in places where the only view was of the buildings on the other side of the road. I know what I prefer. This particular shot, which I took from the garden in July, is just one of the many photos I’ve taken of the clouds. I could look at clouds for hours. They are endlessly fascinating, constantly changing, and often utterly beautiful. Cloud watching. I recommend it.

Aug17

In August we had a day trip to Rochefort but it was a rainy day. It’s easy to get down on a rainy day and wish the rain would just go away, (unless you live in a drought area, when you might welcome a good downpour!), but you can get some great photos on cloudy, rainy days. These magnificent umbrellas were strung across the main street on market day. Well, you couldn’t really not take a photo, could you?

Sep17

September is a great time to go foraging around here. We took a basket with us and came back with these walnuts, figs and berries. How lucky were we?!

Oct17

There’s a barn owl, or a pair of barn owls, who live in my neighbour’s barn and for the past couple of years, they’ve laid eggs in a nesting hole in the house, above the front door. This year, though, three kestrels turned up and fought the owls for the box. I couldn’t bear the thought of them actually catching one of the owls to closed off the empty box with cardboard. I was a bit sorry not to see the owls so frequently after that. However, in October, one night at sunset, I spotted this little owl perched up on the plum tree. From her shape and call I reckon she was a tawny owl. Lovely photo though, don’t you think?

Nov17

In November we had our first ever trip to Scandinavia, with a few days in Copenhagen. Loved it! I’ll definitely go back. I chose this photo because it’s off the Rundetaarn – I’ve really never, ever seen anything like this. Built as an observatory the internal path is wide enough to drive a carriage up. Now there’s a road I’d never traveled before!

Finally, December –

Dec17

The mulberry tree in the garden begins to shed her leaves gradually, but then one day, usually after an overnight frost, she suddenly sheds most of them, laying this astonishing carpet around her feet. The leaves are so varied in size and colour that I just love taking my time and raking them up. It’s my November/December meditation exercise!

I hope you’ve enjoyed these twelve images and that I’ve inspired you to delve into your photo library and find your own dozen – whether you go on to make a calendar or not.

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We’ve had a very hot, dry spell recently here in the Charente. Temperatures rising to the mid or high 30s (centigrade) each day which made the leaves of the plants curl up and wilt. Then this last week we’ve had rain, wind and storms. Yikes! What chance have they got?

Well, look what all that varied weather has done to this bush in the garden.

First it suddenly bloomed, going from zero flowers to dozens of them over about 48 hours. Then the wind and rain has knocked off more than a few of them.

But when I walked outside yesterday evening and the bush caught my eye I was transfixed.

Just look how beautiful this is! Not just the bush itself but the way the fallen flowers have made a pinkish purple circular rug on the grass around it.

This is the kind of beauty which Nature makes.

In “The Great Work”, Thomas Berry talks about the interplay between discipline and wildness…..between order and chaos (or disorder). This is a great example, I think, of the beauty the wildness and disorder brings…..effortlessly.

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Every year I’m amazed to watch the butterflies appear in the garden the very same day the buddleia bushes flower. I’m convinced they both appear at exactly the same moment. No idea how that happens! Are the butterflies just hanging out around the corner somewhere waiting for the blossoms to appear, then zip round as fast as they can the moment that happens?

However it happens, it’s a delight to see so many varieties of butterfly (and the hummingbird moths, which are incredible creatures!), to watch how they fly in such utterly unpredictable directions, how they spread their wings in the sunlight, or close them up so they look like little leaves.

But here’s one thought which comes up for me time and time again when I see butterflies….they make me more aware of the cyclical nature of life. These little creatures have such different life stages, so different you wouldn’t realise they were stages of the same life. Do we think of them as having a beginning and an end? Starting with an egg, progressing through their caterpillar stages, becoming a chrysalis, then emerging as a butterfly which lays eggs, then dies. Is that the life?

I suppose we do all think of ourselves as having a beginning and an end. But where do we begin, and where do we end?

It depends on whether or not you want to reduce a person to just a physical body. My physical body began with a single fertilised egg and this body will die.

But what about ME?

Do I really think I’m only a physical body? Don’t I have a sense of something immaterial too? A consciousness? A sense of Self? A personality? Characteristics, behaviours, values, beliefs, creative acts, destructive acts? Is there anything I can do which doesn’t ripple out into the world beyond me?

When I look at Rodin’s “The Kiss”, or “The Thinker”, what do I see? The product of the imagination and creative skill of the man called Auguste Rodin. When I listen to music composed and performed by people who are long since dead, isn’t there something I’m sharing there which only they could have created? Aren’t these great works of art the ongoing ripples of unique human beings? Or do you think these are just their footprints? (It doesn’t seem that way to me….these works seem full of life and the potential to continue to create and send out ripples into the universe)

And what about those characteristics, quirks or tendencies that I have which others in my “family tree” also exhibited, even perhaps before I was born? Anyone who explores their genealogy encounters remarkable “coincidences”, talents, life events, behaviours which echo down through the generations. Weren’t those threads present even before the egg which became me even existed?

I think it’s inadequate to narrow a person down to a physical body.

But even if we did, there is still the fact that the body changes continually. It never stops. There is a constant turnover of cells, new beginnings, new endings, every hour of every day. There is a continuous exchange of energy, materials and information between my body and my environment, and we all share the same environment, the same atmosphere, the same air, water…..we are all made from the same molecules, all created from the same “star stuff”.

So it seems to me that beginnings and endings are everywhere……wherever, and whenever, we happen to look.

But it also seems to me that they are nowhere. They just don’t exist. We all emerge from, and dissolve into, the great cycles of the universe.

Beginnings and endings are just where we choose them to be. But we can always make a different choice. We can always take a broader view, a bigger view, a longer view, a more holistic view.

I’m reminded of a song from my school days….it’s by Jeff Beck, and it’s called “Hi Ho Silver Lining” – he sang this truth right there in the opening line of this song…in the first five words……

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