Archive for the ‘life’ Category

What is this?

Seriously, I have no idea! I took this photo just over two years ago but I don’t remember it! I’m not sure if this is a rock, a tree, a fossilised tree, a fallen Roman column…….there are elements which make me think of all of those.

But you know what? That makes this more of a mystery! And I love that! Well, actually, even if I knew what it was, there would still be plenty of mystery. More than what is it, how did it come to be this shape, and how did it come to be lying there? And here’s another one….is that a cave entrance under there? It looks like one.

We humans have a bit of a penchant for mystery, don’t we? Put the word “mystery” in the title of a book, a movie, or an article, and people will be enticed to check it out.

I think curiosity might be my strongest characteristic. I am unceasingly curious. As a child I remember getting two different “part works”….magazines which came out once every couple of weeks, and which you collected together into special binders. One was called “Knowledge” and the other was “Look and Learn”. I loved them both. When I graduated from university with my medical degree, with my first month’s salary as a Junior Doctor, I bought a complete set of “Encyclopaedia Britannica” (It’s in the attic! Can’t bring myself to get rid of it even though I use Wikipedia and all the other internet sources to go exploring these days).

I think this same characteristic contributed a lot to the kind of Medicine I practiced, to the way I worked as a doctor. I always looked forward to meeting the next patient, to hearing their story, to unravelling the mysteries of their illnesses. I loved making diagnoses, and I still believe that skill is THE key skill of a doctor. Without a good diagnosis, you’re stuffed! You can only find the treatment which will work best for you patient if you make a good diagnosis.

AND it doesn’t stop there….because how each, individual patient will respond to this particular treatment is a mystery. We don’t know. Nobody can accurately predict it. Will this person get the benefits that “most” people get? Will this be the person to suffer a serious side effect? Will this person find that this treatment actually does nothing for them at all? The only way to know is to stay curious, to follow up, and to listen carefully to what experience the patient has had since this treatment was started.

You’d be amazed how often that is neglected. A distorted use of “Evidence Based Medicine” claims absolute truths where the doctor thinks they know better than the patient what benefit the patient will experience. There are no absolute truths. Evidence changes all the time….informed by more experiences, more experiments and more studies. Treatments are always context-dependent. Two patients receiving the same treatment may well have two diametrically opposed outcomes.

We have to stay curious.

We have to retain our delight in mystery. And, here’s the paradox, we have to keep trying to discover, to learn and make the best decisions we can in every present moment.

There’s a humility which comes with curiosity and mystery. A humility which is the result of realising that there is always more to know.

So, now, bring all that to this pandemic. How many times have you heard the word “unprecedented” in relation to this disease? Over the course of this year we’ve developed our knowledge and understanding of this virus. Learning how it behaves, how different people respond to it, how we can influence the spread and the patients’ responses. And we are far from done yet.

All that can feel a bit more like frustration and uncertainty rather than mystery and curiosity can’t it? I think that’s true. I’ve experienced, and continue to experience, a lot of both frustration and uncertainty these last few months. But hey, you know my “and not nor” theme, don’t you? I think BOTH of these themes exist – mystery and uncertainty, curiosity and frustration. Becoming aware of them is the first step. Learning how to respond to, and adapt to, them, is the next.

So, I’m reflecting on this today and maybe you might too……how am I responding to the uncertainties, and how might I adapt better to them? How am I responding to the mysteries, and how might I make the most of them?

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You’ve probably looked over the edge of a cliff, or stood on a shore somewhere and seen something like this image. Isn’t it beautiful? You can almost hear the sound of the waves crashing against the rocks and the foaming of the sea.

What I see when I look at this photo is the constant interplay of two distinct media, or elements – rocks and water. The rocks look as if they are dancing a circle dance, with the sea swirling between them. I can almost hear the sound of ceilidh music! (well, I am Scottish!)

The rocks form a boundary. They are the limits of the reach of the water. The water can go no further. It crashes against the rocks, foams, splinters, evaporates, and falls back.

But the water changes the rock every time the two make contact. Look at the particular shapes of the rocks, with their smoothed, yet pitted surfaces. How do you think they came to be that shape? Only by years and years and years of constant interplay between the sea and the rocks.

What isn’t so easy to see from this distance, is that every time the water washes over the rocks it takes into the sea some of the atoms which the rock is made of. It dissolves some of the rock.

The sea changes the rocks. The rocks change the sea. Both in form and in substance. Both in shape and in content.

The rocks and the sea co-create each other, co-shape each other, co-make each other.

Isn’t it beautiful to witness?

All of Nature is like this. All of Life is like this. All of Existence is like this.

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I didn’t really know what this was when I took this photo, and years later, when I look at it again, I realise I still don’t really know what it is. One thing I am sure of, however, is that this shape didn’t appear on the wall all by itself.

I don’t know if it started with a damp patch, then some growth of moss, then some shaping and trimming by someone…..but I’ve never seen anything else quite like it.

I think it’s a great example of co-creation. Human and non-human forces working together to produce something unique, something which could only be produced by the human and non-human forces working together.

Co-creation is one of the characteristics of complex adaptive systems. I know we often think of healing as an individual activity but it’s not. It is always a co-creation with others, with other human beings, with other life forms which are not human, with other energies and forces in the world.

We are co-creators, we humans, and we co-create our Selves, our Lives, our communities, societies, environments. There are even some who now call this period of the Earth, the “anthropocene” – a time when human activities are changing the geological nature of the Earth.

So, here’s the thought worth having……what am I co-creating today?

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It’s tempting to think that time is linear, especially when we look at a calendar and can mark off first one day, then the next and then the next. The sequence seems clear and if it’s Saturday today I know that tomorrow will be Sunday…..”as night follows day”.

So what’s going on when we get that feeling of “a return”? Either a “deja vu” experience where you FEEL you’ve been exactly here before, seeing the same scene, hearing the same words, feeling the same feelings. Or, like now, with a daily rise in Coronavirus cases, followed by a daily rise in hospital admissions, and we think “Oh no, here we go again” and dread we are back to where we were about four or five months ago.

Well, in both those cases, we are joining up some dots with straight lines. We are recognising something, or several things, which are strikingly similar to something we experienced already and we think we have jumped back down that straight line to the past.

But that’s a pretty superficial understanding of Life, isn’t it? Because time isn’t linear. Lived time (as opposed to artificially measured time) goes at different speeds, flying by some days, dragging on others. And lived time is influenced by three different streams…..streams of memories, streams of perception, and streams of imagination. The “I remember”, “I can see”, and “I imagine” actions which never seem to cease…even when we are asleep. That means that events don’t neatly flow from one to the other. They leap, jump, circle round, associate, resonate and echo (amongst other things!)

And here’s the other thing to keep in mind…..Life is a creative process. We are “emergent” creatures, constantly changing, transforming…becoming not being. Every day is a first for us. Every day is a last for us.

So, as people talk about a “second wave” of this pandemic, there is definitely a feeling of “here we go again”. Except a lot has changed since this pandemic began. We can’t go back to the beginning and hit the reset button. (I know, I know, much as many of us would like to!) We bring our changed selves into this “second wave” and that means, whilst there might be much that we recognise, there will be more which is truly brand new.

I thought of this when I looked at this photo of this circular ceiling window, with the paper birds flying round in it. I thought, yes, this is what it is like….cycles and spirals which change with every turn around the circle.

We have learned some things, you and I. Learned some things about our lives, our selves and our societies. We will bring these changes to this new cycle, some in a way which reinforces some of what we learned first time around, and some in a way which transforms what we learned first time into something brand new.

Do you feel that?

Does that encourage you to make any different choices? To act differently? To engage with the problems and the solutions differently?

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The other day I came across this. Doesn’t this look like an entrance to you? The curve of the branch from that tree on the right looks like it forms a perfect arch over towards the tree on the left, and the whole structure looks like a delightful, pleasing, enticing doorway. It’s more than a space. It’s more than a frame. It’s an invitation.

So I step forward, and this is what I see…….

Same two trees, same space, completely different perspective. The doorway has gone. The archway has gone. Over the course of half a dozen steps what I was looking at has literally changed shape.

Well, not changed shape in itself….it’s what I could see which has changed shape. Don’t you think that’s interesting? That the form, the shape, of what I could see could entice me, draw me towards it, only for it to change completely before my eyes, as I changed my position, as I took some steps.

I think this happens a lot. When we do more than look, when we act, when we move, then the world changes around us. And, I’m sure, we change with the world too.

Did the attraction disappear?

No, not at all. But the focus of attention did. I was attracted to the doorway, literally drawn towards it. It sparked my curiosity. But a few steps on, that curiosity had shifted. I was no longer wondering what lay through the doorway, what I might discover if I walked through it. I was standing, astonished. Astonished by two things.

First, astonished that the shape could change so completely. That the doorway could become two trees, one with a branch which had a completely different shape from what I initially saw.

Second, astonished at the actual shape of that branch. I mean, look at it! It does way more than curve towards the neighbouring tree. It suddenly changes course. As if it had hit an invisible wall, and so had to grow now in an entirely different direction.

I can’t see that without wondering…..what’s the story here? How did this shape arise? How did this branch arch itself through the air for a bit, then, suddenly, change so completely? What happened? What influenced this change?

Those are the kinds of thoughts I’d have every day with patients. As they described the patterns of their illnesses, shared their unique stories, I’d be astonished. Astonished at the details of the story, astonished at the coping mechanisms the patient had learned, astonished at their powers of adaptation, and curious…..thirsting to understand, to discover, to know….how had this come about?

What events were there in this person’s life, what impacts did those events have, and how did the person adapt to those impacts?

To understand, I had to shift my perspective. I had to act. I had to take some steps to make an active connection, build a trusting, functional relationship, create a bond of care and attention. Without doing that, I wouldn’t know what I was really looking at.

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One day I looked out over the vineyards and I saw this cloud formation. It looked like a tornado, but it wasn’t.

Now that I see it again, as a photo, I realise that this particular view, due to the phenomenon of perspective, makes this band of cloud look cone shaped.

But it wasn’t cone shaped. It was a band of dark cloud, like a wide path, moving across the sky.

That got me thinking about the whole phenomenon of how things appear to us….how everything has a distinct shape, or form, or looks patterned in a particular way….but that is always informed, or even, determined, by where we are standing….we the observers.

I think we tend to forget about that. Especially with social media where echo chambers are created as the algorithms push similar viewpoints and opinions towards us.

The truth is that we humans see reality most clearly when we share perspectives and communicate them without judging them.

We would all benefit from more diversity in science, in education, in health care, in government. Multidisciplinary and rich, inclusive teams, groups and communities offer us the chance to see the world as it really is….not just the way we are used to seeing it from only our own viewpoints.

After all, there’s a huge difference between a band of cloud, and a tornado!

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In the midst of this pandemic many people are beginning to despair. People are asking questions like “Is this the new normal?”, or “Is it always going to be this way now?”

My hunch is…in response to both these questions….no.

Sure, as we look ahead it can seem like we see more of the same as far as we can see. We humans are great at spotting patterns, but we’re often not so great at letting go of them.

We turn repetitions into habits and rituals. Habits into ruts. Rituals into blinkers. We see the future as being full of what we are seeing in the present. And, maybe, in many cases things can seem like this. But the truth is these repetitions, these habits, these already noticed and entrenched patterns are never permanent.

In the history of the planet there hasn’t been an epidemic, or a pandemic, which didn’t go away. I’m not saying the coronavirus will go away, but like pretty much every other bug, it’ll settle in at a lower level. The pandemic will give way to background presence with outbreaks and flares…much the same way as influenza, colds, and even serious diseases like Ebola. Look what’s happened with HIV? Aids hasn’t gone away but learning how to minimise its spread and discovering better ways to treat it has transformed the part it plays in the world now.

So, I remain optimistic, even if there are days when I’m feeling quite despairing. Who knows how long it will be till it all quietens down, and who knows just what the “new normal” will look like when that time comes?

We just have to be wary of getting stuck into the thought patterns which blind us to the nature of Life – a complex, emergent phenomena which is constantly changing and developing, going ways it’s never gone before.

Life is adaptive and creative. It never just keeps on behaving the way it always used to.

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I don’t know about you, but I find this frieze pretty bizarre….even disturbing. What’s so odd about it is the representation of about half a child…..one leg, half a body, make one arm (I’m not even sure about that!)….and I don’t know what’s hiding the child’s head….a cabbage??

This image immediately reminded me of two things. First, a church I visited in Salvador, in Brazil. In one room the ceiling was covered with latex models of parts of peoples’ bodies….arms, legs, hands, and sometimes even a whole small child…..all suspended from the ceiling, each one created in gratitude for a miracle of healing. I know it was supposed to be a celebration but I found it really disturbing!

The second thing it reminded me of was Roger McGough’s wonderful poem “Bits of me”

When people ask: ‘How are you?’
I say, ‘Bits of me are fine.’
And they are.  Lots of me I’d take
anywhere.  Be proud to show it off.

But it’s the bits that can’t be seen
that worry.  The boys in the backroom
who never get introduced.
The ones with the Latin names

who grumble about the hours I keep
and bang on the ceiling
When I’m enjoying myself.  The overseers.
The smug biders of time.

Over the years our lifestyles
have become incompatible.
We were never really suited
and now I think they want out.

One day, on cue, they’ll down tools.
Then it’s curtains for me. (Washable
plastic ones on three sides.)  Post-op.
Pre-med.  The bed nearest the door.

Enter cheerful staff nurse (Irish
preferably), ‘And how are you today?’
(I see red.) Famous last words:
‘Bits of me are fine.’ On cue, dead.

This is the opposite of holism, and we are all guilty of it…..too focussed on too little. Reality needs to be understood holistically…..bits are never enough.

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We make sense of the world holistically. It might not seem like that sometimes, but, even when we put on blinkers, turn abstraction up to the max, and go all in on reductionism, ultimately, reality leaps up and let’s us know…..there’s something else you need to consider here.

There is always something else.

Knowledge is never complete. Truth is never fully known. Understanding is never full.

I love this photo of a crystal because you can see how the sphere contains a multiple of facets, and you can see that through each facet you can see the others. I think reality is like this. Multifaceted, multidimensional, massively interconnected. There are no clear beginnings, no clear endings, nothing is entirely separate and detached, nothing is closed. Life is an “open system” of continuous flow and change, unceasingly responsive and adaptive to environments, contexts and signals.

Human beings are relational, social creatures. None of us live in isolation. We find our uniqueness in our complex webs of relationships, memories, experiences and imaginings. There isn’t a single facet, or aspect, or characteristic, or feature which makes us unique. Our uniqueness is found in our connections.

And so, this is how we make sense of the world – through pattern spotting and recognition, through images, words, myths and symbols, through abstraction and reflection, and synthesis and integration.

Sense making is holistic.

I think that realisation should keep us humble. It should remind us that none of us ever know all there is to know about anyone or anything.

A couple of the most common things patients said to me at the end of a consultation were “I’ve never told a single other person what I’ve just told you”, and, “You know me better now than anyone else does”. And I understood what they meant…..that they had revealed an important, powerful secret, or memory, which they had felt unable to reveal to anyone else, and the revelation was enlightening……or that they felt they had been heard, understood, even known better than ever before. Yet, I would think “Well, how much life have you and I shared through these consultations? (whether this was the first consultation or the tenth one) And how big a proportion of your whole life do those few hours represent?” Because even when I felt we’d achieved a new, and deeper, level of understanding, I still knew that I only knew a little part of this person’s life.

There is always more to know.

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Continuing on the theme of sense making…….I’m endlessly curious about how we human beings do three things – perceive the world, make sense of life, and influence our day to day experiences of reality. Each one of those contributes to the richness of our unique daily lives. No two of us have the exact same experience at the exact same time and place. Never. We will all bring our previous experience, our memories, habits and distinct patterns of being to the present moment.

I think that perhaps one of the most powerful, and certainly most magical, qualities we have is the power of imagination. Some people seem to think we can separate imagination from the perception of reality very easily, that there is a permanent and impermeable barrier between the two. Sometimes I wonder if there’s a connection between that thinking and what doctors used to describe as “the blood brain barrier”, an invisible border between the body and the brain which drugs couldn’t cross. We know it’s not that simple now. But is there a big stretch between that thinking and the idea that some illnesses are “all in your head”? I mean, whatever did that really mean? I remember hearing someone claiming that for a certain patient “her pain is all in her head”. What did that mean? That it didn’t really exist? That she was either lying or deluded? What a way to dismiss a person’s lived experience. What a way to undermine a relationship of trust. What a way to fail to understand.

I think our power of imagination doesn’t switch itself off and on. Blimey, it even keeps going while we are sound asleep!

Perception is a creative act. It involves memory, signals from the environment, signals from within our own bodies, as well as our creative powers of imagination which enable us to make connections, see patterns and create images which we hope provide us with good representations of the world.

Sense making is also a creative act. Whether we draw on numbers, words, stories, images or similarities, making sense of the world is an act of imagination, a creative act of imagination.

Our daily lives are creative acts. We are much more the active agents of our experience than we realise. We are not blank slates for someone else to draw on. We are not data to be fed into an algorithm. Algorithms, statistics and data do not KNOW us better than ourselves. We are creating ourselves every moment of every day.

This photo is of a public work of art, placed in a square in Malmo. It’s a griffin with a crown. A griffin? An imaginary creature. There are no griffins in Nature. But we respond to this, don’t we? We react to it. It influences us. Part of the genius of this sculpture, I think, is the crown. Placing the crown on this creature’s head increases its impact and magnifies its significance and importance.

I’m well used to living with imaginary creatures. I come from Scotland. And, no, I’m not thinking of the Loch Ness Monster. I’m thinking of the imaginary creature which adorns castles, flags and buildings throughout Scotland.

The unicorn.

A magical, mythical creature of incredible power.

I’m not going to describe my own responses to the unicorn today. Instead I’d like you to notice what your own responses are. When you look at an image of a unicorn, what do you experience? What images spring to mind, what thoughts enter your head, what feelings emerge within you? What do you imagine?

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