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The phrase “everything is connected” immediately appeals to me and strikes me as true.

The first thing I think of is the human being.

Although I was taught Medicine in parts, learning about cells, tissues, organs and even systems separately, it was an almost unspoken given that all the parts were connected. In Second Year of Medicine at the University of Edinburgh, one of the main subjects was Anatomy and we were put into groups of six to spend a year dissecting a human body. Our guide was a three volume textbook, “Cunnigham’s Manual of Practical Anatomy”, along with “Gray’s Anatomy” (probably the most beautiful textbook I ever possessed). I was a bit overwhelmed with the sheer number of pages in these texts and asked one of the tutors “Which bits of this book do we need to learn?” He replied, “Which bits of human beings do you think patients will ask you about once you’re qualified?” “Ah, you mean we have to learn it ALL?” He smiled and walked away.

It would be a full two years after that before I met an actual live patient, but, hey, they don’t teach Medicine that way any more do they?

I don’t remember a single lecture about holism, but somehow it was a core value for me right from the start. However it was over a decade after graduation before I came across “Psychoneuroimmunology” and “Psychoneuroendrocrinology” which were fields of study looking at the connections between the Mind, the Nervous System, the Endocrine System and the Immune System. I think that’s where I first encountered a more holistic science, one focused on “systems” not “parts”.

It was much, much later when I encountered “Complex Adaptive Systems” and both “Chaos Theory” and “Complexity Science”. Somehow I think we are still in pretty early days of developing the sciences of the connections. But it sure still excites me!

As a GP I also had to be aware of the individual patient’s connections between themselves and the rest of the world….their relationships, their work, their housing, their family and so on. Those are threads you never quite get to the end of. I think that makes us humble, that knowing that we will never know all there is to know.

Sometimes it seems to me that our minds are like fractals, vast webs of mirrors reflecting similar patterns of reality to each other. Actually, as I write this I remember “Indra’s Net” – where every drop reflects every other drop. I think we humans are great at spotting patterns, and regularities, and that, combined with our ability to use metaphors and symbols enables us to appreciate the incredibly rich, dense nature of reality.

When I saw this shape on the surface of the water I wondered if it had been caused by a boat, or was it something lying on the river bed? But look at the shape drawn by the farmer who has been working this field. What a gorgeous echo of the shape on the river. One of the things that happens when we appreciate these connections is an experience of beauty and wonder intimately entwined.

One time when flying over the English Channel, I looked down and saw the shadows of the clouds on the water’s surface just before the coast. Ooh, that still pleases me so much to contemplate this image! I love the fragility and impermanency of the little clouds. I love the even more ephemeral nature of their shadows on the Channel. And I love that transition of density of the clouds from the area above the water to the area above the land, how you can see in that the dynamic, ever moving dance of the land and the water and the air. Magic!

What connections have you spotted today?

 

 

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I don’t think of myself as a separate object any more. There is a constant stream of materials, energies and information flowing into me. I ingest some when I eat, I breathe some into me when I inspire. Heat, light, sound, gravity, and many other energies I can’t detect, influence and shape me, some stimulating my senses, some influencing the flow of fluids and elements around my body and into and out of my cells. The way my body and brain have evolved allows my whole being to interpret all these flows, to make sense of them, attach values to them, to allow me to respond and react.

I am changed.

Second by second, minute by minute, day by day and year by year, I am changing. Not a single cell remains the same over my life time. The idea of an “internal environment” is quite an old one now, but more than ever we understand that this is a dynamically changing environment, not a fixed one.

We process all these streams and flows. We create new cells, break down some molecules, make some new ones. We make new connections in our brains, strengthen some feedback loops in our body and weaken others. We make sense of now in the light of the past and the myriad of possible futures.

Then these streams continue on their way. We breathe out certain molecules, subtly changing the mix of gases in our immediate environment. We radiate heat, make noises, and we act.

We send out materials, energies and information into the universe every single moment of our lives.

These flows influence, disturb, change and shape our environment, other people, and all the other forms of life we share this planet with.

So, sometimes, I think it’s a good idea to pause, take stock, reflect, and ask ourselves – what shape are the waves that I’m making?

Because these shapes repeat and echo and ripple out way, way beyond the worlds we can imagine.

What kind of world do we create when we send out angry waves? Waves of fear? Waves of kindness? Waves of joy?

I was thinking about this today because I came across this photo I took at Dunrobin Castle many years ago. The concentric shapes of the ripples in this fountain completely fascinate me. It’s mesmerising. Alongside that, I heard from a couple of people in the last couple of days how much they enjoy my blog posts, and how they have been reading them for years. I didn’t know that. Like any author who publishes a book, I don’t tend to hear from my readers. Yes, I know, some of you hit the “like” button, or make a comment, but I have realised before that only a tiny minority of readers do. And that’s how it should be. After all, when I think of all the books I’ve read and enjoyed in my life, how many of those authors (even just the living ones! 😉 ) have I contacted to let them know that? Almost none.

I know people blog, and tweet, and put posts on Facebook for many reasons, but I think it’s always important to wonder about what shapes the waves are that we are sending out into the world. They will travel further and for longer than you think.

I hope I’m sending you some waves of wonder, some waves of joy, some waves of kindness and some waves of beauty. Because that’s my intention.

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Look at these rocks, dropped here by the river. What caught my attention were the colours. It’s too easy to dismiss rocks as grey and just move on. When I stopped to contemplate them I then started to notice the range of sizes and forms. Some are on the way to becoming pebbles, others are rocks way too heavy to lift. I’m not sure I can even begin to describe all the different shapes.

This, to me, is simply beautiful.

So is this…

….the harvest of tomatoes from my garden with their astonishing variety of shapes and colours, and, take it from me, tastes! (Oh, and, yes, I know that one on the left isn’t a tomato. There are some chilli peppers in this shot too!)

and this…

The Hanbury Botanical Gardens in Ventimiglia – one of my most favourite gardens in the world exactly because of the beauty which emerges from diversity.

Even when you stop to look at the sea (don’t tell me the sea is blue) you can’t help but notice the incredible range of colours and shades. It’s all the more beautiful for it.

Diversity is natural.

Uniqueness is everywhere.

Variety is all around us.

The world is all the more beautiful for its absence of mono-cultures.

I wish our societies were more welcoming, not just tolerant but communities which encouraged uniqueness, which relished the rich and beautiful phenomenon of diversity.

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One of my favourite walks is to the Bracklinn Falls just outside of Callendar in Scotland. At the top of the hill there is this old, rather neglected bench with a view stretching miles across the countryside. There’s something wild about this bench isn’t there? It isn’t neat, polished or even painted but I find it all the more appealing for that. Actually, I took this photo many years ago so I wouldn’t be surprised if the bench wasn’t even there any more. After all, nothing lasts forever, does it?

To get to this bench you have to walk through a forest. Well, the path runs along the edge of a forest, but it’s such an appealing forest that I can never resist stepping off the path and making my way through the trees instead.

The forest floor is here is amazing. I laid down on my stomach and took a few photos, partly to get the view from the ground, but also to feel that whole body connection to the organism of the forest. Forests aren’t just a bunch of trees after all. Recent discoveries about tree communication has completely changed what we know about them. The term “Wood Wide Web” has been coined to capture this idea of a highly networked community of living organisms, constantly exchanging materials, energy and information between them. It’s really wonderful to immerse yourself in an environment like this.

Once you leave the forest behind, the path crosses a patch of open land and suddenly the horizons are the far ones, not the ones just in front of your nose. That feels almost like breathing to me. Inhaling and exhaling. Turning my attention from what is close to what is far. Feeling the closeness and connectedness of the forest, then feeling the expanse and openness of the distant hills and the countryside laid out at their feet.

Once you pass the bench, the path enters another forest which immediately feels different from the previous one. The path begins to snake downhill amongst the trees and I am surrounded by something else – the roaring of the waterfall. You can’t see it from the start of the path. In fact, you can’t see it until you are all the way down through the forest, but with each step the noise gets louder and louder. You know it’s coming, but, somehow, it’s still a surprise when you see it.

I can spend ages there.

Everywhere you look you can see how the water has smoothed the surfaces of the rocks and shaped them into exquisite forms. The rocks wouldn’t be the way they are without the water, and the water wouldn’t be like this without the rocks. It’s an intense, lively, creative relationship. Like most waterfalls, this one is best when it’s been raining. The noise is louder, the speed of the water is greater, the volumes are turned up to max, and you can just feel the power.

It feels like a Life Force. It feels like the energy is throbbing through the whole forest, coursing through your body. It makes you feel intensely ALIVE.

I’ve read many times about the importance of being present, of paying attention to the here and now. It’s a good teaching. In the forest, in the gaps, at the side of a waterfall, it all falls into place. Nature creates an attentiveness and repays your attention with LIFE.

There’s a word for this kind of attention and I think it’s IMMERSION.

It’s good to be immersed in Life.

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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……

……pause.

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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It’s many years since I stumbled across these two trees in a forest, but it’s an image which still captures me every time I see it.

I mean, just look at this….as best I could tell these are two trees growing close to each other in a wild forest. So close that one day they joined together. What began as closeness grew into entanglement. In my photo library I’ve labelled this photo “loving trees”. Of course, I don’t know if trees do love each other or not, but I do know there is a growing body of evidence revealing that trees communicate and co-operate much, much more than we ever thought they did.

I don’t mean to anthropomorphise the trees but I do think this kind of phenomenon reveals something about the underlying life forces which shape our universe. It’s natural for living organisms to connect, to get close to each other, to share and to collaborate. I know the dominant narrative of Nature and Society for many years now has been one of competition with every single plant, insect, animal or whatever fighting for its life and competing with every other creature for the common resources. But competition is just one phenomenon we see in Nature, and it may turn out not even to be the most important one.

I think we haven’t paid enough attention to co-operation and collaboration in our world. Look at human beings for example. Our extraordinarily developed brains absolutely excel at making connections and creating relationships. Human babies wouldn’t survive for long with out these innate skills. We understand the importance of infant-parent attachment much better now. We even know that without healthy, loving attachment in the earliest years a baby’s brain will grow less neurones, and make less connections between them. These early experiences of love, care, attention and belonging set us up for life. Conversely, their lack limits us and makes life a whole lot tougher.

I’m always struck by how you can see in any emergency, whether it be a road accident, someone falling ill in the street, or something even more dramatic like a natural disaster or a terrorist attack, there are always many people rushing to help. It’s a human instinct. Actually I don’t think this is reserved to humans. We can see all kinds of co-operation and collaboration in the other kingdoms of life – other primates, other mammals, birds, insects, flowers and trees. The word “ecosystem” refers to the complex, inter-twined, co-dependent, elaborately connected webs of inter-being, connecting all sorts of living creatures and creating the conditions for life and growth.

I often think we get more of what we pay attention to, so I often think it’s a good idea to pay attention to relationships, to love and to care.

I’d like to see a world where we recognise that co-operation, collaboration and sharing is the natural counter to competition, grabbing and hoarding.

 

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This strikes me as a shocking graph. Oxycodone is an opiate painkiller, and this graph charts its annual consumption from 1980 to 2015.

The first thing is astonishing explosion of consumption in the USA since around 1996, and the second is the contrast between the USA and Europe.

What are we to make of this? Did Americans suddenly develop many more painful conditions than Europeans? Why did their consumption remain pretty steady from 1980 to 1995, then rapidly go through the roof?

The answers, of course, are complicated. They relate to the marketing of products by drug companies in different countries, the differences between cultures and changes in economic and social conditions….amongst a host of other things.

It’s true that whilst the great health success story of the last century has been the decline of infectious disease, the not so great story is of ever increasing rates of chronic, non-communicable diseases. In 2014 60% of American adults reported having at least one chronic disease, and 12% actually had at least five at the same time. A report from the NHS in England and Wales today states that men are being diagnosed with their first “significant long-term condition” at the age of 56, and women at 55. In the poorest areas, these figures drop down to the ages of 49 and 47. It found that women in the UK are living “in poor health” for 29 years, and men for 23 years.

Not all of these conditions cause pain, but what does?

Kurt Kroenke has published many research studies showing that symptoms, including pain, are not good indicators of underlying disease. In fact, he has shown that the top ten commonest symptoms patients present to doctors are all highly unlikely to be associated with clear underlying diseases –

Notice that four of these top ten symptoms are pain.

One question then is what is the cause of this patient’s pain? If there is a modifiable cause, then the best treatment is to deal with that. For example, if someone’s pain is due to a severely arthritic hip, then a replacement hip joint will most likely solve the problem. Sadly, most underlying causes are not that straightforward to deal with. Painful chronic inflammatory conditions and incurable cancers are not so easily dealt with. But it gets more complicated, because we also know there is no direct, reliable relationship between the amount of pain a person experiences and the size, severity or extent of any pathology in their body.

So what do we do?

I suspect that what we mainly do is treat pain as if it is an entity in its own right.

The answer to pain, we think, is a painkiller. It’s just a matter of finding the one which kills the most pain for this particular patient. The trouble is this approach has two particularly unhelpful downsides. Firstly, painkiller after painkiller has been shown to be ineffective in the longer term. The longer someone uses a particular painkiller, the less benefit they get from it. Worse than that, the longer they use it, the more likely they are to suffer harm from it. Secondly, by treating pain as if it is an entity in its own right, we lose sight of the causes of the pain. We lose sight of its origins and its variable, daily contexts.

At a population level we have to address the causes of chronic ill health, including poverty, inequality, poor housing, environmental and food chain pollutants, and increasing levels of insecurity and fear.

At a personal level, people need understanding, support, and reassurance. They need to have underlying diseases treated as effectively as possible, and they need to be helped to develop both their coping strategies and the life skills which enhance the daily quality of life. None of this is possible without adequate consultation times, good quality relationships between doctors and patients, continuity of care, and the treatment of every patient as a unique human being.

There will always be a place for good painkillers, but they are never going to be THE answer.

 

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