Archive for the ‘photography’ Category

“one swallow doesn’t make a summer”

Yeah, I know, but, first of all I was trying to get a photo of about a dozen hyper swallows zipping and zooming this way and that above my head, but, hey, I only got one! And only just!

The fact I only got one (in the middle of a summer’s day, by the way) reminded me of that old adage about how spotting one swallow doesn’t mean that summer has arrived. Which brings me to the subject of anecdotes….

Since the rise of “Evidence Based Medicine” I’ve heard it said many times that anecdotes are not evidence, and that a whole bunch of anecdotes isn’t evidence either. Only rigorous, controlled trials, statistically analysed provide evidence. But my problem is that I spent my working life meeting, listening to, conversing with, and treating, one patient at a time. Each patient came and told me a unique story. Not a single patient told me an identical story to one I’d heard before. I tailored my treatments for each patient according to their unique story and the way things progressed from there was unique, and also unknowable.

I had no way of knowing whether or not an “evidence based” treatment would deliver the promised results in this particular patient. On the grounds of probabilities and experience, of course, I could go forward in good faith and with some confidence, but I learned that I always had to be prepared to be surprised when the patient returned. It seemed that no two patients experienced exactly identical effects of the same treatments. Didn’t matter whether I’d prescribed painkillers, antidepressants, anti-inflammatories, antibiotics (seeing a pattern here?) or whatever, the future course of an individual life was, and always will be, unique.

Unique and emergent.

Emergent – that means the future unfolds as it happens in ways which could not be wholly predicted from the knowledge of the past and the present. All living organisms display emergent properties. It’s a characteristic of all “complex adaptive systems”. 

So, whilst I could never generalise from an individual “anecdotal” experience to apply it to every other patient, the truth is, generalisations can’t be applied to every single patient either.

The tendency to dismiss individual stories as irrelevant to medical practice has always struck me as illogical. Irrational even. It might make sense in a research environment, but the individual story remains crucially important in the clinical one.

In deciding on a particular course of treatment with a patient I’d want to take into consideration what I’d learned was good practice, and what the research evidence had shown about the various different options, but, on the day, in the room, with this unique individual sitting with me, and, maybe even more importantly, when they’d return to report what had happened, THE most important thing was them – their story, their experience, their life.

I didn’t know any other way to practice – it was one patient at a time. Ultimately, the patient was always more important than any data – despite the fact a junior doctor told me, not that many years ago, that she’d been taught “Never listen to patients. They lie all the time. The only thing you can believe is the data”

Nope. That’s no way to practice Medicine!

Oh, before I finish, thinking of “one swallow at a time” reminds me of one of my most favourite books about creative writing – Anne Lamott’s “Bird by Bird”. Recommended.


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The Ile d’Oleron is a small island not far from where I live. I visited it a number of times. There’s a pretty village called Chateau d’Oleron with brightly coloured old fishermen’s and oyster farmers huts which are now mostly artists workshops and stores. On my most recent visit I came across this bridge with dozens of oyster shells hung on it, each one inscribed with a wish. The first thing I thought of was the padlocks fastened to the Pont Neuf in Paris which I saw many years ago.

When I looked closer to see what people were wishing for I realised that these oyster wishes were indeed very like the padlocks.

I remember seeing love wishes in Kyoto too –

In fact, most of the wishes I read were for love or happiness, and many of them weren’t really wishes at all, but, more like the padlocks, simply a public declaration of love….two names and a heart, or a date.

Not all the wishes were for love or happiness though. Some were much more specific –

“One house here”!

Which got me wondering about this whole wishing thing.

What’s it about?

Mostly, these are not requests, in the way that a prayer might be. Although some certainly are. I saw a wish for marriage “soon”, no names, just a wish to be married. I saw a wish that a particular child would remain happy forever. Or two names a a hope that their love would endure. But not all were like that.

Most were statements of love or happiness. Declarations of love or happiness. Maybe in some way these were “performative” wishes. By simply, and clearly, stating something, you bring it into being. A sort of focusing. Making love, or happiness, or wellbeing more than just a wish, but a reality, a totem of some kind.

One was even more expressive by making a drawing the centre point, instead of words.

This one says “The song of love”.

I spent quite a while browsing these shells and what, at first, seemed a bit strange, became all the more charming.

After all, don’t they say “The world’s your oyster”?

So, what would you wish for? What would you declare on a padlock, an oyster, a star, or a tree?

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I took this photo a long time ago up at the Bracklinn Falls in Scotland. As you walk through the woods from the car park, you hear the roar of the water long before you can see it. Once you reach its banks, or stand on the bridge, the “new” bridge from 2010, the “old” one having been washed away by the power of the water in a storm some years before, you can hardly hear each other speak for the noise.

There’s a hint about the power of water in the volume of the noise. There’s another hint when you learn the history of the bridge, see the height of it, and wonder about the day the stream turned into a torrent and destroyed the old one. I’m old enough to remember standing on the old, iron, one. I never imagined it could be washed away. The new bridge, is, I think, even more beautiful than the old one.

What caught my eye in that first scene, was the shape of the rock.

It looks like there is a giant mouth opening up to swallow the water.

In fact, many of the rocks here smoothly sculpted by the power of the water. They are beautiful. The water itself does not run smoothly over this section of its path. It is never still, never quiet, and constantly breaks into foam and bubbles. It’s sort of counter-intuitive to think that water can shape rock, yet it’s obvious too because we see that all around us, whether we are looking at cliffs along a coast line, the rocks along the banks of a river, or even stones which lie at our feet.

One of the things which so delights me about these scenes is realising how the rock has become the shape I’m looking at only by interacting with the water.

It hasn’t grown to that shape all by itself.

Because it reminds me that nothing is the way it is all by itself. Everything we see, everything we are, emerges from an infinity of experiences to become the way it is today.

When I look at these beautifully fashioned rocks I see a relationship. I see a history of water and rock. I see continuous motion.

Which isn’t what you’d expect to see when you look at a rock!

Wow! We live on such a creative planet don’t we?

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What do you see when you look up at a sky like this?

The first things to catch my eye are the patterns in the clouds. I just love seeing these ripples, waves and swirls. I can delight in densities and the transparencies. I love how the blue beyond shows through and appears as lakes, streams and rivers in the white land of the cloud.

Then the next thing that happens for me is noticing that some of these patterns here look familiar. They remind me of something else, in the same way that sketches and doodles do, in the same way that paintings and photographs do. My eyes are drawn to the blue zone in the cloud which I can easily see as a pair of lungs – well, I’m sure that’s at least in part due to my working as a doctor all my life – but the idea of a pair of lungs breathing this cloud into existence delights me! Bear with me for a moment longer, because, and this comes and goes for me, I can then see what looks like a head above “the lungs” with a face looking out towards the right hand side of the image. Sometimes that looks SO clear to me that it almost spooks me out! And then I look again and I just can’t see it.

If you’ve been reading the posts on this blog for a bit, you’ll know what’s coming next……the image sets of a train of thought for me.

This time what I start to think about is creation.

I love to see clouds emerge, change, and disappear before my very eyes. So often they look like a work of art, like a piece of performance art. I see it happen and it amazes and delights me.

This, I think, is the essence of the Universe – creation.

The Universe has been creating since its beginning. As best we know, first elements, like hydrogen and helium, then clouds and densities which form into stars, those sources of all the elements we know….and so on, with the rest of the Universe Story…..right up to the creation of the Earth – as far was we know, the only planet like this in the entirety of existence – yeah, I know, people tell you that there are chances there are other Earth-like planets out there somewhere, but we haven’t found any yet.

And on this Earth, creation continues, with the elements forming into molecules, molecules combining and synthesising to create cells, and so to living organisms, no two organisms living identical lives……to the most complex of living organisms in the universe (as best we know)….human beings, no two of whom have ever been, or ever will be, identical.

And so to this day, this day which has never existed before, and will never exist again, where every event, every experience, every body, is new today.

Creation. It’s the essence of the Universe. It’s the essence of Life. The constant, never-ending, creation of novelty, of emergence, of uniqueness.

Yep, all that from a cloud…..how’s that for a creative thought?

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I noticed this little profusion of diversity at the edge of a pavement the other day. Now that I’m reviewing the photo I see really stark contrasts between the natural and the built environments.

On the right hand side here we can see a drain cover cast in heavy iron and imprinted with regular rows and columns of slightly raised boxes. It even looks heavy. It looks rigid. Fixed. You would bet that these covers were produced in a factory. It’s likely that thousands of these almost identical objects were churned out from a production line using a template, or a mould, so that they are as similar as possible. If the factory has “quality control” it’s likely that any which are significantly different from the others will be rejected. The goal is standardisation, efficiency, same-ness.

Human beings are great at this kind of work. We take raw materials from Nature and beat them into the products which we can mass produce. These things are useful. Look at the other useful things human beings have made in this picture. The concrete poured to create kerb stones, drainage paths, and gutters. The tarmac laid and levelled to make roads. The houses built with stone, cement, wood and glass. These are just some of the things which make up our built environment.

But taking centre spot in this image is Life. Bursting out of this manmade environment is a flourishing, a profusion of colour. A tiny, micro-system of flowers. Somehow we know nobody planted them there. Nobody sowed the seeds there. They got there of their own accord, blown in the wind, dropped by animals, carried along by streams of water after a rain. Then they took their chance and growth kicked in. First of all just small green shoots, which grew quickly and diversified. Each developing according to the typical shape of a plant of its species. They look chaotic, disordered, different. You know they haven’t been manufactured.

It doesn’t take long for wild unpredictable nature to make its mark. That’s the essence of Life. That’s the underlying truth of all organisms, including we humans. We grow in unpredictable, diverse ways to create complex communities of Life.

You know, don’t you, that we need all of this. The ability to act on opportunity, the ability to adapt to changing circumstances, the ability to form complex networks of relationships, and the ability to create the environments in which we live.

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It’s 50 years since a human being set foot on the Moon, so there’s been a lot of reminiscing recently. There’s no doubt that journey was more than a great technological achievement. It suddenly made the distance between the Moon and the Earth seem much smaller. Human beings have imagined trips to the Moon for centuries now, but, in that “One small step for Man….” the journey became a reality.

However, the change in perspective which has impressed me even more, is one which, although it is at least as ancient as imagining Moon trips, is represented by the famous photograph taken of the Earth rising above the horizon of the Moon.

This was taken by one of the astronauts on an earlier mission. It gave a powerful and striking impression of the concepts of “Spaceship Earth”, “Blue marble” and other terms people have used to describe the Earth when seen from afar.

I got thinking of this partly because of the coverage of the moon landings, but also because I happen to be reading a book by the French philosopher, Pierre Hadot. The essay I read is about the “spiritual exercise” of the classical philosophers which involves using your imagination to make a trip up into the skies. There are two elements to this exercise. The first is referred to as the “view from on high”. Think of a time you’ve looked out over the landscape from the top of a high hill. You can see the rivers, the forests, the human habitations of individual houses, villages or towns. One of the things you get is a profound change of perspective. By seeing the greater whole, you see the contexts of the elements. You get an understanding of how there it a tree line, a level on the slopes of the mountains above which no trees grow. You can see the scale and the scope of the rivers, and maybe even see the traces of where the rivers used to run before they changed to their current paths.

Go a bit higher now and imagine one of those photos you’ve seen taken from orbiting satellites or the International Space Station and now you can see whole countries, even continents. You can see lakes which have dried up, jungles which are shrinking, deserts which are expanding.

Higher again, till you see the Earth in the distance. That beautiful, but impossibly small, “blue marble”. You see the swirls of cloud formations, the spirals of hurricanes, you see the oceans and the landmasses. You know your home is down there somewhere on the surface. You know the country of your birth is there, but unless it’s completely bounded by water, you can’t see the borders between it and any other country.

Now go higher again, and sweep out through the Solar System, off through the Milky Way, heading at the speed of thought, that speed which is not limited the way the speed of light is, and see our galaxy shrinking to a cluster of stars, a single galaxy amongst millions of others, some larger, some smaller, some about the same size as “ours”. This it the second element. The ancients called it “the cosmic voyage”. You begin to get a sense of the vastness of the universe, and of the smallness of our own little neighbourhood of planets revolving around a single star.

The Epicureans saw this as a liberation from the boundaries of terrestrial life, and a way of connecting to, and immersing yourself in, eternity and infinity. They described it as a “divine pleasure”.

The Stoics said that to find peace and serenity, you should contemplate Nature and everything you find in her; that you should explore the earth, the sea, the air and the sky “attentively”; that you should follow the Moon, the Sun and the Stars with your thought; that you should keep your feet on the ground but let your spirit soar high to discover the “universal laws” and the “powers of the universe”; and that, in so doing, you would become “citizens of the cosmos”.

How beautiful is this? How enchanting? How much more positive that Theresa May’s jibe that those who wanted to belong to more than one country were “citizens of nowhere”!

Plato said that aligning the movements of your spirit with the movements of the stars in the cosmos brought harmony and well-being. Whilst some would interpret that astrologically, I understand it as a call to realism. I see it as a counsel to live harmoniously with the natural laws, of both this planet, and of the cosmos.

Hadot stresses that this exercise can have a double effect. It can produce feelings of happiness and serenity by immersing yourself in Nature, and it can allow you to enjoy a certain distancing which lets you re-evaluate the life and judge things differently (not least by seeing them within their contexts)

Seneca said that when you see how tiny the Earth looks from Space you can see how human beings share the planet with sword and fire. He says you can see how “risible” the frontiers are, and how laughable the luxuries of the rich are.

Lucien applies this exercise in the context of time rather than space and recommends it to historians. He says that when historians take the “view from on high” they can observe with impartiality, courage and a positive regard towards everyone ie to opposing sides in conflicts. He recommends that these same values, impartiality, courage and a positive regard, also influence the way historians report “the facts”.

That reminded me of the historian, Rutger Bergman, who wrote “Utopia for Realists“. I heard him say that becoming a historian allowed him to see how nothing lasts, how great cities and civilisations come and go, and how so much in human life is an invention – money, laws, borders – and that made him optimistic because the historical perspective showed him all these things can be changed. One of his key themes in his book is the abolition of borders. He points out that passports became a common practice only after World War One, and that the only countries which had them before that were the Russia and the Ottoman Empire.

It also reminded me a book I recently purchased which describes the kings and emperors of France over the centuries. Each entry includes a map which shows the territory that king, or emperor, commanded. In the process, you see the emerging shape of the country we now call France. You can do that for any country really. We tend to forget that the modern nation states are an invention.

I love this exercise, and I think our more recent discoveries about the history of the universe, about the complexity of the cosmos, and of the complex adaptive nature of all living organisms, have revealed all the more that everything is connected and that everything changes, just as Marcus Aurelius wrote all those years ago.


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One of the signature plants here in the Charente is the Hollyhock (“rose trémière”). They are astonishing plants which surge upwards of two metres and they produce glorious brightly coloured flowers. It’s not just their rate of growth and their ultimate towering stature which impresses me though.

What really attracts me to them is how surprising they are. You never know, from year to year, just where one is going to grow, you never know which ones are going to grow to the greatest heights and you have no way of knowing just when they are going to produce these fabulous flowers, not only at the tops of their stems, but apparently randomly along the length of each plant.

In a sense, I see them as the local Charentaise version of the Japanese cherry blossoms. In Japan the appearance of the cherry blossom is much anticipated and celebrated. More than their beauty, the blossom is a symbol of transience which inspires people to “savour the day” – because, like the blossom, nothing in life will last. It’s the transience of the cherry blossom which makes it so meaningful.

Well, for me, I equally anticipate the appearance of the hollyhocks and their glorious, towering flowers. I think because each and every one of these amazing plants stands alone, they inspire me to think about transience in a similar way to cherry blossom, but they do something else too. They remind me, every time, of how the future path of any individual life is so unpredictable.

Why should that be something to relish?

The essence of my working life as a generalist medical doctor was to meet with patients one at a time. I’d look forward to every Monday morning because it would be the start of a working week filled with people who would come into my room, sit down, and tell me the most amazing, unique stories.

No two people told the same story.

Understanding a patient’s story is a way of helping them to make sense of what’s happening in their life. It’s also part of what doctors call making a diagnosis. I always saw diagnosis as a level of understanding, not a conclusion, not a label, not a category to place a patient into, not a starting point in a protocol, but the beginning of an understanding.

With that initial understanding would come some sense of the past. In other words it could be the start of making sense of how the present illness had come about, what events and circumstances had contributed to it. But what also came was an opening up of a set of possible/potential futures. Doctors call such an analysis a prognosis. I’d look ahead, taking what knowledge and experience I had of people, of disease, of the typical life history of certain illnesses, and see this unique, particular patient in that context.

Doctors have to be careful when making a prognosis. It’s always only an estimate, an informed expectation. But at the level of the particular, the unique, the individual patient, the path ahead would only be revealed over time.

Remembering that kept reminding me to be humble.

Remembering that kept reminding me that in Life, we never have ALL the information. We always make our understandings and our predictions on the basis of partial, and limited information. There will ALWAYS be more to discover, more to learn, more to learn about everyone.

There’s a fairly new term in biology and philosophy to describe how the future unfolds this way. It’s called “emergence”. Emergence is the development of new patterns, new behaviours, new structures, which could not have been predicted in detail from the prior knowledge. It’s typical of all living organisms.

The individual hollyhock plants remind me of that. They demonstrate this “emergence” beautifully.

Their daily growth astonishes me. Their ultimate size astounds me. Their particular flowers amaze me. I know each seed holds this kind of potential, but I have no way of knowing which particular seed will grow a plant of this actual size, in this particular place in the garden, the driveway, the street, or the roadside.

See, for me, not knowing what lies ahead isn’t primarily a frightening thing. Sure, it’s possible to begin to imagine all the things which can go wrong, to press the fear and panic buttons, but that’s rarely very helpful. Instead, I found, and I still find, I look forward primarily with hope and a positive expectation, and if things don’t turn out that way, I reassess, take stock and consider a different future. It’s a process, not an algorithm leading to an end point. It’s a way of living, deepening and broadening knowledge and understanding at the level of the individual whilst looking forward, with realistic hope, as we interact with, and adapt to, the present.

It’s great to be astonished every day.

I love to be amazed and delighted at the unfolding present. I find it thrilling to witness the future making itself known through this phenomenon of emergence.

Hollyhocks do all that for me. Are there particular plants which are special for you? And why?


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