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cordes sur ciel

There’s a lot of talk about the increasing strain on health services, something I’ve addressed here.

One of things that bothers me about these discussions is the assumption that increasing funding and resources to the health care system will result in a healthier population, which will, in turn, reduce the demand on the health services. This has never happened. And it’s not likely to happen.
The health of a population mainly comes down to how we live, not to the medicines we swallow or how quickly we can get an operation. Let me just clarify that I’m not arguing against more resources and funds for the health service, we need that to improve them. It’s just that this isn’t a way to create a healthier population and so reduce demand.
To create a healthier population we need to invest in what creates better lives. Better lives for as many people as we can.
There are many ways to do this. But let’s start with housing. Because decent housing, warm, weather-proof, houses with enough living space, clean, running water, an efficient sanitation system, and affordable, reliable power, is a foundation for healthier lives.
Would anyone argue otherwise?
If people are homeless, or living in insanitary, unsafe, overcrowded conditions, then they are more likely to get sick – both in the short term, with infections, and in the longer terms, with chronic, inflammatory conditions. I’m not going to list references here. Google these issues for yourself. But I am going to claim that adequate shelter is a necessary first step to better health for a population.

There are many factors and problems to consider here, but I just want to focus on one – waste – the number of abandoned and/or unused dwellings in every town and city.
When I think about this I can’t help also becoming aware of “high streets” full of empty, abandoned shops and offices. So, let’s take that into consideration too. Because when the town centres empty of commerce they aren’t only dying, depressing and, possibly, dangerous, but they represent a huge waste of opportunity for people to work and live together. We need shops, offices, workshops, cafés, restaurants, exhibition and performance venues, to have a healthy community. It’s no good just building lots of apartments in streets which are devoid of the possibilities for people to meet, share, and work together.

Take a walk around the streets where you live, both the residential streets where you dwell, and the town streets you visit most often for shops, offices, cafés, restaurants, and so on.
How many properties are sitting closed up and seemingly abandoned?
At the same time, are there homeless people in your locality? The homeless might be obvious sitting or lying on the pavements, in the doorways of closed shops, or they might be invisible to you, struggling to get by in bedsits, guest houses or hostels. What about decent housing? Is there anyone living in sub-standard, even unsafe properties? Is there anyone housed in overcrowded conditions with landlords maximising their income by minimising the personal living space of their tenants? Are the streets of your town vibrant, filled with people socialising and satisfying their daily needs and desires, for material , social and cultural goods?

I’m asking because it seems to me that it’s very common to find so many shops, offices and houses that look abandoned that a whole area feels either unsafe or unhealthy. The French have a word for it – désertification…..where a once vibrant locality becomes a desert. What could we do to turn this around? Here’s one idea.

A policy of compulsory purchase and leasing.

What if the local authority, the Council, or the Commune, had the right to compulsorily purchase, in its area of jurisdiction, any property which was uninhabited or unused for at least five years? What if all such properties could be compulsorily purchased for the current independent valuation price, then leased out to new tenants?
Residential properties could be rented out to those on housing benefit, paid for directly from the tenants’ housing benefit, instead of the current situation where these benefits go straight into the pockets of private landlords. Some properties could also be rented at commercial rates to either individuals or groups of individuals, encouraging a healthy social mix in the community.
Additionally some could be offered for sale, either directly at market rates, or using co-ownership schemes, where part of each month’s rent is allocated towards the final purchase of the property by the tenants. In a co-ownership scheme, an additional idea could be to agree a contract of improvement and renovations of the properties which would be paid for by the initial rental payments. For example, a property requiring £50,000 of work, and valued at a monthly rental of £1000, could have the works paid for by the first 50 rental payments.
Commercial properties, shops, workshops and offices could be offered rent-free for new tenant businesses. Instead of paying rent, the Council or Commune could be empowered to collect the VAT generated by these businesses, keeping that element of taxation for local use, instead of it disappearing into national funds.
The income streams to the councils from the housing benefits, domestic rents, co-ownership contracts, sales and locally ring-fenced VAT could then be used to make more compulsory purchases.
I’m sure somebody else will be able to take this idea and refine it considerably, but the basic idea is to favour circulation of property and wealth in the local economy and environment, instead of the current picture of stasis and decline.
Community associations, and co-operatives could be included in such schemes. In other words, it’s not just something for independent businesses and entrepreneurs, but something which could also encourage community led activities. Workshops, recycling services, training and education courses, as well as libraries, galleries, theatres and music venues.

Bringing life back to our existing communities by prioritising decent housing for everyone and supporting the daily opportunities for people to live, work and play together, would be a good beginning, if we want healthier populations who have less need of health services.

I’ll explore some other factors in later articles, including food, education and inequality. But maybe you’d like to share your own ideas? If you do, on your blog, your youtube channel, your instagram feed, or wherever you express yourself, please let me know. I’ll include links to your ideas in my posts.

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petite philo des oiseaux

I’ve just finished reading Philippe Dubois and Élise Rousseau’s “Petite Philosophie des Oiseaux”. It reminds me a book I read last year – Emanuele Coccia’s “La vie des plantes”. Both books look at a non-human realm of life and use reflections on the lifestyles and life strategies of, in the first case, birds, and in the latter, plants, to stimulate the reader into reflecting on aspects of what it is to be human.
I’ve never read any books like these in English, so they are a validation of one of my main reasons to retire to France from Scotland – to learn another language and explore a whole other way of thinking and living.

Migration

There are lots of fascinating, even astonishing stories about birds in the “Petite Philo…” book. For example, the “bar tailed godwit” (which has a much nicer French name – “La barge rousse” – which migrates back and forward between the Alaska and New Zealand. It flies non-stop 11,000 km (that’s over 6000 miles) in about a week, meaning it flies at 70 km/hr! All that in a bird which weighs only about 300 grams. Can you imagine? How does it fly all that way without stopping even once? Apparently, when it sleeps, only half of its brain sleeps, the other half staying awake. How would you fancy developing that skill? (Mind you only using half your brain isn’t that uncommon – ha! ha!)
Lots of birds migrate of course, and nobody knows how they find their way so precisely that they return to the exact same nesting sites every year. Think of the cuckoo whose parents abandon it into another bird’s nest when it is just an egg, but when ready, the chick flies off and travels to Africa from Europe! How does it know how to do precisely that?
The Artic Tern is the most traveled of all the migrators. Here’s what wikipedia has to say about it –

A 2010 study using tracking devices attached to the birds showed that the above examples are not unusual for the species. In fact, it turned out, previous research had seriously underestimated the annual distances travelled by the Arctic tern. Eleven birds that bred in Greenland or Iceland covered 70,900 km (44,100 mi) on average in a year, with a maximum of 81,600 km (50,700 mi). The difference from previous estimates is due to the birds’ taking meandering courses rather than following a straight route as was previously assumed. The birds follow a somewhat convoluted course in order to take advantage of prevailing winds. The average Arctic tern lives about thirty years, and will, based on the above research, travel some 2.4 million km (1.5 million mi) during its lifetime, the equivalent of a roundtrip from Earth to the Moon over 3 times

When you read something like that it’s kind of hard to hang onto a belief that human beings are the most superior of all the animals. We need our rather flawed GPS systems to navigate. They just do it.

Living in the moment

I think that’s one of the main themes of the book, actually. In one passage they say (and this is my translation, so sorry if it’s not perfect! The Aegithalidae are what we call, in English, “tits”. In French, they are “mésanges”).

mesange

 

But the little tit, does she have any need of the idea of death? No, certainly not. Because making the most of every moment, appreciating every seed she gleans, every ray of sunshine, she does all that already. She doesn’t need someone to teach this truth, she doesn’t need to philosophise: she is already wholly immersed in her life.
The tit doesn’t look forward, doesn’t make plans, doesn’t put things off until tomorrow, doesn’t imagine that things were better in the old days. She lives.

 

Intelligence

One of my favourite chapters in the one about intelligence, subtitled with a phrase, which, in English, would be “Bird brain!”
When we call somebody bird brained we’re insulting them. But is it true that birds are not intelligent creatures? No!
Just because they have relatively small brains, doesn’t mean they must be relatively stupid. The authors point out that some men have even tried to claim that they are intellectually superior to women because men have bigger brains the women! That hasn’t worked out so well either, has it guys? In fact, birds’ brains have twice as many synapses (connections) in them than the brains of elephants, chimps, or other mammals.
After musing a bit about just what is intelligence anyway? After considering the issue of different kinds of intelligence, including musical and emotional, they describe a number of quite amazing bird behaviours.
Did you know that Blue Jay looks ahead to winter by collecting nuts and seeds and burying them for colder months to come, but if they see another Blue Jay, or other bird, watching them, they’ll pretend to be burying food when they aren’t really?
Some crows have been observed places nuts on the road at traffic lights, when the lights are at red, then when they turn green, the cars run over the nuts to crack them open. The crows wait till the traffic light turns red again, then swoop down to get the nuts.
An experiment done on magpies involved putting a red mark on their brow. When the magpie saw itself in a mirror, it tried to scratch off the red mark.
There are many other examples.

The question the authors ask is shouldn’t we consider that adaptive intelligence, learning how to change your behaviour according to the conditions and environment, actually one of the best kinds of intelligence to have?
As we heat our planet up, fill our oceans with plastic, and our soil with toxic chemicals, it’s tempting to think we’ve got a bit of catching up to do when it comes to adaptive intelligence!

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Usefulness of the Useless

Nuccio Ordine argues that “usefulness”, when thought of as that which has utility, which can make money, or which can be practically applied to solve a problem, limits our capacity to be fully human. His thesis is that utility has its limits, but in recent times, I think particularly during industrialisation and the spread of capitalism, utility has acquired a dominant position. He argues that this dominance impedes our ability to become fully human and live satisfying lives.
His own idea of “usefulness” is “everything that helps us become better” – by which he means anything which helps us grow, anything which helps us to develop and, to live more meaningful, richer lives.
He is concerned about “the logic of profit” and how political leaders nowadays are always talking only about money. He claims that leaders in the past, for example spiritual leaders, would teach about value, honor, and purpose…..qualities and values in life which couldn’t be purchased. What’s worse he says, is that this overwhelming emphasis on money isn’t making life better for most people. He gives the examples of the 2008 financial crash and the use of austerity measures by Western governments since, and he also cites the huge growth in inequality especially over the last few decades.
All of that is maybe not so earth-shattering. I’m sure we’ve all thought about those things before, and we probably find ourselves in conversations about that a lot. But then things start to get really interesting when he says

“In the universe of utilitarianism, a hammer is worth more than a symphony, a knife more than a poem, and a monkey wrench more than a painting: because it is easy to understand the efficacy of a tool while it is ever more difficult to understand the utility of music, literature, or art.”

That’s a beautifully written passage and at that point I begin to think, hey, yes, isn’t that true? How much does music, art and literature mean to me? A lot! But I couldn’t for the life of me tell you why that’s “useful”.
I don’t listen to music, look at art, read or write to some “end”, to “achieve some goal”. And I think there’s something in there for me to remember, because I think when I write non-fiction, like these blog posts, maybe I’m consciously, or at least sub-consciously, writing to make things better. In other words, writing for a purpose. Yet, I often find it annoying when I read texts written by others who have that same goal! Elisabeth Gilbert says in her “Big Magic” book…“please don’t write a self-help book”?

Big Magic

Then he says

“Now it is important for me to underline the vital importance of those values that we cannot weigh and measure with instruments calibrated to assess quantitas and not qualitas. And, at the same time, I wish to make a claim for the fundamental nature of those investments that do not produce immediate returns and cannot be turned into cash.”

People not data

Well, that’s right up my street again, because I have felt for a long time that the most important aspects of medical practice are NOT what can be measured with the machines, but rather the qualities which individuals experience.
I’ve never really been satisfied by visual analogue score systems that try to reduce human experiences and stories to numbers in a range. I remember once having dinner with some dentists after having delivered an address to their annual meeting. The subject was symptoms, such as pain….what they meant. One of them told me about a chronic facial pain clinic which they’d taken over from their predecessor. They were a bit taken aback when they asked the first patient, “How are you doing?” and they replied “9”, then the next patient did the same thing. “How are you?” “7”. The whole clinic proceeded that way. Puzzled, he asked one of the clinic nurses what was going on, why were people responding to his questions with numbers? “Oh, Dr. X, your predecessor devised a scoring system for pain and he trained the patients to tell him what number on the scale represented their pain level. If someone began by telling him a story about what had happened since their last visit, he’d say “Stop. I want the next thing that comes out of your mouth to be a number. Nothing else!” He was pretty scary.”
Numbers aren’t a good way to understand human beings.
However, the author says more than that….he says he wants to make the case for investing in what does not produce immediate returns or money. He wants to make the case for curiosity, from the satisfaction that arises from understanding something better, for the joy of wonder, and for all those apparently “useless” activities that make us human – singing, dancing, drawing, painting, and the pursuit of knowledge.

Effort and passion

“True, everything can be bought. From legislators to judges, from power to success: everything has its price. But not knowledge: the price to be paid for knowing is of a completely different kind. Not even a blank check would allow us to acquire mechanically what is the exclusive fruit of an individual effort and an inexhaustible passion. No one, in short, can tread the laborious path to learning in our stead.”

Learning takes effort. It’s a personal pursuit. Nobody can learn for you. The key there for me is “the exclusive fruit of an individual effort and an inexhaustible passion” – effort and passion – a great combination!
Nobody can learn something for us. Knowledge doesn’t just appear. You can’t just buy it from a shop. It takes time and it takes effort. And there is the key – it’s in the living – it’s in the personal “journey” (oops, don’t like that word very much), it’s in the everyday experiences which gradually make us who we are. He quotes from Dickens’ “Hard Times” on this subject, describing his character, the teacher, Thomas Gradgrind’s approach to education –

“In this life, we want nothing but Facts, sir; nothing but Facts!” The enemy of teaching open to imagination, sentiments, and affection, Gradgrind is introduced “with a rule and a pair of scales, and the multiplication table always in his pocket … ready to weigh and measure any parcel of human nature, and tell you exactly what it comes to.” For him, education and life are reduced to a “mere question of figures,” to a “case of simple arithmetic.” Just as the young pupils are considered to be “little pitchers before him, who were to be filled so full of facts.”

He also quotes Socrates –

“It would be really fine, Agathon, if knowledge were able to flow from the fullest to the emptiest among us and all we had to do was to be in contact one with the other, like the water that flows along a woollen thread from the fuller goblet to the emptier one.”

That reminded me of when I was a teenager. My best friend and I were insatiably curious kids, always finding things out together and conducting our own experiments. We came across the notion of sleep learning. So my friend hooked up a cassette player to two long wires attached to an old loudspeaker we’d salvaged from an old valve radio, and placed the speaker under his pillow. He got me to recite his French vocabulary for the week onto the cassette tape and set the recorder up with a timer so it would come on during the night and play him the words in his sleep…….didn’t work! He didn’t remember a single one of them!!
So learning doesn’t come without effort!
Mutual benefits of sharing

The next point Nuccio Ordine makes is that knowledge challenges the laws of the market place because we can share our knowledge with others without making ourselves one bit poorer. In fact, it’s the opposite – when we share our learning we both gain – both teacher and learner.

“I can teach a student the theory of relativity or read together with her a page of Montaigne thereby giving rise to a miraculous virtuous circle in which both the giver and the receiver are enriched at the same time.”

My experience of teaching, especially in Japan, was that every single time I learned something. I never came away thinking I’d been giving something away in the sense of losing something, or that I was making myself poorer. I felt that I, too, had gained. I learned a new way of explaining something, or I saw a new connection, or I learned a different way of looking at something. I always came away feeling enriched.

Then read this –

“The gaze fixed on the objective to be attained makes it impossible to grasp the joy of little everyday gestures and to discover the beauty that pulses through our lives: in a sunset, in a starry sky, in the tenderness of a kiss, in a flower that blooms, in the flight of a butterfly, and in a child’s smile. Because, often, greatness is perceived better in the simplest things.”

Oh, isn’t that beautiful?? I love, love, love that! And there it is – “l’émerveillement du quotidien” – the wonder of the everyday….my favourite! If we fill our lives with the busy pursuit of short term goals, the days slip by, literally, without us noticing.

He says –

“Kakuzo Okakura, in describing the tea ritual, identified the pleasure of picking a flower to give to a lady friend as the precise moment in which the human species rose above the animals.”

Here’s the value of not only noticing, but choosing to share. Isn’t that where art, music and knowledge excel? I thought of the cave art I’ve seen in France. All those animals painted in the depths of the caves, something which took so much effort, but why? Nobody knows. Maybe that’s because we are so busy trying to figure out what use the art was, that we miss, not only the sheer pleasure of creation and the satisfaction of creation, but also how art adds meaning and purpose to life.

lascaux wall art

That got me thinking too about the cup and ring markings on the stones in Kilmartin valley. How nobody can explain them either. But maybe they are art not utility?

kilmartin cup and ring and bean

Seeing beauty and choosing to share it with another – that is a characteristic which makes us uniquely human.

“Being an artist,” says Rainer Maria Rilke in a passage from Letters to a Young Poet, “means, not reckoning and counting, but ripening like the tree which does not force its sap and stands confident in the storms of spring without fear that after them may come no summer.”
Not “reckoning and counting” but “ripening” – ooh, lovely. I love to watch the new buds appearing on the trees in the Spring, the opening of the bright green new leaves from the buds and the sudden appearance of the blossom.

budding cherry tree

Nuccio mentions Ionesco in the book,

“the need to imagine and create, is as fundamental as the need to breathe”

which is a slight twist on my previously understood “stories are as fundamental as breathing” But I agree, where would we be without our imagination and our creativity?

“Especially when there is an economic crisis, when the temptations of utilitarianism and the wickedest egoism seem to be the only star and the only lifeline, we need to understand that it is precisely those activities deemed useless that could help us escape from prison, save us from asphyxia, transform a dull life, a non-life, into a fluid and dynamic one, oriented toward a curiositas for the spirit and human affairs.”

Curiosity

That made me think of the whole purpose of my “heroes not zombies” blog. It touches on my core value of “curiosity” – curiosity and wonder as drivers in life, as opposed to the desire to possess and consume…..

Here’s another passage explaining his theme –

“While the biophysicist and philosopher Pierre Lecomte du Noüy invited us to reflect on the fact that “in the scale of beings, only man performs useless acts,” two psychotherapists (Miguel Benasayag and Gérard Schmit) suggest that “the usefulness of the useless is the usefulness of life, of creation, of love and desire,” because “the useless produces that which is most useful to us, which is created without shortcuts, without saving time, over and above the mirage created by society.”

Empathy and connection

Time for another insight which is shifting my thinking – this time he quotes the author, Mario Vargas Llosa –

“Mario Vargas Llosa, on receiving the Nobel Prize in 2010, rightly pointed out that “a world without literature would be a world without desires or ideals or irreverence, a world of automatons deprived of what makes the human being really human: the capacity to move out of oneself and into another, into others, modeled with the clay of our dreams.”

There’s the bit that struck me – “the capacity to move out of oneself and into another…” It’s not just that these “useless” activities are for fun, pleasure, or to satisfy curiosity. It’s that they move use out of ourselves and into another – stories do that for sure. Paintings do it. Music does it. I think of concerts I’ve been to where I feel moved to tears from the sheer power of the SHARED experience of the music with the other fans.

A work of art doesn’t ask to be born

“If we think about it, though, a work of art does not ask to come into the world. Or to borrow another splendid observation by Ionesco, the work of art “asks to be born” in the same way “as a child asks to be born”: “A child is not born for society’s sake,” the dramatist explains, “although society claims him. He is born for the sake of being born. A work of art too is born for the sake of being born, it imposes itself on its author, it demands existence without asking or considering whether society has called for it or not.”

I like this too. Another “satori” moment – all this creation, all this art, does not “ask to be born” – just like how we do not ask to be born – we are not born for the sake of society – or even to promulgate a few strands of DNA as Dawkins would have us believe! Can you think of art this way? Again I thought of Elisabeth Gilbert and how she talks about the muse – how if we don’t grasp it, it’ll travel off to find someone else who will!

Freedom

This book really resonated with me. It affirms the value of things like “blue sky thinking” instead of goal-orientated or problem-solving activities. It affirms the value of quality over quantity. But it also sings about FREEDOM – the freedom to BE, to BECOME, to explore, to follow your curiosity and your creativity – not to get to a particular place but JUST COS! Just cos its fun, it’s wonderful, it’s satisfying.

“Free men” have no problems with time and have to account to no one, whereas “servants” are ruled by the clock and by a master who decides”

 

I have no special talents. I am only passionately curious. ALBERT EINSTEIN,

 

It is pleasure, not possession, which makes us happy. MICHEL DE MONTAIGNE, Essays

Flexner

The book finishes with an essay from Abraham Flexner who created the Flexner Institute at Princeton University – an institute which offers academics of many disciplines some time there where the only thing they have to do is turn up and take part – nobody tells them what they should or shouldn’t research or teach. They are encouraged to dream, to imagine, to follow their curiosity and to inspire each other – and it goes on and on that way – the academics don’t work there for life – they go for a few months or years and then return to their other universities, jobs etc – then maybe years later will go again for another spell. Wow! I’ve never heard of such a thing! I’ve often heard university academics talk about how they were fed up chasing funding – that every single grant had to be applied for, fought for, and it had to be shown how the research would be USEFUL!
In this final essay, Flexner gives many examples of how scientists who were simply pursuing their curiosity, following a sense of wonder and a desire to simply understand more, often made discoveries which later led to world changing inventions. Others saw something practical or applicable in their discoveries and turned them into useful technologies, but they were building on the those very “blue sky”, free, thoughts and activities of their “less practical” predecessors.

I thoroughly enjoyed this book, as I’m sure you can tell. It’s a healthy riposte to the bean counters!

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buddha kyoto

Mindfulness has become very popular, especially in America, where it has been pioneered by Jon Kabat-Zinn and others, but also in Europe. The French term for mindfulness is “en pleine conscience” – which more literally translates as “in full consciousness”.
I think it’s become so popular because it’s so helpful, particularly in the field of mental health where it has been developed through “Mindfulness Based Cognitive Therapy” (MBCT) to treat depression, and through “Mindfulness Based Stress Reduction” (MBSR), which does what it says on the tin.
But it’s more than a psychological tool for easing mental disturbances. It’s been found to influence the patterns of neurones and their connections (synapses) in the brain. Yes, it seems to actually have an influence on not just the function, but the shape, of the brain. This takes it into a realm beyond that of a therapy for diseases. As it develops the brain, so it can expand the mind. In other words it seems to have the potential to aid creativity, the growth of emotional intelligence and to increase resilience.

Freedom vs control
All through my working life as a doctor I was keen on therapies which did more than merely reduce suffering. A treatment which simply suppressed symptoms or kept a disease process under control, while potentially valuable (because who wants more symptoms and more disease?) was never that satisfying to me. I was always way more impressed with a therapy which enabled people to deepen their understanding of themselves and their lives, and free them up to grow and develop, to make life changing decisions, and, in so doing, to transform at least some of the underlying factors which caused their illnesses.
Mindfulness meditation is one such therapy. But then so are the exercises which enhance cardiac coherence, like “Heartmath”. And so are other meditation practices, whether they be “Vipassana meditation”, “transcendental meditation”, guided visualisation or “compassion meditation”.

Paying attention and non-judgement
As best I understand it, there are two fundamental tenets of mindfulness –

  • Paying attention
  • Non-judging

I would claim that these were the key tools of successful medical practice long before “mindfulness” became so popular in the West.
The absolute best I could ever do for any patient required that I paid attention to them, giving them my full focus, living together in the present time and place of the consultation. And that I listened with a determination to do two things – to understand them (through empathy), and to help them. I often thought that these were exactly the reasons why people came to consult me – to be understood, so that they could understand what was happening in their lives, and their bodies; and, to be helped, because they’d reached a place where they couldn’t solve their difficulties alone.
The non-judging part was equally crucial, because it’s one thing to pay attention, but if you judge what you hear it’s very hard to hear clearly. Judgement stops thought, as Hayakawa, the “general semanticist”, wrote in “Language in Thought and Action”

“A judgement is a conclusion……The premature judgement…often prevents us from seeing what is directly in front of us”

Diagnosis
Of course a diagnosis is a kind of judgement. It’s a summing up of the patient’s story, their symptoms and their signs. Diagnosis surely is the key to successful treatment. If you don’t know what you are treating, how can you offer the best treatment? So, I wasn’t against judgement as such, just “premature judgement”. In other words, trying to avoid reaching a diagnosis before I’ve paid sufficient attention.

Always more to discover
Ah, yes, I’m sure you’re thinking….so what is “premature” and what is “sufficient”?
And those are great questions. The answers to which are always “time will tell”. You can never be 100% in any particular moment that you’ve grasped the full story, that you’ve completely understood. In fact, it was quite common that patients would tell me towards the end of the consultation that they’d never told anyone the things they had just told me. But I’d respond to that by saying I don’t think anyone can be fully understood. In fact I think we each spend a lifetime trying to better understand ourselves and I’m not sure any of us reach a final, full point of understanding. There will always be more to discover.

“There will always be more to discover”

would be one of my mottos.

The ongoing relationship
Even when I’d made a diagnosis and initiated a treatment, it was important to follow through and follow up. To meet the patient again after an interval and to begin the loop of the spiral – to pay attention and to listen without judging. Failure to do that meant I’d potentially mis-judge how helpful the treatment was for this individual, and would deny me the opportunities to understand them even better.
It wasn’t unusual to hear a story from a patient which transformed my understanding of them, a story told by them several years into our therapeutic relationship. People who had told me several times things they said they’d never revealed to anyone else, could, after many, many consultations, tell me something of fundamental significance which they’d never even hinted at before. That kept me humble and reminded me of my motto “There’s always more to discover”.
I should just add here that my experience of sharing work with colleagues showed me time and time again that I could never say I was always the best person for the patient to work with. Other colleagues would discover things I’d never discovered, just as I’d discover things they’d never discovered. “There will always be more to discover” reminded me to be humble. I should never claim that I was “The One” who “knew best”.

Personalised Medicine
I think it’s those last two points which are forgotten about by some of the adherents of “Evidence Based Medicine”. The only way to know if a treatment is effective for this individual is to continue to pay attention, non-judgementally, to them. The Randomised Controlled Trials, and met-analyses, might help you to select a treatment but the proof is always in the experiencing, the personal experiencing. Only this patient can tell you whether or not their pain is improved, they are sleeping better, they feel less depressed, they can move more easily, or whatever. Only the changes in your measurements of this individual’s body can reveal the success or otherwise of this treatment. The truth is revealed in the follow up.

Personal benefits of medical practice
Finally, I think the work of a GP is a kind of mindfulness training in itself. When consulting at a rate of about ten or fifteen minute intervals you encounter a lot of different people in one day. For each and every one of them you have to be fully present and give them your complete attention. The moment they walk out of the door, and the next patient walks in, you have to stop thinking about them and switch your attention to the person right here, right now. It’s a continuous practice of attending, letting go, and attending again. It’s also a great non-judgement training. Again and again you seek to avoid rushing to conclusions, and again and again, you have to be prepared to drop your diagnosis because now you see there is a better one.
I felt blessed in many ways working as a doctor. Paying attention and listening without judging allowed me to reach levels of understanding with others which felt like a privilege. And, maybe it helped my brain while I was at it! I’d like to think so.

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floating bridge

This is another of Hokusai’s prints, this time it’s a floating bridge.
When I looked at this first I thought why doesn’t the bridge go straight across the river? Why is it on a curve like that? Then I read that it is a floating bridge. Floating bridges are made from small boats or “pontoons” tied together. It moves with the flow of the water.
Have you ever seen such a bridge? Ever walked over such a bridge?
I haven’t.
I don’t know about you, but I don’t look at it and feel very confident. But this is a winter scene and it’s clear that the bridge, like everything else in the scene, is covered with snow. Well, snow and ice I suspect! With that realisation my already low confidence level plummets. Cripes! Really? Walk across a floating bridge that’s covered with ice and snow?
You’d have to be desperate, wouldn’t you?
Or maybe not. Maybe it’s a journey you’ve made many, many times, without any difficulties or disasters. So your confidence is actually high.
I often wonder about the phenomenon of confidence. How we get on a plane, or a train, or get into a bus or a car, and don’t really consider for a moment that we might not get to our destination, or even that we might not get there in one piece. But how many people are injured or killed traveling in cars, buses, trains or planes, or boats for that matter, every year? None of their journeys worked out for them.
But we can’t live like that, can we? We can’t live with the constant fear that the journeys we’ve made time and time again without any problems might turn out to be our last this time?
So we gain our confidence from our experience and we set off, probably not even giving it a second thought.
I suppose that’s the alternative to being paralyzed by fear – to cope with things as they happen – or, to put it another way, to cross the bridge when we come to it!

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How do you begin your day?
Chances are the answer to that question has changed for you over your lifetime. For the couple of decades leading up to my 60th birthday I’d get up around 6am, shave, shower and dress, have a quick coffee, then set off for the railway station to begin my daily commute to the hospital in Glasgow. Once I’d retired and emigrated to France the pattern changed a lot. No commutes any more. And no routine requirement to be a particular place by a particular time. That was four years ago, and my patterns have changed a number of times over those four years. My most recent pattern is to get up when I wake up, usually between 7 and 8am, shave, shower, dress and then spend the next hour or so language learning. I’ve been learning French since I moved here and now I can read it pretty fluently, and can manage conversations with native speakers but I’m far from as fluent as I’d like to be, so I use apps, videos, or podcasts every day, and read articles which catch my attention in the newspaper, “Le Monde”. In addition to that I regularly buy French language magazines and books so always have more to read when I want but I don’t include that in my language learning time. Because I can set off after breakfast and be in Spain for lunch I’ve had a few trips to Spain. I’d never been to Spain until I moved here and I speak absolutely no Spanish, but I like the place so much I’ve decided to learn a bit of Spanish too. So each morning in my language learning session I’m working my way through the Duolingo Spanish course.
Before I settle down to learn though, I open the shutters. We live in a traditional old Charentaise house and all the windows have wooden shutters. The rhythm of closing them all at night, and opening them up every morning pleases me.
When I open the shutters it might still be dark outside but as we move away from the Winter Solstice it gets more and more likely that the first thing I see is the dawn.
Here’s what I saw this morning.

pink dawn1

Isn’t that beautiful?
It’s not like that every morning of course, but how it just captures my attention and entrances me when it does. It strikes me that it’s kind of life enhancing to witness, and pay attention to, the dawn.
So I was very taken with a quotation from Mary Oliver’s essay, “Wordsworth’s Mountain” which The Paris Review printed in an obituary article this week.

But dawn—dawn is a gift. Much is revealed about a person by his or her passion, or indifference, to this opening of the door of day. No one who loves dawn, and is abroad to see it, could be a stranger to me.

I like to think that although I only knew her through her writing, and how, of course, she had absolutely no idea I existed, that I wasn’t a stranger to her. What a lovely way to put it, don’t you think? Instead of just saying she could understand, or sympathise with, or share a point of view with, someone who loves the dawn, she said they couldn’t be a stranger to her.
That reminded me about the importance of the start of every day. Not just our first activities, or even our first thoughts or words, but how we begin the day. How we make that first connection.

What kind of connection do you make at dawn?

Here’s another photo I took this morning. The dawn sky behind the winter mulberry tree. (and, yes, that white spot in the top right corner is the moon! I know…but hey, it was just my iPhone!)

pinkdawn2

By the way, do you have a favourite Mary Oliver poem?
And if you’ve never heard it before, Krista Tippett’s 2015 interview with her remains one of my favourite Onbeing podcast episodes.

Treat yourself sometime.

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The Japanese woodcut I’m looking at today is from Kitagawa Utamaro in about 1790. He created five winter scenes to illustrate the 78 poems of Tsutaya Juzaburo’s collection, “Setsugekka”, (which means “Snow, moon and flowers”)

winter1

I’ve only seen a trace of snow a couple of times in my four years here in France, so snow doesn’t really feature in winter for me just now. However, there are certainly mists and frosts, both of which can be beautiful.

Version 2

tree in misty vines

Of course, I’ve many, many memories of snow from all my years living in Scotland. I can remember one year, a year of my junior doctor training at Stirling Royal Infirmary when the snow fell and the temperatures dropped far into the minus range. The milk inside the milk bottles left on the doorstep (yes, that was a thing…..two bottles of milk delivered early each morning by the milkman) froze, expanding so much that the frozen milk pushed the silver caps up about an inch!

frozen milk
The last place I lived in Scotland before emigrating to France was the top floor of a renovated late nineteenth century textile mill. It had huge arched windows and from three of them I looked out across the Carse of Stirling to Ben Ledi…a shape that became as familiar to me as Mount Fuji is to Japanese people.

snow capped ben ledi

In the woodcut I can see three zones – in the distance, snow capped hills and mountains; in the foreground, a frozen weeping willow; and in the middle ground, two people struggling up a slope in the snow pulling a boat over the what seems to be a frozen river. The angles of their bodies and the lengths and taught-ness of their ropes suggests it’s really a huge effort. There’s a third person on the boat, but most of the boat is hidden by something like a tented canvas. It provokes my curiosity (as usual…..curiosity is probably my core characteristic!) and I wonder what lies under the canvas. Slightly further back is another frozen tree, perhaps a pine, and a snow-covered bridge.

winter1 people

It’s strangely still and frozen while conveying movement, effort and action at the same time. Do the people really have bare legs and feet? It looks like that! What an image of determination and co-operation there. No sense of ease, but of will and strength and progress in the face of adversity. But that adversity is also engagingly beautiful…..though I’m happier looking at it than imagining myself as one of the people in the scene!

I also like the fact that the river seems frozen but not quite. I love that moment when you see water just beginning to freeze.

water starting to freeze

Isn’t water such a curious and amazing element? Combining those qualities of flow and stillness, moving from liquid to solid and expanding as it does so. And when it coats a plant, a flower, or a tree it somehow adds sparkle or even bling!

frosted japanese lantern

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