Feeds:
Posts
Comments

The fairy house

My eldest grand-daughter showed me this the other day –
fairy house behind the pot
“It’s a fairy house”, she said
Come and look closer
fairy house entrance way

It reminded me of how rich the lives of children can be. What is it that makes such a difference?

Imagination.

What a shame that so many toys these days are manufactured right up to the finish point. Kids can get so much more fun out found objects and daily materials which with imagination become castles, boats, and, yes, fairy houses!  If you want to encourage your childrens’ growth and development then encourage their imaginative play.

In fact, I often think adults lead much poorer lives because they’ve lost both childlike wonder and the power of imagination.  When was the last time you let your imagination run loose and played?

Second sight

flight, originally uploaded by bobsee.

From my living room window today I saw this little trail of snow on top of Ben Ledi so grabbed my camera (can’t tell you how long it’s been since Ben Ledi was visible from my window – we’ve had days of wild winds and rain or thick, heavy mists hiding the mountains).
What often catches me by surprise are the really obvious things in the picture which I only see when I put it up on the mac and just didn’t notice at all as I pointed my camera and clicked. First of all look at that huge, heavy, water-laden cloud up there! How didn’t I see that?! But look also at the bird in flight – isn’t that beautiful? You couldn’t manufacture a shot like that. I love that about photography – how it can raise our awareness and deepen our perception of the world. I swear I look at the world differently when I’ve been looking at photos and/or when I’ve got one of my cameras in my hand. It’s a kind of second sight…..you see it once, then you see it better!

Music from the heart

Last night I went to see Aly Bain and Phil Cunningham in concert at Falkirk Town Hall and, oh, how I enjoyed it. What a great evening’s entertainment. To be quite honest I’ve always had a bit of a love/hate relationship with Scottish music which can be everything from twee to tear-jerkingly emotional but I can’t remember the last time I saw such masterly musicianship as I saw last night. The accordion is not my favourite instrument (I was amused that Celtic Connections put on a concert called “Accordion Hell” inspired by Larson’s cartoon where everyone going to heaven is given a harp, and everyone sent to hell is presented with an accordion) but in Phil Cunningham’s hands it is superb. (I’ve never seen anyone’s hands move so quickly over a keyboard of any kind actually!). He played a tune he wrote in memory of his deceased brother and it was profoundly moving. Here’s a video clip of him playing a bit of it and having it analysed to show how it works its power. I love how he says at the end that it’s music from the heart. The best of music is always music from the heart.

amaryllis

I took this photo of an amaryllis (ok, actually it’s probably not truly an amaryllis, but actually Hippeastrum) recently and when I looked at it once I’d uploaded it to my mac, it brought back to my mind a Hermann Hesse fairy tale I read back in my teens (yep, well over three decades ago!). Sometimes you read a novel, or a story, or a poem and it makes such an impression that it stays with you for life. I read a lot of Hesse when I was a teenager and one of my most favourite was (and still is) his collection of fairy stories – “Strange News from Another Star”. One of the stories in that collection is “Iris”. What I remember about that story is how the young boy imagines a whole world inside the Iris flower in the garden and later in life when he has lost touch with that whole way of experiencing life he falls for a woman named “Iris” who challenges him to go back and find what he had lost. I got my old copy off the bookshelf and the moment I started to read, the old magical feeling came back.

In the morning when he came out of the house, fresh from sleep and dreams and strange worlds, there stood the garden waiting for him, never lost yet always new, and where yesterday there had been the hard blue point of a blossom tightly rolled, staring out of its green sheath, now hung thin and blue as air a young petal with a tongue and a lip, tentatively searching for the curving form of which it had long dreamed. At the very bottom where it was still engaged in a noiseless struggle with its sheath, delicate yellow growth was already in preparation, the bright veined path and the far-off fragrant abyss of the soul. Perhaps as early as midday, perhaps by evening, it would open, the blue silk tent would unfold over the golden forest, and her first dreams, thoughts, and songs would be breathed silently out of the magical abyss.

I don’t think I ever looked at a flower the same way after reading that. Oh how I love those images – of the flower “tentatively searching for the curving form of which it had long dreamed” and of it “breathing silently out” its’ dreams, thoughts and songs.

When he stared into her chalice and in absorption allowed his thoughts to follow that bright dreamlike path between the marvellous yellow shrubbery towards the twilight interior of the flower, then his sole looked through the gate where appearance becomes a paradox and seeing a surmise. Sometimes at night too he dreamed of this flowery chalice, saw it opening gigantically in front of him, like the gate of a heavenly palace, and through it he would ride on horseback, would fly on swans, and with him flew and rode and glided gently the whole world drawn by magic into the lovely abyss, inward and downward, where every expectation had to find fulfilment and every intimation came true.

Each phenomenon on earth is an allegory, and each allegory is an open gate through which the soul, if it is ready, can pass into the interior of the world where you and I and day and night are all one. In the course of his life, every human being comes upon that open gate, here or there along the way; everyone is sometime assailed by the thought that everything visible is an allegory and that behind that allegory live spirit and eternal life. Few, to be sure, pass through the gate and give up the beautiful illusion for the surmised reality of what lies within.

Goodness, it is so many years since I last read those words but they feel as vibrant, stimulating and inspiring as they ever did. What a fabulous capacity we human beings have for imagination and creativity! How amazing is the tool of “allegory”? Isn’t it incredible how it turns what seems to be into something so much more? How it unlocks the potential that lies in everything. Wonderful! I’m off to re-read some more Hesse!

Meanwhile, here are a couple of other lily family photos I’ve taken – an iris I saw in Holland once, and a daylily from Rodin’s garden in Paris – hey, that should inspire your imagination a bit!

iris

daylily

Here’s an interesting study which split stroke patients into three groups – one group listened to music of their choice, one to audio books and the third didn’t listen to anything other than the sounds around them.

After three months, verbal memory improved by 60% in the music group, compared with18% in the audio book group, and 29% in the non-listeners. Focused attention – the ability to control and perform mental operations and resolve conflicts – improved by 17% in the music group, but not at all in the other two groups. In addition, patients in the music group were less likely to be depressed, or confused.

The researchers point out that

during the first weeks and months after stroke, the patients typically spend about three-quarters of their time each day in non-therapeutic activities, mostly in their rooms, inactive and without interaction, even although this time-window is ideal for rehabilitative training from the point of view of brain plasticity. “Our research shows for the first time that listening to music during this crucial period can enhance cognitive recovery and prevent negative mood, and it has the advantage that it is cheap and easy to organise.”

What a great idea! And how interesting. I’ve often felt that a lot of hospital time for patients is empty and involves no explicit therapeutic intervention. Yes, the physical environment of the hospital, if well designed, can contribute a therapeutic influence, but not many hospitals are designed that way, and even in the ones that are, it strikes me as a good idea to fill more of the patients’ average day with therapeutic interventions.

This final paragraph in the BBC’s report of this work really struck me –

Dr Isabel Lee, of The Stroke Association, welcomed the research. However, she said: “Further research into the effect of music on stroke patients needs to be undertaken before any widespread use, as presently the mechanisms of any effect remain unclear.”

Really? We’d better not allow stroke patients to choose to listen to music they like until we understand the “mechanism of action”? Has it come to this? Is this an important thing for science to discover? How music works???

fruit bowl

Another excellent episode of the BBC’s Horizon tonight looked at communities around the world where people live longer and live more healthily.

There were different characteristics in the different communities. The first place the programme focused on was Okinawa and the American doctors who were studying the longevity phenomenon there highlighted the Okinawan’s diet. What immediately grabbed me was the focus on how colourful their diet was. I think that’s a good indicator of a healthy diet. The browner the diet, the poorer it’s likely to be. I don’t know if you’ve ever watched any of the rather awful Gillian McKeith’s programmes about diet, but she gets her victims to observe their entire week’s food piled high on a single table. It’s done in a way that’s designed to disgust and it works, but one thing has always struck me about the unhealthy diets on those tables – they are so BROWN!

So here’s one tip for living longer – have a colourful diet! (Oh, let me make clear, I mean naturally colourful, not food that’s been coloured artificially with chemicals!)

Secrets of longevity?

On the BBC’s Horizon programme about longevity, there was one characteristic shared by all the communities of long living people which they studied – it was the sense that they were connected to something greater than themselves, expressed either through adherence to particular religious beliefs, or, at least, to having a sense of meaning, or purpose in life. The books I’ve read about happiness often stress this feature too.

In one community, the main characteristic highlighted was their healthy, colourful diet; in another it was their commitment to regular exercise and in a third it was a genetic factor prevalent through close knit marriages. But all three shared this characteristic of feeling that life had a purpose, or rather that their individual lives were meaningful. How interesting that this is the one common feature – not something physical at all, but something social and cultural. Turns out the communities we live in are important after all – no man is an island!

Francis Peabody of Harvard, way back in 1925 said –

The secret of the care of the patient is in caring for the patient.

I showed a group of medical students a video of a consultation I’d had with a patient. She had strong ideas about her illness and what she would or wouldn’t accept as a treatment. Patients with such clear and strong opinions are frequently viewed by doctors as “difficult” and sure enough the medical students didn’t like her. They admitted as much. Now, nobody can like everybody, and no doctor will be able to like all of his or her patients, so what’s important is that a doctor is self-aware and knows what feelings he has about a particular patient.

The physician’s internal state, his state of tension, enters into and strongly influences his clinical judgements and actions.

(How Doctors Think)

This is why I write this blog – to encourage people to become self-aware, for without self-awareness we cannot make conscious choices. Doctors have a special duty to be heroes not zombies. But let me say this, too, it’s not enough for a doctor to just be self-aware, if a doctor does not honestly care about his or her patients, then it’s time for that doctor to find another job. If I ever have to consult a doctor, I want one who, frankly, gives a damn! (about ME!)

In How Doctors Think, Jerome Groopman, argues against the modern tendency to reduce human beings to averages and medicine to a slavish adherence to algorithms.

Clinical algorithms can be useful for run-of-the-mill diagnosis and treatment….But they quickly fall apart when a doctor needs to think outside their boxes, when symptoms are vague, or multiple and confusing, or when test results are inexact.

There are some people who think “science” (which has been defined as the study of what can be measured – not a definition I would accept!) is about “facts”. By this they tend to mean phenomena which can be isolated and observed objectively. But human life is more complex than the sum of the bits that such scientists study. This is especially obvious to anyone who has worked in a Primary Care setting where patients typically tell stories of “vague, or multiple and confusing” symptoms and where the test results are frequently ambivalent. You can’t understand a person by focusing simply on the measurable bits.

Today’s rigid reliance on evidence-based medicine risks having the doctor choose care passively, solely by the numbers.

You know, it’s almost considered heresy in some places to raise any kind of question mark over the hegemony of EBM, but if we want to be rational human beings who think for ourselves and don’t just do what others tell us, we should question those practices. Those who would try to divide all therapeutic interventions into “proven” and “unproven” and devise “guidelines” which  only allow for the availability of the “proven” treatments are going to stop progress in its tracks. There are not two fixed boxes in medical practice with one containing “proven” treatments about which all that needs to be known is known, and one containing “unproven” treatments about which we needn’t bother finding out any more.

Statistics cannot substitute for the human being before you; statistics embody averages not individuals.

When I read that statement I thought about a talk given by a statistician which pointed out that the average number of legs which each person in the UK has is less than two – yes, think about it for a moment – because thousands of people have lost a limb the total number of legs is less than 2 x the population of the UK, therefore the average number of legs a UK resident has is 1 point something! I know, it’s silly, but it does make a valid point – you can’t treat individuals as averages – frequently, there is no Mr or Mrs Average!

What is Dr Groopman’s recommendation in the face of this? Well, he quotes one of the doctors whose conversations make up the text of this book –

Falchuk paused “And once you remove yourself from the patient’s story, you no longer are truly a doctor”

Patients’ stories are frequently dismissed by scientists as anecdotes (and they say that contemptuously) but in clinical practice they are really the key.

Here’s to the patients! You are the heroes of your stories.

How Doctors Think

“How Doctors Think” by Jerome Groopman (ISBN 978-0-618-61003-7) should be on the recommended reading list of every medical student and doctor. Dr Groopman is a physician who specialises in Haematology. This book is the best presentation on the cognitive processes involved in medical decision making I’ve ever read. Actually it’s main focus is on how doctors make a diagnosis and on their cognitive errors which result in them missing or mistaking the correct diagnosis. It’s clear and it’s comprehensive. It’s the kind of book that stimulates me to think about a number of aspects of medical practice and I’ll probably do individual posts about a number of them.

My summary understanding of this book would be that doctors make diagnoses by recognising patterns – that certainly seems consistent with what I think about my own practice. The key to this is the doctor-patient relationship. It’s the patient’s narrative that holds the key and the effect the patient has on the doctor colours how he or she hears that narrative.

My one criticism of this book would be that the whole focus is on the discovery of the “lesion” which is the source of the symptoms. Trouble is, as Kroenke and others have shown us, the vast majority of symptoms presented to doctors don’t come from “lesions”. I’d have liked to read Dr Groopman’s take on that huge issue.