The best is yet to be

Turning sixty has made me stop and think.   

I've been thinking about everything that’s happened in my life so far: the things I’ve done, the things I wish I’d done, and the things I wish I hadn’t done.  I'm aware that it’s getting to be a bit late to do much to change all that.  Time is beginning to run out. I've got a lot more past than future. I haven’t the energy I used to have. My body is starting to crumble, and I know that’s only going to get worse – tinnitus, restless legs, prostate problems, and now the dreaded bowel screening tests.  Eeugh!

Except it doesn’t feel like that to me.

It feels remarkably good.

That’s partly because I’ve got a wonderful family and lots of  good friends, who helped me celebrate my 60^th birthday in grand style.

And it’s partly because things have generally gone well for me in recent years.

But it’s more, much more than that. 

I'm coming to realise that I don’t have to try quite so hard any more. That it’s OK to take everything a bit easier.  That it’s fine to do less, and be more.

 The Victorian poet Robert Browning starts off his wonderful poem Rabbi Ben Ezra like this:

Grow old along with me!
The best is yet to be...

He’s not talking about everything being a major success, or looking at the world through rose-tinted glasses. He’s thinking about past failures, and how they really don’t matter – What I aspired to be/ And was not, comforts me.  It’s not a problem, he says, it’s OK to have made a pig’s ear of things.  

I know what he means. Whether things up to now have gone well, or not so well – or even if they’ve been disastrous - there is something reassuring about time moving on.  The past is in the past.  We can allow ourselves to leave it there. We don’t need to dwell on it. And we can look forward to different ways of being.

I’m confident that the next twenty years are going to be the best so far.  Growing old looks good to me. Not worrying about getting anywhere in particular, just enjoying being where I am.  Less hassle - and a lot more fun.    

I’m not naive about this. I know everything could go belly up, any time. Like it did for John Lennon – who ironically used Browning’s poem as the basis of one of his very last songs  ‘Grow old along with me’ (you can find it on http://www.youtube.com/watch?v=oixKjpZ5a1o) - just a few months before he was shot.

But that’s not the point. Not at all.

It’s all about living hopefully.

Welcome in the Maumturks

Whenever I’m back in Ireland, my body feels lighter, my step is springier.  I’m energised. My life seems easier, more balanced.  I feel at home.

Last week I was in Galway for a research meeting, with friends and colleagues from all over Europe. We worked hard - and we had a grand time. Our conversations ranged far and wide, from whether Greece would have to leave the eurozone, to how to make room in your bed so that your guardian angel can look after you while you sleep. We had music, dancing and plenty of fine food. We even had a breakfast rainbow (thanks Evelyn, for the picture).

Within this cornucopia of good things, two particularly improved my well-being. 

The first was the welcome we received from Mary and Tomas, who were introducing us to participatory research. Céad míle fáilte – a hundred thousand welcomes – says the Irish Tourist Board.  With Mary and Tomas, it was closer to céad milliún fáilte.

I pride myself on being pretty good at welcoming people, especially in my surgery where I offer a smile and a handshake as people come in to see me, and another handshake as they leave.  But it turns out I’m just a novice, and there is so much more to making people feel fully welcome: lots and lots of friendly visual contact, hugs (sometimes) as well as handshakes, sharing (and remembering) names, physical comfort and refreshment - and the huge importance of chatting. 

I’ve just worked out that welcoming is 75% of wellbecoming! 

The second big thing that improved my well-being was climbing Lackavrea, the easternmost peak of the Maumturk range (it’s on the right in this photo). As you’ll have noticed from my earlier blogs, climbing mountains is one of the ingredients in my own wellbeing recipe.

It was just great to find a new one to add to my list – thanks to Joss Lynam’s walking guide to the mountains of Connemara, and to Tim Robinson’s wonderful Folding Landscapes map. 

Lackavrea only just qualifies as a mountain – it’s a tad over 1000 feet - and you can easily get up and down again in a couple of hours.  But I still had a real sense of achievement, not least at avoiding slipping too many times in the boggy turf on the way down.  There are sensational views from the top, so I’m told, though was covered in cloud when we got there.

So, while we munched our Danish pastries, we imagined the light reflecting off the waters of Loch Corrib to the east, and the sun setting behind the full extent of the Maumturk range, as it rolled away westwards in front of us.

Beautiful!

The Tree of Life

I love big trees. A while back I was sitting under the Banyan Tree in Pakistan.  Recently I’ve been to visit the Tree of Life in Bahrain. 

The Tree of Life is remarkable. It lives all on its own on a small hill in the middle of a desert.  You can see how big it is by the size of the people beside it (including Sue, if you look very carefully). Apparently it’s over 400 years old.  It’s a member of the mesquite family, known for their very deep root systems which can tap water more than 50 metres below ground.

Local legends abound. One story is that the Tree of Life marks the location of the Garden of Eden, and the origins of our knowledge of good and evil.  Another is that it survives thanks to Enki, the Sumerian and Babylonian god of water, mischief and life.   It makes an appearance in the 1991 Steve Martin film L.A. Story, but has nothing whatsoever to do - thank goodness - with Terence Mallick’s pretentious Tree of Life film.

Sue and I get to see it just before sunset, after a tortuous journey through the oil and gas fields of central Bahrain.  There are no other trees or any vegetation in sight, just sand, rocks and a couple of gas flares burning in the distance.  There are a few other people there, Indians on their day off from jobs in the service or construction sectors. Our host, who’s lived in Bahrain for over 40 years, has never been to see the tree before.

It is easy to climb and sit in. Lots of signatures, hearts and dates are inked in its lower branches.   It doesn’t have the immense solidity and security of the Banyan. It’s a comfortable, friendly tree. The sort of tree you'd just like to hang out with for a while. No need to say much, maybe a bit of a chat about old times.  

The Tree of Life is deeply reassuring. It has survived and flourished in the some of the toughest conditions you can imagine, arid and hot, often over 50 degrees in high summer. It’s seen people come and go over the centuries: Portuguese and British, Iranians and Indians, Germans and Americans, Shias and Sunnis.  And it’s still there.  

Given the recent troubles in Bahrain, and the possibility of more to come, the Tree of Life is a powerful symbol of survival and resilience during tough times.

It lives on its little hill, untroubled by difficulties or events around it. As my favourite philosopher Spinoza says, it is 'persevering in its own being'.

It is.

Walking the dogs

I love going out walking with our two dogs.  They scamper to and fro, noses to the ground following scents in apparently random patterns, then rush on ahead of me, turning round every few seconds to check they’re on the right path – and bounce back to me if they’re not. They are living completely in the moment.

They lighten my heart. Sometimes I just laugh out loud at the joy of it all.    

And they are very good for me.  They probably improve my physical health, reducing my blood pressure and my risk of heart disease.  They certainly are part of my wellbeing recipe.

Way back in the seventeenth century, Robert Burton wrote thousands of pages about melancholy and how to cure it.  But he was able to boil all his research and his thinking down to two very simple ideas:

As thou tenderest thine own welfare ..., thy good health of body and minde, observe this short precept, give not way to solitariness and idleness. Be not solitary, be not idle.

Dog walking sorts out both of these things for me, very nicely. It’s not solitary, it’s sociable - and it definitely stops me being idle.

Much more recently, instead of two cures for melancholy, the New Economic Foundation have come up with 5 Ways to Wellbeing. You may have heard of them, but just in case you haven’t, here they are: Connect, Be Active, Take Notice, Keep Learning, and Give.  For me, all five of them are covered by walking with the dogs.

Connect: I connect with the dogs themselves, and with a surprising number of other people. Lots of people just smile, at the dogs and at me, when they seem them lolloping along. And all sorts of interesting conversations emerge with other dog walkers.

Be active: of course walking is good aerobic exercise, releasing those endorphins. The other day (don’t ask me how!) we all ended up on a boat in the middle of a Welsh lake.

Take Notice – all sorts of good things to notice while we’re out:  wonderful sunsets over the sand dunes at Formby, the changing seasons on our usual walk along the nearby cycle path, blackberries ripening and ready for eating as we go along.

Keep Learning – hmmm, this is the challenging one! Dog training is a skill     I have not yet fully mastered. I can get them both to sit, and (usually) to return to heel, but I’m not so good at stopping them leaping up when they meet new people.  So I need to keep learning on that one.

Give – that is, seeing myself and my happiness linked to others, to things or beings beyond myself. When I’m walking the dogs I’m thinking about their wellbeing, and their safety - I’m on the lookout for danger from other dogs, cars, cyclists or whatever.

So for me, walking the dogs is a great antidote to stress and gloom. Who needs pills?  Who needs therapists?

What about you? Tell us about your two cures for melancholy, or your 5 ways to wellbeing. Does dog walking do it for you?  If not, what else does?  

Thank you all

Just a note to tell you how much I appreciate your support for my wellbecoming blog.  We've just passed 10,000 page views. I am thrilled to bits!!

My most popular post has been Reaching Out (22 October). It continues to get regular hits, more than 100 in the past month alone. I wonder if someone or some group has been focusing on this one? If so, do let me know.

You are viewing the blog from all over the world. The main places you are from are the UK and Spain. The next most frequent viewers are from USA, Australia, Canada, India, Ireland, Philippines, Germany, South Africa and Hungary. 

Thank you!

Meadows of delight

My last post on trudging through treacle struck a chord with many people. Thank you so much for your words of empathy and wisdom, and the offer of custard to pour on my sticky toffee pudding.  

One of the many things I love about this blog is the richness and variety of your responses. Catherine, who lives just a few streets away, knows all about the stickiness of treacle, and how hard it is to stay afloat and not drown.  Murthy emails me from India to share his response to the stress of developing diabetes: recognise the crisis, identify changes needed and harmonise them with other aspects of life.  Deb writes about the suffering of others as being tiresome but necessary work to take on; and how “cultivating loving-kindness" may help us to keep giving without the feeling of emptiness. And for Katie, vulnerability is part of being human.

Indeed it is....  We are in this together, for good and for ill. We can’t just choose the fun bits, and leave the rest behind. They’re all part of the package.

I’ve been thinking about the17th century poet John Donne, and his famous poem No man is an island, all about the indivisibility of humanity, and how we can’t help but be affected by the loss of others: ‘never send to know for whom the bell tolls; it tolls for thee’. And Garth Brooks’ lines from The Dance, about the end of a love affair : ‘I could have missed the pain, but I'd have had to miss the dance’.

And – mostly – I’ve been revisiting the writings of the Irish poet and philosopher John O’Donohue, who died far too young in 2008.

Beannacht (or Blessing) is one of his very best poems. Here it is, in its entirety:

On the day when

the weight deadens

on your shoulders

and you stumble,

may the clay dance

to balance you.

And when your eyes

freeze behind

the grey window

and the ghost of loss

gets in to you,

may a flock of colours,

indigo, red, green,

and azure blue

come to awaken in you

a meadow of delight.

When the canvas frays

in the currach of thought

and a stain of ocean

blackens beneath you,

may there come across the waters

a path of yellow moonlight

to bring you safely home.

May the nourishment of the earth be yours,

may the clarity of light be yours,

may the fluency of the ocean be yours,

may the protection of the ancestors be yours.

And so may a slow

wind work these words

of love around you,

an invisible cloak

to mind your life.

(You can find John reading this here)

There are so many healing images in this poem, I can't begin to do justice to them all. They are grounded in the natural world around us - the safety of earth, the energy and guidance of light, the fluency of water.  The wind as an invisible cloak: this puts me in mind of Sue imagining her father's overcoat spread protectively around the aeroplane, whenever she is flying.

The treacle is runnier now, and I don’t have to trudge any more. I can stroll through it, and enjoy the feeling of it trickling and gurgling between my toes.  Perhaps it will nurture my own meadow of delight.  

Trudging through treacle

I’ve been at a conference these past two days, doing a lot of networking and catching up with friends and colleagues. Yesterday somebody asked me, ‘What are you passionate about at the moment?’ The honest answer is ‘I don’t really know’.

These past few weeks I’ve been feeling tired, without a lot of energy to be interested in things. Even just doing everyday things takes quite a lot of effort. Not much creative thinking or imagination going on. In response to the recent post about Iain (Rolling rocks), Natalie wrote about ‘ballet-dancing through treacle’. I’m not sure I can manage any pirouettes or pas-de-deux just now. Trudging through treacle is about the best I can do.

‘Hey, wait a minute’, you’d be forgiven for thinking to yourself. ‘I thought this bloke – and this blog - was all about giving positive messages. What’s he doing spreading doom and gloom?’

Well, the answer is that life’s been tough recently. Not for me specifically, but for people I care a lot about.  My wife Sue’s just had her right knee replaced, and it’s been hurting her like mad – we know it will get better, but it’s very hard going just now. My brother is not recovering from his major surgery as quickly as he’d hoped, and that’s getting him down. And our dear friend Carl has been seriously ill, admitted twice to hospital in the past couple of weeks. 

Life’s becoming intrusive. There’s a bit too much stuff going on for my liking. Its making me aware of contingency, of how things we take for granted suddenly might not be there any more, or might change in ways we just don’t expect - or want.  William Boyd writes brilliantly about this, especially in Any Human Heart.  I’m doing my best to look on the bright side, offering these lovely people constructive advice and encouragement. But you can’t shrug it all off. Sometimes it does get to you.

I know this is how a lot of people feel, a lot of the time. And with much tougher loads to bear. During my most recent surgery, I heard about living with recurring lung cancer; dealing with the sudden death of an older sister and the expected death of a younger brother; having to respond to severe homophobic abuse at work; and the trauma of a dawn police raid for suspected drug dealing.  There is an awful lot of suffering about.

When I ask them how on earth they manage to cope with all this, patients often tell me ‘I plod on, doc, I just plod on’.  They know life is tough, they know there’s not much they can do about it. Sometimes it’s just a matter of wrapping ourselves up against the elements, battening down the hatches, and keeping on doing the things that need to be done.

I’m going to revisit my post on well-being recipes, because I’ve realised the best way out of this is to take the advice I give others.  Maybe watching some cricket, climbing a mountain or diving through ocean waves will do the trick. I’ll do a bit of reaching out, maybe find a hug or three.  And I believe there are some fresh starts just round the corner. Sue’s knee is going to get better, and I’ve just seen a photo of Carl back home, cooking up something in his kitchen.

In the meantime, I'll plod on. I’ll pat myself on the back from time to time, remind myself how well I’m doing, considering what’s been going on. Trudging through treacle – maybe I’m gathering ingredients for a delicious sticky toffee pudding.    

Possibilities

Some of you will have seen this story before, but it is such a wonderful one that it’s well worth repeating. For me, it puts in a nutshell why we doctors spend far too much time worrying about how to diagnose and treat mental health problems.  Given the chance, our patients have much more interesting and useful ideas than we do, about how to find their way out of difficult circumstances and improve their lives.

Jenny comes to see me in my surgery one morning. She tells me she feels dreary, denigrated.  She says she has no self esteem. She is thirty seven, and has realized - like Lucy Jordan - that she’ll never ride through Paris in a sports car with the warm wind in her hair. ‘By the time you’re 40’ she tells me, ‘what is inside you comes out to the surface. I look in the mirror and see an old, ugly, hard bitch’.

She can find no value in her relationship with her partner. Recently he went five days without washing himself. ‘Just attention-seeking’ she reckons, ‘but it didn’t work’. He has warned her that if she ever tries to throw him out of her home he will kill himself - and their eight year old son. Jenny doesn’t really believe him but she is not quite sure. She might risk it when her son is older - thirteen, maybe seventeen – and can look after himself.

I ask Jenny what she would do in an ideal world, if she had all the choices available to her, if she could do anything she might possibly want. ‘Not money or fame,’ she replies. She sits and thinks for a while. ‘Respect from others would be good… and being able to write’.

How would she like to get there, I wonder? We talk about antidepressants – they might be an option, maybe sertraline which she she’s tried before. Alternatively, I suggest she might like to take part in a Positive Thoughts Course, one of the group psycho-education programmes that my wife Sue runs.

Then suddenly, unexpectedly, a whole set of other possibilities emerge from our conversation.

Jenny tells me she’s been thinking about signing up for a creative writing course. She’s also been wondering about taking up meditation or yoga, and exploring Buddhism. Or she might join the anti-war movement (our conversation takes place in the weeks leading up to the second Iraq war).

‘Or maybe’ she says, ‘maybe I should fall in love’.

Racing pigeons

In my last post (Rolling rocks) I told you about Iain, how he can’t see any point in getting up in the morning - and asked you how you’d respond to his despair.

You sent in some great Facebook replies and blog comments.  Thank you.

You have a lot of empathy for Iain’s problems, summed up by Natalie’s trying to ‘ballet dance through treacle’. Karl encourages Iain to be kind to himself, to remember that life is precious, and not to be afraid of trying new things, even if they fail. Natalie would like Iain to stop drinking, and get involved in something that gives him a sense of worth.   I agree.

There is something here about being able to look life in the face and – somehow, despite everything it throws at us– carry on. It’s as simple (or as difficult) as the active acceptance of life as it is, the recognition of the circumstances in which we find ourselves and the determination to make of them the best we can.  

This brings us back to Sisyphus, forever straining to roll his rock up the hill before watching it fall all the way back down again. The French writer Albert Camus has a great take on this story.  He tells us that Sisyphus is happy.  Happy because knows that there is no ultimate logic or purpose in what he is doing – and this gives him a sense of liberation. ‘There is no sun without shadow, and it is essential to know the night’. His fate belongs to him. He remains its master, his mind and body fully engaged in his chosen activity: ‘The struggle itself toward the heights is enough to fill a man's heart.’

And it reminds us of Nelson Mandela and his favourite poem, Invictus:  ‘My head is bloody, but unbowed... I am the master of my fate: I am the captain of my soul’.

This way of looking at life can help us to engage, fully and knowingly, with the real and specific circumstances we find ourselves in: whether that’s the  daily demands of work; the never-ending responsibilities and expectations of caring for young children; a long prison sentence on Robben Island; or living with physical disability or a chronic health problem.  It brings with it a sense of dignity. Even when life is tough and we appear to have run out of luck, we can hold on to the belief that we are, indeed, worth it.

Back to my conversation with Iain. We sit in companionable silence for a while.  Then I ask him, ‘What do you enjoy?’

I don’t honestly expect much of a response. But I am wrong. Coming from nowhere that I had anticipated, he leans forward and starts to tell me about his passion for racing pigeons. He owns some fine specimens, he takes real pleasure in caring for them, and in how well they race. I realise the importance they have for him, in their freedom of movement, the beauty and grace of their flight. They encourage his imagination to take flight, reaching towards new unseen possibilities.   

Our conversation ends at this point. The next time we meet, Iain says ‘You know doc, I can talk to you’. He still has problems with his feet, and tells me he is still drinking more than medical wisdom says he should (though his binges are less frequent and less severe). But now we have a basis for discussion, and a mutual respect which may - in time – enable us to change a few things together.

Rolling rocks

Iain is usually charming and friendly, and has a good joke to tell about his time managing a pub. But not today.

He’s come to see me in my morning surgery, with a lot on his mind. His feet are playing up again. Then it’s ‘some funny do’s I’ve been having, you know like blackouts or something’: three or four of them in the past month

When I ask him to tell me more, he says (with a sheepish smile), ‘Well, I guess I’ve been drinking too much again’.  Indeed he has. Without much prompting he tells me he’s getting through at least half a litre of vodka a day, and doing so mostly on his own at home. And he is smoking more than 50 cigarettes a day. I know Iain has other medical problems. He has diabetes mellitus, which (unsurprisingly) is not well controlled, and high blood pressure. He retired five years ago. His three children are all now grown up and living away from home. 

Using my best consultation skills, I ask Iain to tell me more about his worries and concerns. He has a long list. Apart from his ‘blackouts’ and binge drinking, he reminds me about his painful feet. His teeth hurt a lot.  He is sleeping badly and is often irritable. He has little interest in ordinary things, such as watching television or reading. He rarely goes out of his house, partly due to the pain of walking. And he is distressed because he can no longer be bothered to see his children.

He leans forward and says, ‘You see doc, basically the problem for me is I just can’t see any point in getting up in the morning any more’. 

He talks about his loss of ability, his painful feet and the complications of his diabetes, both present and to come. He talks about his loss of purpose, how he used to be a successful pub manager and a caring father. But now he has no role, with either work or family. His life is futile, a relentless trudge through pain and disability. All he can see is a slow, inevitable path towards death.

Iain’s problems seem to me to be beyond the reach of medicine, and way beyond the relevance of any possible formal diagnosis.

Iain and I are facing a profound, existential question.  What, actually, is the point in his being alive? 

I find myself thinking about Sisyphus, condemned by the Gods to spend eternity rolling a huge rock up a mountain, only to see it fall down again as soon as he’s reached the top.  And then about Bruce Springsteen’s exhausted night shift worker:

‘I get up in the evening and I ain't got nothing to say. I come home in the morning, I go to bed feeling the same way. I ain't nothing but tired. Man, I'm just tired and bored with myself’.

In my next post, I’ll tell you how our conversation went on.  Meanwhile, I’d love to know how you’d respond to Iain.  Maybe you’ve been there yourself, or maybe you know other people who just can’t see any point in it all. What would you say, or do?  

Over to you, dear reader......