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......

Memories

My friend Odd Steffen died a few days ago.  It was a shock. He was wise and solid. I’d expected him to always be there.

I’ve been remembering all the good times we spent together.  A big research conference in Birmingham: his plane was late, we were all panicking. Then he strolled in, calm as you like, just in time to deliver his presentation. Dinner in a Blues bar in Chicago. And a weekend in Ville’s woodland retreat on the south-west coast of Finland.  It was June, daylight lasted for ever. Sunshine, sauna, swimming, Sibelius, sailing.

A magical time.

Memories matter. When life is difficult or sad, we can draw on memories of good times. They help us to get through the troubled present, and nourish the hope that good times will return.  

Memories do more than that. They give us an awareness of continuity. They build our sense of coherence, our identity, our ideas about who we are and where we belong.   

Proust was a delicate creature, who spent most of his adult life in sealed room in Paris, in a state of severe health anxiety. He was also a wonderful writer. He has important things to say about memory and continuity. Tiny, apparently insignificant events – a cake crumbled into a cup of tea, catching sight of a church tower, the smell of mildew – can be triggers that recall lost times, bringing them together with the present in a continuous reality.  

Memories keep us connected with our past, with where we have come from in this unique life we are leading. These connections help us survive and flourish, and build for the future.

‘That’s all very well’ I hear you say, ‘if you’ve got a store of good memories to fall back on. But what if my memories are mainly bad ones?’  

Sometimes memories can be cruel. The Russian writer Dostoevsky was haunted for years by the memory of the moment when he stood before the firing squad waiting his call for execution, before his reprieve was suddenly announced. Many people who suffer trauma in childhood find dark memories returning to haunt their lives and thoughts.  Or maybe your memories are of failures, unrealised dreams, of things that might have been.

Fortunately, memories are not fixed. We can change them.

We can turn memories into sources of energy and hope. We can draw new implications from old memories, or expand them by adding in the experiences of others.

In his Intimate History of Humanity, Theodore Zeldin tells of his friend Olga who used her fearful memories of life as a political dissident as a stimulus to change – given the opportunities provided by glasnost and perestroika – into a life as a commercial statistician. This gives her financial security and the freedom to dress well, travel frequently and indulge her passion for Proust.

And there is Quoyle in The Shipping News. His earliest memory is being a disappointment to his father, because he almost drowned when he was supposed to learn to doggy-paddle.  He grows up as a fat, lonely loser. But new experiences of friendship, creativity and love alter his awareness of the past. His memories expand, enriching his past and his imagined future.

He remembers how he saved a bird his daughter had found, and how thrilled she was.  

‘If a bird with a broken neck could fly away’, he wonders, ‘what else might be possible? It may be that love sometimes occurs without pain and misery.’

What about you? What memories keep you going through bad times? What helps you increase your supply of good memories?

Respect

Over to Sue for this blog, which is all about Respect.

“With respect” is one of those phrases I really dislike.  Usually it’s said when people are irritated and disagree with you, and respect is actually not very much on their agenda.  Nevertheless respect is a word we often hear bandied about.  There are comments like “No self respecting person would wear that,” we hear talk of “Respect needing to be earned”, of young people having “no respect”.   So are there in fact lots of different kinds of respect? 

As a child I wore a hat when I went to church as I was told it was respectful. I hadn’t a clue what it meant but I went along with it.  Most of my friends wore a hat as well so it made me one of the crowd. 

Later on as rebellious teenagers we joined together to show we didn’t respect things, certainly not things that “old" people thought important!   So no hats for us, unless we made them part of the outrageous fashions we felt were our own!

Here’s how I think about respect, and why I think it’s so important.

I was fortunate to grow up in an environment that taught me I was as good as, but no better than anyone else.  This was some intrinsic quality, not related to wealth, status, looks or any of the other parameters we measure ourselves by.

When we are born, to develop to our maximum potential, everyone deserves to be respected by, and to respect, everyone else.  And what a perfect world it would be if that continued to happen as we grew!! 

But none of us live in a perfect world, so how are we going to manage?

If we all deserve respect, but we feel disrespected by someone in, for example, a relationship or in work, what is actually happening?  Someone is not treating us right but should that actually affect our own self-respect?  No it shouldn’t - unless we allow it to.  Here are two wonderful comments confirming this. 

‘They cannot take away our self-respect if we do not give it to them.’  ~Mahatma Gandhi

‘No one can make you feel inferior without your consent.’

~ Eleanor Roosevelt

 If my self-respect is strong and someone treats me badly it’s not my fault  - it’s theirs.  It tells us more about the other person than it does about ourselves. We might feel angry or sad or even scared but that again is to do with the other persons actions. It is only when our self-respect is low we mistakenly blame ourselves.

We can think of our self-respect as a core of positive energy, a bright light that will always be there.  It might be weaker or stronger at different times in our lives, but it is always there.  And we need to feed it by being with positive people as much as we can.

We cannot always choose to be with people who treat us well . But sometimes we can remind such people that we don’t need to tolerate their behaviour. For example, if someone is shouting at you in what you believe to be an unreasonable manner you can say something like, “I do not like or deserve to be shouted at. If you want to speak to me let’s start again.”  It won’t always work – and if it doesn’t, we can tell ourselves we did our best and are obviously at a higher level of personal development than our attackers!

Little things can be very important measures of respect – greeting people with a handshake, smiling, anything that helps the other person feel valued. I was away at the weekend with my daughter and her partner and their 4 month old son.  He is their first child and I happily spent the weekend listening to them talking and singing to him, about how wonderful, funny and cute he is. He was surrounded by a cocoon of total acceptance for who he was.

Now that’s what I call respect!

Under the Banyan Tree

Last week I visited Pakistan with a group of doctors from Liverpool. We were there to develop research links. I was also keen to find out how they run health care in rural areas.

Before we left I was very conscious of the troubled times people are living through, with political instability and natural disasters like last summer’s devastating floods in the Indus Valley. These were evident, but by no means oppressive, during our visit to Islamabad and Rawalpindi.

Much more in evidence were the strengths and resilience of the country, and the people we met. A rolling hilly landscape, dotted with stupas, temples and shrines arising from a rich, diverse cultural heritage much older than ours in the West. A brief but memorable meeting with Dr Tariq Mehmood. He’s a rural medic who works with few resources beyond his own knowledge and skills, yet provides the sort of patient-based care with which I feel great affinity. And wherever we went, generosity and hospitality beyond measure.

But I was most captivated by the Banyan Trees.  Most villages in the region have at least one. One village we passed has six Banyans grouped together.

Banyans are fig trees, which start life as seeds germinating in the crevices of other trees. Once established they can live for hundreds of years, sometimes more than a thousand. They are immense. Deep, deep roots come above the surface and provide natural (and remarkably comfortable) places to sit and rest. Branches spread outwards and upwards into the sky, seemingly forever, and their green leathery leaves offer shade from the baking sunshine.

Sitting under the Banyan Tree I feel at ease, secure, sheltered. I have a clear vision of the world around me. I also have an awareness of the immense strength and solidity of the tree, an undeniably tangible, peaceful, natural being who has seen it all before, and has survived and flourished. I imagine it offering its wisdom and protection to me, and whoever else wishes to rest under its care.

It doesn't surprise me that Buddha found enlightenment while meditating under the Banyan Tree, or that Krishna should choose a Banyan leaf as his final resting place. I can see why Shiva is commonly depicted as sitting in silence under the Banyan, with wise people at his feet. 

And I can see why Robinson Crusoe decided to make his home in one.

A Banyan Tree is a wonderful refuge in times of trouble.