Not ‘them’ and ‘us’. Just ‘us’.

It has been a dream to be face-to-face, talking about Saagar with the Psychiatric community. In the past 7 years that has not really happened. On Wednesday, the 15th of September, I got as up close as possible with an entire department of roughly 100 psychiatrists and Therapists at differing levels of experience and practice. They were in New York and I was here, in London. The Grand Round was organised by a colleague, Prof Mike Myers, who gave it the title:

‘Losing a Son to Suicide: How One Mother is Opening Hearts and Minds Around the World’

After a cordial ‘meet and greet’, the film ‘1000 days’ was screened. It was followed by complete silence. Same as the previous time it was screened. And the time before. Each time the audience was left speechless.

After a long minute I gently stepped in with the assurance that this was a normal response. I invited questions and comments. I thanked them for the work they do and acknowledged how difficult it is for the profession to deal with such losses. I shared my hope that the film will deepen their insights into the human element of such deaths and the value of forging partnerships with bereaved families.

What followed was a fulsome, creative and holistic exchange of ideas.

“What led you to make this film and share your life in this way?” one young Resident asked me.

“I could only work with what I had and do what was in front of me. When I could write, I wrote. When I could speak, I spoke. When I could learn, I learnt. From the moment I heard the news of Saagar’s death, my only intention was that this must stop. No one should have to suffer the way Saagar did or the way I and his friends do. This film came about because it’s time we recognize that these lives are worth talking about, that the desire to end one’s suffering is a normal human desire and that we all have a role to play.”

Winner – BEST DOCUMENTARY – Swindon Independent International Film Festival
Winner – Brighton Rocks Film Festival – Spirit Award
Winner – Compassion Film Festival Colorado – Reflections of Love People’s Choice Award
Nominee – Morehouse College Human Rights Festival Atlanta (winners yet to be announced) 
Semi Finalist – Gold Coast International Film Festival – New York 
Nominee – Long Story Shorts International Film Festival 

Upcoming festivals where the film can be watched starting 23rd September 2021. Tickets available now.

‘1000 Days’  
Morehouse College Human Rights Film Festival – fosters ongoing discussions about human rights and social and political issues.
September 23 – 25 https://morehousehumanrightsfilmfestival.com/2021-film-guide/

‘1000 Days’ at Women Over Fifty Film Festival:
WOFFF is an inclusive, international film festival celebrating women over 50 in front of, and behind the camera.
25 Sept – 2 Oct – tickets on sale
https://wofff21.eventive.org/films/61379c142c09f100b90ae7c4

Comments:

”Bringing people closer and keeping them deeply connected despite social isolation.”

“Keeping the silk threads of human bonds as strong as ever.”

I hate my shoes.

(‘A pair of leather clogs’ by Vincent Van Gogh 1853-1890)

“I am wearing a pair of shoes.

They are ugly shoes.

Uncomfortable Shoes.

I hate my shoes.

Each day I wear them, and each day I wish I had another pair.

Some days my shoes hurt so bad that I do not think I can take another step.

Yet, I continue to wear them.

I get funny looks wearing these shoes.

They are looks of sympathy.

I can tell in others eyes that they are glad they are my shoes and not theirs.

They never talk about my shoes.

To learn how awful my shoes are might make them uncomfortable.

To truly understand these shoes you must walk in them.

But, once you put them on, you can never take them off.

I now realize that I am not the only one who wears these shoes.

There are many pairs in the world.

Some women are like me and ache daily as they try and walk in them.

Some have learned how to walk in them so they don’t hurt quite as much.

Some have had to wear the shoes so long that days will go by before they think of how much they hurt.

No woman deserves to wear these shoes.

Yet, because of the shoes I am a stronger women.

These shoes have given me the strength to face anything.

They have made me who I am.

I will forever walk in the shoes of a woman who has lost a child.”

  • Author unknown.

One death by suicide is one too many. On World Suicide Prevention Day, today, let us start by

  1. believing that suicides are preventable.
  2. knowing that we all play a part, however small, by being aware, educated and resourceful.
  3. being kind and courageous enough to ask the ‘S’ question, listen and respond.

Now, they are pink.

The day after he died, our door-bell went berserk. This time the same young woman from the local florist, who had been here thrice already, stood at the door again. She had arrived with yet another bouquet of pure white lilies and roses. She stood just outside our front-door with tears rolling down her cheeks. Had this stranger accessed her own sadness or was she feeling mine? I thanked her and tried to console her, wordlessly holding her hands in mine, not believing any of that was happening.

Our eyes met through the fresh white flowers and films of salt water. She didn’t know me or the young man who had died and I didn’t even know her name. But we were flowing in the same river of humanity. Of loss.

For weeks, every room in our house reeked of the sickly-sweet stink of white lilies. I used to like that fragrance before all this but now it screamed ‘DEATH’. It crept into every empty space, crevice and corner. It sneaked under tables and inside locked cup-boards. It suffused my clothes and hair and got into my body like poison.

All these years later, that smell can still hit like an axe on top of my head when I walk past an innocent flower shop.

On my birthday last week, a bunch of Freddie’s flowers arrived unexpectedly. I thought I had cancelled that delivery but it seems I hadn’t. Roses, lilies and gladioli – but this time, they are a pretty pretty pink. Six days on, they are open and smiling and guess what … no heart-breaking fragrance.

Our long-distance relationship is working. Thank you, sweetheart.

Yummy!

It would be a bit much to say they are friends. But they are very fond of each other and meet up as often as they can which is about twice a year. They both care deeply for young people and support each other’s work. One is a dedicated mother of five. Keeps a beautiful house and garden. Cooks the best food. Sews gorgeous clothes and looks amazing. The second woman has one child who stopped living a few years ago. She doesn’t care much about her house or garden. Can’t use a sewing machine. Doesn’t pay much attention to her appearance.

The second woman appreciates the first one’s invitation to lunch. They sit at the dining table on top of which appear five large aromatic dishes straight from the oven – roasties, grilled carrots and broccoli, kale chips and baked salmon marinated in exotic spices.

As they settle down with their plates, the first woman starts “My Anne has been challenging since she was little. When she was six and we lived in South America, she got it in her head that she wanted to make a cloth tent. We went to the shops and she chose the materials in the green colour she likes. I put it together the best I could and then she wanted buttons and ribbons to go on it and I did all of that. When the tent was ready, I put it up in the living room before she returned from school with great anticipation. She took one look at it and declared “I no like.” She kicked it. It went lopsided and she went up the stairs to her room.”

“My Mike is dreadfully over-confident. He can charm anyone into telling him their secrets. He can make anyone laugh ….. And my Noel! He’s a big architect in Leeds and I love his girl-friend. She is so down-to-Earth. I am so glad they found each other …. And when they asked me what I wanted for my birthday …. And when we all went on a holiday ….. And when they got engaged …. And my Lisa! She is such a good designer. She comes up with original patterns for her tops and I stitch them for her. She carries her dresses like a model …. And my youngest… Oh! He’s full of ….”

The second woman places her attention on the delicious meal. She has no invitation to speak.

Only one race.

You are not your body. Who you are has nothing to do with how you look.

You are not your mind, your thoughts, your feelings or your memories. All those things are aspects of you but they are not you. They change from moment to moment. Thoughts come and go. Feelings mould. Thousands of old cells are shed and replaced by new ones every second.

During my training to be a doctor, I had to dissect a human body. It was an enlightening experience. On my first day at medical school, it was a shock – the massive Anatomy hall reeking of Formalin, 12 metallic rectangular tables, each occupied by a horizontal human form covered with a white cotton sheet. 4 students in alphabetical order, to a table/ body. All different but more or less the same, students and bodies. Mine was a dark skinned, muscular young man in his thirties. I wondered how he had landed up on this table in the heart of Punjab when he clearly belonged somewhere else. I wondered what his story was.

As I carefully peeled the skin off, a pale yellow silky layer unraveled itself. I peeked at the next table and it was the same. And the next and the next. Men and women, old and young, squat and fit, brown and black. Whatever on the outside, were the same just underneath.

We laugh and cry the same salty tears, we feel the same love, we yawn and sneeze and hiccup and breath the same way. We all are distinct and yet, more or less the same. We are all made up of a substance called ‘love’. We carry the whole Universe inside of us.  We are bundles of boundless cosmic energy. Our bodies are vehicles for us to experience this Earth and for this fantastic energy to express itself. Let us not allow anyone to tell us how we should look, as their vision may be limited. Be fully expressed. Don’t let their limitation be yours. You are whole and complete, just the way you are, no matter what anyone says. Don’t let anyone let you love yourself any less than one thousand percent. Your love and compassion for yourself is the source of all joy for all humanity.

Just as black people are so much more than just black and homosexuals are so much more than just that. And Saagar was so much more than just a handsome brown young man. Underneath, we all are human. We have the privilege of coming from the most gorgeous star. Our numbers are higher than ever before and our potential as a race is the highest it has ever been. At a time when we need more cohesion between humans than ever before, we are building divisions all over the world – us and them. Be it the colour of our skin, our religious convictions, our gender, our choice of sexual partners or our private medical choices. We need bridges, not walls. We need to see ourselves in others and them in us – vulnerable, tough and unique at the same time. Everyone. Absolutely everyone.

I say to all you planning and scheming and dreaming, defending, proving, and justifying, laughing, crying, and feeling people, wanting love and understanding, offering love and understanding people:

 “You be me.  I be you.  They be us. We be them. All be one. Love be all. All be love. Only love. Get down on it.”

One moment on a Friday morning.

Time is a scaffolding. Not the real thing. A construct. A transactional entity. An illusion. A convenience. A cage.

The Time is always Now.

Right now I hear Si pottering in the kitchen downstairs.

Michael, his friend is waiting in his car outside the front door. The engine is whirring, parked slightly to the left of the middle of the road with just enough space for passing cars to slide past.

My second cup of tea is waiting. Steaming.

The sunshine had penetrated many curtains to reach the park across the road.

The wind is gently encouraging the trees to wake up and dance.

The indoor plants watered this morning are feeling fresh. A large green Poinsettia (from last Christmas) on my left and a pink orchid on my right.

The ‘to-do’ list is staring at me from the far side of my table, feeling left-out. My Mind is pulling hard at me, trying to get me out of writing, into ‘doing stuff’. I am watching it. It looks like a toddler yanking at her Mum’s dupatta pleading for attention.

Black and green bins are lined up in tidy rows on the pavement along both sides of our street, waiting to be emptied. Five years ago, when the bin-collection day changed from Tuesday to Friday, I immediately thought I must tell Saagar. Then I remembered. Now, I think of him when I see the bins. I recall us putting the bins out together. In the Now. I feel that memory become a twinge in my chest. Sometimes, it becomes a cloud in both my eyes.

Now, I hold him in my heart on Fridays and every other day. He lives in me. Speaks through me. Sees the world and keeps me calm.

The neighbour’s son’s school bus stops at the same spot every day. He boards it wearing his yellow anorak every day. He sits at the same seat every day – by the window on the left, second row from behind.

The world goes on and I go on with it, carrying you in me. Loving you. Keeping you alive.

Fresh off the boat

Twenty-two years ago, when I first landed in the UK, I arrived as a qualified anaesthetist. I didn’t think of myself as a ‘female doctor’. I did not classify myself as one from the ‘ethnic minorities’. Both of those things were incidental to the fact that there was a job to be done and I could do it well, even if it was in a completely different setting, four and a half thousand miles away from home, at Antrim Area Hospital, Antrim, Northern Ireland. I was nervous but being from an army family, I was accustomed to moving every couple of years from one state of India to another (states as different as Punjab and Bengal), making it my own, learning from a different way of life and moving on to the next. I was sure of my ability to adapt.

My belongings comprised of a family photograph in a silver frame, a suitcase, mostly filled with books and two hundred pounds in cash. From the window of the plane I could see forty shades of green, in a mesmerising patchwork across the fields and hills of Ireland. The sky was the deepest, most startling blue. My heart was up in my throat with the excitement of living and working in a country where everyone was educated (why wouldn’t they be if education was free?)  and well-mannered (why wouldn’t they be if everyone was well looked after by the Government?)

One of the secretaries from the Antrim Area Hospital, Mary, very kindly came to receive me at the airport. The drive from Aldergrove Airport to the hospital was like gliding through a picture postcard. After Delhi, I could fully appreciate the wide golden-green expanses gleaming in the sunshine with not one human being in sight. When I complemented Mary on how gorgeous her country was, she was perplexed, “Really?”

Saagar was 5 years old then. He had stayed back with his dad. My plan was to find my feet and have him join me as soon as possible. I wanted to get my post-graduate exams within one or two years and go back to work in India. In the next few months, as I settled into my job, I acquired a cheap second hand Renault 19, found a family home and an appropriate child-minder. In the tea room of the hospital, the nurses would tell me about their families and ask me about mine. When I told them that I had a 5 years old child back home, they would say, “How could you leave him there?” I didn’t know what to say to that.

I still don’t.

Same story

“Three weeks before that day he was at a bridge and he called his friend who called the police. They came out but just told him to call the GP. One week before that day he called another friend saying he had a panic attack. The friend picked him up. Four days before that day they told the GP what was happening. She gave him a prescription for anti-depressants and said it would take 3 weeks for a referral. 4 days later my brother was dead. At no point did anyone tell the family.”

That day was sixteen days ago.

I wonder if anyone sat down with him to listen to what was going on with him. Two friends, one GP and the Police – none of them could put him in touch with his life and keep him safe. Yes. Ultimately it is up to him but I wonder if he was told that it might be helpful to get in touch with his sister, his brother, his mother, his father – the people who had known him all his life. That he could choose someone who he had a deep connection with, someone he trusted, and let them know how fragile he was at present. Someone who truly cared.

I wonder if you’ve seen this recent advert from St John’s ambulance where a dad is desperately trying to save his son. It encourages lay people to learn First Aid, in case of a physical health crisis. It’s a good one.

Save the boy”

Let’s put this in the context of doctors not knowing how to give First Aid to someone in a Mental health crisis.

The police not knowing that this is life-threatening, that there are resources in addition to the GP, like A&E, Maytree, Papyrus, Samaritans, CALM, their community, their family.

The GP not knowing that this is life-threatening, that there are things in addition to antidepressants that help, like having a proper conversation, exploring the suicidal ideation, informing them that it would be in their best interest if they included a family member or a friend of their choice in their care, giving them details of helpful Charities, giving them compassion and hope, drawing up a Safety Plan, getting in touch with the local Mental Health Crisis Team and  being aware that antidepressants can make things worse for young people in the short term.

Over-medicalisation of suicidal thoughts and behaviours in a setting where most medics are uneducated and unsupported in managing these crises.

Save the boys and girls by insisting on education for all professionals in medicine, nursing, law-enforcement, prison service, youth services, social work, for schools universities, hair-dressers, cab-drivers, students, parents, teachers, managers and everyone else is the only way to get it right – A multi-agency approach to Suicide Prevention.

In the USA, ‘legislation’ was recognised as essential to Suicide Prevention(SP) in 2012. At present, 10 states have legally mandated training for all health care professionals.

ASIST Training (Applied Suicide Intervention Skills Training):

The Office Guy

Once upon a time, trains in London used to be stuffed with people. Every now and then one found one’s head in some random person’s armpit. That Friday evening, my train was not too full.  Every other seat was taken and a few people stood by the door.

He boarded at London Bridge and sat opposite me. We sat facing each other at either end of the long rectangular window, looking out at the dusk, in the typical way Londoners show consideration and give space to one another. I was on my way home after work. The skies were moody. I was glad to be released from the hospital after a long windowless day.

As my gaze shifted from the sunset outside the window to the seat across from me, I saw the young office guy with his neat brown hair, parted on the left side. Crisp white shirt and well-pressed grey trousers. Tense jawline. Fixed steely eyes staring through glass panes. Two vertical frown lines just above the bridge of his nose on a smooth white forehead. He looked sharp, a tense energy encompassed him like a taut canvas. It was palpable. He was, as if a statue with serious internal whirings.

The train was on the move now. My station was six stops away. I had noticed something I couldn’t ignore.

I wasn’t sure if I should do something. If yes, what?

If I did nothing would I regret it? Yes.

Could I fully trust my instinct? I wasn’t sure but probably.

Did it matter if I made a fool of myself by saying something? No.

He could get off the train at any moment so I had to make up my mind pretty quick.

Two stops had now gone by and he was still there. This was my chance. I leant in, my head closer to his, caught his gaze in mine and softly said – ‘Whatever it is, it will pass. I promise. It will.’

I went back to admiring the sunset as if nothing happened.

I didn’t look for a response in anyone. Nothing.

I left it there, feeling like a crazy old woman on the train who talks to strangers, my heart beating in my ears.

One stop later, from the corner of my eye I saw him get up to leave. I brought my eyes back into the coach and chanced looking at him as he stood by the doors. He met my gaze and gave me an acknowledging nod, his frown lines gone. I could have cried. I think I smiled and nodded back.

I was finally learning to trust myself to do the right thing.

CHIME

132 billion pounds = money saved for the UK by unpaid carers.

6.5 million = number of carers in the UK.

6000 = number of people who become carers every day.

1 in 8 adults are unpaid carers for a family member or friend.

Carers UK call them ‘The Second NHS’.

Yet, do we or the Health Service truly value them? Listen to them? Include them? Give them a voice? Understand their concerns? Treat them as an ally? Respect their abilities and contributions? Answer their questions? Educate them? Empower them? Support them? Partner with them as well as we could? Sadly not.

In my experience and that of many other families of individuals with a mental illness, the power imbalance between the health care providers and the service users does not allow for an equitable relationship. Hence, denying the patient the best chances of recovery. There is national and local evidence that proves that carer engagement saves lives.

Triangulation of services is essential for best outcomes for patients and professionals. Risk averse practices may help reduce risk in the short term but may increase risk in the long term. A recovery approach to risk and development of a “life worth living” may have longer lasting benefits through rebuilding relationships, increasing service-users skills and confidence in collaboration with carers.

Norfolk and Suffolk Foundation Trust (NSFT) have developed a program called “Stepping Back Safely” up-skilling staff, carers and service-users. It is based on five main drivers of Recovery: CHIME

  • Connection
  • Hope
  • Identity
  • Meaning
  • Empowerment

NSFT are offering free training in Stepping back Safely in July 2021 on-line. Having heard many stories where a life could have been saved only if there was a meaningful and effective communication between the three parts of the Triangle of Care, I think this training is most relevant and essential. I shall be taking it as I am sure it will deepen my understanding of the subject. If you or anyone you know might like a point of contact, here it is: catherine.phillips@nsft.nhs.uk