The Sliding.

Ryan woke up at least twice every night to run to the loo. But last night he moved like a little whirlwind under the sheets. Sue slept through most of it but found it peculiar. She didn’t say anything, lest it disturb him but he disturbed her at least every hour without knowing it.

She woke up feeling tired at 6.30 am. It was a Monday morning. The day of the week didn’t matter much any more as both of them had recently retired. She as a head-mistress of a primary school and he as an accountant.

Their daughter lived in Liverpool with her boy-friend. Her job as a personal trainer at David Lloyds was less than they’d hoped for her. Her boy-friends spoke funny but for a living, wrote speeches for prominent people. The phony politicians who couldn’t even write what they wanted to say to the people they represented.

Sue put the kettle on and freshened up while it whirred. She put two green and gold Wedgewood cups and saucers on a tray along with a matching milk pot and a tea pot large enough to hold 4 cups. She entered the bedroom with the tray. Instead of sitting up in bed thumbing his phone, Ryan was flat on his back. His eyes red and fine vertical lines above his nose.

‘Morning!’ she sang, ‘You ok darling?’

With a smile, she placed the tray on his bedside table and placed her hand on his forehead.  

“Yes. I’m fine.” Said Ryan.

‘Did you sleep well?’

“Not really. The temperature in this room was all over the place. Couldn’t settle.”

The temperature was just fine, she thought but decided to stay mum.

‘Care for a cuppa?’

“Yeah. Sure.” Ryan raised his head off the pillow. An oval wet patch was imprinted on the white cotton pillow case. He quickly turned it around and stood it up against the cushioned head-board. She noticed but did not comment. She poured the golden-brown tea into the cups and added a few drops of milk for him. Over this first month of their retirement they had been falling into a nice little routine. Opening the day with a shared pot of tea was a special pleasure for them both. It made space for the rest of the day to slide into their lives.  

“What shall we do today?” she asked Ryan.

‘I miss my work. All the friends I had. My clients. The window in front of my desk. The 11 am coffee with colleagues. The laughter. I even miss the commute. I never thought I’d hear myself say that but it was nice. I miss all that.’

“Yes. I am sure. I miss my work too but not much. Shall we go to the garden centre and get some saplings? This is a good time for planting. The Organic Café does some nice coffee too.”

‘Let’s see. I might just enjoy the sun-shine in our garden today.’ He got up to visit the loo again. This was not like Ryan. He was the one who normally put ideas forward and she was the one who normally said yes or no.

As soon as he left the room, she put her cup down and stood up to get a closer look at the other side of his pillow. It was definitely damp. She peeled back Ryan’s side of the duvet. The bedsheet underneath him was certainly moist. It smelt of him. Only stronger. This was unusual.

Sue’s pulse quickened. She’d heard of people working really hard all their lives and then dying soon after their retirement. She shoved her silly thoughts aside and waited for Ryan to come back, trying to focus on the delicateness of the tea.

When Ryan came back, she was surprised to hear the puffing sounds of his breathing. His brow had started to glisten.

“Would you rather have a lie-in Ryan?”

‘No. I am ok. Nice tea. Don’t make an old man of me. I’ll be fine once I’ve had a shower. It’s funny. My left arm feels strange. Must’ve slept funny.’

Now she could hear her own heart pumping in her ears. But she kept it cool.

She managed a fake smile. A polite false agreement. She wanted to jump at the phone and dial 999 but didn’t want to scare Ryan.

“There’s no rush to have a shower. More tea?”

‘No. Thanks. I’ll get myself a glass of water.’

“Don’t worry. I’ll get it for you.” She jumped.

At the kitchen sink Sue stood like a statue, staring at the water pouring down the hole in the stain-less steel basin. Is today the day my life changes for ever?

She debated with herself on what to do next. A tug of war went on within her. Does he know he’s unwell? Is he really unwell or am I imagining this? Is that new virus in him? In our house? In our bed? Will he be terrified if I tell him what I think? Is he just having the blues? Or a heart attack? Or an infection? Or nothing at all?

She carries the glass of water back to Ryan. He glugs it back and slowly slides back inside his duvet. She walks around to her side of the bed, slips under the covers and lays down right beside him, holding him with both her arms, a little bit tighter than usual.

Like a couple of soft cuddly toys, they snuggle up. In that moment, she has all she needs. Ryan breathing, resting right next to her. Her tears meld into her pillow. The past and the future disappear. In that moment, life is whole and complete.

Storyless

The spring knows not.

I need my story.

Who am I without it?

It’s a habitual place.

A refuge.

Something I can lean on and hide behind.

This is my story. This is me.

Is it? Really?

Am I not more than the way I have been taught to respond and speak and act?

More than the stories they told me and I tell myself?

Am I not a mysterious, wondrous creation of the galaxies?

Am I not more than a feelings-crunching machine?

An events-processing factory?

Like all other life forms, am I not designed to evolve through challenges.

Adapt. Learn. Grow?

Processing kills it. My creativity.

Thinking locks me up. In familiar prison cells.

Who I am

flies, flows, dances, melds and reaches out with all its arms.

It knows not what it is.  

Like the ocean knows not how deep it dives.

Like the sky does not care how far above the planets it stretches.

Like the day knows not the secrets that will unfold as it extends into time.

Like the stars twinkle on, oblivious of how many eons pass them by,

Which telescope catches them, which doesn’t.

Like the spring knows not where its flowers will grow.

Like the river sings along, not knowing who will drink from it or

The apple tree that offers all to friends and strangers and

Stands. Story-less.

Who am I?

I am. I am. I am.

Thank you, Rumi.

Welcome, unexpected visitor.

The Guest House

This being human is a guest house.
Every morning a new arrival.

A joy, a depression, a meanness,
some momentary awareness comes
as an unexpected visitor.

Welcome and entertain them all!
Even if they’re a crowd of sorrows,
who violently sweep your house
empty of its furniture,
still, treat each guest honorably.
He may be clearing you out
for some new delight.

The dark thought, the shame, the malice,
meet them at the door laughing,
and invite them in.

Be grateful for whoever comes,
because each has been sent
as a guide from beyond.

  • by Jalaluddin Rumi.

Gullyboy (Street boy)

A Hindi film about young boys growing up in slums, turning into rappers.
(Nominated for the best foreign film at the Oscars 2020.)

Angst escapes as words and song,

To a simple metre they belong.

Expression is art.

Connection at its core.

Honest.

Straight from the heart.

Stay in the flow Bro. Stay in the flow.

Keep working at it.

Be proud of what you is.

Know that all will change.

Nothing is too strange.

Dig deep and dig deep.

Be the shark of the deep.

Not a gold fish in a bowl. Yo.

Stay in the flow Bro. Stay in the flow.

Our day will come

Every dog has his day.

Doesn’t look great right now.

But it will go away.

Respect …. yourself. Yo.

Stay in the flow Bro. Stay in the flow.

The heat of strife will melt your chains

And set your spirit free.

Your friends will stand by you

No matter what may be.

Stay rooted and look high.

Like an eagle. Fly.

No fright. Just flight. Yo.

Stay in the flow Bro. Stay in the flow.

Know. Just know.

It’s okay to show.

The wounds that hurt you so.

Someone will understand.

Trust in life and let go.

Stay in the flow Bro. Stay in the flow.

You are not all alone.

Though it may seem so.

Prayers and blessings galore

Are sewn into the seams of your clothes.

You wear them all the time

But you just don’t know.

You are a rare diamond.

You are my heart and soul.

You are the sun, the moon,

The galaxy to me.

But you could never know.

Stay in the flow Bro. Stay in the flow.

The good times.

Once again I found myself sitting in the waiting room at a Healing Centre in Wales. I sat facing a wall covered with effusive and colourful thank-you messages plus baby pictures. They were addressed to the acupuncturist who had helped these women become mums. I was here to connect with my son through the beautiful, Moya, whom I have seen twice before. She is compassion personified. Each time I have met her, I have found great comfort in her readings and felt close to Saagar. So, despite Storm Dennis, train disruptions, a brewing respiratory infection and a serious jet-lag, I made my way up in water-proofs and a big red polo-neck jumper.

The first thing she mentioned was Varanasi. A seat of learning. A place of pilgrimage, where the temporality of this human body is clear to see. Of course, Varanasi, where Saagar’s ashes are immersed in the Ganges, where we had a prayer ceremony with 5 priests simultaneously chanting and carrying out various rituals for 5 hours to help Saagar’s soul transcend peacefully into another realm. Where my ashes will go.

Then came a string of other places and memories: Playing catching-catch on a beach in Port Rush, stepping over multitudes of hexagonal stones at Giant’s Causeway, crossing the flimsy Carrick-a-rede bridge, the 3-day trip on a narrow boat one beautiful summer, shopping in New York, visiting his Uncle, Aunt and new-born cousin in Chicago, admiring the moon and stars through the big Velux windows in his large loft conversion space. All these sweet things came up.

He wanted to present me a Cherry blossom. Did that make any sense to me? Yes. Coming up to March, we would be using Sakura in our Ikebana arrangements, bringing nature into our homes. A very special time of year for this Japanese art.

Moya said he is peaceful where he is. He understands that sometimes I breath deep and hard to stay alive and sometimes it feels like I am breathing glass and sometimes I wish I could just stop. He understands. And he holds all these happy memories and places that he cherishes.

He’s reminding me of the good times. I need to look at them and cherish them much more than I do. They were ours. They will always be ours.

The ocean and me.

That was the winter of 2014-15. This is the winter of 2019-20.

This was the beach in Goa where I sat paralysed for weeks. Some days I didn’t walk or talk. For days, I peered into my laptop, trying to figure out the ugly intruder who had broken into our house and taken my everything, my son. I swam in the whys and hows of this tragedy that had befallen us. The fact that my life continued while his had ended baffled me. I struggled with how that could be and what was the meaning and purpose of what was left. What now? What now? The question marks sprang up incessantly.

Si was with me then as he is today.

In this time, life has revealed that there is no one answer, no single destination, nowhere to go, nothing to do. All there is, is unfolding. The Universe endlessly expressing itself through this beach, the moon, the sand, the pain and me.

After dark, the wave fronts approach the shore shimmering like sword edges of the cavalry, roaring towards me and then breaking apart into a playful white surf and disappearing into the sandy slope. Again and again. Same but different. In the navy blue of the night it appears as though the special effects team has spent hours to make it look like this.

The lukewarm sand between my toes. The dancing waterline swirling around my feet. My hand tenderly held in Si’s. The rhythmic breathing of the ocean. The ins and out of my breath. The moon, an oval light overhead. The sea breeze ruffling my hair. The hint of salt in the air. The humidity, same as that in my eyes.

A pause. A break. A blank.

A moment holding everything within. It’s all here.

Mental – I – zation

He was 15 when his Hungarian parents thought it would be best for him to come to live in the UK with another family. His parents were refugees in Paris and he in London. World War 2 had ended a few years prior. The times were turbulent and many people were having to make difficult decisions.

This boy did not speak English. He landed up amongst strangers, completely inhibited, unable to do well in school. He was teased and taunted by his contemporaries and no one understood him. At 16, he became seriously suicidal. He had a plan. One day a neighbour noticed that he didn’t look great and encouraged him to speak to someone at the Anna Freud National Centre for children and families.

 “The therapist who saw me could see beyond the struggles and see another person, see they had certain competencies and capacities, and that, if you removed some of the inhibitions, the self-defeating behaviours, and got access to my more positive side then I could do quite well,” he remembers.

Prof Peter Fonagy is now a leading contemporary psychoanalyst who has propounded and researched the theory and practise of ‘Mentalization Based Therapy’ (MBT). He is also Chief Executive of the Anna Freud Centre for Children and families. In simple words, mentalization is the effort an individual makes to understand someone else’s thoughts, feelings, hopes, beliefs, desires and behaviours. It is the ability to mind other minds, to understand misunderstandings, to see the impact of our behaviour on others, to see oneself from the outside and others from the inside. MBT is said to be especially helpful in the management of Borderline Personality Disorders.

The things that block mentalization are, firstly, the strong feelings of anger, shame and fear. And secondly, defensiveness, not wanting to know what’s going on in another person’s mind.

I can see how mentalization could make each and every relationship work. Not just the ones we have with others, but also the most important one, the one we have with ourselves.

1+50+176+?

Merchandise at the Manchester Firing Line. Manchester New Hampshire. USA.

On a board of chess, both sides stand face to face

Using wise moves, strategies and tacts.

No drones, no justified assassinations   

No sneaky cyber-attacks.

Two rooks, bishops and knights, both sides have by rights.

Those are the rules of the game. For both sides, the same.

Some things are clearly wrong and others that are right.

Whether your pieces are black, or brown or white.

The way the moves are made,

the way the game is played,

a knight is often not the first to be slayed.

A murder in plain sight

Yet, everyone kept quiet.

No criticism. No outcry?

The killers had good reason. That is why.

They always do.

But do they speak the truth?

Who knows? Do you?

Vietnam, Iraq and now this.

For what? For who?

He was someone’s dad, someone’s son,

A military leader, not holding a gun.

This was an act of cowardice, just for fun.

Guns are a sport in the land

from where the assassin came.

The killers proudly laid claim

To this, their ‘good deed’.

Knowing full well that yet again,

they are sowing a seed.

A seed of death and conflict.

Within a week, a stampede.

Multiple counter-strikes

Hitting innocent planes and passers-by.

Who are the ones that die?

People like you and I.

While the international bully

Keeps on keeping on fighting

In the name of self-defence,

‘Freedom and Liberty’?

When a gun is fired, two people die.

The one hit by the bullet

and the one who let it fly.

War is not the answer. Please.

How can we tolerate this?

Instead of wrapping the world in daisy-chains,

We are covering it in wreaths.

(Footnote: Sixty thousand war veterans, many of them young men, have died by suicide in the USA in 2008-2017. On an average 17 to 20 suicides per day and the rates are not falling despite massive efforts.

https://www.military.com/daily-news/2019/09/23/alarming-va-report-totals-decade-veteran-suicides.html)

To you, with love. xxx

Sixth Christmas with your empty chair

Now more salt, less pepper in my hair.

That I’ve been breathing all this time

Still makes no sense, no reason, no rhyme.

Your cat makes all the other felines quake

His sweet name, given by you, is still Milkshake.

The Christmas markets we visited at the Southbank

The doughy sweets we gorged and the German beer we drank.

Those candle stalls and hand-knit shops, I believe are still there

But a visit, I cannot bear.

Ice skating at Somerset house with friends

Merry shopping here and there, for odds and ends.

Cocktails at ‘All bar One’ after work at Waterloo

What I would give to have another one, with you.

Beating the hell out of every one at Ping-pong.

Not many of your moves, slow or wrong.

The years trundle in and roll out like a stream,

I watch and wonder how they could be both,

A nightmare and a dream.  

Standing back, I watch and see.

Trying not to judge. Just be.

There are but three things to know,

To love, to learn and to let go.

To love, to learn and to let go.

Patients first.

Credit: Mario Sanchez Nevado (www.aegis-strife.net)

When I speak with gatherings of doctors, I often start with asking them to shout out whether they think the statements below are True or False. What do you think?

  • Sick doctors know when they are sick.
  • Doctors are good at asking for help and following advice.
  • Doctors take good care of themselves.
  • Doctors have strong support networks.
  • Doctors are kind to each other.   

Irrespective of which country I am in, without fail the auditoria flood up with a big resounding ‘FALSE’ for each of the above, accompanied with some sniggering. Isn’t it shocking? One would expect that people who work in ‘healthcare’ would know a thing or two about their own health as individuals and as a community.

These are the highlights of a survey conducted by the Royal College of Anaesthetists in 2016-17:

The NHS Sickness statistics consistently show that NHS hospital doctors have the lowest rate of sick leave as compared to any other staff group.  Here is a list of personality traits of doctors (a broad generalization, of course) that might explain this:

  • Perfectionism (I must do this right!)
  • Narcissism (I am good at what I do.)
  • Compulsiveness (I can’t give up till I finish.)
  • Denigration of vulnerabilities (If I need help, I am weak.)
  • Martyrdom (I care for my patients more than myself. Their needs come before mine.)

The very traits that make us good doctors are the ones that may not be very good for us. But our seniors have not been aware of this and hence they have not been able to help us understand ourselves. This tradition has been going on for generations of doctors. There is a nobility associated with such self-sacrifice, which we all have bought into. The fact is that if your own cup is empty, you cannot serve others well.

Things add up – a dysfunctional department, work pressures, lack of support outside work, ill-health, emotional burden of the job, a traumatic adverse incident, lack of sleep, fatigue, a complaint made against you, poor diet and no time to exercise or pursue hobbies, impaired judgement of one’s own symptoms, fear of letting others down, difficulty in admitting that they have a problem.

Burnout among medics is not unusual. It looks much like depression and sometimes ends in devastating tragedies. But help is available. Sadly, unlike other illnesses, for mental health issues, the onus of getting help lies with the sufferer. It takes courage to acknowledge one needs help and seek it out in good time. It might be the best thing a doctor can do for themselves and their patients.

Sources of support:

  1. https://www.bma.org.uk/advice/work-life-support/your-wellbeing/sources-of-support
  2. Doctors in Distress, a charity set up by Amandip Sidhu in memory of his brother Dr Jagdip Sidhu who was an eminent cardiologist and tragically died by suicide on 27th November 2018.