Hundreds of times, in waiting rooms outside Intensive Care Units I have looked into the eyes of sons and daughters, spouses and partners of patients, held their hands and said, “We did all we could. I am so sorry for your loss.”
When Saagar died, no one looked into my eyes and said that to me. They had not done all they could for him. The hospital carried out a sham investigation, a futile exercise in ‘being seen’ to be doing the right thing.
The GMC found everything to be hunky dory. The doctors ‘looking after’ Saagar had done their jobs to perfection. Just too bad the patient was dead. They did not deem Saagar’s case worthy of an investigation. GMC’s role in its own words:
“We work to protect patient safety and support medical education and practice across the UK.”
The Coroner’s report shone some light on the holes in Saagar’s care. It clearly pointed out the things that South London and Maudsley (SLaM) Hospital got wrong.
There was a general failure to identify the diagnosis on the discharge summary from the Home Treatment Team to the GP.
There was a general failure to communicate thoroughly enough with the parents about the relapse symptoms, what to watch out for and where to go for help in the future.
Last June, I wrote to the CEO of SLaM, requesting an update on the changes that had been made in his organisation in response to the Coroner’s findings above. He said someone would get back to me and I heard nothing. This June, I sent him a reminder and again he said someone would get back to me and I am still waiting.
What are my rights as a parent? Is this too much to ask?
What were Saagar’s rights as a young man with a mental illness?
Are our lives not as important as anyone else’s? Black or white or brown? With Cancer or Diabetes? Or Bipolar Disorder?
Everyone deserves to be heard and seen. With respect.
He dropped out of the security of an Engineering Course to enrol into the futility of a dance school. He carved his way through sheer hard work from a humble home in the north-east of India to the flashing lights at the heart of Bollywood. He personified simplicity. He had no god-fathers in this brutal industry known for its nepotism and ruthlessness. He stood on the sheer credibility of his talent.
Stars, moons and aliens took up a lot of space in his head. He spent hours on his beloved telescope which he called his ‘time-machine’. He made new friends, kept old ones and his humility through the fame and the wealth of stardom. He stayed true to himself and his name which meant ‘Peaceful’.
His charm and talent won hearts all around. His youthful portrayal of his love of cricket came through in his films ‘KaiPoChe’ and “M.S Dhoni, the untold story“. But the media gave him a hard time as they saw him as an outsider. Of journalists he said, “First they’ll ignore you, then they’ll laugh at you and then they’ll fight with you. Right now, they’re laughing at me.”
Not anymore. Bollywood is in a state of shock. On the 14th of June 2020 Sushant Singh Rajput ended his life at the age of 34. It seems he had been on treatment for depression for the past 6 months. Police is frantically interviewing multiple people to establish a ‘cause’ for his death.
Film contracts falling through? Not enough new offers of interesting roles? Disparaging remarks made by influential bitchy colleagues? Being bullied and ignored? Financial difficulties? A painful break-up? The death of his mother at the age of 16? The death of his young manager, Disha Salian 3 days prior to his? Unmet parental expectations? Inadequate treatment for Depression? Migration away from home? Loneliness? Stigma of having a mental illness? Not knowing how to ask for help? Being a man?
That’s what it’s all about. Isn’t it? Our most basic needs.
For some, who were comfortable, these basics are threatened in the current climate. For some they have constantly been under threat. For the lucky ones, all is well. For now.
The fact remains that food needs to be grown by someone. Seeds need to be sown and nurtured. Given the right amount of nutrients, sun and water. Given time to mature and then harvested. Like Midas, even if everything else was made of gold, we could not eat it. Even if we put hundreds of satellites in space, we need our basic needs met.
Over the past few months I have appreciated growing a few things from seed. Sunflowers, mint, coriander and sage. Not enough to keep me alive but enough to give me a smug feel of being someone who grows stuff. I have little trays laid out by the windowsill and they fill me with pride each day they reach out for the sun, a few millimeters more than yesterday. What must it be like to be a real farmer!
In India, more than 11 thousand farmers ended their lives in the year 2016. Too much rain. Too little rain. Aberrant weather. Poor quality seeds. Exploitative middle men. Illness in the family. Monsanto. Easy access to pesticides. False promises of relief measures, incentivising a farmer suicide. The government promises money but fails to deliver again and again. It then blocks articles and videos that try to make this information public.
Kheyti is an organisation that helps small farmers design and implement low-cost farming interventions. “Greenhouse-in-a-Box” is a low-cost greenhouse bundled with end-to-end services. This greenhouse fits in 2-5% of a small farmer’s land, protects crops from environmental risks and grows 7 times more food using 90% less water.
This prolonged lockdown is going to affect many individuals and small businesses. Many are starting to worry about their very basic needs. Uncertainty, insecurity and the feeling of being stuck is rising everyday. Helplines are receiving more calls. Food banks have had to expand beyond capacity. The indirect and unintended consequences of the pandemic might be worse than the direct and predicted ones. As incomes fall away, despair in our communities will rise further.
Each of us needs to think of one person we know whose income might be affected by this and call them. We need to think of one person recently bereaved and call them. Not text. Not e-mail. Phone call. Speak. Directly. Ask questions. Connect, have a chat, come up with ideas and creative answers. Signpost to resources. Reassure. Give hope. Together, figure it out.
This too will pass but before that it will test us. All of us.
Asian countries account for more than 60% of world suicides.
According to the WHO, in the year 2016, suicide was the most common cause of death in the 15-39 age bracket in India, the highest in the South-East Asian region. India’s own official statistics, which map the number and causes of suicides in the country, have not been made public for the last three years, hindering suicide prevention strategies and efforts to implement the WHO’s recommendations in this regard.
In 2014, the WHO released a report with a series of recommendations for successful suicide prevention. It proposed a public health model for suicide prevention, consisting of four steps:
Identification of risks and protective factors
Development & evaluation of interventions
India has not progressed beyond the first step. Lack of political will, social stigma and inadequate mental health awareness in the general and medical communities contribute to the continuous rise in the death rate of young people by suicide in India.
A Junior Doctors World Congress was held at my alma mater, Christian Medical College Ludhiana in April 2019. Si and I ran a Mental Health Workshop that was attended by 75 medical students from India and the wider South and South East Asia region.
Motivated by this event, some students have established community mental health support networks and mentorship programmes at their respective institutions. I am impressed with their passion to make a difference.
Here is an example:
Early March I was back in Delhi and was honoured to be invited by Shruti Verma Singh, the founder of a Youtube channel, Zen-Brain.com. She is determined to increase the emotional awareness in India and does it gently, through a series of interviews. We met one afternoon to talk about Saagar. I hope her work will help wake up the government, break social stigma and drive understanding and compassion.
Last week we got a call to assess a patient for a possible transfer to ITU. Our team of three anaesthetists went along with all our kit and PPE. From a distance, he didn’t look too unwell. And he looked young. I hoped he wouldn’t need too much intervention. We donned out protective equipment and looking like aliens, entered his cubicle. I checked his name and date of birth. He was born in the same year as Saagar. After making a quick assessment, we decided that his breathing needed support. We spoke to him about getting him off to sleep so that we could place a tube in his wind-pipe and assist his breathing. We explained to him that we would transfer him to ITU for further care.
By this stage he was shaking, his eyes swollen with fear. He asked to make a call to his mum. We stood back while he called her. He held the phone to his left ear while oxygen hissed through his face mask. We waited, watching his face slowly relax, his fear melting into tears that dripped down his cheeks. After what seemed like a long time, he said bye to her, told her he loved her, composed himself and said he was ready to go to sleep.
It was like watching the dance of life and death. Love and separation. Help and helplessness. I was grateful and pleased that this mum and this son could connect at this crucial time.
Saagar didn’t have this luxury. He didn’t get to call his mother. No words of comfort fell into his ears. No tears of relief spilt from his eyes. Nobody offered him their understanding. I felt sorry for his mother too. She didn’t have a chance to say good-bye, to tell him that she loved him, that she would pray for him and that she wished him the very best.
When there is political will, governments can bring countries to a shrieking halt, the world can come to a stand-still.
When it is a physical illness, millions of pounds can be spent in seconds. New hospitals can be erected within weeks. Multiple trainings can be put in place for the front-line staff. Awareness campaigns are everywhere. What to do, what not to do, repeated endlessly. Retired doctors can be redeployed. National economies can be allowed to crash. Everything else can be put on hold.
When it is a mental illness, there isn’t enough money. There isn’t enough time. Not enough people. Very little expertise. No effective awareness-raising campaigns. No appropriate spaces. Not enough beds. Not enough research. The bottom-line is that there just isn’t enough respect for the fact that people with mental angst suffer the same, if not worse than those with physical ailments. That on many occasions they too, die alone.
On the 9th of March, I reached Melbourne for the second leg of the Churchill Fellowship. I had been looking forward to it for ages and just couldn’t wait to get started. I had the taken the whole month off. Despite the long journey I didn’t feel any fatigue. My AirBnB was homely and comfortable. After a good night’s sleep, I was ready for work.
The Beyond Blue Office was easy to find. After a brief introduction to the team, we all went out to get coffee together. I was already one of them and the coffee was great. The following days flew past with meetings, interviews, presentations and briefings. A trip to Headspace. Despite some background murmurings of a virus, I was having the best time, learning and exchanging thoughts and ideas. Then Australia closed its borders. Meetings and conferences started getting cancelled.
On the 16th, I took a return flight to London. My trip shrank from 3 weeks down to one. I had to miss Sydney altogether. Now, I am back here with a blank diary for 2 weeks and I am loving it. I have volunteered myself to work and I am on standby.
I can now research and look up things I’ve been meaning to for a long time. I can clear out one cupboard every day and get rid of stuff I don’t need or use or get joy from. Unclutter and create space in my house and my head. I can go to bed without setting an alarm. That pile of unread books that’s been sitting atop my table, feeling ignored and giving me dirty looks, can now be tackled.
Part of me is rushing in to fill the time with a list of a hundred things to do but I am consciously slowing down. Having an easy routine. Fitting in things I love doing, like arranging flowers. Making time for friends. Cooking. Walking. Not getting hooked to the media but keeping an eye. Writing hand-written letters to loved ones. Sitting still. Enjoying our home. Truly appreciating the weirdness of our cat, Milkshake. Cherishing having breakfast, lunch and dinner with Si as he works from home.
12 days ago I left my home and husband with a strange sense of ‘last-ness’. Si and I are familiar with that uncomfortable feeling. We know that the whole world can change in one second. 12 days is a long time.
Melbourne, Australia, was my final destination when I left home to complete my Churchill fellowship. On the way, I broke my journey for a week in India. I find it impossible to fly over India to go to other places without stopping. There, I watched in horror how much India’s centre has moved to the right. It has gone so far that the words ‘liberal’ and ‘secular’ are now bad words. My closest friend there is a Muslim gentleman whom I have known for the last 23 years and have never thought of him as a Muslim. But now I fear for his safety. I fear for the safety of all my family as I know that when there is fire, some are damaged by flames but many more by smoke.
So, here I am, in Melboune, at a house, rented through AirBnB and so much has happened in these 12 days. I have never understood the need for 24-hour News Channels as they endlessly repeat themselves, induce panic and heighten pre-existing anxieties. Many people are petrified. They are understandably worried about themselves and their loved ones. The restrictions being imposed are causing more isolation and angst. Italian prison scenario is a very sad example.
This is a good time to observe the effect news has on you, pay attention to your feelings and take a break when you need to, from the constant ranting of various media. I am doing that. I am keeping myself informed, connected and calm. I am not willing to allow the situation to affect my mind too much. I am taking all the precautions as advised and that is the best I can do. WHO sensibly says let’s look after our bodies and minds.
I suspect that death rates from this virus are being hugely exaggerated. They are based on projections from those who have been tested, but many people, all over the world have had a cold or flu over Jan and Feb and have not been tested. So, where does the truth lie?
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.
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.