Entrances and exits.

The two little lads were inseparable. Saagar and Rohan. They cycled together all evening after school and kicked a ball about for hours. They had dinner at each other’s houses. They created snowmen and played with snowballs together. They even shared a bath every now and then. Luckily, they lived right next to each other and their parents were friends.

At Ulster Hospital in East Belfast, the staff accommodation is a set of six flats. Rohan‘s family lived in the one just below us. His mum, Shruti, was the best grower of indoor plants. A gentle, sweet lady. She was also a doctor but at that time, was not working. Over time our families became close friends and continued to visit each other even after we moved to London and they moved to the north of England. If you ask me to name my oldest friends in the UK, Shruti’s name would be on top.

Eventually Shruti started working in Psychiatry and seemed to enjoy it, even though the exams were a struggle as they are for many of us, when they must fit somewhere in between work, kids, husbands, homes, pets, friends, sleep and homesickness.

When Saagar was diagnosed with Bipolar disorder, I needed to speak with her. I needed her. I asked her by text what time would suit. She said she’s call me after work and she did.

“Hi Shruti. Thanks so much for calling.”

‘No problem. I am driving so we may get cut off. I’ll call you back if that happens.’

As soon as I started speaking it got cut off and she called back and the same thing happened again. And again. And then she didn’t call back.

When Saagar died, she came to see us the very next day with her husband, utterly shocked.

A month later I needed to connect with her again. She said she’d call me back after work. She called while driving. She had to pick someone up from somewhere or drop someone off somewhere. She was on the move. On – Off – On – Off : our phones connected and then rudely disconnected mid-sentence and stayed disconnected for seven years.

Two days back a message arrived from Shruti on Whatsapp saying, “Please join us and bless the couple.” Rohan gets married soon. A nice little electronic invitation to the reception was posted underneath the message. The invitation wasn’t for anyone in particular. It had no names on it. I can’t be entirely sure it was for us.

I am happy for the family and for Rohan. Wishing them all possible happiness, I RSVP’d with apologies for being unable to attend. There’s nothing here and let’s not pretend there is. I felt sad for a little while at this loss of a valued friendship, but not for long. This is an opportunity to let go. Yet again. If there is one thing I want to be skilled at, it is to keep letting go, remembering what the Bard of Avon said – ‘All the world’s a stage, and all the men and women merely players: they have their exits and their entrances …’ I get it.

I would like to live

like a river flows

carried by the surprise

of its own unfolding.”                                    

John O’Donahue

She.

(Pen Vogler by John Burke. BP portrait awards 2017)

With all her worldly wealth, she could not purchase belonging. Especially to herself. Her eyes thirsty for tenderness. Her muscles tense with want, her skin hungry for touch, her lips a straight line of dissatisfaction.

She hoped a painter might find her in his brush strokes and capture her on his canvas. She paid him a mountain, so he could help her find out who she might be … find out if she could like herself. After many hours of sitting still, with her hands clasped together in her lap, she was tired. She was tired of perfectly painting her fingernails bright red, for the painter. She couldn’t wait to see what he saw.

The day came and the painting was ready to be seen by her. Her eyes bulged out of her head, eager to find the joy she so wanted to find in herself. All she saw in the fore-ground, was a golden dress sitting beside a golden yellow lamp shade. All she saw in the back-ground, was dark brown walls and furniture. That was the gist of it. The thing she was dying to find was not there. It was yet to be born. Those clasped hands held the secret. She knew what she had to do – unlock the door with those lovely hands and leave … for some place, white, blue and green.

Thank you for noticing.

She was listed for a minor surgical procedure on my list. I called out her name in the waiting area and escorted this pleasant, middle aged lady into a cubicle for her pre-anaesthetic check-up. We both sat down at right angles to each other. She had an unmissable racoon’s eye on the right side of her face. I looked again. Just to be sure. It was there in its fading pinky-blueness. She was in hospital for a totally unrelated reason but I ventured into asking, “What happened here?” pointing to the eye.

‘Oh. I had a run-in. Couple of weeks ago.’

“A run-in with what?”

‘You know … It’s okay. I don’t want to talk about it.’

“Have you spoken to anyone about it?”

‘Yes. I am okay. I really don’t wish to speak about it.’

“That’s fine. How are you doing today?”

We went ahead, staying focused on preparing her for the upcoming procedure.

I took a moment to call the Safeguarding department of the hospital. They said that it was normal for people suffering abuse, to not talk about it for a long time. They advised us to signpost her verbally. A written set of resources might make her more vulnerable, if discovered by the wrong set of hands.

Two women are killed by a partner or former partner every week in England and Wales.

One in five people suffering domestic violence will plan or attempt to take their own lives.

One in eight of all female suicides and attempts in the UK are due to domestic violence and abuse. This equates to 200 women taking their own lives and 10,000 attempting to do so due to domestic abuse every year in the UK. That’s nearly 30 women attempting to complete suicide every single day. 

Men endure domestic abuse too. This can include physical violence, as well as emotional and psychological bullying, sexual violence or financial control and abuse. 

It is living hell. An invisible prison. Isolating, with no one to confide in.

It takes great courage to speak. It’s often ignored. Many suffer in silence.

Survivors do come in contact with health and social services but disclosure is difficult.

If done right, it is life changing. Appropriate response is invaluable.

Front-line staff must recognise signs and highlight issues.

It is important to ask and act.

After her procedure, I went to see her in the Recovery room.

“Have a nice evening.” She said. “Thank you for noticing.”

Resources:

https://www.rcn.org.uk/clinical-topics/domestic-violence-and-abuse/general-resources-and-support

No words.

Two years back, it could not be screened as scheduled. After a long wait, last weekend it was, at Clapham Picture house where Saagar often went with his friends. People came from Leicester, Salford, Cornwall, Cardiff and Birmingham. Some, I had only ever seen on screen. Others, when they were school kids. They brought their sisters, spouses, friends and colleagues. They stayed for hours afterwards, talking about themselves in a way they never had. They fell in love with Saagar’s big brown eyes and mischievous smile. They saw what a treasure had been carelessly lost. Everyone felt something. Many had no words but there was a profusion of overdue hugs all around. Many felt they knew him even though they had never met him. Some introductions were made to link up the leaders from various sectors of society so they could form stronger and safer networks.

That woman in the film was not just me. She spoke for the fifteen families in the UK, who are plunged into this harsh reality every day. More than 6500 every year.

That young man in the film was not just Saagar, but everyone who has ever blamed themselves for their troubles and felt shame for things that have happened to them, hiding behind their beautiful smiles. Unseen. Unheard. Each one who lost their tribe and couldn’t find a way back.

These were not just Saagar’s friends, but all those who are left behind, trying to figure out how this could happen to someone they loved. Wondering what they could have done then and what they can do now.

This film laments a future lost. It mourns silent suffering. It also illuminates a path that appears out of darkness. It also celebrates love and smiles. It also gives us permission to soften, lighten, loosen. It breaks open our hearts so we can hear the unspoken pain that lies behind the mask of another face and our own. It makes us one.

This is what it means to be human. Here, on this beautiful Earth, there is no other. Only us. Not us and ‘them’. Just us.

PS: International film awards: Eight.

‘1000 days’ is made by Me and Thee films for educational purposes. Hence it is not yet freely available on social media. It was screened in the ‘Lived experience’ section at Middlesbrough, for the Hartlepool and Stockton Safeguarding children’s Partnership and South Tees Safeguarding Children’s Partnership Conference on the 12th of July. It made a profound impact on roughly 350 attendees, motivating them to make individual and collective change so as to protect young lives and their happiness. Will keep you posted on the opportunities to watch it. Thank you for your love and support. Please do share any constructive ideas/ thoughts you may have for the film in the comments section.

What are the chances . .?

It was Tuesday, not my usual day to be working at St Thomas’ Hospital.
It was lunch-time and there was time enough for a proper break, which was extremely rare.
I was able to physically leave the Theatre complex for fifteen minutes, which was usually impossible.
I wanted to clear my head, so I went to the cafe, looking for a seat by a window. I was in my raspberry scrubs, wearing my most expensive necklace which is a green lanyard with my ID batch. The round table by the french doors had three chairs, of which one was occupied. I asked the older gentleman if I could share his table and he didn’t mind. As I sat down I noticed that his left arm was heavily bandaged. My curiosity got the better of me and I asked, ‘What brings you here?’
He looked straight at me and replied, “I tried to die.”
‘I am sorry you found yourself in that impossible place. Must have been terrible. Are you getting the support you need?’
“Yes. They’ve been very good here.”
‘I am glad.’ I paused to wonder if I should tell him but the words left without my permission.
‘You know, I lost my son to suicide a few years ago.’
His gaze connected with mine like a laser beam and his eyes moistened.
Softly, almost apologetically, he stated “When you are in that place, you can’t think about other people.”

Pause.

“Here comes my wife.”
Holding two paper-glasses and a brown paper bag, she joined us and placed one of the glasses in front of him. She took out a Jubilee cupcake from the bag to share.
“Have you traveled a long way today? I asked, shifting gear.
‘Sussex. Straight train. Not too bad.’
“Beautiful part of the world!”
‘Yes. But we lived in Australia for eighteen years which was really pretty. We came back to be with the children.’
“Nice. I wish you all the very best. I must get going now.”

‘Us too. Our appointment is in fifteen minutes.’ she said.
‘You take care’. He said, making that eye-connection with me again.
“You too.” I looked straight at him, nodded, smiled a polite smile and walked away.

(Resources for attempt survivors, their families and friends:

https://www.sprc.org/livedexperience/tool/resources-suicide-attempt-survivors-their-families-friends)

God bless America.

Following the Sandy Hook school shootings in 2012, the Conservative commentator Anne Coulter provocatively proclaimed that “Guns don’t kill people. The mentally ill do.”

“The United States sees an average of 32 000 handgun-related deaths per year (as per this paper published in 2015), and firearms are involved in 68% of homicides, 52% of suicides, 43% of robberies, and 21% of aggravated assaults. Far from the national glare, this everyday violence has a disproportionate impact on lower-income areas and communities of color, and is widely held to be the cause of widespread anxiety disorders and traumatic stress symptoms”… the stigma linked to guns and mental illness is complex, multifaceted, and itself politicized, in as much as the decisions about which crimes US culture diagnoses as “crazy” and which it deems “sane” are driven as much by the politics and racial anxieties of particular cultural moments as by the workings of individual disturbed brains. Beneath seemingly straightforward questions of whether particular assailants meet criteria for particular mental illnesses lay ever-changing categories of race, gender, violence, and, indeed, of diagnosis itself.”

“Persons in the United States live in an era that has seen an unprecedented proliferation of gun rights and gun crimes, and the data we cite show that many gun victims are exposed to violence in ways that are accidental, incidental, relational, or environmental. Yet this expansion has gone hand in hand with a narrowing of the rhetoric through which US culture talks about the role of guns and shootings. Insanity becomes the only politically sane place to discuss gun control. Meanwhile, a host of other narratives, such as displaced male anxiety about demographic change, the mass psychology of needing so many guns in the first place, or the symptoms created by being surrounded by them, remain unspoken.”

“Mass shootings represent national awakenings and moments when seeming political or social adversaries might come together to find common ground, whether guns are allowed, regulated, or banned. Doing so, however, means recognizing that gun crimes, mental illnesses, social networks, and gun access issues are complexly interrelated, and not reducible to simple cause and effect. Ultimately, the ways our society frames these connections reveal as much about our particular cultural politics, biases, and blind spots as it does about the acts of lone, and obviously troubled, individuals.”

Ref: American Journal of Public Health. 2015 February; 105(2): 240-49.

Mental Illness, Mass Shotings and the Politics of American Firearms by Jonathan M. Metzl, MD, PhD and Kenneth T. MacLeish, PhD

PMCID: PMC4318286

PMID: 25496006

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318286/

… and your name is?

S A A G A R.

In Delhi, it was simple and sweet.
In Belfast, it was a problem. It had to be pronounced slowly with exaggerated lip movements and spelt out clearly. Still, it was uttered in all kinds of ways – Segaar, Sega, Saaga, Sags, Sagsy-wagsy. It is after all, a proper noun. “As long as you call him with love, you can call him anything.” I would say with a smile. But of course, it was his name. Not mine.

At the age of 7, one day he came home from school and said, “Can’t you change my name to Aran or something?” I felt for him but laughed. What else could I do? I asked him if something happened at school that day, if someone said something hurtful and he just picked up his soft grey elephant and cuddled it.

I told him the story of his name. I was 24 when I got married. My in-laws lived In Chennai. We visited them a few months after the wedding and one evening we all visited a place called Besant Nagar beach. That was the first time my eyes fell upon the expansive ocean. On the map this water body had the boring label, Bay of Bengal. The vision of a dark blue shimmer below meeting a pale blue glow above in a clean, delicate, straight line made everything else disappear. Its calm, its rhythm, its enormity, its subtle dance, its grace and openness pulled me in. All conversation faded away and there I was, completely soaked in the bliss of the ocean. My soul soothed. My body relaxed. My eyes quenched. My heart happy. I was in love. In that moment, I knew that if we ever had a son, he would be called, ‘Ocean’: Saagar. I reminded him that his name was Saagar because his heart was as expansive and as beautiful as the ocean. He smiled and gave me a tight hug.

As he grew older, he came to own his name. He came to live it. The waters of this ocean ran deep. They appeared placid on the surface but strong currents ran underneath. All I saw was the steady flow of gentle waves, rhythmically lapping against the shore through the seasons. It oscillated with the moon but the high tide was never too high and the low tide was never too low, until one day it was.

Come home, my darling.

I still hear the key turning in the door from the outside and you stepping in. Can you believe it? I still see your face, darkened by the sun. Dressed in your cricket whites, you drag your massive cricket-bag-on-wheels behind you by your left arm.

“Did you take the sun-screen with you?” I ask.

“Yes, it’s in the bag.”

“Did you actually put it on?’

 “Mamma, I’m hungry.”

I still wait for you to join us for dinner. I cook the foods you like, especially on your birthday: spinach-paneer for mains, chocolate mousse for dessert. I wonder what you’d be doing in this realm if you were here. Job? Girl-friend? How silly! Isn’t it? I can’t help it. It’s involuntary. It’s got something to do with the heart. With longing. With missing. With love. It’s not supposed to make sense. You would have had a good old chuckle at my expense if you were here. But you are not and I am. How random is that?

I still remember the first time I felt you elbow-ing or knee-ing me from inside my tummy, as if we had an inside joke between us. I remember holding all three kilos of you in my arms for the first time. I couldn’t believe you were for real. You were all mine. Now my arms ache with emptiness. Is this real?

Do you miss me sometimes?

Happy birthday my darling.

Heaven

It will be the past

And we’ll live there together.

Not as it was to live

But as it is remembered.

It will be the past.

We’ll all go back together.

Everyone we ever loved,

And lost, and must remember.

It will be the past.

And it will last forever.

                      – A poem by Patrick Phillips, on the New York subway.

(“Ghar aa” is a Hindi phrase that means “Come home”)

Two lessons

“He loved me in the purest sense and I loved him. That’s how he kept me alive.” says Marsha about Ted, a catholic priest.

This relationship taught her two important things that she applied to her work as a therapist for seriously suicidal people. She wrote about these things and taught them to her students, the future generation of therapists.

  1. ‘I was unable to say thank-you then. Now I can.’

If you’re giving unconditional love to help someone cope with the hell they are in, if you’re holding them emotionally and physically, don’t interpret their absence of ‘thanks’ as a sign that you are not giving them what they need. You probably are.

2. ‘Keep loving them.’

When someone sees no point in living, they are like someone walking in a mist. They don’t see the mist. They don’t see that they are getting wet. If you’re walking with them, you may not see it either. But if they have a pail of water, you can collect the water that was mist, in it. Each moment of love adds to the mist, which adds to the water in the pail. By itself, each moment of love may not be enough. But ultimately, the pail fills up and the person in hell can drink that water of love and be transformed.

Like Marsha, I know this to be true. I’ve been there and drunk from that pail.

(Inspired by Marsha M Linehans’s book: ‘Building a life worth living’.)

I was so wrong.

I thought that if his doctors would have recognised how sick Saagar was, they would have known that the best thing to do was to refer him to the Psychiatric services. They would admit him to the hospital, look after him and keep him safe.  He would recover fully, return home and resume his life as normal – play the drums, read and speak French, play cricket, go out with his friends, go to the gym, make me laugh till I had tears in my eyes and soon, return to University.

Now I know, that I was so wrong at so many levels.

  1. Recognise?

The GP didn’t think his condition was life-threatening, even after he told him it was. How much more obvious did it have to be? They didn’t believe him. If at all they did, they didn’t take him seriously. Or maybe they simply didn’t know what to do.

GPs are not trained or supported in looking after suicidal patients.

  • Refer?

If they would have made a referral to the Mental hospital, he would have waited for a long time to be seen. Maybe he would have died while on the waiting list, like many others.

GPs are dis-incentivised to make referrals to specialist services in various ways.

  • Admit him to the hospital?

No chance! That would not have happened as there would have been no beds. If there were beds, there would have been others much sicker than him, ahead of him in the queue.

Hospitals have very poor capacity and very high thresholds for admission to inpatient beds.

  • Keep him safe?

490 patients died while detained under the Mental Health Act in the year up to March 21. At least 324, for non-COVID reasons.

Ref: https://www.bbc.co.uk/news/uk-politics-59336579

Being an inpatient does not mean –  safety.

  • Recover fully?

Many patients report traumatic experiences while admitted to mental hospitals. The treatment is often not conducive to recovery. Concerns include coercion by staff, fear of assault from other patients, lack of therapeutic opportunities and limited support.

There is little understanding of what the patient needs, to recover.

(Ref: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/experiences-of-inpatient-mental-health-services-systematic-review/C5459A372B8423BA328B4B6F05D10914)

I am presently reading a book – ‘Building a life worth living’ by Marsha, M Linehan. She is the psychologist who developed Dialectical Behavioural Therapy, to help suicidal individuals to build their lives. Much before she did that, she was a seriously suicidal and self-harming young adult.

I am learning so much.

Marsha M Linehan – Author of ‘Building a Life Worth Living’