Kisa Gautami

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In ancient India, there lived a woman. She was happily married to a rich merchant and was the proud mother of a bubbly one year old. After a brief illness, her only son died. Her grief was unbearable. Wailing and weeping, she took her child’s lifeless remains from door to door pleading with the townspeople to bring her beautiful child back to life. No one could help her. She was destroyed.

Someone suggested she take her infant to the Buddha. She did. Through her tears and sobs she narrated her tragic story and begged Him to infuse life back into her bundle of joy. The Buddha listened with compassion and said, “Kisa Gautami, there is only one way. Bring me 5 mustard seeds from a household where no deaths have occurred.”

Her eyes lit up with hope. She hurriedly gathered up her bundle and once again, went knocking on each and every door in town. To her utter disappointment, every family had experienced death in one form or another. She realised the lesson that the Buddha had wanted her to learn. Suffering is a part of life and death is inevitable. Kisa Gautami’s eyes were now open. In the light of this knowledge, she could handle her grief. She went on to become an ardent follower of the teachings of Buddha.

Like Kisa Gautami, I have found myself at the feet of the Buddha. His teachings have brought light and lightness to my being. Along the way other divine souls have helped in unique ways.

This is the festive season for most people. Planning meals, choosing stocking fillers, selecting wrapping paper, posting greeting cards and preparing to welcome the New Year. Yay! It’s all happening. But a Saagar-shaped piece is missing. I feel for all the families who will have that vacant chair at their table this year. I hold them close to my heart. As time goes by, it does not get easier. This excerpt on the subject of ‘Pain’ from ‘The Prophet’ speaks to me. I hope it helps you too. I wish you as peaceful a time as possible.

“And a woman spoke, saying, “Tell us of Pain.”
And he said: Your pain is the breaking of the shell that encloses your understanding.
Even as the stone of the fruit must break, that its heart may stand in the sun, so must you know pain.
And could you keep your heart in wonder at the daily miracles of your life, your pain would not seem less wondrous than your joy;
And you would accept the seasons of your heart, even as you have always accepted the seasons that pass over your fields.
And you would watch with serenity through the winters of your grief.
Much of your pain is self-chosen.
It is the bitter potion by which the physician within you heals your sick self.
Therefore trust the physician, and drink his remedy in silence and tranquillity:
For his hand, though heavy and hard, is guided by the tender hand of the Unseen,
And the cup he brings, though it burn your lips, has been fashioned of the clay which the
Potter has moistened with His own sacred tears.”
― Kahlil GibranThe Prophet

 

It’s become a ‘thing’.

For a thousand days I wrote every day. It wasn’t a ‘thing’. That’s just what I did. I didn’t worry about who read it and why. It didn’t matter how good or bad it was. I just did it. Then I slowed down to writing roughly once a week.

Now, I think about writing. I talk about writing. I look up ‘writing’ on the internet. I consider on-line courses. I buy books on writing. I worry about writing well. I listen to podcasts of interviews with famous writers. I am on the lookout for writing tips in newspapers and magazines. I wonder what it must feel like to write properly every day. I envy those who can. What I do very little of, is write. I believe I repeat myself endlessly. I say the same things again and again. I forget things that are important. I hardly know any juicy big words. Why would anyone be interested in what I have to say? English is my second language and I can’t fully express myself in it anyway. My imagination is limited. I haven’t read enough books. I have no writing qualifications. Ms Confidence has evaporated and Mr Self Doubt has surreptitiously crept into her space in the vacant apartment of my psyche.

One ‘expert’ on you-tube suggested the way forward is to just write 3 full A4 sheets every day. She said,”… best not to think too much. Just put down on paper whatever comes to mind”. She called it a ‘brain dump’. She promised that over time it would start to make sense. It would become a story in your voice.

Maybe it’s time to go back to writing everyday. Maybe it’s time to start  my “big fat” book 🙂

PS: My favourite book on writing is ‘On Writing Well‘ by William Zinsser.

 

Confidentiality versus Life

Three years back I joined a club no one wants to be a member of. I became a parent who lost their beautiful child to suicide. He was 20. I didn’t think it was possible. I trusted his doctors to take good care of him. I trusted they would tell me if there was a real risk of him dying, given I am his mother and was his prime carer. I thought they had the expertise to identify and address ‘crisis’ when they saw it. Suicide was not in the script. It was not supposed to happen. I turn the fact of his sudden traumatic death over and over in my head and it makes no sense.

There are hundreds of distraught and bewildered members of this club. Common themes emerge from their stories. The commonest one is:

“They knew our child wanted to end his/her life but they didn’t tell us anything about it.”

Who are they?
Decision makers – Medics. Universities.

Why?
Because he/she is over 18, hence, technically an adult.
Their ‘confidentiality’ is paramount.

Is it?
Is it more important than helping them stay alive?

The Hippocratic oath states:
“I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.”

According to experts[1], these are the essential components of an effective suicide prevention safety plan:

  1. Discussing the reasons for living
  2. Safe environment
  3. Identify distress triggers
  4. Removing ways to harm yourself
  5. Activities to calm/lift mood or distract
  6. Contacts for general support
  7. Specific suicide prevention support
  8. Professional support
  9. Emergency contact details
  10. Personal commitment to follow safety plan

Most of the above cannot be implemented without the help of carers and families if the person in question is seriously unwell. This has been recognised by the Department of Health, Royal Colleges of Psychiatrists, GPs and Nursing along with The British Association of Social Workers and The British Psychological Society. Together they published a consensus statement entitled[2] “Information Sharing and Suicide Prevention” in 2014, the same year that my son, Saagar Naresh[3] passed away. It clearly states that practitioners should disclose information to an appropriate person or authority if this is necessary to protect a child or young person from risk of death or serious harm.

“If the purpose of the disclosure is to prevent a person who lacks capacity from serious harm, there is an expectation that practitioners will disclose relevant confidential information, if it is considered to be in the person’s best interest to do so.”

This is still not being practised. The world of medicine is a conservative and defensive one. Until the regulatory bodies, NHS Trusts and the Government come forward to reassure practitioners that their decision to share information appropriately will be supported by them, nothing will change.

While the world carries on, innocent youngsters die from lack of support and understanding from the very people who are best placed to help them. PAPYRUS, a UK charity dedicated to prevention of young suicides[4] demands that information be appropriately shared with carers and families by all who take care of vulnerable young people at risk of suicide.

Confidentiality versus Life. It’s a no-brainer.

References:

[1] https://www.healthcareconferencesuk.co.uk/news/newsfiles/alys-cole-king_1219.pdf

[2] https://www.bl.uk/britishlibrary/~/media/bl/global/social-welfare/pdfs/non-secure/i/n/f/information-sharing-and-suicide-prevention-consensus-statement.pdf

[3] www.kidsaregifts.org

[4] PAPYRUS (https://www.papyrus-uk.org/)

Treatment versus Care

In her entry to this year’s BMA News Writing Competition, a consultant psychiatrist relates the experience of her postpartum psychosis and explains that, although grateful for her treatment, something was missing from the care she received.

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The Human Factor

I am a consultant psychiatrist. Two years ago, I had a taste of my own medicine.

Three sleepless nights after the birth of my daughter, I became acutely ill. I slowly realised I couldn’t sleep — something strange was happening. Within six hours, I was experiencing a kaleidoscope of symptoms — elation, fear, heightened senses, delusions. I wanted to kill myself and my daughter.

Postpartum psychosis is a medical emergency and a consultant perinatal psychiatrist was at my house within the hour. I literally ran to her ward in my socks, my mum running behind, having forgotten her shoes too.

My first night was terrifying, but the staff were fantastic. As I rode an emotional rollercoaster, they reassured me, calmed me, gave me the sedation I desperately needed. Soon, I settled into a mild mania. Though at times it was very scary, I was fascinated. I noted with curiosity how my brain behaved. I felt great love for my daughter, and beneficence for my fellow man. I enjoyed all the activities the ward had to offer.

Five weeks later I was happily home. But what goes up, must come down. Gradually, I became unsettled, filled with self-doubt. I became convinced my baby was autistic. The anxiety became intense, and I considered suicide. My consultant coaxed me into hospital again. ‘It will only be two weeks,’ she promised. ‘I think you need to start lithium.’

You cannot breastfeed on lithium. One day I was connected with my baby, the next she fed from a bottle. My heart broke as my breasts filled to burst. It was a symbolic change, from wonderful to awful. She smelled wrong, artificial. I began a tiresome regimen of sterilising, preparing and cooling bottles, when all the while my baby yelled, to my great shame. As if in protest, she vomited spectacularly after every feed.

This time, the ward seemed an unfriendly place; swelteringly hot, noisy, tedious, excessively rule-bound. The other patients seemed uninteresting and depressing. My eldest son was bewildered: he wasn’t allowed on the ward. Why wasn’t mummy coming home? He became rejecting and oppositional. My heart broke some more.

I begged for leave but developed extreme insomnia and could not get well. I remember one night getting up, sitting down, and getting up again for seven hours, unable to decide whether to wake my baby for a change. A burly nurse was recruited to force me unceremoniously to move to a room near the nurses. I was told I would be sectioned if I tried to leave. An informal patient, I was allowed out for only half an hour each day.

I told my consultant I wasn’t depressed, her ward was the problem. ‘You’re depressed’ she repeated, implacably, and brought in a second-opinion doctor. I was desperate to leave as soon as I arrived, yet those two weeks became two months.

Having a mental illness is one of the most disturbing and frightening experiences one can ever have. The rug is truly pulled out from under your feet. Suddenly you are somehow lesser, rendered powerless. I was one of the lucky ones. I knew what was happening, and was more able than most to speak up for myself. I got treated very quickly. Many don’t.

My consultant was a former colleague of mine, a peer. She was kind but paternalistic, and my care became a battle of wills. She believed her plan was faultless and that her ward was entirely beneficial. She conducted her ward rounds like job interviews and treated me like an adolescent. I watched helplessly as she pathologised my normal behaviour and denied promises to get me to comply.

We were fragile mothers, but were often shamed like naughty children for not ‘doing the right thing’, sometimes berated across the ward for all to hear by opinionated nursery nurses with little sensitivity to our mental state. Mothering a screaming baby during an intense crisis of confidence was a tortuous task, yet it was rarely considered that our babies were exacerbating the problem. Scared and disturbed women were managed by intimidating rapid response teams.

I lost trust in them, I hid symptoms. One night I nearly killed myself but never told.

I now can understand how my patients feel when they say they no longer want to go back to ‘that place’. How lack of insight guides them away from reminders of restraint, coercion, scrutiny and endless questions. How it is difficult to trust people who don’t treat you as fully human.

Despite all the positives and the expertise in my care, an important element was missing. Care needs to be more than medication, therapies and keeping people safe. Now I’ve had a taste of my own medicine, I always ask: ‘What is this like for you, what do you really need to help you get well?’

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Small talk saves lives.

It’s a dry winter morning. I am in my favourite red jumper and floral denims, on my way to the therapist. I have seen him for 3 years and I remain completely unfinished. My train will arrive at this platform, Platform number 1, West Norwood Station in 4 minutes. There are only 2 tracks and only 2 platforms here. The sun is in hiding and all trains are delayed, allegedly due to bad weather. Despite 2 people ahead of me in the queue there is enough time for me to get a cappuccino with one and a half sugars from the newly-opened kiosk, the Blackbird Bakery. The pair of sweet,  smiley girls behind the counter have a way of making things work while maintaining an environment of relaxed, chatty friendliness.

A toddler in a pram doesn’t want her half-eaten kitkat anymore. She wants to feed it to the birds. Her mum takes it from her and lovingly puts it in her own mouth. She gets a quizzical look from her daughter. She beams a gentle smile back on to her baby.

Just as the train pulls up behind me, my order is ready. In the here and now, the yellowness of the foliage on the ground and on trees is bright as stippled sunshine. My drink smells like the warmth of Brazil. Grateful for no rain, I turn around and step onto the train holding my hand-warming  and heart-warming treat.

I look for a forward-facing window seat with a table. The one I find seats an unclaimed blue knitted scarf, coiled up like a snake. An overweight elderly lady sits with a smile opposite me.

‘Is this your’s?’ I ask.
The train starts to move.
‘No.’ says she.
‘How are you?’
‘I am ok’, she says in a strong Spanish accent.
‘Doing anything nice today?’
‘Going to see a friend in Victoria. We don’t talk much. We meet once a week. We go for hot-chocolate.’
‘That’s nice.’
She looks down at a picture of 3 pretty young women in her magazine.
‘I always wanted daughters but I got 2 sons and1 grandson. No girls.’
‘Boys are lovely too.’
‘Yes. But I would have liked a girl.’
I smile.
West Norwood station is well behind us by now.
Saagar, my son comes alive in my mind.
Platform 1 was where he spent his last couple of hours. That was 3 years ago. He was more than I could have dreamt of. All I wanted was him, his happiness. Nothing else.

He was there for at least two whole hours. No one spoke with him. Small talk saves lives. For every life lost on the railway, 6 are saved by those around them. Only if someone had interrupted his train of thoughts. Only if someone had trusted their instincts enough, to act. Only if someone had cared enough to ask if he was ok. Only if everyone had the basic tools of suicide prevention, just like they do for choking and drowning. Who knows?

Now, all I want is for him to come back to me.

Free on-line training for all, in Suicide prevention, launched by the Zero Suicide Alliance. 20 minutes of life-saving skills : https://www.relias.co.uk/zero-suicide-alliance/form.

 

Three years of nothing

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One morning as I set off to work on my bike, my neighbour bundled up her chatty 6 years old son in her car and drove him to school. In the evening when I got back home, huffing and puffing, she was there again, putting the bins out with her son. I unlocked our front door and walked in with the biggest lump in my throat.

A few months ago, a notice arrived from the Council saying that the rubbish collection day would change from Tuesdays to Fridays. My first thought was, “Must let Saagar know.” It’s not the fancy things, but silly, mundane, ordinary, everyday things that make up the essential fabric of life.

Yesterday was three years since we spent a whole day together, going to the GP, then to the green-grocer and bank, then for a walk and then for an afternoon nap. When he was upstairs in his room, I phoned my brother in India and shared my sadness and helplessness about Saagar’s illness. He said he would come over as soon as his Visa came through, most likely within the next couple of days. I felt re-assured. I cooked a nice meal. We ate and watched TV together. We kissed good-night and went to bed.

3 years ago, today was the last time I drove him to the gym and back. He didn’t spend much time there. I noticed but didn’t make much of it. I asked him if he met any of his friends in the gym. He said no. He did his best to carry on. Today was the last time I gave him a cuddle and kissed him good night.

Last week I happened to walk past the GP surgery where Saagar was treated (or not). It has closed. The GP has retired. A barrage of mixed feelings emerged out of nowhere. It felt good to read that sign. Yet, it marked the end of a career, a vocation. God knows how many people found help and comfort there. God knows how many got lost. God knows how many such practices still exist where GPs work single-handedly and in isolation, hiring locums on occasion.

Walking along the Thames a few days ago, a stream of bubbles glided across my field of vision with the majestic, unshakable St Paul’s cathedral standing solidly in the background. The bubbles captured all the colours of the rainbow hidden in the autumn sun. The breeze sculpted subtle shifts in the shapes of the bubbles as they floated along the river. They danced and smiled as they moved with the wind. They added immense beauty to the world even though they lasted less than a few seconds.

Billions of people have lived and died before Saagar and I. Hopefully, billions will live and die after us. We are like bubbles in the ocean of life, capturing all the colourful emotions and being the best we can for as long as we are here, however long or short.

Saagar’s best friend Hugo shares his thoughts and memories. He also sings a beautiful song for Saagar. We love you and miss you darling Saagar. May peace be upon you!

 

 

 

 

I carry your heart in my heart.

It’s a luminous room on the first floor of a Victorian building. The sun pours in from the big window facing the street. The delicate palm leaves throw artistic, dancing shadows on the carpet. I feel the tension in my muscles, the knot in my stomach and the tightness in my chest. Two comfortable black arm-chairs sit facing each other.  I am gently welcomed and ushered to the chair facing the window by a lady with a soft Irish voice and a sweet smile.

We sit down. I am relieved to catch sight of a box of tissues from the corner of my eye. I look at her and say my name. She says hers.  We hold the same belief – the soul is eternal. I ease into the chair and take a deep breath. I am open to this, whatever it brings. For now, I put my anxiety and scepticism aside. I tell her that I am here to find out if my son is at peace. He died by suicide at the age of 20, two years and 10 months ago.

She is sorry for my heartbreak. She shifts in her chair, turning and looking in the direction of the door. Her smile widens. I can only remember a fraction of what she said -“He’s so bright. So lovely.
Your relationship is sweet … special.
Does he play music?
West African drums?
He is not just a good drummer. He is extra-ordinary.
He has an eclectic taste in music. Super-creative!
He’s very proud of his musical heritage.
He’s wearing a long shirt, like a kurta.
He says he enjoys Celtic music too.
Recently a memorial concert was held for him?
He says he was there.
Is there a London connection?
He is showing me a cat sitting on his shoulder.”
She changes the direction of her body and aligns it to  me.
“You … are a writer. A healer.
He loves your writing.
He says it comes from the same field of energy as his creativity. It entwines your souls.
Your nutrition is very good but you suffer with severe stomach cramps. Your distress affects your digestion. You need to take lemon juice on an empty stomach every morning.”

She shifts again.

“The last year of his life was difficult. In his last few weeks the medications messed up his head real bad. He couldn’t think straight.
I see a strong army connection.
Your mother’s mother is there with Saagar. She tells me that your father is a man with great integrity. He has a big moustache. You have had a disciplined upbringing.

Saagar is surrounded by love. He wants you to know that you did your best. He wants to thank you for encouraging him to pursue his passion for languages and music and for not pushing him to do other things. He thanks Si for his patience and his friendship. He is impressed to see the commitment that Si has shown towards you. He is happy for you both.

He is offering me some rose petals.
Does that make any sense to you?”
Not sure, I say with an uncertain smile.
“Is someone’s birthday coming?”
Yes. Mine. In 10 days.
“He is also offering me a small bronze statue of Lord Ganesha. Does that mean something to you?”
Yes. I smile with tears of recognition.
“Would you like to ask any questions?”
Is he at peace?
“Not only is he at peace but he is joyful.”
Can you tell him I am sorry for not spending enough time with him and for not understanding the extent of his suffering?
“He feels nothing but love for you. Can you feel his presence?”
Yes.
“I know you have felt it for short periods of time, here and there in the past. I hope that with time you will begin to feel him around you a lot more.”

I can remember bits of that interaction but can’t comprehend the accuracy. How can a complete stranger know the intimate details of 3 overlapping lives? May be there is no such thing as death. Maybe we all exist together in a big pool of consciousness where different energies manifest in varying realms, like magnetic waves and gravity are invisible but they exist. Infrared and ultraviolet radiations are invisible to the naked eye but they manifest themselves in other ways. Maybe there is no such thing as death.