Not before 12th April

Building up to today, hope of movement. Till this morning, half-fearing the radio might say – it’s been cancelled. After nearly 13 months of this regulation and that and then the other, bungled numbers coming from unreliable sources, u-turns based on dodgy science, I am not sure what is to be believed.

This morning I opened my eyes to snow descending like down-feathers, dancing and swirling outside my window. Wow! There is hope. A clean, fresh start.

As an anaesthetist, over the last few months I’ve been speaking with patients, re-assessing their fitness for the operations that they were supposed to have March 2020 onwards, which have not happened yet but will hopefully happen soon. Several of them have had to live with painful knees and hips and other uncomfortable conditions for at least a whole extra year, unable to move around and exercise. Many of my patient’s health has deteriorated over the last year. They have gained substantial weight, some are drinking much more than before. A few have decided not to have their operations as they are worried about visiting the hospital, leave alone be admitted, for fear of getting the virus.  

A few got Covid and have recovered fully while a small proportion have lingering issues. Others have discovered new health conditions like heart disease, diabetes and asthma. Some elderly patients have developed new ‘minor’ issues after having the vaccine, like loss of balance, making independent living impossible. So many have lost confidence.

The incessant repetition of “you may be next to die a terrible death alone soon” on TV and radio has filled the psyche of the populace with terror. The thorn of fear has made a home in so many chests. It’s easy to put it there but difficult to pull it out. How insiduously our greetings have changed from ‘Have fun!’ to ‘Stay safe’.

Monday, a good place to start afresh. May we find the courage to recover, open and experience life in all its fullness in the coming weeks and months.

“Avoiding danger is no safer in the long run than outright exposure. The fearful are caught as often as the bold.” -Helen Keller

We don’t know it yet.

(A government advertisement which has now been removed)

“We’d better finish in time today. I have tickets for Nitin Sawhney at the Southbank Centre this evening. Would be nice to grab a bite beforehand. Isn’t it Sod’s law that when you have plans, something is bound to crop up and stop you getting there?”

Once upon a time, we made plans. We co-ordinated and arranged a time and place to meet with friends. After work, we visited places, had conversations, chilled out at book shops browsing through poetry and fiction, we waved frantically as we spotted each other in crowds, across a sea of heads. We buzzed in the excitement of the bar and lounge in theatres before the show began. We pre-booked drinks for the interval. We patiently queued outside toilets. We unexpectedly ran into people we knew but didn’t expect to see. We leant into the ushers with our tickets, showing them the number and taking directions to our seats. We squeezed past people apologising as our handbags and knees gently bumped against each other. We quietly admired a dress or a pair of earrings here and the unmissable drama of a sparkling peacock-blue eye-shadow at the base of long brushy eye-lashes there. We hushed as the lights went down. We waited for the curtains to rise. We lost ourselves in the surreal sets, the crazy costumes, the transformative talent, the perfect precision, the heights of the high notes, the tangential takes. The sheer magic of it.

We came back, changed. Enriched. Enthralled. Expanded. Elevated.

That was a long time ago. They say ballet dancers are being encouraged to re-train in cyber-security, singers are venturing into soft furnishings and sound technicians now have the lucrative opportunity to be delivery drivers. Their jobs evaporated.

The pandemic and the response to it are killing people. What else is being killed? Can it be measured? How much of it is revivable? When?

Poverty and the Mind

Vikram Patel is a psychiatrist and a Professor of Global Health who works tirelessly to improve the mental health of people living in low and middle income countries like India and Ethiopia.

His recent research has found that all countries are ‘developing’ countries when you look at the low proportion of the health-budget they spend on mental health. Some wealthy countries may have better systems of care for maternal and child health but overall, mental health remains universally, at the end of the queue.

At present, COVID has overtaken all other agendas. However, now more than ever before, there is a recognition of the two-way relationship between poverty and mental ill-health. This may be a historic opportunity to get this right.

The relationship between poverty and mental ill-health is a complex one. How can we distinguish a normal response to poverty from a disease process? Poverty can increase the risk of poor mental health via multiple pathways, for example, poor physical health, high levels of noise pollution, violent neighbourhoods, insecurity and humiliation.

Can an increase in income improve mental health? Yes. It can but it needs to be sustained.

The fact that having a mental illness may induce poverty is less well recognised. It may affect one’s education and hence, employment opportunities. In low and medium income countries, health care is paid for by people. Due to the length of time it takes to find an effective treatment, much effort and money is wasted in doctor-shopping. Depression is inequitably distributed in society but not recognised as such because wealthy individuals also get it. We accept that long term expensive therapies cannot be delivered to the poor, so what’s the point in studying them?

After nearly a year of job-losses, the number of people below the bread-line all over the world will increase by tens of millions. In India alone, the gains made in economic growth over the last decade are predicted to be wiped out this year. The historically disadvantaged will fare worse, suffer more.

We can expect a surge in mental health problems like we did after the 2008 global financial crisis, mainly led by suicide and drug misuse. Sir Angus S Deaton, a Nobel prize winning economist wrote extensively about these deaths of despair. Economists and global health experts warn that this one will possibly be far worse.

In India, while the state is spending all its energies on the pandemic, livelihood-based organisations are finding very poor mental health in their members. Taking a broad, multidisciplinary approach to depression and anxiety rather than viewing it through the lens of a medical specialty is the need of the hour. Policies all over the world need to de-medicalise the emphasis on specialists and empower front-line providers and communities to enable them to foresee, identify and address this problem.

The bi-directional relationship between mental health and finances means that appropriate mental health interventions can improve finances. Can we persuade policy-makers world-wide to listen to global health experts and economists, look at this fast-approaching  avalanche and steer policies to protect those who are being and will be hit by it?

Talk: Poverty and Depression (https://voxdev.org/topic/health-education/poverty-and-depression-how-improving-mental-health-can-help-economic-wellbeing) – this talk was available till last night but has since disappeared.

Research Papers:

  1. Angus Deaton on the Financial crisis and the well-being of Americans (June 2011):

https://www.nber.org/papers/w17128

2. Vikram Patel on Causal evidence and mechanisms of Poverty, Depression and Anxiety (May 2020):

https://www.nber.org/papers/w27157

Catriarchy

His dad was Russian royalty. Since the age of six weeks he could tell the difference between gourmet and ordinary meals, silk and cotton stoles, real and fake woolen throws, synthetic and down duvets, the warmth emanating from humans and radiators. He could tell if he had the full attention of his staff or not. He still can. He knows how to get them to do what he wants without saying a word, be it opening the door for him or being stroked at the back of his neck.

For entertainment, for a short while the laser pen was fun but very soon he let us, his staff, know it was cheap and silly. He wants action, involving blood and gore. He’s out hunting, bringing home trophies of half-dead mice, baby sparrows and often a big gash somewhere on his body.

He knows he’s good-looking. His James Bond swagger gets exaggerated when he knows he’s being watched. He sits like a statue when he’s being talked about but his upright ears change direction like a satellite dish. If he’s in the mood he humours our affections but prefers that we stick with our duties.

I do believe that he needs to check his cat-privilege. For centuries, cats have pretended to be domesticated while all the time exploiting humans. It’s about time we, as humans did something about it. I am in the process of designing an ‘unconscious bais’ training for him while at the same time preparing myself to be royally ignored. He has a clear preference for male company. It has been communicated to me in no uncertain terms that I am ‘extra’.

Named and reared by one of the finest specimens of the human species, he is a Maharaja of the Kingdom of Two. We celebrate his majesty, Mr Milkshake, paws, claws, whiskers and all. And his surrogate mum, Saagar today and every day.

Happy Christmas. xxx

“What?”
Summer 2013

The Golden Buddha

Once upon a time, far in the east, there was a country called Sayam. In the capital of this country there was an ancient temple of the Golden Buddha. People made long pilgrimages to visit this temple. Everyone knew of it and wanted to see the massive golden statue of the beautiful Buddha within.

One day the news came that a fierce foreign army was approaching the capital. The monks and devotees got together and quickly covered the statue from head to toe in mud and dirt. They made it look ordinary, with every bit of gold out of sight. It now looked dull and drab with no sparkle at all. It even gave out a peculiar odour that had to be camouflaged with incense.

Yes. The army made a huge clang as it arrived in the city with tonnes of ammunition and aggression, looking to plunder anything of value. A platoon of soldiers with armour and swords rode into the temple and looked around like hungry dogs. They found nothing of interest. Just an old dirty statue. They rode out and away.

Over time, new monks and devotees arrived. The old ones forgot to take the mud and dirt off. They forgot to tell the new ones about it. For years and years the Golden Buddha remained in hiding until one day, a young monk was deep in meditation a few feet away from it when he heard a crashing noise. His eyes opened and he saw that a bit of the mud had cracked and fallen off. Smashhhhh…onto the floor. He saw the left hand of the statue glinting in the dim evening light. He walked up to the statue and took a closer look. With eyes as wide as coins he ran out to get the others to see what he had seen. All of them got to work and took the mud shell down to reveal the awesome, pristine Golden Buddha.

This parable reminds us that we are all born pure and all-knowing, one with the divine. Over time we get conditioned to wear the shells or labels of ‘man’ or ‘rich’ or ‘silly’ or ‘mother’ or ‘short’ or ‘engineer’ and so on. Until one day something comes along and cracks the casing, making the gold within visible. Then we can’t help but keep picking at the dirt as nothing else satisfies us. We keep peeling the layers of muck away bit by bit by bit, till it’s all done and we are free.

To my brothers … lean on me.

This video was made after a spate of suicides by senior NFL players in the USA as they were starting to feel the effects of Chronic Traumatic Encephalopathy (CTE). Michael Irvin spoke from the heart without a script and his truth is visible.

If your isolation is getting the better of you, know that you are not alone. You are loved, silently. Reach out your hand and they will be there.

Civilized. Are we?

An anthropologist, Margaret Mead was asked by a student “What do you consider the first sign of civilization to be?” He expected her to mention things like clay pots, fish-hooks and grinding stones but she replied, “A femur that had been broken and then healed. In the animal kingdom, if you break your leg, you die. You can’t run from danger, get a drink from the river or hunt for food. You are meat for prowling beasts. No animal survives a broken leg for long enough for the bone to heal. A bone that has healed indicates that someone took the time to stay with the one who fell, bound up the wound, carried the person to safety and tended the person through to recovery. Helping someone else through difficulty is where civilization starts.”

She also said that we should never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has.

Over the last weeks and months, there have been thousands of job-losses, much sadness caused by separation and bereavement and much suffering due to limited social contacts and falling away of normal support systems. Perhaps explaining this tweet by London Ambulance Service.

May be this is the time for us all to step up and be there for those who are affected. Sharpen our radars and pick up the subtlest signs of despair around us. However small, there is something we can all do – start a conversation, smile, share a hot coffee, offer a few coins or share information on useful resources. There will always be a reason to not do it but you are a member of a small group of thoughtful, committed, citizens who are going to change the world. Slowly. Slowly.

Resource: PAPYRUS: A charity dedicated to the prevention of young suicide: https://www.papyrus-uk.org/

Isness of Is. Clayness of clay.

T: It came to a point when she couldn’t bear to celebrate Christmas with her family. Her brother and sister and their respective spouses could roll out one child per year effortlessly while she had been through all kinds of tests and procedures, and nothing. Absolutely nothing but heartache and multitudes of unbelievably negative pregnancy tests to show for it. Six years of nothing.

S: Yes. I suppose nobody’s got it all. Some of the missing stuff is obvious and some not. Surely, even those who appear to have it all have their painful stuff hidden away. Who said everyone has to have everything?

T: It’s hard for her to watch other people with their babies. Intolerable. I can understand.

S: Isn’t that like saying no one should walk in front of a man in a wheel-chair? They might be offended. Let’s all pretend we can’t walk. Poor man! It might be intolerable for him.

T: That’s harsh. That’s a completely different situation.

S: It is an extreme example. Yes. It’s all about comparisons though. Isn’t it? You have something that I don’t. By right I should have what you have. Everyone should have it. But everyone is different. Their life path is different. The lessons coming their way are different. Her unhappiness comes from ‘yours’ and ‘mine’, ‘desirable’ and ‘undesirable’. Kids come with their own brand of drool, cackles, dirty nappies and tantrums. Those things are there for everyone.

T: But her sister’s kid is not hers. That is fact.

S: Indeed. However, the kidness of the kid belongs to the whole world. It’s okay to be jealous – nothing wrong with it. It’s also okay to know there are other possible routes to take, other possible responses to make. She could choose to recognise jealousy as the most conditioned and expected response and embrace it. She could also be present to the pastness of the past, the kidness of the kid, the sisterness of the sister, the aliveness of her life, the heartfulness of her heart and work with that. See what happens. She might be surprised. There might be a beautiful garden behind that wall.

T: It’s hard though.

S: It’s worth a try. There are more Christmases on the way and they want to be happy.

Optimism?

Last Thursday night I had to think about what to wear as I was going out. Proper going out – to a gig at a small venue in Tower Bridge. Hugo, one of Saagar’s closest friends from school had released a single in his memory and was performing live and raising funds for Papyrus. I would be seeing our friends, have a drink and possibly dinner at a restaurant.  Wow! About time. It’s been ages.

Took a train to London Bridge and as I was walking out of the station, 2 announcements came on in quick succession –

“The 1831 to Peterborough has been cancelled due to a person being hit be a train.”

“The 1830 to Horsham has been cancelled due to a person being hit by a train.”

That Thursday was back again. It was Day 0 again. At this very station, an announcement was made to say my train home had been cancelled. I found an alternative route without thinking once why my train was cancelled.

It is spreading. Despite everything we do. It keeps happening. This morning I woke up to talk of another lock-down and my heart sank. I have an income and a home and someone to share my life with. How many don’t? I have hope and optimism. How many don’t? How many other hearts sank this morning?

The prospect of going on living in a world without a warm touch or hugs or smiles is nothing less than a punishment. The morning is greyer and colder than it has been in a long time. The days are shrinking. I am reminded of 6 years ago, at this time of the year, as autumn was fast approaching and Saagar was ill, I was optimistic. I didn’t have the slightest doubt. I knew he would get better.

Now, I doubt my optimism.

PS: Please listen to this song and share it on: “Lay down” by Hugo Hartley on Spotify

Many more songs by him on Youtube: