Not ‘them’ and ‘us’. Just ‘us’.

It has been a dream to be face-to-face, talking about Saagar with the Psychiatric community. In the past 7 years that has not really happened. On Wednesday, the 15th of September, I got as up close as possible with an entire department of roughly 100 psychiatrists and Therapists at differing levels of experience and practice. They were in New York and I was here, in London. The Grand Round was organised by a colleague, Prof Mike Myers, who gave it the title:

‘Losing a Son to Suicide: How One Mother is Opening Hearts and Minds Around the World’

After a cordial ‘meet and greet’, the film ‘1000 days’ was screened. It was followed by complete silence. Same as the previous time it was screened. And the time before. Each time the audience was left speechless.

After a long minute I gently stepped in with the assurance that this was a normal response. I invited questions and comments. I thanked them for the work they do and acknowledged how difficult it is for the profession to deal with such losses. I shared my hope that the film will deepen their insights into the human element of such deaths and the value of forging partnerships with bereaved families.

What followed was a fulsome, creative and holistic exchange of ideas.

“What led you to make this film and share your life in this way?” one young Resident asked me.

“I could only work with what I had and do what was in front of me. When I could write, I wrote. When I could speak, I spoke. When I could learn, I learnt. From the moment I heard the news of Saagar’s death, my only intention was that this must stop. No one should have to suffer the way Saagar did or the way I and his friends do. This film came about because it’s time we recognize that these lives are worth talking about, that the desire to end one’s suffering is a normal human desire and that we all have a role to play.”

Winner – BEST DOCUMENTARY – Swindon Independent International Film Festival
Winner – Brighton Rocks Film Festival – Spirit Award
Winner – Compassion Film Festival Colorado – Reflections of Love People’s Choice Award
Nominee – Morehouse College Human Rights Festival Atlanta (winners yet to be announced) 
Semi Finalist – Gold Coast International Film Festival – New York 
Nominee – Long Story Shorts International Film Festival 

Upcoming festivals where the film can be watched starting 23rd September 2021. Tickets available now.

‘1000 Days’  
Morehouse College Human Rights Film Festival – fosters ongoing discussions about human rights and social and political issues.
September 23 – 25 https://morehousehumanrightsfilmfestival.com/2021-film-guide/

‘1000 Days’ at Women Over Fifty Film Festival:
WOFFF is an inclusive, international film festival celebrating women over 50 in front of, and behind the camera.
25 Sept – 2 Oct – tickets on sale
https://wofff21.eventive.org/films/61379c142c09f100b90ae7c4

Comments:

”Bringing people closer and keeping them deeply connected despite social isolation.”

“Keeping the silk threads of human bonds as strong as ever.”

Only one race.

You are not your body. Who you are has nothing to do with how you look.

You are not your mind, your thoughts, your feelings or your memories. All those things are aspects of you but they are not you. They change from moment to moment. Thoughts come and go. Feelings mould. Thousands of old cells are shed and replaced by new ones every second.

During my training to be a doctor, I had to dissect a human body. It was an enlightening experience. On my first day at medical school, it was a shock – the massive Anatomy hall reeking of Formalin, 12 metallic rectangular tables, each occupied by a horizontal human form covered with a white cotton sheet. 4 students in alphabetical order, to a table/ body. All different but more or less the same, students and bodies. Mine was a dark skinned, muscular young man in his thirties. I wondered how he had landed up on this table in the heart of Punjab when he clearly belonged somewhere else. I wondered what his story was.

As I carefully peeled the skin off, a pale yellow silky layer unraveled itself. I peeked at the next table and it was the same. And the next and the next. Men and women, old and young, squat and fit, brown and black. Whatever on the outside, were the same just underneath.

We laugh and cry the same salty tears, we feel the same love, we yawn and sneeze and hiccup and breath the same way. We all are distinct and yet, more or less the same. We are all made up of a substance called ‘love’. We carry the whole Universe inside of us.  We are bundles of boundless cosmic energy. Our bodies are vehicles for us to experience this Earth and for this fantastic energy to express itself. Let us not allow anyone to tell us how we should look, as their vision may be limited. Be fully expressed. Don’t let their limitation be yours. You are whole and complete, just the way you are, no matter what anyone says. Don’t let anyone let you love yourself any less than one thousand percent. Your love and compassion for yourself is the source of all joy for all humanity.

Just as black people are so much more than just black and homosexuals are so much more than just that. And Saagar was so much more than just a handsome brown young man. Underneath, we all are human. We have the privilege of coming from the most gorgeous star. Our numbers are higher than ever before and our potential as a race is the highest it has ever been. At a time when we need more cohesion between humans than ever before, we are building divisions all over the world – us and them. Be it the colour of our skin, our religious convictions, our gender, our choice of sexual partners or our private medical choices. We need bridges, not walls. We need to see ourselves in others and them in us – vulnerable, tough and unique at the same time. Everyone. Absolutely everyone.

I say to all you planning and scheming and dreaming, defending, proving, and justifying, laughing, crying, and feeling people, wanting love and understanding, offering love and understanding people:

 “You be me.  I be you.  They be us. We be them. All be one. Love be all. All be love. Only love. Get down on it.”

Fresh off the boat

Twenty-two years ago, when I first landed in the UK, I arrived as a qualified anaesthetist. I didn’t think of myself as a ‘female doctor’. I did not classify myself as one from the ‘ethnic minorities’. Both of those things were incidental to the fact that there was a job to be done and I could do it well, even if it was in a completely different setting, four and a half thousand miles away from home, at Antrim Area Hospital, Antrim, Northern Ireland. I was nervous but being from an army family, I was accustomed to moving every couple of years from one state of India to another (states as different as Punjab and Bengal), making it my own, learning from a different way of life and moving on to the next. I was sure of my ability to adapt.

My belongings comprised of a family photograph in a silver frame, a suitcase, mostly filled with books and two hundred pounds in cash. From the window of the plane I could see forty shades of green, in a mesmerising patchwork across the fields and hills of Ireland. The sky was the deepest, most startling blue. My heart was up in my throat with the excitement of living and working in a country where everyone was educated (why wouldn’t they be if education was free?)  and well-mannered (why wouldn’t they be if everyone was well looked after by the Government?)

One of the secretaries from the Antrim Area Hospital, Mary, very kindly came to receive me at the airport. The drive from Aldergrove Airport to the hospital was like gliding through a picture postcard. After Delhi, I could fully appreciate the wide golden-green expanses gleaming in the sunshine with not one human being in sight. When I complemented Mary on how gorgeous her country was, she was perplexed, “Really?”

Saagar was 5 years old then. He had stayed back with his dad. My plan was to find my feet and have him join me as soon as possible. I wanted to get my post-graduate exams within one or two years and go back to work in India. In the next few months, as I settled into my job, I acquired a cheap second hand Renault 19, found a family home and an appropriate child-minder. In the tea room of the hospital, the nurses would tell me about their families and ask me about mine. When I told them that I had a 5 years old child back home, they would say, “How could you leave him there?” I didn’t know what to say to that.

I still don’t.

No caller ID.

Soon after lunch one Saturday, my phone went. “No Caller ID”.

‘I am James Eames from the New World Building Society’s fraud investigation team. There have been some suspicious dealings with your debit card recently. So, I am calling to ask if you’ve given your card details to anyone lately?’ spoke a smooth cultured voice.’

“Hi. Let me think. On Monday I had an e-mail from DVLA saying I needed to update my card details to pay the road tax in time. So, I did.”

‘Right. So, that’s how they’ve got you. But, don’t worry. I have been doing this job for the last 17 years and I get to work every day, including sometimes a Saturday morning just so I can help people.’

“A bit like me then. For years I worked at least 2 weekends every month.”

‘So, I am just going to send you a text message with a code, just to verify your identity. When you get that could you read out your code to me?’

“Yes. Sure.”

‘So, I see that you have recently made a few purchases from Argos.’

“No. I have not.”

‘Ah. It must be them. We are liaising with the police to get to the computers they are using and that’ll help us catch them. So, don’t worry. This is very helpful. Could you read out the code to me?’

“Yes. It is ——.” I feel so stupid. How could I trust a random e-mail like that? I checked the site and it looked so proper – just like a government website.”

“They are very clever. You must check the sender’s e-mail address by pressing reply. You should also look out for e-mails claiming to be from DPD and Royal Mail.”

‘Gosh. It must be hard for you to keep ahead of the game with this kind of fraud, especially nowadays when everyone is banking on-line. It’s just a battle of wits. Isn’t it? And they are so smart. These youngsters.’

“Yes. We must stay sharp and we have very good security systems in place. So, that helps. I see that you move money regularly to Tina. When was the last time you did that?”

‘About 3 months back.’

“Can you trust her?”

‘Yes. Completely. She’s been a friend for 10 years.’

“Saagar?”

‘Yes. He passed away a few years ago.’

“Oh. So sorry! It seems these guys have set up a standing order in Tina’s name for 2000 pounds.”

‘Can’t you stop them?’

“Yes. We are working on that. In the meantime, can you ask your friend Tina if she has received the money? We might need to close your account and set up a new one for you.”

‘I’ll try.’ I go downstairs to get the handset of the landline and call her.

“Hi Tina. So sorry to bother you. Do you have a few minutes to speak? My bank is on the phone with me trying to sort out some stuff I need your help with.”

She confirms that she has got 2K from me. I am relieved as I know she will help me sort this out.

“Dr Mahajan, do you have a card reader?”

‘Yes.’

“Okay. If you get that and put your card in, I will give you a number to enter. Remember not to speak out your pin aloud please.”

‘Why do I need to do this?’

“To make sure that your card still works for you. If you put your friend Tina on the phone with me, I shall guide her on how to transfer the money back to you.”

Text from Tina – I just got 8,000 from you! Something is wrong. I am worried.

‘Tina says she has got 8,000 from me. I don’t even have that much money in my account. How are they doing this?’

“They might have moved money around from your savings etc. Don’t worry. Put her on the phone with me and I’ll take care of it. I have 17 years of experience in this kind of thing.”

I give Tina’s phone number to James.

I text her: James is trying to help us. He’ll call you soon. Please talk to him. Thank you!

She replies: Send me a picture of your card and I’ll transfer the money.

I do that.

James calls back, “Has she moved the money?”

‘She’s doing it. Please wait. There is no need to rush her.’

“Can you really trust her?”

‘Implicitly. She is highly talented and very hard working. She doesn’t need to cheat anyone.’ I say.

“I found her to be quite difficult. I am trying to help but she is being obstructive.”

‘Well, she has every reason to not fully trust you. You’ve only spoken with her for a few minutes. I have been speaking with you for nearly an hour now. So, it’s easier for me than for her to place her trust in you.”

“That’s right. I didn’t think of that. I can learn a few things from you. Are you doing something nice this weekend?”

‘Gosh! This is so nerve-wracking! Thank God I have a singing lesson in a little while. That’ll help calm me down. Thereafter I might watch a film on Netflix. Do you have a recommendation?’

“Yes. ‘The invisible Guest’ is in Spanish and it’s excellent.”

‘Ok. Thanks. I can recommend ‘Malcolm and Maria’ for you. It’s different. Intriguing. When do you finish work?’

“7.30 pm. I’ll probably get a pizza and watch the football.”

‘Great. Have fun when you get there. What happens now?’

“Can you check if Tina has moved the money?”

‘I don’t want to be so pushy. Let me send her a text.’

Any luck? I ask her.

She replies: I am on the phone with my bank. Nearly there.

Thanks Tina.

“Shall I log into my account and see if the money has come back?”

‘No. We are working on it. So, you won’t be able to access it now.’

“Okay. I am really tired now. Can we please finish this call? I am sure she will move the money back to me.”

‘I am tired too. Shouldn’t take long now.’

Text from Tina: That guy called you was fraud because when you just put your card in your card reader, just then was transferred money. 8000. He give me other account numbers. But I move money to what you give me.

“How do I know that you are calling from New World?”

‘Can you read the name of the sender of the texts?’

“Yes. They are from New World.”

‘That is your proof. That cannot be faked.’

More codes arrived, the card reader was used a couple more times. Finally, James was happy. He said it was all sorted. Gave me a reference code and signed off.

Later on when Si came home, I told him all about it and we looked at those text messages from New World. Each of them said –

“Never share this code with anyone. Only a fraudster would ask for it.”

I held my head in both my palms and broke into a sweat.

Once my breath returned, we phoned the fraud squad at New World and they told me that all the money that had been transferred out had been moved back into my account. A few purchases were attempted which did not get through:

JD Sports.

Fancy shoes.

Pizza.

(PS: Based on true events)

Same story

“Three weeks before that day he was at a bridge and he called his friend who called the police. They came out but just told him to call the GP. One week before that day he called another friend saying he had a panic attack. The friend picked him up. Four days before that day they told the GP what was happening. She gave him a prescription for anti-depressants and said it would take 3 weeks for a referral. 4 days later my brother was dead. At no point did anyone tell the family.”

That day was sixteen days ago.

I wonder if anyone sat down with him to listen to what was going on with him. Two friends, one GP and the Police – none of them could put him in touch with his life and keep him safe. Yes. Ultimately it is up to him but I wonder if he was told that it might be helpful to get in touch with his sister, his brother, his mother, his father – the people who had known him all his life. That he could choose someone who he had a deep connection with, someone he trusted, and let them know how fragile he was at present. Someone who truly cared.

I wonder if you’ve seen this recent advert from St John’s ambulance where a dad is desperately trying to save his son. It encourages lay people to learn First Aid, in case of a physical health crisis. It’s a good one.

Save the boy”

Let’s put this in the context of doctors not knowing how to give First Aid to someone in a Mental health crisis.

The police not knowing that this is life-threatening, that there are resources in addition to the GP, like A&E, Maytree, Papyrus, Samaritans, CALM, their community, their family.

The GP not knowing that this is life-threatening, that there are things in addition to antidepressants that help, like having a proper conversation, exploring the suicidal ideation, informing them that it would be in their best interest if they included a family member or a friend of their choice in their care, giving them details of helpful Charities, giving them compassion and hope, drawing up a Safety Plan, getting in touch with the local Mental Health Crisis Team and  being aware that antidepressants can make things worse for young people in the short term.

Over-medicalisation of suicidal thoughts and behaviours in a setting where most medics are uneducated and unsupported in managing these crises.

Save the boys and girls by insisting on education for all professionals in medicine, nursing, law-enforcement, prison service, youth services, social work, for schools universities, hair-dressers, cab-drivers, students, parents, teachers, managers and everyone else is the only way to get it right – A multi-agency approach to Suicide Prevention.

In the USA, ‘legislation’ was recognised as essential to Suicide Prevention(SP) in 2012. At present, 10 states have legally mandated training for all health care professionals.

ASIST Training (Applied Suicide Intervention Skills Training):

The Office Guy

Once upon a time, trains in London used to be stuffed with people. Every now and then one found one’s head in some random person’s armpit. That Friday evening, my train was not too full.  Every other seat was taken and a few people stood by the door.

He boarded at London Bridge and sat opposite me. We sat facing each other at either end of the long rectangular window, looking out at the dusk, in the typical way Londoners show consideration and give space to one another. I was on my way home after work. The skies were moody. I was glad to be released from the hospital after a long windowless day.

As my gaze shifted from the sunset outside the window to the seat across from me, I saw the young office guy with his neat brown hair, parted on the left side. Crisp white shirt and well-pressed grey trousers. Tense jawline. Fixed steely eyes staring through glass panes. Two vertical frown lines just above the bridge of his nose on a smooth white forehead. He looked sharp, a tense energy encompassed him like a taut canvas. It was palpable. He was, as if a statue with serious internal whirings.

The train was on the move now. My station was six stops away. I had noticed something I couldn’t ignore.

I wasn’t sure if I should do something. If yes, what?

If I did nothing would I regret it? Yes.

Could I fully trust my instinct? I wasn’t sure but probably.

Did it matter if I made a fool of myself by saying something? No.

He could get off the train at any moment so I had to make up my mind pretty quick.

Two stops had now gone by and he was still there. This was my chance. I leant in, my head closer to his, caught his gaze in mine and softly said – ‘Whatever it is, it will pass. I promise. It will.’

I went back to admiring the sunset as if nothing happened.

I didn’t look for a response in anyone. Nothing.

I left it there, feeling like a crazy old woman on the train who talks to strangers, my heart beating in my ears.

One stop later, from the corner of my eye I saw him get up to leave. I brought my eyes back into the coach and chanced looking at him as he stood by the doors. He met my gaze and gave me an acknowledging nod, his frown lines gone. I could have cried. I think I smiled and nodded back.

I was finally learning to trust myself to do the right thing.

CHIME

132 billion pounds = money saved for the UK by unpaid carers.

6.5 million = number of carers in the UK.

6000 = number of people who become carers every day.

1 in 8 adults are unpaid carers for a family member or friend.

Carers UK call them ‘The Second NHS’.

Yet, do we or the Health Service truly value them? Listen to them? Include them? Give them a voice? Understand their concerns? Treat them as an ally? Respect their abilities and contributions? Answer their questions? Educate them? Empower them? Support them? Partner with them as well as we could? Sadly not.

In my experience and that of many other families of individuals with a mental illness, the power imbalance between the health care providers and the service users does not allow for an equitable relationship. Hence, denying the patient the best chances of recovery. There is national and local evidence that proves that carer engagement saves lives.

Triangulation of services is essential for best outcomes for patients and professionals. Risk averse practices may help reduce risk in the short term but may increase risk in the long term. A recovery approach to risk and development of a “life worth living” may have longer lasting benefits through rebuilding relationships, increasing service-users skills and confidence in collaboration with carers.

Norfolk and Suffolk Foundation Trust (NSFT) have developed a program called “Stepping Back Safely” up-skilling staff, carers and service-users. It is based on five main drivers of Recovery: CHIME

  • Connection
  • Hope
  • Identity
  • Meaning
  • Empowerment

NSFT are offering free training in Stepping back Safely in July 2021 on-line. Having heard many stories where a life could have been saved only if there was a meaningful and effective communication between the three parts of the Triangle of Care, I think this training is most relevant and essential. I shall be taking it as I am sure it will deepen my understanding of the subject. If you or anyone you know might like a point of contact, here it is: catherine.phillips@nsft.nhs.uk

Watch it!

After a long wait, we can watch it. Not in a cinema but on the largest screens available in our homes. You might know that a few years ago we set out to make a short documentary on the life of Saagar and our lives after him. I am so happy that it can now be watched at the link below by clicking on the box that reads 1000 days and entering the password as suggested: hiddenFF2021

https://www.festivalreel.org/hff-2021

Presently this film is available through the Hidden Film Festival website but in time it will be a resource to increase the understanding of suicide and bereavement by suicide and the value of kindness. I hope it will generate constructive, life-affirming and healing conversations. It is 20 minutes long and is available till Friday, the 4th of June. At present it is doing the rounds of international film festivals and has been selected for 7 major ones. Thank you for holding Saagar in your hearts the way you do. For shouting out love and hope.

Cast: Freddie, Hugo, Seb, Sam, Bex, Rosie, Azin, Simon, Saagar and I.

Filmed and produced by the magical duo Jeanette Rourke and Ron Bambridge.

What some people have said:

“I cannot get the film out of my head (in a good way!). I am really impressed with the professional job done on the filming and opening drone shots of where you live etc.”

“It is beautifully made and the editing done with such sensitivity. I also loved the music – definitely sounded like a professional music for film composer.”

“Thank you so much for the film and it really brought me a lot of comfort especially  in a rough week like today when I have grief burst. I am grateful to have to know you in this difficult journey and what you have been sharing about your beautiful Sagaar, your thoughts and your journey milestones has helped me tremendously.One thing I learnt from 1000 days is that the hope of surviving this unsurvivable pain which you gave me through your story. Thank you so much Sangeeta.”

Thank you all for funding this film. For illuminating this world in your own special way!

PS: Please feel free to share it on.

Twenty-seven

Dear Saagar,

It was your 27th birthday, last Thursday. You would have been 27 years old. You were 27. You are 27. Which one is it? None of the above? All the above?

You were a Presence eons before you were born as Saagar and you will be one for ever more. You are Awareness, beyond form and name. I am the same. There is no separation between us – both ageless, placeless and traceless. Untouchable. Unknowable.

Didn’t take that day off work this year. Woke up and thanked the blessed day for you, your life. On the beautiful bike ride to work, the heart overflowed with love and gratitude. Had a full productive day at work and another lovely bike ride home. Sat on your bench in the evening under the circle of trees bathed in the slanting rays of the setting sun. Felt the love.

Thank you for bringing me the true experience of love.

Yours,

Mamma.

“When love beckons to you, follow him,

Though his ways are hard and steep.

And when his wings enfold you yield to him,

Though the sword hidden among his pinions may wound you.

And when he speaks to you believe in him,

Though his voice may shatter your dreams

as the north wind lays waste the garden.

For even as love crowns you so shall he crucify you. Even as he is for your growth so is he for your pruning.

… Like sheaves of corn he gathers you unto himself.

He threshes you to make you naked.

He sifts you to free you from your husks.

He grinds you to whiteness.

He kneads you until you are pliant;

And then he assigns you to his sacred fire, that you may become sacred bread for God’s sacred feast.”

  • Khalil Gibran

PS: Please like and retweet the link below if you can. That will give a media presence to this short documentary film, ‘1000 days’, which is based on this blog and has been made with the intention of bringing us all closer together in love, kindness and understanding so that no one reaches a point where they can’t find a way to live another day. You will be able to see the film in late summer, once it has done the rounds of a few film festivals across the globe. Thank you very much.

Changing the Conversation.

First versus second.

Medical versus human.

Symptoms versus experiences.

Problem-based versus Trauma-informed.

Here is an example of language, describing the same thing in two different ways.

First:

“I was 15 when I started to suffer with mental illness. I went to see a psychiatrist who told me that I had something called Schizophrenia. For a couple of years my symptoms got really bad and people were afraid I was going to hurt myself so I was hospitalised. They stabilised me on meds and shock treatments and sent me home. For a long time, I didn’t get sick again.

Later, as an adult, I started to get symptomatic again. I got pretty psychotic and once again got put in hospital. They told me there that I was really sick and should go on disability. For a long time, I was pretty sick but then started to be able to manage my symptoms.”

Second:

“I was 15 when I started feeling different than others and really alone. For a couple of years after that, I would do things in pretty extreme ways. They made sense to me based on what I was thinking and feeling but I guess it was scary for others who didn’t really understand what I was thinking and feeling. I got put in a hospital. There I really lost hope and beliefs about being a ‘regular’ person. They put me on a lot of medication that made me sleepy all the time. After I left, I threw out all the meds and put my intensity into music.

Years later, coming out of a difficult marriage I started to have similar kinds of experiences as the ones I had as a kid. I had really strong feelings and felt pretty separate from others. I got put back in the hospital again. I was told I had a major mental illness and that I should go on disability. Though I did that for a while, I realised that I was just going along with their beliefs rather than looking at how I’d come to think in certain ways. Little by little, I figured out what to do with my intensity and I’ve been really growing ever since.”

Each one of us is simply at a different place in our growth and development. Using language that is personal and descriptive of our experiences enables shared understanding. It forces us to think of ourselves and others more broadly as human beings, free of labels and assumptions.

Reference:

Intentional Peer Support: https://www.intentionalpeersupport.org/?v=79cba1185463