It’s everywhere.

0fe78e72872f186ef1dd7a10f4f09be0

A few decades ago, cigarettes were everywhere. It was normal for men and women to smoke. Physicians were known to recommend smoking. The advertising machinery glorified it.

Today, Electro-Magnetic Fields (EMFs) are everywhere. They wrap us all in multiple layers of invisible weaves of radiations arising from cell-phones, baby monitors, cordless phones, bluetooths, wi-fi routers, smart meters and microwave ovens. There is very little information out there about the effect these gadgets have on our bodies and minds.

According to Dr Mercola’s research these EMFs cause a significant oxidative stress on our cells leading to the release of free radicals which in turn cause serious mitochondrial damage. Mitochondria are “powerhouses” of each cell, breaking down fuel molecules and creating the energy the cells need to perform their functions. Children are at greater risk of such damage than adults. Damaged mitochondria have been held responsible for anxiety, depression, autism, Alzhiemer’s disease, rhythm disorders of the heart and infertility. Dr Mercola also gives practical suggestions on how to minimise the damage.

In 2008, a Danish study involving more than 13,000 mothers revealed some sobering potential effects. Children born of mothers who used cell-phones during pregnancy as compared with children born of mothers who did not, experienced a :

  • 49 % increase in behavioral problems
  • 35 % increase in hyperactivity
  • 34 % increase in peer-related problems
  • 25 % increase in emotional issues

These findings indicate a huge impact on public health and need for further research. Mobile phones are now essential to our lives. Our days begin and end with them. Some people have it right beside them even when they sleep. Lack of one is considered odd. Not being able to locate one’s phone can induce a state of panic. ‘Low battery’ is a highly undesirable state. There is an official term for fear of being without a phone, NoMoPhobia (No Mobile Phobia). I think our generation was the last one to have reached adulthood without cell-phones. Now, they are  everywhere. 

Jo is a dear friend and mother to a 9 year old who is on the Autistic spectrum. Here she shares what it’s like to advocate for her son and how hard it is to ensure that he receives appropriate care. Thanks Jo.

PS: Incidentally all antipsychotic medications are known to cause severe mitochondrial damage too.

Every day my love is new.

All those years ago, when we were kids, we attended medical school together. The Batch of 1983 had its 3rd re-union at Cochin, the capital of Kerala in South India over the last 3 days. I travelled from snow-bound Wiltshire to lush green tropics. Many of my classmates came together from all over the globe. Some brought their families. Others brought videos of their kids doing this and that. I brought memories. We shared stories of our teachers and colleagues from our time as adolescents and young doctors at our alma mater. We felt close to each other, reminiscing our naivety, vulnerability and innocence. Nostalgia of our ‘good old days’ of simplicity, like silk threads knitted us close.

We went sari shopping. My friend chose a pale blue sari with a gold border. Her 15 year old daughter commented, “it’s as bland as playing tennis without a net.” It was exactly the kind of thing Saagar would say. He would also take great pleasure in imitating the way I say, “So pretty. No?”. Aaaaaaaaargh!!!

Looking back:

2014: Saagar went.
2015: Longing
2016: Longing
2017: Longing

If I told my plight to a river, it would stop flowing. If I told it to a tree it would shed all its leaves. I burn in this fire of longing, again and again, every day. I have become a boat of compassion filled with the gold of nothing, riding the waves in search of my beloved. I weather the tides of sorrow and happiness while my longing lives in me. I find my beloved in my longing. There is no destination no more.

An ancient parable goes like this: Once a forest caught fire and all the birds and animals of that forest started to leave. There was a bright little parrot who decided to stay. The tree that housed it said, ”You have wings. Go. Fly away.”
“I ate your fruit, I soiled your leaves, I played from branch to branch. You burn and I fly away? You love but once.”
The utterly foolish parrot goes and plunges herself in a nearby lake, comes back and flaps her wings over the blazing forest fire. Two drops of water fall. She goes back into the lake and come back with another couple of drops of water and sprinkles them over the humungous fire. The other fleeing birds and animals start scoffing and laughing at her.
“What do you think you are doing?”, they say.
The parrot turns around and says “I am doing what I can.”
Just then the Gods pass by and see this bird. They take the form of an eagle and watch her closely. They are incredible moved to see her do what needed to be done, be in the here and now and her passionate endeavours to quench the fire in and around her. The Gods wept and the clouds burst into a heavy down pour of milk.

Everyday my love is new.
I wish you the same.

“Whatever happens in your life, no matter how troubling things might seem, do not enter the neighbourhood of despair. Even when all doors remain closed, God will open-up a new path only for you. Be thankful when all is well. A Sufi is thankful not only for what he has been given but also for all that has been denied.” – From ‘Forty rules of love’ by Elif Shafak.

The sun has risen.

IMG_1022

The longest night of the year is behind us. The sun is rising. We are sitting by the log-fire swapping stories of Christmas’s past, Si’s and his sister’s childhood, drinking pots of tea, mainly to carry with it slabs of brandy-soaked Christmas cake.

We recount our holidays from a few years ago when Saagar had the pleasure (not) of dressing his first pheasant with the help of an aunt from the country.  We all took turns at being beaten by him at table tennis. He looked gorgeous in a navy blue shirt and dark-rimmed spectacles. He had just been prescribed glasses. He was getting used to wearing them and I was getting used to seeing him wearing them.

Until he was 10, we religiously left a glass of wine and an orange for Santa on the mantle-piece. He wrote a letter to him every year. I remember he always started with “Dear Santa and Mrs Santa, …” 🙂 We took pictures with him. We watched his films and we found him to be cool and cuddly.

That year his gift was wrapped in a deep blue paper with glittery stars and snow-flakes in various shapes and sizes. He found just what he wanted inside. He jumped up and down for a bit and then sat down, visibly thinking.

“I saw a roll of this identical wrapping paper in the corner of the boiler cup-board.” He said. I sat on the sofa, over-smiling, as though I had nothing to hide. The mechanics of his brain clicked away as he figured out how the roll might have got there. I made feeble counter arguments.

“Maybe he had too many things to carry so he left some things here.”
“Maybe he wanted you to keep some of his favourite paper.”
“Maybe he has kept it for next year.”
“He left that paper there last year.”

He wasn’t fooled. That was the end of innocence.

Have a good one my darling, wherever you are. Lucky are the angels that are with you.
You are loved and cherished more than you know, Christmas or no Christmas.
Love you sweetheart! xxx

 

Kisa Gautami

download

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.

images

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?’

We have further information on doctors’ well-being and our doctors for doctors services