It changes. And changes again.

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Over and over I asked myself – Now what? Now what? What happens after a severance such as this? How long do one’s bones bleed? Do the tears ever finish? What does ‘recovery’ look like? Is it even possible? How does one keep placing one foot in front of the other? Where is the road? Where does it come from? Where does it go? How long and meandering is it? When does the screaming in my head stop? How long can I keep up the facade? Pretend to be sane? Is this what a new diagnosis of a terminal illness feels like? Is forgiveness possible? Self-forgiveness? Acceptance? Surrender? All these big words! Surrender what? To whom? Who am I now? What do I do?

No answers. Silence. The tilted earth keeps spinning around its imaginary axis. It keeps cradling me. The sun stays at the center of its orbit. My son stays at the center of my being. My breath keeps coming and going. I grow new eyes. My bones carry my weight even though they bleed. The road appears under my feet. It reveals itself one step at a time. Rumi and Khalil Gibran come and hold my hand. The screaming softens. The wall of bricks that was my body, loosens. I come to know the terror and the joy of being insane, catch glimpses of being free. Respect for those who went before and sadly others, who follow. I stop fighting with the big words and keep it simple. Watch. Observe. See. Open. Let the gash in my heart, allow the light in.

A recent talk for The Compassionate Friends, a charity dedicated to supporting bereaved families.

Logotherapy

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It was late 1930s. He was a young man in love. She was a young woman who was delighted to be asked by him. They were married. Soon she was to be a mother. But the clan they belonged to were not allowed to procreate. She was made to abandon the baby even before it was born. They both were sent to different concentration/death camps. But their love story did not end there.

Despite shoveling snow with no shoes on, going for months without proper food, constant beatings and humiliation, not knowing which instant he would be walked to his death, he carried on loving her. He did not know if she was dead or alive but he loved her every second. He hoped to see her again. His longing kept him alive.

Four years later, he was freed and he found out that his sweetheart had passed away soon after their separation, at the age of 24. His father, mother and brother had met the same fate in that ugly assault of humanity on itself. His sister had survived and moved to a faraway land.

Viktor E. Frankl was a Psychiatrist. He took 9 days to pen down his learning and thoughts which became a book – ‘Man’s Search for Meaning’ that sold millions of copies all over the world as it helped them transform their suffering .

He pioneered a new way of counselling patients called Logotherapy or ‘meaning-based-therapy’. When asked of the difference between Psychoanalysis and Logotherapy, he said, “In Psychoanalysis the patient must lie on a couch and tell you things which sometimes are very disagreeable to tell. In Logotherapy the patient may remain sitting erect but he must hear things which sometimes are very disagreeable to hear.”

It is a future focussed approach through which the patient is reoriented toward his unique and specific attributes aligned to a purpose which can be fulfilled by him/her alone. It is based on the premise of freedom – the freedom to choose our response to our experiences, the freedom to choose the stance we take when faced with a difficult and unchangeable situation.

Over the last 5 years I have read Frankl’s book at least 5 times, each time deriving new inspiration. Last week I had the good fortune of being able to share some of those insights on-line with a community close to my heart. The Compassionate Friends helped me discover that Frankl’s love story will never end. It is interwoven into yours and mine and with the love-stories of those yet to come across it.

Patients first.

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Credit: Mario Sanchez Nevado (www.aegis-strife.net)

When I speak with gatherings of doctors, I often start with asking them to shout out whether they think the statements below are True or False. What do you think?

Sick doctors know when they are sick.
Doctors are good at asking for help and following advice.
Doctors take good care of themselves.
Doctors have strong support networks.
Doctors are kind to each other.

Irrespective of which country I am in, without fail the auditoria flood up with a big resounding ‘FALSE’ for each of the above, accompanied with some sniggering. Isn’t it shocking? One would expect that people who work in ‘healthcare’ would know a thing or two about their own health as individuals and as a community.

These are the highlights of a survey conducted by the Royal College of Anaesthetists in 2016-17:

The NHS Sickness statistics consistently show that NHS hospital doctors have the lowest rate of sick leave as compared to any other staff group. Here is a list of personality traits of doctors (a broad generalization, of course) that might explain this:

Perfectionism (I must do this right!)
Narcissism (I am good at what I do.)
Compulsiveness (I can’t give up till I finish.)
Denigration of vulnerabilities (If I need help, I am weak.)
Martyrdom (I care for my patients more than myself. Their needs come before mine.)

The very traits that make us good doctors are the ones that may not be very good for us. But our seniors have not been aware of this and hence they have not been able to help us understand ourselves. This tradition has been going on for generations of doctors. There is a nobility associated with such self-sacrifice, which we all have bought into. The fact is that if your own cup is empty, you cannot serve others well.

Things add up – a dysfunctional department, work pressures, lack of support outside work, ill-health, emotional burden of the job, a traumatic adverse incident, lack of sleep, fatigue, a complaint made against you, poor diet and no time to exercise or pursue hobbies, impaired judgement of one’s own symptoms, fear of letting others down, difficulty in admitting that they have a problem.

Burnout among medics is not unusual. It looks much like depression and sometimes ends in devastating tragedies. But help is available. Sadly, unlike other illnesses, for mental health issues, the onus of getting help lies with the sufferer. It takes courage to acknowledge one needs help and seek it out in good time. It might be the best thing a doctor can do for themselves and their patients.

Sources of support:

https://www.bma.org.uk/advice/work-life-support/your-wellbeing/sources-of-support
Doctors in Distress, a charity set up by Amandip Sidhu in memory of his brother Dr Jagdip Sidhu who was an eminent cardiologist and tragically died by suicide on 27th November 2018.

Three friends

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This is an approximate transcript of a presentation I made at a TCF (The Compassionate Friends) gathering of bereaved parents earlier this month. The topic was “Finding Hope after Catastrophe”. I hope you find it useful in some way.

“Hello. My name is Sangeeta. I am an Anaesthetist by profession and it’s my job to put people to sleep. Thank you TCF, for having me here this evening.

My son is called Saagar Naresh. I could often hear his cackles emanating from his room. I am pretty sure he’s watching cat videos again. He loves to laugh and make other people laugh. He’s as bright as they come, astutely picking up languages, accents and mannerisms of people around him. He would go shopping with his best friend Hugo to Oxford street and they would pretend to be South African tourists all day.

We loved cooking together. It involved chopping of onions. He got tired of his eyes stinging and watering and found a way out – he would wear his swimming goggles whilst chopping onions. It worked brilliantly!

He was an excellent cricketer. A fast bowler to be precise. He also played the drums in a band. He loved to go to the gym. Most of all, he had a heart of gold and even when he was a teenager, he loved cuddles. He spoke French and German fluently and chose to study Arabic from scratch at University as he wanted to challenge himself.

After his second year at Durham University, he came home for the summer holiday and was diagnosed with Bipolar Disorder. He was unable to go back to pursue his studies as his depression started to deepen. We saw a doctor on the 14^th of October 2014. He told us that Saagar would have to wait till his medications kicked in, that he was on the right medicines but they would take time to work. On the 16^th of October, Saagar ended his own life.

That was like a bomb going off in our lives. Losing him suddenly, out of the blue was our catastrophe.

Finding hope …

The Oxford dictionary defines Hope as “a feeling of expectation and desire for a certain thing to happen”.

For me, Hope is the belief that it is possible that some of the best days in my life are yet to come.

Soon after Saagar passed away, just getting through the day was an achievement. The time ‘yet to come’ was a huge burden. I had nothing left to offer to the world and the one thing I wanted, the world could not offer me. My own mortality stared me squarely in my face and it was strangely seductive.

What was I left with? My logical mind had been turned into an emotional pulp as there was no logic to this. The more I tried to make sense of it, the more I suffered. It was like banging my head against a brick wall. It did not make any sense. Period. Deal with it.

What was I left with?

This moment, right NOW
Me, mySELF.
Nature.

NOW

How deep rooted was my belief that Saagar would always be around? How much did I take that for granted?

What am I taking for granted right now?

My breath.

My parents.

My partner.

My job.

My health.

Let death be your teacher. ‘Right now’ is all I have left. Like a bird trapped in a cage. The door is open but the bird is unable to fly away. The cage is where he/she belongs. In the ‘now’, I could only sit and watch the door, knowing that it was open. I could breathe in, take a pause, breathe out, pause, breathe in and repeat… I could fully acknowledge and feel the dark hollow that was my chest and hear the echoes of my sobs returning from the black hole within. Connecting fully with the present moment was the only way past it. There was no short-cut. No secret escape route. One moment at a time. Now, I am walking upstairs. Now, I am halving cherry tomatoes. Now, I am watching the steam rise from my cup of tea and so on… My refuge lay in this moment, right here. Right now. The future is a story. The past exists in our thoughts. Yet, our mind is in one or the other. What is real is this moment.

I had a patient once who had a black ‘Gratitude’ tattoo on her left forearm in a big bold decorative font. I asked her the story behind it. She said, ”I work with kids with learning disabilities. By the time I’ve brushed my teeth in the morning, I’ve achieved more than they can. So, I am grateful every moment.”

SELF

I was lucky to have so much support at that impossible time. My mum and brother came over from India to be with me. My friends, Saagar’s friends, their parents, my work colleagues. Everyone stood by me with love and compassion but ultimately it was up to me to live with this utter devastation. I was filled with so many questions, so much guilt and grief that I felt like I was drowning.

It took 2-3 years but slowly I taught myself to be kind to myself. I am still teaching and reminding myself that our everyday reality is made up of stuff that is unthinkable for most people. We live the life that is other’s worst nightmare. Many can’t even imagine what it’s like to be in our shoes.

So, we need to honour ourselves for carrying on living with as much grace and dignity as possible after having absorbed the impact of such a huge catastrophe. To know that the harsh inner critic will continue to chatter but we need to witness its mumbling, recognise the pointlessness of it and let it go.

We need to have compassion for ourselves. Compassion being not just a gentle kind feeling but small acts of courage. For instance, I used to love dangly ear-rings ‘before’. I would change them every day, to match my clothes. But for 3 years ‘after’ I didn’t change out of the boring old gold studs. One day I decided to change into one of my favourite pair of ear-rings for no particular reason. It was a small shift. It took courage. I cried. But it was an act of kindness towards myself. I needed my own friendship, my own affection. I needed to once again find ways of being at ease with myself. Lord Buddha has said “If your compassion does not include yourself, it is incomplete.”

I am learning that I need to be a ‘compassionate friend’ to myself.

NATURE

That wretched day in the middle of October was cursed but also resplendent with autumn colours. It was a festival of orange, ochre, red, green, yellow and terracotta. These decorative leaves carpeted our street. I stared out of the window watching these leaves gracefully dance their way to the ground. The trees went from being semi-nude to naked. This was the cycle of life. Nature was reminding me and showing me the devastating beauty of life. Cycles upon cycles of change, millions of times over. The impermanence of everything.

Over the next few months, I sat gazing at the Himalayan mountain range, marvelling at its history and all the changes it has undergone. I sat on a beach in Goa, watching the ocean waves change every second. Over time, I started to allow Nature to teach me what I needed to learn and soothe me when I needed to be soothed. I learnt that we humans can carry the utter tyranny of life in one hand while simultaneously carrying the spectacular beauty of it in the other.

I requested everyone to join me in singing this song by ABBA and was delighted by the upward shift of healing energy in the room as everyone sang together. It was a powerfully uplifting evening.

I have a dream, a song to sing
To help me cope with anything
If you see the wonder of a fairy tale
You can take the future even if you fail
I believe in angels
Something good in everything I see
I believe in angels
When I know the time is right for me
I’ll cross the stream, I have a dream

I have a dream, a fantasy
To help me through reality
And my destination makes it worth the while
Pushing through the darkness still another mile
I believe in angels
Something good in everything I see
I believe in angels
When I know the time is right for me
I’ll cross the stream, I have a dream
I’ll cross the stream, I have a dream

I have a dream, a song to sing
To help…”

Hope

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The concert had just finished and the hall was semi-lit. A dance recital entitled ‘Hope’ had coaxed everyone’s feelings up from deep within to just under the surface, like fish in an aquarium hovering at the top for specks of food. The main supporter of the show was the Patel family who had recently lost one of its eminent members. He was survived by his young wife and three kids. The soft thuds of seats folding up, the hiss of people whispering in gentle tones and trudging in small steps towards the exit filled the warm air.

I approached the 17 years old Patel boy, one of the sons. He appeared shrunken. Contracted, like an empty plastic water bottle, after a flight.

“How’re you doing?”
‘Not bad. Thanks’ he stated, unconvinced, looking downwards and sideways.
“Did you enjoy that?”
‘Yes. T’was nice.’ Still expressionless.
“How’s mum doing?”
‘We went for a safari to Kenya. That was good’ he looked up a little.
“I am sorry for your loss. I hope you’re taking good care of yourself.”
‘Yes. Thanks’. Mortified.
“Can I give you a hug?”

It was like hugging a coat stand.

Resources:

1. Child Bereavement UK: https://childbereavementuk.org/for-families/support-for-bereaved-children/
2. Winston’s wish (Charity to help young ones cope with grief): https://www.winstonswish.org/
3. Cruse: https://www.cruse.org.uk/children/how-to-help

Shauna’s Mum says

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” A schoolgirl’s been murdered in our area. It’s a horrible, horrible thing to happen – never should have and is just another reminder of this shit world we live in. I’ve been trying not to follow the news on it but they released CCTV footage of her last known moments and it was actually somewhere my brother drives past on the school run four times a day so I did watch it all and check the timings to just make sure he wouldn’t have been there and possibly seen something. (Different time of day)

I’ve just been struck by how it’s pulled the community together. There’s been balloon releases, marches, leaflet drops – the mum is clearly being very much supported ….I couldn’t find one person willing to have a cup of tea with me; three years on I still can’t. And I know suicide is different. Murder is evil; what was done to this poor girl, there’s absolutely no doubt people should be outraged by it…and I know suicide is about making a decision – albeit a stupid and flawed one…. but there are things I don’t understand why they’re quite so different.

The Head teacher of the girl’s school implored students to come forward because answers were needed. We needed answers with Shauna and anyone at her school who knew anything got told it wasn’t an appropriate thing to discuss. We even had a girl go to her teacher with some information, get told off for it and then to choose to write independently to the Coroner’s Court (with info we found hugely relevant but was promptly disregarded.)

Today the girl’s school announced that they’ll be making a memorial garden for her with lots of nice words about there always being a place for her and her never being forgotten. Shauna’s name wasn’t even allowed to stay on the Year 11 hoodies. The gesture is nice but the words; it would have made such a difference to us if someone had said stuff like that to us.

There was just both girls of a similar age and it’s just really brought it home how differently people see these things. I’m glad this Mum has the support that she so desperately needs, I don’t begrudge her it – I just wish it wasn’t so glaringly different how people reacted – this Mum is a heroine because of what she’s had to endure, we’re just potentially neglectful parents who should be forgotten about/ignored 😦

I don’t know if I’m making any sense. Like I say I do understand it. It doesn’t stop it hurting though. 😦 “