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As I sort and pack books, I cannot help but leaf through many, mainly to remind myself what they were all about (sometimes I think that I have read too many books, and as a result do not always remember the content). Just now, I came across Immortality, published in 1992. On the opening page, we are introduced to a woman – who ‘might have been sixty or sixty-five’ – being observed having a swimming lesson by the writer/the ‘I’ of the narrative. He focuses on a gesture she makes at the end of the lesson – smiling and waving to the lifeguard as she leaves. The narrator is moved by the gesture:

“That smile and that gesture had charm and elegance, while the face and the body no longer had any charm. It was the charm of a gesture drowning in the charmlessness of the body. But the woman, though she must of course have realized that she was no longer beautiful, forgot that for the moment.”

He continues:

“There is a certain part of all of us that lives outside of time. Perhaps we become aware of our age only at exceptional moments and most of the time we are ageless.”

This passage affirms my theory that we read to find and recognise ourselves. I, of course, am that woman, momentarily escaping the constraints of biological age. I like what Kundera says about existing outside of time, and being ageless, although I suspect that society – which includes ourselves – enforces a pretty constant reality check on how we are perceived by others. Thus, being ageless is a rare luxury.

But I also find myself a little angry with Kundera when he appears to pass judgment on the charmlessness of the woman’s face and body because of age, which has also denied her her beauty. Being middle-aged myself, I no doubt take a sensitive and defensive stance on such attitudes.

Perhaps I should suspend my own judgement until I finish re-reading the book.

 

CQ

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I have spent much of my life alone. Mostly by choice. This might suggest that I am a reclusive solitary. I don’t believe so. My world is very often a peopled one. I am, nonetheless, quite content to spend long periods on my own.

Of late, I have been questioning that blurry distinction between aloneness and loneliness. I will be relocating later this year to another city, another continent. London has suited my need to be alone, and I have rarely felt lonely here. But then, being alone, or not, was usually a choice rather than an imposition. My daughter, and only child, is about to leave home. I have lived with her for 19 years, and although our lives are lived increasingly in parallel, her vague presence has no doubt protected me from many potential moments of loneliness.

Heading off to another place and another way of living, aloneness, and perhaps loneliness, may be forced upon me unless I make heroic efforts to ensure otherwise. The evidence suggests, strongly, that the more socially active we are, particularly as we age, the less likely we are to become depressed, and the more likely we are to delay the onset of cognitive impairment, and even possibly dementia.

I have been reading Olivia Laing’s The Lonely City. The tagline for the title is Adventures in the art of being alone, thus suggesting a conflation of both terms, ‘lonely’ and ‘alone’, and an implication that they might be synonymous. I wonder whether I have tried too hard to see them as separate and distinct entities – aloneness being ok, even noble, while loneliness suggests an element of the loser. My own adjudication.

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I am only a third of the way through Laing’s book, an intriguing read thus far that looks to art, both the works and its creators, in an exploration of loneliness, and how inextricably linked it is to the essence of humanity .

Laing reflects that ‘You can be lonely anywhere, but there is a particular flavour to the loneliness that comes from living in a city, surrounded by millions of people.’

True. I remember after my marriage ended, being acutely aware of my aloneness when witnessing the togetherness of couples and families so omnipresent in the urban setting.

As I read Laing’s thoughts on art, Alice Neel comes to mind. Her painting Loneliness has always resonated with me, signifying an emptiness that being alone can instil, and also now suggesting an intertwining of aloneness and loneliness that I hadn’t hitherto appreciated.

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I also think of poetry, particularly Carol Ann Duffy’s Practising Being Dead, which ends:

‘Nobody hears

your footsteps walking away along the gravel drive.’

I suspect that the arts – music, literature, cinema, theatre – have protected me from loneliness. When I find connection within the words of others, I am in a peopled place.

I have spent many hours over the past years in my little study, which is overcrowded with books. As I begin the process of packing up, I am gradually gifting them to friends and charities.

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It feels a little like losing friends somehow. These shelves have been weighed down by books that have kept me company for many years. The people, thoughts and adventures they contain have transported me to alternate realities, and alongside keeping me company, that have also allowed me to imagine, to dream, and to be hopeful.

Even hopeful enough to consider writing my own book.

 

CQ

 

I have just obtained an annual pass at my favourite cinema group. I love all aspects of the arts, but probably cinema is where my greatest passion lies. From my first movie experience – The Sound of Music with my grandmother in rural Ireland – I have travelled the world, ‘physically’ and emotionally, through the screen. My chronological life could be mapped out by key movie milestones.

There are so many ways to access films from one’s sofa today – MUBI and Curzon Home Cinema are my faves – and I do regularly avail of these options. However, I also love going to the cinema, often on my own, and giving the screen experience my absolute attention for 90 minutes or more.

Highlights from recent trips include Paterson, which utterly seduced me. This was American (Indie) cinema successfully achieving the nuanced approach to film making that has always so drawn me to European – particularly French – moviedom. Over the past week, I have seen Toni Erdmann (quite wonderful, it surprised me with its wonderfully balanced sense of humour and melancholy), 20th Century Women (impressed me, and continues to do so days later; a not-straightforward-narrative, and one that was ultimately gratifying), and then, Manchester By The Sea.

Kenneth’s Lonergan’s third feature (I liked his first You Can Count on Me, and even more so Margaret) is a very very wonderful experience. Having said that, I found it almost unbearably tragic and so unremittingly sad. It is full of broken people, and broken lives. And Lonergan treats his audience like grown ups, refusing to fix stuff so that we can leave the auditorium somewhat relieved and reassured. But he does reassure us, in the sense of emphasising that life is a messy and uncertain affair, and that fiction need not necessarily escape this reality but can be true to it. Manchester By The Sea demands so much from the viewer. Little is verbally revealed of the inner turmoil of the characters, yet we know it and feel it acutely. We complete the story in our own minds because we recognise the fragility of our existence and our sanity.

This is great cinema. And a quite wonderful affirmation of the complicated essence of living.

 

CQ

On December 2, Philip Larkin was finally memorialised in Westminster Abbey’s Poets’ Corner. Exactly 31 years to the day since his death.

Larkin was, and remains, a controversial figure, ‘jammed somewhere between celebratory and condemnatory impulses.‘ I have often argued for appreciating the work of poets through their words without dragging their lives into the mix. For me, poetry can stand alone, can be complete in itself as words on a page. Perhaps that is a naive standpoint, but I remain content experiencing great work as a thing in itself.

And for me, Larkin is a great poet. One of the best presents I ever received was the entire collection from my daughter a couple of Christmases ago.

And it being Christmas again, I thought of that gift as I read about Larkin finally arriving in Poets’ Corner. As I put up our Christmas tree, aware of another ending year, Larkin’s wondrous poem The Trees presented itself.

The Trees

The trees are coming into leaf
Like something almost being said;
The recent buds relax and spread,
Their greenness is a kind of grief.

Is it that they are born again
And we grow old? No, they die too,
Their yearly trick of looking new
Is written down in rings of grain.

Yet still the unresting castles thresh
In fullgrown thickness every May.
Last year is dead, they seem to say,
Begin afresh, afresh, afresh.

Philip Larkin

 

Somewhat embarrassingly, I agreed to be interviewed about my movie addiction a few months ago for a newspaper that I have never read. And never plan to. No idea why I agreed to the proposition (no money or free cinema tickets involved). Possibly because film and cinema is so central to my life, and has been since my first experience as a child seeing The Sound of Music with my grandmother, that I wanted to share something of what it all continues to means to me.

I once plotted the shape of my formative experience against specific films that moved/shaped/inspired me at various timepoints. My observations of life on the screen have indeed moulded my own lived experience, and for sure served to make me, me. I have physically travelled relatively little, but I have journeyed through many worlds, landscapes, and cultures through the medium of film.

The London Irish Film Festival took place just over a week ago. I didn’t manage to see as much as I would have liked, but the events I did attend were hugely rewarding. On Thursday November 24th, I was at the Barbican to see silent Irish films (a first for me), with a live musical accompaniment from the wonderful O’Snodaigh brothers and Cormac de Barra. The music was an event in itself, and I marvelled throughout at how the musicians responded and reacted so acutely and viscerally to what was enacted on the screen. The series of silent films were not only part of the festival, but also of the 1916 commemorations, charting the Anglo-Irish relationship from a cinematic perspective. Fascinating. This theme was carried through to a day long event at Birkbeck on November 26th – specifically focusing on the relationship between Ireland and England in the 1980s, again through the eyes of filmmakers. I left Ireland in 1989, and much of what I saw at Birkbeck resonated with me – both the Ireland that I left behind, and the London that has become home. The discussions that emanated from the screenings were equally fascinating.

On the final day of the festival, I saw the premiere of Emerald City, directed by Colin Broderick. All the cast, and their families and friends it seemed, were there for the screening, which made for a vibrant, joyful and moving event. I enjoyed the film, yet it was the Q and A afterwards that completely sold it to me – the passion and commitment that created Emerald City is truly inspiring.

I was back at the cinema the following day, to see Paterson. It is an absolute gem. I was seduced and enthralled by every second of this film, by its inherent unfolding narrative where little actually happens. Which is why it is a triumph. Jarmusch has created an ode to the ‘ordinary’ life, to the mundane. Glorious in its banality, Paterson is a celebration of life. Not a life that is searching for something different, more exciting, more exotic. But a life that takes pleasure in the essence of what it already has. Few directors would have the courage to present such ‘ordinariness’ so triumphantly. Deeply steeped in the cultural history of New Jersey, with passing references to William Carlos Williams and Allen Ginsberg amongst other, Paterson is more explicit about its connection with the poet Frank O’Hara. Adam Driver (wonderful), who plays the character Paterson in the film is a bus driver who writes poems during his lunch hour. Since watching the film, I have been re-immersing myself in O’Hara’s Lunch Poems:

‘It’s my lunch hour, so I go

for a walk among the hum-colored

cabs.’

from A Step Away From Them

I left Ireland in 1989 because the mundane and the routine of life that I saw around me, and believed that I would fall into if I stayed, terrified me. Paterson has shown me something else – our expectations of what life might, even should, deliver reveals so much about ourselves, and our need for the external to fix the unresolved within.

Paterson reminded me of another film that I saw a couple of years ago – Shun Li and the Poet – which is a very different cinematic experience but it moved me in a similarly lyrical way.

Twenty four hours later, Nocturnal Animals. I did not really know what to expect from this film. I had liked Tom Ford’s earlier A Single Man, and his current feature has a similarly sleek, minimalist and polished feel. But Nocturnal Animals is much more disturbing. I found some of the scenes hard to watch – the sense that something awful is about to happen was deeply distressing, at least for me. Yet I enjoyed it. It is a good, very good cinema experience, with some great acting.

Finally, The Unknown Girl. I had been so looking forward to it, being a huge Dardennes brothers fan. But I was disappointed. The plot was flimsy, the storyline lacking a sense of mattering. I did not connect with the protagonist, Dr Gavin, played by Adele Haenel. In fact her character irritated me, intensely at times. The Unknown Girl never captured my sympathy, or my involvement. Which was a huge disappointment as I expected so much more from these particular directors.

CQ

I was devastated by the Brexit win. And non comprehending. And angry in a way I had never experienced before. I struggled to know what to do with these emotions. Being surrounded by like-minded people helped. I ‘got over it’ in a sense, extreme emotions predictably easing with time. However, I do wonder where it all went, the despair that I experienced at the time, that deep sense of alienation and isolation as a European cast aside. I retreated to a bubble of sorts. London of course is ‘different’ – we voted in – and I generally surround myself with ‘my kind’.

As the US elections approached, I was better prepared. I knew that the unexpected, the dreaded outcome, was possible. I stayed up all night to watch the horror unfold. By the early hours, it was clear that Trump was going to be the next US President. And yet I stayed with it, needing to witness the event. Otherwise I might never have truly believed that it had happened.

I was less devastated than I had been over Europe. Probably because the earlier experience encouraged me to believe that the unthinkable might happen. The ramifications for the world, for humanity, feel even greater than for the Brexit event.

For once, I am glad to be older. I have witnessed good things – the fall of the Berlin Wall, peace in Northern Ireland, the successful gay marriage referendum in the Republic of Ireland – that fuelled an optimism and a real belief in the compassion and kindness of humanity.

The bottom seems to have fallen out of such hopefulness, particularly for the next generation as they face decades of right wing extremism, fascism, and a move away from compassion and towards racism, bigotry, and evil. I feel sad that this will be my daughter’s legacy. I have always believed that having a child is probably one of mankind’s most selfish acts, and we compound it by expecting our children to clean up the mess, to somehow right our wrongs.

It is wonderfully inspiring to see young people so much more politically engaged, so galvanised into resisting and not being complacent about the wave of right wing extremism that is increasingly engulfing us. I believe that they can, with our support, make a difference. They can truly enable positive change. But it is a big ask, and a lifelong one.

There are no Brexiters or Trumpers in my bubble. And yet they exist in huge numbers. Just not in my world. I have been asking myself how did this happen – how has society become so segmented. I saw Ken Roach’s I, Daniel Blake last week. This is a harrowing, and necessary, film. It consolidated my belief that I have not been adequately and actively listening and engaging with the world that exists outside mine.

I feel changed by these experiences of 2016. My challenge now is to ensure that such change translates into something and someone more compassionate and less self-centred than she has hitherto been.

Bubbles are made for bursting.

 

CQ

 

 

 

My daughter is 17 and currently meandering around Europe, enjoying a new found sense of freedom and of adventure. Her excitement as she increasingly appreciates life’s possibilities is almost palpable.

And who knows what these possibilities will materialise as…

I came across this poem in a recent issue of The New Yorker. I love its ambiguity and its realism, although I never felt that my daughter was ‘mine’, or that I held any ownership over her.

 

Fourteen

Marie Howe

 

She is still mine–for another year or so–

but she’s already looking past me

through the funeral-home door

to where the boys have gathered in their dark suits.

This is an edited version of a talk I gave to medical students yesterday at Bristol University.

 

Churchill once said ‘The farther backward you can look, the farther forward you can see”.

The opportunity to talk here has been welcome on so many different levels. It has totally encouraged me to indulge in a very nostalgic meandering through my life, a reflective wondering on how and why I have ended where I am, and specifically here today, talking about it all. I have been considering that 16-year old girl as she left school so many years ago, and headed towards her university life in medicine, and have been wondering what she would make of me, and of my life now.

And so this talk is really a hugely narcissistic self-indulgent exercise in me looking at me…

My decision to do medicine was no accident. The youngest of five, I came from a very medical family. I was thought to be clever, top grades, though equally drawn to English and languages as to the sciences. I wanted to be a concert pianist, but I wasn’t good enough. I wanted to be a poet, but no one encouraged me. I tried to persuade my parents to allow me to do journalism. At 16, and a relatively timid convent girl, I lost that battle. And so my life in medicine commenced.

It didn’t suit me from the outset. The training was narrow, limited, and largely shallow. One of my piano teachers remarked that he had known many medical students who were great musicians, but most of them had quit music by the end of their training. That resonated with me. Of course that was decades ago, and training has changed so much over that time, hugely and hopefully in a way that fosters creativity and being true to self. I do so believe that such an approach nurtures people who are doctors because they are themselves.

I got through medical school, without any accolades, pretty much scraping through. I was uninspired by all of my undergraduate medical life. But I had no other (perceived) skills, and so continued on the medical trajectory. I chose internal medicine as my field. I did various medical jobs, attained the MRCP in the UK, and ended up working in the The Royal Marsden Hospital, London. An insanely busy job, it was here that I came across Palliative Medicine. Then very much in its infancy – initially called Terminal Care – I was immediately drawn to the specialty. Having seen many patients go through endless rounds of chemotherapy, even those who appeared to be imminently dying, Palliative Care seemed to connect with patients as individuals in a way that I had not really seen up to then. This realisation – that Palliative Care could uniquely address individual needs, something that medicine in general had hitherto not succeeded in doing –  reminded me of one of my first clinical encounters some years previously, during my house jobs in Ireland. My very first house job, in Chest Medicine.

A German man, in his early fifties, on holidays with his wife, and with a known diagnosis of lung cancer (although given the ‘all clear’ just before going on holiday), presented with a history of increasing shortness of breath. Widespread disease was soon confirmed. The man was dying, away from his native country, and he did not speak English. A number of issues struck me from this tragic scenario, but perhaps most memorably his silence. As I daily checked his blood gases (a futilely invasive procedure in this context), I was profoundly struck by my impotence, my absolute inability to ‘hear’ and to bear witness to his suffering. The silence seemed beyond my inability to speak German, and he to speak English, but rather the silence ‘spoke’, even screamed, of the ineffability of his experience of suffering.

In many ways it was no surprise that I ended up in Palliative Medicine, for me the most creative and individual of clinical medical specialties. It was then in its infancy – I was fortunate enough to work with Dame Cicely Saunders at St Christopher’s Hospice. But while the Hospice movement took off at speed, introducing the concepts of Palliative Care to other doctors was challenging. My training years were mostly spent in teaching hospitals, where acceptance of death and dying was an anathema to the very essence of doctoring. Thankfully, this ethos has changed and continues to change.

Another obstacle at the time was the lack of an evidence base for the medical aspects – symptom control – of Palliative Care. This tapped into my scientific brain. And so I embarked on a mission to forge a medical credibility for what we were doing within Palliative Care. I was one of the first trainees to do an MD – 3 years of research into the clinical pharmacology of opioids. I left Palliative Care to do this, moving sideways into Oncology. A useful and humbling step, as it afforded me an insight into how other specialties viewed Palliative Care.

From then on, pain management became my primary research focus. At this point I was a Consultant and Senior Lecturer in Palliative Medicine, working within a multidisciplinary team in a large teaching hospital as well as having sessions in a nearby hospice. I also became deputy editor of the Cochrane Pain, Palliative and Supportive Care Group, where we organized systematic reviews of the evidence (or not) underpinning what was happening clinically. I was passionate about evidence based care. As such, I spearheaded the medicalization of Palliative Care, seeing it as a necessary step towards establishing a credibility for the specialty. I believed that Palliative Care could only succeed if we managed to convince our non specialty colleagues of its value. I also believed that by achieving this we would eventually do ourselves within Palliative Care out of a job. Naïve opinions on both counts.

And so it continued for a few years.

Until a few things happened. A change in my personal life encouraged me to rethink my life as a whole. I started an MA in Creative Writing at Sussex University, and thus began writing poetry again. This unlocked something within me and I started to see the world differently. Some of the poetry evolved from my own experience as a patient. When pregnant with my daughter I had a vascular episode, which mostly resolved apart from hearing loss. I began to try and make sense of that experience through poetry. Various doctors at the time spoke of how ‘I’ had lost my hearing, as if I had been somehow culpable, or careless. Current language of illness often appears to place the victim in a position of blame – ‘she lost her battle with cancer’ –  as if fault lies with the sufferer, who perhaps did not even try hard enough to ‘fight’ the illness. You notice language acutely when you are on the other side. Susan Sontag’s words came to mind during my own experience: Sontag described the world as sharply divided into two kingdoms, that of the sick and of the well. I had been catapulted into the other kingdom. It was a distressing place to be, and this was not solely because of the condition itself.

At the same time, and interconnected for sure, I started to see Palliative Care specifically, and clinical medicine in general, in a different light. And it bothered me. I became acutely aware of the gap between the patient and the doctor, a gap heightened by language, where one story, the medical one, trumped all others and silenced voices that it failed – or did not try – to understand.

I had many epiphanies which led to my leaving clinical medicine. As the hospital palliative care team we had been seeing a man with pancreatic cancer for pain control. Despite trials of various opioid and non opioid analgesics, his pain continued. I suggested that we as a team were missing something here. This was a middle aged man, recently diagnosed with advanced and incurable cancer, who had a prognosis of less than 3 months. Can the experience of pain be a truly uni-dimensional one in such circumstances? Can analgesics alone alleviate physical pain in the context of dying? One of the junior doctors at the time was angry with me for not appearing to believe the patient’s reports of persistent and unremitting pain. I absolutely believed him. But psychological pain, for want of a better term, is to me as valid and real and authentic as so-called physical pain. This clinical encounter made me wonder where Palliative Care as a specialty was heading, largely spearheaded by people such as myself who were instrumental in its medicalization in the name of credibility.

A further clinical encounter: a woman with advanced cancer, who I was seeing daily, saw me approach the ward one morning. She immediately started to scream ‘save me from the black hole’. Distraught and terrified by a nightmare she had had, I did not know how to respond to this story, this living nightmare that she continued to experience in her waking hours. Yes I listened, but in my medical model, her words were outside and beyond anything I could, or perhaps even wanted to engage fully with. Susan Sontag’s words and kingdoms come to mind again. At times, particularly in serious illness, the gap between the kingdom of the sick and the kingdom of the well can seem vast (even though in reality the dividing line is very thin) and now as I think of it, an awareness of this must surely have heightened her distress, as I stood impotent and silent on the other side.

My leaving clinical medicine was the result of these stories, and many others, both at the bedside and beyond. I left to search for another language, a non-medical one that might have the potential to embrace and express the experience of illness, and of suffering.

And to some extent I found it, though the search continues, within my other passions, literature and the arts.

As is my nature, there were no half measures when I decided to leave clinical medicine. It was all or nothing. I never considered working part time. By then, I have been working full time for 20 years, apart from four months’ maternity leave. Colleagues were both shocked and baffled by my decision. My family – a predominantly medical one – found the decision unsettling, disquieting and difficult to understand, particularly my brother, a Professor of Medicine and a medical workaholic, who believes that medicine is not a job, but a vocation. My views on this would necessitate another platform, and another time.

And so I started my exploration of the language of illness. I wanted, and needed, to better understand what the experience of illness, of suffering, of dying really was, without the metaphorical white coat.

I went to Kings College London to do a fulltime MA in Literature and Medicine. I can honestly say that this was the best year. Ever. To be so totally immersed in a world of literature, reading, discussing, arguing, and writing was a joy. The literature was explored in the light, and darkness, of the world of medicine. We were a relatively small group, mostly comprising English graduates and doctors. Somehow, this masters magically brought both my passions – medicine and literature – together in a way I had never before experienced. It was a blissful year of self-indulgence.

All at a cost, at least financially. To fund myself, I sold my flat, downsizing, and lived relatively meagerly for a year. Which was a valuable and humbling experience. One that I am so glad to have had. I did some freelance medical and scientific editing, which was very time consuming and did not pay a lot. But it helped.

Following my stint as a mature student, I needed, and wanted a job. I also knew that I did not want to go back to clinical medicine. I felt that the time away had benefitted me. I felt different. I lived differently. I was back playing the piano, had taken up the cello. I was writing my own blogs. Yoga became an integral part of my life. I had space to reconnect with my self, the one that I seemed to have left behind during medical school.

I saw a job advertised in the BMJ – medical writer at Medikidz, a company that creates comic books for children on health and illness. I am still there today, more than four years later, now as Managing Editor.

In some ways, this job is not that far removed from my experience working in clinical medicine:

Firstly, it taps into my involvement with evidence based care. Accurate medical information is critical to our ethos and credibility.

Secondly, it may just be me, but I think that doctors almost universally operate from a strong ethical stance. In the clinical arena, this puts the patient first. Within Medikidz, for me, this puts children first. Which can be a challenge. Sometimes people forget that we are creating content, not for parents, HCPs, clients, but explicitly for children. So every word, every image must be meaningful for them. The rest is noise. This is a battle that I fight every day, and one that I do not always win in a highly competitive business world. I am actually rubbish at business, but perhaps this is a perverse advantage in my current working world. My moral high tone may annoy some, but it also reassures most that someone is constantly checking that what we done allies with our mission statement, which has children, not adults, at its core.

Thirdly, working at Medikidz has re-ignited my love of medicine. I have to be up to speed with the latest guidelines on so many conditions that I have learnt so much medicine over the past years. And medicine is endlessly fascinating. It would be hard to find a richer subject that is constantly evolving, challenging and surprising.

A couple of years ago the BMJ Doc2Doc blog invited me to contribute a post. Re-reading it over the weekend, I am a little embarrassed to admit that I called the piece ‘From Dr to Ms’… In it I speak about my ‘walking away from medicine’, a phrase used by others not by me, very much concluding that I had no regrets about leaving. That still holds true. A year ago, I briefly toyed with the idea of returning to clinical medicine, but decided against it. I think I would be a better doctor now, but this is not a hypothesis that I am going to test.  I worked clinically for over 20 years. It was enough, and I am very glad that I had that time, but also glad that I did walk away from the metaphorical bedside to explore other aspects of medicine, and of me.

And I continue to explore. Not only at Medikidz, but also within the Medical Humanities. I am an editor at the BMJ journal Medical Humanities, where I commission book reviews, and curate the blog, which hosts an eclectic mix of posts, focusing on the arts and how it might, or might not, interact with medicine and the experience of illness.  I guess to some extent through this work, I see my role within the humanities as bringing the bedside to the humanities, something that I want to do for all those patients whose lives I have touched on. I carry their stories with me and I hope that I can do something to facilitate the hearing of their voices and others. This past weekend I attended a Pain Conference in London, a truly multidisciplinary event. I chaired a session that included talks by a poet and a playwright alongside an academic reporting on non verbal communication of pain in those with dementia. Such events fill me with hope.

The Pulitzer Prize winning writer Anna Quindlen addressed the American Academy of Family Physicians, urging them to them to make a connection with patients as people, as individuals. ‘Do you know who I am?’ she herself had asked during an unfortunate consultation, meaning not Anna Quindlen the writer, or the condition, but Anna Quindlen the individual.

This is a very important message that I hope all doctors heed. Too often people are seen as their condition, but there has been a chapter before and there will be another chapter after the clinical consultation in the life of each and every patient. Lives that we as doctors too infrequently wonder and enquire about.

But I would like to throw something else out there – something for you all to think about as you embark on your exciting medical lives ahead. Make time to stop and consider a different but inextricably connected question – Do you know who you are?

Thinking back to my 16-year old self as she headed to medical school, to my 21-year old self as she started her house jobs and encountered that dying German man so early on in her medical career, I am grateful to her for making the choices that followed, and for refusing both to drift and to settle.

I am also grateful to medicine for facilitating my journey with her, and for helping me to get from there to here.

Always a controversial and problematic discussion, the much debated association between mental illness and creativity continues to engage and to elude definitive conclusions.

I am one of those sceptical of a necessary link between creative genius and mental illness. But am open to being challenged on this.

Check out this video from Aeon that proposes the potential of art as a better tool that science for understanding mental illness. The art in question focuses on the work of Edvard Munch, who I have spoken about here in previous posts.

 

CQ

 

My daughter, now 17, had her last school day on Friday.

A moment, for both of us, in very different ways.

As a mother, I have mostly delineated my life in accordance with her timelines, her growing upness and its attendant and essential growing awayness. Now, I wonder about her life ahead, about the separate worlds we increasingly inhabit, and I work on allowing the distance between us to flourish.

I like this poem by Natalie Shapero, which wonderfully encapsulates the essence of poetry – the saying of so much with so few words.

Survive Me

It wasn’t for love of having

 

children that I had a child.

Rather, I simply didn’t know how a person

 

could cross, fully shoeless, a bed of coals

and not burn, and I needed

 

someone to pass this to.

I needed my obtuseness to survive me.

 

But I never accounted for our thwarting era.

Every day, the paper

 

runs a remembrance

of a child, the notice struggling to sing the few

 

years lived: He never sketched the Earth without

its hatch of latitudes. She did

 

not like to try new foods.

 

–Natalie Shapero