Starry, Starry Night

I solemnly pledge to consecrate my life to the service of humanity.

We said it together. Wrapped in caps and gowns and excitement, holding on to the sweet pain of relief for as long as we could, and yet filled up to our mortar boards with the best intentions and the purest of ignorance.

I will practise my profession with conscience and dignity.

We threw our caps into the air and promised to stay in touch, and we changed the title on our debit cards as though by doing so, it would also change us as people.

I will maintain the utmost respect for human life.

And we thought we knew what the words meant.

Yet, even now, even after walking a thousand patient-miles, I’m still not sure that I do.

I have sat with those that suffer, and I have prayed to a God I am no longer sure I believe in. I have prayed for an end to their torment; a silent devotion that they may be freed from the cancer that gorges on their flesh, or that the paper walls of their heart might finally be quiet and still.

And even as I prayed, I still felt as though I served humanity.

I still practised my profession with conscience and dignity.

Now I have learned from you that there are many shades of torment. I have learned that the world is filled with frameless heads on nameless walls, a shadowed army suffering an agony that can’t be seen or touched or measured. To share your head with whispered voices, to walk each day alongside fear and misery and self-loathing, to live your life with an unquiet mind, perhaps this is the greatest torment of all.

And who am I to be angry that you needed an end to that torment?

Who am I, the person that prayed by the bed of a cancer patient, who am I to decide whether your life was worth living? And if I judge you, yet continue to wave a banner in support of mental health, then I am serving nothing but my own hypocrisy.

Yet I am still angry with you. I am angry that you couldn’t be reached and I am angry at myself, because my reach wasn’t far enough.

And I am angry because you were alone.

No one should be alone.

Perhaps I am angriest of all, because I could see so much of myself in you. Or perhaps this is just a balm with which I choose to soothe myself.

In dusky, curtained light, I allow myself to wonder how it felt, your slow, obscene goodbye. Not clean and gentle and forgiving, but brutal and chaotic. And I will hide from my own thoughts, until I allow myself to acknowledge that you knew this.

I doubt very much that it was a starry, starry night.

But you can rest with a quiet mind, my friend.

And you will never be alone again, because I will always remember you.

And I will practise my profession with conscience and dignity.

And I will learn to paint my palette blue and grey.

Watch Out For The Normal People

“Grace has been wearing sunglasses,” said one of the nurses, “on a cloudy day.”

“And she spends all her time in her room,” said another.

It was all written in Grace’s notes.

     Inappropriate actions it read.

     Increasingly bizarre behaviour.

Everything was documented. Grace’s life spilled from the nib of a fountain pen, each step, each word, recorded and dated and open to interpretation.

“The other day,” said a doctor, “she sat on the edge of her bed and laughed out loud at nothing in particular.”

“At nothing in particular?” said a nurse.

The doctor nodded gravely and everyone turned to their notes.

“She refuses to take her medication.” The pharmacist flicked through his formulary to find the latest antidote to laughing at nothing in particular. “She claims she doesn’t need it.”

Everyone sighed into manila folders. Non-compliance they wrote, a distinct lack of insight.

I looked through the window and into the garden. “I’ll talk to her,” I said.

~

I stood by the bench and watched.

She sat on the grass, a box of chalks spread out at her feet, drawing on the paving slabs that marked the edge of her world. Her clothes were a kaleidoscope of colour and her hair was dyed to the deepest crimson. She was lost in the image she had created, sweeping chalk across the concrete and chewing at her nails, like a rodent.

When she saw me, she walked over to where I stood.

“I try to keep busy in here,” she said, “or I’d go crazy.”

We both smiled and she lit a cigarette.

I searched her face for the mark that separates personality from illness; the fracture line where her mind had fallen into disquiet, and pulled her towards a life interrupted.

But there was nothing.

So instead, I looked over at the drawing.

“Did you want to be an artist when you were little?” I said.

She sat on the bench and closed her eyes. “When I was very little, I wanted to be a doctor. Maybe even a psychiatrist. I think I would’ve been rather good at it.”

“I think you would too,” I said, “very good at it.”

Grace took another drag on her cigarette. “Ah,” she said, “that’s because it takes one lost soul to rescue another.” She tapped the bench with her hand, “why don’t you sit down and talk for a while?”

“Staff aren’t allowed to sit here, I’d get into trouble.”

She laughed and tucked red hair behind her ears. “Just take off your stethoscope,” she said, “I hate to break it to you, but people will just think you’re one of us.”

I smiled and looked at the drawing.

“And you lot think we’re the mad ones,” she said.

~

I smiled as I moved through the beige corridors, past an army of forgotten patients, each searching for a way back to their own lives. There were those who had walked many miles from the path, yet it seemed to me that some had only stumbled through a mistaken door. I smiled as I walked past steel cabinets, filled with the mistaken doors of others, and I was still smiling as I returned to the office, where doctors write with fountain pens and decide on the definition of appropriate.

They looked up as I walked in.

“What are you smiling at?” said one of them.

“Nothing in particular,” I said.

He frowned.

And I remembered to stop smiling.

And to put the stethoscope back around my neck.

Please note: My stories from the wards are just that – stories. Patients inspire me, but they are not included in my posts. No real-life patients were harmed in the making of this blog.
Artwork reproduced by kind permission.

When You Are Not Eight

This will help you one day.

One day, when you are not eight. One day, when you are not looking for somewhere to stand in the playground, when you are not tying and retying your shoe lace in order to look occupied and unconcerned. One day, if you have nowhere to stand, you will be able walk away.

When you are not eight, you will realise that a view from the corner gave you a different landscape. Eyes that searched for acceptance, that distracted themselves with observation, will no longer see unmeasured glances of cruelty. Those same eyes will see the daffodil yellow of a sunrise and the blush of a robin’s breast and the dance of squirrels along the branches of an oak tree. When you are not eight, you will know that hours spent watching are never wasted.

One day, words will be your greatest ally. When you are not eight, words that cut and bruise so easily will be remembered, and you will understand the power of words and choose them with mindfulness and care.

When you are not eight, your friends will not all live within the pages of a book. You will say goodbye to Aslan and Meg and Mowgli, and your stories will be a choice, not a shelter. But one day, when you are not eight, you will look back on your old friends and realise how wisely you chose them.

One day, you will discover that not being selected is a selection all of its own.

When you have let go of the fear of unbelonging.

One day.

When you are not eight.

To Be A Pilgrim

The visitors appear each day at three o’clock.

     They arrive a muddle of raincoats and carrier bags and walking sticks, and tumble past the nurses’ station like leaves. They colour in an NHS grey, sketching the air with stories of a life once lived, and leaving a trail of sweet wrappers and paperbacks and fresh pyjamas wherever they walk.

     When a bell is rung, they scrape plastic chairs on plastic lino, and disappear back to an ordinary world, fattened with self-sacrifice and thick with relief at a life resumed.

     But there are others. In side rooms all around the hospital, families pleat around besides, saying untidy goodbyes to those who drift between this world and the next. They try to pour a lifetime of unspoken words into the last few hours of life, emptying themselves of guilt and silence and regret. They whisper into ears that cannot hear, and hold hands that cannot feel. They make a journey for someone who doesn’t even know they are there, because it’s the whispering that counts, not the listening. The holding, not the feeling.

     It’s the pilgrimage that matters.

     ‘The Unlikely Pilgrimage of Harold Fry’ is the debut novel from Rachel Joyce. It tells the tale of a man who sets out to post a letter to a dying friend, and who has no idea that he is about to walk from one end of the country to the other. Harold believes that as long as he keeps walking, his friend will live. It’s a beautifully written story of faith and regret and discovery, and I came to love Harold so much, I was willing him on with every step of his canvas shoes.

     I see a little of Harold in those who gather around the dying. I see the pilgrimage they make each day and I hear the rush of last-minute words, the forfeit for a life half-spoken. I see hope so brittle, it breaks before my very eyes, and I see regret so deep and so heartfelt, it sits by the bed like a silent visitor.

     I see a little of Harold in all of us. I see the certainty that no matter how mindful we are and how wisely we choose our words, we will one day find ourselves waiting by a bedside with a lifetime of thoughts in our mouth, holding a hand that can no longer feel.

     And we will make an unlikely pilgrimage of our own.

 

‘The Unlikely Pilgrimage of Harold Fry’, by Rachel Joyce, is published by Doubleday on March 15th.

You can order it from Amazon UK  here

Or from Waterstones here.

 

But please don’t forget your local, independent bookshop.

 

Your life will be a better place for knowing Harold Fry …

 

 

The Gift

     A wishlist for Christmas …

For those who face Christmas alone, I would give the gift of a forgotten memory. The rush of a memory so fresh and new, it makes folds in a stretch of time and builds an easy footpath back to a long-ago Christmas of belonging.

For those who travel each day pressed into strangers on a crowded train, who feel the lives of others leak into their own, I would give the dawn of a December morning and a silent, crimson sky. I would send the flush of hidden pheasants in a winter mist and frosted breath which tumbles across a soundless horizon.

For those who plug themselves into a counterfeit world, I would steal their iPods and their mobile telephones and their earphones and replace them with the blackbird who sits by my window each day and sings with a heart which is filled with joy at just being alive.

For the field, I would give the gift of being a meadow once more. It would no longer be sliced by wire and fence, and machinery would cease to cut into its flesh. The value of the meadow would not be measured in the weight of its crops, but in the whisper of a breeze through its grass and the dance of squirrels across unmeasured branches.

For the pheasants and the lambs and the calves, I would give a life without fear of bullets and slaughter. For those who hunt and kill, I would give the gift of understanding that a life which feeds on control and greed is truly a life less lived.

For those who watch clocks from a marked life, who are fixed to their seats by invisible chains, I would give you the gift of an oak tree. You will sit at its feet and whisper into its bark and you will find the seat so comfortable, you may wonder if it was made just for you all along.

For those who want without need and count without value, for any who take from those with nothing to give and beat people in our society who are already beaten, I would give you eyes to see, a voice to speak out and ears which will listen to your conscience.

Thank you to everyone who has taken the time to read and comment on my ramblings this year and may your best December gift be the one you least expect.

Merry Christmas

x

Shifting Sands

Acopia.

     My spellchecker doesn’t even recognise this word and yet I see it written in so many patient histories. Acopia: the inability to cope. The shameful state of affairs where someone does not possess the correct physical or emotional armoury to deal with the world. God has short-changed them, life has trampled over them in its rush to get on with all the important things it has to do and society has left them to drift alone in an ocean of self-contempt.

     I read acopia and I see an alcoholic.

     I see him lectured to and tutted at. I hear him find the courage to admit to how much he drinks and then I listen to the silence around his bed as people evaluate a life they know nothing about. I watch as chlordiazepoxide is poured into his system and addiction is evicted from his body and I witness the struggle as he allows it to leave. When he is finished, I watch him walk from the ward in borrowed clothes, with a carrier bag filled with nothing, to be catapulted back into a society which neither cares nor even cares to understand.

     I read acopia and I see a suicide attempt.

     I see other patients listen through paper-thin curtains and hide their judgement behind Sunday morning newspapers. I watch someone whose mind is wrapped in so many layers of self-loathing, no one can hear its screams. I see someone who tries to walk through their day with the weighted pull of misery around their ankles and I watch as they try and fail to keep up with everyone else. I listen as they search for the words which will lead those with tranquil minds along a path of understanding and then I feel them admit defeat. I hear them recite from a script. An easy, deceitful script of regretful words and denial of recurrence and I watch as they put on a mask of untruth which is so tight, it won’t even allow a bead of misery to leak on to their face. Yet, as they walk away, I can smell the trapdoor. I feel its pull and I hear its comforting words and I know it lies waiting with patient self-assurance.

     I read acopia and I see an old man.

     I hear how he uses the edge of furniture to get from the kitchen to the sitting room. I look into his eyes and wonder who he used to be and I listen as he struggles to remember the answer for himself. I hear him tell people that he lost his wife and I watch as people regard this with such little significance, no one even bothers to write it in his notes. I sit in meetings where strangers calculate the worth of his life on sheets of A4 paper and I watch them sweep eighty years of existence into a neat manila folder. I see him stapled and paper-clipped and led away from one small life into another small life. And I see a new life which is so small, it doesn’t even allow room for the thin slice of himself he had managed to hold on to.

     I read acopia and I see a cancer patient.

     I see someone the same age as me. I see someone who knows the lyrics to the same songs, who marked their life with the same tape measure as I did, who assumed the same guarantee as I assumed. As I assume even now. I see failed chemotherapy. I read on, as the entries in their notes become shorter and shorter and I try to catch the hope which slips through their fingers, because somehow, I feel I have an obligation. As I stand by their bed, I think about the birthdays and the Christmases and the lyrics to the songs, and I see a mirror. The reflection in the mirror is almost unbearable, and yet I stare and stare because I must find the difference or I will never be able to look away.

     I read acopia and I feel the shifting sands beneath my feet.

Abor Vitae

The oak tree was worn and tired and sat in a field, where it waited to die.

     “I have lived my life,” said the oak tree, “I have felt the seasons turn beneath my roots and I have watched the years unfold and spill themselves through my branches. Now it is time for me to move on.”

     The other trees were distressed and pleaded with the oak tree to stay. The beech shook with copper-filled sorrow, the rowan sighed into a dark, November wind and the sycamore wept for lost friendship and begged the oak to change its mind.

     “No,” said the oak tree, “my moment has arrived and I am happy to go. We each are given a fragment of time in this field and I must leave in order to make room for the future.”

     And so the oak tree slowed its breath and lessened its grip on the earth and waited for its journey to continue.

     Each day, the farmer visited his field and studied the oak tree.

     He walked around it in slow, deliberate circles and he frowned at the blackened roots and the dry, wasted branches. The oak tree knew how powerful the farmer was and it held its breath in fear.

      The farmer listened to the dry whisper of dying leaves and felt the slough of deadened bark and he became angry and resentful.

     “Oh no,” he said, “this won’t do at all. I didn’t become a farmer to allow my trees to die.”

     “But I am old now,” said the oak tree, “I am old and tired and this is my moment.” But arrogance had made the farmer deaf to anything but his own thoughts and all the trees in the field knew it was pointless to argue.

     Each day, the farmer returned to the field and meddled with the oak tree. He brought water to drown its branches, he brought soil to smother its roots and he stripped away its bark, until the oak tree ached with fear and became weakened with the weight of its own misery.

     “What would the other farmers think of me,” he said, “if I allowed my oak tree to just die?”

     The other trees were afraid and gathered in the corner of the field.

     “Why will he not let the oak tree die in peace?” said the beech, who was young and unwise.

     “Because he cares,” said the sycamore, who tried to see the best in everyone.

     “Because he’s forgotten how to care,” said the rowan, who was the wisest tree of all.

     The farmer lay awake through the night, thinking about the oak tree. He paced the floor of the farmhouse, he read through all of his books and he thought back upon his years of being a farmer, in the hope that it would bring him an answer.

     But still the oak tree continued to die.

     The next day, the farmer brought a group of other farmers to the field, to see if they could offer him a solution.

     “But this is my moment,” said the oak tree, “I just want to be left alone.”

     No one was listening.

     All the farmers gathered around the oak tree and whispered to each other.

     “Tear off all the leaves,” said one.

     “Cut away the branches,” said another.

     “Climb to the very top,” said a third, “and slice through the trunk.”

     The farmer did all of these things, but none of them worked.

     The oak tree cowered in the field, weary and longing for peace. Its branches lay rotten and useless and its wasted leaves whispered for release on the cool, hard earth.

     The farmer sat back on the grass and stared at the tree.

     “Very well, then,” he said, “I will allow you to die.”

     The other trees stretched with relief and wept for their friend, as the oak tree was finally permitted to leave.

     But its moment had long since passed and instead of a peaceful field, the oak tree’s final eyes saw only darkened chaos and the air which it breathed was brutal and borrowed. The other trees could do nothing but sit with their friend, as it ached and heaved and pulled itself away from this earth.

     The farmer didn’t stay whilst the oak tree died.

     Instead, he walked back to his farmhouse and smiled and felt satisfied with his work.

     “After all,” he said to himself, “what kind of farmer would I be, if I had simply allowed my oak tree to just die?”

Body and Soul

“I’ve had enough,” Albert said, “can’t you just give me the morphine and let me go?”

      We sat behind a curtained wall in a sleeping ward. I had watched stories like this in hospital dramas, stories where patients whispered for an end to their misery and begged compassion from a soap opera doctor. I had watched them through doubtful, distracted eyes and yet I had somehow found myself in a scene for which there was no script and no well-rehearsed lines for me to deliver to the camera.

     Albert looked up. “No one would know,” he said.

     He was right.

     No one would.

     Albert was dying. He had been bled and photographed and analysed and a formulary of expensive drugs ribboned through his veins. Above our heads, people had discussed him in front of projector screens and counted out his life in milligrams and micrograms, and shifted the weight of expensive educations to explain him away.

     Yet despite all this, Albert continued to die.

     And no one knew why.

     I held the syringe in my hand and he watched me with beaten eyes.

     “I’m just so tired,” he said.

     “I can’t, Albert.” I heard my words and the sound forced me to look away. “I can’t make decisions like that. No one can play God.”

     He looked at drip stands which crouched over him like watchful servants and monitors which measured the grip by which he held on to this world.

     “Can they not?” he said.

     We didn’t need the x-rays and the CT scans and the blood results.

     Albert had simply given up.

     They were reluctant to allow him the courtesy of dying. Medicine is rarely troubled by death, but it becomes very anxious when patients die without explicit permission. Eventually, however, Albert was granted his wish, and the monitors and the drip stands and the projector screens were taken away and he was moved to a side room and allowed to wait for God.

     Albert’s wife Pearl was wheeled in each day from her nursing home. She was lost in a mist of powder and bewilderment and sat by her husband’s bedside as he drifted away and out of her life.

     Each time I passed his room, I looked in at them. Their hands held each other in resignation and Pearl rested her head on Albert’s chest. They looked like teenagers, folded into each other’s arms, but instead of starting a life together, I knew they lay in wait for sixty years of marriage to end.

     But there are some things which medicine can’t explain.

     There are some things which can’t be measured in milligrams and micrograms and there are some things which can’t be scanned and photographed and projected onto a computer screen.

     And very slowly, Albert began to get better.

     I wish I could tell you what Pearl said to him. I wish I could bring you the magic which gave him back his hope, but each time I passed their room, neither of them were speaking and I wonder if, after sixty years of marriage, words had become unnecessary.

     All I know is that the more I see of medicine, the more I am convinced that the greatest healing properties of all lie in the act of human kindness.

     A few days later, I walked past Albert’s room. I looked in to speak, but he was too occupied to notice and I smiled to myself.

     I smiled all the way down the corridor. I smiled as I walked through rooms full of expensive scanners and past a pharmacy which heaved with clever drugs and I especially smiled as I looked into fattened consultation rooms and breathed their air of self-importance.

     I smiled because Albert was reading.

     And I smiled because it was a very thick book.

A Travelling Man

William Shotton was old and creased and lay on an unhappy bed of twisted sheets. He chewed with an empty mouth and when he did, his false teeth did a little dance around his gums for everyone to see.

     “I want to go home,” he said.

     “We all want to go home, Bill, but it’s not so bad here, is it?” I moved the drip stand to one side and looked at his obs chart. “We look after you, don’t we?”

     Bill Shotton didn’t answer, but his teeth danced around his mouth a little more and he stared out of the open window and on to the hospital car park.

     “I don’t like new places,” he said eventually, “I’m not a very good traveller.”

     “Me neither, but even old places were new places, once upon a time.”  I went to shut the window, but he stopped me.

     “No, leave it open. I might decide to escape and catch the last bus home,” he said. And then he winked and smiled and I saw in his eyes a little glimpse of a life he once lived.

     Each day for a week, I visited Bill, to check on his medication and his observations and to be told how much he didn’t like new places.

     “I like my own bed,” he said, “I like to look through the window and see the view I’m used to seeing and I like to stare around the room and find my old life staring back at me.”

     There was no sign of an old life in Bill’s side room. Whilst other patients were dealt a hand of get well cards and collected pictures and ornaments and pieces of the outside world, Bill just had one photograph by his bed. A blurred image of an old border collie, sitting at the foot of the stairs, in a house of long ago times.

     “His name was Charley,” he told me. “When I lost him, I think I lost a little bit of myself at the same time. You knew where you were with Charley. Neither of us liked new places.”

     “But even old places−” I started to say.

     “I know, were new places once upon a time.” Bill smiled and looked at the photograph, but I knew from his eyes that he was seeing something else. “But it’s still scary, isn’t it, a new place?” he said.

     “It is, but sometimes we don’t have a choice. And new doesn’t always mean bad.”

     He squeezed my hand.

     “No,” he said, “I don’t believe it does.”

     Bill put down the photograph and looked at the plate of untouched hospital food by his bed.

     “You know what I could eat right now?” he said and nodded at the open window. For a moment, I thought he was really planning to climb out, but then he turned to me and grinned. “I could just eat a great big plate of fish and chips.”

     And so after my shift ended, I bought us fish and chips and we filled the ward with the smell of hot salt and vinegar and talked about how neither of us travelled very well.  I knew I should have left, but sometimes, even when you know you are building your own gallows, even when you can see the fall you will eventually take, sometimes it’s even harder just to walk away.

     The next time I saw Bill, I knew the cancer which crouched in his body had begun to win the war. His skin was as pale as paper and hands which once played with agitation, now lay still on a hospital blanket.

     “I don’t like new places,” he said, “I don’t travel very well.”

     “Me neither.” I sat by his bed and wondered what had ever first possessed me to become a doctor. “But remember the once upon a time. New doesn’t always have to mean bad.”

     He gripped my hand so tightly, I had to wait until he slept before I could leave.

     The bleep came at four o’clock. I knew it would come, but I selfishly hoped that someone else would be asked to certify Bill’s death. That I wouldn’t have to walk to the gallows I had built for myself and I could be spared another of my Kodak moments.

     I still talked to him. Even though he was gone, I talked about how I hated new places and how I wanted to go home and how I didn’t travel very well.

     And then I saw it.

     I  had never noticed it before. In all the time we had talked, I had never looked closely enough. But there it was. Around his neck, old and tired and worn, was a tiny, silver medal of St Christopher.

     And I smiled, because I knew he’d be fine.

     We’d both be fine.

Remembrance

I am old now.    

     I know I am old, because my body tells me that this is the case. The arms which lie still and wasted on a hospital blanket, once wrapped themselves around my children and pulled them towards me. My arms were once as yours are, strong and free and open. Now I need you to lift a cup to my mouth, but these are the arms which lifted a baby from a cot and linked along a sea front, in the ice cream days of a black and white photograph. And they are the same arms. I remember.

     The skin on my hands is paper thin and roped with veins, but they were once as yours are now, quick and sure and definite. The hands which shake and hesitate were hands which held each day with certainty. Now I rely on the touch of strangers to comfort me, but in my mind, I will forever take the long gone hands of those I used to hold. And they are the same hands. I remember.    

     My heart has grown slow and tired. But once it was as yours is now and would quicken with the sound of another’s voice. This same slow, tired heart was fresh and eager and filled with tomorrow. When I said ‘til death do us part, I never really believed that it would, and yet here I am, alone and with a slow, tired heart. We counted the minutes and not the beats, my heart and I. But it is the same heart. I remember.

     You talk around me and above me and, although I try to speak, my voice is small and blanketed in age. The words I speak are lost in the conversation of others, but this voice which is so easy to ignore, was once clear and strong and certain. My voice knew what it wanted to say and no one shuffled and sighed and tapped as they waited for me to find the words. My voice is no longer heard and yet it is the same voice. I remember.

     My eyes are milky and struggle to see. They were once like yours, free and impatient and looking ahead. Now it is easier to watch the past play out to itself and to feed my mind on times gone by. These eyes which have looked upon a thousand things, now watch as a world passes at the foot of a bed. And yet they are the same eyes. I remember.

     One day, you will find yourself here. One day, you will lie as I do now, with a slow, tired heart and you will look down on livered, worn hands which you cannot recognise. Your dignity will be lost in the hang of the curtain and a stranger’s touch and your words will lose themselves in the folds of a sheet. One day, you will watch the world with milky eyes as it passes at the foot of a bed.

     And then you will remember.