27 December 2010

Xmas holidays

So it was a bad night and a couple of bad days before that with a lot of nausea and stuff like that and oh such awful weakness like you wish someone would catch you falling and even then you keep on falling. Still, managed the odd short constitutional (on Xmas this is what Jack C would call his stroll) and tried to distract myself with British, nay Swedish crime drama and the usual reruns of Hugh Grant movies on TV.
And this morning we dug the car out of the snow and R dropped me at our GP while he stacked up on whatever. And the GP listened to my murmuring complaining abdomen and squeezed a couple of very sore places and declared me ill with gastritis. But not to worry. I mean, would I? Why ever not. I can worry at the drop of a hat.
The cat chases me around the house and I open the back door for her and then the front door and then the laundry door and everytime it's the same old snow and she gives me this reproachful look as if I put it out there myself. She is bored like a spoilt child locked indoors and nips out to mark her realm and stalks back in record time.
The f key has started to get stuck on this ancient second hand laptop (thank you thank you S) and I started to re-read my scribbling for fear of misspelling the odd f-word which I don't use.
And tomorrow we will drive to the coast to see the snow on the sandy beaches. Or maybe we'll get stuck in a drift or on an icy motorway.

22 December 2010

She is 29 years old and in a few months she will receive her PhD in agricultural science. She wants to continue researching crop diseases. She married her boyfriend, a fellow researcher, when they found out that she was pregnant. She wants five sons. This is her first daughter. She will have another daughter and a son within the next four years. She will never set foot in the university again. She will move into a comfortable semi-detached home. She will decorate it stylishly. She will create a lovely garden. She will grow fruit and vegetables, experimenting with different varieties. She will sew matching outfits for her three children. She will have the neighbours round in the evenings for drinks and bridge. She will chat with other mothers at children's parties. She will make jam and bottle the fruit from her garden. She will try out new recipes and solve crossword puzzles. She will drive her kids to horse riding and music lessons. During the summer holidays by the seaside she will read crime novels. She will teach her children how to identify birds and butterflies. She will watch her husband and former colleagues move up in her field of expertise. One day she will take her baby son and climb on the window ledge upstairs and threaten to jump if the daughters don't tidy up the toys.
She will smoke lots and lots of cigarettes and she will have problems sleeping. She will start taking the pills her doctor thinks she should take. She will stop trying out recipes and inviting the neighbours round. She will stop getting up in the mornings to see her children leave for school. She will not watch them perform in school concerts or compete at sports' days. She will start with a martini, maybe a glass of wine, a brandy and so on. She will fight with her husband a lot. She will try to kill herself a couple of times. She will not approve of her daughters' career choices and partners. When her husband eventually moves out she will often forget to eat for days. Some days she will not recognise her children or her grandchildren. She will forcefully reject all offers of help. She will recover from bypass surgery long enough to show affection for her children. Soon after, her lungs will collapse and she will spend six long months on a heart-lung machine unable to speak or move before she will die of pneumonia. She will dedicate her body to medical research. There is no grave.


Inundated with snow, like it has apparently never happened before. Certainly not since we moved here. But there are stories of people crossing the frozen river on foot. Today there is a slight thaw and the river is flooding. The roads are slush and the skies are grey.

This morning long before sunrise I heard birdsong. A single voice, but there it was.

15 December 2010

Three days at work now after over 12 months of sick leave.
There's a moment after about one hour when I feel the sky is falling and, no, this will not work and then I tell myself, you are stuck here, you have to get through this for a bit longer and whoops, another hour goes by and I have managed.
And after about three hours I drive home, on the radio some debate on whatever and then the forecast (blizzard) and I park the car and struggle with the cover (fucking snow) and pick up the complaining cat and open the front door and sit down on the stairs in the hall and watch my hands shaking and shaking.
And I lean back and listen to the roaring in my banjaxed ear and my bones are so so heavy and I wish someone would help me take off my boots and coat.
And I open the kitchen door and R is cooking and listening to the world service and his face is so tired and he leans over the counter chopping celery and I smile and ask him, how was your day.

14 December 2010

it's been a while, rereading Mary Oliver

You do not have to be good.
You do not have to walk on your knees
for a hundred miles through the desert repenting.
You only have to let the soft animal of your body
love what it loves.
Tell me about despair, yours, and I will tell you mine.
Meanwhile the world goes on.
Meanwhile the sun and the clear pebbles of the rain
are moving across the landscapes,
over the prairies and the deep trees,
the mountains and the rivers.
Meanwhile the wild geese, high in the clean blue air,
are heading home again.
Whoever you are, no matter how lonely,
the world offers itself to your imagination,
calls to you like the wild geese, harsh and exciting 
over and over announcing your place
in the family of things.

(Still this overwhelming sense of something too sweet, too right, but so soothing.)

another attempt

So tired, I feel like I have been walking through heavy snow all day. Aching and stiff. I am back at my office for 2-3 hours now, hiding behind my door, late afternoons. Great sense of achievement despite the spinning head. Difficult to avoid people but it's just too much, all this telling and retelling and explaining and over and over "you're looking great" when I am barely getting through. But at least I'm not getting worse. Amazing.
Really hard to pace myself.

12 December 2010

reading Aaron Antonovsky

...throughout our lives, we are all swimming in a river full of potential danger. Or, to change the metaphor to one which may be more appropriate to winter [...], we are all skiing down a long mountain slope, at the end of which is an unavoidable cliff with no bottom. The pathogenic orientation deals primarily with those who have hit a rock, a tree or another skier, or who have fallen into a crevice. Second, it tries to perpetuate the illusion that one should not ski at all. The salutogenic orientation asks, first, how the ski slope can be made less dangerous, and second, how do people learn to ski with a high degree of skill?

Aaron Antonovsky

11 December 2010

Becker et. al, Int. E Journal of Health Ed., 2010; 13: 25-32



Start  = disease or problem
Start  = health potential
Avoiding problems and its causes
Approaching potential and its causes
Eliminate risk factors
Create health (salutary) factors
Reactive - react to signs, symptoms, and indications of disease
Proactive - create conditions of physical, mental, and social well-being
Disease or infirmity is an anomaly
Humans are flawed and subject to entropy
Idealistic perspective - treat disease
Realistic perspective - go get health
Prevent pain or loss
Promote gains or growth
Prepare or help prepare one to live
Enhance capacities/potential for full life
Avoid/prevent from being pushed backward
Help/enhance ability to move forward
Against disease and infirmity
For health
For those who need healing cures
For those who want better health
Prevention of negative health
Promotion of positive health
Health promotion
Prevention of disease and infirmity
Outcome - absence of problem
Outcome - presence of a gain
Keep from making situation worse
Continuous improvement
Minimization of problems
Optimization of potential

09 December 2010

08 December 2010

what we need is here

Geese appear high over us,
pass, and the sky closes. Abandon,
as in love or sleep, holds
them to their way, clear
in the ancient faith: what we need
is here. And we pray, not
for new earth or heaven, but to be
quiet in heart, and in eye,
clear. What we need is here. 

07 December 2010

more snow, icy roads

on the wall in my GP's office

  • Life has meaning under all circumstances, even the most miserable ones. 
  • Our main motivation for living is our will to find meaning in life. 
  • We have freedom to find meaning in what we do, and what we experience, or at least in the stand we take when faced with a situation of unchangeable suffering. 

Viktor Frankl


Most of yesterday it felt like I was losing the ground beneath my feet. Felt so sorry for myself and so ready to go into this long whining misery about how awful it is to be so ill and turning my mind around and around this thought, faster and faster until I am sucked into this so deep that there is no other thought left in my head.
I could really make this into an artform. I could. I could really groom this into a shiny big thing, build and polish a throne for a disease that came uninvited. So why do I treat it like a special guest?
I watch out for its slightest signs, every aspect of it gets VIP treatment. As if I am ill first and myself second.  

Obviously, I cannot ignore it with symptoms like sledge hammers but somewhere in this I am still me. Call it autonomy, spirit, soul or whatever. Right now, it feels very small, impossible even.

In theory, I feel strongly that any health crisis can be understood either as a sign from the body to become aware of certain aspects in life and to find new ways of dealing with them, or, in case of limitations that cannot be changed, as a challenge to discover new ways to accept these limitations and to revalue what is left of my health. Concentrating not on my illhealth and symptoms, my vulnerability, but instead on my personal strengths. Where are they? I do have some left.
I do. 
I do. 
I do. 
I do. 
I do.

In theory, of course. There is a way to go still.

06 December 2010

three steps forward two steps back

Well, it was too good to be true. My intentions about going back to work.
Last week after laryngitis & co had departed I managed two pleasant afternoons - and that included doing stuff at home in the mornings, even cycling and some housework.
On Friday tiny little alarm bells rang but there was so much snow and ice that I decided to stay put anyway. On Saturday I barely managed our shopping ritual but when we got home I furiously cleaned the fridge only to collapse onto my sofa for the remaining day.
And yesterday...
Today there is no getting away from it. Whatever it is, my body floors me. Literally.

So back to boring rest and fiddling around with this blog design to keep the mind from freaking out with anger and fear.

03 December 2010

the boyscout

We first met when he was a medical student in his final year maybe six, eight years ago. He came to me for help with translating his references for an application to work at an A&E hospital in Israel. A cheerful young man with a long ponytail, freckles and a loud laugh. He showed me snapshots of his first child. 
Over the years I translated several of his reports on disaster medicine and triage for publication in expert journals, he showed me snapshots of more children and one day the ponytail was gone. Still, always the laugh, the jolly voice, so many ideas.
Earlier this year there was a story in the local paper about him working for several months with a medical team in Haiti.
Yesterday he stood there at the back door of the institute, freezing in the snow, smoking.  

How was Haiti?
You have no idea, not even if you try to imagine hell.
(Another cigarette.)
But that was nothing compared to Pakistan.
When did you go there?
Just back. We set up a couple of support networks, tried to anyway.
What next?
Benin, next week. Worst flooding in decades, 600,000 people affected, cholera...
What about your family? Children? Xmas?
I never tell them until 24 hrs beforehand. Otherwise there is too much grief.

(Another cigarette.)
So, what are your plans for the future?
This is the future. I can't stop now. 
Your children? Your wife?
Do you know how many dead and dying children I have seen in the last year? 
It's like a drug. Or worse, maybe.
No laughter this time.