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Sunday, December 27, 2015

Haiku on Behalf/ Birthday/ Poet/ Cheap


Speak on my behalf
You tell only half the truth
I speak warts and all

On behalf of me
Please be my other behalf
Behoves us to try

Our politicians
One responsibility
Speak on our behalf


Happy unbirthday
Celebrate each day bar one
Through the Looking Glass

On my real birthday
V2 bombs dropped on London
Not surprised really

Since you were fifteen
I loved each of your birthdays
And you every day


At the railway tracks
The poet stood still and frowned
A line came to him

A channelling poet
Associations well up
And I write them down

Poetic licence
Taking someone else's word
Making it your own


Brightly coloured bird
Cheap, cheap, in a gilded cage
Never made a sound

The cheap end of town
Down near the pier on the rocks
Gulls need a handout

Shopping spree for cheap treasures
Cast off hand me downs

Wednesday, December 23, 2015

Haiku on Trade/ Free/ More/ Entire


Trade winds blowing west
Carrying African genes
To America

Roaring trade in guns
American legacy
High suicide rate

Trade in body parts
Selling off a part of you
To feed family

Trips around the globe
Now provide some walking aids
To stop falling trade


Wants a free trial
Judge, lawyers and the jury
All laugh their heads off

As free as a bird
Except the ones held captive
In aviaries

Here's a free trial
My mind used with discretion
Comes with my body


More substance, more style
And more credibility
New Prime Minister

Please sir, I want more
What the Dickens can you mean?
Gruelling question

Delicate, petite
Beautiful but oh so tough
Sometimes less is more


The entire home team
Stood under one umbrella
Rain had stopped our play

Across entire world
There are refugees in need
They can join our team

Entire flocks of birds
Team up for migration north
Green winged symphony

Haiku on Single/ Visit/ Commit/ Remember


A single second
Fades into obscurity
As time marches on

Single minded man
Decided to change the world
Using crowdfunding

Not one single hair
Out of place in her coiffure
Her mind was a mess


Visiting scholar
Lectures full of old wisdoms
And inspired new minds

Our home is open
Replete with loving kindness
Visit when you can

Grief pays a visit
But may outstay its welcome
Should be sent packing


Commitment begins
Cannot bear to stay apart
Longer than an hour

Commit to World Peace
Share loving kindness at home
Stay strong in resolve

Committed to wind
Catamaran on one hull
Stays thrumming with speed


Remember garbage
It is Monday night again
Bins have to go out

Remember Guy Fawkes
Tried to blow up parliament
There were some fireworks

Have to remember
Memory is always there
We control the pain

Tuesday, December 8, 2015

Making of a Child Psychiatrist (35): Back to the Grind (5)

In neurolinguistic (NLP) theory terms I am a very visual person. I prefer to see a film at the cinema than listen to an audiotape (which can drive me mad after about 10 minutes). As I noted in an earlier chapter, I can often remember passages of words visually so that if I am stuck, I can think back to the page and lines. If I lose something, I can think back to the approximate circumstance and remember where it is most likely to be. This, of course, falls down if you have a tidy partner who puts things into categories and is not particularly visual. Jan will often move things, and then I am totally lost – I have no visual image of where things might be- they are not where I left them! I am sure she does not do that on purpose, but occasionally I have wondered…
This visual sense has held me in good stead in all sorts of circumstances. Once I have driven somewhere, I can always recall the way to get there. In fact when I am planning a journey, I often think through the journey visually in advance to ensure I remember where we took a wrong turn last time. I rarely lose my car in the car park. When I have committed diagrams to memory then I can usually recall the majority of the diagram and piece together the rest. (Of course, as I age, these abilities are deteriorating, so my memory may be less clear and less detailed).
So this means that I have visual memories of particular patients who gifted me their story regarding the onset and process of their illness. Often, if I meet the patient again (even after some years), I can remember the salient features of their story and, if pushed, will be able to fill in the gaps; or at least need minimal prompting to be able to remember once again.
What goes with this way of experiencing the world, is the use of language. I use a lot of visual words and descriptors. So if I am describing something to a friend, it is as if I am seeing the event as a picture in my mind, and using that on which to base my description. The detail I use depends on how I perceive the other person’s expectation; some people get awfully bored if you describe every little detail.
There are two other styles of ‘being in the world’ in NLP theory (which fits so much with my experience in clinical practice; but more of that later). The first is the ‘touchy-feely’ way of being in the world. People like this are sensitive to emotional nuance, and pick up others feelings very quickly. We tend to feel other’s distress very deeply, in part because we ‘get’ every nuance of their posture and facial expression, but also because the words used each have a ‘feeling’ or ‘tonal’ value. We also tend to mirror the other person’s body language, which is marvellous in giving us ‘the feel’ for what they are trying to express. However, we have to be careful with this, because if we go too far with mirroring we may parody the person’s stance and they can become offended. The other reason for being careful, or at least controlling the mirroring, is that we can, as it were, ‘take on’ the feelings of the other – both physical pain and mental anguish – and become overwhelmed ourselves. I used to find myself doing this in the early days of my clinical training, and could get quite distressed. These days I am much better at noting the style, the body language, the words used, and the feeling tone it all gives me, and labelling it in my mind – but being very clear that it is the other person’s problem, not mine.
The third major style of operating in the world is the logico-deductive. These people tend to be very organised. They make lists either in their minds, or on paper. If they are not allowed to follow through with a process which has a beginning, a middle and an end, they can be come either slightly confused or irritated to the point of anger. They may have little time for people who are visual and get the big picture quickly, believing them to be ‘lucky guessers’ (I have been called worse things). They may have little time for people who are ‘touchy-feely’ because they don’t want to hear the whole story, and all the ins and outs, they just want the facts in a clear (preferably time-based) order. They cannot manage the emotion (or ‘do not have time for it’), because it gets in the way (and ‘does little to change the facts’). “If you are going to solve a problem, then just get your facts straight and in order, and then develop a stepwise plan to deal with each facet.”
This is a very superficial explanation of something that is complex and subtle; fascinating in its own way, but may need much more explanation to persuade some of you of its worth. At this point I just need to tell you, that as human beings we are never simple or clear, never quite fitting comfortably into boxes. So in NLP terms, we are a mix of these three broad modes. I can tell you that I am primarily a visual person, with a strong secondary style which is ‘touchy-feely’, and with the logico-deductive bit of me being a rather poor third.
So what did this mean on the wards? Well, retracing our steps a little, you will realise that I got to ‘see’ the general picture the patient was telling me quickly. I heard the symptoms and found it fairly easy to fit that ‘into a picture’. I could feel their pain, their anxiety, their worry for the future, and at the physical level I found myself very good at feeling lumps and bumps and developing those into an overall diagnosis. I was not good at the lists of alternatives that needed to be considered and excluded. I tended to go for the main diagnosis and fixate on that. But as a student, I was expected to have learned the lists so that I could spout them on demand. That for me was ‘boring’, and seemed to be such a waste of time when you had already decided what was going on. I got myself into difficulties, and was often told I was ‘jumping to conclusions’, which were ‘unwarranted’, and not part of the logico-deductive process. I was ‘being superficial’. From time to time over the months, I got to the point of despair, wondering whether I could do all this. Eventually I began to develop the lists on paper (an ‘aide memoire’), and memorised them, so that I could spout the rhetoric on demand. I was so good at ‘being with’ patients, often able to get nuances of history others could be denied. I felt for my patients, began to develop good patient-doctor alliances, but I had to work at the logic.
Writing these things now, I am aware that I am describing my younger self using concepts and understandings that have been hard fought for over the years. I think whenever I got too depressed at my apparent ‘incompetence’, or my ‘glibness’, I went and did other things to fill my time. The saviours were bridge, squash and rugby, and a lot of other pursuits that will appear in this narrative as we move along. Of course, the main saviour of my sanity was Jan, who seemed to be there when I needed her, understanding of my complexities and difficulties, and supportive for when I was depressed (again).

Haiku on Lust/ Went/ Important/ Thrive


Newborn baby cries
The midwife laughs in relief
A lusty pair of lungs

Full moon in night sky
The blood lust was upon him
Dracula emerged

I was filled with lust
In those early days of us
It still lurks somewhere


Peculiar boy
Eyes in the back of his head
In coming he went

The clouds came and went
Threatening much without rain
A story of life

With me all the way
But after our lovemaking
She went somewhere else


Nothing for nothing
Important lesson in life
There is no free ride

Be kind to others
Always do the best you can
It is important

I am not special
A cog in the wheel of life
Important lesson


A plant food called thrive
Used extensively in Spring
Garden burned wasteland

Low tide water still
Fish thrive below the surface
Not leaving a clue

I thrive on silence
Associations surface
Cleansing memory

Making of a Child Psychiatrist (34): Back to the Grind (4)

There were consultants at King’s whom you grew to love. They were gentle and brilliant teachers who had a firm belief that their role in life was to share with you all that they had learned. One such was Dr. Bruce Pearson, who was a real gentleman in the true sense. He wore a three piece suit, winter or summer, and always had a fresh rose bud pinned to his lapel. Ward rounds were wondrous affairs as we explored the subtlety of medical practice. He had the ability to make strong relationships with his patients, who obviously revered him. This was no superficial smarminess, but a core belief that if your patient truly respected everything you stood for, not only would it enhance the doctor-patient relationship but it would also provide the optimum environment for cooperation and cure. It was not a reverence from the patient, but rather a deep belief that this man knew exactly what was best. I was to learn over the years, in particular during my years in general practice, that if you did not take the time, if you were distracted by other issues, if in truth you were not sure you liked the patient, then this would dent the relationship. Whenever a patient seemed slow to recover, not only did you have to re-explore the diagnosis and your management, but you had to gently enquire whether they had believed your summary and advice, and had been willing to try your treatment. It was an amazing revelation much later on to be able to examine the bathroom cabinet of a patient who was not doing well. Often they were not doing well because they had not taken the prescribed tablets. And it took quite a long time for me to learn and accept that it was not their fault. On reflection, you had not believed in yourself, or had been distracted that day, or had not taken the time to truly engage them, or could not be bothered with them as people.
Such lessons began in those first months of ward rounds. And they were there in the teaching of Bruce Pearson, if you had had time to reflect and absorb the lessons. From then I also wanted to be a gentleman doctor. I had not been born into that class of people known as ‘gentlemen’, but that would not stop me from wanting to be a gentle man.
There were other senior doctors who were ‘difficult’. They were brusque; sometimes with patients, more often with us students. They were prone to demean you in the face of your colleagues and the patient. While over time you could gain an admiration for their diagnostic and therapeutic skill, they were edgy or prone to fly into rages if they perceived you had not done a good enough job. These days, I might have wondered about their personal life, or their upbringing, or their alcohol consumption. But at the time I was just to young, and too terrified. You just had to survive.
I guess one of the issues that I saw in some of the senior staff at King’s (and disliked intensely) was a certain arrogance. When you think about it, these people (mostly men at that time), had ‘made it’. They came from ‘the right’ families (very often with strong medical traditions), had been to the right schools, had developed the right contacts, and now held senior positions in one of the best medical institutions in London. They had ‘made it’. They were entitled to behave as they pleased, and if you got in the way, or did not perform to their standards then you were not worthy. On balance, my memory suggests there were more surgeons in this group than there were physicians. But there were some outstandingly ambitious physicians who, like many surgeons, simply treated people like bodies (or sometimes ‘like dirt’). I was always uncomfortable with those attitudes, but as naïve as I was at the time, I was more prone to blame my own ineptitude and try to avoid too much of the spotlight on ward rounds.
But life was about more than work and ward rounds. We would retire to the medical school, have a brief lunch in the refectory and then enjoy student life in the common room. My bridge skills came in handy, and I soon became part of a loose group that played almost every day. Over time I must have made a name for myself, because I ended up with the privilege of playing for King’s in a University of London championship in which we did quite well. In fact we thought we were so good that my partner and I thought it would be a grand idea to go down to East Dulwich bridge club and see how we racked up. We had a great evening chatting with the blue rinse set, and absorbing second hand cigarette smoke, but at the end of the evening we were stuck almost at the bottom of the table for the night. We left with our tails between our legs, determined never to challenge a bunch of old ladies again. In contrast, there was a highlight that was to happen much later in the months leading up to our final medical exams (when I should have been studying of course). I had the privilege over some months in the Med School common room to brush up the bridge of Miss India Reita Faria who, in 1966, was the first Asian to win the Miss World title (and not because of her bridge). At the time, she was a medical student at KCH, but later qualified and married an endocrinologist Colin Powell in 1971; the family live in Ireland. Ah, the brushes with fame!
There were so many opportunities to avoid study (if you tried hard). I joined the squash club. This may seem strange, but I had first learned squash with my parents’ young friend Kiah Bastian during my three months in Adelaide. He had taught me the basic game play, and some strategies, and we had played almost every week. From memory, my Jan also played squash with his partner Jan. So it was always a social occasion. Anyway, there were squash courts on campus and, with the help of a number of med student colleagues I began to work very hard on my skills and fitness. Given I was never a very sporty person, it always amazes me how good I became (or thought I had). I began to play competition squash, and found myself travelling all over London with one of 5 or 6 med student teams challenging on a London University College ladder. It was all good fun, always ended up with a beer or two, and we managed to win several team matches over the next three years (or so my memory tells me). So when I was tired of the bridge or conversation in the common room, there was usually a colleague who also had their squash gear in a locker, and we could breathe new life into tired brains smashing a small black ball around four walls.
Another escape from work was rugby. I had never really thought of myself as good at rugby but, seeing as it appeared to be the thing to do, I joined the Rugby Club. This entailed at least one practice a week a shortish walk from King’s to Dog Kennel Hill where there was a sports field and a smallish pavilion. I am not sure how it happened, but perhaps my squash induce fitness perhaps gave an impression of litheness and speed. After several early practices, I found myself being chosen as a wing forward in the KCH Seconds. I was honoured, bemused, scared and somewhat overwhelmed, but joined the coach on several Saturdays joined in the expressive language and jokiness, and played. Then we would all have showers, or sit in the communal bath with a bunch of other extremely muddy med students and swap stories of prowess. After the game, back at Dog Kennel Hill I became (given my strong tenor voice and training) a member of the ‘We can sing dirty songs louder than anyone else’ club. I had never known how many dirty rugby songs existed. I had never expected them to be so explicit. I had never expected to enjoy male company quite so much. So Saturdays became a (mostly pleasurable) ritual. I began to become practiced at drinking quite a lot of beer on rugby nights, and was known to be able to still play a mean game of darts after seven pints of bitter. Ah, the things you could do then that you can’t do now (and would never want to, of course).

Rugby, of course, had never been my passion. As people and team functioning improved, my skills did not seem to grow as fast. By third year clinical, I had been relegated to the fifth team, and was no longer a star winger. First I became a break away, and later ended up in the front row of the scrum as a prop. After we had played a team of London Police one Saturday, and I had gained deep scratches up and down my rather soft cheeks from the unshaven brute of an opposite prop, I thought my loyalties on Saturdays probably lay more in spending time with Jan. I made a good decision to become ‘not available’ and hung up my exceedingly muddy boots. I have retained one rugby jersey in the King’s colours. For some reason it brings back fond memories (and snippets from a rude song list), and I have had to fight tooth and nail to stop the slightly damaged piece of clothing from ending up in the bin.