The Pragmatics of Grief

-The tears can flow spontaneously and surprisingly so it is worth having a few quiet spaces, a private nook, to quietly slink off to for a quick blub. Have you adventured into every room and cupboard at work? At home do you cry where you drop or is there a target tear space?

I have evolved a gravitation to two spots at work where I can comfortably be alone for a few minutes during those times the tears are beyond my control. At home I always seem to end up in the same room. Always carry tissues. 

-Your closest friends may not be the ones to contact on every occasion. Someone else might be the most appropriate company at certain times. 

-Learn the signs that things are awry. When my breathing begins to labour or when I shiver on that spot between my shoulder blades I know it is the right moment to be alone. 

-Drop everything. You have to prioritise and if you are not in control it is difficult to look after others (or work on that spreadsheet or cook the dinner or pay for those groceries). You should often be your primary concern. 

-Try something new. There is calm and security in familiar routine but one has to actively consider the new normal. This consideration includes adventuring some into unfamiliar places. 

-Expect unexpected emotions. Be prepared to not want to communicate for days or weeks. Be prepared for unanticipated bouts of disproportionate mediocrity. Be prepared for self-induced pathos. Be prepared for laughter and acute sadness that can occur within seconds and be prepared to get used to it. Be prepared for rage and rejection. Be prepared. 

-Keep busy. Bit obvious this one but being occupied is a great distraction. What's less obvious is that busyness usually involves setting small, achievable goals which has a subconscious side effect of increasing your own feelings of self control and empowerment. 

-Eat regularly. Your appetite might be low and eating small, easily made, regular meals will keep your blood sugar stable which can have a knock-on effect of improving your mood. In addition it is likely you will feel lethargic and, put simply, food equals energy. Also, feelings of stress have been shown to reduce an effective immune system and increase the time it takes to heal wounds. Ingesting decent nutrients can counter this problem. 

-Sleep well and rest well. Stop when you need to, nap when you need to, go to bed early, no screens in the bedroom (they play havoc with your circadian rhythm), don't be afraid of medication if you need it, the room needs to be dark and the right temperature, no caffeine within 6 hours of bedtime, no exercise late at night. 

-Stretch those legs. I cycle and jog enthusiastically and get tearfully cranky if I go three days without exercise. A full cardiovascular workout is not demanded every day but a short, fast walk can work wonders and help you sleep deeper. 

-Do what you normally do. You know your own coping mechanisms when used for previous stressors so consider them and adjust as necessary. 

-Be kind and gentle to yourself. Obviously. And being kind and gentle to others helps too. 

Assisting the atheist in the foxhole to die

As a nurse and humanist I would be greatly honoured to help someone to a peaceful death. The old religious maxim that there are no atheists in foxholes has been disproved to me time and time again. I have met a number of people close to death or who are dying and make no concession to religious affiliation through any sense of fear or anxiety. It is humbling and impressive to experience the graceful dignity of an extremely sick person who refutes the fears of divine punishment and the desires for divine reward and, instead, faces their death from a fully human perspective.

After death we are as non-existent as we were before we were alive. When we are dead we are, as we were when we were alive, simply a collection of various chemicals but without consciousness. But when we are close to death we are still alive and, as such, must be afforded all the rights and respects defaulted to all humans- dignity, autonomy, freedom of choice and so on- and this includes rights over ones' body. Dying is part of living. It seems perfectly logical, loving and respectful to assist someone to a peaceful death of their choice if they are unable to provide that for themselves and I would be proud to help someone achieve what they cannot. I consider it a human duty. 

Castlewellan, Co. Down in Autumn

By midday the dew is still refusing to evaporate and continuing to twinkle in the unmistakenly autumnal light. The cloudless sky is an acid blue like a Mediterranean sea in a holiday brochure. We are entirely surrounded by old trees, nestled in a copse of silver birch and in sight of gnarly oaks planted when Galileo was observing the stars. There is more than a hint of the Jurrasic in the evergreens. Bone dry, brown, curly leaves drop into my coffee. The loudest sounds are made by a hundred-strong murder of crows navigating the forest using the highest canopies as junctions. The only other noises are other birds. 

The lake is so smooth I want to jump in with a parachute and fall for years.

The sun is warm only in direct sight and the air is crisp. The shadows are icy cold. There is a lucidity in the distant panorama only possible in moistureless chilled air. 

It is ancient, relentless and simultaneously irrespective of people but unambiguously symbiotic with them. 

Six Clients

In many ways I am a lucky man. One major stream of support and pleasure is my job in which I have interesting experiences every day and work with lovely people who are there for truly ethical reasons. 

But I can't mention the specifics of my work to anyone due to keeping confidentiality with clients. There are many jobs like this so here is an example of my day. None of these six clients are real but are typical.

Liz is 23. She is homeless and has been addicted to alcohol since she was a teenager and has a diagnosis of chronic psychosis, experiencing hallucinations daily ("hearing voices") and clinical paranoia- a complex web of conspiratorial, persecutory organisations that are constantly watching her every move. Her addiction and illness has made her aggressively defensive against perceived slights and she has been barred from every service that helps homeless people except mine. In my office she mistook someone's laugh as a sneer, thought they wanted to harm her and she attacked first. This wasn't her second chance, it was her eighth. She had to be barred from the building. 

Conor is 48 and has been transient for over 20 years since being evicted from a cult and losing his wife, children and all his friends. The stress caused a long-term breakdown in his mental health, he has engaged meaningfully with no service since and carries a box of sharp pencils to defend himself against nurses and social workers who, he believes, all want to detain him and inject him with poison. I need to develop a connection and a relationship with him to complete a more detailed mental health assessment and, thereafter, suggest possible treatment. He has never lived in permanent accommodation and never lives in a city longer than 4 months. 

Lucaz is 29 and from Lithuania. He doesn't speak any English and we use an interpreter to communicate.  He is legally entitled to almost nothing, benefits or housing-wise. After rough-sleeping for weeks he developed a hip problem and was admitted to hospital. He actually had a complex infection that took months of aggressive therapy to clear up due to his newly diagnosed liver failure.  He has developed fibromyalgia and may have become addicted to the opiate-based painkillers he was prescribed. He was discharged from hospital with an inadequate care package and is now homeless, on crutches and with a big paper bag of medication available to abuse. 

Rachael is 34 and has acquired a brain injury after an assault from her father when she was a child. She has a long history of childhood sexual abuse and exploitation. She has four children from four different men, none of whom she has any contact with, and all four children are in care because she has been deemed inacapable of coping with most adult responsibilities. She has recently started a relationship with a known all-round nasty piece of work and multiple violent offender. She knows his history and doesn't appear to care. They are both homeless. 

Ahmed is 24 and from Somalia. He had been seeking asylum for eight months and has been a refugee (received five years leave to remain) for five months. In those five months he has been "sofa-surfing"- moving between friends, friends-of-friends and charitable strangers- and he has been on the streets for a few weeks here and there. He has developed complex Post Traumatic Stress Disorder after his experiences that forced him away from his home country and experiences daily symptoms of a heightened state of persistent anxiety ("hyper-vigilance"), reliving (recurring violent nightmares and horrifying flashbacks) and auditory (noise) and gustatory (taste) hallucinations. As we talk, using an interpreter, he is distracted by the screams of his family and the persistent taste of their blood in his mouth ("like sweat and rust"). I notice he is missing three fingers but can't bring myself to ask why. 

Harry is 28 and had been a bar manager for years. He had no health problems, is on no medication and, up until a year ago, considered himself fit and healthy. Then he got curious and sniffed some cocaine. He now sniffs or smokes cocaine every day. He couldn't cope at work, lost his job, couldn't pay his rent, was evicted by his landlord and has told no-one about his problems due, entirely, to embarrassment. He finds it hard to picture his future. 

All these clients were assessed using a complex-needs, multi-disciplinary assessment tool that takes an hour or two. Their needs were identified, plans were put in place and issues addressed. Five of the six walked away in a better state than when we first met, with a clear plan of support in place and a roof, albeit temporary, over their heads. 

Again, none of these cases are real but the symptoms, issues and experiences described have all been mentioned to me over the years. These are very typical clients seen on a very typical day in my typical week. 

One of the many reasons I enjoy my job is because it is extremely interesting. I meet a very wide population demographic and I am amazed, almost daily, by the strength, courage, dignity and kindness of my brothers and sisters in my human race. 

I am one of millions of workers all around the world who can tell no-one about my job because all cases are extremely confidential. How fascinating it would be to be privy to the specific details of a day in the life of a spy, a psychotherapist, a governmental policy-maker, a prosthetic limb maker, a publisher with a new book, an artist on commision and any other number of quiet, autonomous cogs in the machine. They are millions and they are unmentioned and they are intriguing and they keep it all going. I appreciate the beauty in their anonymity and collective power.