Grief's Unexpected Path

 

The day she died, the day she was born, Father's Day, my birthday, Christmas. It was the date of Ruby's birthday recently, traditionally the second most difficult day of the year for me, a grieving parent. Most people would imagine each passing year should dull the pain, that life should run smoother especially at those difficult dates but those same people are happily unaware the true path of grief is straggled with twists and bends and the occasional impasse that identifies itself at inopportune times. The road of grief is not linear, of course it isn't, but there are times when even the most experienced griever is thrown into seemingly spontaneous discomfort. Ruby's recent birthday- she should have become 23 but died at 11- was such a day.

As with every death day, birthday, Father's Day and Christmas I prepared myself as best I could in the weeks leading up to it. In truth, when one date has passed (in my case, my birthday in July) I begin to consider the next one, I think how to best manage it and prepare myself for the path leading up to that day. I remind myself that the previous weeks and days are worse than the actual day itself, I remind myself to be as kind to myself as I would be to a loved one in similar circumstances, I remind myself that everything passes, that time does not change its pace and that, before I know it, the day is over and all will be well. 

Except this year was different. The path I had created for myself leading up to Ruby's birthday felt different, I was wading through treacle every day and it felt a great effort to keep my head upright. I couldn't straighten my back, I couldn't lift my limbs high, I couldn't focus. On her birthday I barely had enough energy to get out of bed or complete the mindless chores I had prepared for myself. Only one person- an old friend- contacted me, no family or other friends were in touch and that lack of connection amplified my loneliness. It affected me deeply and it took weeks to recover. 

In those weeks of recovery this year I lived with almost constant thoughts of loss, of not being whole or even wholly present- one day a cat ran across the pavement in front of me and I half turned to smile at Ruby but, of course, just turned back again. Another day I swear I heard her voice or maybe something like her voice and I started saying "huh?" but just slowly exhaled instead. On many days I thought I could feel the wiry brush of her thick hair under my chin, her shoulder in my arm pit and her hand on my back (she was never taller than my chin). One day, just after this recent birthday, I think I felt her balled-up fist in my palm- her hands were never large enough to comfortably interlace our fingers and I would cradle her entire hand in mine. Then I suddenly knew it wasn't her and my breath was taken from me and my legs lost all power and I had to sit down for fear of collapse. These were almost hallucinations, felt sensory experiences rooted in such profound deprivation as to be willed into being. I had never experienced this extraordinary physical manifestation of Ruby's wake before and was affected it by it for many weeks. 

Grief doesn't make sense, it follows no logical or expected path. Even now, 11 years after Ruby died, there are days, weeks, months, years and specific anniversary days that are utterly different to all the others, that have power to surprise and move me in new ways. Some are easier than others- mostly I live as well as I can and at peace- but there still exists the spontaneous power of grief to take my breath and my strength, that makes me feel things that aren't there, that reminds me I have missing parts where I look and see nothing. 

11 Years Without Ruby

 

I last saw Ruby 11 years ago. She was 11 when she died and so I will soon be without her longer than we were together. As can be the way with grief, certain dates and times get lodged in memory whether you want them to or not and they can be hard to shake. For example, on a particularly low day not long after Ruby died in 2013, at aged 11 years and 237 days, I worked out the exact date when Tom would be at that same age- 1st August 2022. In hindsight, thinking rationally, it was a terrible idea. For years I hoped the date would dissipate from my memory but it was tattood into my mind forever and so the weeks leading up to August 2022 were some of the toughest yet.

In those earlier years after 2013 my grief timeline was like a mountain range- up and down, up and down, peaks and valleys of no clear discernable timeframe, grief may hit hard for a day then dissapear for days, then return for  a week or longer then there would be weeks of stability then mabye an awful month and so on back and forth. There were noticable periods that were harder than others, particularly difficult weeks within a month, low months within a year, even years that were recognisably harder than other years. 

Normal life gets in the way, of course, influencing my bereavement "process" and I failed to take that into account for years. My other relationships with Tom, with Claire, with friends, family and work colleagues, the ebbs and flows of my job, my own interests and joys and setbacks and dissapointments and achievements all play an influential part in my own grief. Maybe this is fairly usual for other grieving parents, that the bereavement of losing your child becomes, after many years, such an integral part of daily life that it is as usual and, it maybe needs admitting, as banal as a regular irritant. Its effects vary greatly within me of course, and one day it may feel like an irritating neighbour making too much noise but on another day it feels like I have been forced to drag a 100kg bag of soil behind me wherever I walk. 

Over the years it has become impossible to differentiate my grief as something "other", as separate from me and outside of me. The primary disadvantage of this diabolical union of me and my grief, which has existed since the day Ruby died, is that it is always there with me. I am my grief, it can never leave me. But there is also advantageous power in recognising this uncomfortable fusion- or more specifically the pain associated with my grief rather than the grief itself- as being within me, something that I can have potential control over, something I can positively change. It takes many years of hard psychic work, sometimes with professional guidance, but, as has been recognised in a therapeutic context, pain may be mandatory but suffering can be optional. In other words, all my efforts in managing my grief over the last 11 years have been directed towards the navigation of my bereavement, not in ignoring its existence. Having agency is a major coping mechanism.

The importance of having agency- some sense of self-control- was clear to me from day one. In those very early times of shock and disbelief, some tiny message at the back of my brain whispered to me "start your homework now before the shock wears off". So I got to work reading about humanism, philosophy, grief psychology and anything else that I thought might be of use for the mental mountain I knew I was due to climb. I emailed a respected humanist, Professor A.C.Grayling, asking for advice and he wrote back with compassion and informative kindness. I bought books, read articles, asked questions, gathered information. 

A few months after Ruby died the shock began to wear off and the true depth and breadth of the work ahead of me began to reveal itself. Looking back I don't know how I had managed so early to arrange this skeleton upon which to build some kind of new future, I imagine it may have been my deep unconcious making a feeble attempt at damage limitation. Whatever the cause, it developed within me a necessity to disconnect from being a slave to my environment and instead forced me to live in a considered way. In other words, if I was to survive grief I had to investigate the right way for me to do this, to put active effort into how I lived, thought and behaved.

I didn't always travel in the right direction. In the last 11 years there have been many setbacks and many avenues I have walked down only to come to a dead end. I have started friendships which have fallen short and I have investigated therapeutic supports that have come to nothing, I have spent months reading recommended books that were all but useless. But any effortful enquiry that may appear to have failed has at least failed under my direction and as per my instruction- after all, these were my choices to consider- and so their lack of success is not as wasteful as might otherwise be the case. To have choice is to have agency. If I fail I fail on my terms. Eleven years ago I unconsciously chose to become an active participant in my bereavement which means I could ask new questions and create new ways of looking and thinking and coping. Somehow, a part of me knew this to be true- I can be influential in my recovery. 

This influence in my own affairs is an absolute necessity because what else am I to do? At times I feel I have no choice except to put uncommonly huge amounts of energy, all the mental effort I can create, into simply surviving. Just for today. If I didn't I would cry or scream or both and probably never stop. And I know this to be true, sometimes, so when I am quiet or distant this may well be the true reason- it might not be a thoughtfulness that occasionally overtakes me or an acute wonder what Ruby would think of this or of that, it may not be an introspective meditation about loss- it may simply be a defence being internally created against the potential riot that could explode at any moment. A riot is, after all, just an expression of anger and frustration without the polite necessity of control. And who wants that?

Every anniversary every year is different. Not necessarily more easy to manage each year, some years are worse than before, others are not. But a common theme, present every anniversary of her death, has been that I should expect something unexpected, forget that I am expecting this and then become shocked at this year's unusual event. In essence I become unexpectant of the unexpected. This year I felt an anxiety like never before in the days leading up to the anniversary date itself and also on the day (I am not used to irrational or sudden anxiety. Like anyone I would get nervous when it is expected- a job interview for example- but less than once a year I would have a "panic attack" or a similar type of acute anxiety). I was supposed to expect the unexpected, as I have told myself every year to do, but of course I forgot, as I also do every year, and so this anxiety totally shocked me. My anxiety always signals its arrival with waves of nausea too so that was a nice surprise. 

On the day itself, 8th May, Claire and I laid flowers in particular places and kept ourselves gently distracted. Lunch out, plenty of walks, busied ourselves around the house, waited for Tom to come home from school and focused on the evening's routines until an early night to bed to as early a sleep as possible. Then the worst day of the year was over.

It is the worst day of the year, it always is and always will be. The weeks and days leading up to it are difficult, some years maddeningly so, and the day itself is always awful. We have learnt to have a plan for the day but also to let ourselves flag when we need to, be angry if we need to, fall apart if we need to. But we survive, we always do, and then it's over. It is, after all, just another day. Everything passes.

I miss Ruby so much, so, so, so much. I hear a song and I think of her, I read a book and I think of her, I watch the TV and I think of her, I do nothing and I think of her. I work and cook and chat and I live a normal day-to-day life and I think of my dead daughter. I meditate and I have free thought and I allow myself to look out the window and wonder and day-dream and still I think of Ruby. Of course the grief is easier to bear now 11 years have passed- of course it is, how can it not be- but she still isn't here with me and I still remain without her. There is a space near me that I am always aware of where there is nothing, no thing, that is forever existent and forever affecting of the rest of the space near me. Eleven years later there are faded memories, sometime only memories of memories. Grief is at once both visceral and at the fringes of living, it is all-pervading but also indistinct, it is congruous but also inconsistent. It can be fucking horrific, so painful and so distressing and so dreadful. But you survive. You have to. And you keep going, one day after the next, sometimes thoughtfully, sometime on autopilot, and you can eventually thrive again, live again, you can even live well. We grieve because we love but we survive because of it too. 

Lifespan or health span?

Do you want to see your 100th birthday? What if you do get to a century but you have spent the previous 30 years unable to move fast or far, unable to lift bags of shopping and able to breathe only shallow sips of air without daily medication? Instead would you prefer to live to only 80 but with painless mobility and independence until year 79? Modern healthcare and medications can aid our longivity but at what cost? Continual research adds to the body of evidence that fairly simple lifestyle choices can help massively reduce the risks of excess pain and illness in late life and can lengthen the healthiest time of our lives. It is never too late to start.

Most people who survive childbirth and infant years eventually die from heart disease, strokes, respiratory issues, cancer, diabetes, accidents or suicide. Aside from having genetic or geographical luck here are some recommendations that have been shown to reduce the risks of dying younger but also, crucially, increase our health span. 

1) Don't smoke (or "if you smoke, stop now, you'll get better"). Biggest killer in the world, it's a no brainer. It appears to be the case that smoking less or less frequently doesn't make much difference, you have to not smoke. If you smoke you are likely to have a greater than 50% chance of it killing you (cancer, heart disease, COPD, etc). If you stop smoking (treatments are free and plentiful) your body can potentially recover back to the condition of you being a non-smoker but the evidence is not conclusive and, if true, it takes many years and much hard work (a decade of running will probably do it).

2) Calorie frugality (or "don't eat more than you need"). Err on the side of appropriateness with regards to quantity and aim for a plant-based diet- many animal products and most processed food can be linked to heart disease, cancer and other illnesses. You don't have to be vegan to live to 100 but it really helps to be as vegan as possible. There are many accurate online calculators of necessary daily caloric intake and bear in mind the dustructive power of viseceral fat ("belly" fat and around the organs) as compared to the less unhealthy subcutnaeous fat (under the skin). Obviously genes play a part here but even regularly active runners and weightlifters like me should know that the "fat and fit" idea is very nearly mythical. Don't drink alcohol- the evidence now proves that any amount of alcohol is risky (yes, even one glass of red wine a day). The safe alcohol level is…zero.

3) Move (or "be non-sedentary"). Move throughout the day, every day. You don't have to exercise very hard- evidence is inconclusive that huge amounts of exercise helps you live longer but usual recommendations are to get at least 30 minutes of raised heart rate activity each day. What is clearer is the positive evidence for occasional higher intensity movements for cardiac and overall health (such as having a weekly variation of cardiac strain- bouts of high intensity heart rate plus bouts of long, slightly raised heart rate for example). But what is truly conclusive is that being sedentary over the longterm is extremely unhealthy and contributes to heart disease, strokes, COPD, depression and other major killers. Moving little and often every day is a characteristic of the oldest populations on the planet (such as in Okinawa, Japan or Sardinia) but most of them also live up in the mountains so that helps too. So get moving, at least a little and very often. And live in a village halfway up a mountain. 

4) Weightlifting (or "resistance training"). Falls and accidents in older people contribute to rapid deterioration in health and early deaths. Resistance training increases balance and proprioception (ie. our location in space- where is my body in relation to that chair I am about to sit down on?), it enables stronger muscles to save you falling as you trip- imagine a strong but flexible arm grabbing the headrest of a chair as your foot accidentally catches the chairleg- and stronger muscles mean denser bones which means fewer fractures. Start lifting weights (either body weight, iron barbell at a gym, tins of beans in the kitchen) at any adult age but it's more important the older you get. No-one is ever too old, or too young, to start (and evidence now proves that even children can take part in considerate, careful weightlifting to good health benefits with no negative effects on bone development, as was previously thought to be the risk). 

5) Have agency (or "take control"). Find someone who will listen to you and who will help you get control of your life (or learn and practice great introspection). A quarter of the world's population will experience depression, anxiety or other serious mental illness (and almost all of us go through bereavement). There are many therapies and interventions that help including psychiatric medications and talking therapies that are, literally, lifesaving. Aim to be in control of the things we need to be in control of (ie. agency) and aim to let go of what we don't need to be in control of- we can do this most easily by finding someone to listen to us. We all feel an internal chaos, if only occasionally, we all look around for the adults in charge, at times we all feel guilt and insecurity. Work at understanding where you unconciously come from and how to increase gratitude. This is hard work but is always possible, all difficult things can be worked through and addressed, all traumas healed- this is not anecdotal experience, it is medical fact as evidenced by centuries of knowedge. Forgive the child you used to be- that was then but this is now. Allow yourself to be happy. Allow yourself to be happy. Allow yourself to be happy. 

Reflections on an Ultramarathon- I run therefore I am

 

Some weeks ago I completed the run of my life- a 50km ultramarathon- the culmination of five months training after five years reflection on the only marathon I have run. After running the Belfast marathon in 2017 I reassured myself that I wouldn't do anything so ridiculous again- at the time I was undertrained, unenthusiastic and deep in grief for my mum and for Ruby who had died four years previously, almost to the day. It was the most difficult voluntary action I ever performed and took a month or more to recover as I missed half my training due to a chest infection and then my mum died, suddenly and unexpectedly, two months before the marathon. I trained, if it could be called that, by running the classic combination of easy-, training- and long-runs for as many times as grief and exhaustion would allow me. This was nowhere near enough. 

The run was memorable for all the wrong reasons. I had only ever run alone and at the marathon start-line I was surrounded by thousands of people, acutely aware that I experience social anxiety in the company of even small groups. It was un unusually hot May morning, I ran out of my electrolyte drink a quarter of the way through, I ran the full distance barefoot on roads I had never run before and my soles were cut and bleeding within 10km because the surface was so stony. After the marathon I could barely walk for three weeks, my muscles atrophied and the soles of my feet were shredded. And so, considering this experience, I vowed to never do it again.

But a few years later, partly due to my interest in endurance running and long distance racing by runners who could only be described as super-human (100km mountain race, anyone? 260 miles over the Pennines? 24 hours non-stop around a running track?), I got the itch to look into my unfinished business of successful marathon completion. The usual 42.2 km (26.2 mile) length never really interested me - I only chose Belfast marathon five years ago for easily-recognisable fund-raising purposes - and so a 50km ultramarathon (31 miles) was the next logical step. I made the decision to aim for the ultra and, just like that, the commitment was cemented (this realisation about commitment was slow to grow in my mind over the years- to agree to something, even something as seemingly insurmountable as running 50km barefoot, is as easy as saying "OK, go on then" and that's it, I'm signed up). 

But there was a serious obstacle. A year previously I developed sciatica after a run of pure bad luck- three pulled back muscles in three days- and was floored for weeks with the worst pain I've ever experienced which includes motorbikes crashes, broken bones and more than one burst gum abscess. A rigorous stretching regime was the most successful treatment for the acute pain in my back at the time of injury but even though I became a little more mobile after a month and could run again within two I still woke up with sciatic pain every morning after then. A year later I had decided to run the ultra and, to feed two cats with one bowl (Tom and I decided years ago that this is a much more pleasant way to put it)- to train for the ultra and to finally rid myself of daily back pain- I bought a rusted and bent second-hand set of weights and barbell, taught myself how to deadlift on YouTube and designed a training regime. 

It worked. From that very first morning after lifting weights I woke up with no back pain, I evangelically shouted for joy with the zeal of the newly converted and jumped out of bed like a child on Christmas Day. It was revelatory and so I started training for the ultra in earnest by running three times a week (the usual short/training/long) and lifting increasingly heavy weights three times a week too. I quickly realised that you can use weights for different health/aesthetic benefits and, for me, this meant keeping an eye on "functional" body strength (being strong when moving through a range of different motions instead of just one plane- the difference between moving a sofa and deadlifting) but also using the weights to focus on running-specific exercises to increase the strength in my joints and core.

My runs changed slightly over the next five months as my cardiovascular fitness, mobility and strength noticeably increased. A typical training run might include hill repeats- in the early stages a warm-up jog down to the sea at the bottom of the hill I live on, race up the hill for 30 seconds which is as far as I could go before retching (this speed is zone 5 heart rate), slowly jog back down to the sea (zone 2 heart rate) then repeat 6 times- but by the end of five months training I was running up that hill 12 times for 50 second bursts. Similarly, my easy run started at 5-8km and ended at 15km five months later, my long runs started at 20km and ended at 40km. 

The open secret about running is that, once you can run for 5km without stopping (about 30-40 minutes), it isn't a great hurdle to run any distance because all you have to do is practise. It takes time and effort, of course, but there's no magic formula here - you simply increase the long run gradually until you are where you want to be- 10km, 50km, 100km or more. 

Early September was crunch time. It was a psychologically busy period of the year and is usually the most stressful time too- both our very old cats died within a few weeks of each other a month earlier (they had been with us for 17 years), it should have been my mums birthday on the 6th and it was also Ruby's birthday on the 13th  (she would have been 21 this year). The weekend closest to these two anniversaries arrived and part of me wanted to go to bed and ignore the world for a week which is the same part of me I have to make peace with every year (much of the management of long-term grief is about making peace with yourself, of navigating the journey rather than trying to circumvent it). 

But this weekend was different. The weather was perfect for running - chilly, bright and clear - my training was complete and it was also the tenth anniversary of when I started running, to the week. I was buoyant and I felt unusually strong so I headed out on the pavement with a rucksack full of flapjack, some peanut butter wraps and two litres of electrolyte fluid and, without warmups or fanfare or a starting gun, I started to jog round a double 25km loop on foot (which still makes me tired to even contemplate. 50 kilometeres, on foot, running, it's a pretty ridiculous idea by most standards). I was off.

Although unexciting to announce, the run mostly went like clockwork. I smiled around the first 40km or so, roads I had covered  hundreds of times over the last ten years. I ate and drank little and often and I ran effortlessly. I incidentally glanced at my smartwatch at 42.2km, the exact marathon distance, and took a big gulp as I had never run further than this in my life. But I plodded on and continued to gorge on wild blackberries growing in the hedgerows by the side of the road (the flapjack and wraps had become impossibe to digest after 30km). I pulled a muscle in my back when reaching up for this perfect autumnal roadside snack which hampered my breathing and speed for the last 8km (actually it was as painful as the broken rib I endured a few months previously but, this time, the pain dissipated by the evening) but I eventually hobbled across the finishing line, breaths like stabs, bruised soles, jellied legs but goal achieved - 50km complete. There is no shower as deeply cleansing as the shower after a long run and there is also no pizza as delicious.

So, was it a profound experience as I had hoped and had read it might be? Was I a changed person because of it? In short, yes and no. On a superfluous level (type 1 fun, as I have heard it called) I enjoyed the run for the simple pleasure of movement for movements' sake - there were times I jumped a little higher than I needed to when going up the pavement after crossing the road, times that I skipped down to the sea shore for a quick paddle halfway round and times that I stopped at a beautiful viewpoint (of which there many on that route) just to breathe it all in and appreciate the luck I have simply to be able to run. I waved at every runner, patted every dog, stroked every cat, thanked every car that gave way and gave a thumbs up to every child that looked my way. I think I even winked at a few people. One older gentleman even got a salute from me, something I've never done in my life.

But, in addition, type 2 fun is how runners really get their kicks and is the true, deeper reason we know it is worth putting ourselves through such hard work- all those cold, early mornings and vomit-inducing sprints and exhausting long runs, all the chaffing and rolled ankles and sore knees- all for the psychological rewards that sometimes arrive long after the run itself. The sense of achievement that I felt after running 50km was certainly not greater than reaching my first 5km ten years previously (I want to be able to feel that sense of joyous achievement again but have concluded, sadly, that if finishing a marathon or ultramarathon doesn't give me the same buzz as my first 5km, no run ever will) but it was nevertheless a distance to be proud of, being a man who has no real skills, no discernable talent and who hates training. 50km was a goal I had aimed for, that I had created a plan to achieve and I had put great quantities of effort into its realisation. The endeavour was worth all the hard work I had invested. 

Also, it isn't that I ran a long way that rewards me, it is that I can run a long way. The ability to move in a way that we as a species have evolved to do- particularly if I run long distances barefoot - proves that I am animal, that I am tangible and that I am afforded a place here in nature and this is where I should be. As has been stated elsewhere (notably by philosopher Heidegger) it isn't that I "have" a body, rather it is that I "am" bodily. Running a long way proves not only that I am a visceral member of the animal kingdom but also that I am psychically linked to, and coupled with, nature. My body is not separate from my brain, they are one and the same as I am with my surroundings. 

Some runners talk of "conquering" mountains, or even "combating" them, but I don't want to be an opponent. I want to be amalgamated with my surroundings and I want to relate to it. I want to be striated within it and, it turns out, running gives me this. The profoundest lesson I have learnt from running is this- to run is to be human, to be human is to be animal and to be animal is to be a component of the natural world, to be of it and within it. To paraphrase Heidegger, it isn't that I am "in" nature, it is that I "am" natural. 

My Extraordinary NHS

 

On November 1st- last week as I write this- I had fairly major surgery. I hadn't been unwell and in need of surgery, it was elective in that it had been planned for nearly a year and followed numerous tests and examinations to ensure my physiology was strong enough to cope with surgery and recovery. I initially started this process around seven years ago but did not feel able to compete the procedure at that time- I was informed then that being fit and healthy was necessary for my long-term survival and at that time I could not be 100% sure that my then-new lifestyle of running, weight-loss and vegetarianism was to be permanent. But it became clear since then that my "new" way of living wasn't particularly new but was instead a more profound return to the person I was born to be having given up good health and sports for 20 years when I discovered motorbikes, cigarettes and whisky as a teenager. Seven years later, here in 2022, I had no excuse to not continue with the process of surgery as I had run every week for the last 10 years, cycled whenever I could, walked and hiked every day, lifted weights, stopped smoking, stopped drinking alcohol, stoped eating meat and had generally become an annoyingly smug arsehole with a pointlessly restricted lifestyle (but it felt more natural to me and I was happy with it). Time to put my money where my mouth is.

I attended many appointments in the hospital over the months of 2022 being weighed and measured, being drained of blood and urine, being poked and prodded and tested. Here is rough list of some of the tests I received during only one typical day, for free on the NHS, remembering that had anomalies been identified they would be immediately addressed and treated, also for free:

• Full Blood Picture 
• Liver Function Test
• Cholesterol level
• Urea and electrolytes 
• Coagulation screen
• Testing for Hepatitis A, B and C, HIV and syphilis 
• Body weight and blood pressure
• Cannula insertion into my arm
• Ultrasound of kidneys and bladder
• DMSA (dimercaptosuccinic acid) injection 
• EDTA (ethylenediaminetetraacetic acid) injection
• Electrocardiography (ECG) test
• Chest X-ray 
• Blood set
• DMSA scan
• Next blood set
• Urine test
• MRSA swabs
• Next blood set
• X-ray Computed Tomography (CT) scan
• One to one with medical consultants including physical exam 

There were many other tests at other times including a psychological evaluation in readiness for surgery, kidney tests, etc. 

I was admitted to the ward on the afternoon of Monday 31st October, sharing a large room with two other patients, had some baseline, last-minute tests ready for surgery, nil-by-mouth from 10pm (after I was stuffed with toast and jam and a gallon of tea) then surgery at 9am the next morning for three hours, into the recovery ward for an hour then back to the initial ward for three days recovery prior to discharge home. Discharge included physiotherapy support, medications for two weeks and ongoing outpatient appointments each year for life. 

Every single member of staff I saw during my entire three days as an inpatient moved with quiet and calm purpose through their respective roles. The surgeons were pragmatic and to-the-point about the physical procedure ahead (their focus is mainly on the unconcious patient), the auxiliaries were supportive and thoughtful without being over-familiar as they helped me choose the most appropriate vegetarian meals and advised me about low salt and low fat options and which may suit my delicate stomach post-surgery. The two cleaners were as much a fascination to watch as I would a carpenter making a chair or a skilled sushi chef feeding customers- they used exactly the correct and specialised mops and clothes and liquids to clean every single square centimetre of that 4 bedded room, every horizontal surface and door handle and light switch at known risk of contamination, they wiped under my bed in a strict and meaningful pattern, they moved with the cordinated efficiency of robots but were also polite and warm, apologising for their "intrusion" (their diligence was almost usurped by their inspector who arrived minutes later and ran his fingers along the light shade two metres up the wall, then the heating switches and then crawled under a bed to wipe his little finger along the floor in the hardest to reach corner and then, obviously satisfied with the lack of dirt on his hand, nodded lightly, scribbled a tick in his clipboard and strode away). The medical consultant was the overseer who collated information from all sources and kept me educated and informed about all the processes I would undergo and about the treatments and prognoses. 

The nurses moved with a sometimes contemplative and sometimes reactive but always well-measured care-giving. This is clearly and primarily based on their training and learned skills but is also because they are all, simply, kind and because they wanted the sick person in front of them to feel better, as one human to another. Certainly, you can learn the skills of nursing in a classroom and on the hospital wards- from empathy improvement to catheter insertion, from violence deescalation to intravenous medication administration, from surgical procedures to electrolyte management- but, as a patient, their care only feels truly human, genuinely valuable, when their hand is reassuringly and empathically placed on your forearm or when a tissue is somehow created from nowhere after a tear drops out your eye or when, after being extraordinarily sick, post-general anaesthetic, and covering everything- myself, my bed, the floor, my wife's shoes- with watery vomit, a small team of meticulous staff suddenly appear as if from nowhere and unfussily wipe and clean and mop and disinfect and change everything for new in two minutes and without one word being said except to reassure me because I was feeling guilty for making a mess. Practical skills are absolutely necessary of course, and every member of staff I met had those specific skills or were there to learn, but those skills flounder without the most important human foundational attributes- that of warmth and genuineness and common decency and, it has to be said, simple human kindness.

As is typical of the NHS I was looked after by staff from India, the Philippines, Pakistan, Poland, Australia, Ireland, Northern Ireland, England and other countries. I can think of no other employer with such a broad range of staff, from the young student nurse nervously measuring my blood presure for her first time to the elderly porter wheeling me to the operating theatre from my ward.

And it is "my" ward in "my beloved NHS". Such is the admiration for the NHS we should all talk about it in that vernacular- free to use, tax-funded, human-centred and socialist-modelled- just about every UK resident and foreign guest receives care and support at some time in their life. The NHS has around one million employees, half of them clinically trained, and almost all of them are underpaid for their efforts but are buoyed by their ethical beliefs and moral priciples, clearly seen from their behaviour.

Hospitals are places where most people become well but also where, inevitably, some people die. Staff must support patients through both these experiences- to facilitate improved wellness or to help someone die well. To be cared for by the staff and to be a recipient of their shared humanity and warmth is to be afforded a clear recognition of the extraordinary beauty in human kindness. 

The Universe Should Mourn its Loss

 

I won't allow the universe to have the audacity it needs to be unchanged, I want it to grieve with me. 

I want everyone alive to know what they have missed and I want them to feel forever sad at their loss. 

Every human should be aware of not knowing her. 

Every animal should know she will never look at them in wonder.

Every building that will not know her breath should want to collapse. 

Every landscape she will not admire should be in shadow, the sun should dim, flowers should bow, forests should be in winter. 

Every rock she will never climb should become mossy and crumble into the sea, they have no purpose. 

Every star that will never shine on her should drift away into inky space, they have no reason. 

All the water not drunk by her, washed over her, swam in by her should wish for frost, not one drop is  needed. 

Every pillow is cool and plump, every sheet pressed, every brush unaware of her contour.

Billions of brains unchanged by their lack of Ruby, billions of smiles and tears of joy 

that will not happen because billions of ears will never hear her,

there are billions of cold hands that won't know her touch, billions of unsparkling eyes that have not seen her. 

I pity them all and I am angry with them all for their ignorance. 

Whether it knew her or did not know her the universe should mourn its loss. 

Progress is not linear

In life, as in running, progress is not linear. Neither is bereavement, love, friendships, health or a whole list of natural and normal experiences for us all. In the career I have chosen- mental health- I regularly remind my patients that, even if they are putting in consistent effort for self-improvement, this won't always equate to a consistent outcome. Overall their improvement will be positive and one must always have the end goal in sight but one must also be fully aware that the route to autonomy will entail setbacks as well as triumphs and that periods of illness, injury or just normal life getting in the way happens to everyone and that any desired results- contentedness, joy, wellness, etc- are connected indirectly to their input. In other words, work input does not always correlate to product output.

In 2015, when I ran my one and (probably) only marathon I was underprepared because of life getting in the way. My four month training programme taking me from a half-marathon weekender to full marathon finisher over 16 weeks of shake-down runs, hill repeats and long runs stuttered along at half pace due to a lung infection that put me 6 weeks behind by the halfway point of training. And then my mum died, unexpectedly. And then the race was only a few weeks later, only one day before the anniversary of Ruby's death. I was undertrained, exhausted and deep in grief plus I had not planned for the shocking reality of running in the centre of a crowd of thousands of people when I had never run with anyone else in my life. Never again. 

But those were obvious setbacks that clearly changed the desired outcome. As of today, early September 2022, I have decided to complete the 50km ultramarathon I am training for within the next few weeks. My training progress- that is, the outcome of my training input- has been only vaguely connected to the effort I have put in. I have completed all the work necessary- heavy weight training sessions twice per week and three runs including shake-downs, long runs of increasing distance and "training runs" (hill repeats, intervals, HIIT, fartleks)- and I have tracked my progress throughout to help motivate me and keep me accountable. I can feel the improvements, my increased flexibility, a stronger back and hips, an improved posture, a lower heart rate for the same speed of movement, and, most importantly, feeling less tired after the first 10km on a long run (this appears to be the main benefit of a tough training run like hill repeats, an increase in lactate processing so my muscles don't get tired so quickly and a quicker recovery after the run). These improvements started from my first week training for the ultramarathon some months ago and were directly proportional to the work I put in. Also in direct proportion to my effort was the rest and recovery I had to undergo when I tripped up on a fast 10km run and fractured a rib a few weeks ago which stopped all weight training and slowed all runs for a while- at least it only hurt when I breathed in. 

But then I experienced a sudden thrust forward after a few months in the training programme- the 35-40km long runs weren't so exhausting any more, the fast 500 metre hill runs had to be repeated ten times instead of the usual five or six, I was recovering much quicker and I was able to walk comfortably the same day after a marathon-length long-run. My fitness had appeared to move forward a notch into the realm of 50km possibility although my progress had not been linear.

There is non-linear progress too through the lifelong process of beareavement. I have written before about there being bad days and bad weeks, feelings that even people who do not experience grief can understand, but there are also bad months and bad years within the arc of our individual histories. It is nearly ten years since Ruby died and I can clearly identify specific years that were tougher than the preceeding year, specific months (and not those troublesome anniversary months) that were darker than preceedings months or more difficult than months from previous years. But all moments in between these periods are lighter and more easily navigable and, overall, it is a cliche - and therefore true- to say time dimishes pain. To paraphrase, the arc of time bends towards entropy, away from chaos. 

Time stops for nothing, including grief. The skill of grieving well- as the skill of living well, of loving well, of dying well- is that of navigation. For us to enable ourselves in spite of our grief we have to go through it and not attempt to circumvent it. It is natural to expect a clear path along a straight timeline for our bereavement, including pain and longing of course, but the reality is often very different. The reality is a bit like this: crawling, then running, then an anniversary setback, then smooth coasting, a bit more coasting, a minor bump but our resilience is good so we're OK, then a bigger dip- maybe illness or more grief, then we are picked up, then rushing ahead smoothly, then racing a bit too fast- we're feeling good for weeks or months, then an intense crash when we feel like giving up but this is short lived, then a slow but strong recovery, then undulations of grief for afew months, then...and so on.

A non-linear run such as intervals or fartleks or hill repeats enables our bodies to cope with unexpected terrain. We would do well to extrapolate.