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. 

Ultramarathon training- week 6 of 23

 

I am on week 6 of a 23 week training programme to run a 50km ultramarathon, a goal I’ve been eyeing up as my 50th birthday creeps up on me next year. 

So, week 6: Monday was rest day, Tuesday was 12km “easy” recovery run, Wednesday involved an hour of weight training for overall strength and conditioning, Thursday was the worst day- training run (this week it was hill repeats, next week is the dreaded interval training), Friday was rest day and yesterday, Saturday, was more weight lifting. 

Today, hallelujah, is long run day. Today is all about going slow and far, all about TOF (time on feet), all about enjoying the view, listening to music, getting decent headspace, becoming knackered but simultaneously charged. Today is the most important of all training days. If you are training for a race- any race- and you do only one run a week, make it the long run. 

I have a newish route planned for today, a 28km loop along the local roads and streets. I get my brightly coloured shorts on, running sandals, long sleeved black t-shirt, small rucksack, sunglasses on, waterproof jacket in the bag just in case, vaseline smeared. It’s perfect outside- 15 celsius, slight breeze, bit of cloud, bit of sun, just right. I start running as soon as the front door closes behind me. 

At 100m the nuchal ligament that attaches my skull to my spine relaxes from leather to elastic and my vision transforms from blurry to sharp (I am informing my body I am running), at 1km I am up the local “warm-up” hill, at 2km I think I am properly “warmed up”, at 5km I am properly, properly warmed up. This is the point I stop sweating. And as I run my breathing slows to the same cadence as when I am not running, my whole body starts to move smoothly and horizontal, not jagged or bouncing up and down. This is when I am comfortable, when I not simply running but I am “in” the run, and I feel I could continue indefinitely (I know I can’t carry on like this forever but my instincts inform me differently- that this is my natural state, I have evolved to be at this point, I am- we are- born to run). This is when I can stop consciously focusing on putting one foot in front of the other, I am not “getting going” any more, my thoughts now flow in and out, sometimes staying for while, sometimes fleetingly passing by, and I allow myself to float, physically and psychically. This is the big secret about running that new runners need convincing of- the hardest part is learning to run. Once you can run- really run for a few miles past the warm up, past the breathlessness and aching legs of those early stages- it becomes smooth and freeing and transcendent. It felt beautiful. 

Until I nearly get taken out by car. There is one 500m stretch of road with no pavement which I almost always avoid but it connected two areas I wanted to cover and so, for change, I took the risk. Bright daylight, straight road, I could be seen for miles, she raced past at 50mph missing me by an inch, no concession at all to at the soft and vulnerable human moving directly towards her as if I simply didn’t exist. I screamed and was forced to jump off the road into a bush.

So I took out my mobile phone and pointedly held it clearly in front of me, recording every passing car for the last few hundred metres of that same pavement-less road. Every car after that, without fail, gave me a very wide, slow berth being at greater fear of getting points on their license than squashing a human to death. 

Then back on the pavement, phone back in my rucksack, I reached the coastal road. Now my mind wasn’t drifting anymore- I was fully present in a strong headwind, salty air in my nostrils, the strong smell of seaweed, waves spraying onto my face. I slowed down for a quick biscuit break, slurp of electrolytes then carried on running next to the sound of the surf, down the long straight in the direction of home. 

The last few kilometres were tough- no flow here- as I was reminded that my weight lifting session yesterday was particularly taxing as my legs get heavier and heavier. And that I donated blood two days ago so had 15% fewer red blood cells than I needed for a long run. Then the third and final biscuit break as more energy was needed but it was too much sugar- I started to retch into a bush (I am still trying to figure out the best snacks to take on a long run as it’s a delicate balancing act between calorie intake and stomach function). But I have great self-confidence in one very specific thing - attrition. I can continue, without great pace or grace, for a very, very long time. And so I do. I buckle up, kick myself up the bum and move relentlessly forward. 

To finish the last 2km on an uphill appears to be a terrible idea. But I have a method- so much of this particular route is very flat, mostly next to the sea, that my muscles will begin to atrophy towards the end and will hopefully be happy to move in new ways up that final hill. I wasn’t wrong- I was beginning to crumble at the 26th kilometre but as soon as I started to climb those last vertical 2km my legs could stretch out as if getting a mini massage. I easily sped up, fast and loose, and I zoomed up the hill.

I almost fell through the front door- a slightly epic 28km complete, my longest run for several years, 2 litres of electrolytes drunk, half a pack of dark chocolate digestives munched, a ten-pack of tissues used (I have no idea why I get such a snotty nose when I run). There’s no shower quite like the shower after a long run. And there are no calories quite as enjoyable as the (preferably pizza-based) calories after a long run too. 

Then I’ll review the stats (mainly pace and cadence, I don’t really care about the time), consider next week’s training regime, rest day tomorrow, recovery run the day after that. Then, next Sunday, a longer long run, an increase in TOF. 

50km? Bring it on. 

Better to be Haunted

 

It is nine years since Ruby died and her ghost is everywhere. 
Her nearly-hereness teeters just outside my route

and is a persistent hint of her presence without intrusion. 

Her essence is exactly that- an essential striation in everything I do and 

everything I think and everything I am and everything I will be and everything everywhere and forever. 

When I am about to forget just for a minute, she hints and I am so glad she does- 

by far I would rather be haunted, 

and have that hint of materialisation that affords me her nearness, nearer than you are, 

and I can drown in her, suffuse myself in my Ruby. I just wish her and she is here. 

And who can say this of their child- I can wish them into being- as I can? 

I am lucky- today I ran with her and we bought her favourite pasta and we cooked her favourite dinner together with the grated cheese the way she likes it

and I found one of her hairs but I didn't brush her hair and I moved her Lord of The Rings after blowing the dust off the top and I thought about her, I thought about her and I thought about her.

I thought about her but then I didn't think about her when I didn't need to because I wished her into being. 

And who can do that?

Refresh your Run- How to Banish Boredom when Running

Many runners, like me, find great solace in the comforting repetition of placing one foot in front of the other mile after mile after mile. The almost banal sameness of the action feels comfortable somehow, familiar and homely. There comes a deep satisfaction that connects on a neurological level, satisfaction that appears to be rooted in a primal relationship between our brain, our body and the surrounding landscape. Those repetitive movements are the cue to release memories of a million years ago when we would only survive, day to day, by running after prey, by running away from danger and of always being on the move, nomadic hunters that we were. We are, as is the cliche, born to run.

But if we run for pleasure rather to survive prehistoric dangers- for the good of our mental or physical health, to lose weight or just simply to move as our evolution affords us- we can get bored of this routine and sameness. Because there is often so little change in our running routes and techniques, the tiniest shift towards something new can feel refreshing and exciting (yes, I know it sounds pretty lame that wearing a new pair of shorts can make that much difference but it really does). 

Here are some tips to keep your runs interesting when boredom sets in:

-Run your route the opposite way round, if it is a loop 

-Try a new route. Run off road if you usually run on pavements, pavements if you are a trail runner. Include a hill or two if you usually run on the flats

-Listen to music if you normally go without. If you run with headphones, try a new genre or a podcast instead.

-Add side roads. It doesn’t matter if you run around in circles or up and down the road, it’s all movement and it’s all distance. The tiniest change in scenery can make a big difference to your interest levels

-Try fartlek running (stop sniggering. Fartleks- Swedish for "speed play"- are the type of run you make up as you go along eg. marathon slow pace for 10 minutes, then race to that lamppost, walk to the street corner up there, race that pigeon, slow down to that next bush, etc)

-Change the time of day you run. This can hugely affect the feel of the run as your body may have already completed a full day of movement prior to your run instead of going out in the morning as usual, or your hydration levels will be different from one end of the day to the other which makes the run feel different too. Going for a run at the end of a working day, when you are tired, may be a surprisingly invigorating pick me up or may positively add to feelings of calm prior to settling down for the evening meal and movie

-New clothing or accessories. You would be surprised how much difference a new T-shirt or shorts can make. Or if you change your phone holder from an arm-band to a waist belt. See also: cap, sunglasses, step-counter, smartwatch, etc.

-Phone apps that encourage new running styles. I know some people who have traversed a running funk by downloading an app to their phone and can now hear zombies chasing them as they run- if their pace slows down the zombies’ moans get louder and louder as they catch up with you encouraging you to keep going

-Read running books. I always find that reading about running hugely motivates me to get out there and go for it. This could be motivational stories of fighting adversity or trauma through being active or, my preferance, books about our human evolutionary history of running, the philosophy of running or the anatomy/physiology of running and movement. 

-Run with others. Having company when you are out can be the change some people need to refresh their love of running. It is useful to note that the majority of runs (certainly all long runs when training for a race and most other non-training runs) are at “marathon-pace” ie. you can hold a conversation when running, and therefore running with a partner and having a chat on the way is good practice. You don’t have to wait for a close friend to run with because a running club will do. Or do you remember that friend of a friend who wants to get out but might be too nervous to go alone? This could be the company you both need

-Review your reasons to run. Runners sometimes call this their “why”. Why do you run? Losing weight? Mental health? Want to live longer? Worried about those messy unwell years at the end? Sometimes when I am in a rut I will revisit the latest health statistics that prove how much better my chances are, if I run regularly, of avoiding diabetes, cancers, heart disease, strokes and a whole range of other killers and disabling diseases. For me, running is primarily about maintaining mental wellness- keeping depression and the trauma of raw grief at bay is my “why” above all others- but revisiting these physical health benefits keeps my incentives fresh.

-Training runs when you are not training. Most runners, most of the time, value their "long run" above all others, it speaks deeply to us, it is why we run, it is how we have evolved as a species. But other types of runs assist us to mix up these experiences and help keep boredom at bay. Just like fartlek training above you can try hill repeats (30-40 second fast-as-you-can rush up a steep hill, slowly jog down and repeat 6-20 times depending on fitness levels), High Intensity Interval Training (HIIT) such as 30 second fast pace sprint, then 2 minutes gentle jog then repeat 10 times, Ladder runs (30s fast run, brief jog, 1 min. fast run, brief jog, 2 min. fast run, brief jog and so on) or the Run/Walk method (there are many variations but one that suits me- run for 14 mins, walk for 3 mins and repeat or run for 5, walk for 1).

-Turn off (or on) your gadgets. There are fewer people more obssessed with exercise gadgets than runners (with a possbile exception of road cyclists, the ones with all the lycra, drop-handlebars and very austere expressions). It is easy to pore over every measured stride, heartbeat, and minutes per mile but there is also freedom to be had from consciously disconnecting from the prison of statistics and running purely by feel. Try it. And if you usually run without any quantification or measuring gadgets, boredom might be the necessary catalyst to start keeping a closer eye on perceived progress, personal bests and incremental gains.

-Smile at every passer by and smile to yourself. Know how much fun running can be so make it fun- pretend you are 7 and in a school race, imagine yourself as the Olympic hopeful on the marathon's final straight, be the hero in your own movie racing down a beautiful exotic beach smashing the world record, be the bronzed Greek god admired by all who see you blaze past. If you look and act sunny you will feel sunny. 

 

Fixing is Crafting

 

I undercharged my the early days as a cycle mechanic because I was learning as I went along and each job took at least twice as long it would have taken an experienced mechanic. Of course I am always learning which is why some jobs that pose new problems can take hours, even now, instead of only minutes as it should. I will charge the customer for much less time than the job takes me and I alway enjoy those learning experiences as a mechanic growing in skill partially for the simple joy of stretching my knowledge and having increased my skills in a very specific way but, most valuably for me, I overcome a problem. This is a skill uniquely enabled by experience- that of problem-solving confidence rooted in pragmatism.

For example, it is only when you have worked on the same gear changer scores of times can you feel confidently aware that you will find a workaround for that corroded spring that, to the inexperienced eye, looks like an irreplacable part (which it isn't) that cannot be fixed (which it can). It may appear as if this means the end of the gear changer's life with the associated cost and increased customer waiting time while a new part is ordered. Instead you literally make a new one from wire. Or you cut the old one and reshape. Or you find a replacement part in a different gear changer that you have in the parts drawer and you modify sections. This is experience- crafting as fixing, the aesthetic becomes ergonomic.

One moment of great satisfaction working with bicycles came when I received a much loved commuting bike that had been in a crash. The crankset (three big cogs at the front) was bent like a taco. I knew it was made of steel rather than aluminium which meant it could be bent back to something resembling a straight line (aluminium can also be bent but it fails quickly after flexing). Some parts of this steel crankset were buckled and the only way to move those parts the few millimeters that were needed was with a punch (a small steel rod with a pointed end) and hammer, specifically a punch with a horseshoe-shaped point which, as far as I know, doesn't exist to buy. I had a choice, I could either order a new crankset at great time and cost to the owner or I could make a new tool- a horseshoe-shaped punch- learning a new skill in this process and charge the owner for only the 30 minutes it took to do the actual work of straightening the crankset. So I cut a 15cm length of 12mm diameter "01 tool steel" bar, shaped the end into a horseshoe with a set of drills and files, hardened it with a blow-torch (around 800 degrees celcius) and, when quenched and cooled, tapped the crankset teeth twice with the punch and hammer and they were free. The rest of the crankset took minutes to gently tease back into a working mechanism- as straight as it would ever be. I've never used that punch since and probably never will again but the feeling I had when it knocked those cog teeth free after those two light but thoughtfully placed taps from the hammer clarified this important aspect of mechanics to me- that of craft. Not only the craft of making a tool but the idea of craft behind the physical manifestation of the tool itself- I had to design and craft a tool imaginatively to solve a problem. My predictions, based on repetitive experience, provided the solution. To fix is to craft, the aesthetic becoming the ergonomic.