Let’s Talk About Death – breaking the taboos that surround suicide

Trigger warning: This article is all about death and suicide. It may not be an easy read.

The first time I thought about suicide was when I was eight. Leeds Utd had just lost to Chelsea in the FA Cup Final and the shame of trying to beat up my big brother’s cocky friend and collapsing in tears was too much. I was in the garden afterwards trying to focus on the beautiful cloud of butterflies landing on the purple buddleia.

And then this quiet voice wafted over me, landed and drilled into my forehead: “Why bother?”.

This question has haunted me ever since. And it probably haunts you. But we are not allowed to ask it.

In 1990, in the thick of my six year long 24/7 obsessive anxiety state, I thought much more about dying than living. It was not a cry for help. It was a wanting to be free of pain. The fantasy of dying was an escape valve – I assume a little like self-harm is for some people, though I wouldn’t know.

 

The Dabbler

I dabbled with suicide. I took some over-doses. I remember sitting on a bed washing down half a dozen paracetamol with half a bottle of whisky and calculating how much more would do the job. But what scared me more was the double pain – the stomach pump and possible liver damage plus the shame of coming round in A&E with my mother frowning down. What if I did not succeed? Why bother? Oh, irony.

I also remember wandering up and down Union Street in High Barnet for hours burning with anxiety about living and dying and eventually wondering into the path of a white van that had turned into the side street. But it was only doing a max of 20mph. I think the police that came were chortling at my half-hearted attempt. And I had fucked up the nerves of the poor van driver. I had brought one more sorry soul into my sick circle. What a shit I was. This proved it.

And so then there was the shame of thinking I was not even decisive enough to kill myself properly. I was a dabbler who was fortunate to stay alive in hindsight.

 

The Decisive

Back on the ward, Steve went off and hung himself in his caravan. Larry stole one night to the reservoir and drowned. Decisive. That was the way to do it.

So, there is my first learning about suicide – that there are different types of folk. Even in the mists of pain and suffering, there are different ‘styles’ of suicidal behaviour. Is anyone studying this? Or are we stuck in our simplistic ‘suicide prevention’ models – the ‘let’s talk’ or ‘breaking stigma’ approaches that allow us all to be smug – that raise Twitter awareness – that conflate ‘hits’ on a website with true analytical thinking about what works and what doesn’t?

If we truly understood what’s going on with folk as they near the brink, maybe we could have more subtle approaches, based on involving users in that work. Maybe this sort of work is happening – I’d love to know about it.

 

The vulnerable time

Lesson two about suicide came later. I was ‘recovering’, with the volume, intensity and frequency of ‘intrusive’ thoughts receding. So much so that my psychiatrist wanted to prescribe pills to prevent me from being too high! He thought I might turn psychotic.

When he realised that this was a positive turn of events, he ‘discharged’ me. I spent a few weeks popping back into the day centre to sit amongst my semi-comatose, drugged up, fearful but lovely compatriots. Then I was ‘discharged’ from that limbo-land. I was in the ‘real’ world that I had spent six years away from.

In that vulnerable state, with fewer lifelines, I was ‘getting better’. I was doing more, but feeling still like shit. This gap between behaviour and feelings – where to ‘act as if’ precedes the nervous system re-wiring – is surely the most potentially risky in terms of suicide. This time I had the energy to do it. I was stronger in some ways, and more vulnerable in others.

I went swimming again (I had been a competitive swimmer in my younger less fat with drugs years). But when I realised I wasn’t ‘enjoying’ it, I thought ‘why bother?’. Those buddleia days returned with a vengeance. I projected into the future. If I can do things but they don’t bring me emotional reinforcement, truly why bother? What is the point of life? What nobody told me – what all the myriad psychiatrists (and later psychologists and self-help authors) never did – was that feelings follow behaviours. That the ‘act of will’ (read more about ‘psychosynthesis’ please) can help re-wire sensation, emotion, feeling.

But I didn’t know that, and was both recovering and feeling worse at the same time. I wonder whether anyone is seriously looking at this. In the widening gap between the NHS and seriously under-funded social care, my guess is that suicide figures for this segment of the population may be increasing – anyone know whether this is true. Are the stats there? Anyone looking?

 

Ambivalence

My third lesson about suicide is how it feels when a loved one or friend does the deed. Many people reading this will know of Rosamund Snow’s calculated insulin overdose. She was probably in the Steve and Larry category. And in that respect I almost admire her deliberate act (careful David – taboo thought, you’re not allowed to say that. What the hell. I’m too old to pretend). But I also hate her for what she did, how she deprived us all of her talents. And I also hate myself for not being able to help.

It is this swirl of ambivalent and confusing feelings that is also not allowed of people close to those who decide to die. I hear people telling others who have been bereaved to ‘stay strong’. WTF? How? The need for strong support for the bereaved is my third lesson in coming to terms with suicide. And for those who have tried to kill themselves, to witness someone else doing it leads inevitably to comparison, to guilt of all sorts and the questions about ‘could I do it’? The answer is obvious to me now: Don’t. Just don’t. Trust me: Don’t. But boy the mind can weave some wearying diabolical pathways before you come up with that conclusion.

 

Four Lessons

So here it is, if anyone feels like taking the ‘mental health awareness’ message seriously and putting money where mouths are….

Lesson One: Recognise the different ‘styles’ (I can’t think of a better word, sorry) of those who want to die. Let’s learn to approach support in nuanced ways.

Lesson Two: Acknowledge the danger of the ‘recovery’ period. We need people not to fall into the gaps.

Lesson Three: Don’t tell people who have lost folk to suicide to ‘stay strong’. Go find them and give them space to share their feelings and words. Support them for more than a week or two.

Lesson Four is the one that has been slowly taking root since Dave fucking Webb scored a late Wembley winner that I still think was a foul. And my buddleia experience. That it is OK. Repeat: OK to think about ending it all. That is part of our life experience. We cannot control our thoughts, merely be mindful of them. Stop listening to the shiny shiny positivist ‘let’s be happy’ brigade. It’s OK to think about death, to think about life being futile, to recognise existential doubt.

And when it gets to a bad patch when these thoughts become heavier in volume, frequency and intensity, it’s OK. Repeat it’s OK. This too shall pass – slowly, painfully, slowly, painfully. But they can and they will.

I am glad I did not kill myself. But I think of death a lot. As my lovely uncle Robin once said: ‘what else is there to think about. Cucumber sandwiches’? If we don’t consider death, life is not worthwhile. Think about that. Those who don’t think about it, may well find themselves more prone to the kickback later of emotional suppression.

Good luck. Be gentle, wherever you are and whatever your tricky mind is doing. And: Don’t.

© David Gilbert 2017

If you liked this blog, do read more at http://www.futurepatientblog.com

For My Tired Friends – don’t give up!

My friends seem tired. Those ‘patient leaders’ – people with life changing illness, injury or disability – continue the slog with the rock up the hill. Those ‘patient and public engagement’ champions, ditto – professionals who continue to make the space for others to have difficult conversations and to influence resistant NHS cultures.

My friends, Simon Denegri and Jess Cunnett, two of the kindest, most experienced, wise and passionate ‘PPI’ professionals have both recently blogged their frustrations. The former about being deemed ‘too professional’ to be a ‘patient advocate’ and the latter appealing to a rekindling of a mindset that values people and simple conversations as the basis for PPI. This latter blog seems critical of the ‘engagement industry’ that can be self-serving and sometimes over-complicates things.

Meanwhile, I have heard about an interesting conference taking place about ‘mis-selling of PPI’ and the possible lack of evidence of impact. I laughed at first at the cleverness of the title and then felt undermined. I know it’s a joke. I know it’s well meant. I know we need evidence.

But it felt to me like another ‘why have I bothered’ moment. I imagined people in a room somewhere dissing what I have done for 30 years. Paranoid? Moi?

At the same time, I know of patient leaders who have been triggered back into illness because of the sacrifices they have made for this outsider cause, this unpaid, undervalued, under-invested in, impoverished terrain of work. I have written about the ‘emotional labour’ of being a patient leader elsewhere. Now is not the time though to brood…

Could these pent up frustrations, these sighs, these outbursts, be signifying a deeper shift in the patient movement landscape? And signal a need to double our efforts? While some of us see immense frustrations in breaching the walls of the citadels, maybe something else is happening too. Maybe this is what they call a ‘tipping point’. An over-used phrase – sorry.

Two weeks ago, 11 patient leaders in our Sussex MSK Partnership came together for a planning day to develop our fragile but emerging network – our merry band. Two have gone away (and come in to the office) to write role descriptions and welcome packs and to help plan the next phase of recruitment. We are developing information governance and confidentiality processes. I am writing guidance for staff on how to work with patient partners – two patient partners will be presenting at our staff conference the week after next on what it feels like to be partners. As one of them said, a long time ‘involved patient’: ‘ It feels like we are doing something special and different to what we were doing before’.

Meanwhile, at national level, about thirty amazing patient partners are helping to co-design a national patient and carer partners network – slowly, carefully, gently and trying to practice what we preach about how we work together along the way. Watch this space.

And last week, there was an amazing workshop with patient partners and health professionals at the BMJ-IHI safety and quality conference on ‘patient partnerships’, that I co-facilitated with the fab Carolyn Canfield, Alies Maybee and Jonathon Tomlinson. The freshness of conversations to me indicated a real hunger for an international network of patient partners. And Carolyn, Alies and their fellow pioneers are leading the way with a ‘Patient Advisers Network’ in Canada.

So, perhaps it’s not all doom and gloom. Perhaps the frustration is a sign that we are getting somewhere, that a new line of resistance is being drawn up – by well-meaning academics who demand evidence which may be useful, but could also stifle progress through an over-reductive approach; by intransigent activists who are not yet in partnership mode, by the unconscious blindness of people in the system who fail to see our value and continue putting up the barriers (we can’t pay you; we can’t invest in training; we just want feedback fodder). Maybe we are just more visible. Can we reframe our frustrations and signs of impact?

Maybe we are at the next stage of the struggle. I am tired too, I have to say. If someone were to pay me to write poetry for the rest of my life (fat chance) I would take it. But now is not the time to stop.

Yesterday was the clincher. I was at a leadership meeting of our organisation. We talked about difficult stuff – about the challenges of shifting the system and holding onto the vision of what we want to do with, and for people who we serve. I was bowled over by the passion, wisdom and insight of those around the table – people that I would have labelled a few years as ‘faceless bureaucrats’. To hear them talk about why they were in this game gave me fresh hope. I thought – I am glad I have fought back from two breakdowns this year to do this work. I don’t care what I’m called – a patient leader, a mental health service user, a PPI professional, a manager, an advocate… Whatever.

So, here we are. A NHS crisis. A world gone slightly mad. And the emergence of something fresh. It is spring after all. Vive la patient revolution. Excuse my French (grammar).

Onwards.

If you liked this blog, check out others at http://www.futurepatientblog.com

 

(C) David Gilbert, 2017

 

Let’s (Not) Talk About Depression

A few weeks ago, a friend said: “I love your openness about your mental health problems. But remember some of us are not in your position, some of us do not want to talk. And if I do, I am worried I may lose my job. I think the Let’s Talk campaign is wrong”.

It got me thinking.

Many years ago, I criticised the ‘defeat depression’ campaign, that tried to reduce stigma, owing to its heavy reliance on promotional materials that accentuated drug treatment as first-line therapy. Heavily endorsed and, in some cases sponsored, by big-pharma, it led, in my opinion to biased information materials that emphasised medicalised approaches.

I have more recently gently challenged the ‘zero tolerance of suicide’ campaign. I argued it risked being taken forward in a reductive manner. In a target-driven NHS at a time of competing priorities and confusing decision making, I worried that implementation would mean a loss of its intended holistic focus – concentration on preventing suicide would distract attention from upstream prevention. People would end up ticking boxes related to removing ligature points on wards, for example. I related this to my own experiences on the ward.

Now I have qualms about the ‘Let’s Talk’ campaign on depression.

Let me make myself clear: ‘Let’s Talk’ is a great campaign. It’s got a resonant title, it has no doubt been thought up by wise minds with real involvement of service users. It has been endorsed by celebrities and charities that I respect and admire. And, on the surface, surely it is a good thing – we do need, as a society, (desperately) to talk about the pain and stigma of mental health problems.

However, it is not that simple.

Some people are ‘introverts’. If you have not read Susan Cain’s marvellous book ‘Quiet’, please do. She writes persuasively about how we have shifted as a society, in our work, life and play to one that rewards and values ‘extroversion’ and the ability to be outgoing, demonstrative, collaborative and upbeat. We do not value those who ‘don’t talk’.

Meanwhile, it is intriguing that many of those who have ‘come out’ with mental health problems are those who have least to lose. This is no indictment of their courage. However, it is difficult to think that Stephen Fry, Ruby Wax or Prince Harry are about to lose their status or cred as a result of their bravery. Perhaps the reverse.

I am a Patient Director. My professional status has always been tied to my openness about my mental health problems. Yes, it has been tricky for me to re-negotiate my entry back into working life after having more breakdowns. Yes, it has taken an element of courage to talk about it. But what if I was not established in my career? Would I risk it?

Early on, I lied about my CV to get a job at the Consumer’s Association. I said I had been ‘freelance’ (which is quite funny really… I was seriously ‘freelance’ mentally). Many continue to have to fabricate their history, particularly when climbing a career ladder.

Add to this, that if you have depression, the last thing you want to do is talk. It is indeed ironic that the very trait that is so integral to the state of depression is the one that the ‘sufferer’ needs to stretch themselves to doing – and what if you can’t? What if you are surrounded again by societal messages – in your community, on telly, at the day centre, on the ward, when you go to your GP – that you have to talk. I would be well pissed off. It would make me more depressed.

And remember, for many who have had terrible depression and anxiety (like me), we have been told by mums and dads for years and years to ‘stop thinking so much’. Our inward facing minds, feelings and hearts, our sensitivity and fragility are characteristics that have often been left unsupported by a harsh society. The societal focus on ‘let’s talk, have fun, go to parties’ may have led to our depression in the first place! A campaign to tell us to talk more openly may risk exacerbating our feelings of shame – and shame is a huge issue for us.

And if well-meaning friends and loved ones pick up the ‘let’s talk’ message and interpret that narrowly, then I can well imagine dinner tables where family feuds pick up all over again: “Well, David, the doctors say you have to talk… Come on, son”. “Fuck off, dad”.

I know that is not the ‘intention’ behind the campaign. I know that there is a deep and holistic message underneath. I know that it could help support society to become more accommodating to those of us who have suffered – that a campaign like this can create more space – that it is about safety to talk. But I fear, for some people (not all, I hasten to add) that it can have the reverse effect.

I wonder whether the ‘Let’s Talk’ message will make people and parts of society – in particular those people who are well-meaning, but ignorant of what it means to have mental health problems – feel better about themselves. Perhaps, dare I say it, smug?

I once attended a spiritual community for a week. After one intoxicating workshop, a hundred of us held hands and circled round the room dancing. As the dance circle grew, we surrounded a couple who were having a quiet conversation. We smiled and cajoled, then urged (and in retrospect, bullied) them to join our circle. They were shamed into the ‘Let’s Dance’ campaign.

Let me repeat – I am not against the ‘Let’s Talk’ campaign. But I do have a hunch – borne of my own experiences – that, for some, it may have the reverse effect. It may secure some in their continued silence – through guilt, through shame, through fear.

And, when I meet my friend again, I am going to sit with him in silence and see what happens.

Let’s think.

 
If you liked this blog, or even if you didn’t, you might be interested in other at http://www.futurepatientblog.com – about mental health, patient and public engagement, patient leadership, and a bit of poetry…
© David Gilbert

Resilience – recent poetry

For those who like poetry, maybe even for those who don’t or are wary. Give these a try. You just never know.

If you are viewing these on a smart phone, the line action may be astray.

 

Resilience 1

When still within the story
or the unsteadying silence

or when at best
the only sound is boundless
time – its headlong whoosh – your bare foot on the floor
to begin again this long struck morning

the sky as unsure of itself as it was
above that day of fog and ocean, formless
yet skin tight round this land work of breath
or as it will be later – the storm’s eye –

restless cream and bestial mauve you take up
the shaky pen, unready for the next
line

The Wren

 

The wren
left the branch

like death – altogether lighter –
delighted to let go,

gravity become so
cumbersome.

Entering the trees,
I cannot see her now

on this unfortunate earth
as the foot stalls,

but somehow know
that the tiny black

blazing eye
follows me.

Pineapple

 

The sound of thought had died down
while he was eating tinned pineapple chunks
in their own syrup on his bed with a cake fork.

He knew that a spot of light rain was due
was glad he didn’t need to fetch more bread or milk.
It was always like this at the end of the season.

The tourists had fled and chip shops boarded up.
He would see his old mate pissing against a wall
and not know what to say to make it better

for either of them. If he had a dog, perhaps
he’d get more exercise, but middle age spread
was the least of his worries. He could end it

in The Netherlands, but knew he wasn’t such a dramatist.
He’d probably see things out closer to home,
a bit of Classic FM, pineapple (in water

– his tongue tingled. Maybe allergic)
view of the ocean. He was OK. Sometimes,
it was nice just to sit and not think too much.

The Plans I Had

 

I would build a rock pool
to see me through,
a smoothing waterfall
dedicated to the hours

where I would entertain
long lost cousins
with stories of how
mere words freeze time.

Stilled carp and lily pads,
definitely a bird table
with a pair of sprightly goldfinches
at a worn down fat ball,

my dad with his shirt off,
two-finger typing at his Smith-Corona
me and mum splitting pea pods,
tight in our summer corner.

I will become a footballer.
The house remain unsold.
I will not need to write
or build a rock pool.

 

A Death

 

It had carried us eighty thousand miles.
On our way to the End Of The Road festival
we had come to a halt by a rape seed field
after a seismic shift in engine temperature
and the arrow’s whizz around the gauge’s arc,
the volcanic bonnet spewing hot ferocious
yellow jets, everyone at me screaming stop,
then panicky behind the low and puny metal fence
artics bombing at us blind around the curve
waiting for somebody to answer the damn phone
hook us up to some local mechanical god
for life support, miraculous revival
or the heartless, now seemingly inevitable

putting down. Now we wait, late
aggrieved, bereaved in Enterprise Car Rental
near Poundbury, classic FM, paperwork done
with surprisingly good, complimentary coffee
waving to our tied-down, still hissy heap
on the back of Billy’s monstrous truck,
accelerating back up to the A35.
One of the kids wants a coke, the other
to be very very sick. I want bed,
weepy Susan a couple of photographs
of our never to be seen again (whisper it
‘dead’) 1999 Toyota Corolla
1.6 GLS silver (grey) automatic.

Resilience 2

 

Out of Ferny Hill along the A111
as it nears the roar of the M25
there are three hollowed out abandoned cars
one grey, one blue, one silver.

And you know what they say about abandoned cars.
And you know what abandoned cars mean, right?

They mean
the chance of again
dauntless blue rhythm from the songster’s throat,
a man who does something finally of consequence,
snowdrops that covered the battlefield
once Spring melted the snow.
The knife in the hand, dropped.
Sign at the edge of the bluebell meadow
that tells of ‘keep off’ and how

you’ve had it with that.
That’s what abandoned cars mean.
Don’t let anyone tell you different.

Avocet

 

I used to be able to sit
in damp wellies and blue kagool
under the rain-beaten corrugated iron roof
of a low cold hide scanning the Broads.

I used to be able to wait
for the waders to come sift at low tide,
their scuttle and wash of greys and browns,
dreams of Bellamy and Attenborough.

I used to be able to listen
for the curlew’s cry, tick off
the dunlin, knot and sanderling
in our tatty Observer Book of Birds.

I used to be able to see
through thickening hours of mist,
thermos and jam sandwiches without crusts
softening crisps on the tongue so as not to scrunch.

I used to be able to watch
the tide crawl back across the marsh,
risen flocks against the low red sun
and at last, an avocet.

 

Thin

Poets are supposed to be thin, as though the words they use feed off their bodies; their bodies shrink a few centimetres every day under the effects of all the images and ideas that fall on their heads. From Gertrude. By Hassan Namji.

 

I have eaten, but my metabolism is against me,
used to be good
at woodwork,

am not where I ought to be
on the scale,

dream of a salon
next to a kitchen
next to a couch
and looming gargantuan therapist,

wake, unblinking
to explosions of dust.

It is not just us.
Flowers grow weightless.
The room too small to house our travelings.
Moon heavy. Teapots gaseous.

Ingenious doctors are either
worried or insufficiently curious.

Scans reveal echoing beams
through and back and through
the walls of the machine,
me, a corona.

They need cause
though I may be useful
for the future of education.

My sister told me it would be so, then left me alone.
Nobody important visits.

Dog only knows – he is as thin as me.
We hover together across silent parks
distill, evaporate, become steam
drifting, hallelujah, over grass.

If you liked these poems, or even if you did not, try some of my other blogs about: healthcare, mental health, patient and public engagement, or maybe more poetry?

© David Gilbert, 2017

It’s Not All About You – why we need new stories about healthcare

Our stories about healthcare sustain the status quo.

We like our stories. Neat beginning, a little bit of mess in the middle and a coming through to a tidy end.

We like them now in healthcare. The pathway, the journey… those gentle phrases suggestive of our story being akin to a stroll through a meadow, rather than traversing Hanger Lane Gyratory System.

Narratives are common place in medicine. Story-telling has become part of the improvement methodologist’s toolkit. Stories have become ‘embedded’ in healthcare practice, some might say (and I would like to suggest) ‘co-opted’ by institutional forces.

It’s the way we tell ‘em…

Those who plan and design healthcare ‘pathways’ assemble in rooms to try to focus on ‘what matters’. Those in the room become both the tellers of the story and the protagonists. They craft a story that is inevitably and unintentionally, largely about themselves.

The centre of the story becomes the institutional citadel. It is a narrative about punctuated periods of crisis when outsiders (patients) get visibly ill and come seeking succour and ‘professional’ help. It is a tale of access to the technology of wonderment and diagnosis and the wizardry of healers at dramatic moments. Hospitals, GP surgeries, pills and potions, powerful sorcery.

If patients or carers are allowed into the secret room where stories are told and written, they can and often do, shift the tale. They will articulate those moments of sheer terror, the consequences of illness on identity, the wobbly quest for certainty, and hopelessness when met with deeper questions and prolongation of angst, the fear of power, long waits in the valleys of unreason, travails that only momentarily meet the therapeutic masters.

The locations of darkness lie outside the city walls.

Our ordinary story

My story began at school, continued at college and work. The characters are mostly friends who could not cope, mum and dad baffled by the fall from grace, brothers reduced from gods to bit parts, colleagues who laughed at, or cried with me. And many who simply disappeared.

It was about early fears that were not requited. Forgiveness not granted. Gentleness towards myself and others unable to be given. Long days and nights. My brain an enemy. My stomach and heart cut off. Like so many others. This story is not unusual. It happened in bedrooms, kitchens, playgrounds, swimming pools, shopping centres, gardens, and many many winding streets (literally and metaphorically).

And when it all became too much. When my suffering erupted and was noticed by societal guardians, I walked into the gates of hell. The psychiatric system.

And within the citadels themselves, it wasn’t always the doctors or nurses that I recall – it was the porters, the cleaners, the receptionists… who touched me.

It wasn’t so much the psych unit that helped heal me. It was the hospital canteen. It was the local Chinese takeaway. The park. Those places where I began to re-learn liberation and autonomy. Even the church I strolled into once where I met someone who became my dearest friend. The tale of coming again to belong. The stories took place elsewhere. Often far away from the ward and GP surgery.

Yes, yes, yes… And

Yes, the clinicians needed (and need) to be able to listen, to communicate, to explain, to advise, to support.

But let us not continue to collude in the wrong story. They have their walk on parts at significant moments of emotional drama – that is why they are remembered. Because our brains are wired to respond emotionally and rekindle those moments of emotion when re-telling stories. We are Dorothy. The story lies on the yellow brick road mostly.

And yes, relationships with clinicians and staff are critical. And yes, all professionals need to learn the art of walking alongside us. But it’s not all about them. In fact, it’s often not about them at all.

However, when I tell my story in healthcare circles, all most people want to hear is about the contact and relationships I have with doctors or clinicians. Or about my ‘experience’ in a healthcare setting. And often that is the bit of the story I tell. Why?

Partly, I suggest, is that it is uncomfortable to realise that those who usually gather in improvement circles do not have the power and influence to change things as they might. They talk about ‘what matters’. But if ‘what matters’ is my contact with friends, then they may be unable to divert resources towards those avenues, even if they want to.

Maybe it’s about fear? About their own vulnerability? About their loss of authority? About them being reduced to signposts to healing sources, rather than fonts of wisdom and knowledge.

Blimey – if I had been trained long long hours to think I was part of an elite, suffered through years of being treated badly as a junior doc, pumped full of amazing arcane knowledge, got to wear the white robe, then I would want to feel I could heal and really make that crucial difference. And in many cases, they do…. But it’s only part of the story.

Are people afraid that if I tell a deeper, wider, bigger story, that the importance of doctors, hospitals and drugs will be demeaned? That the natural corollary of my story is to pump resources into schools, parks, local spiritual enclaves, helping friends who can listen better, helping my poor mum and dad to cope? Who might be the losers?

The stories we tell about ourselves give us meaning. And sustain us. Or can betray us – I have learned recently that my story about my healing from mental health problems has been wrong all along. I did not ‘recover’. I learned to adjust for a while before succumbing again. I need to learn to ‘live with’. That is hard to tell myself and hear. My new story means I have lost certainty and am vulnerable to further periods of unwellness, god forbid. I have lost something in the art of re-telling. And/or maybe I am still within a story that is perhaps never-ending.

Telling the wrong story?

When it comes to healthcare, perhaps we are all telling the wrong story. Perhaps we are all prone to telling and recasting the story from the wrong end of the lens. If we continue to do so, not only will we continue to uphold doctors, pills and hospitals as the overly-powerful actors that they are. But we also risk maintaining a story of healthcare that is not fit for purpose in a cash-strapped age – that reduces patients to the bit parts rather than the main protagonists.

If we want patients ‘at the centre’ then we need to retell our stories about health and healthcare. There is a risk that story-telling – the meta-story of healthcare – is being co-opted by those who sustain power? Or maybe I am telling it wrong?

What’s your story?

(c) David Gilbert, 2017

If you liked this blog, you can find 60 or so more at http://www.futurepatientblog.com

You Who – an offering on ‘resilience’

There is a small miracle happening in Hemel Hempstead. I am watching my boy snowboard. And I can see him.

Two months ago I had another painful breakdown. When I came to see my boy snowboard, I could not see through the mess of my own mind, the blindness induced by the hell of my own estranged thinking.

Now I seem to have re-emerged. This is the second significant breakdown in a year, after twenty five years of being (mostly) OK. I have come close prior to this double episode – when I was bullied at a university, when the Centre for Patient Leadership dream died, but have got across the thin ice. Until last Summer…

This bout has been scary as well as shocking. I am reappraising my life, my work and how I look after myself. I carried on working at home, ‘acted as if’ I was OK when I wasn’t, and… despaired. Well, you know the sort of stuff if you’ve been through it. And if you haven’t, well lucky you.

I have also been asked, as writer in resident at the wonderful Bethlem Gallery, to pen thoughts on ‘resilience’. It is a word I am not comfortable with for many reasons, not least because it implies an old style mental toughness that I don’t have. Bouncing back is also a poor analogy for what I have been through. Maybe it is mere ‘adjustment’ but that seems banal. It is certainly a ‘coming through’. It is the walk through fire. It is the stripping down. I have gained and lost. And vice-versa. It is all these things and more.

I was not sure whether to write a blog. Or a poem. This below seems a combination of the two. I hope it helps a little to those going through it. It is also written in anger. Rage almost, at those who pretend to know and due to their unknowing, pontificate and academicise suffering. To those in power who will not open the gates of the citadels to the deeper wisdom of those who bring back jewels from the caves of suffering. Our call is growing. But I shall leave the politics for another time.

Anyway, here it is, whatever it is – an offering….

 

You Who

 

you who

have been through so much
have been turned endlessly inside out
have had your identity blanked at the border of normalcy
are still within your story and do not know what…
have been bankrupted
torn
become nocturnal
sweat and come to know the rank sweet smell of your own pillow
cry for rusty miracles and dusted off kindnesses
feel to the bone and muscle and nerve
what one bloody step counts for
who wait and wait and

know

that there are fearful readers of your life who do not understand
the pretty island story-tellers
who shrug and cannot land
who do not love and do not listen
yet give and give of their own spittling words
and light cold foreign fires
that smoke for blanketing years
and yet you pay them your grave
attention and grace
for their worthless weavings
and power and insouciance

come

away to the elsewhere
the softness of your eyes
and purple darkness behind the moth lids
shift the look slowly right then slowly left
for a moment open
then days and days until
the belly begins its tentative fall
and though the haunts of thought
will stalk you when your blossomy look
finally sights the green
stand stand and breathe across the graze of thorn
know that the most toughened fences of wire bend
that this is coming yours – the field –
the precise centre of the else and un-
greened field
you’ve always felt for

then
let’s gather at the edge

 

___

(c) David Gilbert 2017

 

If you liked this offering, or even if you didn’t, see more of my blogs on the NHS and on mental health; and poetry at http://www.futurepatientblog.com

 

Can I Ask A Question? The travails of a grumpy old git

I used to think it was easy to ask questions. Easier at least than providing answers. Now I’m not so sure. Asking truth of power risks further hurt.

When I was 15, I asked my parents whether things were OK. I sensed the vibes. My mum said that I was thinking too much, and of course everything was alright. Six months later my parents divorced.

Perhaps from then on, I’ve questioned the validity of my insights, sometimes getting it horribly wrong. Sometimes horribly right. I’ve always looked to others for advice and got paralysed when the plethora of well-meaning, but subjective views of my situation conflicted.

Lately, I’m asking lots of questions of NHS power – whether a man should lead a specialist women’s trust; about the concentrated policy clout of ‘thinkies’ as one friend calls the think tanks; and of course about why patients – those who have had life-changing illness, injury or disability – have no power in the system.

Grumpy Git

I find myself particularly irritated these days – and there I was imagining a mild middle age with pipe and slippers. Sad grumpy git. Maybe I’m still not quite balanced after another shitty time of terrible anxiety. Or maybe I am just flexing my professional authority (???).

Maybe the questioning is indicative of me getting older and feeling nothing is changing. I know social movements take an age, but FFS when is another organisation going to pick up the baton of Patient Director role? It’s a no brainer – see my recent blog.
But what gets my goat most is that patients have no part in policy making. I know Simon Stevens means well. But I see little seriousness from him, despite the rhetoric, or from ‘thinkies, from clever social media commentators, or ‘movers and shakers’ that give me confidence in the direction we are travelling in.

This at a time when wonks come on the radio and say ‘the public has to decide’ about the future of the NHS. Well, if you don’t let us in, how can we?

But maybe the tone and framing of my question is wrong – maybe I should phrase it more politely? ‘What will help patients to be more involved in policy making?… Mr Stevens? Please? Hello? Hello?…’ When nobody is listening, when you have no power, what can you do but try to shout a little louder?

The questional hypothesis

I have come up with a hypothesis – that, if you feel powerless, that the closer you are to decision makers the further away you are from asking difficult questions. I call it the ‘questional hypothesis’. You can challenge Trump safely on twitter and feel that you are doing something. But what about challenging the local authority about litter? Or making a complaint to the NHS? Or tackling neighbour’s about the noise. Not easy. Better to keep your head down. Quiet life tablets.

Look at how difficult it is for a women interviewer to ask a tricky question of a middle aged white man in charge of a football club. You get threatened with a slap – of course it’s a joke… or is it? Who dared question Fergie? Or now Mourinho?

Equalising power in the room is the answer of course – taking the time to facilitate trusting relationships means safer environments to ask questions – but you’ve got to be in the same room first. It is hard long work trying to even out power relationships.

But then the opposite danger is apparent – cosiness. You love everyone so much that you won’t challenge at all. This is why powerful and wise organisations prefer to have people ‘pissing from inside the tent, than outside’.

Anita Roddick said she kept the door open for mavericks to challenge her because she knew the dangers of over-cosines and group think.. Meanwhile Elton John realised he was going mad when he wrecked a hotel room that had the wrong coloured flowers. He noticed that not one of his minders raised a finger to stop him.

That’s why we have to ask questions. Always. Forever. Never ever give up.

I am tired

But it is wearying. It’s part of the emotional labour of being a patient leader (or any other disrupter of the status quo). You become the lightning rod for other people’s anxieties about the questions you raise. People – particularly those in power – can pile in and try to bury the questioner as if they hold a view contrary to their own.

I am tired: I am tired of thirty years of saying ‘what about patients’? I am tired of seeing the same arguments come round and listening again and again to my spiel about how to do engagement. I am tired of running focus groups that won’t change anything. I am tired of pointing out that it is the same folks in the NHS and think tanks that dominate public discourse.

I am tired of seeing defenders of the status quo puff themselves up over invitational breakfasts or leave just after their event presentations before the speaker on co-production – yes Ally, that’s for you 🙂

I am tired. What was the question? Can you keep on asking?

If you liked Ines this blog, see more at http://www.futurepatientblog.com

 

(c) David Gilbert 2017

 

 

 

 

 

The Forgotten – how non-clinical staff are the key to a better NHS

Andy, who was later to hang himself had put his fist through the window. The trail of blood from the window led down the corridor of the psychiatric unit. While all clinical staff were deployed chasing him out to the car park, with their readied needles, we ‘residents’ watched the drama unfold. The only person that helped calm things for me, was Mandy the receptionist, who sat me down in the ward entrance area and made me a cup of tea (sugary).

I have written more about Mandy et al here

Non-clinical staff – security staff, fire officers, receptionists, porters, admin folk, even those nasty ‘bureaucratic box tickers’ called managers – are as forgotten sometimes as people who use services. How would the NHS function without estates managers, HR professionals, finance experts, those who run the show, who have a public image that lies somewhere between politicians and estate agents.

Even the title ‘non-clinical’ defines them by what they are not. It isn’t asset based, that’s for sure!

I’ve just read an article suggesting that the NHS might consider saving money on the ‘soft jobs’, such as chaplains.
There is little evidence of the ‘impact’ that such roles have on quality, safety or patients’ experience. But in this frenzied system, where what is measured matters, you can bet that there is not a whole lot of money going into validating the role of such folk.

Absence of Evidence

The system’s perpetual focus on clinical delivery (and money of course) is exacerbated by a research industry that focuses almost entirely on the clinical. It’s an absence of evidence, not evidence of absence. Any work would also need to focus on ‘what matters’ to people who use services. And the chaplain at the psych unit was my only visitor most days, when I had lost my identity, my health, my job, my relationships… Almost my life. How do you want to measure that?

I’ve done some work in this area professionally. I ran the first national survey on GP receptionists when I worked for Which magazine. We asked receptionists and patients for their improvement priorities. Surprise, surprise, they were almost identical, with receptionists also wanting more knowledge of clinical issues (perhaps because they felt in the frontline, having to ‘screen’ patients inadvertently sometimes). Many told us about how hard their job is. I’m not sure I would want to be one.

At the ill-fated NHSU, we explored patient and staff perspectives of non-clinical staff to generate standards of ‘supporting care’ (I need to fish that one out – see below). And while at Croydon PCT, I kickstarted a project to find out what non-clinical staff (and clinical staff) learned from patients through their ‘thousands of everyday conversations’. Unfortunately, the new Director of Community Services scrapped the project just after we bought 10,000 post-it notes that we’re going to be used in staff meetings to record their learning. I wonder if they are still there?

The non-valued clinical staff still are.

Why I took the Patient Director role

When I learned about the Patient Director job at Sussex MSK Partnership, I was invited down for the day to meet folk. It was cold, it was a dawn ride around the M25, and I had a heavy cold. I wasn’t sure about the job. I met various lovely people.

Then I shadowed Stephen Cracknell, who was then what we call a ‘patient care adviser’. When we receive GP referrals for musculoskeletal conditions, an expert clinician ‘triages’ (assesses and screens) the referral and decides whether the person should come to one of our ‘community specialist clinics’ or be advised to go to see someone in secondary care (the hospital). Then it’s people like Stephen who take over.

The PCAs get in touch with the patient by phone or letter, offer an appointment and handle any queries on the phone.

I was intrigued. I had never worked in a service that so relied on such people and who were integral to everything it did. I listened to Stephen handle calls, leave messages, answer difficult question, keeping his calm, and sorting out tricky problems.
Here was an ‘expert’ who required the skills and qualities of the top end of ‘customer care’ services. And, if they were in this close contact with patients, then surely they could also be a ‘sponge’ for learning about what matters to patients and carers. Their thousands of everyday conversations could fuel any ‘patient experience’ work we (I was beginning to think ‘we’ by this time) could do.

But there was one more thing I needed to know. I asked Stephen whether he enjoyed his job. Staff experiences and patients’ experiences go hand in hand as you all know. He said he loved it, that his team were all friends, that he enjoyed being of service and got a real kick out of supporting people.

And that’s when I decided I would apply for the job.

The above is a story I tell regularly, partly to embarrass Stephen. But also to remind us all why we are here.

Time for an exciting piece of work

Now I have the opportunity to be part of a project that could help Stephen, the PCAs, other non-clinical staff, and of course the people we serve. The local CCGs (Brighton and Hove, Mid Sussex and Horsham) have agreed to make a project called ‘Supporting Care’ one of three CQUIN projects for 207/18. This means we will get additional funding for Focusing on this aspect of improving quality – supporting non-clinical staff to get even better at providing a great service.

We will focus on:
• Patient Care Advisers and phone contact – including their ‘contact’ skills, signposting abilities, etc
• Receptionists – including their welcoming of people, but also how they can improve the environment, etc.
• Other corporate staff – for example, how do people in ‘backroom’ roles keep connected to ‘what matters’

The project will be co-produced with our Patient and Carer Forum, Patient Partners and of course staff (clinical too!). We will explore the issues (partly through surveys and qualitative research) and come together in June to think through some ways of improving quality. It’s going to be fun.

Can you help?

This is where you come in: Do you know of any work that explores these issues?? In the health or non-health sector? Do you know of any ‘standards’ or ‘values and principles’ that have been generated with, and for, non-clinical staff? Do you have ideas on how we can explore what helps and what gets in the way of these good folk delivering a great service?

I am not interested in work that is about ‘beating up’ staff for doing a bad job – of course, we need to know what’s going wrong, but if we don’t, in the work itself, model the relationships we want to see at the ‘frontline’, what’s the point? We are all under enough pressure as it is. Nobody is trying to do a bad job, and few in the health service feel valued as it is. This is a chance to celebrate great practice too!

I’d love to hear from you. Please get in touch with me at david.gilbert3@nhs.net

Let’s remember the forgotten, this time before they fall.

If you liked this blog, please see my other 60 or so posts at futurepatientblog.com

© David Gilbert 2017

What’s Stopping You Appointing A Patient Director? An open letter to all healthcare organisations

Dear Chief Executive

What’s stopping you appointing a Patient Director?

I know you are struggling to keep your organisation’s head above water. I know the demands of the system and the seemingly inescapable tide of pressures – the demographics, the ‘expectations’, the limited capacity, the desire to uphold and even improve quality and safety. The money. The money.

I know you want to ‘put patients at the centre’. I know you do all you can to ensure you gather patient experience data, set up involvement groups, ‘involve’ people in decisions, satisfy the seemingly voracious ‘demands’ of the ‘the public’. The media. The money.

I know you have a patient and public involvement lead over there, reporting somehow to the Board. I know you have a patient experience team over here. Both sets of people up to their neck in trying to ‘engage’ and influence upwards – to put patients on an equal footing.

I know you have the Board at your back, a Chair who believes that the values of the organisation need instilling a vision that focuses on quality. I know you have patient stories that move you all, at the beginning of each board meeting, that sets the tone (you hope) for all subsequent conversations.

Back at the ‘coalface’, your clinicians are shifting towards believing in, and supporting, shared decision making. Trying to encourage supported self management and linking up with health and well being initiatives in the community.

So, why not take the next step?

In all parts of the country, the patient movement is growing. There are ‘patient entrepreneurs’ inventing apps and social entrepreneurs, community development activists, people with ‘lived experience’ gathering in pathway redesign meetings, moving beyond just ‘telling their stories’ – staying in the room to reframe problems and come up with new insights and angles; using the wisdom they have gained through suffering – wanting not to shout or merely have a ‘voice’ any more. But to be true partners.

And you want to do ‘integration’, be up there with the Vanguards, keep abreast of the agenda from STPs, and somewhere in your heart, you know that it is patients – those who know about fragmentation, lack of consistency and coordination – who could be the glue that provides the ammunition for peace. They could help stop the warring partners fighting over who needs ‘control’ of the system. Maybe it’s time to let go a little?

You’ve been to the fancy conferences, you’ve been inspired by folk who have been doing good stuff in patches. You’ve begun to notice out of the corner of your eye, a new breed of ‘patient leaders’ – those who have experience of life-changing illness, injury or disability who want to influence change. And they want to be partners.

You have begun to realise perhaps that the old way of doing engagement does not work – feedback mechanisms that don’t focus on what matters, or fail to have impact, and focus group reports that sit on the shelf. You are tired of hearing about committees where a ‘rep’ bangs on the same drum month after month. You may even notice that it is the very structures you have that are preserving an unnecessary status quo – that keep a ‘them and us’ that situates people perennially on the circumference rather than ‘at the centre’.

And yet at the same time, you are distrustful that any one patient can ‘represent’ others (isn’t that what a Patient Director does, big time?) and are beginning to wonder if there is a way out of this self-fulfilling and vicious cycle – poor ways of doing engagement don’t work, so why bother at all. Let’s keep the façade and get on with the real work, every day service delivery, maintaining quality, governance, improvement… The money. The money.

And the real decisions keep on taking place in secret. You’re uncomfortable, because you know there are tricky times ahead. The STPs all posit huge change. You want to engage people, but you don’t know how. Everywhere there is fear about public ‘opposition’. You want to ‘educate’ the public, know (perhaps?) you should have involved them in the first place, but aaagh, how?

So, take a look at what we’ve done in Sussex MSK Partnership. When the CCGs put out a contract for a partnership to oversee the entire musculoskeletal pathway and to make sure ‘patients are in control’ through an emphasis on supported self-management and shared decision making, they went the step further – they appointed a Patient Director at executive level.

The Patient Director ‘represents’ nobody, not even themselves. They are there to ensure that there is a culture and systems that embed ‘patient partnerships’ in everyday business. We are there (I have an equivalent in the Eastern partnership, Anne Sabine) to model the relationships at exec team level that should be shared throughout the culture of the organisation. We are there to broker opportunities for patients at all levels – at corporate and pathway governance level; in improvement work; in training; in induction; in values and vision work. And more…

It is not perfect. We are still learning and evolving. But the early signs are good. On each of our three CQUIN projects for 2016/17, patient partners contributed to design and delivery of work on pain services redesign, shared decision making and patient-centred outcomes. We have eight supported, trained and valued partners who will meet next month to decide how to move forward and how to bring along others – and how to link to the two hundred patients who have volunteered to be ‘more involved’.

These patient partners are becoming a fixture whenever quality or safety is discussed – they are not ‘reps’ and they do not displace other engagement or patient experience work – but they are supposed to be in the room when decisions are made – the aim is to share power. And the joy is seeing clinicians, non-clinicians and patient partners in the room together exploring why they hold different views, going beneath the surface, checking their own and each other’s assumptions, being vulnerable, staying at the table for difficult discussions (The money. The money) and coming up with new ways of doing things.

This year’s CQUIN includes a piece of work to support non-clinical staff to improve patients’ experiences. And the team that will do the work will include all of us – patients, receptionists, administrators, clinicians, etc. That is why I have kept going through dark times this year – this is why I hold onto the light. There is a heart and a mind and a wisdom to this work that I have seldom seen in thirty years of ‘doing’ involvement.

I would say this wouldn’t I, but I do not believe we would be where we are in just two years of a new partnership, trying to transform and deliver services for a catchment population of three-quarters of a million population, if there was not a Patient Director. Someone who could help oversee the various strands of patient-centred work and broker these sorts of opportunities. And believe it or not, it could save money – piloting of a new appointment system has been estimated to save thousands of cancelled appointments. The money. The money.

It is also the right thing to do, ethically, morally, philosophically, politically, personally, professionally. After all if you were a man leading an organisation made up entirely of men that was devoted to women’s rights, you wouldn’t just set up a couple of focus groups, get a ‘woman’s involvement’ lead, have a ‘women’s sub-committee’ and have emotional ‘women’s stories’ at the beginning of Board meetings and think that was really ‘putting women at the centre’.

The more I think about it, the more ridiculous it seems. There are 209 clinical commissioning groups, 136 acute non-specialist trusts, 17 acute specialist trusts, 55 mental health trusts, 34 community providers, 10 ambulance trusts, 7,674 GP practices, 853 for-profit and not-for-profit independent sector organisations, providing care to NHS patients from 7,331 locations. There are also dozens of national agencies, regulatory bodies and think tanks, etc.

That’s a hell of a lot of organisations wanting to be ‘patient-centred’. Yet only two organisations with Patient Directors (NB. There is another brave trust, Sussex Partnership Trust that is employing user/carer leaders in their business teams). Not really good enough, is it?

It all adds up: need for new engagement approaches + valuing patients for what they bring + creating opportunities + supporting people …. ++++ patient director = a better way of doing things that can help heal the healthcare system.

So, what’s stopping you?

Let me know, and I’d be happy to help and I’m sure our fellow patient partners would too.

All the best

© David Gilbert, 2017

If you liked this blog, there are lots more at futurepatientblog.com 

Poetry In The Mean Time

I haven’t been able to write a blog recently. Hopefully soon. So here are some more poems written in the meantime and mean time.

Once An Avocet

I used to be able to sit
on a rough wooden bench
in a hide on the north-eastern point of the Norfolk Broads
with jam sandwiches
and big binoculars
and big brother in his grown up kagool
me in my knitted light blue jumper with a white hoop
waiting for the waders
to come sift the marsh at low tide
water still sloshing in my wellies
and the tatty grubby print tacked onto the gnarled wall
depicting knot, sanderling, curlew, oyster catcher
the wind throbbing over the corrugated iron roof
thinking about what would be on telly
dying to itch my bum
heroically still for nature’s sake
because, beyond anything and football
I wanted to be Bellamy or Attenborough.
Was it worth it? It was cold.
Sometimes we saw the usual
muddy greys and browns
red legs, yellow legs, tall, squat, long billed, short, slow and the quick
once an avocet
which we ticked off in the Observer Book Of Birds
the marvel of a flock lifting simultaneously against the dying sun.
Mostly it was tedious as hell
particularly when we had finished the cheese and onion crisps
which we melted on the tongue so as not to crunch.
But I used to be able to sit.

Reasons Not To Believe

That distant dot at dusk twinkles
like a low fractious star.
We bely our freight.
Thought’s drag is heavier than tide.

Outlandish promises reveal themselves
vacuous as great aunts.
You knock on wood three times
for nought.

See the bells that do
not chime.

Here’s a trick you need to learn:
Watch that star approach
and turn to plane.

Takes

The park is quiet.
I have the birds to myself.

I’ve been told crows
remember the faces
of those that disturb them.
I’m in no mood.

Enfield Borough Council has taken five days
to strip down and polish the wooden gate
and barred the way to cars.

Oz, the café owner, friend,
takes the piss and reckons
he could have done it in a day.

I’m not complaining.
And nor does the wren on the post.
The lake is not scummy with crusts
bins far from overflowing.

I am new to this business
of nowhere. I want cake.

The book says it takes weeks, if not months
to disinvest from thought
and re-inhabit the resulting emptiness
with a different sort of presence.

But for the first time, I notice the sign
‘c u ion idth estricti n’

I have new glasses – the woman at Specs Direct
said they take years off me.
We talked about therapeutic optometry.

A man with a white parrot on his shoulder
orders a coffee and three scones.
Cream and strawberry jam.
I want to break into applause.

How long does it take for a man
to take a minute for himself?
Oz tells me the surveyors
have OK’d the re-opening of the gate.

The Open Field

It has taken me 34 years to walk out
through a broken fence
into the middle of an open field,
hills to one side, ash trees to the other

through the body’s inchoate fear
into the open presence
getting used to these new lenses,
a trail of lugubrious, undulating crows

against the vast grey dome
of transaction, restlessness and flight,
knowing I am alone
and alright

Back In Town – an everyday tale of resurrection

 

I would better recognise this place
if there were a dove
or some mad man broke from the cover of that hedge
and screamed hallelujah.

Failing that, a pigeon would do.
The weather is nailed grey
everything levelled out.

They’ve planted saplings by the rails,
the old church is surrounded by fork lift trucks
as if they’re getting ready to up it into the sky.
And my favourite wine bar has gone.

Maybe I should not have come back.
I know that this is how it has to happen
like everyone with cancer must wake at 3am
alone at the alone time
the hours having moved before they were ready.

All stories of beautiful returns are lies.
They are uneventful
and rely on witnesses
you don’t often see at this hour of the morning.

Take that man on the bench
as he sweeps his thumb across his screen.
Been out all night.
And even if he looked up,
wouldn’t know me now from Adam.

There’s a broken sign, its arrow
leaning into the ditch.

He knows and I know
we may be equal, but we are still restless
that what we recreate is as meaningless
as what we have dismantled.

I want to tell him
love is glue. But
it looks like he will have to re-learn
the hard way.

For now, the chances of such meetings
are hardly propitious.
And I need a good breakfast
before it all begins again.

Elephants. Fragile.

Not yet. You are not yet ready.
They are not yet ready for you.

This morning, the warm hold of the small room
Haydn’s sweet piano through your ribs
making you think of playgrounds
and suddenly tears.

The white sun through the condensation on the glass.
The window jammed.

You waited in the silence.
The scary, crazy silence.
You tried to scare yourself with thought
and its drilling down
and when done for a while
you tried to scare yourself with silence.

Walk eyes down.
Eyes down.

The white painted cross on the pavement.
The builder who ‘fuck it, I left my fucking new phone at fucking screw fix’.
The ‘First Class Garage’.

Last night, you read of the island in the Finnish archipelago
and the adventures of grandmother
lying down and watching the feather
loosen itself from the blade of grass.

This morning, you got ready slowly.
You wanted the words for a story of yourself:
Lightness. Tentativeness. Nothing quite expressed –
vulnerability not quite.
Resilience. Re-silence-I.

Then you remembered when you moved house.
Stacking the small wooden figures in little boxes marked:
Elephants. Fragile.

Field Trip

On the botany field trip to Abergavenny
we paired up to investigate the flora
of an old cemetery with yellow lichen

spilling greedily over the grave stones
obliterating names of husbands and wives.
(Remember, they are half fungi, half algae,

living in symbiosis. They love the south.
Healthy growth is a sign of unpolluted air).
We threw quadrats into the long grass.

I like to imagine that I could still name
each specimen we found. But I can’t.
This was the morning of that famous last night

we got drunk with girls from another school
who we wouldn’t see again, holding hands
as long as we could in the dark.

The Path Has Dried

The path has dried,
green moss grows on bark.

There’s a flurry of leaf litter
and sun through the chill.

I can make out the markings
of a sparrowhawk, low

over the field, I would
not have seen last week.

To be the rain

slipping from the cold
grip of the sea
discrete, almost invisible
drawn by the heat

gathered into the hold
and urgency
of the tightening cloud
and its atmospheric thrust

then departing again, hurled
as indivisible sheets
through flights of birds

released, unfurled
enveloping earth
like a lover returned

© David Gilbert, 2017