Comparative faith

 Who says the Middle Ages were all dark? 

There was religious fervour 

Lots of exclusively male spiritual events 

With music or chanting 

https://m.youtube.com/watch?v=kK5AohCMX0U

And we are just going through the same phase which is nearly happening a few hundred years later similar to gap between the start of it all 

https://youtu.be/-cicQ_wp02Q

The adolescent stage of religion 

Full of recklessness

Dangerous living 

Arguments with other who don’t get you 

Full knowledge and absolute conviction 

Acne

And some of the most wonderful art and songs

Autonomy

 It seems strange to others that this is the stumbling block

Not the security situation ever fragile

Not the financial situation so divided

Not the systems or lack thereof

No 

The concept of secrecy being the best medicine

The deeply engrained concept that knowledge leads to loss of hope

That if only loved ones are kept in the dark they will not give up 

And that in their ignorance hope remains alive

The vast majority of my medical career has been practiced where the reverse is hammered into our brains

We attend courses on how to do it

We observe seniors

And are observed and signed off before being let loose on patients alone

Autonomy is the goal

Knowledge is the only way to consent 

Consent the only route to treatment 

And only if discussed openly can wishes become the whole team's aims

I was the one who explained the scan to my mother

I was the one who translated medical jargon into steps and durations

"You can tell me, I will not break down don't worry" she told the consultant on the phone informing her that nothing could be done

We had four weeks 

We all dropped everything and moved in 

We screamed, shouted, cursed and cried 

There were nights of truths never previously spoken

And our relationship with each other will never be the same again 

But

As she lay on her bed with two daughters curled up on the ground on either side of her bed

She whispered "time to sleep girl"

And there is peace in knowing we knew she knew we were there because we wanted to be

Maybe in a few centuries

 I remember the events with such clarity

Thats what happens when you are shocked

I am walking along the crowded narrow side road in Shorja with my mother

I am 13 or 14 years old

Suddenly I am jolted by someone's hand pressed between my legs 

I am so taken by surprise that it takes a few seconds to actually register what has happened 

By the time I turn there is no-one there, it is too late and I later realise that I am never fast enough to actually see the person let alone do anything about it

Once I slap my arm around frantically after another episode and strike an older woman behind me, our eyes meet, I am bright red she nods and I know she understands but whoever it was slipped in and out of the crowd.

I start to avoid the entire area, and try to get out of going there

When there is no way out, I dress in the baggiest ugliest clothing I can find, including my father's oversized army sweaters

I take to carrying a large bag strategically positioned to completely cover my back from the waist down to the thighs (an only slightly less shocking grope was hands pressed into my waist or almost encircling it)

The last time I remember being manhandled was in the airport the last time I flew out of Baghdad, without my trusty bag and last in the family line I remember thinking the tall man had a strange look about him, but was too afraid that he was an official to say anything before settling into the flight knowing the groper was on board with us.

I try not to recall these memories

The behaviour of my male countrymen was one vital factor in the sense of being "home" when I eventually settled here, the first time I sat down in a coffee shop alone and relaxed knowing that what I was doing how I looked or dressed mattered not one bit to anyone else.

So why the resurfaced memory?

In the early hours of the morning of the 1st day of this year I picked up my 19year old daughter from a new year's eve party she had been to in London, and sensed she was seething

It took a while on the drive home for her to tell me what had happened that night, and at times before that

The leering, the comments, the drivers slowing down as she walked to school

Then the number of times she had swatted men's arms off her waist at parties, asking politely to be left alone, and then less politely if they persisted 

Tonight one of the offenders was on the receiving end of every single curse word she had learnt in her life in Arabic.....

After I calm down 

I try to rationalise to myself

At least she isn't being groped in the street in the daytime 

And she has the confidence I lacked to deal with it 

But that does nothing to the sinking feeling in my stomach...maybe in a few centuries's time....we will be safe

Letting go

 

One year ago

Linked chain 

Pressure like none before  

Crowded cluttered 

This doctor daughter

Breaking the news 

Predicting

Secret pains spoken 

Old ones poured into journals 

Telling Me not to cry! 

Asking Me not to get upset! 

Your mind sharp

Lapsing into Arabic 

Asking the vicar if he was from the Church at the “Rass El  Shareh”

Sleeplessly failing 

To keep the fragile shell intact 

Anger erupting  

Running in the rain 

Soaked under the tree in the cemetery 

Screaming at the sky 

Cursing whatever 

Out there allows such agony 

Tears spent 

I return

“What is today?” you ask

“Why does dying take so long? ” you ask 

In under a week you were ready to let go

In under a year we have all let go…..

One click eternal

Don’t read too much into it 

It is a most extraordinary time 

Ample alternative explanations 

The edge there all along 

I would have jumped 

Even if not pushed  

Lifted for a second 

Off the ground 

Light and lightheaded 

Smile so wide

More than I have for half year or more

Looking back so far back 

Thirty years or more 

Innocence and indifference 

Choices and decisions 

When I thought I could have it all 

Laughter bubbling up inside 

And then 

A moment when my stomach is left behind 

As I stop....then fall.....faster and faster 

Panic overcomes me 

I flail clutching at hope eternal 

And fall some more 

Just before I crash 

“Hi”

A posy

A warm feeling 

I accept hope eternal

I sway on the edge again 

I see the ravine now 

And it is oh so tempting 

Our Nuha

 https://www.c-span.org/video/?181127-1/baghdad-diaries-womans-chronicle-war-exile&fbclid=IwAR12p6uuxWRCx_M78PgbUUZkigzIQSK9GW7KCNxlW9bTqWgH9YfYCK-OLM4

Shared by her sister in law and copied here 

How long ago this was 17 years already 

There is something so very different about a video a recording of the voice the intonation the send of humour even in the darkness 

Ah Nuha..... rest in peace 

All medical advances since Spanish flu pandemic wiped out by COVID-19

There is an eerie silence about the world.

I love the clear sound of birdsong without the noisy cars and planes

But hate the distancing we all have to practice

I have for the past five weeks been repeatedly reminded of a different time, a different place
Of the 1980s war the silence after the sirens went off as we waited for the sounds of the fighter planes overhead

Of the months spent at home when university was closed during a particularly hideous battle and all male students where drafted in and taken to training camps

Of Dhuha my very first patient with acute leukaemia, trying my best to treat her during a war, under-treating because to give full dose would render her so ill and we didn't have what we needed to support her through, two months of directed transfusions from staff and family fresh blood when platelets were not available, taking her into the office in "isolation" every day when the hospital became full of visitors to protect her from catching an infection

I am on the face of it coping better than my peers I feel that I have been through this before and know that somehow we will find the inner strength to overcome

Other younger colleagues are in a state of shock at how quickly the world has changes
At how fragile our existence and all we take for granted really is

It will take many months to recover I say to them....
It is going to get a lot worse, before it gets better.....
It is best that we stay in the hospital for a week at a time and alternate rather than all be here at the same time....

We have like every other hospital lost around half of our staff through prior ill health meaning people are at risk of working, through illness, or the illness of someone in their family.

We have discovered the joys of zoom meetings (and got to see other people in their kitchens and what art people have on their walls)

We have brought in a temporary mortuary, ours has even been in the news after the team from podiatry were redeployed and had the duty of moving 40 patients into the new premises after a particularly bad weekend and published details online

We have wards that you can only enter after you have donned goggles, mask, full gown and gloves, and where everyone looks the same and it is difficult to speak, or be heard

We have five times as many ITU beds as we used to, with ventilators in surgical wards, in cardiac wards and in theatres

We have at last count 200+ COVID patients, nearly 60 in ITU

We have daily meetings where a team go through the list of thirty or so admissions from the day before and assign for or not for ventilation decisions based on risk factors (age over 65, diabetes, high blood pressure, prior lung disease, smoking, obesity) if you end up being ventilated and you have these risk factors there is a 70% chance you will never wake up, and when ventilators are scarce and patients stay on them for weeks a decision is made on admission that ITU will not be called even if you deteriorate

We have rows of patients all with the same disease, pale, hot sweaty with purple lips gasping for air in bays of six beds separated now from the corridors and nurses' areas by rapidly constructed temporary walls of plywood and plastic windows

We have patients ventilated on their stomachs losing blood from somewhere who cannot be investigated

We have patients going into cardiac arrest on the ward and a five to ten minute wait for the team to don the PPE before they can attend

But what we do not have is people with heart attacks, people with strokes, people with a whole long list of other conditions, they are staying away from hospital for fear of being a burden and for fear of becoming infected

What we don't have is the ability to treat patients with appropriate treatments

Patients with heart attacks no longer have emergency angioplasty, instead they are having bedside thrombolysis, something I remember doing in the 1980s

Patients with cancer have their treatment stopped or not started if their life expectancy is less than one year, they have their treatment delayed if their life expectancy is five years

The only cancers being treated are those with >50% chance of cure, and even then they are being treated with reduced doses, less frequent courses and with everyone wondering if they will survive until their next course or if they will succumb to pneumonia, there is of course no ventilation for cancer patients

And if they get admitted for any other reason they die of COVID in hospital possibly from someone else or from one of us untested doctors or nurses who might have a very mild or symptom free disease