Thursday, 29 December 2016

Watership Down

One of the most challenging times of my life was the three months from January to March 1973. Through those months alongside my fellow medical students I studied relentlessles for my 2ndMB (the exam that used to be taken after 5 terms of anatomy, physiology, biochemistry and pharmacology). It was a monster of an exam and required rediculous amounts of retained knowledge. Thankfully I scraped through. One of the things that kept me going was reading a portion of Watership Down for half an hour before I went to sleep. It calmed me down and transported me away from my problems to those of the rabbit warren, Bigwig and all.

It's a beautifully told tale and was written by Richard Adams who died this week at the age of 96 years. Subsequently made into a film with gorgeous singing from Art Garfunkel-one of the last vinyls I bought (before my recent conversion back to vinyl!).

Reading the book helped. It calmed me, it distracted me and gave me just a tiny insight into the struggle that others face in life, whether man or beast. And since most of us easily become preoccupied with our own challenges, it was a helpful nudge towards less self-absorption. We'd all be better off with what Tim Keller calls Self-forgetfulness. Something to aim for in 2017?

Tuesday, 6 December 2016

Suicide

I was very struck this week catching up on the BMJ (I tend to only read the obituaries to make sure I'm not mentioned), in reading about a correction. Someone had written a tribute for a colleague which had then been inaccurately reported as saying the deceased, 'committed suicide'. The BMJ apologised noting that the terminology recommended internationally (and endorsed by the Samaritans, www.samaritans.org) was 'died by suicide', or in North America, 'took his own life'.

I regard that as a good thing. Not least before suicide being no long regarded as a criminal act it is not something 'committed'. However it is more difficult to find correct language for someone professing Christian faith. Is their suicide a sin in the sense of a rebellion against God's rightful sovereignty?  Well I guess in some sense that is true, and yet what Christian hasn't often and sadly rebelled in less dramatic ways but without incurring the stigma of suicide.

As one writer points out the extraordinary words of the apostle Paul in Romans 8 give us considerable grounds for hope. Since neither life nor death-not even death by suicide-can separate us from the love of God, why should a momentary act of tragic self-annihilation be regarded any differently to other less obvious failings?

Of course more to say. Check out some helpful resources from John Piper here, and the Gospel Coalition.

I can only recall three suicides in my long career at Olney. All so sad in their own way. My first was many years ago and was of an elderly lady who found a chronic neurological condition intolerable. Her aged husband called me to her bedside where she had suffocated herself with a plastic bag. It was such a sad scene, and my immediate instinct was to spare him pain by suggesting that she died of natural causes. Of course I would have been wrong and was corrected by a friend who was deputy coroner with whom I discussed the matter. The aged spouse looked at her and said gently, "I still love her you know". Now I realise Dolly Parton wasn't thinking of this, nor indeed theologically, in her wonderful song, 'I will always love you', but it carries such a powerful message that I frequently come back to. The power of unquenchable love. And for those of us privileged to experience it, the relentless love of God.




Thursday, 1 December 2016

The empathetic doctor.


Like many GPs I grapple with how to help the patient with chronic (that is longstanding) back pain. Well probably not by shovelling opiates in their direction, since such drugs are fraught with difficulties and drawbacks. And nor are surgeons of much use here. Rather disarmingly one major contribution is "simply' to be empathetic. And yet it seems so touchy feely, or soft even, when such macho men as spinal surgeons are on the prowl.

Nonetheless a BMJ review from 2015 (BMJ 2015;350:g6380), points out that empathetic GPs are more successful at managing chronic low back pain than those who are not. So what is this magic ingredient? It is said that empathy is, 'unlike sympathy, which is defined as feeling sorry for another person, clinical empathy is the ability to stand in a patient’s shoes and to convey an understanding of the patient’s situation as well as the desire to help.' 1. It seems that some GPs, like the rest of the population, have this more than others, and yet according to Professor Hojat from Jefferson Medical College in Philadelphia, it's a skill that can be learned. So my sceptical colleague why should you bother?

1.    Your patients are more likely to appreciate your help and indeed more likely to follow your advice.

2.    Your patients are more likely to cope with and recover quicker from their illness

3.    You are more likely to experience job satisfaction.

4.    Your patients are much less likely to make a complaint against you.

5.    It will save you time! Really? Yea, it can enable you to focus on the patient’s real concerns and seek to address those, perhaps preventing repeat visits.

Empathetics is a course developed by Psychiatrist Helen Reiss from Massachusetts General Hospital. It encourages doctors how to ‘show up not what to say’. As James Tulsky from Duke University points out ‘doctors are explainaholics. Our answer to distress is more information, that if a patient just understood it better, they would come round. In reality bombarding a patient with information does little to alleviate underlying worry’ 2.

In her brilliant Ted talk, Dr Reiss teaches the acromym, E-M-P-A-T-H-Y. It’s a brilliant talk.

E-Eye contact is so important

M-Muscles of facial expressions-learn to recognize emotion

P-Posture matters, standing over a patient's bedside can be intimidating-sit down!

A-Affect. Learn to gauge patient’s mood

T-Recognise tone of voice signifying underlying emotion

H-Hearing. Hear the whole person, understand their context

Y-your response. Allow your emotions to respond.

Lots to think about here. I recall teaching a Communication Skills course to secmd year medical students at a London medical school, some years ago,. They really thought the subject was a waste of time. How sad and I guess by now they are realizing that empathy and other skills are as just important as any diagnositic or surgical skill they may have acquired.
References.
1.http://www.theatlantic.com/health/archive/2015/03/how-to-teach-doctors-empathy/387784/
2. ibid

Monday, 28 November 2016

4 things for doctors to remember

Humbling stuff from Thomas Sydenham, the 17th century physician known as the English Hippocrates.

 "It becomes every man who purposes to give himself to the care of others, seriously to consider the four following things:
First, that he must one day give an account to the Supreme Judge of all the lives entrusted to his care.
Secondly, that all his skill, and knowledge, and energy as they have been given him by God, so they should be exercised for his glory, and the good of mankind, and not for mere gain or ambition. Thirdly, and not more beautifully than truly, let him reflect that he has undertaken the care of no mean creature, for, in order that he may estimate the value, the greatness of the human race, the only begotten Son of God became himself a man, and thus ennobled it with his divine dignity, and far more than this, died to redeem it.
And fourthly, that the doctor being himself a mortal man, should be diligent and tender in relieving his suffering patients, inasmuch as he himself must one day be a like sufferer." 

Wednesday, 19 October 2016

Books that make men cry

What a stunning book. A bright, talented young neurosurgeon recounts his journey into medicine and the story of his all too brief career cut short by his cancer and then his grappling with death.

Like Kalanithi I believe in the power of literature and would love every doctor to read, mark, learn and inwardly digest this book. It's almost a one-sitting read so beautifully written and so thought provoking. The pilgrimage from dynamic doctor to weak, helpless patient is not easy, but the insights gained would enlighten any practicing doctor-especially  those who haven't had to grapple with serious illness in their own lives or close loved ones.

Patients are our best teachers, and when a doctor becomes a patient he or she is often given a unique perspective which can change one's practice for ever. If Henry Marsh (he of Do no harm) thinks every doctor should read this book, I'm not going to disagree. Did I cry? Yep, sitting in Cafe Nero, as the epilogue described his final days and hours, I welled up, thinking of Kalanithi's story, my own mortality and how precious life is.



Monday, 17 October 2016

One step forward

So what has technology deprived us of?

I was thinking about this whilst doing some tidying in my study (a task that makes painting the Forth Road Bridge manageable). I found some beautifully handwritten letters that I had received from a good friend and colleague (who is now too elderly and frail to write), which I had clearly not had the heart to dispose of. His writing style produced an immediate recollection of him as a person and friend. And so I still bemoan the loss of the hand written (particularly the Lloyd George notes). Yep I realise some writing was hard to read and positively untidy, but at least there was less of the searching for the wood amongst the trees that so often occurs when I'm  trying to read a hospital discharge summary.

But back to Lloyd-George, those natty little folders and continuation notes that became increasingly unmanageable wth the explosion in typed correspondence fighting to squeeze in. But a few seconds with such notes gave so much information that I just don't get with the ubiquitous System One (I wonder who has become a millionaire on the strength of System One's dominance?). Anyway within a flash of holding L-J notes I can tell if the patient attends often (thick or thin folder), I can also tell if she has seen multiple doctors by the varying handwriting, and also what her maiden name was, since it will have been crossed out on the front cover (ah, so she's a Smith etc, I bet she's Mary's sister..), and for some, like Elizabeth Taylor,  it may have been crossed out a few times!!

And then what about electronic prescribing?  Yep I'm well aware of the potential for error and the problems we had in the 'old ' days of handwriting all the repeats etc, but there is something about hand written instructions on the script, which is then ceremoniously passed to the patient. It was somehow more personal and perhaps all the more effective for that. Now I don't even have to look at the patient, I just type the script and tell them that it has gone electronically to the chemist. Then I fleetingly look at them and ask if there is anything else. But one of the joys of the handwritten script was timing the moment of pass-over to the patient. The handing over of the script brought the consultation to a neat conclusion. So much more effective than, "OK we're done then, goodbye".

Yet again, good old TS Eliot got it right,
“Where is the wisdom we have lost in knowledge?Where is the knowledge we have lost in information?

Friday, 9 September 2016

The Long Goodbye

No, not the Raymond Chandler novel from 1953 (an auspicious year), but my decision to retire from Cobbs Garden Surgery where I have been a partner since 1983. Sometime between the end of this year and February 2017 I wont be making the daily short commute to Olney. I'll be sad.

So I'm going to try to blog moire frequently about things that I have picked up along the way which I hope might be of some interest, especially to other GPs who feel equally passionately about the uniquely privileged job we have.

In the popular mind our work consists of dealing with sore throats, coughs and colds and sickness certificates (or fitness certificates as they are now called-a rose by any other name). In fact a fair proportion of our work is about explanation or clarification. What does condition X mean? How worrying is it? Should I go for this treatment or that, or none at all? Etc, etc.

Today I fielded a phone call from a very concerned patient who had received a copy of a letter from the local hospital written to me (I have to say I'm not a fan of the copied in letter between health professionals). At the head of the letter was written the various diagnoses, as is standard in such letters. He was alarmed to read the words, 'malignant neoplasm of....'. 'But I was told I no longer have cancer, now it sounds as though it's spread'. It was the word malignant that had struck fear. Sticks and stones may break my bones but words will never hurd me, was often heard when I was a lad. Oh yeah?  How consistently untrue that proverb has proved to be!

My patient felt that malignant meant that the cancer had spread, and anyway why was he still listed as having cancer when the specialist had told him it had all been removed? I tried to simply explain that noting his diagnosis was a record of his medical past which did not necessarily mean the condition was currently active (although it is an alert to the clinician that the recorded diagnosis may be relevant to the presenting problem). No, malignant did not mean spread (I think he was confusing the word with metastases), and neoplasm was just another fancy word for abnormal growth (which can be benign or malignant!).

All to say, if you are communicating with patients, especially when writing to a fellow health professional, be aware that the words you use may mean something different to the patient. Yep, it means being more thoughtful, which takes more effort and time. If necessary, add very brief explanation for the patient, it will save the patient worry and free up a bit more of the GPs time.

Saturday, 3 September 2016

Couple therapy

Many GPs find it a little unsettling when patients attend with their partner. However often there is significance to it. How best to greet them? I confess I attempt a little levity with most of my patients, since I generally know them well and have been around a long time. My favourites are...


1. Ah its Bonnie and Clyde.
2. And how are the happy couple?
3. Welcome to the dynamic duo.
4. Ah I see you've brought your bodyguard.
5. You'll be charged double on the way out.


All such comments of course are to be avoided if you do not know the couple or sense that the humour gene is lacking (in my experience fairly few patients, although perhaps they avoid me).

Greetings to be super cautious with are...

1. Ah..its little and large.
2. Ah..two fat ladies
3. Ah-oh this looks ominous
4. Not you two again....

But there is another side to this, why have they come together?

1. They may be expecting worrying news and want to be present together to hear it.
2. The non patient partner wants to make sure the patient tells the truth the whole truth and nothing but...
3. The non patient partner wears the trousers (in this case usually the female!!)
4. The adult male patient is a mummy's boy
5. The patient may be hard of hearing
6. The non patient may be super caring and devoted
7. They may want to gang up on you
8. They may want to sneak an extra opinion from you on the non patient.

And more and more. All to say that there is a lot going on in GP consultations which is why they are so endlessly fascinating.

Friday, 19 August 2016

'I think my melodies are superior to my lyrics' Freddie Mercury

Not sure how I came across Zanzibar whilst trawling the internet, and anyway, where is it? Ah, off the coast of Tanzania, ah where's that?.......And lo and behold it seems that Freddie Mercury was born there, one Farrokh Bulsara (handy knowledge for that pub quiz).

I happened to be attempting to play one of his songs from a book I got the library the other day and came across a song I was scarcely familiar with (yep I've lived a a sheltered life),  Love of my life, crikey what a beautiful, haunting song. Freddie himself is quoted as saying, 'I think my melodies are superior to my lyrics', and that is certainly true of many rock and pop songsbut I would say that sometimes there is perfect harmony twixt the two, eg take the famous Hallelujah Chorus by Handel, or the haunting, Yesterday by Paul McCartney, and I think Mercury comes pretty close here.

Wednesday, 17 August 2016

Screw-up fix

Still waters at the Turvey Mill near Olney
 We all screw up in life. Some of us more overtly and painfully than others. We all need to hear the words of Jesus again, 'let the one without sin cast the first stone'.

The healing words of Psalm 23 are like a balm. Yep its a modern rendering (from the Message) and doesn't always hit the spot, but,  'Your beauty and love chase after me every day of my life', is a lovely, humbling thought. He really does know how to fix us.                                          
23 1-3 God, my shepherd!
    I don’t need a thing.
You have bedded me down in lush meadows,
    you find me quiet pools to drink from.
True to your word,
    you let me catch my breath
    and send me in the right direction.
Even when the way goes through
    Death Valley,
I’m not afraid
    when you walk at my side.
Your trusty shepherd’s crook
    makes me feel secure.
You serve me a six-course dinner
    right in front of my enemies.
You revive my drooping head;
    my cup brims with blessing.
Your beauty and love chase after me
    every day of my life.
I’m back home in the house of God
    for the rest of my life.

Friday, 12 August 2016

What seeest thou else?

It was good to take a walk around Olney with my friend Jon the other day, he'd never been before and there was much to show him. However having previously lived near the river and the water meadows, I was keen to take him there. So we walked past the Mill House and into the fields to be greeted by one of those Constable vistas. "This would have looked the same to Cowper and Newton over 200 years ago," boasted I. "Did they have wind turbines then too?" came the reply.

Now admittedly you have to look very carefully, and probably need to zoom the picture to see the wind turbines, but they are certainly there. It seems my familiarity with the lovely pastoral scene had obscured what I happily ignored.

For the purposes of a medical report, I discovered today that I had seen one patient 36 times in the past 12 months. That's alot of contact and alot of time for familiarity to be part of the consultation. It occurs to me that if I am going to see alot of a patient it's probably worth asking an equivalent of my friend Jon to take a look every now and then. In other words get a medical or nursing colleague to take a look. They just might see the wind turbines.

On Thought for the Day recently the speaker mentioned a phrase that crops up in the Tempest, Propero is trying to help Miranda with her memory and says, 'What seeest thou else'? That is, there is more to see than you originally thought.

Jon and I continued our walk along the river as I have done many times before, walking to the Rec and then back to the surgery. He noticed how still the water was, how low the level was, how green the grass was. I just walked passed it, just enjoying being in dear old Olney by the river.

What seest thou else? It's not a bad question to ask your self at any and every time and circumstance. There's always more to appreciate in everyone and every part of life.


Wednesday, 10 August 2016

Men, crying and poetry

I increasingly love poetry and the emotion that is stirred by it. I was touched to have been given Poems that make grown men cry and find the first poem in that book both sad and moving. It was written in 1585 by Chidiock Tichborne (I often feel my name is so boring) on the eve of his execution for being part of a plot to assassinate Elizabeth I and replace her with a Catholic monarch. It was written on the eve of his execution in the Tower and was sent with a letter to his wife Agnes. He was 28 years old.

As one commentator says, it reminds of us of the 'profound contradictions implicit  in the human condition'. Yep we are all a bunch of contradictions.


 My prime of youth is but a frost of cares, 
My feast of joy is but a dish of pain, 
My crop of corn is but a field of tares,
And all my good is but vain hope of gain.
The day is past, and yet I saw no sun,
And now I live, and now my life is done.

My tale was heard, and yet it was not told,
My fruit is fallen, yet my leaves are green:
My youth is spent, and yet I am not old,
I saw the world, and yet I was not seen.
My thread is cut, and yet it is not spun,
And now I live, and now my life is done.

I sought my death, and found it in my womb,
I look for life, and saw it was a shade:
I trod the earth, and knew it was my tomb,
And now I die, and now I was but made.
My glass is full, and now my glass is run,
And now I live, and now my life is done.

Monday, 8 August 2016

I don't deserve it

One of my favourite answers to the question, how are you? Is, 'better than I deserve'.Indeed so. So blimey O'Reilly! Two boxes of Maltesers and a card arrive this afternoon. I blame my mum.

I don't know how many years ago that she started the ritual of buying me boxes of Maltesers at Christmas and birthday time. And now it seems I must have dropped rather a large hint to a patient, that since my dear my mum is no longer with us....I do hope the GMC wouldn't take me to task.

One of the ironies of being a GP is that it is often the patient for whom you have just 'done your job', who is thoughtful and generous enough to send a card or even bring a gift (by the way don't run away with the idea that gifts are frequent!). And anyway I've been in practice for  longer than my GP daughter has been alive and already her patients have showered her with more presents than I've received in my career :-)

It is humbling. The patient is clearly grateful and I'm touched. But I guess there are many patients whom I have disappointed or let down in some way. Thankfully they have seldom complained, and for that too I am grateful.

Being a GP is a privilege and a responsibility. I know I will have to make a decision about retirement at some point, but there is so much I will miss. Somethings I can replace. After all I can buy my own Maltersers, but relationships built up with patients and colleagues over years, that'll be much harder.



Saturday, 6 August 2016

Love, Whitney Houston and God


Listening to Whitney Houston's stunning version of 'I will always love you' this morning set me thinking. Most of the time I'm just aware of the melody when I listen to songs, although I know some people who focus on the lyrics, but this morning it was her sung words hit me, 'I will always love you'.


Tragically Whitney's life ended so prematurely and in in such a sad way,  with a long tale of broken relationships, drug addiction and others who took advantage of her fame and wealth. It was the lasting nature of love that eluded her. At the close of a long article in Vanity Fair from May 2012,
written just 3 months after her death,  she is quoted as saying,
'I just want to love and be loved, I want to love like Jesus did. Unconditionally'
I just want to be loved. Gosh what a constant in every human heart.

Tim Keller is one of my favourite preachers, has a wonderful knack of encapsulating Christianity's essence, which is so helpful and reassuring,

'There's nothing I can do to make God love me more, and nothing I can do to make Him love me less 
The gospel says you are more sinful and flawed than you ever dared believe, but more accepted and loved that you ever dared hope'. 
We sadly, certainly and tragically hurt each other all too often, and I can certainly vouch for that, but the Christian hope is founded upon a God whose love cannot be thwarted. I cannot excel at goodness to earn anymore of his love, but nor can I descend so far into the depths to be separated from it.

In another of Whitney's cracking songs, she belts out, 'I wanna dance with somebody who loves me'. If life is a dance we need look no further for a dance partner than the wandering preacher from Galilee who's love for us is as relentless as the ocean tides. If only that love had sustained Whitney.

Wednesday, 29 June 2016

The GP as chess piece


One of the joys of working in general practice at my surgery is the daily coffee break with my other partners. I nearly always cone away having learnt something. Today one of my colleagues suggested that GPs need to be like knights on a chess board, willing to think laterally and change tack should the need arise. It got me thinking-the GP as chess piece.

 
The Pawn

Ok much GP work, like any other job is routine. Whether that be reading and writing letters, checking results, and dealing with some (although surprisingly few) straightforward problems. But pawns also only work at close quarters, they can never move far. As a GP it’s important that I can identify with patients. For me this has meant that getting older has given me opportunity to experience bereavement, personal illness, children growing up, and personal dealings with NHS, amongst many other things. I know how difficult life can be and am les critical of my patients who are struggling.

The Castle/Rook

The castle can move great distances across the board, but only in a straight line. I have increasingly made an effort to make contact with colleagues across the country who could advise me on various issues. With the internet and email it’s remarkably easy to track down the right person to ask. This in turn has been a great benefit to my patients. Not only can I access expert help, but generally it is immediate and it puts me in a good position to advise my patient’s accordingly.

The Bishop

The bishop can also cover large areas across the board, but in a diagonal direction only. Thus I have found it helpful through my career to not just gain knowledge form the obvious-what you might call, ‘straight in front of me’ sources (medical textbooks and lectures etc), but from novels, popular medical books written for the lay public, patients in other professions (GPs have a great opportunity to learn from our patients, especially when they have skills from academia, marketing, management, logistics etc-what a great resource GPs have meeting so many different people every day).

The Knight

As my colleague said, GPs need to be able to be flexible and think around problems. Patients don’t always know what their main problem is and we need to talk round and listen well to unpack what they are saying to try to find clarity for them. This may sometimes mean asking a question that initially seems rather angular, but may lead to particular focus. I think asking a great question is a skill all GPs need to work on.

The Queen

Ah the mighty queen. Able to move in all directions. All powerful. As GPs we need to be adaptable to our patients, whether that be their age, experience, education, ethnicity, life circumstance etc. A one size fits all just does not constitute good GP. Humour helps some patients and alienates others. An investigation is helpful for some but exacerbates anxiety in others. Knowing what to say and do when, and what not to do, must be developed through our careers.

 
The King

Dignified and slow moving. Hmm doesn’t sound like me. But I think an ability to be appropriately serious at times and thoughtful always,  is necessary. Even making quick decisions can still be conveyed in a considered way. The patient must feel they have been taken seriously. Sometimes just taking the pace off a consultation, and occasionally  just saying, ‘we really don’t have time now to properly help you, let’s meet again soon and make it a double appointment’, will give time for reflection and perhaps prevent unnecessary investigations and treatment which may have been arranged precipitately.


Now for Mah Jong.

 

Wednesday, 25 May 2016

Letters for the bereaved

I was brought up by a mother who believed passionately in letter writing. Right up to her death at 84 years she was laboriously writing letters every week. And she'd always write one or two drafts before scribing her final copy. Sadly the art of hand writing letters is fading fast to be replaced by the much less valued email. But as my mum frequently reiterated, people love to get letters.

So I was interested to read of an article published this week in  ecancermedicalscience and which was picked up by much of the print media. It was about how the practice of  Oncologists writing to the bereaved relatives of their patients. As one commentary put it in summary,
'For doctors, this overlooked practice appears to be an important -- and now acknowledged -- part of the cancer story'

I must say I have for many years tried to write to the recently bereaved and offer my sympathy and words of support. I think it would be a good practice for all GPs and it is one area where longevity in a practice  brings its own reward in terms of intimate knowledge of the family relationships and  their dynamics. Locums and short stay GPs just may not get the perspective.

A few suggestions

1. Don't send a standard letter merely signed by you (or worse, your secretary)
2. Do personalise it.
3. Try to find something true and interesting about the deceased which you can briefly state. It might be something faintly humorous (although of course humour at such times is incredibly delicate).
4. Find a non trite way of acknowledging the level of pain (for some our of patients the death of a loved one comes as something of a relief-so no standard, 'you must be devastated').
5. Chose your timing. For some as soon as possible after the death would fit, for others 2-3 weeks later might be more helpful when the initial attention and busyness has passed.
6. Think about hand writing it (currently I dictate but I'm thinking of changing this)
7. I prefer headed notepaper to a card. Not sure why except it brings a certain formality accompanied by warmth into the relationship.
8. It doesn't need to be long

I know patients appreciate these letters and have had many patients tell me that they read them over and over and keep them for years. It suggest that our patients matter to us and we are not merely professional with no soul.




Friday, 20 May 2016

Tears for fears

Its a long time since I read about the place of tears in the practice of medicine (and indeed in the practice of life). As a GP I have had the enormous privilege of listening to countess people pouring their hearts out to me, and often it means the tears flow. I am not expected to cry with them, although I confess I've been pretty close a few times. It seems I'm a professional tear gatherer. Indeed Matthew Sweet in The Economist writes,

'We would consider it a dereliction of duty if surgeons, nurses, police officers and soldiers wept during working hours. They have surrendered their right to cry in the same way that other employees might sign away their expectation of fixed hours or sick pay. Their restraint gives us the space to express our pain or gratitude, which we buy from them through taxation.'

Why humans cry has been a mystery for a very long time and was first investigated by Charles Darwin in his Expression of the emotions in man and animals. I don't think he ever quite cracked it. I am however, rather taken with this quote form The Shack (a book I'm re-reading and enjoying currently)
'Don't ever discount the wonder of your tears. They can be healing waters and a stream of joy. Sometimes they are the best words the heart can speak.'
There is something both wonderful, unsettling and relieving about our tears. And there is so much we still don't understand about how we humans function in this crazy, glorious and beautiful world.

The Long Walk

It's always a bit chancy to give someone a book. A little like recommending a restaurant. Will others like it? Will the service be as go...