Thought Picnic: From the midst of my considered mortality

A considered mortality

Three years ago yesterday, I boarded a plane from the Netherlands after a 147-month sojourn. I left a life completely shorn of everything but with a slight possibility, one of hope and some dignity, the little left.

Days before I left, I wrote an email to six of my closest friends, I also saw them as my pallbearers; about my plans to return to England, bruised, vulnerable and also with a dying wish, instructions given as to where I will like to be buried.

That last paragraph of that email was stark and shocking for some of my friends to read, some even thought I have completely given up. There were many reasons for giving up if I wanted to, I did not, I was 3 years after a cancer diagnosis and the long bushy tail of cancer was wagging the dog of my life. It was my considered mortality in the midst my particular reality.

Blog - Thought Picnic: When Things Don't Matter Any More

A start again

Yet, in the contemplation of an end laid the possibility of a new beginning, how that would become I had no inkling of, but leaving the Netherlands was one that was forced upon me by circumstances well beyond my control.

I arrived in the UK, got a new phone number, updated my resume and posted it to as many agencies as I could find. Within 6 days of my arrival, I had interviewed for and secured a job that was to start in 3 weeks travelling to 26 countries in Europe and North Africa. It was promising, interesting and exciting.

The team met up at London Heathrow and made for France with schedules already in place for Germany and Switzerland. In the end, we only did 4 weeks in France before the whole project was canned. It was a hard blow and it took another few months before another good opportunity came.

That other untold story

The business of settling back in the UK was not easy, you need a proof of address to open bank accounts, to secure long-term jobs, to find a home and to do much else. One was in a Catch-22 situation because there is no template or manual for resettling back in the UK. If not for all sorts of technicalities, good fortune, familial and friendly support along with the story that had become one of the defining elements of my life, I might well have gone to make clear plans for eternal repose.

I reflect today on the story, of return, of jobs, of joblessness, of plenty and of lack, of shelter and the threat of homelessness, of brothers and sisters with large bosoms of kindness and compassion, of friends who never let a hair of my head fall to the ground, of a mentor, one of my six friends who has since passed on.

Thank you for a wonderful life

It was hard and difficult, yet I cannot deny, it is also a wonderful life. Even if I am nowhere near where I once was, I am grateful for mercies great and small, triumphs to whisper and ones to shout about, for where there is life, there is hope. Even is my spirituality leaves me with more questions than I have had answers, a little voice in me still cries out with Christian ululation – To God be the glory.

Thank you for being here, near and where I have needed help, support, encouragement, vision, comfort, advice, love and fun.

Thought Picnic: I don't know it all

Know why you do

In my line of work, I have variously found myself at loggerheads with others when it comes to problem resolution.

In context, it is important for me to understand why scenarios and circumstances present themselves before seeking a range of paths towards solutions that might resolve or eliminate the problem entirely.

A background in logic

There are many people who come from many walks of life and careers into the Information Technology profession taking up roles from design and architecture, through project and change management to support and much else.

It goes without saying that whilst many again are good at what they do when things are working like clockwork, the gaps in their fundamental knowledge of things begin to show when problems or emergencies arise.

There is a great user and support community out there from where one can get answers to a range of issues and problems. Yet, being able to craft a question properly or explain the scenario properly lends itself to other being able to visualise that setting and hopefully present ideas, opinions or clear solutions with steps to implement them to resolution state.

What an engineering mind gives you

My engineering background requires that there must be a purpose for any activity undertaken towards obtaining a solution. For me, it has to be logical, sensible, goal-oriented and capable of advancing knowledge and experience that any other similar scenario can literally use those steps as a template.

I do not work too well with trial-and-error, where purpose and goal are lacking that brawn rather than brain is used to hopefully get an unexpected outcome that then turns out to be the solution.

Because there is no particular method to trial-and-error problem resolution, stumbling upon a solution might well be fine, but you are left with whether you can backtrack and formularise those trial-and-error steps into a clear guide with full understanding of the problem, why the problem arose and what can be done to resolve it.

Reading the runes

I regularly peer through error logs trying to ‘divine’ from the logs what set of circumstances have presented the error observed from after. In doing that, I have to make more deductions over assumptions to begin to make headway.

In many cases, what the logs tell me gives me a sense of certainty about where things have gone wrong and possible insights as to how to right the situation. It is at this stage that I might become unpersuadable of alternative thinking if the logic and the reasoning is neither clear nor convincing.

In exasperation, I have sometimes walked away from a situation, though usually after I have shared my views and wait for the doubters to come to the conclusion that I might have been talking sense all along.

I don’t know it all

Yet, I have to be careful that this assuredness does not descend into intellection arrogance blinding me from other perspectives and perceptions. It is important to have a good idea of what knowledge you have, what knowledge you do not have and most pertinently be quick to retrace your steps where the absence of knowledge has precipitated into negligence or ineptitude.

Ignorance is fine if it means the quest for knowledge remains an ongoing pursuit with the view of mastering the rules established and then breaking new ground with new thinking and new perspectives.

Make allowances to learn anew

The constant quest for knowledge also limits the occurrences of negligence borne of not acquiring and using knowledge that is already available and the possible crime of ineptitude where wilfulness or hubris has made one almost too sure of a situation when it really is not the case.

Curiosity and a sense of precociousness are attributes one must always possess along with a questioning and challenging disposition. We can trust many things, but they should really only be trusted that much if they have also been verified as trustworthy – paraphrasing Ronald Reagan aphorism of “Trust, but verify.”

The inspiration for this blog came from Dr Atul Gawande’s first Reith Lecture in 2014 on The Future of Medicine, titled, Why Do Doctors Fail? [PDF Transcript]. In this lecture, he referenced an article Toward a Theory of Medical Fallibility [Subscription PDF], Samuel Gorovitz & Alasdair MacIntyre (1976) Published in The Journal of Medicine and Philosophy, 1976, Vol 1, No 1.

Hospital: Between ancient and modern phlebotomies

Ancient and modern

I cannot say I look forward to this experience as I did when I lived in the Netherlands. Things are so different around here and it does leave a kind of psychologically negative effect on the mind.

Walk into any of the hospitals in the Netherlands and it is somewhat welcoming rather than foreboding; well-light, the open expanse of atriums, nature giving life to places where people visit to find cure or respite for their ills and sicknesses.

With note and with thanks

Our much vaunted NHS, the National Health Service, one of the largest employers in the world, probably in the top five and things are not just different, but quite noticeably different.

Now, for my expensive drugs that are covered by NHS system, I am more than grateful, I probably will not see another 3 months if I did not daily dose myself with these therapeutic and prophylactic formulations, that must be said.

However, at the point where you walk into the hospital as I did a few days ago, things are just not as they probably should seem. Asking for directions at the main reception, I could not help but notice that it was staffed by volunteers. Bless their hearts, there have been cuts everywhere that we have to depend on volunteers and charity to get around the hospital.

The charity that helps

In fact, there are many areas where charity and selfless service has been exploited at the expense of getting professionals to do the job. Yet, volunteerism allows for people to feel useful and relevant to their communities. Even the main shop serving tea and coffee with snacks was manned by volunteer pensioners too and in a way the profits from that shop might be ploughed back into helping the hospital in some little way, it is help all the same.

The directions to the phlebotomy waiting room were clear enough and I got there, Blood Room, it is called to find probably 20 people ahead of me, prey for the vampires we were, every kind of person was there from those you could look at with concern to those you caught a glimpse of and yet were afraid to take a second look and we were all there for the same thing, to get blood drawn.

Forget the comparison

The Dutch have a rather slick operation for phlebotomies, you present your form which lists the blood tests to be conducted and hence the number of vials of blood to be drawn. The nurse keys in the tests and a list of labels are spewed out of the printer with the date of birth, the number of vials, the colour coding of vials and a queuing ticket.

Within 10 minutes, you are called into a cubicle, private with the curtain screen drawn, a greeting, a verification of date of birth, maybe a conversation and then the phlebotomy.

In the UK, Florence Nightingale will not look out of place. For the billions spent on computer systems, it has not caught up with this section of the hospital establishment anywhere I have been. Things are as manual as they come and forget the privacy, we all go into an open plan room where we are just as exposed for the same thing.

Needles!

After the confirmation of name and date of birth, the tourniquet is applied to the upper arm to help bulge up a vein on lower arm and the needle, the needle, steely and vicious, attached to a syringe-like plunger is inserted into the temple of body to draw life.

This needle is usually attached to a flexible tube in the Netherlands ensuring there is no discomfort with any movement especially when changing the vials. You can read from that, that it is different in the UK, our experience here is almost as Victorian as the old buildings that host these ‘modern’ hospitals.

This time, I even looked as the needle went in and did not flinch a bit as 6 vials of blood were drawn, the needle taken out and a bulb of cotton wool applied to the puncture wound which was held in place with plain masking tape. The sort that grabs your hairs in a painful waxing feeling when you are ready to take it off.

I cannot say where the vials went after that, but I can only hope that when the results are shared in a few weeks’ time, they will be from me. It goes without saying that I miss the sense of organisation and professionalism that I found in Dutch hospitals. Yet, when in the UK, we just have to make do with what we have got in the UK. C’est la vie.

Thought Picnic: Just like a baby, I have not talked

Should we have talked?

I have a compendium of blogs that serve not only as reference material, but time capsules of a situation or state of mind when I wrote those pieces.

Those blogs are somewhat journals of my discomfiture and sense of discomfort, betrayal, annoyance or some other ill feeling that I have decided to write about to help me deal with the issue at hand.

Sometimes, I do wonder if some of those things will have been better dealt with if I had addressed the people concerned directly.

Just like a baby I could not talk

Then I realise that though I could quite bold and forthcoming in some situations, in others I could as shy as to become literally dumb that my only outlet becomes my blog.

Yet, in writing that blog, it becomes a very cerebral exercise, rarely one in which ones spleen is vented with vehemence but something that I attempt to with a sense of English reserve, cryptic enough not to be direct and obvious enough as to make the point.

I’ve been hurt, aggrieved, maligned, belittled, disrespected and abused by too many to mention, some so close as fraternal, maternal and in the clan, the offences rarely dwell on my mind but things can be recalled with a trigger, at a confluence of circumstances sometimes completely unrelated and yet quite palpable.

For silence is still golden

There are reasons why I ignore many things, it is because I do have enough on my plate even if others do not realise that I have my one unique circumstance though I might not have the same kind of responsibilities we should all bear our burdens stoically with dignity and self-respect.

I then went over one of those blogs written over 6 years ago and realised that a very recent interaction of sorts brought to life an unresolved conflict and there are many of those lurking in memory, ensconced in a dangerous pressure-cooker situation that once again for the fact that a lot can be said, the wiser counsel is that silence is golden except for when another blog of obfuscation can be written to assuage the unrest.

There is a certain sentiment expressed in the video, maybe we should talk for a minute.

Thought Picnic: The career skill of knowing chances, choices and risks

From before

I will like to continue on the blog I started yesterday on the response of Atul Gawande to the question about why he left the politics of being a policy wonk in the White House to return to medical school and take up surgery.

Blog – Thought Picnic: Becoming less dependent on the fortunes of others

“I wanted to be less dependent on the fortunes of others in making my own career; I wanted to be able to develop and voice my own ideas. And then there was this desire to have some skill besides just being at the abstract level of policy and work at that level. So I returned to medical school instead of taking up the offer to work on welfare reform.”

He went on to say about surgery, “I loved the sense of skill. And it reminded me of politics in some way – that the really good surgeons had to be like really good politicians in being willing to take chances, deal with risk, know that your knowledge and your skills are uncertain.”

Of skill to do

“There was this desire to have some skill besides just being at the abstract level of policy and work at that level…” Here, it is apparent that Atul Gawande had to make some serious life-changing and career-defining decisions. Whilst he did not knock the idea of being involved in policy making, he realised he needed to have other skills such that when the need for policy derived from his being dependent on the fortunes of others dried up, he will still be fully able to chart his own course.

It is also quite revealing for him to suggest that policy work was quite abstract rather than practical, even though policy has a way of affecting people’s lives. Yet, it was clear that if he had stayed, he still had ample opportunity within that political setting to be involved in welfare reform.

“I loved the sense of skill…” Yet, in leaving policy work for medical school and specialising in surgery, he had found a new vocation and calling, a sense of skill that went well beyond the abstract.

The excitement in the sense of skill is captured in his applying his acquired policy knowledge to his growing medical skill that he found ways to conflate politics and surgery in the following response.

Of chance and risk

“It reminded me of politics in some way – that the really good surgeons had to be like really good politicians in being willing to take chances, deal with risk, know that your knowledge and your skills are uncertain…” In essence, no knowledge in all his fields of endeavour was lost, rather the whole body of knowledge had become uniquely his own experience.

This experience is what now allowed him to understand the similarities between good politicians and good surgeons, and one might even say any profession where ability, skill, expertise and experience matters.

For we all have to be willing to take chances where there choices are not as obvious or the course is uncertain. In that, there is risk, some calculable and in other cases quite unquantifiable that is becomes somewhat adventurous, because from another viewpoint, noting ventured is nothing gained.

Knowing the uncertainty of skill

Many of us may be risk-averse, but without understanding risk and exploring the possibilities beyond what we know for certain, we risk living unproductive, mundane and boring lives with sadly unpromising careers to boot.

In all this is the ultimate lesson of knowledge and wisdom, that is to know what you know and what your skills can achieve whilst being very cognisant of the limitations of your knowledge and beyond attempting to bluff your way past issues where you have no ideas, you are geared to learn, to research, to reach and to extend yourself to acquire new knowledge and chart new courses.

The awareness of the fact that our skills even when well-honed might be uncertain to dealing with particular situations that we might have to adapt or withdraw to reflect and relearn is one of the greatest gifts of self-development.

My experience

Having worked in the Information Technology industry for about 28 years, I am well aware of the limitations of my skills, however, more importantly is the fact that I do not always have the answers or solutions to problems or challenges to hand.

In many cases, the knowledge to tackle an issue has only come from being presented with a particular situation that requires a resolution and since not all situations are the same, the solutions will differ.

Yet, all this knowledge becomes part of the body of knowledge uniquely mine that is a subset of my wider experience beyond just my profession and when presented with a similar set of circumstances again, I will probably be better equipped to provide a resolution much quicker than when I first encountered that setting.

I have never feared not knowing, nor have I been held back by not knowing what to do, rather, I have seen such challenges as new opportunities to broaden my knowledge and then return to resolve that conundrum, and doing the next thing. There is excitement is not remaining stagnant, but in pressing on and moving on.

These responses laid the ground for the beginning of the lecture on the subject – Why Do Doctors Fail? [PDF Transcript]

I hope to cover that lecture in some detail in another blog.

Thought Picnic: Becoming less dependent on the fortunes of others

An introduction

This is a blog of many blogs I should have written many months ago when I was first inspired, but I have left it until recently as I dithered over the last week on how to start writing.

Dr Atul Gawande gave four lectures for the Reith Lectures in 2014 on The Future of Medicine, the enlightening and interesting things he touched upon about medical practice and personal experiences with medicine and patients made for repeated times of listening in again.

The first lecture was titled, Why Do Doctors Fail? [PDF Transcript], there is much to discuss in this lecture, but I will first concentrate on some answers he gave when he was introduced to the audience.

I will eventually cover the topical issues in further blogs, every doctor and in fact, patients or prospective patients should take the time to read or listen to these lectures.

Some background

Atul Gawande is a typical third-culture-kid, born to Indian medical practitioners in the United States, studied at Stanford University, and was a Rhodes Scholar at the University of Oxford before taking medical degrees at Harvard.

However, before going to Harvard, he was a policy wonk on healthcare for Bill Clinton and was in the White House to help Hillary Clinton on her ill-fated Clinton Health Care Task Force. Being in the deep corridors of power, he could have chosen to stay there among the movers and shakers of America, but he did not.

Sue Lawley, the moderator of the first lecture at the John F. Kennedy Presidential Library and Museum in Boston, having surmised that he had worked for Clinton and gone to Washington, asked why surgery eventually won over politics.

Career independence

Atul Gawande answering many questions in the discussion before the lecture began showed a great sense of self-awareness and purpose.

“I wanted to be less dependent on the fortunes of others in making my own career; I wanted to be able to develop and voice my own ideas. And then there was this desire to have some skill besides just being at the abstract level of policy and work at that level. So I returned to medical school instead of taking up the offer to work on welfare reform.”

About surgery, he said, “I loved the sense of skill. And it reminded me of politics in some way – that the really good surgeons had to be like really good politicians in being willing to take chances, deal with risk, know that your knowledge and your skills are uncertain.”

Daring to chart an uncertain course

“I wanted to be less dependent on the fortunes of others in making my own career …” This profound sense of independence is incumbent on people at the beginning of their careers to comprehend. You need to understand and appreciate where your career is going, how it develops and who it might depend on.

Many for their skills and ability find themselves in positions of privilege and opportunity that they somewhat forget that situations and circumstances might be ephemeral or transient, they get comfortable.

I remember a younger friend who at 29 was about to be made a partner in a global consulting firm, probably the ambition of a majority, it represents the pinnacle of achievement for some, a fulfilment reckoning of accomplishment and achievement. My friend thought at that age, that becoming a partner with its opportunities would create a limiting perspective on his broader career, so he left the firm and embarked on an exciting middle-management career at other global firms.

With politics, nothing is certain either

With politics, there is even less certainty, your position is at the pleasure of the chief or patron, and you can be dismissed on a whim. When your principal ends their tenure you will likely be out of work too. Recognising this tenuous relationship can be the saviour towards a more fulfilling career.

In my own career, I have rarely been an organisation man, in all the years I have had any kind of employment, I have only been a full-time employee for 7 years spread over 4 different jobs in Nigeria, the UK and the Netherlands since 1988.

I began my foray into self-employment and consultancy in Nigeria after a year of being fully employed and wading into the uncertainty of the market but assured by the certainty of my skills and knowledge that I could not only dictate my terms but also reap huge rewards for choosing to be different.

This has served me well since July 1995 when I first went contracting in the UK, but for a 2-year stint of full employment in the Netherlands and when I had cancer through treatment and recuperation.

My fortunes have mainly been borne of my knowledge and instinct, skills I have acquired through self-motivation and ambition that have taken me into blue-chip companies around Europe proffering ideas and solutions to their challenges, both little and large.

To voice my own ideas

“I wanted to be able to develop and voice my own ideas.” There is every pleasure in having a mentor, in life and in your career, I have had quite a few and I cherish them. Most especially, I had John Coll who passed away last year. I was never his employee as I did not have the skills he needed in his organisation, he was always there to provide guidance, encouragement, advice and the steeling up I needed whenever my confidence was lacking.

More particularly, even when he first helped me redraft my resume in mid-1994 he was quite particular that it was written in my voice and my kind of thinking since I will be the one to defend it when at interview. I was offered a new job on that new marketing literature within weeks of publishing it.

Develop yourself as you

There are uses of patronage and the peddling of influence, but one must maintain a sense of independence of thought and voice with the ability to fearlessly convey those views. I can say that in my career, either as a contractor or a full-time employee, I have always been a good communicator of my views, some will say I am quite strong-willed, maybe I am.

Rather than being obsequious to your principal, I am of the view that if your views are forthright, sensible, reasonable, honest and clear, you will be of great benefit to all that you engage with, earning the respect of those around you even if you are disliked for your autonomy.

There is no pleasure in being a clone or a parrot, a poor imitation of the real thing schooled in the required talking points and jargon, acting to a set script in robotic obeisance and necessity, all in the quest to be appreciated and to belong.

It is so false, boring and quite unedifying in the long run. You eventually lose who you are and become a non-descript personality only differentiated by appearance and nothing else.

There is much else to mine in those quoted responses, but let’s start with this.

Extricate yourself from following others so close that you can’t cut loose when you need to, that you go down with them, if and when they do.

London: Bussed to distraction,

Before it all happened

At the end of our journey, as we thanked the bus driver for the trip, I walked up to the driver to commiserate about the somewhat sordid day he was having. In fact, a good few of us had not enjoyed the bus ride and it was no fault of the driver, but of passengers and schedulers.

This was on one of my unannounced trips to London, I boarded the bus from East Street in South London to Euston, route 68 it was and journey expected to take about 34 minutes. I had the time.

I would normally have taken a Priority Seat, seeing that I use a cane and I was laden with shopping from the Agege Bread shop on East Street having taken a leisurely 1.6 mile walk from Vauxhall rather than use public transport that would have taken just about the same time. [My Blog on Agege Bread]

Disconcerting conversation

The Priority Seats were already occupied by those who did not need them, especially one where a man had his arm comfortably draped over the head of the aisle seat with him sat by the window, making it difficult for me to take the seat behind backing onto the side of the bus. Yet, that was the better seat to take, so I snuggled in.

The man, quite volubly Nigerian and as cantankerously annoying as you can get was ensconced in a mobile phone conversation for the entire length of the journey and I can only imagine where he got on. The volume of his speech in another language I could not care to comprehend him enough to want to call him to order, though I doubt the scene that might have developed afterwards would have been nice. We all endured it.

Pissed off from a screen

The driver, however, had to contend with schedulers who because of certain events in London had the buses running outside schedule that he was advised to slow down to help even out the schedule. In the ensuing conversation, we learnt that we were already going at 10 miles an hour on a 20 miles an hour route causing congestion and inconvenience to others.

The scheduler insisted the more unconvinced of the chaos he might be causing on the roads from the comfort of watching screens and tapping keyboards, that the driver let it be known that he had been a driver for 30 years and that he will not have his intelligence insulted. I raised an eyebrow whilst seemingly agreeing with him. He was doing his best.

Tripping up on London place names

A few stops later, a lady got on with a rather large suitcase and an accent that was caught in the Shibboleth of London place names. She was going to Aldwych, but managed to pronounce it with an ‘s’ replacing the ‘d’ and ‘w’ that is sounded like Alsish. It occurred to me from her accent that she also might be Nigeria and somehow, my ear trained to such accents and having an idea of the route, I surmised she was going to Aldwych.

The driver was none the wiser, she however, got on the bus and made to sit beside the chatterbox man who shifted uneasily to give space without breaking from his conversation. However, she needed help with directions and he was about to give her the wrong information based of apparently knowing assumption.

I intervened, first by letting her know the proper pronunciation of Aldwych and that the stop she wanted was the Aldwych / Kingsway stop where she could board the bus on route 9 to Hammersmith. It transpired that she was really going to Victoria and though it was a circuitously contrived journey to go from where she boarded to Aldwych, to Hammersmith and then to Victoria, she was more comfortable to do that than take the London Underground. I was not going to dissuade her, but she had enough information about what she needed to do.

The power of example

Over the next few stops, people boarded and disembarked some needing directions and asking questions until a point where someone had found to use the bell as some musical instrument. You only have to ring the bell once and the Bus Stopping sign lights up on both decks, it also alerts the bus driver to stop at the next bus stop.

This unnecessary peeling of the bell in the midst of the cacophony of our conversationalist who had hardly paused to take a breath since I got on the bus some 30 minutes before had the driver make an announcement that whoever was ringing the bell should behave.

A mother and child descended from the upper deck and rather than get off she decided to have words with the driver about the fact that she son was under control and that he had every right to ring the bell. Her unladylike manner at the highest volume she could muster and then leaving having been quite abusive to the driver was enough for everyone to conclude her ill-discipline was fully developed in the child. Such is the power of example.

We finally cantered, as it were into Euston, the talkative conscious enough to disembark and give way for me to have a quick chat commiserating with the driver, who had one more trip to Camberwell before playing another route. I was in time to make my train too.