The Unexpected Pleasure of a Social Fail

Last week I was invited to a publisher’s event in London and despite my terrible track record at attending such things, I decided I would go. There are plenty of reasons why I hardly ever attend, beyond my chronic fatigue. They all seem to start at 6.30 p.m., for instance, which is a dreadful time if you are a creature of habit and like to eat regularly. To arrive in good time, I need to leave my house about half past four, which is too early for tea beforehand, and then if one stays to the bitter end at 8.30, this means eating dinner at home around 10.30 p.m. which is even past my bedtime. Obviously other people find their way around this, but I admit it perplexes me.

Anyhoo, I boarded the train with my emergency supplies of a Marks & Spencer wrap, made it to London and walked to the venue which was just off Charing Cross Road. I visited the new Foyles as I had a a little time to spare, and found it very spiffy to look at, but a tad confusing in layout. Mind you, it’s definitely a step up from arranging books by publishers. Then I walked to the venue, eating half the wrap as I went (and trying not to drop lettuce into the folds of my scarf) and still arrived a bit early. I cased the joint, as the old gumshoes used to say, from the other side of the street, and saw people going in. At the door there was a young woman with a clipboard taking names, and I feared things were not going to go well when she could not find my name although I had written to rsvp. I had my invitation printed out in my bag, but it seemed she didn’t want to challenge me, just hastily added me to the bottom of her list and waved me on to coat check. The people in front were having their coats taken, and when that young woman never returned, I thought it wouldn’t hurt to keep my coat with me, which was a good decision in the end.

I sat in one of the alcoves in the bar, watching London publishing people arrive and flicking through the publicity brochure. This is when I realised I had made a mistake in not checking beforehand whether any other bloggers were going to attend. I’d been so sure somebody would be there who I knew, but as jolly partygoers poured in, I realised there was no face I recognised. They all knew each other though. They were doing that social clumping thing, where they separate into little, dense groups of furiously chatting people. When I finally saw a face that was familiar it took me a while to place it. Then I fervently hoped I hadn’t been staring. I think it was the owner of a book store who I met several years ago now, offering to create content for a website for the shop. This person was dead set against any idea of a website and we parted company less than pleased with one another. Yikes.

Well, half an hour had passed and I was very bored, and nothing seemed to be happening and I really had no desire to talk to the only person who might know me. And so I put my coat back on, slipped through the crowds in the room, and left without anyone noticing. Then I walked back to the station, got on the train and ate the other half of my wrap for dessert. It was one of those sleepy trains with the final few commuters of the evening all happy to nap in their seats or read. Across the aisle from where I was sitting an Indian gentleman slept through the first half of the journey and then when he woke up, he took a book from his bag. Inevitably I craned my neck to read the title and was intrigued when I saw it was a memoir by Michael Greenberg called Hurry Down Sunshine about a severe breakdown his daughter suffered. I’ve had it on my shelves for a couple of years without having read it yet (same old story!). Well, the gentleman saw me looking and smiled, and I smiled back at him and it was clear we both were on the brink of saying something but were a little too reserved. Ten minutes later, as the announcer said we were arriving home, and we were all shifting and leaning forward in our seats, we just started chatting (he was enjoying the memoir, though it was very sad, so maybe enjoy was not quite the right verb). And I had my bookish conversation after all.

When I told this story to Mr Litlove with the stated intention of blogging about it, he wasn’t sure I should mention it. I think this is because Mr Litlove is an alpha social animal, who would never be intimidated by a room of strangers and would find an easy, natural way to enter a conversation other people were holding. I do admire him for that. But that’s not me. I dislike parties, and travelling, and I fear being stuck in social situations I’m not enjoying. I was quite pleased that I took the decision to leave and to conserve my energy which is still in short supply and precious to me.

And it’s very intriguing why I should have found it easy to talk to the stranger on the train and impossible to talk to the strangers at the party. All I can say is that the train felt like a level playing field, socially. At the party, the people there knew each other already and I was at a disadvantage. And on the train, we had made a connection over the book; it was a tiny thing, barely perceptible, but it made all the difference. Something real had occurred, and the real is always simple to capitalise upon. When the connection is artificial, you have to work so much harder.

In case you’re interested, I had a bowl of cereal when I got home, to round off my nutritionally impoverished evening and I still managed to come down with a chronic fatigue relapse a few days later, which goes to show that evenings in London are probably still beyond me physically as well as socially.* But the experiment was interesting in all kinds of unexpected ways.

 

* And yes, Dark Puss, you are top of my list for when I am able to spend a bit more time in London!

Chronic Fatigue Gets A New Name

So, The New York Times reports that the Institute of Medicine has suggested a new name for chronic fatigue syndrome. The proposal is that it should be called ‘systemic exertion intolerance disease’, which is quite a mouthful. But maybe an almost-unsayable name is appropriate for an almost-intolerable illness. Basically, the name is designed to reflect a significant symptom of the condition: ‘a sustained depletion of energy after minimal activity, called postexertional malaise.’

I used to describe the experience of the illness as akin to having a leaky car battery. You could charge and charge that battery, but as soon as you started doing anything you could feel the energy draining away. Quicker than seemed possible you’d be reaching the point of exhaustion. Sleep makes no difference. So during term at the university, I’d be struggling by about the second week in, watching my symptoms come earlier every day in the third, and running dangerously on empty from the fifth onwards, knowing I was just going to feel sicker and sicker and trying to manage the panic about that.

The harder you try to push through the fatigue and the illness and keep going, the worse it will all be when you finally stop. In fact the worse it is day in day out. I always thought that if it was only tiredness I felt, that really wouldn’t be a problem. The difficult part is that you feel extremely ill. There’ll be symptoms – nausea, headaches, general aches and pains, sore throats, dizziness, all that sort of thing – but the hard part to deal with is a kind of essence of all illness. You lose control of your temperature, your heart rate, your blood pressure. All of these experiences are invisible. The habitual words do not convey the reality of the feelings. No one will understand.

When I finally came off work, the suggestion from medics was that I try ‘pacing’. I began with no more than one hour’s activity a day, and would stick to that for a week. If all went well, then the following week I could increase my activity by five minutes. And again if all went well, five minutes more the week after that, and so on and so forth. There would be relapses. I remember several years ago, Mr Litlove and I were on a beginners’ tango course. This was a big ask for me – three hour sessions every weekend. Towards the end it was becoming too much and I intended to miss a session. My mother-in-law, who had been visiting, couldn’t understand it – I didn’t want to miss out, did I? If I was tired the next day I could just sleep in. Of course healthy people think this way. For me, I knew that completing the session would mean three days or so in bed, followed by a long, slow, increase of activity afterwards. And it’s hard to enjoy things when you are aware how expensive they are going to be.

I still think of energy as money. Some activities are a lot more expensive than others – for me, socialising, travel and stress are the most costly (this differs from person to person). But everything costs a little – being excited about something is as energetically demanding as being anxious. Laughing takes energy. Engaging in an intellectual activity doesn’t come cheap. Television is more expensive than a book. I have an expensive personality – my normal demeanour is bright, cheerful, engaged. Even being myself was more than I could afford some days, and of course the sense of outrage and unacceptability is so overwhelming when you cannot even behave like your own self that you (I) tend to push through regardless, out of frustration and stubbornness, and build up a large debt that then takes forever to repay.

Doctors have long wanted to push for depression as a key part of chronic fatigue, but I think that’s putting the cart before the horses. It’s hard to stay positive sometimes when you have an illness that is like a punishment for living. And inevitably, the sort of mindset you need to get better – calculating all the time what amount of exertion you can afford, always playing it safe, shying away from anything demanding – affects your confidence over time. Doing something new, or something you haven’t done in a while, can be frightening when you have no idea how you will feel afterwards.

I write about chronic fatigue for two reasons. The first is to raise consciousness, because it is still such a misunderstood and stigmatised condition. I’ve had a lot of time to think about it, and I’m motivated to find ways to express the reality of living with it. The second reason is that for a long time, I felt terribly ashamed of myself. I thought it was my fault. I didn’t want to confess to all the things I couldn’t do without severe consequences. I hated not being able to live like a normal person. But you know what? Denial is a very expensive habit, and I came to realise it was far better for me to accept the condition, to understand it was part of me, like it or not. And it still is a part of me. The past eighteen months have been a very stressful time for me and my family, and for most of it I kept up a reasonable level of activity. This was encouraging – I thought I was seeing the back of chronic fatigue. But then when things finally calmed down towards the middle of November, I felt the familiar old exhaustion. In December I caught every bug going, every time I tried to raise my level of activity even a little. I resigned myself to more of the same in January. This month, I’ve felt more like myself, but I have to calculate my energy every day and make decisions accordingly (hence minimal blogging for which I apologise).

But even the experiences that take the most away, do give something valuable back despite themselves. If there’s one thing this condition has taught me, it is the resilience of the human spirit. Since 1997 I’ve been on a wild cycle of ups and downs, but no matter how low I have been brought, I have always risen back to the surface. There has always been a return of energy, a renewal of appetite, an improvement in my overall wellbeing. And each time that happens, I have felt acutely, exquisitely, how precious life is. I live a very quiet, peaceful life, but living quietly and peacefully with much time for contemplation turns out to be something I cherish and for which I am profoundly grateful. Not many people have the luxurious time and space that I do for observation and for thought. The blessings only come from accepting the truth of the situation, and that can be hard with a condition that is so poorly understood. In the absence of a cure, perhaps a new name (however awkward!) will help the healthy and the sick understand what’s at stake, and deal with it better.

 

 

Medical Misadventures

On Friday, Mr Litlove fell off his bike on his journey to work. He was rounding a corner when the bike slowly slipped from under him, and it wasn’t until he was on the ground that he saw the sheet ice. A couple of builders working nearby came over to check on him, but by then Mr Litlove was back on his feet and brushing himself down and being thankful he hadn’t broken any bones. He’d bruised his ribs and his hip, though, and when he limped in on Friday evening after work, he was clearly a man who had sustained injury and wanted some sympathy. Need I say more?

‘So you won’t be going rowing in the morning, then?’ I asked him.

Mr Litlove’s eyes slid away from mine. ‘I expect I’ll be fine,’ he said.

And so of course, the stubbornness of the male being unparalleled, he was up at 6 am and off to the river. And then we went out to lunch, so it’s possible that he overdid things a tad because by Sunday he was very stiff and sore indeed.

I was expecting a skype call with our son that morning. He has an essay paper to do this year and I offered to lend a hand, given that he’s not written one in several years. The topic is science communication, which turns out to be rather fascinating. It’s a jolly good idea for the public to have some notion of what science is up to, but as with all these vague mission statements, things become tricky when we actually get down to nuts and bolts. How much information do we need to have any sort of useful judgement about current developments in science and technology? Who needs to know? And who is going to tell us in the ‘right’ way? When scientists talk about public understanding, what they often mean is public appreciation – getting the power of mass influence behind their research in order to secure more funding. Whereas what often happens is panic or aversion thanks to sensationalist and inaccurate media stories.

Let me give you a little example of some of the issues involved. Back in the 1950s a medical researcher, Alice Stewart, started to collate the figures on infant deaths by leukemia in women who had been x-rayed during pregancy. The statistics spoke for themselves; up to a child a week was dying from the disease and the mortality rate was almost 40% higher in children whose mothers had been x-rayed. Stewart published her findings in the Lancet in ’56, in the British Medical Journal in ’58 and yet the Medical Research Council absolutely refused to accept her conclusions. Stewart was a lone female voice without the backing of a large organisation. Doctors were in love with the technology, which they believed could only be useful. They were unwilling to take any one else’s word on a problem they had not identified themselves – the more authority at stake, the more unwilling people are generally to admit mistakes. And finally, they believed that as doctors they were always healing people; they simply could not hear the opposite. Too many cherished assumptions needed to be overturned and so for the next 25 YEARS doctors continued with the x-rays, and thousands of children died.

Science needs to be in the public eye, because keen public observation keeps people more honest. And the general public is a useful moral barometer, reacting strongly when science moves into territories where ethical issues are complex. But then we have to think about the scares over the MMR vaccine, which were sparked by one set of results that have since been called into question. The real problem is in the calculation of risk, which we are not encouraged by the media to do with any pragmatism. And anyhow, when our health or that of loved ones is at stake, it’s hard to be cool-headed.

I have an interesting calculation of risk of my own underway at the moment. Last week an invitation from the NHS popped through my letterbox to attend a cervical smear test. Oh joy. It’s not the test itself that bothers me, it’s the inaccuracy of the results. One in twenty women screened will register a false positive and have to go through an unpleasant medical procedure in consequence. One in twenty is a lot. On any given day, assuming a 50/50 gender split, ten women will read this blog who have been scared and treated invasively for no reason at all. I’m tending to agree with Germaine Greer on this one.

I readily confess that I am not good with medical procedures – a touch phobic, for sure. And I am terrified by the prospect of falling ill again, having so recently regained (most of) my health from the worst of chronic fatigue. Am I sensible about this? No, of course not. I had a bad viral illness and it took me 13 years to get over it. How could I possibly be sensible after that? But I know for sure that the stress and anxiety over the test and a false positive result would result in another stretch of chronic fatigue for me. More months lost to illness, when I’ve lost too many already.

Don’t worry; I am the least reckless person you’ll ever meet and I daresay I’ll go and talk it through with my nice doctor. But I have a little fable involving Mr Litlove to tell you about. When I expressed my displeasure at the arrival of the summons, Mr Litlove sighed and clearly wanted to say something he thought better of.

‘You think I should go and have it, don’t you?’ I asked.

‘Well yes, I suppose you should just get it over with,’ he replied.

‘You men should try it once in a while. Some sort of unpleasant, embarrassing test with an uncertain outcome. Something that involves shaving your balls and having them weighed or some such. How many men would do that?’

‘Oh don’t make me laugh,’ said Mr Litlove, clutching his sore ribs. ‘Please don’t. It hurts.’

‘And that reminds me. If those ribs are no better on Monday morning, you should go to the hospital and get an x-ray.’

The look on his face was transparent. It said: NO WAY.

‘Casualty won’t be too bad on Monday morning, I expect.’

‘My sister’s coming to stay on Monday,’ Mr Litlove mumbled. ‘I’ll ask her.’

Back in the day his sister was a GP and now works in academia in public health, none of which to my knowledge has gifted her with x-ray vision. But this is typical. He’ll tell me soon enough what to do, but he’d rather walk around with cracked ribs than go to a doctor. What has understanding science got to do with our behavioural choices, I wonder?

 

 

 

 

 

Of False Correlations

I’ve been trying to think what’s been happening around here lately to tell you all, and can only come up with events that involve unusual modal tenses.

There are things I ought to have done but haven’t. For instance, several months back I was invited to chair an author event at the local bookstore. I did that thing where you look far ahead at a blank calendar and think, oh I shall be so free and well-rested in those empty days! And agreed to do it. After all, I used to chair a great deal, back in the university era. Well, I quite liked the idea of it for a good six weeks or so, and when I had a chronic fatigue relapse I thought, I’ll doubtless be fine when the time comes. I even bought a new pair of boots (any excuse!). Then, when we got to a couple of weeks before the event, I began to feel the stirrings of horror. Did I really want to have to stand up before an audience and talk? I always did have stage fright, but there was a time when I was very stern with myself about repressing it. Plus I was practised then and knew I would do the performing stuff well. I reminded myself that this was a local event which would probably have no more than twenty or so people in the audience, half of whom would be related to the author, half of whom would have wanted to come in out of the cold. But still I trembled and the chronic fatigue was settled in for the duration; knowing your body can give out on you at any moment is a fun thought to take into a stressful situation.

Preparation is the key, I told myself, and so I went to the bookshop and asked whom I should talk to, in order to have a look at the space we’d be in and familiarise myself. I was a little surprised to find the bookseller had no knowledge of the event. And when I looked at the advertising posters in the shop, it clearly wasn’t on them. I went home and checked the internet, nope nothing on the website either. See, I told my chronic fatigued self: this will be the best event ever, because it’s going to be just you, the author and the publicist! You can all go down the pub! But I was still chronic fatigued and easily stressed and I began to think that finding someone to take my place might be the best idea. But wasn’t it unethical to hand an event over to someone else, knowing as I did that it was going to be…well, intimate?

Just as I was getting tangled up in knots over the various strands of worry involved, I received an email from the publicist telling me the event had been cancelled due to ‘poor ticket sales’. I’ll say! It’s hard to sell tickets to an event no one knows about. Through the immense relief, I felt a stirring of sharp curiosity to know what had happened. Had the event been cancelled before I went in the shop or after? Was there someone in a London office somewhere tearing at her hair and yelling ‘Christ, I knew there was something I’d forgotten to do!’ or was it more the case that no one had the heart to disappoint that poor blogger, who was probably gagging to appearing in the real world rather than the virtual one? Either way, I was just relieved, and it was a good reminder to myself that my public speaking days are over at the moment. Just because you were good at something in the past doesn’t mean you have to keep doing it.

Then there have been things I wonder whether I shouldn’t do but am still doing. The cancellation of the event meant I felt able to commit to writing another chapter of the book I am STILL working on, knowing it would be a tiring thing to do. Since I began writing this book in the early summer of last year, there has been a string of disasters, some acute, some chronic, all unpleasant, that make me wonder whether the universe is not on the side of this particular project. Despite my best efforts, I cannot help but read omens and portents into the world around me, and maybe these scare tactics of fate are a way of saying: Give up! Do something different! And still I stubbornly trudge along, churning out stuff that probably no one will want to read out of some cussed conviction that what I start I ought to finish. Of course there is a line of theory that suggests life is random, and cannot be interpreted as if it were a narrative whose end is obscured by future time. But given that every part of my life has been bound up with stories one way or another, what sense would that hold for me? Surely a refusal to interpret would go against everything I have ever held dear?

Mind you, away from these mental minefields, there has been some straightforward stuff, too. My capacity for comedy accidents continues to astound me. On the way into the funeral last week, walking in the slow, solemn procession into the crematorium, I suddenly realised my forward progress had come to an abrupt halt as the heel of my shoe got stuck in a grating. The line of mourners snarled up behind me as I struggled to hoick myself out, and I wondered for a moment if I’d have to walk in barefoot. To the kind woman behind me who said in a most sympathetic voice, ‘That sort of thing happens to me all the time,’ thank you.

And then yesterday I noticed as I headed out to my car that an industrious and quite substantial spider had constructed a large web across the garden path. Ha! I thought, and avoided it by walking over the lawn. Yes, sure spiders are great, but not on me. When I returned, I remembered the spider and carefully walked around it again. And then, mid-afternoon, I realised there was a book in the library I needed and I thought I would nip out quickly and collect it. You know what’s coming next, don’t you? I really hope my next door neighbour was not working in his garage as there was rather a lot of squealing. And I did a little raindance, too. Proof that troublesome as my brain may be when it’s working, not much good comes of switching it off entirely.