True Stories 1, Medicines and Cognition

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I hope this blog helps others avoid serious illness and unnecessary diagnosis and development of Dementia. As a facilitator I hear many significant stories. Bill says I can publish his.

Bill is now 64 years old; he began smoking when he was 11 years old and stopped when he was 48. When he was 16 he became a vegetarian and probably ate too much cheese. He began eating meat again just after he had given up smoking at about 50, and apart from topical antibiotics and the occasional painkiller (remember Ponstan?) he was never prescribed any significant medication.

After standing on a set of bathroom scales at the age of 52, and being shocked to see his weight ballooning, he joined a gym and ended up running as many miles as he could, until three years later he suffered a massive heart attack, as his last pulmonary artery seized up with calcified cholesterol. A quadrupel bypass miraculously transformed his cardiac function and, replumbed, Bill emerged from hospital to resume an even more energetic lifestyle, and launched himself back into full time creative work, entirely re-energised.

However, Bill was now taking an ACE inhibitor (Ramipril), a beta blocker (Bispoprol) used in combination with the ACE inhibitor to reduce blood pressure and relax the blood vessels. Bill was also prescribed dispersible Aspirin and the maximum dose of Atorvastatin (80mg daily). He has taken these medicines everyday for the past 9 years, and has coped with any side effects by taking these medicines, which he accepts have kept him alive, at optimum times of day and diet, a fine tuning process of trial and error. He believes that if he stops taking these four medicines he will die a horrible death.

The one side effect Bill could do nothing about was the stomach irritation and acid reflux generated incrementally over the years as a result of taking a daily dose of medication. Bill took ranitidine morning and night for seven years to counteract both the corrosive effect of the essential aspirin and the irritant effect of the other medications. For seven years it worked.

Slowly, however, the ranitidine became less effective. It worked while it did by neutralising the stomach acids generated by the other medications, however, after seven years Bill began to suffer a parietal cell reaction to the ranitidine, which was extremely distressing, like having a permanently bursting ulcer.

Several visits to the GP only brought suggestions that he could supplement his ranitidine with Rennies. Bill at home tried yoghurt in excess, and also milk, and bananas, particularly at night, when he began to suffer extreme gastric reflux every time he lay down. He resorted, indeed, to frequent additions of Rennies to his daily intake of medications. Relief was essential, but such relief was merely temporary.

High in calcium, Rennies contributed to a kidney stone attack, for the first of Bill’s life, and the parietal reaction to ranitidine contributed to the development of a hiatis hernia, which was picked up when he had his kidneys scanned for stones. In disabling pain, and affected every day and night by extreme acid reflux, a new GP in Bill’s practice told him to stop taking ranitidine immediately and prescribed Omeprazole, a proton-pump inhibitor (PPI). PPIs, like bisoprolol and ramipril, are amongst the most “essential” and highly prescribed medicines in the world. Indigestion today is a major health problem, and also a major source of income for the pharma/medical combine. PPIs work by reducing the production of stomach acids by up to 80%. And they do work, they stop indigestion in effect by stopping digestion.

The very first time that Bill took Omeprazole, he experienced an immediate end to the severe discomfort of acid reflux, and his hernia pain also greatly reduced. He genuinely felt he had found a cure, but a month later he, and those close to him, began to notice that his cognitive function had reduced considerably. Normally energetic, astute and industrious, Bill had become suicidal, withdrawn, lethargic and forgetful. He crashed his car, and felt his sensory judgements declining. He was needing to urinate several times throughout the night and defecating up to four or five times a day. He had a huge appetite but was undernourished. He had no energy and it was real struggle to keep upwith his busy life; his relationships were beginnig to be affected-negatively.

His GPs prescribed Gaviscon Advance to supplement the Omeprazole, and told him it was ok to alternate – 3 days of one, 3 days of the other. gaviscon just felt toxic and temporary. every time Bill ate, he had to swallow some gaviscon. Bill noticed that if he stopped the Omeprazole for a few days, his energy and cognitive levels slowly picked up again, he slept better, he pooed less. Within three days of returning to Omeprazole, he fell into a lethargic stupor again. He bagan to worry again, as did his loved ones and colleagues, that he might be developing dementia. He was forgetting words, names.

Being an educated man with a lifetime experience of working with the health problems of others, Bill dived into the internet and discovered the researched link between PPIs and amyloid plaques, a significant component of Alazheimer’s dementia. He was suffering all the listed side effects of Omeprazole, and returned once again to his GP in distress. He saw a locum, by chance, who told him to stop taking the opemprazole immediately. She was unaware of the PPI link with amyloid plaques. Amyloid plaques block transmission on neural pathways in the brain, they clog up the brain’s enzyme flow, and there is no getting rid of them once they are there.

For a short while Bill got by with four hourly swallows of Gaviscon Advance and the occasional Omeprazole (he had plenty left over) together with Rennies in emergencies. He felt he was dying and had nowhere to turn. Life was becoming profoundly unpleasant. On the one hand, philosophically and existentially, Bill realised that he was in fact lucky to be alive at all, and was living on borrowed time. He had to keep taking the medication, and he had to take something to mediate the stomach damage he was experiencing as a result. But he was losing hope, he was not functioning well, and he was beginning to hide this from others, becoming secretive, while hoping that by sheer will he could plot his way through each day.

He was forgetting some tasks, struggling with names and details, and was daily conemplating suicide as he lost hope; his natural optimism began to drain away. In a final attempt to put this right, Bill went back to the GP, almsot a year after first being prescribed Omeprazole, and this time saw a new doctor at the practice, who listened to everything he said. She accepted the link between Omeprazole and Amyloid plaques, and told him that he should never have mixed the Rennie, Gaviscon and PPI medication. She prescribed another PPI, Lanzoprazole for Bill. Lanzoprazole has “less” side effects, and for three months Bill felt almost like his old self. No stomach discomfort, no lethargy, some return of cognitive function. A rebirth of positivity.

However, slowly but surely, the same symptoms begain to recur. The lethargy became accute again, then chronic, an uncharacteristic sense of “can’t be bothered” took over his persona, his jittery memory and irritability began to become his new personality. Walking to the kitchen became a challenge. He couldn’t even turn his laptop on, any effort at all left him exhausted. Food passed through him in a couple of hours. Reading was a massive challenge. He was beginning to stop caring. He was missing emails and repeating himself in business meetings.

He studied again the pharmacology of the PPIs – Lanzoprazole and Omeprazole. They act by reducinbg to 20% levels of digestive acids in the stomach. Digestion of food is therefore equally reduced, in partcular magnesium, Vitamin D3, iron and Vitamin B12, all essential for the productions of the enzymes which support a healthy neurology. In the brain this creates a higher potential for the concretisation of amyloid plaques, in the gut the growth of probiotics is similarly reduced. Food literally passes straight through you, and congnitive function reduces. In short, slow malnutrition sets in. Infection is harder to resist.

Together, Bill and his wife worked out a supplementary plan. Lanzoprazole in the morning, and with the main meal a strong Multivitamin and Acidophilus. Within a day Bill felt so much better, within a week he had begun to function with positivity, writing, walking, being really active, suffering no muscular or existential lethargy, no aching limbs, no suicidality. He was reading, he was laughing. He has had no need for Gaviscon or Rennies. He can eat and drink as normal, but is able to focus on a healthy diet.

Without Bill questioning the best way of using the Lanzoprazole, without compensating for the negative effects of the PPI, he may now indeed be undergoing diagnostic tests for early onset Alzheimer’s. perhaps the plaques are already there. None of the doctor’s he saw knew anything about the link between PPIs and Ameloid plaques, and doctors all over the world are prescribing them to older people.

How many older people with multiple pathologies, are prescribed PPIs? – Worldwide, millions – in the UK hundreds of thousands. How many of those people give up, and are then further hurt with “dementia medicines”? Bill says he has never felt more like giving up than when he was taking Omeprazole. He says that if he had just carried on he may have indeed developed dementia.

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Postscript.

Bill went to see a medical consultant for a review, and told him his story. The consultant was shocked. He said, “I take Omeprazole. I have noticed my memory getting really bad.” Together they checked out the research. Check it out yourselves, dear readers.

Those if us who suffer multiple pathologies and are multipharmologically treated, should be aware that, even if we have to take some medicines, there are things we can do to avoid medicine’s lazy outcomes. Bill and I have never heard anyone from any “professional” or pharmaceutical research body suggest that such widely used medicines can actually be a major cause of dementia. Vitamin B12 and magnesium should always be prescribed with PPI’s, just as Acidophilus should always be prescribed with antibiotics (they kill good bacteria as well as bad ones). Bill says that a cynic might say that the pharmaceutical industry might almost have a vested interest in developing such covert dementias, as there is therefore a justification for new “research”, and of course new drugs. As long as not too many Bills find out. That’s what Bill thinks, anyway, how about you? PPIs it seems, can cause and accelerate dementia. Shouldn’t doctors know, and should we be told?

We have often been told that taking Vitamin B12 will “help minimise memory loss”, but not that this is due to the malnutrition caused by PPIs. Bill, nor I, for what it’s worth were ever advised that Omeprazole or Lanzoprazole could lead to amyloid plaques, we had to find out for ourselves.

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0058837

https://drugsafetynews.com/2016/08/26/proton-pump-inhibitors-amyloid-beta-dementia-connection/

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Next Time : Peggy;s story – Thyroxine and memory loss.

 

At The Dementia Show

At the Dementia Show

 

So unfriendly, these Trade Fairs;

Travelling salesmen, peddling their wares;

The venturous midwifery of palliative care.

But no-one speaks to Eileen because nobody will dare.

 

The talks, the lectures are self-congratulatory:

So many remote champions, so many distant friends;

So many unanswered questions, so many loose ends;

So many statistics, so many prosthetics

To atomise life.

But no-one speaks to Eileen, the looked after wife.

 

“When you can no longer cope

We will take her from you

We will provide for her with a mean-tested expertise;

A top down demonstration of ethical strip-tease.”

 

The Dementia Show is brash,

The Dementia Show is bright,

It is really about business, it is not about life.

 

It is a territorial and possessive arena;

A ravenous competition for souls.

 

Catholic, Puritan, Carmelite,

Ecumenical and Mythical

A concatenated chaplaincy of conditional political roles;

A religious bazaar of unsubstantiated substantiation.

We are trained, we are pseudo clinical

Evangelical proto medical.

But no-one listens to Eileen,

For that could be  considered unethical.

 

The “funeral supermarket” is funded by confiscation

A deregulated free trade of fabrication

behind an ever revolving door;

A conflicted and parasitic oddity

It would signify nothing without the poor

Husk of the human, the ultimate commodity.

 

We, the non-customers, sit with Eileen,

and we are superficially side-lined

so we laugh and we listen with an open mind

And the deep human humour of being kind;

The wisdom of experience, unlike youth’s love, is not blind.

 

We don’t crave or need your manufactured protection

Or your scavenging and costed prescription of affection

We are marking down our own home grown selection

With our gentle and imperfect sense of perfection.

Sometimes true change comes

Simply from adopting a positive perception.

 

Seen through this lens, with Eileen we glow;

So why does no-one else see Eileen at the Dementia Show?

 

Afterword

Once we were incarcerated In a systemised cortege

The pathway of paper pillars was drawn for us,

in the secret architect’s zone.

Nowadays we have started to draw

maps all of our own.

 

Our maps are maps of excarceration

And we are free to roam –

To lighten the dark, to deepen the light

And warm our hearts at home.

 

Gathering………….

It was my great privilege to facilitate a workshop at govconnect in London, at the Royal Society of Medicine no less. Before our Workshop time, we asked the main forum speakers about what role they felt Human Rights should play in their future plans for policy and service provision for people who live with the experience of dementia. Nobody had mentioned rights on their powerpoint slides or in their presentations.

Our own gatherings and conversations have inevitably gravitated to the subject of rights. The rights of people living with dementia are customarily overlooked, veiled behind a technical mirage of medicalised double-speak, tethered to pillared “pathways” and nuanced “palliare” policies. Protection, risk aversity and commodification present obstacles to the recognition of people’s rights. The question of rights shakes strategies to pieces. When a person has rights it is not so easy to do things “to” or “for” them in the same way any more, and professional conceits are threatened.

Gathering produces pearls of wisdom, magic and serendipity. We can gather and glory in being positive and making a difference, together. We can now “stand on the shoulders of our own giants.” To name a few would be disrespectful to the many, Agnes was with me at the workshop.

Not everybody wants or receives post diagnostic support. The long years between the five pillars and the eight pillars, the years of “self-management”, can feel like being in a black hole. People living with the experience of dementia have the right to support to be able to live independently in the community.” Human rights are the missing pieces in the jigsaw; completing a positive, holistic and human picture for all of those affected by dementia; that is, all of us.

These pearls, these profound insights, were gathered from people living with the experience of dementia. The sharing of the experience and the assertion of a rights based agenda went down a storm at the workshop which we presented in London. You see, many people still see people living with the experience of dementia as the “other”, the the demented, fragile, unable to speak, on the inevitable downward spiral; to be pitied.

“Many people think of dementia as the end of the world, but I actually enjoy my life.”

Psychiatry and its confinements it seems, have less and less to offer. Doctors are reduced to telling jokes and humourous anecdotes. Service providers aim to obscure reality with statistics. Pharmacology consumes billions in pursuit of …… nothing. People living with the experience of dementia are not “they” but “we”. When we grasp that simple truth the world changes. Experience and ownership is everything.

Gathering together we begin to assert our rights. Marvellous and magical people, heroes and heroines; they rise above the patronisation of being “research subjects” (guinea pigs) and we begin to write our own script. “We have rights, please respect those rights.” We can check out many cafes but if we don’t like what is on the menu, then we don’t have to eat there at all. Better to have support to cook and eat at home and together. It doesn’t have to be complicated. If we only have the cafes to go to, then our choice is in effect limited.

Following our workshop I was lucky enough to have a few days in London, and Kerry and I visited the British Museum, where I came across this fantastic casket of shells preserved from 18th century shoreline gathering.

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Oysters, mussels, clams, limpets and scallops have been “gathered” for thousands of years. Food sustained the gatherers in their communities, and the particularly beautiful shells and pearls which were inevitably “found” adorned life with their magic and meaning, in jewellery and artwork.

Gatherings of experience embellish understanding more than complexes of professional perspectives, based irreductibly on a “doing to” or “doing for” philosophy. Augustine and Freud have much to answer for.

At their best they are now “doing with” but increasingly we are stressing that the best philosophy derives from the “doing by” of people living with the experience of dementia.

Metaphors; the oyster, clams, mussels and limpets all, they illustrate the human polyphony in the most unlikely, and most blindingly obvious places, such as “Pre-historical Europe” rooms of the British Museum. Magic happens when we look. It has been happening for millenia, as people gather in the ways that suit them best and are enabled to roam freely as themselves. I didn’t notice the birds of light in this picture until I posted it on this blog………..

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The Grit In The Oyster – A Meditation

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A piece of grit, or grain of sand, finds it way inside the shell of an oyster as the currents of sea and tide ebb and flow along the sea or river bed. As oysters live their entire lives in sandy and gritty environments they are quite used to spitting these pieces of sand and grit back out, and they do!

It is, in fact, a myth that it is the “grit in the oyster” that generates the beauty of pearls. It is other foreign intrusions, whether due to chance or predestination, depending on what you believe, which are the true generators of pearls.

What are these foreign bodies, the “true grit”? Perhaps a small parasite will burrow into the oyster through a soft part of its shell, and by dying inside will become lodged in the oyster’s soft body. Perhaps a floating fish scale, or a piece of shell from another creature will become lodged inside the oyster, causing an injury, a scar which needs to heal, a gift of regeneration. It is these intrusions which generate pearls.

To cope with such irritations, the oyster secretes a liquid, which encloses the intrusion in a blister of nacre and conchiolin and over time, this blister hardens and forms itself into a pearl. What was originally a source of irritation becomes a thing of beauty on the one hand, and of value on the other. It gains its value when it is traded or coveted, and this trade requires manufactory and organised industry. People pay a lot for pearls, and others make a lot of dough.

Natural pearls are almost impossible to find nowadays, as they are entirely random in their genesis and require great skill and expertise to find. They have become a commodity of antiquity. The divers who harvested them require skill and lung capacity foreign to our modern times.

Nowadays, cultured pearls alone are manufactured. They are grown on shallow beds, so that the skill and grace of the diver has become redundant to the modern pearl, like the natural pearl a marvel of the past; as pollution and mechanised dredging have expropriated both from our phenomenological ecology. Pearl divers have drowned in history’s tsunami, and like dolphins perform for us, if at all in the raraified and exotic tanks of a televised world.

The erroneous metaphor of the “Grit in the Oyster” survives however. Like all metaphors it is nearly right, and we all think we know what it signifies. In my role as a listener, in communication and facilitation, I am aware that I have to be vigilant; sensitive to non-congruent intrusions into my own process. I have to be aware that I form protective blisters around comments and observations that grate against my own personal sensitivities, that add to or subtract from my personal agenda. I am a faciliator, but I am also a person. My professional task is only partly related to my personal growth, but the intruding foreign element attaches itself without preference. Once my blister forms around it, the pearl will grow. I can’t help it, because I don’t even know it is there, I just feel the irritation.

Most of us are involved in what we do with a passion, with committment. The courageous and the gentle, those who are both fragile and strong at the same time convene with us and share themselves with trust. I absorb irritants and I gaze in awe at the pearls others display. Sometimes ego and organisational priority compete for control of the oyster bed, even seek to expropriate it. It is a fact that cultivated pearls can be mass produced, uniformally spherical, even identically “perfect”. They can be timeously harvested. Natural pearls, however, are far more irregular, indeed they are universally unique, and require skilled acquisition and harvesting.

I am protective of my own pearl, for like everybody else I have nurtured it internally from its irritating genesis, until it has become part of my own identity, even though I may not even know it is there. When somebody else wants it, I become protective; defensive; even confrontational and argumentative. A sense of ownership can assume dominance. I do not want to lose what I have grown, for it is a natural pearl, it is unique.

Pearls grows from the inside out, although they are stimulated in the beginning by the intrusion of a foreign body. It takes great skill to remove a natural, or even a cultivated pearl from an oyster without killing the host, and the shell itself can cause an injury to the surgeon; it can be very sharp; protective gloves are recommended for modern farmers.

In facilitation, it is often enough to witness the pearls we bring to show, for pearls of wisdom is often what they are. It is always better to simply share their glory in the now, and leave them in place in their own soft nurturing spaces. Even the occasional parasite can help to produce new pearls, simply by being a little too intrusive for its own good. Of course, just as natural pearls come in all shapes and sizes, it is not commonly understood that pearls can grow in other molluscs, such as mussels and clams, characteristics which carry their own metaphorical legends.

However, it is also the case that if a pearl is removed gently enough it can be freely shared with others, and another may well grow in its place. Only molluscs, with their soft interiors, nacre and conchiolin and sharp protective shells can generate true pearls.

When an irritant enters my sense of congruence, I try to remember it is better to let it settle for a while, rather than try to eject it, unless it is merely a grain of sand.  All sorts of influences culture our pearls.

From South to North and Back Again

From Lockerbie to Inverness by road, a rare departure nowadays for me, as train has become my usual mode of travel. The Senior Railcard helps of course, but of late I have come to realise that a numbness can result from train sitting. The clatter of station noises, and the poor quality of coffee can affect my balance. Besides, the task in hand at Inverness requires me to take my printer, my pop up banner, my guitar, my bazouki, a flat screen TV, and my medication, an increasingly bulky item in itself! I would almost have needed a whole carriage to myself had I taken the train, and the prospect of carting it all up and along the platforms, the stairs and escalators of Waverley and Perth Stations caused me more anxiety than the facilitating, planning and preparation role itself, so……….just as I had done last week to Hawick and back, I chose to drive. And what a journey!

Northwards in sunshine through the open spaces of the ancient lands of Clyde and Lanark, reflecting on the beauty of human connections last week in Hawick, and the unknown potentials awaiting me in Inverness. Sweetness and light subdued to monochrome and mist as I hit the roadworks at Glasgow. The traffic slowed and snarled, and drivers around me became impatient, cutting in and cutting up. Brows were furrowed. The rain began to spatter, and the radio became unbearable, the inane commetary on Brexit ruining my concentration. My bubble was burst asunder by the grind of connurbation. Near accidents and potential overheating intruded into my meditations.  I began to worry about my tasks.

I emerged from the fraught chaos of motorway madness, indecipherable diversion signs and riddling roadworks into the fresh open space of the north, Stirling fading to my right, Perth passing as a mere roadsign reference as the Cairngorms beckoned me on. The rain now stops,the traffic thins but the potholes appear on the A9 with its legends of fast crashing. The sunshine reappears. I put my new CD, George Harrison’s “Wonderwall Music” into my player, and relax into a blissful drive as far as Pitlochry. Time for a late breakfast, or as the cafe calls it, a “Full Scottish Brunch”.

My mum and dad spent their honeymoon in Pitlochry, in 1952, and I popped into the world just under a year later, so I was almost made here, or at least I was brewing!

All that love shadowing my life’s journey; from the cradle to the grave. It envelops me still. I have the image in between my heart and mind now, as I walk through the town, of a photograph of my dear mum and dad as a young couple, arms around each other, leaning against a dry stane dyke on the outskirts of Pitlochry. Dad died 33 years ago now, mum enjoys her late years, and we have embraced ageing well, we have always shared love and laughter, despite the sensory and memory glitches.

I finish my brunch, and set off again through the glory of the Cairngorms, my motor rolling on well, in beautiful sunshine, at a dignified pace. My colleague and a dozen or so people await me in Inverness, some from the Islands, some from the city. People are travelling by plane, by train, by car, by bus, by boat. We are converging so that we may Gather “the gether”. The rain begins again as I reach the outskirts of the city. The super-stores reappear, as do the roadworks. I draw at last into the hotel car park.

My journey has taken me through three of the many parts of Scotland; the South, with its border concerns; reivers’ remembrances and open spaces around communities of shared identity; the Central Belt, all connurbation and bleakness, engrossed motorways and steamy trains – a nation within a nation, as London to England, as Moscow to Russia; I sense the disconnect: and the North, with its salty maritime “taing” and island connections, its space and innate remoteness. The North and the South with their memories of Clearances, the Central Belt with its motley concentrations. The nations seems to be pointing northwards, away from the Border, towards the fresh air and the sea.

In my role I help to facilitate the crystal clarity of dementia. The deep honest memory of times past and the wisdom of experience, and the conflict brought by stigma imposed by those on the outside who are merely looking in. This conflict foments the grit in our oyster, affirms the sacred value of connecting with love and humour, eye to eye, hand to hand and hug to hug as we meet, many of us for the first time. The beauty of accepting each other as people is immediately apparent.  I become overwhelmed by the courage, the honesty and wisdom of the people I meet. Even though I am the faciltator, I am facilitated into community by the kindness of those gathered together. We talk and we share, we move from an awkward struggle with how to “self-manage” our conditions into a more dynamic construct, a rights based activism. We are more than commodities of observation, tethered to the pillars which map the “inevitable” pathways of decline; Of course, we acclaim – we have the right to be supported to live independently, to do the things we choose to do. We can step back into community, with our loved ones by our sides.

These have been magical gatherings, they have enabled us to get out of the goldfish bowl, and those “professionals” who wanted to come and “observe” have been turned away, so that we can converse without restriction, without the confinement of serviceland, of postcodism. An excarceration of the soul has been enabled. The clarity of communication amongst our gathering for people who are living with “dementia” is, from my perspective, life changing. I can taste the spirit, and feel the breath of life in the sweet accents around our tables, The Gaelic, the La’lands, the Glasgae and the Black Isle, the English too. We laugh, we cry, we talk and we listen. We love. Things are changing, and this may be the gentlest revolution of all time. How could society have overlooked to right to self determination in this gentlest of communities for so long?

When everyone has gone home again, I re-pack up my car. My journey home is, quite naturally, the reverse of my journey north(though I am not driving in reverse gear!). I listen, on my way, to Bach’s Mass in Bminor. Elizabeth Shwarzkopf, Kathleen Ferrier. Half way through the Mass  I stop off again at Pitlochry, for coffee and cake. I am not a religious person, but I always remember what my mum told me when I was a child. I asked her, when I was about 8, what God was, and she just answered that “God is Love”. That’ll do me, I thought then, and still do now. I search Pitlochry for a postcard to send her, just to let her know that I am here. There are a few art and card shops, but none of them have postcards in stock, just art cards. It seems they are a thing of the past, in our digital age, almost. I even search the charity shops, the second hand bookshop. Yet not one postcard do I find, to connect my journey with my mum’s own, deep, living memory.

I find one, eventually, on a rack of cards in WH Smith. After I have bought it, and as I sit writing it, I notice that the photograph was taken by an old friend of mine, who has made his living out of making postcards. I haven’t spoken to him for many years, but now I reflect that if you look hard enough, and take the time; if I keep myself open to the possibility of connection and serendipity, even the most demanding of journeys can turn out to be pure pleasure, and the treasure can be found. These gatherings in Hawick and Inverness have been a pure privilege to facilitate and have inspired me. As I hit the roadworks outside Stirling, the rain comes down, Bach’s Mass finishes, but I don’t worry. My engine keeps turning over, it is filled with the best of fuel.