Middle Age

This week I thought I'd discuss … middle age.  Wait.  Don't run away screaming.  This is a happy-ish blog.  This can be a happy-ish topic.  Truly. Those two words - middle age - can be synonymous with opportunity and enjoyment and happiness and growth (and not just of your waist line).  I'm middle aged (late 40's) - so I'm talking from my own experience, and from  the experience of my middle aged friends … and from the many years that I've been a doctor.   Middle age can be a great time in your life.  Really.

For many people the concept of middle age is a bit depressing.  Youth has gone.  Old age draws nearer.  Images of wrinkles and grey hair and weight gain and tiredness fill our minds … and our mirrors.  Of course, not you.  I mean other middle aged people, naturally.  

For some people middle age can conjure images of doors closing to opportunities; being judged negatively with regards to success achieved in your life;  being viewed by others as less capable or important or useful than younger people, and, for many women, middle age can mean feeling invisible to men … and even to society.   

So, the topic of middle age can often be one that people don't want to think about - or talk about - or read about.  A depressing topic.  It might be thrown into the basket of horrible topics like fungal-nail infections or gangreen or … budgeting.  Yuck!  Change the subject!  Please!   

But … it doesn't have to be like that.  It's all how you look at it.  Middle age can be a lovely time.  It can be one of the best times of your life.    Like death and taxes - it's unavoidable - so you can decide to do it the easy way or the hard way.  Choose the former and you can have a lovely ride with it.  So, lets discuss middle age.  Be brave.  You can do it.  Take a deep breath.  Here we go.

Firstly, what is middle age?  Well it's the period of time between 1066-1485 when knights on horses roamed around having battles and saving fair maidens … when we, middle aged people, were just children.   OK - that's a joke.  Let's start again.  Middle age is the period of time in our lives between either 40-60 years old or 45-65 years of age - depending on the dictionary you use. It's the period of time after 'young adulthood' and before 'old age'.

In Australia the life expectancy is currently 82 years.  Women live about four years longer than men.  And, married men live longer than unmarried men.  Or it just seems longer - they tell me.  Actually, that is  a fact.  Not the part about it seeming longer - but actually living longer.  We women do tend to shove our men off, kicking and screaming, to the doctors for health checks and medical appointments, and we may force a few vegetables and fruit into their diet.  A favourite phrase of my husband, David, is:  "I'm so hungry I could eat a vegetable'  - and he's  only half joking!  And, he's rarely that hungry!

So,  sorry guys (male guys that is - not the generic 'guys' for everyone) - but sometimes, as a doctor myself, with 25 years experience, I have found that  you just don't prioritise your health quite as much as you should.  Women, can also neglect their health - obviously - but it is a fact that men visit doctors less than women do.  And this is generally not a good idea. 

There are theories as to why men access doctors less than women.   It's thought that some men  think it's a bit sissy and weak and 'over-worrying' to see the doctor about a 'little' health issue (I've found this more with men from  rural areas.  Maybe, a tough and rugged life out on the land means  these  men have a slightly different idea of what  'real' men do - and don't do.   I've seen many sad cases, over the years, when even young men wouldn't go to the doctor with things like a 'changing mole' or rectal bleeding or chest pains.  'She'll be right', they've told their worried friends.  And they have died - from things like disseminated melanoma or bowel cancer or heart attacks.  Such a shame.  These things could so often have been easily treated - if the patient had presented earlier.  Timing can be so important).  

It's also been hypothesized that men think they can DIY (do it yourself) their health care - similar to how they often don't like to ask for directions with maps, I suppose. 

So, getting back to the topic of middle age - and leaving poor men alone from my reprimanding for a little while -  'middle age'  is a time around the third quarter of the average life span.  Yet, this is a lot better than things were 50 years ago.  In Australia in 1960 the average life expectancy was only 71 years.  And 100 years ago, around 1900, the average life expectancy in Australia was only 55 years.  So, being aged over 45 or 50, if we lived 100 years ago, would  be considered  'old age, or we'd be  'pushing up daisies' by this age. We would have kicked our buckets,  bought our pine condos, be checking out the grass from underneath, have gotten stamped 'return to sender',  kicked our oxygen habits.  See!  Middle age is not such a bad thing.  It could be a lot worse!  It could be the alternative!  

The increased life expectancy over the last 100 years is due mostly to improvements in medicine - antibiotics, surgery available, obstetric care and many other areas - including preventive medicine.  It is also  due to the  improved standard of living, in the industrial world, over this time.  

Oh, and course our longevity is  related to all of our own efforts  eating the recommended quota of fresh  vegetables and fruit daily plus all of the  exercise we do so religiously.  I'm joking.  I'm afraid for most of us eating well and exercise are things we discuss every New Years Eve, when we make our New Year's resolutions,  and then we give our healthy plans up  by about lunch time on January 1st.  Or, at least, I do.  Maybe, for some of you, it's lunch time January 3rd - give or take a day.  But, I agree, that it is really hard to change one's lifestyle.  Junk food and sloth are so much fun! 

Although, to anyone out there disciplined enough to eat the healthy 'recommended' diet and do all of the exercise that we all know we should be doing  - we all envy you … and hope that you trip over while choking on your carrot stick while walking to the gym.  Not really.  Well, maybe just a tiny bit. And not fatally.  Just a little grazed knee, maybe.

People age at different rates - so during middle age - some people may enjoy much better health than others.  In developed countries, mortality begins to increase after 40 years - mainly due to age-related health problems such as heart disease and cancer.  I have already seen a number of my friends and colleagues develop cancer and heart disease  in their 40's, and I've  had a couple of middle aged friends die already.  My own father had a heart attack in his 50's.  This is a sobering reality of this age.  However, there are a few fairly simple things that you can do to improve your health and, therefore, your enjoyment of this age.  I'll list and discuss these things, briefly, at the end of this blog. 

I think  the fact that  middle age people are already starting to see friends, their age, die or become ill creates a slight sense of urgency  to do things in their own life - before it's too late.  For many of my friends, including myself, ideas relating to 'bucket lists' become talked about now.  Bucket lists, for people unfamiliar with the term, are the lists of things that we want to do in our lives before we 'kick the bucket' (AKA: go to the big coffee shop in the sky).  

The bucket lists of my friends have included:  travelling overseas, climbing to the base camp of Mt Everest, hiking on the Kokoda trail, learning to make a cup of coffee on one of those coffee-machines(that friend doesn't aspire very highly - and he's a teeny bit lazy - but what the hey.  His is a short list.  But at least he has a list!.  Yes, it is a him.  I'll leave men alone again.  Sorry), and learning to write (Yours truly.  Or  more correctly, I'm attempting to write), and  going back to university to change careers (My mother did this.  She got a couple of degrees, made some great friends, wore jeans and windcheaters to uni, with her old backpack thrown over her shoulder - through her 40's and 50's.  Good on her!  She was still at uni into her mid 50's, and she would occasionally wave to me, from across the university cafeteria, when I was attending uni in my teens and early 20's. She became a social worker, in her mid 50's; a job she enjoyed until her 70's.  Oh, and in her 70's she was still line-dancing every week, travelling the world, and leader of her neighbourhood watch group.  She told me, in her 70's, that  if she were just 10 years younger - she'd go back to uni and get a Law degree.  At the time she was enjoying Law-court work in her job as a social worker in child protection).  

Dreams can become plans - during middle age.  The difference between a dream and a plan, however, is a 'time frame'.  The slight sense of  'urgency,' that  comes with middle age, means that  people I know have finally put a 'time' and a 'date' to their dreams.  They've got  up off their couches - and actually done some amazing and wonderful and exciting and adventurous things - during their middle age. They've stopped talking.  They've actually started doing.

I think that middle age presents opportunities that a younger age may not have.   Often the kids are older, if you have them, giving you more time to do things for yourself - without having to watch over  toddlers and babies.  Many people, in middle age, are also a bit better off  financially, than they were in the 'salad-days' of their  20's.   These things - time and money -  give middle age more scope to realistically do some of the things that you've always dreamed of doing.

Another advantage of  middle age - is that you have the experience and the knowlege  accumulated from life in  your earlier years.  This can take the form  of wisdom.  One of my elderly patients once said to me that she thought her middle age was her favorite age of her long life.  When I asked her why - she said that at this age she had her health still but she also had wisdom.  

'Wisdom' is different to 'fact' knowledge.  Wisdom means understanding what is truly important in life.  Not just knowing the capital city of Kazakhstan, or pye to 15 places.  Wisdom helps us to understand that so many things that we struggled with in our younger years - trying to find happiness in our lives -  just don't matter and are not prerequisites to happiness.  Things like pushing ourselves to endlessly achieve things, trying to get certain people to approve of us, or admire us, or even envy us.   We learn, with middle age and with wisdom,  to enjoy our lives more - with a lot less strings attached.  Just as we are.  Now.

For me wisdom has brought with it  an understanding that it doesn't matter what other people think of me - partly because I know, now, that they rarely actually do think about me.  Phew!  I can make mistakes and not be 'perfect' (another lesson in wisdom - 'nothing and no-one is perfect') and be silly and immature sometimes, (alright - quite frequently), and joke around and not climb career-ladders  if I don't want to. And I don't want to - anymore.  And not worry that I'm not thin enough, or pretty enough, or wealthy enough,  or appear  wealthy enough.  

With middle age I am now aware of  the things that truly make people happy: friends, family, health, money (although only up to a moderate income. Studies have shown happiness doesn't increase as income increases above $100,000/year.  This is a  level of income where you don't need to worry about paying essential bills, and you can afford a few little luxuries - like coffees out and occasional movies and so on), balance in your life (work and leisure), control in your life ( the ability to make choices about when and where and how often you work or don't or the type of work you do or the hobbies you have), achievable goals ( See!  Goals again!  Make that list of things you've always wanted to do … one day.  Work out 'the day'.  Start planning. Why not? You may think - 'but if I study writing or study painting or start saving for that overseas holiday or go back to uni or whatever… I'll be 50 or 60  when I finish or get there.  Well, guess what?  You'll be 50 or 60 - anyway!  So, you may as well get there with a thrill and fun and excitement - and hope along the way).

With middle age, I've also become aware that the lessons of life are not  that  the richest and smartest and prettiest person wins  life's game.  They don't.  Permission to have a moment of smug reflection - a little schadenfreude. These people can be sad and lonely and bitter and unhappy - just like anyone else.  Those variables are not part of the equation to happiness.  And 'winning' is not what life is about anyway.  No one wins or loses.  We all just live - and learn things - and have some fun and wonderful times in the process - with people we love and/or just like - and we help each other along the way.

The lessons of life that I have learned - in my 'wise' old middle age - involve things like: love (for ourselves as much as anyone), forgiveness (ditto about 'for ourselves'), helping (altruism is a lovely thing - it improves your self esteem and with helping others you can meet some lovely people in the most unexpected places - sometimes those people can be really inspiring), tolerance (other people are not all like you - and they don't have to be.  No offence, but it would be a bland dull world if they 'all' were), patience (I'm still working on that.  My favourite phrase as I get the kids ready every weekday morning is 'Hurry up!!! - screamed at a pitch  which could break glass.  I'm not proud of myself there.)

Anyone still reading - well done!  You've been very brave.  Middle age can be spooky - but it doesn't have to be.  It can be what you choose to make it. Choose to be positive about it - and you'll love it - or at least - like it - quite a lot! 

Most people in middle age, in the industrialised world, make it through to old age.  Most people don't experience midlife crises.  They might have midlife stresses - like caring for aging parents and their own children, at the same time, and balancing work and finances and dealing with the aging process (sagging, wrinkles, grey hair - aagh).  Yet, every age has its challenges and I think if most people in middle age were given the chance to relive their younger lives - they would choose not  to. 

Midlife 'crises' happen to a minority of people - where they can become clinically depressed in middle age, or abuse alcohol, or/and make dangerously drastic and rash decisions - like buying expensive items that they can't afford - sports cars, jewellry, motorbikes; running off with a much younger person (think: stereotype 'secretary-situation'); become overly worried about their appearance (lots of plastic surgery or wearing their teenage daughter's clothes - especially a worry if it's the dad!) and so forth.  Some people are more at risk of such crises.  

However, there are things that you can do, and things that you can change, in your life, for a smoother and happier ride through middle age.  And the things that you can't change or achieve (I've almost given up my dreams of Olympic stardom in gymnastics) are almost never necessary for you to be happy, anyway.  

So my advice for a happy and healthy middle age are as follows:

1.  Write a list of your dreams.  Now make them goals.  Plan out how you might achieve them, or a  modified version of them.  Plan the steps needed and a time frame and how you can fit these things into your life.  And start.  You may not get there until 5 or 10 or more years from now - but you'll feel happiness from the pursuit of these things  along the way.  I have a goal to  write.  My friends have goals related to  travelling.  

Also, you could modify your goals to make them more achievable.  For example, your goal may be to 'win gold at the Olympics in gymnastics'. A very common goal for many middle aged people, I suspect. Well, a compromise might be to go to the gym 3X/ week, or learn to swim, or learn dancing.  These things are still physical activity - at which you could get quite good - not necessarily Olympic standard though.  You could still feel passionate about these interests, and get fit and healthy while doing them. Plus, you could meet new people with similar interests.  This would be a modified goal.    A mature approach to your dreams.  

You would still feel the joy and sense of achievement that comes with success in your chosen activities/hobbies - as you shift your 'bar' lower.  Setting bars 'too high' leads people to feel needless like  a failure. Even when they may have done a really good job at something.  It's all how you choose to 'look at it'.

2.  Be mindful that 'body image' and 'self image' are not the same.  You are a valuable and wonderful person who has a right to enjoy your life - at any age.  That is your 'self-image'. While 'body image' is how we see our physical bodies.  Quite a different thing. To confuse the two - may mean that you feel less worthwhile in your self (self image) - as you see your body ageing (body image). Which is not correct.  

Bodies grow older - but our souls, instead,  mature and become more wise - hopefully. There is a difference.  I think that our souls are where true beauty lies and where our true selves are.  

That is why - as you get older - you still feel the same inside.  Other cultures often appreciate this - more than western cultures do - where we often have a 'youth' ideal.  

How you view getting older will affect how happy and content you'll find the process.  It can be a really happy and lovely time. Older patients tell me this a lot.  

However, what I've said doesn't mean that you should not make any effort with your appearance.  A sense of pride and pleasure can come from  dressing nicely, or having a nice hair cut, or buying a nice new skirt or jumper or jacket.  As Jerry Seinfeld once commented - those people who go everwhere in an old tracksuit  - are saying to the world 'I give up.  I officially don't care anymore'.  He was joking - but  I know that I enjoy wearing nice clothes - and they don't need to cost much - in a lovely color and fabric.  I look my age - but that doesn't mean boring and dull and matronly! 

3. Watch your health.  Being chronically ill, or suffering with an advanced form of cancer, or a serious illness - which all could have been treatable and/or easily managed if these things had been diagnosed sooner - would be a real bummer!  That could put a big dampener on your fun in middle age. So what to do?

- Try to eat a little healthier.  Look - you can eat cake and chocolate and Mc Donalds - just in moderation.  And throw in a few veges and fruit.  Don't be too tough on yourself.  Any improvement is a good thing.  And try to eat on smaller plates and a little less but more frequently through the day - when you're hungry.  That way you're less likely to binge.  

I weigh the same now (51kg - 5ft 6.  BMI - 19) as I did as a teenager.  I eat junk food and I love it.  Just in moderation.  I think you crave junk food less when it's not a taboo in your life.  It becomes less of a treat. 

Another time I  might write a blog about how I've managed to stay the same weight, all my life, and stay reasonably fit (I can swim a couple of kilometers and not get tired, and I enjoy walks up hillside trails.  That's enough fitness to enjoy life, and keep my bones and heart healthy-ish. If the Olympic gold-medal dream re-ignites, for me, I might need to increase my fitness a little more than this.  But for now - fitness in moderation is fine).  

This level of moderate fitness and adequate weight control has been achieved for me - even after having four children, dealing with the stress related to a chronically ill child, working four days a week in an office job - while doing no formal exercise and never dieting.  I'm all against 'diets' - for a number of reasons.  A topic for another time - maybe. 
Lifestyle and moderation are the key.  Not overzealous  fads. 

So, if I can do this - then anyone can!  

Any improvement in your health - including: control of your weight and some improvement in your fitness - will improve your well-being during middle age.  

Key word - Lifestyle. Not - fads and quick fixes.

4. Exercise.  It's been found in studies that simply walking and standing more during your routine day at work and home -  improves your fitness as much as going to the gym regularly.  Taking the stairs at work or hopping off the bus one stop early and walking the difference to work or standing more during the day - will help a lot.  If you like the gym or swimming or dancing or tennis - then that is great too.  Just ease into it, if you've been out of practice for a while.  Your general practitioner might be able to advise you first.  

I injured my achilles tendon, two years ago, on a treadmill; and I was limping for six months. Embarassingly, I had to literally hop all the way out of the gym.  But, I didn't give up on exercise.  Instead, I took up swimming - which also helped my ankle heal.

5. Medical screens:  I won't pick on the men anymore - but I hope men are still reading this - as the  suggestion of having regular medical screens may well save your life and your health in middle age and beyond.  I would advise everyone visit their general practioner and ask him/her about the health screens for your age group - cholesterol. glucose levels, blood pressure, prostate and mammogram screens, skin checks and so forth.  

Imagine your body is a car that you get serviced annually.  Then, after you've put yourself through the nuisance of such visits and test -  reward yourself with a lovely coffee, a new book, a foot massage.  Whatever blows your hair back and floats your boat …  or blows your boat back. You get the idea.  

So, to finish off,  middle age can be what you choose to make it - just like every other age in your life.  Hopefully, you'll choose to have a lovely time during these decades - and beyond.  This may be the best time of your life.  It will take some planning, however,  and a positive mindset.

I'll finish with a poem - hopefully to inspire you in  your life, and the choices you make:

A Psalm of Life (extract)

Lives of great men all remind us

We can make our lives sublime,

And, departing, leave behind us

Footprints on the sands of time;

Footprints, that perhaps another,

Sailing o'er life's solemn main,

A forlorn and shipwrecked brother,

Seeing, shall take heart again

Let us, then, be up and doing,

With a heart for any fate;

Still achieving, still pursuing,

Learn to labour and to wait.

Have a lovely week - and next week I'll write a short story of fiction - about the topic this week:  'middle age'.  

Winter (a story of fiction)

Dark clouds hung low and heavy over the riverbank.  The park was almost deserted, on this mid-winter evening, as most of the city commuters had already rushed home to their warm dinners and their families.  The bleak scene was now still and silent - apart from the low pitch, thunderous rumble of the gushing river, and the occasional laugh and soft voices of two dark figures - standing high on a hillside pathway.  A pram stood unattended behind them.  

An icy wind rushed between the sparse trees in the parkland and, as their barren limbs shivered in the cold, a flurry of dead leaves scattered to the muddy ground.  With the gust, the pram moved a fraction; almost imperceptibly at first.  Another blast of frigid, anatarctic air followed the first, and again, the pram, on the dark hillside, moved a little further and a little faster down the wet asphalt path. The two figures were oblivious to the events relating to the pram, engrossed, as they were, in their conversation.  The black projectile gained speed and accelerated quietly on its trajectory toward the hungry, racing torrent - waiting to swallow it whole - at the foot of the hill.

While the scene unfolded, a tall, solitary figure stood on a grassy spot closer to the water - hidden in the shadows of the night - watching.  He wore a  long coat and a dark, woollen beanie.  He stood motionless - waiting - uncertain - until the pram was almost at the river's edge and then, as the inevitablility of the situation became obvious - he sprang into action.  Running, as hard as he could, along beside the river, between where he had stood and the path of the on-coming carriage, he reached his destination, just as the pram lifted slightly into the air, when it hit the grass beyond the asphalt, and he blocked it from flying off into the waiting jaws of the growling river beyond. 

The heavy pram slammed, like a cannon-ball, into his torso - throwing him backwards onto the grass and the mud of the embankment.  The pain, from the impact, exploded through his body and pushed the air completely from his lungs.  He remained unable to draw breath for several moments. Shaking, and in spite of his agony, he used every last ounce of his strength  to anchor the pram to the grassy spot, and keep it from the raging waters behind him. He gripped the vinyl, of the pram's frame, and he held it fast.  He kept it safe. His knuckles were white in his grip.  He would not let go.  He must not let go. The sound of his pounding heart filled his head and hammered in his chest.  Perspiration dripped from his brow. His eyes were wild - with fear and determination.  Finally, after some moments, frozen in that position, he was able to gasp the cool air and, as he did so, a sharp pain dug into his chest like a knife. But, the child was safe. That was all that mattered. The child was safe! 

A high pitch scream, from the baby within the contraption, brought Daniel back into the moment again. Back to the still, darkness of the park. To where he had been before the drama of the emergency. He prised his icy hands from the frame of the pram and, swallowing hard and holding onto his aching side with one hand, he managed to get up off the grass, to stand again.   

The child continued to scream and Daniel became aware that the two figures, further up the hill, were now running toward him. They were calling out to him - as they ran.  At first he couldn't make out what they said.  He held onto the pram handle and waited.  With his other hand he straightened his muddy coat and his hat.  

As they drew near - their words became clearer.  'Get way from my baby - you drunk!'  The first woman was yelling at him - waving her phone in the air.  'Get way from my child - or I'll call the police!' she screamed. 

When she arrived at the base of the hill, Daniel could see her more clearly. She wore a finely-cut, navy woollen-coat, a pale silk scarf around her neck, and white linen pants.  She appeared to be in her late twenties or early thirties. She gave Daniel a look of disgust, and she sneered at him before snatching the pram from out of his hands.  Daniel stood up straight. Defiantly, he lifted his chin and stepped back from her. He knew that he looked much older than his 42 years. He was cognisant of his unkempt appearance: his old brown coat - filthy and in tatters; his unshaven, scarred face; his grubby, long hair - peppered with grey … the whisky bottle  protruding from his coat pocket. 

'Get away from me and my child - you filthy tramp!' she yelled again.  

'I was just …' Daniel tried to speak as he also tried to catch his breath. He was still exhausted after the recent events. And his chest still hurt terribly.  

The companion of the woman had now arrived and she too sneered at Daniel.  She appeared to be a similar age to the first woman, and she, too, was well dressed. 

Together the women yelled more profanities at Daniel before they marched briskly away with the pram. When they had walked a short distance, they turned to briefly look at him once more. They laughed, and then they turned and left; disappearing into the night. 

Daniel took a swig from the bottle in his coat pocket.  He pulled his collar up high around his neck and, after returning the bottle to whence it came, he walked along beside the river again. Alone. Alone with his thoughts - and his pain.  

While his chest hurt, the endless pain which tortured his mind was much worse.   He knew that the pain of his memories was killing him - slowly - like a cancer - eating him away from within. The memories had dragged him down into this long, dark winter of his life - for all of the last ten years. Haunting him endlessly. Even in his dreams.

As he shuffled along - his feet squelching in his brocken sandals, his toes and his fingers grew numb, and his face burned with the cold.  A soft, drizzling rain floated down around him, and intermittent gusts of icy wind cut through his thin, wet clothes. 

While he walked the images of his memories played out in his mind - as they so often did when he was alone:  His wedding day - the little church, the golden shards of light filtering in through the stained glass windows, his wife, Jane's  pretty young face looking up at him. Smiling. The matching gold wedding rings. The birth of their only son, Oliver.  The yellow baby-blanket with the embroidered blue elephant.  His son's little fingers clutching gently at his own finger - so soft.  The cherub face, the blue eyes, framed with long dark lashes, looking up at him.  His son's birthday-parties.  The little boy's arms wrapped around his neck and the soft, warm kisses on his cheek.  His wife holding his hand and leaning into him - as they laughed with their little boy - on those magical days.  His medical practice, which he had shared with his doctor wife, Jane.  His patients asking him about his  family.  His pride in his little clan. His overwhelming love for his family.  The accident.  Blinding white lights.  Screaming from his young son in the back seat. Those last words: 'Daddy!  Daddy! Daddy - '  The silence.  The deafening, awful silence that followed … before the sirens.  His wife slumped next to him.  Blood.  Brocken glass.  Pain.  The hospital.  The faces looking at him - in pity. Horrible, torturing pity. His questions … unanswered.  Where is my wife, Jane?  Where is my son, Oliver?   Are they alright?  Silence.  Silence …  The attempts to reassure him.  'It wasn't your fault, Daniel' they had said.  'It wasn't your fault'.  The truck had gone through the red light. He couldn't have known.  He couldn't have prevented it …  The funeral.  The small white coffin -  a little toy car inside it with his sleeping son. His beautiful son who would never wake. A larger white coffin. Red roses on its lid.  His own wedding ring inside it, beside his wife.   He would never marry again.  With her, in death, his heart and his soul had gone too.  Buried in that white coffin.  Buried with his ring. He had died that day too - only no-body else had realised it - except for him. He had known.  There would be no life for him from that day forth.  Ten years now.  Ten years of pain ...

Daniel took the bottle from his pocket and took another swig.  The pain eased slightly.

He soon reached the bridge, under which he would spend the night. The thunderous roar of traffic, moving over the bridge above, was very familiar.  This was one of Daniel's frequent sleeping places.  Sometimes, there were other homeless people sleeping here with him.  But, on this wet and bitterly cold night, he was alone. Although, he acknowleged to himself, even when there were other people with him on the streets - he always felt alone.  

He felt as if he had existed on the periphery of life - during the past ten years.  Distant to everyone else and everything else. He felt like he was forever skimming across the surface of  life, while other people jumped right in and became part of the world around them. He felt like he was forever looking on - from a distance. Not dead … but not alive either.

He cleared away some of the rubbish, from a patch of ground: bottles, cans, papers.  Then he sat down.  He felt tired. His chest hurt and his limbs felt stiff and heavy in his ice-cold, wet coat and hat. The wind picked up again - cutting right through him - sharp, painful-cold.  He pulled the bottle from his coat and drank from it again. The liquid momentarily warmed him. It dulled his senses. He finished the last of the whisky - and he felt himself begin to drift off to sleep.  He lay down amongst the rocks and the dirt and the weeds, closed his eyes, and let the tiredness consume him.  He fell into a deep sleep. His last thoughts, however, were of his wife and child.  Their faces smiling at him - warm with love.  

The sunshine returned to the riverbank with the morning. A soft yellow-orange light filled the eastern sky. The clouds were gone. The sky was a deep blue. The bare, wet limbs of the trees sparkled in the morning light, and frost covered the grass in the park like snow.  The river was tamed and quiet now. The wild torrent had settled and the water flowed peacefully.  

Early morning joggers would soon invade this tranquil scene.  They would run under the bridge alongside the river.  They would see the still, lifeless body lying on the cold earth amongst the litter.  They would call for the police and for an ambulance.  But it would be too late.  Daniel was gone.  A smile on his blue lips.  His long winter was over.

                                        The End

I wrote this short story this week - as I have often thought - when I complain about the winter-cold from my heated car, or my heated home,  or from under my doona with blankets piled up on top at night - how do the homeless people, living in the streets 'rough,' cope with this cold?  The sad truth is that in Australia, with our social-welfare system, the people who tend to slip through the cracks of this system often suffer with addictions to drugs and/or alcohol, and/or they suffer from mental illnesses.  Unfortunately, even living in Adelaide, we can have incidences where people living on the streets die from exposure (hypothermia) during our winters.  

When I was a teenager I used to collect money for the Salvation Army yearly, with the rest of my family, at Easter.  I still give regularly to that charity.  While I was collecting money I came upon many people living in very humble abodes - often the working poor - who would have the few dollars that they would have saved ready to give to the Salvation Army Appeal.  As they handed over to me the few dollars that they had managed to carefully save -  they so often told me about their own experiences, during the hardest and lowest times of their lives, when the Salvation Army, and other kind people, had helped them turn their lives around.  Often very hard times are transient - and the help of others during these times - can make all the difference in some people's lives.  

Addictions and mental disorders - often both, including depression, can be difficult to overcome.  But, I would say to anyone reading this and living through a hard time now - don't lose hope.  

Hope, in psychology, means believing that bad times are neither permanent nor pervasive.  That means that bad times - don't last forever, things eventually do almost always get better; and they are not 'pervasive' - ie the difficult time is limited to one area of your life - not your entire life. For example, if you lose your job or you fail a test or you make a mistake - it doesn't mean that every aspect of your life is bad or difficult. There will be many other aspects of your life that are going well and, as I've said so many times, while life can be hard - I think that other people are here, in our lives, to help each other.  Everyone has had hard times - I know that as a doctor with 25 years experience - and through all our hard times - there will always be someone to help you and someone who will understand how you feel.  Even the Salvation Army or your GP.

Have a good week and keep warm everyone.

I'll write something a bit less wintery next week.  A bit sunnier and more cheerful. 

Winter

I got up, on this frosty morning, to find a sea-fog enveloping the silent, frigid world beyond my window.  My neighbourhood seems to be hibernating.  At this time, were it a summer morning, my beach-side  suburb would be buzzing and vibrant.  Yet, out there, under this  ghostly, drifting fog - there is now only stillness and silence.  A world still sleeping.  A world: cold; dormant; waiting.  Almost dreamlike - with the thick fog blanketing us.  A legacy of the even colder night before. 

There are  no cars to be heard in the street now.  No voices of local children playing in their yards, or teenagers kicking a football on the road out the front - intermittently calling out 'car!' before they grab their ball and wait on the footpath. No neighbours chatting over fences, no people talking and laughing as they walk down our road to the beach - only  100 meters west of our bungalow.  No-one is going to the beach on this icy morning: to  swim; or to watch pods of dolphins playing along the shoreline; or to fish from the beach, with the occasional pelican resting beside them, as they sit on their eskies; or to watch the many small fishing-boats, out since before dawn in the summer months,  dotting the horizon on the glimmering, sapphire ocean; or to lounge on the warm sand and watch the clouds drift by in the endless azure sky above - beyond the palm trees and Norfolk pines  lining my beach;  or to watch the white sails of yachts glide like swans across the water.  Those are things for summer.  Those are the memories that keep us warm now, and hopeful for a time distant -  beyond the spring.  

It is winter and the beach is transformed.  The ocean is now a grey-green. Sullen and unfriendly. Waves crash and sea-foam litters the empty beach. Our beach is cold; deserted. However, as the cold air burns my cheeks during these winter months, and the powerful wind catches my  hair and whips it around in a wild confusion, and I  taste the salt and smell the ocean blowing ashore from far out beyond the grey horizon - the beach holds a different charm.  A winter charm.  An atmosphere  of danger in the mountainous, violent waves crashing onto the shore. Invigorating. Exciting. Dramatic.  An atmosphere similar to the one  I imagined out on the wild moor in England - in tales like Wuthering heights - although mine is a nautical environ.  The heavy dark clouds menacing overhead.  Wild.

Yes, winter can be fun and cosy and a nice change after a long hot summer. 

I know that in the northern hemisphere - the summer has either arrived - or it is about to, depending on the country in which you live and therefore the different dates at which summer officially starts.  Half your luck.  Enjoy.  You've all had your winter - and you deserve some sun and warmth. You deserve what we have had for at least the last six months - through our summer and then through the Indian summer we enjoyed this autumn.  

Summer will mean:  long sunny days;  alfresco coffees and meals under large umbrellas or shady trees or verandahs; country and/or beach walks; vibrant colours and fragances of flowers; swimming in  lakes and beaches and pools: holidays; ice-creams; and lazy, warm days reading novels and news-papers outside.  Bliss.

The onset of the summer season varies around the world.

In Australia, the seasons begin on the first of the months: December 1st - summer, March 1st  - autumn, June 1st - winter, September 1st - spring.

In countries such as the UK, Denmark, Ireland and Australia - the seasons are decided according to the Roman calendar - with the seasons decided by the hottest and coldest quarters of the year and beginning on the first of the month.

For countries such as the US - the seasons are determined astrologically - and begin at the soltice and equinoxes: spring - March 19-22, summer - June 19-23, autumn - September 21-24, winter - December 20-23.

The winter soltice - here in the southern hemisphere, or summer soltice if you live in the northern hemisphere, will occur next Saturday June 21st.  This, for some countries, will mark the  beginning of the season of summer. 

Soltice is a word derived from the Latin words - sol (sun) and sistere (to stand still).

This is because at the soltices the sun stands still in declination.  The sun reaches the highest and lowest excursion relative to the equator.

The day of the sotice is the longest day of the year  (in summer) or the shortest day of the year (in winter) - for any place outside the tropics.

Places  on the arctic circle (latitude 66 degrees North) will see the sun just on the horizon during midnight - and all places north of that will see the sun above the horizon for 24 hours (ie the sun will never set).  This is the midnight sun.

Places on the antarctic (latitude 66 degrees South) will see the sun just on the horizon during midday, and all places south of it will not see the sun above the horizon at any time of the day (ie there will be no daylight at all).  This is the polar night. For Adelaide, during June, our daylight hours will amount to almost 10 hours.

I talk about our cold winter.  However, I am aware that this is a relative concept.

Anyone reading this might have a different understanding of the word cold - depending on your own experiences of winter and cold weather.  I will therefore be more specific about our Adelaide winter weather.

The temperature in Adelaide is currently 12 degrees Celsius (54 degrees Fahrenheit). The humidity is 100% (hence the fog).

Today our maximum temperature will be 17C (62F) and our minimum will be 11C (52F). The wind will rise to a maximum of 2km/hour.

The average temperature for an Adelaide winter day is: maximum  15-16C (59-61F); minimum 7-8C (45-46F).  We have no appreciable snowfall (rarely a few flakes on top of our Mount Lofty).

In contrast, our average maximum summer temperature is 29C (84F).

Adelaide has a temperate climate.  Temperate latitudes lie between the tropics and the polar regions. In temperate climates the changes in weather, between summer and winter, are generally relatively moderate - rather than extreme hot and cold.  Although, in some areas, in these latitudes, such as  Asia and central North America, the variations between summer and winter can be extreme - because these areas are far away from the sea - causing those places  to have a Continental climate.

Adelaide has  a variant of Temperate climate  known as Mediterranean, where the summers are hot and the winters are mild.

So, depending on where you live in the world, and, as such, your experiences with cold weather, people reading this will either feel terribly sorry for us poor shivering Adelaideans - or you will snigger and sniff, in disgust, at my whinging about the cold, that I have no idea what real cold weather is.  

I live in Australia - so if you are reading this  in Europe or the northern states of the US, or in Canada, or in the northern states in Asia - then you are completely correct.  We don't really understand what it is like to live in very cold climates.  It is likely similar to how we see people visiting Australia - who know little about the extreme heat of our Australian summers - especially inland.

So, to give me some perspective about our winter weather - I've researched a little to find the coldest inhabited area on Earth.  It is a place called Oymyakon in Russia - where the average winter temperature is minus 50C (minus 58F). Although, its lowest recorded temperature was minus 71.2C (minus 96.1F) back in 1924. Oymyakon lies a two day drive from the regional capital city of Yakutsk - which itself has the lowest winter temperature of any city in the world.

Oymyakon ironically means 'unfrozen water'.  This is due to the thermal spring located nearby.  Originally, the location was used by reindeer herders who would water their flocks at the warm springs.

The ground in Yakutsk and Oymyakon is frozen and crops therefore cannot grow.  The population survives mostly on meat - especially fish (raw arctic fish, white salmon, whitefish).

The ground is so hard that it is hard to dig graves.  So before a funeral the ground needs to be warmed with a bonfire.

The frozen ground also makes it difficult for working indoor plumbing, so most toilets are outhouses.

Cars need to be kept in heated garages.  If a car is left outside - it won't start. 

Planes cannot fly into the area in winter.

Frostbite can occur within minutes.  

Summer in Yakutsch and Oymyakon are relatively warm - with the average temperature in the mid 60's- 70's F (mid teens - mid 20's C) and even up to 94F (34C).  Although the winters are long and the summers are short.

So back to winter in Adelaide.  Maybe our weather is not as cold as many places in the world - but for those of us unacclimatised to harsh winters - this weather  is enough of a struggle for us.

Many of my older patients are migrating en masse up to the north of Australia for the winter.  They take off in their caravans, or fly, or drive their cars to places like Brisbane in southern Queensland, or Cairnes in far north Queensland, or even Darwin in the Northern Territory.  They leave around this time of the year - annually - and they don't return for three to five months.  They often catch up with the same groups of retirees, from many different Southern Australian towns and cities, who do the same thing every year. They wink at me, before they leave, when I tell them how I envy them leaving this cold weather.  They tell me - my time will come once I retire and my children grow up.  Maybe.

My patients, and even some of my friends, tell me that they also find themselves becoming a bit depressed in the colder, less sunny months.  Some of my friends and patients have  said that they  put on weight in the winter.  

In fact, there is a disorder, which is documented in the well respected and standard reference Psychiatry textbook The Diagnostic and Statisical Manual of Mental Disorders (DSM IV), called 'Seasonal Affective Disorder' (SAD) which is a form of recurrent major depression which occurs seasonally - mainly in the winter. This form of depression remits completely at other times of the year.

People with this condition experience serious mood changes when the seasons change.  They may sleep too much, become lethargic, feel depressed, have reduced libido, overeat - especially carbohydrates which often leads to weight gain during these months, and they may withdraw from friends, family and social activities.

All of this can lead to depression, pessimistic feelings and feelings of hopelessness.

The seasonal mood variation is thought to be related to the variation in the amount of light with the different seasons.  An argument for this is that 'light therapy'(sunlight or bright lights) is often an effective treatment for this form of depression, and the incidence of SAD increases at latitudes closer to the poles - where, in winter, the days are shorter. For example, the incidence of SAD in North finland - 9.5%; Ireland - 20%; Netherlands - 10%; Alaska - 9%, Florida - 1.4%.

A milder form of depressed mood in winter, The 'winter blues' is even more common than SAD.

I would advise anyone who feels depressed at any time - whether it may be seasonal or not, to see their local doctor and seek support and help from friends and/or family.  Note that you are never alone and, if the first person you seek help from is not supportive enough for you - then persist in seeking help from other people until you get the help and support you need.  You are important and loved, by the rest of us humans, and as the poem Desiderata  says - you are valuable and a child of the universe - you have a right to be here.  I also say that you have a right to ask for help, when needed, to feel better.

The depression of SAD - can also be treated in the more conventional ways too - antidepressant medication, possibly just through the winter months, and cognitive-behavoural therapy (CBT).  Your doctor could help you with all of this.  He or she could also be someone for you to talk to; or they could  help you to problem-solve specific issues; and/or put you in touch with other people for social support and help - groups for friendship and support. 

Well, in a timely fashion - I have just looked out into my garden from the window of my 'home-office' (AKA: dining room table) - later now in the morning, since I began writing this blog entry, and the sun has returned! The fog is gone. The world is glistening.  The sky is  blue with fleecy clouds scattered across it.  Beautiful.   

The world beyond my window has awoken and, within my house, my family are also now all up and out of bed.  The quiet misty ethereal morning  has been replaced by shouting, talking, laughing, running footsteps,  televisions, Nintendos … so many noises and so much activity.   

Over the last half hour, as I wrote,  my 11 year old daughter brought me steaming hot pancakes which she made in the kitchen.  As she cooked she  chatted with her dad, David, and her siblings, who all sat around her like sea-gulls - waiting for the next batch of pancakes - to swoop.  

My dear husband also brought me a lovely plunger-coffee - Mocca Java flavour - he grinds his own beans (quite the connoisseur).  I usually just drink a flat white espresso. My cat, Lilly, is now sitting at my feet - next to my bar-heater - and  my other children have intermittently dropped by my dining-table office to chat with me, or give me morning cuddles. Winter can be cosy … and lovely in its own way.

I will leave this snug place now, alas, to get out into the world myself - and begin the chores of my day. 

I will first, however, finish this week's blog  with the lovely speech from one of my favourite movies, Groundhog day.  It is the speech where the character Phil 'the weatherman' (played by Bill Murray), addresses the camera and the crowd on the Groundhog Day:

When Chekhov saw the long winter, he saw a winter bleak and dark and bereft of hope.  Yet, we know, that winter is just another step in the cycle of life.  But standing here among the people of Punxsutawney and basking in the warmth of their hearths and hearts, I couldn't imagine a better fate than a long and lustrous winter.

Plus, a winter Poem:

                                                   Winter-Time

                               (Robert Louis Stevenson;  1850-1894)

Late lies the wintery sun a-bed,

A frosty, fiery sleepy-head:

Blinks but an hour or two; and then,

A blood-red orange, sets again.

Before the stars have left the skies,

At morning in the dark I rise;

And shivering in my nakedness,

By the cold candle, bathe and dress.

Close by the jolly fire I sit

To warm my frozen bones a bit;

Or with a reindeer sled, explore

The colder countries round the door.

When to go, my nurse doth wrap

Me in my comforter and cap;

The cold wind burns my face, and blows

Its frosty pepper up my nose.

Black are my steps on silver sod;

Thick blows my frosty breath abroad;

And tree and house, and hill and lake,

And frosted like a wedding-cake.

If you live in cooler climes, like me on this June day -  stay warm and remember, as I  constantly remind myself,  no matter how cold the air and the wind and the rain - the people you love and the people who love you will keep you warm in your heart and bring sunshine to your world - wherever you are and whatever the temperature.  For, no sun could ever bring so much light and warmth to your life as love and friendship and happy times you remember and enjoy.  That is the place from where real warmth derives.

Also, a hot brew of coffee, or tea if you prefer, and a piece of cake, and an interesting conversation, a good laugh, a wonderful story - in a conversation, or in a novel, or in a movie - will brighten your day - during any season of the year.

I have a lovely chocolate cake recipe, in my recent blog on Birthdays - which you could get into the oven in less than 10 minutes.  Easy.  Warming.  Yummy.  Economical.

Have a lovely week.  And if you live in the Northern hemisphere - enjoy your summer!  Half your luck! - as we say in Australia.