Sometimes things just pop into my head. Unprompted, unwanted and not always helpful. But sometimes things pop into my head unprompted, unwanted and very, very helpful. Like yesterday when I started thinking about learning vs. teaching.

I mentioned in yesterday’s post that I wanted to move this site and these posts further towards the original intention of this blog. While mulling it over after I posted it I realised what wasn’t working.

Every time I’ve tried to restart this blog I’ve focused on what I can teach. What lessons from my life I can shape to apply universally. How I can benefit other people (like you, Dear Reader) with my knowledge.

And that’s bullshit.

If I sit here every morning1 and try to think about what I can teach today, I’m going to tie myself up in knots. But – more importantly – I’m going to create inauthentic, disingenuous posts.

The reason my blog resonated with people when I first started writing was because I was focused on learning. I was trying to make sense of my world as it was. Horrible, scary, intimidating but also funny, bright and full of excitement.

That’s precisely what I need now. Not a place where I can come to preach my wonderful wisdom, but a place I can put down what I’m learning every day.

If that’s something you can also learn from, fantastic. Have at it. Take away what you want to take away. But this place is for me. For my lessons. For my knowledge. For my experience. This place is where everything starts to make sense. I hope.

1. or afternoon, or evening, whenever I managed to plonk myself down [↩]

There are some spoilers at the end of this piece. There’s a warning before them in the text.

Warning: I also allow the filmmakers some artistic licence, which may be unpopular, but sue me, I’m a filmmaker.

Five Feet Apart is a fantastic film.

Five Feet Apart is a terrible film.

You’ll love Five Feet Apart.

You’ll hate Five Feet Apart.

But what Five Feet Apart provides is the most accurate on-screen portrayal of cystic fibrosis (CF) that I’ve ever seen. Of course there are little things (and one major thing) that don’t quite ring true, but those are few and far between and some may even be explained away by US/UK experiences. What matters to me is the feel of live with CF and the picture it paints.

It’s important to note, however, that no one can represent the views of experiences of everyone with CF — I am always at pains to say I am not ‘people with CF’, I am a person with the condition. It’s also worth noting in this piece I also don’t represent the views of the Cystic Fibrosis Trust (my employer).

Let’s be clear, at its heart, this movie is a soppy teen romance where two teens fall in love amid seemingly insurmountable obstacles. No spoilers here (I’m confident it’s pretty clear in the trailer!), but if don’t like those kinds of films, you won’t like this one.

Nor will people affected by CF like this if you want it to be a film about CF; it’s not. It’s a film about two teens falling in love amid seemingly insurmountable obstacles. And the biggest obstacle is their different personalities… and the life-shortening condition they live with.

There is a lot this movie can teach you about living with CF, and we’ll come to that later, but what it won’t teach you is anything about and what we have to tackle first is —

Cross-infection

Cross-infection is a major and very real thing. Research has shown that potentially lethal bugs can pass between people with CF and travel remarkable distances. In the UK, the guidelines suggest that no two people should ever be in the same room together for fear of causing each other irreparable damage,

In the film, the characters (mostly) abide by the ‘six feet apart’ rule that’s common — although not ubiquitous — in American CF centres. This would never be allowed in the UK.

That inaccuracy, then, is the biggest hurdle for people to get over when watching the film. For people with CF, we have to let it go, which you really should have done if you’re going to the cinema in the first place! For people without a connection to or knowledge of CF, just be aware it’s much more complicated than the conceit of the film makes it.

Regardless, it’s still a good introduction to some of the more difficult elements of a life with CF and the tortuous nature of the condition that has to be faced, dealt with and accepted.

The way the characters walk the halls with masks on to protect themselves and others from bugs, but take them off to speak to each other is also a little jarring; that’s not the point of the masks, but you have to allow some artistic licence because when we watch a film we learn so much from someone’s face. Having a film where the actors are all hidden away behind masks doesn’t make for compelling drama.

And it’s this level of artistic licence that I think will guide most reactions from people with CF, because you either accept that you have to do some things for the sake of the drama and allow yourself to get swept up in it, or you don’t and and every element that’s not quite right will drive you potty. That’s something most people won’t be able to choose, it will just be an immediate reaction they can’t control.

While we’re on the subject of minor niggles, the way they show the coughing up of sputum is a bit too vomit-like to me.

The biggest challenge — especially for a British audience — is knowing how much inaccuracy is the filmmakers being wrong and how much is the American norm. Things that jump out to us may just be differences in our systems.

With all that out of the way, here’s what you’ll learn from watching Five Feet Apart.

The Cystic Fibrosis Team

Inthe film, Barb plays a critical role that’s a bit of an amalgamation of the multi-disciplinary teams we have here in the UK. She a ward nurse and a nurse specialist, and a little bit of a physio/junior doctor, too.

Regardless, the characters with CF have a special relationship with her that is wholly accurate. All of the specialist CF nurses I’ve had have been incredible people. Deeply caring and understanding, but ready with a swift kick to the rear when you need it.

I’ve known one of the nurse specialists at my hospital in Oxford, Lisa, for more than 18 years now. No visit is the same without seeing her, even if it’s just to say hello. She’s seen me through the best of times and the worst of times and she was the one I first discussed my declining health and road to transplant with — not an easy conversation for anyone.

On the hospital ward in the old Churchill Hospital in Oxford way back in early 2005, I’d just endured a horrible winter of infections, hospitalisations and intravenous antibiotics (where the drugs are pumped into your body through a line in your veins). I’d also been looking at my notes and lung function results and noticed that my peaks and troughs weren’t as far apart as they used to be. Even worse, the intensive treatment for the troughs wasn’t bringing my lung function back up to the level of the previous peaks. I was losing lung function that I wasn’t able to recover.

Lisa came in, as she did every morning I was incarcerated on the ward, for a bit of idle chit chat before her day started ‘properly’1 . I vividly remember saying, “We need to talk about transplant, don’t we?”

That was the start of a near 3-year journey to my new lungs, where she (and the rest of the team) stood solidly beside me, even as I was being introduced to a new team at a new hospital, always making sure I was keeping as well as I could while we waiting for that fateful call.

The second half of Barb in the film (Barb II we’ll call her) for me was and remains my physio, Ali. I’m not sure anyone can understand how important the relationship between a person with CF and their physio is. I know because I’ve had awful physios, good physios, great phyios, and I’ve had Ali. The worst physios come into your room, push you to do your physio and chastise you if you haven’t. The best physios make any session feel like a visit from a friend.

We didn’t have afflovests in my day, and indeed they’re still not usually provided by the NHS in the UK, which meant we had to make do with some form of breathing exercise coupled with ‘physical manipulation’ — either percussion or chest squeezing when you cough and those sorts of things.

This means that when hospitalised you might have two or three 30–60 minute sessions with a physio everyday. That’s a long time to spend with someone. When I was in hospital I would spend more time with Ali than I would with my family.

I was really, really lucky to make such a great friend in Ali because it made physio sessions at least bearable, and sometimes even fun.

The depiction of the relationships between the main characters and Barb felt spot-on to me. Part police officer, part friend, part medical professional, the central importance of that relationship was shown brilliantly and demonstrated a real understanding for what life in the confines of a hospital can be like.

Isolation

When I was a kid, back in the late 80s and early 90s there was no such notion as cross-infection. Everyone thought it best for people with cystic fibrosis to hang out with each other so that we could share our personal experiences and learn that others faced the daily regime of treatments we did, too.

Only in the mid-90’s did we start to discover it wasn’t a good idea. Then we saw it was a bad idea. Then we saw it was a very bad idea. Then we saw that it was potentially fatal. That’s why cross-infection rules are so strict.

That means for people like me we had to work hard to adapt. Rather than hanging out with our mates in hospital, sitting on beds together, sharing war stories and bitching about the junior doctors who didn’t know how to take blood properly, we were now confined to single rooms, closed off from the rest of the ward and unable to even see the other people with CF on the ward. In the beginning, the best we could muster up was sending messages with the ward nurses or physios.

The Internet has been something of a (limited) saviour for people with CF because it suddenly opened up more and more opportunities to connect with each other. We began chatting again, finding new friends online, most commonly in ‘chat rooms’2 and web forums, the quaint forms of interaction that seem almost archaic today.

Then social media came along, making it even easier, followed by FaceTime, Skype, WhatsApp etc etc, allowing us to be more connected than we have been in more than 20 years.

But don’t let that fool you.

Speaking from experience from both sides of the coin, nothing but nothing beats being able to sit on a bed, seeing your friend in perfect HD, 3D, human resolution, being able to properly look them in the eye, hug them, whisper about your favourite nurses with them and having friendships just like all the ’normals’ out there in the world.

It’s not just the isolation and separation from your friends with CF that the condition can rob you of, though. Separation from your other circles of friends and family is real, too.

Being in a hospital more than an hour-and-a-half away from my home town means that my friends couldn’t just pop in to see me if they got out of work early or had some time before starting. It made it a mission that’s hard to expect anyone to make. That said, plenty did, and they also did incredible things for me, like joining my then-girlfriend, now-wife one weekend to totally overhaul the second bedroom in our little flat into a study where I could work and earn money as a freelancer from. I didn’t know anything about it until I got home from hospital.

More than just hospital visits, my CF stopped me doing things I would have leapt at doing otherwise. Shortly before I was listed for transplant, a bunch of my best friends went off to Australia for six months, which I was excited to do with them. Thanks to an unplanned, three-month spell in Texas due to a lung that wouldn’t properly inflate (ask me about it another time), I was too unwell to join them. Every email we got from them (this was in the days before WhatsApp and universal WiFi, kids) made me more and more happy for them and sad for me. I ended up reading Bill Bryson’s Down Under to try to at least vicariously experience the same things they did.3

And then there are relationships. Not the generic kind, the intimate kind. Without spoilers, it’s fair to say this comes up a lot in the film and it shows just how hard some of the decision-making can be around what’s fair and what’s not. It’s something I struggled with for a long time.

My destructive cycle consisted of meeting someone, spending time with them, getting to know them better, being open about my condition, getting closer and closer to them and then totally self-destructing and ruining the relationship a couple of months after getting serious about things. I’m not even sure I knew I was doing it, but I systematically pushed people away until they stopped trying to come back.

The only reason I ended up getting married to my wife was because she was perceptive enough to see this and simply wouldn’t accept me pushing her away. She took it, she dealt with it and she kept telling me she wasn’t going anywhere. So eventually I stopped pushing and she helped me realise that it’s not my decision whether someone loves me or not, just as it’s not theirs that I love them. Love is love.

But that still didn’t stop me refusing to propose or get married until after I’d proved my transplant had been successful. I was listed for transplant at 23, got together with my wife at 24 and was eventually transplanted at 25. The last thing I wanted was to leave a 24-year-old widow behind, because it felt too unfair.

There are as many different views on this as there are people with CF— and I know and respect many people who have felt the polar opposite to me (including my wife!) — but the point is that what the film captures brilliantly is that relationships (of any kind) are difficult. The are harder than they otherwise could be. They are more complicated. Because CF is incapable of getting out of the way.

Death & Dying

While it may not be easy watching, for me it’s entirely true that when you get to Stella and Will’s stage of CF — what’s commonly called “end-stage” — death looms daily. Whether you choose to acknowledge it, talk about it, mope about it or make jokes about it, the Reaper always feels like he’s tap-tap-tapping away at the glass in your window.

The portrayal of how Stella and Will (and Poe) deal with this looming presence is a fantastic demonstration of how different people with CF are, how there’s no one rule for all of us and how we react to any given situation. Just look at all the people who really, truly hate this film, compared to my delight with it! In life, everyone deals with everything differently and there is no one way that’s better than another. There is only way works for you.

While I hope that helps people with CF, what I’d like to say to you, dear reader, is that there is truth in every one of the reactions you’ll see in this film.

What you don’t see is just how interminable waiting for a transplant is. How boring it is. How frustrating it is. How humbling it is. How much of a daily millstone it can become and so how easy it is to fixate on what may come next.

That’s what this film really teaches you: it’s not healthy to think about death so much, but I’ve been thinking about it since I became aware of my own mortality around 5 or 6 years old. When you know your life is likely to be shorter than everyone around you, it’s natural to focus on it and think dark thoughts, and that’s why we have to develop our own coping strategies to cling onto whatever helps us cope with that knowledge.

For those who want to avoid spoilers, this is the time to start scrolling rapidly, where I’ve made clear the spoilers have ended. Because this brings us finally to the most important part when it comes to the portrayal of CF in the film.

**SPOILER WARNING**

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Losing friends

Watching the final months, weeks and days of people you’ve known and loved caused by the same condition that you know will eventually — transplant or not — kill you, is the exquisite torture of a life with cystic fibrosis.

For everyone with CF who gets to know other people from the community and is ‘lucky’ enough to survive long enough you will eventually reach the point where your friends die.

Several years ago, I remember talking to my grandfather about life in his late-80s. He was healthy, still walking miles every day and completing the Telegraph crossword most days, and had plenty of time to enjoy his six grandchildren. He said to me the hardest part was that he now had no friends. He’d watched them all die, been to all of their funerals, and he didn’t know what to do with himself. He was too old, he felt, to make new friends.

That’s exactly where I am now. I feel at 36 the same way he felt at 86. At last count (and yes, I do keep count, because I once forgot one of my friends who had died until I was reminded of them and the pain of that moment still lives with me) I had lost 24 friends and been to around half that number of funerals.

And you better believe that that makes you angry. Angry with the world. Angry with whatever higher power you may believe in. Angry with yourself for being happy that it wasn’t you, and angry for the family that it was their child and not your parents’.

It’s terrifying because it’s another one gone and you know you’ll be there one day. It’s terrifying because you know that one day those pews at the front will be reserved for you wife, your husband, your mum, your dad, that the poems will be read by your friends and your cousins, that everything you see happening now is in your future.

So when you see Stella react as she does to Poe’s death, you better believe that that’s 100% authentic. That the rage, the need for destruction, the need to feel something real is all-consuming, even if only for minutes. It’s all true.

When Stella says, “He was my best friends and I never even hugged him,” you can trust that nearly ever single person with cystic fibrosis has had the same thought, at the same moment, in their own lives.

Because life just isn’t fair. But for people with CF — and all those affected by it — it’s just that little bit more unfair.

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***SPOILERS OVER***

Five Feet Apart might not be 100% accurate when it comes to life with cystic fibrosis, but it is 100% faithful to how it feels to have cystic fibrosis. And that, to me, is what I’d love everyone to experience.

[1] It took me a really long time to recognise that these visits were the ‘proper’ start of her day, and that spending time with everyone on the ward was a critical part of what she did, helping us all feel a little be less lonely.

[2] I was unable to type ‘chat rooms’ without quotation marks because it just feels so wonderfully dated!

[3] I met and became friends with Bill a couple of years later and was delighted to be able to tell him the difference his book had made to me at such a tough time.

1. It took me a really long time to recognise that these visits were the ‘proper’ start of her day, and that spending time with everyone on the ward was a critical part of what she did, helping us all feel a little be less lonely. [↩]
2. I was unable to type ‘chat rooms’ without quotation marks because it just feels so wonderfully dated! [↩]
3. I met and became friends with Bill a couple of years later and was delighted to be able to tell him the difference his book had made to me at such a tough time. [↩]

I’ve not been quite so grateful for flexible working as I was today. Struck down by the lurgy (a really nasty cough with nothing to shift off my chest and no streaming nose to be able to call it a cold) and hardly sleeping, the prospect of a 5am alarm to get me into Bromley for the various meetings and epic To Do list that faced me this morning wasn’t a good one.

So I switched things up, slept in until 8am and worked from home taking all my meetings over Lync (the rubbish Microsoft “official” version of Skype) and cracking through my To Do list like a demented giant-omlette-making chef gets through eggs.

Flexible working FTW!

Coincidentally, I had a meeting in the very same area this afternoon that gave us chance to explore the area and find the best local watering hole for us to re-christen our Meeting Room 5.

The move is exciting in itself. The pub we found tonight (two minutes from Aldgate East station and a fast train home) was lovely. As was the company.

Many reasons to smile.

I had a meeting with the lovely people at the Duke of Edinburgh’s Award Scheme today, finding out how we might be able to assist people with CF to undertake the award and also how we might be able to support them and all young people taking it on to complete their volunteering section. CF is still a young people’s condition, so it’s vital that we support young people with CF as much as we can, a huge part of which is helping them do things that everyone else does, as well as raising everyone else’s awareness.

It wasn’t until I was sitting across the table from my colleague at lunch just outside Victoria station that I realised the meeting would be in the same building as World Vision UK’s London office – they’re all in the same charity office complex there – and it made me smile to walk the familiar roads up from Victoria to Belgrave road and into the familiar surroundings of the slightly dowdy-building with the always almost friendly security guards.

It did cause me to reflect on the downside of an overly-scheduled day, however, knowing that straight after the meeting I had to head back to Victoria to get back home in time for another meeting in the afternoon. With a little more breathing room in my schedule I’d have had time for serendipity to jump in and lead me back up to that familiar fifth floor to drop in on my old colleagues and catch up. My day was missing the Big Orange today and although the building made me smile, my inability to take advantage of the visit made me just a tiny bit sad.

For many reasons I can’t go into much detail about today’s smile moments (yes, more than one), but I can say that I walked from work to the station home with a smile on my face the whole way tonight.

A nice work-related smile today as we presented some initial creative concepts for a big piece of work that is rapidly descending on us.

Any creative will know presentation of concepts to a senior leadership team is always slightly nerve-wracking as you face that awkward “what do I do with this if they don’t like it?!” thought process.

Luckily they not only liked it, some of them even mentioned that when they first heard the concept they really didn’t get it and thought it would be a dead end, but seeing the execution and possibilities they got almost excited.

Score one for the creatives today!

It’s the end of January and the end of my first month of habit change.

What with everything that’s been going on for the last few weeks, I’m actually surprised at how well my meditation practice has been going. I’ve missed a couple of days here and there, and some of the days I did it my mind wouldn’t let me focus, but that’s not a bad record.

What I love about the Headspace app is the way it guides and supports you in achieving what you need to, as well as the way it explains meditation. Here’s what I’ve learned in the last few weeks:

Meditation can be a habit like any other

I meditate first thing in the morning, before I do anything else. It’s 15 minutes of my morning that sets me up for the rest of the day. The days I struggle with it are when my routine is disrupted for some reason, like at the weekends.

If I don’t have an alarm set and wake up naturally, I find it harder to settle myself and do a meditation session. I suspect this is because on weekdays my habit trigger is the alarm going off – I know what my first 2 hours of my day looks like and it’s kicked off with the alarm followed by meditation. Perhaps I need to find a different trigger so I don’t lose momentum when I’m not setting an alarm.

It’s OK to think

The biggest lesson I’ve learned is that meditation is not about not having thoughts, but rather about noticing those thoughts and bringing your focus back to the breath.

The problem I always used to have with meditation was getting cross with myself for thinking things and losing focus. Now I just recognise that I am thinking and bring my attention back to my breath. This has been particularly useful when I’ve been trying to meditate at times of high emotion and stress.

Anyone can do it

If you’ve ever thought that meditation just isn’t for you, give Headspace a try for free – their Take 10 programme is perfectly formulated to ease you into the process and learn more about yourself and the practice.

You will feel calmer

I used to be a very short-termpered person. It really didn’t take much for my fuse to be exhausted, and I’m not going to pretend that my new-found calmness is due to the last 30 days, but it is thanks to the collective experience of meditation in fits and starts for the last months.

That’s also not to say I’m now a picture of zen or incredibly boring; I still have the same passion and drive, the same energy and enthusiasm I’ve always had, I’ve just learned how to let things that I can’t do anything about slide past me without letting them annoy me or make me angry. And that makes commuting a lot more pleasant.

Give it a go

You’ll have gathered that I’m a fan, and I’d love you to try it. Check out Headspace or any other guided meditation app, or just read up on getting started from someone like Leo Babauta.

In February, I’m going to make sure I’m writing 500 words a day. Read more in tomorrow’s introductory post.

Last week I had a Nissen fundoplication. Exciting, huh?

It’s an operation that wraps the top bit of your stomach around the base of the oesophagus in order to prevent stomach acid (and anything else) from travelling the wrong way up and, potentially, creeping into the lungs where it can do a fair amount of damage.

That is to say it’s a fairly major operation to correct a potentially very serious problem.

I’m now the owner of five (count ’em) new holes in my stomach, taking my torso scar-count to 13 – awesome!

I also currently have scars healing both on the outside and also on the inside. Scars healing internally is the weirdest feeling every, because it hurts and is uncomfortable, but you can’t actually see any of what it is that’s hurting you. It is, quite, genuinely, one of the weirdest sensations that I’ve ever felt. I also have no idea how well (or badly) it’s healing and when the pain may subside.

So I’m now recovering at home and trying my best not to go out of my mind with boredom or let my brain get too over-excited with creativity while I’m largely unable to act on it.

Hopefully the process won’t take too long.

Last week I wandered down to London to be part of a Parliamentary reception for the CF Trust as part of their CF week celebrations/promotional push. I’m always happy to speak for the Trust because I believe 100% in what they’re doing and hope that, in some small way, my contribution helps to persuade others how valuable their work is.

The CF Trust published this lovely 5 minute video of the event on their website last week, so do take a look. The full text of my speech is below the video. I’d love it if you wanted to connect with me on Twitter or Google+ and let me know what you think.

Hello. I just have to say I love the layout of this event; because you’re all already standing it means I get an automatic standing ovation.

I’m here to give you a personal perspective on CF and transplantation. I was diagnosed with CF at 18 months of age and five and a half years ago, at 25, I received a life-saving double-lung transplant.

It’s far harder for me to convey the horrors of CF than if you were hearing from someone currently enduring them. I used to turn up to speeches dragging an oxygen cylinder and looking like death and tell people it’s rubbish and they would instantly agree. Now it takes a little more nuance.

So, I could stand here and tell you all about a life with CF. I could tell you about the endless rounds of physio, the mountains of medication, the time-sapping regimes of nebulisers and the moral-sapping stays in hospital every few months. I could talk to you about the fear that comes with waking up in the morning and not being able to take a proper breath in.

Or, I could talk about the difference transplant has made to my life – about being able to walk or run up a flight of stairs without stopping halfway for a five minute break to get my breath back. I could talk about how I’ve seen my the 30th birthday no one expected me to see or my wedding day almost a year ago to the day. Or I could talk to you about how it feels to be able to play football with my Godson, to chase my niece or to lift my nephew up for a cuddle.

These are all things I could tell you about, if I had the time.

Instead, let me put this to you: imagine, for a moment, you suffered from a disease where you knew that transplant was your last – and only – option. Imagine being forced to communicate with friends solely through the internet because you can’t be in the same room. Imagine the isolation and the fear and then imagine seeing your friends, slowly but surely, die from the very same thing that is destined to kill you.

That is the reality of a life on the transplant list; it’s a life on pause. That is the reality of day-to-day life with CF: no let-up, no respite, no days off. Just 24/7/365 fear, pain and often despair, mixed with hope, belief and often, a bit of a giggle – we’re known for our dark senses of humour.

Here’s the thing: this is something that we can do something about. If we can increase the number of potential donors in the UK, if we can increase the number of pairs of lungs made viable for transplant, if we better support the teams involved in performing the myriad complex duties of making a transplant happen, we can stop people with CF – my friends – from dying while they wait.

When I was listed for transplant, the stats said I had a 50/50 chance of actually receiving one. With a life-expectancy of less than two years, I lived for two and a half years filled with fear and hope. It’s fantastic to see that people with CF now face 70/30 odds, but they’re not much better than a coin toss.

The real reason I’m here today isn’t to talk about me and my life, but to talk about that 30%. That statistic that represents not just numbers on a list, but real people, real friends of mine and real family of many. That 30% represents people that we can – and we must – do better by. Because their lives are within our power – your power – to save. Thank you.