Saturday, 22 July 2017

Don't lose the shock!

I was talking to a patient this week who has worked in very senior positions in a number of companies. We were discussing how new employees are in a very good position to notice quirks and faults in the new place of work. My patient said that he encouraged his new managers to take the first Monday of each month for some months, and try to view the business with new eyes, he asked them not to 'lose the shock', of their first impressions.

I've just discovered this very sweet version of the much loved (and much sung) hymn of Charles Wesley, And can it be, which I have known from my earliest days as a Christian. The new tune has enabled me to think about the words with a fresh appreciation.

It's helped me to regain some of the shock of a lovely, holy God finding it in his heart to value, accept and love me.
'Amazing love how can it be that Thou my God shouldn't die for me?'
And then that feeling off 'why me'? Which I increasingly feel as I go on my way though into 'older'(!!) age, why bother with me God? There's plenty of better material out there.
'Tis mercy all immense and free,  for oh my God it found out me'
But cometh the end and I face God,  what do I offer Him? My feeble efforts of prayer or church attendance, sermons, giving or niceness? Nope, none of that will count. Indeed I'll want to hang my head in shame for all the 'devices and desires' of my heart. But yet I'll not even approach God with my head in my hands, for I can approach Him boldly. Blimey that is a indeed a shock. Long may I feel like that.
'Bold I approach the eternal throne and claim the crown through Christ my own'.

Tuesday, 20 June 2017

Pick up a penguin

I've just so enjoyed reading The Penguin Lessons by Tim Michell. It really is a lovely read.

Whilst travelling to Argentina to teach in a private school, Tim stops off in Uruguay and stays in a friend's appartment. On his last evening he goes for a wander along the local beach whereupon he is confronted by a teeming mass of penguins, sadly all dead as a result of a carelessly produced oil slight. I say all dead, but in fact there was one feeble looking penguin just hanging on to life. It is this penguin that becomes an unlikely travelling companion for Tim. Having cleaned the penguin up (amusingly recounted by Tim), it simply would not leave his side and in consequence is 'smuggled' into Argentina and then onto the school.

It is here that San Juan (by now the penguin has acquired a name), is gradually adopted and loved, by students and staff alike. In one incident when San Juan jumps into the school swimming pool, he is joined by a student who thus far has been rather isolated and shunned because of his lack of sporting prowess, and yet who in the water swims fast and naturally in a way that leads to him swimming in the school team and gaining acceptance from peers and teachers alike.

So what's this all got to do wth life and the practice of medicine?

I think I generally underestimate just what a contribution animals can make to our lives. I'm not a particular animal lover, and I must admit they are something of a blind spot to me. As a GP I need as many tools as possible to bring relief and well-being to my patients, who often present with ill defined symptoms and impossible to classify medical conditions. they are in fact medically unexplained, and yet I suspect for many of them there is a loneliness or sadness at the root of their lives which leaves them vulnerable to all manor of physical manifestations. I wonder if a pet (ok it doesn't have to be a penguin) might be part of an answer. I recall an elderly isolated old lady living in a village near to my practice who found a reason to get up in her morning when she acquired a budgie, and another sad and poorly old lady living alone who found talking to her cats and stroking them, brought just a little meaning and joy to her life.

Being a GP over a long career, you're going to need a very large tool-box. Don't forget pets!! There's virtually no side effects, and they cost the NHS nothing (ok there's a cost to the patient), and they work. It's a win-win-win!

Take a look here

Saturday, 3 June 2017

Happisburgh-a happy borough?

Happisburgh lighthouse
It was a lovely day in Norfolk yesterday and it was good to visit Happisburgh. It's a remarkable little place on the north east Norfolk coast famed for its lighthouse (the only independently operated one England)  and the devastating effects of coastal erosion.  It's fun to hear folk pronounce the name who have never been before, it comes out something like, ''Happysborough' when in fact it should be pronounced Haze-bruh! I wonder if there is such a thing as a happy town? And what would it be like to live and work there?

Of course the reality is that depression is a profound and increasingly noted experience for very many people, causing much distress to sufferers and their loved ones. And with death by suicide affecting over 6000 people in the UK every year (it's over 40000 in the US), it is a huge public health challenge .

I was thinking of this whilst in Happisburgh since I have finally got round to reading Lincoln's melancholy-how depression challenged a president and fuelled his greatness which has sat on my shelves for a few years. It is a remarkable analysis of the life long struggle that Abraham Lincoln endured as he contended with severe bouts of depression. The book is full of insights from various psychological and psychiatric studies on the experience of depressive disorders and also the various treatments which were tried in the 19th century. Most remarkably of all it tells of why Lincoln's longstanding depression in many ways contributed to his greatness as a leader at such a pivotal point in US history. His personality is a profound contrast with that of of Donald Trump!

Lincoln's melancholy is full of so many insights its hard to know where to start, but just one sample of his wisdom, forged from his own personal struggles, and for a man so well known for his seriousness, is interesting since it's notable how important humour was to him (referred to by psychologist George Vaillant as a 'mature strategy' to combat depression).

The phrase 'coping mechanism' comes from the function served by a coping, the top of the wall that protects against the elements. Humour gave Lincoln some protection from his mental storms. It distracted him and gave him a measure of relief (it's interesting that many of our comedians also suffer with depression-my note).
Humour gave Lincoln a way to connect with people. Withdrawal is an essential feature of depression, and once withdrawn a person can grow steadily more awkward in company. Many depressives find small talk to be a Herculean effort... 
As president Lincoln was asked why he would pardon soldiers who deserted for cowardice, he said, "It would frighten the poor devils to death to shoot them".

Any contribution that might help us all understand the experience of depression and offer insights into managing it, is to be welcomed. This remarkable book does both and offers a helpful view of what one might almost call the potential 'positive effects' of depression-which of course may well be impossibly hard to appreciate whilst in the midst of a severe depression.

Thursday, 1 June 2017


At the Ardbeg distillery on a rainy day
Had an excellent few days on Islay with son in law Owen. It happened to be the whisky festival week,  Feis Ile 2017. And it was really good to hear the Coaltown Daises too.  These lassies certainly make a great sound.

Islay, like its neighbouring island of Colonsay is a magical place. I'm so glad I 'discovered' the Hebrides in my late teens when I hitch-hiked up to Iona with a bunch of mates.

The quality of the light, the freshness of the air, the pace of the island, and the natural beauty never fail to lift my spirits. And talking of spirits, Owen and I did enjoy a few drams and met some fascinating people. And it was good to visit some of the distilleries. Well Bowmore, Bruichladdich, Ardbeg, Lagavulin and Laphroiag, didn't get round all of them!

Yet another example of undeserved grace for 'God has given us all things richly to enjoy' (1 Timothy 6.17).

Tuesday, 16 May 2017


My dear brother John would have been 67 years old today. Alas he died at the age of 50 years nearly 17 years ago. He had been wonderfully brave and understated as he endured multiple treatments for his cancer which impacted his life so much for nearly 20 years. There are many times when I have missed having a brother.

John with Sarah

At his funeral (before I was unable to continue) I was able to say what a faithful friend he was to me. We didn't see each other often, but he was someone with whom I had grown up, and consequently knew me through and through. All of us need people in our lives who have known us from an early age, and consequently may be suitably  unimpressed by any achievements we may have made since childhood.

John was humble but surprisingly loud in conversation. No having a confidential chat in a cafe with him-everyone could hear the conversation. He was a passionate supporter of Guide Dogs for the Blind, and like me was interested in all things First World War. One of my treasured memories is of a day trip we took to Flanders when we looked around various battle sites and visited those painfully beautiful Commonwealth War cemeteries.

I thank God for him and the gentle faith he had in a hope beyond the grave. As the good old Book of Common Prayer has it,

'In sure and certain hope of the resurrection to eternal life though our Lord Jesus Christ'

Friday, 12 May 2017

Mental Health Awareness

I'm glad that this week is Mental Health Awareness week. Mental distress is horrible, and as Matt Haig writes in his memoir on depression and anxiety (Reasons To Stay Alive), 'depression is one of the deadliest diseases on the planet'.

I've had the privilege of seeing many patients over the years with mental distress and have often recommended books, in addition to counselling and medication. I thought it might be helpful to list a few of the ones I've recommended  and/or read for myself.

1. Overcoming Anxiety by Helen Kennerly.  A really good intro for learning to cope with anxiety. Its not too demanding a read and has some helpful explanation of the basics of CBT and relaxation.  It's not written by a self help guru, but a recognised authority.

2. Feeling Good by David Burns. Very helpful on understanding the negative patterns of thinking that we can fall into, such as catastrophising, jumping to conclusions etc. Ok its verbose and relatively dated but still an excellent read, again applying the principles of CBT.

3. Say goodnight to insomnia by Jacobs, and Overcoming Insomnia by Espie. Both really fine books. The first American and second British. Since disturbed sleep is so often a feature and can be a contributory cause of mental distress, it's  important to get help with this problem.

4. Manage your stress by Looker. A fabulous book that I've been recommending for over 20 years. Still the best on stress I think. Helpful before one gets too far down the spiral of distress and into more serious mental health problems.

5. Reasons too stay alive by Matt Haig. An honest and hopeful book charting the agony of mental distress and the journey out. Can be read in short bursts.

6. A darkness visible by William Styron. A classic memoir of depression.

7. Mindfulness for Health by Danny Penman. Very helpful for learning to deal with chronic pain and the stress and anxiety associated with physical illness.

There are of course many more. And some times when we are too anxious or low, its just impossible to read. So best to check them out before the darkness descends.

And yep most of us will need someone else to help us. Family and loving friends, counsellors, doctors, hairdressers (well most of them are amateur psychiatrists) etc. Don't neglect to get help. And don't forget the Samaritans.

Monday, 13 March 2017

Making real conversation possible

Most of us have heard of Westboro Baptist Church and their truly awful behaviour towards gay people. They are not alone in giving Christianity a bad name and sadly I play my part too, although I certainly don't share their hostility to gays.

This remarkable talk by a young woman who grew up as part of that church and was taking part from the age of 5 years, in protests against gay people and holding up placards that she scarcely could read let alone understand, is salutary and can teach us much.

For those of us who work as doctors it can give  an insight into how to help and relate to those patients who we may feel have wacky health beliefs. Sadly there is often hostility, frustration and impatience which rarely leads to a satisfactory consultation.

And for those of us who claim to be Christian believers and who would love others to share our convictions there are lessons here in how to approach the 'other' who does not share our views. Megan ends with 4 principles to make real conversation possible.

1. Dont assume the other person has bad intent in their beliefs and ideas.
2. Ask questions and listen well. Map the disconnect
3. Stay calm. This needs practice and patience. 'The rightness of our position does not justify rudeness'
4. Make the argument. The value of our position is not self evidently true otherwise everyone would share it.

Don't lose the shock!

I was talking to a patient this week who has worked in very senior positions in a number of companies. We were discussing how new employ...