Tuesday, 24 October 2017

The Long Walk

It's always a bit chancy to give someone a book. A little like recommending a restaurant. Will others like it? Will the service be as good? Etc. And so recently a friend gave me The Long Walk. it proved a great choice.

It tells a remarkable story of endurance, deprivation and at times great tenderness. It concerns a young Pole who was wrongfully imprisoned and sentenced for being a spy. Arrested in the early part of the Second World War, after a mock trial he was sent to Siberia to serve 25 years of hard labour.  Joined by a small band of  other escapees he set off on a 4000 mile journey on foot across the freezing wastes of Siberia, the barren intensity of the Gobi desert and the forbidding Himalayas. Along they way they are joined by young 17 year old Kristina who is also fleeing the Soviets. Her interaction with the hardened men is remarkable and touching.

They experienced all too brief times of kindness, hospitality and generosity, as their paths crossed with solitary shepherds and hunters. These times  really were wonderful examples of what theologians would call 'common grace'.

Having read he book and throughly enjoyed it a web search throws up a lot of debate around the veracity of the book (see here...although this is 'only' wikipedia ) amongst much else. I'm not in a position to judge, but I suspect that the book is probably a gathered up collection of the stories of various Polish ex-prisoners. Powerful all there same.

Yet again, just as after reading about our forbears who endured the rigours of the Great War, or those who explored Antartica at the turn of the 20th century,  I'm left humbled and wonder how well the majority of our current generation would cope with such adversities.

Friday, 13 October 2017

Noel Chavasse Double VC

I have long been in awe of Captain Noel Chavasse RAMC. He is the only recipient of two VCs awarded during the Great War. Visiting his simply marked headstone in  Brandhoek New Military Cemetery, Vlamertinge Belgium, gives little clue to his extraordinary courage other than the two small VC emblems discreetly engraved (interestingly the second VC emblem was only added in 1981).

His story is well told in Ann Clayton's biography written in 1992 and which I have just read. Like many stories associated with the Great War there is an inevitable mix of tragedy, resilience and bravery which leave one musing just how our current generation would cope with such life changing events.

I guess I'm drawn to his story because of a long term fascination with the First World (I still recall reading The first day on the Somme sitting in Bedford library in the mid 1960s), the uniqueness of the  man's exploits, his Christian faith, his work as a non combatant doctor and somehow wanting to share  the sadness of his family (especially his fiancee Grace who came so close to marrying him). This latter emotion is a curious one but is experienced by many of us when we read stories of great sorrow and tragedy in our newspapers, and in reading somehow feel we are sharing in and with those affected.

As a doctor he was hoping to be an orthopaedic surgeon, but happily joined up and served virtually from the outset of the war. He was to be away from home with his fellow soldiers for three Christmases before he was fatally wounded. His courage was most shown in the times he went into no-mans land to tend to and bring back those who had been wounded during various attacks. Some of these rescues were within twenty five yards of the enemies trenches, little more than a cricket pitch.

I'm humbled reflecting on his commitment. As a doctor for just 40 years I have seen tremendous changes in attitudes of my fellow medics to working conditions. There is certainly  no lack of hard working and devotion in many of my fellow doctors, but somehow there is also a strong seam of what I can only describe as 'office hours' mentality. Perhaps Chavasse went to the other extreme, some doctors have and still do, such that their family, health and wellbeing have suffered. Chavasse literally died because of his unstinting work ethic.  But as in all things there is a balance to be struck and I can't help but feel that despite the recognised need for doctors to have strategies to cope (i.e. build resilience), it would be good-not least for our patients sake- to meld that self care with  more of  what I can only call devotion to the patients who entrust themselves to us.

Chavasse: Double VC. Read, learn and inwardly digest. And see what you think.

Tuesday, 12 September 2017

A light touch

Just pebbles
Its great to be back in the Hebrides. Although lots of rain is forecast this week, yesterday was a pleasant surprise. So we walked from the Strand in Colonsay over to Oronsay. It's an even smaller island with a population of about 6 including a couple of RSPB rangers.

Oransay priory cross
What often strikes me when visiting here is the quality of the light. Somehow everything seems sharper and clearer (well when the sun shines anyway). Even looking down at your feet as you walk over pebbles is lovely (the pebbles not the feet!).

 The Augustinian priory dates back to the early 14th century and has had lots of changes over the centuries and is dilapidated now but is a very atmospheric place.

I guess we just get used to light pollution and when we are at home going about our regular lives we fail to notice what's beneath our feet and the sky above us, and beauty around us.

Friday, 1 September 2017

The eyes have it

I recently worked a one week locum in Scotland. All of the requests to see the doctor were triaged by a return phone call from the doctor. I've never been a fan of this system although I completely understand why it may be used in an attempt to manage workload. I have two main concerns.

1. The information over the phone is limited. This is especially an issue when trying to help patients with English as a second language. But it is also restricted in losing out on the 'extras'; that face to face conversation brings. After all what would you prefer if talking to your husband, daughter, bank our insurance company. Almost inevitably we prefer human physical contact. But in the context in a medical consultation there are particular disadvantages.

Bilateral congenital ptosis
I recall a 3 month old baby whom I saw recently. The complaint was of a cough persisting for one week. In itself this would usually not cause concern, especially if the baby was feeding ok and was generally well. But when I greeted the baby and mum as he was wheeled into my room, I recall commenting that the baby looked half asleep. 'Oh he's just woken up' was the reply. Having examined the babe and finding him perfectly well I was just about to dismiss him when it suddenly occurred to me that he still looked half asleep. Indeed his eyes were half closed throughout the consultation even though he was clearly wide awake. In fact I realised he has Congenital Ptosis. A condition in which the eyelids are partially closed and that if left untreated can lead to squint and even defective vision. He needed referral and I'm glad I saw him a phone consultation would not have helped.
2. I think it has the danger of creating an adversarial situation in which the doctor starts from the premise that they need not see the patient and the patient strives to justify the request rather than describing the problem. And of course for some patients (particularly men) it takes a fair bit of encouragement for them to seek medical help in the first place.

The telephone is indeed a mixed blessing.

Thursday, 10 August 2017

It's only words

I recall whilst a medical student being encouraged to clarify the meaning of words when taking a history from a patient. So when the patient says they have diarrhoea, what symptom are they describing? Is it very loose stools, is it going more frequently, is it one loose stool per day, or six times? In other words it needs clarifying.

I'm working for the first time in Scotland as a locum in Lochilphead 'just now', a lovely part of Argyll. And so when I ask an elderly lady how long the pain in her calves has troubled her, she confidently says, 'a wee while', and when I ask how far she can walk  before the pain starts she tells me, 'only a wee way'.  Concerned that she may have peripheral vascular disease I ask if she smokes. 'Oh yes of  course, but I gave up ' she says. 'And how long was that for'? I ask, fearing the worst....'Oh a wee while ago'.

Communication is at the heart of General practice and helping patients tell their story is a crucial skill. It may seem laborious at times, but it's essential to gently and persistently seek to understand what the patient actually means by what they say. Otherwise mistakes can so easily be made.

More and more health care is delivered by phone or even online. I'm sure some of that is helpful and appropriate, but without the to and fro of a normal, face to face conversation we may get the wrong end of the stick, leading to misunderstanding. So just speaking to patients on the phone should  be approached with a degree of caution, since we can also miss those non verbal cues which can fill out what the patient is trying to say to us (let alone the added benefits of examination). With increasing telephone triage in the NHS as it seeks to cope with increasing demand, we need to be alert to the risks.
Tarbert harbour near Lochgilphead 

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 http://petsastherapy.org/.

The Long Walk

It's always a bit chancy to give someone a book. A little like recommending a restaurant. Will others like it? Will the service be as go...