Friday, 29 June 2012

It's all about you


On a rare visit to T K Max (!) I was greeted with the sign. I guess that sums up life for many of us, for self centredness has never had it so good. That's just so much to do for yourself, from spa days, to chocolates, to another pair of shoes, to a new car. But what a small world it turns out to be.
Last  Sunday I was speaking in my home church from 2 Timothy 4.6-8.  As St Paul contemplates his likely execution, he passes on strong words to his young son in the faith, Timothy. Paul reviews his life in which he uses athletic metaphors about having been involved in a great contest,  finishing the race, and keeping the faith-as though he were holding tight onto the baton beforee passing it on. For Paul the Christian life was anything but cosy and parochial. It was to be centred upon Jesus Christ and his vast significance for our world.
I tried to explain that we were made for more than just the love of friends and family and the stuff we acquire. Indeed I played a clip of the beautiful song of a blackbird. Lovely though it is, it is simply a call of love for a mate, and a declaration to rival suitors that 'this is my territory'. Now that summary of life  may be ok for a blackbird, but we were made for higher and grander things.

To follow Christ is to be involved in the noblest of all lives. It is to move the focus of one's life from merely self-absorption to a placing of God at the centre. We all have moments of transcendence when we feel instinctively that there is more to life than just physicality, perhaps when seeing a child born, or being present at the death of a loved one, or gazing out at the ocean. C. S Lewis (in his sermon, The weight of glory) refers to theses moments as 'longings'. It's a long quote, but well worth the effort, 

In speaking of this desire for our own far- off country, which we find in ourselves even now, I feel a certain shyness. I am almost committing an indecency. I am trying to rip open the inconsolable secret in each one of you—the secret which hurts so much that you take your revenge on it by calling it names like Nostalgia and Romanticism and Adolescence; the secret also which pierces with such sweetness that when, in very intimate conversation, the mention of it becomes imminent, we grow awkward and affect to laugh at ourselves; the secret we cannot hide and cannot tell, though we desire to do both. We cannot tell it because it is a desire for something that has never actually appeared in our experience. We cannot hide it because our experience is constantly suggesting it, and we betray ourselves like lovers at the mention of a name. Our commonest expedient is to call it beauty and behave as if that had settled the matter. Wordsworth’s expedient was to identify it with certain moments in his own past. But all this is a cheat. If Wordsworth had gone back to those moments in the past, he would not have found the thing itself, but only the reminder of it; what he remembered would turn out to be itself a remembering. The books or the music in which we thought the beauty was located will betray us if we trust to them; it was not in them, it only came through them, and what came through them was longing. These things—the beauty, the memory of our own past—are good images of what we really desire; but if they are mistaken for the thing itself they turn into dumb idols, breaking the hearts of their worshippers. For they are not the thing itself; they are only the scent of a flower we have not found, the echo of a tune we have not heard, news from a country we have never yet visited.

Wednesday, 27 June 2012

All good gifts around us

Great at last to sit in the garden this evening and wind down after a busy day. God has indeed given us all things richly to enjoy.

The garden is looking lovely. And the beer is Wagail Brewery's English Ale. Very tasty.

Tuesday, 26 June 2012

Another boring GP day

Long day day, with the unique variety of general practice.

1. Patient with severe trigeminal neuralgia and associated dental infection-needed hospital admission.
2. Lady with long standing silver nose stud, which had migrated through the nasal skin into the nasal mucosa lining.
3. Seventeen year old with mumps. Hardly see this nowadays.
4. Fifty year old male with haematemesis and severe inter scapular pain. Off to hospital he goes.
5. Sweet 5 year old lass with stool holding, constipation and abdominal pain
6. And a 3 year old with stool holding and constipation!
7. A weary 92 year old who continues to worry about the health of her son. On multiples drugs. So in discussion with her and her daughter and son, we rationalised and stopped thee different medications. It's so difficulty to know just how much benefit is likely to be gained by what amounts to preventative medications-especially with what must be a limited life expectancy.
8. A guy with an acutely painful swollen knee. Probably gout. So I aspirated the joint and await the microscopy report. In meanwhile he has some Arcoxia.
9. A visitor from South Africa with post-menopausal bleeding. To hospital on Two week Wait.
10. A 3 year old with breathlessness and wheeze which didn't respond to nebulised Salbutamol.He gradually worsened so I admitted him with ? pneumonia.

And they are the ones I can remember...happy days.

Sunday, 24 June 2012

Doctors as patients

Andrew Drain was 33 year old high flying cardio-thoracic surgeon in training who was diagnosed with acute lymphoblastic leukaemia September 2007. He died peacefully at home July 2010.

In a wonderfully moving book (Code Red) in which are published some sermons which he preached from the Old Testament book of Job, he briefly reflects at the end of the book, how he might have practiced differently as a doctor if he had survived his illness, in the light of his journey as a terminally ill patient.

Three lessons for busy doctors

1. Never forget a patient's dignity: Curtains around a hospital bed are not soundproof. It's very difficult to have confidential conversations with loved ones in an open ward. Leaving urine samples next to a patients bed may be amusing to good friends, but is a source of embarassment  with less close visitors. There are so many situations when we doctors can forget the essential dignity of each human being.

2. Patients hang on to every word the doctor says: 'As a doctor I can't remember how many times I would have told patients casually that we would get a chest X-ray or a scan. For me the day continued as normal. I now realise that for the patient it would be a day waiting and thinking about nothing else but the scan.'

3. Doctors should be careful before dismissing patient's and relatives concerns: 'For me this was exemplified when Ruth (Andrew's wife) shared concerns about me with a member of staff. Ruth had seen me everyday for weeks and was concerned that something was wrong and that I was going downhill. In a five minute conversation Ruth was told to stop being a doctor (she was a doctor actually) and just go home and be a good wife. Within days I was admitted to a different hospital with a serious Graft versus Host disease. I remember as a houseman my professor telling me to listen to the patient-they are usually right!'

Teach me my God and King, in all things Thee to see-part 2

Thank you George Herbert 1633

A man that looks on glass
On it may stay his eye
Or if he pleaseth, through it pass
And then the heav'n espy.

Here the thought is that a man can look at a window pane and chose to arrest his eyes on the glass itself. But he may choose to look through the glass and see what is on the other side. This is how it is with everything we do. We can chose to simply focus on the task or we can look through the task and see (espy) it as an opportunity to serve God. I believe it was CS Lewis who commented that the cynic who 'sees through everything' actually ends up seeing nothing!

All may of thee partake:
Nothing can be so mean,
Which with this tincture (for thy sake)
Will not grow bright and clean.

All, that is all our actions, may benefit from this  principle-nothing is so mean (insignificant) that it cannot serve God. The tincture ('a colour that pervades or distinguishes') is the principle of doing all things for his sake, so when added to every action it makes them all 'clean'.

Thursday, 21 June 2012

Strike!

So today is the BMA strike.  We discussed this in our partnership recently and decided against industrial action. Apart from anything else it is such bad pr for a profession already frequently targeted by the Daily Mail amongst other media.

Steve Fuchs from the Christian Medical Fellowship wrote a helpful piece at the time of the ballot to aid Christian GPs think through the issues. He concluded..
So, in Christian workplace ethics, obedience and service are vital, putting the interests of others first, standing up for what is right, but seeking to honour our employers, and in so doing honour God. We serve God ultimately through serving the needs of our patients in obedience to our employers.
I would suggest that after thinking through these questions and the theological principles, there is one last question to ask when making a decision on how to vote, namely will I be honouring God in taking or not taking industrial action in this instance?
Finally, I would urge all CMF members in the BMA to vote in this ballot after weighing up these issues. To not vote is to tacitly accept the decision finally reached by the majority, but only those who actually vote can shape that final decision.
History, in the end, is only made by those who actually turn up!
Read the whole thing here. Another helpful contribution cam the from Urban Pastor with advice to Christina teachers considering strike action.

Wednesday, 20 June 2012

What shall I render to the Lord for all His benefits?

Some lovely stuff from John Newton in a letter from October 1787.

'What shall we render unto the Lord for all his benefits? Ourselves surely. At best it is a poor return; but let us give him the whole. Two methods he points to to us, by which to show our gratitude...
1. That we make his bounty to us the pattern and the motive of our bounty towards our fellow creatures, and that we devote and employ our time and talents, in every possible way, according to our situation,  to promote the good of others. That we live no more to ourselves, but aim at being useful and subservient to his merciful designs.
2. That we show forth the power of his grace, and the tendency of the Gospel, by a spiritual,  humble, meek and holy conversation, by watching unto prayer, that our tongues, our tempers, our pursuits, may all bear witness for us to his praise, that we have received the grace of God in truth, and that our light may so shine before men, that he may be glorified.'

Saturday, 16 June 2012

Carolyn of Holkham

Robin of Sherwood, Anne of Cleeves and now Carolyn of Holkham.

Biddy and I enjoyed a lovely time a couple of days when we went up to North Norfolk for the day. Walking through the grounds of Holkham Hall we came to a gatehouse on the west side. And there was the most beautiful cottage garden being lovingly tended by Carolyn  (and her black lab, whose name I failed to enquire of!).


She had only moved in with her forester husband one year ago and had created the most beautiful display of poppies, foxgloves and lupins amongst others. There is something so special about these simple colourful flowers which brings joy to your heart.


We were heading out to Holkham beach which is surely one of the most exhilarating coastal stretches in England. Always windy and yet never failing to clear the proverbial cobwebs in the most satisfying way.

Friday, 15 June 2012

Little steps

I'm always looking for simple advice that I can pass onto patients with the hope that their everyday lives will be improved. So I was interested to read a short article in the magazine InTouch which is a a quarterly publication for alumni of Kings College in London.  Called 'Boost your mental health' it was written by Kumar Jacob who is the chair of Maudsley Charity, (a charity supporting mental health and well being) and had five easy to understand tips for improving well being.

1. Connect: Happy people have stronger social relationships. You're doing yourself a big favour when you invest a little time in friends, family and colleagues. This can range from developing deep personal friendships to taking a few moments to chat with the office security guard.

2. Be active: There's clear evidence showing that physical exercise reduces depression and anxiety. This doesn't mean you need to become a marathon runner. Walk to that meeting half a mile away rather than take the bus; take the stairs instead of a lift.

3. Take notice: Or, to put it another way, be curious. As we walk past the same buildings and shuffle through the same streets each day, it's easy to forget that there is beauty around us. Take a few moments on your journey to work to look at fields and villages passing by.

4. Keep learning: You've heard this before: learning to speak a foreign language or play a musical instrument does wonders for your brain. Hepful learning of this sort also includes less time-consuming activities, such as trying a new way of cooking or mastering new software.

5.Give: This doesn't necessarily mean giving money, although donating to your old school or favourite charity will probably boost your spirits. It also means giving positive feedback, expressing your appreciation and even holding a door open for someone.

Good basic stuff. And not very original. But just little steps which could do great good.

Monday, 11 June 2012

War Horse

I haven't seen the film but I did read the book last week.

It must be some years since I have read a children's book, and although I  enjoyed reading to my daughters when they were growing up, it must be 50 years or so since I read one for myself!

War Horse is a touching story, set during the Great War. I found it evenly balanced in its view of the Tommy and German soldier-so different from the war stories of my youth when all Germans were evil and the Tommies were all saintly brave.

The book closes with a simple and I suspect commonly held view of death and memory. A Belgian farmer whose grand-daughter had greatly loved Joey (the War Horse) stepped forward after the War, when the War Office had insisted  selling all redundant horses, and bought Joey. Then in an act of sweet compassion, he virtually gave (he only asked for an English penny)  the horse  to Albert,  who had cared for Joey at the beginning of the book.  He was a young farm hand from England who had travelled all the way to the trenches to track down Joey, and rather miraculously found him.

The old farmer had bought Joey for his grand-daughter Emilie. She had cared for Joey during the German occupation, but had lost touch after Joey was requisitioned away. Sadly Emilie had died, and the old farmer, bought Joey in her memory.
'I will sell this horse to you (Albert) for one English penny and for a solemn promise-that you will always love this horse as much as my Emilie did, and care for him until the end of his days. And more than this, I want you to tell everyone about my Emilie, and about how she looked after your Joey, and the great black horse when they came to live with us. You see my friend, I want my Emilie to live on in people's hearts. I shall die soon,  in a few years no more, and then no-one will remember my Emilie as she was. I have no other family alive to remember her. She will be just a name on a gravestone that no-one will read. So I want you to tell your friends at home about my Emilie. Otherwise it will be as if she'd never even lived. Will you do this for me? That way she will live for ever. And that is what I want. Is that a bargain between us?'
I guess that encapsulates many peoples view of  'living on after death'. Sadly the reality is that broken down and neglected grave-stones, and family tree hunting-with all their surprises, prove that such 'living on for ever' is an illusion.

The Christian hope of 'life after life after death' (Tom Wright's phrase), is so much more solid. As dear old John Newton would say,
Solid joys and lasting treasures, none but Zion's children known'

When you get a minute, take a listen to this exhilarating talk on resurrection by Professor Tom Wright.

Sunday, 3 June 2012

Teach me my God and King in all things Thee to see

I have loved this hymn since my teens when I first heard it (many times) at school assembly. I suspect the singing wasn't terribly enthusiastic (an all male school of about 500 boys aged 13-18 years), but the words have stayed with me through the years and become more probing as my life goes on.

The words come from a poem by George Herbert called The Elixir. In 1633 as he lay dying Herbert gave a copy of his poetic writings to a friend and asked him to publish them,  if he thought, 'it may turn to the advantage of any poor dejected soul'. Many a soul have greatly been advantaged since then, including notably Charles Spurgeon and C S Lewis.

Teach me my God and King,
In all things Thee to see,
And what I do in anything,
To do it as for Thee.

The Elixir is a fabled substance or stone that had the ability to transform base metals into gold. 

Not rudely as a beast,
To run into an action,
But still to make thee prepossest,
And give it his perfection

Here  Herbert asks not to act like an animal that simply acts out of habit or instinct....not to run hastily and without thought. Rather he says, 'let me deliberately dedicate every action to you before I do it' (Orrick). And may it thus be a 'perfect' action. The thought here is not referring to God's action since throughout the poem he has been addressing God directly, and if that were the case here he would have said, 'your' perfection'. No rather the idea is that when an action is dedicated to God it becomes perfect, or better, complete.


The following verses are equally wonderful and thought provoking. I'll write more on them when I have time. For this and many other of Herbert's poems check out a wonderful book by Professor Jim Orrick,  A Year with George Herbert.

Saturday, 2 June 2012

It must be true I read it in the Daily Mail

Striking doctors.

No, not Dr Kildare, nor even Dr Mark Porter. But as most of our national newspapers told us the other day, it seems that the BMA is urging it's members to take industrial action Thursday 21 June.

'Doctors voting to strike are more concerned about their pockets than patients'..with thanks to the Daily Mail (which goes on to  tell us that
'There will be no public sympathy'... is that a Daily Mail command?)

So should doctors go on strike?

I'm personally not in favour of strike action, but I do understand some of the motivation of those who are. Unfortunately I think it more likely to aggravate the public's perception of doctors. The action is called over the changes to NHS pensions. These have historically been really quite good for NHS doctors, and in fact will remain so, although paid for by a significant hike up in contributions which will now also have to be paid for longer. In that sense the same will apply to many others whether in the public or private sector.

I'm fortunate to be in a secure job and to be paid well. Yes I've worked consistently for the NHS for nearly 35 years, and I haven't always been paid well. Indeed when I started in general practice it was the norm for a junior partner to earn one third of what the senior partners earned-despite often working harder than them!  Now the situation is completely different with junior partners having exactly the same share as all the other partners from the moment the partnership is formed.

The issue of differentials is at the heart of much of the unrest in our society-a point discussed so well in Oliver James' book Affluenza. And writing in the Big Issue (OK I do buy it...but only occasionally), Dr Faiza Shaheen had this to say,

We need maximum pay ratios within companies and across sectors to put an end to chief executives getting paid more than 250 times what cleaning staff earn. Over the past 30 years the top one per cent have seen a 50 per cent increase in their share of every pound. When a fifth of the working age population earn less than the living wage this is simply not fair.
For businesses, the boss taking an ever-larger share of the pie undermines team spirit. This then has a knock-on affect on productivity, absenteeism and employee turnover. Those at the top argue that the monetary rewards improve their performance, but robust academic research has found that excessive cash rewards hinder rather than aid cognitive performance.
For a helpful review of the issues of striking facing those doctors who are Christians, Steve Fouch writes,
 So, in Christian workplace ethics, obedience and service are vital, putting the interests of others first, standing up for what is right, but seeking to honour our employers, and in so doing honour God. We serve God ultimately through serving the needs of our patients in obedience to our employers. 
I would suggest that after thinking through these questions and the theological principles, there is one last question to ask when making a decision on how to vote, namely will I be honouring God in taking or not taking industrial action in this instance?
History in the end is only made by those who turn up! 
Lots to think about

History, in the end, is only made by those who actually turn up!

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...