Tuesday, 31 December 2013

Beauty and the Beast

So yes,  I went to a seaside panto this Christmas. Oh yes I did.....in fact it was Snow White and the 7 dwarfs.  And so as Eric Metaxas writes,
The old fairy tales confirm that what everyone in their hearts knows to be true is true.  That there are such things as goodness and beauty and truth-and even though in this life they are often hidden and obscured altogether, a time will come when the truth will be revealed, when dragons are slain and bewitched captives will be set free forever.
Maranatha! And a very happy new year

Sunday, 15 December 2013

The power and glory of the manger

'For the great and powerful of this world, there are only two places in which their courage fails them, of which they are afraid deep down in their souls, from which they shy away. These are the manger and the cross of Christ. No powerful person dares to approach the manger, and this even includes King Herod. For this is where thrones shake, the  mighty fall, the prominent perish, because God is with the poor and lowly.'

So speaks Dietrich Bonhoeffer quoted in his lovely advent book, God is in the mangerThe manger and the cross. Two anchor points.. The manger takes us by surprise, since we are used to those who shout loudest getting their own way. We are impressed by status and station in life. The manger shatters our illusions. The cross of Christ humbles us. It insists that everyone needs a substitute, and someone to take their place. We are 'needy' whatever our attainments and emotional strength.

Thanks be to God for the manger and the cross.

Thursday, 5 December 2013

Morissey versus Merton

Dear 'old' Morissey is quite the poet and dare I say 'mystic'. His self esteem is bordering on the malignant with his insistence upon his recently released autobiography coming out under the imprint of Penguin Classics. He certainly takes himsef and life seriously. So when he appeared on Desert Island Discs a couple of years ago, in response to Kirsty Youngs', "Who do you feel yourself to be?"
"..I have absolutely no idea. I really do not. Life leads me...I follow it...I think I see poetry in everything and I see sadness in everything, and I take that and I carry it with me and that's quite difficult......life is terribly serious and I think it's much better if you face it head on."

At first reading one might expect a Christian believer like me to agree with him. But I have to say that I find his words just a little unbalanced. A more nuanced and helpful comment comes from the most unlikely source of Thomas Merton, who was somewhat of a Christian mystic himself. Writing about the relationship between a believer and his or her spiritual director (I guess I would call it , 'pastor'),  he writes,

'It often happens as a matter of fact, that so called 'pious' persons take their 'spiritual life' with a certain kind of seriousness. We should certainly be serious in our search for God-nothing is more serious than that. But we ought not to be constantly observing our own efforts at progress and paying exaggerated attention to 'our spiritual life'......The danger is to want a spiritual director who will confirm our hope of finding pleasure in ourselves and in our virtue, rather than finding one who will strip us of our self-love and show us how to get free from pre-occupation with ourselves and our own petty concerns, and  give themselves to God and to the church.'

Tim Keller talks about the blessing of self-forgetfulness in a great sermon here. As Tim says,
Few things in this world are as self-focused as the human ego. Every triumph and every slight has the potential to send us either into pride or despondency. Yet, in this passage from 1 Corinthians (3.21-4.7), the Apostle Paul shows us another way: a way where we forget ourselves to the point where we not only cease caring what others think, but where we even fail to care what we think of ourselves. Instead, we rest and rejoice in what God thinks of us in Christ.

Wednesday, 4 December 2013

Shivering at Christmas

'We have become so accustomed to idea of divine love and of God's coming at Christmas that we no longer feel the shiver of fear that God's coming should arouse in us. We are indifferent to the message, taking only the pleasant and agreeable out if it and forgetting the the serious aspect, that the God of the world draws near to the people of our little earth and lays claim on us.'
                                Dietrich Bonhoeffer

Monday, 2 December 2013

God is in the manger

Writing to his fiancée Maria von Wedemeyer from his prison cell in December 1943, Dietrich Bonhoeffer expresses confidence in God's ability to 'make all things work together for good to those who love God'.
When everything is bearing down on us such that we can hardly bare it, the Christmas message comes to tell us that all our ideas are wrong, and that what we take to be evil is really good and light because it comes from God. Our eyes are at fault, that is all. God is in the manger, wealth in poverty, light in darkness, succour in abandonment. No evil can befall us whatever man may do to us, they cannot but serve the God who is secretly revealed as love and rules the world and our lives.

Sunday, 1 December 2013

Advent waiting

Waiting is not a concept much in evidence. And more especially as the Christmas adverts dominate our screens, with their promises of have it now and pay for it later. Fast food, instant downloads, speed dating and instant dieting, do not encourage a culture of patience nor gratitude.

Today is the first Sunday in Advent. In the lovely advent book of readings by Dietrich Bonhoeffer, called God is in the manger, we are reminded of the necessity and value of waiting,
Through all the Advents of our life that we celebrate runs the longing for the last Advent when the word will be , 'See, I am making all things new' (Rev 21.5)
The Advent season is a season of waiting, but our whole life is an Advent season, that is, a season of waiting for the last Advent, for the time when there will be a new heaven and a new earth. 
I'm not sure that I have seen this so clearly before. Sure, there is much that God has promised us in this life, but it's folly to expect heaven on earth. Sad to say that us Christians (and many Christian groups I suspect), swing from one extreme to the other. Either never expecting God to intervene in life's affairs at one end, or anticipating daily miracles of healing, advantageous circumstances and wealth at the other.

Yep, waiting is built into this fallen world. Waiting for that answered prayer, that perfect job, that ideal spouse, that perfect church and on and on. But waiting keeps us dependant and expectant at one and the same time.

They that wait on the Lord shall indeed renew their strength (Isaiah 40.31)

Tuesday, 19 November 2013

Selfie, moi?

So the OED people say that 'selfie' is the word of the year.  I gather this denotes the taking of one's own photo and posting it on social media. Oh my, what a diagnosis for our modern plight. I me, my, mine, sang George Harrison in what was to be the last new song recorded by the Beatles. Harrison was expressing the Hindu concept of renouncing all selfish desires, the breaking away from the ego cage... to be united with the Lord (so says Wiki).
Pretentious moi?

The Christian understanding is more nuanced. Certainly self centredness lies at the root of most of what ails us, however the gospel of Christ is liberating in its ability to both free us from self absorption whilst at the same time giving us a wonderful sense of self worth  (we are so sinful that Christ had to die, and we are so loved that Christ was willing to die for us...a paraphrase I think of Tim Keller).

A prayer,

Dear Father, I know that I don't deserve it, but I'm so grateful that your love for me is real. I admit that I am so sinful that Christ had to die in my place. But I'm greatly relieved that I am so loved that Christ was willing to die for me. Help me to live with humble confidence because of your grace given to me so freely. Amen.

Friday, 15 November 2013

Beauty justice and the faith that enhances life

I've blogged before about beauty, whether it be in music, art or architecture. Here's a series of great little interviews with Tom Wright, former Bishop  of Durham. And thanks to Anthony Billington for the link.


Monday, 4 November 2013

A woman to be remembered

I've really enjoyed reading through Dick France's daily commentary on the gospel of Mark. For chapter 14.1-9 and the extravagantly 'wasteful' breaking of a very expensive jar of perfume poured over Jesus by Mary (named in John's gospel), France comments,
There is room in the kingdom of God both for the careful stewardship of resources for the sake of those in need, and, on occasion, for spontaneous and uncalculating devotion. True discipleship embraces not only scrupulous accountancy but also reckless exuberance. There is, 'a time to gather....and a time to throw away' (Ecceciates 3.3-6)

Wednesday, 30 October 2013

Punching individualism on the nose

This is one great talk by Andrew Wilson who speaks powerfully and personally from an apparently obscure list of names in the Old Testament book of Nehemiah, chapter 3. 'Mugged by the world, but loved by God'.

Its a very worthwhile investment of 40 minutes.

Sunday, 27 October 2013


Our courteous Lord does not want his servants to despair even if they fall frequently or grievously. Our falling does not stop him loving us. Julian of Norwich
This helpful quote comes in the book I am currently reading, The art of prayer by Timothy Jones. After initial chapters encouraging the believer to accept the simplicity of prayer, and the need for quietness of soul, he moves on practically to the different aspects of prayer. And so his chapter, Facing our failings:Confession and repentance, begins with the quote from Julian of Norwich. Jones goes onto say,
Admitting in prayer what plagues my conscience, or nags at my peace, or destroys my relationships with others, helps me deal with places that need forgiveness and purifying. I am learning that confession is a wonderful way to keep my relationship with God clean and uncluttered. Confession is where my tender conscience and the love of I'd meet.
 And those wonderful words from the New Testament,

If we confess our sins He is faithful and just and will forgive us our sins and cleanse us from all unrighteousness 1 John 1.9 

Wednesday, 23 October 2013

Music to my ears

It was plain speaking Martin Luther who said, 'A person who does not regard music as a marvellous creation of God is a clodhopper'.'

That is a tad blunt, and yet what joy and comfort and even a sense of deep longing music often brings. Are we really merely chemical and biological as the new atheists woud have it? Or does our love of music point to something more profound.

By the way the Oxford English Dictionary tells me that a clodhopper is,

One who walks over ploughed land; a ploughman or agricultural labourer; a country lout; hence, a clumsy awkward boor, a clown. 
Or perhaps even an Oxford Don?

Monday, 21 October 2013

A tale of three Apples

In his book, How to think like Steve Jobs, Daniel Smith notes a tweet from the time of Jobs' death, summarising how the history of the world has been defined by three apples,
'The one that Eve ate, the one that dropped on Newton's head, and the one that Steve built'
Now there are significant objections to that mantra, after all the Bible does not recall Eve eating an apple, but rather the 'fruit from a tree', and Steve Jobs is not the Saviour of the world (although some techie Apple freaks may believe he is), but with a little (a lot?) of imagination, the three apples do (sort of) fit nicely into the Bibilcal understanding of history,
I guess there might be an evangelistic talk in there somewhere! 

Monday, 14 October 2013

The sublimest motive for the smallest duty

It was good yesterday to sing the old Wesley Hymn, Forth in thy name O Lord I go. We sang a contemporary  tune which was composed by the prolific Graham Kendrick and wasn’t too difficult to get hold of. He has modernised the language (your rather than thy etc). He’s also made some minor additions which I think do capture the spirit of the hymn and enhance it.

I’ve written before about the value of hymns Apart from the value of singing them together with other believers as a kind of mutual encouragement, they can give such help to the individual believer when words are memorised and become part of the vocabulary of one’s faith. Indeed this very hymn was on my lips many times during my early years at medical school , often using the opening verses as a prayer for the day as I left my rather less than salubrious bed and breakfast in Clapham North.

Forth in thy name O Lord I go
My daily labour to pursue
Thee only thee resolved to know
In all I think or speak or do

I don’t think the sentiment here is to suggest that human interaction throughout the day is of no consequence. It is not a plea for a sort of other worldly mysticism. Rather I see it as a prayer that in all the contact and activities of the day there would be a sense of recognising the image of God in ones fellows, and a request to follow the leading of God’s Spirit, in thinking, speaking or doing.

The second verse perhaps expresses it more directly

The task Thy wisdom has assigned
O Let me cheerfully fulfil
In all my work Thy presence find
And do thy good and perfect will

It seems to me that a here is a similar thought to George Herbert’s,

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

 Indeed may I cheerfully live my life under God’s wise and good leadership, and may I throughout the day have a recurring sense of God’s presence. And may I do all that I do in a way that pleases God my father. The Christian disciple lives every moment with an impetus to live life well-all of it and not just the 'religious' bits. As the Victorian preacher Phillips Brooks put  it, ‘Never fear to bring the sublimest motive to the smallest duty’

Here is the Kendrick version, with some lovely stills. The words are just a little different from Wesley's original.

Forth in your name O Lord I go

My daily labour to pursue

You, only you, resolved to know

In all I think or speak or do

In your name I go Lord

The task your wisdom has assigned

O let me cheerfully fulfill

In all my works your presence find

And prove your good and perfect will
In your name I go

Be glorified in me, Be glorified in me

Saturday, 12 October 2013

Will you still need me...

Ringo was famously concerned abut reaching 64 years of age. I enjoyed my 60 birthday a couple of days ago and so far at least, I'm not getting especially worried. Indeed I'm pretty grateful for reaching the milestone in reasonable health and with a body still functioning fairly well. Daily I see many patients younger than me coping with chronic illness and it leaves me rather humbled.

I had a lovely day. Biddy and I went down to London the day before my birthday and then to the Royal Albert Hall to see Crosby Stills and Nash. They are a band I use to enjoy listening to in my medical school days, so it was somewhat nostalgic. And those guys are even older than me! They're mostly in their early seventies,  but still with great stage presence and indeed outlasting us on the night-we left at 11pm with the music in full flow, and before their encore! It was getting a bit stuffy and I felt they were becoming somewhat self-indulgent on stage (I recall seeing Eric Clapton do the same thing at the same venue).

We stayed at the Royal Society of Medicine which is centrally positioned just north of Oxford circus. It's a great location with excellent facilities. On the morning both our daughters met us there and we went off for some brunch together. It was a mild October day and so we walked though bustling London streets until we reached Conduit Street and the wonderfully eccentric and rather marvellous Sketch. Im not sure how you would describe it since its a cross between a quirky patisserie, restaurant and cocktail bar with Louis XV seating. I suggest you go there to find out for yourself!

Back at Sarah's we were joined by Owen and we all enjoyed a glass of Proeco whilst I opened my presents and a bumper collection of cards (well twenty or so which beats by some distance my usual six- ok it's nowhere near the number my dear mother used to get!!)

In the evening we went to the little 'Georgian gem' that is the Albion pub in Islangton. We had an excellent meal and enjoyed lively banter. I had had a truly fabulous  day and will in future days think back on it with real joy and contentment. Indeed it was one of those days that you just want to last forever. And that feeling is no accident, as the old scriptures put it, 'God has set eternity in our hearts' (Ecclesiastes 3.11). The instinct to 'want it to go on and on' comes from Him, for we weren't just made for finite time and transitory experience, but to enjoy an eternal new heaven and a new earth. Because Christ has conquered our past enemy of death, He has 'brought life and immortality to light hrough the gospel'. 2 Timothy 1.10.

So I feel much gratitude for reaching sixty. God has been good to me. His love has never faltered and His mercies have been immense. And indeed why me?  And I so appreciate the love and care shown to me by Biddy, Sarah and Hannah and look forward to formally welcoming Owen into our family when he and Sarah marry next Spring.

How good is the God we adore
our faithful unchangeable friend
Whose love is as great as His power
And knows neither measure nor end.
Joseph Hart 1756

Sunday, 6 October 2013

You must remember this...

The gradual loss of memory and the associated difficulties of performing simple tasks, is a hallmark of dementia. It is generally insidious and not always noted by the sufferer, but loved ones have usually been aware of the difficulties, but have most likely been reluctant to comment, assuming it is, 'just old age'.

Thankfully there is an increasing awareness of the burden of dementia, although there is a lively debate about the merits or otherwise of early diagnosis (see recent BMJ articles and comments-although you have to be a BMA member or use library access to see it). I'm of the opinion that each case should be judged on it's merits, and that a blanket approach of assuming everyone would like to be informed is taking the non paternalistic approach of medicine too far.

For Christians and Christian churches there is a particular challenge; not to be so enamoured with the vibrancy of youth that ageing members, and those with dementia, are neglected. I was at a meeting in Bedford yesterday of the local support group for Pilgrims Homes. One particular comment from Brian Edwards the retired pastor of Hook Evangelical Church, really struck me. He wondered if churches which employed a youth pastor might also include within the remit, a responsibility to encourage the your people of the church to visit the elderly and generally show interest in them-perhaps even attending and taking services at the care homes where some of the older folk with dementia might be living.

I have been particularly struck by a verse form Proverbs 31.8
Speak up for those who cannot speak for themselves, for the rights of all who are destitute.
Speak up and judge fairly; defend the rights of the poor and needy.

In his excellent book, Is faith a delusion, Professor Andrew Sims the former President of the Royal College of Psychiatrists, notes that as a young Christian he was motivated to go into psychiatry on the back of that verse. It seems to me especially appropriate as we think of those (and their) carers sliding into dementia, that  we see this as a particular responsibility, particularly to speak up for them and indeed defend them. Louise Mores on behalf of Pilgrims homes has written an excellent introduction to the subject in her book, Could it be dementia? There are particular aspects of dementia which are a challenge for the Christian believer and she addresses these well. She also reminds us of great resources in the Scriptures, the fellowship of the church,  and the deep seated memories of ageing Christians who at times can pray lucidly and sing along to some of the great hymns of the faith. All the more reason to keep singing some of those great  historic hymns, in addition to the wonderful contemporary hymns of Getty and Townsend, so that the words and their associated truth get into our marrow.

Wednesday, 2 October 2013

Communication and the NHS

Like many other GP practices we are soon going to be changing to a new computer records and appointment system. To help with that change the new suppliers  provided  us with an information leaflet to give to patients. It's very badly written.

The leaflet tells patents when the changes are going to occur. But rather than just saying that, it talks about a "cut over" period. When I complained to the new company about the jargon, the reply was that, 'everybody in the trade has used that expression for the last 9 years.' Sadly I think they failed to realise that the document was not written for those in the trade but for ordinary mortals like you and me. How often failure of communication is simply due to thoughtlessness. Misunderstandings abound in life and GPs especially need to be masters of succinct and clear communication. Failure to understand can lead to unnecessary anxiety or even more serious problems.

The leaflet also spoke of a 'Go Live' date and hoped the change would be 'undisruptive'. What's  wrong with hoping the change will not be disruptive?

Some years ago I taught a 'communication skills' course at the Royal Free Medical School. The students were not especially interested and I spent a lot of time urging them to realise that communication  is near the top of the list for most doctors in needed skills. I guess they are probably realising that now.

Monday, 23 September 2013

My premature funeral

It was Mark Twain who is said to have claimed, 'reports of my death are greatly exaggerated', when his death was mistakenly reported in the New York Journal. Now so far as I am aware my death has not been reported in any obituary column, but recently listening to friends say kind things about me was somewhat funereal!. At funerals I have so often hoped that the words that are spoken about the deceased had also been uttered to the deceased before that person had died! So now I know.

Just a couple of weeks ago some twenty of us went up to Colonsay in the Hebrides to celebrate my iminent 60th birthday. In addition to my small family, several friends kindly made the trek up. At the beginning of the celebratory meal my longstanding friend Dave Greaves spoke generously about me. I have to say I felt rather choked. And then just to put the nail in the coffin (so to speak), my pastor Ray Evans, also said some very touching complimentary words. That clinched it. Although I would love to have stood up and given a witty talk, I felt completely lost for words. I was truly moved by a sense of being loved. Now I haven't lacked for love, since I had wonderfully loving parents, I've had a devoted wife for 35 years, and two daughters who shower me with thoughtful love on a regular basis. But there was something about the coming together of friends and family, and the milestone that is 60 years of age, that just got to me.

Am I going soft? Maybe. But to be loved and to know that you are loved is so crucial. Of course different people have differing ways of showing love (hence The five love languages by Chapman), but it does need showing.

Some years ago I was at a James Taylor concert with my wife and daughters. He sang the beautiful song, Shower the people you love with love, show them the way that you feel. I have often thought just how important  that sentiment is. Indeed it's not enough to feel the emotion of love, it needs demonstrating.

So as a Christian I know I am loved, extravagantly, undeservedly and consistently.

'God demonstrates his own love for us in this, while we were still sinners, Christ died for us'. Romans 5.8

Wednesday, 18 September 2013

Jumping to conclusions

Oh no!
It is well known that GPs make very quick judgements about patients right from the moment the patient gets up out of the waiting room chair, whether with a sigh or a groan or a glum expression. Multiple thoughts pass through the physician's mind. Perhaps a prediction of a request for a sickness certificate (OK they are not called that now), or a concern that the consultation is going to be long and draining. And with 10 minutes per consultation, speed of thought is necessary.

This morning I saw a man who had spoken to me on the phone the previous day. He had experienced some blood in his urine and was naturally concerned. I arranged to see him first thing and asked him to bring two urine samples. Now men have a habit of bringing rather unusual containers for their samples, whether it be the traditional Lucozade bottle or the wife's empty perfume bottle, or even an old style milk bottle. So I was somewhat concerned when I saw him clutching a John Lewis bag with a large container outlined within it. I had visions of having to carefully decant the large bottle into appropriate containers, no doubt spilling some urine down the sides in the process. So what joy when the contents ere revealed-two universal containers compete with urine, and a bottle of Spanish Gran Reserva.

Oh joy!
How many difficulties would be lessened if we learned to not be hasty in our judgements, whether it be patiently listening to a faltering patient who finds it hard to express themselves, or assuming that all patients with similar symptoms need similar treatments or just being in that hurried state that so many of us get ourselves into when we are not managing ourselves very well.

At root of this difficulty is what has been popularly called 'hurry sickness'. GPs are particularly exposed to this, especially with an increasing number of opportunities for measurement and advice (much of which is urged by the DOH),  which are present in every consultation. Whether it be height and weight, smoking status, advice on longterm contraception, enquiry about vaccination, 'lifestyle advice...and that all before the poor old patient has had a chance to say anything! No wonder many GPs feel stressed. Somehow we have to learn to take the pace off the consultation, rather like a top batsmen coping with a very fast bowler-not by hitting straight back over the bowler's head, but by guiding the ball with soft hands on the bat, using the of pace the ball generated by the bowler. So don't try to accomplish everything in every consultation, allow the patient to speak, try to prioritise what is achievable, and don't jump to conclusions!

Happiness, holidays and the Hebrides

Just back from nearly two weeks on the lovely Hebridean island of Colonsay. I'm reluctant to extol it's virtues too much since I'm not sure that I want too many people to know about it!

It was lovely to be with my family and my soon to be son-in-law Owen, in addition to longstanding fellow Colonsay-ites, the Greaves family along with Alex. And then several good friends who joined us for a few days to celebrate my forthcoming 60th birthday. I so appreciated the effort everyone made since Colonsay is not easy to get to.

One of the many reasons that we have returned so many times is the spending of time doing simple things, like walking, talking, cycling, reading, 'golfing' (you would understand why the quotes if you knew the course), and all in a beautiful setting. OK Hebridean weather can be truly awful but we probably had 50% of the time with lovely clear bright days. And then there was then Folk Festival with truly superb music. One of the performers was Roberto Diana, a humble Sardinian guitarist with extraordinary skill.

Here he is performing on Colonsay's lovely Kiloran beach.

Friday, 30 August 2013

Dave Lee Travis, Tyler Hamilton, Adam and Eve (and me..)

In his remarkable account of the widespread doping which has been the norm for Tour de France cyclists, Tyler Hamilton has finally come clean. For many years he and former colleague Lance Armstrong strenuously denied all accusations. In Hamilton's case even when directly asked by his parents if he was doping. He even allowed his parents to support a campaign to clear his name when he  knew that he was guilty.

The whole sorry tale is told in considerable detail in The Secret Race,  a book that contributed largely to Lance Armstrong's downfall.  Armstrong, like Hamilton, had denied wrong doing for many years. But as the evidence accumulated against him, he finally conceded defeat. His interview with Oprah is almost painful to watch, although it's hard to feel any sympathy for him.  He'd mislead so many people for so long and brazenly supported anti-doping campaigns, when he was indulging all the time.

I really don't know if Dave Lee Travis is innocent of the charges against him and which he strenuously denies. I sincerly hope so. But I do know that denial of wrong doing is all too easy and no guarantee of truth telling. Blame shifting is innate and is first recorded of Adam and Eve when confronted with their disobedience towards  their loving Creator. What is so disturbing about Hamilton's book is just how long such deceit can continue, despite leaving the person ever more trapped in the web of lies needed. It's salutary and a reminder of how powerful sin is. Attractive it inevitably is at first, but once drawn in, we find ourselves no longer free agents but are at the mercy of a force seemingly beyond our control. 

It's interesting that he closes the book with the words of Jesus recorded in John's gospel chapter 8,
'And you will know the truth and the truth will set you free'
It's perhaps ironic that those who do not to claim to be followers of Jesus Christ regard some of his teaching as oppressive and constricting, when in reality he offers his followers true freedom. As Jesus said in another place,
'If the Son sets you free you will be free indeed' (John 8.36)

Thursday, 22 August 2013

Community shops

Good to visit Itteringham Village Shop this morning. It's just 15 miles from Norwich and 11 miles from Cromer. It's a great example of a community shop, and in fact was the first winner of the Community Shop Awards organised by the Plunkett Foundation which exists to support rural communities though community ownership and advice.

We were served by a very warm and helpful older man. In the tiny corner of the shop we were able to enjoy coffee and croissants and the dinky little Post Office in another corner, was open. There was a thoughtful  collection of stock, from fresh meat and veg (all sourced from maximum of 30 mile radius), dental supplies and local beer.

When communities function well how much better it is for everyone. But how can such community be reproduced in our larger towns and cities.? Perhaps this is where local churches can play their part, and be an example of disparate people working together for the common good.

Tuesday, 20 August 2013

The secret of leadership

Jesus is a fascinating figure and he had some ideas that wouldn't easily find a place in the 'Business and Mangement' section at Waterstones. So when discussing leadership and authority with his close followers, who were beginning to position themselves in anticipation of Jesus' death, Mark gives us this interchange, (Mark 9)
33 They came to Capernaum. When he was in the house, he asked them, “What were you arguing about on the road?”34 But they kept quiet because on the way they had argued about who was the greatest.
35 Sitting down, Jesus called the Twelve and said, “Anyone who wants to be first must be the very last, and the servant of all.”
In his helpful little commentary, Dick France observes,
Rather than looking for greatness, they should be eager to be at the bottom of the pile. Rather than aiming to dominate others, they should aspire to be the servant of all.  The object of their ambition should be not influence and authority but usefulness (my emphasis).The greatest is the least and the leader is the dogsbody.
Yes,  it's very hard to work this out in everyday life, and even more difficult for church leaders, but I think France's comment about 'usefulness', gives us a helpful way in to the nature of Christan leadership.

Saturday, 17 August 2013

Where did you get that from?

Many is the patient who, when offered a prescription by me, replies with a, 'Oh no, my friend says....' And then proceeds to tell me why that particular prescription is not a good idea, because of side effects or lack of efficacy etc. But it's not only patients who repeat baseless 'facts'. In the current NHS there is a myriad of guidelines, protocols, proformas which are generally not challenged despite their someimtes flimsy foundations.

One interesting area is the subject of fertility and the associated figures that are banded about. There's a great little article in the August edition of The Atlantic Monthly, entitled,  How long can you wait to have a baby. As a 30 year old and entering a second marriage, Psychology Professor Jean Twenge from San Diego State University,  didn't just have an academic interest in the subject,
My new husband and I seemed to face frightening odds against having children. Most books and Web sites I read said that one in three women ages 35 to 39 would not get pregnant within a year of starting to try. The first page of the ASRM’s 2003 guide for patients noted that women in their late 30s had a 30 percent chance of remaining childless altogether. The guide also included statistics that I’d seen repeated in many other places: a woman’s chance of pregnancy was 20 percent each month at age 30, dwindling to 5 percent by age 40.
Every time I read these statistics, my stomach dropped like a stone, heavy and foreboding. Had I already missed my chance to be a mother?

Unlike most of us who just accept what we hear, Twenge used her professional skills,
As a psychology researcher who’d published articles in scientific journals, some covered in the popular press, I knew that many scientific findings differ significantly from what the public hears about them. Soon after my second wedding, I decided to go to the source: I scoured medical-research databases, and quickly learned that the statistics on women’s age and fertility—used by many to make decisions about relationships, careers, and when to have children—were one of the more spectacular examples of the mainstream media’s failure to correctly report on and interpret scientific research.
The widely cited statistic that one in three women ages 35 to 39 will not be pregnant after a year of trying, for instance, is based on an article published in 2004 in the journal Human Reproduction. Rarely mentioned is the source of the data: French birth records from 1670 to 1830. The chance of remaining childless—30 percent—was also calculated based on historical populations.
In other words, millions of women are being told when to get pregnant based on statistics from a time before electricity, antibiotics, or fertility treatment. Most people assume these numbers are based on large, well-conducted studies of modern women, but they are not. When I mention this to friends and associates, by far the most common reaction is: “No … No way. Really?”
The remainder of the article is a model of lucid and helpful information. Her summary advice, which seems sensible to me, is
No. 1: fertility declines with age. No. 2, and much more relevant: the vast majority of women in their late 30s will be able to get pregnant on their own. The bottom line for women, in my view, is: plan to have your last child by the time you turn 40. 
I guess I should be reading the BMJ or Lancet, but every now and then , a journalist takes the trouble to challenge the status quo and brings clarity and challenge to an oft repeat mantra.

Learning from Eddie

I've commented before on the tender love that longstanding sports  hack and natural world lover, Simon Barnes, has for his Down's syndrome son Eddie. He doesn't mention him often, but a lovely piece in todays Times caught my eye,

Shocking news -- an addition to the half-century of family traditions of Cornish holidays. Eddie, my younger son, has taken to walking.
This being Eddie, it is a fiercely individual take on the concept, one that resembles normal ideas of walking as much as our rambling games of garden cricket resemble the game they play at Lord's.
I'm not sure how much of this is Down's syndrome and how much the singularities of his own nature, but it's a great thing in every way.
Physical exercise is hard for him because of the lax muscles of his condition but the pleasures of a stroll in dramatic circumstances have come to him at the age of 12. We set off most mornings with his grandfather's dog Bessie and take a walk to a spot that's as dramatic as anywhere on the British coast. It's a good half-mile away, a damn good effort.
But once there, seated on our rock, looking out over a slope of heather and gorse that hits the Atlantic with a bravura burst of granite, we take our time. A good long sit, with Eddie and I both using binoculars to see what the world has brought us this morning.
A stare out to sea usually produces a gannet or two: "Got 'im!" Eddie says, and sometimes he actually has. Staring a mile or so out, I also found Manx shearwater a couple of times, dipping decisively seawards. There was sometimes a wail of kittiwake. Above our heads the gronk of ravens, passing overhead, one always followed by the other. "Got 'im!"
I still experience this cultural ambivalence when reading about disability. On the one hand our culture increasingly idealises disability and disability rights, whilst on the other, assumes and affirms the basic human 'right' of abortion on demand and antenatal screening tests to 'eliminate' disability. I certainly don't underestimate the challenges of bringing up a disabled child, but oh for some honesty in the debate.

Barnes ends with a touching note on what disabled children enable us to see. Speaking of Cornwall,
This place with its strong views has affected Eddie very deeply. Once installed on the rock with the cliff's inhabitants going about their daily duty, he's been happy to stay there for an hour or more, sometimes eagerly watching, sometimes slipping into a reverie, at other times engaging me in the complex system of Jokes that keep us going. Walking at Eddie-pace brings revelations denied to the hurrying walkers who pass us intent on their destination.

Monday, 12 August 2013

There's no substitute for experience.

Just enjoyed reading Alistair McGrath's new biography of C.S. Lewis. Lots of helpful detail, with particular insights on Lewis's various publications throughout his carer. McGrath provides helpful context as well as notable features. I was particularly struck by the contrast between The Problem of Pain, written by Lewis in 1940, and A Grief Observed written in 1961. The contrast is a classic observation about the difference that personal experience brings to our understanding and appreciation of the affairs of life.

The Problem of Pain was Lewis' first Christian apologetic book. It contains the famous quote,
'God whispers to us in our pleasures, speaks in our conscience, but shouts in our pains. It is His megaphone to rouse a deaf world.'
However as McGrath points out,
'The Problem of Pain tends to treat pain as something that can be approached objectively and dispassionately. The essence of pain is presented as an intellectual puzzle which Christian theology is able to frame satisfactorily, if not entirely resolve.'

Some 20 years later and within a year of the death of his wife, Joy Davidman, Lewis entered what McGrath calls an 'emotional firestorm'. Out of that experience Lewis wrote A Grief Observed.
'While Lewis undoubtedly recovered his faith after his wife's death, A Grief Observed suggests that his faith was some distance removed from the cool, logical approach to faith that he once set out in The Problem of Pain.'
Later in Grief Oberved Lewis expresses the longing that many a parent or spouse will felt deeply-the desire to bear the suffering of the other.
'Lewis's line of thought is that this is the mark of the true lover-a willingness to take on pain and suffering, in order that the beloved might be spared its worst'
Lewis realises that this is generally not humanly possible, but his thoughts irresistably pass to the crucified Christ,
'It was allowed to One, we are told, and I find I can now believe again, that he has done vicariously whatever can be done.' 
Twenty years had moved Lewis from a primarily academic and theoretical knowledge of the theology of pain, to an awareness of the magnitude and vast effects of both human suffering and the cross of Jesus Christ.

Christian books are churned out in their hundreds (? thousands). Many written by fairly young writers. I guess they will say some useful things, but more often than I suspect they realise, it would be better to write from a more 'lived' position.

Friday, 9 August 2013

Nosy doctors

I saw a pleasant man today. He was about my age and as he walked in the flash thought  went through my mind that he looked somewhat parkinsonian. It wasn't a full thought but just one of those millisecond impressions that one gets from time to time. If I was to analyse it I guess it would be an impression of his slightly laboured waking with slight stooping of the shoulders.

As I always try to remember to do, I had quickly looked at his notes before I called him in. There were no ongoing health concerns and he hadn't been seen for over a couple of years, so there were no clues as to his reason for attending.

"I was at a folk festival a couple of weeks ago" was his opening gambit. No clear thoughts entered my mind. Had he had a fall, taken illicit drugs, had casual sex, or been close to a very loud speaker (all except the first very unlikely, this is folk not Glastonbury!).

"A guy came up to me in the interval and said that he had seen me earlier (I'd have been little unsettled at that point), and asked me if I knew that I had Parkinson's disease. He told me he was a GP and suggested that I see mine as soon as possible".

My patient was a little taken aback, not so much by the diagnosis as the rather precocious behaviour of the doctor. And I shared my patient's reaction. I really don't think it is up to me to casually approach members of  the general public with what are known as 'spot' (nothing to do with the skin) diagnoses. I don't know the patient's context, I've no idea how much anxiety I might cause and I might be wrong!

The only situation I have decided in advance when I might approach a stranger and suggest a diagnosis would be if I was behind someone in a queue and noticed a likely malignant melanoma on the skin.  I would justify this intrusion on the genuine likelihood that if the patient ignored the mole in question, it could literally be fatal. So in the case I really might be saving a life. That's hardly analogous to sharing a diagnosis  that may not result in a treatment for some time and merely might induce anxiety and solve nothing.

Colleague keep quiet.

Tuesday, 6 August 2013

Jess Ennis and me

It's often amused me that even top athletes performing at premier events still wear a piece of paper bearing their number held on their shirt by a safety pin! At least in one sense I am on a par with the great Jess Ennis.

I was reminded of that this week when I saw a photo of her in the paper with the disappointing news that she is injured and will not be able to compete in the World Championships this summer.

When I think about the extraordinary scope of Christianity and the wonderful levelling effect of the entry requirements, I'm genuinely moved. No qualifying standard required, no crossing of the palm of the entry panel, no heats and then the final, no, just an honest acknowledgement of my need of God's grace, that I have and do fall short of God's glory, and that only through Jesus Christ do I have a hope and substitute. It's an old truism but I'm grateful for it, 'the ground is level at the foot of the cross'.

Monday, 29 July 2013

A time to kill?

Stephen Grady was just 15 years old when the German army overran his village of Nieppe in Northern France in 1940. Towards the end of his life at 87 years he feels the time is right to record his wartime experience as a young teenager in the French Resistance. It is a remarkable story simply told in Gardens of Stone: My boyhood in the French Resistance by Stephen Grady.

He thought nothing of cycling 60 miles (and pushing another bike!!)  to collect downed Allied airmen and deliver them in to another safe house. He endured a spell in Loos prison for defacing a downed Messerschmidt with the graffiti, Long live the English airmen who shot down this filthy Kraut! And then hanging around to collect memorabilia, only to be captured by a German patrol, and all whilst Stephen was only 15!

Truth is nearly always more powerful than fiction, and in his account of shooting a German soldier in cold blood, there is a pathos that is lost when one simply reads the statistic of the millions that died during the conflict. For various reasons,  he had been delegated to shoot a German officer who was having an affair with a French waitress. The German in question had been boasting that he  knew the names of many of the Resistance in the  local village and thus couldn't be allowed talk. And so, walking into the cafe, with Luger in pocket, Stephen shoots him.

  'The German officer, is he here?' I ask with all the casualness I can muster.
  'Why? What do you want with him?'
  'I'm looking for work....'
  The old woman narrows her eyes and sucks air through her teeth. Finally she calls out: 'Hans, there's a young man here. Say's he's looking for work.'
  He is right there, just behind that wall. A man called Hans.
  My mouth goes dry and my stomach lurches...a moment later, a tall fair-haired man in his early thirties appears from the kitchen, wiping his hands on a cloth.
  I do my best to swallow. I was expecting him to be in the khaki uniform of the Todt organisation, with a scarlet swastika armband stretched around his bicep. Instead, he is in shirtsleeves and a pair of pleated corduroy trousers, thoroughly off duty. Perhaps he was doing the washing up.
  He is a German officer I remind myself,  he has threatened to talk.
  In no great hurry, Hans sits on one of the bar stools opposite me. He folds his arms.
  I reach for my glass then think better of it. My hands would give me away.
  He looks me up and down.
  'What is it you want?' he asks in perfect French. No accent. He even smiles.
  Madame retires to the kitchen.
  I put my hand in my pocket.
  Now. It's now.
  I leap to my feet. The Luger jumps wildly in my hand as I pull the trigger, once,  twice,  at point bank range, First his chest and then just above the waist.
  Hans screams in a far-off voice and glares at me, his eyes full of shock and rage.
  So loud, I didn't expect the gun to be so loud.
  His shirt is all messed up.
  I am just standing there, holding the gun.
  And then his eyes disappear into his head, and he goes down.

Later when reflecting with his older colleague, who had commended him, Stephen said,
  'Thanks'. I am surprised to find that I feel no elation, no warmth in my belly at the thought of having killed a Kraut. I just feel numb and hollow inside.
The whole book is understated and fascinating as it records the conjunction of almost normal family activities, with clandestine Resistance work, and the sadness of communities punished by Nazi reprisals.

It's a very worthwhile read.

Monday, 22 July 2013

Is love ever wasted?

On the day when it seems the whole world is rejoicing at the news of Kate and William's new born baby born, it's perhaps not inappropriate to stop and think about those parents who today may have received more difficult news about their baby.

Today I read an article in the journal of the Christan Medical Fellowship. It was about baby Millie who was born to consultant oncologist Martin Scott-Brown and his wife Frances.  Millie had life shortening abnormalities of her brain and facial development. Earlier in the pregnancy the parents were given the option of termination, with the comment that, '98% of parents in your position would terminate the pregnancy'. Their's was no easy decision, but was helped by an apparent chance meeting with someone who recommended a book (The shaming of the strong by Sarah Williams, a parent who had been in a similar position), which brought hope and clarity to their situation. They began to see their future daughter, 'who had been given to us by God, not as a medical problem to be faced, but a daughter, however imperfect to be treasure and loved'.

At Millie's funeral her grandad made reference to Mary Magdelene, who had washed Jesus' feet with her hair and had gone on to lavish her seemingly priceless perfume on him, much to the chagrin and criticism of those present. What a waste! Was the near universal cry-although such sentiment was far from Jesus' lips.

Love is not a currency like money. Economics shouldn't come into it. Love is something freely given.     Indeed St Paul tells us that love bears all things and hopes all thngs (1 Cor 13.7). If God had waited for me to be worth loving, it would be an extremely long and fruitless wait. Jesus demonstrated extraordinary love for all and sundry when he walked the earth, and today, every now and then we get a further glimpse of what God's love is like. As Martin and Frances Scott-Brown 'wasted' 2 years of their life loving Millie, so they experienced the grace of God in their lives, humbling them and yet increasing their capacity to love. Their's is a beautiful story simply and powerfully told. In no way is it a criticism of ofhers who may have made other choices.

Do read the article here, http://www.cmf.org.uk/publications/content.asp?context=article&id=26067

Spotting the sick child

There's alot of paediatrics in general practice, and one of the most important aspects is the ability to spot the sick child. Like most other skills in life, there is no substitute for experience, but web-based learning tools like the website, www.spottingthesickchild.com from NICE are very helpful indeed.

I was reminded of this recently when I telephoned the duty paediatrician at my local hospital to admit an acutely unwell child. The young paediatric SHO rather sternly asked me what I thought the diagnosis was. I had to say to her that I really didn't know, other than to say that I considered the child poorly enough to warrant urgent admission and assessment. And that it what matters most.

So whilst attending a GP update at Great Ormond Street recently I was gratified to hear my convictions confirmed when  the paediatric A and E consultant from UCLH told us, 'Dont worry about the diagnosis, worry about how sick the child is'. What a very useful mantra. He was also keen to point out that children decompensate quickly. Hence all the more reason to act quickly.

Sunday, 21 July 2013

The shape of our lives

Since becoming a Christian at the age of 16, I have spent most of that time in churches which are non-conformist, in other words 'non-Anglican'. So I am more familiar with prayers which are spoken spontaneously rather than read from a book. However as I get older I appreciate more and more some of the historic prayers, some of them written centuries ago. One particular type of prayer is what as known as a 'Collect'.

The collects are short prayers which in one form or another have been around since the 5th century, but are largely known in the Western world through the efforts of Archbishop Cranmer who updated them for the first Book of  Common Prayer in 1549.

The collect for today is,
God whose providence is never deceived, we humbly beseech thee that thou wilt put away from us all hurtful things, and give us those things which are profitable for us; through Jesus Christ our Lord.

Don't worry about the archaic language, but read on for the excellent explanatory comments of Barbee and Zahk from their superb book, The collects of Thomas Cranmer. 

'God whose providence is never deceived, is an arresting phrase. The idea is that the purposes of God in the world, in our lives, and in every circumstance that we can imagine, cannot be turned aside......We can be deceived. The fact that you can fool some of the people all of the time, and all of the people some of the time, is proof that no human being is invulnerable to deception. God is the great exception....This being the case, we can trust the shape that our lives are taking. The plan or big picture will not be derailed , even by the heaviest breathing deception (my emphasis).

Convictions like that should give the Christian believer much quiet confidence throughout life.

Great stuff.

Tuesday, 16 July 2013

When the music stops

Euthanasia is a very sensitive subject. No-one who has been present at the death of another underestimates the power, finality and sadness of the event.

Just a couple of years ago I recall a TV documentary showing us the last few hours of a lady who had chosen to go to the Dignitas 'clinic' in Swtizerland in order to terminate her life. The image presented was of an ageing woman who had decided that her imminent and worsening frailty was not worth the effort of continuing to live, and she was apparently completely at peace with her own death. She lay in her hotel room with Mozart playing as she took the drugs that were to arrest her  breathing and lead to her death.

What struck me however was that soon after her death the music stopped. The assissitant saw no need for the music to continue, a life had been extinguished.

Just this past Sunday I gave a short talk at our church on one of my favourite hymns-How sweet the name of Jesus sounds-written by one of my heroes. It was scribed by John Newton the former slave ship captain, who converted to faith in Jesus Christ and who eventually became a Christian minister for 16 years in the small market town of Olney where I have been in practice for 30 years. He is most famously known for his hymn, Amazing grace.

In the last two verses of How sweet...Newton says,

Weak is the effort of my heart
And cold my warmest thought
But when I see Thee as thou art
I'll praise the as I ought

Till then I would Thy love proclaim
With every fleeting breath
And may the music of Thy name
Refresh my should in death.

Ah, now that is  lovely thought, May the music of Thy name refresh my soul in death.  The lady in the Dignitas clinic was of the opinion that, when you're dead you're dead. She offered no hope beyond the grave. But the Christian goes into the apparently uncharted waters of death following one who has faced death and defeated it. The music doesn't stop, but grows and grows though a crescendo of joy that makes Handel's Hallelujah chorus seem like the faintest squeak of a mouse. This is one of the greatest privileges for those who simply place their faith in Jesus Christ.

'O death where is your sting?  O grave where is your victory?'

Monday, 1 July 2013

Christians behaving badly

A previously homeless patient handed this £20 'note' to me the other day. He has very little money and not surprisingly was delighted with this happy 'providence'. Imagine how he felt when turning the folded note over, he read the words, 'Don't be fooled, Jesus is the real thing'.

Oh dear, I have to say I was dismayed by the tackiness and insensitivity of it all. Reading the gospels, Jesus is certainly straight with people, but he did not set out to humiliate and fool them. OK Christian believers are to be as wise as servants and harmless as doves, but are we called to be smart alecs?? Hmm...

Riding my bike around my home town today, I come across this notice board outside a Christian church,

I fail to see how the invitation we may give to our friends, colleagues and workmates, to come with us to church to hear the Bible taught and to experience the family of God meeting together, should be restricted to those who are 'well-disposed'. The Bible offers a wonderful invitation to 'all who are thirsty', or in the words of Jesus, 'come to me all who are weary and burdened' (Matt 11.28).

There are enough barriers and obstacles in the way of  people in our secular culture without making the gospel decidedly unattractive. As Paul says to Titus, we are indeed to 'make the teaching about God our Saviour attractive' (Titus 2.10). Thank God our only 'qualification' is our sense of need.

A message from the other side

No, not that side! But thank God got through surgery ok yesterday. And thanks to all for love support and prayer.