Thursday, 31 January 2013

Not your average paperman

Love this short animated film from Disney. Here's a short intro


But catch the whole thing here. It's magic.

http://m.youtube.com/watch?feature=player_embedded&v=aTLySbGoMX0&desktop_uri=%2Fwatch%3Ffeature%3Dplayer_embedded%26v%3DaTLySbGoMX0

Sorry couldn't find the embed code-it's well worth 6 minutes of your time.

Wednesday, 30 January 2013

The secrets of Kennedy's speech giving skills

Been enjoying reading excerpts from I have a dream-The speeches that changed history,  a book given to me at Christmas. I was quite taken with this quote from JFK's inaugural address in 1961.
'The same revolutionary beliefs for which our forebears fought are still at issue around the globe-the belief that the rights of man come not from the generosity of state but from the hand of God'

There's an excellent analysis of the whole speech on the BBC website here. The writer suggests that there are six features of his speech which make it so effective
  • 1. Contrasts
  • 2. Three-part lists
  • 3. Contrasts combined with lists
  • 4. Alliteration
  • 5. Bold imagery
  • 6. Audience analysis
On the subject of contrasts, the author writes
For Kennedy, contrasts were the preferred weapon, coming as they did at a rate of about one every 39 seconds in this particular speech. Some were applauded and some have survived among the best-remembered lines.
He began with three consecutive contrasts:
  • "We observe today not a victory of party but a celebration of freedom"
  • "Symbolizing an end as well as a beginning"
  • "Signifying renewal as well as change"
From the 20 or so he used, other widely quoted contrasts, all of which were applauded, include:
  • "If a free society cannot help the many who are poor, it cannot save the few who are rich"
  • "Let us never negotiate out of fear. But let us never fear to negotiate"
  • "My fellow citizens of the world: ask not what America will do for you, but what together we can do for the freedom of man"
Ah well I ask not that the few who read this will forget it, but that they will tell the many orators out there to get contrasting.
Watch the speech here and see further analysis.

Tuesday, 29 January 2013

Best books on the Great War

Having recently returned from a great trip to the Somme where we stayed at Martin and Kate Pegler's, I'm working my way through yet more books on the Great War. Although a truly tragic time in the history of our planet, I remain deeply interested in the plight of the Tommy in the trenches and the extraordinary resilience which he showed.

Martin is an expert on the period and has written extensively about it.  I asked him for his favourite books on the Great War and he has kindly consented to me reproducing his list.

Memoirs of an Infantry officer, Siegfried Sassoon
Goodbye to all that, Robert Graves
Old soldiers never die, Frank Richards
Some Desperate Glory, E. Campion Vaughan
Sagittarius Rising (aviation), Cecil Lewis
Storm of Steel, Ernst Junger (German)
A Subaltern's War, C.E. Carrington
Singled Out (women post war) Virginia Nicholson*
The Unknown Soldier, Neil Hanson

Interestingly despite having read about a dozen books on the subject, I've not read one of these! Still Saasoon is next on my list after I finish reading Undertones of War by Edmund Blunden, a reminiscence written in 1924 by a junior officer who went in to become Professor of Poetry at Oxford. There are some fascinations in the book and deadpan descriptions of the reality of life in the trenches, athough he looses me in his flowery prose at times

Manet Manet Manet

Really enjoyed going to the Manet exhibition at the Royal Academy last week. It seems that he was a controversial figure in mid nineteenth century Paris, and for some time had paintings turned down by the Salon. When it was rather too late and with his powers declining as a result of syphilis, he gained more critical approval.

Perhaps as much as any artist he proves the very subjective nature of art appreciation. I wouldn't say he's my favourite artist, but there was much in the exhibition to enjoy-alhthough I have to say I found some of Julian Barnes fanciful comments on the audio guide rather ridiculous and not a little 'smart-alecish'. Ever since studying poetry and art at school I've been sceptical of the confident deductions of the critic.
Emile Zola

One of my favourite paintings at the exhibition was of Emile Zola, the French novelist. I've had something of a soft spot for Zola ever since a delightfully erudite and elderly patient of mine encouraged me to read some of his novels. I recall boldly telling my patient that I was reading Zola's Le Debacle, a novel of the Franco-Prussian war of 1870. Without flinching, my patient asked, 'Are you reading it in the French or the English?' Ok I know when I'm beaten.

Sunday, 27 January 2013

Tears at the cinema

Oh dear, another first. Watching Les Miserables yesterday I found my eyes welling up a couple of times. There is just such pathos and beauty in the story, let alone the beautiful production with great acting, emotional singing (OK Russell Crowe was er... Russell Crowe) and stunning cinematography.

The plight of Fantine just hit home to me so powerfully in her haunting song, I dreamed a dream. How many dear men and women in our culture feel that life has just passed them by, and that the wounds of personal history have left them with so little hope.


And then the themes of redemption as Jean Valjean is powerfully affected by an action of great kindness and extravagant forgiveness. It's interesting that forgiveness wasn't just handed to him in a kind of effortless way, it  cost something. In this case the priest's golden candlesticks. In every case of forgiveness there is a cost. In personal relationships it involves absorbing the hurt inflicted into oneself.  And when we speak of  God's forgiveness, Oh yes there is great cost.

In the words of the Bible
God demonstrates  his own love towards us in that whilst we were great sinners Christ died for us. Romans 5.8
Like Valjean we don't deserve it. But if we receive it what a powerful force for change it can be.

I had a bash at some of these themes when at our church we did a short series on God in the West End. Take a listen here if you have a moment or two.

Monday, 21 January 2013

Coward


"COWARD" from Stephen Murphy on Vimeo.

Fresh on my mind after my recent trip to the Somme, came across this remarkable short film (28 minutes), which goes a small way towards understanding the experience of war. Check out Coward.



Somme reflections

Just enjoyed three days visiting the Somme area of northern France with my good friend Bruce. I've had an interest in the infamous battle of the Somme since early teens when I recall reading about the mass slaughter of Bristish and Commonwealth troops in the first hour of attack on the morning of July 1st 1916. I even remember where I was when I read about it-standing in the far left corner of the old central library in Harpur Street Bedford.

Delville wood
 Having recently visited the Ypres area with my family just before Christmas, it was good to see a different area of the conflict. For all the time we were there the ground was blanketed in fairly thick snow which added to the vast panorama of gently sloping and exposed slopes which our troops would have had to attack along. It was vey cold everywhere (on our first morning at Delville wood it was minus 10!), but the resulting solitude just made it all seem more atmospheric. Indeed some friends had questioned my sanity when I told them I was visiting in January, but for me the brief periods of discomfort from the cold were part of trying to identify in some way with our young men who had endured far far worse depredation, nor withstanding the sheer fear and anxiety of being in the trenches.


 The museum at Peronne was helpfully laid out, and I was particularly impressed by the short video clips scattered throughout the museum. Especially one short clip showing soldiers burying their comrades in a mass grave, with the chaplain mouthing words of committal surrounded by solemn looking tommies with heads bowed. With statistics of a one in ten chance of being killed whilst serving at the front line, it's not hard to imagine the thought that for many of them it would not belong before it was their turn to be wrapped in a shroud and join previous victims in the cold earth. But most tragic for me were the videos of soldiers suffering from what we would now call combat stress, although at the time was regarded as shell shock. During and just after the war there was considerable division about whether it simply denoted 'lack of moral fibre', or even simply cowardice, or whether it was truly a psychiatric condition. Hysterical symptoms were little understood at the time (and still challenge today's doctors! There's an excellent history of hysteria by Shorter called From paralysis to fatigue). Some years ago it was heartbreaking to read of the men executed for cowardice, and all For the sake of example (an excellent book by Babbington).


We stayed at Orchard Farm cottage with the wonderfully hospitable Martin and Kate Pegler. Martin has published several books on different aspects of the Great War. Their knowledge was cheerfully passed onto us, and in better weather,  Martin would have been able to provide professional guided tours of the battlefields. I would heatedly recommend staying with them and benefiting form Kate's excellent cooking and Martin's expert knowledge. One unusual feature of our time there was the sharing of mealtimes with our hosts. Eating together is such a time honoured way of extending friendship and our times eating breakfast and supper together were in many ways the highlight of our trip.


At the German military cemetery Rancourt
 So much to take in and reflect upon. I am just staring to read Edmund Blunden's autobiographical Undertones of war. A wonderful read and not a bad place to start to understand both the glory and horror of life at the front. My friend Bruce commented that if the war was a remarkable example of bringing chaos out of order (the opposite to God's creative 'order out of chaos'), then the lovingly tended Commonwealth war graves (and to a lesser extent the German and French military cemeteries), are testament to a small bringing of order our of chaos, and in that sense are a harbinger of what Christians believe will happen when God renews the earth. In that day, as the mysterious book of Revelation chapter 21 tells us,
Then I saw a new heaven and a new earth, for the old heaven and the old earth had disappeared. And the sea was also gone. And I saw the holy city, the new Jerusalem, coming down from God out of heaven like a bride beautifully dressed for her husband. I heard a loud shout from the throne, saying, “Look, God’s home is now among his people! He will live with them, and they will be his people. God himself will be with them. He will wipe every tear from their eyes, and there will be no more death or sorrow or crying or pain. All these things are gone forever.”

That is a result.

Thursday, 17 January 2013

Farewell Auntie Gwen

Yesterday we buried auntie Gwen. She was 6 months short of 103 years old!  At the funeral I recollected memories of her from my childhood. Specifically she had been the first person to buy me a Corgi toy-in her case a two-tone Ford Zephyr estate, costing 4 /- (that's shillings by the way!!).

Auntie Gwen's 100th birthday
At the close of the funeral we sang Abide with me. I say sang,  but in all fairness the sound of voices was hardly deafening. This very moving hymn (I fear no foe with Thee at hand to bless, ills have no weight and tears no bitterness...), used to play a significant part in English national culture. And even yet, since the 1927 FA Cup final, the first and last verses have been sung before the match. Most recently by Mary-Jess with less than enthusiastic joining in by the crowd. Still it's remarkable that in these secular days a song with such profound spiritual lyrics should find any place at all.

It set me thinking about music and the extraordinary thing that happens when people sing together. Just before Christmas, a tv documentary about the Military Wives showed interviews with women who had found that singing and practising as a choir had regularly lifted their spirits. And in the May 7th 2012 issue of the Big Issue on the subject of, 'How to start a revolution', Charles Hazlewood,  a BBC conductor and producer, had this to say,
Music can be a healing force for change. It sounds facetious, but I think if people were to sing together every day, I don't think we would have the kind of social divisions we have in society. Music make us feel better about the pople around us'
What a generous God to give us such a wonderful 'unecessary' gift as music.

Monday, 7 January 2013

Farewell full time general practice part 2!

I'm now into my second week of reduced hours. So far so good, but I suspect it's not going to be easy for sometime. I've accumulated a fair number of patients throughout my 30 years and I suspect it will take them a while to take their custom elsewhere if I'm not available. Thus I'm expecting my remaining three days per week to be rather full.

Reviewing some more changes from when I first started, I must now get into the dreaded 'evidenced based medicine'. This represents the application of reliable clinical trial information to the everyday practice of medicine. Sounds good, but...

1. In 1983 I wasn't encumbered by the extraordinary myriad of clinical guidelines. Now it seems that every situation I'm confronted with in general practice has a guideline which I must  adhere to or have very compelling reasons for deviating from.  My concern with the practice of medicine in this way is that it becomes very 'guideline focused', a sort of tick-box affair, and fails to recognise the sheer variety of individuals in their particular social, emotional, spiritual,  physical, relational (and other axes) context. And it is these very contexts which an experienced GP carries in his/her head, oftentimes without even realising it, and which influences the choices of treatment, or none, recommended.

2. Thus in 2013 if a patient of mine is admitted to hospital having had a heart attack, he will be discharged on at last 4 drugs, all of which can bring their own problems individually, and who can say what effects will occur in their interactions Thus each subsequent consultation becomes much more complicated.

3. In my early days in practice there were far fewer associations to worry about. Thus we know now that if a patient has say rheumatoid arthritis or diabetes, he is at greater rest of coronary heart disease. The two conditions act as compounding factors.  We are much more alert to the needs of children and increasingly adults, whose well-being needs to be safeguarded. Screening has brought it's own problems with the increasing burden of over-diagnosis, and we are much more alert to the place of family history in certain cancers. And all to say that a GP's life is so much more complicated.

4. One pleasing change is the loss of what was previously known as 24 hour responsibility of care. Now many GPs go home at the end of their working day and no longer have to take calls from home and stagger out of bed at unwelcome hours. The out of hours care is provided by various local organisations, largely staffed by local GPs who work a shift pattern, and who are paid for that extra work.  I have mixed feelings about it since there's no doubt with the demands of a typical working day being much greater than when I started, the thought of continuing on through the evening and night-only to be followed by the next working day-is truly unthinkable. Nevertheless something has been lost.

5. Being on call at night for one's own practice (and perhaps for a neighbouring practice as well), did lead in time to a certain familiarity with the clientele. And certainly to a decent knowledge of  the geography of the patch. There was also a sense of continuity since either one would brief the on-call doctor of what may happen, or there would be a discussion the following morning of what had happened.  Its hard to get that with the current system, although at least there is a fax each morning with details of what has transpired through the night with our patients.

6. One major change is the massive increase in night time calls for a doctor (and a similar increase in A+E attendances).  It seems we are just more intolerant of waiting, or to put it another way, we are just impatient.  Exacerbating that, we have lost the ability to check with mum or granny what we should do before calling for help. With job mobility and increasing family breakdown, the connections are often just not there.

So is health care better now? Hmm...

Sunday, 6 January 2013

Star of wonder

Much as I like the recently deceased Patrick Moore, I refer here to the star of Bethlehem.

The Collect* for this Sunday (Epiphany) begins, O God, which by the leading of a star didst manifest thy only begotten son to the Gentiles.  This old prayer is a reminder to us that unless God had taken the inititiative with us as he did for those Magi of old (in providing the star to lead them to worship the new born Christ), we would still be in spiritual darkness.

'We are Gentiles who know Christ not by sight, as the Magi did, but by faith. Moreover, we are not genetically related, most of us, to Isreal, from whom the Messiah has sprung. So it is in every sense 'by faith' and not by means of something palpable, whether sight or sure inheritance, that we are in relation to God. We are in there by the ''skin of our teeth' or rather, by his own free decision to make us His. We had nothing to do with it' (Barbie and Zahl)
It's very humbling to realise that we have not so much chosen Him, as that He has chosen us.

'O God may you shine your light into the hearts of all my friends and family who have not yet come to know you. For unless you open  eyes we remain blind to the wonder of your gift of Christ for us'.

*The Collects are a collection of prayers formalised into the Prayer Book (The book of Common Prayer) of the Anglican Church in 1549 and gathered together by Archbishop Thomas Cranmer. The collects were regarded as a 'collecting up' of the petitions of individual members of the congregation into one prayer.

Wednesday, 2 January 2013

Farewell full time General Practice

A mere 30 years ago today I began as a partner at Cobbs Garden Surgery in Olney. Even in 1982 New Year's day was a bank holiday, so I began on January 2nd.  And as of today I have now reduced my commitment to three-quarter time. Perhaps not a major change, but significant for me none the less. What's changed in general practice over those 30 years?

1.  I seemed to have quite a lot of free time in my early years. Particularly in the middle of the day and the early part of the afternoon when leisurely lunches (sometimes paid for by drug companies) and pottering around at home was quite possible. Indeed this is probably where the 'he's probably on the golf course', rumour began of many a GP.

2. Patients received less from us but were somehow more grateful than many seem to be today. I guess this is all part of a culture change in a society which expects banking, shopping and medicine to be on tap at any time of the night or day with an associated decline in 'reverence' for authority figures.

3. We had no mobile phones!  How on earth did we cope?  It certainly meant that you were far more tied to your home or surgery.  Indeed I even remember with some mild excitement hearing of a neighbouring GP who had a 'portable' phone that enabled him to be at the bottom of his garden and still take calls. So 'housebound' were we-or rather was my wife (before the change in demographics of medicine; in my graduation photo the percentage of females was about 10%).

4. Adding to the disadvantage of no mobile phones was the necessity of being on call one evening per week (or more if colleagues were on holiday). In addition I was on call for one in three of the whole weekend having done an open surgery Saturday morning.  With no means of contacting me directly the patient had to ring my home-thus restricting my wife to house-sitting, and then she had to track me down, via a succession of phone numbers of the patients whom I was visiting. Indeed often I would return before she could get hold of me, only for me to need to retrace my steps for another visit in a similar area.

5. I recall many times when reading a bed time story to one of my daughters, that  I was interrupted by the need to go on a house visit. On the other hand the generally undemanding nature of much of the day work meant that I was nearly always available for attendance at school  functions.

6. Getting out of bed at 3am on a cold February morning, defrosting the car (and my hands) and finding   a house with just a name and not a number in a small village, only to find that the distressingly wailing child had now gone to sleep, was challenging. Indeed home visits  and often keeping the patient at home,  after such conditions as myocardial infarction or heart failure or stroke was not at all unusual. How much money, resources and time are currently wasted by the knee jerk call for an ambulance for relatively minor problems. Some of the latter is due to the inexperience of the operator on the other end of the phone who may well simply be using a pro forma tick list. Of course I realise that the threshold for just simply going to A+E is much lower generally-whether it be patient, NHS Direct or even doctor mediated.

Oh blimey, I think I've got about another 20 points. It's just as well I've 'retired'.  More anon.

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...