Sunday, 31 March 2013

Easter day

These wonderful words adorn the base of my parent's gravestone. Thanks be to God for Jesus and his resurrection.

'There is no hope unless God himself has punched a hole in the ceiling of the universe and our great Captain Jesus Christ, who has opened a cleft in the pitiless walls of the universe, bids us come to see him. He has entered in. He was born. He died for our sins. Now he’s raised again. He has risen from the dead. If all that’s true, then you can be saved, then there’s hope for the future, then your sins can be forgiven, then you can have a relationship with God, then the Spirit of God can come into your life and change you.'
Tim Keller

Saturday, 30 March 2013

Good Friday in Bedford

It was good to join several hundred other Christian believers in the centre of Bedford yesterday for an open air Good Friday service. The musicality and the energy of the worship band was extraordinary. The worship leader particularly had a wonderfully exuberant stage presence. I admit I was expecting a more reflective style.

Of course it is not easy, nor even desirable for Christians to behave as though Easter morning never happened. Thus to sing on Good Friday about the cross without a note of triumph is always going to be a challenge, since Christ did conquer death and did rise to a new life just 3 days later. But, and it's a big but, we must learn to praise God in differing shades and capture differing moods. Neither life nor Christian life is always upbeat, and neither is it 'always winter and never Christmas', but it is joy and sorrow, pain and pleasure, hope and disappointment , and that is why the hymn book God has give us at the centre of the Bible (the Psalms) is so important to gauge the balance of our worship. I reflected on this last month when talking about the importance of lament.

Christians are not one-dimensional. We must learn to be 'faithful dispensers of the magnificently varied grace of God' (1 Peter 4.10 JB Phillips translation).

Thursday, 28 March 2013

Please Mr Postman

It'll be sad if the age of the letter and postcard was over. Emails are fine for immediacy and information but they just don't carry the emotional weight of the hand help piece of paper with real handwriting on.

A great study in the British Journal of Psychiatry (2013, doi:10.1192/bjp.bp.112.112664) has demonstrated the value of the good old-fashioned postcard. The study from Australia, sent eight supportive postcards over a period of a year, to patients who had been admitted to hospital with overdose. This support halved subsequent self-poisoning events and reduced psychiatric admissions by a third after five years. There was substantial savings in general hospital and psychiatric hospital bed days.

So resurrect those old writing skills. A postcard through the post could make all the difference. I don't think you need to have taken an overdose to find your mood lifted when you read it.

Wednesday, 27 March 2013

Every good endeavour

Some great stuff here from Tim Keller and Katherine Alsdorf, largely summarising their very helpful book on faith and work, Every good endeavour,. But also along the way, why not to write your first book till you are 50 years of age, how to find your calling, what to do if you dread going to work, and how to manage poorly performing  members of the church staff!

Every Good Endeavor from Redeemer Video on Vimeo.

Tuesday, 26 March 2013

The problem with twitter

I've not quite got into the Twitter thing, and I think I'm less likely to after hearing a short piece by American Christian speaker Shane Hipps. He makes the point that Twitter inheritantly simplifies things,  and he goes on to  distinguish between what he calls simplicity before complexity from simplicity after complexity. Got it?

Ok, he gives an example. If you go into a church and the very young worship pastor enthusiastically tells the congregation, 'God is good, all the time', you're not sure whether this is a mantra, a statement of faith or a testament from experience or what. It could well be that it is 'simplicity before complexity'. But if you also meet, in that same church, an 80 year old widow, who has been a Christian believer for much of her adult life, and she says to you, 'God is good, all the time', you perhaps take more notice. For as you hear her story of how God has sustained her though many trials, of personal sickness, the death of her husband, the death of her eldest son in an accident, and financial difficulties all her life, her  statement that God is good, all the time, carries so much more power. It is simplicity after complexity.

Twitter isn't all bad of course it just has its limitations. The ease with which I can tweet a sentence from say a great writer, ignores the fact that the writer in question may have agonised over every single word in that sentence. Real life is hard, tweeting is easy.

So you want to be a doctor?

It seems I'm stuck in a 10 minute vortex. My day is revolves around 10 minute appointments, the BMJ runs a series on 10 minute consultations for common problems, and just last week I was invited by a good teacher friend to speak at her school to year 11 and above on, 'what attributes do you need to be a doctor''? I was given only10 minutes.

So for the sake of my memory and to simplify I used 5ps

1. Perseverance: I think they were a little surprised that from start to finish (to become a GP at least), the training is 10 years, and if the RCGP get their way, it will go up to11 years next year, and maybe 12 years from 2015. That probably does seem an awful long time when you're 17 years old, and yet I know from experience how little you feel  you know when doing your very first solo surgery, and making important decisions yourself.

2.People: It  may be obvious, but it's preferable if you are a people person. Ok you might be rude and difficult to work with, yet be a brilliant neurosurgeon, and some would argue that that's ok. But yet is it? Purely from a self protection point of view, the kind, thoughtful, empathetic doctor is far less likely to receive serious complaints (it's a though you could 'get away with murder'-ok only joking), it seems if you're kind, that patients will just accept the errors and mishaps. I told them that in my year of qualification, 1978, I paid £40 annually to be affiliated to the Medical Defence Union, and my last year's bill was £6600, so much have claims for medical negligence risen.  And how much more enjoyable the workplace is if you work with supportive and witty colleagues. Oh yes, it really helps if you like patients too.

3.Pressure: There's no doubt that the job can be very stressful. At times the demands seem to outstrip one's experience, knowledge, wisdom, energy or inclination, but by and large, doctors just press on through it. That isn't to say one shouldn't look at the work load and think through ways of coping better. I've been so helped by the Managing Stress book which I have recommended to countless patients. It's helpful use of the seesaw metaphor which is at the heart of the book, and its look at demands and coping on opposite sides and what you can do about each, is simple but ultimately so useful.

4. Problems: There is a real element of problem solving in medicine, whether in research, surgery, hospital medicine, general practice, or whatever.  For a GP at least, each day brings a mix of undifferentiated problems, which require analysis, synthesis and some solutions.  The ability to think quickly and adaptably is vital, and of course to be a life long student of the human condition aids the problem solving.

5. Privilege: Its not all giving in medicine, since there is an immense amount of sheer privilege in the daily practice. Whether in being the first to know outside of the excited couple who have just discovered that they are expecting their first child, or the 84 year old cockney lady who tells you with tears in her eyes, of her early life abuse, which she has never told anyone before,  or just being aware of a variety of socially embarrassing 'secrets' about so many people, and which patents entrust you with. Oh yes its a great privilege, and not one to be taken for granted.

Yep, it's a great career, and I've loved it.

Monday, 18 March 2013

When I fall down you pick me up

Just returned from a first family holiday to the slopes of the southern French alps. I had only ever skied for a couple of hours once before, so I wasn't expecting too much of a performance. I was not disappointed!  In fact the holiday wasn't solely for the purpose of skiing , but to enjoy the opportunities of other winter sports. Our daughter Sarah had found a company called Undiscovered Alps in the Lonely Planet magazine and who put together a package of different activities to suit each family and budget.

I managed to fall at least once every day of the holiday. Initially on a guided moonlit snow shoe hike in the mountains, and then when attempting Huskey dog sledding, which in turn was followed by several falls the next day for my first ski lesson. And so onto the adventure of buddy paragliding. Tomas clipped me to him and placed me on the edge of the mountain with my parallel skis facing down and told me to  'just let myself go whilst keeping upright'. Hmm. I thought that's what I had done, but within less than a second I was not airborne but instead was gracefully face first in the snow on a steep incline. Tomas managed to unclip me and he skied down to a ledge some 30 yards below me, leaving my rather awkward self to try to get down to him. After what seemed an age I finally reached him and struggled to get upright, but eventually, we made off on our flight.

The next day was another skiing lesson. Having thought I had made good progress, I seemed to forget everything I had learned the day before and managed another few increasingly painful falls. By the last day I was ready for the cross-country skiing lesson. This was even more accident prone for me and I just couldn't get it. After two falls I gave up. Although Stefan was a delightful and patient coach,  he was happy to let me try to struggle up unaided each time I fell.

So back to the lovely worship song, You are my strength when I am weak.  We sing it in a round at Grace and it sounds beautiful. One of my favourite lines is, 'When I fall down you pick me up'. And what a great comfort to know that the Christian life is not just struggling on and doing your best, rather it is putting your trust in the ultimate  guide who is amazingly patient and ready to lift us up when we fall.

In the quaint language of the King james Bible Psalm 146.8 we have, The Lord raiseth them that are bowed down. As Spurgeon comments, 'Let those who are bowed down to the ground appeal to him, and he will speedily upraise them'. Perhaps my mistake in the Alps was not to ask for help, that old dog pride kicked in and wouldn't let me go. 'Many things in life push us around, or knock us down, but God cares for us and lifts us up again. The next Psalm will say, The Lord heals  the broken hearted and binds up their wounds (Boice). 

Lord lift me up.

Monday, 4 March 2013

The death throes of polio?

So, what do Pakistan, Afghanistan and Nigeria have in common? I guess many things, including religious conflicts and instability, but the answer I'm looking for is that these are the only three countries  where the disease of polio is still endemic. According to a report in last week's Independent there has been a reduction in worldwide cases from 350,000 in 1988 to just 212 in 2012. That is truly wonderful news. But, reaching the goal of polio eradication is proving elusive, not least because of the vast sums of money needed (it is estimated that each case averted cost $2000).

The vast majority of western doctors trained in the last 30 years will probably never have seen a case (at least not in its acute phase, I qualified in 1978 and have only ever seen old cases with residual muscular difficulties). Indeed the workload of the average GP is so different from pervious generations.  Writing in 1927 from his Yorkshire practice, Dr Stanley Sykes put influenza, acute bronchitis, tonsillitis, measles and whooping cough as the commonest problems. He saw more cases of pneumonia than cancer. I guess I see about 4-5 cases of pneumonia each year and something like 30 cases (including minor skin cancers) of cancer.

One of the biggest changes is what medical historian Roy Porter calls, 'the age of the acute yielded to the age of chronic disease.'  So coronary artery disease, stroke, hypertension, diabetes, asthma, COPD, dementia and the challenges of the faulty of old age, take up the bulk of a GP's time. Consequently it's easy to forget just what a scourge infections diseases used to be before widespread vaccination. So thank God for  continued efforts,  such as that by the humanitarian organisation Rotary International which was the first body to take on the global threat of polio. I'm pretty unfamiliar with the work of Rotary although attended my first event last week when I joined friends at the Kempston Rotary quiz night (we were robbed by choosing our joker in the 'wrong' round!).

So it looks like the Summer plaque (as polio used to be known), may be on its last legs. I hope our government continues to support the Global Eradication initiative, and although I'm a Mac man rather than  a PC man these days, I'm grateful for Bill Gates and the vast sums of money he has put in to the polio campaign.

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.