someone left a cake out in the rain

Today I sat outside a shop, the rain it pitter pattered,
But even though ‘twas cold and wet to me it hardly mattered.
For I took consolation in, something that’s quite unhealthy,
A shortbread slice adorned the way so loved by those who’re wealthy.

.

But as I then about me gazed, beneath those skies of grey
I saw ‘twas only me who ate that treat baked in a tray.
No millionaire did with me share, as I sat there and shivered,
On days like this I guess the rich have their cakes home delivered!

together in line

unrelenting sadness lingers

hope slips through her outstretched fingers

no pill can tend a grief like this

and words well meant their target miss

with soulful eyes replete with tears

she sinks beneath a sea of fears

together though, we stand in line

her breaking heart now breaking mine.



Related Blogs

To read ‘the wrong patient’, click here

To read ‘beaten’, click here

To read ‘Resting in Pieces’, click here

To read ‘Crushed’, click here

To read ‘Masked’, click here

To read ‘She’s The Patient You Don’t Know You Have’, click here

the wrong patient

THE WRONG PATIENT

.

It’s not that she no longer knows

the reason for her tears

It’s not that she no longer feels

the pain of all those years

.

It’s not that she no longer cares

to make her daily calls

It’s not that she no longer stays

confined within her walls.

.

It’s just that now she doesn’t see

a reason to go on

It’s just there’s nothing left that’s right

in a world where she’s

so wrong.

.

Not any longer



Related Blogs

To read, ‘together in line’, click here

To read ‘beaten’, click here

To read ‘Resting in Pieces’, click here

To read ‘Crushed’, click here

To read ‘Masked’, click here

To read ‘Patient’, click here

To read ‘She’s The Patient You Don’t Know You Have’, click here

To read a few Covid-19 related poems you could start with ‘Old Hands’, by clicking here

To read ‘Spare me a doctor’, and other medically themed poems click here

And for an attempt at something humorous, click here, for ‘How the Grinch and Covid stole General Practice’s Christmas’.

Easter Sunday 2021

Happy Easter!

It was Good Friday, but now, as surely as day follows night, sunshine follows rain, and a more normal life will surely one day follow this pandemic, it’s Easter Sunday. A day to both remember and celebrate the most significant event in history, a source of hope powerful to sustain in even the darkest of days.

The following is an updated version first posted last year.


Easter Morning. The tomb is empty and Jesus is raised. Obviously.


I say obviously because it never could have been any other way. Some people have a problem with that – they say irrational things like ‘Dead people don’t come back to life – that’s simply impossible’. But the Bible says just the opposite, the Bible says it was impossible for Jesus to stay dead!


‘God raised him up, loosing the pangs of death, because it was not possible for him to be held by it.’ (Acts 2:24)


Granted, the dead rising to life again is not a common occurrence. But if the rationale for you not believing in the resurrection of Jesus boils down to, ‘It can’t happen, so it didn’t happen’, then you are not being intellectually honest with yourself, drawing your conclusions on preconceived assumptions which are not based on fact. And it’d only take a resurrection to happen once for you to have to change your point of view. 

At the end of a lecture he had given on the reasons for his atheism, noted philosopher Anthony Flew, was once asked the question, ‘But what if Jesus was raised from the dead?’. ‘Well,’ he replied ‘If Jesus was raised from the dead, that would change everything’. His response was consistent with his lifelong commitment to go where the evidence led, a commitment that would, a few years before his death in 2010, ultimately lead to him coauthoring a book which was entitled ‘There is a God’.


It was the apostle Peter who made the above statement regarding the impossibility of Jesus staying dead. It is interesting to note the change that had occurred in Peter since Good Friday. After Jesus’ arrest he had been running scared, denying to everyone that he had ever even known Jesus. But here, on the day of Pentecost, just seven weeks later, he stands and publicly proclaims, to a crowd of thousands, the reality of the resurrection. The reason for the change in Peter isn’t hard to find: ‘This Jesus, God raised up,’ he says, ‘and of that we all are witnesses.’ (Acts 2:32). 

Like Anthony Flew, Peter had followed the evidence.


The evidence for the resurrection is well documented and a couple of links follow for those interested:


http://www.desiringgod.org/articles/historical-evidence-for-the-resurrection


https://biblicalstudies.org.uk/article_resurrection_anderson.html

But why was it not possible for Jesus to stay dead? This is a philosophical argument and is based on the nature of death and the underlying reason for it. We tend to think that death is normal – the inevitable end to the wearing out of our bodies after long years of use or, alternatively, the tragic result of some violent insult, overwhelming infection, or malignant growth, something that our bodies cannot withstand. But the Bible says that there is a more fundamental reason for why we die. And that, it says, is because of sin. 

Death is not part of how things should be – rather it is a travesty, the consequence of the presence of the wrong that is in the universe, the penalty for the sin of which we are all guilty – myself more than anyone. An awareness of this opens the door to our being able to better understand how Peter can make his assertion that it was not possible for Jesus to stay dead. 

It is because Jesus was sinless, that death could not hold him. 

If we struggle to believe anything about the Easter story, it shouldn’t be the resurrection of Jesus – that bit stands to reason. The amazing part of the story is that he ever died at all. That the author of life should die is a great mystery – but die he unquestionably did. As it is for his resurrection, the evidence for Jesus’ death is overwhelming, even bein* attested to by a paper published in the Journal of the American Medical Association in 1986. You can read it here: 

https://jamanetwork.com/journals/jama/article-abstract/403315

So what then was the reason for Jesus’ death? The answer to that can be given in one word: Love. The love he had for those he came to save, those he was willing to lay down his life for, [John 10:15], those for whom his death would bring eternal life. 

The reason that Jesus’ was born in the first place was ‘to seek and save the lost’ [Luke 19:10]. As the apostle Paul once wrote, the ‘saying is trustworthy and deserving of full acceptance, that Christ Jesus came into the world to save sinners’ (1 Timothy 1:15). 

Jesus knew this and understood that the salvation he had come to achieve would be realised through his death. ‘The Son of Man must suffer many things’ he said, ‘and be rejected by the elders and chief priests and scribes, and be killed, and on the third day be raised.’ (Luke 9:22). That is the reason why, when the time of his crucifixion drew near, Jesus ‘set his face to go to Jerusalem’. (Luke 9:51).

Jesus went to Jerusalem on purpose, with the expressed intention of dying there. 

But why did he have to die? More than that, why did he have be killed? Why couldn’t he have simply slipped away quietly in his sleep at a ripe old age? The answer to that question is that ‘the wages of sin is death’ (Romans 6:23). If justice is to be upheld, sin must be punished, and the penalty for sin is death. 

We all want to live in a just universe – we cry out for justice when we see others maltreated especially when that injustice is particularly great or when we are find that it is who are the ones who are experiencing the injustice. The only time we are unhappy with justice is when we are guilty! I believe speeding drivers should suffer a penalty but many were the excuses I had for why I shouldn’t have had to attend the speed awareness course I was invited a few years ago!

God is, by his very nature, holy. He is perfectly right, perfectly just. And if he is to remain just, His standards must be he upheld. We, on the other hand, are not what we should be. We know, if we are honest, that we don’t live up to even our own standards let alone those of a holy and righteous God. Therefore, since as has been already been said, the ‘wages of sin is death’, we have a problem. We all deserve death, myself included and, unless a suitable substitute can be found, we face the prospect of experiencing that punishment ourselves.


But this is where the bad news of the law of God becomes the good news of the gospel. Because, not only is God holy and rightly angry at injustice he is, at the same time, merciful and gracious. God gave his only son to be a penal substitute, one who would act as the wrath absorbing, justice satisfying, atoning sacrifice for our sins. One who would gladly take our place and suffer for us the punishment we deserve. 

At this point it is important to remember the mystery of the Trinity. God, though one, is three persons. We are not, therefore, seeing here a loving Jesus who absorbs the wrath of an vengeful despotic God. On the contrary, Jesus is himself fully God even as he is fully man. And the Father and Son, along with the Holy Spirit are one. As the Father loves the son, so the son loves the Father. Therefore, the death of Jesus, planned and agreed by all three persons of the Godhead before time began, and pointed too throughout the Old Testament [see for example here and here] reveals a loving Father every bit as much as it reveals a loving son,

The Old Testament prophet Isaiah had, some 700 years prior to the crucifixion, prophesied how God would one day lay on Jesus our sin and punish him in our place: ‘But he was pierced for our transgressions;’ he wrote, ‘he was crushed for our iniquities; upon him was the chastisement that brought us peace, and with his wounds we are healed. All we like sheep have gone astray; we have turned, every one, to his own way; and the LORD has laid on him the iniquity of us all.’ (Isaiah 53:5-6). 

Jesus, because of his love, both for his Father and for us, willingly took on our sin and died in our place so that we need not suffer that punishment ourselves. He was put to death so that ‘whoever believes in him should not perish but have eternal life.’ (John 3:16). For our sake [God] made [Jesus] to be sin who knew no sin, so that in him we might become the righteousness of God. (2 Corinthians 5:21). 

That is, God treats Jesus as if he had lived like us so that he can justly treat us as if we had lived like Jesus. This is what it means to say that God loves us. It’s not that he thinks everything about us is just peachy, but rather that he treats us well despite how little we deserve his kindness. He loves us, not because we are lovely, but because he is loving. 

And how great is that love with which he loves us. We cannot conceive how vast that love is. ‘For as high as the heavens are above the earth, so great is his steadfast love towards those who fear him; as far as the east is from the west, so far does he remove our transgressions from us’ [Psalm 103:11-12]

‘In this is love, not that we have loved God but that he loved us and sent his Son to be the propitiation for our sins.’ (1 John 4:10). ‘The wages of sin is [indeed] death, but the free gift of God is eternal life in Christ Jesus our Lord.’ (Romans 6:23). ‘And this is eternal life, that [we] know…the only true God, and Jesus Christ whom [he has] sent.’ (John 17:3).

This then is how God loves us. Jesus death is not just a sign of God’s love, it is an act of love too, one that achieves our salvation. One that achieves our rescue. If I’m walking along the river with my wife and I turn to her and say ‘Darling, I love you so much and because I want to show you how much I love you I’m going to throw myself into the river’, and then, having made my declaring, I promptly proceed to do just that and drown, I am, what is commonly known as, an idiot! If however, as we walk along the riverbank she falls in and begins to drown, and I jump in to rescue her but, in so doing, lose my own life, then I have acted out of love. I will have demonstrated my love by my actions, by what I have done, by what I have achieved. I will have done a loving thing, but one that is no where near as loving as that which was done by the son of God who, of infinitely greater worth than I, died for those who were only deserving of death.

God then, in the death of his beloved son, at great personal cost, rescues us from himself so that we might enjoy knowing him forever, no longer having to live in fear of his righteous anger towards us. God’s justice was satisfied by his wrath being directed toward another, toward Jesus, the one who willingly absorbed it all for us on the cross. So completely did Jesus’ death pay the penalty for our sin that there is now no longer any of God’s anger left over to be directed at us. That is what is meant by Jesus’ death atoning for the sins of those he died for. That is the meaning of ‘propitiation’ in the verse above. God hasn’t merely laid aside his anger at sin only for it to rise up again at some later date, on the contrary, it has gone for good, even as it was fully poured out on Jesus. 

That is why Jesus, as he hung on the cross, cried out ‘My God, my God, why have you forsaken me?” (Mark 15:34). Remarkably God was turning his back on the son he loves so deeply in order to save we who have ourselves turned our back on God. And it why the apostle Paul can write that ‘There is therefore now no condemnation for those who are in Christ Jesus.’ (Romans 8:1). All condemnation towards those whose only hope for salvation lies in Christ is gone! The job of satisfying the requirements of the law and thereby maintaining God’s justice even as he forgives we who have sinned and deserve death is complete. As Jesus died he said ‘It is finished’ (John 19:30). He wasn’t talking about h8s life, rather he was talking about his work of atonement. And he was right, the resurrection on Easter morning proving that his sacrifice really was fully effective in paying the price for all that we have done wrong. God’s grace really is completely sufficient for even the chief of sinners. 


Rest assured, knowing God for all eternity will not be dull like some people imagine. We have all had moments in our lives when we have experienced something truly beautiful – a glorious sunset perhaps, a magnificent mountain view maybe or perhaps waves crashing powerfully against a rocky coastline. These are awesome sights, ones to be fully enjoyed enjoyed. But they are mere a faint echo of what we will one day experience, they will pale into insignificance when we see God face to face, when heaven is on earth and the dwelling place of God is with man. ‘He will dwell with [us], and [we] will be his people, and God himself will be with [us] as [our] God. He will wipe away every tear from [our] eyes, and death shall be no more, neither shall there be mourning, nor crying, nor pain anymore, for the former things [will] have passed away.’ (Revelation 21:3-4). 

Seeing God and experiencing that future new creation will be infinitely more satisfying than the happiest times this world has to offer, better even than Easter Day. And the prospect of that future joy might just be enough to sustain us through the saddest times this world affords – days like Good Friday.


Easter morning – the tomb is empty and Jesus is raised.That’s good news – but not unexpected. It was always going to happen.


It was Good Friday.

But now it is Easter Sunday.

Obviously.


Happy Easter.


Addendum:


If you have read thus far, I am (a) surprised [I believe the expression is TL:DR – Too long: didn’t read] and (b) grateful. Thank you.


I am aware that this has been long but some things need more than the length of a tweet if one is to have any chance of conveying their importance.


I am also aware that there will be some, perhaps many, who will consider what I have written as naive, irrelevant and perhaps even offensive. If that is you I trust you’ll accept my words as a genuine attempt to explain things I hold to be of first importance for us all to know and understand. If, as a doctor, I genuinely believed I had a life saving cure for your terminal illness, you’d consider it cruel of me if I withheld that treatment from you even if you didn’t share the belief in its effectiveness. So consider me foolish by all means, but I hope you’ll not consider me unkind in writing as I have. If one can not write of these things at Easter time, then when can one write of them?
For all that however, I hope that there may be others who will agree with what I have written and, rejoicing with me at the news of Jesus’ life death and resurrection know that this news is simply too good not to share.


Related posts

To read, ‘Good Friday – 2021’, click here

To read, ‘The Resurrection – is it Rhubarb?’, click here

To read, ‘Real Love?’, click here

To read, ‘Hope comes from believing the promises of God’, click here

To read ‘John 3:16’, click here

To read ‘Water from a rock’, click here

To read ‘The Sacrifice of Isaac’, click here

Good Friday – 2021

Sorrowful yet always rejoicing.

I saw it again this week, tears amidst the laughter, smiles amidst the sorrow.

The first occasion came whilst I was watching an old episode of ‘The Repair Shop’. As an item of great sentimental value was returned to its owner, the recipient’s joy at its restoration was evident even as they were overwhelmed by the sadness brought on by the distant memories of the one with whom it was once associated. There was pleasure in the sadness, heartache in the delight.

And there it was again, in my patient. Distraught, she sat crying in my room, all hope seemingly lost. And yet, as we chatted, there was a smile, and then a laugh. Not one that indicated, even for a moment, that the sadness had gone. But there it was none the less, evidence that even in the darkest of moments there was still a glimmer of light.

And there it was again, in my patient. Distraught, she sat crying in my room, all hope seemingly lost. And yet, as we chatted, there’s was a smile and then a laugh. Not one that indicated, even for a moment, that the sadness had gone, but it was there none the less, evidence that even in the darkest of moments there is still a glimmer of light.

And it’s there in my own life too, genuine causes for sorrow sitting alongside sources of real joy, not least that associated with the excitement of hearing the news that I’m to be a grandfather. Sadness and happiness coexisting, neither one ever entirely absent, each simultaneously both intensifying and diminishing the other

Sorrowful yet always rejoicing.

Even in the good times, we can not deny the existence of sadness. And neither, on the darkest of days, must we imagine that there is nothing we can take pleasure in. Perhaps we cannot know what happiness really is without knowing the pain of sorrow and, for sorrow, to be fully realised, perhaps it requires the experience of knowing what it is to be truly happy. If so, if we are to be happy, it must be alongside our sadness. We must neither wait for the absence of sorrow before allowing ourselves to be happy nor deny our sadness because there are things to be happy about. Life is not black or white, it is a kaleidoscope of grey. It is not that we can not be happy because we know sadness, nor that we can not be sad because there are things to be happy about, but that, paradoxically, we can be happy and sad at the same time.

We can smile, therefore, even as we cry.

We too need to learn what it is to be sorrowful yet always rejoicing.

Today is Good Friday, a day like no other to ponder such things, as we wait for Easter Sunday.

What follows is something I originally posted a year ago. I find it helpful to consider these things, so as to make life more meaningful, more understandable, and more bearable. Perhaps you will to.

Because even the eternally happy God knows what it is to sometimes cry.


One Maundy Thursday I wished a good friend of mine a happy Easter break. He hesitated however to return my good wishes because, he said, that he understood that Good Friday was a day for Christians like me to be miserable. It got me thinking to what extent he was he right.

Paul, writing in his second letter to the Corinthians, describes Christians as, ‘Sorrowful yet always rejoicing’ [2 Corinthians 6:10]. If such a paradoxical existence was the reality for Christians back in Paul’s day, it is surely no less true a reality for Christians living the 21st Century. ‘Good Friday’, the name we give today, is itself a paradox – for how can we apply the adjective ‘good’ to describe the day of Christ’s crucifixion? For sure, it is a day on which Christians should grieve over their sin and what it was that Jesus had to suffer in order to secure their redemption, but, at the same time, it is a day for rejoicing in the triumph of his sacrifice as we anticipate and remember his subsequent resurrection from the dead on Easter Sunday.


‘Sorrowful yet always rejoicing’ – it was the experience of Paul and it was also the experience of Jesus himself. For he was himself ‘a man of sorrows and acquainted with grief’ [Isaiah 53:5]. Matthew recalls the words of Jesus to Peter, James and John, in the Garden of Gethsemane:


“My soul is very sorrowful, even to death; remain here, and watch with me.” [Matthew 26:38].


And yet the writer to the Hebrews has it that Jesus, ‘for the joy that was set before him endured the cross’ [Hebrews 12:2].


Suffering, then, is not the end of joy – it can even be the passage to joy. Again this is not a contradiction – but it is a paradox! A paradox that the second thief, even as he was being crucified alongside Jesus, understood. There he was, in just about as bad a position as it is possible for a person to be in, minutes away from an excruciating death, when he, nonetheless, made his remarkable request:


‘Jesus,’, he said, ‘remember me when you come into your kingdom’ [Luke 23:42].


Like everybody else that day, the second thief saw Jesus suffering and dying on a cross. But unlike the religious rulers, the Roman soldiers and the other thief who was also being crucified that day, he didn’t see defeat. He continued to speak of Jesus as one who was coming into his kingdom. For him Jesus’ death didn’t mean an end to all the kingdom and salvation talk. Whilst all those others, those who mocked Jesus as they watched him die, were looking for a salvation FROM death, the second thief saw that the salvation Jesus was bringing about was a salvation THROUGH death. 

Jesus’ death wasn’t the end of Christ kingdom, on the contrary, his death was its beginning.

This is a profound truth – one we do well to try and grasp some understanding of.


Far from a simple faith, the second thief’s faith was remarkable. And it is on account of his wonderful faith that we should not be surprised by Jesus when he responds to him with these words:


‘Truly, I say to you, today you will be with me in paradise’ [Luke 23:43].


Jesus saw in the second thief somebody who got it! Somebody who trusted the power of God despite seeing that which to unspiritual eyes was nothing but weakness. Somebody who saw victory where most saw only defeat. Somebody, indeed, who understood the paradox of Good Friday.


That suffering is not irredeemable,

That sorrow is not incompatible with joy,

That even the darkest nights can be followed by the brightest days.


‘Sorrowful yet always rejoicing’? It was the experience of Paul. It was the experience of Jesus. It was the experience of the second thief.
And it will be our experience too.


Some of us are sick? Some of us mourn the loss of loved ones? Some of us worry over our future? Some of us have experienced great tragedy in our lives – some recently, some longer ago but who nonetheless still feel the pain just as keenly as if it were yesterday.


There is indeed much today for us to be sorrowful over. Some Christian types can sometimes well meaningly suggest we should always be happy. ‘Smile’, they say, ‘Jesus loves you’. But though they are right to proclaim the truth that God really does love us, they are wrong to suggest that we should never be sad, for even the eternally happy God knows what it is to cry. [1 Timothy 1:11, Luke 22:62]. Even Jesus wept at the tomb of his friend Lazarus, his grief no less intense for knowing that he would soon bring him back to life. [John 11:35].

Perhaps, then, even God knows what it is to be sorrowful yet always rejoicing. 

So it’s not wrong to be sad, it’s simply normal. The Bible never tells us to masochistically rejoice about our suffering. But it does tell us to rejoice inour suffering.


Because despite our sorrow – there is much to rejoice over! We truly are loved with an everlasting love, a love that transcends our current struggle, a love that means that we too can be sorrowful yet always rejoicing.

As we suffer we can rejoice because of the Gospel. The good news is that Good Friday was followed by Easter Day, that Jesus died for our sins, bearing the punishment we deserve, and that when he rose from the dead Jesus proved the sufficiency of his sacrifice. By it we are justified, counted righteous, declared to be ‘not guilty’.


Some of us grieve over our unrighteousness and can not even lift our eyes to heaven. We beat our breasts and cry out, ‘Have mercy on me, a sinner’ [Luke 18:13] But because of Jesus’ work on the cross on our behalf we are made right with God – regardless of our current situation.


Not because of our worth – but because of his grace.

Not because of what we do – but because of what he did.

Not because we are lovely – but because he is loving.


So, if you’re sorrowful today, remember you’re not alone, God weeps with you. And know that, because of Jesus, his life, death and resurrection, ‘Weeping may tarry for the night, but joy comes with the morning.’ [Psalm 30:5].


It’s Good Friday – but Easter Sunday is coming. Because of what took place over those two days nearly 2000 years ago, we can know real forgiveness for all those sins that we so bitterly regret, no matter how great they are.

But if that were not enough to rejoice over this Eastertide, we can also look to the future with a certain hope. Suffering is all too real today but the day is coming when God ‘will wipe away every tear form [our] eyes, and death shall be no more, neither shall there be mourning, nor crying, nor pain anymore, for the former things [will] have passed away.’ [Revelation 21:4]


‘So we do not lose heart. Though our outer self is wasting away, our inner self is being renewed day by day. For this light momentary affliction is preparing for us an eternal weight of glory beyond all comparison, as we look not to the things that are seen but to the things that are unseen. For the things that are seen are transient, but the things that are unseen are eternal’. [2 Corinthians 4:16-18]


It’s Good Friday – but Easter Sunday is coming.


So may we all know happiness this Eastertide – even those of us who are sorrowful.

Especially those who are sorrowful.


Related Blogs

To read ‘Easter Sunday’, click here

To read, ‘Luther and the Global Pandemic – on becoming a theologian of the cross’, click here

To read, ‘T.S. Eliot, Jesus, and the paradox of the Christian Life’, click here

To read, ‘Why do bad things happen to good people? – a tentative suggestion’, click here

To read, ‘Suffering – a personal view’, click here

To read, ‘The “Already” and the “Not Yet”‘, click here 

To read, ‘Hope comes from believing the promises of God’, click here

To read, ‘Faith in the time of Coronavirus 1’, click here

THE VERY MODEL OF A GENERAL PRACTITIONER?

I am a type of doctor one who majors in the general,

I have a working knowledge of those matters anatomical,

I deal with illness physical, and problems psychological,

And try to make suggestions that aren’t only pharmaceutical.

.

Each day at work I undertake, a range of consultat-i-ons,

And lately have become one skilled, in giving vaccinat-i-ons,

I’m always on the look out for, hern-i-al strangulat-i-ons,

Whilst still exploring all ideas, concerns, and expectat-i-ons.

.

I’m competent if called upon, to tackle venesect-i-ons,

And know just what I am to do with urinary infect-i-ons,

I know the interval between all those B12 inject-i-ons,

And for appraisal purposes, I note down all re-flect-i-ons.

.

I know that those who vomit blood will contact me annoyedly,

And so I give a PPI with all drugs non-steroidal-y,

And those who come to me who have been bleeding haemorrhoidally,

I duly send them for a scope, exploring them sigmoidally.

.

I love to sit with patients both the shy and the loq-ua-ci-ous,

And listen to their stories which, are sometimes quite sal-a-ci-ous,

But nothing brings me greater joy than when I’m effi-ca-ci-ous,

At, with a little xylocaine, removing cysts seba-ce-ous.

.

In truth those houseman days of old, were like a fire baptis-i-mal,

But now my days in medicine are not so very dis-i-mal,

There are of course those things at which I’d truly be abys-i-mal,

E.g. repairing pulsatile aortas aneurys-i-mal.

.

After W.S. Gilbert and Arthur’s Sullivan


To read, ‘I’ve got a little list’, click here

Book Review: ‘The Book about Getting Older’, by Dr Lucy Pollock

Having read this week ‘The Book About Getting Older (for those who don’t want to talk about it)’, I have a few problems with its author, Consultant Geriatrician, Dr Lucy Pollock. The first is that, since she is of a similar age to me, should I be fortunate enough to make it to a ripe old age, it is extremely unlikely that she will still be working when I have need of someone to oversee my medical care. However, with luck, whoever it is who will one day have the misfortune of being called upon to advise me in my dotage will have read her book and taken on board all that she has written there, for it sums up what good medicine is, for me, all about. And so the second problem I have with Dr Pollock is that she is liable to cause me to run out of the superlatives necessary for describing what she has said.

For this is a book that, along with considerable humour, oozes wisdom, overflows with compassion and is chock-full with sensible counsel which really does make it a must read for hospital consultants, general practitioners and anybody who cares for an elderly person. And that, of course, includes anybody who is themselves elderly or one day hopes to be so. No wonder she is so highly regarded by those I work with who refer into the hospital where she works and who, on occasions have had the very great pleasure of hearing her speak.

Much of the book is written like a novel with exquisitely drawn descriptions of patients, written by somebody who clearly cares deeply about those she is writing about and who draws the reader into their stories, making us care for them too. Here then is somebody who cares enough to notice the little details of an individual’s character, somebody who listens attentively to what it is they are saying, spoken or otherwise, and somebody who makes every effort to understand those who come to her for help, surely the foundation upon which all good care must rest. Here too are elderly folk, described as they truly are, not as burdensome individuals who drain the healthcare system with their multiple problems, but people who have lived and loved and have much to offer despite the level of their current need for support.

The book takes an honest look at the problems that increasingly longevity brings with it. As more and more of us are living longer, with those added years inevitably being at the end of our lives, greater numbers of us are consequently spending our final years increasingly dependent on others. The book urges a thoughtful consideration of how medicine can be best applied to those individuals for whom yet another medical intervention will not always be in their best interests. But Dr Pollock never suggests that old people are not worthy of being treated. On the contrary, as she helpfully puts it, some treatments are simply not good enough to be used on some elderly folk. It is the treatments, not the patients, that aren’t worthy.

Rather than thoughtless adherence to medical protocols and treatment algorithms, it is for Dr Pollock an understanding of her patients and what it is that is important to them as individuals that should drive the decisions that are made by the clinician, the patient and their families, as to what should and should not be done. Just because something can be done doesn’t mean it should be. The book is full of cases of how this principle is not one that is held merely theoretically. Her sadness and frustration at the case of the elderly patient who, over the course of a previous three month hospital stay, suffered 77 blood tests, undertaken for reasons that were no doubt well meant but were nonetheless almost entirely unnecessary, is a case in point. Rather than yet another investigation being ordered, a discussion of what was important to the patient leads to the individual going back home to enjoy watching football on the TV with his son whilst taking a few sips of cider. That really is good practice, medicine that, rather than vainly seeking to add years to life, aims to add life to the limited time those who of an advanced age inevitably have.

The book also has a useful discussion about advance care plans, a realistic look at the success or otherwise of attempts at cardiopulmonary resuscitation and the challenges of dementia. There are also some practical chapters on assessing capacity, powers of attorney and considerations around driving.

It really is a superb book in which the author clearly cares about the reader every bit as much as she does her patient as evidenced both by the gentle way she softens the delivery of less palatable truths and by the slightly larger font that has no doubt deliberately been employed whilst mindful of the deteriorating eyesight of some of her readers. Please do read it, and then recommended it to your family and friends and, for those of you working in healthcare, recommend it to your patients. It really does deserve a very wide readership.

Which brings me to my final problem with Lucy Pollock. In the unlikely event that I am ever cast away on a desert island, I am now going to have an even more difficult task choosing what book I might like to take with me alongside the Bible and the complete works of Shakespeare. For this is a book, full of delightful characters, that is in turns both moving and inspiring, one that makes me want to live better and practice better. It is also one that, marooned on a desert island far from any medical attention, might just reassure me that perhaps we don’t always need quite as much medicine as we sometimes foolishly think we do. Even so, all alone on an island I would undoubtedly miss doctors like the writer of this excellent book and the wonderful patients I, like her, have had the joy or caring for.

But never mind this review, read the brilliant Lucy Pollock’s, brilliant book. Easily worth six stars.


To read, ‘Vaccinating to remain susceptible’, click here

To read, ‘Shot of Love’, click here

To read, ‘On not remotely caring’, click here

To read, ‘The Did – it’s well worth it’, click here

To read, ‘The Repair Shop’, click here

I’ve got a little list…

I’VE GOT A LITTLE LIST – Take One

As some day it may happen that a victim must be found

I’ve got a little list — I’ve got a little list

Of medical offenders who might well be underground

And who never would be missed — who never would be missed!

There’s the patient who believes that he has suffered every ill

And even those he hasn’t yet he knows someday he will

The CQC inspector who insists the rules are kept

And pouring urine samples down the sink he won’t accept

The turmeric advisor – yes that dreadful herbalist –

I don’t think he’d be missed – I’m sure he’d not be missed.

.

He’s got them on the list — he’s got them on the list;

And they’ll none of them be missed — they’ll none of them be missed

.

There’s those who deal with teeth and gums who aren’t there to prescribe

The elusive dentist – I’ve got him on my list

And patients who have symptoms that they simply won’t describe

They just do not assist – they never would be missed

The chap who takes his jacket off and hangs it on the door

The halitotic sufferer whose breath you can’t ignore

The ones who by their actions make it clear that they’re acopic

The bloke who needs a blood test but who says he’s needle phobic

The one advised to see you by their crystal therapist –

I don’t think she’d be missed — I’m sure she’d not be missed!

.

He’s got them on the list — he’s got them on the list;

And they’ll none of them be missed — they’ll none of them be missed

.

The fellow feigning sickness who requires of you a note

That symptom fantasist – I’ve got him on my list

The ones, cos you were running late, complaining to you wrote

I wish they would desist – they never would be missed

The folk you ask what pills they take who haven’t got a clue

They only know that some are red and others they are blue

The ones who think they’re dying since they did that Google search

Who know that they’ve got cancer cos their little finger hurts

The medicines advisor who on certain drugs insists

I’d like to slap his wrist – I’m sure he’d not be missed.

.

He’s got them on the list — he’s got them on the list;

And they’ll none of them be missed — they’ll none of them be missed

.

And then there are the patients who have issues that are legion

They’ve got a long long list, I’ve got them on my list

Who seem to have a problem with their every bodily region

Their think perhaps a cyst, they never would be missed

Those moaners at prescription costs despite their untold wealth

And those who want a call from you who say they’ve ‘mental ‘elf’

And those who say it’s urgent though they’ve had their problem years

The chaps who come with issues with their gentlemanly spheres

Who really would be handled best by a vasectomist

He’d give them both a twist, I’m sure they’d not be missed.

.

He’s got them on the list — he’s got them on the list;

And they’ll none of them be missed — they’ll none of them be missed.

.

Those saying the pandemic was by Bill Gates orchestrated

The conspiracy theorist – I’ve got him on my list

And all those antivaxers who unfounded fears created

They never would be missed, they never would be missed

The one who says that Covid caused his cough in ‘92

And won’t accept a single thing you ever say is true

The people who in parliament who only cause us hassle

The government advisor that once went to Barnard Castle

Who should instead have gone to see, a skilled Optometrist

I don’t think he’d be missed – I’m sure he’d not be missed.

.

He’s got theem on the list — he’s got them em on the list;

And they’ll none of them be missed — they’ll none of them be missed

.

After W.S Gilbert and Arthur Sullivan

For those unfamiliar with the song, the original appears in the comic opera, ‘The Mikado’, first performed at London’s Savoy Theatre in 1885. Sung by The Lord High Executioner, modern productions include topically updated versions of the song with tongue in cheek suggestions of those people whose loss, were he to be called upon to act professionally, would be a distinct gain to society. If you’d like to hear an example of a fairly recent version, a link to one follows.

https://youtu.be/-MDyurTABdU

.

I’VE GOT A LITTLE LIST – Take Two

Because, in reality, having always enjoyed good relationships with both patients and colleagues alike, and that includes dentists and medicine management advisors, there are many I’ll miss when my time comes to retire from General Practice. Please be assured that the truth is that I am really very fond of everyone that my job brings me into contact with and no more mean to suggest real criticism in the above than, presumably, Gilbert and Sullivan did when, in their original song, they identified children who had an impressive knowledge of historical dates and those with irritating laughs as those deserving of the attention of the Lord High Executioner.

.

As one day I’ll retire when my working days are done

I’ve got a little list, I’ve got a little list

Of people I will want to thank, who’ve made my job such fun

They’ll all of them be missed, they’ll all of them be missed

There’s the patients who forgave me for mistakes that were my fault

The folk who every Christmas gave me smokey single malt

And those who every morning, at half ten knocked on my door

And brought me cups of coffee and those biscuits I adore

They’re none of them draconic, those kind receptionists

They’ll all of them be missed – they’ll all of them be missed.

.

I’ve got ’em on the list — I’ve got ’em on the list;

And they’ll all of ’em be missed — they’ll all of ’em be missed.

.

And then there are the nurses who were always sympathetic

I’ve got them on my list, I’ve got them on my list

When I got into a pickle managing a diabetic

They’ll all of them be missed, they’ll all of them be missed

The HCAs who helpfully squeezed in those ECGs

And never made me beg for one whilst down upon my knees

The times when I had issued drugs whilst just a tad distracted

And someone pointed out the way they may have interacted

Indeed I am so grateful to our helpful pharmacists

I know that they’ll be missed – I’m sure that they’ll be missed.

.

I’ve got ’em on the list — I’ve got ’em on the list;

And they’ll all of ’em be missed — they’ll all of ’em be missed.

.

The team up there in admin, those who type what I dictate

I’ve got them on my list, I’ve got them on my list

Who hear the words I mumble that they’ll first have to translate

Though I sent them round the twist, they’ll all of them be missed

The practice manager who I have driven up the wall

By not reading my emails and by changing my on call

My partners who I have been glad to have close by my side

Who’ve been there as I’ve laughed a lot, who’ve been there as I’ve cried

Well I am very sure now that you all have got the gist

They’ll all of them be missed, they’ll all of them be missed.

.

I’ve got ’em on the list — I’ve got ’em on the list;

And they’ll all of ’em be missed — they’ll all of ’em be missed.


To read ‘A Very Model of a General Practitioner?’, click here

The Repair Shop

‘Everything is broken’

Bob Dylan

‘There’s a crack, a crack in everything – that’s how the light gets in’

Leonard Cohen

This week I watched another episode of The Repair Shop. It’s an excellent programme in which items of great personal worth that have fallen into a state of disrepair, either as a result of neglect, misuse or simply the passage of time, are brought to a team of expert craftsmen and craftswomen for repair. We then watch as they apply all of their skill and experience to the task of restoring the inner workings and external appearance of the precious items. Slowly they are given back their former glory before being returned to their owners, all of whom are invariably delighted with what has been achieved in making what was once broken whole again.

Despite my utter incompetence in all things practical, why anyone would ever allow me to perform minor surgery on them I’ll never know, I found myself feeling envious of those I was watching, wishing I too worked in The Repair Shop. Until, that is, I realised how similar our job is to theirs.

Those who come to us are also of great value but have become broken, likewise due to having been either neglected, treated badly or as a result of simply becoming old. And it is our job to use all our skill and experience to bring about some kind of repair.

The artisans in the programme clearly derive a huge amount of satisfaction from their job and it left me wondering why it is that, if our jobs are alike in so many ways, we do not always experience the same sense of satisfaction that they do.

As I watched this weeks episode I was struck firstly by how all those who work in The Repair Shop seem to really care about the item they are working on, both in terms of appreciating its intrinsic worth as well as recognising its value to the one who brought it. And then there is the obvious love that they have for what they do, the enjoyment they get from the challenge of applying all of their expertise to the task in hand as they work out how best to effect a repair. And finally there is the the very apparent pleasure they experience when they see the joy their efforts bring about in those for whom they have worked.

All of which might give us some clues as to why we sometimes struggle to find the same degree of joy that those in the Repair Shop seem to experience and, more importantly perhaps, thus offer some pointers as to how we might go about deriving greater job satisfaction ourselves.

But before we do, it needs to be acknowledged the differences that exist between our world and that of those who appear on the TV programme. To watch ‘The Repair Shop’ is to spend an hour in a wonderfully reassuring place where everything can be fixed, where everything can be put right. The hectic reality of our daily working lives is, however, very different to the serenity of the world within The Repair Shop where only things of genuine value are brought and where those who work have all the time, space and equipment required to do their job properly. We, in contrast, with our limited resources, sometimes struggle to find the time to do properly those things that are of value, bombarded as we are by the constant demand to also attend to the seemingly relatively trivial. Furthermore, whereas those working in The Repair Shop are always hugely appreciated, we not infrequently feel like we are sometimes being taken for granted. And unlike those in the programme who invariably achieve all that they set out to do, we know all too well that we can’t fix everything. Inevitably we are not always as successful as we would like to be and, as a result, often have to face the fear of being criticised by those who cannot accept that we are unable to bring about the impossible.

Even so we would do well to value those who come to us for help. They really are of immense value. People have huge intrinsic worth and their health is something that is of the utmost importance to them. In the busyness of our working day this is something that is frequently lost as we all too easily end up seeing patients, not as individuals with genuine needs but as merely nuisances instead, ones who seem set on spoiling our day with their difficulties. In reality however, the majority of the problems that are presented are genuine, even if some are more significant and more appropriately brought to a doctor than others. Furthermore, people really are amazing creatures, intricately knitted together, a beautiful and complex amalgamation of the physical, emotional and spiritual, too complex indeed for any of us to fully understand. Perhaps then, if we are to recover some job satisfaction, we need to try to rediscover that sense of wonder that our increasingly frantic working lives have succeeded in squeezing out of us. And perhaps we also need to gain a greater appreciation of what a privilege it is to be involved in the important work of seeking to restore such a precious thing as a fellow human being who finds themselves in need of repair.

That said, it is of course not only our patients who are broken. We, some more than others, are broken too, physically, emotionally and spiritually, both inherently and as a result of circumstances be they our neglecting ourselves, our being treated badly by others, or simply as a consequence of long years in a job that has taken its toll. We all sometimes need the help of others if we are going to make it through – it’s no shame to ask for it. Because we too would sometimes benefit from being taken aside by a master craftsman, to place ourselves in the hands of one who genuinely values us, understands our inner workings and has all the skill, patience and kindness required to complete the good work he begins in putting us back together.

Perhaps then we too need to visit The Repair Shop. If we do we may find ourselves reassured that everything really can be fixed, that everything really can be put right. Furthermore, having spent a little time there, someone, somewhere might just experience the joy of having us back, a little less broken than we were before.


To read ‘Rest Assured’, click here

AN UNCOMFORTABLE TRUTH

‘I’ll go along with the charade until I can think my way out’

Bob Dylan

Recently a patient presented at the practice where I work having been sent to us by a doctor from the local minor injuries unit. She had been advised to request an urgent blood test to determine her blood levels for a certain heavy metal after an ECG she’d had had shown some minor abnormalities. It subsequently turned out however that the automated report had attributed these abnormalities not, as had been believed, to lead poisoning but merely to lead positioning!

An embarrassing mistake to have been made by somebody who had clearly not been thinking properly. But before we laugh too loudly, I wonder how many times we too have stopped thinking for ourselves, failed to see what was there to be seen and addressed only our own ideas, concerns and expectations rather than those of our patients.

As time pressured clinicians it is all too easy for us to stop thinking for ourselves and fall into stereotypical patterns of behaviour based on the assumptions we make and which, though they may speed our decision making, too often serve our purposes more than they do our patients causing us as they do to draw conclusions which steer us down those familiar paths along which we find it more comfortable to travel.

Might it be that we too have stopped thinking properly, failed to see what was in plain sight and thereby absolved ourselves from any responsibility to help as we have passed blindly by on the other side? I don’t doubt that I have, on occasions, done just that and am left asking myself why that might be.

Of course the easy answer to that question would be to say that it’s because I’m either too lazy, too incompetent or too busy to address the problems that are presented to me properly. I suspect that, if I am honest, each of those explanations have almost certainly sometimes been true, but another explanation might be that, rather than face the distress of a problem that cannot be solved, it has sometimes been easier for me to not notice what medicine cannot fix.

In his book, ‘How to think’, Alan Jacobs writes of how, once established, the consensus is hard to challenge because there is great comfort in sharing the commonly held position. He quotes Marilynne Robinson who suggests we have a ‘collective eagerness to disparage without knowledge or information’ alternative or unpopular views ‘when the reward is the pleasure of sharing an attitude one knows is socially approved.’

If this is true, as doctors we are, in the medical setting, predisposed, without thinking, to endorse the view that medicine can solve all our problems because we know that, given they have presented to us, those we are talking to are likely to share this view, and will approve of us for so doing. This is, perhaps, particularly true on account of how so many of us in medina do so want to be liked.

We are, in the moment of the consultation, invested in not thinking because, it would feel too uncomfortable to disagree because, as Robinson puts it, ‘unauthorised views are in effect punished by incomprehension…as a consequence of a “hypertrophic instinct for consensus”.’

Jacobs asserts that if we want to think, then we ‘are going to have to shrink that “hypertrophic instinct for consensus.” But, he says, ‘given the power of the instinct, it is extremely unlikely that [we will be] willing to go to that trouble”

Jacobs believes that the ‘instinct for consensus is magnified and intensified in our era because we deal daily with a wild torrent of what claims to be information but is often nonsense’. That is certainly true in the medical world where nonsensical demands are too often unjustifiably imposed upon us. Jacobs quotes T.S. Eliot who, almost a century ago, wrote, ‘When there is so much to be known, when there are so many fields of knowledge in which the same words are used with different meanings, when everyone knows a little about a great many things, it becomes increasingly difficult for anyone to know whether he knows what he is talking about or not.’ And in such circumstances, ‘when we do not know, or when we do not know enough, we tend always to substitute emotions for thoughts.’

That is, confused about what to believe, we will default to what feels comfortable and agree with the consensus, the perceived wisdom. Could it be then that when we are presented with a problem we cannot fix, a problem for which medicine is not the answer, the cognitive dissonance we therefore experience serves to make it less likely that we will see that problem at all and and end up seeing only those with which we feel we can deal.

Jacobs believes that ‘anyone who claims not to be shaped by such forces is almost certainly self-deceived.’ We are social beings who need to feel accepted and, since agreeing feels good, we are prone to toe the line. ‘For most of us’, Jacobs suggests, ‘the question is whether we have even the slightest reluctance to drift along with the flow. The person who genuinely wants to think will have to develop strategies for recognising the subtlest of social pressures…The person who wants to think will have to practice patience and master fear.’

So could we as General Practitioners do that? Could we practise patience and master fear and thus resist the ‘hypertrophic instinct’ which insists that medicine is the answer to all our problems.

I’d like to think we could but it will be uncomfortable, as speaking the truth often. It’ll mean giving up the charade that as doctors we have all the answers and accepting instead that there are times when we can do no more than simply notice the distress our patients are experiencing, acknowledge it for what it is and, perhaps, try to ease it a little by being human enough to sit alongside them and share in it with them for a while.

Which will be a whole lot more use than another unnecessary blood test.