In my Bible reading notes this morning I was asked the question as to who can know God and I was to directed Psalm 33:8 which, to me at least, is a somewhat curious verse:
‘Behold, the eye of the LORD is on those who fear him, on those who hope in his steadfast love.’
A similar verse is found in Psalm 147:11 which reads
‘but the LORD takes pleasure in those who fear him, in those who hope in his steadfast love.’
So the eye of the LORD is on those he takes pleasure in – namely those who fear him and yet hope in his steadfast love. And that to me is what is curious about these verses – we are to hope in the one we fear.
Generally speaking we run from things that we are afraid of. Well I do! If a lion came into the room that I’m now sat, I’d be afraid – I’d run from a lion. Likewise, as a result of my dislike of all things eight legged, if a dirty great big spider dropped from the ceiling above me, I would be mightily unsettled. I’d run from a huge spider. And if the building that I’m in began to collapse I’d be terrified and would be out of here in a shot. I’d run from a collapsing building.
But if we fear God – if we fear the consequence of all the wrong things that we have done – then our only hope is to not to run away from God, but to run towards Him.
And most particularly we need to run to the cross – where God’s anger was poured out – not on us, but on his son Jesus who took the punishment we deserve.
I live in Somerset, on the edge of the Blackdown Hills. If we were ever to have a long dry summer and some dreadful fire took hold and began to destroy the countryside near where I live, the safest place for me to be would be where the fire had already burned the ground before moving on. That ground can’t be burnt again. So it is with God – the safest place from God’s wrath – is where it has already fallen and cannot fall again – that is – in Christ
So I think there is no contradiction in hoping in the one we fear. At first glance it might seem crazy for sinners like us to run towards a holy, righteous God. But actually the only sensible thing for someone who fears God is not to hide from Him but to run to Him for mercy – putting one’s trust in his steadfast love, hoping in the one who is both our hope and shield, the one who will surely deliver us from death.
May that be the response of us all. May his unfailing love rest on us as we put our hope in him and may our hearts rejoice as we trust in his holy name.
The following is a transcript of the long lost and little known masterpiece written by Beatrix Potter, one that may prove of interest to some in the medical profession. Entitled ‘Mr McGregor’s Revenge’ it was written whilst Miss Potter was under the influence of a little too much Earl Grey tea, a brew which rendered her able to see into the future with a clarity unmatched by any other novelist of her day.
I was fortunate to come across a copy of the fabled apologue whilst holidaying this last week in the Lake District where it’s author spent much of her life. Unseen and unread since her death in 1943, I gladly share it with you now.
So, if you’re sitting comfortably, I’ll begin.
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Peter Rabbit was in trouble – big trouble. He had ventured into Mr McGregor’s garden once too often, his predilection for root vegetables getting the better of him such that he was no longer able to heed the dire warnings issued so lovingly by his mother. It had started with a single carrot, tasted initially simply out of the perhaps understandable desire to know just how it would make him feel. But despite telling himself he could cope with, what was known to those with whom he hung out as, a little ‘Orange’, Peter soon found himself nibbling on parsnips, radishes and beetroot and lately he’d even succumbed to indulging in celeriac, that substance so loved by only the highest echelons of leporine society. But now, shivering in the damp watering can where he had hid, and listening to Mr McGregor’s footsteps as they came ever closer, the foolish rabbit knew it was far too late to follow Mrs Rabbit’s advice of just saying ‘No’.
Remembering where Peter had concealed himself before, Mr McGregor looked inside the watering can the moment he entered the greenhouse and finding the sodden rabbit he promptly shook him out on to the cold, hard, red brick floor. Whereas once he wouldn’t have hesitated to turn Peter into a rabbit pie, Mr McGregor had recently adopted a plant based diet. Even so, for a moment he tried to persuade himself that it wouldn’t be against his principles to devour the blue coated individual that cowered before him since the bedraggled creature in question was no more than the product of the bergamot influenced imagination of a young lady from a bygone age. But realising then that the same could also be said of him, he decided that, rather than spending too long wrestling with his conscience, it was probably best if, on this occasion at least, he tried to think of an alternative and less morally conflicting punishment to inflict on the one who once again threatened his chances of taking home first prize in the village turnip growing competition.
Sadly Peter Rabbit was not a particularly bright rabbit, and neither was he one known for his quick thinking. And so, when he sensed his need to plead for mercy from Mr McGregor, rather than a plan of his own, the one that he came up with was one that he recalled from a bedtime story that his mother had once told him.
‘Please Mr McGregor’, whimpered Peter, his teeth chattering as he did so on account of how cold he now was, ‘do whatever you like with me but please, please, please don’t throw me into the briar patch.’
‘Briar patch?’, growled Mr McGregor, laughing menacingly at his captive as he did so. ‘I’m not Brer Fox you know! There’ll be no briar patch for you. I’ve got a far better idea for what I can do to you than that, something so despicably horrible that after you’ve experienced it you’ll never venture back into my garden in an attempt to get your thieving paws on my artichokes!’
Peter Rabbit stood motionless, his eyes staring like the frightened rabbit he was.
‘W-what are you g-going to do with m-me?, he stammered.
Mr McGregor lowered his voice and whispered the following dreadful words into the terrified rabbits ear – ‘You, Master Peter, are going to be banished to the local medical centre where, in a forlorn attempt to deal with the ever increasing shortage of GPs you will do a day’s work as a primary care physician! And,’ Mr McGregor added, his evil face displaying the evident delight in the sheer vileness of his plan, ‘you’re going to be on call!’
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And so, unlikely as it seems, Peter Rabbit arrived the following day at the medical centre and was duly shown to the room from which he would spend the day consulting. The following are just a few of the many, many individuals who sought his advice:.
Jemima Puddle-Duck came along with a particularly severe form of syndactyly characterised by extreme webbing of her feet.
Miss Moppet was sent from the nearby minor injury unit with a high temperature and the skin lesions that had resulted from the altercation she’d been involved in with Tabitha Twitchit. Peter Rabbit subsequently diagnosed her as having cat scratch fever.
Mrs Tiggy-Winkle consulted worried about what she’d tell her husband if she developed warts having kissed Jeremy Fisher in a moment of madness at her work’s office party. She was also suffering with prickly heat.
Pigling Bland’s father rang concerned about his son’s mental health. He reported that the young man in question wasn’t taking care of himself, that his personal hygiene now left much to be desired and that the place where he was now living was a pigsty.
Mrs Tittlemouse required dietary advice when blood test results revealed that, as a result of her propensity to eat large quantities of cheese, her serum cholesterol level had reached a level that was now the cause of some concern.
During a video consultation in which he divulged that he had recently frequented the hen house at Hilltop Farm, Peter Rabbit was able to confirm that Mr Tod’s widespread blistering rash was indeed chicken pox.
Squirrel Nutkin attended having come out in wheals following the ingestion of an undisclosed quantity of acorns. She went on to insist that she be supplied with an Epipen and that she should be referred to a dermatologist in order that she might undergo allergy testing.
Samuel Whiskers presented with depressed mood and low self esteem. He considered himself unlovable as a result of his belief that he’d been responsible for the death of thousands of people by his involvement in the transmission of bubonic plague.
And Mrs Rabbit presented questioning why she had been commenced on thyroxine tablets having misunderstood how it was myxoedema, and not myxomatosis, for which she was being treated. Not only was this awkward for Peter on account of her being his mother but she then proceeded to ask Peter to deal with a number of minor symptoms being experienced by Flopsy, Mopsy and Cotton-tail who had attended along with their mother in the belief that he’d have time to deal with their problems too.
At the end of the day, when the last patient had finally left, an exhausted Peter Rabbit hopped miserably home and, like so many others before him, vowed never to return again.
Jack Leach smiling as he inspects his Man of the Match Award
Back in 2019 I wrote about Jack Leach’s now legendary contribution of one not out in the last wicket partnership he shared with Ben Stokes in the Ashes test match held that year at Headingly. Together the pair put on an exhilarating 73 runs and brought about an victory for England that had seemed unlikely when Leach had first walked out to bat.
The perhaps all too obvious point of my blog was to simply highlight how seemingly small contributions are every bit as important as the more obviously headline grabbing performances of others and how, whilst general practice might not seem as glamorous or spectacular as some other aspects of medicine, the countless small interactions that take place in primary care each and every day are, nonetheless, highly significant in the provision of good healthcare in the U.K.
In short my point was that, just as without Jack Leach’s one run there would have been no win for England over Australia, so without general practice, there would be no NHS. As such, despite their seemingly more humble efforts, those working in primary care should not underestimate their value in the exceptional efforts of the NHS as a whole.
That blog entitled ‘For when we can’t see why’, can be read here.
Now, whilst I continue to stand by all that I wrote back then, three years on there is something more that has to be said. Because last weekend, in another test match at Headingly, this time against New Zealand, Jack Leach shone once again. But this time, rather than his being a small but crucial contribution to the teams collective effort, his was a match winning performance in its own right, one that, by his achieving his first ever ten wicket haul in a test match, he earned himself the Man of the Match award.
I guess you could say that the bespectacled slow left armer played a blinder!
And it seems to me that general practice is putting in a career best performance too.
Obviously I exclude myself in that assessment and not solely because I’m contributing nothing to the cause at present, holidaying as I am in the Lake District. But whilst I’m wasting my time dodging the somewhat inclement weather and trying, unsuccessfully, to pen humorous verse, my friends and colleagues up and down the country are continuing to pull out all the stops as they endeavour to care for patients despite the toll that has been taken as a result of what has undoubtedly been an exceedingly difficult couple of years for primary care.
Like Jack Leach who was diagnosed with Crohn’s disease at the age of 14 and consequently takes immunosuppressive medication, general practice is currently clinically extremely vulnerable. Despite governmental promises of additional doctors in general practice, the number of fully qualified full time equivalent GPs currently stands at 1,662 lower than it did in 2015 and, with an increasingly demoralised workforce partly made up by doctors, 80% of whom report having suffered from anxiety, stress or depression in the last year, it isn’t surprising that a third of GPs are looking to leave the profession in the next five years. If that predicted exodus does indeed take place without the necessary recruitment of sufficient new doctors to take their place, one can not help but fear for the future of general practice and with it the future of the NHS as a whole.
And also like Leach who, whilst out on tour in New Zealand just months after his heroics with Ben Stokes, feared for his life when he was hospitalised with sepsis, General Practice too is critically unwell and faces, as has already been said, an uncertain future. With patient demand increasing and the number of both GPs and community nurses in decline, medical centres up and down the country have been forced to close since staff shortages make it impossible for them to remain open safely. 89% of GPs now believe they have inadequate time with patients to provide a thorough diagnosis, 77% of GPs feel that staff shortages are putting patients at risk and, in some parts of the country 82% of GPs say that their practices are not always safe for patients. And all of this is simply because of the immense pressure under which general practice is currently ailing.
Furthermore with the country’s population having been steadily increasing such that it now stands, as was announced this week, at a record breaking 59,597,300 in England and Wales, a 6.3% increase since the census of 2011, it’s little wonder that, like Jack Leach who recently suffered concussion after sustaining a blow to the head whilst fielding, GPs are feeling punch drunk too.
But despite all this General Practice is currently delivering care at levels never seen before with figures proving that it is GP capacity that is the problem and not GP access. According to NHS Digital workforce data, general practice is at present managing an eye watering 1 million appointments a day. This is more than a million more consultations per month than was the case in 2019 and includes an additional 980,000 same day appointments over the last three years. Furthermore, General Practice sees more people every day than the rest of the NHS put together despite the fact that it receives just 5% of total NHS funding.
So whilst they may not be part of the most glamorous aspect of modern medicine, and though they may not be integral to the most eye catching parts of the NHS, those who work in primary care are, irrespective of whether they be doctors, nurses, or HCAs, practice managers, administrative staff or one of the countless other supporting members of the general practice workforce, nonetheless, together putting in an exceptional team performance.
So it’s not only Jack Leach who can feel justly pleased with his efforts. And neither is it only he who deserves a medal!
Because, contrary to what you may have heard, general practice is playing a blinder too!
Holidaying in the Lake District we walked past the one time home of William Wordsworth. Some experiences are truly inspirational…
We wandered lonely ‘neath the clouds, Alas they numbered plenty, And as we strode along the path, Those clouds, they chose to empty. But still we ventured bravely on, We so enjoy our rambles, And soon we were rewarded by, A host of thorny brambles.
With apologies to William Wordsworth
And on a separate occasion, whilst strolling on the Quantocks…
Upon smooth Quantock’s airy ridge we roved Unchecked, or loitered ‘mid her sylvan combes Our faces creased, their smiles, our pleasure showed ‘Till Hinckley C, the idyll fades, on landscapes fair it looms.
‘Blessed is he whose transgressions are forgiven, whose sins are covered. Blessed is the man whose sin the LORD does not count against him and in whose spirit is no deceit.’ [Psalm 32:-2]
Some years ago I went on a study day. Suitably interactive, involving a variety of teaching styles and fully addressing a personally relevant learning need, it was the best educational event that I’ve ever attended. The only downside was the fact that it was a Speed Awareness Course.
The day began with the leader asking for a show of hands from all those present who’d told friends and family that they were attending the course that day. Most hands went up, as did the corners of many people’s mouths, their smiles suggesting that few, if any, were ashamed at their having been required to be there. The leader then pointed out that breaking the speed limit was no less likely to cause a road traffic accident than driving whilst over the legal blood alcohol limit. He then asked how many people would have told friends and family they were on the course had it been run for those who had committed a drink driving offence. You’ll not be surprised to learn that no hands went up. Latter in the day, those gathered were asked to list the reasons why, on occasions, they might drive faster than the law permitted. A substantial list was generated. A short recording was then played of a man describing how his child had been killed by a speeding motorist. The leader then commented how our list, made up of what we had felt were potentially justifiable reasons for speeding, now seemed like nothing but a collection of weak excuses. It was a highly effective learning experience. And one that offered me spiritual insight too.
Because those contained within the Highway Code aren’t the the only laws I have broken. Though too often I don’t like to admit it, I have broken God’s law too. And so uncomfortable am I in accepting that I sometimes sin that, when I do err, I am, on occasions, want to try to preserve my spotless image, either by relativising my failures such that I am not really seen as a failure at all or, alternatively, justifying them by insisting they were understandable given the circumstances at the time. What the speed awareness course taught me was just how inappropriate and foolish both these approaches really are.
Furthermore to deny my sin is also ultimately burdensome.
‘When I kept silent, my bones wasted away through my groaning all day long. For day and night your hand was heavy upon me; my strength was sapped as in the heat of summer’. [Psalm 32:3-4]
Rather than carrying that burden, it’s better by far to be honest, not only with ourselves but also with God. Regardless of how uncomfortable it may make us feel, we have to take responsibility for our sin, owning our mistakes and feeling the genuine regret of our not being as good as we ought to be. This isn’t, I trust, an exercise in self pity but simply an honest acknowledgment of the reality of my sinfulness and the sadness that it causes. Though it would be kind of you to do so, please don’t try to reassure me by telling me I’m ‘good enough’. Because it simply isn’t the case – the truth is that I am a sinner, one who sins in ways for which there are no mitigating circumstances sufficient to absolve me of the responsibility for what I have done.
I don’t believe I am alone.
So then, ‘If we say we have not sinned, we make [God] a liar and his word is not in us’. But the good news, the gospel even, is that ‘if we confess our sins, [God] is faithful and just to forgive us our sins and to cleanse us from all unrighteousness.’ [1 John 1:9]
Or as David puts it in Psalm 32,
‘Then I acknowledged my sin to you and did not cover up my iniquity. I said, “I will confess my transgressions to the LORD” – and you forgave the guilt of my sin.’ [Psalm 32:4-5]
Admitting our sin will be humbling – but God ‘gives grace to the humble’ [James 4:6]. Grieving over our unrighteousness will be painful but ‘blessed are those who mourn, for they shall be comforted’ [Matthew 5:5]. And though having no confidence in ourselves may put us at odds with a world that likes to think that we are the masters of our fate and the captains of our souls, we will nonetheless find that ‘the LORD’s unfailing love surrounds the man who trusts in him’ [Psalm 32:10]
Then we who are counted righteous in Christ and who, in him, are upright in heart will sing. And rejoicing in the LORD we will be glad. [Psalm 32:11]
Once upon a time, not so very long ago, in a town close to where you now make your home, there lived a family doctor called Jeepy Leepy. Every day he went to the local medical centre where he worked hard, for long hours, doing his best to care for the sick who came to him for help.
Over time Jeepy Leepy’s workload steadily increased and eventually it reached the point where it was unsafe to try to do all that was being asked of him. But still his workload grew busier and busier until the day inevitably came when he had over a hundred contacts with patients, all of whom were seeking urgent medical advice or treatment. Some needed drugs that the pharmacy could not supply. Some needed a specialist opinion but were told it would be a year before an outpatient appointment could be offered. And some needed an ambulance but found that, even in an emergency, there wasn’t one that was available.
Concerned, too, that, with GP numbers in decline and patient demand outstripping GP capacity, his patients were having to face increasingly long waits before they could see him, Jeepy Leepy knew what was all too obvious to anyone who cared enough to notice – the NHS was falling down. And so, on his next day off, Jeepy Leepy decided to go and tell the Queen. He picked up his medical bag, hung his stethoscope around his neck and set off for London. Most of his patients agreed with Jeepy Leepy’s grave assessment on the state of the nations healthcare system and, sympathetic to his cause, cheered him on his way.
But Jeepy Leepy had only travelled a few hundred yards when he met Covid Lovid. ‘Where are you going?’ asked Covid Lovid. ‘Oh Covid Lovid’, said Jeepy Leepy, ‘The NHS is falling down and I’m off to tell the Queen’. But Covid Lovid laughed at Jeepy Leepy and told him that, because two of his partners had gone down with a new continuous cough, Jeepy Leepy would have to forgo his time off, return to the practice and spend the day working there instead.
Two weeks later, his colleagues having now returned to work, Jeepy Leepy set off again. But before very long he met Entitled Lentitled. ‘Where are you going?’, asked Entitled Lentitled. ‘Oh Entitled Lentitled’, said Jeepy Leepy, ‘The NHS is falling down and I’m off to tell the Queen’. But Entitled Lentitled laughed at Jeepy Leepy and, claiming he knew his rights, demanded that Jeepy Leepy see him immediately about his urgent need for a letter requesting the provision of softer cushions at his place of work.
The patient dealt with, Jeepy Leepy set off again. On the way he met Expert Lexpert coming out of an ivory tower. ‘Where are you going?’, asked Expert Lexpert. ‘Oh Expert Lexpert’, said Jeepy Leepy, ‘The NHS is falling down and I’m off to tell the Queen’. But Expert Lexpert laughed at Jeepy Leepy and insisted that Jeepy Leepy carry out an urgent review of all patients taking both flucloxacillin and paracetamol due to their increased risk of developing high anion gap metabolic acidosis.
The review undertaken, Jeepy Leepy carried on his way. Next he met Journo Lerno. ‘Where are you going?’, asked Journo Lerno. ‘Oh Journo Lerno’, said Jeepy Leepy, ‘The NHS is falling down and I’m off to tell the Queen’. But Journo Lerno laughed at Jeepy Leepy and wrote a story in his newspaper that was full of lies and which implied that Jeepy Leepy was overpaid and lazy.
Hurt though he was by the report, Jeepy Leepy carried on his way. Next he met Seekewsy Leekewsy. ‘Where are you going?’ asked Seekewsy Leekewsy. ‘Oh Seekewsy Leekewsy’, said Jeepy Leepy, ‘The NHS is falling down and I’m off to tell the Queen’. But Seekewsy Leekewsy laughed at Jeepy Leepy and told Jeepy Leepy that he was required to put in place a protocol for the safe storage of paper clips and develop an emergency plan detailing how he would respond if ever an acorn were to land on the medical centre’s roof.
The documents written, Jeepy Leepy carried on his way. Next he met Empee Lempee. ‘Where are you going?’, asked Empee Lempee. ‘Oh Empee Lempee’, said Jeepy Leepy, ‘The NHS is falling down and I’m off to tell the Queen’. But Empee Lempee laughed at Jeepy Leepy and by regurgitating a load of meaningless sound bites tried to convince Jeepy Leepy that the NHS really was safe in his party’s hands.
Far from reassured, Jeepy Leepy continued on his way. Next he met Healthsec Lealthsec. ‘Where are you going?’ asked Healthsec Lealthsec. ‘Oh Healthsec Lealthsec’, said Jeepy Leepy, ‘The NHS is falling down and I’m off to tell the Queen’. But Healthsec Lealthsec laughed at Jeepy Leepy and introduced a law that said that Jeepy Leepy had to work for even longer hours and for additional days in the week.
At which point Jeepy Leepy put down his medical bag, removed the stethoscope from around his neck and sat down on the side of the road. He could no longer go on.
And so the NHS fell a little further. And it kept on falling until, one day, inevitably, it collapsed completely.
And no one lived happily ever after.
THE END.
Other GP based stories:
To read ‘The Three Little GPs and the Big Bad Secretary of State for Health’, click here
Having learnt last weekend that, like Paddington, the Queen always keeps a marmalade sandwich close at hand in case of emergencies, here’s how I’m preparing for my next on call day in General Practice.
This weekend we are celebrating the Queen’s Platinum Jubilee – and it is well worth celebrating because, for the 70 years that she has been Queen she has been one who has served her people dutifully, one who has always shown integrity and one who, though of course not perfect, has been one that many have been happy to have rule over them.
But of course she won’t be Queen forever. She is getting frailer and increasingly we hear how she has not been up to attending certain functions and needing other royals to step in and take her place. And although we may not wish to think about, we know, just as all the Kings and Queens before her have, she too will sadly one day die.
A little over a week ago there was another special day that some of you you may have celebrated. Or maybe you didn’t because, perhaps as it did me, that very special day might well have passed you by. I didn’t notice anything about it in the papers, nor did I hear it mentioned on the news.
I’m referring to Ascension Day.
It’s a shame that Ascension Day doesn’t tend to garner much attention these days. It doesn’t help of course that it’s always falls on a Thursday but even so it really is a pity that we don’t make more of it than we do. Because it really is a very important day, one that we should most certainly celebrate. For it is the day that Jesus ascended, not only to heaven, but also, far more significantly, to a throne.
A throne on which he still sits.
Jesus is King – and not just any old king. He is the perfect king, one who rules over us with ‘understanding and knowledge’ [Proverbs 28:2], one to whom we all can gladly submit confident that his perfect rule is one that is without injustice and characterised by his perfect righteousness.
Furthermore, his is a rule which will never end.
Do you remember the words of Isaiah’s prophecy that we often hear at Christmas? It’s found in Isaiah 9:6-7
‘For unto us a child is born, unto us a son is given: and the government shall be upon his shoulder: and his name shall be called Wonderful, Counsellor, The mighty God, The everlasting Father, The Prince of Peace.
Of the increase of his government and peace there shall be no end, upon the throne of David, and upon his kingdom, to order it, and to establish it with judgment and with justice from henceforth even for ever. The zeal of the Lord of hosts will perform this.’
At the service of thanksgiving for her 70 year reign, the Archbishop of York, Stephen Cottrell, suggested in his sermon that there would be no better way to celebrate the Queen’s Platinum Jubilee than by following her example and putting our trust in Jesus Christ.
And he wasn’t wrong!
And so, at the name of Jesus may we all joyfully bow the knee, gladly submitting to him who, as well as being God, truly is the King of kings and Lord of lords.
Not forgetting of course, as Queen Elizabeth herself recognises, that he is King of queens too!
To read “Why do bad things happen to good people – a tentative suggestion”, click here
To read “Luther and the global pandemic – on becoming a theologian of the cross”, click here
To read ‘Covid -19. Does it suggest we really did have the experience but miss the meaning?’, click here. This is a slightly adapted version of “T.S. Eliot, Jesus and the Paradox of the Christian Life’.
Some musings 