Some musings

I hope you’ll bear with me for a while but, I wasn’t born yesterday, I know you’ve a lot on and this is a little on the long side.

Recently I watched the BBC adaptation of ‘Little Women’. Despite the fact that it wasn’t the kind of programme I would naturally be drawn to, I enjoyed it and found it genuinely moving. Let’s just say, on a number of occasions I found myself affected by what I can only assume was a speck of dust in my eye. Watching it I was struck by the ability that the characters had to bear great hardship. On several occasions in the story, there were those who spoke of having to simply bear, together, the trials their were experiencing – trials that included the anxiety of having a relative away at war, the pain of experiencing a debilitating illness and the sorrow of having to look on powerlessly as a loved one died. Though only a story, this ability to accept suffering, and bear it together, has a place in real life too.

I wonder, however, if today we have lost our ability to bear with suffering, to sometimes simply endure what life throws at us. We have, perhaps, come to assume that we have a right to comfort and ease and, when that dream falters, have become accustomed to the NHS, and others, always being there to rush to our aid. We may even have foolishly developed the notion that there is no limit to the help that can be provided – that no problem needs to be put up with. If we have come to believe this however, we are deluded. If one thing in life is certain, it is that, to a greater or lesser extent, hard times will come to us all. And sometimes there is no earthly solution to the difficulties we face. Sometimes they simply have to be endured – maybe for weeks, maybe for years. Sometimes the pain just has to be borne.

In his book ‘The Uses of Pessimism and the Danger of False Hope’, Roger Scruton warns against what he calls ‘The best case fallacy’, the illusion that we are prone to believe that progress will inevitably bring about a future state of affairs when all will be well. ‘There is’, he writes, ‘a kind of addiction to unreality that informs the most destructive forms of optimism: a desire to cross out reality…and to replace it with a system of compliant illusions.’ Scruton advises that we act as a ‘scrupulous optimist’ might. Alongside other characteristics, Scruton suggests that a scrupulous optimist ‘knows the uses of pessimism’, that conscious awareness that things may well go wrong, and that we ‘live in a world of constraints’. Scrupulous optimists, he says, ‘like all rational beings’ take risks ‘as part of their desire to improve things’ but do so ‘always counting the cost of failure and evaluating the worst case scenario.’ They know that things sometimes go wrong and that they and those around them are limited.

Both those who are ill and those working in the health service to support them in their sickness need to have this healthy dose of pessimism. We aren’t always as tough as we would like to be and we can’t always assume that we’ll be able to cope. Simply demanding that we, or others, be more resilient, is not always either helpful or realistic. Demanding that we be more resilient can even add to our burden. When the problems really are too much, beyond what any of us can cope with, it’s OK to find ourselves broken and awash with tears. On those occasions we may simply have to bear the pain – and it won’t be pleasant.

Sometimes the problems are too many for even the most capable
Sometimes the problems are too complex for even the most wise.
Sometimes the problems are too heavy for even the most strong.

Every now and then a day will inevitably come along which is just too much – when the demands put upon us exceed that with which we are able to cope. Our best efforts to meet the overwhelming need drains us of every ounce of energy we posses. Sometimes we can be so overwhelmed that it can feel that our inability to deliver the impossible reflects negatively on us, that our failure to solve every problem suggests some moral failure on our part. But we need not feel like this. There is no shame in being asked for more than we have and only being able to give all that we’ve got. We are, after all, only human.

We’re not all #NHSsnowHeroes. Some of us didn’t have 4x4s with which to brave the roads, some of us didn’t walk 20 miles to work, and some of us didn’t work additional hours because we simply couldn’t. I am genuinely grateful for those who did but we must not berate ourselves for not doing what we could not. To make the mistake of thinking we can meet every need will only crush us more. We do not help ourselves by being that foolish.

We need to be more realistic, we need to be those ‘scrupulous optimists’. Of course the demands of all our jobs are often overwhelming and the recent flu epidemic and now this bad weather has made things harder still. When the calls for help from those who are sick just keep on coming, those in health care ought not be surprised that there are days when it is all too much. Sometimes that is simply the way that it is, the nature of the job – the nature, even, of existence. Whilst we might bemoan the actions of others, and let’s face it we’re all good at that, it is not always someone else’s fault that our day has been hard. Though their actions have not always helped, and not denying that we should press for change in how the NHS is run, not even the government is wholly responsible for the struggles the NHS is currently facing. We need to accept that sometimes, in the midst of a flu epidemic or in atrocious weather for example, the job of health care professionals will, as a consequence, be significantly harder. And whilst not encouraging a resigned fatalism, we need to accept that when it is, that harder time will have to be borne for a while, not only by those in the NHS but also by society as a whole. Complaining about it today won’t help anyone. On the contrary, what will help today is if we bear the problem together. Blaming others only serves to isolate us at the very time we need others alongside us.

Though it may cost us to do so, we need to support one another especially those who find the struggle hardest. That includes patents but also those with whom we work alongside. We must not demand that they are superhuman. If we aren’t very careful, exalting #NHSsnowheroes will become a new way of our playing an old game – that of playing God. Some of us aren’t always as resilient as we’d like to be, and when we aren’t we may be the ones who struggle the hardest and need help. I am fortunate to work in a practice where that support is found and I am grateful to all those I work with that that is the case. I am grateful that there are those who help me: other doctors, nurses, reception, admin and managerial staff – even patients, who for the most part appreciate the pressures the NHS is under – we’re all in it together. Sometimes I help others, sometimes others help me.

Medicine is a wonderful thing. It can ease many burdens – but not all. Like those who practice it, it has its limitations and will never bring about a world where sickness and death is no more. I am not suggesting that medicine should therefore stop trying to find new ways of alleviating suffering but none the less, it must maintain that healthy dose of pessimism that reflects the reality that not every need can be met, that nobody lives for ever. Doctors also need that healthy dose of pessimism. Sometimes we should go the extra mile but we mustn’t lose sight of our limitations, our inability to meet impossible demand and that even despite our best efforts, some of those who get sick will have bad outcomes..

Furthermore doctors need to be wise enough to know that sometimes the kindest thing that we can do is stop striving for a cure and not burden a patient more by constantly demanding that they get better. Sometimes, when there is no longer any earthly solution to sickness and disease, when medicine has reached its limit, we mustn’t be afraid to acknowledge our weakness and our inability to help as we would like. Even so, as we look on and watch our patients, even our friends and family, suffer and die, we will do well if we can still bear with them in their suffering, if we can share in their sadness and ‘weep with those who weep’.

So when the going gets tough, what about those who don’t feel tough enough to keep going? What about those who lack, for now at least, the necessary resilience? Do we demand they toughen up as we regale them of the superhuman efforts of the strong? No. Instead we pick them up and carry them just as far as we can because those who are overwhelmed by the avalanche of need are no less worth carrying than those who are sick.

I wasn’t born yesterday – but I may need to be borne tomorrow.
And when one day I am too heavy to bear – and that day will surely come – lay me down and, if you can, please bear with me a while longer. And I’ll try to do the same for you.
Because bearing things alone would be truly unbearable.