Bond looked at ‘M’, his hand shaking as he lifted the vodka martini to his lips.
‘Let me check that I’ve understand you sir. You want me to work undercover in a primary care setting. You want me to manage unprecedented patient demand, deal with ever more complex clinical cases and battle an increasing hostile press. The only gadget that ‘Q’ has come up with to assist me is a pulse oximeter. And I’m to kill no one?’
‘That’s right James. It’ll be your most challenging mission yet. Can I rely on you?’
‘I’m sorry sir. Such a mission is beyond even my astonishing capabilities. For that you’re going to need someone genuinely exceptional. For that you’re going to need… a GP’.*
[*And just to be clear, that GP will have to be far better than the one I am and will also have to be supported, as I am by an exceptional support team made up of other doctors, practice nurses, HCAs, receptionists, administrators, secretaries, pharmacy staff and, of course Practice managers. And let’s not forget those oh so vital cleaners!]
Paddington woke up. He stretched out his arms and yawned the yawn of a bear that had grown accustomed to the comfort of sleeping in a soft bed in a warm house in Notting Hill rather than in a leafy tree in the rainforests of Peru. He emitted a contented growl as he slid his legs over the edge of the bed and made his way to the bathroom. Having washed his hairy face and attended to his impressive teeth, being a bear who was always careful to obey instructions, Paddington left the cotton buds in their packet and, as had become his custom, proceeded to clean his ears out with an electric toothbrush. Then, with a couple of puffs of Otomize, sprayed into each of his auditory canals to treat his unaccountably persistent otitis externa, he finally completed his morning ablutions.
Downstairs breakfast was almost over and Mrs Bird was already beginning to clear the table. Mr Brown however was still there, sat reading the morning paper. Paddington noticed the headline on the front page. Once again it was being reported that GPs were irresponsibly refusing to see patients in their surgeries for face to face appointments.
‘I don’t know’, Mr Brown said to Paddington, noticing him as clambered onto a chair and begin to help himself to a bowl of cereal. ‘Who’d be a doctor these days, what with all the bad press they seem to be getting? Sometimes I worry about whether Judy has done the right thing by going to medical school. Surely there must be better ways for her to make a living’.
Paddington continued to eat his breakfast. He was making something of a mess of things and it wasn’t long before Mrs Bird was fussing around him, mopping up the milk that was dripping off the table and collecting in small pools on the floor.
‘I hope you’re not planning on spending the whole day at home’, she said to Paddington. ‘I’ve already got plenty enough to do today without you making more work for me.’
Paddington thanked Mrs Bird for the breakfast and assured her that he had other plans for the day.
‘I thought I might go and see my friend Mr Gruber’, he said to her. ‘There’s something rather important I’d like to talk to him about’.
Paddington made himself a packed lunch made up solely of marmalade sandwiches which he then proceeded to balance on his head before covering them with his hat. Then he put on his old blue duffel coat and bright red Wellington boots and stepped out of the front door of number 32 Windsor Gardens. As he began to make his way down the steps to the street below he heard an angry voice coming from his neighbour’s house. Mr Curry was leaning out of the front window holding a phone to his ear.
‘Oi bear’, he shouted at Paddington ‘I need you to make yourself useful for once and post a letter for me. It needs to be in the post box at the end of the road before 10 o’clock. I can’t do it as I’m stuck here on the phone trying to get through to the GP surgery. I’ve already been kept waiting for 15 minutes and apparently there are still 37 other callers in front of me in the queue. What kind of service do you call that?’
‘I’m sure they’re all doing their very best’, replied Paddington, ‘I hear they are exceptionally busy at the moment and are struggling to cope with…’
Mr Curry was having none of it and interrupted Paddington mid sentence. ‘Don’t you start with all that rubbish about GPs being busy. The truth is that GPs are overpaid and lazy. They’re just scared of a hard days work and are taking advantage of all this nonsense about Covid-19 to make excuses as to why they can’t do their jobs properly. It’s not good enough. Some of us have urgent medical problems that need sorting. I’ve had a nasty wart on my finger for nearly a week now and I’m going to absolutely insist that somebody sees me about today.’
With that Mr Curry threw an envelope out of the window which landed at Paddington feet. Paddington picked it up and waved it cheerfully at Mr Curry. He then carefully slipped it under his hat explaining that that was where he kept everything that was important. He assured Mr Curry that he’d be sure to post it promptly.
‘Just be sure that you do’ Mr Curry growled at Paddington before slamming his window shut with such force that the glass rattled in the frame and Paddington thought for a moment that it might break.
Paddington continued on his way and before too long he was stood on the Portobello Road, outside the antique shop owned by Mr Gruber. Paddington pushed open the door, and as he did so a small bell chimed to announce his arrival.
‘Ah Mr Brown!’ Mr Gruber exclaimed emerging from the room at the back of the shop, ‘How very lovely it is for me to see you. Come in, come in. You are just in time for elevenses. I was just making some tea. Please join me and tell me what it is that I have done to deserve the honour of your company’.
Paddington sat down on an old chair. Mr Gruber poured them both a small cup of a tea from an old China tea pot and then, noticing that Paddington had a troubled expression on his face, asked his dear friend if anything was the matter.
‘Well it’s like this, Mr Gruber. Everyone seems to be blaming GPs for everything. Almost every day the newspapers have something unpleasant to say about them. Are they really the cause of all the problems in the NHS? And what about Judy? She seems such a kind young lady. Will she become mean and uncaring too after she’s been studying medicine for a few years?’
Mr Gruber walked over to where Paddington was sitting and sat down next to him. He smiled to himself as he placed the cups of tea on the small table that was positioned between them.
‘GPs aren’t the problem’, Mr Gruber began in his strong Hungarian accident. ‘And most of the people know it. But there are those who like to have somebody to blame and though it’s only really a very small number who have it in for GPs at the moment, they are making such a lot of noise just now. So you see Paddington, you shouldn’t believe everything that you read in the papers. If there’s one I know for sure it’s that not everything that’s reported there is strictly true. And something else I know for sure is this. You absolutely needn’t worry about Judy. She’ll always be as lovely as she is today.’
‘But why would reporters not want to tell the truth?’ asked Paddington.
‘Why indeed, Mr Brown Why indeed? Now drink your tea and l’ll see if I can’t find us something nice to eat’.
Paddington and Mr Gruber sat and chatted about how busy the NHS was and discussed what, if anything, could be done to make things easier for those who worked in what was, they both agreed, an organisation that needed to be supported rather than constantly criticised. After a while, Paddington stood up.
‘I think, Mr Gruber, that I had better get going. I think I’ll pop along to the doctors surgery that the Brown’s are registered at and see for myself just how busy they really are. Perhaps I could even lend a helping paw.’
And with that Paddington said ‘Goodbye’. He left Mr Gruber’s shop and made his way to the medical centre. It was about a twenty minute walk away and when he arrived it was approaching midday. Outside the front door of the building was a long queue of people. Paddington made his way to the front where a man was shouting at a receptionist and insisting that he be allowed to speak to the practice manager.
Paddington didn’t like the way the man was speaking to the lady behind the desk who was clearly close to tears. He gave a couple of firm tugs on the man’s sleeve in order to gain the man’s attention. The man duly stopped his tirade towards the poor receptionist and turned to look at the furry faced figure that was standing by his side.
‘Excuse me, sir,’ Paddington began. ‘I’m sorry to interrupt what I am sure is a very important conversation but I thought you might like to hear something that my Great Aunt Lucy used to say. She lives in a home for retired bears in Lima now but she always told me that ‘If we are kind and polite, the world will be alright’.
And with that Paddington wandered on into the main body of the medical centre, the man looking incredulously on as he did so. Slowly the man turned back to the receptionist, seemingly lost for words.
‘Was there anything else’, the receptionist asked him, her mouth now breaking out into a broad smile.
‘No, No, Nothing at all. thank you’, said the man. ‘Other than…’ He paused turning to watch as Paddington slipped out of sight. ‘Are you aware that you have bear in your health centre?’
Paddington, meanwhile, was making his way along a quiet corridor. At the end was a door. He pushed it open and found himself in what appeared to be a small store room. In front of him was a cupboard labelled with the words ‘Blood Bottles’. Paddington was a little concerned as to what might lie within so it was with some relief that, when he eventually summoned up the courage to open the door, he found that the shelves were all empty.
To his right was a trolly on which lay a strange looking machine, the like of which Paddington had never seen before. He looked at it closely and saw written over what appeared to be two handles, the words ‘Lift here’. Doing only what he was instructed, Paddington took hold of the handles noticing as he did so their shiny undersides. As he picked them up a light appeared on the machine and a voice that seemed to come from within the machine announced that a shock was advised. Paddington wasn’t quite sure what that meant but as he was pondering what he should do next the voice in the machine spoke again helpfully suggesting that he should press the button that had now started flashing insistently. Paddington clasped the two paddles to his chest with one hand and in so doing freed up the other hand to press the button as he had been directed.
Paddington wasn’t entirely certain what happened to him at that point but the next thing he knew he was he was lying on the floor looking up at the ceiling. Amazingly his hat was still on his head but the fur on his chest was badly singed, his body was covered with a soot like material and he noticed that wisps of smoke were spiralling out of both his ears.
‘Well that was a shock’, Paddington said to himself getting to his feet and brushing himself down. ‘Perhaps it would be better if I moved on and see if I might be able to offer my help more fruitfully elsewhere.’
Paddington made his way back down the corridor passing the reception area again and continuing on until he eventually came to a large room in which were a number of chairs placed in pairs, each pair a couple of metres away from any others. Only one chair was occupied. A young woman sat with her head down staring at the ground. She was fidgeting with her hands and she was having difficulty keeping her feet still. Paddington thought she looked sad and he went over to her seating himself in the chair next to hers.
‘What’s the problem’, he said to the woman who looked up at him, seemingly not registering the fact that she was being talked to by a bear.
‘Oh just everything’, she answered and with that she began to cry and proceeded to tell Paddington so many things that she was concerned about that Paddington didn’t know what to say. He thought it would be best therefore if he said nothing at all and decided instead to gently place his paw on the woman’s hand.
‘I’m sorry you’re sad’ he said, and as he did so a tear began to trickle down his cheek. As he sat there he remembered something else his Aunt Lucy had once told him, something she’d once read about how a real friend, a friend who truly cares, is someone who knows how to share the pain of another, who can stay with that person in their hour of grief and can face with them the reality of their powerlessness.
After a few minutes of silence, the woman looked up and smiled at Paddington, ‘Thank you’, she said. ‘It’s been lovely having you sat with me for a while. You’re a very kind bear.’
Just then a man stumbled into the waiting room. He staggered around until eventually he collapsed onto one of the chairs on the other side of the room to where Paddington and the young woman were sitting. He looked unwell. Very unwell. His skin was sweaty and he appeared confused. Paddington walked over to man and tried to make conversation but Paddington couldn’t make any sense of what the man was saying.
Paddington looked at the clock on the waiting room wall and noticing that the time was a little after one o’clock, had an idea. Perhaps, he thought, the problem was simply that the man was hungry. And with that Paddington lifted his hat and took the marmalade sandwiches that he’d made earlier down from off his head.
“Would you like to share my lunch?’ Paddington asked the man, ‘I never feel my best if I go without something to eat around this time of the day.’
The man didn’t appear to understand what Paddington was saying. He only seemed to be getting more and more unwell. Paddington, confident now that he’d diagnosed the problem correctly, forced open the man’s lips and pushed a little of one of the sandwiches into the man’s mouth. At first nothing happened but slowly the man’s colour returned and his speech became more coherent. Within a minute or two he’d stopped sweating and was sat upright in the chair smiling.
At that moment a doctor rushed into the room having been called by a receptionist who had noticed the sick man when he had first lurched into the building a few minutes previously.
‘What’s up?’ gasped the doctor, catching his breath after running as fast he could from his room on the other side of the building. He’d been busy all morning seeing other folk who were unwell and had just been admitting a patient who was acutely short of breath with what he suspected was a pulmonary embolus.
‘Nothing now, doc!’ smiled the man. ‘thanks to this ‘ere bear! I’d given myself too much insulin this morning and I was having another one of my hypos. But this young bear’s marmalade sandwich has put me right good and proper so it has!’
Paddington didn’t really understand what the man was saying but was glad he was clearly feeling very much better. A number of other people were now gathering in the waiting room and every single one of them was looking at Paddington. Paddington smiled back at them, taking a mouthful of what was left of the half eaten sandwich. ‘Would anyone else like I bite?, he asked. ‘I find that most things seem better after eating a small amount of marmalade’.
It was then that another receptionist walked into the room. She was looking somewhat alarmed. ‘Dr Mungo’, she said nervously. ‘There are some people here to see you. They say they are from the CQC’.
The receptionist stepped to one side revealing the two men and one women who were stood there behind her. They were all wearing smarts suits and clutching clipboards. None of them were smiling. The woman, who seemed to be the leader of the group, stepped forward.
‘We’ve come as a result of reports we’ve received that there is a bear on your premises. As you’ll be aware this is entirely unacceptable and if true will undoubtedly lead to the practice being rated as inadequate and having to shut down immediately’.
The room fell deathly silent. But then the man who had until recently been so unwell, stood up and approached the group of officials. ‘I’ll have you know this young bear just about saved my life’.
‘That’s as maybe sir. But how well a bear may or may not have managed your particular condition doesn’t change anything. The presence of a bear within the walls of a GP practice is a clear contravention of the guidelines that have been laid down to ensure the safe running of medical centres and I am afraid that I therefore have no option but…’
At this point the CQC inspector stopped talking, her eyes drawn to Paddington who had also stood up and was now looking at the woman intently. In fact, so intently was he looking at her, he might even be said to have been staring, one of those hard stares that Aunt Lucy had taught him to give to those who were acting in ways of which they should be ashamed. The inspector flushed, obviously embarrassed by her behaviour.
‘…but perhaps’ the woman continued slowly, ‘we can make an exception in this case. In fact, it will be my recommendation that this practice be rated as ‘Outstanding’, and I will see to it that you won’t face any further inspection for at least three years’.
With that the team of inspectors turned and left the building and everybody started clapping in delight. Somebody shouted ‘Three cheers for Paddington’ and before long a song started up, the gist of which seemed to be that everyone was happy to agree that Paddington was ‘a jolly good fellow’. Paddington however was feeling uneasy and his ursine features could not conceal the fact. Dr Mungo, noticing something was up, stepped over to where Paddington was sat and asked him what the matter was.
‘It’s this letter’, said Paddington, holding out the envelope that Mr Curry had thrown at him earlier. ‘I promised my neighbour that I’d post it by 10 o’clock but I completely forgot. It was only when I went to get my sandwich out from under my hat coat and it fell on the floor that I remembered. And now it’s too late and I won’t be able to post it on time’.
Dr Mungo took the letter form Paddington and laughed. ‘It’s OK, Paddington’, he said. ‘look at the address. It’s a letter for here! And if I’m not very mistaken I recognise the handwriting. It’s that of somebody who is always writing letters of complaint to the practice. I’ll file it with the others!’
Paddington was delighted by the news that Mr Curry’s letter had safely arrived at it’s intended destination. ‘Oh I am glad’, he said, ‘because it is so important one keeps one’s promises’. He paused for a moment. ‘Dr Mungo, try not to be too hard on Mr Curry. I don’t think he means to be unpleasant, it’s just that he doesn’t seem to have much that makes him happy. I think perhaps his life may have been rather hard’.
‘Don’t worry Paddington‘ said Dr Mungo smiling, ‘I’ll do my best to follow the advice of an old Peruvian bear who I believe once said that, ‘If you look for the good in people, you’ll generally find it’.
Paddington smiled. ‘Oh that’s so true, Dr Mungo. Aunt Lucy certainly is a wise old bear. But before I leave you to get on with your work, here’s something else she used to say. ‘However busy you are – always stop for lunch’.
And with that Paddington removed his hat and held out to Dr Mungo what was left of his lunch. ‘How do you fancy a marmalade sandwich?’ he said.
For those of you who may be wondering where Aunt Lucy gets all of her considerable wisdom from, the answer, at least in part, may be from Henri Nouwen. In his book ‘Out of Solitude’ Nouwen wrote these words which seem to be the basis for what Paddington was trying to remember his Aunt Lucy telling him when he was sat with the young woman in the story:
First introduced in 1911, General Practitioners rapidly became indigenous across the United Kingdom and Northern Ireland following the establishment of the NHS in 1948. They have been considered ideally positioned for pretty much everything ever since.
Although commonly found walking the aisles of the local supermarket during late night shopping hours or overseeing the secondhand book stall at the school summer fête, the principal habitat of the GP is the medical centre. Leaving their burrows and making their way to their consulting rooms an hour or two before dawn they typically remain at their desks until long after dusk. During the middle part of the day, however, they will often venture out and be found in peoples homes, instinctively drawn there by their desire to help the most frail and infirm. Whereas once they could be encouraged to prolong their visits by being proffered cups of tea and pieces of cake, GPs have latterly found it unsettling to leave their medical centres for longer than strictly necessary, preferring instead to return to deal with the countless phone calls that will have come into the medical centre whilst they’ve been away, determining which will require a face to face appointment and then working out how they are to be squeezed into that afternoon’s already busy schedule.
GPs come in a wide range of shapes and sizes and vary greatly in the extent to which they employ displays of colour to stand out from their otherwise often drab surroundings. Early in the morning some GPs can be seen clad in brightly coloured lycra riding their high spec bicycles. A more portly subspecies of the genus can be identified by the threadbare jumpers that they wear and the way that they gasp and wheeze as they make the short walk from their car to the back door of the practice building. The characteristic call of the GP is however universal and consists of a high pitched wail often heard alongside the sound of somebody banging their head against a brick wall. Under extreme pressure, such as might be the case when having to deal with a global pandemic, most GPs will revert to a plumage made up entirely of blue. This makes them entirely indistinguishable from one another especially given the obligatory blue latex gloves and surgical face masks that are also worn at such times.
Though at times they are active at night, GPs have a principally diurnal existence. They are both industrious and highly pragmatic creatures that are, by nature, capable of dealing with the wide range of problems that are presented to them with a combination of ingenuity and patience. They are easily startled when approached aggressively but if treated gently are by and large amiable souls who will generally try to help those who come to them in some kind of need with a degree of kindness and compassion. Reports of adverse events following GP encounters are mercifully low, with comparable patient mortality rates being recorded irrespective of the gender of the GP encountered thus giving the lie to Kipling’s assertion that ‘the female of the species is more deadly than the male’.
By day GPs are largely dependent on the coffee and custard creams brought to them by kindly receptionists at designated feeing times. In addition they will sometimes forage for additional foodstuffs in the practice’s kitchen area. In contrast, at weekends GPs confine themselves to the consumption of orzo and fennel along with any other ingredients that may have been mentioned in the Ottolenghi recipe they stumbled across in that Saturday’s edition of The Guardian.
GPs are hermaphrodites with both male and female GPs being able to bring forth young GPs. The parent GP then takes on the responsibility for the nurturing of their offspring with the fledgling GP typically remaining under their wing for the first year of his or her GP life. During these formative months they are encouraged to act increasingly independently by being asked to take on the most complex of home visits solely because they have been identified by the parent GP as those which will afford ‘the most excellent training opportunities’. Having demonstrated the skills necessary to survive on their own, the young GP then leaves the safety of the training nest to join a separate colony of GPs with whom they will spend the rest of their adult life.
In recent years GP numbers have been in decline. Whereas once the GP could be expected to survive well into their 60s, the increasingly hostile climate means that few now achieve this degree of longevity having previously either drowned under the excessive workload or, alternatively, killed themselves trying to deliver the impossible. Furthermore, many younger GPs are now considering a change of career with many looking at retraining as HGV drivers seeing the delivery of fuel and other essential items as a more sure way of fulfilling their childhood dreams of wanting to help people. Matters have been made worse with the proliferation of attacks on GPs by a new predator that has recently emerged. These Journalists (Reporteramus deceptionus) are employed by national newspaper editors who love nothing more than having a GP headline displayed on the front page of their daily periodicals. Sadly, calls to introduce legislation to ban the hounding down of GPs have fallen on deaf ears with many to whom such calls have been made enjoying taking part in a spot of GP baiting themselves. In recent years the government has pledged to increase GP numbers by releasing thousands more into the community but as yet this boost to the GP population has not materialised.
SURVIVAL STATUS: ENDANGERED
To read ‘Professor Ian Aird – A Time To Die?’, click here
In his essay ‘The Decay of Lying – An Observation’, Oscar Wilde has one of his characters say, ‘If something cannot be done to check, or at least to modify, our monstrous worship of facts, Art will become sterile and beauty will pass away from the land.’ I think Wilde has something to say to our current situation for unless something is done to check our monstrous worship of modern medicine, a world in which a patients clinical parameters are all too often elevated above the individual to whom those clinical parameters apply, our working lives will also become sterile and devoid of beauty.
That is, of course, if they haven’t already.
Life is more than merely attending to one’s health and yet, as we plough on through our working days with our heads permanently down and without us ever having a chance to look up, this is something that we all too often fail to appreciate. Whilst, as their enter end of life care, we might be pretty good at rationalising the medications that we have previously urged our patients to take, I wonder if we sometimes have delayed too long the lightening of the burden that we sometimes place on our patients to be healthy. Because medicine is a burden for many – and not just for our patients. It has become a burden for us too.
At the end of another extraordinary busy week, not only for me and the other doctors but for everyone in the practice, one in which we have once again been flooded with patients and their concerns, it’s no wonder that many of us feel that we are drowning. When, as now, many feel they are on the point of going under and are understandably concerned only about survival, it’s hard to appreciate beauty. As a result, as we try to cope with all the competing, seemingly urgent, demands made upon us, as we struggle to simply make it through the day, all the joy that we once drew from our working lives slowly drains away
Part of the problem though is of medicine’s own making. We have medicalised life too much by our insisting that what is in reality entirely normal is in fact dangerously abnormal and in need of medical attention. This is as true for what we would term marginally raised cholesterol levels as it is for the everyday unhappiness that characterises all our lives from time to time. No wonder we are inundated with requests for medical help when we have made far too much a medical matter, no wonder the lists of those we have to phone grow ever longer when we continue to urge everyone to ‘not hesitate to call if it gets any worse’, no wonder we have the worried well when we have told the well that they should worry.
It’s not only that there aren’t enough of us working in medicine, part of the problem is that medicine is trying to do more than it should. With our increasing obsession with data we are in danger of losing sight of the art of medicine and consequently we risk doing ourselves and our patients a disservice by causing concern where none was warranted. We need more medics but we also need less medicine, at least less of the unthinking algorithmic, protocol driven medicine that is increasingly encouraged. If only though we had the time to think!
Because the truth is that it really is possible to live a long and happy life with a cholesterol of 5.8. Indeed, it may be easier to do so than with a cholesterol of 4.7 when one has to worry whether that externally imposed target is being maintained by the medication one is taking, medication that, in addition to its side effects, daily declares to us as we are take it, that we are ill. This is not to say that we should never prescribe, but we must not imagine that what we tell our patients to do is more important than the real purpose of living. We will all have our views on what the real meaning of life is but I suspect we can all agree that it consists of more than swallowing a tablet of atorvastatin every day.
The truth is that we will continue to find our jobs impossible to bear for as long as we insist on carrying the weight of demand that we have created.
Elsewhere in ‘The Decay of Lying’, Wilde famously made the claim that ‘Life imitates Art far more than Art imitates Life’. I’m still pondering whether or not I agree with Oscar on this, but what I do know is that the lives of our patients are mirrored in our professional lives. As our patients lives are a mix of the good and the bad, so too are our times at work. Our jobs will never be easy – did we really ever expect them to be – and as it is sometimes a struggle for our patients, so too will our jobs sometimes be a struggle too.
This is not to suggest that we should roll over and accept how impossible our jobs are becoming, far from it, but we do have to accept the inevitability that sometimes we too will experience times of particular difficulty. Even so, it is worth perhaps remembering that even in the toughest of times there will be, if we look out for them, moments to enjoy and beauty to be appreciated. This last week has been as tough as any I can remember but in it I have experienced the kindness of a colleague, the appreciation of a grateful patient, and the concern of the person that, as I rang them at 9pm, told me that I really ought to be going home. There have even been the odd occasions when, amidst the chaos, I have even enjoyed the satisfaction of having managed one or two genuine medical problems with perhaps a modicum of competence!
But it’s not just our work that is this mixture of pleasure and pain. As our patient lives mirror our work lives, so too do they mirror our personal lives. Ancient wisdom tells us that there is ‘a time to weep, and a time to laugh; a time to mourn, and a time to dance’. [Ecclesiastes 3:4]. We are, therefore, out of synch with reality if we think we should be happy all the time. It is normal to grieve the sadnesses that we all sometimes experience in this life.
Even so, as one of those Christian types, I am frequently comforted by those words written by the apostle Paul, with which he describes himself as somebody who is ‘sorrowful, yet always rejoicing’. [2 Corinthians 6:10]. For me this speaks to matters beyond this life but i think it also applies to the here and now.. It reminds me that even in the sad times that we all sometimes experience we can still know what it is to be happy. As for me, for example, I am currently looking forward to becoming a Grandad, my daughter being a little over 38 weeks into her first pregnancy. And this, despite there being other circumstances in my life that cause me to be sad, is something that, along with many other people and things, is a constant cause of great joy to me.
Although not always an easy one, the trick I think is to realise that, just as one can still experience sorrow when there are things that make us happy, one can also be happy when there are things that make us sad. We don’t have to wait until all the sadness in life is gone before we allow ourselves to be happy. We can take pleasure in those things that bring us joy even when there is much that causes us distress.
For me, as I start a welcome couple of weeks off and prepare for ‘grandfatherhood’ with a pipe, a pair of slippers and a packet of Werther’s Originals, I suspect I may find it easier to take pleasure in the coming days than some who may read this post. Even so, I hope that this weekend, irrespective of how hard your week has been, you too can find some happiness to enjoy.
It was early morning and Festive Road was quiet. Most of the residents were indoors reading the newspaper reports of how GPs were hiding behind locked doors and still refusing to see patients. Some others though, having found themselves put on hold after phoning for an emergency ambulance, were discovering that it wasn’t just primary care that was currently facing unprecedented demand.
At number 52 Mr Benn was sitting in his chair and thinking to himself how it seemed that some people had forgotten that the ‘S’ in NHS was for ‘service’ and not for ‘slave’, that the NHS was intended to be free at the point of need, rather than at the point of whim, and that healthcare can’t be simultaneously quick, cheap and good. ‘You can only have two of those three ideals at any one time’, he said to himself getting up from his chair. ‘But never mind that, what I need is to get away from all of this negativity’. And with that Mr Benn put on his black bowler hat, left his house and started to make his way to the special costume shop from which he knew adventures could start.
On the way he saw a man trying to lift a large box out of the back of his car. Though it was far too heavy for him to carry himself, the man refused to accept the help being offered by his friends who were standing nearby and who were being forced therefore to watch him as he struggled.
It wasn’t long before Mr Benn arrived at the costume shop. He went in and started looking at all the costumes, wondering which one to try on. He saw one costume hanging up that he’d not noticed before. It consisted simply of a cardigan and a tweed jacket complete with leather elbow pads.
‘Who wears a costume like that?’ Mr Benn thought to himself.
Just then, as if by magic, the shopkeeper appeared.
‘Good morning, sir’, said the shopkeeper.
‘Good morning’, said Mr Benn. ‘What uniform is this?’ he asked pointing to the costume he’d just been looking at.
‘Why don’t you try it on and see for yourself?’ the shopkeeper replied. ‘But’ he added, ‘you’ll be needing these accessories’. And he passed Mr Benn a flimsy plastic apron, a surgical face mask and a pair of blue latex gloves.
Mr Benn took the costume into the fitting room and, once inside, he quickly changed. He looked at himself in the mirror and then walked through the door that he knew could lead to an adventure.
On the other side Mr Benn found himself outside a GP surgery. There was a long line of people queuing to enter the building. Mr Benn noticed that the doors were unlocked and that there was no electrified concertina wire fence surrounding the building. Neither was there a sniper gunning down anybody who approached the practice seeking to gain entrance.
Mr Benn made his way past the people, the vast majority of whom were waiting patiently to be dealt with. At the front of the queue, however, a man was shouting at the receptionist and complaining that GPs were lazy, work shy cowards who were overpaid and ought therefore to be ashamed of themselves. He insisted that he knew all this was true as he’d read about it in the paper that morning. When he finally finished shouting, the receptionist calmly explained that, if he’d just like to wait outside for a few minutes, the GP would call him on his mobile and see him for the appointment that had been agreed the previous evening when he’d rung in about his medical concerns.
Inside the building Mr Benn made his way through to the waiting room where a few chairs were appropriately spaced to allow social distancing. On one was sat a frail elderly man. He rose unsteadily to his feet when a smiling young doctor came out of her consulting room and called his name. As she did so, the doctor noticed Mr Benn.
‘Hello’, she said, ‘Are you the locum? It’s so good to see you. We’re snowed under here today as we’re short on doctors, what with one partner self isolating and working from home and another on long term sick leave due to some personal difficulties. Pop yourself in that room over there. All the passwords you’ll need should be in an envelope that you’ll find on the desk. If you need anything, give me a shout’
Mr Benn made his way to the room the doctor had been pointing to as she’d been speaking and within a few minutes, Mr Benn was sat gazing at a computer screen on which a long list of patient names was growing ever longer. As he picked up the phone to make the first call, Mr Benn looked at the clock and noticed that it was only just gone eight o’clock in the morning. The working day had begun. All morning Mr Benn consulted patients either on the telephone or, whenever necessary, face to face. When he had finally completed the morning’s work it was gone half past one.
Having spent the whole morning in his consulting room, Mr Benn felt the need to stretch his legs so he decided to tour the building and see what else was going on. Reception was still busy dealing with a huge numbers of telephone calls and one of the office staff was checking how many blood bottles were left in the building so as to determine whether or not there would be enough for the blood tests that were booked to take place over the coming weeks. The practice nurse was squeezing in an extra leg ulcer dressing at the end of her morning clinic and the HCA was seeing a patient for whom a doctor had requested an urgent ECG.
Upstairs, as if her day was’t busy enough already, the practice manager was now having to have an urgent discussion with the CCG regarding the growing crises over the impending collapse of a neighbouring practice and the admin team were rebooking all the flu clinic appointments that they had spent hours arranging the week before as they had just been informed that the vaccines would be arriving two weeks later than had previously been promised. Back downstairs most of the doctors were still in their rooms either still consulting or working through the mountain of results, letters and reports that still had to be dealt with.
In the final room that Mr Benn came to a doctor was slowly rocking in his chair with his head in his hands. He looked close to tears. Mr Benn stepped into the room and closed the door behind him. The nameplate on the door read Dr Mungo.
‘Are you OK?’ Mr Benn asked. ‘How’s your morning been?’
‘Not the greatest’, the doctor replied. ‘But then, there haven’t been many days that have been all that great recently. One wonders how long it can carry on like this with just too much being asked of us. And I wonder too how long I can carry on. Sometimes I feel like a cardboard cutout of myself, going through the motions like a two dimensional character in a poorly animated children’s cartoon from the late 1960’s or early 1970’s!’
‘Nobody can do it all’, said Mr Benn. ‘And there’s no shame in being asked for more than you’ve got and only being able to give all that you have. Is there anything I can do to lighten your load? I’d be happy to help’.
Dr Mungo asked if Mr Benn would mind doing a home visit and Mr Benn said he’d be glad to and so, within a few minutes, he was heading off to see a man in late middle age who was suffering from a neurodegenerative disease. His wife, Mary, had phoned that morning as she was becoming increasingly concerned about his frame of mind.
When he arrived at the house Mary was waiting for him on the doorstep. She ushered Mr Benn upstairs adding the words ‘You’ll find Midge in the front bedroom’. A cachectic looking man who appeared much older than his years was laid on the bed. He was reluctant to make eye contact and more reluctant still to speak. Mr Benn sat on the edge of the bed and looked around the room. The contents revealed that the occupant had a keen interest in cricket and Mr Benn noticed a photograph of the man he’d come to see batting for the local village team. It had clearly been taken in happier times. Mr Benn allowed the silence to remain for a minute or two before asking in a quiet voice ‘What’s up?’
The man looked at Mr Benn and began to speak.
‘It’s just that I’m such a burden to everyone. And especially to my wife. I can’t do anything for myself now that I’m so weak and so she has to do everything for me. It’s ruining her life. She’d be better off if I was no longer around. I just wish I was dead’.
Mr Benn wasn’t sure what to say and so, for a short time, he said nothing. But then he gently spoke to the man
‘I’m saddened to hear how difficult your life is at the moment. It must be so very hard for you. I don’t know why this is happening to you and it’s hard for me to know quite what to say. But can I say simply this? You’re not a burden. Just now you need to be carried, but a burden is something that is unwilling borne. Your illness is a burden – but you are not. Though she would no doubt rather that things were different, though your condition is no doubt something that causes her great sadness, it’s clear that Mary loves you. And so, though your condition weighs you both down, she is glad to help carry the load. You are not a burden because she carries you gladly, and a burden gladly carried is not really a burden at all. Please try and take some comfort that you’ve somebody who cares for you as she does. You really are so well loved by her’
Mr Benn paused for a few seconds before adding. ‘And, for what it’s worth, I care about you as well.’
After a few more minutes of silence, Mr Benn stood up. He didn’t know if he’d been of any help but, as he turned to leave, he saw Mary standing at the bedroom door. She smiled at him and whispered ‘Thank you’ as he passed her. Mr Benn, started down the stairs but, as he did so, he glanced behind him and noticed that Mary had entered the bedroom and she and Midge were embracing. And that made Mr Benn smile too.
He arrived back at the surgery just in time to start a busy afternoon consisting of still more phone calls and numerous face to face consultations. Eventually, shortly before 7pm, the work for the day was complete.
Just then a man appeared, sporting a moustache, a pair of circular framed glasses and a purple fez.
‘Excuse me Doctor’, he said ‘Would you mind seeing just one last patient? Given his symptoms, you’ll need to see him in the isolation room’.
Mr Benn followed the man along a corridor until they reached the room situated at its end. The man opened the door and Mr Benn stepped though it. As he had expected, Mr Benn found himself back in the fitting room of the costume shop. He took one last look at himself in the mirror before changing back into his own clothes. In the shop he returned the costume to the shopkeeper before starting the walk home to Festive Road.
As he approached number 52, Mr Benn noticed that the man he’d seen that morning was now being helped by his friends to carry the heavy box into his house. And as he passed a group of people who were chatting happily to one another Mr Benn was able to overhear the topic of their conversation. It was about how much they all appreciated the efforts of those working at the local health centre. It seemed that not everybody believed what they had been reading in the papers.
As he reached his front door Mr Benn thought about the days events. He’d enjoyed spending some time with Midge and Mary and hoped he’d been at least a little help to them. He didn’t want to ever forget that there would always be some things that were genuinely worth doing.
He reached into his pocket for his house key but found there instead an old cigarette card. On it was a picture of a cricketer and Mr Benn recognised it as Midge as he had been in his younger days.
‘How on Earth did that get there?’ Mr Benn said to himself. ‘I guess I’ll never know, but I’ll keep it just the same. It’s just what I need to remember’.
In recent weeks the media has been full of reports of desperate suffering. So quickly does one story follow on from its predecessor, it is all too easy to forget the events which shocked us just a few weeks ago. Just as the shootings in Plymouth were superseded by events in Haiti and Afghanistan, so these too will one day fade into our collective subconscious as some new tragedy comes to the fore and takes its brief turn on centre stage.
But despite the newsworthiness of such dreadful events, most suffering goes by unnoticed. To all but those caught up in it, most suffering is unexceptional, with life continuing mundanely on for those unaffected by those events of which they are unaware. W.H. Auden had it right when he wrote in his poem ‘Musée des Beaux Arts’,
‘About suffering they were never wrong, The Old masters: how well they understood It’s human position; how it takes place While someone else is eating or opening a window or just walking dully along…
They never forgot That even the dreadful martyrdom must run its course Anyhow in a corner, some untidy spot Where the dogs go on with their doggy life and the torturer’s horse Scratches its innocent behind on a tree.’
A few weeks ago a practice in the town where I work collapsed resulting in those that had been registered there being allocated to the remaining local practices. Our practice list size increased overnight by about 10% as 1700 individuals joined us bringing with them the stories of their lives, many of which inevitably included great hardship. I was struck by how totally unaware I was of the genuine suffering that was occurring in the town where I have worked these past 25 years despite the fact that, on some occasions at least, that suffering would have been playing out in households neighbouring those I myself was visiting on a regular basis.
I wondered how it must feel to experience grief whilst all too conscious that few others shared it with you. For, despite it being ignored by an indifferent world, those who feel the pain of suffering experience it as something worthy of everyone’s attention. To the grieving individual, nothing remains the same and for the world to continue on, unchanged and unmoved, must surely only add to their sense of disorientation.
Auden’s poem ‘Funeral Blues’, is in stark contrast to his ‘Musée des Beaux Arts’. In it he has his bereaved narrator demanding that everyone should stop what they are doing and, having been made aware of his loss, join him in his mourning. Furthermore, given what has happened, he considers the whole of the created order no longer serving any useful purpose.
‘Stop all the clocks, cut off the telephone, Prevent the dog from barking with a juicy bone, Silence the pianos and with muffled drum Bring out the coffin, let the mourners come.
Let aeroplanes circle moaning overhead Scribbling on the sky the message ‘He is Dead’. Put crepe bows round the white necks of the public doves, Let the traffic policemen wear black cotton gloves.
He was my North, my South, my East and West, My working week and my Sunday rest, My noon, my midnight, my talk, my song; I thought that love would last forever: I was wrong.
The stars are not wanted now; put out every one, Pack up the moon and dismantle the sun, Pour away the ocean and sweep up the wood; For nothing now can ever come to any good.’
It’s a beautiful poem capturing the intensity of the grief that accompanies the loss that for the most part goes by unnoticed by an uncaring world.
In reality, of course, nobody has the capacity to become emotionally involved with all the suffering that is all too prevalent in what is frequently a very sad world. As George Eliot wrote in her novel ‘Middlemarch’
‘That element of tragedy which lies in the very fact of frequency, has not yet wrought itself into the coarse emotion of mankind; and perhaps our frames could hardly bear much of it. If we had a keen vision and feeling of all ordinary human life, it would be like hearing the grass grow… and we should die of that roar which lies on the other side of silence.’
Nobody should expect the whole world to experience so intensely the sadness that they themselves feel, but we should not be surprised perhaps when there are some who seek to share their sadness with us and thereby give it a significance more in keeping with that which they feel it deserves. Though the pain that is often brought to us is frequently the result of something we can do nothing about, to acknowledge the sadness of others is nonetheless hugely valuable.
And perhaps that is part of why our job is currently so difficult. With so many struggling and, seemingly, doing so alone, perhaps there is a need for some to have their struggles noticed by somebody other than themselves. If, rather than pretending that we have the answer to their problems and offering platitudes that suggest that things aren’t as bad as they seem, we are able instead to be human enough to perhaps share a little of their sadness, then we will have done something that is immensely worthwhile.
It will not of course be easy, not least because the whispers of our own individual struggles, in a job that too few appreciate is itself increasingly difficult, are themselves seldom heard. Even so, in a world where once many lead lives of what Thoreau described as only quiet desperation, we would do well to at least hear what has now become their sometimes silent but nonetheless deafening distress.
[With thanks to Frank Skinner whose Poetry Podcast on W.H. Auden got me thinking along the above lines.]
When I first posted this elsewhere I was asked how one can ensure that being with those who share their experiences of pain, loss, and grief don’t wear us ever so slightly down each time we meet with them. I suspect that the answer to that is that we can’t but that our being worn down a little, rather than ultimately doing us any harm actually makes us more than we were before. My reasons for thinking this are quite complex and are theologically underpinned. For anyone who might be interested They are touched on in some of the related pieces which are linked to below.
To read ‘General Practice – a sweet sorrow’, click here
To read ‘Covid 19 – could it mean we really did have the experience but missed the meaning’, an updated version of ‘T.S. Eliot, Jesus and the paradox of the Christian life’, click here