Last weekend I spent a day in Topsham. Whilst sheltering from a heavy shower in a bird hide and watching the waterfowl that inhabit the salt marshes there, I was fortunate to witness a particularly spectacular rainbow and was reminded how, in the biblical account of the flood, the rainbow was given as a sign of God’s covenant promise to never flood the whole earth again. Interesting to me is the fact that the Hebrew word that the Bible uses for bow in Genesis 9 is ‘qešet’. The same word is used elsewhere in the Bible for that type of bow that is used as a weapon of war suggesting that the bow we are talking about here is a ‘bow’ as in ‘bow and arrow’. More interestingly still is that the bows we see in the sky after rain are ones that always point towards heaven.
The story of Noah and the Ark, as given to us in the book of Genesis, tells how the flood was an act of judgement on God’s part, ordained by him because he ‘saw that the wickedness of man was great in the earth, and that every intention of the thoughts of his heart was only evil continually.’ Scary stuff! And all the more so perhaps given that the world isn’t fairing any better today. But we should remember that the account of Noah and the Ark is first and foremost a picture of the salvation that is available to us through faith in Christ. For just as those who were hidden inside the Ark were brought safely through the flood, so too there is hope for us who, hidden in Christ, will surely be brought safely through death.
After the flood the earth was not cleansed of all sin and God remains angry therefore at our continued wrongdoing. Judgment will follow. But the rainbow reminds us, not only of God’s promise to never flood the whole earth again, but also of God’s willingness to fire the arrow of his judgment at himself. God himself is reminding us of his promise to take the punishment that his people deserve on account of their continuing to sin.
It is a feature of covenant promises that they are always accompanied by covenant signs. The Christian practice of taking communion is another such covenant sign. And a greater one too. When at the Last Supper, Jesus inaugurated the practice, he told the disciples to take the bread and wine ‘in remembrance of him’. And of the wine in particular he said, ‘this is my blood of the covenant, which is poured out for many for the forgiveness of sins’ [Matthew 26:28]. Like the rainbow, drinking the wine is a sign of God’s promise to be merciful to us. When we take the cup we are reminded that the blood shed by Jesus on the cross is sufficient to allow God to lovingly forgive us our sins without him having to compromise his justice. When we take the cup we are reminded that God has indeed let loose that arrow of judgment and that he himself has been pierced by it. For it was on the cross that Jesus paid the price for all our sin, it was there that he was ‘pierced for our transgressions’ [Isaiah 53:5], it was there that, as he suffered and died, he took the punishment we deserved.
But it’s not just we who are reminded of covenant promises by covenant signs. Remarkably perhaps, it reminds God too. Consider the rainbow again. When he first gave it as a covenant sign, God said:
This is the sign of the covenant that I make between me and you and every living creature that is with you, for all future generations: I have set my bow in the cloud and it shall be a sign of the covenant between me and the earth. When I bring clouds over the earth and the bow is seen in the clouds, I will remember my covenant that is between me and you and every living creature of all flesh. And the waters shall never again become a flood to destroy all flesh. When the bow is in the clouds, I will see it and remember the everlasting covenant between God and every living creature.
[Genesis 9:13 – 16]
The rainbow therefore reminds God, as well as us, of his promise. And so it is when we take Communion. It too is a covenant sign which reminds God of his covenant promise to us. When we take communion it isn’t just about us remembering what God has done for us in Jesus Christ. As we take the bread and wine “in remembrance of [Jesus]” we proclaim the Lord’s death, tangibly representing the gospel as a memorial, not only before ourselves and those who may be watching on, but also before God. And God, who sees the sign, remembers once again his promises to us.
It’s a wonderfully reassuring thing to remember God’s promises. But how much more reassuring to realise that God himself remembers them too, that his ongoing grace towards us is assured.
Family doctors were facing mounting criticism last night after it was revealed how consultations in primary care were spiralling out of control. Yesterday’s publication of the long awaited ‘Black and White’ report exposed how GPs have been contravening restrictions that had previously been laid down by government with the express purpose of ensuring that contact with patients was reduced.
Standing outside Downing Street with a glass of champagne in his hand, the Secretary of State for Health lambasted those working in primary care, laying on them the blame for what he described as another shameful example of the profession acting without any thought for what some politicians were going through.
Jajid Savid was responding to data that revealed that in December 2021 GP appointment figures were a staggering 20% (4.9 million) higher than the same month two years previously. before the pandemic.
‘What these people need to realise’, said Mr Savid, ‘is that last year, while they were booking more appointments than ever before, an eye watering 367 million, many in Whitehall were facing the distress of having to bring their own bottle to alcohol fuelled social events. It’s about time GPs took a long hard look at themselves and apologised for not acting in accordance with official government policy that seeks to portray them as lazy ne’er do wells.’
Pledging to do all that he could to bring locally responsive medical services to an end, the Health Minister closed by saying, ‘It is absolutely clear that GPs are responsible – it’s time they went’.
A number of GPs were asked to respond to Mr Savid’s comments but none were available, all claiming to be far too busy providing patient care.
Well I don’t know how I’ll get through today With all the patients that are headed my way If I’m to see all those who are sick My consults they had better be quick Phones to the left of me, Patients to the right Here I am – stuck in the middle with you.
Yes I’m stuck in the middle with you, And I’m wondering what it is I should do. It’s so hard to keep this smile on my face. I’m headless chicken like all o’er the place. Friends to the left of me Colleagues to the right! Here I am – stuck in the middle with you
And then there are the patients who with coughs and colds they do their best But no matter how they try they can not get a PCR test… Test…
So with ambulances in short supply To timely treatment now we must say goodbye Outside of A&E’s they all wait As staff inside must self isolate Queues to the left of me Delays to my right Here I am – stuck in the middle with you
And then there are the patients who are left with pain that just won’t stop Who none the less discover that they have to wait years for their op… Op…
I’ll see patients who no longer can cope I’ll see patients who have given up hope I’ll see patients who no longer know why I’ll see those who say they just want to die Sad to the left of me, desperate to my right Here I am – stuck in the middle with you
Stuck in the middle with you . . . Stuck in the middle with you . . . Stuck in the middle with you.
After Stealers Wheel
A musical rendition of this song can be found on my Facebook page on 7th January 2022. It is performed, in his own inimitable style by Lenny the Lion. But I wouldn’t bother if I were you.
And a hidden track, also recorded by Lenny and entitled ‘Who Do You Think You Are Kidding Mr Putin?’, can be found on my Facebook page on 12th March.
For more song adaptations please follow the links below:
Last weekend I was flipping through this year’s, supposedly ‘legendary’, double issue Christmas edition of the Radio Times. In it the editors wrote this:
‘We live in uncertain times, but that’s why Christmas is so important. It’s a glimpse of normality in an abnormal world; a glorious distraction from the sense that life is fragile, real and earnest. No one ever used to talk about saving Christmas, but now that’s seen as a pressing priority. No wonder. We all need a chance of escape’.
Which got me thinking.
Over the last couple of years it has frequently been said that we live in uncertain times and understandably so. In a week which began with us still not being absolutely sure if by it’s end we would be allowed to gather with family and friends for Christmas, we might indeed wonder if we can be sure of anything anymore. But are things really more uncertain now than they once were? Perhaps we are mistaken in thinking that we could previously have been more sure of what the future might bring. Because what we once imagined was certain was never as certain as we thought it was. In the New Testament James, never one to mince his words, tells us that we are arrogant and evil to ever imagine that we know what tomorrow will bring!
‘Come now, you who say, “Today or tomorrow we will go into such and such a town and spend a year there and trade and make a profit” – yet you do not know what tomorrow will bring. What is your life? For you are a mist that appears for a little time and then vanishes. Instead you ought to say, “If the Lord wills, we will live and do this or that.” As it is, you boast in your arrogance. All such boasting is evil.’ [James 4:13-16].
For James therefore, the only things that are seemingly more uncertain for us today than they once were, are those things we are told we should never have considered as certain in the first place!
But that’s not the only reason why we shouldn’t unquestionably accept the idea that everything is more uncertain these days. Because it is still true that the things that really matter, those things that relate to the unchanging character of God, are as sure now as they have always been.
God has always been in complete control – and he remains so today. As James implies in the verses above, whatever the Lord wills, will be. And though we may sometimes struggle to understand why He would allow some things to happen, knowing that a God of love is sovereign over our day to day lives is something we can still draw comfort from. Furthermore, the writer to the Hebrews reassures us that ‘Jesus Christ is the same yesterday and today and forever.’ [Hebrews 13:8] And his steadfast love is certain too. His is a love that will never cease. Likewise God’s mercy will never come to an end. It is new every morning. God’s faithfulness is as certain today as it proved to be yesterday, and will undoubtedly prove to be tomorrow. [Lamentations 3:22-23].
So, uncertain times? Well maybe, but then again, maybe not.
The Radio Times editorial continued by suggesting that Christmas is ‘a glorious distraction from the sense that life is fragile, real and earnest’. Well I wouldn’t disagree that life is fragile, nor that it is frequently filled with suffering and sadness. But Christmas, a ‘glorious distraction’? Is that all that Christmas has to offer us? If so it will do us no good at all come new year when we remove our heads from the holes in the sand in which we’ve stuck them for a fortnight and are forced to face the freight train of 2022 that will inevitably come bearing down on us.
But Christmas is not merely a distraction from the very real difficulties that to a greater or lesser extent we all have to face. Rather it is the answer to those difficulties. Those who are experiencing great sadness this Christmas, those who are anxious about what the New Year will bring, don’t need to be merely distracted from their troubles, rather they need something that is genuinely able to turn their tears to laughter, something that will give them a reason to no longer be afraid. And that is exactly what Christmas offers.
Do you remember what it was that the angel told those shepherds who were out in the fields keeping watch over their flocks that first Christmas night?
‘Fear not, for behold, I bring you good news of great joy that will be for all the people. For unto you is born this day in the city of David a Saviour who is Christ the Lord’ [Luke 2:10-11]
This news that the shepherds heard is just as true and just as good today as it was two thousand odd years ago. This is news that can bring us happiness in the midst of our presence sadness, a reason for confidence in our ever present anxiety. Because this is news that promises us a genuinely better tomorrow.
This last year has, for many, been a hard one. And not only as a result of the pandemic. This year many terrible events have occurred around the world as indeed they do every year. In addition to far away natural disasters and closer to home terrible tragedies that have made the headlines, there have also been our personal difficulties known only to ourselves and those close to us. It’s understandable that we might want to forget about all this suffering at Christmas, to pretend that Christmas, with all its tinsel and television is, as the Radio Times puts it, ‘a glimpse of normality in an abnormal world’.
But that’s the problem with Christmas, or rather the problem with the Christmas that we have created. As with life, we struggle to conceive that the realities of hate, pain and suffering sit alongside those of love, joy and peace, that these things, to a greater or lesser extent, are normal, present in all our lives, present indeed, even in ourselves. We have marginalised the horror of the Christmas story, preferring the sanitised version that fits better with our over optimistic outlook on life, our over optimistic view of who we are. But such a Christmas bears little relation to the world we actually inhabit, existing as we do in a world of both good and evil.
Life can be filled with overwhelming joy. And yet, life can be hard, for some impossibly hard, and for many the sadness is just too much.
The Christmas story reflects this – the joy of the birth of Jesus and the hope that the arrival of a saviour brought with it, is mixed with the abject poverty into which he was born, the rejection experienced by his parents and the murder of the innocents at the hands of Herod. And, of course, what began in ‘O little town of Bethlehem’ didn’t end there. The ‘little Lord Jesus’ who once ‘lay asleep in the hay’ grew up and, thirty or so years later ‘hung and suffered’ as he was nailed to a cross on ‘a green hill far away.’
The Roman orator Cicero described crucifixion as ‘a most cruel and disgusting punishment’ and suggested that ‘the very mention of the cross should be far removed not only from a Roman citizen’s body, but from his mind, his eyes, his ears.’
But such horrors still exist in our world, a world of joy and sadness, of pleasure and of pain. We cannot have one without the other. Indeed the two are mutually dependent. The existence of suffering is the very reason why we need a redeemer, and that redemption is secured through the suffering that that redeemer himself endured, a suffering that we all still share in.
Cicero, then, was wrong. We must consider the cross.
Sorrowful yet always rejoicing. These were words of the apostle of Paul in his second letter to the church at Corinth and we would do well to ponder them, to reflect on the fact that we cannot expect to live trouble free lives. Hardships and calamities will befall us and they will bring with them times of great sorrow. Yet despite those hardships, despite the awful suffering, there is, in Christ, still hope and a cause for rejoicing.
Leonard Cohen says it well in words from his song ‘You Want It Darker’:
‘There’s a lover in the story But the story’s still the same There’s a lullaby for suffering And a paradox to blame But it’s written in the scriptures And it’s not some idol claim’
We live in the tension of ‘the already and the not yet’. Because of Jesus’ life death and resurrection, and the redemption that he as secured, I believe the future is assured. So assured in fact that we can consider it a present reality. We can, ‘already’ live rejoicing in the confidence of its inevitability whilst at the same time, honestly acknowledging that it is still ‘not yet’, that we still live in the very real pain of today, the heart breaking awfulness of now.
As we celebrate the joy of Christmas, we dare not tell ourselves, or indeed our children, differently. For to do so is to delude ourselves, and them, and ensure disillusionment and despair when eventually the truth can, like now, be denied no longer.
So at the end of this most difficult of years, I continue to believe the news that was brought by the angels to the shepherds all those centuries ago, news of great joy that is for all people. I believe that though weeping may tarry for the night, joy comes with the morning. For some the night has already been long and the day may still seem a long way off, but there is I believe a day still coming when all our tears will be wiped away and death shall be no more. [Revelation 21:4]
So it’s not Christmas that needs saving, rather it’s us, by Jesus, so called for he would save his people from their sins. No matter then how difficult our lives might be, Christmas remains a time to rejoice that our rescue is in hand, that it began with the birth of a child who came into the world for the express purpose of saving sinners like you and me and was secured for us when, having grown up and lived a perfect life, the man who was, and is, God was crucified for us, dying in our place for the forgiveness of our sins, thereby redeeming, not only us but also the broken world in which we currently live, the guarantee of which being his resurrection from the dead three days latter.
And therein lies my hope. This Christmas therefore, despite everything that might cause me to doubt it, I remain absolutely confident that with God I am in safe hands.
Some years ago, whilst out on a walk, one of my children announced that they were lost. This was on account of said child not having a clue as to where they were. But the individual in question was wrong – they weren’t lost because the one who held their hand, me, knew exactly where they were.
I knew the way home.
Perhaps we can’t see a way through all that’s going on just now. But rest assured, with God by our side we’re not lost because the one who holds our hand knows exactly where we are and, even in these particularly difficult days, that same loving Heavenly Father will ensure that we will all eventually make it safely home.
For the one who knows the end from the beginning holds us still and of that you can be certain.
And so this year, regardless of whether or not you share my faith I pray that, alongside any sadness you may be experiencing, you, and all whom you love, may know real joy at Christmas.
Related Blogs:
To read “A Merry and Resilient Christmas – A Personal View” click here
To read “The ‘Already’ and the ‘Not Yet’”, 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’.
This is Book Two of ‘The Scrooge Chronicles’. To read Book One, ‘A Primary Care Christmas Carol’, click here.
PART ONE: A TALE OF TWO PATIENTS
In which Dr Ebenezer Scrooge finds some meaning in the seemingly meaningless and determines to keep on keeping on – at least for a little longer yet.
Almost three years have passed since Scrooge was visited by the three spirits and the world is in the grip of a global pandemic.
It was a little after eight in the morning and Dr Ebenezer Scrooge was sitting at his desk, looking at his computer screen. He watched as, with every passing minute, the list of patients he had to call lengthened. He was the only doctor in the practice that morning as his partner, Dr Robert Cratchit, had phoned in earlier to report that, since his six month old son had developed a fever overnight, he’d have to self isolate and work from home pending the result of the Covid swab that he’d organise to have taken later that day. Though frustrated, Scrooge didn’t blame Bob. He knew his colleague wasn’t one to avoid work and understood that the practice had to be seen to comply with government guidance on limiting the potential spread of the coronavirus, even if the actual risk from his partner coming in to work was small and, perhaps, less than that posed to patients as a result of their care being compromised by his not being at work.
Scrooge reflected on how he’d never been so dissatisfied with his working life as he was now, more dissatisfied even than he had been, three years previously, when the spirits of General Practice Past, Present and Yet to Come had made their life changing nocturnal visits to him. A lot had happened since then. Bob, who had been a registrar at the time, had completed his training, joined the practice as a partner and even found time to marry one of the admin staff and have a child. But then Covid-19 had arrived on the scene and, as well as all the suffering and death it had caused, it had also had a significant effect on the provision of primary care.
Scrooge was alarmed by how fast the vision brought to him by the Ghost of General Practice Yet to Come was becoming a reality. More and more consultations were being undertaken remotely, a trend that, though undoubtedly necessary for a time, had been welcomed by much of the profession and was one that now seemed destined to continue. Scrooge though, a man so old fashioned he’d yet to switch to a height adjustable desk, was less enthusiastic. Though, to some, this contactless life might be considered ‘the new normal’, in Scrooge’s eyes at least, whilst new, it was in no way normal.
Furthermore Scrooge also found himself constantly worrying about the long term harm the response to the coronavirus might have. He understood, of course, that steps had needed to be taken to control the spread of the virus and a tricky balance had to be struck.
In the early days of the pandemic he had been informed that, as a GP, he’d be responsible for providing end of life care to patients with the coronavirus. He’d been told it was likely he would have to explain to many of them that, due to a lack of ventilators, it would not be possible for them all to be admitted to hospital and that a good number would, instead, have no option but to take their chances at home.
Scrooge had found all this deeply concerning, but when he started being asked to contact all his vulnerable patients and discuss with them their end of life preferences he sensed something wasn’t quite right. This feeling grew when he did a few calculations and realised that, were there to be 50,000 deaths in the country, a figure the government had initially suggested was the worse case scenario, he himself could expect to lose just one or possibly two of the 1800 patients on his own list. Was it really appropriate then, he wondered, to have hundreds of inevitably distressing discussions with his patients on such a sensitive subject when the actual numbers of those likely to die was so small?
What Scrooge did know though was that nearly six months into the pandemic not one of his patients had actually died, and only a couple had been hospitalised. He knew that elsewhere in the country the experience of other GPs would, no doubt, have been very different but nonetheless Scrooge remained worried about the consequences of the measures that were being taken to tackle the pandemic: the tens of thousands of non-Covid related deaths due to patients not receiving sufficiently timely treatment for their conditions, the hundreds of thousands of additional deaths that were likely to occur over time as a consequence of the lockdown having so badly damaged the economy, and the millions of people who would find themselves joining the queue for NHS treatment.
Scrooge sighed. It just seemed impossible to know what was genuinely for the best. It was, he thought, the worst of times – an age of foolishness and an epoch of incredulity – with absolutely no positive side to it. Still, his was not to reason why, his was but to do and, hopefully not die. And with that Scrooge realised that he’d better stop wondering how long he could continue working as a doctor and start instead phoning the numerous patients who’d already requested urgent contact with him that morning.
He quickly dealt with the first couple of calls which involved patients seeking advice about minor upper respiratory tract infections. He hated himself both for prescribing antibiotics (‘just in case’ due to his not being able to see and assess them properly) to patients who almost certainly didn’t need them, and for then going on to advise them that the whole household would now have to self isolate pending the symptomatic family member having a Covid swab. He knew that the former went against all he had tried to teach patients regarding how antibiotics were unnecessary for self limiting viral infections and that the latter would threaten the livelihoods of families but was nonetheless deemed essential even though, ever since patients with possible Covid symptoms could have a swab taken, not one had come back showing a positive result.
The morning continued in similar fashion though soon, amongst the physical problems that were being presented, a number of cases relating to the mental health of patients required triaging. The isolation of lockdown was now getting a lot of people down and many more were experiencing high levels of anxiety. For many the concern was about catching the coronavirus, even amongst those for whom there was very little risk of their coming to any harm were they to do so – for others it was the threat to their livelihood that was causing them to lose sleep. Scrooge tried to support them as best he could but knew he’d be able to do it so much better if he could see a few of these folk face to face. Even then, however, the requisite plastic apron, latex gloves and face mask would make meaningful conversation on sensitive matters difficult.
At mid morning there was a knock on the door announcing the arrival of one of the reception staff with a cup of coffee and a selection of biscuits. Scrooge accepted them gratefully and munched on a custard cream whilst signing the prescription handed to him by the receptionist. It had been requested urgently by a patient who was currently waiting for it in reception.
Brushing the crumbs from his lips, Scrooge looked back at his computer screen and noticed another call had come in from an elderly man who’s problem had been flagged simply as ‘back pain’. Pleased to have such a straight forward call to deal with, Scrooge picked up the phone and dialled the patients number. Within a few rings the patient answered.
‘Hello, is that Mr Carton? It’s Dr Scrooge, how can I help?’
‘That was quick doctor, I hadn’t expected you to ring back so quickly, I know how busy you all are, what with this virus and all. But don’t worry about that with me, it’s just my back that’s the problem. It’s kept me awake all night it has – I’ve never before experienced anything like it.’
Scrooge asked a few more questions and didn’t sense that anything particularly concerning was going on other than the fact that Mr Carton, a man not prone to call for help unnecessarily, seemed quite agitated by the pain and that he’d not had any relief from even his wife’s reasonably strong painkillers. Scrooge decided that he had perhaps better see his elderly patient after all. He felt guilty for doing so since the guidance was so insistent that all patients should be managed remotely wherever possible.
‘I’d like to see you Mr Carton, but before I do I need to ask a few more questions. Have you developed a new persistent cough lately?’
‘No doctor, it’s just my back, it’s like …”
‘Or a fever?’
‘No doctor, as I was…’
‘And have you lost your sense of smell at all’
There was a pause on the end of the line as Mr Carton clearly struggled to understand the relevance of such a question to his clearly stated problem of back pain. Eventually he answered in the negative and Scrooge asked him to come down to the surgery but to wait in the car park until he was ready to see him. He’d ring in 15 minutes and say when it was safe for him to enter the building.
Whilst he was waiting Scrooge dealt with a few more telephone calls including one from Enid Gray. Mrs Gray was terminally ill and had been so for some while. She had survived longer than had been expected despite, on Scrooge’s advice, repeatedly ignoring the letters sent out under his name inviting her to have a repeat blood test to determine if she were still pre-diabetic. But now she was undoubtedly losing her battle with cancer and was very definitely going rapidly downhill. He picked up the phone and was soon speaking to the patient he’d become very fond of ever since he’d invited her to share Christmas Day with Cratchit and himself a few years previously.
‘Hello Mrs Gray, how are you? How can I help?’
‘Oh I am sorry to bother you Dr Scrooge. It’s just that I feel so tired at the moment. Since I came out of hospital I’ve simply no energy at all’.
Mrs Gray had been admitted the week before having taken a fall at home. She had been discharged precipitously under the guise of it being too dangerous for her to stay in hospital in the middle of a global pandemic. Little thought seemed to have been given, however, to the risk of her living alone without an adequate package of care. Mrs Gray did not have a smart phone so there was no possibility of Scrooge doing a video consultation with her. Despite this, and though he hated himself for even thinking it, were Mrs Gray to die, since she’d been seen so recently in hospital, Scrooge knew he wouldn’t have the unnecessary nuisance of having to liaise with the coroner about her death, not under the new guidance that had come out on the issuing of death certificates during the pandemic. Even so, Scrooge looked up the results of the tests taken during Mrs Gray’s hospital stay. He noticed that she’d been found to be a little anaemic and so Scrooge suggested that he write Mrs Gray a prescription for some iron tablets and arrange for the district nurses to check a further blood test later in the week. Mrs Gray seemed happy enough with this plan but Scrooge nonetheless stressed that, should she feel any worse, she could call him again at any time.
By the time he’d done this he noticed that it was time to see if Mr Carton had arrived. He called him on his mobile and learnt that he was indeed waiting in the carpark. Scrooge invited him in saying he’d meet him in the waiting room. He then donned his PPE being careful to tie the plastic apron about his waist before putting on his gloves, experience having taught him that with gloves on it was nigh on impossible to tie the apron effectively. Mask applied Scrooge then went to the empty waiting room pending Mr Carton’s arrival. As he sat there, perched on the radiator, he surveyed the carefully spaced seats that so few people these days sat on. It saddened him that this was no longer a place where people gathered waiting to be seen, somewhere one might bump into an old acquaintance that one hadn’t seen for years and with whom one might catch up on each other’s news.
A few minutes later Mr Carton arrived accompanied by an obviously very anxious Mrs Carton. It was becoming something of a trend now but once again Scrooge found himself hating what he was doing as he asked Mrs Carton if she wouldn’t mind waiting outside. ‘Because of the Coronavirus’, he added by way of explanation. Walking together toward his consulting room Scrooge paused by the waste bin in the corner of the waiting area and, by holding his apron close to the container, indicated to Mr Carton how that which was now supposedly protecting him from a deadly virus, was made of the the exact same material as that which now lined the bin. It always amused Scrooge to point this out to patients even if by doing so it served only to make him feel even more rubbish about himself.
Back in his consulting room, and having run over the symptoms again, Scrooge asked Mr Carton to pop up on the couch. Scrooge had noticed that the agitation that he had sensed in his patient on the phone was apparent speaking to him in the flesh, Mr Carton was finding it difficult to stay still. Up on the couch Scrooge noticed something else – a pulsatile mass in his abdomen which could be nothing other than an abdominal aortic aneurysm.
After explaining the seriousness of the situation and calling for an ambulance, it wasn’t long before Mr Carton was being led away by two paramedics to the emergency vehicle that was now parked outside the front doors of the medical centre. Scrooge walked out with them and caught site of his patient’s increasing worried wife. Stepping over towards her, Scrooge explained what was happening to the man she’d been married to for more than fifty years.
‘I’m afraid you won’t be allowed to go with him, Mrs Carton. The hospital aren’t allowing any visitors at the moment you see.’
‘But he will be OK?’, she asked, ‘I will see him again won’t I?
Scrooge wanted to look her the eye but found himself unable to meet her gaze. ‘I’m sure he’ll be fine’ he said, trying to sound confident before adding, more honestly, ‘At least, I hope he will’. With that Scrooge went back inside, removed his PPE and placed it in the bin. Along with all that was being used both by him and the rest of the practice staff, he pondered how long it would take for all of it to biodegrade. He thought how insignificant his previous use of the odd plastic straw now seemed in comparison to environmental impact of all this discarded PPE.
The day continued in similar vein and when he eventually finished the days work shortly after 7.30 he noted that he’d completed 86 individual patient contacts made up of telephone calls and face to face consultations. In addition there had been the day’s post to read and act on, blood results to deal with and many, many repeat prescriptions, requests for sick notes and sundry other administrative jobs. It hadn’t been the busiest of days but it was somewhere close to it. And yet he thought to himself, if the posts he had seen on social media were anything to go by, many people out there felt that GPs had reneged on their duty throughout the coronavirus crisis.
As he logged off from his computer he noticed the four cold cups of coffee sitting undrunk on his desk, together testifying to how busy his day had been. What he couldn’t understand however was why there was never an accompanying pile of uneaten biscuits! ‘Another medical mystery’ he said to himself as he stood up, ‘but one that will have to remain unsolved for the time being. I’m off home.’
Scrooge locked up the building, got into his car, and set off for home. He tried to turn his thoughts away from the day, but as he drove the radio was playing Solomon Burke’s ‘Cry to me’. Hearing of how loneliness was such a waste of time, of how it made you want to cry, Scrooge couldn’t help but think again of Mrs Gray and so, having deviated from his usual route home, he soon found himself parked up outside her home instead.
Walking to the door to the stairwell of the block of flats in which she lived, Scrooge noticed a now faded rainbow that someone had painted on the adjacent wall. Underneath were written the ubiquitous words ‘Thank you NHS’. Scrooge averted his eyes, uneasy at what seemed to him as yet another shrine erected to an organisation that, whilst wonderful, was being deified in ways that weren’t helpful, by a population that was putting all its hope in an NHS that could not possibly deliver all that was being asked of it. He didn’t consider himself a hero of the pandemic, that particular label he felt, would surely be better applied to those who would lose their jobs and livelihood over all of this.
Scrooge pulled opened the door and climbed the steps to Mrs Gray’s flat. As he donned yet more PPE he noticed the piles of bottles filling the recycling box of the flat opposite that of Mrs Gray. Somebody was clearly doing their bit to support the local off-licence in these difficult times. Scrooge wondered if the young Mum who lived there, and who had called him several times this week regarding various minor problems, might be better served by a face to face consultation. Perhaps she’d feel freer to talk when she wasn’t being overheard by her partner, given how he was known to have problems ‘managing his anger’. He made a mental note to call her in the morning before turning back to Mrs Gray’s flat and ringing her doorbell.
Nobody came to the door and so Scrooge rang it again. Again there was no response. Trying the door and finding it unlocked, he gently pushed it open and entered the flat.
‘Hello? Mrs Gray? It’s Dr Scrooge – is anybody here?’
Scrooge made his way in the direction of the feeble voice that called out from the back room and found there Mrs Gray, laid uncomfortably on her bed, desperately pale, weak and laboured in her breathing.
‘Dr Scrooge, what are you doing here?’ Mrs Gray asked, barely able to voice the words. ‘I wasn’t expecting you to call round, I know how busy you all are at the moment. And aren’t you supposed to avoid visiting people like me?’
Scrooge looked down at his feet and felt ashamed at the thoughts he’d had when he’d spoken to her earlier that day.
‘Some would say so, Mrs Gray, some would say so’, he replied and, realising that Mrs Gray’s time was near, Scrooge did something else that he wasn’t supposed to do. He pulled off his mask and apron and, after slipping off his gloves, took Mrs Gray’s hand as he sat down next to her on the chair that stood by her bed
‘Enid’, he added, thinking to himself how nobody should be allowed to die without a friend present, no matter what anyone says, ‘I suspect that what I am now doing is a far far better thing than I have ever done. Of course I should be visiting you.’
Mrs Gray smiled at Scrooge, and Scrooge smiled gently back.
Thirty five minutes later, after a call to the local funeral director, Scrooge was back in his car. Picking up his phone he dialed the number for the hospital and was informed that Mr Carton had had his aneurysm repaired and, all being well, would be allowed home the following day. The vascular team had apparently had little else to do and so had wasted no time in dealing with what was the most interesting case they had had in weeks.
Scrooge smiled again, this time to himself. Perhaps his actions today hadn’t changed the world, but they had made a world of difference to at least one or two people he’d had the privilege of helping. Perhaps he thought, he would continue in General Practice, at least for a little while longer. And that, he decided, was cause for celebration. After all, as one whose income had not been threatened by the events of the last six months, he had much to be grateful for, not to mention a civic duty to support the local economy.
And besides, he’d had nothing to drink all day.
PART TWO: IT’S A WONDERFUL GP LIFE
in which Dr Scrooge has another Christmas encounter.
It was a little after 6.30pm on Christmas Eve and Dr Ebenezer Scrooge had just finished the final telephone consultation of the day. A receptionist appeared at his open door holding a plate on which sat two sorry looking mince pies. Careful to keep her distance, she placed it carefully on the end of the examination couch that was positioned just inside Dr Scrooge’s room.
‘Is there anything else you need Dr Scrooge?’, she asked from behind her mask. ‘Only, if it’s OK with you, I’d like to get off promptly this evening. Will you be all right to lock up?’
‘Yes of course Alice, you head off’, Scrooge replied, ‘Thanks for all your help today. And have a very Merry Christmas.’
But Scrooge himself was in no mood for merriment. It had been a long hard year which had seen the job he loved change beyond all recognition. So great had those changes been that at times he felt as if he was working in a glorified call centre. And he wasn’t enjoying it. The work had remained just as difficult with on call days being busier than ever but, disappointingly, there had been little recognition of this from some quarters, with many seeming to think that GPs had shirked their responsibility during the pandemic, imagining perhaps that they’d spent the whole of the summer on the golf course.
This was certainly not the case for Dr Scrooge who, apart from that incident involving a lemon, a stained glass window and the irate members of the parochial church council, hadn’t picked up a golf club for many years. But still the profession had been on the wrong end of much criticism and had even, on at least one occasion, been branded a national disgrace in the papers. Though he knew it wasn’t true, such allegations hurt.
‘Sometimes’, Scrooge muttered to himself, ‘I don’t know why I bother.’
At least now he had a few days off work but, with no family of his own, spending that time alone wasn’t something he was particularly looking forward to. Furthermore a letter of complaint had arrived that morning that had only served to dampen his spirits still further. He’d been expecting it for a while and, as one who in recent years had found it easy to be overly self critical, he couldn’t help feeling the claims made against him were wholly justified.
‘I could have managed things better’ he thought to himself. ‘If only I was a better doctor. It just wouldn’t have happened if I’d done my job properly.’
Slowly he stood up from his desk and, ignoring the mince pies, made his way out of his consulting room. He stopped as he passed the waiting area, empty now as it had been most of the year. He missed interacting with a full waiting room. He liked to greet those he knew and, on occasions, in the hope of lightening the mood a little, sharing a joke with those anxiously waiting their turn to be seen. It must have been at least nine months now since he’d bent down low to look under the chairs when the person he was calling hadn’t been present, as if somehow they might be hiding from him there. He must have done this hundreds of times over the years but it always seemed to make someone smile, even if that someone was only Scrooge himself.
There were now only two chairs left in the waiting room. Scrooge walked over to one of them and sat down. He starred at the screen mounted on the wall. Used to convey information to those gathered, he mused to himself that, like the current TV schedules, it only ever showed repeats. Still in a melancholy mood, Scrooge sat down and considered the past year.
It had been one in which he had been urged, not without good reason, to distance himself from those who had sought to come to him for help. But, he feared, this had, as a consequence, resulted in his seeing the needs of his patients in isolation and that the care he offered them had inevitably become less personal as a result. This he felt had been as detrimental for him as it undoubtedly had been for his patients. Understandably focused on the coronavirus the world had sometimes failed to see the bigger picture. Lost in the woods that could could no longer be seen, and confused by the trees that had crowded its view, the world had, he sensed, in its desperation to keep on living, forgotten the meaning of what it was to be alive.
And it wasn’t only at work that things had changed.
Last week he’d been shopping. First he’d parked in a multi-storey car park where, ‘due to Covid restrictions’, the top three storeys had been closed off. But to his mind at least, such action had only succeeded in forcing people to crowd into the two remaining lower levels. Then, outside a department store, he’d heard a father reassuring his little boy that his mother wasn’t dead but had simply popped into a shop. It’d have been funny if it hadn’t been so sad, evidence of the crippling and excessive anxiety some, including children, were experiencing. And then, to top it all, he’d visited his local branch of Waitrose and bought fennel, dill and some apparently ‘essential’ orzo, three items that a few years previously he’d never heard of let alone considered buying. What, he wondered, was the world, and he, coming to.
‘What’s the point? I’m a failing doctor, in a failing system in a failing world. Time for me to call it a day. If I write a letter of resignation and give in my notice now, by the summer I’ll be free of all of this. And the practice and the local community will be all the better for that!’
His mind made up, Scrooge started back to his room in search of some headed paper. But as he did so the TV screen burst into life and the figure of an elderly man appeared surrounded in swirling mist. He was dressed in a old duffel coat and he was sporting a trilby hat. From within its confines, he tapped on the TV screen and called Scrooge’s name.
Scrooge turned back to address the figure, less startled perhaps than some might have expected him to be on account of his previous experiences with ghostly yuletide apparitions.
‘Oh for goodness sake. Not again!’ he started. ‘Must I be haunted every Christmas? Who are you this time? The Ghost of The Christmas We Never Expected?’
The elderly figure seemed a little taken aback but nonetheless began to make his way awkwardly out of the TV. Before long he was standing in front of Scrooge, smiling broadly.
‘Well a good evening to you too, Dr Scrooge’, he replied. ‘As it happens I’m not a ghost. Far from it. My name’s Clarence, and I’m your guardian angel – allocated to you now that George has no further need of me.’
Scrooge was, momentarily, lost for words.
‘Clarence? What kind of a name is that for an angel. And who’s George when he’s a home?’
By now Clarence was removing his coat and carefully placing it on the back of a chair in that rather irritating way that patients sometimes do at the start of consultations. He was clearly planning on staying a while.
‘I’m a little surprised you don’t recognise me’, Clarence replied, ‘but then you’ve probably only ever seen me in black and white. But surely you must remember George. His was a wonderful life.’
‘Well bully for George is all I can say. I hope he’s happy’
‘Indeed he is. Very happy. But from what I’ve been hearing, that can’t be said of you. Have you thought about chatting it over with your appraiser?’
‘Not likely! I know they’re supposed to be supportive but I prefer to pretend that everything’s fine with my appraiser. Fortunately they’re not generally hard to fool. Like long haired sheep it’s easy to pull the wool over their eyes!’
‘Then perhaps I can help a little – I do have some experience in the area’.
‘How do you mean? You’re not going to suggest CBT or mindfulness are you? Only, if you are I’m not interested’.
‘Not as such. It’s just that…well it seems to me that you are questioning just how useful your life as a GP has been. You think you haven’t made a difference. But that’s not true. You’ve made a huge difference, in innumerable ways, often without you ever having realised it’.
Scrooge remained silent, though on this occasion it was not by way of employing a therapeutic tool. The truth was that he was eager to hear what Clarence had to say but was reluctant to appear as such. The angel, sensing Scrooge’s predicament, continued.
‘Well let’s start with the obvious shall we? Take Mr Carton. Surely you remember how, after your telephone consultation with him you agreed to review him face to face and were thus able to diagnose that his back pain was due to an abdominal aortic aneurysm. He’s alive this Christmas because of your actions. And then there was the kindness you showed to Mrs Gray as she lay dying. That mattered too you know? Enormously’.
Scrooge grudgingly indicated his agreement. ‘But it’s no more than any GP would have done’.
‘Perhaps, but that’s not the point. The fact of the matter is that what you did made a difference. If only ‘The Ghost of General Practice Present’ were here we could have taken you and shown you how happy so many people are this evening because of your actions over the years. I’d WhatsApp her but I know that right now she’s very busy haunting a Covid vaccination centre. It’s been a tough year for the members of BASIL too you know.’
‘BASIL?’, Scrooge interrupted, ‘I’ve heard of SAGE, but who the heck are BASIL?’
‘“Beings and Spirits in Limbo”’, Clarence replied. ‘We’ve all been meeting on Zoom this year. It’s been awful. The Ghost of General Practice Past still hasn’t learnt how to unmute himself and the oh so smug Ghost of General Practice Yet To Come can’t stop telling everyone how he correctly predicted the increase in remote consulting and the wearing of face masks during face to face reviews.’
‘Enough of that though, back to what I was saying. In addition to those positive outcomes that you know about, there are so many small actions that you have taken that, unbeknown to you have had similar wonderful consequences. Take that occasion when you reassured a couple who were worried that their child’s rash was meningitis. Because of you they didn’t call the ambulance that they had been planning to and, as a result, a man who was suffering a MI at the time was attended to promptly when he called 999. Wonderfully he was stented within an hour of the onset of his chest pain. And then there’s Dr Cratchit of course.’
‘Bob? What about him?’
‘He really was desperate that Christmas a couple of years ago you know. He didn’t tell you the half of it at the time but, back then, he really was close to the edge. It was your support that pulled him through. And don’t forget that it was you who gave a job to the young lady that is now his wife, not to mention the mother of their child. You gave Emily a chance when many wouldn’t have, not with her previous poor employment record. If you hadn’t taken her on, she and Bob would never have met. Indirectly the happiness of that young family is down to you. And I could tell you a thousand other similar stories of how you’ve influenced individual lives for good.’
‘Even so, that complaint I received today. It’s completely justified you know. I made a mistake. A big one. And people are suffering because of the error I made’.
‘So you slipped up. And that is both regrettable and so very hard to live with. But did you really ever imagine that you would go through your whole career as a doctor without ever making a mistake? Surely not even you are that stupid. Working as a doctor is a bit like pushing people out of the way of speeding trains. On occasions you’ll not be able to push someone out of harms way in time. And sometimes you might just get hit yourself. Even so, you must still try to remember all those folk you have been able to help, all those who have avoided pain and distress because of what you were able to do for them.’
As Clarence had been talking, Scrooge had been gazing at the ground but now he lifted his head and, addressing his companion, looked him in the eye.
‘But it’d be nice to be appreciated a little.’
‘Well of course it would and the truth is many people do appreciate your efforts. But be that as it may, the value of an action remains irrespective of whether any appreciation is shown for it. Pleasant though it undoubtedly is, is it really so important to be lauded for what you do? Surely happiness comes more from performing an act of kindness than from the appreciation that might follow it. Besides if you really want to be appreciated, post an amusing video of a cat on Facebook. Only don’t expect that to satisfy you for very long.’
‘If Covid has taught us anything Ebenezer, surely it’s this. That it is possible to be content with less and that, rather than striving constantly to gain more in life, we would do well to be content with and enjoy the gift of life we already have. Life is uncertain, it always has been. We are not the sole masters of our fate, nor that of those we love or those for whom we care. There is much that we do not know, much indeed that we cannot know. As such we need to learn some humility and acknowledge just how little we truly understand. We need to stop arrogantly pretending we invariably know best. Everyone makes mistakes sometimes. Even you GPs!’
Scrooge smiled and took a step towards Clarence who had got to his feet and was now putting his hat and coat back on. Scrooge hesitated as he once again became mindful of social distancing guidelines. Clarence didn’t seem too bothered though as he too was taking a step forwards. The two men exchanged a firm handshake.
‘Thank you, Clarence’ said Scrooge. ‘It was good of you to come this evening’.
‘‘Not at all, Ebenezer, not at all. It was a pleasure. And thank you for all your hard work this year. You, and all your staff, are doing a grand job in difficult circumstances. Don’t think that it’s not appreciated. And trust me, it isn’t going unnoticed, not by those who count, not by those you’ve actually cared for. Now, you’ll forgive me if I don’t stand and applaud you, and since I can’t give you a voucher entitling you to a free coffee or a discount bar of chocolate, I’m afraid this will have to do!’
And with that, and before he could undertake a detailed risk assessment regarding the merits of such behaviour, Scrooge was experiencing something he’d never experienced before. He was being hugged by an angel.
‘Don’t worry about Covid-19, Dr Scrooge,’ said Clarence, laughing as he sensed Scrooge’s unease. ‘This duffel coat and trilby hat offer complete protection. Or at least as much as those flimsy plastic aprons you’ve all been wearing these past few months. And besides, what’s the worst that could happen. Only that you die and discover what has long been joyfully known by many, that there aren’t varying degrees of danger in the place where I come from.’
As they separated, Scrooge looked somewhat bemused by the strange comment of his unexpected visitor.
‘Haven’t you heard, Ebenezer?’, said Clarence, continuing to chuckle to himself. ‘There are no tiers in heaven!’
And with that a warm glow surrounded Ebenezer. As it did so a bright light filled the waiting room. In a moment though it was gone, as indeed was Clarence. Scrooge, alone once more, stood motionless for a few seconds, trying to collect his thought. Perhaps he’d need to rethink that letter of resignation.
He walked out of the waiting room and made his way to the back entrance. He switched off all the lights and set the alarm before finally leaving the building and locking the door behind him. As he walked to his car he felt a vibration in his pocket. Pulling out his phone he noticed that he’d received a text message. It was from Bob Cratchit.
‘Where are you? We’ve been waiting for you. I trust you’ve not forgotten you’re bubbling with us over the next few days. Get over here quick or you’ll miss all the fun of putting the little one to bed. Remember we’re expecting you to do the full Father Christmas routine for us. See you soon.’
As he gazed at its screen, the phone vibrated again and another message appeared.
‘And we’re a little short of mince pies. Do you know where you could lay a hand on a couple?’
Scrooge looked back at the surgery. ‘I rather think I do!’ he said to himself smiling. Perhaps, he thought, this might be a Merry Christmas after all.
BOOK THREE: BLEAK PRACTICE
in which Scrooge considers calling it a day.
Dr Scrooge was tired. All the time tired. He was more tired than a myxoedematous narcoleptic with sleep apnoea who’d just completed a week of nights. He was tired of Covid, he was tired of work, and increasingly he was tired of life.
It was just gone eight and he was alone in the practice catching up on paperwork at the end of a long day on call. Only it wasn’t the end as he was still left with a home visit to do. And to make matters worse he was supposed to be gathering with Dr Cratchit and a few other friends that evening to celebrate a friends eightieth birthday. ‘Looks like I’m going to be late for another social event’ he sighed to himself as he picked up his bag and the printout of the patient’s details that had been bought to him, along with a consolatory custard cream by the receptionist just before she’d left an hour or so previously.
As he left the building it was beginning to rain and the last light of the day was beginning to fade. Scrooge got into his car and drove out of the car park at the back of the surgery premises and began to make his way to the nursing home where the patient he was visiting lived. The staff there had insisted the man be seen on account of him just not seeming himself and Scrooge had been too worn down by the busyness of the day to do anything but agree to the visit even though he’d felt there would be little point in visiting somebody who he couldn’t help thinking, from his cursory scanning of the notes, was just a demented old man who’s life meant nothing now that all he did all day was sit in a chair.
Scrooge’s frustration increased still further as, barely having started out on his journey he was held up by traffic lights. The red light reflecting on the wet road seemed to goad him into thinking what he’d been considering for some little while. ‘Perhaps it really is now time for me to just stop’, he muttered to himself. ‘After all I could always make ends meet by exploiting the black market in blood sample bottles’.
The year had been a hard one. Though positive swab results of Covid tests continued to appear daily in his inbox, Scrooge hadn’t seen anyone ill with the disease for several months. Even so workload was higher than he’d ever known it to be and he no longer felt he was doing a good job. There just wasn’t the necessary time to give to patients. Earlier in the year he’d worked sessions at the local vaccination centre and had derived great pleasure from doing so, but now he found no satisfaction in rushing headlong through the seemingly endless list of patients that daily presented themselves to him only to later hear in the media how GPs were hiding away from their patients, supposedly behind locked doors. And it looked like it was all about to get a lot worse now that a neighbouring practice had collapsed and he and Bob had been forced to accept several hundred additional patients onto their practice list, including the man he was now on his way to see. With no additional staff to deal with what amounted to an overnight increase of 10% to the practice list, Scrooge wondered how he and all his clinical and non clinical colleagues would cope with the inevitable additional work. No wonder that even his excellent practice manager was now beginning to feel the strain.
It was the worst of times, it really was the worst of times.
As the car idled Scrooge realised that he had long since given up any hope of his turning out to be the hero of his own life and remembered instead something he’d once read about how everybody eventually experiences the defeat of their lives. Perhaps that was what he was now recognising to be the case for himself. His appraisal was coming up soon and, rather than discussing with his appraiser how he might look to improve over the coming year, Scrooge thought that perhaps it was time to get real and instead take the opportunity to discuss how he might best manage his now inevitable decline.
As the traffic lights changed Scrooge continued on his way and within ten minutes he was pulling up outside the nursing home. The rain continued to fall as he climbed out of the car and hurried to the front door. He pressed the doorbell and, as he waited to be let in, he donned the mask, ridiculous plastic apron and blue surgical gloves that purported to be PPE but only managed to make him look like some sinister Smurf with a burgeoning interest in basic butchery.
Eventually he was let in and led to a small room on the second floor of the old building that, over the years he had visited countless times. The room was a barren affair, sparsely furnished with the only decoration being a few framed verses of scripture urging the reader to remember that there was always reasons for hope in even the darkest of days. ‘If only’ thought Scrooge as he turned his eyes towards the frail elderly man he had come to see who sat hunched in a chair with his eyes closed and his mouth wide open. He saw and said nothing. Scrooge walked over to him and, crouching by his side, attempted to make conversation though, even as he did so, he knew there was little prospect of any meaningful communication. Scrooge examined the man but found no specific cause to account for his increasingly frail condition other than the all too apparent dementia that had brought him to the home some years previously. The man was clearly coming to the end of his life.
Stepping back outside of the room, Scrooge explained his findings to the young nurse who had been accompanying him. She passed him the patients treatment escalation plan on which was stated that hospital transfer should be considered in the event of his becoming unwell.
‘Shall I get his things together whilst you call the ambulance?’ the nurse asked. ‘How long do you think it will be?’
Scrooge’s heart sank. He’d been in this situation before, where what was written on the TEP form seemed inappropriate and, rather than helping to make decisions, only succeeded in making things harder. Surely admission wasn’t in the man’s best interests and yet to go against what was clearly written down made Scrooge feel uncomfortable.
The pair walked back along the carpeted corridors to the office where he recognised the familiar face of one of the senior members of the nursing staff who had worked at the home for as long as Scrooge could remember.
‘What do you think Clare?’ he asked her, ‘It can’t be right that we admit the poor chap can it?’
Clare looked up from the desk where she was sat. ‘All I can say’, she replied, ‘is that I’ve known Harry for a very long time, ever since he arrived here I forget how many years ago. And I’d be sad if he died in hospital’.
That was enough for Scrooge. Even so he thought he would try to speak to a member of the elderly man’s family, just to make sure they felt the same way that he did.
‘Do you know who his next of kin is?’ Scrooge asked Clare. ‘Is there anybody at all I can talk to’.
‘There aren’t any children, Harry never married. But there is a younger brother who visits him regularly’. Clare flipped her way through Harry’s file and found the number and, passing it to Scrooge. added ‘Just press ‘9’ for an outside line’.
Scrooge picked up the phone and made the call. After a few rings it was answered and Scrooge introduced himself to somebody whose gentle elderly voice confirmed he was indeed Harry’s brother.
‘I’m sorry to bother you at this time in the evening’, Scrooge began, ‘but it’s about your brother. I’ve been called to see him and I’m afraid he’s not at all well.’
‘He’s not been well for a long time Doctor. It’s his age you see. That and the dementia. It’s been years since he was the man I once knew.’
Scrooge smiled to himself realising already that this conversation was not going to be as difficult as he had feared.
‘I understand’, Scrooge continued, ‘but Harry’s deteriorated rather a lot of late and if I’m honest I think he’s only likely to get worse over the next day or two. I thought you ought to know, just in case you wanted to pop over and see him. Unless of course you thought he ought to be admitted to hospital. The thing is I have a bit of paper here which suggests that some discussions were had previously and that it was felt then that, if he were he to become more unwell, Harry would want to be admitted. But I really don’t think the hospital would be able to do a great deal for Harry and I’m not sure that sending him in now would really be the best thing for your brother’.
‘Please don’t send him to hospital doctor – he wouldn’t want it. It’s like this you see. When you’re old, eventually it happens that the only thing you’re left with is your memories, and Harry, well he hasn’t even got those anymore. They’ll look after him well in the home. Leave him with those who know him best.’
The line went silent for a few seconds and then Harry’s brother spoke again, this time his voice wavering a little as he tried to control the tears.
‘Can I tell you something Doctor? You might look at Harry and think he’s just a demented old man, but I want you to know that that demented old man is still my hero. Always has been – always will be. When I was a boy he looked after me when there wasn’t anybody else who could. He was a good man. And he still is. Even now that his time has come’.
The two men chatted on a little longer before Scrooge eventually put down the phone. He relayed the nature of the conversation to Clare and it was agreed that Harry would stay where he was and the staff would continue to care for him just as they had for many years already. Scrooge updated the TEP form and, though he didn’t imagine they’d be necessary, wrote up some ‘just in case’ medications before saying his goodbyes.
Back in his car Scrooge thought about what had just happened. He remembered those words on the wall of Harry’s room, words that his brother had said both he and Harry still believed. Maybe there was cause for hope in dark days after all, even at that moment of apparent defeat. And perhaps, as was the case with Harry, even in the years of one’s inevitable decline, you could remain someone of worth, someone who was still both loved and valued. Scrooge’s mind went back to those sessions he’d worked in the vaccination clinic when the frail and elderly had been wheeled in by those who still loved them irrespective of how dependent they had become on others. It had been a joy to give them their vaccinations, vaccinations that had seemed at the time to be nothing less than a shot of love.
And he thought too of something else he’d recently heard, something about how ‘shiny and new’ was all very well but that things with no past somehow lacked any soul. Perhaps that was true of people too. Although in physical terms Harry and his brother were both past their best, they undoubtedly had soul, their experiences of brokenness producing in them a depth that only age can bring, the wisdom of experience allowing them to accept others despite their imperfections.
*******
It was gone 10 by the time Scrooge arrived at the party and people were already beginning to make their way home. Dr Bob Cratchit was still there though. He was on a weeks leave and had clearly been taking full advantage of the fact by enjoying the liquid refreshment that had been freely on offer. He was a little worse for wear as he handed Scrooge a glass containing what little remained of the celebratory bottles of champagne that had been opened over the course of the evening.
‘What the dickens are you doing turning up so late?’ Cratchit asked Scrooge before adding in a more concerned tone of voice, ‘Are you alright. Looks like it must have been a bad day for you today Ebenezer’. Cratchit felt the need to look out for the man who had once been his trainer but was now his senior partner at work.
‘Yes and no, Bob. Yes and no. The day was certainly busy, made busier still by a late visit request. But you know what? I wouldn’t have missed that visit for the world. And I’ll tell you something else. What with the influx of new patients, we’re going to need to try and recruit a new partner. But don’t get any ideas of you lording it over them as senior partner. I’m afraid you’re stuck with me for a little while longer yet.’
And with that Scrooge raised a half full, rather than half empty, glass of warm, flat champagne and drank to all that was good about General Practice.
PART FOUR: GRAVE EXPECTATIONS.
in which Scrooge meets a red faced portly gentleman and finally calls for help.
It was Christmas Eve and Dr Scrooge was writing up the notes of the final consultation of his afternoon surgery. He looked up at the clock on the wall and noted that it was just before 7pm. It had been a long day. Through his open door he could hear Dr Cratchit singing a medley of Christmas songs. Clearly his colleague was looking forward to Christmas with his young family and his excitement had undoubtedly been heightened by the fact that during the afternoon it had begun to snow.
‘So here it is merry Christmas everybody’s having fun’, sang Dr Cratchit poking his head around the corner of Scrooge’s door. ‘Look to the future now it’s only just begun!’
‘Christmas it may be Bob, but I’m not sure that everyone is having fun,’ countered Scrooge suppressing a cough. ‘And I’m not so sure the future has just begun either. It rather seems to me that the future is on hold.’
Dr Cratchit however was not going to allow his spirits to be dampened. ‘I hope you’re not reverting to being a Christmas grump, Ebenezer. Why don’t you come round to our place for Christmas? You really would be most welcome’.
‘Thanks Bob, but I’d rather not. Maybe next year. You head off home. And do tell the receptionists that they can go home too. I’m nearly done – I won’t be here much longer.’
‘Well OK. As long as you’re sure. Have a good few days Ebenezer and I’ll see you on the other side!’. And with that Dr Cratchit left and a minute or two later Scrooge could hear him laughing with the receptionists as they braved the icy car park just outside his window. Soon all was quiet and Scrooge knew he was all alone in the building.
Scrooge had enjoyed spending last Christmas with Bob but this year his heart simply wasn’t it. It had been a hard year with his workload spiralling out of control. The weight of expectation on GPs had taken its toll with everybody seemingly wanting more and more from a profession that was already on its knees. Furthermore the constant criticism that had come from both the media and government had only made matters worse and the end result was that his mood had sunk ever lower.
‘Right now,’ thought Scrooge to himself, ‘Christmas is the last thing I need. The days off, of course, are welcome, especially after the last couple of weeks but Christmas isn’t like it was when I was a child. Back then Christmas was a magical time, a time you could really enjoy. But now? Now it’s seems it’s just another opportunity to burden oneself with the thousands of things we are expected to do if we are to be deemed acceptable celebrants of what our consumerist society has now made Christmas. I’ve had enough. I just want it all to stop.’
Even Scrooge’s Facebook feed seemed now to be asking more of him. All those memes which appeared to be simply offering winsome advice were, to Scrooge’s mind at least, just more examples of others exhorting him to do more. Urging him to ‘Be kind’ was all very well, he thought, but they might as well simply have insisted he ‘Do better’. Nonetheless Scrooge had made every effort to be kind, but no matter how hard he had tried there always seemed to be someone whispering in his ear, telling him that he still wasn’t good enough. Even that frequently offered advice that he be kind to himself felt to Scrooge like one more demand that he’d not been able to fulfil.
For over and above all others, there was another reason why Scrooge had not wanted to spend Christmas with the Cratchit’s. All week he’d been feeling unwell. He’d been coughing too. A PCR test the previous weekend had come back negative so, despite not really feeling up to it, he’d continued to work, unwilling as he was to leave Cratchit to manage the escalating workload by himself. That afternoon though he’d taken a significant turn for the worse. At one point he had been rigoring with a temperature of 38.7 and only by taking a couple of paracetamols had he been able to bring his fever down such that he felt well enough to keep on seeing patients.
Feeling so unwell meant it took Scrooge rather longer than he had expected to complete his paperwork and it was nearly 8pm before he finished all that he needed to do. Sensing his temperature was once more on the climb Scrooge rummaged through his desk drawers till he found some doxycycline that a patient had handed back to him earlier in the week. Then, for reasons he wasn’t quite sure of, he stuffed his pulse oximeter into his pocket before finally leaving his room and making his way out of the building. Outside it was bitterly cold and the snow was falling more heavily such that it was now beginning to settle. Scrooge got into his car and tried to start the engine only to hear the ominous clicking sound that could mean nothing other than the battery was completely flat.
Scrooge allowed his head to slump forward and rest on the steering wheel. ‘Great’, he said to himself. ‘That’s all I need!’ With it being Christmas Eve and not wanting to risk spoiling somebody’s family celebrations, Scrooge couldn’t bring himself to call anybody out and and so he decided to walk home instead. ‘It seems that this year I won’t be driving home for Christmas’ he muttered to himself as he began to cough once more, this time rather more forcefully.
Once he’d stopped coughing Scrooge got back out of his car and started to make his way home. Initially he trudged along main roads but it wasn’t long before he came to where his route took a sharp right turn. Scrooge pushed open the iron gates of the cemetery and, passing through them, continued a few paces on before stopping to gaze upon the gravestone that was clearly illuminated by the nearby street lights. The inscription read ‘In loving memory of Enid Gray who fell asleep August 6th 2020’. Scrooge remembered the elderly lady who had once been his patient, one with whom he’d spent Christmas with only three years previously and whose hand he’d held as she had taken her final breath. The inscription on her headstone ended with the words ‘Now at rest’. Scrooge couldn’t help feeling momentarily envious of Mrs Gray. How he could do with a little rest too.
On the other side of the path was another grave. This one was freshly dug and had yet to have been dignified with a headstone. Scrooge though didn’t need informing just who it was that lay beneath the still raised turf. Mark Ashley had died just three weeks previously, having presented to Scrooge only a month earlier already in the advanced stages of a malignant disease. He’d delayed attending because of concerns about catching Covid and now left behind him a grieving wife and two teenage children. Like Mrs Gray, he had been overcome by a disease that had been far more effective than Covid 19 in removing individuals from Scrooge’s patient list.
Scrooge continued along the cobbled path that ran straight across the centre of the cemetery. The night closed in on him as he ventured ever further from the streetlights that lined the road he had now left behind. About a hundred yards ahead a solitary lamp was shining brightly, driving back the darkness that surrounded it. Beneath was a bench upon which sat a portly gentleman who appeared to be wearing a red suit and whose face, itself somewhat rosy, was endowed with a long white beard. As Scrooge approached him, the figure stood up and greeted Scrooge with a broad smile and a cheery wave.
‘Good evening Dr Scrooge.’ said the man who clearly knew who Scrooge was.
‘Good evening’, replied Scrooge. ‘But I’m afraid you have me at a disadvantage. I don’t recognise you in your costume’.
‘You don’t recognise me?’ questioned the man, clearly amused by Scrooge’s failure to know who it was that had addressed him. ‘That’s most unusual. I tend to get recognised by most people. So much so that’s it difficult sometimes to have a few quiet minutes to myself!’
‘I know the feeling’, interrupted Scrooge before allowing the man to explain that he had a number of names but that he was most commonly referred to as either Father Christmas or Santa Claus.
‘Very amusing I’m sure’, said Scrooge, but who are you really. ‘Are you one of my patients perhaps?’
‘No no,’ said the man, ‘I’m not local. I’m just passing through. But I’ll be sure to register as a temporary resident at your practice should I need any medical assistance. I do sometimes suffer with a touch of gout. I suspect it’s a consequence of all the port that I’m proffered at this time of year’
‘Oh come of it’ said Scrooge. ‘Father Christmas doesn’t exist’
‘Are you sure?’ the man replied. ‘I mean – haven’t you seen “Miracle on 34th Street?”’
‘Of course I’m sure. And some sentimental Christmas film isn’t going to persuade me otherwise. I’m a bit old to believe in Father Christmas!’
‘Nobody’s too old to believe in me. Next you’ll be saying that Christmas is for the children!’
‘Well isn’t it?’
‘Well yes – but it’s for adults too. However old we are, we all still need Christmas. What would life be without something as fantastic as Christmas to look forward to, something to lift our spirits and give us hope in even the hardest of hard times?. Don’t you believe the Christmas story?’
‘Of course I don’t. The Christmas story is no more true than your beard is real!’, Scrooge snapped back.
‘Well I’d have to agree with you there’, said the man in the red suit pulling on his beard firmly and surprising Scrooge somewhat when it failed to come off in his hand. ‘What about peace and goodwill to all men? Especially in these days of pandemic, couldn’t we all do with a little more of such things?’
‘Peace and goodwill – bah humbug!’ said Scrooge who was somewhat taken aback by hearing himself using an expression he’d not used for years. ‘Say what you like! I don’t believe in you or the Christmas story. The idea of there being someone so good and kind as to dispense gifts on everyone is ridiculous. The world is a tough place.’
‘Indeed it is – but there’s always hope.’
‘Not for the dead there isn’t’ said Scrooge indicating to the stranger as he did so the graves that lay scattered around them. The man in the red suit appeared to want to challenge Scrooge’s assertion but Scrooge wasn’t about to let a man he had decided was one bauble short of a fully decorated Christmas tree interrupt him now. ‘The truth is’, Scrooge continued, ‘that in the end the world defeats us all. And just now that most certainly includes me. That said, the idea of their being someone who is as kind as the person you’re claiming to be is, undoubtedly, quite appealing. Wouldn’t it just be heaven if there really was somebody who could bring some genuine joy into this miserable world, who could give us some hope for the future, who could put an end to all this death and disease?’
‘That’s quite a Christmas list you have there Dr Scrooge and you may have to look to someone other than myself for all that it contains. Nonetheless the less, I’ll see what I can do. In the meantime how about a yo-yo, a penny whistle and this half eaten satsuma that Rudolph mistook for a carrot?’
‘That’s very kind of you Santa’, smiled Scrooge resigning himself now to playing along with the peculiar man who was clearly set on staying in role. ‘I don’t suppose you could sort out the crises in General Practice too could you?’.
‘I’m not sure that I can I’m afraid, not this Christmas at least. But I’ll say this. When you have 55,000 GPs, all of whom are doing their best in incredibly difficult circumstances and some are still saying that it still good enough, then the problem isn’t with GPs. And here’s another thing. You are aware aren’t you that I know who’s been good and who’s been bad this year? Well you GPs, and all those who work alongside you, are most certainly not on my naughty list!’
And with that the man gave a whistle and from out of nowhere a sleigh appeared. It was laden down with presents and was pulled by eight reindeer one of whom had a particularly shiny nose. The man stepped on to the sleigh and took hold of the reigns. Then, with a hearty ‘Ho, ho, ho’, he gave them a sharp tug and a second later he had disappeared from sight leaving a bewildered Scrooge alone once more.
Scrooge stood motionless for a few minutes not knowing quite what to make of what had just happened. What was it about Christmas Eve that in recent years had resulted him repeatedly having such strange encounters? Soon though his thoughts turned to more pressing concerns when he suddenly developed a sharp pain in the side of his chest. He started coughing again and brought up some mucky green sputum which this time, Scrooge noticed, was flecked with blood. Keen to get home, he tried to quicken his pace but it was another twenty five minutes before he eventually found himself outside his house. As he turned the key in the lock and pushed open the front door Scrooge was really rather breathless from his exertions.
Inside it was dark and Scrooge stumbled his way to the lounge where he collapsed into his favourite armchair. He switched on the small lamp that stood on the table next to him and noticed the advent calendar that one of his patients had given him at the beginning of December. The last door was still closed as Scrooge hadn’t had time that morning to open it. He peeled it back now revealing a picture of a new born baby lying in a manger but Scrooge paid no attention to the scripture verse that was written on the inside of the door. Instead, conscious that his breathing had deteriorated still further, Scrooge reached into his pocket and pulled out the pulse oximeter that he’d placed there earlier and applied it to the index finger of his left hand.
Seeing it record a pulse rate of 128 and an oxygen concentration of just 86%, Scrooge realised that, Christmas Eve or not, now was the time to call for help. He took hold of his phone and tapped out 999 only to hear a message explaining that due to the volume of calls that were currently being received there was nobody immediately available to take his call but that it would be answered as soon as somebody was free. Several minutes went by before somebody eventually responded. After determining what the problem was the call handler assured Scrooge that an ambulance would be dispatched as soon as possible but cautioned him that, due to the unprecedented demand that they were currently experiencing, they may be some delay.
Scrooge sat quietly in the chair feeling himself becoming more and more tired. He looked down at the advent calendar and now noticed the words that were printed on the inside of the door he’d just opened. ‘The light shines in the darkness, and the darkness has not overcome it’. They were the last words Scrooge saw. He found them strangely comforting and, believing them to be true, he managed a smile as, letting go of his hopes and fears, his eyes grew ever more heavy until he eventually fell into a deep, and dreamless sleep.
Outside, up in the sky, the silent stars went by.
*********
Early in the new year the local newspaper reported Scrooge’s death and described how he’d been found by the ambulance crew when they eventually arrived at his home in the early hours of Christmas Day. It had been several hours after Scrooge had made his initial call for help.
His funeral was well attended and many there spoke of how much they had appreciated all that he had done for them. Had he been there it would have cheered Scrooge’s heart. But, of course, he wasn’t. Scrooge was somewhere far better, somewhere where he enjoyed everlasting light and could spend his days resting a while with Mrs Gray or learning the art of encouragement by spiritual visitation from Clarence, the angel he’d met the Christmas before and with whom he had become firm friends.
In time Scrooge took on the role of ‘The Ghost of General Practice at it’s Best’. There was nothing he loved more than visiting GPs and reminding them that, however great their struggle, there was always hope, always something good to enjoy about their work, always some light to be found in the darkness.
So if one Christmas something unaccountable happens, if perhaps a mince pie appears on your desk whilst you’ve been called away to a colleague’s consulting room as a result of their panic button going off for seemingly no reason whatsoever, ask yourself if you too may have been visited by Dr Scrooge, someone who now really is having fun and whose future, like yours, has ‘only just begun’.
THE END.
To read the whole of ‘The Scrooge Chronicles’, click here
Other medically related Christmas themed blogs:
To read ‘How the Grinch and Covid stole General Practices Christmas’, click here
To read ‘Twas the night before Christmas – 2020’, click here
To read ‘A Merry, and Resilient, Christmas’, click here
This tale is Part Four of ‘Scrooge in the Time of Coronavirus’ which is itself Book Two of ‘The Dr Scrooge Chronicles’. Book One is entitled ‘A Primary Care Christmas Carol’.
To read ‘A Primary Care Christmas Carol ’, click here.
To read Part One of ‘ Scrooge in the Time of Coronavirus – A Tale of Two Patients’, click here.
To read Part Two of ‘Scrooge in the Time of Coronavirus – It’s A Wonderful GP Life’, click here.
To read Part Three of ‘Scrooge in the Time of Coronavirus – Bleak Practice’, click here
GRAVE EXPECTATIONS
in which Scrooge meets a red faced portly gentleman and finally calls for help.
It was Christmas Eve and Dr Scrooge was writing up the notes of the final consultation of his afternoon surgery. He looked up at the clock on the wall and noted that it was just before 7pm. It had been a long day. Through his open door he could hear Dr Cratchit singing a medley of Christmas songs. Clearly his colleague was looking forward to Christmas with his young family and his excitement had undoubtedly been heightened by the fact that during the afternoon it had begun to snow.
‘So here it is merry Christmas everybody’s having fun’, sang Dr Cratchit poking his head around the corner of Scrooge’s door. ‘Look to the future now it’s only just begun!’
‘Christmas it may be Bob, but I’m not sure that everyone is having fun,’ countered Scrooge suppressing a cough. ‘And I’m not so sure the future has just begun either. It rather seems to me that the future is on hold.’
Dr Cratchit however was not going to allow his spirits to be dampened. ‘I hope you’re not reverting to being a Christmas grump, Ebenezer. Why don’t you come round to our place for Christmas? You really would be most welcome’.
‘Thanks Bob, but I’d rather not. Maybe next year. You head off home. And do tell the receptionists that they can go home too. I’m nearly done – I won’t be here much longer.’
‘Well OK. As long as you’re sure. Have a good few days Ebenezer and I’ll see you on the other side!’. And with that Dr Cratchit left and a minute or two later Scrooge could hear him laughing with the receptionists as they braved the icy car park just outside his window. Soon all was quiet and Scrooge knew he was all alone in the building.
Scrooge had enjoyed spending last Christmas with Bob but this year his heart simply wasn’t it. It had been a hard year with his workload spiralling out of control. The weight of expectation on GPs had taken its toll with everybody seemingly wanting more and more from a profession that was already on its knees. Furthermore the constant criticism that had come from both the media and government had only made matters worse and the end result was that his mood had sunk ever lower.
‘Right now,’ thought Scrooge to himself, ‘Christmas is the last thing I need. The days off, of course, are welcome, especially after the last couple of weeks but Christmas isn’t like it was when I was a child. Back then Christmas was a magical time, a time you could really enjoy. But now? Now it’s seems it’s just another opportunity to burden oneself with the thousands of things we are expected to do if we are to be deemed acceptable celebrants of what our consumerist society has now made Christmas. I’ve had enough. I just want it all to stop.’
Even Scrooge’s Facebook feed seemed now to be asking more of him. All those memes which appeared to be simply offering winsome advice were, to Scrooge’s mind at least, just more examples of others exhorting him to do more. Urging him to ‘Be kind’ was all very well, he thought, but they might as well simply have insisted he ‘Do better’. Nonetheless Scrooge had made every effort to be kind, but no matter how hard he had tried there always seemed to be someone whispering in his ear, telling him that he still wasn’t good enough. Even that frequently offered advice that he be kind to himself felt to Scrooge like one more demand that he’d not been able to fulfil.
For over and above all others, there was another reason why Scrooge had not wanted to spend Christmas with the Cratchit’s. All week he’d been feeling unwell. He’d been coughing too. A PCR test the previous weekend had come back negative so, despite not really feeling up to it, he’d continued to work, unwilling as he was to leave Cratchit to manage the escalating workload by himself. That afternoon though he’d taken a significant turn for the worse. At one point he had been rigoring with a temperature of 38.7 and only by taking a couple of paracetamols had he been able to bring his fever down such that he felt well enough to keep on seeing patients.
Feeling so unwell meant it took Scrooge rather longer than he had expected to complete his paperwork and it was nearly 8pm before he finished all that he needed to do. Sensing his temperature was once more on the climb Scrooge rummaged through his desk drawers till he found some doxycycline that a patient had handed back to him earlier in the week. Then, for reasons he wasn’t quite sure of, he stuffed his pulse oximeter into his pocket before finally leaving his room and making his way out of the building. Outside it was bitterly cold and the snow was falling more heavily such that it was now beginning to settle. Scrooge got into his car and tried to start the engine only to hear the ominous clicking sound that could mean nothing other than the battery was completely flat.
Scrooge allowed his head to slump forward and rest on the steering wheel. ‘Great’, he said to himself. ‘That’s all I need!’ With it being Christmas Eve and not wanting to risk spoiling somebody’s family celebrations, Scrooge couldn’t bring himself to call anybody out and and so he decided to walk home instead. ‘It seems that this year I won’t be driving home for Christmas’ he muttered to himself as he began to cough once more, this time rather more forcefully.
Once he’d stopped coughing Scrooge got back out of his car and started to make his way home. Initially he trudged along main roads but it wasn’t long before he came to where his route took a sharp right turn. Scrooge pushed open the iron gates of the cemetery and, passing through them, continued a few paces on before stopping to gaze upon the gravestone that was clearly illuminated by the nearby street lights. The inscription read ‘In loving memory of Enid Gray who fell asleep August 6th 2020’. Scrooge remembered the elderly lady who had once been his patient, one with whom he’d spent Christmas with only three years previously and whose hand he’d held as she had taken her final breath. The inscription on her headstone ended with the words ‘Now at rest’. Scrooge couldn’t help feeling momentarily envious of Mrs Gray. How he could do with a little rest too.
On the other side of the path was another grave. This one was freshly dug and had yet to have been dignified with a headstone. Scrooge though didn’t need informing just who it was that lay beneath the still raised turf. Mark Ashley had died just three weeks previously, having presented to Scrooge only a month earlier already in the advanced stages of a malignant disease. He’d delayed attending because of concerns about catching Covid and now left behind him a grieving wife and two teenage children. Like Mrs Gray, he had been overcome by a disease that had been far more effective than Covid 19 in removing individuals from Scrooge’s patient list.
Scrooge continued along the cobbled path that ran straight across the centre of the cemetery. The night closed in on him as he ventured ever further from the streetlights that lined the road he had now left behind. About a hundred yards ahead a solitary lamp was shining brightly, driving back the darkness that surrounded it. Beneath was a bench upon which sat a portly gentleman who appeared to be wearing a red suit and whose face, itself somewhat rosy, was endowed with a long white beard. As Scrooge approached him, the figure stood up and greeted Scrooge with a broad smile and a cheery wave.
‘Good evening Dr Scrooge.’ said the man who clearly knew who Scrooge was.
‘Good evening’, replied Scrooge. ‘But I’m afraid you have me at a disadvantage. I don’t recognise you in your costume’.
‘You don’t recognise me?’ questioned the man, clearly amused by Scrooge’s failure to know who it was that had addressed him. ‘That’s most unusual. I tend to get recognised by most people. So much so that’s it difficult sometimes to have a few quiet minutes to myself!’
‘I know the feeling’, interrupted Scrooge before allowing the man to explain that he had a number of names but that he was most commonly referred to as either Father Christmas or Santa Claus.
‘Very amusing I’m sure’, said Scrooge, ‘but who are you really. Are you one of my patients perhaps?’
‘No no,’ said the man, ‘I’m not local. I’m just passing through. But I’ll be sure to register as a temporary resident at your practice should I need any medical assistance. I do sometimes suffer with a touch of gout. I suspect it’s a consequence of all the port that I’m proffered at this time of year’
‘Oh come of it’ said Scrooge. ‘Father Christmas doesn’t exist’
‘Are you sure?’ the man replied. ‘I mean – haven’t you seen “Miracle on 34th Street?”’
‘Of course I’m sure. And some sentimental Christmas film isn’t going to persuade me otherwise. I’m a bit old to believe in Father Christmas!’
‘Nobody’s too old to believe in me. Next you’ll be saying that Christmas is for the children!’
‘Well isn’t it?’
‘Well yes – but it’s for adults too. However old we are, we all still need Christmas. What would life be without something as fantastic as Christmas to look forward to, something to lift our spirits and give us hope in even the hardest of hard times?. Don’t you believe the Christmas story?’
‘Of course I don’t. The Christmas story is no more true than your beard is real!’, Scrooge snapped back.
‘Well I’d have to agree with you there’, said the man pulling on his beard firmly and surprising Scrooge somewhat when it failed to come off in his hand. ‘What about peace and goodwill to all men? Especially in these days of pandemic, couldn’t we all do with a little more of such things?’
‘Peace and goodwill – bah humbug!’ said Scrooge who was somewhat taken aback by hearing himself using an expression he’d not used for years. ‘Say what you like! I don’t believe in you or the Christmas story. The idea of there being someone so good and kind as to dispense gifts on everyone is ridiculous. The world is a tough place.’
‘Indeed it is – but there’s always hope.’
‘Not for the dead there isn’t’ said Scrooge indicating to the stranger as he did so the graves that lay scattered around them. The man in the red suit appeared to want to challenge Scrooge’s assertion but Scrooge wasn’t about to let a man he had decided was one bauble short of a fully decorated Christmas tree interrupt him now. ‘The truth is’, Scrooge continued, ‘that in the end the world defeats us all. And just now that most certainly includes me. That said, the idea of their being someone who is as kind as the person you’re claiming to be is, undoubtedly, quite appealing. Wouldn’t it just be heaven if there really was somebody who could bring some genuine joy into this miserable world, who could give us some hope for the future, who could put an end to all this death and disease?’
‘That’s quite a Christmas list you have there Dr Scrooge and you may have to look to someone other than myself for all that’s on it. Nonetheless the less, I’ll see what I can do. In the meantime how about a yo-yo, a penny whistle and this half eaten satsuma that Rudolph mistook for a carrot?’
‘That’s very kind of you Santa’, smiled Scrooge resigning himself now to playing along with the peculiar man who was clearly set on staying in role. ‘I don’t suppose you could sort out the crises in General Practice too could you?’.
‘I’m not sure that I can I’m afraid, not this Christmas at least. But I’ll say this. When you have 55,000 GPs, all of whom are doing their best in incredibly difficult circumstances and others are saying that it still isn’t good enough, then the problem isn’t with GPs. And here’s another thing. You are aware aren’t you that I know who’s been good and who’s been bad this year? Well you GPs, and all those who work alongside you, are most certainly not on my naughty list!’
And with that the man gave a whistle and from out of nowhere a sleigh appeared. It was laden down with presents and was pulled by eight reindeer one of whom had a particularly shiny nose. The man stepped on to the sleigh and took hold of the reigns. Then, with a hearty ‘Ho, ho, ho’, he gave them a sharp tug and a second later he had disappeared from sight leaving a bewildered Scrooge alone once more.
Scrooge stood motionless for a few minutes not knowing quite what to make of what had just happened. What was it about Christmas Eve that in recent years had resulted him repeatedly having such strange encounters? Soon though his thoughts turned to more pressing concerns when he suddenly developed a sharp pain in the side of his chest. He started coughing again and brought up some mucky green sputum which this time, Scrooge noticed, was flecked with blood. Keen to get home, he tried to quicken his pace but it was another twenty five minutes before he eventually found himself outside his house. As he turned the key in the lock and pushed open the front door Scrooge was really rather breathless from his exertions.
Inside it was dark and Scrooge stumbled his way to the lounge where he collapsed into his favourite armchair. He switched on the small lamp that stood on the table next to him and noticed the advent calendar that one of his patients had given him at the beginning of December. The last door was still closed as Scrooge hadn’t had time that morning to open it. He peeled it back now revealing a picture of a new born baby lying in a manger but Scrooge paid no attention to the scripture verse that was written on the inside of the door. Instead, conscious that his breathing had deteriorated still further, Scrooge reached into his pocket and pulled out the pulse oximeter that he’d placed there earlier and applied it to the index finger of his left hand.
Seeing it record a pulse rate of 128 and an oxygen concentration of just 86%, Scrooge realised that, Christmas Eve or not, now was the time to call for help. He took hold of his phone and tapped out 999 only to hear a message explaining that due to the volume of calls that were currently being received there was nobody immediately available to take his call but that it would be answered as soon as somebody was free. Several minutes went by before somebody eventually responded. After determining what the problem was the call handler assured Scrooge that an ambulance would be dispatched as soon as possible but cautioned him that, due to the unprecedented demand that they were currently experiencing, they may be some delay.
Scrooge sat quietly in the chair feeling himself becoming more and more tired. He looked down at the advent calendar and now noticed the words that were printed on the inside of the door he’d just opened. ‘The light shines in the darkness, and the darkness has not overcome it’. They were the last words Scrooge saw. He found them strangely comforting and, believing them to be true, he managed a smile as, letting go of his hopes and fears, his eyes grew ever more heavy until he eventually fell into a deep, and dreamless sleep.
Outside, up in the sky, the silent stars went by.
*********
Early in the new year the local newspaper reported Scrooge’s death and described how he’d been found by the ambulance crew when they eventually arrived at his home in the early hours of Christmas Day. It had been several hours after Scrooge had made his initial call for help.
His funeral was well attended and many there spoke of how much they had appreciated all that he had done for them. Had he been there it would have cheered Scrooge’s heart. But, of course, he wasn’t. Scrooge was somewhere far better, somewhere where he enjoyed everlasting light and could spend his days resting a while with Mrs Gray or learning the art of encouragement by spiritual visitation from Clarence, the angel he’d met the Christmas before and with whom he had become firm friends.
In time Scrooge took on the role of ‘The Ghost of General Practice at it’s Best’. There was nothing he loved more than visiting GPs and reminding them that, however great their struggle, there was always hope, always something good to enjoy about their work, always some light to be found in the darkness.
So if one Christmas something unaccountable happens, if perhaps a mince pie appears on your desk whilst you’ve been called away to a colleague’s consulting room as a result of their panic button going off for seemingly no reason whatsoever, ask yourself if you too may have been visited by Dr Scrooge, someone who now really is having fun and whose future, like yours, has ‘only just begun’.
THE END.
To read the whole of ‘The Scrooge Chronicles’, click here
Other medically related Christmas themed blogs:
To read ‘How the Grinch and Covid stole General Practices Christmas’, click here
To read ‘Twas the night before Christmas – 2020’, click here
To read ‘A Merry, and Resilient, Christmas’, click here
Ain’t it just like the night to play tricks when you’re tryin’ to be so quiet? We sit here stranded, though we’re all doin’ our best to deny it
Bob Dylan – Visions of Johanna
I’ll spare you the embarrassment of me breaking into song but, as has been made very clear of late, a GPs lot is not an entirely happy one.
The last year and a half has been difficult professionally. And especially so in recent months during which time our workload has rocketed. But although it hasn’t helped, for me at least, it hasn’t simply been the busyness of the job that has made it less enjoyable. Rather it has been how we have been made to work.
I know I’ve banged on about this before but working remotely isn’t a remotely good way to work. It’s not good for our patients and it’s not good for us either.
It’s not good for our patients because, as research has shown, the more distant we are from those we interact with, the less we care about them. And the less we care about them the less we will be inclined to help. I suspect that my concern for my patients has been less this past year than perhaps it once was, and I feel that I’ve not been as good a doctor as a result, not that for one minute I’m suggesting I was ever all that great a one in the first place.
It was Bette Midler who wrote the song ‘From a distance’. In it she suggests that ‘form a distance’ it appears that we all have enough and that no one is in need. ‘From a distance’, she continues, there are no guns, no bombs, and no disease. And it would seem that there are no hungry mouths to feed.
Which only goes to show that ‘from a distance’ we haven’t got a clue about what is really going on. To live our lives separated from what hurts has its appeal of course ‘A rock feels no pain’ sang Simon and Garfunkel, ‘and an island never cries’. Looking on ‘from a distance’ makes life simpler, tidier, less painful. Even so the reality remains that life is generally complicated, it is frequently messy and all too often it hurts.
But being close enough to care makes us better doctors. And being better doctors is ultimately what will make us happier in our work despite the sadness we will undoubtedly experience in the process. That’s not to say that as doctors we will always be able to help. Often we can’t, not, at least in any material way. Henri Nouwen once wrote:
‘When we honestly ask ourselves which persons in our lives mean the most to us, we often find that it is those who, instead of giving advice, solutions, or cures, have chosen rather to share our pain and touch our wounds with a warm and tender hand. The friend who can be silent with us in a moment of despair or confusion, who can stay with us in an hour of grief and bereavement, who can tolerate not knowing, not curing, not healing and face with us the reality of our powerlessness, that is a friend who cares.’
Perhaps that is also the type of GP who cares. One who is not satisfied to look on dispassionately from a distance but who instead is willing perhaps to take a leaf out of the Beatles songbook. One who realises that it is only by letting others into our heart that we can we start to make things better. One who well knows that ‘it’s a fool who plays it cool by making this world a little colder’.
A couple of years ago retirement seemed an age away for me. Now it seems a lot closer. A few weeks back, after chatting about the imminent retirement of one my colleagues, a patient said to me, ‘You’re not thinking of retiring too are you?’. I replied: ‘All the time!’. But my partners needn’t worry, I’ve no immediate plans to go. But it’s only my being able to be close to patients again that will keep me in the job.
Because that’s what I enjoy. I need to enjoy my job, and my patients need me to enjoy my job too. For it is better to be cared for by someone who enjoys their work than someone who is dutifully going through the motions.
So let me hang some of these ideas on an example or two. On things that have brought me pleasure this year.
Firstly there was helping out at the local Covid vaccination centre. Without a doubt the most rewarding work I’ve done this year. To be part of a team doing something so simple and yet so genuinely worthwhile was immensely satisfying. Back then the daily death rate was at its highest – peaking at 1820 in a single day if memory serves me right. At the time it was tempting to console oneself with the thought that it was only the frail and elderly that were actually dying in any numbers, and that as such it somehow didn’t really matter. But in those early days it was the self same frail and elderly that were attending the vaccination centres for their jabs, each a representative of the cohort of people who were largely making up those whose deaths were being reported daily on the news. And what a warm, friendly, appreciative bunch of people they were. ‘From a distance’, it was just old people who were dying. Up close they were a group made up of delightful men and women.
And secondly there was that time up at one of the local nursing homes. I admit to having been a little frustrated to be called to visit a demented old man late one evening at the end of what had already been a busy on call day. He was ninety if he was a day and clearly close to death. The junior nurse showed me his TEP form which suggested that I should be admitting him to hospital but to my mind that seemed a far from sensible course of action. The nurse manager who, incidentally, started working at the home the same year I first worked at my practice, was there that evening. She said how she’d be sad if the man she’d known for 15 years died in hospital. So I spoke to his only relative, a younger brother, who agreed that he should be left where he was and simply kept comfortable. But what I found hugely touching was what the brother said next. ‘I want you know something doctor. That man is my hero – for caring for me when nobody else would.’
He didn’t say ‘He WAS my hero’ – he said ‘He IS my hero’. From a distance the patient was a demented old man with no quality of life, but up close he remained somebody who was someone else’s hero. It was good for me to be at that nursing home that evening. I was glad I was there.
We need to get close to our patients if we are to care for them as people rather than merely manage them as problems. Furthermore getting close to our patients increases the chance of them caring about us. Keeping our distance diminishes our patients even as it dismisses us as doctors. I hope we never think a contactless existence is the goal to which we should aspire.
Because there are too many people living contactless lives already. And some of those lives are immensely sad as a result.
Leonard Cohen, sometimes known as the ‘Godfather of Gloom’ on account for his reputation for writing songs that some consider depressing once wrote: ‘We all love a sad song. Everybody has experienced the defeat of their lives. Nobody has a life that worked out the way they wanted it to. We all begin as the hero of our own dramas in centre stage and inevitably life moves us out of centre stage, defeats the hero, overturns the plot and the strategy and we’re left on the side-lines wondering why we no longer have a part – or want a part – in the whole damn thing. Everybody’s experienced this, and when it’s presented to us sweetly, the feeling moves from heart to heart and we feel less isolated and we feel part of the great human chain which is really involved with the recognition of defeat’.
Sometimes I feel that sense of defeat at work, and sometimes outside of work too. But that’s ok. At least it is in my saner moments. Because I am of course getting older. I’m way passed my best, finished with growing stronger, and done with constantly striving to get better. Mine is a ‘necessary fallibility’. At my next appraisal I hope to talk with my appraiser, not about what I need to improve nor even what I can do to simply maintain the position I now find myself in but rather how I might best manage my inevitable decline! But though being defeated may be painful at times, it is not without meaning. Like Leonard Cohen in his song ‘The Goal’, I need to be able to smile a ‘smile of defeat’. For me that will only come from understanding that it is OK for me to lose when the one by whom I am defeated is one to whom I can happily surrender, one who is able to rule my life far better than I could ever rule it myself and is the one whose own apparent defeat led to what I consider to be the greatest victory of all, that over even death itself.
‘Anthem’ is another of Leonard Cohen’s songs. In it he sings ‘Ring the bells that still can ring, forget your perfect offering. There’s a crack, a crack in everything, that’s how the light gets in.’. I take that to mean that we should be content to do what we can and stop imagining we can ever be perfect. We learn through our mistakes, and sometimes it’s our mistakes that enable us to better understand. Bob Dylan expresses something similar in lines reflecting the fact that he knows he’s getting older and will soon die. ‘It’s not dark yet’ he says, ‘but it’s getting there’. Even so ‘behind every beautiful thing there’s some kind of pain’. I love these songs. I find them helpful. And I think the reason for that is the one that Cohen suggested, the connection that they make between those who feel the same.
I am of course grateful too for all the support that I have received from those I work alongside, both my clinical and non clinical colleagues some of whom are themselves finding life difficult. I hope I am never so wrapped up in my own problems that I am not a support to others. Because I really do like them, they are amongst my best friends and I couldn’t wish for a better bunch of people to go through life with. Or perhaps I could. I wish the colleague who is soon to retire could hang around longer. I am going to miss him. When he’s not there. Hugely. Because not only is he the best doctor I have ever had the pleasure to work with but he has also been a genuine and generous friend, someone I have known I could ring anytime day or night if I had need. And over the last twenty five years there have been times when I have had just such a need. When we first met in 1996 he promised me that he’d make me a millionaire as a result of some scheme he had back then of exporting medicines to America. Well I’m still waiting for that but I’ll forgive him because his friendship has been worth vastly more than a mere million pounds. His replacement has big shoes to fill!
But before you imagine that my life is all doom and gloom, let me assure you it’s not. Somerset had quite a good season this year and I enjoyed introducing my sons girlfriend to the joys of singing ‘Sweet Caroline’ with thousands of others one memorable August evening at the county ground in Taunton. There was the evening of laughter with my wife watching Ed Byrne at a packed Bridgwater Art Centre. Hilarious! And Bob Dylan recently had a cracking new album out and, at the age of 80, 24 years after he first noted the light was fading, he has, perhaps optimistically, just announced a new three year world tour. Hopefully I’ll get to see him on stage once more before he dies – because everything is better done live. The Korean food beautifully cooked by my daughter is best experienced when tasted rather than when seen via a photo shared on messenger. Things done remotely don’t come close! Oh and I nearly forgot, I have become a grandad too and after a hairy start my grandson is doing just fine. He too can now smile as well as cry. I’ve some lovely photos I could show you but he’s even more gorgeous in the flesh. It feels good to hold him.
In what has been a difficult year, these are things that have brought me pleasure. I have long considered that we make a mistake if we wait until there is nothing in life that makes us sad before we allow ourselves to be happy. Because, as it seems to me, happiness and sadness sit constantly alongside one another, we must allow ourselves to be happy even though there are things that make us sad just as we must allow ourselves to be sad even though there are things that make us happy.
Finally back to that song by Bette Midler. For me the saddest lines of the song are the ones suggesting that God is watching us from a distance. I don’t believe that’s true. Rather, I believe that He is close, intimately involved in my life, in all our lives and indeed in the lives of those who are struggling in circumstances far, far greater than our own. And though I’m aware that not everyone will share my faith I nonetheless believe that God really does knows what we are all facing, that He is in absolute control of it all, and that He will ultimately make everything right.
Written shortly before his death, ‘You want it darker’ contains, for me, one of Leonard Cohen’s finest lines. It goes like this: ‘There is a lullaby for suffering and a paradox to blame. But it’s written in the scriptures and it’s not some idle claim’
And it’s in those scriptures that I read that though weeping may tarry for the night, joy will come with the morning, that though I may fall I will nonetheless one day rise and that a day is coming when God will wipe away every tear from our eyes, and death shall be no more.
It’s promises like these that provide me with the hope I need to enable me to keep on keeping on irrespective of how dark it sometimes still seems.
And, from where I’m standing, I reckon that we can all have good cause to believe that that hope, that ‘hope of hopes’, is one which is very well founded indeed.
And so, for me at least, for this and for many other reasons, a GPs lot is not an entirely unhappy one either.
Once upon a time there was a Miller and he lived in a house with his only daughter Nessie. Though her name was but a poor approximation to that of the well known healthcare organisation that she is meant to personify in the tale that follows, Nessie was renowned throughout the land for her great beauty. But hers was not just skin deep, rather hers was a beauty that ran deep, a beauty that was most clearly seen in the way she sought to tend to the sick who came to her for help – a help that was always free at the point of need.
Her father loved Nessie and enjoyed nothing more than to boast of her beauty. ‘My daughter’, he would say to any who cared to listen, ‘is the envy of the world. No matter what ails you, Nessie will make you well. She will solve all your problems, big and small’.
This though was not strictly true. But the Miller was so insistent that Nessie really could solve everybody’s every problem, that, in time, many began to believe that it really was so.
One day the King was visiting the village where the Miller and his daughter lived and heard Nessie’s father exalting his daughter’s charms. The King asked the Miller if what he was saying was true and the Miller, hoping that if he were to find favour with the King he might be richly rewarded, assured him that it was.
‘Then bring your daughter to me tomorrow’, said the King, ‘and if I find that what you say is indeed true I will give you half my kingdom.’
And so, early the next morning the Miller and his daughter made their way to the king’s castle where Nessie said goodbye to her father and promised him that, as far as she was able, she would do all that the King asked of her.
Nessie was then led to the great hall where the King was sat upon his throne. The King then showed her to a large room in which lay dozens of people each clearly suffering from some disease or another.
‘Do you see these poor souls?’, the King asked Nessie. ‘It is my wish that you would make them all well by morning. If you succeed I will show you kindness. But if you fail you will be locked in the highest tower of the castle and you will never see your father again’.
With that the King left the room and, locking the door behind him, left Nessie with the sick individuals who were coughing and vomiting in front of her.
Nessie did not know where to begin for in truth she had but a rudimentary knowledge of medicine. She looked around her in the hope of finding somebody who might be able to help but, finding no one, she fell to her knees and started to cry.
But she had not been crying long when she felt a tap on her shoulder and, looking up, saw behind her a wizened old imp like figure who was wearing a tunic, tight stockings and pointed leather boots.
‘Who are you?’ Nessie asked the stranger, ‘And why are you here?’
‘As it happens I’m the Professor of Medicine at the local university. And I have come to help you make all these people well. But it will cost you. If I help you fulfil the king’s wishes you must promise me that you will give up something that is important to you. Might I suggest your lunch break?’
Nessie readily agreed and so the peculiar fellow began to teach Nessie the basics of antibiotic prescribing and how to administer parenteral antiemetics. Nessie started to put into practice all that she had been taught and soon all those who had been unwell were beginning to feel very much better. When she had finished tending to the last patient Nessie looked around for the Professor of Medicine in order to thank him for all his help but he was nowhere to be found. He had disappeared as mysteriously as he’d appeared the evening before.
When at last morning came and the king returned to the room he was delighted to find that all those who had been unwell were now completely cured. He rewarded Nessie with the most marvellous breakfast before leading her to a luxurious bedroom. There Nessie climbed into the bed, the largest and most comfortable that she had ever seen, and fell instantly asleep.
That evening Nessie was once again brought before the King who once again showed her to a room. This one was several times larger than the one in which she’d spent the previous night. Within it were hundreds of people, each one clenching their chests, gasping for breath and turning a far from healthy shade of grey.
‘Do you see these poor souls?’, the King asked Nessie. ‘I command that you make them all well. If you succeed then I will not treat you harshly. But if by morning you have failed in your task then you will be locked in the highest tower of the castle and you will never see anyone ever again’.
Once again the King left Nessie in the room and locked the door behind him. Nessie looked around for someone to help but finding no one sank once more to her knees and started to cry.
But it wasn’t long before she again felt a tap on her shoulder and looking up saw once more the strange looking man who had visited her the night before.
‘If you like, I can help you again’, the strange looking figure said to Nessie, grinning at her in a way that made her feel a little uncomfortable. ‘But it will cost you. If I help you fulfil the King’s command you must promise me that you will give up something that is important to you. Might I suggest your evenings and weekends?’
Nessie had no choice but to agree and soon she was being taught how to insert cardiac stents into coronary arteries, all that is required for the secondary prevention of cardiovascular disease and, on at least a couple of occasions, the timely administration of CPR and the effective use of a defibrillator. By morning everyone was fit and well and in the corner of the room was a mountain of GTN sprays that the patients found they no longer required. Smiling contentedly to herself Nessie looked round for the Professor of Medicine but found once more that he had mysteriously disappeared.
Soon the King arrived and was again delighted to see all those who had seemed so close to death the night before now looking so hail and hearty. Nessie was looking forward to a hearty breakfast and a restful sleep but instead the King led her to a small pokey office and insisted she write up comprehensive case notes on all those she’d spent the night treating and then produce a report explaining why three patients still hadn’t had their cholesterol reduced to optimal levels.
At the end of the day Nessie felt more tired than she’d ever felt before but still there was no time for her to rest. Instead she was once more brought before the King who showed her to yet another room. This one was several times larger than even the one she had spent her second night in the castle. And the room was heaving, filled with thousands upon thousands of people, many of whom looked close to death.
‘Do you see these poor souls?’, the King asked Nessie. ‘I demand that you make them all well. If you succeed then I will know that I can ask even more of you tomorrow night. But if by morning you have failed in your task then you will be locked in the highest tower of the castle and you will never see the light of day again’.
Once more the King left Nessie in the room and locked the door behind him. Nessie looked at the people who filled every inch of floor space before her. As well as the many who looked extremely unwell, Nessie noticed that there were some who seemed only a little poorly and who she thought she could probably manage to treat with her current level of medical knowledge. Even so, Nessie knew that, even with help, she couldn’t hope to come close to curing everyone by morning.
In addition to those who were clearly in need of some medical attention, there were many others who Nessie thought could expect to get better without medical attention. As she talked to them, she discovered that they had come along because they were worried that their symptoms could be due to some more sinister underlying disorder. A wizened old imp like man, one with an undeniably curious way of dressing, had, it seemed, encouraged them to come, advising them that they really ought to be checked over because, as he had told them, ‘One really can’t be too careful’.
As Nessie chatted with the good folk who were gathered before her she also came across many who seemed to be completely well but who nonetheless had problems which, though genuine, didn’t seem to Nessie to require a medical solution at all. ‘Why’, Nessie wondered to herself ‘does the King expect me to be able to solve all these problems by myself. And why isn’t he here to help. Rather than simply burdening me, couldn’t he lend a hand. After all, as far as I can tell, many of the problems that these people are experiencing are down to how he’s choosing to run his kingdom.’
Nessie looked behind her hoping that the Professor of Medicine might once again be found there tapping her on the shoulder. But, alas, tonight he was nowhere to be seen. In the face of such demand not even medicine appeared to help.
Nessie realised then that she didn’t know the Professor of Medicine’s actual name. Mind you, she didn’t much care, she had plenty of names she could think of for the one who, having created such demand, had now abandoned her when she needed him most.
Tonight then, there was nothing for it. Nessie would have to go it alone. Even so, stretched as she was, she knew that good medicine would in large measure have to go out of the window. The room had but one and, looking through it, Nessie could see a long line of ambulances queuing far into the distance each one containing yet more individuals bringing with them their own unique and pressing needs.
Nessie’s heart sank. She’d already given up her lunch breaks, her evenings and her weekends. Now it seemed she would have to give up everything, trapped in a system she could not hope to ever escape.
And so Nessie fell to her knees for one final time. And she wondered if she’d ever get up off them again.
After ‘Rumplestiltskin’ by The Brothers Grimm.
Other GP related stories:
To read ‘The Happy Practice – A Cautionary Tale’, click here
To read ‘The Three Little GPs and the Big Bad Secretary of State for Health’, click here
Once upon a time, not so very long ago, in a town close to where you live, there was a medical centre. It was positioned at the top of a hill where the people of the town could look up and see it as they went daily about their business. The people loved the medical centre and even those who rarely made use of it were glad to know that it was there. Even the Mayor spoke of how much it was valued and loved nothing more than to court popularity by praising its beauty. In time the medical centre became known as ‘The Happy Practice’ and the people would, on occasions, show their appreciation for all that it stood for by stepping outside of their homes and applauding all those who worked there.
But the ‘The Happy Practice’ was not really so happy because it was all too aware of how great the suffering was of so many of the people who lived in the town. One day, aware of the medical centre’s sadness and conscious of his own, having himself been disappointed by love, Dr Swallow, joined the practice in the hope that he might find some consolation for what might have been in his life by being a help in the lives of others.
The work was hard and Dr Swallow found that he was invariably tired by the end of the day. Even so, such was the sense of satisfaction that he gained from serving others that he found that he was always contentedly looking forward to the following day’s work when each night he at last came to rest his head on his pillow before slipping into a deep and peaceful sleep,
But no matter how hard he worked the suffering of the people never ended. And so the time inevitably cane when the medical centre asked Dr Swallow and all the others who worked there with him if they would do just a little more. And because they all wanted to help if they possibly could, Dr Sparrow and all his colleagues agreed.
So the doctors, the nurses, and the HCAs, the receptionists, the admin staff and the practice managers, they all worked a little harder. And as they did so they all grew a little more tired. The joy of the job began to wane a little as the time available to spend with friends began to be cut short and family occasions were not always made.
But despite their efforts the suffering of the people still continued. And soon the Mayor told the medical centre that it had to try and do more. And so, as well as working longer hours, Dr Swallow and those he worked with began to provide ever more complex care, care that once had only been given in hospitals. Everybody tried to do their very best but, with more to do but no more time to do it, sometimes things could not be done as quickly or as well as would have been like. In time a few of the people in the town started to become a little frustrated by ‘The Happy Practice’ and the Mayor began to say that he now thought the medical centre was not such a thing of beauty after all.
Meanwhile Dr Swallow and his colleagues just kept on – working ever more hard and growing ever more tired. So tired, in fact, that sometimes they couldn’t sleep at all.
But no matter how much the medical centre tried to meet the needs of those who came to them for help, the suffering of the people continued. The requests for help kept on coming, not only from the people but also from those who courted the favour of those who suffered despite they themselves being the cause of that suffering.
And soon the requests became demands with the Mayor warning the medical centre that it would ‘suffer the consequences’ if it didn’t work harder, if it didn’t do better.
So the medical centre strived all the more to provide all that was being asked of it even though, without the necessary additional sources, it became increasingly difficult to do so. Waiting times steadily increased until, in time, the delays which once were merely inconvenient for the people became unacceptable. Seriously unacceptable. Soon even ambulances were unavailable to attend the critically unwell.
But rather than being supported to do the job that was being asked of it, the medical centre was merely blamed for anything that went wrong. Even the local press joined the clamour insisting that the practice should deliver the impossible. A long letter was written claiming that the problem was simply the sheer laziness of those who worked there. Everyone quoted it so full was it of arguments that nobody understood.
And so in time, more and more of those who worked at what now could no longer truthfully be called ‘The Happy Practice’ became so tired that they were no longer able to work at all. Soon, understandably, they began to give notice, leaving behind an ever more struggling healthcare team.
And ‘The Happy Practice’ became less happy still. So unhappy that to many it became unsightly, something that many no longer seemed proud to have situated at the top of the hill in their town. The people no longer applauded and, though many, even most, remained quietly appreciative, not infrequently the sound now heard on the doorsteps of the people’s homes was that of criticism. And from a few, there came a hostility that would not even have been imagined possible only a few years previously.
And slowly the heart of ‘The Happy Practice’ was broken. And Dr Swallow decided one night to finally call it a day.
Soon after the Mayor, declaring that it was nothing but a disgrace, decreed that ‘The Happy Practice’ be pulled down. He insisted it was for the best. But he was wrong – it wasn’t for the best at all. For what had once been admired and appreciated soon came to be greatly missed by the people of the town. For, though their still suffered, and in time increasingly so, they no longer had anywhere to go for help.
Not now that Dr Swallow and the ‘The Happy Practice’ were gone.
Forever.
After Oscar Wilde’s ‘The Happy Prince’
But with the Guardian reporting that 23% of GPs are set to retire in the next few years this is not a fairy tale. And, as with Wilde’s original, not all stories can be guaranteed to have a wholly happy ending. If General Practice falls, the NHS falls too
Other GP related stories:
To read ‘The Three Little GPs and the Big Bad Secretary of State for Health’, click here
As coronavirus cases climb And locked down it feels we’re doing time How I long to take your hand in mine To make you feel my love
As the news it goes from bad to worse And we lose those things we cherish most How I wish that I could hold you close To make you feel my love
They say restrictions they must stay for now And so imprisoned we must be They say one day that it will end, but how If nobody has the key
And so behind a mask we still must hide Concealing all of the tears we’ve cried Until I walk again close by your side And let you feel my love
Instrumental
The world is changing as is plain to see Much that is precious has been lost Perhaps some day we’ll all be virus free But what will have been the cost
How much longer must we live like this? How much longer must your touch I miss? I hope that one day soon your lips I’ll kiss To make you feel my love To make you feel my love
IMAGINE COVID
Imagine there’s a.country It’s easy if you try Where you must not give comfort To grieving ones who cry
Imagine all the people Living all alone
Imagine loved ones dying It isn’t hard to do Who as they face their final days Are kept from seeing you
Imagine all the people Kept always apart
You may say that I’m mistaken That these thing could never be But take a look around you It’s already plain to see
Imagine no more parties No sport, no theatre too No singing songs together What would you find to do?
Imagine all the people Scared to show their face
Imagine empty high streets No parks for kids to play No jobs for those without them So unemployed they’ll stay
Imagine all the people Living lives concealed
You may say that we’ve no option If we are to all survive But if this is what is called living Do we really want to be alive?
Now know that there’s a heaven A better place to be No pain no death no sorrow A place where we’ll be free
Imagine all the people Living there at peace
You may say that I’m a dreamer Well I’m not the only one I hope some day you’ll join us And the world will be as one
LOCKDOWN DAY
Just a lockdown day I don’t try to, even dress Just eat and drink, to excess That ain’t on
Just a lockdown day Spend the time, so alone Can’t do this all on my own It’s no fun
Oh, it’s such a lockdown day (I wish) I could spend it with you All of these lockdown days They just keep lingering on They just keep us lingering on
Just a lockdown day Loved ones I long to see All of them kept from me For too long
Just a lockdown day Sadness fills every hour Freedom no longer ours It’s all gone
Oh, it’s such a lockdown day (I wish) I could spend it with you All of these lockdown days They just keep lingering on They just keep us lingering on
We’re going to reap, just what we sow We’re going to reap, just what we sow We’re going to reap, just what we sow We’re going to reap, just what we sow
After Lou Reed
As you’ll have noticed all three of these songs are available on YouTube. They’re best not experienced whilst locked in and alone. Help should be at hand!
For more song adaptations please follow the links below:
I’ve been a GP now for many a year To all the NICE guidelines I’ve tried to adhere But I’ve no idea why the CQC thinks That urine samples can’t be poured down our sinks.
And it’s no, nay, never No, nay never no more Will I play the wild GP No never no more
East Quay is a practice in Bridgwater town The patients are lovely, the river is brown At EQMC we all work as a team And everyone’s awesome except for Doreen*
And it’s no, nay, never No, nay never no more Will I play the wild GP No never no more
Each day you will find us we’re all hard at work The phones in reception are going berserk The patients who ring in then all indicate The hue of the phlegm that they expectorate
And it’s no, nay, never No, nay never no more Will I play the wild GP No never no more
These days of pandemic have made us all sad But not everything at the practice is bad The one very good thing ‘bout Covid 19 Is now our door handles are shiny and clean
And it’s no, nay, never No, nay never no more Will I play the wild GP No never no more
We all wear our masks and our gloves of bright blue My glasses mist over obscuring my view But please do not worry, though blind I’ll not stop I’ll still somehow muddle through your minor op
And it’s no, nay, never No, nay never no more Will I play the wild GP No never no more
When busy on call days make stress levels rise To drink too much coffee is really not wise For there’s every chance when one’s bladder is full There won’t be the time to answer nature’s call
And it’s no, nay, never No, nay never no more Will I play the wild GP No never no more
On duty doc days though we’re jolly and bright We’re cheery, and smiley, we’re just a delight We grin and we laugh and we’re happy and gay But that’s only when it’s the end of the day
And it’s no, nay, never No, nay never no more Will I play the wild GP No never no more
And it’s no, nay, never No, nay never no more Will I play the wild GP No never no more
*With apologies to ‘The Dubliners’…and Doreen who, though I wouldn’t want her to hear me say so, is actually awful awesome too!
The picture above is a photo of Luke Kelly one of the founding members of The Dubliners.
An audio version of this song can be found here:
For more song adaptations and woeful attempts at poetry, all with a GP flavour, please follow the links below:
Once upon a time there were three young doctors who set out to be GPs.
The first little GP built his practice on enthusiasm.
One day the big bad Secretary of State for Health came knocking on the door of the practice where the first little GP was busy working hard.
‘Little GP, Little GP, let me come in’, said the the big bad Secretary of State for Health.
‘Not by the hairs on my chinny chin chin’, replied the first little GP.
‘Then I’ll huff, and I’ll puff, and I’ll bring your practice down’, said the Secretary of State for Health.
And with that the big bad Secretary of State for Health huffed and he puffed and, as a result of years of systemic underfunding of primary care services, he brought the first little GPs practice down. The first little GP had no enthusiasm left to rebuild the practice so he took a job as a barista in a local coffee shop instead.
As well as enthusiasm, the second little GP built his practice on good will.
One day the big bad Secretary of State for Health came knocking on the door of the practice where the second little GP was busy working hard.
‘Little GP, Little GP, let me come in’, said the the big bad Secretary of State for Health.
‘Not by the hairs on my chinny chin chin’, replied the second little GP.
‘Then I’ll huff, and I’ll puff, and I’ll bring your practice down’, said the Secretary of State for Health.
And with that the big bad Secretary of State for Health huffed and he puffed and, by introducing more and more red tape which made it increasingly difficult to get on with the job of caring for patients, he brought the second little GPs practice down. The second little GP had no good will left to rebuild the practice so he took a job stacking shelves in a local supermarket instead.
As well as enthusiasm and good will, the third little GP built his practice on evidence based medicine, an exceptional ability to adapt to change and large amounts of pragmatism and common sense.
One day the big bad Secretary of State for Health came knocking on the door of the practice where the third little GP was busy working hard.
‘Little GP, Little GP, let me come in’, said the the big bad Secretary of State for Health.
‘Not by the hairs on my chinny chin chin’, replied the third little GP.
‘Then I’ll huff, and I’ll puff, and I’ll bring your practice down’, said the Secretary of State for Health.
And with that the big bad Secretary of State for Health huffed and he puffed and announced that GP surgeries would be open in the evenings and on Saturday mornings for routine care.
But although the practice shook a little, the third little GPs practice stood firm.
The Secretary of State looked unhappy. He knocked on the door of the third little pigs practice again and, in as sweet a voice as he could manage, promised the third little GP lots of extra GPs to help get all the work done.
But no extra GPs were forthcoming and the big bad Secretary of State for Health stopped pretending to be nice.
And he began to huff and puff a second time.
This time he tacitly supported a media campaign making GPs out to be lazy ne’er do wells who were being paid large salaries whilst hiding behind locked doors and refusing to see those patients they were supposed to care for.
And again the third little GPs practice was shaken. But still, even with morale at an all time low, it did not collapse.
So the big bad Secretary of State for Health started to huff and puff for a third time and demanded that, despite the fact that they were working harder than ever before, little GPs across the country must work even harder still and promised to ‘name and shame’ any he felt weren’t pulling their weight.
And again the third little GPs practice was shaken. But still, even though it was on its knees, it did not collapse.
The third little GP carried on working and with the rest of the practice team did as good a job as they possibly could. But, over time, fewer and fewer young doctors decided to become GPs and as those who continued to work came to retire, many sooner than they had planned as the result of the job becoming ever more impossible, General Practice eventually was no longer sustainable and so became a thing of the past.
And the big bad Secretary of State for Health was happy at last.
But everyone else was sad and nobody lived happily ever after.
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 sat there 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 he clambered onto a chair and began 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:
This is the second of three stories making up the Dr Mungo Chronicles. It is preceded by ‘Mr Benn – the GP’ and is followed by ‘Scooby Doo and the Deserted Medical Centre’. A forth story, ‘Paddington and the Ailing Elderly Relative’, links ‘The Dr Mungo Chronicles’ with ‘The Dr Scrooge Chronicles’.
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.
HABITAT
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.
IDENTIFICATION:
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.
BEHAVIOUR:
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’.
DIET
By day GPs are largely dependent on the coffee and custard creams brought to them by kindly receptionists at designated feeding 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.
LIFECYCLE:
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.
SURVIVAL PROSPECTS:
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
Related posts:
To read ‘Professor Ian Aird – A Time To Die?’, click here
Patients you help and who start to feel better When you receive an appreciative letter Duty doc days when the fat lady sings These are a few of my most favourite things
Those in the office who suffer frustration Making some sense of my dodgy dictation Those in reception whose phone always rings These are a few of my most favourite things
Helpful consultants who hear my entreaties Practice Nurses who can treat diabetes She who each morning hot coffee me brings These are a few of my most favourite things
When the day’s hard And I’m left scarred And I’m feeling sad I simply remember my most favourite things And then I don’t feel so bad
Health care assistants who though lunch approaches Don’t meet my heart trace requests with reproaches Stories of patients with happy endings These are a few of my most favourite things
Patients who know of my love of malt whiskey How every evening my dog shows he’s missed me Those who each year send me Christmas greetings These are a few of my most favourite things
Those on the days that the workload it tests you Friends who are colleagues who come to your rescue Managers skilled at what work at them flings These are a few of my most favourite things
When the press lies It’s no sur-prise That I’m feeling blue But then I remember my most favourite things And focus on what is true.
After Oscar Hammerstein II and Richard Rodgers
For more song adaptations and woeful attempts at poetry, all with a GP flavour, please follow the links below:
Fifty plus phone calls to make of a morning CQC visits with too little warning He who a very long problem list brings These are a few of my least favourite things
Not enough bottles now for venesection Those who are rude to the staff in reception Just one appointment for several siblings These are a few of my least favourite things
Visit requests at the end of the hard days Ambulance shortages causing long delays Slurs that at GPs the press daily slings These are a few of my least favourite things
When the day’s done And the blood’s spun And I’m feeling glad I simply remember my least favourite things And then, very soon, I’m sad
Long waiting times to be seen in outpatients Early requests for repeat stupefacients Headlines inflating a GP’s earnings These are a few of my least favourite things
Busy on call days with patients too numerous MPs who don’t know their glutes from their humerus Fitted Mirenas with no sign of strings These are a few of my least favourite things
Lies about lazy GPs in the papers Flatulent folk with their foul smelling vapours Replacing PVC pessary rings These are a few of my least favourite things
When the week ends And I’m with friends And I’m feeling high I simply remember my least favourite things And then I begin to cry
After Oscar Hammerstein II and Richard Rodgers
For more song adaptations and woeful attempts at poetry, all with a GP flavour, please follow the links below:
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
Are GP dreams so hard to beat? Every patient that I ever meet I long to see them, see them face to face Cos as a GP I’m ideally placed
I’m gonna consult, gonna use techniques Get GP kicks right through the week
To understand them, my heart it yearns All their ideas and their concerns And I feel a deep frustration ‘Till I know their expectations
I’m gonna listen, gonna let you speak Get GP kicks right through the week, all right
When the CQC inspector calls Everybody briefly keeps the rules And so from him at his insistence I’m glad to keep my social distance
For a rating, one of good, I’ll seek Get GP kicks right through the week
With too much work and too little time And with criticism on the climb I’ll see the patients that I really should And try to see in that there’s something good
And though the future, though the future’s bleak Get GP kicks right through the week, all right
And though the future, though the future’s bleak Get GP kicks right through the week, all right
After ‘The Undertones’.
An audio version of this song is available by following the link below:
Sitting at my desk and feeling low Sometimes I’d like to quit Work into the time won’t fit Too much to do Working the whole day through On call days and Mondays always get me down
What I did I used to find worthwhile Could always have done more Now it just feels a chore Get the job done Now it’s no longer fun On call days and Mondays always get me down
Sadly, every week it seems it ends up much the same Demands constantly made on me Sadly, now the job’s like this, it’s really such a shame It’s not how it ever should be
What I feel I’ve never felt before No need to talk it out We know what it’s all about Its all a mess Criticism in the press On call days and Mondays always get me down
Sadly, now the job’s like this, it’s really such a shame It’s not how it ever should be
What I feel I’ve never felt before No need to talk it out We know what it’s all about Its all a mess Criticism in the press On call days and Mondays always get me down
Its all a mess Criticism in the press On call days and Mondays always get me down
Do you remember? Seeing all your patients face to face Do you remember? Working at a manageable pace Do you remember? Operations happening when planned Do you remember? Plentiful blood bottles close to hand
By the way, how did it all go wrong? Please excuse me, it never should have gone so wrong So sorry, it never should have gone so wrong But it went wrong
GPs, will the day come when we’re sorry When GPs we can’t ever again for you send We just can’t go on still thinking That’s it’s time for your natural end GPs, oh we never thought we’d miss you And GPs we can not simply always pretend That by asking of you more and more It won’t come to a bitter end
Do you remember? Needing not to wear those bright blue gloves Do you remember? Work was then still one of your great loves Do you remember? Being trusted to do what was right Do you remember? When your GP future was still bright
By the way, how did it all go wrong? Please excuse me, it never should have gone so wrong So sorry, it never should have gone so wrong But it went wrong
GPs, we just want to say we’re sorry But GPs now we can’t get through on the phone We hear how now you’re far too busy And you’re late every day getting home GPs, we’ll now try to write a thank you GPs, it’s so important to us, now you’re gone Maybe it can say that you were right And can say just how we were wrong
~~~
Blood bottles red dilly dilly Blood bottles blue When they are gone dilly dilly What will we do? A penny for your thoughts my dear A penny for your thoughts my dear I’ve no clue for you love I’ve no clue for you love
This tale is Part Three of ‘Scrooge in the Time of Coronavirus’ which is Book Two of ‘The Dr Scrooge Chronicles’. Book One is entitled ‘A Primary Care Christmas Carol’.
To read ‘A Primary Care Christmas Carol ’, click here.
To read Part One of ‘ Scrooge in the Time of Coronavirus’ which is entitled ‘A Tale of Two Patients’, click here.
To read Part Two of ‘Scrooge in the Time of Coronavirus’, which is entitled ‘It’s A Wonderful GP Life’, click here.
BLEAK PRACTICE
in which Scrooge considers calling it a day
Dr Scrooge was tired. All the time tired. He was more tired than a myxoedematous narcoleptic with sleep apnoea who’d just completed a week of nights. He was tired of Covid, he was tired of work, and increasingly he was tired of life.
It was just gone eight and he was alone in the practice catching up on paperwork at the end of a long day on call. Only it wasn’t the end as he was still left with a home visit to do. And to make matters worse he was supposed to be gathering with Dr Cratchit and a few other friends that evening to celebrate a friends eightieth birthday. ‘Looks like I’m going to be late for another social event’ he sighed to himself as he picked up his bag and the printout of the patient’s details that had been bought to him, along with a consolatory custard cream by the receptionist just before she’d left an hour or so previously.
As he left the building it was beginning to rain and the last light of the day was beginning to fade. Scrooge got into his car and drove out of the car park at the back of the surgery premises and began to make his way to the nursing home where the patient he was visiting lived. The staff there had insisted the man be seen on account of him just not seeming himself and Scrooge had been too worn down by the busyness of the day to do anything but agree to the visit even though he’d felt there would be little point in visiting somebody who he couldn’t help thinking, from his cursory scanning of the notes, was just a demented old man who’s life meant nothing now that all he did all day was sit in a chair.
Scrooge’s frustration increased still further as, barely having started out on his journey he was held up by traffic lights. The red light reflecting on the wet road seemed to goad him into thinking what he’d been considering for some little while. ‘Perhaps it really is now time for me to just stop’, he muttered to himself. ‘After all I could always make ends meet by exploiting the black market in blood sample bottles’.
The year had been a hard one. Though positive swab results of Covid tests continued to appear daily in his inbox, Scrooge hadn’t seen anyone ill with the disease for several months. Even so workload was higher than he’d ever known it to be and he no longer felt he was doing a good job. There just wasn’t the necessary time to give to patients. Earlier in the year he’d worked sessions at the local vaccination centre and had derived great pleasure from doing so, but now he found no satisfaction in rushing headlong through the seemingly endless list of patients that daily presented themselves to him only to later hear in the media how GPs were hiding away from their patients, supposedly behind locked doors. And it looked like it was all about to get a lot worse now that a neighbouring practice had collapsed and he and Bob had been forced to accept several hundred additional patients onto their practice list, including the man he was now on his way to see. With no additional staff to deal with what amounted to an overnight increase of 10% to the practice list, Scrooge wondered how he and all his clinical and non clinical colleagues would cope with the inevitable additional work. No wonder that even his excellent practice manager was now beginning to feel the strain.
It was the worst of times, it really was the worst of times.
As the car idled Scrooge realised that he had long since given up any hope of his turning out to be the hero of his own life and remembered instead something he’d once read about how everybody eventually experiences the defeat of their lives. Perhaps that was what he was now recognising to be the case for himself. His appraisal was coming up soon and, rather than discussing with his appraiser how he might look to improve over the coming year, Scrooge thought that perhaps it was time to get real and instead take the opportunity to discuss how he might best manage his now inevitable decline.
As the traffic lights changed Scrooge continued on his way and within ten minutes he was pulling up outside the nursing home. The rain continued to fall as he climbed out of the car and hurried to the front door. He pressed the doorbell and, as he waited to be let in, he donned the mask, ridiculous plastic apron and blue surgical gloves that purported to be PPE but only managed to make him look like some sinister Smurf with a burgeoning interest in basic butchery.
Eventually he was let in and led to a small room on the second floor of the old building that, over the years he had visited countless times. The room was a barren affair, sparsely furnished with the only decoration being a few framed verses of scripture urging the reader to remember that there was always reasons for hope in even the darkest of days. ‘If only’ thought Scrooge as he turned his eyes towards the frail elderly man he had come to see who sat hunched in a chair with his eyes closed and his mouth wide open. He saw and said nothing. Scrooge walked over to him and, crouching by his side, attempted to make conversation though, even as he did so, he knew there was little prospect of any meaningful communication. Scrooge examined the man but found no specific cause to account for his increasingly frail condition other than the all too apparent dementia that had brought him to the home some years previously. The man was clearly coming to the end of his life.
Stepping back outside of the room, Scrooge explained his findings to the young nurse who had been accompanying him. She passed him the patients treatment escalation plan on which was stated that hospital transfer should be considered in the event of his becoming unwell.
‘Shall I get his things together whilst you call the ambulance?’ the nurse asked. ‘How long do you think it will be?’
Scrooge’s heart sank. He’d been in this situation before, where what was written on the TEP form seemed inappropriate and, rather than helping to make decisions, only succeeded in making things harder. Surely admission wasn’t in the man’s best interests and yet to go against what was clearly written down made Scrooge feel uncomfortable.
The pair walked back along the carpeted corridors to the office where he recognised the familiar face of one of the senior members of the nursing staff who had worked at the home for as long as Scrooge could remember.
‘What do you think Clare?’ he asked her, ‘It can’t be right that we admit the poor chap can it?’
Clare looked up from the desk where she was sat. ‘All I can say’, she replied, ‘is that I’ve known Harry for a very long time, ever since he arrived here I forget how many years ago. And I’d be sad if he died in hospital’.
That was enough for Scrooge. Even so he thought he would try to speak to a member of the elderly man’s family, just to make sure they felt the same way that he did.
‘Do you know who his next of kin is?’ Scrooge asked Clare. ‘Is there anybody at all I can talk to’.
‘There aren’t any children, Harry never married. But there is a younger brother who visits him regularly’. Clare flipped her way through Harry’s file and found the number and, passing it to Scrooge. added ‘Just press ‘9’ for an outside line’.
Scrooge picked up the phone and made the call. After a few rings it was answered and Scrooge introduced himself to somebody whose gentle elderly voice confirmed he was indeed Harry’s brother.
‘I’m sorry to bother you at this time in the evening’, Scrooge began, ‘but it’s about your brother. I’ve been called to see him and I’m afraid he’s not at all well.’
‘He’s not been well for a long time Doctor. It’s his age you see. That and the dementia. It’s been years since he was the man I once knew.’
Scrooge smiled to himself realising already that this conversation was not going to be as difficult as he had feared.
‘I understand’, Scrooge continued, ‘but Harry’s deteriorated rather a lot of late and if I’m honest I think he’s only likely to get worse over the next day or two. I thought you ought to know, just in case you wanted to pop over and see him. Unless of course you thought he ought to be admitted to hospital. The thing is I have a bit of paper here which suggests that some discussions were had previously and that it was felt then that, if he were he to become more unwell, Harry would want to be admitted. But I really don’t think the hospital would be able to do a great deal for Harry and I’m not sure that sending him in now would really be the best thing for your brother’.
‘Please don’t send him to hospital doctor – he wouldn’t want it. It’s like this you see. When you’re old, eventually it happens that the only thing you’re left with is your memories, and Harry, well he hasn’t even got those anymore. They’ll look after him well in the home. Leave him with those who know him best.’
The line went silent for a few seconds and then Harry’s brother spoke again, this time his voice wavering a little as he tried to control the tears.
‘Can I tell you something Doctor? You might look at Harry and think he’s just a demented old man, but I want you to know that that demented old man is still my hero. Always has been – always will be. When I was a boy he looked after me when there wasn’t anybody else who could. He was a good man. And he still is. Even now that his time has come’.
The two men chatted on a little longer before Scrooge eventually put down the phone. He relayed the nature of the conversation to Clare and it was agreed that Harry would stay where he was and the staff would continue to care for him just as they had for many years already. Scrooge updated the TEP form and, though he didn’t imagine they’d be necessary, wrote up some ‘just in case’ medications before saying his goodbyes.
Back in his car Scrooge thought about what had just happened. He remembered those words on the wall of Harry’s room, words that his brother had said both he and Harry still believed. Maybe there was cause for hope in dark days after all, even at that moment of apparent defeat. And perhaps, as was the case with Harry, even in the years of one’s inevitable decline, you could remain someone of worth, someone who was still both loved and valued. Scrooge’s mind went back to those sessions he’d worked in the vaccination clinic when the frail and elderly had been wheeled in by those who still loved them irrespective of how dependent they had become on others. It had been a joy to give them their vaccinations, vaccinations that had seemed at the time to be nothing less than a shot of love.
And he thought too of something else he’d recently heard, something about how ‘shiny and new’ was all very well but that things with no past somehow lacked any soul. Perhaps that was true of people too. Although in physical terms Harry and his brother were both past their best, they undoubtedly had soul, their experiences of brokenness producing in them a depth that only age can bring, the wisdom of experience allowing them to accept others despite their imperfections.
*******
It was gone 10 by the time Scrooge arrived at the party and people were already beginning to make their way home. Dr Bob Cratchit was still there though. He was on a weeks leave and had clearly been taking full advantage of the fact by enjoying the liquid refreshment that had been freely on offer. He was a little worse for wear as he handed Scrooge a glass containing what little remained of the celebratory bottles of champagne that had been opened over the course of the evening.
‘What the dickens are you doing turning up so late?’ Cratchit asked Scrooge before adding in a more concerned tone of voice, ‘Are you alright. Looks like it must have been a bad day for you today Ebenezer’. Cratchit felt the need to look out for the man who had once been his trainer but was now his senior partner at work.
‘Yes and no, Bob. Yes and no. The day was certainly busy, made busier still by a late visit request. But you know what? I wouldn’t have missed that visit for the world. That for me was worthwhile general practice and immensely satisfying. And I’ll tell you something else. What with the influx of new patients, we’re going to need to try and recruit a new partner. But don’t get any ideas of you lording it over them as senior partner. I’m afraid you’re stuck with me for a little while longer yet.’
And with that Scrooge raised a half full, rather than half empty, glass of warm, flat champagne and drank to all that was good about General Practice.
To read Part Four of ‘The Dr Scrooge Chronicles’ which is entitled ‘Grave Expectations’, click here.
To read ‘The Dr Mungo Chronicles’ made up of ‘Mr Benn – the GP’, ‘A GP called Paddington’ and ‘Scooby Doo and the Deserted Medical Centre’, click here
To read ‘Paddington and the Ailing Elderly Relative’, which links and then concludes both the Dr Scrooge and Dr Mungo Chronicles, click here.
Other GP related stories:
To read ‘the day LITTLE RED RIDING HOOD got sick’ click here
To read ‘Dr Jonathan Harker and the post evening surgery home visit’, click here
Some musings 