Some musings

ISN’T THAT LIKE LIFE…?

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.

And even, perhaps, some beauty too.

To read ‘Blaming it on the Boogie’, click here

To read ‘Health – it’ll be the death of us. Is there institutional arrogance in the NHS?’, click here

And now three blogs which, in my head at least, make up a trilogy on the subject of burnout:

To read ‘Somewhere over the Rainbow’, click here

To read ‘When the Jokes on You’, click here

To read ‘With great power…’, click here

And one blog on the dangers of perfectionism:

To read ‘Professor Ian Aird’ – A Time to Die?’, click here

And finally, a couple of related Christian blogs to finish with:

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

To read ‘Good Friday’, click here

MR BENN – THE GP

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’.

HEARING THE GRASS GROW

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

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

To read ‘Monsters’, click here

To read ‘The Windhover’, click here

To read ‘Be Drunk’, click here or for a longer version with a theological view, click here

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

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

GP KICKS

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

After ‘The Undertones’.

An audio version of this song is available by following the link below:

To read ‘Baggy White Coats’, click here

To read ‘A Hard Year For us All’, click here

To read ‘GPs – Do You Remember?’, click here

To read, ‘What a wonderful job this can be’, click here

To read ‘On Call Days and Mondays’, click here

To read, ‘Yesteryear’, click here

To read, ‘Summertime’, click here

To read ‘Spare me a doctor’, click here

To read ‘I knew a Man’, click here

To read ‘If’, click here

To read ‘Room Enough’, click here

To read ‘Old Hands’, click here

To read ‘I am the very model of a General Practitioner’, click here

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

On Call Days and Mondays

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

After Paul Williams and Roger Nicholls

To read ‘Baggy White Coats’, click here

To read ‘GPs – Do You Remember?’, click here

To read, ‘What a wonderful job this can be’, click here

To read ‘GP Kicks’, click here

To read, ‘Yesteryear’, click here

To read, ‘Summertime’, click here

To read ‘Spare me a doctor’, click here

To read ‘I knew a Man’, click here

To read ‘If’, click here

To read ‘Room Enough’, click here

To read ‘Old Hands’, click here

To read ‘A Hard Year For us All’, click here

To read ‘I am the very model of a General Practitioner’, click here

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

GPs – Do you remember?

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

After Marillion.

To read ‘Baggy White Coats’, click here

To read, ‘What a wonderful job this can be’, click here

To read, ‘Yesteryear’, click here

To read, ‘Summertime’, click here

To read ‘Spare me a doctor’, click here

To read ‘I knew a Man’, click here

To read ‘If’, click here

To read ‘Room Enough’, click here

To read ‘Old Hands’, click here

To read ‘A Hard Year For us All’, click here

To read ‘I am the very model of a General Practitioner’, click here

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

BLEAK PRACTICE

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.

SUMMERTIME

Summertime

And the workload’s gone crazy

Calls keep coming

From the sick and the sad

The car park’s full

But the waiting room’s empty

These days are as hard as any we’ve had

They’ve all got coughs

That they just know ain’t Covid

Or insect bites

With a fear of sepsis

The sun is out

And the temperature’s rising

Who wears plastic aprons in heat like this?

Appointments now

They are so hard to come by

Day by day though

Still the telephones ring

Now half the staff

They’re in self isolation

Cos they’ve had an NHS test and trace ping

After George Gershwin and DuBose

Heyword

To read ‘Baggy White Coats’, click here

To read, ‘What a wonderful job this can be’, click here

To read, ‘Yesteryear’, click here

To read ‘Spare me a doctor’, click here

To read ‘I knew a Man’, click here

To read ‘If’, click here

To read ‘Room Enough’, click here

To read ‘Old Hands’, click here

To read ‘A Hard Year For us All’, click here

To read ‘I am the very model of a General Practitioner’, click here

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

BAGGY WHITE COATS

Early morning taking bloods
Thinking we looked cool in scrubs
Spot tests in anatomy
Lectures in virology
Teaching rounds consultant led
Stood around the patient’s bed
Asked what we could not recall
Made to look a silly fool

Oh what fun we had
But did it really turn out bad
Learning at med school
How best to bend not break the rules
Oh what fun we had
But at the time it seemed so bad
Trying different ways
To make a difference to our…

Hours spent on labour ward
Trying not to look too bored
Four foot primip Mum to be
Not much chance of an NVD
Incidence and prevalence
Being taught the difference
Epidemiology
Always was a mystery

Folk in pain from retention
Wanting speedy attention
Catheters brought quick relief
Gratitude beyond belief
Clerking patients whilst on take
Trying hard to stay awake
Through the night ‘till break of day
Post take ward round’s on its way

Long white coat and stethoscope
Oxford Handbook our one hope
Telling us when we’d no clue
What it is that Doctors do
Patients who were feeling icky
Venous access proving tricky
Siting venflons back of hand
Seldom went as well as planned

Baggy white coats, baggy white coats,
Baggy white coats, baggy white coats,
Baggy white coats, baggy white coats,
Baggy white coats, baggy white coats.

After Madness

And if it’s madness you’re after a rendition of this song is available here

To read, ‘What a wonderful job this can be’, click here

To read, ‘Yesteryear’, click here

To read ‘Spare me a doctor’, click here

To read ‘I knew a Man’, click here

To read ‘Summertime’, click here

To read ‘If’, click here

To read ‘Room Enough’, click here

To read ‘Old Hands’, click here

To read ‘A Hard Year For us All’, click here

To read ‘I am the very model of a General Practitioner’, click here

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

YESTERYEAR

Yesteryear

I consulted with my patients near

Now they seldom in my room appear

Oh I believe in yesteryear

Suddenly

It’s not half the job it used to be

With a plastic apron wrapped round me

Oh yesteryear went suddenly

Why it had to go

I well know, it’s all too clear

Something went so wrong,

Now I long for yesteryear

Yesteryear

Life could simply be so full of cheer

Now so many folk just live in fear

Oh I believe in yesteryear

Why it had to go

I well know, it’s all too clear

Something went so wrong

Now I long for yesteryear

Yesteryear

Work was something that I once held dear

Now I sometimes find I shed a tear

Oh I believe in yesteryear

Mm mm mm mm mm mm

After John Lennon and Paul McCartney

To read ‘Baggy White Coats’, click here

To read, ‘What a wonderful job this can be’, click here

To read ‘Summertime’, click here

To read ‘Spare me a doctor’, click here

To read ‘I knew a Man’, click here

To read ‘If’, click here

To read ‘Room Enough’, click here

To read ‘Old Hands’, click here

To read ‘A Hard Year For us All’, click here

To read ‘I am the very model of a General Practitioner’, click here

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

On Managing Disappointment

‘Some people think football is a matter of life and death. I assure you, it’s much more serious than that.’

So quipped Bill Shankly, the former manager of Liverpool F.C. Even so, a week on from England’s defeat in the Euro 2021 final, most of us, if we ever cared at all, will have got over our disappointment that, once again, football wasn’t coming home after all. Despite Shankly’s assertion, we will have come to realise that, whilst an enjoyable distraction, whether England won or lost wasn’t really all that important at all. It is perhaps only those whose lives have nothing of greater value to worry about who will still be struggling with the heartbreak of yet another penalty shootout defeat and only those who are so insecure in who they are themselves that will feel the need to vilify those they see as responsible for the disappointment that they continue to feel.

Even so, we all know what it is to feel disappointment when things that we have looked forward to don’t materialise in the way we had hoped they would. Many of us, if we haven’t holidayed already, will be anticipating times away from work and all the more so given how pressurised General Practice has been of late. Though it will be good to have that much needed break, it won’t be just a few of us who will experience some disappointment related to our holidays this year. For some of us it will be because our week or two away won’t turn out to be as enjoyable as we had hoped, others of us won’t quite be able to avoid taking with us some of the sadness that we would have liked to have left at home, and for others of us our disappointment will come simply because, however great our vacation experiences turn out to be, they will inevitably eventually come to an end and we will be forced to return to a normality that, for some of us at least, is far from how we would like it to be.

But if we can experience disappointment because our two weeks in the south of France is ruined by the lack of a decent local boulangerie, how much more must the disappointment be for many of our patients who don’t have the luxury of being able to look forward to any time away from the difficulties that they face. For some of them it is not merely disappointing individual incidents that they struggle with but rather an overall, all encompassing, disappointment with how their lives have turned out, be that on account of the social deprivation that they have to encounter daily, the poor physical health with which they suffer or the deep personal sadnesses from which there is never any prospect of any even temporary escape. And then there are those who are facing the prospect of death which, after even the most satisfying of lives, is still unwelcome and a cause for disappointment that the good times are now forever over.

So how are we to help those with whom we consult who come to us with such a sense of disappointment that it is hard for them to carry on. And how are we to cope with our own disappointments when they inevitably materialise in our own lives. Because unlike a lost game of football, not all disappointments can be dismissed by a realisation that the thing that brings us sorrow never mattered at all in the first place.

Whilst it is true that we are all sometimes more disappointed about things than we need be, to sing along in nihilistic agreement to the closing lines of Bohemian Rhapsody that ‘nothing really matters, nothing really matters to me’, makes fools of us all. Because some things really do matter. Our disappointment is a measure of how far things are from how we want them to be. Though unpleasant, it is not an unhelpful feeling, given how it speaks to us, not only of the difficulties that we are currently experiencing but also the better circumstances that we all so long for, testifying perhaps that things can and indeed should be better.

This last week I was sat on Whitesands Beach not far from St David’s in Pembrokeshire watching people enjoying themselves playing in the sea. For some reason, despite wanting to, I didn’t feel able to join them irrespective of how awesome I would undoubtedly have looked with my wetsuit on and ‘Atom’ emblazoned across my chest like some modern day comic strip superhero! My feelings were similar to those I almost always experience at discos, if indeed discos are what they are still called. On such occasions you will always find me on the edge of the dance floor, too self conscious to show off my highly original and frankly alarming dance moves and resorting instead to clutching a pint and simply wishing I could enjoy myself by joining in with those who are dancing and clearly having such fun in the process. I wonder if this somewhat melancholic experience is one that others of us sometimes have, one in which we are all too aware that genuine happiness really is to be found out there somewhere but that it somehow always remains elusively just out of reach.

It was C.S. Lewis that wrote ‘Most people, if they had really learned to look into their own hearts, would know that they do want, and want acutely, something that cannot be had in this world. There are all sorts of things in this world that offer to give it to you, but they never quite keep their promise…If I find in myself a desire which no experience in this world can satisfy, the most probable explanation is that I was made for another world.’

As I say then, our disappointment has real meaning, speaking to us of a better tomorrow that really is out there for us to enjoy. And, welcome though it would be, I am not referring here to an England victory in next year’s World Cup! On the contrary, regarding our desire for something better, Lewis continues that ‘Probably earthly pleasures were never meant to satisfy it, but only to arouse it, to suggest the real thing. If that is so, I must take care, on the one hand, never to despise, or be unthankful for, these earthly blessings, and on the other, never to mistake them for the something else of which they are only a kind of copy, or echo, or mirage. I must keep alive in myself the desire for my true country, which I shall not find till after death; I must never let it get snowed under or turned aside; I must make it the main object of life to press on to that other country and to help others to do the same.’

If Lewis is right then medicine needs to stop imagining that it can bring about a utopia of perfect health, still less that which not even a fortnight on the Côte d’Azur can bring about, a world characterised by perfect happiness that never ends. That is something that medicine simply cannot deliver, not with a pill, not with a procedure, not even with a course of therapy. On the contrary, even the happiest of lives come to an end and when death does eventually inevitably draw near, medicine has no answer save to ease an individuals passing. This is not to say that palliative medicine isn’t hugely important, only that we make a mistake if we believe that there is ever such a thing as a truly good death. Because there isn’t, not at least for those who believe that our lives matter and that death, however less bad it can be made, is never truly good given the loss it entails and the end of what might otherwise have been.

Rather then than imagining itself to be the answer to everyone’s problems and in so doing only serving to disappoint those who do come to rely on it too heavily, medicine needs instead to play its part in helping others to press on to that other country of which Lewis speaks.

And so, whilst not being it’s main role, I believe medicine needs to make room for other philosophies and, acknowledging it’s limitations, be honest enough to at least suggest to patients that the answers to their greatest needs may be better found somewhere other than in the treatments we sometimes all too readily offer, in something bigger and better than all that even medicine has to offer. And, for me at least, that will, on occasions, involve me encouraging my patients to consider God, in whose presence, ancient wisdom tells us, can be found both fullness of joy and pleasures for evermore. [Psalm 16:11].

Recognise this and perhaps both we and our patients will be better able to cope when the bad times come, regardless of whether the associated disappointment is caused by circumstances, others, or ourselves. Furthermore we may be better able to enjoy more fully the good times when they come without our requiring them to be more than they actually are, without our requiring them to be perfect. Instead we can enjoy them, recognising them to be the echoes of those endless yet better times to come which so many of us continue to look forward to. And when that hope is finally fully realised, as I believe it one day will be, when every tear is wiped away and death is no more [Revelation 21:4], we will discover that it will more than amply compensate, not only for those missed opportunities to go wild on the dance floor, the absence of fresh croissants on our holiday breakfast tables and the consequences following a missed penalty kick, but also for all the genuinely heartbreaking disappointments in our lives, even that of death itself.

For then it will not be football that’s coming home – it will be we ourselves who are homeward bound. And having arrived there and found that we are home for good, I for one can’t imagine ever being disappointed again!

Postscript:

Later in the week I finally overcome my former reticence and adopted my altered ego of ‘Atom Man’ and so braved the waves of Newgale. It was good to forget myself and to feel, not lost or insignificant, but still wonderfully small, happily caught up and enveloped in something immensely bigger and vastly more impressive than I will ever be.

But by golly it was cold!

Related blogs:

To read, ‘Because sometimes not even chocolate is good enough’, click here

To read, ‘Covid-19. Does it suggest we really did have the experience but miss the meaning’, click here

To read, ‘Something to reflect on – are we too narcissistic?’, click here

To read, ‘Towards a more compassionate resilience’, click here

To read, ‘Health – it’ll be the death of us. Is there institutional arrogance in the NHS?’, click here

To read, ‘Waiting patiently for the Lord’, click here

To read, ‘The Lord is my Portion’, click here

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

ON APPROACHING ONE’S SELL BY DATE

The thing is, I don’t play golf.

Apart from that incident involving a lemon, a stained glass window and the irate members of the parochial church council, I haven’t picked up a golf club in anger for many years. Whilst it is true that I was soundly beaten over 18 holes last summer by my octogenarian father-in-law, it should be remembered that that was just a friendly encounter without any competitive element whatsoever.

Well at least that’s my story and I’m sticking to it. And no you don’t want to know the score. And whilst it’s true that he was 81 at the time, it should be remembered that he was, and indeed remains, remarkably good for his age!

Furthermore, what he didn’t tell me when I agreed to the match, was that, not only had the cataract in his one good eye been dealt with, but also the artificial limb fitting he’d been waiting months for had been brought forward and he was thus now able to stand upright without the support of a walking aid.

Unbelievable!

But the reason why my lack of proficiency at golf has been on my mind lately is that, like my dog, who, though formerly always eager for his early morning walk, now looks at me as if I am mad if I so much as even hint that we might start the day with more than a single circuit of our local field, I too am getting older.

As for Barney, we were thinking of sending him to ‘The Repair Shop’, that wonderful place where things of great personal value are restored to their former glory. Our hope was that ‘The Bear Ladies’ would be able to work their magic and thereby be able to blacken his nose, re-fur his balding back leg, and freshen up his breath.

But sadly of course, none of that is possible and instead the fact that he is ageing has to be accepted. And so, just as Emily loved a saggy old cloth cat, one who was a bit loose at the seams, so we too love a dog who has long been dear to us and will always remain so despite his sometimes pungent aroma.

I’m not sure if it was ever really a thing, but the idea of a GP finding time for a round of golf between morning and evening surgeries has long gone – these days we’re lucky if we’re able to squeeze in a cup of tea and a trip to the tiniest room in the practice building. But though playing golf seems to be something that a good number of retired folk enjoy spending their latter years doing, I can’t see myself following their example.

The other reason that retirement has recently been on my mind is that a few weekends ago I went to a reunion of the eight partners who worked in the practice when I joined it almost 25 years ago. Only two of us are still working, and in five months time that number will be reduced to one when I become the longest serving doctor in the practice.

As we dodged the showers in the garden where we gathered, it was good to reminisce about the good times we had shared together – and to be reminded also of how fortunate I was all those years ago to land myself a partnership with such a lovely bunch of people. And to realise how my good fortune has continued as, with each successive retirement, a replacement partner has been found who has been just as much a joy to work with as those who have left. It seems odd to think that the partner we are now seeking is likely to be the last who will join the practice before the search begins for someone to replace me.

And when that time comes, as it surely will, a replacement will most certainly be found. Because for every Andy Murray whose best years are in the past, there is an Emma Raducanu starting out with a bright future laid out before them. This is not to imply that my racket skills are any better than my prowess with a driving iron, only that, like a certain dour Scotsman, I too have passed my best before date.

Which got me thinking as to how I might approach my next appraisal. Rather than striving to set targets by which I might pretend to seek to ever improve, perhaps now is the time to get real and instead identify goals by which I might manage my inevitable decline.

This is not to suggest that we cease being useful once we retire, on the contrary, there is of much that we can contribute as we get older, but it is nonetheless true that what we can offer others does, in time, inevitably reduce.

But before anyone thinks this is simply me being all maudlin and questioning what worth we have as our capacity to be useful begins to diminish, let me tell you about somebody I once met who was also past his best.

Visiting the nursing home which had been his home for some 15 years, I was ushered into a room to see a frail elderly man, not quite yet 90 years of age. Not being my patient I’d not met him before but as I looked at him sitting uncomfortably and uncommunicatively in his chair, his mouth hanging open and his eyes tightly shut, it was clear that his life was drawing to a close. It was tempting to dismiss him as a demented old man whose apparent imminent death would surely be of little significance.

My attention was then drawn to a TEP form which seemed to be out of date since it suggested that hospital admission should be considered in the event of becoming unwell. And so I spoke to those who knew him best.

Firstly I chatted to the senior nurse manager who had been acquainted with him throughout his time at the home and who cared enough about him to express that she would be sad if he were to die in hospital. And then I spoke to his only relative, a younger brother who, after saying that he felt sure that hospital was best avoided, added words which I will not easily forget.

Barely able to control his voice, I was only just about able to make out what he said:

‘I want you to know something Doctor. That man is my hero. As a boy, he looked after me when there was no one else to’.

I found those words intensely moving on account of the fact that he didn’t say ‘He WAS my hero’, but rather ‘He IS my hero’.

Four words that whispered something that needs to be heard loud and clear.

The fact that a ‘demented old man’ remains somebody else’s hero is worth pondering. Or at least it is for me. Because it is all too easy for me to sometimes self importantly, mistakenly imagine that I am more significant than others and foolishly dismiss as of no value those I casually deem to have no practical use.

Furthermore we all need to recognise that we too will all one day pass our best before date. Even as we do though, our worth will remain, just so long as someone, somewhere cares enough to remember who we are, who we once were and who, despite our palpable defeat, we might yet one day become.

The truth is that, even as we mentally and physically decline, when we don’t know one end of a golf club from the other and are unable to walk five metres in a day, let alone in the four seconds that we are required to if we are not be considered frail, our worth nonetheless remains.

Because even though our best before day might have long since passed, our value remains.

And extends well beyond our sell by date.

To read ‘Bleak Practice’, a story based around the home visit described above and another genuine real life home visit, click here

To read ‘A Farewell to Barnes’, click here

Other Related blogs

To read ‘Vaccinating to remain susceptible’, click here

To read ‘Shot of Love’, click here

To read ‘The Repair Shop’, click here

To read ‘Three Times a Patient’, click here

To read ‘A Not So Shaggy Dog Story’, click here

To read ‘Book Review – The Book About Getting Older’, click here

To read ‘Old Hands’, click here

To read ‘Room Enough’, click here

To read ‘I knew a man’, click here

What a wonderful job this can be…

Don’t know much about anatomy
Don’t know much physiology
Don’t know much about the CCG
Don’t know why we have the CQC
But I do know that as a GP
‘Cos of those who work along with me
What a wonderful job this can be

Don’t know much about nephrology
What the ‘C” is for in CRP
Don’t know how to read an EEG
Why no Zantac’s in the pharmacy
But I do know that I can see
‘Cos of those who still consult with me
What a wonderful job this can be

Now I don’t claim to be a good doctor
But I’m trying to be
For some day by being a good doctor – maybe
I could please the GMC

Don’t know much about anion gaps
Don’t know how to do those pleural taps
Don’t know much about such a lot
Don’t know quite what’s in my pension pot
But I do know that it’s still OK
If I only help just one today
What a wonderful job this can be.

After Sam Cooke.

Far from a wonderful job however is the rendition of this song that can be found here

take full responsibility, follow the links below. Audio versions are available for those marked with an asterisk. There are others, but these are the least worst!

We’ve got a brand new GP Vacancy*

GP, GP, We’re so in need of you*

Baggy White Coats*

Working in a Healthcare Hinterland*

What A Wonderful Job This Can Be*

The Wild GP*

GP Kicks*

A Hard Year For Us All*

East Quay Medical Centre Madness

To read ‘Spare me a doctor’, click here

To read ‘I knew a Man’, click here

To read ‘If’, click here

To read ‘Room Enough’, click here

To read ‘Old Hands’, click here

To read ‘A Hard Year For us All’, click here

To read ‘I am the very model of a General Practitioner’, click here

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

ON BEING CRAZY BUSY – A TICKLISH PROBLEM

For me, the last few weeks have been crazy busy and, I suspect, they will have been no less so for you. Nevertheless I have had some fun moments. A highlight for me was meeting one of the Mister Men. Patient confidentiality prevents me from mentioning his name but it will I think suffice to say that, not only was his skin not as vibrant as I’d expected, but neither were his arms as long as I’d been led to believe they would be.

And then there was the patient who, noticing that she had a lump ‘down below’, thought she might have a uterovaginal prolapse.

Being a lady of a certain age she was initially a little reticent at exposing that most intimate part of her body to me on account of my being a chap but, eventually, she rationalised her decision to allow me to have a look with her assertion that I’d no doubt seen more of the anatomical structure in question than she’d had hot dinners.

So we did a calculation.

Hazarding a guess that the days on which she had eaten nothing but cold food would be no more than 20% of the total number that had made up her life, we came up with a conservative estimate that the number of cooked meals she’d eaten during her almost 95 years was 27,695.

At which point I assured her that I’d not seen anywhere near the number she imagined I had of the aforementioned body part.

It made us both laugh – and that seemed to matter.

But even so, the last month ot so has been busy – dangerously busy. And oftentimes it has been hard. The phrase ‘unprecedented demand’ has considerable precedence when used in the context of GP workload but these last few weeks certainly have seemed to have been busier than I can remember it ever having been before. General Practice has felt like it has been under siege with every day seeing us called upon to deal with far more patients than anyone could possibly conceive that we could ever manage properly. As such the work, as well as being less enjoyable and satisfying, has, for me at least, felt less worthwhile too.

The reasons for the surge in demand are many and varied but amongst them would be that some patients are now feeling brave enough to come forward with problems that previously they had felt too anxious to bring to our attention, that long hospital waiting times have resulted in patients repeatedly having to turn to their GP for the care that they might otherwise have received from specialist teams and, of course, that the uncertainty and fear generated as a result of the pandemic has seen a huge increase in the number of mental health problems being presented to primary care.

There will be undoubtedly be many other reasons for why demand has increased but over and above these understandable and appropriate reasons for patients wanting to consult with us, I wonder if there is another, more existential, cause.

With increasing numbers of people no longer believing that there is a better world to come, be that in this life or the next, and fewer of us experiencing any hope for a brighter tomorrow, too many of us are insisting on our best life now. We are increasingly unwilling to wait for what the media tells us we should expect our lives to be characterised by, namely an absence of pain and inconvenience and an abundance of happiness and fun.

But real life is not like that. Though we may be able to airbrush our social media profiles, we cannot airbrush out those aspects of our life that are not to our liking. And, despite the best efforts of health care professionals, neither can medicine.

Even so, the expectation remains and the attempt to do so goes on. When medicine is portrayed as possessing a god like omniscience, is it any wonder that so many people bring their problems to us, promised as they have been that we can provide for them the solutions they desire.

The truth though is that medicine does not posses the resources or ability to deliver the answers it does not have.

If things are ever going to get better, we, our patients, and the policy makers who continue to demand of us what we cannot deliver, are all going to have to recognise both our limitations and the limitations of the profession that we are a part.

Because good health begins, not with good medical care, but with having something worth being healthy for. And that’s something that increasing numbers of people are finding that they do not have, some, for the first time perhaps, as a result of the wider consequences of the coronavirus pandemic.

And for as long as a packet of fags, a bottle of scotch and a Happy Meal are the highlights of our lives, so we will continue to seek, and fail, to find our happiness in such things.

In his book ‘Walden’, Henry David Thoreau wrote that ‘the mass of men lead lives of quiet desperation’. That may have been true once but now that same desperation is becoming ever louder such that now it is a deafening roar. Even so, still the desperation remains and many are still set to ‘go to the grave with the song still in them’

As more and more people experience what Leonard Cohen once said we sooner or later all come to know, that is the ‘defeat of our lives’, the question becomes will they continue to expect medicine to provide a way back? Or will they instead be encouraged to look elsewhere for the help that so many of them so desperately need?

And that, of course, includes us.

Many of us are increasing feeling overwhelmed and threatened by the demands put upon us. Under siege we continue to try to fend off all attacks yet succeed only in finding ourselves imprisoned behind the barricades we have erected in our forlorn attempts to stave off defeat. Perhaps it is time instead to at last appreciate that since medicine does not equip us for the battle in which we are engaged, ours is a fight that we can not ultimately hope to ever emerge as victors. Recognise this and we may find ourselves free from always having to win, free from always having to be the ‘NHS Heroes’, that, inundated as we are now, it is all to clear none of us were ever cut out to be.

And then who knows, we might just find that we are able to find some satisfaction, some enjoyment, even some fun, in our work once more.

We might even meet Mr Happy!

Related Blog:

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

desolation row

she’s taking photos of the future

she’s painting the background black

the walls they’re closing in on her and

she’s not pushing back

and the minutes pass like hours

the weeks they pass like years

as eyes keep filling up until

there’s no room for her tears

and she’s stuck inside of silence

not knowing where to go

so she’s resigned to living on

Desolation Row.

now there’s no hope for tomorrow,

as there’s no dream for today

her thoughts they’re going nowhere,

and those thoughts won’t go away

and her only true companion

is her cold contactless phone

it’s never very far from her

it keeps her on her own

but the only calls she’ll ever make

in the life that she’ll forgo

are the calls she’ll make whilst dying on

Desolation Row

After Bob Dylan

To read ‘together in line’, click here

To read ‘the wrong patient’, click here

To read ‘beaten’, click here

To read ‘Resting in Pieces’, click here

To read ‘Crushed’, click here

To read ‘Masked’, click here

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

To read ‘Eleanor Rigby is not at all fine’, click here

To read ‘Contactless’, click here

My Back Pages

‘Ah, but I was so much older then, I’m younger than that now.’

As a boy, I spent my early years playing. I did not endeavour to please anyone as I did so, though my parents no doubt were happy to see me having the fun that all children ought. I did not seek to play better than those I played with – what would be the point? I simply played, and was glad to do so.

Then came school and, though I did not seek to impress, I was, from time to time, rewarded. Stars for pleasing the teacher. And I saw that the number of stars I received was compared with those that were bestowed on others. I was, I realised, in competition with my peers.

School continued and the tasks set me became more complex – the rewards more contingent on my reaching a certain standard. ‘Work hard’, they said, ‘and you might do well – you might progress’. Which I did. But there was always a next stage, never a point beyond which one could simply stop and rest.

And so I continued on to university – where those who strived hardest secured the best jobs. Then, inevitably, came work. And the rewards dried up, replaced now by the threat of sanctions. Instead of rewards for achieving, now there were punishments – even for those who were simply standing still. Good enough was no longer good enough. ‘You must improve’, they said, ‘You must be better, you must do more’.

And then, finally, came criticism. Initially implied, then explicit. It was not merely that I was not good enough, rather it was that I was to blame.

So harder and harder I worked until, finally, I stopped – exhausted – defeated.

And I realised I had grown old. And not only in years

Oh for a lesser load, and a little rest, for a yoke that was easy and a burden that was light. Oh to be treated gently, by someone strong enough to cope with my weakness, someone who, rather than treating me harshly and constantly demanding of me ever increasing levels of perfection, was lowly of heart. Oh to be cared for by someone accepting, someone forgiving, someone who could, and would, provide for me the long desired perfection I had long been striving for and thereby offer me rest for my soul.

And so I remembered my days as a boy. And I sought to become like a child again, someone who was wiser than the foolish adult I had become, someone who accepted his need of help. And as I did so I looked to simply enjoy doing what it was that I was meant to do.

Because the world can be a cruel taskmaster and competing in a misguided attempt to prove our perfection makes losers of us all.

Perhaps though there is someone out there who, even now, is glad to see me imperfectly endeavouring to do what is right, someone who cares for me, someone who isn’t only out to criticise and condemn. Perhaps there is someone out there who loves me that much.

I happen to believe there is.

If I’m right, what a relief that would be!

[‘My Back Pages’, is the title of a song by Bob Dylan from which the line ‘Ah, but I was so much older then, I’m younger than that now.’, is taken. It appears on the 1964 album, ‘Another Side of Bob Dylan’. This blog is an updated version of one originally written in 2018. It expresses, of course, more of an aspiration of where I would like to be rather than where I actually am. As with much in life, we journey on to become what we already really are.]

Related blogs:

To read ‘Rest Assured’, click here

To read ‘“The Medical Condition” of “Hannah Arendt is Completely Fine”’, click here

To read ‘Somewhere over the Rainbow’, click here

To read ‘Professor Ian Aird – A Time to Die’, click here

To read ‘Expressive Individualism and the Drive for Perfection’, click here

To read ‘Nicky Alexander’, Dr Perfect?’, click here

To read ‘Don’t forget to be ordinary if you want to be happy’, click here

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

Getting in touch with your inner Womble.

Sometimes, being a GP feels like something akin to being a Womble – that’s right, sometimes it seems that we are dealing with rubbish all day long!

But that’s not the only reason I feel an affinity to those inhabitants of Wimbledon Common that scurry around, diligently clearing up after others. Nor is it simply because one of those fury little creatures takes his name from the town in which I live. And no, I do not live in Tomsk and, though I may be a little on the short side (5’4” thank you for asking), neither am I particularly hirsute. My Wombleness is much more layered than that.

‘People don’t notice us, they never see.

Under their noses a GP might be

We GP by night and we GP by day

Looking for ways to take problems away.’

Furthermore we all sometimes find ourselves having to dance. But even though the one on which we are led may seem a merry one, it is a dance that we are accompanied by nothing as delightful as the Minuetto Allegretto. Instead we are encouraged to quick step to the cacophony of sound that emanates from NHS England and the media, and to waltz to the unearthly din generated by the government, QoF and the appraisal process.

‘Oh slave now like your partners

Young GP’s were told

With satisfact’ry colleague feedback

You will work ‘till you’re old’

Unless of course you burnout young.

More positively though, like Wombles, GPs are organised, work as a team. GPs are tidy and’, for the most part at least, ‘GPs are clean’. Furthermore we are ‘so incredibly utterly devious’, that lesser known Womble characteristic that enables us to make good use of the things that we find, irrespective of how limited those resources that we come across actually are. Just as it is with Wombles, so it is with we GPs – our communities would be a lot messier without us. Our work is hugely valuable and, though our efforts may not be valued by some, most of our patients, really do appreciate all that we do.

So…

When the sun doesn’t shine and it’s cloudy and gray

And it’s only the beginning of the GP-ing day

And the CQC inspectors say that they’re on their way

…

When the phones are going crazy and you just can’t see

How you will even find the time to drink a cup of tea

And every patient says that you must see them urgently

…

When the newspapers are saying things that just aren’t true

And everyone is laying blame for everything on you

And they’re telling you exactly what it is you’ve got to do…

Remember, remember, remember, remember Remember, remember, remember (member, member, member)

(Altogether now)

Remember you’re a GP (Remember you’re a GP) Remember you’re a GP (Remember you’re a GP) Remember you’re a GP (Remember you’re a GP) Remember you’re a GP (Remember you’re a GP)

Remember, member, member, what a GP, GP, GP, you are.

And remember too just how loveable and cuddly you really are!

And with that, like Orinoco, I’m off to get an extra 40 winks!

To read ‘A Hard Year for Us All’, click here

A Hard Year For Us All

A HARD YEAR FOR US ALL

Oh, where have you been, my GP team?
Oh, where have you been, whilst you I’ve not seen?
We’ve worked every day of this dreadful pandemic
We’ve managed all kinds of conditions systemic
We’ve delivered shots at the Covid vaxs clinic
We’ve tended the folk whose hearts are ischaemic
We’ve been close at hand to those emphysemic
And it’s a hard, and it’s a hard, it’s a hard, it’s a hard
It’s been a hard year, for us all

Oh, what did you see, my GP team?
Oh, what did you see, whilst you I’ve not seen?
We’ve seen face to face those we needed to
We’ve seen desperation in not just a few
We’ve seen the dyspnoeic as they became blue
We’ve seen all the poorly requiring review
And palliative people their dying all through
And it’s a hard, and it’s a hard, it’s a hard, it’s a hard
It’s been a hard year, for us all

Oh, what did you hear, my GP team?
Oh, what did you hear, whilst you I’ve not seen?
We’ve heard news reports that caused us to bridle
We’ve heard people saying that GPs were idle
We’ve heard some denying the pandemic viral
We’ve heard people crying – fighting for survival
We’ve heard those describing their thoughts suicidal
And it’s a hard, and it’s a hard, it’s a hard, it’s a hard
It’s been a hard year, for us all

Oh, who did you meet, my GP team?
Oh, who did you meet, whilst you I’ve not seen?
We’ve met with so many their mood melancholic
We’ve met young and old with a too high systolic
We’ve met those in pain from their biliary colic
We’ve met breathless people from causes embolic
We’ve met those depressed by hardship economic
And it’s a hard, and it’s a hard, it’s a hard, it’s a hard
It’s been a hard year, for us all

Oh, what’ll you do now, my GP team?
Oh, what’ll you do now, you who I’ve not seen?
We’ll watch as the problems towards us they throng
And lean on each other to somehow stay strong
And wonder how long all of this may go on
And whether or not we still want to belong
In a job where some things they seem sometimes so wrong
Cos it’s a hard, and it’s hard, it’s a hard, and it’s hard
It’s been a hard year, for us all.

After Bob Dylan’s ‘A Hard Rain’s A-Gonna Fall’ – in the week of his 80th birthday.

And if you want to make this year a little harder still for you to bear, a rendition of this song is available here

For more song adaptations and woeful attempts at poetry, all with a GP flavour, please follow the links below:

To read ‘Baggy White Coats’, click here

To read ‘What a wonderful job this can be’, click here

To read ‘I am the very model of a General Practitioner’, click here

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

To read ‘On Call Days and Mondays’, click here

To read ‘My Least Favourite Things’, click here

To read ‘My Most Favourite Things’, click here

To read ‘The Wild GP’, click here

To read ‘Yesteryear’, click here

To read ‘GPs – Do You Remember?’, click here

To read ‘If’, click here

To read ‘Spare me a doctor’, click here

To read ‘I knew a Man’, click here

To read ‘Room Enough’, click here

To read ‘Old Hands’, click here

To read ‘Summertime’, click here

To read ‘GP Kicks’, click here

To read ‘How the grinch and Covid-19 stole General Practice’s Christmas’, click here

To read ‘’Twas the week bedore Christmas – 2020’, click here

To read ‘If’, click here

To read ‘I knew a man’, click here

To read ‘Reintroducing GPs Anonymous’, click here

To read ‘On not remotely caring’, click here

Reintroducing GPs Anonymous

Today is the Glorious 13th – the day that marks the start of the GP shooting season. Admittedly, this year, many seemed to have jumped the gun but, with headlines a plenty in the national papers, it is clear that the annual tradition of having a bop at your local provider of primary care services is, once more, well and truly underway.

This is not to suggest that the criticisms aren’t entirely appropriate, it’s not as though we’ve been experiencing unprecedented demand of late, or that we have had to struggle to balance the twin concerns of managing patients safely whilst avoiding unnecessary contact in light of a global pandemic. On the contrary, we have all been enjoying more time on the golf course having finally been able to take up that executive club membership as a result of the vast profits we’ve made from administering Covid-19 vaccinations.

In recent years it’s been increasingly accepted that GPs are to blame for most of the problems in the NHS and being a GP is now, quite rightly, seen as something for which we ought to be ashamed. Surely, then, it’s time we considered getting ourselves some help.

Whether it be our delayed diagnoses, our inappropriate admissions or our failure to offer enough appointments, it’s time to face up to the uncomfortable truth, GPs are the problem. Having for years been told this repeatedly it’s finally time we listened. The facts, as they say, speak for themselves – it really is all the fault of we GPs.

We must deny it no longer. We must stop trying to convince ourselves we’re OK and instead acknowledge our failings. After all, if we don’t, how can we expect anything to be done to help us. We will just go on making our own life, and everyone else’s, miserable.

Everyone’s aware of how embarrassing GP behaviour can be. You know the kind of thing, how we love to spoil people’s fun by advising those with a fever and a new continuous cough not to visit their great aunts for tea or how we refuse to allow our waiting rooms to fill up with patients who wish to discuss the sudden loss of their sense of smell. Without a doubt it is selfishness such as this that leads to A&E departments being inundated with such patients who are thus forced to waste precious hours of their time seeking a proper medical opinion.

And then, of course, there is our wilful ignoring of patients whose symptoms clearly suggest that they have cancer but who we deliberately neglect to refer preferring instead to put an unnecessary burden on secondary care services by recklessly admitting patients to hospital just for the fun of it.

So let’s all face up to our problem. I’ll go first by introducing myself:

My name is Peter – and I’m a General Practitioner.

If you’re similarly afflicted, come and join me – I’m setting up ‘GPs Anonymous’ in the hope that together we can support all those who are stricken with the affliction that is ‘being a GP’.

But perhaps you’re still not convinced that you have a problem. If so, can I urge you to ask yourselves these four screening questions? Answer two in the affirmative and you may have a problem – answer ‘Yes’ to all four and you’re in real trouble.

C – have you ever felt you wanted to cut down how much general practice you do?

A – have you ever been annoyed by criticism of your actions as a GP?

G – have you ever felt guilty for what you have done as a GP?

E – have you ever started doing your ‘GP thing’ early in the morning?

Extra phone lines will be installed should demand for this new service prove overwhelming.

But why do people fall into the destructive behaviour patterns that are characteristic of general practitioners? Some have suggested that in some cases there may be a genetic component – seeing your parents behaving as GPs seems to predispose some to follow a similar path. Mercifully, however, this is becoming less common. Others experience a little bit of general practice early on in their medical career and naively imagine that it’s a good thing – something that they can control. After all, just one attempt at a ten minute consultation can’t hurt can it? But before long they’re out of control – only in it for the extortionate pay, the long hours of ‘off duty’ and the kicks one gets from the systematic mismanagement of those who thought they were there to help.

It’s a tragic condition but now, with the arrival of ‘GPs Anonymous’, there is at last some real hope for change. So please give generously, together with your help, this year we can rid the country of the blight that GP’s have become.

And then won’t everyone be happy?

[This is a reworking of something I wrote previously. Apologies to those who may have seen it before but sadly it continues to seem ever more relevant today.]

someone left a cake out in the rain

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

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

together in line

unrelenting sadness lingers
hope slips through her outstretched fingers
no pill can tend a grief like this
and words well meant their target miss
with soulful eyes replete with tears
she sinks beneath a sea of fears
together though, we stand in line
her breaking heart now breaking mine.

Related Blogs

To read ‘the wrong patient’, click here

To read ‘beaten’, click here

To read ‘Resting in Pieces’, click here

To read ‘Crushed’, click here

To read ‘Masked’, click here

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

the wrong patient

THE WRONG PATIENT

It’s not that she no longer knows

the reason for her tears

It’s not that she no longer feels

the pain of all those years

It’s not that she no longer cares

to make her daily calls

It’s not that she no longer stays

confined within her walls.

It’s just that now she doesn’t see

a reason to go on

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

in a world where she’s

so wrong.

Not any longer

Related Blogs

To read, ‘together in line’, click here

To read ‘beaten’, click here

To read ‘Resting in Pieces’, click here

To read ‘Crushed’, click here

To read ‘Masked’, click here

To read ‘Patient’, click here

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

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

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

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

Easter Sunday 2021

Happy Easter!

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

The following is an updated version first posted last year.

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

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

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

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

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

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

Like Anthony Flew, Peter had followed the evidence.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It was Good Friday.

But now it is Easter Sunday.

Obviously.

Happy Easter.

Addendum:

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

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

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

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

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

To read, ‘Real Love?’, click here

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

To read ‘John 3:16’, click here

To read ‘Water from a rock’, click here

To read ‘The Sacrifice of Isaac’, click here

Good Friday – 2021

Sorrowful yet always rejoicing.

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

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

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

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

Sorrowful yet always rejoicing.

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

We can smile, therefore, even as we cry.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

That suffering is not irredeemable,

That sorrow is not incompatible with joy,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Especially those who are sorrowful.

Related Blogs

To read ‘Easter Sunday’, click here

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

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

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

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

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

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

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

THE VERY MODEL OF A GENERAL PRACTITIONER?

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

I have a working knowledge of those matters anatomical,

I deal with illness physical, and problems psychological,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

After W.S. Gilbert and Arthur’s Sullivan

A musical rendition of this song, performed by Lenny the Lion, can be found on my Facebook page on April 30th 2022.

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