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:
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:
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.
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.
Having read this week ‘The Book About Getting Older (for those who don’t want to talk about it)’, I have a few problems with its author, Consultant Geriatrician, Dr Lucy Pollock.
The first is that, since she is of a similar age to me, should I be fortunate enough to make it to a ripe old age, it is extremely unlikely that she will still be working when I have need of someone to oversee my medical care. With luck, however, the poor soul who will one day be called upon to advise me in my dotage, will have read her book and taken on board all that she has written there, for it sums up what, to my mind, good medicine is all about.
And so the second problem I have with Dr Pollock is that she is liable to cause me to run out of the superlatives necessary for describing what she has said.
For this is a book that, along with considerable humour, oozes wisdom, overflows with compassion and is chock-full with sensible counsel which really does make it a must read for hospital consultants, general practitioners and anybody who cares for an elderly person. And that, of course, includes anybody who is themselves elderly or one day hopes to be so. No wonder Dr Pollock is so highly regarded by those I work with who refer into the hospital where she works and who, on occasions have had the very great pleasure of hearing her speak.
Much of the book is written like a novel with exquisitely drawn descriptions of patients, written by somebody who clearly cares deeply about those she is writing about. The reader is drawn into their stories and made to care for them too.
Here then is somebody who cares enough to notice the little details of an individual’s character, somebody who listens attentively to what it is they are saying, spoken or otherwise, and somebody who makes every effort to understand those who come to her for help – surely the foundation upon which all good care must rest.
Here too are elderly folk, described as they truly are, not as burdensome individuals who drain the healthcare system with their multiple problems, but people who have lived and loved and still have much to offer despite the level of their current need for support.
The book takes an honest look at the problems that increasingly longevity brings with it. As more and more of us are living longer, with those added years inevitably being at the end of our lives, greater numbers of us are consequently spending our final years increasingly dependent on others. The book urges a thoughtful consideration of how medicine can be best applied to those individuals for whom yet another medical intervention will not always be in their best interests.
But Dr Pollock never suggests that old people are not worthy of being treated. On the contrary, as she helpfully puts it, some treatments are simply not good enough to be used on some elderly folk. It is the treatments, not the patients, that aren’t worthy.
Rather than thoughtless adherence to medical protocols and treatment algorithms, it is for Dr Pollock an understanding of her patients, and what it is that is important to them as individuals, that should drive the decisions that are made by the clinician, the patient and their families, as to what should and should not be done.
Just because something can be done doesn’t mean it should be.
The book is full of cases of how this principle is not one that is held merely theoretically. Her sadness and frustration at the case of the elderly patient who, over the course of a previous three month hospital stay, suffered 77 blood tests, undertaken for reasons that were no doubt well meant but were nonetheless almost entirely unnecessary, is a case in point.
Rather than yet another investigation being ordered, a discussion of what was important to the patient leads to the individual going back home to enjoy watching football on the TV with his son whilst taking a few sips of cider. That really is good practice, medicine that, rather than vainly seeking to add years to life, aims to add life to the limited time those who of an advanced age inevitably have.
The book also has a useful discussion about advance care plans, a realistic look at the success or otherwise of attempts at cardiopulmonary resuscitation and the challenges of dementia. There are also some practical chapters on assessing capacity, powers of attorney and considerations around driving.
It really is a superb book in which the author clearly cares about the reader every bit as much as she does her patients as evidenced both by the gentle way she softens the delivery of less palatable truths and by the slightly larger font that has no doubt deliberately been employed whilst mindful of the deteriorating eyesight of some of her readers.
Please do read it, and then recommended it to your family and friends and, for those of you working in healthcare, recommend it to your patients. It really does deserve a very wide readership.
Which brings me to my final problem with Lucy Pollock. In the unlikely event that I am ever cast away on a desert island, I am now going to have an even more difficult task choosing what book I might like to take with me alongside the Bible and the complete works of Shakespeare. For this is a book, full of delightful characters, that is in turns both moving and inspiring, one that makes me want to live better and practice better. It is also one that, marooned on a desert island far from any medical attention, might just reassure me that perhaps we don’t always need quite as much medicine as we sometimes foolishly think we do.
Even so, all alone on an island I would undoubtedly miss doctors like the writer of this excellent book and the wonderful patients I, like her, have had the joy or caring for.
But never mind this review, read the brilliant Lucy Pollock’s, brilliant book. Easily worth six stars.
To read ‘Paddington and the Ailing Elderly Relative’ in which Dr Pollock, or someone very like her, makes a special guest appearance, click here!
To read, ‘Vaccinating to remain susceptible’, click here
As some day it may happen that a victim must be found
I’ve got a little list — I’ve got a little list
Of medical offenders who might well be underground
And who never would be missed — who never would be missed!
There’s the patient who believes that he has suffered every ill
And even those he hasn’t yet he knows someday he will
The CQC inspector who insists the rules are kept
And pouring urine samples down the sink he won’t accept
The turmeric advisor – yes that dreadful herbalist –
I don’t think he’d be missed – I’m sure he’d not be missed.
.
He’s got them on the list — he’s got them on the list;
And they’ll none of them be missed — they’ll none of them be missed
.
There’s those who deal with teeth and gums who aren’t there to prescribe
The elusive dentist – I’ve got him on my list
And patients who have symptoms that they simply won’t describe
They just do not assist – they never would be missed
The chap who takes his jacket off and hangs it on the door
The halitotic sufferer whose breath you can’t ignore
The ones who by their actions make it clear that they’re acopic
The bloke who needs a blood test but who says he’s needle phobic
The one advised to see you by their crystal therapist –
I don’t think she’d be missed — I’m sure she’d not be missed!
.
He’s got them on the list — he’s got them on the list;
And they’ll none of them be missed — they’ll none of them be missed
.
The fellow feigning sickness who requires of you a note
That symptom fantasist – I’ve got him on my list
The ones, cos you were running late, complaining to you wrote
I wish they would desist – they never would be missed
The folk you ask what pills they take who haven’t got a clue
They only know that some are red and others they are blue
The ones who think they’re dying since they did that Google search
Who fear that cos their tongue is white they’ll soon fall off their perch
The medicines advisor who on certain drugs insists
I’d like to slap his wrist – I’m sure he’d not be missed.
.
He’s got them on the list — he’s got them on the list;
And they’ll none of them be missed — they’ll none of them be missed
.
And then there are the patients who have issues that are legion
They’ve got a long long list, I’ve got them on my list
Who seem to have a problem with their every bodily region
Their think perhaps a cyst, they never would be missed
Those moaners at prescription costs despite their untold wealth
And those who want a call from you who say they’ve ‘mental ‘elf’
And those who say it’s urgent though they’ve had their problem years
The chaps who come with issues with their gentlemanly spheres
Who really would be handled best by a vasectomist
He’d give them both a twist, I’m sure they’d not be missed.
.
He’s got them on the list — he’s got them on the list;
And they’ll none of them be missed — they’ll none of them be missed.
.
Those saying the pandemic was by Bill Gates orchestrated
The conspiracy theorist – I’ve got him on my list
And all those antivaxers who unfounded fears created
They never would be missed, they never would be missed
The one who says that Covid caused his cough in ‘92
And won’t accept a single thing you ever say is true
The people who in parliament who only cause us hassle
The government advisor that once went to Barnard Castle
Who should instead have gone to see, a skilled Optometrist
I don’t think he’d be missed – I’m sure he’d not be missed.
.
He’s got theem on the list — he’s got them em on the list;
And they’ll none of them be missed — they’ll none of them be missed
.
After W.S Gilbert and Arthur Sullivan
A rendition of this song, performed by Lenny the Lion can be found on my Facebook page on April 30th 2022.
For those unfamiliar with the song, the original appears in the comic opera, ‘The Mikado’, first performed at London’s Savoy Theatre in 1885. Sung by The Lord High Executioner, modern productions include topically updated versions of the song with tongue in cheek suggestions of those people whose loss, were he to be called upon to act professionally, would be a distinct gain to society. If you’d like to hear an example of a fairly recent version, a link to one follows.
Because, in reality, having always enjoyed good relationships with both patients and colleagues alike, and that includes dentists and medicine management advisors, there are many I’ll miss when my time comes to retire from General Practice. Please be assured that the truth is that I am really very fond of everyone that my job brings me into contact with and no more mean to suggest real criticism in the above than, presumably, Gilbert and Sullivan did when, in their original song, they identified children who had an impressive knowledge of historical dates and those with irritating laughs as those deserving of the attention of the Lord High Executioner.
.
As one day I’ll retire when my working days are done
I’ve got a little list, I’ve got a little list
Of people I will want to thank, who’ve made my job such fun
They’ll all of them be missed, they’ll all of them be missed
There’s the patients who forgave me for mistakes that were my fault
The folk who every Christmas gave me smokey single malt
And those who every morning, at half ten knocked on my door
And brought me cups of coffee and those biscuits I adore
They’re none of them draconic, those kind receptionists
They’ll all of them be missed – they’ll all of them be missed.
.
I’ve got ’em on the list — I’ve got ’em on the list;
And they’ll all of ’em be missed — they’ll all of ’em be missed.
.
And then there are the nurses who were always sympathetic
I’ve got them on my list, I’ve got them on my list
When I got into a pickle managing a diabetic
They’ll all of them be missed, they’ll all of them be missed
The HCAs who helpfully squeezed in those ECGs
And never made me beg for one whilst down upon my knees
The times when I had issued drugs whilst just a tad distracted
And someone pointed out the way they may have interacted
Indeed I am so grateful to our helpful pharmacists
I know that they’ll be missed – I’m sure that they’ll be missed.
.
I’ve got ’em on the list — I’ve got ’em on the list;
And they’ll all of ’em be missed — they’ll all of ’em be missed.
.
The team up there in admin, those who type what I dictate
I’ve got them on my list, I’ve got them on my list
Who hear the words I mumble that they’ll first have to translate
Though I sent them round the twist, they’ll all of them be missed
The practice manager who I have driven up the wall
By not reading my emails and by changing my on call
My partners who I have been glad to have close by my side
Who’ve been there as I’ve laughed a lot, who’ve been there as I’ve cried
Well I am very sure now that you all have got the gist
They’ll all of them be missed, they’ll all of them be missed.
.
I’ve got ’em on the list — I’ve got ’em on the list;
And they’ll all of ’em be missed — they’ll all of ’em be missed.
A rendition of this song, performed by Lenny the Lion can be found on my Facebook page on May 13t 2022.
To read ‘I’ve got a little CRICKET list’, click here
To read ‘A Very Model of a General Practitioner?’, click here
This week I watched another episode of The Repair Shop. It’s an excellent programme in which items of great personal worth that have fallen into a state of disrepair, either as a result of neglect, misuse or simply the passage of time, are brought to a team of expert craftsmen and craftswomen for repair. We then watch as they apply all of their skill and experience to the task of restoring the inner workings and external appearance of the precious items. Slowly they are given back their former glory before being returned to their owners, all of whom are invariably delighted with what has been achieved in making what was once broken whole again.
Despite my utter incompetence in all things practical, why anyone would ever allow me to perform minor surgery on them I’ll never know, I found myself feeling envious of those I was watching, wishing I too worked in The Repair Shop. Until, that is, I realised how similar our job is to theirs.
Those who come to us are also of great value but have become broken, likewise due to having been either neglected, treated badly or as a result of simply becoming old. And it is our job to use all our skill and experience to bring about some kind of repair.
The artisans in the programme clearly derive a huge amount of satisfaction from their job and it left me wondering why it is that, if our jobs are alike in so many ways, we do not always experience the same sense of satisfaction that they do.
As I watched this weeks episode I was struck firstly by how all those who work in The Repair Shop seem to really care about the item they are working on, both in terms of appreciating its intrinsic worth as well as recognising its value to the one who brought it. And then there is the obvious love that they have for what they do, the enjoyment they get from the challenge of applying all of their expertise to the task in hand as they work out how best to effect a repair. And finally there is the the very apparent pleasure they experience when they see the joy their efforts bring about in those for whom they have worked.
All of which might give us some clues as to why we sometimes struggle to find the same degree of joy that those in the Repair Shop seem to experience and, more importantly perhaps, thus offer some pointers as to how we might go about deriving greater job satisfaction ourselves.
But before we do, it needs to be acknowledged the differences that exist between our world and that of those who appear on the TV programme. To watch ‘The Repair Shop’ is to spend an hour in a wonderfully reassuring place where everything can be fixed, where everything can be put right. The hectic reality of our daily working lives is, however, very different to the serenity of the world within The Repair Shop where only things of genuine value are brought and where those who work have all the time, space and equipment required to do their job properly. We, in contrast, with our limited resources, sometimes struggle to find the time to do properly those things that are of value, bombarded as we are by the constant demand to also attend to the seemingly relatively trivial. Furthermore, whereas those working in The Repair Shop are always hugely appreciated, we not infrequently feel like we are sometimes being taken for granted. And unlike those in the programme who invariably achieve all that they set out to do, we know all too well that we can’t fix everything. Inevitably we are not always as successful as we would like to be and, as a result, often have to face the fear of being criticised by those who cannot accept that we are unable to bring about the impossible.
Even so we would do well to value those who come to us for help. They really are of immense value. People have huge intrinsic worth and their health is something that is of the utmost importance to them. In the busyness of our working day this is something that is frequently lost as we all too easily end up seeing patients, not as individuals with genuine needs but as merely nuisances instead, ones who seem set on spoiling our day with their difficulties. In reality however, the majority of the problems that are presented are genuine, even if some are more significant and more appropriately brought to a doctor than others. Furthermore, people really are amazing creatures, intricately knitted together, a beautiful and complex amalgamation of the physical, emotional and spiritual, too complex indeed for any of us to fully understand. Perhaps then, if we are to recover some job satisfaction, we need to try to rediscover that sense of wonder that our increasingly frantic working lives have succeeded in squeezing out of us. And perhaps we also need to gain a greater appreciation of what a privilege it is to be involved in the important work of seeking to restore such a precious thing as a fellow human being who finds themselves in need of repair.
That said, it is of course not only our patients who are broken. Some of us are broken too, physically, emotionally and spiritually, as a result of our neglecting ourselves, being treated badly by the job and others or simply as a result of long years in a career that has taken its toll. We all sometimes need the help of others if we are going to make it through – it’s no shame to ask for it. Because we too would sometimes benefit from being taken aside by a master craftsman, to put ourselves in the hands of one who genuinely values us, understands our inner workings and has all the skill, patience and kindness required to put us back together.
Perhaps then we too need to visit The Repair Shop. If we do we may find ourselves reassured that everything really can be fixed, that everything really can be put right. Furthermore, having spent a little time there, someone, somewhere might just experience the joy of having us back, a little less broken than we were before.
‘I’ll go along with the charade until I can think my way out’
Bob Dylan
Recently a patient presented at the practice where I work having been sent to us by a doctor from the local minor injuries unit. She had been advised to request an urgent blood test to determine her blood levels for a certain heavy metal after an ECG she’d had had shown some minor abnormalities. It subsequently turned out however that the automated report had attributed these abnormalities not, as had been believed, to lead poisoning but merely to lead positioning!
An embarrassing mistake to have been made by somebody who had clearly not been thinking properly. But before we laugh too loudly, I wonder how many times we too have stopped thinking for ourselves, failed to see what was there to be seen and addressed only our own ideas, concerns and expectations rather than those of our patients.
As time pressured clinicians it is all too easy for us to stop thinking for ourselves and fall into stereotypical patterns of behaviour based on the assumptions we make and which, though they may speed our decision making, too often serve our purposes more than they do our patients causing us as they do to draw conclusions which steer us down those familiar paths along which we find it more comfortable to travel.
Might it be that we too have stopped thinking properly, failed to see what was in plain sight and thereby absolved ourselves from any responsibility to help as we have passed blindly by on the other side? I don’t doubt that I have, on occasions, done just that and am left asking myself why that might be.
Of course the easy answer to that question would be to say that it’s because I’m either too lazy, too incompetent or too busy to address the problems that are presented to me properly. I suspect that, if I am honest, each of those explanations have almost certainly sometimes been true, but another explanation might be that, rather than face the distress of a problem that cannot be solved, it has sometimes been easier for me to not notice what medicine cannot fix.
In his book, ‘How to think’, Alan Jacobs writes of how, once established, the consensus is hard to challenge because there is great comfort in sharing the commonly held position. He quotes Marilynne Robinson who suggests we have a ‘collective eagerness to disparage without knowledge or information’ alternative or unpopular views ‘when the reward is the pleasure of sharing an attitude one knows is socially approved.’
If this is true, as doctors we are, in the medical setting, predisposed, without thinking, to endorse the view that medicine can solve all our problems because we know that, given they have presented to us, those we are talking to are likely to share this view, and will approve of us for so doing. This is, perhaps, particularly true on account of how so many of us in medicine do so want to be liked.
We are, in the moment of the consultation, invested in not thinking because, it would feel too uncomfortable to disagree because, as Robinson puts it, ‘unauthorised views are in effect punished by incomprehension…as a consequence of a “hypertrophic instinct for consensus”.’
Jacobs asserts that if we want to think, then we ‘are going to have to shrink that “hypertrophic instinct for consensus.” But, he says, ‘given the power of the instinct, it is extremely unlikely that [we will be] willing to go to that trouble”
Jacobs believes that the ‘instinct for consensus is magnified and intensified in our era because we deal daily with a wild torrent of what claims to be information but is often nonsense’. That is certainly true in the medical world where nonsensical demands are too often unjustifiably imposed upon us. Jacobs quotes T.S. Eliot who, almost a century ago, wrote, ‘When there is so much to be known, when there are so many fields of knowledge in which the same words are used with different meanings, when everyone knows a little about a great many things, it becomes increasingly difficult for anyone to know whether he knows what he is talking about or not.’ And in such circumstances, ‘when we do not know, or when we do not know enough, we tend always to substitute emotions for thoughts.’
That is, confused about what to believe, we will default to what feels comfortable and agree with the consensus, the perceived wisdom. Could it be then that when we are presented with a problem we cannot fix, a problem for which medicine is not the answer, the cognitive dissonance we therefore experience serves to make it less likely that we will see that problem at all and and end up seeing only those with which we feel we can deal.
Jacobs believes that ‘anyone who claims not to be shaped by such forces is almost certainly self-deceived.’ We are social beings who need to feel accepted and, since agreeing feels good, we are prone to toe the line. ‘For most of us’, Jacobs suggests, ‘the question is whether we have even the slightest reluctance to drift along with the flow. The person who genuinely wants to think will have to develop strategies for recognising the subtlest of social pressures…The person who wants to think will have to practice patience and master fear.’
So could we as General Practitioners do that? Could we practise patience and master fear and thus resist the ‘hypertrophic instinct’ which insists that medicine is the answer to all our problems.
I’d like to think we could but it will be uncomfortable, as speaking the truth often. It’ll mean giving up the charade that as doctors we have all the answers and accepting instead that there are times when we can do no more than simply notice the distress our patients are experiencing, acknowledge it for what it is and, perhaps, try to ease it a little by being human enough to sit alongside them and share in it with them for a while.
Which will be a whole lot more use than another unnecessary blood test.
‘Those who feel the breath of sadness, sit down next to me
Those who feel they’re touched by madness, sit down next to me
Those who find themselves ridiculous, sit down next to me’
James
Back in the 1960’s, in the days before research required ethical approval, American social psychologist Stanley Milgram carried out a series of experiments designed to investigate the extent to which subjects would submit to the demands of those in authority. Individuals, believing that they were assisting research into how punishment influenced somebody’s ability to learn, were, on the instruction of an ‘experimenter’, asked to act as ‘teachers’ and administer electric shocks to ‘learners’ every time they failed to answer a question correctly. With each wrong answer the ‘learner’ gave, the strength of the administered electric shock increased. Unbeknownst to the ‘teachers’ however, it was they and not the ‘learners’ who were the real subjects of the experiment. In reality, no electric shocks were being given and the ‘learners’ were merely actors who were simulating the effects of the shocks that they were supposedly receiving. The study revealed an alarming willingness on the part of subjects to act against their conscience when told to do so by authority figures with some, on the say so of another, even prepared to give potentially lethal electric shocks to vulnerable individuals with supposed heart conditions.
But what, to me at least, is more interesting still, is how the subjects of the study were prepared to give significantly higher shocks, when those supposedly receiving them were at a greater degree of separation from they who were administering them. That is, as the strength of the shocks got increasingly more dangerous, subjects were more inclined to refuse to administer them when they were able to see the one supposedly being shocked than when they could only hear their apparent cries of anguish. And they were more willing to administer the most dangerous shocks to those from whom they more separated, those who they were kept from both seeing and hearing.
It would seem therefore that the less contact people have with others the less they are concerned about their welfare and the more they are prepared to act against conscience in order to just get the job done.
I wonder if this has something to say us who, over the last year in particular, have been encouraged to remain remote from our patients. Leaving aside the dangers of missing important diagnoses and the withholding of human contact from those who really would profit simply from sometimes seeing us, could it be that working remotely has adverse effects on us too? Might it be that the less contact we have with those for whom we are supposed to care leaves us less concerned about their welfare than we might otherwise have been and result in our being more likely to simply going through the motions as we too just seek to get the job done? Furthermore, as a result of less time with us, might our patients also end up caring less about us?
A year ago we heard a lot about the so called ‘new normal’ but make no mistake, there has been nothing normal about the virtual world we have been living and working in this last year. We are all diminished by such a virtual existence. As tentative steps now begin to be made towards a life without restrictions I hope we won’t seek to hold on to our remote methods of consulting, or, at least, not too tightly. For though some problems may genuinely benefit from such an approach, many do not. And even though some conditions can be managed perfectly safely over the phone, that doesn’t mean that they aren’t better dealt with face to face. I know for sure that this week I have made at least one better, more humane, decision as a result of seeing a patient I might otherwise have even tempted to manage from a distance.
Since, as Milgram’s experiments seem to suggest, remote care runs the risk of us not remotely caring, avoiding patient contact is detrimental for both patients and doctors alike. Furthermore, by working at arms length from our patients, we have allowed much of the satisfaction that the job once held to slip though our fingers. As restrictions begin to lift, rather than holding onto the remote consulting that some see as more efficient, I believe we would do well to once again make face to face consultations with patients our normal working practice. By doing so, not only will we providing better care, we will begin to grab back some of the job satisfaction that has been lost in the last year.
Two years ago I wrote of my unease about how medicine was being encouraged to adopt more remote ways of delivering healthcare. That article can be read here. I never imagined then that I would be practicing the way I have been forced to this past last year, encouraged as I have been to avoid patient contact wherever possible. For me it has not been a happy transition and it has not been one I have found terribly easy. Nor is it something that I have done terribly well, for which I am not sure I’m sorry. Even so, as we now move slowly out of lockdown, such a remote existence must not be allowed to become the norm, not for medicine, nor, indeed, for any other area of our day to day lives. Because it’s simply not healthy.
Humans are social creatures, to fully live we need to have contact with one another, we need to touch. When lovers kiss, it’s more than just a sign of their love, it is an act of love too. And that’s important because more than simply knowing we’re loved, we need to feel it too.
We need to be present in each other’s lives. As in the words of the song, ‘It’s hard to carry on when you feel all alone’. Sometimes, when it seems there is nothing one can do, to simply be there is of genuine value. In ‘Out of Solitude’, Henri Nouwen wrote,
‘When we honestly ask ourselves which persons in our lives mean the most to us, we often find that it is those who, instead of giving advice, solutions, or cures, have chosen rather to share our pain and touch our wounds with a warm and tender hand. The friend who can be silent with us in a moment of despair or confusion, who can stay with us in an hour of grief and bereavement, who can tolerate not knowing, not curing, not healing and face with us the reality of our powerlessness, that is a friend who cares.’
Perhaps that is also the type of GP who cares. If Milgram’s experiments have anything at all to teach us, perhaps it is this: that it is not simply that those who care will draw close to those in difficulty but rather it is those who draw close to those in difficulty who will find themselves caring for others in ways that they wouldn’t otherwise have been able.
We have all had to endure it for nearly a year now, but over the coming months let’s look to leave social distancing behind – in all its forms. And let’s look to sit down with, and care for, each other once more.
Because living a contactless life isn’t a remotely good idea. It would be shocking to think otherwise.
To read ‘Contactless’, the article mentioned in the above post that was written two years ago, click here
To read ‘Eleanor Rigby is not at all fine’, click here
To read ‘Hannah Arendt is completely fine, click here
To listen to the song ‘Sit Down’ by James, click here. You can even sing along – you know you want to!
Spare me a doctor, who makes the mistake Of telling me how, I must stop eating cake Who hasn’t a hint of the apologetic When he tells me at 90 I’m pre-diabetic One who in truth is a silly old fool Who’s not learnt a thing since at medical school One who insists he must always keep trying And solemnly swears that he’ll keep me from dying.
After W.H. Auden
And Auden’s original.
Give me a doctor partridge-plump Short in the leg and broad in the rump An endomorph with gentle hands Who’ll never make absurd demands That I abandon all my vices Nor pull a long face in a crisis, But with a twinkle in his eye Will tell me that I have to die.
‘I have found that attending to one’s own faults is seldom as entertaining as attending to those of others. But it is generally more profitable.’
Jack Leach is a man I admire greatly, both for what I see of him on the cricket field and for what I read about him off it. Writing after England’s win over India in the first test at the MA Chidambaram Stadium in Chennai, the former England captain, Michael Vaughan, wrote this about the England and Somerset slow left arm bowler:
‘Sometimes there is one character who defines a team. For England it is Jack Leach. Yes Stokes, Anderson, Root and Archer are world class. But Leach stands out for me as someone who epitomises what this England team is about. He has got immense character and spirit. He has a lot of self-doubt but he keeps going. He bounced back from that pummelling by Rishabh Pant and the way he bats down the order with such courage proves his inner fight. It tells you the team are together. Every team needs a Leach…alongside world-class players. They are not necessarily the most talented players but they have the biggest strength of all, which is wanting to fight for the team’.
This weeks second test was not so enjoyable for England supporters with India comprehensively winning a one sided game. Leach still took half a dozen wickets but he was unable to recreate his batting heroics of a couple of years ago when his one not out proved vital in England’s win over Australia at Headingley in 2019. This week though, as England vainly attempted to save the match, Leach was out for a first ball duck.
Even so it’s still the case that, ‘every team needs a Leech’. And not just cricket teams. Primary Health Care Teams need one too.
Though, perhaps, it would be fun to be a GP version of a Ben Stokes or Joe Root, a world class doctor capable of great acts of medical heroism, the plain truth is that I’m not. The reality is that I’m not the greatest doctor in the world, nor am I the greatest doctor in my practice. And sometimes, I’m not even sure I’m the greatest doctor in the consulting room when the only people there are me and my patient. Like Jack Leach, I know what it is to experience self doubt and to sometimes fall short. Perhaps you do too. But even so, we who are not the most talented still remain important members of the teams we are a part, both inside and outside of work. Because ‘every team needs a Leach’.
The problem for many of us though is that we tend to compare ourselves with the most magnificent and often end up feeling, therefore, a poor second best. Perhaps then we would do well to stop imagining we could ever perform at the levels of those exceptional, seemingly superhuman, individuals we sometimes read about. Perhaps we need to accept a more modest, but no less important role. Perhaps, instead of wondering how we can magic up a degree of awesomeness that is beyond us, we would do well to sometimes simply ask ourselves ‘WWJD – What Would Jack Do?
If we do we may come up with a helpful answer, one which encourages us to keep going despite our weakness and failures, one which spurs us on to keep fighting for the team.
I don’t know about you but I sometimes find myself wanting nothing more from the working week than to get through it unscathed. But taking such an attitude never leaves me with any sense of satisfaction. I want and need to be part of a bigger cause than that, one that has me looking for more than to merely leave work promptly at the close of play, one that will stretch me beyond my abilities and which will mean that I therefore sometimes fail. Because to settle for a life in which all I want is for my reputation to remain intact and to have enough free time to make full use of my Netflix subscription will see me having settled for something that I will not find fulfilling.
So sometimes it’s good for me to be out of my depth, even if on occasions it means I start to drown, for it is then that I most feel my need of others, it is then I most feel my need of rescue.
Like England’s test players, even the best teams have bad days. But it’s important that we maintain the fighting spirit of a Jack Leach and seek to display something of his character and courage in order that we may continue to play our part, even on those bad days which are due to our own weaknesses. Though it will sometimes be painful we still need to bear that pain, alongside team mates who hopefully will be there for us just as we are there for them when they too inevitably make their mistakes. But it’ll be worth it because, regardless of how little credit we ourselves may receive, much that is achieved by the teams we are a part is genuinely worthwhile, whether that be Team GP, other working teams or the teams made up by the members of our own family. And it is frequently all on account of the seemingly small things.
Because, sometimes, even a modest ‘1 – not out’ makes all the difference.
Even so, there will be occasions, like it was for Jack Leach this week, when even the small things will be beyond us. The sad truth is that sometimes we simply will not possess the strength of character that we aspire to, our courage will leave us and we will let ourselves and others down. At such times, however long we spend asking ourselves ‘What would Jack do?’, we will nonetheless find ourselves unable to perform the way we would like. Because, let’s face it, we’re none of us as great as Jack Leach is portrayed in Micheal Vaughan description of him above. I doubt that even Jack Leach himself is always that perfect in his weakness. If, then, we hope to ease our burden by simply lowering our expectations, by contenting ourselves with being a Jack Leach rather than a Ben Stokes, we will find that we will not actually have eased our burden at all. Because however hard we try, and however modest our ambition, we simply won’t always be up to the task.
It won’t only be others then, that we disappoint, it will be we ourselves as well. So when we feel that weak, that powerless, when we find that all we have is nothing and it is no further use to keep on asking what it is that we should do, what then?
When unsure of what to do, there are some who walk in similar circles to me who ask themselves what another ‘J’ would do and seek then to act as he would. But whilst it is not wrong to do so, it is foolish to imagine that we will ever fully succeed since, if we can’t attain to the standards of a Jack Leach, how will we ever attain to the standards of one who really was perfect. For me then, whilst appreciating that on occasions it may be helpful to ask what that particular ‘J’ would do, realising full well that the answer might be to suffer and die for those who don’t deserve it, when I am conscious of having messed up, when I am at the end of myself and am finding life a struggle, I find it helpful to ask a different question. Rather than asking ‘WWJD’ I ask myself ‘WHJD – what has Jesus done?’ And what did he achieve as he hung there?. For it’s the answer to that particular question that gets me through the night when I am particularly conscious of my weakness and failure.
Because when my best is not good enough, it’s good to know that somebody else’s is.
‘Raking is easy, but all you get is leaves; digging is hard, but you might find diamonds.’
John Piper
Recently I watched ‘The Dig’, the excellent new Netflix Film based on the Sutton Hoo archeological excavation. It is well worth a watch. Alongside the story of Basil Brown, the amateur archaeologist who, in 1938, began exploring what lay beneath a grassy mound near Woodbridge in Suffolk, the film explores the importance of trying to hold on to the transient by remembering the past.
I’ll not spoil the film for those who have yet to see it, but the character of Rory is at one point asked what it was that drew him to photography. He gives the answer, ‘It’s just a way of trying to fix things as they go past, to keep what’s vital from being lost’.
‘To keep what’s vital from being lost’. I suppose that’s what, in large measure, we who are doctors, along with all those in healthcare and, indeed, many other fields too, are trying to do in our work as, daily, we act to try to preserve the preciousness of life. But we are not up to the task. Like the character who is distressed by his failure to protect the one he had been charged to care for, and no matter how much, like him, it’s not what we want to hear, we too have to be sometimes reminded of the truth: ‘We all fail, every day. There are some things we just can’t succeed at, no matter how hard we try.’
A little later in the film Rory asks Peggy, one of the site archaeologists, what would be left of them both if a thousand years were to pass in and instant. Looking around her Peggy replies, ‘Parts of your watch, the torch, fragments of the mug’. Rory then adds what Peggy’s words have left unspoken, ‘But every last scrap of you and I would disappear’.
It’s a sobering thought, one which brings with it with an implication, expressed in the words of another character who reveals what she herself has come to realise, that ‘Life is very fleeting. There are moments you should seize’.
But if there are moments that we should seize, then there are moments that we should remember. Because the past is part of who we are, part of what makes us what we are today and part of what will determine our tomorrow. I’m not referring here merely to our own personal back story, on the contrary, as the film seeks to portray, we are all shaped to some extent by the whole of human history.
As Basil Brown has to be reminded, his work ‘isn’t about the past or even the present. It’s for the future. So that the next generations can know where they came from. The line that joins them to their forebears.’
Our past, it is suggested, will last longer than our future.
So, as we consult with our patients, perhaps we should sometimes cease from our constant striving to achieve those things which we can not hope to succeed at and seek instead to remember together what it is that we are all a part. As individuals ‘We die. We die and we decay. We don’t live on.’ But, as Basil Brown replies to the one who speaks these stark words, ‘From the first human handprint on a cave wall, we’re part of something continuous’. As a result, Brown claims, ‘We don’t really die’.
It’s a comforting notion but is it one that’s true? For, no matter how prettily we try to wrap it up, the ugly reality is that we do all die. Even so, perhaps there is something worth thinking about here. If we make our lives only about ourselves and what we can experience or achieve, all of what we are will indeed die with us. But if we are part of something bigger, something we gladly accept our being a part of, something vast that continues on beyond the few years of our existence, then there is a sense in which what we are does indeed continue after our death.
Sometimes we, as well as our patients would do well to be encouraged to appreciate this bigger picture. Because sometimes, rather than looking in, it is better to look out, rather than looking down, it’s better to look up, and rather than looking forward, it’s better to look back.
Without denying the ugliness of death, we all need to remember the beauty of life. There are moments that we do indeed need to fix as they go past, moments that ground us in something bigger than the here and now, moments that will stop us from being lost in our own individual present and, perhaps, enable us to muster some hope for our future. Maybe it is the inability to do this that contributes to the tragedy of dementia, that cruel disease that vividly displays for us the importance of our need to remember, that we are not meant to live merely in the moment, that we are not meant to live such lonely disconnected lives.
But if we would do well to see our lives as a small part of the whole of human history, might we not do even better by considering if we might not be part of something even greater still? I believe we would. And that’s why, unlike Alistair Campbell, who famously said that he didn’t, I do ‘do God’, both here and, yes, occasionally, with my patients too. For me it’s too important not to. It is dishonest to pretend that medicine has all the answers to the problems that we are presented with, not least that of our own inevitable demise. Our lives are about far more than merely attending to our clinical parameters in the vain hope of eking out a few short additional years of life. For, no matter how meticulous we are in adhering to clinical guidelines, all our lives will, in time, draw to an end.
Even so, it is my belief that my death will be but temporary, for I consider that my life really is a part of something far bigger than my own individual existence, that life really is all about someone who is far greater than me, and that that someone really will one day restore everything to how it was always meant to be. And it is all on account of what has happened in the past that, regardless of how difficult the present might be, I can remain confident that the future really will be as good as it has been promised to be.
Because the dig really is worth it in order that we might uncover what happened, not under a grassy mound in Suffolk but on top of a green hill far away. Like Basil Brown could say of Sutton Hoo, I can say of Calvary, that ‘a man could dig the earth his whole life through and not find anything like I’ve discovered here’. For there is found the greatest treasure of all, in amongst which is a future where every tear will have been wiped away and death shall be no more.
For me then, if we are to not really die, it’s that particular historical event that we all need to remember. It’s that which is truly vital, it’s that which must not be lost.
To read ‘Something to feast your eyes on’, click here
To read ‘Don’t forget to be ordinary, if you want to be happy’, click here
To read ‘Hope comes from believing the promises of God’, click here
To read ‘On being confronted by the law’, click here
To read ‘The Resurrection – is it just rhubarb?’, click here
This week brought the sad news of Captain Sir Tom Moore’s death with coronavirus. The last of his 100 years was certainly a remarkable one as he made the headlines, and many admirers, by lovingly walking around his garden a hundred times. As a result of his tremendous fundraising efforts, £33 million was donated to NHS charities. I, for one, am grateful for his efforts.
Another frail elderly man died this week. Also from Covid 19. Few will know his name, just those who loved him for who he was, many of whom won’t have been fully aware of the ‘heroics’ of his life, how he worked to provide for his family, how, year after difficult year, he was there for his children, and how it was his habit to show kindness to those he lived alongside in the community where he made his home.
His too was a remarkable yet ordinary life.
Last weekend I spent a day at a local vaccination centre. One patient stood out as she was wheeled to the station where I was working. Lost under a swathe of blankets, her bent body was curled up in one of those chairs which allowed her to lie out rather than insisting that she be sat up. With her chin on her chest and her eyes closed, she neither said, nor appeared to hear, anything. Hers seemed to be a life that it might have been easy to dismiss as without value but for the fact that she was clearly loved by the daughter who brought her. I did not know the story of her life but, as we tunnelled through the layers in order to find a small area or aged skin in which to plunge a needle, it felt good to live in a society that values the elderly enough to offer the vaccine to all, regardless of an individual’s achievements or current economic worth. It was a privilege and a genuine joy to vaccinate this particular elderly lady.
It is good to herald the exceptional achievements of individuals, but we do, I think, need to be a little careful that in doing so we don’t lose sight of the value of the ordinary. Most of us will not achieve greatness in the eyes of the world, but our everyday contributions still make a significant difference to those among whom we live and work. Furthermore, as my vaccinated elderly lady demonstrates, our value isn’t lost the moment we no longer contribute or achieve in the way we may once have done.
Life shouldn’t be competitive, a race to see who wins, rather it should be collaborative, ensuring we all get to the finish line in as fit a state as is possible. Constantly judging each other’s worth, on the basis of our achievements does none of us any good, burdening as it does the currently ‘successful’ with the need to maintain their lofty position whilst demonising and demoralising those deemed to have failed. We, and those with whom we live alongside, need to learn how to be kinder to one another, accepting each other and acknowledging our humanness. We need to stop insisting that we all must be more than we actually are and start, instead, to accept one another despite our being the flawed people we, inevitably, sometimes prove ourselves to be.
Captain Tom is quoted as saying that he always believed that things would get better, that the sun would shine again and that we’d all have a lovely day tomorrow. He’s not the first to have said such a thing. Some of us will be familiar with the words of the psalmist who wrote how, ‘Weeping may tarry for the night but joy comes in the morning’. I don’t doubt the truth of these words written, as they were, thousands of years ago, but equally we must accept that, for some, the night has already been long and the day still seems an eternity away.
So until that better tomorrow, that wonderful day when all our tears will have been wiped away, we’ll do well to support the weak as well as celebrate the strong, to rejoice with those who rejoice whilst weeping with those who weep.
Because one day soon, we too may be glad to have somebody who loves us enough to wheel us to a vaccination centre under a sea of blankets and allow us to be the recipient of what is itself an expression of something we all need – a shot of love.
She’s the patient you don’t know you have Sat all alone Forgotten, unknown She’ll not answer her phone She’s the patient you don’t know you have
She prefers it that way
She’s the patient you don’t know you have She’s given herself licence To suffer in silence Her pain and her violence She’s the patient you don’t know you have
She prefers it that way
She’s the patient you don’t know you have Her tears you’ll not see They’re for her eyes only She’ll just let them be She’s the patient you don’t know you have
She prefers it that way
If only for today
To read ‘She’s the patient you still don’t know you have’, click here
Two weeks ago I was faced with a clinical dilemma, a patient of mine who was repeatedly eating, yes eating, the dressings that his carer kept applying to his non healing leg lesion, so much so and that he’d worked his way steadily through a box of Elastoplast.
I sought the advice of my medical colleagues. What, I asked them, might I best do for my patient. Should I:
a) For fear of provoking an intestinal obstruction, counsel the carer to desist from applying the dressings and instead suffer the consequences of the lesion bleeding all over the carpet,
b) Seek a psychiatric opinion, or
c) Advise the carer to take a more authoritarian tone with the patient and threaten no further doggie chocs if the behaviour were to continue.
Their recommendations for action came back from all corners of the country. Had I considered pica, had I checked his ferritin levels and, from those more fully appreciating my patient’s four leggedness, had I tried a cone of shame. This last suggestion, however, despite its suitability and soundness, was not one that was possible for me to employ since all I had at my disposal was a cube of discontent and a cylinder of regret.
Of course the only real option open to me was to seek out a specialist opinion. But having done so and received the advice that a surgical solution was what the leg lesion required, the surgeon sought out my opinion as to whether the procedure should go ahead.
My initial reaction was an unqualified yes but, after reflecting on the matter, I realised that, in terms of quality adjusted life years, performing the operation on a nonagenarian patient made poor financial sense irrespective of how much the old fella was loved by those dear to him.
I sought the opinion of my esteemed colleagues once more in the hope that their collective wisdom would aid me in my ethical dilemma. I asked them whether, in these days of ever increasingly tight purse strings, I should
a) stick with my original advice and, as his allocated key worker, bear the cost of the surgery myself.
b) withdraw my support for the proposed intervention and advise instead that the patient be kept off the furniture for fear of him bleeding on the upholstery, or
c) remove, as it were, the patient from my list, and take on a younger, less arthritic patient who was likely to have better smelling breath.
The advice was universally in favour of proceeding with the proposed surgery, a decision which in truth was never in doubt.
And so, this morning, after a night during which the air was filled with the rancid smell of necrotic tissue, and the silence was disturbed only by the incessant sound of a wound being constantly licked and all too many Elastoplasts being declared lost, presumed missing in action, [does that still count as ‘nil by mouth’?], my elderly patient slipped into an acute confusional state on account of his carers refusing to give him his usual breakfast of cornflakes with milk. [I know, but I’m sorry, he really likes milky cornflakes!]
Transport was duly arranged and he was promptly conveyed to the surgical assessment unit from where he, soon after, was taken down to theatre.
A few hours later, after a brief spell in recovery, he was back home with nothing to show for his ordeal save for a bald patch on his leg, that long overdue cone of shame, and an anaesthetic induced propensity to stagger amusingly when he tried to walk. [Is it wrong to laugh at the afflicted?]
So today was a good day as a result of a job well done. Thank you to Eric, Glen, Jessie and everyone at The Mount Veterinary Hospital, Wellington for early diagnosis, prompt referral and timely surgical intervention all combining to ensure, for today at least, a happy outcome.
“Dead people receive more flowers than the living ones because regret is more powerful than gratitude”
Anne Frank
These words, written by the German-Dutch diarist Anne Frank were brought to my attention earlier this week. I found them arresting and started me wondering as to why, if true, such a thing might be so. Not many of us can honestly sing along with Frank Sinatra and claim that our regrets are ‘too few to mention’ and neither, surely, would anyone join with Edith Piaf and genuinely claim ‘Non, je ne regrette rien’. On the contrary, for there are things in all our lives that we wish were not, things we wish had never been, and things we wish we had never said or done. And there are things that have happened to us or to those we love, things that we continue to bitterly regret ever took place.
But why might it be then, as Anne Frank suggests, that regret is more powerful than gratitude in provoking a response from us when gratitude is something that surely we have all also experienced.
I wonder if the answer might lie in what we have come to expect from our lives. Might it be that we too easily take for granted the good things in our lives, considering them as our right? Might we have become less grateful for them, less appreciative of the kindnesses we have been shown, all as a result of coming to believe, perhaps, that they are all somehow deserved? If so, might that be the reason why we feel less gratitude than we should, and why we may express our thankfulness less forcefully than we could?
In contrast, it seems, we tend to be more easily moved by those things we regret, those things which upset our rosy view of the world. Promised as we have been that, if we believe in ourselves and listen to our hearts, all of our dreams will come true, we have come to expect good things in our lives, that health, wealth and prosperity are there for us all to enjoy. But we have been lied to. And when the reality of the difficulties that invade all our lives can be denied no longer, when it is all too plain that both our lives and we ourselves fall far short of that ideal, we are startled into a response.
Despite the existence of both good and bad, we have tried to airbrush our view of life in an attempt to maintain the illusion that all will be well. So adept have our efforts been that, when pain and suffering inevitably comes, we are shocked, when sadness fills our lives we are surprised, and when death rears its ugly head we are overwhelmed.
And so it is then that we buy flowers – a reminder of beauty, a reminder of love, a reminder of life.
Anne Frank of course knew how hard life could be, spending two years hidden away in a secret annex in an Amsterdam house before being arrested by the Gestapo and eventually dying in the Bergen-Belsen concentration camp in 1944. She was just 15. And yet her writing reveals that, despite the horrors that she undoubtedly experienced, she knew what it was to be grateful. Without denying the bad, she was able to appreciate the good.
‘As long as this exists’, she wrote, ‘this sunshine and this cloudless sky, and as long as I can enjoy it, how can I be sad?’
Perhaps it was because she had learned that the good things in life were not to be taken for granted that she was able to appreciate those good things when she had them to enjoy. Perhaps, instead of allowing anger and criticism of others to flow so readily from within us when things go wrong, we could too. Perhaps we could be a little more thankful and appreciative than we are.
In these days of pandemic nobody’s lot is a universally happy one. The truth is that life is difficult for everyone just now and it may well remain so for some considerable while yet. But ours is not the first generation to find it tough. And though the sky may well be full of dark clouds at the moment, they will, as they have before, one day part and the sun will shine once more. And when it does we will be grateful for its brightness and warmth, just as we can be grateful for all the many things, big and small, that we can take pleasure in today.
Despite, then, the universal nature of sadness, happiness can still be experienced alongside it. Perhaps it might even be true to say that we cannot fully know what happiness is without knowing the pain of sorrow and that sorrow itself requires the memory of the temporary nature of happiness for it to be fully experienced. If so then, if we are to be happy, it must be alongside our sadness. We dare not wait for the absence of sorrow before allowing ourselves to be happy. 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. Paradoxically, we can be happy and sad at the same time.
Even so, as we wait for those infinitely better, brighter days that we all so long for, we would do well to take another leaf out of Anne Frank’s book where she quite rightly once wrote:
‘How wonderful it is that nobody need wait a single moment before starting to improve the world’
To read ‘I’ll miss this when we’re gone’, click here
To read ‘General Practice – A Sweet Sorrow’, click here
Last Saturday I spent the day at a local Covid Vaccination Centre jabbing octogenarians, not to mention one or two even older folk, with the Pfizer vaccine. And, after getting over my initial trepidation of adding 1.8 mls of saline to a glass vial, not something that would generally bring me out in a cold sweat, what a genuinely enjoyable day it was. In large measure, the pleasure I experienced came from working alongside lovely people, many of whom I’d never met before, to deliver something that, please let this be true, will make a real difference in the ongoing fight against coronavirus.
But every bit as enjoyable was meeting the warm hearted, good humoured and affable elderly folk who were being vaccinated. As I merrily stuck needles into their arms I was struck how, since it was they that we were vaccinating first on account of their greater vulnerability, it is in large measure similar folk to them who are being represented in numerical terms when each depressing day the number of deaths from coronavirus are announced.
It has frequently been remarked that there are three kinds of lies: lies, damned lies, and statistics. Mark Twain wrote of how statistics can beguile us into thinking things we shouldn’t and this is most certainly the case with regard to the figures we are currently being presented with daily. I am not referring here to whether or not the figures are an accurate reflection of the true number of coronavirus deaths, rather I am thinking of how they lie to us by distancing us from the personal tragedy behind the numbers, numbing us to the sadness associated with each of the deaths as they are marked down by another stroke of a statisticians pen.
Because however statistically significant it may be, it is all too easy to lose sight of a statistic’s significance.
For example, I wonder how many of us would find ourselves rejoicing next week if there were ‘only’ 500 deaths each day. Whilst we might understandably be pleased that the numbers were falling, might we also find ourselves forgetting how such a number would still represent considerable heart break and pain to those affected. And how many of us have guiltily allowed ourselves to be comforted by considering how a large percentage of those who die from Covid-19 are the frail and elderly who, we may be tempted to tell ourselves, are ‘dying anyway’. Sadly, of course, there may perhaps be some truth in this but we have unquestionably believed a lie if we take that to mean that it therefore doesn’t matter. Last Saturday, for me at least, was a reminder that thinking in such a way is to forget that the lives of the elderly that are being lost are the lives of warm hearted, good natured and affable folk like those I was vaccinating that day.
People aren’t statistics. Each individual who has succumbed to the coronavirus is more than merely one more of the approaching one hundred thousand who have thus far had to be counted. On the contrary, to those who loved them, they are those who were considered as one in a million.
This is not to dismiss as comparatively inconsequential the very real sacrifices being made by the younger generation in the battle against Covid-19, nor is it a call to pursue a particular course of action in the naive belief that every elderly life can be saved. Rather it is to acknowledge that behind the dispassionate statistics there are real people, in real pain, experiencing real grief and that, although, sadly, the deaths of many may be unavoidable, it is, nonetheless, not OK.
As the great vaccination effort continues, let us never become immune to the sadness surrounding those for whom it came too late, let us always stay susceptible to the reality of grief.
And may we mourn the loss of the frail elderly every bit as much as we do those who die early in their lives. Because to believe that the death of somebody who is old or clinically extremely vulnerable is one that should somehow be wept over less than that of someone who is young and fit is to value the strong over the weak and opens the door to a world where the aged and infirm can be forgotten and discarded.
And that’s not a world in which any of us want to grow old.
Some musings 