It’s December 1st and up and down the country, the first doors are being opened on a million ‘Sleeps till Santa’ calendars. The choice this year is huge. Believe it or not, today you could be opening drawers or pulling back cardboard squares to reveal nail varnish, Play-doh, or components to build an FM radio. My favourite though has to be the ‘Drinks by the Dram’ Calendar available on Amazon for a shilling short of £10,000 – who wouldn’t want to start the day with a 60 year old Glenfarclas to accompany their coco pops? But don’t worry if you’re a traditionalist, there are still plenty of calendars out there that retain the true meaning of the holiday season and counting down the days with chocolate impressions of characters from Star Wars remains an option. There’s no doubt about it, ‘It’s beginning to look a lot like Winterval’.

The word Advent is derived from the Latin ‘adventis’ which is itself a translation of the Greek word ‘parousia’ which was often used to speak of the second coming of Christ. Traditionally, therefore, the advent season is that time of year when the church not only looks forward to remembering Jesus’ birth at Christmas but also anticipates his return at the end of history. In many households, as Christmas approaches, the excitement is, no doubt, beginning to build but, when all is said and done, for many Christmas is a huge anticlimax, a deeply unsatisfying time. I wonder why that might be.

For some, Christmas is just too busy, there is simply too much that has to be done. Perhaps we long for the Christmases of our childhood, fondly remembered as magical times when we believed in someone who was better and kinder than ourselves, who insisted on bestowing upon us one kindness after another without us doing anything whatsoever to deserve it. Now though, as adults, we have lost sight of any transcendence that Christmas once held and, rather than resting in the generosity of one greater than ourselves, find ourselves burdened with a list of a thousand things we must do if we are to be deemed acceptable celebrants of what a consumerist society has made of Christmas. Wouldn’t it be lovely if we could experience Christmas, indeed experience life as a whole, as we did when we were little, with a childlike faith that someone other than ourselves would be kind to us in ways we don’t come close to deserving and would see to it that everything worked out just fine in the end. If that sounds appealing to you, if that sounds like heaven, then be encouraged by the words of one wiser than me who once said ‘Truly, I say to you, unless you turn and become like children, you will never enter the kingdom of heaven’ [Matthew 18:3]. You can’t work your way in, but you are offered a free pass – because the one who said these words has paid the entry fee for us, undeserving though we are, and seen to it that everything will indeed work out just fine in the end. We enter the kingdom of heaven by grace, not works.

For others, of course, the forced jollity is unwelcome – when life is characterised by sorrow and despair few of us are up for a party, regardless of how many amusing Christmas jumpers are on display. Some have said that we should no longer wish others a ‘Merry Christmas’ as to do so risks being insensitive to those who are experiencing difficult times. But to suggest as much is to misunderstand Christmas, to consider it nothing more than an excuse for overindulgence as we try to deny the vicissitudes of life. One of my favourite carols is ‘God rest ye merry, gentleman’ – note the position of the comma. For many years I misunderstood this carol imagining that the words were expressing the hope that God would give a bunch of already merry gentlemen a well earned rest! This is not the point at all, as the position of the comma makes clear. What is being hoped for is that God would cause these souls, of undisclosed happiness, to be rendered merry. And the reason that they should be left in such a state of merriment, the reason that, as the carol goes on, nothing should cause them to dismay, is that ‘Jesus Christ our Saviour was born on Christmas Day’. And why was he born? ‘To save us all from Satan’s power when we had gone astray’. This is news worth hearing, very good news in fact, tidings, no less, of comfort and joy, even for those whose lives may have taken the most precipitous of down turns.

Once I asked a group of youngsters which of the following had the most to do with Christmas: a Christmas tree, a mince pie or a fire engine. The answer I was looking for was the fire engine, my point being that Christmas was all about rescue or at least the arrival of a rescuer – the birth of a saviour. Forget this and Christmas loses all of its significance. But even if we are minded to remember what Christmas is really all about, even if we piously pronounce ‘Jesus is the reason for the season’, might we still be missing the point? Could it be that even religious types sometimes get too excited about Christmas?

Imagine this. It’s night time and you wake up to discover your house is on fire. You’re trapped upstairs in your bedroom and the flames are getting higher and higher. The heat is intense and the smoke is getting thicker and thicker. All hope seems lost. The morning was to have brought with it a shot of Pappy Van Winkle’s 23 Year Old Family Reserve but now, at best, it is going to be a little on the warm side to appreciate at its finest. And then, in the distance, you hear the sound of sirens telling you that help is on its way. You run to the window and in the distance you can see the flash of blue light that confirms that the fire brigade is close by. What a relief. Moments later the fire engine comes round the corner and stops outside your house and the neighbours all gather around the crew celebrating their arrival. Everyone is happy. But then you realise, to your horror, that the firemen aren’t doing anything to rescue you – and none of your neighbours seem concerned by the fact. They’re just happy that the rescuers have arrived. What a tragedy that would be. Christmas is about the birth of Jesus but his arrival is only the start – he came with a job description, work to do. The angel had it right – you remember what he told the shepherds? [Luke 2:10-11].

‘Fear not, for behold, I bring you good news of great joy that will be for all the people. For unto you is born this day in the city of David a saviour, who is Christ the Lord’

The Angel brings good news ‘for all the people’ which gives the lie to the assertion so often heard at this time of the year that ‘Christmas is for the children’. And the good news of great joy is that a saviour has been born. Jesus, so called as he would ‘save his people from their sins’ [Matthew 1:21], came as a saviour but, remarkable though the fact that God should become a man is, in and of itself, Jesus’ birth achieved nothing. Yes he came as a saviour but, more importantly still, Jesus went on to secure the salvation he came to achieve. By living a perfect life, a life which God graciously credits us as having lived and thereby enabling him to count us righteous, and then dying in our place, bearing the punishment we deserve for our sinfulness, Jesus saves us from the wrath of God by satisfying God’s need for justice. At Christmas, forgetting the rescue that Jesus was sent by God to secure for us is as tragic, and foolish, as our delighting at the arrival of the fire brigade at our burning home and having no interest in them putting out the fire!

But there’s more. It is not the arrival of the rescuer at Christmas that is the main thing. Nor is it our rescue itself that is the main thing. The main thing is what we are rescued for. And the thing that we are rescued for, mans chief end, is to glorify God and enjoy him for ever.

This life cannot satisfy – not ultimately. Sometimes it might seem to for a while but, sooner or later, its inability to do so is all too obvious – when life is hard and bad things happen to us, as they surely will to a greater or lesser extent, there is no pretending otherwise. Not even the very best of times can ultimately satisfy as even the most pleasant of days, when everything goes well for us, even those days come to an end. A year or three ago, Kaye and I had a great day out in London – we went on the London Eye and took a boat trip down the Thames, we visited the Houses of Parliament and took tea on the terrace there. And lastly, we went to the theatre and saw ‘The Lion King’ – you know the one, ‘Hakuna Matata’ and all that (It means, as you are probably aware ‘No worries’ – great little song but a facile philosophy for this life if it’s not grounded in anything that can relieve us of our anxieties). It was a genuinely lovely day but eventually, of course, it ended. In twenty four days I hope we will all have a really lovely day celebrating Christmas with those we love most – but it will end. All good things do, inevitably so – it’s the nature of our human condition. Memento mori.

C.S. Lewis, author of the Chronicles of Narnia, wrote :

‘If I find in myself a desire which no earthly experience in this world can satisfy, the most probable explanation is that I was made for another world’.

But where might that other world be – where might our longing for infinite joy be eternally satisfied. David gives us the answer in Psalm 16 where he writes

‘[O God,] You make known to me the path of life, in your presence there is fullness of joy; at your right hand there are pleasures forevermore.’

You want infinite joy? It’s found in the presence of God
You want everlasting pleasure? It’s found at his right hand.

The rescue that was heralded by the prophets of the Old Testament, that began with the arrival of Jesus at the first Christmas and was secured by the death and resurrection of Jesus at the first Easter prior to his ascension into heaven, will find its fulfilment when Jesus comes back. Advent is that season of the year when we look forward to the coming of Jesus. It’s good to remember Jesus’ first coming at Christmas but it’s better still to remember he’s coming back. If we’re looking for infinite and everlasting joy, let’s not put our hope in a few fun-filled days at the end of December each year, pleasant though those days may be. Let’s not put our hope in our perhaps seventy or eighty years of life for those years are soon gone and we will ultimately ‘bring our years to an end with a sigh’ [Psalm 90]. Instead let’s hope in God and the new heavens and new earth that he will establish when Jesus returns. It is going to happen! It’s not wrong to long for infinite and everlasting joy, indeed we only truly honour God when we find our joy in him. Delighting in God certainly honours him more than our dutiful religious observance. So let’s rejoice in God – we have every reason to do so as God has promised that he will dwell with us and we will be his people.

Another name for Jesus often heard at Christmas is Emmanuel which means ‘God with us’. Jesus came at the first Christmas as God in human form ‘The word became flesh and dwelt among us’ [John 1:14]. And he has promised that he’s coming back again one day. And when he does he will wipe away every tear from our eyes, death will be no more, and there will be no mourning or crying or pain. Only then will ‘Hakuna Matata’ be a philosophy that will hold true. Today we can only know this by faith – faith in the God who has told us that this is how it will be and who has done everything necessary to see that it works out just fine in the end. Now we see by faith, but when Jesus comes back, then we will see it in all its glorious reality!

This certain hope for the future has the power to change our present, to lift our hearts today, no matter how downcast they might be, as we consider the tomorrow that awaits us. As the psalmist wrote:

“Why are you cast down, O my soul, and why are you in turmoil within me? Hope in God; for I shall again praise him, my salvation and my God. My soul is cast down within me; therefore I remember you” [Psalm 42:5-6]

Merry Christmas.

Reflections on the death of Leonard Cohen

I have a confession to make. I like the music of Leonard Cohen and was saddened to hear the announcement of his death at the age of 82 just three weeks after the release of what until recently was his last album. I understand that he is not everybody’s cup of tea, it wasn’t without reason that he was known as ‘the godfather of gloom’. But for all that, he seemed to me, in his later years at least, a gentle person with a wry self-deprecating sense of humour who thought deeply about the big issues of life. I would have been interested to have met him and would certainly have liked to have heard him play live and see first-hand the obvious pleasure he experienced from the audience’s ironic cheer as he growled out the line ‘I was born like this, I had no choice, I was born with the gift of a golden voice.’

Born and raised in a Jewish family, Leonard Cohen evidently explored religious ideas throughout his life even spending several years at a Buddhist retreat in California where he eventually became a Buddhist monk in 1996. Many of his songs convey religious ideas and his own struggle to understand the nature of existence and though some of what he wrote, to my mind at least, falls very wide of the mark, sometimes his lyrics, often rich in Christian imagery, get things absolutely right.

One of my favourite songs is one called ‘Amen’ which includes the line: ‘Tell me again when the filth of butcher is washed by the blood of the lamb’. This powerfully brings home to me the idea of how the sacrifice of Christ’s death by crucifixion is enough to secure redemption even for the very people who nailed him to the cross. Elsewhere he sings: ‘There is no God in heaven, and there is no hell below, so says the great professor of all there is to know. But I’ve had the invitation, that a sinner can’t refuse, and it’s almost like salvation, it’s almost like the blues.’

I was interested to read in the coverage of his death, an answer Cohen gave some years previously in response to a question regarding the fact that much of his music is melancholic in tone. He said:

“We all love a sad song. Everybody has experienced the defeat of their lives. Nobody has a life that worked out the way they wanted it to. We all begin as the hero of our own dramas in centre stage and inevitably life moves us out of centre stage, defeats the hero, overturns the plot and the strategy and we’re left on the side-lines wondering why we no longer have a part – or want a part – in the whole…thing. Everybody’s experienced this, and when it’s presented to us sweetly, the feeling moves from heart to heart and we feel less isolated and we feel part of the great human chain which is really involved with the recognition of defeat”.

I like this quote as I think that it gets to a truth that is rarely expressed in these days of perpetual self-promotion. It confronts us with the view that making ourselves the hero of our life is sure to end in defeat, and that to make life all about us, is foolishness.

This is something that those of us who are Christians have known, or at least ought to have known, for a long time. And yet it is a truth that I all too often forget. Are we not all, perhaps, tempted to make our triumphs, or even our disasters, front page news imagining that what happens to us is of huge importance rather than realising that we are but minor characters in His story, the story in which he, Christ, is the hero. As John the Baptist said: ‘He must increase, but I must decrease’ [John 3:30].

There is in all of us, admittedly stronger in some than others, a desire to be important, to be newsworthy. The truth, though, is that few of us will ever make the headlines. Though occasionally someone of the stature of a William Wilberforce may live a life of historical significance, most of us will live ordinary lives each with its everyday ups and downs. This is, I believe, to be expected. A constant searching for the so called ‘wonderful plan’ God has for our lives can be, if we are not very careful, little more than a seeking to make a name for ourselves and risks leaving us thinking that when our lives are merely ‘ordinary’ that somehow we have missed out on what God had planned for us.

As Mike Horton writes:

‘Facing another day, with ordinary callings to ordinary people all around us is much more difficult than chasing my own dreams that I have envisioned for the grand story of my life’.

The truth is that God has told us what his ‘wonderful plan’ for each of our lives is and it is this – that we be transformed into the likeness of his son Jesus Christ ‘who, though he was in the form of God, did not count equality with God a thing to be grasped, but emptied himself, by taking the form of a servant, being born in the likeness of men. And being found in human form, he humbled himself by becoming obedient to the point of death, even death on a cross.’ [Philippians 2:6-8].

This is quite a calling and one that will see us having to give up being ‘the hero in our own drama’ that will surely end in our defeat. It will, of course, be a struggle, a struggle in which we will all too often fail. But before we get too introspective and constantly bewail our inadequacies, let’s remember that even our inadequacies fade into insignificance when we recall that the story of our lives has a hero who will never be defeated. Even our sinfulness, great though that sinfulness is, is far eclipsed by the greatness of the one who really is newsworthy. It is He, not us, who guarantees our salvation since we are promised that ‘he who began a good work in [us] will bring it to completion at the day of Jesus Christ.’

The lyrics of his final album clearly reflect Leonard Cohen’s awareness that he was approaching death. ‘Magnified, sanctified, be thy holy name. Vilified, crucified, in the human frame’ he sings and then adds ‘Hineni (a Hebrew word meaning ‘Here I am’) I’m ready my Lord’. The album also contains a song called ‘Treaty’ and it is a reprise of this track with which the album ends. Cohen’s last recorded words were therefore those that the song ends with:

‘I wish there was a treaty between your love and mine’.

These are heart achingly sad final words. I said I’d liked to have met Leonard Cohen, I said I’d like to have heard him sing live, but most of all I’d loved to have been able to tell him that there is a treaty, a covenant between God and his people, not signed by us, but secured by the blood of Christ.

Jesus, at the institution of the Lord’s supper, and referring to his imminent death on the cross said ‘this is my blood of the covenant, which is poured out for many for the forgiveness of sins’ [Matthew 26:28]. I really hope that Leonard Cohen understood and rejoiced in that when he died, I really hope he was one of the many. I really hope he was ready – if so I may yet have the pleasure of meeting him one day.

ADDENDUM – added November 7th 2020

Leonard Cohen died four years ago today. I wrote then on some of the words he had written during the course of his life and, in particular, those contained in what I imagined would be his final album, released as it was a few weeks before his death.

But last November a posthumous collection of new songs was released, one of which is called ‘The Goal’. It opens with words which seem particularly relevant today.

‘I can’t leave the house’.

But in penning that line, rather than foreseeing our heading into another lockdown, Cohen, was referring to his own failing health. The song continues to reflect on his frailty and failures and includes the lines

‘I sit in my chair

I look at the street

The neighbor returns

My smile of defeat.’

Some may think these lyrics as depressingly typical of Leonard Cohen but the song ends, perhaps, more optimistically. Echoing words from the final track on the album in which he urges us to listen, not to himself but to ‘the mind of God’, he leaves us with this final thought

‘No one to follow

And nothing to teach

Except that the goal

Falls short of the reach.’

What did he mean by that enigmatic last couplet. We must all of course decide for ourselves but I wonder if he is suggesting that too often we strive for something impossible and miss what we actually have, something we have been given which is more precious than we give ourselves time to realise.

This lockdown, despite our feelings of powerlessness, I hope we all may have the opportunity to uncover that ‘pearl of great price’. [Matthew 13:45-46]

An Inappropriate Blog? – I Hope You Like It

It can be difficult to decide whether to write a blog. Most blogs aren’t appropriate and can have adverse effects. Too many blogs can mean the benefits of genuinely necessary and helpful blogs are lessened. But, knowing all that, I’ve decided to blog anyway – just in case. After all you’ve come to the blog page, you presumably expect a blog, and you might not be happy if one isn’t offered – I don’t want to disappoint you.

So here goes. This week I’ve received some good news! I’ve been ‘liked’ by the GMC! 🙂 Well I say liked, I mean of course ‘revalidated’ but it comes to the same thing. I posted a few comments of dubious value on an appraisal website and, lo and behold, I’ve been affirmed by no less an organisation then the GMC! My wife may not have been impressed when I told her but, come on, I mean, the GMC. Does it get any better than that?

Yet the experience left me feeling somewhat flat. Curiously, being approved of by a faceless organisation, who demands of me certain requirements that I must satisfy in order to have their approval bestowed upon me, turns out not to be as fulfilling as I’d hoped!

Tragically though,it seems that we are being driven by an ever greater desire to be liked. It’s not just Facebook. It is a requirement that we be approved of by various groups – groups that sometimes have diametrically opposed ideas of what it is they want from us.

Take the antibiotic prescribing issue. On one hand we are quite correctly being encouraged to reduce our antibiotic prescribing and being threatened with a reprimand if we do not curtail their inappropriate use. But, on the other hand, we are being judged by how satisfied our patients are by our practice and, despite, what patient education programmes try to convey, the idea continues to be held, even by some of the most educated of our patients, that antibiotics are required for minor self limiting infections. Without them many of our patients won’t be satisfied. One wonders if scientific explanation of the facts will ever be effective in a society that increasingly has dismissed scientific fact in favour of what we feel is right. Aren’t we all a little like Stewart Lee’s taxi driver who dismisses what he doesn’t want to believe with, ‘Well you can prove anything with facts!’? Leaving aside that particular question though, one thing is certain – it is impossible to satisfy the competing desire of patients who want antibiotics and the ‘powers that be’ who want us to reduce their being prescribed.

Similarly we are being asked to avoid unnecessary admissions to hospital whilst being increasingly criticised for delays in diagnosis and referral. Some have called for a doubling of our referrals to cancer services and starting primary prevention for heart disease at ever lower levels of risk, and yet our referral rates and prescribing practices are under ever more scrutiny.

Who are we going to choose to please?

I wonder if we doctors are particularly vulnerable to the need to bring liked. How many of us were the good boys and girls at school, driven by the desire to please our teachers, who didn’t like to disappoint the careers advisor who suggested we tried our hand at medicine, and jumped at the chance of entering a profession which made our parents proud. Not that there’s anything wrong with any of this – it’s just that we may not be the best people to say an appropriate ‘No’ to our patients and risk disappointing them. After all didn’t we go into medicine, first and foremost to help patients – to please them, and not our bureaucratic taskmasters?

The truth is that one can’t please everybody all the time – and we are fools to try. In a society which constantly and increasingly seeks affirmation is it any wonder that we are overwhelmed by the need to please those with competing desires. Whatever we do is wrong in somebody’s eyes. The incessant double binds threaten, not only our own happiness but also the stability of the whole system – a system already creaking from the overwhelming demand and time limitations that together drive us, perhaps, along the route of least resistance – the route that earns us a ‘like’ most easily – the one that comes from our patients. We may not be proud of it, but haven’t we all issued an antibiotic or renewed a sick note, not entirely appropriately, as we simply did not have the time or energy to do otherwise and out of a desire to please the patient – after all, the customer is always right, aren’t they, the doctor-patient relationship is at least partly built on the doctor being seen as helpful rather than obstructive isn’t it, and we need a positive patient satisfaction rating and some thank you letters to show our appraiser, don’t we?

But none the less, something is going to have to change in regards to the the way we behave if things are to improve. In short we need to be professionals who are in the job, not to be admired, but to do what is necessary. Whisper it quietly, but we are going to have to be less patient centred in order to be more patient friendly. We are going to have to be less concerned about doing what our patients want, what they will like us for, and try instead to do, to the best of our ability, what is right. And we are going to have to care less about how we are thought of by our patients – I’m not sure just how valid their opinion is anyway. On a single day last month I received two pieces of feedback – one accused me of negligent incompetence, the other rated me as unusually astute. So which is it? Well of course it is neither – I am no more ‘awesome’ than I am ‘useless’. I am in fact ‘ordinary’ – an ordinary GP who, like ordinary GPs up and down the country, knows less cardiology than a cardiologist – but more than my patients. Our patients, our politicians, and we ourselves are going to have to accept this – whether they, or we, ‘like’ it or not.

Well that’s the blog written – I’ll leave you to decide if it was appropriate or not.
But I hope you ‘like’ it!