Dr Dog

Dr Phil Hammond once said: ‘For 90% of symptoms you’re better of with a dog than a doctor’. He pointed out that dogs are an antidote to loneliness and a lack of exercise and that they give encouraging licks, which GPs are generally reluctant to do.

So, by way of experiment, and to see if the recruiting of a canine workforce might be the answer to the current shortage of General Practitioners, this week we employed Barney as a locum in our practice.

This may have been a mistake as it seems it’s true what they say. Now over 14 years old it has indeed proved impossible for him to learn any new trucks. Here he is seen insisting that my card was the Jack of Hearts when it was in fact the Queen of Spades.

And you should have seen the mess he made of cutting my wife in two!

Despite his unpromising interview however, such was our desperation to find somebody to help with the clinical workload, we nonetheless went ahead and offered him eight sessions a week. Here he is getting home after his first day on call – as you can see, he’s already cream crackered, just like the rest of us.

Unlike his previous job though, it turns out that a penchant for daytime torpidity, a propensity for covering the living room floor with unwanted hair, and a particularly appealing pair of dark brown eyes doesn’t make up the sufficiently broad skill set required for working as a GP.

Furthermore, the previously agreed remuneration of an additional Bonio and a handful of doggy chocs is no longer considered sufficient reward for his labours which, to be fair, isn’t too surprising seeing as we made him do Advanced Access.

He tells me he won’t be back in next week so the search for a solution to the shortfall in primary care clinicians goes on.

Anyone know if hamsters can take blood?


Related Blog:

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

BUT THIS I KNOW…

Yesterday, under clear blue skies, I went for walk. As I strolled across green fields all was quiet, the silence only broken by the sound of my footsteps, the birds singing in the trees and the hum of a light aircraft overhead. I was conscious of how different things were for so many of my fellow Europeans whose lives are so very different, characterised as they now are by the sound of explosions as Russian forces advance on cities throughout the country they have long called home. No wonder I cannot sleep tonight – It’s hard to lie comfortably in your bed when you know that others remain anxiously awake, terrified that they and their children will be dead by morning.

Most of you who know me will be aware that I am a Christian. Perhaps some of you are asking yourselves, if the God I say I believe in exists, why doesn’t He do something to stop the violence – why doesn’t He stay Putin’s hand? It is, of course, a fair question, one to which I have a simple answer: I don’t know. There will, no doubt, be those who say that this war is a sign that we are now living in the last days and there is a sense in which I believe that they are right since the Bible speaks of the last days beginning some 2000 years or so ago. But whether we are now seeing them drawing to an end or whether they will continue on for another 2000, 20,000 or 200,000 years, I for one, do not know.

It would seem then that there is much that I do not know. And there is. Furthermore there is much that I do not understand and much that I wish was different to how it is. Even so, there are some things that I do know, there are some things about which I believe we can be certain.

1. God is still in control. Nearly 3000 years ago King Uzziah died, and the future seemed very uncertain for the people of Israel. Isaiah, however, saw beyond the immediate political uncertainty. ‘In the year that King Uzziah [he] saw the Lord sitting upon a throne, high and lifted up; and the train of his robe filled the temple. [Isaiah 6:1]. Here is a picture of a God who is utterly in command. I believe he still is today. In the year that Vladimir Putin invaded Ukraine, God remains on the throne.

2. What Putin means for evil, God means for good – irrespective of how unable we are to see or even imagine what that good might be [Genesis 50:20]. God has a habit of working in mysterious ways and though it may sometimes grieve him to do so, we shouldn’t perhaps be too surprised if, on occasions, He is want to operate outside our way of thinking. It is after all He who is God, not us. ‘For as the heavens are higher than the earth so are [His] ways higher than [our] ways and [his] thoughts than [our] thoughts’ [Isaiah 55:9]. When Jesus was crucified most who looked on saw nothing but defeat. How, they thought, can a dead Messiah save anyone? And yet there was one, the second thief who hung on a neighbouring cross, who saw that the bleeding, dying man next to him remained a King, and what’s more, one who, far from defeated was, even through his death, securing a victory that would last for all time. Similarly then, God can, and will, bring something genuinely good out of what is currently, self evidently, so dreadfully bad.

3. ‘God opposes the proud but gives grace to the humble’ [James 4:6]. Make no mistake God is against all that Putin is currently trying to achieve even if he is currently allowing him to continue his violent assault on the Ukraine people. Further more, ‘The LORD is a stronghold for the oppressed, a stronghold in times of trouble’ [Psalm 9:9], ‘The LORD works righteousness and justice for all who are oppressed’ [Psalm 103:6]. Even if it takes longer than we would like, we can be sure that ultimately Putin will be defeated, righteousness will prevail and love will triumph over all that is evil.

4. God is with those who suffer. Even though there will be those who, even today, walk through the valley of the shadow of death, they need fear no evil, for God is with them, his rod and his staff will comfort them [Psalm 23:4]. God has promised to never leave us of forsake us and not even death can separate us from the love of God. [Romans 8:38-39].

Now don’t make a mistake. I am not offering here a platitudinous ‘Smile, Jesus loves you‘ to the people of Ukraine and suggesting that those facing such terrifying days should simply cheer up and not worry. On the contrary, Though it is most certainly true that Jesus does indeed love those caught up in the conflict, I fear that their suffering will be huge, their sorrow intense, and their anguish all too real. Even so I believe that there is yet hope, and a certain hope at that, because there is a God of love who cares for those who are currently being so dreadfully afflicted.

And neither am I suggesting that we in the West should simply ‘Let go and let God’. A high regard for God’s sovereignty does not mean we should stand back and look on from a distance, comforting ourselves by imagining we have no role to play ourselves. Just as my believing that God has set the day of my death does not mean that I no longer need to look both ways when I cross the road, so too my belief that God is in control of the situation in Ukraine does not mean that I should not act to help where I can. And help we all most certainly can. We can both petition and support world leaders as they seek to undertake the near impossible job of trying to decide what best can be done to help those being attacked. Many of us will be able to offer financial support for the huge humanitarian aid effort that will no doubt be made to help those in need and some of us may even be in a position to offer physical help to those refugees who will perhaps end up on our doorsteps. And all of us can pray, really pray – to the God who is really there and who really does care.

I am of course very well aware that it is easy to write this from a distance, that it is easier sometimes to believe things theoretically than it is to do so in practice. But I hope and pray that I will both believe and count on all this being true when my time comes to die, be that comfortably in my bed at a ripe old age, or as a violent consequence of an escalation of the war that we are now seeing in its infancy in Ukraine.

For tonight though my heart breaks for the people of Ukraine, the news reports coming out of that great nation move me to tears. And so until an opportunity affords itself for me to help in perhaps more tangible ways, my prayers are for the men, women and children whose future appears so uncertain tonight.

Please do join me.

Here is a link to a hymn I have been listening to of late. It is a comfort to me that its words remain as true today as they ever have been, both for the people of Ukraine and for me. Perhaps you might like to sing it along to it too.


Related posts:

To read “Suffering- A Personal View”, click here.

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

To read “Luther and the global pandemic – on becoming a theologian of the cross”, click here

To read ‘Covid -19. Does it suggest we really did have the experience but miss the meaning?’, click here. This is a slightly adapted version of “T.S. Eliot, Jesus and the Paradox of the Christian Life’.

To read, ‘But this I call to mind and therefore I have hope’, click here

To read “Hope comes from believing the promises of God”, click here

To read “Waiting patiently for the Lord”, click here

To read “Good Friday – 2021”, click here

To read “Easter Sunday – 2021”, click here

To read “True Love?”, click here

THE STATE OF DISREPAIR SHOP

Ouch! This isn’t just going to hurt – this is hurting already.

At my GP practice this week we received another email from our local hospital asking that, if at all possible, we avoided admitting those patients that in normal circumstances we would consider needed inpatient care. Such communications are always somewhat irksome since they seem to suggest that sometimes, simply for the fun of it, we want to expose our patients to the dubious pleasure of hospital food. Even so, one could understand, on this occasion at least, why the email had been sent since it was clear that our hardworking hospital colleagues were clearly experiencing unprecedented demand for, as it was being sent, there were 30 patients in the A&E department requiring admission for whom no bed was available.

But it’s wasn’t just the hospital that was struggling because, as that email was being received at our practice, the on call Doctor was himself overwhelmed as he tried to single-handedly deal with over 80 urgent individual patient contacts on a single day, proving, as he did so, that, once again, it is not GP access that is the problem but GP capacity.

On Wednesday evening I took refuge in the comforting surroundings of ‘The Repair Shop’. Those of you who watch the BBC television series will know what a brilliant program it is, showcasing as it does, the wonderful skills of a number of master craftsmen and women as each week they restore to life various cherished possessions that have long since seen better days. As I watched it this week I couldn’t help but wonder how different things would be if ‘The Repair Shop’ was part of the NHS as it now is. Because, for all its fantastic efforts, the NHS is daily becoming a more and more frenetic place to work and, this week of all weeks, nobody working on its frontline is finding life a breeze.

So…

This week in the repair shop:

The owner of a treasured timepiece arrives at ‘The Repair Shop’ and is shocked to discover that, after waiting three years to see him, clock restorer Steve isn’t on hand to help. Informed that horological services are no longer available locally she is told that she will have to make a 200 mile round trip to have her chronometer looked at elsewhere.

An antique camera is restored by Brenton but, in order for its handle to be attended to, its disappointed owners are told that they will have to return home and see their local photographic dealer who, they are assured, will be happy to organise the necessary separate referral for them to see leather expert Susie.

Dom tries to repair an old battered bicycle but has to abandon the attempt when his sand blaster breaks down and he is therefore unable to remove its many years of accumulated rust. Ironically, Dom can’t tell the two-wheeler’s heartbroken owner when the sand blaster might be repaired and has to explain to him that he’ll simply have to wait a while longer.

Amanda is off with Covid and Julie, having been in close contact with her, is self isolating pending the result of her own PCR test. Consequently ceramic conservator Kirsten, despite her limited expertise in the area, takes over a soft toy repair and upsets a child when she inadvertently stitches back on the head of a thread bear teddy the wrong way round. Later, upset and distracted by what she’s done and swamped by her own escalating workload, Kirsten has to rush to get things done and consequently drops a priceless Ming vase.

Overwhelmed by unprecedented demand for his furniture repairs, Will is no longer able to cope. Not wanting his colleagues to witness his tears, he crawls under his workbench and is seen sat on the floor rocking back and forth with his head in his hands. Subsequently he joins Lucia who is already on long term sick leave as a result of work related stress. The two are heard considering taking early retirement.

As the queue of cars outside ‘The Repair Shop’ grows ever longer, with each vehicle containing another broken family heirloom in need of urgent care, Jay’s attention is drawn to a newspaper report suggesting that the craftspeople are themselves responsible for the the long waiting times currently being experienced by clients. Staff morale sinks lower still when BBC head office sends out an edict demanding that all employees in the barn reflect on their lackadaisical attitude towards their work. The diktat also inform them that from now on they will all be required to double their current levels of productivity .

But, of course, none of this would ever happen at ‘The Repair Shop’.

Perhaps that’s why I so enjoy watching it.
Perhaps that’s why I find it so uplifting.
Perhaps that’s why I would so love to work there.

Because everything at ‘The Repair Shop’ is just a little less painful.


Related Posts:

To read ‘The Repair Shop’, another, more positive, blog comparing Medicine with the television programme, click here

To read ‘The Dig – it’s well worth it’, click here

To read ‘Hearing the grass grow’, click here

To read ‘The Three Little GPs and the Big Bad Secretary of State for Health’, click here

To read ‘Mr Benn – the GP’, click here

To read ‘A GP called Paddington’, click here

To read ‘On Being Crazy Busy – A Ticklish Problem’, click here

To read ‘Reintroducing GPs Anonymous’, click here

To read ‘On Call Days and Mondays Always Get Me Down’, click here

DR WORDLE AND THE MYSTERY DIAGNOSIS

Dr Wordle picked up the phone and dialled the number of his next patient. After only a few rings his call was answered and a woman’s voice announced herself as Miss Tina Fied.

‘Hello Tina, it’s Dr Wordle here. I’m ringing with the results of your tests.’

‘Oh Dr Wordle, I was hoping you’d call. I haven’t been able to stop trying to work out what my symptoms could be caused by’.

‘Was there anything you were particularly concerned it might be?’

‘Well Doctor, I’m probably being silly but I was worried I might have cancer.’

‘Cancer!’, exclaimed Dr Wordle, ‘don’t be ridiculous Tina. How could you possibly have cancer? Cancer has six letters. Don’t you know I only deal with illnesses which have just five letters in their name. So try again – have a wild guess at what might be the problem.’

Tina was a little taken aback and took a few seconds to think of a condition with the requisite number of letters in its title.

‘Piles?’, she hesitantly offered as an answer, not with any real expectation of being right.

‘Well that was a wild guess’, laughed Dr Wordle. ‘You could hardly be more wrong. That said, and although haemorrhoids are rarely the cause of a new continuous cough, you have got one letter right. There is an ‘I’ in your diagnosis, but it’s not your condition’s second letter. Have another go.’

Miss Fied was beginning to get a little irritated by Dr Wordle and asked him if he couldn’t simply tell her what she was suffering from.

‘Simply tell you? Absolutely not! Where would be the fun in that? Do please have another guess.’

Tina racked her brain for what seemed like forever desperately trying to come up with any five lettered illness that might cause her to cough. Suddenly she had a flash of inspiration.

‘Croup’, she said excitedly, confident that the conundrum had finally been solved.

‘Obviously not’, replied Dr Wordle pointing out rather dismissively that there was no ‘I’ in ‘croup’. ‘But’, he added, sounding a little disappointed as he did so, you have nonetheless been somewhat lucky with your guess for I can reveal to you that your illness does indeed begin with a ‘C’ and that it also has an ‘O’ in it though it’s not its third letter’.

Tina scratched her head again and thought hard for a disease with five letters that began with ‘C’ and contained both an ‘O’ and an ‘I’. For a moment she considered Covid but she couldn’t see how her cough could possibly be Covid. And since she had tested negative on a lateral flow test that morning she quickly dismissed the idea.

‘Colic?’, she offered tentatively, knowing inwardly how unsatisfactory her answer was. Anxiously she awaited Dr Wordle’s response.

‘Close – but no cigar’ Dr Wordle countered. ‘In my book colic is more a symptom than a disease but even so I can tell you that, as well as the initial ‘C’ you now have the ‘O’ and the ‘I’ in the right place. But I’m afraid there is no ‘L’ and only the one ‘C’ in the disease you’re looking for’.

‘You really are most irritating Dr Wordle! Must we continue playing this silly game. Is this really how they teach you to break bad news these days?’

‘I’m afraid it is Miss Fied, I’m afraid it is. And if I have anything to do with it everything will soon be Wordle-fied!. It’s already begun of course. Take our world leaders. There’s Biden and Putin and of course there’s Boris. You see what I’m saying? So come on Tina, you must guess again.’

Now totally exasperated by the situation, and despite having previously discounted it as a possibility, Miss T. Fied found herself blurting out the only answer that remained open to her.

‘Covid’, she announced resignedly, ‘Have I got Covid?’

‘Congratulations, Tina, you have indeed. Now all that’s left for you to do is to tell all your friends and family that, despite it taking you a while, you’ve finally got it. After that you’ll find that none of them want anything to do with you for a while. Now, is there anything else I can do for you today?’.

‘No thank you, Dr Wordle, I don’t think there is. But if I ever find myself suffering from polio, mumps or worms I’ll be sure to get in touch.’

‘You make sure you do! Goodbye then Miss Fied. I’m sure we’ll speak again soon’

‘I don’t doubt it, Dr Wordle, perhaps even tomorrow. But until then ‘Goodbye’ to you too.’


Other GP related stories:

To read ‘Mr Benn – the GP’, click here

To read ‘A Bear called Paddington’, click here

To read ‘The Three Little GPs and the Big Bad Secretary of State for Health’, click here

To read ‘A Mission Impossible’, click here

To read ‘Jeeves and the Hormone Deficiency’, click here

To read the whole of ‘The Scrooge Chronicles’, click here

To read ‘The Happy Practice – A Cautionary Tale’, click here

To read ‘A Grimm Tale’, click here

THE RAINBOW’S END

Last weekend I spent a day in Topsham. Whilst sheltering from a heavy shower in a bird hide and watching the waterfowl that inhabit the salt marshes there, I was fortunate to witness a particularly spectacular rainbow and was reminded how, in the biblical account of the flood, the rainbow was given as a sign of God’s covenant promise to never flood the whole earth again. Interesting to me is the fact that the Hebrew word that the Bible uses for bow in Genesis 9 is ‘qešet’. The same word is used elsewhere in the Bible for that type of bow that is used as a weapon of war suggesting that the bow we are talking about here is a ‘bow’ as in ‘bow and arrow’. More interestingly still is that the bows we see in the sky after rain are ones that always point towards heaven.

The story of Noah and the Ark, as given to us in the book of Genesis, tells how the flood was an act of judgement on God’s part, ordained by him because he ‘saw that the wickedness of man was great in the earth, and that every intention of the thoughts of his heart was only evil continually.’ Scary stuff! And all the more so perhaps given that the world isn’t fairing any better today. But we should remember that the account of Noah and the Ark is first and foremost a picture of the salvation that is available to us through faith in Christ. For just as those who were hidden inside the Ark were brought safely through the flood, so too there is hope for us who, hidden in Christ, will surely be brought safely through death.

After the flood the earth was not cleansed of all sin and God remains angry therefore at our continued wrongdoing. Judgment will follow. But the rainbow reminds us, not only of God’s promise to never flood the whole earth again, but also of God’s willingness to fire the arrow of his judgment at himself. God himself is reminding us of his promise to take the punishment that his people deserve on account of their continuing to sin.

It is a feature of covenant promises that they are always accompanied by covenant signs. The Christian practice of taking communion is another such covenant sign. And a greater one too. When at the Last Supper, Jesus inaugurated the practice, he told the disciples to take the bread and wine ‘in remembrance of him’. And of the wine in particular he said, ‘this is my blood of the covenant, which is poured out for many for the forgiveness of sins’ [Matthew 26:28]. Like the rainbow, drinking the wine is a sign of God’s promise to be merciful to us. When we take the cup we are reminded that the blood shed by Jesus on the cross is sufficient to allow God to lovingly forgive us our sins without him having to compromise his justice. When we take the cup we are reminded that God has indeed let loose that arrow of judgment and that he himself has been pierced by it. For it was on the cross that Jesus paid the price for all our sin, it was there that he was ‘pierced for our transgressions’ [Isaiah 53:5], it was there that, as he suffered and died, he took the punishment we deserved.

But it’s not just we who are reminded of covenant promises by covenant signs. Remarkably perhaps, it reminds God too. Consider the rainbow again. When he first gave it as a covenant sign, God said:

This is the sign of the covenant that I make between me and you and every living creature that is with you, for all future generations: I have set my bow in the cloud and it shall be a sign of the covenant between me and the earth. When I bring clouds over the earth and the bow is seen in the clouds, I will remember my covenant that is between me and you and every living creature of all flesh. And the waters shall never again become a flood to destroy all flesh. When the bow is in the clouds, I will see it and remember the everlasting covenant between God and every living creature.

[Genesis 9:13 – 16]

The rainbow therefore reminds God, as well as us, of his promise. And so it is when we take Communion. It too is a covenant sign which reminds God of his covenant promise to us. When we take communion it isn’t just about us remembering what God has done for us in Jesus Christ. When we take communion, we are tangibly representing the gospel as a memorial before God. As we take the bread and wine “in remembrance of [Jesus]” we proclaim the Lord’s death before God. And God, who sees the sign, remembers once again his promises to us.

It’s a wonderfully reassuring thing to remember God’s promises. But how much more reassuring to realise that God himself remembers them too, that his ongoing grace towards us is assured.

That is the rainbows end.


Related blogs:

To read, ‘Water from a Rock’, click here

To read, ‘The Sacrifice of Isaac – Law or Gospel?’, click here

To read, ‘Rest assured’, click here

To read, ‘Hope Comes From Believing The Promises Of God’, click here

And for something completely different, to read ‘Somewhere over the rainbow’, a blog based on the excellent film ‘Judy’, click here

‘GPs ARE RESPONSIBLE – IT’S TIME THEY WENT’

Family doctors were facing mounting criticism last night after it was revealed how consultations in primary care were spiralling out of control. Yesterday’s publication of the long awaited ‘Black and White’ report exposed how GPs have been contravening restrictions that had previously been laid down by government with the express purpose of ensuring that contact with patients was reduced.

Standing outside Downing Street with a glass of champagne in his hand, the Secretary of State for Health lambasted those working in primary care, laying on them the blame for what he described as another shameful example of the profession acting without any thought for what some politicians were going through.

Jajid Savid was responding to data that revealed that in December 2021 GP appointment figures were a staggering 20% (4.9 million) higher than the same month two years previously. before the pandemic.

‘What these people need to realise’, said Mr Savid, ‘is that last year, while they were booking more appointments than ever before, an eye watering 367 million, many in Whitehall were facing the distress of having to bring their own bottle to alcohol fuelled social events. It’s about time GPs took a long hard look at themselves and apologised for not acting in accordance with official government policy that seeks to portray them as lazy ne’er do wells.’

Pledging to do all that he could to bring locally responsive medical services to an end, the Health Minister closed by saying, ‘It is absolutely clear that GPs are responsible – it’s time they went’.

A number of GPs were asked to respond to Mr Savid’s comments but none were available, all claiming to be far too busy providing patient care.


Other GP related stories:

To read ‘Reintroducing GPs Anonymous’, click here

To read ‘Mr Benn – the GP’, click here

To read ‘A Bear called Paddington’, click here

To read ‘The Three Little GPs and the Big Bad Secretary of State for Health’, click here

To read ‘Jeeves and the Hormone Deficiency’, click here

To read the whole of ‘The Scrooge Chronicles’, click here

To read ‘The Happy Practice – A Cautionary Tale’, click here

To read ‘A Mission Impossible’, click here

To read ‘A Grimm Tale’, click here

Stuck In The Middle With You

Well I don’t know how I’ll get through today
With all the patients that are headed my way
If I’m to see all those who are sick
My consults they had better be quick
Phones to the left of me,
Patients to the right
Here I am – stuck in the middle with you.

Yes I’m stuck in the middle with you,
And I’m wondering what it is I should do.
It’s so hard to keep this smile on my face.
I’m headless chicken like all o’er the place.
Friends to the left of me
Colleagues to the right!
Here I am – stuck in the middle with you

And then there are the patients who with coughs and colds they do their best
But no matter how they try they can not get a PCR test…
Test…

So with ambulances in short supply
To timely treatment now we must say goodbye
Outside of A&E’s they all wait
As staff inside must self isolate
Queues to the left of me
Delays to my right
Here I am – stuck in the middle with you

And then there are the patients who are left with pain that just won’t stop
Who none the less discover that they have to wait years for their op…
Op…

I’ll see patients who no longer can cope
I’ll see patients who have given up hope
I’ll see patients who no longer know why
I’ll see those who say they just want to die
Sad to the left of me, desperate to my right
Here I am – stuck in the middle with you

Stuck in the middle with you . . .
Stuck in the middle with you . . .
Stuck in the middle with you.

After Stealers Wheel

A musical rendition of this song can be found on my Facebook page on 7th January 2022. It is performed, in his own inimitable style by Lenny the Lion. But I wouldn’t bother if I were you.

And a hidden track, also recorded by Lenny and entitled ‘Who Do You Think You Are Kidding Mr Putin?’, can be found on my Facebook page on 12th March.


For more song adaptations please follow the links below:

To read ‘The Wild GP’, click here

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

To read ‘Baggy White Coats’, click here

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

To read ‘GP Kicks’, click here

To read ‘Three Lockdown Songs’, click here

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

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

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

To read ‘My Least Favourite Things’, click here

To read ‘My Most Favourite Things’, click here

To read ‘Yesteryear’, click here

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

To read ‘Summertime’, click here

CHRISTMAS 2021

Last weekend I was flipping through this year’s, supposedly ‘legendary’, double issue Christmas edition of the Radio Times. In it the editors wrote this:

‘We live in uncertain times, but that’s why Christmas is so important. It’s a glimpse of normality in an abnormal world; a glorious distraction from the sense that life is fragile, real and earnest. No one ever used to talk about saving Christmas, but now that’s seen as a pressing priority. No wonder. We all need a chance of escape’.

Which got me thinking.

Over the last couple of years it has frequently been said that we live in uncertain times and understandably so. In a week which began with us still not being absolutely sure if by it’s end we would be allowed to gather with family and friends for Christmas, we might indeed wonder if we can be sure of anything anymore. But are things really more uncertain now than they once were? Perhaps we are mistaken in thinking that we could previously have been more sure of what the future might bring. Because what we once imagined was certain was never as certain as we thought it was. In the New Testament James, never one to mince his words, tells us that we are arrogant and evil to ever imagine that we know what tomorrow will bring!

‘Come now, you who say, “Today or tomorrow we will go into such and such a town and spend a year there and trade and make a profit” – yet you do not know what tomorrow will bring. What is your life? For you are a mist that appears for a little time and then vanishes. Instead you ought to say, “If the Lord wills, we will live and do this or that.” As it is, you boast in your arrogance. All such boasting is evil.’ [James 4:13-16].

For James therefore, the only things that are seemingly more uncertain for us today than they once were, are those things we are told we should never have considered as certain in the first place!

But that’s not the only reason why we shouldn’t unquestionably accept the idea that everything is more uncertain these days. Because it is still true that the things that really matter, those things that relate to the unchanging character of God, are as sure now as they have always been.

God has always been in complete control – and he remains so today. As James implies in the verses above, whatever the Lord wills, will be. And though we may sometimes struggle to understand why He would allow some things to happen, knowing that a God of love is sovereign over our day to day lives is something we can still draw comfort from. Furthermore, the writer to the Hebrews reassures us that ‘Jesus Christ is the same yesterday and today and forever.’ [Hebrews 13:8] And his steadfast love is certain too. His is a love that will never cease. Likewise God’s mercy will never come to an end. It is new every morning. God’s faithfulness is as certain today as it proved to be yesterday, and will undoubtedly prove to be tomorrow. [Lamentations 3:22-23].

So, uncertain times? Well maybe, but then again, maybe not.

The Radio Times editorial continued by suggesting that Christmas is ‘a glorious distraction from the sense that life is fragile, real and earnest’. Well I wouldn’t disagree that life is fragile, nor that it is frequently filled with suffering and sadness. But Christmas, a ‘glorious distraction’? Is that all that Christmas has to offer us? If so it will do us no good at all come new year when we remove our heads from the holes in the sand in which we’ve stuck them for a fortnight and are forced to face the freight train of 2022 that will inevitably come bearing down on us.

But Christmas is not merely a distraction from the very real difficulties that to a greater or lesser extent we all have to face. Rather it is the answer to those difficulties. Those who are experiencing great sadness this Christmas, those who are anxious about what the New Year will bring, don’t need to be merely distracted from their troubles, rather they need something that is genuinely able to turn their tears to laughter, something that will give them a reason to no longer be afraid. And that is exactly what Christmas offers.

Do you remember what it was that the angel told those shepherds who were out in the fields keeping watch over their flocks that first Christmas night?

‘Fear not, for behold, I bring you good news of great joy that will be for all the people. For unto you is born this day in the city of David a Saviour who is Christ the Lord’ [Luke 2:10-11]

This news that the shepherds heard is just as true and just as good today as it was two thousand odd years ago. This is news that can bring us happiness in the midst of our presence sadness, a reason for confidence in our ever present anxiety. Because this is news that promises us a genuinely better tomorrow.

This last year has, for many, been a hard one. And not only as a result of the pandemic. This year many terrible events have occurred around the world as indeed they do every year. In addition to far away natural disasters and closer to home terrible tragedies that have made the headlines, there have also been our personal difficulties known only to ourselves and those close to us. It’s understandable that we might want to forget about all this suffering at Christmas, to pretend that Christmas, with all its tinsel and television is, as the Radio Times puts it, ‘a glimpse of normality in an abnormal world’.

But that’s the problem with Christmas, or rather the problem with the Christmas that we have created. As with life, we struggle to conceive that the realities of hate, pain and suffering sit alongside those of love, joy and peace, that these things, to a greater or lesser extent, are normal, present in all our lives, present indeed, even in ourselves. We have marginalised the horror of the Christmas story, preferring the sanitised version that fits better with our over optimistic outlook on life, our over optimistic view of who we are. But such a Christmas bears little relation to the world we actually inhabit, existing as we do in a world of both good and evil.

Life can be filled with overwhelming joy. And yet, life can be hard, for some impossibly hard, and for many the sadness is just too much.

The Christmas story reflects this – the joy of the birth of Jesus and the hope that the arrival of a saviour brought with it, is mixed with the abject poverty into which he was born, the rejection experienced by his parents and the murder of the innocents at the hands of Herod. And, of course, what began in ‘O little town of Bethlehem’ didn’t end there. The ‘little Lord Jesus’ who once ‘lay asleep in the hay’ grew up and, thirty or so years later ‘hung and suffered’ as he was nailed to a cross on ‘a green hill far away.’

The Roman orator Cicero described crucifixion as ‘a most cruel and disgusting punishment’ and suggested that ‘the very mention of the cross should be far removed not only from a Roman citizen’s body, but from his mind, his eyes, his ears.’

But such horrors still exist in our world, a world of joy and sadness, of pleasure and of pain. We cannot have one without the other. Indeed the two are mutually dependent. The existence of suffering is the very reason why we need a redeemer, and that redemption is secured through the suffering that that redeemer himself endured, a suffering that we all still share in.

Cicero, then, was wrong. We must consider the cross.

Sorrowful yet always rejoicing. These were words of the apostle of Paul in his second letter to the church at Corinth and we would do well to ponder them, to reflect on the fact that we cannot expect to live trouble free lives. Hardships and calamities will befall us and they will bring with them times of great sorrow. Yet despite those hardships, despite the awful suffering, there is, in Christ, still hope and a cause for rejoicing.

Leonard Cohen says it well in words from his song ‘You Want It Darker’:

There’s a lover in the story
But the story’s still the same
There’s a lullaby for suffering
And a paradox to blame
But it’s written in the scriptures
And it’s not some idol claim’

We live in the tension of ‘the already and the not yet’. Because of Jesus’ life death and resurrection, and the redemption that he as secured, I believe the future is assured. So assured in fact that we can consider it a present reality. We can, ‘already’ live rejoicing in the confidence of its inevitability whilst at the same time, honestly acknowledging that it is still ‘not yet’, that we still live in the very real pain of today, the heart breaking awfulness of now.

As we celebrate the joy of Christmas, we dare not tell ourselves, or indeed our children, differently. For to do so is to delude ourselves, and them, and ensure disillusionment and despair when eventually the truth can, like now, be denied no longer.

So at the end of this most difficult of years, I continue to believe the news that was brought by the angels to the shepherds all those centuries ago, news of great joy that is for all people. I believe that though weeping may tarry for the night, joy comes with the morning. For some the night has already been long and the day may still seem a long way off, but there is I believe a day still coming when all our tears will be wiped away and death shall be no more. [Revelation 21:4]

So it’s not Christmas that needs saving, rather it’s us, by Jesus, so called for he would save his people from their sins. No matter then how difficult our lives might be, Christmas remains a time to rejoice that our rescue is in hand, that it began with the birth of a child who came into the world for the express purpose of saving sinners like you and me and was secured for us when, having grown up and lived a perfect life, the man who was, and is, God was crucified for us, dying in our place for the forgiveness of our sins, thereby redeeming, not only us but also the broken world in which we currently live, the guarantee of which being his resurrection from the dead three days latter.

And therein lies my hope. This Christmas therefore, despite everything that might cause me to doubt it, I remain absolutely confident that with God I am in safe hands.

Some years ago, whilst out on a walk, one of my children announced that they were lost. This was on account of said child not having a clue as to where they were. But the individual in question was wrong – they weren’t lost because the one who held their hand, me, knew exactly where they were.

I knew the way home.

Perhaps we can’t see a way through all that’s going on just now. But rest assured, with God by our side we’re not lost because the one who holds our hand knows exactly where we are and, even in these particularly difficult days, that same loving Heavenly Father will ensure that we will all eventually make it safely home.

For the one who knows the end from the beginning holds us still and of that you can be certain.

And so this year, regardless of whether or not you share my faith I pray that, alongside any sadness you may be experiencing, you, and all whom you love, may know real joy at Christmas.


Related Blogs:

To read “A Merry and Resilient Christmas – A Personal View” click here

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

To read ‘Covid -19. Does it suggest we really did have the experience but miss the meaning?’, click here. This is a slightly adapted version of “T.S. Eliot, Jesus and the Paradox of the Christian Life’.

To read “Suffering- A Personal View”, click here.

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

To read “Luther and the global pandemic – on becoming a theologian of the cross”, click here

To read “Hope comes from believing the promises of God”, click here

To read “Waiting patiently for the Lord”, click here

To read “Good Friday – 2021”, click here

To read “Easter Sunday – 2021”, click here

To read “True Love?”, click here

SCROOGE IN THE TIME OF CORONAVIRUS

This is Book Two of ‘The Scrooge Chronicles’. To read Book One, ‘A Primary Care Christmas Carol’, click here.

PART ONE: A TALE OF TWO PATIENTS

In which Dr Ebenezer Scrooge finds some meaning in the seemingly meaningless and determines to keep on keeping on – at least for a little longer yet.

Almost three years have passed since Scrooge was visited by the three spirits and the world is in the grip of a global pandemic.

It was a little after eight in the morning and Dr Ebenezer Scrooge was sitting at his desk, looking at his computer screen. He watched as, with every passing minute, the list of patients he had to call lengthened. He was the only doctor in the practice that morning as his partner, Dr Robert Cratchit, had phoned in earlier to report that, since his six month old son had developed a fever overnight, he’d have to self isolate and work from home pending the result of the Covid swab that he’d organise to have taken later that day. Though frustrated, Scrooge didn’t blame Bob. He knew his colleague wasn’t one to avoid work and understood that the practice had to be seen to comply with government guidance on limiting the potential spread of the coronavirus, even if the actual risk from his partner coming in to work was small and, perhaps, less than that posed to patients as a result of their care being compromised by his not being at work.

Scrooge reflected on how he’d never been so dissatisfied with his working life as he was now, more dissatisfied even than he had been, three years previously, when the spirits of General Practice Past, Present and Yet to Come had made their life changing nocturnal visits to him. A lot had happened since then. Bob, who had been a registrar at the time, had completed his training, joined the practice as a partner and even found time to marry one of the admin staff and have a child. But then Covid-19 had arrived on the scene and, as well as all the suffering and death it had caused, it had also had a significant effect on the provision of primary care.

Scrooge was alarmed by how fast the vision brought to him by the Ghost of General Practice Yet to Come was becoming a reality. More and more consultations were being undertaken remotely, a trend that, though undoubtedly necessary for a time, had been welcomed by much of the profession and was one that now seemed destined to continue. Scrooge though, a man so old fashioned he’d yet to switch to a height adjustable desk, was less enthusiastic. Though, to some, this contactless life might be considered ‘the new normal’, in Scrooge’s eyes at least, whilst new, it was in no way normal.

Furthermore Scrooge also found himself constantly worrying about the long term harm the response to the coronavirus might have. He understood, of course, that steps had needed to be taken to control the spread of the virus and a tricky balance had to be struck.

In the early days of the pandemic he had been informed that, as a GP, he’d be responsible for providing end of life care to patients with the coronavirus. He’d been told it was likely he would have to explain to many of them that, due to a lack of ventilators, it would not be possible for them all to be admitted to hospital and that a good number would, instead, have no option but to take their chances at home.

Scrooge had found all this deeply concerning, but when he started being asked to contact all his vulnerable patients and discuss with them their end of life preferences he sensed something wasn’t quite right. This feeling grew when he did a few calculations and realised that, were there to be 50,000 deaths in the country, a figure the government had initially suggested was the worse case scenario, he himself could expect to lose just one or possibly two of the 1800 patients on his own list. Was it really appropriate then, he wondered, to have hundreds of inevitably distressing discussions with his patients on such a sensitive subject when the actual numbers of those likely to die was so small?

What Scrooge did know though was that nearly six months into the pandemic not one of his patients had actually died, and only a couple had been hospitalised. He knew that elsewhere in the country the experience of other GPs would, no doubt, have been very different but nonetheless Scrooge remained worried about the consequences of the measures that were being taken to tackle the pandemic: the tens of thousands of non-Covid related deaths due to patients not receiving sufficiently timely treatment for their conditions, the hundreds of thousands of additional deaths that were likely to occur over time as a consequence of the lockdown having so badly damaged the economy, and the millions of people who would find themselves joining the queue for NHS treatment.

Scrooge sighed. It just seemed impossible to know what was genuinely for the best. It was, he thought, the worst of times – an age of foolishness and an epoch of incredulity – with absolutely no positive side to it. Still, his was not to reason why, his was but to do and, hopefully not die. And with that Scrooge realised that he’d better stop wondering how long he could continue working as a doctor and start instead phoning the numerous patients who’d already requested urgent contact with him that morning.

He quickly dealt with the first couple of calls which involved patients seeking advice about minor upper respiratory tract infections. He hated himself both for prescribing antibiotics (‘just in case’ due to his not being able to see and assess them properly) to patients who almost certainly didn’t need them, and for then going on to advise them that the whole household would now have to self isolate pending the symptomatic family member having a Covid swab. He knew that the former went against all he had tried to teach patients regarding how antibiotics were unnecessary for self limiting viral infections and that the latter would threaten the livelihoods of families but was nonetheless deemed essential even though, ever since patients with possible Covid symptoms could have a swab taken, not one had come back showing a positive result.

The morning continued in similar fashion though soon, amongst the physical problems that were being presented, a number of cases relating to the mental health of patients required triaging. The isolation of lockdown was now getting a lot of people down and many more were experiencing high levels of anxiety. For many the concern was about catching the coronavirus, even amongst those for whom there was very little risk of their coming to any harm were they to do so – for others it was the threat to their livelihood that was causing them to lose sleep. Scrooge tried to support them as best he could but knew he’d be able to do it so much better if he could see a few of these folk face to face. Even then, however, the requisite plastic apron, latex gloves and face mask would make meaningful conversation on sensitive matters difficult.

At mid morning there was a knock on the door announcing the arrival of one of the reception staff with a cup of coffee and a selection of biscuits. Scrooge accepted them gratefully and munched on a custard cream whilst signing the prescription handed to him by the receptionist. It had been requested urgently by a patient who was currently waiting for it in reception.

Brushing the crumbs from his lips, Scrooge looked back at his computer screen and noticed another call had come in from an elderly man who’s problem had been flagged simply as ‘back pain’. Pleased to have such a straight forward call to deal with, Scrooge picked up the phone and dialled the patients number. Within a few rings the patient answered.

‘Hello, is that Mr Carton? It’s Dr Scrooge, how can I help?’

‘That was quick doctor, I hadn’t expected you to ring back so quickly, I know how busy you all are, what with this virus and all. But don’t worry about that with me, it’s just my back that’s the problem. It’s kept me awake all night it has – I’ve never before experienced anything like it.’

Scrooge asked a few more questions and didn’t sense that anything particularly concerning was going on other than the fact that Mr Carton, a man not prone to call for help unnecessarily, seemed quite agitated by the pain and that he’d not had any relief from even his wife’s reasonably strong painkillers. Scrooge decided that he had perhaps better see his elderly patient after all. He felt guilty for doing so since the guidance was so insistent that all patients should be managed remotely wherever possible.

‘I’d like to see you Mr Carton, but before I do I need to ask a few more questions. Have you developed a new persistent cough lately?’

‘No doctor, it’s just my back, it’s like …”

‘Or a fever?’

‘No doctor, as I was…’

‘And have you lost your sense of smell at all’

There was a pause on the end of the line as Mr Carton clearly struggled to understand the relevance of such a question to his clearly stated problem of back pain. Eventually he answered in the negative and Scrooge asked him to come down to the surgery but to wait in the car park until he was ready to see him. He’d ring in 15 minutes and say when it was safe for him to enter the building.

Whilst he was waiting Scrooge dealt with a few more telephone calls including one from Enid Gray. Mrs Gray was terminally ill and had been so for some while. She had survived longer than had been expected despite, on Scrooge’s advice, repeatedly ignoring the letters sent out under his name inviting her to have a repeat blood test to determine if she were still pre-diabetic. But now she was undoubtedly losing her battle with cancer and was very definitely going rapidly downhill. He picked up the phone and was soon speaking to the patient he’d become very fond of ever since he’d invited her to share Christmas Day with Cratchit and himself a few years previously.

‘Hello Mrs Gray, how are you? How can I help?’

‘Oh I am sorry to bother you Dr Scrooge. It’s just that I feel so tired at the moment. Since I came out of hospital I’ve simply no energy at all’.

Mrs Gray had been admitted the week before having taken a fall at home. She had been discharged precipitously under the guise of it being too dangerous for her to stay in hospital in the middle of a global pandemic. Little thought seemed to have been given, however, to the risk of her living alone without an adequate package of care. Mrs Gray did not have a smart phone so there was no possibility of Scrooge doing a video consultation with her. Despite this, and though he hated himself for even thinking it, were Mrs Gray to die, since she’d been seen so recently in hospital, Scrooge knew he wouldn’t have the unnecessary nuisance of having to liaise with the coroner about her death, not under the new guidance that had come out on the issuing of death certificates during the pandemic. Even so, Scrooge looked up the results of the tests taken during Mrs Gray’s hospital stay. He noticed that she’d been found to be a little anaemic and so Scrooge suggested that he write Mrs Gray a prescription for some iron tablets and arrange for the district nurses to check a further blood test later in the week. Mrs Gray seemed happy enough with this plan but Scrooge nonetheless stressed that, should she feel any worse, she could call him again at any time.

By the time he’d done this he noticed that it was time to see if Mr Carton had arrived. He called him on his mobile and learnt that he was indeed waiting in the carpark. Scrooge invited him in saying he’d meet him in the waiting room. He then donned his PPE being careful to tie the plastic apron about his waist before putting on his gloves, experience having taught him that with gloves on it was nigh on impossible to tie the apron effectively. Mask applied Scrooge then went to the empty waiting room pending Mr Carton’s arrival. As he sat there, perched on the radiator, he surveyed the carefully spaced seats that so few people these days sat on. It saddened him that this was no longer a place where people gathered waiting to be seen, somewhere one might bump into an old acquaintance that one hadn’t seen for years and with whom one might catch up on each other’s news.

A few minutes later Mr Carton arrived accompanied by an obviously very anxious Mrs Carton. It was becoming something of a trend now but once again Scrooge found himself hating what he was doing as he asked Mrs Carton if she wouldn’t mind waiting outside. ‘Because of the Coronavirus’, he added by way of explanation. Walking together toward his consulting room Scrooge paused by the waste bin in the corner of the waiting area and, by holding his apron close to the container, indicated to Mr Carton how that which was now supposedly protecting him from a deadly virus, was made of the the exact same material as that which now lined the bin. It always amused Scrooge to point this out to patients even if by doing so it served only to make him feel even more rubbish about himself.

Back in his consulting room, and having run over the symptoms again, Scrooge asked Mr Carton to pop up on the couch. Scrooge had noticed that the agitation that he had sensed in his patient on the phone was apparent speaking to him in the flesh, Mr Carton was finding it difficult to stay still. Up on the couch Scrooge noticed something else – a pulsatile mass in his abdomen which could be nothing other than an abdominal aortic aneurysm.

After explaining the seriousness of the situation and calling for an ambulance, it wasn’t long before Mr Carton was being led away by two paramedics to the emergency vehicle that was now parked outside the front doors of the medical centre. Scrooge walked out with them and caught site of his patient’s increasing worried wife. Stepping over towards her, Scrooge explained what was happening to the man she’d been married to for more than fifty years.

‘I’m afraid you won’t be allowed to go with him, Mrs Carton. The hospital aren’t allowing any visitors at the moment you see.’

‘But he will be OK?’, she asked, ‘I will see him again won’t I?

Scrooge wanted to look her the eye but found himself unable to meet her gaze. ‘I’m sure he’ll be fine’ he said, trying to sound confident before adding, more honestly, ‘At least, I hope he will’. With that Scrooge went back inside, removed his PPE and placed it in the bin. Along with all that was being used both by him and the rest of the practice staff, he pondered how long it would take for all of it to biodegrade. He thought how insignificant his previous use of the odd plastic straw now seemed in comparison to environmental impact of all this discarded PPE.

The day continued in similar vein and when he eventually finished the days work shortly after 7.30 he noted that he’d completed 86 individual patient contacts made up of telephone calls and face to face consultations. In addition there had been the day’s post to read and act on, blood results to deal with and many, many repeat prescriptions, requests for sick notes and sundry other administrative jobs. It hadn’t been the busiest of days but it was somewhere close to it. And yet he thought to himself, if the posts he had seen on social media were anything to go by, many people out there felt that GPs had reneged on their duty throughout the coronavirus crisis.

As he logged off from his computer he noticed the four cold cups of coffee sitting undrunk on his desk, together testifying to how busy his day had been. What he couldn’t understand however was why there was never an accompanying pile of uneaten biscuits! ‘Another medical mystery’ he said to himself as he stood up, ‘but one that will have to remain unsolved for the time being. I’m off home.’

Scrooge locked up the building, got into his car, and set off for home. He tried to turn his thoughts away from the day, but as he drove the radio was playing Solomon Burke’s ‘Cry to me’. Hearing of how loneliness was such a waste of time, of how it made you want to cry, Scrooge couldn’t help but think again of Mrs Gray and so, having deviated from his usual route home, he soon found himself parked up outside her home instead.

Walking to the door to the stairwell of the block of flats in which she lived, Scrooge noticed a now faded rainbow that someone had painted on the adjacent wall. Underneath were written the ubiquitous words ‘Thank you NHS’. Scrooge averted his eyes, uneasy at what seemed to him as yet another shrine erected to an organisation that, whilst wonderful, was being deified in ways that weren’t helpful, by a population that was putting all its hope in an NHS that could not possibly deliver all that was being asked of it. He didn’t consider himself a hero of the pandemic, that particular label he felt, would surely be better applied to those who would lose their jobs and livelihood over all of this.

Scrooge pulled opened the door and climbed the steps to Mrs Gray’s flat. As he donned yet more PPE he noticed the piles of bottles filling the recycling box of the flat opposite that of Mrs Gray. Somebody was clearly doing their bit to support the local off-licence in these difficult times. Scrooge wondered if the young Mum who lived there, and who had called him several times this week regarding various minor problems, might be better served by a face to face consultation. Perhaps she’d feel freer to talk when she wasn’t being overheard by her partner, given how he was known to have problems ‘managing his anger’. He made a mental note to call her in the morning before turning back to Mrs Gray’s flat and ringing her doorbell.

Nobody came to the door and so Scrooge rang it again. Again there was no response. Trying the door and finding it unlocked, he gently pushed it open and entered the flat.

‘Hello? Mrs Gray? It’s Dr Scrooge – is anybody here?’

Scrooge made his way in the direction of the feeble voice that called out from the back room and found there Mrs Gray, laid uncomfortably on her bed, desperately pale, weak and laboured in her breathing.

‘Dr Scrooge, what are you doing here?’ Mrs Gray asked, barely able to voice the words. ‘I wasn’t expecting you to call round, I know how busy you all are at the moment. And aren’t you supposed to avoid visiting people like me?’

Scrooge looked down at his feet and felt ashamed at the thoughts he’d had when he’d spoken to her earlier that day.

‘Some would say so, Mrs Gray, some would say so’, he replied and, realising that Mrs Gray’s time was near, Scrooge did something else that he wasn’t supposed to do. He pulled off his mask and apron and, after slipping off his gloves, took Mrs Gray’s hand as he sat down next to her on the chair that stood by her bed

‘Enid’, he added, thinking to himself how nobody should be allowed to die without a friend present, no matter what anyone says, ‘I suspect that what I am now doing is a far far better thing than I have ever done. Of course I should be visiting you.’

Mrs Gray smiled at Scrooge, and Scrooge smiled gently back.

Thirty five minutes later, after a call to the local funeral director, Scrooge was back in his car. Picking up his phone he dialed the number for the hospital and was informed that Mr Carton had had his aneurysm repaired and, all being well, would be allowed home the following day. The vascular team had apparently had little else to do and so had wasted no time in dealing with what was the most interesting case they had had in weeks.

Scrooge smiled again, this time to himself. Perhaps his actions today hadn’t changed the world, but they had made a world of difference to at least one or two people he’d had the privilege of helping. Perhaps he thought, he would continue in General Practice, at least for a little while longer. And that, he decided, was cause for celebration. After all, as one whose income had not been threatened by the events of the last six months, he had much to be grateful for, not to mention a civic duty to support the local economy.

And besides, he’d had nothing to drink all day.

PART TWO: IT’S A WONDERFUL GP LIFE

in which Dr Scrooge has another Christmas encounter.

It was a little after 6.30pm on Christmas Eve and Dr Ebenezer Scrooge had just finished the final telephone consultation of the day. A receptionist appeared at his open door holding a plate on which sat two sorry looking mince pies. Careful to keep her distance, she placed it carefully on the end of the examination couch that was positioned just inside Dr Scrooge’s room.

‘Is there anything else you need Dr Scrooge?’, she asked from behind her mask. ‘Only, if it’s OK with you, I’d like to get off promptly this evening. Will you be all right to lock up?’

‘Yes of course Alice, you head off’, Scrooge replied, ‘Thanks for all your help today. And have a very Merry Christmas.’

But Scrooge himself was in no mood for merriment. It had been a long hard year which had seen the job he loved change beyond all recognition. So great had those changes been that at times he felt as if he was working in a glorified call centre. And he wasn’t enjoying it. The work had remained just as difficult with on call days being busier than ever but, disappointingly, there had been little recognition of this from some quarters, with many seeming to think that GPs had shirked their responsibility during the pandemic, imagining perhaps that they’d spent the whole of the summer on the golf course.

This was certainly not the case for Dr Scrooge who, apart from that incident involving a lemon, a stained glass window and the irate members of the parochial church council, hadn’t picked up a golf club for many years. But still the profession had been on the wrong end of much criticism and had even, on at least one occasion, been branded a national disgrace in the papers. Though he knew it wasn’t true, such allegations hurt.

‘Sometimes’, Scrooge muttered to himself, ‘I don’t know why I bother.’

At least now he had a few days off work but, with no family of his own, spending that time alone wasn’t something he was particularly looking forward to. Furthermore a letter of complaint had arrived that morning that had only served to dampen his spirits still further. He’d been expecting it for a while and, as one who in recent years had found it easy to be overly self critical, he couldn’t help feeling the claims made against him were wholly justified.

‘I could have managed things better’ he thought to himself. ‘If only I was a better doctor. It just wouldn’t have happened if I’d done my job properly.’

Slowly he stood up from his desk and, ignoring the mince pies, made his way out of his consulting room. He stopped as he passed the waiting area, empty now as it had been most of the year. He missed interacting with a full waiting room. He liked to greet those he knew and, on occasions, in the hope of lightening the mood a little, sharing a joke with those anxiously waiting their turn to be seen. It must have been at least nine months now since he’d bent down low to look under the chairs when the person he was calling hadn’t been present, as if somehow they might be hiding from him there. He must have done this hundreds of times over the years but it always seemed to make someone smile, even if that someone was only Scrooge himself.

There were now only two chairs left in the waiting room. Scrooge walked over to one of them and sat down. He starred at the screen mounted on the wall. Used to convey information to those gathered, he mused to himself that, like the current TV schedules, it only ever showed repeats. Still in a melancholy mood, Scrooge sat down and considered the past year.

It had been one in which he had been urged, not without good reason, to distance himself from those who had sought to come to him for help. But, he feared, this had, as a consequence, resulted in his seeing the needs of his patients in isolation and that the care he offered them had inevitably become less personal as a result. This he felt had been as detrimental for him as it undoubtedly had been for his patients. Understandably focused on the coronavirus the world had sometimes failed to see the bigger picture. Lost in the woods that could could no longer be seen, and confused by the trees that had crowded its view, the world had, he sensed, in its desperation to keep on living, forgotten the meaning of what it was to be alive.

And it wasn’t only at work that things had changed.

Last week he’d been shopping. First he’d parked in a multi-storey car park where, ‘due to Covid restrictions’, the top three storeys had been closed off. But to his mind at least, such action had only succeeded in forcing people to crowd into the two remaining lower levels. Then, outside a department store, he’d heard a father reassuring his little boy that his mother wasn’t dead but had simply popped into a shop. It’d have been funny if it hadn’t been so sad, evidence of the crippling and excessive anxiety some, including children, were experiencing. And then, to top it all, he’d visited his local branch of Waitrose and bought fennel, dill and some apparently ‘essential’ orzo, three items that a few years previously he’d never heard of let alone considered buying. What, he wondered, was the world, and he, coming to.

‘What’s the point? I’m a failing doctor, in a failing system in a failing world. Time for me to call it a day. If I write a letter of resignation and give in my notice now, by the summer I’ll be free of all of this. And the practice and the local community will be all the better for that!’

His mind made up, Scrooge started back to his room in search of some headed paper. But as he did so the TV screen burst into life and the figure of an elderly man appeared surrounded in swirling mist. He was dressed in a old duffel coat and he was sporting a trilby hat. From within its confines, he tapped on the TV screen and called Scrooge’s name.

Scrooge turned back to address the figure, less startled perhaps than some might have expected him to be on account of his previous experiences with ghostly yuletide apparitions.

‘Oh for goodness sake. Not again!’ he started. ‘Must I be haunted every Christmas? Who are you this time? The Ghost of The Christmas We Never Expected?’

The elderly figure seemed a little taken aback but nonetheless began to make his way awkwardly out of the TV. Before long he was standing in front of Scrooge, smiling broadly.

‘Well a good evening to you too, Dr Scrooge’, he replied. ‘As it happens I’m not a ghost. Far from it. My name’s Clarence, and I’m your guardian angel – allocated to you now that George has no further need of me.’

Scrooge was, momentarily, lost for words.

‘Clarence? What kind of a name is that for an angel. And who’s George when he’s a home?’

By now Clarence was removing his coat and carefully placing it on the back of a chair in that rather irritating way that patients sometimes do at the start of consultations. He was clearly planning on staying a while.

‘I’m a little surprised you don’t recognise me’, Clarence replied, ‘but then you’ve probably only ever seen me in black and white. But surely you must remember George. His was a wonderful life.’

‘Well bully for George is all I can say. I hope he’s happy’

‘Indeed he is. Very happy. But from what I’ve been hearing, that can’t be said of you. Have you thought about chatting it over with your appraiser?’

‘Not likely! I know they’re supposed to be supportive but I prefer to pretend that everything’s fine with my appraiser. Fortunately they’re not generally hard to fool. Like long haired sheep it’s easy to pull the wool over their eyes!’

‘Then perhaps I can help a little – I do have some experience in the area’.

‘How do you mean? You’re not going to suggest CBT or mindfulness are you? Only, if you are I’m not interested’.

‘Not as such. It’s just that…well it seems to me that you are questioning just how useful your life as a GP has been. You think you haven’t made a difference. But that’s not true. You’ve made a huge difference, in innumerable ways, often without you ever having realised it’.

Scrooge remained silent, though on this occasion it was not by way of employing a therapeutic tool. The truth was that he was eager to hear what Clarence had to say but was reluctant to appear as such. The angel, sensing Scrooge’s predicament, continued.

‘Well let’s start with the obvious shall we? Take Mr Carton. Surely you remember how, after your telephone consultation with him you agreed to review him face to face and were thus able to diagnose that his back pain was due to an abdominal aortic aneurysm. He’s alive this Christmas because of your actions. And then there was the kindness you showed to Mrs Gray as she lay dying. That mattered too you know? Enormously’.

Scrooge grudgingly indicated his agreement. ‘But it’s no more than any GP would have done’.

‘Perhaps, but that’s not the point. The fact of the matter is that what you did made a difference. If only ‘The Ghost of General Practice Present’ were here we could have taken you and shown you how happy so many people are this evening because of your actions over the years. I’d WhatsApp her but I know that right now she’s very busy haunting a Covid vaccination centre. It’s been a tough year for the members of BASIL too you know.’

‘BASIL?’, Scrooge interrupted, ‘I’ve heard of SAGE, but who the heck are BASIL?’

‘“Beings and Spirits in Limbo”’, Clarence replied. ‘We’ve all been meeting on Zoom this year. It’s been awful. The Ghost of General Practice Past still hasn’t learnt how to unmute himself and the oh so smug Ghost of General Practice Yet To Come can’t stop telling everyone how he correctly predicted the increase in remote consulting and the wearing of face masks during face to face reviews.’

‘Enough of that though, back to what I was saying. In addition to those positive outcomes that you know about, there are so many small actions that you have taken that, unbeknown to you have had similar wonderful consequences. Take that occasion when you reassured a couple who were worried that their child’s rash was meningitis. Because of you they didn’t call the ambulance that they had been planning to and, as a result, a man who was suffering a MI at the time was attended to promptly when he called 999. Wonderfully he was stented within an hour of the onset of his chest pain. And then there’s Dr Cratchit of course.’

‘Bob? What about him?’

‘He really was desperate that Christmas a couple of years ago you know. He didn’t tell you the half of it at the time but, back then, he really was close to the edge. It was your support that pulled him through. And don’t forget that it was you who gave a job to the young lady that is now his wife, not to mention the mother of their child. You gave Emily a chance when many wouldn’t have, not with her previous poor employment record. If you hadn’t taken her on, she and Bob would never have met. Indirectly the happiness of that young family is down to you. And I could tell you a thousand other similar stories of how you’ve influenced individual lives for good.’

‘Even so, that complaint I received today. It’s completely justified you know. I made a mistake. A big one. And people are suffering because of the error I made’.

‘So you slipped up. And that is both regrettable and so very hard to live with. But did you really ever imagine that you would go through your whole career as a doctor without ever making a mistake? Surely not even you are that stupid. Working as a doctor is a bit like pushing people out of the way of speeding trains. On occasions you’ll not be able to push someone out of harms way in time. And sometimes you might just get hit yourself. Even so, you must still try to remember all those folk you have been able to help, all those who have avoided pain and distress because of what you were able to do for them.’

As Clarence had been talking, Scrooge had been gazing at the ground but now he lifted his head and, addressing his companion, looked him in the eye.

‘But it’d be nice to be appreciated a little.’

‘Well of course it would and the truth is many people do appreciate your efforts. But be that as it may, the value of an action remains irrespective of whether any appreciation is shown for it. Pleasant though it undoubtedly is, is it really so important to be lauded for what you do? Surely happiness comes more from performing an act of kindness than from the appreciation that might follow it. Besides if you really want to be appreciated, post an amusing video of a cat on Facebook. Only don’t expect that to satisfy you for very long.’

‘If Covid has taught us anything Ebenezer, surely it’s this. That it is possible to be content with less and that, rather than striving constantly to gain more in life, we would do well to be content with and enjoy the gift of life we already have. Life is uncertain, it always has been. We are not the sole masters of our fate, nor that of those we love or those for whom we care. There is much that we do not know, much indeed that we cannot know. As such we need to learn some humility and acknowledge just how little we truly understand. We need to stop arrogantly pretending we invariably know best. Everyone makes mistakes sometimes. Even you GPs!’

Scrooge smiled and took a step towards Clarence who had got to his feet and was now putting his hat and coat back on. Scrooge hesitated as he once again became mindful of social distancing guidelines. Clarence didn’t seem too bothered though as he too was taking a step forwards. The two men exchanged a firm handshake.

‘Thank you, Clarence’ said Scrooge. ‘It was good of you to come this evening’.

‘‘Not at all, Ebenezer, not at all. It was a pleasure. And thank you for all your hard work this year. You, and all your staff, are doing a grand job in difficult circumstances. Don’t think that it’s not appreciated. And trust me, it isn’t going unnoticed, not by those who count, not by those you’ve actually cared for. Now, you’ll forgive me if I don’t stand and applaud you, and since I can’t give you a voucher entitling you to a free coffee or a discount bar of chocolate, I’m afraid this will have to do!’

And with that, and before he could undertake a detailed risk assessment regarding the merits of such behaviour, Scrooge was experiencing something he’d never experienced before. He was being hugged by an angel.

‘Don’t worry about Covid-19, Dr Scrooge,’ said Clarence, laughing as he sensed Scrooge’s unease. ‘This duffel coat and trilby hat offer complete protection. Or at least as much as those flimsy plastic aprons you’ve all been wearing these past few months. And besides, what’s the worst that could happen. Only that you die and discover what has long been joyfully known by many, that there aren’t varying degrees of danger in the place where I come from.’

As they separated, Scrooge looked somewhat bemused by the strange comment of his unexpected visitor.

‘Haven’t you heard, Ebenezer?’, said Clarence, continuing to chuckle to himself. ‘There are no tiers in heaven!’

And with that a warm glow surrounded Ebenezer. As it did so a bright light filled the waiting room. In a moment though it was gone, as indeed was Clarence. Scrooge, alone once more, stood motionless for a few seconds, trying to collect his thought. Perhaps he’d need to rethink that letter of resignation.

He walked out of the waiting room and made his way to the back entrance. He switched off all the lights and set the alarm before finally leaving the building and locking the door behind him. As he walked to his car he felt a vibration in his pocket. Pulling out his phone he noticed that he’d received a text message. It was from Bob Cratchit.

‘Where are you? We’ve been waiting for you. I trust you’ve not forgotten you’re bubbling with us over the next few days. Get over here quick or you’ll miss all the fun of putting the little one to bed. Remember we’re expecting you to do the full Father Christmas routine for us. See you soon.’

As he gazed at its screen, the phone vibrated again and another message appeared.

‘And we’re a little short of mince pies. Do you know where you could lay a hand on a couple?’

Scrooge looked back at the surgery. ‘I rather think I do!’ he said to himself smiling. Perhaps, he thought, this might be a Merry Christmas after all.

BOOK THREE: BLEAK PRACTICE

in which Scrooge considers calling it a day.

Dr Scrooge was tired. All the time tired. He was more tired than a myxoedematous narcoleptic with sleep apnoea who’d just completed a week of nights. He was tired of Covid, he was tired of work, and increasingly he was tired of life.

It was just gone eight and he was alone in the practice catching up on paperwork at the end of a long day on call. Only it wasn’t the end as he was still left with a home visit to do. And to make matters worse he was supposed to be gathering with Dr Cratchit and a few other friends that evening to celebrate a friends eightieth birthday. ‘Looks like I’m going to be late for another social event’ he sighed to himself as he picked up his bag and the printout of the patient’s details that had been bought to him, along with a consolatory custard cream by the receptionist just before she’d left an hour or so previously.

As he left the building it was beginning to rain and the last light of the day was beginning to fade. Scrooge got into his car and drove out of the car park at the back of the surgery premises and began to make his way to the nursing home where the patient he was visiting lived. The staff there had insisted the man be seen on account of him just not seeming himself and Scrooge had been too worn down by the busyness of the day to do anything but agree to the visit even though he’d felt there would be little point in visiting somebody who he couldn’t help thinking, from his cursory scanning of the notes, was just a demented old man who’s life meant nothing now that all he did all day was sit in a chair.

Scrooge’s frustration increased still further as, barely having started out on his journey he was held up by traffic lights. The red light reflecting on the wet road seemed to goad him into thinking what he’d been considering for some little while. ‘Perhaps it really is now time for me to just stop’, he muttered to himself. ‘After all I could always make ends meet by exploiting the black market in blood sample bottles’.

The year had been a hard one. Though positive swab results of Covid tests continued to appear daily in his inbox, Scrooge hadn’t seen anyone ill with the disease for several months. Even so workload was higher than he’d ever known it to be and he no longer felt he was doing a good job. There just wasn’t the necessary time to give to patients. Earlier in the year he’d worked sessions at the local vaccination centre and had derived great pleasure from doing so, but now he found no satisfaction in rushing headlong through the seemingly endless list of patients that daily presented themselves to him only to later hear in the media how GPs were hiding away from their patients, supposedly behind locked doors. And it looked like it was all about to get a lot worse now that a neighbouring practice had collapsed and he and Bob had been forced to accept several hundred additional patients onto their practice list, including the man he was now on his way to see. With no additional staff to deal with what amounted to an overnight increase of 10% to the practice list, Scrooge wondered how he and all his clinical and non clinical colleagues would cope with the inevitable additional work. No wonder that even his excellent practice manager was now beginning to feel the strain.

It was the worst of times, it really was the worst of times.

As the car idled Scrooge realised that he had long since given up any hope of his turning out to be the hero of his own life and remembered instead something he’d once read about how everybody eventually experiences the defeat of their lives. Perhaps that was what he was now recognising to be the case for himself. His appraisal was coming up soon and, rather than discussing with his appraiser how he might look to improve over the coming year, Scrooge thought that perhaps it was time to get real and instead take the opportunity to discuss how he might best manage his now inevitable decline.

As the traffic lights changed Scrooge continued on his way and within ten minutes he was pulling up outside the nursing home. The rain continued to fall as he climbed out of the car and hurried to the front door. He pressed the doorbell and, as he waited to be let in, he donned the mask, ridiculous plastic apron and blue surgical gloves that purported to be PPE but only managed to make him look like some sinister Smurf with a burgeoning interest in basic butchery.

Eventually he was let in and led to a small room on the second floor of the old building that, over the years he had visited countless times. The room was a barren affair, sparsely furnished with the only decoration being a few framed verses of scripture urging the reader to remember that there was always reasons for hope in even the darkest of days. ‘If only’ thought Scrooge as he turned his eyes towards the frail elderly man he had come to see who sat hunched in a chair with his eyes closed and his mouth wide open. He saw and said nothing. Scrooge walked over to him and, crouching by his side, attempted to make conversation though, even as he did so, he knew there was little prospect of any meaningful communication. Scrooge examined the man but found no specific cause to account for his increasingly frail condition other than the all too apparent dementia that had brought him to the home some years previously. The man was clearly coming to the end of his life.

Stepping back outside of the room, Scrooge explained his findings to the young nurse who had been accompanying him. She passed him the patients treatment escalation plan on which was stated that hospital transfer should be considered in the event of his becoming unwell.

‘Shall I get his things together whilst you call the ambulance?’ the nurse asked. ‘How long do you think it will be?’

Scrooge’s heart sank. He’d been in this situation before, where what was written on the TEP form seemed inappropriate and, rather than helping to make decisions, only succeeded in making things harder. Surely admission wasn’t in the man’s best interests and yet to go against what was clearly written down made Scrooge feel uncomfortable.

The pair walked back along the carpeted corridors to the office where he recognised the familiar face of one of the senior members of the nursing staff who had worked at the home for as long as Scrooge could remember.

‘What do you think Clare?’ he asked her, ‘It can’t be right that we admit the poor chap can it?’

Clare looked up from the desk where she was sat. ‘All I can say’, she replied, ‘is that I’ve known Harry for a very long time, ever since he arrived here I forget how many years ago. And I’d be sad if he died in hospital’.

That was enough for Scrooge. Even so he thought he would try to speak to a member of the elderly man’s family, just to make sure they felt the same way that he did.

‘Do you know who his next of kin is?’ Scrooge asked Clare. ‘Is there anybody at all I can talk to’.

‘There aren’t any children, Harry never married. But there is a younger brother who visits him regularly’. Clare flipped her way through Harry’s file and found the number and, passing it to Scrooge. added ‘Just press ‘9’ for an outside line’.

Scrooge picked up the phone and made the call. After a few rings it was answered and Scrooge introduced himself to somebody whose gentle elderly voice confirmed he was indeed Harry’s brother.

‘I’m sorry to bother you at this time in the evening’, Scrooge began, ‘but it’s about your brother. I’ve been called to see him and I’m afraid he’s not at all well.’

‘He’s not been well for a long time Doctor. It’s his age you see. That and the dementia. It’s been years since he was the man I once knew.’

Scrooge smiled to himself realising already that this conversation was not going to be as difficult as he had feared.

‘I understand’, Scrooge continued, ‘but Harry’s deteriorated rather a lot of late and if I’m honest I think he’s only likely to get worse over the next day or two. I thought you ought to know, just in case you wanted to pop over and see him. Unless of course you thought he ought to be admitted to hospital. The thing is I have a bit of paper here which suggests that some discussions were had previously and that it was felt then that, if he were he to become more unwell, Harry would want to be admitted. But I really don’t think the hospital would be able to do a great deal for Harry and I’m not sure that sending him in now would really be the best thing for your brother’.

‘Please don’t send him to hospital doctor – he wouldn’t want it. It’s like this you see. When you’re old, eventually it happens that the only thing you’re left with is your memories, and Harry, well he hasn’t even got those anymore. They’ll look after him well in the home. Leave him with those who know him best.’

The line went silent for a few seconds and then Harry’s brother spoke again, this time his voice wavering a little as he tried to control the tears.

‘Can I tell you something Doctor? You might look at Harry and think he’s just a demented old man, but I want you to know that that demented old man is still my hero. Always has been – always will be. When I was a boy he looked after me when there wasn’t anybody else who could. He was a good man. And he still is. Even now that his time has come’.

The two men chatted on a little longer before Scrooge eventually put down the phone. He relayed the nature of the conversation to Clare and it was agreed that Harry would stay where he was and the staff would continue to care for him just as they had for many years already. Scrooge updated the TEP form and, though he didn’t imagine they’d be necessary, wrote up some ‘just in case’ medications before saying his goodbyes.

Back in his car Scrooge thought about what had just happened. He remembered those words on the wall of Harry’s room, words that his brother had said both he and Harry still believed. Maybe there was cause for hope in dark days after all, even at that moment of apparent defeat. And perhaps, as was the case with Harry, even in the years of one’s inevitable decline, you could remain someone of worth, someone who was still both loved and valued. Scrooge’s mind went back to those sessions he’d worked in the vaccination clinic when the frail and elderly had been wheeled in by those who still loved them irrespective of how dependent they had become on others. It had been a joy to give them their vaccinations, vaccinations that had seemed at the time to be nothing less than a shot of love.

And he thought too of something else he’d recently heard, something about how ‘shiny and new’ was all very well but that things with no past somehow lacked any soul. Perhaps that was true of people too. Although in physical terms Harry and his brother were both past their best, they undoubtedly had soul, their experiences of brokenness producing in them a depth that only age can bring, the wisdom of experience allowing them to accept others despite their imperfections.

*******

It was gone 10 by the time Scrooge arrived at the party and people were already beginning to make their way home. Dr Bob Cratchit was still there though. He was on a weeks leave and had clearly been taking full advantage of the fact by enjoying the liquid refreshment that had been freely on offer. He was a little worse for wear as he handed Scrooge a glass containing what little remained of the celebratory bottles of champagne that had been opened over the course of the evening.

‘What the dickens are you doing turning up so late?’ Cratchit asked Scrooge before adding in a more concerned tone of voice, ‘Are you alright. Looks like it must have been a bad day for you today Ebenezer’. Cratchit felt the need to look out for the man who had once been his trainer but was now his senior partner at work.

‘Yes and no, Bob. Yes and no. The day was certainly busy, made busier still by a late visit request. But you know what? I wouldn’t have missed that visit for the world. And I’ll tell you something else. What with the influx of new patients, we’re going to need to try and recruit a new partner. But don’t get any ideas of you lording it over them as senior partner. I’m afraid you’re stuck with me for a little while longer yet.’

And with that Scrooge raised a half full, rather than half empty, glass of warm, flat champagne and drank to all that was good about General Practice.

PART FOUR: GRAVE EXPECTATIONS.

in which Scrooge meets a red faced portly gentleman and finally calls for help.

It was Christmas Eve and Dr Scrooge was writing up the notes of the final consultation of his afternoon surgery. He looked up at the clock on the wall and noted that it was just before 7pm. It had been a long day. Through his open door he could hear Dr Cratchit singing a medley of Christmas songs. Clearly his colleague was looking forward to Christmas with his young family and his excitement had undoubtedly been heightened by the fact that during the afternoon it had begun to snow.

‘So here it is merry Christmas everybody’s having fun’, sang Dr Cratchit poking his head around the corner of Scrooge’s door. ‘Look to the future now it’s only just begun!’

‘Christmas it may be Bob, but I’m not sure that everyone is having fun,’ countered Scrooge suppressing a cough. ‘And I’m not so sure the future has just begun either. It rather seems to me that the future is on hold.’

Dr Cratchit however was not going to allow his spirits to be dampened. ‘I hope you’re not reverting to being a Christmas grump, Ebenezer. Why don’t you come round to our place for Christmas? You really would be most welcome’.

‘Thanks Bob, but I’d rather not. Maybe next year. You head off home. And do tell the receptionists that they can go home too. I’m nearly done – I won’t be here much longer.’

‘Well OK. As long as you’re sure. Have a good few days Ebenezer and I’ll see you on the other side!’. And with that Dr Cratchit left and a minute or two later Scrooge could hear him laughing with the receptionists as they braved the icy car park just outside his window. Soon all was quiet and Scrooge knew he was all alone in the building.

Scrooge had enjoyed spending last Christmas with Bob but this year his heart simply wasn’t it. It had been a hard year with his workload spiralling out of control. The weight of expectation on GPs had taken its toll with everybody seemingly wanting more and more from a profession that was already on its knees. Furthermore the constant criticism that had come from both the media and government had only made matters worse and the end result was that his mood had sunk ever lower.

‘Right now,’ thought Scrooge to himself, ‘Christmas is the last thing I need. The days off, of course, are welcome, especially after the last couple of weeks but Christmas isn’t like it was when I was a child. Back then Christmas was a magical time, a time you could really enjoy. But now? Now it’s seems it’s just another opportunity to burden oneself with the thousands of things we are expected to do if we are to be deemed acceptable celebrants of what our consumerist society has now made Christmas. I’ve had enough. I just want it all to stop.’

Even Scrooge’s Facebook feed seemed now to be asking more of him. All those memes which appeared to be simply offering winsome advice were, to Scrooge’s mind at least, just more examples of others exhorting him to do more. Urging him to ‘Be kind’ was all very well, he thought, but they might as well simply have insisted he ‘Do better’. Nonetheless Scrooge had made every effort to be kind, but no matter how hard he had tried there always seemed to be someone whispering in his ear, telling him that he still wasn’t good enough. Even that frequently offered advice that he be kind to himself felt to Scrooge like one more demand that he’d not been able to fulfil.

For over and above all others, there was another reason why Scrooge had not wanted to spend Christmas with the Cratchit’s. All week he’d been feeling unwell. He’d been coughing too. A PCR test the previous weekend had come back negative so, despite not really feeling up to it, he’d continued to work, unwilling as he was to leave Cratchit to manage the escalating workload by himself. That afternoon though he’d taken a significant turn for the worse. At one point he had been rigoring with a temperature of 38.7 and only by taking a couple of paracetamols had he been able to bring his fever down such that he felt well enough to keep on seeing patients.

Feeling so unwell meant it took Scrooge rather longer than he had expected to complete his paperwork and it was nearly 8pm before he finished all that he needed to do. Sensing his temperature was once more on the climb Scrooge rummaged through his desk drawers till he found some doxycycline that a patient had handed back to him earlier in the week. Then, for reasons he wasn’t quite sure of, he stuffed his pulse oximeter into his pocket before finally leaving his room and making his way out of the building. Outside it was bitterly cold and the snow was falling more heavily such that it was now beginning to settle. Scrooge got into his car and tried to start the engine only to hear the ominous clicking sound that could mean nothing other than the battery was completely flat.

Scrooge allowed his head to slump forward and rest on the steering wheel. ‘Great’, he said to himself. ‘That’s all I need!’ With it being Christmas Eve and not wanting to risk spoiling somebody’s family celebrations, Scrooge couldn’t bring himself to call anybody out and and so he decided to walk home instead. ‘It seems that this year I won’t be driving home for Christmas’ he muttered to himself as he began to cough once more, this time rather more forcefully.

Once he’d stopped coughing Scrooge got back out of his car and started to make his way home. Initially he trudged along main roads but it wasn’t long before he came to where his route took a sharp right turn. Scrooge pushed open the iron gates of the cemetery and, passing through them, continued a few paces on before stopping to gaze upon the gravestone that was clearly illuminated by the nearby street lights. The inscription read ‘In loving memory of Enid Gray who fell asleep August 6th 2020’. Scrooge remembered the elderly lady who had once been his patient, one with whom he’d spent Christmas with only three years previously and whose hand he’d held as she had taken her final breath. The inscription on her headstone ended with the words ‘Now at rest’. Scrooge couldn’t help feeling momentarily envious of Mrs Gray. How he could do with a little rest too.

On the other side of the path was another grave. This one was freshly dug and had yet to have been dignified with a headstone. Scrooge though didn’t need informing just who it was that lay beneath the still raised turf. Mark Ashley had died just three weeks previously, having presented to Scrooge only a month earlier already in the advanced stages of a malignant disease. He’d delayed attending because of concerns about catching Covid and now left behind him a grieving wife and two teenage children. Like Mrs Gray, he had been overcome by a disease that had been far more effective than Covid 19 in removing individuals from Scrooge’s patient list.

Scrooge continued along the cobbled path that ran straight across the centre of the cemetery. The night closed in on him as he ventured ever further from the streetlights that lined the road he had now left behind. About a hundred yards ahead a solitary lamp was shining brightly, driving back the darkness that surrounded it. Beneath was a bench upon which sat a portly gentleman who appeared to be wearing a red suit and whose face, itself somewhat rosy, was endowed with a long white beard. As Scrooge approached him, the figure stood up and greeted Scrooge with a broad smile and a cheery wave.

‘Good evening Dr Scrooge.’ said the man who clearly knew who Scrooge was.

‘Good evening’, replied Scrooge. ‘But I’m afraid you have me at a disadvantage. I don’t recognise you in your costume’.

‘You don’t recognise me?’ questioned the man, clearly amused by Scrooge’s failure to know who it was that had addressed him. ‘That’s most unusual. I tend to get recognised by most people. So much so that’s it difficult sometimes to have a few quiet minutes to myself!’

‘I know the feeling’, interrupted Scrooge before allowing the man to explain that he had a number of names but that he was most commonly referred to as either Father Christmas or Santa Claus.

‘Very amusing I’m sure’, said Scrooge, but who are you really. ‘Are you one of my patients perhaps?’

‘No no,’ said the man, ‘I’m not local. I’m just passing through. But I’ll be sure to register as a temporary resident at your practice should I need any medical assistance. I do sometimes suffer with a touch of gout. I suspect it’s a consequence of all the port that I’m proffered at this time of year’

‘Oh come of it’ said Scrooge. ‘Father Christmas doesn’t exist’

‘Are you sure?’ the man replied. ‘I mean – haven’t you seen “Miracle on 34th Street?”’

‘Of course I’m sure. And some sentimental Christmas film isn’t going to persuade me otherwise. I’m a bit old to believe in Father Christmas!’

‘Nobody’s too old to believe in me. Next you’ll be saying that Christmas is for the children!’

‘Well isn’t it?’

‘Well yes – but it’s for adults too. However old we are, we all still need Christmas. What would life be without something as fantastic as Christmas to look forward to, something to lift our spirits and give us hope in even the hardest of hard times?. Don’t you believe the Christmas story?’

‘Of course I don’t. The Christmas story is no more true than your beard is real!’, Scrooge snapped back.

‘Well I’d have to agree with you there’, said the man in the red suit pulling on his beard firmly and surprising Scrooge somewhat when it failed to come off in his hand. ‘What about peace and goodwill to all men? Especially in these days of pandemic, couldn’t we all do with a little more of such things?’

‘Peace and goodwill – bah humbug!’ said Scrooge who was somewhat taken aback by hearing himself using an expression he’d not used for years. ‘Say what you like! I don’t believe in you or the Christmas story. The idea of there being someone so good and kind as to dispense gifts on everyone is ridiculous. The world is a tough place.’

‘Indeed it is – but there’s always hope.’

‘Not for the dead there isn’t’ said Scrooge indicating to the stranger as he did so the graves that lay scattered around them. The man in the red suit appeared to want to challenge Scrooge’s assertion but Scrooge wasn’t about to let a man he had decided was one bauble short of a fully decorated Christmas tree interrupt him now. ‘The truth is’, Scrooge continued, ‘that in the end the world defeats us all. And just now that most certainly includes me. That said, the idea of their being someone who is as kind as the person you’re claiming to be is, undoubtedly, quite appealing. Wouldn’t it just be heaven if there really was somebody who could bring some genuine joy into this miserable world, who could give us some hope for the future, who could put an end to all this death and disease?’

‘That’s quite a Christmas list you have there Dr Scrooge and you may have to look to someone other than myself for all that it contains. Nonetheless the less, I’ll see what I can do. In the meantime how about a yo-yo, a penny whistle and this half eaten satsuma that Rudolph mistook for a carrot?’

‘That’s very kind of you Santa’, smiled Scrooge resigning himself now to playing along with the peculiar man who was clearly set on staying in role. ‘I don’t suppose you could sort out the crises in General Practice too could you?’.

‘I’m not sure that I can I’m afraid, not this Christmas at least. But I’ll say this. When you have 55,000 GPs, all of whom are doing their best in incredibly difficult circumstances and some are still saying that it still good enough, then the problem isn’t with GPs. And here’s another thing. You are aware aren’t you that I know who’s been good and who’s been bad this year? Well you GPs, and all those who work alongside you, are most certainly not on my naughty list!’

And with that the man gave a whistle and from out of nowhere a sleigh appeared. It was laden down with presents and was pulled by eight reindeer one of whom had a particularly shiny nose. The man stepped on to the sleigh and took hold of the reigns. Then, with a hearty ‘Ho, ho, ho’, he gave them a sharp tug and a second later he had disappeared from sight leaving a bewildered Scrooge alone once more.

Scrooge stood motionless for a few minutes not knowing quite what to make of what had just happened. What was it about Christmas Eve that in recent years had resulted him repeatedly having such strange encounters? Soon though his thoughts turned to more pressing concerns when he suddenly developed a sharp pain in the side of his chest. He started coughing again and brought up some mucky green sputum which this time, Scrooge noticed, was flecked with blood. Keen to get home, he tried to quicken his pace but it was another twenty five minutes before he eventually found himself outside his house. As he turned the key in the lock and pushed open the front door Scrooge was really rather breathless from his exertions.

Inside it was dark and Scrooge stumbled his way to the lounge where he collapsed into his favourite armchair. He switched on the small lamp that stood on the table next to him and noticed the advent calendar that one of his patients had given him at the beginning of December. The last door was still closed as Scrooge hadn’t had time that morning to open it. He peeled it back now revealing a picture of a new born baby lying in a manger but Scrooge paid no attention to the scripture verse that was written on the inside of the door. Instead, conscious that his breathing had deteriorated still further, Scrooge reached into his pocket and pulled out the pulse oximeter that he’d placed there earlier and applied it to the index finger of his left hand.

Seeing it record a pulse rate of 128 and an oxygen concentration of just 86%, Scrooge realised that, Christmas Eve or not, now was the time to call for help. He took hold of his phone and tapped out 999 only to hear a message explaining that due to the volume of calls that were currently being received there was nobody immediately available to take his call but that it would be answered as soon as somebody was free. Several minutes went by before somebody eventually responded. After determining what the problem was the call handler assured Scrooge that an ambulance would be dispatched as soon as possible but cautioned him that, due to the unprecedented demand that they were currently experiencing, they may be some delay.

Scrooge sat quietly in the chair feeling himself becoming more and more tired. He looked down at the advent calendar and now noticed the words that were printed on the inside of the door he’d just opened. ‘The light shines in the darkness, and the darkness has not overcome it’. They were the last words Scrooge saw. He found them strangely comforting and, believing them to be true, he managed a smile as, letting go of his hopes and fears, his eyes grew ever more heavy until he eventually fell into a deep, and dreamless sleep.

Outside, up in the sky, the silent stars went by.

*********

Early in the new year the local newspaper reported Scrooge’s death and described how he’d been found by the ambulance crew when they eventually arrived at his home in the early hours of Christmas Day. It had been several hours after Scrooge had made his initial call for help.

His funeral was well attended and many there spoke of how much they had appreciated all that he had done for them. Had he been there it would have cheered Scrooge’s heart. But, of course, he wasn’t. Scrooge was somewhere far better, somewhere where he enjoyed everlasting light and could spend his days resting a while with Mrs Gray or learning the art of encouragement by spiritual visitation from Clarence, the angel he’d met the Christmas before and with whom he had become firm friends.

In time Scrooge took on the role of ‘The Ghost of General Practice at it’s Best’. There was nothing he loved more than visiting GPs and reminding them that, however great their struggle, there was always hope, always something good to enjoy about their work, always some light to be found in the darkness.

So if one Christmas something unaccountable happens, if perhaps a mince pie appears on your desk whilst you’ve been called away to a colleague’s consulting room as a result of their panic button going off for seemingly no reason whatsoever, ask yourself if you too may have been visited by Dr Scrooge, someone who now really is having fun and whose future, like yours, has ‘only just begun’.

THE END.


To read the whole of ‘The Scrooge Chronicles’, click here

Other medically related Christmas themed blogs:

To read ‘How the Grinch and Covid stole General Practices Christmas’, click here

To read ‘Twas the night before Christmas – 2020’, click here

To read ‘A Merry, and Resilient, Christmas’, click here

Other GP related stories:

To read ‘Mr Benn – the GP’, click here

To read ‘A Bear called Paddington’, click here

To read ‘The Three Little GPs and the Big Bad Secretary of State for Health’, click here

To read ‘Jeeves and the Hormone Deficiency’, click here

To read ‘The Happy Practice – A Cautionary Tale’, click here

To read ‘A Mission Impossible’, click here

To read ‘A Grimm Tale’, click here

GRAVE EXPECTATIONS

This tale is Part Four of ‘Scrooge in the Time of Coronavirus’ which is itself Book Two of ‘The Dr Scrooge Chronicles’. Book One is entitled ‘A Primary Care Christmas Carol’.

To read ‘A Primary Care Christmas Carol ’, click here.

To read Part One of ‘ Scrooge in the Time of Coronavirus – A Tale of Two Patients’, click here.

To read Part Two of ‘Scrooge in the Time of Coronavirus – It’s A Wonderful GP Life’, click here.

To read Part Three of ‘Scrooge in the Time of Coronavirus – Bleak Practice’, click here

GRAVE EXPECTATIONS

in which Scrooge meets a red faced portly gentleman and finally calls for help.

It was Christmas Eve and Dr Scrooge was writing up the notes of the final consultation of his afternoon surgery. He looked up at the clock on the wall and noted that it was just before 7pm. It had been a long day. Through his open door he could hear Dr Cratchit singing a medley of Christmas songs. Clearly his colleague was looking forward to Christmas with his young family and his excitement had undoubtedly been heightened by the fact that during the afternoon it had begun to snow.

‘So here it is merry Christmas everybody’s having fun’, sang Dr Cratchit poking his head around the corner of Scrooge’s door. ‘Look to the future now it’s only just begun!’

‘Christmas it may be Bob, but I’m not sure that everyone is having fun,’ countered Scrooge suppressing a cough. ‘And I’m not so sure the future has just begun either. It rather seems to me that the future is on hold.’

Dr Cratchit however was not going to allow his spirits to be dampened. ‘I hope you’re not reverting to being a Christmas grump, Ebenezer. Why don’t you come round to our place for Christmas? You really would be most welcome’.

‘Thanks Bob, but I’d rather not. Maybe next year. You head off home. And do tell the receptionists that they can go home too. I’m nearly done – I won’t be here much longer.’

‘Well OK. As long as you’re sure. Have a good few days Ebenezer and I’ll see you on the other side!’. And with that Dr Cratchit left and a minute or two later Scrooge could hear him laughing with the receptionists as they braved the icy car park just outside his window. Soon all was quiet and Scrooge knew he was all alone in the building.

Scrooge had enjoyed spending last Christmas with Bob but this year his heart simply wasn’t it. It had been a hard year with his workload spiralling out of control. The weight of expectation on GPs had taken its toll with everybody seemingly wanting more and more from a profession that was already on its knees. Furthermore the constant criticism that had come from both the media and government had only made matters worse and the end result was that his mood had sunk ever lower.

‘Right now,’ thought Scrooge to himself, ‘Christmas is the last thing I need. The days off, of course, are welcome, especially after the last couple of weeks but Christmas isn’t like it was when I was a child. Back then Christmas was a magical time, a time you could really enjoy. But now? Now it’s seems it’s just another opportunity to burden oneself with the thousands of things we are expected to do if we are to be deemed acceptable celebrants of what our consumerist society has now made Christmas. I’ve had enough. I just want it all to stop.’

Even Scrooge’s Facebook feed seemed now to be asking more of him. All those memes which appeared to be simply offering winsome advice were, to Scrooge’s mind at least, just more examples of others exhorting him to do more. Urging him to ‘Be kind’ was all very well, he thought, but they might as well simply have insisted he ‘Do better’. Nonetheless Scrooge had made every effort to be kind, but no matter how hard he had tried there always seemed to be someone whispering in his ear, telling him that he still wasn’t good enough. Even that frequently offered advice that he be kind to himself felt to Scrooge like one more demand that he’d not been able to fulfil.

For over and above all others, there was another reason why Scrooge had not wanted to spend Christmas with the Cratchit’s. All week he’d been feeling unwell. He’d been coughing too. A PCR test the previous weekend had come back negative so, despite not really feeling up to it, he’d continued to work, unwilling as he was to leave Cratchit to manage the escalating workload by himself. That afternoon though he’d taken a significant turn for the worse. At one point he had been rigoring with a temperature of 38.7 and only by taking a couple of paracetamols had he been able to bring his fever down such that he felt well enough to keep on seeing patients.

Feeling so unwell meant it took Scrooge rather longer than he had expected to complete his paperwork and it was nearly 8pm before he finished all that he needed to do. Sensing his temperature was once more on the climb Scrooge rummaged through his desk drawers till he found some doxycycline that a patient had handed back to him earlier in the week. Then, for reasons he wasn’t quite sure of, he stuffed his pulse oximeter into his pocket before finally leaving his room and making his way out of the building. Outside it was bitterly cold and the snow was falling more heavily such that it was now beginning to settle. Scrooge got into his car and tried to start the engine only to hear the ominous clicking sound that could mean nothing other than the battery was completely flat.

Scrooge allowed his head to slump forward and rest on the steering wheel. ‘Great’, he said to himself. ‘That’s all I need!’ With it being Christmas Eve and not wanting to risk spoiling somebody’s family celebrations, Scrooge couldn’t bring himself to call anybody out and and so he decided to walk home instead. ‘It seems that this year I won’t be driving home for Christmas’ he muttered to himself as he began to cough once more, this time rather more forcefully.

Once he’d stopped coughing Scrooge got back out of his car and started to make his way home. Initially he trudged along main roads but it wasn’t long before he came to where his route took a sharp right turn. Scrooge pushed open the iron gates of the cemetery and, passing through them, continued a few paces on before stopping to gaze upon the gravestone that was clearly illuminated by the nearby street lights. The inscription read ‘In loving memory of Enid Gray who fell asleep August 6th 2020’. Scrooge remembered the elderly lady who had once been his patient, one with whom he’d spent Christmas with only three years previously and whose hand he’d held as she had taken her final breath. The inscription on her headstone ended with the words ‘Now at rest’. Scrooge couldn’t help feeling momentarily envious of Mrs Gray. How he could do with a little rest too.

On the other side of the path was another grave. This one was freshly dug and had yet to have been dignified with a headstone. Scrooge though didn’t need informing just who it was that lay beneath the still raised turf. Mark Ashley had died just three weeks previously, having presented to Scrooge only a month earlier already in the advanced stages of a malignant disease. He’d delayed attending because of concerns about catching Covid and now left behind him a grieving wife and two teenage children. Like Mrs Gray, he had been overcome by a disease that had been far more effective than Covid 19 in removing individuals from Scrooge’s patient list.

Scrooge continued along the cobbled path that ran straight across the centre of the cemetery. The night closed in on him as he ventured ever further from the streetlights that lined the road he had now left behind. About a hundred yards ahead a solitary lamp was shining brightly, driving back the darkness that surrounded it. Beneath was a bench upon which sat a portly gentleman who appeared to be wearing a red suit and whose face, itself somewhat rosy, was endowed with a long white beard. As Scrooge approached him, the figure stood up and greeted Scrooge with a broad smile and a cheery wave.

‘Good evening Dr Scrooge.’ said the man who clearly knew who Scrooge was.

‘Good evening’, replied Scrooge. ‘But I’m afraid you have me at a disadvantage. I don’t recognise you in your costume’.

‘You don’t recognise me?’ questioned the man, clearly amused by Scrooge’s failure to know who it was that had addressed him. ‘That’s most unusual. I tend to get recognised by most people. So much so that’s it difficult sometimes to have a few quiet minutes to myself!’

‘I know the feeling’, interrupted Scrooge before allowing the man to explain that he had a number of names but that he was most commonly referred to as either Father Christmas or Santa Claus.

‘Very amusing I’m sure’, said Scrooge, ‘but who are you really. Are you one of my patients perhaps?’

‘No no,’ said the man, ‘I’m not local. I’m just passing through. But I’ll be sure to register as a temporary resident at your practice should I need any medical assistance. I do sometimes suffer with a touch of gout. I suspect it’s a consequence of all the port that I’m proffered at this time of year’

‘Oh come of it’ said Scrooge. ‘Father Christmas doesn’t exist’

‘Are you sure?’ the man replied. ‘I mean – haven’t you seen “Miracle on 34th Street?”’

‘Of course I’m sure. And some sentimental Christmas film isn’t going to persuade me otherwise. I’m a bit old to believe in Father Christmas!’

‘Nobody’s too old to believe in me. Next you’ll be saying that Christmas is for the children!’

‘Well isn’t it?’

‘Well yes – but it’s for adults too. However old we are, we all still need Christmas. What would life be without something as fantastic as Christmas to look forward to, something to lift our spirits and give us hope in even the hardest of hard times?. Don’t you believe the Christmas story?’

‘Of course I don’t. The Christmas story is no more true than your beard is real!’, Scrooge snapped back.

‘Well I’d have to agree with you there’, said the man pulling on his beard firmly and surprising Scrooge somewhat when it failed to come off in his hand. ‘What about peace and goodwill to all men? Especially in these days of pandemic, couldn’t we all do with a little more of such things?’

‘Peace and goodwill – bah humbug!’ said Scrooge who was somewhat taken aback by hearing himself using an expression he’d not used for years. ‘Say what you like! I don’t believe in you or the Christmas story. The idea of there being someone so good and kind as to dispense gifts on everyone is ridiculous. The world is a tough place.’

‘Indeed it is – but there’s always hope.’

‘Not for the dead there isn’t’ said Scrooge indicating to the stranger as he did so the graves that lay scattered around them. The man in the red suit appeared to want to challenge Scrooge’s assertion but Scrooge wasn’t about to let a man he had decided was one bauble short of a fully decorated Christmas tree interrupt him now. ‘The truth is’, Scrooge continued, ‘that in the end the world defeats us all. And just now that most certainly includes me. That said, the idea of their being someone who is as kind as the person you’re claiming to be is, undoubtedly, quite appealing. Wouldn’t it just be heaven if there really was somebody who could bring some genuine joy into this miserable world, who could give us some hope for the future, who could put an end to all this death and disease?’

‘That’s quite a Christmas list you have there Dr Scrooge and you may have to look to someone other than myself for all that’s on it. Nonetheless the less, I’ll see what I can do. In the meantime how about a yo-yo, a penny whistle and this half eaten satsuma that Rudolph mistook for a carrot?’

‘That’s very kind of you Santa’, smiled Scrooge resigning himself now to playing along with the peculiar man who was clearly set on staying in role. ‘I don’t suppose you could sort out the crises in General Practice too could you?’.

‘I’m not sure that I can I’m afraid, not this Christmas at least. But I’ll say this. When you have 55,000 GPs, all of whom are doing their best in incredibly difficult circumstances and others are saying that it still isn’t good enough, then the problem isn’t with GPs. And here’s another thing. You are aware aren’t you that I know who’s been good and who’s been bad this year? Well you GPs, and all those who work alongside you, are most certainly not on my naughty list!’

And with that the man gave a whistle and from out of nowhere a sleigh appeared. It was laden down with presents and was pulled by eight reindeer one of whom had a particularly shiny nose. The man stepped on to the sleigh and took hold of the reigns. Then, with a hearty ‘Ho, ho, ho’, he gave them a sharp tug and a second later he had disappeared from sight leaving a bewildered Scrooge alone once more.

Scrooge stood motionless for a few minutes not knowing quite what to make of what had just happened. What was it about Christmas Eve that in recent years had resulted him repeatedly having such strange encounters? Soon though his thoughts turned to more pressing concerns when he suddenly developed a sharp pain in the side of his chest. He started coughing again and brought up some mucky green sputum which this time, Scrooge noticed, was flecked with blood. Keen to get home, he tried to quicken his pace but it was another twenty five minutes before he eventually found himself outside his house. As he turned the key in the lock and pushed open the front door Scrooge was really rather breathless from his exertions.

Inside it was dark and Scrooge stumbled his way to the lounge where he collapsed into his favourite armchair. He switched on the small lamp that stood on the table next to him and noticed the advent calendar that one of his patients had given him at the beginning of December. The last door was still closed as Scrooge hadn’t had time that morning to open it. He peeled it back now revealing a picture of a new born baby lying in a manger but Scrooge paid no attention to the scripture verse that was written on the inside of the door. Instead, conscious that his breathing had deteriorated still further, Scrooge reached into his pocket and pulled out the pulse oximeter that he’d placed there earlier and applied it to the index finger of his left hand.

Seeing it record a pulse rate of 128 and an oxygen concentration of just 86%, Scrooge realised that, Christmas Eve or not, now was the time to call for help. He took hold of his phone and tapped out 999 only to hear a message explaining that due to the volume of calls that were currently being received there was nobody immediately available to take his call but that it would be answered as soon as somebody was free. Several minutes went by before somebody eventually responded. After determining what the problem was the call handler assured Scrooge that an ambulance would be dispatched as soon as possible but cautioned him that, due to the unprecedented demand that they were currently experiencing, they may be some delay.

Scrooge sat quietly in the chair feeling himself becoming more and more tired. He looked down at the advent calendar and now noticed the words that were printed on the inside of the door he’d just opened. ‘The light shines in the darkness, and the darkness has not overcome it’. They were the last words Scrooge saw. He found them strangely comforting and, believing them to be true, he managed a smile as, letting go of his hopes and fears, his eyes grew ever more heavy until he eventually fell into a deep, and dreamless sleep.

Outside, up in the sky, the silent stars went by.

*********

Early in the new year the local newspaper reported Scrooge’s death and described how he’d been found by the ambulance crew when they eventually arrived at his home in the early hours of Christmas Day. It had been several hours after Scrooge had made his initial call for help.

His funeral was well attended and many there spoke of how much they had appreciated all that he had done for them. Had he been there it would have cheered Scrooge’s heart. But, of course, he wasn’t. Scrooge was somewhere far better, somewhere where he enjoyed everlasting light and could spend his days resting a while with Mrs Gray or learning the art of encouragement by spiritual visitation from Clarence, the angel he’d met the Christmas before and with whom he had become firm friends.

In time Scrooge took on the role of ‘The Ghost of General Practice at it’s Best’. There was nothing he loved more than visiting GPs and reminding them that, however great their struggle, there was always hope, always something good to enjoy about their work, always some light to be found in the darkness.

So if one Christmas something unaccountable happens, if perhaps a mince pie appears on your desk whilst you’ve been called away to a colleague’s consulting room as a result of their panic button going off for seemingly no reason whatsoever, ask yourself if you too may have been visited by Dr Scrooge, someone who now really is having fun and whose future, like yours, has ‘only just begun’.

THE END.


To read the whole of ‘The Scrooge Chronicles’, click here

Other medically related Christmas themed blogs:

To read ‘How the Grinch and Covid stole General Practices Christmas’, click here

To read ‘Twas the night before Christmas – 2020’, click here

To read ‘A Merry, and Resilient, Christmas’, click here

Other GP related stories:

To read ‘Mr Benn – the GP’, click here

To read ‘A Bear called Paddington’, click here

To read ‘The Three Little GPs and the Big Bad Secretary of State for Health’, click here

To read ‘Jeeves and the Hormone Deficiency’, click here

To read ‘The Happy Practice – A Cautionary Tale’, click here

To read ‘A Mission Impossible’, click here

To read ‘A Grimm Tale’, click here