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Posts by Beth Routledge

In Order To Form A More Perfect Union

The polls in the referendum on Scottish independence open in twelve and a half hours, and I will be at my polling station to vote No.

It has not been a simple decision, and over the last few weeks I have swithered from Definitely No to Undecided to Very Nearly Yes and back to No. I probably owe flowers to the poor pollster from Ipsos-Mori who got paragraph long answers to tick-box questions as I tried to work through my own confusion at her. As a concept, independence is not without its charms. To live in a socialist utopia like the one that I believe an independent Scotland could become? I want that. But what I want more is to be a part of building that utopia for everyone.

I love Scotland. I love her people and her mountains and her towns and her culture. I’ve walked the cobbled streets of Edinburgh and run through the green spaces in Dundee and driven the banks of the Clyde estuary. I’ve stood at the very edge of the Western Isles with nothing between me and North America. I have now worked in every hospital in Scotland west of Stirling, except Oban. And I love Glasgow, too, this beautiful broken city, this dear green place that welcomed me with open arms and that I am now privileged to call home.

“Where are you from?” I am asked.

“Glasgow,” I say promptly. And then there’s a confused silence and then I catch up: “Oh, you mean where did I grow up.”

I dare anyone to tell me that my No vote means that I love this country less than someone who is voting Yes.

I want the utopia. But do I want to abandon Wales and Northern Ireland and the North of England to the right-wing rule of the South East? I don’t want that. Or to share a border with the country that England without the moderating influence of Scotland would almost doubtless become? I don’t want that either. And on a globe that is not shrinking but growing, why in any case would I want to erect any new borders? We vote in this referendum at the end of a summer during which the world has seemed more fragile and yet more bound together than it ever has been. It’s a time to start breaking down barriers, and I’m more interested in world-building than nation-building.

Perhaps we could do wonderful things in an independent Scotland. But perhaps we can also do wonderful things in the United Kingdom as a Scottish nation in which the landscape of political engagement will never again be the same.

Race Report: Great North Run 2014 (I Am Made Of Every Stranger Who Cheered My Name)

Now, get a cup of tea and settle in, because this is a long one (and it comes with a soundtrack).

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There was only one word to describe the North East this weekend:

Hot.

I didn’t think, after nearly a month of distinctly autumnal temperatures, that the thing I’d regret standing on the start line of the Great North Run was that I’d not brought sunscreen. By the afternoon, I had a burnt nose and a tan line where my shorts stopped.

This year would mark the millionth person to cross the finish line at the Great North Run. It is a landmark in mass participation distance running, and it is the first race ever to reach it – long before the same landmark will be reached for the marathons in London and New York. I have to wonder what it must have been like to be Brendan Foster today, to look at what happened in South Shields this afternoon and think: I did that.

I’d had better training and better race prep than when I’d last had a crack at this one in 2012, a month into FY1. I had gone nine and a half miles in a shade under two hours on my last long run ten days beforehand, and I was still upright at the end of that. I had tapered, sort of. I had remembered my running shoes. I had packed porridge, because one never quite knows with England and one especially never quite knows in my mum’s kitchen. I did not severely underestimate how long it would take me to find a baggage bus and then my start pen. The night before the night before, which people keep telling me is the one that counts, I had fallen off the train in Newcastle and I had slept well.

The only potential issue I had was that, a few weeks before, in the middle of a long run, I had had a bit of a niggle in my IT band and it had lingered for a few days. I had trouble with my left IT band years ago and I am distressingly familiar with what it feels like, but this was on the right side where I have never before had so much as a whimper. But it seemed to have settled itself down with a bit of taping and rolling and ice, and I re-taped it on Sunday morning just to be sure.

My plan was to walk only the water stations, to lock onto a 12 minute mile pace and stick with it, and to hope that those things together would get me to the sea in 2:36-ish. That would have been a big PB. (My half-marathon PB is 2:53:52, set at this race in 2012.)

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On Sunday, race morning dawned bright and clear and with just a bit of a bite in the air. It was perfect. “If only it doesn’t get too much hotter than this, this is amazing,” I said. I’d be eating those words by the time the start gun went off – by that time, it was so warm I had already ditched the cheap fleece I’d bought the previous day for start line chucking away in favour of standing about in shorts and a vest. My mum and I walked up Claremont Road, soaking in the sunshine and the buzz as I got last minute water and slathered Vaseline across all my moving parts and found my baggage bus, and then we parted ways, me to head off to the start line and her to stand on the bridge for the start before she began the hike to South Shields by public transport.

It seemed like no time at all before Seb Coe fired the gun and Local Hero swept across the crowd. I cried, and I cried all over again when I watched it back on TV later that evening.

(“Oh, but you do cry at things like that, Beth,” said a friend at choir practice this week as I told the story. It’s like they know me.)

It took about forty minutes for my pen to get to the front. The wait included the Red Arrows doing their flypast. There is no sight in the world quite like that one. It is one of the memories of my childhood, watching them on television on the day of the Great North Run – a thing that I, uncoordinated and asthmatic and doing well in everything at school except PE, would never have even entertained the idea of doing, but here I was doing it for the second time, and let me tell you, television’s got nothing on real life. A few minutes later, I was across the start line. I hit my Garmin and started running, and out of the speakers came Lindisfarne singing Run For Home.

“Run for South Shields,” I thought.

The first three miles ticked by quite nicely. They have the high points of the tunnels under the Central Motorway where endless streams of runners shout, “OGGY OGGY OGGY” and then the Tyne Bridge, and after that you’re into Gateshead. I was feeling the heat (so was everyone), but my only real complaint was my sloshing bladder. I couldn’t think beyond the three mile point, where I knew there would be a toilet – one toilet and a queue of about fifteen runners. I would later discover that there were more toilets about two hundred yards up the road, but I didn’t have time to find that out and I wasn’t up for waiting in the queue. I went for the nearest tree and was followed by four more people who seemed to think I had the right idea. I hit three miles at 34 minutes on my Garmin and then didn’t get to the 5K chip mat until 38:20, which will have been the toilet stop.

Relieved, I carried on. The stop had somehow made me aware of just how hot it was and I was glad when I saw the sign for a water station 100 yards ahead. I decided to hang onto my water until my Garmin beeped for 3.5 miles, and that I’d have a little walk while I drank it. When I started running again, my IT band went twang. It wasn’t enough then to make me stop, but I think I knew then that I was in for a long day.

I took Lucozade at the feed station just before five miles. I had misgivings about taking it, I hadn’t trained with sports drink and the mantra of nothing new on race day was ringing in my head. But I was working hard and sweating badly, and I had taken on a lot of water at the start line and more since then and I was going to be taking on more at every single water station, and I needed to replace electrolytes somehow. I took half a bottle, and that plus the decision to take more at the next feed station would turn out to be the smartest decisions I made all day. I was the only one (so far as I knew) experiencing what felt like really awful toothache in my knee, but the heat was getting to everyone and all around people were being taken into medical tents. St John’s Ambulance were worked very hard on Sunday and they were magnificent.

It was turning into the kind of race that, any other day and any other race, I’d have thrown the towel in at six miles. But you don’t do that at the Great North Run unless your leg actually falls off. If you can’t get round, that’s okay, because the wonderful wonderful people of the North East will drag you around.

Just before the Black Bull Junction, which is the high point of the course, I went past a woman who was standing alone on the right hand side of the road, most of the spectators being on the other side at that point. “Come on, Beth, you’re doing really well!” she shouted. “You can see the top of the hill now!” And I could and I got there, and soon after that, running when I could and walking when I couldn’t, to the sign on the dual carriageway marking the halfway point. ENJOY THE SECOND HALF! it said.

Apart from the 10K chip mat, which I crossed in 1:22:33, I have very little recollection of the third quarter. I vaguely remember that there are a lot more uphills in that section than there seem to be on the elevation profile. I think it might have been here that I overtook Tony The Fridge.

My next clear memory is of the roundabout just before 9 miles, which I walked around while having a bit of a chat to a man dressed in a very pink and very sequinned ball dress. I suspect I’m accidentally in a lot of peoples’ photos from that roundabout. “It seemed like a good idea at the time,” he told me. On the other side of that roundabout was the Boost Zone, with more Vaseline (which I didn’t need) and Queen singing Don’t Stop Me Now (which I did).

At the end of that, sitrep:

  • Knee: Shot.
  • Legs: Dead.
  • Tank: Empty.
  • Blisters (a new and unwelcome thing, developing from the biomechanical weirdnesses I was forcing on my body in an attempt to not actually scream at my knee): Oooh, boy.

But I hadn’t come all this way to quit now. I had less than four miles to go, and I knew by then that I would finish. Even if I had to walk it in (and I had no intention of doing that), I was going to finish.

I started running again. A childrens’ choir singing Let It Go acapella at the side of the road gave my legs a much needed boost and made my eyes suspiciously damp. This is the best road race in the world. I ran from 10.2 miles to 11 miles, which was the longest continuous running I’d managed for some time, and then walked with to Elvis for a little while. A mile and a half from the finish, I exchanged a high five for an orange slice from some kids by the side of the road and I started to run again. “You’re doing amazing,” I said to Elvis. “You aren’t doing so bad yourself,” he said. It was exactly what I needed to hear. Running, slowly and really quite painfully by now, I made it to the water station by the Marsden Rock and to the Scout leader manning it who shouted at me, “You’re nearly there, Beth, the sea’s just down that hill!” There is no sight in the world quite like the Red Arrows doing a Great North Run start line flypast, but even that sight isn’t so beautiful as the sight of the billboard just off that roundabout that proclaims: IT’S THE SEA.

Screen Shot 2014-09-10 at 20.46.13I walked to 12 miles before I tried to pick it up again, and from there it was a little run and a little walk and a little run and a little walk and… well, you get the idea. The crowds on South Shields seafront are astonishing. I went past the Kidney Research UK cheering section, who cheered when they saw my shirt. I went past a woman who was on a one woman mission to personally scream to the end every runner who ran by her: “YES, YES, THAT’S IT, GO ON, BETH!” As the finish line came into sight, the millionth finisher, Tracey Cramond, who had been raising money for the Butterwick Hospice, was announced from the stage, and Chariots of Fire swelled through the speakers, bringing me home.

Because in my head I am an Olympian.

“You can’t cry,” I told myself. “No, really, you can’t cry. You need all the bloody oxygen you can get at this point.”

I all but fell across the finish line in 3:06:43 (chip time, my Garmin time rendered almost wholly irrelevant by the detour I took behind that tree at three miles). It wasn’t the race I had planned, but I am very proud of having finished it and I have never worked harder for a medal.

I was greeted at the Kidney Research UK tent by my aunt and a very welcome chair and the best cup of tea in the world and a physio with magic hands who proceeded to work my IT band loose enough for me to walk back to South Shields town centre and loose enough that three days later I can walk on it with only mild discomfort going down stairs. I have made the decision to not look at my running shoes this week. (I ran for the bus yesterday and that was far enough, thank you.) I may, possibly, if I feel like it, go for a very gentle swim at the weekend to try to shake everything loose. But, far from deciding that this was terrible and that I must never do it again, I had decided before I’d even bandaged my feet that I’ll be back next year and for Kidney Research UK again if they’ll have me.

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My donations page is open until December, but thank you so much to all the people who donated. I was doing this for this charity for a very personal reason as well as for a shot at a fantastic event, and it means a great deal to me and to them.

 

Books Lovely Books

There is a thing going around social media at the moment about ten books that have stayed with you. I’ve been asked for mine now by a couple of different people (and it’s a much nicer thing to be hit up for than, f’rexample, throwing a bucket of ice water over one’s head).

I picked them quickly, as I was instructed to do so, and then I rambled a lot about them. Really, hands up anyone who’s surprised that I talk too much to keep this on Facebook? Nobody? Okay, then.

 

1. The Witch of Portobello by Paulo Coehlo

Paulo Coehlo is better known for The Alchemist, but this slightly lesser known book is a novel with a worthwhile story and an interesting structure, meandering as it does among the point of view of its protagonist and the various characters who pass through her life, none of whom, including Anthea, have the whole story.

But actually it stays with me for one section, told in the voice of her Catholic priest shortly after Anthea has divorced her husband:

One day, all that will matter is love and Christ’s words: ‘Come unto me all ye that labour and are heavy laden, and I will give you rest.’ I’ve devoted my entire life to the priesthood and I don’t regret my decision for one second. However, there are times, like that Sunday, when, although I didn’t doubt my faith, I did doubt men.

I like to imagine that, when she left the church, Athena met Jesus. Weeping and confused, she would have thrown herself into his arms, asking him to explain why she was being excluded just because of a piece of paper she’d signed, something of no importance on the spiritual plane, and which was of interest only to registry offices and the tax man. And, looking at Athena, Jesus might have replied: “My child, I’ve been excluded too. It’s a very long time since they’ve allowed me in there.”

2. The Harry Potter series by JK Rowling

I think that the Harry Potter phenomenon sometimes makes it easy to forget what these books were all about: about courage and friendship and loyalty; about that there are some things you can’t accomplish without ending up liking each other and that one of them is knocking out a twelve foot mountain troll; about all the people, Remus Lupin and Alastor Moody and George Weasley and Nymphadora Tonks and Cedric Diggory, all of them, who were honest and brave and true right to the very end; about unlikely heroes and people who can change; and about good and evil, and the victory of light over darkness and the shades of grey in the middle.

 

3. Extremely Loud and Incredibly Close by Jonathan Saffran Foer

The story of a boy whose father was killed in the terrorist attacks of September 11th.

I don’t know objectively how good of a book Extremely Loud is. My memory is that it’s a bit heavy-handed and mawkish in its sentimentality, and I’ve never been moved to re-read it to find out if I was right. But I read this in New York in the same week I saw for the first time the still-smoking crater of the World Trade Center and that’s the sort of thing that stays with you.

 

4. My Family and Other Animals by Gerald Durrell

I have a friend who claims that my mother is Mrs Durrell, and the thing is that she’s probably right.

I am not allowed to read this in public. We read it in English lessons when I was in Year 8, and on many occasions the reading had to be paused while the class gazed, bewildered, as I screamed with laughter and wept tears of pure hilarity.

“Why keep in touch with them; that’s what I want to know,” asked Larry despairingly. “What satisfaction does it give you? They’re all either fossilized or mental.” 

“Indeed, they’re not mental,” said Mother indignantly.

“Nonsense, Mother… Look at Aunt Bertha, keeping flocks of imaginary cats… and there’s Great Uncle Patrick, who wanders about in the nude and tells complete strangers how he killed whales with a pen-knife… They’re all bats. 

“Well, they’re queer; but they’re all very old, and so they’re bound to be. But they’re not mental,” explained Mother, adding candidly, “Anyway, not enough to be put away.”

 5. The Greatest Benefit to Mankind by Roy Porter

I have an A-level in British and European History, which, when you take the content of it as a whole, probably says a frightening amount about the person I am.

The syllabus was framed in such a way that it mostly means I have an A-level in the history of the Protestant churches of Europe and the Church of England, but there was a divergent part to it which allowed students to choose their own subject for their upper sixth coursework. The question I set for myself was: “The years 1901 to 1948 were a golden age for public health medicine in the United Kingdom. Discuss.” I covered the development of sanitation and the Public Health Act, the influence of triage medicine and war medicine during the First and Second World Wars, and the advent of the NHS. (I would find plenty of holes in it to poke now, I’m sure, but it is the thing I most regret losing when that laptop went blue-screen-of-death.) Roy Porter’s book covers, in broad strokes, the whole history of medicine starting, I recollect, from the ancient people of Greek and Egypt, and I hope one day to get hold of a copy of my own, but the chapters on the early twentieth century informed the bulk of my background reading when I started answering that question.

 

6. The Wrong Messiah by Nick Page 

This is my go-to book in Holy Week, and I associate it with reading the last chapter while sitting on the freezing cold tiles at the back of church during the Vigil. It’s a historical examination of the life of the son of a carpenter, about why he would have been the very last person anyone would have chosen to make Messianic claims to front a new religion/cult/political movement and why that means that we know he was for real. It’s also a beautifully painted and intricate portrait of Jesus of Nazareth, of the life he led and the mission he had and, ultimately, the death he died.

 

7. Birdsong by Sebastian Faulks

I would read a shopping list if it was written by Sebastian Faulks. When I was at Durham, I had a long-standing friendly disagreement with my College principal about our respective preferences for Birdsong and for Charlotte Grey. This was the first time I’d read Faulks. I think it was the first time as an adult that I’d read any war literature at all — coming at it with a teenager’s memory of being struck, deeply and immuteably, even now, by a school visit to the battlefields of France and Belgium. I finished it at 4am, sprawled out on the bed of my first year room in halls, snotty and weeping, the sun rising over the Tees out the window as my mind struggled to climb out of the trenches. My experience of reading Birdsong was not unlike my experience of seeing War Horse, one night that hit me so deeply in the gut I’ve been reluctant to go back to it for fear that it couldn’t possibly be so perfect the second time around.

Stephen looked down at the floor of the German trench. He could not grasp what had happened. Four years that had lasted so long it seemed that time had stopped. All the men he had seen killed, their bodies, their wounds. Michael. His pale face emerging from his burrow underground. Byrne. The tens of thousands who had gone down with him that summer morning. He did not know what to do. He did not know how to reclaim his life.

8. Pages for You by Sylvia Brownrigg

This is a coming-of-age story. It is about growing up and falling in love and poetry and making mistakes and New York in the fall. It’s like Catcher in the Rye and The Perks of Being a Wallflower, except that (1) the protagonist is a woman, (2) the protagonist is a lesbian, and (3) the story is, fabulously, not actually about either of those things. It is wonderfully well written. It wasn’t marketed as LGBT fiction and at that time of my life I probably wouldn’t have bought it if it had been.

If you want to believe in serendipidity: I picked it almost entirely at random in the WHSmiths in Newcastle Central at 5am, when I realised that I had no book and an eight hour round trip ahead of me to a medical school interview. And for a seventeen-year-old who didn’t know what to think about her own sexuality and wasn’t used to seeing people like me in the books I read or the television I watched or the films I saw, it was an incredibly important book.

I plan to learn enough to read you like a book.
I plan to give this book to you and know you’ll read it,
so our minds may meet across these pages,
in the colourful country of another writer’s language,
where we can flourish in the knowledge
that we are learning how to speak to one another.
 

9. The Crimson Petal and the White by Michael Faber

This is simply a proper good read, for people who like to curl up on wet Saturdays with a decent pot of coffee and a couple of cats and a massive story.

It has Victorian London and intrigue and a prostitute called Sugar and the Church (and Charles Darwin setting it all of a flap, and you do know how I like to set the Church all of a flap). I read it years before the BBC series was even thought of and I find that I don’t want to see it, ever, none of it, no matter how good everyone tells me it is, because there are some books so fantastic that I refuse to allow someone else’s imagination in.

 

10. Never Let Me Go by Kazuo Ishiguro

 You’ve heard of magic realism (Jonathan Strange and Mr Norrell, for reference, and The Green Mile, a bit). I think that this is what science fiction realism would look like if that were a genre, but don’t let that put you off.

I’m going to torture a metaphor for a little bit, via being an enormous nerd: the Doctor once told Amy and Rory Pond about a thing that has been there for as long as there’s been something in the corner of your eye or creaking in your house or breathing under your bed or voices under a wall. That’s how I remember the secret in Never Let Me Go. You will know from the beginning of Chapter 1 that there is something going on that you don’t know about, something that isn’t quite right, something simmering under the surface, something right there in the corner of your eye. And then you will find out what it is. And it will break your heart.

Tales Of Clinic

I have in the decade-and-a-bit since I left the city in which I was born been mistaken for Irish (a lot), Indian (casual racism in the general direction of call centre staff, which was my old job), “from New England” (by a Canadian), and Scandinavian (yesterday).

Occasionally, someone gets it right. For example, when, as is usual for me these days, we have been talking at some length about their cancer.

 Beth: Your bloods all look quite good, and…

Patient: *develops fit of giggles*

Beth: Um?

Patient: Oh, gosh, I am sorry, but it’s like I’m talking to Sarah Millican.

*

In which I am minding my own business as I dictate letters and inhale coffee.

Nurse: Oh, excellent! Oh, I just saw you there, Doctor, and I was reminded of sputum!

The Great North Run — Again

In a little over two weeks time, I’ll be on the start line of the Great North Run.

(Or, if I choose to be accurate, I’ll be standing about a mile back from Seb Coe and his starting gun. My number is forty-five thousand and something.)

If you have been around that long, you may recall that I ran a bit when I was a medical student. You may also recall that my last race was this same race in 2012, a month into FY1. It was peppered with disasters, like, for one thing, my training plan, such as it was, and also like leaving my shoes behind a photocopier in Stirling and so spending the first part of the weekend trawling Newcastle for an identical pair. Nevertheless, it was an incredible experience (I high-fived Mo Farah!) and I swore then that I’d be back, one day, for the Red Arrows and the Tyne Bridge and Local Hero and that amazing final straight along the South Shields seafront.

Afterwards, I mostly hung up my running shoes for a year. I was too exhausted for a lot of FY1 to do much of anything at the end of the day besides collapse into a tiny heap in the middle of my sofa. But eventually I developed some kind of stamina and then, slowly, sometimes painfully, through my FY2 year, I laced up my shoes and began to be a runner again.

And now it’s 18 days until I am indeed back for the Red Arrows and the Tyne Bridge and all the rest of it.

My training this time around has been far from textbook – for example, there is a hole in it that I can identify as my cardiology weekend on call – but it has been an awful lot better than I did last time. The highlights of my training will be the time I’ve spent running along the Clyde, particularly the day when I wasn’t expecting the Commonwealth Games flotilla to suddenly appear over my right shoulder. And, for sheer bullheadedness, the night I accidentally ran nine miles in hammering rain. I feel that I’m more psychologically prepared for it this time, and that is as important as anything.

I am running this year on a charity place that was kindly given to me by Kidney Research UK. They were the first charity I ever fundraised for, twenty years ago, and I’m doing this for them because kidney disease was the thing that brought to an untimely end the life of my dad, Bob, twenty years ago next summer. You can read more about his story and about the work of Kidney Research UK on my fundraising page, and if you feel moved to do so you can also donate there.

18 days.

Two more long runs.

And shoes. I really must remember my shoes.

Dear Vicky

Dear Vicky,

I was quietly checking my Twitter feed before bed last night when I learned that with few fireworks and little fanfare, you had spoken to the Independent about being a gay Christian woman and thus launched what I imagine must have been 24 hours of somewhat of a circus.

In the world in which we live (and which I rejoice in living), there are going to be a lot of folk scratching their head over why what you have done is important, because, after all, being gay (or lesbian or bisexual) isn’t a big deal anymore, right? Alas, not in the Church. Also, for the record, not in professional sports or in Hollywood, thus completing the unlikeliest trifecta since eggs, bunnies, and Jesus. I know you know that. I know, because it’s the history written in your scars and your soul and now across the world in newsprint.

In the church that I now attend, it took me six weeks to sneak up to one of the clergy after Mass and say, “Um, so, about this LGBT Group…” St Mary’s has never been in the closet about its liberalism; on my very first Sunday we prayed during the intercessions for a blessing of a civil partnership, plus, well, there was an LGBT Group, so it’s not like I didn’t know. But, at the time, being out at church felt like a big deal in a way that being out in the rest of the world didn’t. Even now there are plenty of delightful liberal well-intentioned people who presume until told bluntly otherwise that “gay Christian” isn’t a thing. This year at Synod, on the first day, I got up and proposed a motion that was viewed by parts of the establishment as terrifyingly radical and, had it passed, would have put us on a trajectory to allow the marriage of same-sex couples within the Church — and then on the second day I had to actually out myself, because apparently that part hadn’t been clear to everyone.

And all of that was just for me, with no reputation at stake and nothing to lose and quite comfortable in the knowledge that conservative evangelical America has never cared who I am. You have done a big thing and a brave thing, and nobody gets to minimise that. If they try, ask them when the last time was that a Church of England Bishop came out voluntarily and they’ll soon shut up.

Vicky, I hope you have seen the outpouring of goodwill for you on the Internet over the last 24 hours. I pray that that goodwill is reflected by what you encounter out there in the world. I know that it won’t be so everywhere, and so do you.

I talked to a friend last night as your story was breaking. “They’re going to throw rocks at her,” I said. (Metaphorically.) “They are, and she knows it and she’s done it anyway.”

But when they do, I want you to remember this: I want you to remember that for every Scott Lively, there is a young gay man who has thought for years that he is somehow broken and who knows now that he is loved and blessed and perfect just the way he is. I want you to remember that for every Ann Coulter, there is a teenage lesbian who was told that she would be condemned by her God and who knows now that she was made in His image and likeness. I want you to remember that for every Westboro Baptist, there is a family who rejected their gay son or daughter and are now maybe starting to think differently about what God would want for them. For every person who condemns you, there is a person whose life you have just made better by telling them that God loves you and God loves them and God loves all of us anyway.

It is no easy feat, to live the story that you’ve now shared with us and to come up on the other side with grace and faith.

As you move forward in the world, gather in the love and the love and the love that we all offer you, and may God bless you, today and always, in everything that you do and in all that you are.

With prayers and good wishes,

Beth

Dear FY1s

Eat breakfast.

You are not expected to function on Day 1 of FY1 at the same level as the people who today were on Day 364 of FY1.

It is normal to want to giggle the first time you introduce yourself as a doctor.

Write everything down.

For at least the first month, you will be exhausted all the time and you will have sore feet all the time.

FY1s cannot live on chocolate alone.

You can’t fill in a DNACPR or an AWI or an Emergency Detention Certificate, even if your consultant asks you to.

There is no shame in needing a hug.

Your fellow FY1s are your allies, with whom you will mourn in times of tragedy and celebrate in triumph.

The learning curve is vertical. In a year’s time, you will look back on this day and you will not believe how far you came.

There are lots of people who will tell you that when you go home, you should turn it off and forget about it and not talk shop. And you probably should, as far as you can. But it is okay sometimes to need to talk shop. It is okay to need to tell someone about the awful day that you had or the awful week that you’re having. And if the choice is between calling work to check that that patient is okay or that that thing got done and not sleeping for worrying about it, it is okay to call work.

Do your best all the time, and then remember that that is all you can do.

It is not abnormal to cry after your first arrest, or after the first time you pronounce someone dead.

There are no stupid questions.

Take a deep breath, ABCDE, and phone your senior.

This is the best job in the world.

Enjoy it.

Asking For Help (And Getting It)

The well thumbed hashtag on Twitter will give you its own advice about treating your pharmacists and physios and senior nurses as the pillars of wisdom they are, doing a warfarin and fluid and insulin prescribing round before you go home for the night, remembering #hellomynameis, not leaving ePortfolio until the last minute, not putting yourself into acute kidney injury (no, really), and a great deal more.

I have one piece of advice – a #tipfornewdocs, but, perhaps more importantly, a #tipfornewshos – and a few short stories to go with it.

Get help.

The highest compliment I was paid in FY1 was being told, while asking a consultant surgeon to come and review my medical patient, yes, I know it’s half past three on Friday afternoon, that I was quite bolshy for an FY1. I am almost certain that it wasn’t meant as a compliment. It also disguises the truth that I am as prone as anyone to prefacing any question I ask my seniors with, look, I think this is probably a stupid question… But developing the ability to get help and get it quickly requires getting over that apologist instinct we all have to presume we’re being a bit silly.

“The reason we might seem a bit on edge is that you are describing to me something that is relatively uncommon and that could be extremely serious,” I say, sometimes. “I could easily be wrong, but indulge my paranoia until we’ve got these investigations done, okay, because there are worse things than being worried and wrong and I wouldn’t be doing my job properly if I weren’t.”

“I’d rather you were paranoid, too, Doc,” they say, sometimes.

And sometimes I’m right, but often I’m wrong and we can all breathe a little easier.

I’m okay with that. (I don’t want to be proven right about the parts of my differential that are 1) Awful Thing, 2) Awful Thing, 3) Really Awful Thing.) The broad strokes of acute medicine are in the sometimes diagnosis but more often elimination of the things that are statistically improbable but acutely life-threatening. The trouble with any kind of medicine is that it isn’t a science, which means that nothing looks like it does in the textbooks and anything that does isn’t what the textbook says it ought to be.

And speaking as the person who has very often this past year been the first in line to be paged by a worried FY1, it is never wrong to ask for help.

I’m certain that most of us have had at least one nightshift when nobody seemed able to maintain their blood pressure. My new wee FY1 colleagues, I promise that you will have this experience in your storybox before long.

Sometimes, this is because there is a local policy that routine four hourly obs should include overnight obs. Do you know who gets hypotensive at 2am? Everyone. Or, on one particular occasion when I was the only doctor actually in the building, nine people, all at once. The skill lies in working out which of those nine people dropped their blood pressure because it’s two o’clock in the morning and they’re trying to sleep, and which of them has dropped it as a precursor to falling off the proverbial cliff. It is a triage skill and it is not one that anyone learns overnight, and I am still learning it. But if a good nurse tells you that two fluid challenges haven’t done anything and the systolic BP is now in the sixties, that’s a hint and you should take it. It might be that the only way to get help is to point out that if nobody comes when you ask for it you will sooner rather than later be summoning it from the arrest team. I’m not saying that that ought to be your opening gambit. I am saying that if things are actually getting to that point, it at least has the merit of being true.

For my newly minted SHO friends, you should know that the help you think you ought to be asking for does not always come. It doesn’t happen often and I wish that it were not so, but it does happen and it is so and you should know that. And the reason you should know that is so that I can tell you this: get help from someone else. One of my newly minted SHO friends will remember the time when they were my FY1 and found me crying in the sluice because I had not been able to convince help to come. This was after I had quoted a remarkable array of very terrible numbers and deployed the phrase “this is incompatible with life” and explained my inability to fix the situation. The help I thought should be coming never did, and I got the med reg and muddled through and kept the patient alive until morning. A few days later, on a morning when my educational supervisor had asked me if I was always able to access senior support, I blurted out the whole story. He looked at me in moderate horror. “If that ever happens again, ignore them and ring the consultant instead,” he said. It had never occurred to me that I could do that.

Incidentally, and this is just as important for FY1s, the med reg is always in the building and will always come (unless someone else is dying), even if it isn’t a medical patient.

Remember this, too: If a patient is unwell, the question is never what you think you should be able to do but only what you can do. On that day when you vowed to make the care of the patient your first concern and became professionally bound to act within the limits of your own competence, you were agreeing to let go of your own ego.

A few weeks ago, I phoned my registrar who then phoned a consultant because I had convinced myself, largely based on a chest X-ray, that one of the patients I was looking after had a pneumothorax and I have never put in a chest drain. Very quickly, the nicest consultant in the world arrived from home and looked at it and then found me. “Ah, Beth. It was you who ordered that X-ray? Come, show me where you think this pneumothorax is.” I brought up the film and showed him the line between the lung and the chest wall. “And where does that line go?” he asked. I followed it down. “It goes… er, well, it sort of bends,” I said. This was a teaching moment for him, and he asked me: “And which anatomical structure might you expect to find there?”

The blood drained from my face. “Oh, no, God, the scapula,” I said.

And spent the next ten minutes apologising.

“It’s all right,” said the nicest consultant in the world. “You have to learn these things. Anyway, I’d rather you were paranoid and got help and were wrong than the alternative.”

Tales From Pride

I Love Martha Jones

As we made our slow way back to where I had abandoned the car, laden with placards and banner and toddler, I was stopped by a gentleman asking whether we were going to a protest.

“No!” I said. “It was Gay Pride!”

He read the text of one of my by now quite soggy placards.

St Mary’s Cathedral: Open, Inclusive, Welcoming

“And, erm, were you protesting it?” he asked, looking hopeful.

“Of course not,” sayeth I. “We’ve been suppporting it.” And, pulling out one of the lines that I’d been using on people all morning when I’d worried that they might think that I was trying to save them, “We’re the good kind of church!”

He didn’t like that at all.

It’s true, though.

And don’t forget about this:

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Pride and the Commonwealth

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For your diaries, there are three events in Glasgow next weekend all well worth coming to:

  • The annual gathering of Piskies at Pride takes place next Saturday (19th July). This year, the parade for Glasgow Pride starts from Clyde Place on the south bank of the river and then heads across the Clyde into the city centre and into Merchant City. If you would like to walk with a group of Scottish Episcopalians, we will be meeting at the south end of the Tradeston Bridge (the wiggly pedestrian bridge) at 9.15am on Saturday. This is a ten minute walk from Bridge Street, which is the nearest subway and is also likely the easiest place to park. If you are at the Clyde Arc (the squinty bridge) or can see the SECC/Hydro, you are in the wrong place.
  • On Saturday evening at 6.30pm, Peter Tatchell is giving a lecture on Human Rights and the Commonwealth at St Mary’s Cathedral. Taking place on Pride Saturday and immediately ahead of the arrival of the Commonwealth Games in Glasgow, this will be a compelling evening which has been arranged by the cathedral Justice and Aid Network. St Mary’s is on Great Western Road, between St George’s Cross and Kelvinbridge subway stations. Tickets are £5 on the door.
  • Peter Tatchell will be at St Mary’s Cathedral again on Sunday morning, at 12 noon, in conversation with Kelvin Holdsworth. This is one of the Forum events which we hold on occasion, with past speakers including Bishop Christopher Senyonjo of the Episcopal Church of Uganda and Professor John Curtice of Strathclyde University, known to many more people from his frequent work with the BBC.  The Forum is a free event, as is the glorious Sung Eucharist which will take place beforehand at 10.30am.