The news headlines are full of news about LGBT issues today.
In England and Wales, the Marriage (Same-Sex Couples) Bill returns to the House of Commons for the next two days to go through its third reading, further debate, and a vote by MPs tomorrow afternoon. The main threat to it has been the attempted amendment to extend civil partnerships to opposite sex couples, which looks more like a stalling tactic than a genuine attempt. If the House of Commons votes in favour tomorrow, the next hurdle will be the House of Lords on Wednesday.
A little closer to home, the General Assembly of the Church of Scotland happens this week and today they have been talking about the ordination of LGBT ministers and particularly ministers-who-happen-to-be-LGBT-and-in-civil-partnerships. They voted a few minutes ago in favour of a convoluted neither yes nor no option that Kelvin has explained better than I can attempt to. This has been an ongoing debate in the Church of Scotland for over a decade, but particularly since 2009, when Scott Rennie was appointed minister of Queen’s Cross Church in Aberdeen.
On the radio tonight, I heard a lesbian minister in the Kirk tell the General Assembly that this is painful for her because for two decades she has had to listen to the Church debate whether or not it accepts her as part of it. This is quite often how I feel about the Anglican Communion. Justin Welby shuddered theatrically a couple of weeks ago during an interview with the Financial Times when presented with the idea of two men kissing. The General Synod of the Scottish Episcopal Church meets in a couple of weeks and we will be faced with more of the stalling and the delaying and the refusal to actually talk about any of it. The churches forget, sometimes, I think, that this is not an academic exercise but a conversation about actual people who are caused real pain by it.
And not in the news headlines but a lot closer to home, Professor John Curtice, who is professor of politics at Strathclyde University and our resident expert, as well as the resident expert of the BBC – you may know him from such niche programmes as Newsnight – on public opinion in the UK, will be speaking at St Mary’s on this coming Sunday at 12.15pm about public opinion on equal marriage.
It’s all go, here.
I’m settling into my new job as the surgical F1.
The way I can tell that I’m working with surgeons, who are turning out to be unexpectedly lovely, is that sometime between medical school finals and FRCS, some of them, no matter how lovely, have clearly given themselves a common sense-ectomy. To wit, the instructions I was given on Monday on the ward round vis a vis one of the very well elective patients who was almost ready for discharge.
“Beth, this man had a heart rate of 90 when he was assessed in pre-op and he had a heart rate of 90 during theatre and he had a heart rate of 90 when he returned to the ward post-operatively and now he still has a heart rate of 90.”
“His ECG has been normal.”
“His other obs are all fine.”
“So, I got the F1 who was on the ward last week to check TFTs. If those are normal, can you refer him to medics for cardiology assessment, please?”
… Wait. What?
1. Thou shalt have a basic grasp of mathematics.
You are looking after between seven and twenty patients. Your FY1 is looking after a minimum of 96 patients. She is entirely within her rights to growl when you try to tell her that you are “very busy”.
2. Thou shalt learn how to read a EWS chart.
The score for BP is for systolic BP, not diastolic BP — a diastolic BP of 8o does not trigger an urgent clinical review, no matter how many times you try to tell me that it does. The nausea score is not part of the EWS — you cannot decide that a patient whose obs are all normal is scoring EWS 3 because they were sick three times. And if a patient has had their parameters adjusted, you need to observe the new parameters — your FY1 is unlikely to be impressed with your long-standing COPD patient’s SpO2 of 91%.
3. Thou shalt put non-urgent jobs on the non-urgent jobs list.
You do not need to page your FY1 to rewrite a Kardex.
4. Thou shalt not put urgent clinical reviews on the non-urgent jobs list.
A review of a patient with a new tachycardia does not belong on the non-urgent jobs list. A review of a patient who has dropped her systolic BP by 40 in the last hour does not belong on the non-urgent jobs list. A review of an unconscious patient with a blown pupil does not belong on the non-urgent jobs list.
5. Thou shalt not harrass.
It is a waste of your time and your FY1′s time when you page her “just to check whether you’re coming back to the ward” or “just because we haven’t seen you yet today”. She has not forgotten that she is covering your ward and she has not gone for coffee. If you have not seen your FY1 for a while, it is because the brown stuff is hitting the fan somewhere else. The only way your FY1 knows that you are paging her with a stupid question rather than a properly sick person is if she stops what she is doing and calls you back, and if you are the third person to pull your FY1 away from a properly sick person just to tell her that it’s been a few hours since she looked at her non-urgent jobs list, she will be rude to you and she will not apologise later.
6. Thou shalt learn how to use a telephone.
Do not page your FY1 and then walk away from the phone. Do not page your FY1 and then pick up the phone to make another phone call. Do not page your FY1 to the paging system.
7. Thou shalt not expect on a Saturday that which can (and should) wait until Monday.
You may be right in thinking that your patient’s high blood sugars, which have been high for a fortnight and which they are asymptomatic of, are steroid induced, but your on-call FY1 is not going to make a unilateral decision at the weekend to stop steroids that they were started on by a neurosurgeon for their brain tumour.
8. Thou shalt use SBAR.
The on-call FY1 has never met your patients before. If you ask your FY1 to review a patient, she will expect you to know why you want them to be reviewed, what their current obs were, what their obs were before that, and whether a plan has been made by their day team. If you ask your FY1 to review a patient urgently, she will expect you not to have gone on your break in the three minutes it takes her to walk up the stairs.
9. Thou shalt read.
If you ask your FY1 to prescribe analgesia/anti-emetics/fluids for your patient who is, quote, not written up for any, your FY1 will assume that you have actually checked and will be unamused when she comes to the other end of the hospital and opens up the Kardex to discover that you had not checked and that those things had been there all along.
9. Thou shalt realise that it is in your best interests that your FY1 does not keel over in the middle of the ward.
If your FY1 says at 6pm that she is leaving the ward to buy lunch and will be back in five minutes, do not block her path and ask her to “just…” unless your patient is actively trying to die. It is at this point more important for her to treat her own hypoglycaemia and acute renal failure than it is for her to treat your patient’s nicotine withdrawal.
*blows cobwebs away*
Are you all still out there?
My absence from the Internet has been mostly because I’ve had some annual leave. I’ve not been away or done anything particularly, but I’ve caught up on a lot of sleep and read books and baked things and spent time with the cats and gone to the seaside, and altogether had an agreeably lazy couple of weeks. It was a sign that I’ve been away for longer than I usually am when I went back to work on Monday and had forgotten all my computer passwords and the phone number for the biochemistry lab.
I am not built to be a permanent lady of leisure, though, and it is good to be back at work.
Today, I was given my very own medical student.
As you may remember from when I did them, my medical school holds finals in March, and the post-finals part of fifth year is taken up with classes on how to be a good doctor and then a final few weeks of hospital placement spent with an F1. There are a lot of useful things about doing that last placement. I think especially for students who have been more in the major teaching hospitals and less in the district generals way the heck out in the middle of nowhere, because for those students it might well be the first time they’ve really been much with juniors rather than trotting around after consultants. Hell, I did spend almost all of my fourth year in district generals way the heck out in the middle of nowhere and I spent a lot of time then with F1s, but, by the time Preparation for Practice rolled around, I had just spent the better part of six months hiding away in the library, which mattered a lot for passing finals and mattered not very much at all for learning how to actually do my job. And then there’s the other nice thing about doing a placement like this, which is that the students who are staying in this Deanery after graduation get to do it in the hospital that is going to be their hospital. There’s a lot to be said for having the chance to learn where the toilets are and where the coffee is and how to use the phones before you turn up to work.
My medical student is wonderful and I think, in so far as you can think anything after nine hours, that he is probably going to be a very good F1.
He kept me a jobs list during the ward round, which I missed a lot of because I spent most of it getting progressively more frustrated with a hospital in England, to the great amusement of my ward pharmacist (“His notes are on microfilm? Yes, I know it was 2007. It was 2007, not the Stone Age!”). And when he gave me the jobs list, he also said, “I’ve done this and this, and that hasn’t been done yet but I took it to radiology and they’ll do it this afternoon.” And then he chased all my bloods and wrote them in the notes. And he did it all without needing to be asked.
I like that I have someone who is competent and cheerful and eager to learn things, and not because it makes my life a bit easier for a few weeks, but because when I really thought about it, I realised that what I’m doing is training my replacement.
This is all very bittersweet in a way that I didn’t expect.
It’s weird, to start with, to look at someone else who is now where I was this time last year and to see that I really am a different person and a different doctor — a better doctor, I hope — than I was last summer. And to look at my SHOs, who were my F1s just after my finals, and to see how much they’ve changed, too, and to think about how much more I’m going to change in the next twelve months.
And then there’s the other part, which is that I won’t be here in August.
I’m doing my F2 year in a different hospital. I chose that. I chose when I applied to FPAS to not stay in the same place for two years, and I think that was the right choice. I also think, although this isn’t wholly relevant, that I chose to do it the right way around. But even though I know that I chose to do these things for good reasons — I love my hospital.
And that’s it, right there, that’s the hard part.
I could dispense lots of advice about how to sweet talk radiologists and how to present someone on a post-take ward round versus on the phone at three o’clock in the morning and how to not leave an on-call weekend with worse renal failure than the patients, and I will. I will dispense all of that advice.
But I’ve loved my job and I love my hospital, and all I really want to tell any of them is that I’m handing over my baby and that I’d really rather they didn’t break it.
I’m at home, getting ready to go out for a run.
It’s only going to be for a couple of miles, but I can’t not go, not today.
I am not the fastest member of the running community. I can’t run the furthest. I am not the most loyal or the most dedicated, even. I will never, probably, except maybe in my wildest dreams, qualify for the Boston Marathon, that Everest of all distance runners.
But I am a runner.
The words of Melissa Etheridge’s song, written eight years ago for a different kind of race, are ringing in my ears.
And someday if they tell you about it,if the darkness knocks on your door,remember her, remember me.We will be running as we have before,running for answers, running for more.
I’ve jumped up and down on a start line.
I’ve put in the training.
I’ve talked about the state of my bowels with people whose names I’ve never learned.
I’ve run in the footprints of Wilson Kipsang and Liz Yelling.
I’ve watched hundreds of thousands of pounds raised for good causes.
I’ve been given chocolate buttons and orange slices by people who have never met me.
I’ve run off bad days and I’ve run on good ones.
I’ve been spurred on by the cheers and the high fives of the kids who come out to support the people whose daft hobby has forced a shutdown of their roads for a whole Sunday.
I’ve known the agony and joy and exhilaration of finish lines.
This community is my community. These people were my people.
The streets of heaven are too crowded with angels tonight.
I am a runner and today I run for Boston.
Today, every foundation doctor in the country changes jobs.
It isn’t like Black Wednesday — we’ve all been here for eight months, at least, and are slightly less terrified than we were on the first day of our first jobs, back in August, and mostly know at least where the toilets are by now, and it’ll be another four months before the next set of newly minted doctors start work. It’s still weird, though, because no two wards ever keep blood forms or radiology requests in the same place and you keep writing down your old pager number and the consultants are all different and you don’t actually remember the first thing about gastroenterology.
It’s a curse and a blessing at the same time that, in my job, I’m almost always on the move to somewhere new. It keeps things interesting. It means that I get a lot of experience in a lot of different kinds of medicine. But just as I’ve learned all of the nurses’ names and started to sound as if I might vaguely know what I’m talking about, I’m gone.
I loved my first job.
And then not only did I change jobs but I changed from a ward-based specialty to four solid months in medical receiving, which is absolutely crazy and like no other job in the hospital. I spent the first fortnight of my new job wandering around and muttering oh-my-god-I-want-to-go-home.
A few weeks ago, I talked about feeling as if I was getting burned out on receiving. It’s a fast pace and a high turnover and a constant string of long days punctuated by the occasional day off, and unless, I suppose, you’re an acute physician by temperament, which I’m not, it’s difficult to keep that level of energy up for four months all in a row. I would like, just occasionally, to finish work before bedtime. I would far rather have done a second general medical job and had both of them punctuated by receiving weeks and receiving weekends, which is the way my SHOs and the F1s in a lot of other hospitals do. Anyway, a lot of it is because this isn’t the job that I want to do — among the best parts of medicine for me are having my ward and having my patients and getting to the end of the story, and that’s not what this has been about.
So, yes, I did get burned out on it.
But that isn’t the whole story.
Because once I conquered the oh-my-god-I-want-to-go-home feeling of once again not having a clue what I was doing, I learned a lot and I worked with some cracking people and I had fun. I learned how to make a management plan for real and how to take responsibility, and, oh, so much about the kind of doctor I want to be and also the kind of doctor I don’t want to be. I’ve been right and I’ve been wrong, and the times I was right were important but I’ve learned more from the times I was wrong. The most crucial thing I’ve learned, I think, is that there are ways to make a difference to people even in an environment like that, and that an environment like that is maybe one of the places where it’s most important to do it.
I’ve been on nights this week and I worked last night, the very last night of this rotation. Thus, why I’m at home writing about my old job instead of at work doing my new one, but it meant that I hadn’t left yet when the F1s who are about to start there came crowding into the office for their induction, all two-thirds of the way through their F1 year, just like me, and every one of them looking like Sputnik had crashed down on their heads. The best way to deal with that is to just jump into the chaos and not think too closely about the way nothing really makes any sense and trust that it will, eventually, come to make its own kind of sense, somehow.
It’s just how this year goes.
Looking like Sputnik has crashed down on my head is after all precisely the way I looked in August and again in December and precisely the way I’ll look again on Friday when I realise that I have to work with surgeons now.
“There was a good and righteous man named Joseph who came from the Jewish town of Arimathea, and was waiting expectantly for the kingdom of God. This man went to Pilate and asked for the body of Jesus. Then he took it down, wrapped it in a linen cloth, and laid it in a rock-hewn tomb where no one had ever been laid.” (Luke 23:50-53, NRSV)
I believe in God, who died.
Where do we go from here?
It isn’t quite over for us. Not yet.
In every place on Earth where blood has been spilled, people remember. We remember in the battlefields of France and Belgium. We remember on the sands of the Middle East and the Gulf. We stand by the graves of the known soldiers and the unknown ones, of the martyrs and the heroes, of the people whose deaths have changed the course of human history, and we remember.
And now we bury our dead.
It is the last thing we will ever do for them. It is the last thing we will do for him.
God of the grieving, we turn to you in our hour of despair.
As we lay your Son in his tomb,
we weep for the dead.
We pray for all those who have died in conflict.
For all those who have died as a result of ethnic cleansing.
For all those who have died on the streets of Glasgow.
For all those who have died violently.
For all those who have died with their names unknown.
For all those who have died alone.
For all those who will die tonight.
And we pray that they, with your Son and the souls of all the departed, may rest now in peace.
Jerusalem, Jerusalem, return to the Lord your God.
“At three o’clock, Jesus cried out with a loud voice, “Eloi, eloi, lema sabacthani?“, which means, “My God, my God, why have you forsaken me?” Someone ran, filled a sponge with sour wine, put it on a stick, and gave it to him to drink, saying, “Wait, let us see whether Elijah will come to take him down.” Then Jesus gave a loud cry and breathed his last.” (Mark 15: 33-34, 36-37. NRSV)
I believe in God, who so loved the world that he gave his only Son that whoever believed in him would not perish but would have everlasting life.
There is nothing left for us here. There is a God-shaped hole in the world, and we are left with only an ugly raw wound in our souls where he used to be.
The darkness has fallen.
The light of the world has gone out.
As we stand at the foot of the cross, we think of all that we have loved and all that we have lost.
“The other rebuked him, saying, ‘Do you not fear God, since you are under the same sentence of condemnation? And we indeed have been condemned justly, for we are getting what we deserve for our deeds, but this man has done nothing wrong.’ Then he said: ‘Jesus, remember me when you come into your kingdom.’” (Luke 23:40-42, NRSV)
I believe in God, who we crucify still.
So, this is how it will end.
A true and righteous man, too true and too righteous for his government and so they treat him as they do the common criminals. Crucified. Scorned. Abandoned.
He is nailed to his cross in solidarity with women executed under the Taliban, in solidarity with pacifists killed by firing squad, in solidarity with the victims of the IRA, in solidarity with Matthew Shepard and Damilola Taylor and Lucy Meadows.
And even in this moment, he will not back down. “Father, forgive them,” he says.
Father, forgive us.
God of the repentant, your Son came to us with a message of love.
As we call to mind the promise to the thief,
we pray for ourselves.
For the faith to trust in an unending and unconditional love.
For the grace to accept forgiveness without limits.
For the hope to see beyond the cross
and to look to the day when we will enter with him into that heavenly city.
Jerusalem, Jerusalem, return to the Lord your God.