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Posts by Beth Routledge

The Final Countdown

My desk calendar was a Christmas present from a dear friend who did not know when she gave it to me in December what my plans were for later in the year.

Which makes it all the more serendipitous that this morning when I flipped it over from March to April, it said this:


Return To The Lord Your God

A number of years ago, I was asked by a friend from a different faith tradition to talk about Holy Week. He said that he knew what Easter was about and he understood why we made a big fuss over that, but that no one had ever told him what this week leading up to it was really about. He asked if I could explain.

I couldn’t.

Oh, I told him the names of the festivals — which he already knew. And probably I could have offered a historical account of the events of the week according to Mark, if I had been moved to do so. And while stumbling over my own incompetence I may have slipped in a, “… and then on Holy Saturday we clean everything.” 

We ended dinner with him more baffled than he had been and wishing he hadn’t asked, and the reputation of informed intelligent Christians in tatters on the plates before us.

You must understand that I used to avoid Holy Week. I knew the story of the Passion, but I didn’t live it; and I had a theoretical knowledge of what each of the services was supposed to be re-enacting, but I didn’t really get what it was about. I slipped into a back pew for the big festival service on Easter Day, when the flowers were in bloom and the place had been polished to within an inch of its life and, so I was told, a miracle had happened. I hadn’t been a guest at that very particular Eucharist. I had never witnessed the tearing apart of the temple, or been the friend who fled when they came out to arrest him, or wept at the foot of his cross. I had never crept out of my house in the dark and stillness of a Sunday morning to visit a tomb, not knowing whether there had been a resurrection.

I had not yet taken seriously the promise that had been made to me that if I kept Holy Week in the place where I now keep it, that it would change my life and change my faith.

And so I didn’t know.

I didn’t know what it was like to have incense in my nose and cold tile against my face and adrenaline in the back of my throat, and to lie there silent and terrified and furious.

Or about the love and the joy and the betrayal and the fear and the anger, and that I would experience all of those things in a few short hours.

Or why Judas betrayed him, or why Peter denied him, or why Thomas doubted him. I didn’t know why he didn’t just run when he had the chance. I didn’t know that they were all just as human as I am.

I didn’t understand why it was important.

That it might be about something that happened in Jerusalem two thousand years ago, but it’s about things that have happened in Germany and Rwanda and Bosnia and the Sudan. It’s about what happens in Jerusalem today and in Syria and the Ukraine and in Glasgow too.

I didn’t know that it’s about being willing to live it.

I didn’t know that it’s about being broken up into a thousand pieces and hanging onto the faith that tells us that in the dark and stillness of a Sunday dawn, we will be put back together.

And I didn’t know that I would never ever be the same.

Thou shalt make me hear of joy and gladness;
that the bones which Thou hast broken may rejoice.

Inotropes for Bemused Medical SHOs

Yesterday, I attended the first of what looks as if it’s going to be high quality and useful series of lectures aimed at the medical trainees in my hospital. The whole series is on issues that are seen in patients requiring care at what we call Level 2. That broadly means High Dependency Units and Coronary Care Units, although there are a very few other units that are able to do a limited number of Level 2 interventions.

The lectures were organised by one of the medical trainees who I’ve been working with recently, which is how I managed to finagle my way onto the list despite not currently being a trainee. I was keen to attend them because I feel as if the whole area is a gaping hole in my knowledge at the moment. I won’t easily forget the night in FY2 when I turned up to be the so-called senior surgical nightshift cover for my hospital and had to start by getting an HDU nurse to teach me about noradrenaline infusions.

Obviously, I haven’t yet started CMT and some of these things may well be covered in the formal curriculum and teaching when I do. But I don’t think I’m the only person to be grateful for more teaching in these areas — a conference room was filled last night, all people who had had a busy day at work and yet were still awake and engaged when the session ended at 8pm.

PDF: Notes on Level 2 Care – Optimising Organ Perfusion (+/- Inotropic Support)

I learned a lot of really useful things. I didn’t make verbatim notes and so this isn’t comprehensive, but I took away some key points which have started to demystify the topic of inotropic support for me and I’m posting those notes up here. Because they were made principally for my own use, they are informal and peppered with colloquialisms. If you spot any factual errors, those are my own fault and not that of our excellent lecturer.

This Girl Can

In four weeks, I intend to be pleasantly full of chips and enjoying the Brighton sunshine from a very sitting down position with my lovely posse. I hope to be doing those things with a new shiny piece of bling around my neck, but let’s not count our chickens and all that.

Screen Shot 2015-03-15 at 18.42.19A thing that happened while I was beginning my marathon training was the launch of the fabulous campaign from Sport England, “This Girl Can”. The purpose of it was to address the fear of judgement that women told Sport England was their biggest barrier to joining in sport and athletic activities: fear of being judged for not being the right shape or the right size, or for not being “fit”, or for not being skilled enough. The first campaign video aired on ITV in early January. The original version of it alone has been viewed seven and a half million times on YouTube. It’s the first sporting campaign I’ve ever recognised myself in.

The video is brilliant, by the way. It’s full of sweat and messy hair and hard work and unairbrushed bodies and real people. Go on, watch it. I’ll wait.

Don’t get me wrong — the Olympics are amazing and being in Glasgow for the Commonwealth Games was amazing and I have BBC Sport open in a browser window permanently for the whole of Wimbledon, but no matter what I tell myself when I’m running down a finishing straight with Chariots of Fire playing in my head I am not really an Olympian.

Let me tell you a secret, Internet. I am not a natural athlete. I am slow and I am not coordinated. I would have failed PE, if there had been grades for it (and half my life later, a good run is still a little bit of a screw you to all the PE teachers who ever told me I was no good). I started running when I did the Couch-to-5K program in the first year of medical school, and the first time I ran twenty minutes without stopping I put my foot down a pothole on the Saltmarket outside a pub on a sunny summer weeknight where fifteen people saw and my glasses fell off. I sweat and I grunt and I hurt and my ponytail falls out. I run a 10 minute mile on a very good day. I work very hard for it.

Screen Shot 2015-03-15 at 19.52.55But these women? I am these women.

I have taken from this campaign my mantra and my hashtag for the last three months. 12 mile run? 10 minute mile? A couple of miles after work in pelting rain and gale force wind? #thisgirlcan.

I am in no way confident about what I’ll be able to do in four weeks time. It is almost a year since I signed up for this madness. I live somewhere between excited and terrified and convinced that I must have been actually mad. I’m going to do my damndest though.

Because: #thisgirlcan.


All images are copyright Sport England 2015.

Diocesan Synods and Religious Conscience

At the Diocesan Synod of Glasgow and Galloway on Saturday, the following motion was passed by a 67% majority of voting members:

In light of the recent coming into force of the Marriage and Civil Partnership (Scotland) Act, this Synod agrees that Canon Law should be revised to ensure that no member of the clergy should be expected to act against their conscience with a view to same sex marriage and proposes a motion to this effect to the General Synod of 2015.”

A similar motion had been passed earlier in the day by the Diocese of Edinburgh at their Synod.

I proposed the motion in Glasgow and Galloway on behalf of the Glasgow North East Region, who had conceived and approved it. The motion was seconded by Kennedy Fraser, who is also a member of the Glasgow North East Regional Council.

This is what I said at Diocesan Synod.

It is my joy and privilege to speak to you today on behalf of North East Regional Council, to propose the motion which you have before you from the Glasgow North East Region.

I would like to speak very briefly now about where the Church is at present on this issue and what we think is the beginning of a possible way forward.

As you arrived today, you will have been given a copy of the House of Bishops guidelines concerning marriage. These were issued by the House of Bishops in December to all clergy and lay readers in the province, and they represent the official position of the Church on the matter of marriage between same sex couples – legally and pastorally.

When we spoke about the issue of same-sex marriage at this Synod last year, we did it with a particular view of the world and a particular understanding of what we expected to happen next.

The world has changed.

This is a country where marriage equality is now the law of the land, and where it is possible for any two people who love each other to be married regardless of their gender. I was present at the first marriage to take place between a couple of the same sex, as the bells in Glasgow rang out for a new year, and a new world, and a better world. I was very proud to be there. It is difficult perhaps to understand how much that moment meant, if you didn’t do your growing up in a world that told you you wouldn’t ever be good enough to get married and to profess your love before your family and friends and community.

And in this community, that love is still not considered good enough to proclaim before God and I am hurt by that.

However, this is now a Diocese where we have sat down and talked about these issues together at the Cascade Conversations which took place last year. In the discussion which led to the motion that you see before you, the clergy and lay representatives to the Glasgow North East Region had a long conversation about the Cascade process. There was a diversity of opinion in that room as there will be in this room, but we were agreed on two things:

First, a recognition of the valuable conversations that took place in Cascade and that for many people the process has been genuinely helpful.

Second, the urgent sense that the substance of those conversations must be taken forward, that they must inform action and decision, and that this must happen with urgency.

Bishop Gregor’s point [made in his Charge to Synod] about the hypothetical proposals which may come on this matter from the Faith and Order Board to General Synod is well made, but I think it is important to remember that we as a Synod are also the Body of Christ of this Church and that it is just as important for us to ensure that we tell General Synod of our hopes, our fears, our dreams, and our aspirations.

It seems to me that that urgency has become more pronounced in the last few months.

The law has changed, and as a result there are clergy in this Church who now find themselves in a position where they are legally unable to marry some couples. They are struggling with the question of how to make an appropriate pastoral response to couples who are able to marry and who wish to do that in the presence of God. They are expected to act against their conscience.

And the position of the Church has changed, too.

There are clergy and charges who for the last decade have been able to offer blessings to same-sex couples, and who suddenly find that there are unprecedented restrictions placed on this practice.

There are clergy and lay readers who last year were planning their own weddings, and who now find that the Church will not allow them to marry – to be clear, will not allow them to marry even in a registry office.

And there are people going through discernment for ordination and for lay readership who have been told that they must choose between their vocation and marrying the person who they love.

These people are also being expected to act against their conscience, and to compromise the honour and integrity with which they conduct their private lives.

These are things that I think make us a less loving and a less welcoming Church.

They are also things that stand against the long held tradition of the Church that the solemnisation of any marriage is a matter of religious conscience. This is something that we wish to see rectified, to enable those who wish to solemnise marriages of any kind to be able to do so, to recognise the views of those who do not wish to conduct same-sex marriages, and to allow all who work for and within the Church to conduct their personal lives with integrity.

I commend to Synod the motion and with the permission of the Chair, I am happy to take questions and comments.

A lot of you will already have read the Bishops’ Guidelines which I alluded to at the beginning of the proposal. They were provided to members of Synod when they arrived. I was also asked by the Bishop to provide a short paper explaining the purpose behind the motion, and that was also given to members of Synod. They are available here as PDFs, for context and completeness.

House of Bishops’ Guidelines Concerning Same-Sex Marriage

Explanatory Notes on Motion to Diocesan Synod

Because Happy Is What Happens When…

Yesterday, I was offered a Core Medical Training post in the West of Scotland.

There was much hollering and cheering and waking up of pre-night shift friends who seriously ought to have been asleep, and then the moment when I dropped my phone and went skidding around the corner of the haematology day unit to shriek at the charge nurse who was the only member of staff besides myself left in the building.

It is difficult to explain exactly how thrilled I am about this.

My friends and consultants claim that I have not been grumpy and anxious over the last three weeks while I’ve waited for the outcome of my job interview. They are clearly all liars, and for that I kind of love them.

This is absolutely the job that I’ve wanted and absolutely where I want it to be.

To answer a few questions that I’ve started to get from my non-medical and non-British friends, let me explain:

The job I have just accepted is a two year training post in general medicine.

It is somewhere in the west of Scotland. I will begin to get a more precise idea of where exactly in the west of Scotland over the next couple of months, after I’ve learned where I ranked nationally and after I’ve had the opportunity to express my own preferences as to where I might go. I will be able to continue living in Glasgow and for at least some of the time I’m likely to be in Glasgow — for the purposes of higher medical training and in my view for the purposes of sensibleness, anything north of Stirling is considered to be North rather than West.

This is the point where I begin to specialise. I understand that this part is baffling to people, because it seems like I’ve been doing medicine for eight years. It is at this stage that people who want to train as paediatricians go off and spend all their time with small people, and people who want to be surgeons start to learn how to cut things up, and people who want to end up as GPs enter a training programme that is specially designed for that. My people are the people who want to work in adult hospital medicine, which is a specialty just like all the others. I have been doing medicine for the last eight years, but this is when I start learning how to be a physician and then at the end of those two years I get to decide what kind of physician I want to be.

Actually I’m almost sure that I already know what I want to be when I grow up, but that’s maybe a conversation for another time and a decision that I definitely don’t have to make for real quite yet.

I start work in August.


Are All Welcome?

On Saturday 21st February, Changing Attitude Scotland is holding a Eucharist for Change where we will pray for LGBT inclusion and justice in the Scottish Episcopal Church.

Frankly, at the moment it doesn’t feel as if all are welcome in this Church. A sign hangs outside every Scottish Episcopal Church in the land that proclaims, “The Scottish Episcopal Church Welcomes You” — and I’m not sure that it does. In the wider sense of Church, this is become a Church that I don’t much like and that I don’t recognise.

A church cannot be sometimes inclusive and sometimes not. A church either welcomes people who are LGBT every week, or it doesn’t at all. It speaks up for justice issues whenever it sees injustice, or it doesn’t at all. It models diversity all the time, or it doesn’t at all. It recognises the relationships of same-sex couples within its congregation publicly and proudly, or it might as well not bother recognising them at all.

If you want to do justice, do it in the boring and the ordinary and the everyday.

I stayed at St Mary’s Cathedral because the day I came here as a visitor was the same day as two of our congregation had their civil partnership blessed, and their relationship was prayed for in the intercessions as if to do so were no big thing. By treating it as the most ordinary thing in the world, it was the most extraordinary thing I had ever heard in a church.

But it can also be important to do something a little out of the ordinary, and I think that time is now.

I feel as if we need praying for.

I feel that as we come up on the season of Diocesan Synods and the preparations for General Synod that go along with that, we need to pray for change and the will to make it happen. I feel that as we still struggle with the hurtful and harmful things that have been said by the Church this year, we need to pray for those who have been most badly damaged by it. I feel when I look at the hierarchy of the Church that we need desperately to pray for the wisdom and courage that often feels lacking from those who lead us.

This is LGBT History Month, and that’s significant — not only to pray in thanksgiving for those who came before us and got us to where we are now, but to pray for ourselves and for our place in our own history and for what we might do to change the world.

Holding Pattern

I spent the better part of last week growing increasingly twitchy as absolute radio silence was maintained by whomever it is who is responsible for letting CMT applicants in Scotland know that they do or do not have jobs. The national deadline for releasing initial job offers is sometime in the middle of March and so I may seem unreasonably impatient, but Scotland were preternaturally quick about doing it last year. I have been refreshing the website like it’s my job.

A possible explanation is that last year I had to take my own references to interview in a sealed envelope, while this year we were told that references would be sought post-interview. I know this because I read that and then made someone verify twice that I was reading it correctly, but, nevertheless, it took until yesterday for me to remember it. I am no less impatient, but I am a little less twitchy.

In the meantime, I did learn last week that I have finally passed Part 1 of the MRCP. I am mostly relieved, mostly that I can stop throwing cash at the Royal Colleges for a bit. Yay.

Interview Season

Yesterday, I went to Edinburgh to be interviewed for the Core Medical Training programme.

You may remember that when I applied to CMT last year I was offered a job in the frozen North. I did a lot of hand-wringing, but in the end I chose to try my hand at having a year out and not being in a training programme for a bit and staying in the West. (Spoiler: I made the right decision. I also made the inevitable decision. I live here.) For the last six months I have been essentially pretending to be a haematologist and then intermittently at the weekends pretending to be an acute medic. And that makes for a lovely year but probably not for an actual career plan, so back I’ve gone to job applications and putting back together a fortunately already mostly together portfolio and the reading and rereading of my own audit data.

I’m bypassing the whole bit with the hand-wringing this time around. I did it briefly when I was going through the application form, and then simply didn’t list the jobs that I didn’t want to take.

The thing to know is that everyone says that everyone gets a CMT job. The other thing to know is that that is bullshit. The competition ratio in Scotland was 2:1 in 2014. Now, don’t fixate on the number. It doesn’t reflect the fact that some people who have applied to this specialty have also and preferentially applied (for example) to paediatrics or for a job in Australia, but it does reflect the fairly fundamental point that there are less available CMT posts than there are applicants for them. And anyway, the third thing to know is that getting a CMT job is not the same thing as getting a CMT job in a town you’d be happy to live in for two years.

I say all of this because everyone said to me last year that everyone gets a job, and while they were saying it I knew but was unwilling to express out loud to most people the fact that my interview had gone badly.

I say it had gone badly: I was pleasantly astonished to discover that I hadn’t been ranked as an unappointable candidate, based largely on my performance in the clinical scenario.

For example:

Me: The patient has a supraventricular tachycardia.

Interviewer: And how would you like to treat that?

Beth: As he is haemodynamically stable, I am going to try to reverse it first using a Valsalva manoeuvre so I would get him a 50ml catheter tip syringe and ask him to blow into it*.

Interviewer: It doesn’t reverse, so what are you going to try next?

Beth: Oh. Hell. I’ve forgotten the name of it.

Interviewer: Hm?

Beth: It begins with an A. It isn’t adrenaline or amiodarone or atropine. Obviously I’m in resus so there are other people around for me to ask and I would look it up if I weren’t sure. Oh, hell. IT BEGINS WITH AN A.

Interviewer: Adenosine?

Beth: YES.

In a lot of ways, if I’d not realised that it had gone badly I’d have had to start asking questions about my lack of insight.

It got better from there, but you have to admit that that’s a low bar to set**.

And in my own defence, when a patient really did go into SVT three weekends later I didn’t forget the name for adenosine.

The best I am willing to say about this year’s interview while I’m still on this side of job offers being made is that it went less badly than last year, in that I at least managed not to forget the names of any resuscitation drugs or lose control of the situation to the point that I had to shout, “CARDIOVERSION!”, or, for that matter, shout.

* For my non-medical audience, you should know that this really is a real thing.

** In the first station of my medical school finals, the patient / mannequin who had, as I later learned, placental abruption, told me that she’d really rather I didn’t “have a look down below”, and I forgot that I was meant to be an FY2, not a medical student, and said, “okay, never mind, sorry”, and never found out that she was haemorrhaging out of her vagina, and even I’ll admit that that was worse. And you wonder why I sometimes wonder that they let me be a doctor.

The Never-Ending Merry-Go-Round of Exams

It’s always a bit odd to go back to work when you’ve been away for a wee while. In FY1, the way I knew I’d been off for a fortnight was that I’d come back and I couldn’t remember any of my passwords or the phone number for the biochemistry lab. I’ve been in only very intermittently since Christmas. The public holidays got mixed up with the weekends and they got mixed up with the one day when I was dying of some awful viral hideousness, and then I was lucky enough to be able to take a week of annual leave before I nipped down to England at the start of this week to sit Part 1 of my MRCP.

I’m sincere about the “lucky”. The stars align well enough to get anyone a whole week off straight before an exam about as often as elephants fly.

But it does bring reality crashing back rather to then go into work and have to answer truthfully when people start asking whether you had a nice holiday. A holiday that consisted mostly in sitting in my living room with the coffee pot and a bank of thousands of practice questions, and in intermittently complaining at Twitter about the surgical patients and small children who kept wandering into my Royal College of Supposedly Grown Up Physicians practice questions, and in cursing the name of aforementioned College, and in occasionally being head-butted by a cat. I diagnosed so many vignettes with obscure enzyme deficiencies that by the end of last week I was starting to pine for real patients.

“I don’t really understand, because you graduated,” said my grandmother, all innocence. “If you pass this one, will that be you done with exams?”

Oh, how we laughed.

I bitch and moan about it, but the thing is that it’s not even that unusual these days in professional circles. There was a time when every conversation I had with my financial friends started with, “What, another one?” and I was mostly the one doing the asking.

I’m not sure how things went on Tuesday. It didn’t feel like as much of a disaster as it did the times I’ve failed it, but I don’t know how far to trust that instinct and so I’m trying to touch wood and type at the same time. I had a brain-freezingly awful moment and nearly became unglued when I thought they might not let me sit it at all, due to an expired passport and a minor difference in my name as I’m registered with the GMC compared with my name as it appears on my NHS ID. But do you remember when I did this exam last year and at the end of it I said that it felt a lot like spending six hours getting kicked in the head by the All Blacks? It could just be that my brain is becoming inured to being used as a metaphorical punching bag, but I felt a little less like that this time around. A little less (not not, don’t be daft) as if I’d turned page after page and said, cartoon stars flying around my head, “I don’t think that’s even a word!”

And then afterwards I met my parents for dinner, because I had taken it in Newcastle. And learned that they had thought I’d been doing the same exam this whole time — being asked the same two hundred questions and just, over and over and over, continually getting them wrong.

So, I don’t want to fail it again. I’m tired of giving the College all my money, for one. But it’s kind of nice to know that even if I do, I’m not actually as dense as it turns out they thought I was.