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Posts by Beth Routledge

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.

Bishops’ Response to Letter of Concern Regarding Guidelines on Same-Sex Marriage

The following letter was received shortly before Christmas from the Primus of the Scottish Episcopal Church, the Most Reverend David Chillingworth. This was in response to the letter of concern which was signed by over fifty clergy and lay readers in the Province following the publication of the College of Bishops’ guidelines on same-sex marriage.

I have an exam tomorrow and so I will most likely have more to say about this at another time, but for now I think it probably goes without saying that this is not a satisfactory response to the concerns that were expressed.


22 December 2014

I am responding to your letter which has been passed to me by our Secretary General. My response has been agreed with the other members of the College of Bishops. I would be grateful if you would circulate this response to the other signatories of your letter.

The situation in which we and other churches find ourselves is one of considerable challenge and we are grateful to you for your recognition of that and your support for us in our ministry. It is not within the experience of any of us that we find our church out of step with the provisions of Civil Law with respect to marriage. We are aware that a substantial section of our church would wish to bring the practice of our church into line with the Civil Law as soon as possible. Others, of course, wish to continue to uphold a more traditional position.

As bishops, we are acutely aware that the issues which are part of the wider discussion of human sexuality and are touched on in the Guidance issued by the College are not abstract matters of policy. They affect deeply the lives and relationships of members of our church, both clergy and laity. It is regrettable, therefore, that some have been upset by the style and tone of our Guidance document; this was not our intention. We are aware that what we say should be expressed in a way which is compassionate and which honours the depth of the feelings involved.

The Guidance offered by the College of Bishops was not intended to pre-empt any future discussion or synodical decision. It was issued at this point because of the need to bring clarity as the new Marriage Act becomes effective in Scotland. This is where we are at the moment. Our document is not seeking to defend the status quo but rather to preserve a space in which both the Cascade and Synodical processes might be allowed to work themselves through to a point where we can discern the mind of the church on this matter. We feel that for a diversity of practice to arise before we have done this will neither contribute to the unity of our church nor ultimately will it assist us as we try to move forward together.

I know that many who signed your letter are committed to the Cascade process. It is a process which, in a number of forms, has been followed by many churches. It seeks to provide an opportunity for honest conversation across difference and to foster a sense of belonging to one another in Christ. Whilst it did not achieve universal acceptance, we were greatly encouraged by the Pitlochry Conference and by expressions of the process at other levels. The purpose of the Cascade process has not been primarily to seek a resolution of these issues – rather it offers a way in which we can respond to our diversity and thereby create an environment in which resolution may be possible.

Ultimately, this resolution must come through General Synod. The process for doing so in 2015 will be the subject of debate by the Faith and Order Board at its meeting in March. This may lead to a full debate at General Synod in 2015 on the Theology of Marriage in response to a paper to be prepared by our Doctrine Committee. We also expect a debate which gives General Synod members the opportunity of expressing a considered view on a number of options for canonical and other changes. The College trusts that our Cascade Conversations will mean that votes on the floor of General Synod – when they come – will give expression to a deeper unity and catholicity which our church has sought in honest conversation, mutual respect for diversity and prayer.

The question of the authority of the Canons is of particular difficulty. It affects clergy and all who hold a licence for ministry in our church. Whether or not a priest or a deacon can promise obedience to the Canons is ultimately a matter of personal and ministerial integrity. But, because we are an episcopal church, it also involves the bishop before whom such declarations are made.

There are of course wider issues involved here – about the nature of the Scottish Episcopal Church and its place in Scotland today. Many people in and beyond our church would recognize that we have, over the years, bravely represented and advocated gospel-inspired positions on social, moral and justice issues. We honour that history and our tradition of openness and compassion. The challenge we now face is to be open and courageous about engaging with our own theological diversity – honourably resolving difficult questions in a way that strengthens and deepens our oneness in Christ. I believe that we are not only capable of doing this for ourselves but of offering it as an example to others.

Thank you again for your letter. I know that it arises from the deeply held feelings of many people within our church and I hope that this response helps to answer some of their concerns.
With kind regards,
The Most Rev’d David Chillingworth

That Was The Year That Was

The last days of 2014 were ushered out amid a very fuzzy haze of wobbly legs and mucous which were my family’s parting gift to me after the first Christmas we’ve spent together in three years.

It was a very good year. It wasn’t sunshine and roses. In the last twelve months there have been things that were difficult and things that were appalling and things that I failed at and things that made me so angry I could barely speak, and, for most of it, I was making it all up as I went along. But the things worth having never come easy, and 2014 was a year that was worth having.

And as for my recent uncharacteristic silence…

2015 has come in with a flurry of deja vu and MRCP revision, to be followed rapidly (I hope) by another crack at getting a training post.

Back soon.

Here Comes The Sun

Today is the Winter Solstice.

It is the mid-point of winter, the darkest and longest of these dark days and long nights. It is the time of year when all the major religions of the world celebrate, in their own way, the coming of the light into this dark world. It is the moment when everyone on Earth stops and tells each other that we have come halfway out of the darkness.

We have had some terribly dark days, these last few weeks. We have had days when I have thought that that Advent God for whom we wait must look at his church with dismay and believe us to have abandoned all that he lived and died for.

On this final Sunday of Advent, we turn our eyes to Bethlehem, to the star that has appeared in the East, and to the promise that dark days give way to light and that, yes, yes, the age of miracles is not yet past.

For from these days of darkness has emerged a new dawn of hope, in the will and testament and action of the ordinary and now extraordinary people of God. They are people who work for the promise of that Advent God; of the bravery of Mary and the compassion of Joseph and of all that that child in the manger might yet do.

It isn’t simple. It won’t be easy. It’s not anywhere near done yet.

But as we look into that light, it becomes just a little easier than it was last week to believe that we will get there in the end.

Stir up in us O long-awaited God the will to join your revolution, to change your world, and to be in word and deed your living Body and the rock on which your Church can be rebuilt.

Letter from Clergy and Lay Readers to the SEC College of Bishops

The following letter has been sent to the College of Bishops in response to the guidelines on same-sex marriage which were sent out last Tuesday to clergy and lay readers. It was organised by clergy of the Diocese of Edinburgh, and it has been signed by some fifty or so clergy and lay readers from across the Province whose names appear below.

To every single one of them: Thank you.


Dear Bishops of the Scottish Episcopal Church,

We read with dismay the Guidance for Clergy and Lay Readers in the light of the Marriage and Civil Partnership (Scotland) Act 2014.

We appreciate that we are bound by the law, and that until our canons are changed, we cannot legally perform same-sex marriages. However, we are disappointed by both the timing and the tone of the document. We have been urged by you to enter into ‘cascade conversations’ in a spirit of open and sensitive listening with people of all views on this matter. This document only makes this process much harder for us, even impossible for some. Far from acknowledging the reality of differing experience and views in the church, it gives the impression of a definitive answer to the question we have yet to discuss or debate. The document ought to make it clear that the restrictions it describes may be temporary, if the church decides to change its canons. Because of the confusion created by this document, we now believe that such canonical change should be decided in Synod as soon as possible.

But we were especially dismayed by the section of the document which refers to clergy, lay readers, and ordinands, should they be in a same-sex relationship and wish to be married. In particular, we find the warnings to ordinands, both currently training and those who might be training in the future, to be unrepresentative of the generous and communal characteristics of the Scottish Episcopal Church. Even though our church has not yet agreed to solemnise same-sex marriages, they will nevertheless become a civil institution which we will recognise like everyone else under the law. It is our firm belief therefore that any prohibition on obtaining a civil marriage is outwith the moral and canonical authority of a bishop.

We acknowledge that this process is one which creates anxiety for all church leaders, and bishops in particular. We empathise with the difficult situation that you as bishops are in, and reaffirm our desire to support you in your leadership of our church, and as fellow members of it.

Nevertheless, some of us are now uncomfortable about solemnising marriages at all until such time as all can be treated equally, and all of us will continue to feel morally compromised in our ministries, and wish to make clear our continuing commitment to affirm and support all people in our church, and to recognise and rejoice in all marriages, of whatever sexual orientation, as true signs of the love of God in Christ.

Yours sincerely,

Revd Carrie Applegath
Revd Philip Blackledge
Revd Maurice Houston
Revd Canon John McLuckie
Revd Canon Ian Paton
Revd Kate Reynolds
Revd Martin Robson,
Revd Malcolm Aldcroft
Dr Darlene Bird (Lay Reader)
Revd Jim Benton-Evans
Revd Cedric L. Blakey
Revd Andrew Bowyer
Revd Canon Bill Brockie
Revd Tony Bryer
Revd Steve Butler
Revd Christine Barclay
Revd Lynsay M Downes
Revd Markus Düntzkopfer
Revd Canon Anne Dyer
Revd Janet Dyer
Revd Jennifer Edie
Revd John L Evans
Revd Samantha Ferguson
The Revd Canon Zachary Fleetwood
Kennedy Fraser (Lay Reader)
Revd Kirstin Freeman
Revd Frances Forshaw
Revd Ruth Green
Revd Bob Gould
Very Revd Kelvin Holdsworth
Revd Ruth Innes
Revd Ken Webb
Rev’d Canon Mel Langille
Revd Kenny Macaulay
Revd Simon Mackenzie
Revd Duncan MacLaren
Very Revd Nikki McNelly
Very Revd Jim Mein
Revd Nicola Moll
Revd Bryan Owen
Revd Canon Clifford Piper
Revd Donald Reid
Revd Colin Reed
Revd Canon John Richardson
Revd Malcolm Richardson
Revd Gareth J M Saunders
Very Revd Alison J Simpson
Very Revd Andrew Swift
Kate Sainsbury (Lay Reader)
Patsy Thomson (Lay Reader)
Revd Prof Annalu Waller

(It’s Time) To Build A Cairn

The last seven days have been difficult ones. I know that I speak for a lot of people in the Scottish Episcopal Church when I say that we have been made to feel angry and ashamed. I stand in sorrow and solidarity with my LGBT friends who are called to ministerial vocations in the Church and who in this last week have been made to feel threatened. We are all left asking questions about what kind of church we are, what kind of church we want to be, and what kind of church we want to belong to.

I suspect that the answer is: not one that behaves like this.

It is clear that for those of us in the Scottish Episcopal Church, the fight is far from over.

But that’s for tomorrow, because marriage equality will become the law of our land at midnight tonight and that is a thing for which we must be joyful and celebrate. It has been a long journey and one that I am and will always be proud to have been on.

Through the ages, people on great journeys have stopped at important places and at decisive moments to build cairns at the roadside to which they and others can always return. Our lives consist not only in being but also in becoming — they are journeys in which we grow and are transformed. This has been a great journey that we have travelled and, in different ways, will continue to travel together. Today, we pause at a decisive and important moment for us all. We mark this decisive moment now, adding to the cairn the stones of our love, our pride, and our prayers. *

And now, one more time, all together, one, two, three:

* Adapted from the Marriage Liturgy of the Scottish Episcopal Church (2007).