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Posts by Beth Routledge

Dust and Ashes

You are only dust and ashes.

The world was created just for you.

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Courtesy of Wikimedia Commons

At last week’s CNN Town Hall for the Democratic presidential candidates, a rabbi from Nashua posed a question to Hillary Clinton. He related the oral teaching of Rabbi Simcha Bunim of Peschischa, who said that everyone must have two pockets and must keep a note in each pocket, so that a person in dark times might reach into their right pocket and find the words, “for my sake the world was created”, but that in times of success and plenty they might be able to reach into their left pocket and be reminded, “I am but dust and ashes.”

“I want you to think about what you would tell us about your two pockets,” said the rabbi in the audience.

You are only dust and ashes.

The world was created just for you.

The first place I heard that story was in an old article in the BMJ, based on advice that had been given to the inaugural students of the Hull York Medical School in 2003. I’ve never forgotten it. As doctors, the contents of our two pockets are together a contradiction and a truth that we carry with us every day of our lives. The right pocket, to carry the weight of profound responsibility and an awareness of incredible privilege. The left, a gentle reminder that we can do only what we can do and that it almost never feels like enough.

You are only dust and ashes.

The world was created just for you.

In my religious tradition, the season of Lent is about the realisation of these truths that are Gospel and the acceptance of what they mean for each one of us. The dust of Ash Wednesday begins a journey that will end on Good Friday, and at the end of that journey none of us will ever be the same. Today, we come to God in all of our humanness, with all our flaws and our imperfections, with none of the sparkle or the razzmatazz, and we are told that God loves us anyway. And that there is nothing, nothing in the world, that we can do to change that. And maybe we won’t believe it yet. But maybe when we have met God in the breaking of the bread and in the tears that we shed and in the fear that, somehow, is always real, and then when we have met him again in the rising sun on Easter Day, maybe then we will start to believe it. A contradiction that isn’t a contradiction, but the most straightforward and profound of truths: that you are loved, and you are blessed, and nothing and no one can take that away.

Remember you are mortal, formed of the Earth; from dust you came and to dust you will return. And remember too that God so loves you and so loves the world that he will give his only Son.

You are only dust and ashes.

The world was created just for you.

Like A Lady Doc

I’ve got a story to tell you about my Sunday.

As a doctor working in a National Health Service whose doors (no matter what the Health Secretary might have you believe) are open twenty-four hours a day and seven days a week, I work my fair share of Sundays.

This Sunday, I went to a 9am meeting and took a handover from the female medical SHO who had been on overnight. The female medical consultant, who had been there since 8am, continued reviewing the overnight admissions, I headed off to the medical wards to start seeing overnight admissions. A member of the nursing staff on the first ward that I arrived on had a message for me, to say that the female gynaecology SHO would be up that morning with her female registrar to review a patient I’d spoken briefly with them about the previous night. I spent a little time on that ward, reviewing blood results, refining treatments, and arranging to get two patients discharged home. As I left, the female haematology consultant arrived to review her patients. The rest of my morning was reasonably uneventful, reviewing patients on the wards that I’m responsible for. A female FY1 was doing some bloods when I went into my usual ward shortly before lunchtime. I raided our coffee stash, reviewed several patients, and tried to review another one but was told by the nursing staff that there was no need as a female respiratory consultant had already seen her. I stopped in briefly to the receiving unit to see how my colleagues were getting on, and was then bleeped to go see a patient in resus who it was thought might need to be admitted to the coronary care unit. I was met there by the female consultant in emergency medicine who had seen the patient initially and thanked me for coming. It quickly became clear that there was more going on than we had first thought. I spent quite a bit of time getting them stable and making a plan, and calling the female medical consultant, who was in the receiving unit having by that time started her second ward round of the day, for a bit of advice. She came down to the department to see if there was anything else that needed to be done — after all, she was also going to be the one who would be phoned at any time overnight if anything had been missed. The patient was transferred and I left the department after saying hello to a few of the female emergency medicine registrars and SHOs who were congregating for their afternoon handover meeting. In the corridor, I met the female orthopaedic SHO who let me know that a patient I’d reviewed on her ward on Saturday was doing much better. I went back to the wards and continued on with my planned reviews. In the coronary care unit, the nursing staff made me a cup of tea and fed me a sandwich when they realised that I hadn’t yet eaten lunch. I was bleeped by one of the surgical wards asking for some medical advice, and I went across there to see the patient they were asking about. As I wrote in the notes, I chatted briefly to the female neurosurgical trainee who I’d first met the previous evening with her female anaesthetic colleague when we had attended a periarrest call. And then, finally, five minutes late as usual, I ran down to the evening handover meeting where I handed over to the female medical SHO and the female FY1.

I did work with men this weekend, of course. I just haven’t mentioned them here. I am careful about what I say on the Internet, for many good reasons. This story has been judiciously and deliberately edited to not mention identifiable information about patients, or the exact nature of the curse that I uttered in a public corridor when I realised that I’d spent so long in ED that the sandwich place had closed, or the existence of my male colleagues.

This is because I got home from work to discover that while I had been working my thirteen hour Sunday, the Times had published a column by Dominic Lawson claiming that female doctors are pushing the NHS to the precipice of disaster by refusing to work antisocial hours. It’s better in the airline industry, for example, because there aren’t a lot of female airline pilots and that’s a good thing, he said, as Amelia Earhart rolled over in her grave and the 1950s called, outraged, to ask for its glass ceiling back.

I don’t know what the rotas of those women I was working with on Sunday look like. I don’t know if they work full time or part time. I don’t necessarily know that about the men I was working with, either, because it’s not only women who have responsibilities outside of their primary paid employment or find it important to have a work/life balance. I know that a lot of them will work full time, as I do myself. I don’t know if the ones who don’t are working an eighty percent job or a fifty percent jobshare or not on Wednesdays or forty hours a week — which is part time, in this job. I don’t know if they’re part time because of family responsibility or for medical reasons or because they split their time between clinical duties and teaching or research commitments. It is truly none of my business, and none of Dominic Lawson’s, either. The only thing I know for sure is that on Sunday they were all at work with me.

I feel sad for Dominic that his life so clearly doesn’t include any women who happen to be doctors.

I know doctors who are brilliant, smart, competent, compassionate, passionate, driven, committed women who work ferociously hard and who inspire me to be a better doctor. I know doctors who are all of those things and who are my family. I know doctors who are all of those things and are also raising children, and they are legends.

You will forgive me if this response is a little less than timely, Dominic. I worked 88 hours last week and then I went into work on Monday morning to keep going for five more days, and lives have needed saving and antisocial hours have needed worked and the laundry has at some point needed done so you will understand that you are not at the very top of my priority list. The kingdom of God will surely have arrived on Earth when I do not live in a society in which it continues to be relevant for me to incessantly link people to a post that I was compelled to write three years ago about why I am not a woman doctor. I’ve seen a lot of patients in the last week and a half, Dominic. My vagina — a bleeding one, at that — has at no point been an impediment to my making clinical decisions, or doing difficult procedures, or running up six flights of stairs, or breaking bad news (or good news), or crushing peoples’ ribs as I’ve tried to restart their hearts. I have intermittently been mistaken for a nurse, which happens, too often, yes, but people don’t look upon me as if they’ve just met a unicorn when I correct them and I still live in hope that the day will come that I don’t have to.

In the course of my working day, I turn up at a lot of beds and I say the words, “Hello, my name is Beth and I’m one of the doctors.” The reply has not once, not ever, been, “Oh, it’s lovely to meet you, dear, but I’d really rather see a doctor with a penis.”

A New(ish) Year

Due to flooding on the west coast, a reduced speed limit of There Are Not Actually Roadworks Happening Tonight most of the way through East and West Lothian, and absolutely not leaving work on time, I had a moment there where I thought I would end up seeing in 2016 from the car park of a 24 hour Macdonalds in Berwick. The stars over the A1 are very pretty that time of night, but nevertheless I was glad to make it to my parents’ house and my promised turkey sandwich with an hour to spare before the bells.

This is woefully overdue as a New Year blog goes, but I feel it would be remiss of me to let the old year pass away entirely without a note of gratitude for how very good a year it was for me.

I became a whole decade older. I finally laid to rest the many failures of the first part of the MRCP and then to my still sometimes surprise passed the second part too. I started Core Medical Training, and without having to move to the frozen north to do it, and I made some decisions about my career. I crossed the finish line of my first marathon. On a still extraordinary day in June, I witnessed changes and actions in the Scottish Episcopal Church that I am starting to believe will someday soon make it a better place. I met new people, remade old friendships, and spent time with the people I love.

Over the last few days I’ve been thinking about goal-setting, and have come up with some things that I’d like to accomplish this year. I wouldn’t call them resolutions, as such. They include things like “pass PACES” and “run another marathon” and “get the first reading of Canon 31 through General Synod” and “learn how to knit socks”. If I resolve anything, it is that I do my very best to make 2016 a year as fabulous as 2015 was.

A very happy and belated New Year to you all.

Merry Christmas

*blinks awake*

I was at a birth until the middle of the night, you know. These babies, turning up whenever they want to. Still, there’s coffee and I’m off to adore the baby Jesus again. I hope he and his mum got some sleep while we were gone.

We did the place up nice for him coming.

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Photo: Martin Hammond

A very merry Christmas to you all.

O Little Town of Bethlehem

O little town of Bethlehem,
which lies tonight beneath a sky that glows not with the light of Christ but with the fires of conflict.
Your streets are blighted by violence.
Your people live in fear.
Your sleep does not come easily.

You yearn for peace, for hope, for a miracle.
A miracle of two thousand years ago,
and of right here and right now.

And unto you this day in your city of David
is born a saviour who is Christ the Lord.

From a God who does not look down at a far off Earth and see stillness and silence,
but who came himself into the broken, messy, unjust reality,
to a stable that was a place of last resort.

For all of God’s children everywhere,
who he will love in our happiness and our sadness, in our tears and our joy.
This truth we believe, and we believe it for it is Gospel.
That in even the darkest days of Earth in the darkest places on Earth,
the dark night will wake,
and glory will break,
and Christmas will come once more.

Tonight we pray for the people of the West Bank,
to whom the truth of the incarnation was first revealed,
and for all the victims of violence, terrorism, and inequality around the world.

We remember Mary, who said yes.
We pray for ourselves, the living body of her son Jesus Christ, that we will also say yes.
For the modern day prophets.
For activists and truth tellers, for diplomats and peacemakers.

We glory in the birth of a child who would live to change the world,
and we pray for all of God’s children who today seek still to change a world that needs changing.

The Appalling Silence of the Good

This weekend, it was reported in the Salisbury Journal and then very quickly all over my social media feeds that retired Canon Precentor Jeremy Davies had been banned by the Diocese of Winchester from taking services.

Jeremy is the former Canon Precentor of Salisbury Cathedral. In 2004, he had entered into a civil partnership with his partner of (then) eighteen years, and continued to serve as Canon Precentor until his retirement in 2011. He seems to have remained very active since his retirement, preaching and lecturing on both sides of the Atlantic and, by invitation, taking services in both Salisbusy and Winchester Cathedrals. In 2014, he and his partner were married. He was formally reprimanded by the Bishop of Winchester for getting married — in this case, as in the cases of Jeremy Pemberton and Andrew Forshew-Cain, the House of Bishops have missed a couple of century’s worth of etiquette lessons on how not to congratulate an employee on the occasion of their wedding. In the report in the Salisbury Journal, it is reported that he has continued to officiate at services in Winchester since his marriage and has been invited back by the Cathedral to a number of future services. In the middle of last week, he received notice from the Bishop of Winchester, Tim Dakin, that because of his marriage he was being denied permission to officiate in the Diocese.

The silence from the hierarchy of the Church of England has been deafening.

Senior figures of the Church have either been living under a rock since Saturday, or else they are all keeping their heads down and hoping that if they stay quiet then this will all go away.

For some time now I’ve been saying that my enemies in the Church are not the people who disagree with me. A lot of people disagree with me, and they are mostly people with whom I can have a conversation that is reasonable and respectful on both sides.  Nor are my enemies the people who have yet to make up their mind and are truthful with me about the fact that they are still working out what they think. My enemies in the Church are the people who claim privately to agree with me and in public refuse to support me — because they’re afraid of what their bosses will say, because they’re afraid of what the papers will write, because they’re afraid that it will stir up trouble, and because, in the end, it is much easier for them to keep quiet and offer platitudes to the people whose lives are ripped apart as they stand by doing nothing and then to be surprised and offended when we lose our collective temper.

Martin Luther King once said: “We will have to repent, in this generation, not merely for the hateful words and actions of bad people, but for the appalling silence of the good.”

In our generation, too.

Earlier in the day on Saturday, the Spectator had run an interview given by the Archbishop of Canterbury, Justin Welby. He was asked by Michael Gove how he would react if one of his own children fell in love with someone of the same sex and asked for his blessing, and he told Gove that he would pray for them together, he would pray with them together, and, yes you bet he would go to their wedding. Asked whether he would say to them that while he loves them he would caution them that their relationship was sinful or inappropriate, he responded: “I will always love you, full stop.”

I was really pleased when he said that. It’s a big thing and a brave thing for the Archbishop of Canterbury to say that, and never mind that it shouldn’t be. I know that when I ask people to put their head over the parapet I’m not asking them to do something easy; if it were easy, I wouldn’t have to ask.

But a few hours later, this story about Jeremy Davies, which is in its way simply the next iteration of the way in which the Church has chosen over and over and over again to let down those who have asked nothing but to serve it.

I still struggle to find any love or common sense in the response of a Church that chooses to punish someone for marrying the person they love. I’ve witnessed it from inside the process — on this matter, the Scottish Episcopal Church cannot claim any moral high ground — as well as watching from the outside when something like this happens in England. I find anger and hurt and pain. I rarely find any sense of pastoral response or responsibility. I cannot believe I am seeing what God wants.

And three days after this story broke, still that deafening sound of nothing from everyone associated with the Church of England.

That is a strategy that isn’t acceptable and never worked anyway, and speaking for myself I find that I’m no longer able to pretend to respect individuals who are supportive of me just so long as I never expect them to say it out loud or in public or when it might matter.

Because here’s the thing:

Either people in the Church think that LGBT people are made in the image and likeness and love of God, and recognise that LGBT people are in and of the Church, and want the Church to value and cherish the hopes and dreams of its LGBT clergy, or they don’t.

The more we hear of stories like this one and the more senior figures in the Church of England avoid talking about them, the louder I hear their answer.

Advent: The Days Are Surely Coming

This weekend I was at an event of stories, reflection, and hope for refugees.

I wear a badge on my coat that says, “Refugees Welcome”. We began making and selling these at church at the time when the Syrian crisis was coming to national attention, and we’ve sold out and sold out and sold out again. There is one member of the congregation who has taken a new badge at least every other week because hers keeps sparking conversation while out in the city and then she gives it away.

On days when I leave work after 9pm, the only route open out of the building takes me through A&E. The act of walking through an NHS waiting room displaying a badge that says refugees are welcome feels like a political statement. It is a political statement. And a human statement. And an article of faith. And in a hospital as much as in faith communities and at border control and in the street, a statement worth making.

The church that I call home is one that has been called the church of last resort. It is the place place people have felt they can go when there has been no other place left to them. That’s true for lots of reasons, and something I recognise in some of my reasons for being there too. And it is not an unworthy thing to be.

I am from a faith tradition where today marks the beginning of a time in which we are waiting for something.

Waiting for what I call God.

For what some of the people I spent yesterday evening with call Allah, or Yahweh.

For the light to come from the darkness.

In my faith, that waiting comes to an end with a welcome extended to an unusual family, of stigmatised status, in a desperate circumstance. Except that it doesn’t, of course. Because then it all falls apart. Not with nails and a tree or on the steps of the Emperor’s palace. But with that family fleeing terrified into a foreign land from a genocide.

A story older than the Church, and happening right in front of our eyes today.

This is an article of our faith.

Come, O Lord Jesus, reconcile all nations.

All About The Glamour

If you ever find yourself thinking about going into medicine for the cars (with lights and sirens) and the booze (rx: diazepam and Pabrinex) and the women (competent women in scrubs are attractive in real life, too), remind yourself of this:

It will happen from time to time that you are eating lunch and doing paperwork, when one of the nursing staff will appear, and, via eyebrow semaphore and a series of deeply apologetic hand gestures and the fact that with the other hand they are carrying a distinctive shape covered in an array of paper towels, communicate something that, eventually, leads to you saying,

“Oh, God, do you want me to look at it?”

For The Souls Of Our Departed

For empty spaces at dinner tables. For graduations and weddings and birthdays not attended. For family not met. For hugs that will never be given and calls that will never be answered.

For all the saints who’ve known your love.

For those who died trying to make the world a better place, and for those who died trying to make a better place for themselves in the world.

For those who have died in the broken heart of this city.

For those who have died on the battlefield.

For those who have died as a result of racism, or homophobia, or sectarianism, or gender inequality.

For those who have died at the hand of their own demons.

For the people whose hands I’ve held as they died. For the people who I couldn’t bring back to life.

For the times I send someone into a room to say goodbye to their person, and the ones I can’t get there in time.

For the person for whom the wail of a siren broke from Great Western Road into the middle of Psalm 23, a brief invasion of chaos to remind us that the tragedy goes on, always, and that our humanity is in grieving it, yes, but in fighting it too.

For the names and the names and the names of the people we have remembered by name. For the safekeeping of those names throughout the year. For the people who they were loved by, and are loved by.

For the people who I love and see no longer.

For those who die alone.

For those who will die tonight.

For those who die with no one else to pray for them.

For all who here sought and here found him, whose journey is ended and peril is past.

For everyone who we have ever loved who is now safe with God.

For the tears we cry tonight, and for the promise of the Resurrection too.

Alleluia, Alleluia.

A Meditation On The Never-Ending Shift

I am a newly minted SHO, on my first weekend of FY2 nights.

It is a couple of minutes after one o’clock in the morning.

I have been at work for nearly five hours already and things are mostly under control. I’ve checked in with the seven wards that are my responsibility, chased a few bloods and a CT scan, admitted someone who had been transferred from another hospital in the late evening, seen a couple of sick people, answered a phone call from my registrar who is on call from home and wanted to check in with me before she went to her bed.

The staff on this ward have made me a cup of tea and encouraged me to help myself to the box of Quality Street on the desk as I write them up some paracetamol and routine fluids.

My tea-and-chocolate-and-fluid-prescribing is interrupted by my bleep, shrill in the night shift quiet.

A patient on another ward has spiked a temperature. It isn’t unexpected, but can I please go up and do the appropriate things? I go, dropping off my fluid chart at the nurses’ station on the way.

Upstairs, the patient I have been called about is reasonably well with their temperature. I examine them and explain what I’m going to do. It is a hospital where we have regular patients, and for this person it is not their first time at this particular rodeo. They are ruefully accepting. I look through their notes and obs, take bloods and blood cultures, and prescribe antibiotics and a bag of fast saline. I make a plan with the nursing staff that I’ll review them again later in the night, after the antibiotics have gone through; but they’ll bleep me before that if they are worried.

The radio that I carry on these shifts squawks at me. The shift coordinator wonders if I can put in a venflon — the patient is due medication, and our clinical support worker is busy and anyway in a building on the other side of the hospital campus. Yes, of course I can. The procedure is straightforward and done quickly. I check my jobs list, and rewrite a prescription chart and update some fluid prescriptions while I’m there.

I cut through the ward next door on my way back downstairs. I am intercepted by a member of the nursing staff. A person has died. We speak about whether the death was expected — yes — and the patient was comfortable — yes — and the family were there — no, but they are on their way back. I go into the room and spend a few minutes with the person, and perform the last offices of my profession. Afterwards, I locate their medical notes and document my findings. Rest in peace, I write.

I arrive back at my now stone cold cup of tea. I have been away for an hour.

It is still a couple of minutes past one o’clock in the morning.

Keep watch, dear Lord, over those who worked and watched and wept this night.