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Posts by Beth Routledge

Change

It’s changeover day on Wednesday. I went to the supermarket after work today, and almost without thinking about it I did the sort of grocery shop you do when you’re about to go onto a run of nights. I haven’t done nights since the Commonwealth Games, but in my new job I’m starting on Team Nightshift.

In this job, as a trainee, a year is a long time to stay in one place. I’ve been here through the FY1s and SHOs switching jobs in December and again in April, and through the registrars changing over in February. And now that everyone is moving again, it’s time for me to go too.

People keep asking if I’m looking forward to leaving, which isn’t a question with a straightforward answer. I’m looking forward to starting my new job, but I’m not exactly looking forward to leaving this one. I’ve grown comfortable in it where I am. It’s been a long time since I’ve been the new girl; even on my weekend locums, it’s mostly been going back to jobs that I’ve done before and places where I’ve been remembered. I’m going to be brand new on Wednesday, in a hospital and a department that I’ve never worked in before, and, due to rota complexities, am going to be brand new all over again next Monday. My most oft uttered words for the next fortnight are going to be a variation on, “where are the venflons?” or maybe, “where are the toilets?”.

This time of year is weird for more than just the FY1s.

The job I’m going to is the beginning of the training post that I wanted all along. It will be good for me, and it is the next step in the journey of what I really want to do with the rest of my life.

My gap year came on me unexpectedly, taken for geographical reasons rather than career reasons. I’ve learned a lot about haematology and developed a lot of transferrable skills; I’ve passed two parts of my MRCP, I’ve audited some things, some of them important things; I’ve worked with some brilliant people; I’ve run a marathon; and I think, maybe, in a roundabout sort of way, I’ve figured out what I do want to do with the rest of my life. Not a bad year for a year that I hadn’t really been looking to take in the first place.

The first Tuesday in August is always a bit bittersweet, I think. I’ve liked this job and I’ve had a long long time to get settled in it, and that makes it just that bit more unsettling than usual. But it’s time to move on.

“Scarecrow,” said Dorothy. “I think I’ll miss you most of all.”

Dear Baby Doctors

Dear Nearly New FY1s,

I remember my shadowing as a blur of paperwork and an urgent sense that I needed to assimilate all the knowledge in the week I had before someone handed me a pager and left me with actual responsibility for actual patients. I kept thinking that eventually I’d be escorted from the building when someone realised that I’d graduated medical school by mistake. I felt a little bit as if Sputnik had landed on my head.

You can’t have missed what’s been going on in the the last fortnight: take that seriously, by all means, we’re being disrespected and disenfranchised and lied about, and, yes, be furious and be engaged and get involved, but don’t let that ruin this for you and don’t think for a minute that it means we love our jobs any less. The political bullshit: yes. The job, the being doctors, the looking after people: no. The thing about the #ImInWorkJeremy pictures wasn’t just that we were in work, it was that we mostly looked pretty happy to be there.

I love this job. Yes, it is hard and exhausting, and you’ll have days when you want to scream and days when you come home and sit in the dark and cry at the cats. I love it anyway. It has terrible days, but it also has days when I catch myself thinking, I can’t believe I get to do this for a job. I think it’s the best job in the world. I hope you will too.

There is a lot of advice that I could give, and I’ve tried to do that below. I’ve stolen a few of my #tipsfornewdocs from my Twitter colleagues and I’ve tried to credit them appropriately.

But there are only three things really: care for and about your patients, remember ABCDE, and don’t be scared to ask for help.

Love,

Beth

*

On Days

– Be early.

– Comfy shoes. Get some.

– At the beginning of the day, ask the nursing staff the following questions: is there anyone sick, is there anyone new, is there anyone going home?

– I thought until recently that this was self-evident, but you need to go on the ward round.

– Whatever you need, it is in the secret drawer at the nurses’ station: pens, markers, death certificates, chocolates. Ask. (@STIrwin)

– Cultivate relationships with the nurses, the pharmacists, the person carrying the on call microbiology bleep, and the radiologists.

– You will develop compulsive tendencies regarding lists and systems of half coloured in boxes. This is normal.

– Eat something.

– Drink something. Don’t succumb to on-call AKI.

– There are no routine investigations. If you don’t have a reason for doing it, don’t do it.

– For blood transfusions and contrast scans, you shouldn’t be using anything smaller than a pink venflon.

– Ask where the phlebotomist leaves the blood forms for the samples that they couldn’t do. There’s really nothing quite like getting to three o’clock, chasing all the bloods, and realising that half of them haven’t even been taken yet…

– If a patient has died or if a patient has a complicated discharge, phone their GP.

– Never ask a GP to chase an outstanding result. If a test has been done in secondary care, it is the responsibility of secondary care to follow it up.

– The bloods need chased and acted upon. It is important that you record a low potassium, but it is also important that you do something to replace it. It is important that you draw a circle around a rising CRP, but it is more important that you try to find out why and do something about it. If you get a weird result and don’t know what to do about it, ask.

– Do a fluid / insulin / warfarin / gentamicin / vancomycin round before you go home.

– Don’t take the on call bleep home. (@DrLatifaPatel)

– There are some things that it is bad manners to hand over to the on call team. PRs, for example.

On Nights

– A routine for the day before going onto a run of night shifts is essential, and you have to figure out what works for you which will not be the same thing as what works for someone else. This advice from the Royal College of Physicians is a good place to start.

– Try thinking of your nights as something to be embraced rather than something to be endured. As an FY1, this is where you’ll get to practice some actual medicine.

– Eat something.

– On ward cover nights, try doing the following in this order: 1) if you are concerned about anyone you’ve been handed over, let your SHO know that you’re going to review someone sick and might be calling for help or advice sooner rather than later, 2) go and review them, 3) take a tour of the wards that you’re responsible for, to ask the nurses if they’ve got any routine jobs that need doing and to ask them to keep a list of routine jobs for when you come back round later in the night, and 4) actually go back round later in the night.

– At 5am on a busy night shift what you need is a piece of white toast with a lot of proper butter and a strong cup of tea. (@traumagasdoc)

– Give me the grace to accept with serenity the things which cannot be fixed overnight, the courage and skills to fix the things which should, and the wisdom to distinguish one from another. (@drewseybaby)

– If you are asking switchboard to put you through to the haematology lab or the biochemistry lab at 3am, take the extra ten seconds to make sure they know you really do mean the lab and not the consultant. I mean, they’ll still get it wrong sometimes but at least you tried.

– If you are covering an area that doesn’t have a formal handover in the morning, do make sure to either ring round or visit wards where there were overnight issues.

– Your bed is the best place in the universe. Seriously. You will never look at it in the same way again.

On Your Fellow FY1s

– Be kind to each other.

– If you’re ever tempted to burn bridges, remember that medicine is a really small world and you’re probably going to be referring patients to each other for the next thirty years.

On Receiving

– Do some.

– Don’t listen too much to the horror stories. It is one of my favourite things in the world and if you approach it with a little bit of enthusiasm you’ll learn more here than anywhere else in FY1.

– In surgical receiving, don’t forget to do a coag and a group and save.

– Try to corner someone who has done receiving before and interrogate them about how the post-take works. If you’re starting on receiving and haven’t spent your shadowing week there, this might mean cornering the outgoing FY1 or SHO who has just come off night shift. They will almost certainly not mind. It is a system unique to each individual department, and consultants who have worked in their department for twenty years often have a tendency to think that that system is something we pass on to each other through divine inspiration. I worked in a surgical department once where they were very particular about how and in what colour things were written on a paper handover and two different whiteboards.

On Bad Days

– People make bad choices when they’re mad or scared or stressed. Breathe.

– There is no shame in tears.

– If you make a mistake, admit to it.

– Your first failed arrest call will be awful. Your second one will be awful, too. Eventually, you won’t always (but you will sometimes) need to cry in the sluice afterwards but it will never not be awful. That’s okay. There are some things we aren’t meant to get used to.

– The first time you have to confirm death, take someone in with you.

– Some days you have to come home, eat a banana, and go to bed at 7.30. Tomorrow is another day. (@medicalaxioms)

On Learning

– Eat when you can, sleep when you can, read when you can, learn something new every day. (@TraumaAnnie)

– Reflection is valuable. Reflection all in a rush at the end of May because you haven’t done any yet for ePortfolio is not.

– There is no getting away from exams, but nor is there any obligation to take them at the very first available opportunity. The fact that everyone else is sitting an exam not an actual reason to sit an exam.

On Getting Help

– No one expects an FY1 in August to be functioning at the same level as an FY1 in July.

– If you aren’t sure, ask. (@PenfoldDr)

– If your patient is sick and you’re out of your depth and your immediate senior can’t or won’t come, your next step is to go to their senior.

– If your patient is sick sick sick and you’re assessing them, I absolutely do not expect you to wait for all their investigation results to come back before you come to get me.

– SHOs don’t bite.

– The med reg is your best friend.

On Patients

– #hellomynameis

– Your patients are people. Don’t ever refer to them as diagnoses or bed numbers.

– Always remember that a patient, usually unwell, is at the centre of all that you do. (@DrMarkMcInerny)

– For your patients, a hospital is almost never going to be something as benign as the place where they go to work. It isn’t a big deal for you to go into hospital in the morning. It is a huge deal and usually a really scary thing for them, and that shouldn’t be minimised.

– A patient with a chronic condition will usually know more about their disease than you will.

– The importance of ideas, concerns, and expectations isn’t just a medical school thing. It’s a real thing.

– Don’t make assumptions.

– Listen.

– Care.

How To Create A Giggle Loop In An Outpatient Waiting Room

It is mid-afternoon and I am in the outpatient department, with four doctors in our clinic and by this time of day perhaps twenty-odd people with their assorted relatives in the waiting room. We are running late. We are always running late.

I am going down the corridor to collect my next patient, sticker sheet with their details on in my hand. My consultant’s door is open and I poke my head into his office to ask a question.

“Yes, that sounds fine,” he says. “You could add on this test to her bloods.”

“Okay,” I say. “Thanks. You don’t happen to know the phone number for the lab off the top of your head?”

“61234,” he says immediately. My consultant is often a better telephone directory than switchboard is.

I exit his office and continue on my way, patient’s details still in my hand.

“61234,” I shout. Loudly. The response is thirty heads swivelling, sixty eyebrows going up. I wait. And then the person in the chair nearest me dissolves into laughter and then the person next to her and the person across the room who catches his eye, and then I hear it.

“Oh, hell,” I say, not quietly enough. “Mrs Smith!”

The Health Secretary and His War On Doctors

It would not be an understatement to say that doctors this week feel as if the government has waged war on them.

It would not be an understatement to say that because that is what Jeremy Hunt actually said this week, as if there were no better rhetoric to use in a speech about public servants whose job involves the actual saving of peoples’ lives. From accusing us of being unprofessional, to trying to impose upon us an unsafe training pathway, to threatening us with having new contracts forced upon us if we don’t stop pointing out minor technicalities like that we already work weekends and that healthcare does not run on doctors alone. Oh, we are furious, and righteously so.

A lot of the proposals that the Health Secretary puts forward are great soundbites.

5000 new GPs, 15% fewer deaths, and a seven day NHS.

As I listened to the Radio 4 coverage of Mr Hunt’s speech at the King’s Fund on Thursday, I heard in my head the voice of Jed Bartlet, my memory dredging up a twelve-year-old line from in a fictional debate speech that finally articulated what I’ve been thinking since before the election:

There it is. That’s the ten word answer my staff’s been looking for for two weeks. There it is. Ten word answers can kill you in political campaigns. They’re the tip of the sword. Here’s my question: what are the next ten words of your answer. Give me the next ten words. How are we going to do it? Give me ten after that, I’ll drop out of the race right now.

You can’t. You can’t get 5000 new GPs when you’ve insulted and browbeaten them so much that no one wants to be a GP, and you can’t run a hospital on the weekend the same way that you do during the week unless you can also get us weekday levels of staffing from support staff and allied health professionals and you’re prepared to make social services run the same service.

So, tell us, Mr Hunt; tell us how you’re going to do it.

And then he refused to commit to the continuing of an NHS that is free at the point of need. I still don’t understand how that part wasn’t on the front page of all the papers.

But while we were all incensed by that speech, what slipped in almost under the radar was an announcement that the Doctors and Dentists Review Board had made proposals regarding changing the pay structure for both consultants and trainees.

The important things for you to know are that training grade doctors are currently paid a basic salary with a percentage increase based on how many hours over 38 per week and how many unsociable hours we are contracted to work, and that if implemented these proposals would amount to a real-terms pay cut of a lot.

Now, to be clear: I am paid a professional salary for doing a professional job, and I am wary when I talk about money of coming across like I’m whining.

But it is also important that you know that I do not live what I consider to be a life of objective luxury or excess or waste. I don’t drink alcohol or smoke, and the most exotic drug I’ve ever taken without prescription is Naproxen. The last time I left the UK for a holiday was two years ago. I have cats to feed, which I am given to understand is less expensive than having children to feed. My biggest expense after rent is paying off the debt incurred in the course of getting the degree that I had to get in order to do the job that I do. It occasionally occurs to me, usually as I’m feeling guilty about them, that my theatre tickets and bookshelves and cleaner and the fact that I haven’t got a flatmate aren’t things that I should have to make excuses for having, and yet I feel guilty about them anyway.

In the last year I have spent £420 on being registered with the GMC, £220 on being a member of my trade union, £40 to be insured to do my job, and £1670 on postgraduate exams with £400 in associated study costs. No, that zero isn’t a typo. I am about to be charged £338 for the privilege of having my indentured servitude to the NHS for the next two years recognised as a training post and being required to sit and pass further exams involving enormous amounts of study time for which I will not be renumerated.

No, I am not badly off. I couldn’t book a flight to New York or afford for my car to break down right now, but I manage just fine. In four years time when I have fulfilled my current obligations to my bank (see above re: debt incurred in the course of getting my degree) I will manage better than fine. I am well aware of my financial privilege.

The truth though is that as a well trained, highly educated, skilled professional who does a difficult job under often impossible circumstances and works evenings and nights and twelve days in a row and unacknowledged overtime and, yes, weekends, largely without complaint, if the DDRB proposals for training grade doctors are implemented then I will not manage fine. I will, under those circumstances, struggle to pay rent. That is the bottom line. In a week when we have delivered world class healthcare while trying to protect our healthcare system from a man who is doing his level best to implode it, that is the situation that is faced by doctors in this country.

It’s okay, though, because I hear there’s work to be had. I hear Jeremy Hunt could do with a new communications director.

Of Course There Are Still Exams

Yes, of course I recommend sitting nine hours worth of exam in a room with no crosswind on the most humid two days of the year; why do you ask?

Last week on Tuesday evening, I told the collected Internet that I was knocking off and going for a run and an early night — “this is going to go however it goes now”, I said. I’m sure the Internet was relieved. I had been using my last little bit of annual leave to study for the exam I was about to take, and while stuck in front of my laptop I had been intermittently making fun of the more ridiculous of my practice questions for the benefit of Twitter.

For example.

The correct answer suggested that I have the power to quarantine dogs in Uruguay. By the power vested in me by the medical receiving page.

The correct answer suggested that I have the authority to quarantine dogs in Uruguay. By the power vested in me by the medical receiving page.

In the middle of all this, a friend who is not a doctor confessed himself to be curious as to why I was still being obliged to sit exams. The short version of the answer and to put it in a broader context is that for the time being this is just what I do as CPD. The longer answer is that medicine, after medical school, always requires some form of specialist qualification, which is what this is, and then sometimes, later, a subspecialist qualification too. I’m sitting my membership exams for the Royal College of Physicians, with what I did last week being the second of three parts. You may remember that I’ve moaned and mumbled about this sort of thing before, and that was Part 1. If I wanted to be a surgeon or a paediatrician or a GP, for instance, they all have their own college and so their own kind of exam.

A few people had warned me that I would feel as if I’d been hit on the head with a hammer, afterwards.

There are 270 questions split into three papers that are spread over nine hours across a day and a half. The questions all have a wee story, which is called a stem, normally about twice the length of that story about the Uruguayan dog, and then five options, of which a single option is “best”, to be selected and changed and then changed back using a 2B pencil and an inadequate eraser. My question paper, which they don’t mark, thank God, is full of circles, arrows, sums, and manic scribbles. A bit of sensible reasoning through of logic, a lot of notes-to-self, and the odd piece of exam-induced snark: “prob talking to an obstetrician before I do anything with the 38 wk pregnant woman tbh”.

You would think that this would all be old hat. It is a broadly similar format to Part 1 — the stories are slightly longer and the material is more clinically relevant, more about my actual job, although slanted heavily towards the weird and wonderful, and less about my ability to remember specific trinucleotide repeats on specific chromosomes, but generally familiar territory. And it’s not like I did Part 1 just the one time.

Except: in Part 1, you don’t have to come back the next day.

At the end of the second paper and a rudimentary debriefing over dinner (“I don’t even know where I’d start. Did you know what a rupture of thingummy of the sinus of Valsalva is? Are those prawns?”), I took myself off for a swim where I got to cool down (have I mentioned that it was hot?) and do nothing more complicated than count laps and ponder whether it would be appropriate to sit the third paper in the pool.

Back in on Thursday morning, and by the two hundred and sixty ninth question my eyes had crossed and even the invigilators looked like they were flagging. After a day and a half of mostly sitting in a chair, I was exactly as knackered as I would have been if I’d done four days of medical receiving. But, except maybe the candidates, nobody in that exam had anything as mundane as a troponin negative chest pain.

It’s done, anyway, and now I’ve got a few weeks grace before I’ll know how it really went.

The lessons learned from the experience are:

  1. If you can, don’t sit an exam in the two days of the year when humidity comes to Glasgow.
  2. I have rarely felt more ancient than the morning after, when, having spent my week sitting a postgraduate exam, I had a work experience kid in clinic who was waiting for the results of his Highers.
  3. Don’t forget to cuidado con el perro.

Letting Streams Of Living Justice Flow Down Upon The Earth

The General Convention of the Episcopal Church of the United States begins on Thursday morning — their equivalent of the General Synod that I was at a couple of weeks ago and that I’ve spent much of the couple of weeks since mulling over.

In the liturgy that I’ve witnessed, in the music that I’ve heard, in a trip to Edinburgh Pride this past weekend with fellow Episcopalians. A spark of optimism is there that burns brighter than it did before. It says that we can do this, and that we can do it while still all doing that most simple and complex thing of loving each other.

As part of their business over the next nine days the Episcopal Church of the United States will be considering an amendment to Canon I.18, which is their marriage Canon. The proposed changes are mainly based in the removal of doctrinal statements, and in that sense are similar to those which the Scottish Episcopal Church has just agreed to consider.

In my mulling over of the business that was done here in Scotland, I am still struck by the atmosphere of constructivity and generosity that I experienced in those three days in Edinburgh. At the time, I was struck by how hard people were willing to work to ensure that a satisfactory process was embarked upon. I was struck by the determination of people on all sides of the conversation to look for a compromise and an answer that we could all live with. I was moved then and am still by the willingness of people to be vulnerable, to talk about their lack of certainty, to lay their lives and their journeys bare, to show us all the deepest corners of their faith.

We in the Scottish Episcopal Church credit ourselves with having birthed the Episcopal Church of the USA when we consecrated Samuel Seabury in 1784 against the wishes of the Church of England.

It is my prayer for our sisters and brothers in the United States that they encounter as much love in their General Convention as we did in Edinburgh, and that Scotland will once again have lit for them a beacon of hope.

General Synod 2015: Going Forward In Diversity

Tonight, at the service of Evening Prayer with which we close each day’s business at Synod, I found myself in tears.

Not the tears that I wept at General Synod last year, when I had to make an escape from the building to have a few moments of quiet with a friend in my anger and my frustration. No, I said to those who came to me when worship was over. No, these are the good kind, these are the tears of joy. The weeping that I do today is the weeping of Easter Sunday.

The motion put to Synod before lunch today was whether we wished to proceed to debate the options for potential change to Canon 31, which is the canon the deals with how we marry people in the Church.

Section 1 of Canon 31 states that:

The Doctrine of this Church is that Marriage is a physical, spiritual, and mystical union of one man and one woman, created by their mutual consent of heart, mind, and will thereto, and is a holy and lifelong estate instituted of God.

Having decided that we did want to vote on some form of change to that Canon, the options we were choosing between were as is written here.

74% of Synod voted for Option A as their first preference. We have asked the Committee on Canons to prepare canonical material removing Section 1 in its entirety from Canon 31. If that passes through subsequent Synodical procedures, the result will be that Canon Law in the Scottish Episcopal Church is silent on the doctrinal nature of marriage and that our doctrinal understanding reverts to that which is found in the liturgies of the Church.

And to save you looking it up: The liturgies of this Church as they already exist allow for many possible understandings of marriage, including that which is between two people of the same gender.

I voted for Option A. I dithered, and I considered voting for Option C (altering “one man and one woman” so that it instead read “two persons”) which would have produced something that I could have joyfully lived with. I chose instead to put it as my second preference.

Because it isn’t just about me, is it?

It used to be about me. This conversation used to be a conversation that was being had only amongst people like me and people who agreed with us. But if anything has become clear over the last two days, it has been that this is now a conversation that is being had by the whole Church, willingly and intelligently and diversely and overflowing with love.

That has been a wonderful thing to witness.

And so I voted for the option that I think allows us to go forward together, loving one another in our diversity and our difference and our disagreement. I think that that is the kind of Church that we are, and it is the kind of Church that I want us to be.

Now, the work is not done.

To change Canon Law as has been requested in principle by General Synod today will require two years worth of procedures. The canonical material which has been requested will be brought for first reading at General Synod 2016, requiring a simple majority. If passed, that will go to the Diocesan Synods of 2017 for further discussion before being brought for second reading to General Synod 2017 where in order to pass and to actually become Canon Law it will require a two thirds majority from each of the House of Laity, the House of Clergy, and the House of Bishops.

No, the work is not nearly done.

But the things that have happened today have been good things, marvellous things, things that if you had asked me two years ago I would have said that I didn’t know if they would ever happen at all.

And as the words of Psalm 40 were read, I wept for joy and for gladness:

I waited patiently for God
and God bent down to hear me.
God lifted me from a murky pit
and set me firmly on a rock
where I can stand confidently.

God put a new song on my lips,
a song of praise to my Maker;
many will look on in wonder
and put their trust in God.

Countless are your wonders, O God;
in goodness you have no equal.
We would proclaim all your works
were they not too many to number.

General Synod 2015: Sit Rep on Day 1

I am in Edinburgh, where the General Synod of the Scottish Episcopal Church has reached the close of business for Day 1.

There is a significant amount of business to be conducted in this Synod, and a lot of it is about marriage and about Canon 31. The motions that came on Thursday were largely procedural in nature, relating to whether Synod wished to adopt the process that had been suggested by the Faith and Order Board. It required a two thirds majority of Synod voting in one House.

The motion passed with the following amendments as I understand them:

  • A procedural motion will be taken following the substantive debate as to whether Synod should move to a vote on it (and, by implication, whether Synod is of a mind to have any change to the Canon)
  • If so moved, the vote will be by what has been described as single transferable vote, rather than by the allocation of points as had been suggested originally by the Faith and Order Board.
  • If so moved, the vote will be on Options A / C / E as writ in the Synod Papers (1 / 3 / 5 in the linked blog post). There will then be a separate motion as to whether a conscience clause should be added.

A further amendment was proposed, suggesting a further option for the ballot that Canon 31, Section 1 should be maintained in its present form and that a conscience clause should be added allowing individual ministers to solemnise marriages between individuals of the same sex. That amendment did not achieve a majority of Synod and so that option has not been added to the ballot: it is my view that that was a right and proper decision by Synod, as it would not have been an option that could not possibly have resulted in a competent Canon but instead might have led to the Church having a Canon Law that contradicted itself.

Now, that is all procedure. It is all preamble. It is not yet the substance of the thing, but it seems to me that it has been significant nonetheless and that Synod has had important conversations amongst itself today and done work that it was necessary to do. It seems to me particularly important that Synod did not choose to merely follow along with the process presented to it or indeed merely to vote down the whole thing, but chose to do that hard work that it felt was needed to make that process better. I think — or hope, at least — that that represents a willingness to engage.

Tomorrow, we move to substance.

There is a vote before lunch on whether we go on to debate. If we do vote for that debate, that will take place after lunch on the canonical options as listed, and, if it is agreed to move to a vote, a vote on those options by ballot. If voted on, we will then be able to choose whether to ask the Faith and Order Board to instruct the Committee on Canons to prepare canonical material for first reading in 2016 in line with that vote. The final piece of business tomorrow will be to discuss whether the Committee on Canons should prepare a new Canon which if agreed to would enable the registration of civil partnerships in the Scottish Episcopal Church — it is worth noting that that piece of business is not contingent on anything that has gone before it.

There is a live audio stream available on the Provincial website for anyone who wishes to follow along at home, and the public gallery at St Paul’s and St George’s where we are meeting is open to the public for all debates.

The Doctor That Glasgow Built

This past weekend was the (mostly) completion of the closing down of five of the hospitals in this city and their transfer to a new hospital in South Glasgow that so far as I can tell mostly contains furlongs of corridors.

I exaggerate, I suppose. I’ve been in the new place just enough to have decided big and confusing, and I don’t work there really although doubtless I will at some point. I expect eventually I’ll adjust, and I expect eventually everyone will stop wandering around like a crossbreed between frightened rabbits and lost sheep. There is no question that the buildings that have closed are no longer fit for purpose, and have become increasingly even less fit for purpose over the past ten years as apathy and not-here-for-much-longer have set in.

But the days and nights I’ve spent in them are ones that have been the making of me as a doctor so far, and sentiment is a powerful thing.

Screen Shot 2015-06-08 at 16.26.33

If I could take a single memory from the old hospitals, it would be of standing at this window as one of the worst nights I’ve ever had finally ended; when, inexplicably and unexpectedly, the sun came up and everyone lived.

Marriage and the General Synod

Next week, the General Synod of the Scottish Episcopal Church meets in Edinburgh to do its annual business. A significant chunk of our agenda this year is to talk about marriage: what we believe about it, what we say about it, and what steps (if any) we as a Church want to take to recognise the lives and loves of couples who happen to be of the same sex.

It is my view that we should be recognising those lives and loves in precisely the same way as we recognise those of couples within the Church who happen to be of opposite sexes – and it is not only my view. The most profound social change in the last decade has not been the rewriting of old laws and the enacting of new ones. It has been the basic truth that society no longer thinks I am being radical when I say that in life and law and linguistics there should be no difference between gay couples and straight couples.

But it is the truth and beauty of the Scottish Episcopal Church that we are not all of the same view, and that we are not all required to share a single view. It is right and proper that we have this conversation and that the matter is given due process in accordance with the procedures of the Church.

It is proposed that the Synodical debate this year will be based on six options drawn up by the Faith and Order Board for changing Canon 31, or a separate option for no change.

For avoidance of doubt, Section 1 of Canon 31 states:

The Doctrine of this Church is that Marriage is a physical, spiritual, and mystical union of one man and one woman, created by their mutual consent of heart, mind, and will thereto, and is a holy and lifelong estate instituted of God.

Also for the avoidance of doubt, Clause 1 was written into Canon Law for the express purpose of clarifying the Church’s position on the then newly enacted divorce laws.

The options laid out by the Faith and Order Board are:

  1. Removal of Section 1
  2. Removal of Section 1, with the addition of a conscience clause stating that no cleric is obliged to solemnise a marriage against their conscience.
  3. Alteration of Section 1 to render it non-gender specific, e.g. by replacing “one man and one woman” with “two persons”.
  4. Alteration of Section 1 as in (3), with the addition of a conscience clause.
  5. Alteration of Section 1 to include two expressions of marriage, i.e. to state that there are two expressions of marriage in the Scottish Episcopal Church: one between a man and a woman and one between two persons of either gender.
  6. Alteration of Section 1 as in (5), with the addition of a conscience clause.

We are told that in order to debate these options, a two-thirds majority of voting members will need to agree to do so. If the Synod agrees to the debate, the Faith and Order Board ask that the subsequent voting be conducted by a ballot and we are told that that voting mechanism will also need to be agreed to by a two-thirds majority of voting members.

I think that it needs to be understood that the requirement for one at this stage in the conversation means that Episcopalians who happen to be lesbian, gay, bisexual, and transgender are being required to meet a higher standard just to get in the door. I am not scared of the requirement, but it must be distinctly understood that to require it at this point is not just.

The proposal for the voting mechanism is that representatives will be asked to give six points to their most preferred option, and five points to their second most preferred option, and so on. After the points are added together, Synod will be declared to have expressed a preference and will then be asked to vote on whether the Committee on Canons should be asked to prepare canonical material relating to that preference. That vote requires a simple majority of 51%, not voting in houses. The canonical material would be presented to the General Synod of 2016 for first reading.

The agenda and papers for General Synod 2015 have been made available on the Provincial website. The relevant points are the motions themselves on pages 1-10, and the process paper from the Faith and Order Board  on pages 46-50. The Doctrine Committee have produced a paper on the theology of marriage, which is also available on the Provincial website and which I believe is intended to inform the debate.

In addition to the material on same-sex marriage, the Faith and Order Board have proposed a separate motion relating to whether the Scottish Episcopal Church wishes to undertake the registration of civil partnerships. There is an ongoing discussion about this on Kelvin’s blog, which is worth reading and joining in with. I have not been able to answer his question and I’m not convinced anyone knows the answer, including those who proposed the motion. I am against that motion, and I think it must be clear in everyone’s mind before we get to Synod that this should not be a question of either/or — I do not believe we are looking for religious civil partnerships, and as I said some weeks ago we are certainly not looking for them as a consolation prize.

I urge members of Synod to read and digest the material that is in the Synod papers — there is a lot of it. I also urge people within the Church who are not on Synod to read the material — if you have an opinion on this, talk to your clergy or your lay representative or any member of Synod and make your views known.