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Posts by Beth Routledge

Open, Inclusive, Welcoming (and Proud)

It always gives me great joy to march at Glasgow Pride in the company of my Episcopalian brothers and sisters.

Photo: Gordon Smith

Photo: Gordon Smith

Today, I was marching with Changing Attitude Scotland, which is the network within the Scottish Episcopal Church that works for the equal rights of LGBT people within the Church and beyond. I was out there today with people from the Diocese of Glasgow and Galloway, many of whom were from my home church of St Mary’s Cathedral; but I was also out there with people who had come from across the Province to join us.

Pride is about marching for gay rights, which are equal rights. Pride is about celebrating everything that has been accomplished, and about remembering the work that has still to be done.

A number of us out there today were involved in the equal marriage movement in Scotland. A number of us have now turned our attention to the movement for marriage equality within the Church. Our work is not done.

I think it’s really important for religious groups to be seen at Pride. I’m always pleased to see groups from the Reform Jews, and to have a chance to catch up with the Metropolitan Community Church and Affirmation Scotland. I think it’s important for this face of the church to be public and out there. The group that I march with has grown in size and enthusiasm, year after year after year. There were more than thirty of us at Glasgow Pride today, a far cry from the four wet and bedraggled Piskies who gathered on the Royal Mile in 2008. This year was the first year that our efforts at Pride have been partially funded by the Diocese of Glasgow and Galloway, and that’s a big thing. We are no longer a fringe movement or a special interest group. We are in the Church and of the Church, and the Church is starting to recognise that. That’s a really big thing.

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You think the world has changed, but as I walked through George Square today there were still flashbulbs turning to the priest walking next to me and people nudging their friends as they read out the words on the banner that I was carrying:

“Look! Look! The Scottish Episcopal Church Welcomes You!”

The world has changed. It’s changed because we keep changing it. And every time we do something like this, we change it a little bit more.

As long as our religious institutions are not equal. As long as our youth are rejected by their families. As long as a teenager can be killed merely for being on a Pride march. Our work is not done.

Today was a great Pride. Thanks to Glasgow Pride and to the Scottish Episcopalians who came out to support us.

Small Voice: Tanzania, Healthcare, and the NHS

I was honoured when the brilliant team from GRF invited me to contribute to their Small Voice podcast which is recorded right here in Glasgow.

It was a joy to visit their studio and to be interviewed by the lovely Anne for the Thousand Words segment. Here I am on the August edition of Small Voice, talking about my time in Tanzania, my experiences of healthcare, and my love letter to the NHS.

Small Voice: August 2015

I’m on at 24:43.

For All Doctors: New and Old, Starting and Starting Over and Starting Again

Go placidly amid the noise and haste, and remember what peace there may be in silence.
As far as possible without surrender be on good terms with all persons.
Speak your truth quietly and clearly; and listen to others, even the dull and ignorant; they too have their story.
Avoid loud and aggressive persons, they are vexations to the spirit.
If you compare yourself with others, you may become vain and bitter;
for always there will be greater and lesser persons than yourself.

Enjoy your achievements as well as your plans.
Keep interested in your career, however humble; it is a real possession in the changing fortunes of time.
Exercise caution in your business affairs; for the world is full of trickery.
But let this not blind you to what virtue there is; many persons strive for high ideals;
and everywhere life is full of heroism.

Be yourself.
Especially, do not feign affection.
Neither be critical about love; for in the face of all aridity and disenchantment it is as perennial as the grass.

Take kindly the counsel of the years, gracefully surrendering the things of youth.
Nurture strength of spirit to shield you in sudden misfortune. But do not distress yourself with imaginings.
Many fears are born of fatigue and loneliness. Beyond a wholesome discipline, be gentle with yourself.

You are a child of the universe, no less than the trees and the stars;
you have a right to be here.
And whether or not it is clear to you, no doubt the universe is unfolding as it should.

Therefore be at peace with God, whatever you conceive Him to be,
and whatever your labors and aspirations, in the noisy confusion of life keep peace with your soul.
With all its sham, drudgery and broken dreams, it is still a beautiful world. Be careful. Strive to be happy.

Max Ehrmann, Desiderata

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.