Wednesday, December 19, 2012

Devil's Graffiti

One of my favourite authors is, no, my favourite author is, Adrian Plass. His ability to communicate deep truth, often through humour is, I think, unmatched. Some write-off his books as silly humour and miss the true depth (in my view). His ability to entertain is of course worthy in and of itself but most of the time it is a means-to-an-ends. To communicate something more profound about God's love. He is also a good and skilled theologian but perhaps not in the traditional sense. And for me that is the key to his authenticity. Theology is important as it's about the truth of God but it is not what disciples of Jesus are called to - we are called to be disciples. Theology that does not change how we live is worthless. Plass's writing expresses the reality of a relationship and not just dry academic study. What you might call practical theology. Ultimately for a true disciple, no other kind is worthy of any consideration. 

Plass wrote some years ago about The Devil's Graffiti, drawing on Jeremiah 31 where God declares that he will write His laws on our hearts. A little bit of theological work is probably needed here to understand what this means. Certainly I think it a mistake to see it legalistically. Good laws increase freedom and I believe what Jeremiah 31 is saying is that God would change cold hearts such that external laws become less and less important. Plass's observation was that sometimes before God can begin to write said laws he first has to scrub away to remove the Devil's Graffiti that's in the way.

The problem, assuming your heart is anything like mine, is that negative graffiti has built up over the years leaving very little space for anything else. The devil gets busy with his infernal aerosol can! Things people have said, failures that have destroyed confidence, traumatic experiences, profound, unforgettable embarrassments – all sorts of things.
Usually each one tells you a lie about yourself:
you will never succeed,
you are not lovable,
God has cast you aside because of that sin,
you’re boring,
happiness is impossible,
your life has no purpose.
The almost invariable untruthfulness of these scrawling should be sufficient indication of their ultimate authorship. The father of lies is anxious that our hearts be covered with a confused mass of misinformation, some of it etched so deeply it comes close to breaking our hearts.
I have written elsewhere, in a different context about the poisonousness of lies. I don't think you have to believe in the spiritual interpretation to see the truth of the observation. Most people carry with them deep scars and things that have been burned into them that aren't true. This is of course, most profound in people who suffered in childhood - particularly from abuse but it is also true that some of us accumulate it over the years through constant knock-backs or repeated messages from the world around us. These lies - for that is what they are - are often deeply poisonous, affecting relationships, confidence and hope.

My own personal graffiti - well there's probably a few bits - but the most important one said simply this; "You are unlovable." I can chart particular experiences that are probably the origin of these words but it doesn't really matter. These words, scarred into me, often made liars of good people - for it didn't matter how much people expressed their love, it just wasn't actually possible for people to love me. It's not that I doubted them, I doubted me.

I believe in a God of healing. These words are faded now - God has spent a long time scrubbing away to remove them. In fact they're not visible most of the time; it's only when the rain falls in a certain way that you can see them at all.

I have seen in the lives of many people the poison of such lies. I think recognising them for what they are is the first step to ridding ourselves of them, the first part of the healing the process.


Sunday, December 09, 2012


Back in the day, when I was growing up, Crusaders produced yearly posters. These posters consisted of a bible verse with an illustrative image. The one I remember most vividly quoted 1 Samuel 16; "Man looks at the outward appearance but God looks at the heart." The image to accompany this verse was a hippopotamus. Presumably because this is an image of ugliness.

For reasons lost in the midst of time (and probably best left there) this became in family-lore "Man looks at the outward appearance but God looks at the hippo..." Now this silliness serves a purpose in that it makes the verse very memorable to me.

Then, when I (kinda) grew up I went to medical school and learnt anatomy. I learnt that there is a part of the brain (well, technically 2 of them) called the hippocampus. Now the hippocampus is part of the limbic system. It is somewhat questionable that the seat of the aphoristic human heart has any anatomical location but if it does, then it is the limbic system for this is the part of the brain responsible for emotions and instincts. So it turns out, worryingly that I was right all along, man does indeed look at the outward appearance and God looks at the hippo...(campus).

All of this extreme silliness is indeed going somewhere. Martin Luther King said that he dreamt of a world in which a child was judged not on the colour of their skin but on the content of their character. And whilst, in many aspects of life, racism itself is not tolerated, different kinds of superficiality still prevail. God however is much more concerned about what goes on in the heart (or limbic system if you prefer). In Matthew 23 Jesus expounds on this inside-out holiness. Get the heart right and the rest of life will follow.


Thursday, August 30, 2012

Vocation and Calling

I have been thinking a lot about vocation and calling recently.

There is so much to say. But for now I want to concentrate on some words that really touched me a few years ago and the key truth that I think they express beautifully.

In 1928, in St Mary's Hospital in London, Alexander Flemming discovered Penicillin. It is difficult to overstate the significance of this or the effect it has had on the world in the past 84 years. This plaque sits just outside the laboratory where Flemming worked. When I visited the lab I noticed it and asked the guide about it. He told me this was put up in Flemming's lifetime and he approved of the wording.

Very few of us will have as dramatic effect on the world as Flemming did. But whatever we do, I believe if we do it for the glory of God and for the benefit of the people who's lives we touch then we are very much living out a vocation.

I also think that if you haven't found your calling yet, working in this way in the meantime means that whatever you actually do, it can be of immense value.

Just some thoughts.


Monday, August 27, 2012

Is God... A Doctor?

It has been my great pleasure to spend the last two days at Greenbelt. One thing I particularly enjoyed was a series of short talks under the title "Is God...?" Speakers are strictly limited to 10 minutes to answer their specific question. (They will all be available on Greenbelt TV over the course of this year). I have to admit I was disappointed not to learn the answer to the vital question "Is God Scottish?" but I did learn answers to the following: Is God Time? (Quite philosophical but actually practical; no and yes) Is God Evangelical? (Emphatically No but actually...) Is God offended? (Importantly, no) Is God Jewish? (No.) Is God Anglican? (Well, no. But interestingly Sir Christopher Wren is apparently the founder of Anglicism). Perhaps inevitably this set me thinking as to what question I could attempt to answer in 10 minutes. Perhaps more inevitably I was struck by the question Is God a Doctor? So here goes:

Is God A Doctor?
In my life I have taken a large number of exams. One of the cardinal rules of exams is that you must answer the question asked and not a different one that you want to answer. However when speaking or writing it is often a useful device to answer a different question. So I want to start by asking Is God A Surgeon?


It's easy to tell the difference between God and a surgeon - God has no illusions about being a surgeon.

In his excellent book on medical ethics, John Wyatt presents the analogy of the human person as a masterpiece made by God and the role of the doctor is to restore this masterpiece. For me surgery can be quite humbling. When we repair bowel or a blood vessel, it is the body's own healing processes that does most of the work. When we 'fix' what's wrong with the body, it is evident to me that my restoration work is rarely - if ever - up to the standard of the original. Surgical solutions are certainly very good but surgery is still a relatively crude instrument.

This kind of thinking does beg a question; If God's masterpiece is so wonderful why do we have disease and (particularly) congenital anomalies requiring surgical correction? For me, the answer lies in the answer to the question of why a good God allows suffering. I don't want to duck that question but I don't want to get stuck in it either - simply I want to acknowledge that we live in a fallen world. So God is not a surgeon.

But is God a doctor?

The word 'doctor' has a couple of meanings - the original is 'wise and learned one.' In that sense of course God is emphatically a doctor; omniscience does give him something of an unfair advantage.

More commonly we think of a doctor as a healer. In this sense I also believe that God is a doctor. I believe God is very much about healing. Healing in every sense; physically of course, but moreover and perhaps more importantly emotionally and also most significantly spiritually. And everyone who's a follower of Jesus has a role to play in that.

I have no doubt that God heals miraculously and that annoys me - because he doesn't do it very often. Moreover I think it vital that we do not despise or minimise the non-miraculous. Any healing is a manifestation of God's grace. It is my great privilege to be part of that. The healing miracles of Jesus show that healing is indeed something God values and it is making earth just a little more like heaven and in that sense fullfilling the command to be the Kingdom of God on earth.

But what about when God doesn't heal? There is, I believe a very dangerous heresy around healing - the 'name it, claim it' theology. Your healing is available to you, if you simply have enough faith. I think this kind of thinking very dangerous and often damaging to vulnerable people. In response to it - to the idea that if you do not experience healing, is is because you don't have enough faith - I say this: Paul. Anyone who's read the New Testament would struggle to conclude he lacked faith - anyone who can write "For me to live is Christ, to die is gain" is someone who has deep faith and understanding of his place in this world and the next. And yet God did not heal him of his thorn-in-the-flesh. Despite Paul's repeated prayers. There are two things to say about this. Firstly, God does not promise to always heal in this life - the fact that godly men and women have died over the past 2000 years suggests to me that more often than not God says "no" to those prayers. Secondly God is not only a doctor but also God. He has a bigger agenda about building his kingdom and glorifying his son.

So what about when we see God not healing - what about death? It is always very dangerous to talk to a doctor about death, because we don't like what we can't cure! We cannot cure death - but I do know a man who can! I can offer a pretty good cure for appendicitis but for death... It is important to note that whilst death is inescapably part of God's judgement on a fallen world - the wages of sin is death - it is also paradoxically part of God's grace. For the follower of Jesus, death is release from the suffering of this world and of course so much more - death is the perfect healing!

Jesus reveals himself to be the ultimate physician in that he provides the cure for death - in every sense. Jesus the self-sacrificing physician who chose not to heal himself so that you and I might be healed.

Is God a doctor? He's the very best.


Monday, August 13, 2012

Glibness - a definition

I've had a strong dislike for glibness for a very long time. As with all communication the key is not what is said but what is heard. I think glibness is so dangerous because it is a lie wrapped in a truth.

"Smile, Jesus loves you" definitely contains much truth. Jesus loves you more than you can possible imagine and that truth is the source of much joy, but most often when someone says that what they are saying - or rather what is heard is very different.

Glibness is this: "Your pain makes me feel uncomfortable so please can you pretend to feel better so I don't have to be uncomfortable..."


Saturday, June 09, 2012

Truth and lies...

I have in the past commented on my strong dislike of using factual statements to mask lies and deceive. Here is another example that is really winding me up at the moment;
"...this is the debate we ought to be having: how do we get resources from the back office on to the front line? How do we do it when right now only 11% of police officers are on the streets at any one time? That is the mess we have inherited; that is the mess we are going to clear up.”
David Cameron, Prime Minister’s Questions, 17 November 2010

“I think we all want more visible policing; it cannot be right that the system we inherited from Labour means that only 11% of police officers are ever seen on our streets at any one time. That is wrong and it must change.”
Nick Clegg, Prime Minister’s Questions, 10 November 2010

This 11% figure has been used quite a lot; it has come up again in the aftermath of last year's riots, with quotes like this: "Only one in ten police officers are on the streets fighting crime at any one time..." And this argument is used to suggest that the police force is very inefficient and can make savings without effecting community policing.

11% is quite impressive - that means 89% of police officers aren't available... Wow! And this is an official figure, it comes from Her Majesty's Chief Inspector of Constabulary.... You can read the Guardian's take on this report here.

The thing is though, that if one looks a bit closer at this figure, a somewhat different picture emerges.... Let's start by saying that as a nation we do want our police officers individually to have time off to sleep and eat and have a life and thus don't want them working 24 hours a day....

As you know I live in Alien Castle in England. Which lies in a small village. Now the local villagers are quite nice and don't cause much trouble but if we wanted to have a police station in the village that was staffed by one officer 24 hours a day, how many police officers would we need?

Three 8-hour shifts a day adds up to 1095 shifts a year. An individual officer working a 40 hour week would fill 260 of these shifts therefore we would need 4.2 officers. If we are going to allow them to have the normal amount of annual leave and allow for the potential of sick leave then just to staff one police station with one officer for this small village we would need 4.7 police officers.

So already we need 5 officers; so by definition only 20% of them are available at any one time (1 in 5!). Never mind the fact that real police officers do have to do a myriad of functions such as go to court from time to time and that many of the police's most effective roles such as CID are much less visible. This leads me to wonder if having 11% of serving officers actually available at any given moment is actually startlingly efficient?


For the first time in 40 years, UK doctors are taking industrial action...

I am very torn by this. I didn't vote in the ballot - I couldn't decide what I thought. I certainly would never take strike action personally. In general I think the right to strike is a vital right in helping to redress the massive power imbalance between employers and employees. Of course, for vital services, like medicine, striking can never be an option.

In principal, I do think that taking some form of industrial action that did not harm patients could be justified. I am not convinced however, that such a thing is possible. On the other hand, the last time similar action was taken, apparently mortality went down - same number of staff on duty, only doing emergency work.

I am a paediatric surgeon in training and currently I am working in paediatric intensive care for a short secondment. Therefore this action will not effect me in any way - there's no way I could participate.

For most doctors this dispute is about honesty and fairness. And there is a lot of anger about this. It's also worth noting, that it's the same pension scheme for all NHS staff. So it's not just about high-earning doctors. Doctors only make up 10% of NHS staff, around a third are nurses and another ~15-20% are other professions aligned to medicine.

It is true that the NHS pension scheme is a very good scheme but I object to the term 'generous' for two reasons. Firstly, it is a contributory scheme and so - to a large extent - we pay for it ourselves. And secondly, it is part of the terms and conditions that everyone signed up for.

I've done a little bit of reading around this. As a back-of-the-envelope calculation, a lot of consultants will be on ~£100,000 / year. If they have 40 years of service to the NHS they would then be entitled to 50% of that as a pension (forty 80ths). A quick look on one of the many private pension sites tells me that such a pension would require a pot of ~£1.1m. I worked out that my pension contributions of around 8% on current pensionable pay for the years as a junior plus years as a consultant, roughly (without any interest or investment) comes to £500,000.

Notionally, the way the NHS pension scheme works is that the employer puts in a contribution of up to 11%. If you put these two contributions together over 40 years, then this pays for the pension. Over the past 30 years (or longer) the NHS pension has had a significant surplus. Governments of all flavours have decided, rather than investing the notional pension funds to keep the money in the exchequer and act as an underwriter to the fund. That is not necessarily unreasonable - for a nation-state. The excess returned to the exchequer is money the government would otherwise have to borrow. Currently the NHS pension fund is running at a £2Bn/year surplus.

In 2008, the NHS pension scheme was reformed significantly in such a way as to make it sustainable for the long term. Nothing has changed since then, the scheme is still sustainable in the long term. So this is simply a money-grab by the government.

The dishonesty and unfairness of it has angered many.

On the other hand, I daily thank God for the chance to do a job I love. And be paid well for. My income is very substantial and even if they do gut my pension I'll find other ways to save money.

It is worth noting that at my level (6-7 years experience - after 5 years at university) my basic pay is around £33k. I earn a lot more because of the out of hours work we do. I have to pay around £4000 / year in student loan repayments, £1000 / year in professional subscriptions so I can do my job and I have to pay for all my post graduate exams and most of the courses that I need to go on.

I am not pretending that I'm hard up. I'm really not. It's just that when you work a 90 hour week, you do tend to feel that you've earned the money you get. And that includes the pension scheme.

Having said that, I remain uncomfortable with the notion of taking action which runs a risk for patients. However, it is difficult to argue when people say the government has not given us any other option. They have completely and totally refused to negotiate. They have said, this is what is happening. No debate.

One final thought. When I read the various newspaper stories - all united in condemning doctors - I noted that in the comments sections, most of the comments were critical of the reporting and supporting doctors in taking action.

I remain torn. This is grossly unjust. There is no need for this change and the government is consistently lying about it (as they did about NHS reforms). On the other hand, I am a very well paid professional and the abuse and the indignity inflicted on the poor and particularly the disabled is a far greater injustice. So what is right? To stand up to this injustice or to accept that as well-off as I am, it is a minor indignity really? On the other hand, most NHS employees are not well paid doctors who will seriously suffer as a result of this assault on their pensions.


Monday, May 07, 2012

snoitcelfer - 7 years on...

Recently I was preparing for a humongous, horrible and highly significant medical-interview. At stake, was my entire career - well future prospects anyway. One of the things one does in this situation is to review one's professional portfolio. In it I have a section - beyond all the publications and professional qualifications on Reflective Practice. 

This is there, because it is a requirement. Please don't misunderstand me, I think that reflecting on one's practice is vital, continuous and at the core of what we do. It's just that when someone gives me a piece of paper and tells me to "Reflect" I don't find it very helpful. Over my seven years of being a doctor there are a few interesting things I've put in there, often when things have not gone as well as we'd hoped. Learning how to deal with the unavoidable problems in medicine is - well - unavoidable... What really caught my eye though was something, again that was forced, which was a piece of reflective writing we had to do before qualifying.

My medical school - as do many - arranged for us to spend two weeks shadowing the doctor we would replace when we started work. This is a vital part of the process; learning where the blood bottles are kept, meeting the ward sister and learning how that particular job works. At the end of this time, we had to write something; this is what I wrote. 7 years on, I'm wondering what I would write now as a 'middle-grade' doctor.

Sunday, February 26, 2012

Thoughts from a railway platform.

Some days, you being gone doesn’t matter as much
On those days, there isn’t a strange hole in my world
On those days, I don’t think about you constantly
On those days, I can remember certain things:
I can remember that we were trapped;
I remember that life goes on
I remember that truth is always better than a lie
I remember there is so much hope for many futures.

Some days, you being gone doesn’t matter so much
On those days, my world makes as much sense as it ever did
On those days, I think about all the parts of life I love
On those days I can be so much more free;
I can be free to live
I am free to enjoy what I enjoy
I am free from the hurt and the sadness
I am free from the fears of what won’t be.

The trouble is, today isn’t one of those days
It’s one of the other kind of days.