Category: Quote

Convalescence, the lost-ish art

Photo by Isaac Quick on Unsplash

Just finished an illuminating book called ‘Recovery’ by practicising GP Dr Gavin Francis. I am drawn back again to the idea of healing (I was in hospital when I wrote this) and really enjoyed how this book taught me things I’d previously groped towards. Some snippets:

Psycho-social

We fall ill in ways that our profoundly influenced by our past experiences and expectations, and the same can be said of our paths to recovery. (p8)

Green and growing

He talks of the difference Florence Nightingale made in the Crimea, how hospitals should have ‘the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet’. (p 13, quoting Nightingale’s own 1859 Notes on Nursing). Windows should look out something green and growing. After her arrival in 1854, the rate of soldiers dying from their wounds fell from 1 in 2 or 1 in 3, to 1 in 50

Convalescence

But in changing times and with new drugs something has been lost:

It’s not possible for me now, as a GP, to admit a frail, elderly patient somewhere for nursing care and convalescence alone – the hospital gates don’t open unless there’s a medical diagnosis, and a plan in place that prioritises getting the patient out again as soon as possible (p15).

You might not find ‘convalescence’ or ‘recovery’ as a heading in the medical textbooks but you will find ‘post-viral fatigue’… Long-term symptoms from viral infections will be different for everyone, but can include varying amounts of breathlessness, difficulty concentrating, forgetfulness, mood changes, insomnia, weight-loss, exhaustion, muscle weakness, joint stiffness and flashbacks.

All these are to be considered normal – not evidence that recovery has stalled or is going (p20) into reverse.

Pacing

He suggests ‘pacing’ as the route forward – not the boom and bust cycle of activity and exhaustion, but steady efforts, frequent rests, small meals, not doing much for an hour after a meal, getting fresh air, sitting down a lot, avoiding exerting. With boom and bust, your world narrows; with careful pacing, it slowly widens.

Work aids recovery

He talks about the world of sick-notes, and that doctors are better coaches than judges. ‘Many of the patients I sign off from the obligation to find a job could undoubtedly work in some capacity, at something, if support were available to help them do it… Work aids recovery in all sorts of ways… If I could sign my patients up to a supportive back-to-work scheme, rather than simply signing them off sick, I would‘ (p27)

A misfortune whose cost should be shared

He notes Aneurin Bevin’s championing of the idea that illness is ‘neither an indulgence for which people have to pay nor an offence for which they should be penalised but a misfortune the cost of which should be shared by the community’ (p 29. Bevan was borrowing his ideas from T H Marshall, a sociologist.)

Healing: the future of the NHS

Photo by Daniel Chicchon on Unsplash. The photo is of San Francisco; note that bridge in the background.

I read a short article by Matthew Taylor, Chief Executive of the NHS federation, in the current Wired magazine (July-August 2023). This is an unashamed abridgement of that fine article.

Taylor points out that the human species is better at developing technology than thinking through its consequences. He sees these issue for the NHS:

  1. A revolution in diagnostics. This really good thing– catching disease early– depends a lot on how willing we are continuously to monitor our health. This is not so simple. Already there are harmless incursions in my life. Under my bed is a device that downloads my pacemaker data and sends it to my hospital in London. One time when I was developing symptoms, they asked for a download, then called me in, then re-timed the pacemaker and fixed the problem: really nice. On the other hand, when I was in hospital recently, nurses were taking observations several times a day. My observations are problematic and sometimes set alarms off. At least twice they sent a more senior nurse to redo the observations as they didn’t believe what a junior nurse had recorded. These constant readings do no good whatsoever to how I feel about myself. They are stressful and discouraging. Heaven forbid that I should have a thing on my wrist that did this to me all the time.
  2. The fact that diagnostics are usually probablistic, not black-and-white. In any case, diagnostics don’t help as much you’d like. If you might develop cancer, or might not, but will develop side effects to treatment, whaddya do?
  3. Inequality. Matthew Taylor points out that technology empowers people, but usually it is only some people, and inequality increases given that other people, already disadvantaged, don’t benefit. (This actually is a slightly curious argument when things are on average getting better, but let it pass.)

Finally he talks about care. He makes some fascinating observations: ‘Medicine is technocratic and scientific; care is human and relational‘. Medical expertise is sort-of expected by us patients; care is what makes the difference to how we feel about our treatment. That is very true in my experience.

Medicine is technocratic and scientific; care is human and relational

He points out this issue is especially important in end-of-life care. End of life treatment is usually the most expensive medical phase in a person’s life, but still ‘a lot of people don’t get the end of life care they want. They might receive expensive care, when they would rather have cheaper care that’s more humane, at home, with loved ones.‘ This is fascinating. Having watched friends die both in government hospitals and in our local (charitably run) hospice, I know which of the two I would choose. Give me the lovely hospice every time.

Perhaps a contribution that people of Christian faith can offer in their last days is choosing not to have every possible intervention to keep us hanging on, but to decide our time’s up, go home, or to a hospice, to face the end of life in peace? It is oddly the opposite of euthanasia, realizing our time has come and accepting it. Interesting.

Healing and social justice

One of our local miracle drugs

I’m struck (but then I’m a slow learner; it’s obvious when you think about it) how much health and social justice are linked. For churches, it’s fascinating how important this ‘pre-healing’ ministry is. And any church interested in ‘healing’ ought to be fascinated by the possibilities of pre-healing people before they ever get sick. The good we can do! The changes we can make! Look at this from the current Wired magazine 1, which finds its way to us among articles about virtual wards, remote robotic surgery, and unlocking the NHS’ troves of digital records.

… about one in five people live in poverty in the UK. Poverty has an awful impact on physical and mental health: it is associated with higher infant mortality, lower adult life expectancy, poorer mental health, asthma, diabetes, cardiovascular disease and obesity. It has been estimated that getting your daily calories from healthy foods costs three times more compared to buying poor quality food.

Housing is another big problem. According to the Health Foundation, one in three people reports a problem with the affordability, security, or the quality of their housing. Issues such as mold and damp can lead to respiratory problems and headaches…

Green spaces are another massive issue. There’s a lot of evidence now proving that exercise is like a miracle drug. There is also plenty of evidence that if you provide more open, free, green spaces to people, you end up with higher levels of physical activity in the population, and improved mental health. In 2020, the government itself estimated that if every citizen had access to green spaces, it could save the NHS billions of pounds a year.

… We need to realize that almost all policy has an impact on population health, and think more holistically about what our health priorities are for the longer term.

The missing story that leaves us wandering in the dark

Photo by Sixteen Miles Out on Unsplash

One of Britain’s leading disaster planners recently wrote this:

In disaster planning, you usually see an event of total destruction followed by a fragile, precarious rebuild. But we haven’t got there in terms of explaining the damage done by the pandemic. We’re trying to pretend it hasn’t happened. Until we find a narrative to explore the damage wrought that is not political and not partisan, you won’t get to explore what a build-back might look like.

Lucy Easthope, Wired Magazine, July-August 2023, ‘The opportunity to change the NHS has arrived.’

Lucy Easthope is the person you want around when a disaster has happened, or better still, hasn’t yet happened. Her book When the Dust Settles is in turns moving and thought-provoking, one of my favourite reads of the year. We are collectively lucky to have her wisdom and care. When she speaks on her subject, you are inclined to listen.

Then add the sense of crisis all around us. Every government institution that opens its doors to everyone who needs it (NHS, schools, courts, prisons, social care) seems to be short-staffed, stretched, demoralized, near to being overwhelmed. Years of funding cuts have removed many of the buffers that helped people outside of school, hospital, the doctors, the prisons. Then we were wopped by the pandemic, a national heart attack.

Stories have power to motivate and mobilise whole nations. This is obvious: think not just of Churchill’s speeches in 1940, or the Ukrainian president today, but also of the populists who by saying ‘Take back control’ or ‘Make America Great Again’ put heart into many people who were otherwise disillusioned (for good or ill). I was not around for the post-war Labour government but I am struck that despite national bankruptcy, trauma and loss they dreamed up a new nation, inventing the NHS and the welfare state. For all their faults and failings, they presumably at least partially captured a recovery moment and a recovery narrative.

What would a recovery narrative look like? How about something like this?

  1. We’ve suffered a pandemic – a quarter of a million of us died before our time and the nation stumbled to an eerie halt, locked up at home. This harmed and affected all of us.
  2. We’re still convalescing, nationally and individually. We’re fragile. We need to be gentle with each other and the failings all around.
  3. This is a moment for rebuilding. We can rethink how the government spends its money, what national thriving looks like and how to achieve it; we can be patient with schoolchildren and students who have lost years from their learning; we can bear inconveniences, so long as they are the inconveniences of living on a building site. We can put things in place today, in battered today, that will bear fruit in decades to come.
  4. Today we can make choices that will make higher and wider the lives of our children and grandchildren, even if we don’t see the day ourselves. A damaged generation, we can be an optimism generation.

And this should not be

This post doesn’t need a commentary really. I have an interest in youth justice and this landed in my in-box. 1 On April 26 2023, just a few weeks ago, the Chief Inspector of Prisons wrote this about His Majesty’s Youth Offender Institution at Cookham Wood:

An inspection of a HMYOI Cookham Wood in April 2023 found that a quarter of the boys were being held in solitary confinement for extended periods, including two for more than 100 days, as a means of managing conflict between children. Records showed that it was not unusual for these boys to not come out of their cells for days on end, with no meaningful human interaction, education or other intervention. At the time of the inspection, 90% of children were subjected to ‘keep aparts’ meaning they were not allowed to mix with some of their peers, and staff were managing 583 individual conflicts in a population of 77 children.

Children told inspectors they felt unsafe, and were increasingly resorting to carrying weapons, many of which were made from metal which boys had scavenged from equipment in their cells, including kettles, in a bid to protect themselves. More than 200 weapons had been recovered in the six months preceding the inspection, despite inadequate searching procedures.

Cookham Wood was in a poor overall condition, with dirty living units and broken equipment. Prison staff were exhausted, with significant shortfalls on wings, and, while many clearly cared about the children, they felt unsupported by senior managers and had given up hope that improvement was possible. Four-hundred-and-fifty staff were employed at Cookham Wood, including 44 directly employed managers, of whom 24 were senior leaders. The fact that such rich resources were delivering this unacceptable service for just 77 children indicated that much of it was currently wasted, underused or in need of reorganisation to improve outcomes at the site.

The findings of this inspection represented the culmination of a steady decline in standards documented in inspections since 2016 that cannot be allowed to continue.

I’m glad we have a Chief Inspector of Prisons, that their work is public, that (on government directions) they require immediate action from the government, and that we ordinary people can write about this stuff without people turning up in vans accusing me of ‘insubordination’ or ‘spreading instability’ as might happen in many countries. I’m glad there are caring people at Cookham Wood and others who will campaign and fight. I’m glad we don’t incarcerate that many children (fewer than 1000 in the whole country). But the good news stops somewhere there.

The gift of curiosity

Image by Pexels from Pixabay

I have realized that I hide from people who have too much certainty.

This is largely confined to people with a Christian faith, probably because I hang around with them a lot of the time.

But I have learned to dread them. Like Russian battle tanks, they approach, waving their whatsit, ready to turn their turret on anything that departs from the Doctrines of Grace, ‘the faith once-for-all delivered to the saints’. They’re good at it too, and I feel myself shrivel as they gun for my theological loose thinking.

I think I’ve always felt this dread, so it is unlikely to be a virtue. When I was a young Christian I remember the pastor of my then-church say during a sermon, ‘I was reading C S Lewis recently and I’ve found the error in him.’ Given that their relative intellectual attainments were as different from each other as a sideboard is from a lunch-box, I did not feel this was an especially wise thing to say.

Where is the curiosity? Where is the head-in-shower joy in discovering that you are completely wrong? Where is the zest for learning, and growth, and change? Where — we might add– is the humility, the poverty of spirit? It is not that there isn’t certainty in the Christian faith — there is — it is that people can get carried away and have too much of it, in too many areas, and it isn’t pleasant to see; gracelessly and proudly defending grace.

While all the while, shafts of truth can flash from completely outside the Christian space, or from theologically-dubious people within it, and do us the world of good.

I think of Isaac Newton’s famous quote:

I do not know what I may appear to the world, but to myself I seem to have been only like a boy playing on the sea-shore, and diverting myself in now and then finding a smoother pebble or a prettier shell than ordinary, whilst the great ocean of truth lay all undiscovered before me.

That was Isaac Newton. Meanwhile Russian tanks are proving a bit vulnerable, much better parading around the place than seeing real action.

The perils of music

Especially if you’re trying to avoid invisible beings

It can bite. Photo by Raúl Cacho Oses on Unsplash

I had to write an article recently about what happens to people who leave God and God-stuff alone 1.

I wrote about my suspicion that God doesn’t leave them alone.

One culprit was music:

Perhaps this is a stretch for some of us. But theology teaches us that music is a shared feature of heaven and earth. Both realms ring with song, heaven more so than earth, and for a reason. Think of an orchestral or choral performance: unity, diversity, individual gifts, some performers with a great range and others just bashing triangles at appropriate moments, all blended into a completeness that is not static or boring, but fluid and dynamic; at its best, an ever-flowing perfection of fulfilled performers harmonizing together. Isn’t it, can’t it be, a heavy hint of what God and his people are destined finally to be? When you hear or perform music, are you distantly echoing what the divine is and does? Are your expressing a desire for something greater than what you have now? Are you reaching for transcendence? If I may say so, I think you may be. Even some of the most hard-boiled atheists I know seek transcendence in music.  

Food for thought.

The future of Christianity and the view across the worlds

pixabay

Fascinating quote I came across from an unpublished paper called The Future of Christianity 1

When you give an honest account [of how] your life was encountered by Jesus Christ, and how that encounter has brought you to your present vocation and ministry, the witness of a Sri Lankan Catholic Bishop, a Pentecostal pastor from Peru, a bearded Coptic monk from Los Angeles, a Bolivian Baptist catechist, a Methodist nurse from Norway, or an Anglican woman Bishop from Canada, sound remarkably the same. And each carries a palpable integrity. And from such encounters, I have seen real friendship develop between such former bitter rivals bearing fruit in common service to the poor and marginalised as they continue to meet.

Robert Gribben, writing about the Global Christian Forum.

He concludes:

A future for Christianity? On God’s side, an assured yes. On ours: if we watch and pray, listen and learn, discern and discover, within the extraordinary diversity of the oikoumene, if we are ready to be radically changed  – that is, to grow again from the same roots -will not God honour that?

That surprising Mr Warnock

Just read a fascinating article about Raphael Warnock, Georgia’s freshly elected Democratic Senator.1

Mr Warnock is still a pastor, of Martin Luther King’s old church in Atlanta. He has, it seems, a fresh take on the tired left/right, liberal/conservative tropes that like leaden wordclouds, rain down on our politics both in the UK and the US. There’s just a sniff of Advent hope about him. Here are a few quotes:

‘Democracy is the political enactment ofa spiritual idea, the sacred worth of all human beings.’

‘A vote is a kind of prayer for the world we desire.’

Martin Luther King, he says, ‘Used his faith not as a weapon to crush other people, but as a bridge to bring us together.’ Now there’s an idea.

He is a kinder sort than is typical among democrats, seeing the Jan 6th sackers of the Capitol as people who had suffered the ‘violence’ of poverty, ‘a kind of violence that crushes all the humanity of poor people,’ but who retaliated badly and mistakenly. I’m not myself a massive fan of stretching the word ‘violence’ to mean ‘any bad stuff that happens to people’, but still, this reaching out in sympathy to the illiberal is notable if only because it doesn’t represent a default setting for Democrats in my observation. It’s something a little new, loving his enemies. He reiterates:

‘There’s a kind of violence of poverty, a failure to recognise that there is enough in God’s world for all God’s children. There’s no poverty of possibility. There is a poverty of moral imagination.’

Interesting.

Everything we touch

Photo by Ruthson Zimmerman on Unsplash

We’ve noted before in this blog that we humans are all spliced together: what we do, even what we believe, is steered by the people around us. It’s been measured and proven to crazy extents: if you are slim, or self-harming, or right-wing there is a measurable effect on the slimness, self-harming tendencies or right-wing views of your friends’ friends’ friends.

And none of this is static. As we go about our days, all of us are processing the views of everyone else. The whole human network is humming to itself, tossing thoughts around.

If we had clever software, or a suitable imagination (another novel, anyone?), we could watch opinions flood through the human network like the networked pulses of neurons they are. Surveys catch some of it: see how cultures change their views on marriage, divorce, violence. Flowing through the human network are endless upgrades to human cultures. Like software upgrades, some of them are even worth having.

Who changes the network? We all do. We all do. Everything we touch, every word we speak, every response we make, filters into the humming background of inter-human processing.

The implications of this for those of us who seek to be shepherded by Jesus Christ are enormous. I have just finished reading the Letter to the Philippians in the Bible, in my attempt to read the whole NT in Greek, and I noticed that the apostle Paul got this. He thought like a networked being. My imprisonment makes other people bold, he says. What’s happened to me has stiffened the spines of others. And later on he sails into that magnificient passage: whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable—if anything is excellent or praiseworthy—think about such things. 9 Whatever you have learned or received or heard from me, or seen in me, put it into practice. 1 He was encouraging his hearers to bear the image of Christ themselves, and to praise it in whatever unlikely spots they saw it.

The sticky, fluid culture

A hugely cool thing about influencing networks is that things can stay set up for generations. Our imprint on the culture outlives us. What we are and how we believe and behave, as a nation for example, bears the imprint of culture-changers long-departed. As one of the 16th century Protestant martyrs said to another, as the barbecue underneath him was being lit: ‘we shall this day light such a candle by God’s grace in England as I trust shall never be put out’ 2 –and nor has it.

I recently read the resignation letter of the UK’s Lord Chief Justice. He said this: ‘I have been honoured to lead a wholly independent judiciary dedicated to the rule of law, the administration of justice and public service which confidently celebrates its traditions yet has quietly assimilated very many modern working practices.‘ Having worked in bits of the justice system over the years, I tend to agree with him. The judicial types I work with are passionate about justice, rather than, for example, using their position to leverage money from claimants. Who set that culture up? Who maintained and refined it? Generations before us, I suppose, and (while it can be corrupted) it has been embedded and passed down to the current lot of wig-wearers.

The great subversive

Everything we touch or talk about. It’s Advent as I write this 3, and so we’re thinking about the Incarnation, and it makes a lot of sense that God, wanting to reclaim the human species to himself, should deploy the tactic of becoming a single fertilized cell– undermining the whole human network by being born to a teenage mum and raised in a peasant village; embedding himself in the network. As we see churches spreading or having spread through the Mediterranean, through Europe, through all the Americas, through sub-Saharan Africa, and the Pacific, across the Philippines and China and Indonesia, and now in various irruptions across the Islamic world, and with Christ now standing as a kind of Morning Star for a third of the earth’s inhabitants–his subversive scheme seems to be working.