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.)

We don’t know if we’re going, but we’re going

In which we try to understand History

Is there anything beyond the next banana? Photo by Giorgio Trovato on Unsplash

Are we going anywhere? Are we nearly there yet? The fun thing about blogging is that you can attempt subjects in which you are completely and entirely out of your depth.

This has all happened because I was listening to a set of lectures on St Augustine’s City of God, as I have written elsewhere.

The question is easy enough to pose: are we (as a species, or even as an entire created order) going anywhere?

  1. First let’s congratulate ourselves. No other beasts or plants are asking this question. Even our brother apes appear not to worry much about the tides of history; they are happy knowing where the next banana might come from.
  2. One possibility is that history isn’t going anywhere: it’s just random, pointless noise.
  3. A second, more popular I think, is that it is in some sense cyclic: the rivers pour into the sea, but the sea is never full; what comes around, goes around; no-one can ever say, ‘this is new’; that kind of thing.
  4. A third, beloved of Christians, Muslims, rationalists, communists and many cosmologists among others is that history has a direction, it’s going somewhere. Some science fiction too: ‘Space,’ said James T Kirk, ‘The final frontier’: the universe is a giant unploughed prairie, just awaiting the covered waggons, and that is our story and destiny. The idea of ‘Progress’ and ‘Progressive policies’ still resonate, and when we see the decline of poverty and the advance of medicine worldwide, we can sort-of believe it.
  5. It’s possible to argue that this idea of history having a direction, a start and an end, originated somewhere in the Judeo-Christian scheme.

Augustine saw history this way. For him, history had a direction and the big clue was the incarnation of Christ, when the beyond-time God hitched himself to the time-bounded creation. There was a time before this happened; there is a time afterward; there is a direction for the future.

It must be very bad form among proper historians, I imagine, to believe this. But I think it is Christian orthodoxy. History is about conception, resurrection, consummation, all around Christ, all about the timeless God involving himself with his creation and eventually filling it out with love and making it whole.

Surely this idea can be criticised all over the place. But it does give a point to each of our individual lives. The point: everything we are and do now that anticipates, outlines, foreshadows or even hastens that consummation has point and value. Everything that doesn’t, doesn’t. Not only does history have meaning and direction, our each individual moments have too–and they revolve around love.

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.

In praise of great courses

What listening to good lectures is really like. Photo by Jonny Gios on Unsplash

This is an unashamed plug for Audible. After a long time protesting that the only way to get audio books at a good price was to join Amazon’s equivalent of a book-of-the-month club, we finally capitulated few years ago and signed up.

One book a month is more than I would like to buy. There are still such things as libraries that give you books for free. But to sweeten the deal Audible also offers free books that are additional to your subscription, and I think these disappear from your personal library if you ever stop paying your £7.99.

Somewhere along the line, Audible appear to have bought a whole catalogue of courses that used to be marketed separately as ‘The Great Courses’ ; and they added some of these to their free offerings. They are lecture sets, from able and obsessive communicators, and like most lectures I’ve ever been to, I enjoy the feeling of dining at a rich person’s table, even if I don’t belong there, and soon forget most of what 1I took in.

They are so good. I tend to listen to them while I work through a keep-fit programme, which, as anyone who does this kind of thing will testify, is among the most boring activities on earth. Unfortunately it’s also a kind of investment in health that you get compelled to make.

So, the Great Courses, to distract from the zombifying act of personal training. Like I said, they are so good. Here’s what I’ve listened to so far:

London: A short history of the greatest city in Western World by Robert Bulchoz. Wonderful story from a lecturer (I think) at Loyola University in Chicago, who in my listening never put a foot wrong in his knowledge of the city, told me huge amounts I didn’t know, and gave me the little warm glow that happens when someone from the outside praises a thing you love from the inside.

Classics of British Literature by John Sutherland. Another survey of the UK by an American lecturer (if I remember right), starting with Beowulf and ending in somewhere in the 21st century. He has evidently read everything and slotted it into its historic context. Absolutely wonderful. Wish I could remember 90% and forget 10% of this rather than the other way around. His only fault was not talking much about Anthony Trollope.

The world of Biblical Israel by Cynthia R Chapman. So nice to hear Biblical studies from a Biblical scholar who isn’t aggressively trying to undo and unpick the Bible, or indeed aggressively defending it, but rather treating it as a thing that is there and explaining it with respect.

Understanding Complexity by Scott E Page. This was somewhat nearer the maths and physics that I failed to understand as an undergraduate. An introduction to the theory of complex systems, with entertaining divertissimos (if that’s the plural of divertissimo) into how complexity theory should be applied to the life we find all around us. Complexity is why economic predictions are always wrong and why (I think) a drug that did me a lot of good when I took it for a season nearly killed me when I went onto a second course. Drugs and human interactions are not simple, they are complex. Doing the same thing a second time can have the reverse effect to what it did the first time. I wish every politician and civil servant who tries to manage a complex entity like the UK, and every physician who tries to solve human body problems would listen to this.

Augustine: Philosopher and Saint by Philip Carey and Books that Matter: The City of God by Charles Mathewes. Two majestic introductions to the life and thinking of the North African saint and ‘Doctor of the Church’. I’m still working through the lectures on Augustine’s great work ‘The City of God.’ I’m used to physics and so I’m aware how Copernicus changed the whole way we think about the solar system, how Newton did the same for physics, and Einstein did it again for cosmology, and the founders of quantum mechanics did for quantum theory. I didn’t realize that Augustine had done much the same for Western theology and perhaps even historiography. This is well beyond me. But even the bits I do understand are revolutionary.

I believe no-one should ever listen to a lecture or read a book because it’s ‘important’. You should only ever tackle anything if it’s fun, a rollercoaster. These were.

  1. ↩︎

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.

Populist bingo

After another heavy day on the Select Committee. Ashish Upadhyay on Unsplash.

And so Boris is gone, sulking, in a spray of adjectives and grievances.

In the USA, justice is chasing down President Trump, suspected of hiding documents in his toilet.

The populist First Minister of Scotland has fallen, with the cops sniffing around her house and looking for (among other things) a motorhome and a wheelbarrow. The suspicion (still unproven and hotly denied) is that the Caledonian Cabal made off with party funds to buy a wheelbarrow. This is a misuse of the misuse of funds. If you’re going to misuse funds, I mean, don’t do it at B & Q.

Over in Russia, let us hope, the authority of the president is pouring away like the water from a (former) Ukrainian dam.

Let us play populist bingo. Cross off the words when your favourite populist departs:

Witch-hunt

Kangaroo court

I did not lie

Not a shred of evidence

I am innocent

I was saying what I believed sincerely to be true

I take my responsibilities seriously

They have wilfully chosen to ignore the truth

I am now being forced out of Parliament by a tiny handful of people

A political hit job

I am bewildered and appalled that I can be forced out

Anti-democratically

Egregious bias

A phrase book for your convenience

I’m also providing a phrase book since language means a different thing on whatever planet the populists’ heads reside:

‘Tiny handful of people’ = A majority of the House of Commons, of the consituency, and of the whole country.

‘Egregrious bias’ = fact-based

‘Anti democratically’ = democratically

‘I am bewildered and appalled that I can be forced out’ = I am bewildered and appalled that I have to obey the rules

‘They have wilfully chosen to ignore the truth’ = They have wilfully chosen to follow the evidence

‘Not a shred of evidence’ = pants round ankles, hand in the cookie jar

Bananas for free!

Hello you,

Your book is wonderful! I do hope that it is very widely read.

|Prof. Sir Colin Humphreys CBE FRS, Cambridge University

A slightly out-0f-time blog entry with the happy news that my book More than Bananas is now free again on Amazon. So you can read it on your Kindle, or (as I do) on your phone with a Kindle app.

The joy of free books is that people can sample my stuff and then if they wish, part with coinage for the next titles in the series. It was free on Kindle a while ago, and became a worldwide theology bestseller, which helped me feel good if nothing else. So I’m so glad it’s back, with the great joy of anyone being able to help themselves to it for nothing.

Audio fans can listen to my reading of the book as a set of podcasts.

Please enjoy and tell your friends.

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.

A vote is like a prayer

Maybe we won’t bother with voting. Image by Mystic Art Design from Pixabay

OK, so what is the difference between a nation and an organized crime network?

Sometimes, not much. I understand the civil conflict in Sudan (and the one in Libya too) is between two people who would like to be president. They are not fighting to set the nation free from tyranny; they’re just unhappy with someone else being the tyrant. The winner will join the world of gold-plated bathroom fittings on a personalized jumbo, and can conveniently use the army, the courts, the prisons and the police to make sure the racket continues.

(There is, or was, a wonderful democracy movement in Sudan that toppled the old tyrant but the would-be replacement tyrants unfortunately have lots of guns.)

Our own history in the UK shades this way sometimes. When our soldiers went around Ireland or India collecting taxes in a famine and hanging those who declined to fill out a tax return, which did we look like more? A nation or a criminal gang?

Augustine addressed this problem in the City of God (book 3-ish?), applying it pointedly to Rome, which was rather proud of being a nation and an empire. I believe his solution was that a nation is only a nation when it has a principle of justice for all the nation’s stakeholders. Everyone gets a say. In his context, that included God, since Rome was officially Christian by then.

Including God makes slightly more sense of our recent coronation, which seemed to me a thing wobbling indeterminedly between a national bowing to God and an old man sitting on an old chair holding a ball and a stick. But even including God doesn’t seem to be quite enough on its own. The Iranian republic is big on God but his role seems to be a big stick – as used by the clerics to hit people with. Unless you include the people who don’t do God in the decision-making, I’m afraid I’m not sure you can only trust those who do.

Eventually, I think, we have to get to democracy, that rambunctuous process that tries to act on those those weighty words, ‘We, the people‘. The people are the employers. The rulers have to reapply for their jobs every few years. The tyrant says to the people, ‘You work for me.’ The democrat says, at least in principle, ‘I work for you.’ So slow. So messy. So prone to spasms of populism. So ugly and unseemly and cruel and abusive and vulgar at times. But not a criminal gang most of the time, because everyone over whom the nation rules has a say in who rules it. We, the people.