Archive for February, 2010

Violent past

I think Sunday afternoons are there for a reason. Sofas and books.

At only 100 pages Living violently in a gentle world is a good afternoon’s read.

Stanley Hauerwas is becoming a firm favourite of mine.

The book covers the work and theology  behind l’Arche communities, largely the work of Jean Vanier.

The basic thrust of their work has been to develop communities of people with and without intellectual disabilities to share a mutuality of care and need.

The attempt has been not to provide service to those with disabilities but to provide a community where both benefit.

All of this is founded on some of the most basic gospel principles – that the gospel breaks down divisions amongst our humanity, and significantly that the gospel inverts the who’s who of our society.

There is a story told in the introduction of a deaf woman who re-tells a dream where she meets the risen Jesus in heaven and the incredible powerful experience it was. But the most exciting comment she made was that she was really excited that Jesus signed exceptionally well.

I have always held the belief that I, in all my functioning physiology am normal. That people with disabilities such as deafness are abnormal. I believe that the gospel tells us that GOD plans to restore us, that he is making all things new and that the state that I know as abnormal will be no more.

But one read of the story that Jesus signed in the dream turned things on its head – who am I to think that I am normal? Who am I to think that when GOD makes someone who is deaf new – that he will make them like me?

Without doubt the new creation will end the negative implications that go along with the term disabled. Partly because I will finally realise my own disabilities.

But if the new creation only has the power to make someone like me then I’m going to be really disappointed.

Hauerwas and Vanier describe people with disabilities as holy because they represent GOD’s character, they represent Jesus. In these people they find the gentleness that comes with powerlessness that the church so desperately needs.

It is a well argued and perspective shifting book.

I’ll end with a prolonged quote from Hauerwas because it’s health care related and states more clearly than I could a lot of what I have been saying about medicine for a number of years.

After all, “progress” we assume means eliminating what threatens to kill us or at least slow us down. You can cure cancer without eliminating the patient. You cannot “cure” the mentally handicapped without eliminating the patient. L’Arche stands as a reminder that “progress” should not mean eliminating all that threatens us.

Modernity gets us caught up in some funny contradictions. For example, in the US we now spend between 15 and 17 percent of the gross national product on crisis-care medicine, which of course has little to do with the health of the population. If we’re interested in the health of the population, the most important things to focus on are windows, sewers and good nutrition. Crisis-care medicine is not going to keep us alive. It may keep someone alive for 6 months but it is not going to improve the health of the population.

This is controversial stuff no doubt. This is writing myself out of a job. I am crisis-care medicine. But my job has little to do with health, little to do with living life dare I say it.

I love my job. I am just sceptical of the role society (and the profession itself) has given it.

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Mission of GOD – 4

In my university years I spent a lot of time playing guitar with a bunch of folk at various Christian events. These were good times with occasionally great music and always great banter.

One of our more regular gigs was a PCI event called Route 66. The banter was good but I specifically recall learning quite simply huge things about the very basics of scriptural understanding.

One of the most memorable series was by Andrew Smith (formerly of Dun Laoghaire Presbyterian) on covenant. I still have the CDs. Cracking stuff.

The repeating motif of the phrase “I will be their GOD, and they will be my people”.

And this is where Chris Wright takes us now.

After a brief mention of the covenant with Noah (and skipping over the sometimes suggested covenant with Adam) he gets to the most well known covenant – that of GOD with Abraham in Gen 15.

The covenant was made with Abraham in order to fulfil the mission of GOD – that is “to bring blessing to the nations.”Again this brings up the point about Israel’s election being something done in the interest of the nations and not as GOD’s rejection of the nations.

The chapter traces the covenant promises in all their forms and developments, through Moses and the law and the horrible depressing inevitability of the coming failures declared in Deutoronomy; onwards through the time of the Kings and into exile with Ezekiel’s concern that perhaps the covenant is now no more.

The covenantal theme is the great story thata underlies all of Israel’s identity and is implicit throughout the NT texts and both Jesus and Paul’s words.

This is most clearly articulated at the last supper (the point of rememberance for Israel that GOD keeps his covenant) when Jesus declares that he is the new covenant.

It is traced all the way through Paul’s writings and into Revelation – the final declaration that the Mission of GOD is now – mission accomplished.

Mission then, as articulated in the Great Commission, is the reflex of the new covenant. Mission is an unavoidable imperative founded on the covenantal obedience to CHRIST among the nations. And it is sustained by the covenantal promise of the perduring presence of CHRIST among his followers.

Superconnected

I have a tendency to be over prepared. I think I was ready to marry Transfarmer on the basis of the first email she ever sent me. Or maybe that’s presumptuous, not over-prepared.

I like being organised. I like lists and plans.

Having decided a date on which to move out of my current house I phoned BT to try to set a date for closing my account and eventually through their monolithic website got in contact with a nice lady who agreed to terminate the contract on the agreed date.

Three days later my phone line gone dead. Not the three months I’d intended.

So I gradually got more frustrated with the BT website – which loudly proclaimed there was no problem with my account but unfortunately their online line tester was malfunctioning. I reported the fault online and checked the next day to see how it was coming along to find there was no record of a fault on the website.

The web is all well and good – when it works.

So after 30 minutes via Bangalore and back again on the phone I get to speak to someone who recognises the cock up and agrees to reconnect me the same day.

All well and good.

At least till I try to reconnect the internet. And I find out that BT disconnecting me has also disconnected my broadband connection and Plusnet need 65 pounds to reconnect me (which I presume is a charge BT make to Plusnet).

I spent all evening rehearsing how to phone BT and shout and give off and demand recompense for their cock up. I fell asleep thinking that “nah, I can’t be arsed, they’ll just say it’s a third party problem and deny any responsibility…”

I got a phone call today from a lovely wee Northern Irish BT woman today who was following up on all the attempted fault reporting I’d tried on the BT website. She was a little bit behind the times and not aware that I had been disconnected and reconnected but was very lovely when I hinted that maybe BT should pay the 65 quid I forked out.

So the email and receipt has been emailed and I await their response. I’m almost tempted to be optimistic about it.

What to learn and where to learn it

I am a big fan of the use of ultrasound in emergency medicine. It appears to combine my previous statement about liking medicine and technology.

There has been an explosion in published work on it and it seems that there’s nothing in medicine that you can’t stick and ultrasound probe on.

And what I like about it is the sheer availability of resources on it. Go to You Tube see what you can find. There are a range of web sites providing quality videos and tutorials – all for free.

This is open source at its best – this is what these guys are all about.

I have quite literally done things to my patients solely because of stuff and skills I learnt off the internet.

The other day I used a technique I learnt from an online journal article to glue a friend’s child’s head closed using only superglue and hair as suture material.

I started using a whole new way of anaesthetising hip fractures following guidance I found on You Tube.

I am a big fan of being self-taught. If you are willing to put the time and energy in, you can attain all kinds of skills in medicine away from any training programme.

Now of course there is a right and proper process to go through to ensure safe application but the knowledge is free. Just get out there and look.

Pictures of You

I like technology. I like medicine. I should have been a radiologist. I’m in the wrong career. I realise that now…

In the real world of the 21st century you have computers, most of you do all your work on computers. All your records are on computers.

Not so in medicine, at least not in Craigavon Hospital…

Currently when you arrive a reception, your details are booked onto  a DOS based system (with lovely red, green and black colours) and a dot matrix printer prints them on a triplicate carbon copy sheet that I make my notes on when I’ve seen you. Those of you were there in the eighties will know what I mean by all that.

I make notes with a shaft of plastic filled with ink called a pen. I make odd, uninterpretable symbols with this device that communicate what has happened during your stay.

When you leave, the various bits of the triplicate carbon copy go to various places in the department and are stored in reception in little cardboard envelopes in a big machine that rotates.

If I want to look at those notes then I have to turn the big machine and find your name in alphabetical order and read the piece of paper.

And this is just the emergency department. You should see the main hospital notes –  a chaotic mass of dog eared cardboard and paper filled with poorly timed and dated illegible nonsense about physicians rubbing their hands over whether to give you 2 or 4 litres of oxygen a minute.

This is current practice. It shows little sign of changing.

However when it comes to the fancy pictures we take we have moved on somewhat. Someone decided that perhaps digital storage and display of the images produced by small doses of something similar to what pours out of Chernobyl, would be a good idea.

In many parts of the western world, and many parts of Northern Ireland this is already happening.

Our wonderfully effective and always sensible devolved assembly decided that they would make a ton of money available into implementing digital radiology over the entire province. All so that I, in Craigavon can see the x-ray of your big toe that you had done in the Royal Victoria Hospital 2 weeks ago.

One would think this is simple.

It has required employing full time staff to solely dedicate themselves into working out how to do this. It means lots and lots of hi-res screens and computers being installed and lots of negotiations of where to put them, and lots of arguing on whether or not we’ll be allowed to show World Cup matches on them…

I was at my first implementation meeting today –  lots of people asking lots of really useful and important questions about what we do when the computers crash (not if but when), are we going to keep a printer somewhere as back up? What do we do with all the locum doctors who come – are they going to have log-ins to use the system?

We go live – or dead – March 29th. It’s like the day the new doctors start – stay away from the hospital.

Old soul song (for the new world order)

[Just as a preamble – no doubt you are aware of this but one of the sinle biggest determinants of health at all levels is your socio-economic background. And this does not just mean access to clean water and vaccines, it is also true in the affluent west.]

The world health organisation is an odd beast. It swings between saving millions of a lives a year with WHO solution and then trying not to get bogged down in arguments about how to redefine a heart attack using expensive biochemical tests, unavailable to the majority world. They even have a topic on CJD, which while potentially terrifying has not exactly set the world alight. And again largely irrelevant to the majority world as you have be able to afford meat to get it. Incidentally cannibals in the south pacific who eat the brains of their victims have a whole different topic.

But they do come up with wonderful things like this that articulate lots of what is wrong with the world and how to go about making an impact on it.

The BMJ covered it this month and made this great video [i’m afraid i can’t work out how to embed so you’ll have to click the link] with Micahel Marmot (incidentally the next head of the British Medical Association)

I like this guy. I’ll quote him:

…medicine, and in particular surgery is just failed prevention…

and

social injustice is killing people on a grand scale

My favourite quote (in relation to finding the funding) was this:

…we can find 2500 billion dollars in no time at all…

He refers to what was found in a matter of days to “fix” the financial crisis. He suggests a good start would be using 100 billion to upgrade the slums – where 1 billion people live.

[note it will take 10 billion dollars to provide clean water to the entire world]

He sees the financial crisis as an opportunity to make an impact on social inequality – now is the time to look at how we do our economics and how it affects the world. He suggests that our current method of unregulated markets has been repeatedly shown to fail and now is the time not to repeat it.

Monkey gone to heaven

I love this place

Man bailed as lemurs seized


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