Archive for August, 2010

Something good can work

I got 50 pages into The Beauty of the Infinite and gave up till my PhD arrives. So the following comes with a definite limit on  what has been previously said and accepted on the subject of beauty

My current stance is this:

Often I find that things are beautiful because they are functional.

Beauty is a big complex word. I claim no authority on what smarter people than me have to say on the matter.

I see beauty in lots of places (link is my favourite beach where I lived in New Zealand) were functionality has no role. But then sometimes I look at my Volvo with the seats down and I get a little teary at the beauty of it.

Now the simple answer to this is – it’s a bloody car, stop your crying you big fairy!

The slightly more complex answer is that I confuse beauty and functionality. So why do I like things that work?

[I also may be confusing good with beauty so feel free to substitute the appropriate words…]

My basic argument for functionality as beauty is the idea that God’s purpose in creation was to bring order out of chaos. I (think I) learned that from NT Wright and some people here.

Things that are functional bring order of the chaos of my life. And if creation is beautiful and creation is bringing order out of chaos then my Volvo is beautiful. Though by such reasoning if beauty is truth and beauty is in the eye of the beholder then truth is in the eye of the beholder too. Hmmm.

You can hold off on giving me the PhD in theology for now.

Talking about this with Zoomtard he pointed out the obvious problem with my argument:

Yes my Volvo may bring order out of the chaos of all the stuff that I own and need to move around but it doesn’t deal with the problem of stuff in the first place. Stuff takes over our lives and produces chaos and mere functionality does not solve the problem which comes from further back down the line.

At the time we were (or rather I was) talking about simplenote and how I loved it as a free open source way of keeping all my little important bits of text organised and how the cloud is such a wonderful concept.

In that context bringing order to my digital world is perhaps good in itself but let’s face it – my digital world is entirely superfluous to my existence as a glorious and fallen eikon of God.

So perhaps my Volvo provides a slightly better argument that f you’re going to try and bring order out of a chaos that doesn’t need to exist then you may as well use a 15 year old Swedish car that works.

The beginning stages of…

[Brief note – this is not intended as any kind of commentary or criticism about the hugely controversial and emotive issue surrounding beginning of life issues. If I seem flippant it is not my intention]

In preparation for the new job I’ve been doing a bit of reading. I’ve even covered the most feared of subjects – molecular biology. Remarkable what your brain can learn only to forget entirely, and how quickly it comes back when you read it again.

I’ve also covered some embryology which I find one of the more mind-boggingly amazing parts of our existence. Sure all kinds of mammals do embryology they just don’t grow up and study it and reflect upon it.

In work (Emergency medicine – my real work as I call it) we see lots of concerned young women who are in the really early stages of pregnancy (say 6-8 weeks) who turn up with some tummy pain and a bit of bleeding (say less than a period). They’re all concerned that they’re having a miscarriage. Which indeed many of them are. Once I’ve satisfied myself it’s not an etopic pregnancy – which is what will kill them if I miss it – they generally go home with some follow up with the gynae folk. Some of these women will go on to miscarry (though certainly not all) and I tell them this and explain that 20% of early pregnancies miscarry and 95% go on to have a normal pregnancy in the next couple of years.

But in reading about the staggeringly tiny collections of cells that go on to be embryos and foetuses and babies and toddlers and all the varied parts of our humanity – I was thinking surely lots of these pregnancies/conceptions never make it to a missed period (the usual reason people do the pregnancy test in the first place).

This study looked at just that (back when I was already 7 years past the most risky part of my life) measuring pregnancy tests daily on women who were trying to get pregnant (however you do that… I’ll ask Wylie…).

They found lots of sub-clinical pregnancies (enough to cause a big HCG rise – ie implantation – but failing before anyone missed a period) that mis-carried before anyone thought they were pregant. Overall 30% miscarried and 70% of these were before anyone thought they were pregnant.

When combined with another study it’s estimated that 50% of conceptions do not result in a live birth. This surprised me – I imagine because this is one of the things that I was told in medical school but wasn’t paying attention at the time. On reflection that was probably most of the time.

So maybe it is possible to be a little bit pregnant after all.

Old old fashioned

Some of the more wonderful people in my life bought us a wee holiday to celebrate our marriage.

This was all planned some time back before the wedding and I knew we were going somewhere but knew none of the details.

We had a little brown envelope with spending money, directions and a USB drive with details and a 2 and a half hour podcast from the gents themselves to keep us entertained on the drive. This was above and beyond the call of duty.

It was so good in fact that I didn’t want to pick up a gun and murder someone when Lady in Red came on.

Our destination was here.

The wonderful Hay-on-Wye.

Despite the misleading advertising above, the town is quite simliar to other towns and has houses made of bricks and mortar as opposed to books. You can tell I was disappointed.

And despite the sign saying welcome to Wales, this is one of the most English-feeling towns I have ever been in. It even had a Conservative Club with a portrait of Winston hanging in the hallway.

The pub we had dinner in had a portrait of someone who just may have been Maggie Thatcher but seen in a good light through beer goggles.

Maybe it’s a fair statement that all the best bits of England are in Wales.

They must get a bit pissed off being lumped in with the English all the time. Every time there’s a national report on the state of whatever it’s always for England and Wales combined and Scotland gets its own report and our esteemed leaders in the North haven’t agreed on anything long enough to even do the report.

Seems a bit of a shame for a country passionately pursuing a Welsh culture and language to be amalgamated at almost every level.

We stayed here which was absolutely bloody lovely and comes highly recommended. Incidentally its Sandy Toksvig’s favourite B&B so we’re in good company.

It’s so authentic as an 18th century house that the floors and the ceilings aren’t entirely level. There’s even a tiny door in the wall that opens into the greenhouse for ventilation which has a little figurine inside it.

The bedroom felt a little like the inn in The fellowship of the ring when the Nazgul come in and stab the pillows in the beds.

Hay-on-Wye is famous for its book festival. So famous in fact that i had no idea till someone told me.

There are 30 second-hand bookshops in a fairly tiny space.

There were even “honesty” book shops which were just shelves under tarpaulins where you could just leave 50p and walk off with such a high quality book such as:

But when you’ve got one you may as well get the sequel:

Second-hand bookshops are wonderful places but you have to realise the sheer staggering amount of trash and nonsense you have to browse through to find a gem like the obsucre Vonnegut you were looking (Goddamnit you gotta be kind…) or the third copy of Gilead that you really need (it was only £1.50…).

The shops themselves are fairly intriguing with lots of old broken down sofas, often with a cat asleep on them.

There were of course other attractions like this:

and this:

But I was mainly excited about getting a go on this:

Which I duly did:

All in all a cracking wee holiday. Cheers muchly lads.

Life in technicolour

Worth viewing if only because I believe that people were actually black and white before 1950.

The impossible dream

I have this dream that I get sometimes.

Dad is alive after his surgery, back in the good period when he could cut the lawn and paddle a bit in the canoe.

And it’s all great.

And then I realise in the dream that it’s about 3 or 4 years from his diagnosis and he’s still alive and he’s doing great and you know what – he’s going to be alright, he’s cured.

Then I remember it in the morning and I know it’s not true.

Sucks.

Timestretched

I was back in work on Saturday for another shift and some time on-call.

It was lovely actually, which always surprises me. Good bunch of new docs and it wasn’t as crazy as it often was. I came away having made a lot less of the compromises that I normally have to make that make me hate the job.

Our esteemed leadership had put this up in the tea room:

Many of you will be aware from this blog and general knowledge that we have a target of 4 hours from when the patient arrives at the ED until they are disposed of (an appropriate term for a target that dehumanises patients that much) at either admission to a ward or discharge.

We have lots of patients who breach on a marginal basis eg they get admitted at 4hrs 2mins or something like that.

So in their wisdom and cunning the powers that be have decided that telling us the target has changed to 3 hrs 30 mins will help cut out these marginal breaches.

The target of course has not changed (for now). Surely they must know that we know that. Though perhaps the fact this poster exists at all is a testament to how stupid they must think we are.

Incidentally i think it’s a great thing that patients should wait less than 4 hours in the ED but not because of a target, simply because it’s the right thing to do. I bust my ass in work to see patients in less than 4 hours, not because of a target but because it is the right thing to do.

And yes I am a better person than you.

Wishful thinking

I used to be really good at introspection. I could spend a long time with my head up my arse thinking my life through. This had its disadvantages but you definitely learn a lot about yourself.

I was reading some of this today for the first time in months.

I cried. I suppose that’s understandable.

[Incidentally you’re right Ann – i did used to write much better]

Reading it seems like reading someone elses words. It’s like “aw remember when I used to be that person…”

Not in the sense that I reject that person or feel I have “moved on”, just that it feels different.

Back then I wrote this:

I’m not sure I’m entirely well. All this thinking has done me no favours, the perpetual worry has changed nothing. I always find myself thinking is it worse or better to know what I know. Tonight it’s worse.

Is this what an “anxiety disorder” feels like? Is this what “not coping” feels like? I am too used to being invincible, I am too used to taking responsibility and bearing burdens and looking out for people. I know how to do that. I think.

My fear, or maybe resigned acceptance, is that maybe this is just life, maybe this is just what loving someone means. That this is just the way it works when you love someone.

and even this:

I don’t plan too far ahead. I say no to every request for appointment, commitment or meeting. Thinking I’m too fed up of letting people down at the last minute. I’ve applied for a job I’m not sure I want any longer and living in a house I’m not sure I’m gonna want to keep and going on trips I’m pretty sure I don’t even want to go on.

I’ve committed myself to a life of bitterness and sadness and holding onto all my grief and resentment as I neglect every opportunity and gift that GOD leads me too.

I’m OK alone. It’s just everyone else I worry about.

And as I read it I remember what it was like to feel doubt and to feel out of control of something.

I haven’t felt that for a long time. I have become certain of my beliefs, and even certain of my doubts.

I have filled my life with opinion and reading and work and easy answers to difficult questions so that I at least have a sense, or project a sense of control.

Everything I set myself to do I approach with the opinion that I am well able to do it. I do not doubt what I have been gifted with and I have a clear insight into how other people respond to me (or how I can influence them to respond) but this is mere illusion.

We structure our lives to give us the impression that we are in control to deceive ourselves from the terrifying reality that our lives are fragile and our relationships and the things that bring joy are even more fragile.

I trust that my heart will keep on beating at 50 times a minute for the next so many years. I trust that my wife will keep on loving me. I trust that my friends will still want to be with me.

I am in control of none of these things. And they terrify me.

Sometimes life is just desperately hard and oh so painful. There is beauty, so much beauty and joy and truth and warmth but oh can it be difficult sometimes.

Loving people is difficult. They either hurt you (or you them) or sometime they’ll just not be there.

Being alive is just the most precious gift that we have and how casually we treat it and how easy we take it for granted.

I am not who I once was, even though I am and always will be who I am in my very being. We change but in the same way a child becomes an adult as opposed to the way a frog turns into a prince.

I never thought I would say this but I have neglected my “introspection” in the sense that I have not spent enough time in quiet gardens on sunday mornings enjoying the beauty of existence.

The call to discipleship – 8

On piety:

The witness of the disciple consists in the fact that he refrains from attesting his piety as such. If we are to display the kingdom of god and proclaim it from the housetops we will not make a show of our own devoutness but keep it to ourselves.

The call to discipleship – 7

With regards to the family:

The coming of the kingdom of god means an end of the absolute of family no less than that of possession and fame.

The call to discipleship – 6

With regards to force and violence Barth says this:

the decisive contradiction of the kingdom of God aginst all concealed or blatant kingdoms of force is to be seen quite simply in the fact that it invalidates the whole friend-foe relationship between one person and another.

If the world ends

This is the way the swine flu ends, not with a bang but a whimper

Note to self: Don’t die

Atul Gawande is an endocrine surgeon in North American who has a good way with words. For a doctor at least.

His two books – Complications and Better are a wonderful inspiration for someone who genuinely cares about how the job is done (as an aside if you were a dermatologist with similar passions you could never get the stories to make the books interesting. That seems unfair). His call to audit our practice – to measure something got me all excited about audit and research.

He made news headlines (with lots of other folk) with the surgical safety checklist. A mixture of almost comedic routine and common sense that should help stop the surgeon leaving his car keys in your abdomen.

He writes regularly in the New Yorker and this piece about end-of-life care caught my eye. Both morally and personally I have an interest in this.

On the inability of medicine to consistently “save lives”

We’ve created a multitrillion-dollar edifice for dispensing the medical equivalent of lottery tickets—and have only the rudiments of a system to prepare patients for the near-certainty that those tickets will not win. Hope is not a plan, but hope is our plan.

The USA spends a colossal amount on people in the last 6 months of their lives. This would be great if it helped them but it’s not clear it does. The following comment belies the different attitude between the UK and the USA on ICU admission. I worked in ICU for a over a year and we were deliberately choosy about who we would bring to intensive care – partly a resource issue but largely because we put people through horrible things in ICU and for a lot of people it simply won’t work. In the US it seems as if ICU is a frequent option for those who might be allowed to pass on without a tube in their throats in the UK.

I spoke to Dr. Gregory Thompson, a critical-care specialist at Gundersen Lutheran Hospital, while he was on I.C.U. duty one recent evening, and he ran through his list of patients with me. In most respects, the patients were like those found in any I.C.U.—terribly sick and living through the most perilous days of their lives. There was a young woman with multiple organ failure from a devastating case of pneumonia, a man in his mid-sixties with a ruptured colon that had caused a rampaging infection and a heart attack. Yet these patients were completely different from those in other I.C.U.s I’d seen: none had a terminal disease; none battled the final stages of metastatic cancer or untreatable heart failure or dementia.

I find the article interesting as it’s one of the few articles that talks about how we deal with dying in the terminally ill as opposed to how we bring about death in the terminally ill.

Gawande nails the underlying issue that both the medical profession and society needs to learn:

But the issue isn’t merely a matter of financing. It arises from a still unresolved argument about what the function of medicine really is—what, in other words, we should and should not be paying for doctors to do.
The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And, in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knew how to fight for territory when he could and how to surrender when he couldn’t, someone who understood that the damage is greatest if all you do is fight to the bitter end.
This is what I think what medicine is here to do (primairily and given here without thinking out all the implications) our role – is to relieve suffering in whatever form we find it.

The apple of my eye

There are nerds out there. I know you’re there somewhere. Nerds with macs and iPhones who’ll appreciate this.

Following is a list of (mainly free) stuff I’ve recently picked up off the net via blogs like lifehacker and people I know.

[And I’m obviously a mac user –  i’m sure you can do all this stuff on a PC or simply using your hands just as easy but forgive me this once…]

Papers

For those of you involved in any form of academic research or any fellow medics who are trying to keep on top of the medical literature then this program is great.

I was beginning to get a bit befuddled by own filing system for PDFs (there’s over 400 by now) so it’s nice to see someone has thought about it more than I have.

Basically you dump all your PDFs into this program and it tries its best to pull all the meta data (references, authors, abstracts etc…) off PubMed or whatever suitable database and then organise them all into one nice database on your computer so you can actually find them again.

I am an organisational obsessive and as a result this was like heroin to my veins.

I’m still on the free trial and it costs 30 Euro for the full version.

PS there is a built in reader in the program which you can make notes with but I still prefer Preview for the cool annotation tools.

Itunes Remote Control

I’ve had remote on the iPhone for a while which is pretty useful as a remote control for computer I use as a media player but I always wanted an easy way to do the same thing from my lap top. I only got ITRC today. Took me a while to get my mac to connect to it but now it seems to work pretty well as yet another way not to exert calories in having to get up and turn the volume down.

Bean

Everyone hates MS Word (don’t they?) – just a bit of a beast of a program. Far too many features for what most use it for. But .doc files are an essential part of life but this free open source desktop app will open and let you edit the vast majority of what you need from a word file.

Free Books and Free Audiobooks

Despite the irony of a free books app costing $1.99 this is a great set of apps. They contain thousands of all the out of copyright classics that any monkey can pull off the net for free – this just puts it all in one place.

It’s companion – free audiobooks –  does the same thing with the wonderful and ambitious Librivox project and gives you access to several thousand fairly high quality amateur audiobooks.

Simplenote

I know there’s lots of others like Evernote out there but I started on this and now i’m sticking to it. Keeps all my notes synced to any possible place I might need them. Plain, simple, free – can’t beat it.

Dropbox

This and simplenote (and i suppose everything google that i touch) has been my first foray into the world of the cloud. And I love it.

If everyone I knew was on dropbox I’d use it a bit more too. Nice favourites feature on the iPhone that lets you store all your errr… favourites on the phone off line.

Join dropbox – if you want I can get you an invite then I get more free storage.

Well I suppose that’ll do me for now, and I didn’t even get started on the joys of Skype, Google Docs or Angry Birds.

I’m planning a blog on aesthetics and functionality in regard to technology but it needs some serious thinking.

The call to discipleship – 5

The call has consequences for b) position in society

the disciple of Jesus can descend from the throne – the little throne perhaps – which even one may be allotted in human society

The call to discipleship – 4

The call has consequences for a) possessions

… renounce their general attachment to the authority, validity and confidence of possessions, not merely inwardly but outwardly, in the venture and commitment of a definite act.

The call to discipleship – 3

With regards to the lordship of Jesus:

… He decides what can and cannot be, what is and is not, a divinely given reality for us. If we are his disciples we are freed by him from their rule.

This does not mean that we are made superior, or set in a position of practical neutrality. It means that we can and must exercise our freedom in relation to them. It must be attested in the world as a declaration of the victory of Jesus.

The cowshed

Back when the garden used to look like this:

The shed had two big holes on either side of the apex (which I regret not photographing at the time) where the trees had grown though the felt and into the shed. Everything in the shed was a little bit and damp and useless including the electric lawn mower.

So using bits from a dismantled book shelf and a needless number of nails and screws at random angles – I find that an equal ratio of wood to metal fittings is the best way to keep anything standing, it may also be the mark of a rank amateur.

Anyhow, so using whatever junk I could find, I got a new roof put on and fixed (ever so subtly…) some of the floorboards.

This was all topped off by some roofing felt that I slightly mis-measured and had to correct at the end. It is not exactly a work of art but hopefully it’ll keep the lawnmower dry this time.

[I am of course available for all your home maintenance and roofing needs. Quality not guaranteed. Getting the job done without being distracted by the internet also not guaranteed]

Ode to my family

Now that we have a fairly well functioning house we have began to receive guests as they say in the trade. They may not say that but i think they should.

We had my Liz, Simy, Morsies and the dog down for a weekend. It worked out well as we managed to enlist Liz in the garden for the morning achieving more beauty than me and Wylie had achieved since moving in.

They also got the usual tour of Maigh Nuad taking them round the grounds of Saint Patricks College. Thankfully this is both spectacular and long enough that they don’t realise that this is the only bit of the tour. Still it’s more than Portadown has to see.

Despite coming here for over a year I still hadn’t made my way into the chapel yet (though I stil forgot to take any photos so check out these incredible photos by my friend Florian instead) so we put that right too.

There was scrabble – which most importantly I won.

Pictures in an exhibition

The woman who in a moment of drunken madness agreed to marry me organised a youth arts festival in Maynooth the other day.

The teenagers from our church gave their utmost to the whole thing and the church in general baked and painted themselves into a festival creating mass and it was really cool.

There was some  music in the evening which I partook in. Below is a wee video of me singing if you can tolerate it. [Filmed by our very own Catriona Mitchel]

[I have some videos of some of the other performers but won’t put them up unless i get permission from the lovely ladies themselves.]


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