Random Thoughts on a Rainy Sunday

Youngest daughter is home  and our musical tastes are to put it mildly totally dissimilar. Poor Alexa if she were human would have long since gone home early with a headache. I envy her bland unflappability.

Sunday is allegedly my day for writing so as I am looking at a preparation for a presentation a pitch for a meeting ,an article and two or three letters I start this blog instead.I read somewhere that a woman with some writing to do has a very clean house. To avoid this I have hesitated to venture downstairs. There’s a smudge on the bedroom window though  and a cobweb. A trip to the loo can’t be avoided and the handtowel and bathmat need changing. I will tiptoe down and bung them in the washing machine.

Some time later! There was other washing waving at me so I loaded the machine .I also fed the cat fed the permahungry hens( who love cold chips) , collected the eggs emptied the dishwasher filled the dishwasher, cleaned the sink, watered the greenhouse, collected some tomatoes- need I go on. Its now so late I will be lucky to get the damn letters done . All else is longfingered to be fitted in during the week along with work and the activities of daily life .

Is procrastination the punishment of the presently unpublished, the thief of the already time impoverished? Or is it just my problem ?

A loose agreement has been reached on the music and Alexa is giving us hits from the Seventies. As I hear the all too familiar   dirge of Dr Hook and the Medicine Something or other song for the utterly depressed it occurs to me that Sylvias Mother is a pain in the ass, probably got all her tasks done on time and  that its no wonder Sylvia left home .

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Waxing Lyrical.               This afternoon having retreated from the tinsel, tintintabulation and throngs of shoppers in Galway city , and avoided the excited murmuration of ladies of a particular age queuing with enthusiasm to meet Francis Brennan in Terryland I retreated to my winter garden. Sad and sodden though it may be, I brightened it up with some red and pink cyclamen and polyanthus . I refilled the bird feeders hearing the whirr of wings above my head as they hurried to eat before sunset . From the greenhouse radio the strains of Jussi Bjorling sing O Holy Night wafted out onto to the winter evening , over the dull sodden leaf strewn grass and bare branched trees lifting my task troubled thoughts .The song was sung in Swedish but the message was unmistakeable . I stood as the birds flew past and watched the fading red streaks of sunset as the lovely notes poured into the winter air – magic!

Points of View 

Two overarching themes emerge from the story of Dr Bernadette Scully -the first of which is that of loss . Both Bernadette and her daughter suffered many losses Bernadette lost her dad at a young age and lost her first and second husbands.She was one of the last to know of her first spouses gender orientation thus suffering loss of self esteem . During her second marriage she had a number of expensive rounds of IVF . When the marriage ended she suffered a massive financial loss along with that of the father of her child – and again I am sure endured another blow to her self esteem.

Bernadette was also denied by cruel fate a life with the daughter Emily might have been. She will not be photographed proudly with Emily smiling in her graduation cap and gown . She will not see Emily walk up the aisle in her wedding dress . She will never cradle Emily’s child , her grandchild , in her arms. Emily too suffered the deprivation of all of those moments , dotted through a normal childhood and growing up . Emily and Bernadette lost the support and presence of their husband and father.A newspaper article at the weekend alluded to the probably unlikely possibility of sanctions against Dr Scully from the Medical Council . The Council sensibly advises against us being the GP of members of our own families except in case of emergency and the implication appears to me to be that Dr Scully might be sanctioned for contravening that advice . Which brings me to the second theme of her story that of fear . The fear engendered by being accused of her daughters killing . Fear of a jail sentence and a criminal record and all the difficulties that can bring in its wake. 

The criminal charges now behind her , Dr Scully ” will probably not face sanctions” from the Medical Council . If I were the subject of that headline I would be terrified .Bernadette Scully was Emily’s mother and carer and she was her GP . The principle of double effect refers to a situation where ones otherwise legitimate act might have a result one would normally be obliged to avoid . It is a philosophical principle derived from the work of Thomas Acquinas; Summa Theologica and is frequently quoted in the context of giving medication which while mitigating the pain and suffering of a severe , possibly terminal illness may cause undue sedation and / or a slightly shortened life . The nature of the action and the intent of the person carrying out the act intends only the good effect .

Dr Scullys administration of her daughters final doses of medication in a desperate attempt to mitigate her suffering , and her role as Emily’s GP are both defensible under this principle .What GP with the same knowledge and experience of Emily’s unique situation could have been available 24/7 to deal with all the medical complications and emergencies arising out of her condition . If Emily had been in day care or had regular respite an independent GP would have been necessary but neither of those situations arose. 

In all human tragedy we try to look for something positive , we seek for hope . Emily’s life has ended  and Bernadette must go on with her own life without her.I hope that she gets the opportunity to grieve her loss without suffering any more fear .

When  I think about Christmas , like Dickens’ Christmas Carol my thoughts turn to Christmas’ past. Today the festive season is a burst of colour and beautiful scenes , a conglomeration of wonderful lights and decorations and a cacophony of seasonal carols and songs. The choice of anything we might want is unending – provided we have the wherewithal to pay.But we are all impoverished by time deprivation and more of us than ever before are so poor that we lack proper nourishment , clothing and even a home !So I see Christmas in the first two decades of the 21st century as a large shimmering decoration , shining , sparkling , inviting us to admire closely and to touch but which looks dark and tawdry on closer examination and crumbles to dust when it is touched. Christmas present is an illusion of happiness , inducing an orgy of consumption which leaves us curiously unsatisfied .Christmas past lies like a shabby old christmas stocking , neglected and dusty in the corner of the attic of our memory . Dull and unappealing it doesn’t invite admiration , and we don’t rush to pick it up . On closer inspection however , once shaken free of dust ,bright shades of green and red emerge.It feels solid to the touch and when I lower my nose to it and sniff I inhale the scent of Christmas , orange , old woodsmoke and a hint of cinnamon .I am back in the top floor of Glynns of Galway , buying a christmas stocking each for my two eldest children.I am back much further into my own childhood , feet on the creaking wooden steps of Wynnes top floor christmas shop in December , cherishing the sight of simple dolls , windup toys and train sets. I an back in my mothers winter kitchen inhaling the scent of christmas cakes baking , with the steam from boiling puddings fogging the windows . My mouth waters at the tang of a tangerine and the first taste of rich marzipan iced glistening cake. I recall the sweet smell of wood burning and the pine scented Christmas tree . I remember our helpless laughter as the friend who offered to bring a wisp of hay for the crib materialises from behind a moving hay cock at the back door .Most of all I cherish the wonderful memory of a fullthroated male voice choir belting out Cry out and Shout Ye Inhabitants of Zion into the still biting cold of the christmas day church.    Gathering all of those memories together I tell myself that Christmas is about the simple things evoked by sight , touch , smell , sound and taste . Add laughter and the company of beloved family and friends and the ingredients of a wonderful festive season are yours. The glister is ephemeral – and optional.

Resilience 

Our  Gp trainees do a research project in their fourth year. Those who have ventured into postgrad territory will be familiar with the two main types of research , quantitative and qualitative. In my opinion qualitative is of greater interest so when , instead of yet another questionaire I was invited to be interviewed on the topic of Resilience , I was immediately hooked. 

Resilience to me means strength ,courage , and downright pigheadedness, tempered by common sense . All of the above are necessary for any GP and indeed every GP working in our resource starved, unheeded and ignored primary care health service possesses all of the above in spades!Resilience also implies flexibility and durability , and an Irish GP is as flexible as a whippy , snippy bendy sally rod.( a long flexible stick , usually cut from willow ).

On my travels through social media , having mastered Twitter and Facebook , I exchange views with medics in other countries. We are all facing the perfect storm of the slow suffocation of primary care from underfunding , excessive demands and unrealistic expectations from patients and politicians – we are the Christians they throw to the lions in order to hold their own positions.

How do we foster and nourish resilience in order to survive?

First , we shouldn’t take ourselves too seriously . Medicine is an evolving , imprecise science so even if we had 100% knowledge and recall we are incapable of solving every single problem we meet . 

Involve the patient as an active responsible partner in their care . 

Embrace the concept of good enough .

Interact , socialise with and support your colleagues , we need each other . This frequently is damaged by the intensely competitive nature of GP in my part of the world and very likely elsewhere . Rise above it – ní neart go chur le chéile ( working together we are stronger)

 ◦ Most of all remember you are a finite human being , entitled to a life outside work . As Socrates advised centuries ago ” Beware the barrenness of a busy life .”

 ◦ 

Memorial to Bishop Michael Courtney .

Atop St Brendan’s altar glass entombed

Burundi bishops mitre splendid stands 

In dark and distant Africa deaths doom

Removed its touch forever from his hand.

In Polands Auschwitz glass enshrined remains

Of Jewry , legions of the long gone dead 

Sad detritus inanimate withstands

Fate of their fragile life force long since shed

Into the next world unencumbered go

The sin enfettered descendants of man

No mitre , cloak. No worldly goods or gold

Shuffle off this mortal coil within their hands .

But Michael – bishop, martyr , someday saint 

Before St Peters altar surely stands

Bishop , Brendan of the Lakes demise despite

First act of joining Saints communion band . 

M Rogan

1/1/2004 

Bishop Courtney was titular bishop of Annaghdown when he was murdered in Burundi in December 2003 .He had attended the bicentenary of St Brendans church Annaghdown and the parishioners had commissioned a mitre for their bishop. The mitre was on display in the church enclosed in a glass case pending his return to receive it . He died before the presentation could take place . This writer had visited Auschwitz Birkenau a short time before seeing the bishops mitre. In Auschwitz Birkenau personal belongings and effects stolen from murdered Jews are displayed , also in glass cases.