What Matters Most? Reflections on the pandemic: the way we live and die matters.

#DMAW21 Episode 1

The impact of the pandemic.

‘Approximately 91,000 more people died this year compared to the average for each of the previous five years. This is an appalling statistic in a year when it would be easy to become immune to the daily death toll numbers . Many of the most elderly in our community who died, would have died naturally without covid19 but many more were afflicted with the virus or have died as a side effect of the pandemic when they wouldn’t have otherwise. My cousin was one of those people.

The pandemic has had big impacts on dying people and their families and carers, regardless of cause of death. Many who died had no time to plan and were unable to say and do the important things they would have chosen to had they known what was around the corner.

For people with terminal illness, lockdown and social distancing policies have caused isolation and loneliness during a phase of life where relationships and human contact are of utmost importance.

Community care has been stretched at the same time as people may have felt discouraged from seeking hospital care.’

https://www.mariecurie.org.uk/policy/better-end-life-report

Whilst there has been a huge amount of publicity about numbers, policy, tiers, R numbers and roadmaps to ‘normal’ (whatever that is!) there has been little reflection about the individual costs: the grief of those home alone in a lockdown, inability to be with family at this most important of times, people in care homes deteriorating and dying from broken hearts and minds due to separation from loved ones and stimulation, front line staff exhaustion, both physically and emotionally. As a GP, I am confronted daily with the tsunami of grief and anxiety that the isolation of lockdown had imposed on all of us.

There is little evidence about the quality of the experience of those families who had planned ahead for their own ends compared with those who had not. This evidence is slowly emerging and should be shared, learned from and acted on – not just by government but by the wider community. It is already well known that the benefits of making an advance care plan are considerable for both health and social care and patients alike. There are now many useful tools and resources that have been developed to help people with this. (see the Resources section of ‘Being Mortal’)

The graph below reflects the change in unplanned admission for people who had had an opportunity to record an advance care plan and Respect Form (where a person’s wishes and care plan highlights are recorded and shared) in 2020 in Nottinghamshire. Reduced admissions have been exaggerated to a significant degree by the pandemic: fear of separation from family and of catching cover infection in hospital, however we have robust evidence that planning ahead means fewer emergencies.

This pre-amble highlights the need to continue to be open about the prospect of ourselves or someone close to us dying in the forseeable future, whether from progressive disease, with the added benefit of time to plan, or from a sudden infection like #Covid19 or other sudden event, when we don’t plan ahead.

For as long as we’ve lived, we’ve died. It’s a simple fact of life. We will all die. We will all lose someone we love. We will all grieve. No one is immune. It’s something we all live with. And yet we still find death, dying and grief so difficult to talk about.

https://www.bigissuenorth.com/comment/2021/04/why-dont-we-talk-about-death-dying-and-grief/#close

Talking about dying doesn’t make it more likely to happen.

Ali Sutherland

If we don’t address the elephant in the room head-on, how can we know what really matters to a person and how can we plan for what is, after all, inevitable for all of us at some point?

‘Our reflex reaction is to shut conversations about death down and I think that’s a mistake'
https://www.mariecurie.org.uk/blog/leah-green-death-land-anxiety/268316

We all have a role to play in caring for each other and planning ahead. Its something that can be fun as well as serious; after all, if we can’t laugh about life and death what is the point of being alive at all?

Mary, age 91, never married and lived happily at home in a small village supported by neighbours. She had no close family. When her heart failure progressed and she began having difficulties with her memory, she was very happy to talk about how she would like to be cared for in the future should she need more care. Her doctor included her carers in the conversation about this and Mary contributed to a Respect form at a time that she could do so in a relaxed fashion. Her form shared the following information about her:

  • Her conditions
  • Important communication information e.g. the fact that she couldn’t hear without her hearing aids
  • The things in life that are most important to her – her dog
  • The things she most feared and wanted to avoid – pain and being alone
  • Her priorities for future care e.g. wanting to remain at home
  • Key contacts in an emergency

Several months later Mary’s carers found her on the floor, conscious but unable to communicate. She had had a major stroke. They weren’t sure what to do and called an ambulance. The paramedics were shown Mary’s Respect form and discussed her ongoing care with her carers then contacted her GP. It was agreed that Mary’s wishes should be respected and Mary’s carers were helped to make her comfortable in bed. Her GP and community nurse team ensured that she was enabled to remain at home, safe and peaceful. She died 3 days later in her own bed with her favourite music playing and with her dog nestled under her arm.

She had lived a full life and she had a good death – what she had hoped for.

So What? What should we all do about it?

In episode 2 of this blog, I will be considering the conversations in more detail; how we can start them, who we should talk to, how we can best prepare for them and what we could consider including.

These 3 books are well worth reading for all those contemplating their own priorities for the now and for the future. They have helped me in my conversations with my patients too. I would strongly recommend them to everybody who feels inspired to ponder more on this subject.

Further information:

The Nottinghamshire Website for information and resources to help both professionals and the public plan for good End of Life Care has lots of useful information.

Learning through Lent

This is a wonderful example of intentional living to one’s values.
Thank you Ruth.
#EatLocal #Sustainability #ClimateChange #Southwell

Green Southwell

A year ago one of our co-founders, Ruth Murray, embarked upon a challenge.  An organisation called Living Lent presented a choice of 6 ways to do Lent differently in order to benefit the planet. 

Ruth chose the ‘Local Living’ challenge – to eat food only produced within 30 miles for the duration of Lent. This was indeed challenging, but has had a longer term impact too…

Sourcing local food makes sense to me, it’s good for local jobs, food is fresher and it reduces carbon emissions from transport and storage.  Over 50% of the food we consume in the UK is imported from abroad. A staggering 95% of fruit consumed in Britain comes from overseas, and whilst only 1% of food is transported by air, it accounts for 11% of carbon emissions from food.

But Lent is a tough time to take up this challenge – the seasonal foods that…

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10 Advent ideas

Great ideas for Advent: transform your anticipation from dread to delight!

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Picnics with peacocks, presents and parties! Half term break was a good one. We went away to one of our familiar holiday lets, and enjoyed a slower pace for a week of pottering and walking, eating and playing. Sleep was awful, still all the usual family dynamics and stresses plus the transition into and out of the week but as these things go it was a good one! And we’re nearly the other side of the autumn family birthdays… one belated horse themed party tomorrow still to enjoy and then we start thinking advent!

Do you make plans to mark advent as a family?

For us, times like this can be very hit & miss and we don’t always achieve the picture perfect social media effect. Isn’t it hard to look at ideas thinking ‘I’d love to, but…’ – comparisons are not a good thing. Lets face it every family…

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movie night: discussing difficult questions together

Cathy’s thoughtful reflections on war from a Christian perspective unpack the key themes and resources are really helpful. Thanks Cathy! Can I come an be a cousin to join in your film nights?

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SV400002 summer fun – many years ago

In the middle of the busy-ness of holiday club at church, which we were all part of (proud mummy week!) we made time to sit and watch a film together that A had seen and wanted to share with us. Now this was not, obviously, one to share with T so late one evening the rest of us sat down to watch Hacksaw Ridge (rated 15). If you are looking for a feel good, easy on the eye movie this is NOT it. It is hard to watch, gritty and violent. It is based on a true story of a conscientious objector who was awarded the US medal of honour in America during WWII, showing his decisions and people’s reactions to him. It is a film of inner struggle, the way we are shaped by our circumstances, of principles being lived in the extreme…

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the unexpected conversation – prayer

Or even a scary conversation? Prayer = a conversation with the phenomenon that is the Creator of the Universe plus our personal eternal Daddy! How weird is that? What a truly awesome privilege. Thanks Cathy for enhancing my relationship with Him in this blog.

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When you actually stop and think about it prayer is unbelievable – in the awestruck sense! One simple, everyday word that means approaching the Creator, Eternal God, and being invited not just to an audience with majesty but also being invited to climb onto our Father’s knee.

Last week I was involved in ‘prayer week’ at the local secondary school (one of the things I do is being an active member of the school’s chaplaincy team). It’s a week when one of the year groups gets brought to a prayer discovery/experience lesson led by us as part of the RE curriculum. We then also go and visit RE lessons and answer questions and chat together about their thoughts on Christians and prayer.

Of course not all students are Christians and the activities we plan hope to open up discussion and a chance to chat with us as chaplains about our…

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Finding freedom in the dance.

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This picture represents what I feel in my heart and soul as I come close to my Lord; none of those aches and pains, no heavy rucksack of guilt, shame or fear, no tears, just freedom and joy.

I began the preparation for this, my final faith marker, in reflecting what it means to me to be set free from earthly cares, contemplating an eternity living in the promises of our faithful God, now and after earthly death.  I used some of of my favourite scripture with the help of Bible Gateway and Word It Out to create a word cloud to visualise the promises.  This is a great help to me in the compilation of my dance, the medium I have rather rashly chosen to put together my 4 faith markers in the hope that it will bring them together to make the whole; my journey.

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The cloud brings out so many of the words that describe the life Jesus would wish us to live as a child of God.  Which ones stand out for you I wonder?  None of us know what our life will look like, what amazing things God has planned for us, what challenges we will meet.  We would like to be able to see the bigger picture, like the impressive people picture created by Hamburg in its bid to host the 2024 Olympics.  However, in His great wisdom, our Lord gives us what we NEED to know, in small steps, rather than what we WANT to know.

I have just come to the end of a five day exploration of north-west Spain, based in the 3rd most travelled pilgrimage destination for Christians, Santiago de Compostela.  Although the main purpose of our visit was to spend time with our daughter, Katie, who is now living and working there, it seems curiously apposite, and possibly a gracious answer to prayer that she is based here.

Pilgrimage seems to be about a personal journey of exploration, reflection, people, challenge, walking, sometimes singing, sometimes hurting, perhaps feeling lost and ultimately victory and joy having successfully reached the end of the route.

The purpose of Christian pilgrimage was summarized by Pope Benedict XVI this way:

To go on pilgrimage is not simply to visit a place to admire its treasures of nature, art or history. To go on pilgrimage really means to step out of ourselves in order to encounter God where he has revealed himself, where his grace has shone with particular splendour and produced rich fruits of conversion and holiness among those who believe. Above all, Christians go on pilgrimage to the Holy Land, to the places associated with the Lord’s passion, death and resurrection. They go to Rome, the city of the martyrdom of Peter and Paul, and also to Compostela, which, associated with the memory of Saint James, has welcomed pilgrims from throughout the world who desire to strengthen their spirit with the Apostle’s witness of faith and love.[4]

I have just come to the conclusion of an excellent book about overcoming oppression and persecution, ‘The Beekeeper’s Promise’ by Fiona Valpy.  It also unexpectedly mentions Santiago and pilgrims and concludes; ‘Life is not about waiting for the storm to pass, it’s about learning to dance in the rain’.

So this is why I have chosen dance as my means of expressing my journey of faith.  I have chosen ‘No Longer Slaves’ by Bethel Music to dance to.  Its lyrics and compilation describe my 4 markers closely and its ultimate verse declares my new identity:

You split the sea so I could walk right through it

My fears were drowned in perfect love

You rescued me and I will stand and sing

I am child of God.

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Finding my way in the storm….

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I remember an occasion a few years after I began my journey of discovery, having a conversation with a fellow member of the church youth team as we were planning a session for our young people.  He had been a disciple for a lot longer than I and I felt I had a lot to learn. We were reflecting on how it may be easier to be confident in our faith when all was going well but what if it wasn’t?  What if our foundations are severely tested, like Job?  How would our faith stand up then?  I hadn’t at that time had a ‘storm’ in my life so I really didn’t know.  I have always loved St Paul’s prayer for the church in Ephesus and prayed this for myself over the years:

Ephesians 3: 16 ‘I pray that from his glorious, unlimited resources he will empower you with inner strength through his Spirit. 17 Then Christ will make his home in your hearts as you trust in him. Your roots will grow down into God’s love and keep you strong.’  

Like the parable Jesus told about the man who built his house on the rock such that it stood strong during the storm, would my foundations prove robust enough to stand when inevitably I encountered life’s storms?

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Well, I was soon to find out via my twin 3rd key markers; my suspension from work and my father’s illness and death.  I’m not going to go into the details of the work situation except to say that it arose partly through my own naivety in applying my faith to trying to help another.  There was an investigation and an exoneration and lessons learned.  When Dad was dying I cried out to God to save him.  He didn’t answer that prayer by keeping him alive but he answered it in several other ways that demonstrated God’s infinite and unfathomable grace mercy and timing.  I now understand why I had had a deep conviction that I needed to talk to him about Jesus during the 2 years leading up to his illness.  When I was crying out to him for a miraculous healing, I wasn’t told that I would be granted my request.  Instead I was given peace and the promise that Jesus would be with me throughs this difficult journey, helping me to be strong for my family.  During Dad’s final days we were given a ‘window’ of lucidity that interrupted his descent into coma during which we could say the things that needed to be said and I was assured that God had indeed saved him.  I look forward to the day when we get to hang out together again and he can given me the heavenly guided tour!

During those times I was aware of being carried by the prayers of my church family and by my Lord’s strong arms holding me up and stopping me drowning.  The one who was the co-orchestrator of the beginning of time and the Universe, who can control the skies and seas was holding me up and enfolding me with love.  I was pointed to some of the Psalms; 30 and 31 were the perfect salve and source of hope.  The words of Brian Doerksen, ‘Faithful One’, have always spoken powerfully to me about this time and the wonderful art of Iain McKillop perfectly depicts how the drowning person is rescued by Jesus (by reaching out to His outstretched hand), the link to the unknowable all-powerful one.

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Finding the truth about me, finding true love.

As W Paul Young, the author of The Shack, said in his interview, ‘Once I have discovered the truth about my being, through the Holy Spirit, I can then start to live out the truth of my being’.

So, the next step for me was to respond to that still small voice.  Having now married a wonderful man by God’s grace (to us both) and been blessed with 2 beautiful children, I wanted the best for us all.  The biggest facet of this wish was to get off the fence about what I believed about God so that I knew how to give my family the best of me and the best of the world:  Did God exist?  Was Jesus who he said he was?  If so, so what?  Whilst Dave and I had got married in church that was all about family expectations and a romantic view of marriage on my part.  Dave went along with it because he loved me and no other reason.

It was at this point that I began to start attending Holy Trinity Church and  along with a group of others, embarked upon the ‘Saints Alive’ course (similar to Alpha) where we got to consider the evidence together and then choose to make a response.  During this time I read a lot of books.  One of these, ‘Who Moved the Stone?’ by Frank Morrison, an atheist journalist who, in researching his book purported to disprove Jesus’s claims, found them to be so convincingly true, he became a follower.  Much like Lee Stroebel, author of ‘The Case for Christ’.  By the end of the course I had heard enough to be convinced that the evidence stacked up, so now it was down to me.

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I prayed the prayer of acceptance, repentance and commitment and asked for Jesus’s spirit to live inside me.  I was somewhat disappointed that there were no thunderbolts or discernible signs that God had heard me but gradually over the weeks God’s promises all came about:

  • I became aware of my identity as a child of God (John14:20, Eph 1:4-5)
  • I am loved by him unconditionally (J
  • I could trust God’s word (2 Tim 6:16)
  • I could understand God’s word in his book, the Bible, for the first time.(John 14:26)
  • I wanted to go to church and worship with the rest of God’s family (Hebrews 10:25)
  • I stopped worrying and became when Mum calls ‘my serene daughter’. (Phil 4:6)
  • I started by transformation into a new creation (a work in progress)! Col 2:6-7
  • I want to share my great blessing with others! (Rom 1:16)
  • Finally, given that it’s Valentines Day, I want to share with you the greatest love letter ever written.  This excerpt, known as The Father’s Love Letter, is taken from verses throughout his larger letter to us, The Bible.  It describes the unique types of love that God has for his children:

חֶסֶד CHESED – The unique love of God for his children; a permanent, covenant, faithful love; not changeable, temporary or based on feelings, as it is in our modern culture.  It provides a steadfastness and a security that is completely reliable. The Greek equivalent word ‘Agape’ is described in wikipedia as the highest form of love.  As demonstrated by Jesus, it is the love that offers complete giving of self.

Having read it from cover to cover more than once, I can truly say that I am now coming to understand for the first time what unconditional love means in all its depth and complexity.  This is the second key marker in my faith journey.

Jewish saying, ‘We must meet extravagant and unreasonable hatred with an extravagant and unreasonable love’.

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As Valentines Day approaches, and musing on my own journey of faith, I find myself considering how gracious God has been in creating me in his image, loving me in a way that no-one else can, calling me, waiting patiently for me to respond through years of rejection (mine of Him), rejoicing when I finally accepted Jesus as Lord, adopting me into his family. The picture of Jesus’ parable of the lost sheep speaks powerfully to me: as a teenager and young adult, I was truly lost.  I didn’t love God and I certainly didn’t love myself.  The sheep being carried by Jesus is black for a reason.

Yet my beautiful saviour was carrying me all that time!  He never gave up on me and through my university years, even though I was truly lost, he tried to engage with me through other angels (thanks Janet!) and that still small voice which I became increasingly aware of.  At this point I will share that one of the songs that really speaks to me of this time is ‘Stars’ from the film of The Shack by Paul W Young, and his interview with Nicky Gumbel is incredibly poignant for me.  He talks about the importance of telling our story and that in doing so, we are treading holy ground!

So be inspired guys and join us in the telling of our stories through this truly inspired project.  Thanks Esther for helping us to share.

Next scene will be published on Valentines day but anyone interested in my other Musings on the interface between working as a doctor and being a follower of Jesus could pick this up.

Distress.

This is an excellent accessible blog for everybody with so.e very useful tips and resources.

Dr Abbie writes

I have wanted to write a post specifically about mental illness for a while now and Mental Health Awareness Week has pushed me to put pen to paper (or hand to keyboard). I have started this post so many times, struggling with how to appear sincere and not clichéd but relevant. It’s ironic how anxious I have been to get this right! I want to do justice to Mental Health Awareness Week and my many patients who have inspired me. This is a small snapshot and I hope to do more blog posts on specific conditions/presentations in the future.

I haven’t suffered a mental illness but, as a GP I have witnessed the effect of mental illness on patients and their families. I cannot truly understand what it feels like to endure these distressing symptoms day by day but I can share my experience of mental illness in general practice…

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