Poem for Christmas Service

There's blood on the straw
on my face
on His hair,
my legs won't stop shaking
my belly is an empty wineskin
and pain blurs all the faces
except one.

He lies at my breast
looking at me,
so tiny, so immaculate, so real.
His wide clear eyes fix on mine
and I see eternity.

My heart is full of joy and triumph;
the women cry "a son, a son!"
as if I hadn't always known.
And I long to call Him mine
and I long to say "I made Him,"
but the shadow of Another holds me back.

The little face crumples;
His first cry
melts my heart to milk.
When I said "I am the Lord's servant,"
I thought that with this birth
my task would be complete

...now I realise it's only just begun.

Back to School

You probably know the feeling. It's a very specific, nostalgic, optimistic feeling that only happened on one day per year. I'm certain the retail industry know the feeling, and use it perenially to advertise something or other. The type of weather we've been having lately - still sunny but with a slight chilly edge to it - always brings it back to me so powerfully.

You wake up earlier than usual to the sound of your alarm (or your mum calling you). The air feels a bit colder than the day before, maybe there's some dew on the cars and grass outside. Your new unspoilt uniform is hanging up waiting (instead of on the floor where you usually keep your clothes). Your bag is already packed, containing pencils with unbroken leads, fresh virgin notebooks, maybe a new textbook, a new pen, set of compasses, a clean rubber. You leave the house knowing that you are on time, tidy, and haven't forgotten anything at all. You will have a new teacher, maybe new classmates, no-one will remember how sad and stupid you were last term, or how much you got into trouble, or the pointless argument you had. In fact you can feel yourself morphing into a whole new person... Everything will be different this year...

A few weeks ago I was feeling quite disillusioned with myself. I fairly often wish I was the type of person who got things done, followed things through, and stuck to the high standards I set myself. (This is despite the fact that I have met a few of these types of people and generally they are not any happier than me - probably the reverse, because their standards are even higher.) In the practical world of keeping the house clean, getting DIY done and doing my tax return, and also in the spiritual world of staying close to God, praying regularly, fixing my mind on things that are not of this world, I fall short so often.

As I was praying about this I remembered something which is one of the most beautiful and releasing things about the Christian faith - whenever we ask, God can give us a new beginning. Through Jesus death, which paid for all of our messes, sins, mistakes and hurts, we can have a fresh start a thousand times a day if we need it. When we are forgiven, God looks at us and sees the righteousness of His Son. The tricky bit is remembering to use this amazing freedom. When I do, it's like every day is the first day of term...

negative voices

It all started this morning when a friend dropped by to lend me a baby door bouncer... My elderly next door neighbour said hello to her and her 1 year old daughter, and she mentioned that it was a lovely day for gardening. He then said pointedly to me, "Yes, did you hear that? it is a lovely day for gardening."

Now our next door neighbour is a retired man (normally really lovely), and obsessed with his garden. As far as I can tell, he spends most of every day out there, despite his fairly advanced lung disease, and it is always pristine and beautiful in every season. Our garden, on the other hand, is a little rough around the edges. It has a wild unmown section at the bottom, which is a deliberate choice to give bees etc some habitat, but I sense he's not too keen on that feature, since some weeds grow there. The beds mostly have easy care perrenials in, because that's all I had time for at the best of pre-baby times. And ok the lawns haven't been mown yet this year, and things have gone a bit "to seed" since the pelvic pain kicked in halfway through pregnancy. But in my opinion it looks presentable. Compared to two and a half years ago when we bought the house and the plot was half rubble, half bed full of weeds, it's practically an oasis.

What was really disturbing was what that simple jokey comment, (which I may have totally read too much into), did to the rest of my day. I was instantly torn between paranoia (oh no he thinks I'm a terrible neighbour and inadequate housewife, gallivanting off to baby groups all week without attending to my own back garden) and anger (doesn't he understand what it's like having a new baby to take care of and how difficult it is to even keep the house clean?). I became unable to focus on the conversation with my friend after she came into the house, even though she dismissed him as a cheeky old man, and then I began to feel bad that I was coming across as scatty and absent and not in control. We talked a little about it at the end, and she said to me as she left "You're doing a great job. Hear that." But sadly this was no use. The negative comment had sunk into my brain somehow and was blocking all positivity out.

By the time I set off for my breastfeeding support group, my brain was a storm of negative voices. I spent the pleasurable sunny walk across the park thinking about my choices as a mother, and spiralling down into self-doubt. I began thinking about what will happen when I go back to work. Currently I'm planning to complete my training working half time, and then get a permanent job with even less sessions than that, if possible. I started hearing the (mostly male) voices of my colleagues at my current practice, who already feel that a year of maternity leave is an extended holiday and that I won't remember anything when I get back. Soft option they were saying to me, don't you care about your career? don't you want your son to go to private school like our children? don't you want to be a partner? Then my paranoid version of my parents voices started, You need to give your time to your child, they grow up so fast... and Christians I have read books by if you have the means you should give up work, God intended mums to look after their children. I began to feel that I will be giving both baby blue and my work less than my best. Next I began to worry what mr me was feeling about me, and projected onto him the view that I spend all week having fun and coffee with my friends, while he slaves away at work. Then I started wondering what other mums think of me, and whether they see me as a failure because baby blue is still in disposables and still has to be cuddled to sleep for his daytime naps. Then my childless friends - do they think I've turned into an antisocial baby bore? Then my own judgements on me - I forgot to clean his tooth again this morning, maybe he'll grow up with tooth decay... I didn't realise he was hungry for half an hour of grumpiness, maybe he's not growing as well as he should be because I don't feed him enough.... You get the general idea.

Fortunately the thought bog was stopped when I got to baby cafe by an hour of chatting to fellow mums, venting my frustrations re the next door neighbour, and feeling a little more that everyone's in the same boat i.e. we're all doing our best. This evening has cheered me up even more, with some affirmation from mr me, and an 8pm decaf vanilla latte at Borders, accompanied by some Marie Claire reading while he kindly manned the baby monitor at home. However, just typing out these frustrations and insecurities and (mostly unfairly attributed) opinions of others has already put a bit of a weight back into my chest.

What really annoys me is that I am still this vulnerable and weak. I was chatting with some church friends last week and bitching about the fact that most church seminars and days for women seem to keep reinforcing the same point - that you are accepted and valued by God, you are His daughter, His princess, you don't have to worry what others think of you. I implied that I'd got that by now, I'd heard it enough times, couldn't they move on to something meatier? Not all women were seething masses of insecurity, I said. Well maybe they're not, but sadly, and mortifyingly, it seems that I still am. I still need this message to sink from my head to my heart. I know this needs more prayer. I know I also need practically to learn to let little comments bounce off me, especially as society seems to judge mums for every choice that they make. I'll never be able to do everything and please everybody. I need to learn to be happy and confident in our family choices and in doing my best. But how? Does anyone have any more tips on how to beat the guilt, insecurity and self doubt that being a mum seems to exponentially increase?

brief pause on a Sunday evening

...to feel sad about nothing...

...sad that another busy week has just sped past and another is on its way...

...to think about my friends, who seem to be going through some hard things recently...

...to ponder how I'll feel if I fail this exam on Wednesday, which I really think I might...I'm not good at doing failure...

...to hope that mr me is really ok, and not pretending to be ok because he knows I'm only just coping with myself, as usual...

...to wish it was the summer time and I was escaping to a cottage somewhere...

...to wish I spent less time wishing my life away...

...to think about the sermon today, and ask God to give me a servant heart...

...to count my blessings, which are many, including a husband who loves and supports me, a career that fulfils and stimulates me, friends and family who care about me, and all I need materially...

...to decide it really is time for bed, actually...

Happy Christmas!

I am going to stay back with my parents in Liverpool from tomorrow, and not sure whether I'll have time to blog, so just wanted to wish everyone who reads this blog a very happy, peaceful and blessed Christmas. Hope you find some time amongst the manic-ness and consumption-fest to spend with somebody you love and think about the real Meaning of christmas. love doctor/woman xxx

The Pedestal

I have had one of those periods of my life where my insecurities surface more than usual recently, for various reasons, and one of them reared its ugly head the other night when stressing to mr me at about 1am when we were in bed. This insecurity is one of the worst things about being a doctor.

Rightly or wrongly, when you tell people you are a doctor, they have a certain reaction. Normally it involves the word "wow!", and there is instantly a certain mystique about you that wasn't there before. You have seen babies born, you have seen people die, you have (hopefully) stopped a few people dying, and most people place their trust in the integrity and competence of their doctors. So they suddenly look at you in a slightly different way. Being me, I normally say "I'm a doctor," in a slightly apologetic way, as if to say, "please don't look at me differently" (although I notice I have recently started introducing myself as a doctor, instead of a junior doctor. So maybe I am getting slightly less self-deprecating)

I am getting more able to live with the pedestal that people put me on. Perhaps too much so - sometimes I try to imagine how I would feel if I wasn't a doctor any more, and I realise that I am slowly depending more and more on my career for my sense of self. I am well aware that pride lies that way, and I attempt to "consider everything a loss compared to the surpassing greatness of knowing Christ Jesus my Lord." (Phillipians 3:8) I know that I need to work more with God on finding my sense of identity in Him and not in the things I have or am here in this world.What I still find very hard to live with is the nagging fear that one day I am going to fall off the pedestal.

Medicine is a lot about the way you present your knowledge. E.g. you have a young female patient with a chest pain which sometimes occurs at rest, on breathing in, then goes away again after a few minutes. You ask a few questions and it sounds like a chest pain related to anxiety. That is your diagnosis. You know that there is probably a tiny percentage chance that it is something else. But the risk calculator instilled into your brain by practice is telling you that this tiny risk is not worth investigating for. Do you tell the patient all this? No. She is already anxious, you don't want to make her more anxious. So you tell her in your best reassuring manner to try a few simple measures to reduce her stress and that the pain is nothing serious. To safety net you maybe ask her to come back if things don't improve. For the patient to go away happy and to get better, you need to come accross confident. This "bedside manner" that doctors have to have can sometimes feel like an act. You are taking on the anxiety, so that the patient can stop thinking she is ill. But the general public often seem not to understand that the art of diagnosis is, by it's very nature, a sophisticated type of educated guessing. In many cases there will be some uncertainty. But if your educated guess later proves to be wrong, the patient may forever think you are a bad doctor, even if 9 out of 10 colleagues would have done the same thing.

Then there is the question of knowledge. The volume of medical knowledge is vast. It covers all diseases from prematurity to senility, and from every system of the human body. It is almost impossible for one person to know it all. Especially with some of the questions I get asked in my day to day life, eg "why does my tongue hurt when I drink pineapple juice?" or "is it usual for one twin to be left handed and one twin to be right handed?" But if a patient, or worse, an aquaintance who is asking you medical questions, suddenly finds that you don't know the answer, sometimes they look at you like their world is tumbling around their ears. Because doctors know everything.

Maybe some doctors know everything. Gregory House, for example - he knows everything, and that is very lucky, because he has the most statistically improbable caseload of conditions I've ever seen. I have met a few who seem to remember every footnote from medical school. But the vast majority of doctors know about the conditions we see every day in our chosen field, and for the rest we depend on remembering some of the information, knowing where to find the rest of it, and recognising when to refer to somebody else.

I find it very hard to be under the constant pressure of being expected to be some higher form of human being, who never gets things wrong or doesn't know the answer. It doesn't help that I am naturally rather ditsy, and tend to bump into things a lot. Sometimes I can see people looking at me thinking "well, at least she's not a surgeon!" after I have done something particularly dyspraxic. I am getting better at coming across confident and all-knowing at work, but in my day-to-day life, it's just not me. I'm too honest to pretend I know all the answers all the time. Sometimes I love to be somewhere where nobody knows what I do, and I'm just a girl, just another person on the street. I also regularly fantasise about being a housewife, and not bearing this responsibility that sometimes seems so heavy.

I am well aware that I tend to live my life far too much through other people's eyes, and worry constantly about what others think of me. I think for this reason I feel these pressures more than many of my colleagues. I am also aware that a lot of what I'm describing may well be me projecting my own insecurities onto others, and imagining they are mentally criticising me when in fact they are doing nothing of the kind. I don't think it helped that in my first few years of medical school, my housemates were constantly commenting "I can't believe you are going to be a doctor, you're so dozy/clumsy/I can't believe you're going to skip a lecture!" etc. I know that I am a bit scatty, always have been, and this is something I have to fight daily in order to make sure I practice safely by staying organised. I never go beyond the reach of my competence, and I am honest with patients about this. Maybe if I can deal with my inner critic, I can start to let the rest of the world think what it likes about me.

Easter

Feel a bit short of ideas and inspiration at the moment so can't quite think what to write. Thought would jot down a few random thoughts that occurred to me over Easter. Easter can be a funny holiday sometimes because I feel it's the most important celebration in the Christian calendar, but sometimes it passes by and I hardly seem to notice it, especially if I'm working. Because our church doesn't own its own building and there are a lot of young people in the congregation who tend to go home for the Easter break, there are not normally any extra services at our church for Good Friday or anything. Due to much messing around of my rota at work by HR department, I was at some stages during the week supposed to be working on the Saturday, so we decided to go back to Liverpool (where both our parents live) for the Sunday and Monday, and stuck to the decision even when I wasn't working at the weekend any more.

...On Good Friday I watched a programme on BBC called "Who do you say I am?" which was a meditation and a telling of the Passion story based around works of modern art using the image of the cross by Christian and non-Christian artists. I thought it was a refreshingly good piece of religious programming - not so preachy that it was only watchable by Christians, not deliberately critical for the sake of having a new and controversial approach, but open and asking questions. I found parts of it very moving...

...Decided to go to the local Anglican church for the 2pm service on Good Friday as well with a friend who lives locally and it was refreshing to be in a different church tradition than my own for a while - more meditative and symbolic than what I'm used to perhaps. Not many people there really, but the vicar was very sweet and made a special effort to speak to us...

...Also enjoyed Easter Sunday morning at the church my parents-in-law attend - they had us all write down what Easter Sunday meant to us on little pieces of paper, and stick it to the wall at the front, after listening to a passage being read from Matthew 28:1-10 The thing that struck me most at the time was the phrase "Suddenly Jesus met them." Became newly aware that the Resurrection meant that not only could they meet Jesus again, but that anyone can meet Him, ever since then, if they want to. It is why I can still know Him today. I know this is pretty obvious, but it just reminded me in a new way, OK?...

...I fasted alcohol for Lent, because although I hardly ever drink more than 2 glasses of wine at a sitting, I feel I sometimes use it if I'm particularly stressed and wanting to let go of any worries from the day's events. I don't think that's very healthy. I can see why lots of doctors become alcoholics. So I think it was a success giving it up. At the beginning I thought I would be desperate to have some on Easter Sunday, but as it turns out, I wasn't all that fussed. My first glass of wine did turn my head quite dizzy though...

Hearing the voice of God

Here is a quote from "Psyciatric Interviewing and Assessment" (Rob Poole and Robert Higgo, Cambridge 2006) about pseudohallucinations.

"there is a heterogenous group of experiences that is very similar to hallucinations. They are almost invariably associated with underlying severe emotional distress. The only major exception is a small group of individuals in the general population, neither evidently mentally disordered nor distressed, who have a strong religious faith and who hear the voice of God in their everyday lives. We recognise that they may be right about the origin of the experience, but we prefer to believe that it is due to some other, as yet poorly understood psychological process."

I first ran up against this issue in medical school - the issue that may cause other doctors to think I have an "as yet poorly understood psychological process," and normal people to think I am a bit loopy - the fact that I believe that I hear God speak to me. A hallucination is defined as a sensory perception experienced in the absence of an external stimulus. However, beliefs or perceptions which can be accounted for by the patient's religious or cultural background are not considered true delusions or hallucinations. Also, for it to be a true hallucination, you must be convinced that what you can see or hear is real, and perceptible to anyone close by. We had some examples to work through in small groups to force home these points, and had to say whether they represent hallucinations or not, eg "you are walking home alone late at night, and you are feeling anxious about being followed. you see a shadow in the trees and become convinced it is a person" - that kind of thing. (not a true hallucination by the way) One of the examples was "you have a friend who is devoutly religious. He tells you that he talks to God and God talks back to him." The group started to debate it, but I said "no - that's normal." They knew I was a Christian, so looked at me weirdly and left it at that. A Muslim girl in the group said that this would not be normal for a Muslim, as God spoke only to the prophet, not to other people. (Not sure whether this is the mainstream Muslim view or not, by the way.) Came away from this session feeling slightly uneasy, as I normally do when people think I'm mad.

Now I have never heard God speak with an audible voice that I can hear with my ears. I know of people who have, but for me it's a lot harder to explain than that. It kind of comes like the internal monologue that most of us have all the time. I think I may have this inner voice more than most, because whenever mr me asks me what I am thinking about I can tell him the 2 worries, one random wondering thought and the plan for the curtains in the back bedroom that were chasing each other around my head. When I ask him what he was thinking about, he normally says "dunno - football I think." Anyway...when God speaks, the internal monologue suddenly seems to turn into a conversation - i.e. an answer comes back at you different and faster than what you would have thought for yourself. That is my experience sometimes. I can normally tell it's God by what He says - it is in line with the Bible and what I know about His character, it's frequently something uncomfortable or out of left field, but when I try to follow it or pray into it or whatever action is required, I get a peace about it, which is again difficult to explain.

It's not always like that, and particularly if I am praying for guidance about a specific thing and waiting for God to talk to me like that I can become very confused between my own thoughts and His voice. Sometimes God speaks through reading the Bible - I can be reading and suddenly something jumps out of the page at me and applys itself to my life - I think a lot of Christians have that experience. Sometimes God speaks more through feelings and emotions - normally to let me feel His love or a sense of peace at leaving things in His hands. This happens mostly when I'm worshipping and open to Him. Sometimes God speaks through circumstances in my life, and I know some of the times when I've been closest to Him have been when I'm going through a really hard time and having to depend on Him completely. I'm not one of these Christians who prays about what colour socks to put on in the morning etc - I believe God gave me a brain to decide that kind of thing with, and sometimes I think even the bigger decisions can be taken with some common sense, a background of what kind of things God wants for you and a willingness to hear Him if you're going the wrong way. I think sometimes the decisions which are most significant to us (eg which job should I take?) can be different to the ones which are significant to God (eg He might want us to forgive somebody because otherwise we will do something which hurts them or us and will somehow affect the rest of our lives.)

So anyway - this is my confession. I hear God talking to me. Do you think I'm mentally unwell, or subject to a poorly understood psychological process? (feel free to say so) If you're a Christian, do you hear God's voice and if so how?



"The watchman opens the gate for him, and the sheep listen to his voice. He calls his own sheep by name and leads them out. When he has brought out all his own, he goes on ahead of them, and his sheep follow him because they know his voice." John 10:3-4