On being a medical curiosity

When the medics and the tests finally reached a diagnosis of the condition that has taken out six weeks of my February and March (so far!), it was that I had osteomyelitis of the symphysis pubis. This is a rare condition: so rare that it doesn’t even appear on the NHS website. A ‘rare and elusive diagnosis’, which probably explains why it took them so long to arrive at it.

When I finally got around to pressing for a consultation with my surgeon, he was as puzzled as the local GPs had been. That’s the great advantage of being a medical curiosity: the professionals get interested and really want to find out what’s going on. Although it involved a lot of sitting around in hospital waiting rooms both that day and a number of days following, the battery of tests finally pointed to a result. Two MRI scans and blood tests indicated that there was evidence of an infection around the symphysis pubis. This is treatable with antibiotics, but they have to be pretty serious antibiotics, and the course is likely to take six weeks or longer. Naturally it’s important to identify the exact bacterium and target it with the most appropriate antibiotic. My surgeon was very keen to get me in and start IV antibiotics as soon as possible; so after the second MRI and a cystogram to make sure there were no leaks of urine from my bladder or urethra, I was admitted to the Urology Ward, precautionarily catheterized (oh, joy!) and written up for broad spectrum antibiotics.

At this point a near mythical character enters the story: The Microbiologist. My surgeon told the Microbiologist what he proposed, and the Microbiologist commanded to hold off on the treatment until a biopsy could be performed. I suppose this is the problem with having a condition that requires interdisciplinary cooperation: it’s not a question of my surgeon being outranked, but that if you ask a colleague of another specialism for help, you pretty much have to do what they say, even if you’d prefer to get on with what you first thought of. But it made sense, really. Broad spectrum antibiotics before the biopsy could easily mask the real cause of the infection, and make that all-important targeting difficult to impossible.

So I was sent home with catheter, after 24 hours in hospital, to wait for the biopsy. We hoped this would be done on Monday. It wasn’t possible until Tuesday, when we returned to the hospital’s orthopaedic centre. A biopsy of the pelvis isn’t a pleasant procedure, no matter how charming the radiologists and nurses may be, who are administering it. It involves lying under the X-ray, having your belly injected with local anaesthetic until the repeated question “Any pain, now?” gets an honest No answer. Then the biopsy needle is inserted, and though I wasn’t looking too closely (I wouldn’t have been able to see anyway) it was clear they were drilling into the bone. They did succeed in getting three good samples.

Then we drove on to the Urology Ward again. (The hospitals are on three different sites, and my surgeon wanted to keep his eye on me, rather than let me be taken over by orthopaedics, which is probably what they wanted to do.) Admission again, cannula in, more blood tests, and finally the first IV antibiotics.

The following day was taken up with waiting for results of the biopsy, because on this depended whether I would be allowed to go home with oral antibiotics, or whether they would want to continue IV administration which would involve setting up a plan for that to happen. There were some high points in the day: family visiting, and a consultant (I’m not sure of what specialism) coming to ask if she could bring some medical students to talk to me about my condition. (Another fun consequence of being a medical curiosity.) With various health professionals in the family, I’m happy to help in the training of future medics; and the four students who arrived were delightful young people. I enjoyed watching them being put through their paces of asking me questions, telling the consultant what they had learned from my answers, what else they should have asked or noticed, and carrying out some physical examination. One of the most helpful things in the whole experience of going through all this pain and incapacity, has been the opportunity to talk to many different people about it. Talking somehow puts things in perspective: the ‘talking cure’ is obviously not just for mental health problems, but can also help in the cure of physical ones.

During the day we were inching towards an identification of the infection: word came up that it was a coliform bacterium – maybe not that surprising, but they still needed to know which one. They weren’t any nearer to knowing why I was one of the 1 in 500 prostatectomy patients who suffer this complication. The video of the surgery showed that the pelvis had not been nicked during the procedure. Possibly the cutting and rejoining of the urethra had allowed some urine to remain in the pelvic space, and this might have caused an E.coli infection some five weeks after the operation. Perhaps we’ll never know. E.coli is always present in the body, but why should it be ‘triggered’ in this particular case?

While MPs in Westminster were voting to reject a ‘no-deal’ Brexit, I was getting ready for a second night in hospital. It was uncomfortable because of the pain, but at least the catheter meant I wasn’t having to get in and out of bed to go to the toilet every hour.

And another day dawned. At last the Bone Infection Unit consultant brought news that it was indeed an E.coli infection and could be treated with a six-week course of oral ciprofloxacin, and I would be allowed home that afternoon. This would have meant returning the next morning to have the catheter removed, so I asked if that couldn’t be done that afternoon: it was only a little more than 12 hours earlier than we had agreed. Luckily, my surgeon agreed, the nurse had the catheter out within minutes, there was the usual procedure of drinking fluids and producing urine to prove that the bladder and urethra were working normally, and at last I walked out through those hospital doors.

You always hope that every next step in the treatment process will produce almost instant results, that you’ll feel immediately well again. It’s already clear that isn’t how it works. So, though I have moved on to the next stage of recovery, it is only the next stage. There is still more to come. Readers of a queasier disposition may be hoping, not too much more.

Learning the Word by heart

Elle Dowd makes a case for progressive Christians to memorize Scripture, in order to argue back to conservatives.

At the Network of Biblical Storytellers International we prefer to call this ‘learning by heart’, because it’s a kind of embodied, whole-body learning, much more than the ‘in the brain’ stuff the word ‘memory’ evokes. But it’s the same thing when it comes to it, and it’s certainly something that all Christians should take seriously, not just the ones who make such big claims to be ‘bible-believing’ (and don’t always seem to know their Bibles that well).

The Satanic Verses 30 Years On

Somewhere on my bookshelves, I used to have a copy of Salman Rushdie’s The Satanic Verses. Its pages slightly browning, because even though I never read it, it must be over 20 years ago that I bought it, and for some of those years it sat on a window sill in the sun. But had it survived the downsizing, and terrible cull of books, that took place when we moved to Thame?

It didn’t take long for me to find it, and yes, it had survived, and is still on my list of Books To Read. Some time. (Being able to find it so quickly, incidentally, is an indicator of how few books remain…)

This search happened after I was reminded of Rushdie’s book by the recent BBC2 documentary, The Satanic Verses 30 Years On. In this film, presenter Mobeen Azhar examines the lasting effect Salman Rushdie’s The Satanic Verses has had on the Muslim community and how the events of 1989 continue to have an impact today. Those ‘events’ followed the book’s first publication, when Muslims in Britain were scandalized by Rushdie’s fiction, convinced that it was a blasphemous affront to Islam. Huge demonstrations took place in Britain, where the book was notoriously burned in the public square in Bradford, and in other countries, especially Iran and the USA. Ayatollah Khomeini issued the notorious fatwah calling upon faithful Muslims to assassinate Rushdie, and death threats were also made against the book’s publishers and all the individuals who had been involved in its publication. 59 people lost their lives in the most violent demonstrations around the world.

At the time there were laws against blasphemy in England and Wales, but they only protected the Christian religion. For a time there was some discussion, supported by a number of liberals and Christians, about extending the law to protect Islam and other faiths. In the end this did not happen: instead, the blasphemy law was repealed in its entirety in 2008, and may be considered to have been replaced (in part) by legislation against religious and racial hate crimes.

It was nothing but a good thing for the Blasphemy Law to have been repealed. It was ridiculous and out-dated, had hardly ever been used by Christians in the hundreds of years of its existence, and the possibility of it being used by Muslims in a case such as the Rushdie case, simply appalling. It’s also an unfortunate reality of the differences between the world faiths, that there are passages even in the sacred Scriptures that could be construed as blasphemous by the adherents of other religions. Christians ‘blasphemously’ (to Muslims) believe that Jesus is the Son of God. The Quran ‘blasphemously’ (to Christians) asserts that Jesus is not the Son of God, and that he did not die on the cross. This is just the start of the problem…

Mobeen Azhar’s documentary followed up the events of 1989, interviewing some of the men who had been involved in the protests. His conclusion was that, although the protests had given the Muslim community the opportunity to make a protest which was, as much as anything, about the racial intolerance and disadvantage they had suffered, it had also had many negative consequences. In particular, the caricature of the Muslim bogeyman was born, because of the way the tabloid press reported the riots. Azhar’s final comment:

“It ushered in this age of division, with Muslims being seen as the other. But we’re not outsiders. We’re a really important part of British society. But we have to be able to stomach debates about our culture, and actually our religion as well. Even if we find them offensive, we have to be able to do that. And it’s only when we can do that, that the ghost of The Satanic Verses will truly be put to bed.”

That blasphemy is still considered a crime anywhere in the world, in the 21st century, is a scandal. We only have to look at the terrible way it is used in Pakistan and other Islamist countries, where not only Christians and ‘apostates’ from Islam are routinely lynched or murdered, but also Muslim politicians and justice officials who try to protect them. And this in a country which, as a member of the United Nations, is supposed to subscribe to the UN Declaration on Human Rights, with its protection of Freedom of Religion. (Including guarantees of the freedom to choose one’s religion, to hold to any religion or none, and to change one’s religious beliefs without fear of reprisal.)

Are human beings offended by material insulting to the God they believe in? They need to just get over it. Is God offended? I think God is likely to have a good laugh about the presumption of us thinking that God might be. But even if God is offended, I’m pretty sure God knows how to deal with it. Probably by grace, mercy, and love, and (I hope) opening the blasphemer’s eyes to see the foolishness of insulting the Divine.

Literacy and life expectancy

A new documentary, H is for Harry, to be released in cinemas on 7 March, focuses on the fact that white, working class boys form the demographic that does worst in our education system. It’s said that 1 in 5 children left primary school in 2018 unable to read or write properly. I’ve heard this statistic before, and understood the difference it makes to life chances, employment, and health, but I was especially shocked to read in the Guardian report on this documentary about the difference it also makes to overall life expectancy:

Adults with poor literacy skills are more likely to be unemployed or in low-paid jobs. There is a link between low levels of literacy and shorter life expectancy, depression and obesity. According to the National Literacy Trust (NLT), a boy born in Stockton-on-Tees, which has some of the most serious literacy challenges in the country, has a life expectancy 26.1 years shorter than a boy born in north Oxford.

26 years off a life expectancy of around 80 is 54. Let that sink in.

A couple of days ago I posted about the differences in library funding between the UK and Finland. It’s instructive to note a few other comparisons as well, described in another article in the Guardian. Life expectancy in Finland is rising; in the UK it has stopped rising. Infant mortality is twice as high in the UK as in Finland. Finland has some of the best education in Europe, because it trusts and rewards its teachers, so that professional morale is high. It also provides free school meals for all pupils, so that no child goes through the school day unable to learn because of hunger. And its system is truly comprehensive, with none of the blight caused by our private schools and selective grammars creaming off the most advantaged children. Finland is dealing effectively with homelessness, and its truly preventative health care measures include the provision of genuinely affordable housing for all, so that people can afford good food rather than paying much of their income on the kind of astronomical private sector rents we see in our system. Finland spends a slightly lower proportion of its GDP on health care provision than the UK, but it can afford to because doctors don’t need to be paid as much as they are in the UK, since housing costs are lower. For every 10,000 people in Finland, there are 32 doctors, compared to 28 in the UK, and there are 40 hospital beds for every 10,000 Finns, compared to 26 in the UK.

There’s more: Finland is also seeking to introduce a truly universal basic income. It has the best green credentials in the world, ranking top in the 2016 Environmental Performance Index. Add to this that Finland is one of the most equal societies in the world: the gap between the richest 20% and the poorest 20% is one of the lowest in the world, second only to Japan.

If we’re looking for ways to improve British society in the coming years (if such an aspiration is even possible) we could do a lot worse than look at how Finland does it.

Why do we need libraries, anyway?

I’ve said it before, I may well say it again: inside this retired vicar’s breast there still beats the heart of a librarian – albeit one who is very relieved he didn’t spend his whole life in librarianship, in view of the trials and tribulations libraries have been suffering in this country, for as long as I or probably anyone else can remember. Just a few of the statistics tell it all:

  • In 2016 alone, 105 public libraries closed in the UK.
  • Between 2016 and 2017, public library spending fell by £66 million.
  • Annual UK spending on public libraries is just £14.40 per head of the population.
  • The UK is only the 17th most literate nation in the world.

Meanwhile, in Finland, which the UN declared in 2016 the most literate nation in the world they spend £50.50 per inhabitant on public libraries. Nearly four times as much. They’ve just spent €100 million on a new library in Helsinki, called Oodi, even though there are already 36 public libraries in the city.

I wonder if there could be any connection between these statistics, and the highest rate of literacy?

In a May 2018 story in the Guardian about Finland’s libraries, the report begins with the inspiring story of a young girl named Nasima Razmyar who arrived in Finland from Afghanistan in 1992 as a political refugee and asylum seeker. Her father had been a former Afghan diplomat, forced to flee with his family to seek safety elsewhere.

“A library card was the first thing that was mine, that I had ever owned,” says Nasima Razmyar. … Unable to speak the language, with scant resources, and trying to make sense of the strange new city she found herself in, she was stunned to discover she was entitled to a library card that would grant her books – for free. Her appreciation of the privilege has not faded: “I still have that library card in my wallet today,” she says proudly.

That girl is now the deputy mayor of Helsinki, and justly proud of the new library which provides so much more than most of what we in the UK associate with libraries. The Finns see libraries as the visible symbol of their beliefs in education, equality and citizenship, which make me want to ask hard questions about whether we even mean the same things as they do, when we or our politicians mouth those words.

Public libraries are clearly one of the key providers of equality of opportunity. Maybe that’s one of the reasons why successive cost-cutting Governments have starved them of resources?

What happened to February, then?

It’s alarming to find myself at the end of February / beginning of March, with two months of this year already past, and myself still feeling so incapacitated. I had expected to be up and running, more or less fully functioning again (though still able to say I have to take it easy, if I felt like it). Instead, February has disappeared in a fog of pain and inability to do very much at all, sometimes even walk without the aid of walking poles, or hobbling around the house levering myself around the furniture.

It started on 31 January, when I woke up with a pain in my groin, which felt as if I had just pulled a muscle or tendon in the night. However, it went on for several days; at that time walking was still possible, but getting in and out of bed was uncomfortable, rather like when you have lower back pain. When I went to the hospital for my post-operation check-up, the consultant examined me to make sure I didn’t have a hernia (apparently I didn’t, but I didn’t think I had), and said this pain was the kind of thing that might occur any time for two or three months after a prostatectomy. And “Just keep taking the paracetamol.”

A week into The Pain, when it felt much more as if it was in the whole lower abdomen, I phoned my GP to see if she had any bright ideas. She recommended taking ibuprofen as well as the paracetamol, and said she could prescribe a stronger form of non-steroidal anti-inflammatory if I wanted. I said I’d leave it for the time being and get back to her if I changed my mind. I carried on trying to keep up a normal routine as much as possible, but at the end of the second week I phoned the GP again to get the stronger painkiller (Naproxen) and omeprazole to protect my stomach from bleeding.

The painkillers didn’t seem to do very much — there was no sense that the pain got better after taking them, and then gradually got worse again as the time for the next dose drew near. The day after starting the naproxen we thought it would be nice to go into Oxford for lunch. This was the first time I went out with my two walking poles in the hope they would help me walk more easily. They did; but most days I didn’t feel much like going out at all, and sat a lot at home, hoping that wasn’t making things worse, but not really being able to do anything else anyway.

In the meantime (because I had thought that by February I would be getting better) I had agreed to take a few Sunday services and other commitments. Mostly I managed these, but after the last one I was in so much pain I could barely hobble around the house, dragging myself about by holding onto the furniture and the walls. Luckily it’s a small house, so a wall is never far away.

The following day I phoned the GP again. This time he was of the opinion that something more was going on, than just a post-operative healing complication. He asked me to let them have a urine sample, to test for a urinary infection. “But surely a UTI couldn’t cause this much pain to the whole groin region, and make it so hard to even walk?” Apparently it can; and by now I was getting some of the other, more familiar, symptoms of a UTI — which I hadn’t had before — needing to pee much more often (up to 5 or 6 times a night) and not producing very much when I did. It’s a funny thing to be pinning your hopes on having a urinary infection, because at least that can be treated with antibiotics, and if it is the cause of all the pain, you might actually start to feel better.

So now it’s the end of Week 4, and I’ve been told my test results have reached the practice, and probably show I do have an infection, but they haven’t yet been checked by a doctor, and my request for a call today doesn’t seem to be possible. So another night and probably day of pain lie ahead, especially as our local pharmacy is also woefully understaffed, and even if they get the prescription tomorrow, they may not be able to dispense it till Saturday.

And that’s what happened to February…

Postscript: My GP is a star! She phoned at 7.40 p.m., when I imagined she would have long finished work (and indeed, as the father-in-law of a GP, think she jolly well should have) to tell me she’s written a prescription for antibiotics and it will be ready to collect at reception in the morning. I’m hoping collecting it and taking it to the pharmacy in person may get it dispensed quicker than her sending it electronically.

The Elephant in the Nave

We’ve been worshipping in our current church for nearly 2½ years now, and I must have lost count of the number of times I’ve been aware of the elephant in the nave. The huge Thing that may not be named, that has almost never been named, that (presumably, for some reason) no one dares to name.

The elephant is called Brexit.

Surely it would have been possible to mention it at least in the intercessions, when we pray for this country. You wouldn’t have to take sides and pray for a swift and brutal no-deal Brexit, or for no Brexit at all; surely you could pray for ‘a successful outcome to the Brexit negotiations, that would ensure the best and most prosperous outcome for all people in this country, and for Europe’. And people could entwine that neutral form of words with whatever meaning they wanted to attach to it. But no, it has barely had a mention of any kind.

This morning our curate, greatly daring, preached on The Politics of Jesus, from Luke 4.14-21.

“The Spirit of the Lord is upon me, because he has anointed me to bring good news to the poor. He has sent me to proclaim release to the captives and recovery of sight to the blind, to let the oppressed go free, to proclaim the year of the Lord’s favor.”

“I’m not talking about party politics,” he says, “I’m not telling you who to vote for.”

And he goes on, “No one gets left out, or left behind, in Jesus’ kind of politics.”

Disingenuous, I call it. If that’s not telling us at least who not to vote for, I don’t know what would be.