ADVANCED PAEDIATRIC LIFE SUPPORT!

I've been away on holiday for a couple of weeks and now I need to knuckle down and work through the APLS manual ready for the course next week at Guy's Hospital in order to renew my APLS certificate.

Jim Swift, killed in action, aged 19.

James Swift was my father's elder brother who died on the Western Front in 1918. When I was a kid the First World War seemed like ancient history to me but the older I get the time difference seems less and less significant.

Last weekend in Leeds I attended my aunt's 100th birthday party. Auntie Anne would have been 8 years old when Jim was killed; it is a remarkable idea that the records I airily pick over represent a real person that Anne knew and grieved for.

The details I have on Jim are sparse but knowing the date of his death and the unit he was with I can place him in the path of the German Spring Offensive of 1918. This was the German's final gamble to win the war outright before the Americans could intervene in force. The offensive is now known as "The Kaiser's Battle" or "Kaiserschlacht". German forces no longer required on the Eastern Front following the military collapse of Russia during the Revolution of 1917 were transferred west and the full force fell on the British front line starting on 21st March. British forces reeled under the blow, the Germans broke through and the army was forced to retreat across ground won at such a high cost in the preceding years. Eventually the British lines held and the German threat was contained.

I gather from the family that Jim had only just got to France when he was killed. This is the record I obtained from the Commonwealth War Graves Commission.

Casualty: Private JAMES SWIFT. 205628
Served With: 7th Bn. Queen's Own Royal (Royal West Kent Regiment)
Died: 28th March 1918
Commemorated: POZIERES MEMORIAL
Somme
France
Panel 58 and 59
Additional Information: Age 19
Son of Patrick and Mary Ann Swift, of 38 Exeter St.,
Bradford, Yorks.
He was born and enlisted in Bradford and formerly served in the Yorkshire and Lancashire Regiment.

Jim has no known grave.

How long is a Piece of String?... ooops Cable?!

At the conclusion of our week of heart surgery we had dinner at an Italian restaurant in Nairobi. Cliff, our 'perfusionist', held a sweep-stake where we all had to make a guess as to how long the cable was from the maintained power socket to the Cardio-Pulmonary Bypass Machine in theatre. We all put a £1 into the pot.

Ivy won! It was 29 metres or 95 feet!

Clifford Longley.


I love listening to radio 4 - unfortunately there are occasional bits of grit in my breakfast that have to be endured like "Thought for the Day" on the "Today" programme. This morning I had that awful sinking feeling as I listened to the contributor.

Clifford Longley is a journalist with a long career commenting on religious affairs so it is more with a sense of depression rather than any other emotion that I say what I am about to say. I barely know where to start in unravelling his confection of platitudes... any way here goes.

The notion that people make ethical decisions based on whether they believe they may be rewarded or punished and that atheists, having no such motive, can actually operate on a higher ethical plane leaves me speechless. This is such a childish notion.

The adult reality is that people make ethical decisions based on the worldview they hold to. If one is a thoughtful Christian one makes Christian decisions. An atheist will make choices consistent with that worldview. If it happens that one is an atheist who follows a none Social-Darwinian ethical process then one does so because one instinctively knows (by God's 'Common Grace'!) that such a course is right even if one finds oneself acting in a logically inconsistent manner. That is hardly operating on a higher plane.

The bishop CL was damning on air I suspect was actually pointing out that our values arise from the worldview we hold to be true. Reading between the lines of CL's garbled account the poor bishop was probably simply affirming a Christ centred worldview (which is his job afterall!) but that obviously went completely over CL's head.

A Christian may act unChristianly/Atheistically. An Atheist may act unAtheistically/Christianly. It all depends on the operating worldview. But this is all beside the point because merit is not earned in God's eyes by what we do. That implies that correct ethical choices put us in God's good books but that is not how it works! We all foul up from time to time - so the adult issue is how now do we get right with God given the reality of our failure? As a Christian I believe in Jesus not in my capacity to make correct ethical choices. A Christian, by definition, is someone who has come to a point of repentance rather than the media caricature of someone who is self-righteous, ie someone who believes that they always make correct choices!

As a Christian I seek to make ethical and personal choices consistent with the world as it actually is; though in my weakness I often feel brow-beaten by media pundits pushing the official line and find myself compromising against my better judgement. And when I do fail my primary concern is not fear of being punished it is the sense I have of not having 'walked worthily of Lord'. Others may make ethical choices on worldviews they are in a better place to explain. I seek to make choices which please the Lord, so reward/punishment are not the primary consideration! The ethical debate lies elsewhere entirely in the nature of reality and truth and relationship with God.

Clifford Longley's piece this morning is merely yet another example of the infantilisation of religious discussion in the country when it is crying out for informed comment and debate.

Return from Africa!

I arrived back from Nairobi a couple of hours ago. In all our "MEAK" team did 17 operations on children with congenital heart defects including some of the more complex procedures yet attempted; Truncus, TGA etc.

Sadly one of our patients died midweek which was a low point for us all. We did have our successes - a baby girl with a huge VSD and failing heart had no clear left lung fields on X-Ray. Not only was her heart huge but she also had a raging chest infection. We did physio on her and suctioned out lots of gluey secretions. This is her X-Ray now - hurrah! we have some air on the left side!

The other highlight was that we did the first ever "Switch" for Transposition of the Great Arteries ever attempted in Kenya.

I'll write more about all of this but right now I'm exhausted after a sixty-five hour week and this will have to suffice for now!

The Kenyatta National Hospital in Nairobi.

During our time in Kenya we are aiming to do three major cardiac operations each day. I was speaking to the manager here this morning who told me that they only have the resources to do two or three a week normally; so in our time here our team could clear 2 or 3 months backlog! Which is quite an amazing thought!

I am also given to understand that we did Kenya's first ever "Switch" for 'Transposition of the Great Arteries".

An Amusing Sign by the road en route to the Kenyatta National Hospital in Nairobi.

A group of us from the PICU will be based there 15th-24th May 2009 as part of a team doing open heart surgery.

Nairobi sunset.

Crack PICU team,

Nairobi May 2008.

Claire Barker, Fiona Lynch, Natalie Robertson & Tim James

(I'm behind the camera!)

Peritoneal Dialysis.

During our 2008 trip to Nairobi on a Cardiac Surgery mission one of our post op children went into acute renal failure. I improvised a PD set, as well as made our own bicarbonate dialysis fluid. The advantage of taking a dinosaur like me along is that I remember how we used to have to do things twenty+ years ago!

Take a one litre bag of sterile 0.9% Saline for IV use and remove 350ml using an aseptic technique. Discard this 350ml.

Using an aseptic technique add the following to the remaining 650ml bag of 0.9% Saline; 300ml Glucose 5%, 10ml Glucose 50% and 40ml Sodium Bicarbonate.

Properties of this solution are as follows Sodium 140mmol/L, Glucose 2% and Bicarbonate 40%. PLEASE NOTE THIS SOLUTION CONTAINS NO POTASSIUM! Normally one would add 4mmol/L of Potassium Chloride depending on the patient's serum K+ level; however if the patient is hyperkalaemic use a reduced amount, eg if their potassium level is 5-7 add just 2mmol/L, and if the patient's level is >7 add no potassium to the solution.

Start with Fill Volumes of 10ml/kg. In over 5 minutes, dwell 10 min and drain over 15 min. And repeat the cycle. This will draw off some excess water as well as correct the patient's electrolytes and acidosis. Monitor patient's fluid balance and serum electrolytes regularly until the patient's kidneys recover. Until they do recover restrict the patient's fluid intake to 2ml/kg/hour if they weigh less than 10kg, and if they are upto 20kg give 1ml/kg/hour.

For larger patients give a maximum of 40ml/hr if they weigh more than 20kg (please note this is NOT 40ml/kg/hr but 40ml total volume per hour!)

Facebook.
I recently joined the Facebook crowd........................ so if you can't get enough of me here you can always look me up there!

(ps Gym today: ran 3.52 Km in 20 mins, weigh 91.0 Kg.)

More Training.


Today I completed my annual "Moving & Handling" mandatory training. And, as a special treat, we had a short session on the respirators we are being fitted with in case of pandemic Swine Flu. 3M Respirator type 7500 with p3 filters........................... so I'm okay!.........................

The Age of Aquarius!

Among the wide range of gadgets we use in PICU to help support the sick kids we have is this one. It is an "Aquarius" haemofilter produced by 'Edwards Lifesciences Services GMBH'. We use this for Continuous Venous Venous Haemofiltration (CVVH). We generally use this when the children are in acute renal failure and need excess fluid removing &/or their chemistry correcting. Occasionally we will have children who need a drug dialysing out.

In essence we draw blood out from the patient through a large intra-vascular catheter called a 'vascath' by means of the "blood pump" which is the red roller pump [top left]. The patient's blood is pre-diluted with a dialysis solution [Multi-Bic] drawn from a reservoir bag slung beneath the machine by the green pumps before entering the blood filter in the centre of the picture. Excess water is drawn out from the filter by the yellow pump into a waste bag also underneath the machine (not shown). The filter will also correct the patient's blood chemistry and pull out any other waste products too.

Depending on the size of the patient (and they can be infants all the way up to teenagers!) we will select the appropriate size filter and the various parameters for an effective treatment. This is programmed into the computer screen at the top of this picture.

Renal Replacement Therapies is one of my 'specialities'.

Covenantal Objectivity.


If someone died on the way to their baptismal service do you believe that that would be "objective" evidence that they were not saved?

Return to Africa.

This coming May I will be returning to Nairobi with a team of people to do open heart surgery on children there. This will be my third such trip having been before in 2007 and 2008.

My role will be to help set up an improvised Paediatric Intensive Care Unit on ward 4b in the Kenyatta National Hospital and to care for children following their heart operation.

The picture above was of first impressions taken by me in 2007 when we very first arrived on the unit we were to use. The electric bar fire was an improvised attempt at an incubator! The hurricane lamp was the emergency lighting. The ventilators were pretty good though. The monitors were clunky old Hewlett Packard monitors which I recall using twenty years ago - they're outdated but effective. Lab facilities were pretty minimal so we had to rely on our own clinical judgment a lot. It was a real privilege to be part of this whole enterprise organised by MEAK (Medical & Educational Aid to Kenya).

During our time there we did over twenty operations. My proudest moment came last year when I improvised a means of giving peritoneal dialysis to one of our patients with my own homemade brew of dialysis fluid! He was very ill and went into acute renal failure. The advantage of taking a dinosaur like me along is that I remember how we used to have to do things here 15-20 years ago.

We fly out on 15th May and return on 24th. If I can I'll try and post a couple of blogs describing our adventure there - but the photos might have to wait until I'm back in the UK!

Jars of Clay! Just Jars of Clay!

Last night at St Helen's we had our 'Annual Parochial Church Meeting' at which William Taylor and a number of others laid out the vision for the church over the next ten years. The venue is pretty sizeable but even so it was packed out!

The numbers on the electoral roll at St Helen's are currently 895 people - although I am sure that many more actually attend our range of services. This makes us one of the largest churches in London despite having lost a significant number of people in recent years to our various church plants around the city. We have a thriving Mandarin speaking congregation and on-going work among other communities within London. St Helen's continues to support work in the French speaking world and Sub-Saharan Africa. But William was very clear to emphasise that the continuing growth of the ministry here is not down to our abilities. It is the power of God's Word alone - it has to be - because we are just jars of clay! It is in our very weakness that God's power can shine through.

By God's grace our vision is to see 20 gospel hearted churches planted by 2020. We also want to develop a French speaking congregation from among the many such people based in London.

There is also a plan to beef up our 'Digital' ministry. The whole internet social networking thing is a vast new area we need to grow into. Our web page gives the impression that St Helen's is all about programmes rather than people and we hope to redress that perception by drawing on the individual stories of the people within our church family. So watch this space!

After the public business was wound up there was a brief meeting of the PCC - the Parochial Church Council - of which I am now formally a member. It is a real privilege to be part of this 20-30 strong group especially with such a fantastic strategy in place. It is comforting to be reminded that it is in our weakness that God's power will be demonstrated - I am very conscious of my own inadequacy, but I'm sure I'm not alone. Jars of Clay! Just Jars of Clay!

Latest on the Gym front!

Today I had a good run; 3.45km in 20 min! I also did some 'core' muscle exercises to help my back.

I would like to get to a point where I can run 10 kilometres comfortably again.

Cherry Blossom Snow.

Our lovely cherry blossom tree has slowly shed its petals.

Floating pink blossom gently fluttering down like snow on a warm spring breeze.

Daniel for Adults!

Today William Taylor continued his new series of talks on the book of Daniel. Last week we looked at chapter one and this Sunday we covered chapter two. What I find enormously encouraging is how faithful God is to his promises. Great empires come and go, nations rise and fall but God remains constant and those who put their trust in him are secure.

The great statue which depicted a whole sequence of mighty empires is ultimately overwhelmed by a rock not cut by human hand and the remnants of these empires are blown away like so much chaff in the breeze.
Where is babylon now? In a room belonging to the British Museum! In my own life time an empire like the Soviet Union - which seemed such a monolithic power at the time - vanished overnight. The recent financial crisis is a warning to us that God doesn't owe the west anything either. The veneer of civilisation we naively think is so secure is anything but. All such confidence is vanity.

Thank God that he stays true to his promises though. Are you going to build on the rock or on something else?

C.S. Lewis "The Most Reluctant Convert".

After paying an extended visit to "the dark side" with my recent readings about Stalin's Russia it has been a real JOY to read something which refreshes my soul.

David C Downing's biographical account of CS Lewis's journey to faith has been a real encouragement, not just because it's a great story but because there are nuggets of spiritual insight that resonate with any believer.

I was particularly struck by Lewis's struggle with self analysis - something most sensitive people are troubled by. Lewis's initial loss of faith arose when he realised that he was not being "sincere". Later (p132) he came to the realisation that one cannot "enjoy" and "contemplate" at the same time. You cannot be both unselfconscious and selfconscious simultaneously. To contemplate one's sincerity at prayer (for example) is not to be praying. Consequently such self analysis becomes self defeating. The key seems to be to enjoy the moment and not over-think your own personal significance within it. Lewis calls this 'fussy self attentiveness'. That is an absolutely brilliant insight! I say this as someone often guilty of the same pointless introspection!

I've always been impressed by Lewis's attack on "chronological snobbery"; the conceit that one's own era is superior for no better reason than it comes later. This is the arrogance that fed the Modernist totalitarianism that Lewis confronted in the mid 20th century. Perhaps it will take 50 years for our present day 'chronological snobs' to be unmasked and people then will stand aghast at how our generation was taken in by our own ideologues! The lesson of history is clear; when we abolish God we find we also abolish Man!

Prior to his conversion Lewis had written a couple of obscure books of poetry. His faith in Christ fired up his creativity. He became a prolific writer of the most diverse range of subjects; apologetics, children's stories, science fiction etc. People will still be reading Lewis when the Pullmans of this age are long forgotten. Of course these others will have a momentary notoriety but the things that last touch us with truths that transcend the momentary and remind us of our deeper humanity.

This is the lovely Helen working on her water colours. Today is our 14th Wedding Anniversary.

The caption on the 'Matt' cartoon about today's Budget speech......

"How is it possible to be both alarmed AND bored at the same time?!"

RCN Consultation on

Assisted Suicide.

The Royal College of Nursing in the UK is presently carrying out a consultation among it members to see what the consensus of professional opinion is about 'assisted suicide'. So if you are a member and have an opinion on this topic you have until 22 May 2009 to send your views into the RCN.

One of the worrying aspects of this so-called "debate" is how the pro-euthanasia lobby frequently misrepresent the issues in the media and not infrequently caricature people who object to euthanasia as motivated by ill-will or sheer ignorance.

For example; the case is often put forward that it is accepted 'custom & practice' for patients to die in pain and that they are subjected to unwanted medical interventions. These commonly accepted fallacies are repeated so often and so authoritatively that the innocent public are unduly influenced by them. It is no surprise that public opinion is moving towards euthanasia but the fact is they are faced with the phoney "false choice" argument ie 'do you want your loved ones to die in agony, yes or no?' Who in their right minds would say anything but 'no!' given that proposition?

I have worked in children's and adult's critical care for more years than I care to remember and I can honestly say that I do not recognise the caricature of our profession.

First up, it is NOT acceptable practice for patients to be in pain - that is not acceptable and there is no excuse for it. If the disease process is such that pain control foreshortens life then so be it - that is not euthanasia or assisted suicide - that is effective pain management. This is exactly the same legal situation as someone dying as a consequence of any other medical treatment aimed at controlling the disease process.

Secondly, everyone has a right to refuse medical treatment. All interventions require informed consent. No one has any intervention "forced" on them - indeed to do so is a criminal offence! (There are some legal exceptions of course - when the mental capacity of the patient may be in doubt - in which case there are legal procedures to be followed). In my experience it is more often the case that family members insist on medical interventions when the professional consensus is that further treatment is futile.

Thirdly, the withdrawal of treatment is not euthanasia or assisted suicide. The purpose of medical treatment is to enable the patient to make a recovery. If the consensus of opinion is that no such recovery is possible then active treatment may be withdrawn and the disease process allowed to take its course.

None of the above are the cause of any ethical or professional dilemma! Okay? Clearly the truth does not suit the pro-euthanasia lobby's arguments which is why they resort to caricature.

When the pro-euthanasia lobby stress the 'pain' people are suffering we must of course exclude physical pain because that can and should be adequately treated. I suspect the 'pain' they refer to is existential pain - the pain we will all have to face at some time in our lives as human beings living in a fractured world. How far do you really want to push the limits of state sanctioned suicide as a cure for this? It is no surprise to me to hear that people who are physically healthy but feeling depressed are being offered suicide at a Swiss clinic. Given everything I have said above about the reality of pain control and informed consent and withdrawal of treatment I do not see where the pro-euthanasia lobby is attempting to take society except down the same route.

Oh! And no I am not motivated by ill-will!!!

ps there is a video about this RCN consultation at http://www.policyreview.tv/embed239/882

Our Cherry Blossom Tree!

Lesbian Vampire Killers!

So the Lesbian Vampire Killers aren't lesbian after all.

They're Lesbian-Vampire Killers.

That clears up a lot of confusion here.

Thought for the Day.

Giles Fraser, the vicar of Putney in London, was giving this morning's "Thought for the Day" on BBC radio 4's "Today" programme. He took issue with those Christians who emphasise the significance of the Cross. He said that such an emphasis "left the resurrection 'with nothing to do'!" It seems rather self evident to me that you cannot have the resurrection without first having the cross and actually, when you think about it, the cross gives profound meaning and significance to the resurrection.

But Giles clearly has an issue with the Cross as "all about violence and retribution". In a way, that is not unusual, many people (such as Steve Chalke etc) find the atonement concept outrageous. They will say that it is fundamentally unjust but I think what they actually baulk at is the neccesity of the Cross. Human nature is not so bad that any atonement is neccesary; which is a Humanist worldview rather a Christian one.

For Giles the Cross is an example of Christ sharing in humanity's suffering... please do not misuderstand me, that is perfectly true and I am not denying it, but while it is the truth and nothing but the truth it is not the whole truth. Jesus himself said that his death would have a much richer, far deeper meaning than that, the Cross is not a later theological construct as some allege.

The thing is what really struck me was that Giles sounded so angry about it all - there was some venom in his delivery that astonished me. But perhaps I shouldn't be surprised because he was in the unfortunate position of proposing a poorer and shallower theology than the one he was attacking. Or maybe he was deliberately trying to be provocative.

No doubt some of my fellow Evangelicals might be considering penning a robust counter-attack. I hope that they will do so graciously in a way that will speak to him rather than merely confirm his preconceived ideas. We need to respond with grace if we are to defend the Gospel of Grace.

I notice that Giles Fraser also had a column in the Guardian newspaper on Saturday attacking the Cross in pretty much the same terms as Steve Chalke did a few years back when he described it as "cosmic child abuse". (Incidentally the media seems to have given a fair wind to this particular theological stance hasn't it?) Obviously it is difficult to gauge the tone of a written piece but, again, Giles does seem to be a very angry man.


The fact that an innocent party is punished in my place IS unfair and unjust. But this is an act done in the context of Trinitarian Christianity (it will make no sense outside such a worldview!) God willingly takes on HIMSELF the punishment rightly due to me. That is indeed unjust, but God is a God of Grace.... and grace is not about getting what I deserve - quite the contrary! Not only do I not receive what I do deserve, but I also receive what I do not deserve in exchange (the righteousness of Jesus himself!) and I have all the privileges that come with it. [God's Riches At Christ's Expense!]

One day we will all face God; are you going to front up to him and demand justice? Or like me you may not have such confidence in your own righteousness in which case you, like me, will not be asking for justice but asking for mercy and grace!

Blooming Blossom.

Good Friday is the Best of Days!

I went to the Good Friday service at St Helen's this morning. There was a short talk by Mark O'Donaghue who described Good Friday as the best of days. Of all the days marked in the Christian calendar today's is not one the world has sought to commercialise like Christmas or even Easter and yet for the Christian it is a day commemorating something amazing.... the day Jesus made 'the Great Exchange'. Jesus willingly took on himself the punishment due to me and in exchange I was given his sinless standing before God!

During the service we had a series of readings and hymns and a solo all of which were very moving.

In the eyes of the world the Cross represented the most ignominious of deaths and yet, as is always the case with the Gospel, appearances can be deceptive. As Jesus dies the curtain in the temple is torn in two - the barrier that ceremonially separated a holy God from a less than holy people is split apart. The centurion, a representative of all of us who are foreigners to the things of God, perceives something astonishing in this death "Surely this man was the Son of God!"

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

ps

12th April 2009. Easter Sunday, the very best of days!

Check out the St Helen's Easter Films at www.st-helens.org.uk/easter/

Russia.

I've always been intrigued by the history of Russia having recently read books about Catherine the Great & Prince Potemkin and Robert Service's "History of Modern Russia".

Latterly I have completed "The Whisperers" by Orlando Figes and "Absolute War" by Chris Bellamy.

For whatever reason I have been fascinated by the war on the Eastern Front between Nazi Germany and the Soviet Union during the second world war. (Of course from the Russian perspective it was the Western Front!) The sheer scale of the conflict and its ideological nature between two equally odious totalitarian regimes makes it utterly unique in modern history. "Absolute War" as a title reflects the total nature of this staggering theatre of war; it was a battle to the death of two peoples, two giant economies and two ideologies on a scale never before witnessed.

A quarter of the entire Russian people (as opposed to the other Soviet peoples) are said to have perished in the war so it is not surprising that "The Great Patriotic War", as the Russians call the 1941-45 conflict, still casts a huge shadow over the Russian psyche and probably explains why the Russians are still very sensitive about national security. This scale of casualties of young men caused a major demographic shift; in some towns women outnumbered men by two to one and in some places it was as much as three to one! This altered demography was such that it would not correct itself within one generation but would take several.

The war on the Eastern Front has been well documented from the German perspective but it is only in recent years that the old Soviet archives have been opened up and their contents studied in depth. This has turned up some surprises such as the fact that the Soviet generals detested each other with a passion! There are intriguing hints that the Russians were preparing for a surprise attack on the Germans in 1942 had they not been beaten to the punch! "Absolute War" also casts doubt on certain commonly held fallacies; I had always thought that the Battle of Kursk in 1943 was the largest tank battle in history but according to Bellamy it was no larger than other encounters and was much more ambiguous in its outcome - it sounds like the protagonists traded blow for blow, but maybe the important point is the Russians could afford the losses where the Germans couldn't. Certainly the Germans perceived the battle as a defeat and perhaps that is what really counts.

In Alan Clark's "Barbarossa" there is a fascinating account of the 'sniper duel' in Stalingrad between Vasily Zaitsev and a German officer sent to eliminate the Russian ace - this was the storyline of the movie "Enemy at the Gates" - interestingy Bellamy could find no evidence of such a duel ever having taken place. Also there is no evidence for the suggestion put about by Beria that Stalin had a nervous breakdown when the Germans invaded in 1941. Speaking, please note, after Stalin's death in 1953 Beria said that the dictator was reduced to a catatonic state by events but Bellamy demonstrates that Stalin actually worked tirelessly throughout those initial calamitous days and indeed made some ultimately war winning strategic decisions, such as evacuating the industrial economy beyond the Urals and away from German interdiction. Stalin may have been many things but he wasn't stupid or indecisive.

An interesting question is 'why did the Russian people fight so hard for Stalin?' The reality is they didn't. The Nazis regarded the Slav people as 'untermensch' who were to be eradicated or enslaved; whatever illusions the Russian people might have had of the German army as liberators from the Stalinist regime were quickly dispelled as the Nazis imposed their brutal rule. The "absolute" nature of this war became self evident. It is also a curious fact that even the Gulag prisoners felt that they had a stake in the war-effort and believed that they had a valuable contribution to make toward their Motherland's ultimate victory. Prisoners released to fight on the front line would find, paradoxically, a sense of personal freedom and liberation even in the fiercest fighting. At least here people could be their true selves and didn't have to lead a double life as they might have to in civilian life sloganising in public but being someone else in their private thoughts.

The book is a great stonking read marred in places by some ghastly typos; instead of "lend-lease" there are several lease-lends and even lease-lands! There is also at least one reference to the Soviet Black Sea Fleet which logically ought to read Arctic Fleet. Despite these defects it is well worth a read.

"The Whisperers" is about private life in Stanlinist Russia when there was a concerted effort by the state to eliminate the notion of the personal and substitute the communal as a basis to society. To that end communal apartments were created with shared facilities and family life discouraged by means of quickie divorce. Children were to be raised by the state rather than being "indulged" by families into "bourgeois" thinking that they are uniquely loved, thus causing them to become "egoists". The window this book gives on a gigantic social experiment is breathtaking and has a lot to tell us about our own age as it too engages in a massive social experiment which jettisons the family and society atomises rather than becomes more cohesive.

Where "Absolute War" looks at the big scale "Whisperers" looks at individual stories and is heart rending in its ability to communicate the sense of personal loss as the Messianic state machine arrests and deports to the Gulags innocent, uncomprehending people. School children raised by the system to idolise Stalin and who find role models in the likes of Pavlik Morozov (who betrayed his own father to the state) become obsessed with denouncing 'class enemies' and fuel the paranoia indulged in by Stalin. Wholesale arrests and deportations on a quota basis crush individuals and ruin lives but this human sacrifice serves the Stalinist 'Five Year Plans' by providing slave labour for a crash programme of industrialisation. The enterprising peasant culture is overthrown in favour of farm collectivisation.... resulting in famine. I believe that Christianity gives value to the individual but given the collective mentality of the Soviet state the highest 'good' was that the state was served; all other considerations were secondary at best and more likely to be considered suspiciously deviant. Individual justice was 'bourgeois' and outdated in this Modern Age and a failure in food production could only ever be explained in terms of 'sabotage' - the state's farm collectivisation policy could not possibly be wrong by definition. Enterprising, prosperous peasants were denounced as 'Kulaks' (tight-fisted) and were persecuted - thus driving the 'work ethic' out of Russia's agricultural system. Even Kulak parents might consider their own values as outdated and would abdicate responsibility for their children to the state in a vain attempt to help protect them, but the collective presupposition was such that relatives, including the children, of 'enemies of the people' were just as guilty by association. These children would attempt to conceal their tainted biographies and become model Soviet citizens ever fearful of being unmasked. Whole people groups - Volga Germans, Chechens, Crimean Tartars etc - could be condemned in toto.

The persecution is not confined to the countryside, any problem (real or supposed) within the new industries is rationalised as sabotage by 'enemies of the people'. The most pathetic tales are those of die-hard Communists who find themselves denounced and yet who connive in their own downfall as a way of still yet serving the state! One daughter despairs of her Communist father who is released from the Gulag after many years and who still thinks that the system is just, "you can't talk to a believer!" she says.

The title of the book "The Whisperers", refers to the privately spoken thoughts of everday people in Stalin's Russia and refers not just to the victims point of view but also the many people who make whispered accusations to the secret police. Most of these remain unrepentant to this day and are still convinced that those they caused to be arrested, tortured, imprisoned or shot were indeed 'enemies of the people'. (How else can they live with themselves one might ask!). The police state provided ample opportunity to cause the removal of the irkesome neighbour, a love rival or the occupant of a job one coverted. The system either crushed you or corrupted you. Many individuals brutalised by years and years spent in the Gulag system find that they cannot make the transition back into normal family life again. Yet some relationships prove more resilient. "The Whisperers" is a haunting, heart rending read but well worth it.

In case anyone is under the illusion that Stalin deviated from a gentler version of socialism which might have prospered had Lenin not died in 1924 (only seven years after the Russian Revolution) please refer to Robert Gellately's "Lenin, Stalin & Hitler: Age of Social Catastrophe"! Stalin merely built on Lenin's legacy, he didn't pervert it.

A sensitive man like the poet Konstantin Simonov, who wrote the famous poem "Wait for Me", has a dubiously upper class pedigree and so remodels himself as a proletarian by putting himself through a 'factory school' and consciously suppresses any reservations he has about the regime. Perceived injustices are dismissed as mere bourgeois sentiment; as such he makes an interesting case study of how a sensitive man turns himself into a thorough-going Stalinist. You might think that this may have little to tell us - but from a Christian perspective it is all very familiar Romans chapter 1 territory, how people suppress the truth and are destroyed by what they idolise. It is telling that those individuals who do retain their humanity are those who have an alternative mental framework from which they can draw moral values critical of the all pervasive Messianic state ideology. Only those who had a moral compass of their own could avoid being sucked into the accepted values of their dominant society. Tellingly the odious phrase 'you can't make omelettes without breaking eggs' is a constant refrain of those state functionaries who try to rationalise their own part in wholesale injustice.

It is interesting that Simonov appears in both these books; during the "Absolute War" he was a correspondent reporting directly from the front-line. As the Red Army crosses the eastern borders of the Third Reich Simonov joins in the call for vengence to be visited on the German people in the form of murder, rape and pillage: events described in Antony Beevor's book "Berlin: the downfall 1945" as the German 'holocaust'. Please note these events were not spontaneous acts by unruly soldiers, this was a 'top down' directive promulgated as a patriotic duty! Simonov has misgivings about the vengence policy but again rationalises and suppresses these reservations as bourgeois sentiment and writes the neccesary articles for the army newspaper. As a Christian both these books describe a reality which chimes with the Christian worldview. "Evil" is not perpetrated by in-human 'monsters'': evil turns out to be a very human trait indeed. (I would argue that the word "inhuman" is the most mendacious word in the English language!). Current liberal conceptions of "evil" fall drastically short of the mark; for the present day Humanists all evil has to be 'other' than human! (If only it were that simple!) Yes, we do have our own ideologues don't we? People who try and make reality fit their worldview and "otherise" evil as something remote from themselves.

Perhaps the ghastly nature of Stalinism seems obvious now but in the mid 20th Century many Western intellectuals and trend setters looked on the Stalinist state with profound admiration and saw in it the way of the future. The horrific realities of life within the Soviet state were dismissed by gullible onlookers as western propaganda. In my own lifetime, after the "Khrushchev Thaw" was replaced by Leonid Brezhnev's reassertion of Stalinist principles, and when the Soviet state once seemed a permanent feature on the world stage, I heard many people speak out in defence of the USSR as a force for good. Lenin described such people as "useful idiots". Humans have a capacity for self delusion and our cultural elite are certainly no exception. Given that humans look to themselves for salvation there is no reason - no reason at all - why history should not repeat itself!

Philosophy of Care!

It is not unusual for our Paediatric Intensive Care Unit to receive patients from all over the UK, we are a centre for some highly specialised cardiac surgery, but we have just had a patient flown down to us with a relatively common cardiac condition called 'Transposition of the Great Arteries'; this tells us that (as at today's date) there are few childrens' intensive care beds available nationwide. There are other PICUs which were a lot closer! Certainly our unit has been horrendously busy in recent weeks and I'm sure we are not alone.

When I first started working in PICU, nearly two decades ago, I recall having a conversation with one of our consultant intensivists during which I suggested that a referal we had received could not be accepted because our unit was at capacity. He replied, "Peter, there isn't a 'St Elsewhere' for this kid!"

Up until that moment in time I had had the naive notion that the state would always provide. If we couldn't take this child then another unit somewhere else would. I had a vision of an all wise, monolithic system that planned and made provision for all eventualities. How wrong I was. No "system" works, not really.

In so far as any system functions; it is down to the good will of individual people. If individuals have a 'jobs-worth' approach to their work then no system will serve its intended purpose. I recall this same consultant having to battle the system to get our "Retrieval" service up and running; we had to start on a shoestring budget and prove that it served a purpose.

At the "Saline Nerve Child Hospital" our philosophy is always to try and make room for any child who needs intensive care - we will be loathe ever to say that "we have no beds" when the 'Emergency Bed Service' phones to ask what our 'bed state' is. We will bend over backwards to find a way of creating a bed for a child who needs PICU - it's a philosophy of care I feel comfortable with.

In Praise of Kilometres!

This year I am trying to make a concerted effort to stay fit. Before I did my back in I got pretty good at running but since 2006 it has been difficult to get back into the swing of things again. Anyway as a belated New Year's resolution I'm heading down to the gym at Guy's Hospital on a regular(ish) basis. I've been a member at The Fitness Centre since 1991 and used to get there at least once and usually twice a week. The peak of my accomplishments was to run 10 Kilometres in under 50 minutes - I'll let you be the judge if that is respectable for a middle aged man or not!

Then in 2006 I was laid low with sciatica for months and never really recovered that level of fitness. Anyway I'm determined to fight back. The gym is only small and unpretentious but I like it; especially on a morning when its quiet. The sub has just gone up to £24 per month so I have an incentive to get my money's worth now!

Aren't Kilometres great? Unlike Miles, which are a pain to do, I can pound away on the treadmill at a fair old clip - double figures on the speedo and see the distance covered click by at an encouraging rate. I'm converted!

Ten minute run at 10.8kph covered 1.78k. Okay that's my baseline - I'll keep you posted!

Weight 91.3kg... not bad, not bad at all!

Parochial Church Council.

I received a phone call the other day asking if I would consider joining the PCC at St Helen's; in reply I said "Power!.... Power at last! ...Ha Ha Ha! power! power!! power!!!....... HA HA HA!" or words to that effect.

The View from our Front Garden.
The Cherry Blossom is starting to come out.

I Was a Teenage Post-Millennialist!

I have previously related the story of the time I joined a church in Bradford (Yorkshire, UK) back in 1979 where this fellowship had a clearly "Post-Millenialist" ecclesiology. The "Millennium" is a term derived from a passage in Revelation 20 - the prefixes of "Pre", "A" and "Post" describe the period when the Kingdom of God, as promised by Jesus Christ, will be truly inaugurated.

"Pre-Mill" means that Jesus will return first and then establish his kingdom on earth. This is usually attributed to a re-establisment of the State of Israel which is then overtaken by "the rapture" and an apocalyptic world conflict. This is often the subject of "pop prophecy" in Christian circles and treats the Gospel era as a kind of hiatus in God's plan.

"Post-Mill" means that Jesus will return after his kingdom has been established through the agency of the Church... generally taken to mean that the Church will so predominate the life of the world community that the vast majority of people will be saved - and the rest will be notionally "Christian". Isn't it interesting that Jesus poses the question in Luke 18 v8, "Nevertheless, when the Son of Man comes will he find faith on earth?"

"A-Millenniallism" is a bit of a misnomer. "A" as a prefix means "without" which implies that A-Millennialists do not believe in the Biblical Millennium. A-Millennialists actually believe that the Millennium is a real and present reality - it is what Jesus called the Kingdom of God... an entity which is here now and yet not easily nailed down. It will yet be revealed in all its fullness when Jesus returns. (Contrary to some people who ought to know better "A-Millennialism" does not mean a disbelief in the Return of Christ!).

Does any of this really matter? Well, yes. Depending on your stance regarding the Millennium you will adopt one of several attitudes towards contemporary culture. The pre-mill believer will probably tend to be rather separationist from his or her non-believing contemporaries. The post-mill believer will tend to be an active lobbyist seeking to enculturate Christianity into the contemporary scene; such lobbyists tend to be rather right-wing. An A-mill believer will see that only the gospel of Jesus Christ can reform society by changing people's hearts, neither isolationism nor moralising will change a thing. By refusing to be enculturated in any place or time the Kingdom of God transcends all human categories and by doing so demonstrates the power of God.

The Shard!


Preparations are under way for the foundations of The Shard between London Bridge Station and Guy's Hospital.

The Shard, also known as London Bridge Tower, is due for completion in May 2012. At 310m (1,017ft) it will be the tallest building in the UK and among the tallest in Europe.
It will be great to have such a signature building south of the river!

Children Die Too.



Last night I carried a two week old baby in my arms down to the mortuary. Statistically our PICU has a better than average mortality rate compared to similar units - about 4%; which isn't much of a comfort when its your child. For parents the loss is 100%.

Apologies to Ros Clarke.

One of the problems of submitting a comment on somoeone's 'blog' is that one cannot always inject the right tone into what is written - especially if the comment is a questioning one.

The thing is I realise that I was coming across as boorish and I want to apologise for any offence I might have caused. On a previous occasion we were, coincidentally, on-line at the same moment; so the exchange we had occurred in real-time; in other circumstances the conversational theology we were having might have passed off without all the defensiveness. But that is no excuse, I was being tetchy and immature and I apologise.

Church Sunday Lunch........

The Sunday School riot....

becomes a venue for 250 lunches within 45 mins!

Every month or so we have a church lunch together after the morning service. Helen & I are involved in helping organise things. Essentially that means hot-footing the short distance across to St Andrew's Church (which is effectively the church hall for St Helen's) and helping get the venue ready.

The trouble is the Sunday School are all there until their parents come to collect them. Once the coast is reasonably clear we can set up tables and serving points and by 12:30 we should be ready to start dishing up. It is quite amazing how quickly the whole place can be transformed. Then we served roast beef and yorkshire pudding followed by bakewell tart and custard.

At last month's Sunday Lunch we had 264 meals served - today was a bit quieter with some folk away on a residential weekend at a conference centre and of course it was Mothers' Day so some people had other arrangements; even so we served 209 people today..... and washed up after them! A big 'thank you' to all our helpers.

Why not join us sometime? We are quite a friendly bunch!

Leithart's Presupposition.

This evening at our regular Bible study we looked at 1 Corinthians 12 v12-31. The opening verses contain a reference to baptism which the commentator Peter J Leithart asserts should normally be taken to mean literal WATER baptism unless that makes a nonsense of the text.

If that presupposition is accepted then a number of conclusions follow which we discussed last week in the "Federal Vision" blog. For Leithart Water Baptism inducts people into the covenant people of God and fills them with the Holy Spirit; they are regenerate, 'born again' and justified: but in the final analysis not necessarily saved.

As an exercise I thought that I would examine the 'baptism texts' as they arise in the normal course of life and see how they square up against Leithart's presupposition. Tonight's Bible reading is here by reason that it is simply the next in the sequence of readings. (Actually this isn't quite true because on Sunday morning the reading included Mark 10 v35-44 which everyone takes to be a metaphor!)

Tonight's passage happens to be is 1 Corinthians 12 v12-31, for our purpose we will be looking at verse 13 "for we are all baptised by one Spirit into one body - whether Jews or Greeks, slave or free - we are all given the one Spirit to drink." Let's test this with Leithart's presupposition which would insist that this passage refers to the unity of all believers, across racial and social divides, on the basis of the shared experience of WATER baptism.

"All baptised by one spirit" doesn't sound like the agency of a Church minister - besides which what would constitute a 'valid' sacrament if it was? Everyone would end up bickering about how it was done and by whom... hmmm... actually could that be the issue in 1 Cor 1 v13-16?

"Given one Spirit to drink"; metaphor or literal? Certainly sounds like a metaphor. One does not drink baptismal water - at least I didn't! If that is a metaphor then it's probable the baptism reference is too, we certainly cannot dogmatise that it is literal. Surely the whole point Paul is stressing is the spiritual unity of the Corinthian church above and beyond outward show!

No? Okay. Could the passage be referring to water baptism and communion? I could be wrong but I don't recall any Bible passage linking the consumption of the Spirit with the Lord's Supper. However Leithart does link this passage with 10 v2 where God's people are said to have been baptised into Moses as they crossed the Red Sea and to have drunk from the rock that is Christ. But the problem there is that 10 v2 is set up as an example NOT to follow, the passage is making an analogy which - if anything - completely undermines confidence in sacramental assurance....hmmm... if anything perhaps that is Paul's point!?

I played "devil's advocate" in our Bible study group and pressed Leithart's presupposition. Our group are not a bunch of twenty-somethings living in an academic hot house but a fair cross section of ages, social backgrounds and, prior to conversion, a variety of religious backgrounds.... hmmmm... exactly the type of people 1 Corinthians was actually written for! (I'm sure they won't mind me saying that!)

Water baptism was politely considered but the unanimous opinion was that made absolutely no sense of the text. If Paul was appealing to a highly developed sacramental basis for the life of their church community a la Leithart and that water baptism was THE way in to new life in Christ why does Paul say "Christ did NOT send me to Baptise, but to preach the gospel...not with words of human wisdom, lest the Cross of Christ be emptied of its power"? 1 Cor 1 v17. Hmmm... good point!

Mandatory Training.

Although today is actually a day off for me I went into Guy's Hospital this morning for a lecture on "Mentorship". The Guy's site is closer to home than the other hospital where I actually work. (This picture is of the Colonnade at Guy's).

There are a variety of courses one is obliged to do over the year to keep up to date. Some of these; like 'Health & Safety' and 'Fire' are done as part of an online training programme. 'Moving & Handling' involves the practice of shifting people around. As that involves some familiarity with the gadgets we use these days we need to attend practical sessions for that. I'm up to date with my 'child protection' training. So I'm pretty much on track although later this year I have the joy of doing my "Advanced Paediatric Life Support" course again. Let me tell you about APLS.

Now that APLS is seriously scary! The last time I did it it was a three day course involving a relentless series of scenarios overseen by outside assessors. It's a bit like being on "Crystal Maze": you enter the room and someone gives you a brief synopsis of a child (in the form of a computerised manikin) about to be admitted; here's just one instance by way of example, 7 year old fallen from tree, no loss of consciousness but now deteriorating and you just enough time to calculate a few basic essentials like an estimated weight based on age and resuscitation drugs for that weight.... then Go! You have sole responsibility to guide your team; YOU make all the clinical decisions based on your own patient assessment. The assessors follow an algorithm and project details onto a monitor as your interventions alter the 'patients' vital signs. Head injury? Internal bleeding? Penetrating chest wound? I quickly worked out that it was the latter which required immediate treatment but it does not preclude any of the others on top of that does it? Broken leg can be temporised while we sort out the life threatening stuff. Oh yes, we have internal injuries too....oh joy!.....

I passed but even so I'm still traumatised from that last assessment!!!

Anyway today was a fairly gentle affair looking at the documenation and processes of mentoring student nurses who pass our way. We get students from Kings College and South Bank University and wider afield on a variety of courses. The Paediatric Intensive Care Unit (PICU) is a great learning opportunity for them and we are responsible for teaching them, helping them through this placement and assessing their competence to be registered nurses. But the bottom line is if someone isn't up to the job you have to fail them which is just as traumatic in it's own sweet way.......................

Holiday Scruff... before and after...

I've just finished having a few days annual leave I needed to use up before the end of the financial year. It has been a chance to catch up on my reading, write up my diary (which got way behind), develop my household chores avoidance tactics and work on reviving my 'blog' of course!

I gave up shaving on my holiday but it's easily past the fashionable stubble phase and into patchy grey/ginger poor-excuse-for-a-beard territory. It is a relief to be rid of it. If we are ever required by the Taliban to wear beards I have had it!

The scruff has to come off because I have decided to go in to work today for a few hours study even though it is actually a day off; I need to get some of my mandatory training requirements up to date. As Guy's Hospital is closer to my home I'll pop in there rather than go all the way to the other hospital site.

Do Not Resuscitate Me - I'm Mediocre!

I just managed to catch on camera this ambulance as it raced by the other day. I couldn't quite believe what its logo said. It is a private ambulance operated by "Carillion" a company with interests in a wide variety of sectors of which health care is one. The mission statement on the side of the vehicle might work well in other contexts but in the area of health care provision it does not translate so well!

Bringing Excellence to life.

Maybe the paramedic would say, "sorry mate, I can't help - you're crap!"

How about, "your medical insurance is invalid; you didn't declare that you're rubbish!"

Breaking bad news: "I'm really sorry... we tried everything... but your husband's mediocrity was irreversible".

Tabloid headline; "the 'average' gene discovered - hope at last for sufferers!"

Maybe there is a niche in the market for a company specialising in "bringing bog-standard to life"! The 'National Institute for Clinical Excellence' (NICE) would become the institute for clinical indifference. Think about it; instead of Intensive Care for the critically ill you could have an Average Care Unit for the moderately poorly. Rather than a hospital being described as 'a centre of excellence' it could be a 'centre of mediocrity'. It could be a winner.... well.... no, thinking about it, that would be against its ethos wouldn't it?