Life, death and perfectionism

Lately, for various reasons, I've been thinking a lot about mistakes. I've always been a perfectionist, I don't think I know any pharmacists who aren't. But in recent years I have been trying to move towards a healthier form of attention to detail, which is tricky because a step away from perfectionism tends to swerve into embracing mediocrity (of the 'oh **** it I can't be bothered' variety). This healthy version is about recognising and accepting that there are limits to what I can do (such as the time available) and that if and when I make a mistake, I do my best to learn from it. That's how I explain it to colleagues at the beginning of their careers awho are struggling with their mental health in the face of all-consuming perfectionism. For myself I understand these as practical steps on the path of growing in humility.

So what happens when you've made a mistake that has serious consequences (or has contributed to serious harm, because these things are never straighforward) but by the time you find out about it, the consequences have already happened, there is nothing you can do about them, and your learning is limited because you don't know how or why the error occurred. How do you move away from perfectionism when you know that your work can have life and death consequences? How do you learn from a mistake when you know nothing about it except that it happened? When you don't even know what the consequences were because it was part of a chain of errors? How do you not veer off into finding a job with no direct impact on real people (or possibly, retiring to a remote cave)? 

On one level, the answer to these and many other questions is that I have no idea: I don't know how to live with this, I don't know how to move on from this. On the other hand, humility (I am fragile, limited and human and will make mistakes) and the knowledge that the truth undoubtedly does set us free, is absolutely what makes this possible. Loving truth means co-operating with an investigation. It means knowing that the truth is not just important for me but for those of my colleagues who were involved in the same chain of events and for our patients, past, present and future and their families. Embracing humility means not just the part about making mistakes, it may also mean recognising that I am good at what I do and therefore hiding in a cave is not the answer to one mistake. It means accepting that I may never know exactly what happened. And this faith perspective also involves trust and patience and generosity and forgiveness and prayer and no doubt a lot more. Maybe there will be no work-related learning point. Maybe my learning point is: grow in virtue

The very easy road to heaven. Oh, wait...

So...there's this massive humanitarian crisis in Syria and this is leading to a refugee crisis that no-one wants to deal with. Let's build fences. Let's share them out. Let's take people who really deserve help but not those who don't (laying aside the fact that anyone who views crossing the sea in a tiny boat as better than what they're going through right now is presumably in the middle of a pretty awful state of right now). Then we have the added complications of politics and political ramifications which mean that the response to such suffering isn't based just on the person in front of us and their need. This doesn't just happen at government level, but also on a personal one.

But I was thinking that welcoming the stranger is a corporal work of mercy, up there with feeding the hungry etc, so it's pretty clear that that's what we ought to be doing. Jesus was pretty unequivocal ergo let's get on with it. But perhaps the reason that we aren't getting on with it is the same reason Jesus had to be so specific is: these things are really, really hard work. I happen to know a bit more about one of these than the others: caring for the sick. This is my job. I get paid for it, and I really like it, but when I'm on call and I'm at home tucked up in bed and I get a call at midnight with a question from a doctor or a need for medication in an emergency, caring for the sick is not fun. I think it's hard and in these circumstances I might not even need to leave my home to do it. Having said that, it is a strangely priviledged experience to go to work at midnight because someone needs my help, even while I complain. But if the additional reimbursement I receive for on call work still leaves it challenging, how much more so doing these things without obvious compensation.

I am not sharing my house with a refugee right now. And while I don't claim to know what the answer is, I think we also need to recognise that it's not just the fact of refugees and migrants and human suffering which is hard, but also responding to that. Obvious, but hard.

Recognising I can't solve the world

I currently work on an acute medical ward. Our patients are poorly, but mostly in the short term we can diagnose and solve their problems so that they can be followed up as outpatients or by their GPs. Their medical problems, that is. We have limited success with their social problems, and as for their spiritual problems...

My patients are challenging, even when medically they are straight forward. What do I saw to the young woman who has overdosed three times this week but says she isn't trying to kill herself. Can I ethically give her any medication at all to take home, even though she's in pain? Actually I would rather sit down and explain to her that she is loved and has incredible dignity and that even though life has treated her badly, it doesn't have to be this way, but I can't do that because I don't have time and I don't have any kind of relationship with her, she won't even make eye contact.

How do we deal with the patients with serious mental health issues? If I have 3 hours to review 25 patients, I can't really deal with the one agitated patient who wants to ask me a lot of (possibly irrelevant) questions, who is never there when the doctor comes to see her because she keeps going out to smoke, and who is only in hospital because their persistant self-harm makes a not very serious problem much, much worse.

And then there's our favourite frequent flyer who is frankly, bonkers, (psych assessment pending) and also seems to think that every single member of staff on the ward is there only for him. He needs a pen, he needs the phone, he just wants to talk and medically speaking, he doesn't really need to be in hospital. He's also either seriously confused, in denial or compulsive liar. As my technician said to me this morning, his readmission has ruined the whole week.

As a Christian, I know I am supposed to love these people. What I am learning though, is that the best way to love them is to do my job. So I might want to sit down with them, and their families, and their neighbours, and work out how best to look after them (because their non-medical problems are so much worse than their medical problems) and solve everything, but that's not what I'm there for, nor any of my colleagues, and their problems are the problems of the world and will definitely take more than three hours to fix, but I increasingly doubt whether anyone outside the hospital has realised this.

Unplanned and therefore unwanted?

This week in our staff meeting, we had a brief talk from a local charity which provides counselling for women in crisis pregnancies. Our patient population has a very high number of women who have had abortions, and many of these have had more than one abortion (this, despite the fact that of the 7 doctors I work with, only 2 will refer for terminations). This charity is, I would say, pro-choice but their approach to choice is that it should be a considered choice, and they do play an important role locally in identifying women who are being coerced into abortion (at the point where the woman has already checked into hospital for the termination) and supporting them in keeping the baby should they decide to do so. They also provide counselling to those suffering the consequences of abortion: women, men and family members. One of the reasons I do not mention their name here is that I do not wish to endorse them - yes, some of the work they do leads women to choose not to have an abortion, and too often the long-term consequences of abortion are ignored or denied - but the fact is that they support a 'woman's right to choose' rather than recognising the evil of abortion for what it really is.

However, something very interesting (or possibly horrifying) which was mentioned during the presentation, were some statistics around abortion, namely:

- 34% of women under 30 have had an abortion

- 10% have had more than one

- one third of pregnancies end in abortion

and then the one which struck me as most interesting

- 50% of pregnancies are unplanned.

It wasn't so much that the proportion is fairly high (given our contraceptive mentality in this country) but that the person giving the presentation felt that this was a surprise, as she said, 'given everything we know'. Well, the fact is, that we surely must know by now that babies never come when they are planned. I don't know anyone who can say, yes, our baby arrived exactly when we wanted it to. I know couples who have waited years (regardless of whether they had previously used hormonal contraceptives or NFP and really wanted children), I know couples who decided not to and then went through IVF and still didn't end up with children, I know a couple who got pregnant having slept together only once, the fact is that what we actually should know is that the contraceptive mentality is not working. If it was, then there wouldn't be so many abortions and so many unplanned pregnancies. And the fact that whilst 50% of pregnancies are unplanned, only (God help us, it's still horrific) 34% are terminated means that an unplanned baby is not necessarily and unwanted baby, therefore why this conviction that planning is everything, that we must be in control of absolutely everything? 

I generally think that abortion debate comes down to the fact that people don't recognise that the unborn child is a person. But from these figures, and the accompanying attitude, it is presumably about our desperate desire to be in charge of the universe.

Professor Dawkins and the increase of the sum total of happiness

Poor Professor Dawkins has apparently caused a furore on twitter after tweeting, to a woman who said that she would face a serious ethical dilemma if she found she was pregnant with a baby who had Down's Syndrome, that she should abort it. He seems suprised by this. His apology, as reported by the Guardian, seems to be an apology for causing a riot rather than for what he actually said, claiming that those who objected did so from an emotional point of view, that twitter did not give him enough space to put his whole argument across and that because of this he left himself vulnerable to wilful misinterpretation.

However, the thing that really bugs me about this is that Dawkins claims that his response is totally down to logic. According to the Guardian, he wrote: "If your morality is based, as mine is, on a desire to increase the sum of happiness and reduce suffering, the decision to deliberately give birth to a Down's baby, when you have the choice to abort it early in the pregnancy, might actually be immoral from the point of view of the child's own welfare." I take issue with this, and in fact, I am frequently irritated by people who claim that anyone who disagrees with them is arguing emotionally, and that they themselves are basing their argument purely on logic. 

• If your morality is based, as Professor Dawkins' is, on a desire to increase happiness and reduce suffering you should presumably never say anything that might offend anyone because offense generates suffering, even if this is a subjective response. 
• If you believe that this life is all there is, that there is no life after or other than this one, then the abortion of an unborn child would presumably decrease the sum total of happiness, seeing that without life there cannot be happiness.
• If your aim is to increase the sum total of happiness rather than the happiness of the individual, and given the amount of great joy which those families express regarding their children with Down's Syndrome (and indeed their children without Down's) then presumably the termination of a child would not increase happiness and the reduction in suffering (given the absence of the child and the effects on the family) could well outweigh the non-increase in happiness.
• Given that people who are objectively suffering can experience happiness, and that people who are happy can suffer, suffering and happiness are not necessarily opposed and therefore the aims to decrease the former and increase the latter may, in fact, be conflicting.
• By extension of his argument that it is immoral to maintain life where there is suffering, all those who suffer from any illness, or indeed with the potential to suffer from any illness, however short or long term, should be exterminated because their existence may lead to their own suffering or the suffering of others.

Given the logical outcome of his moral framework, perhaps it is time to reconsider the starting point. If the outcome is outrageous and not what he intends at all, perhaps that is because some of his reasoning is based on an emotional understanding of happiness and suffering. 

Eugenics, ante-natal testing and choice

Some time ago I blogged about testing for Down's Syndrome. Now, there is news about some other genetic disorders: namely Patau and Edward's sydromes. Like Down's Syndrome they are due to trisomy - where a person has three copies of one of their chromosomes instead of the usual two - caused by random genetic mutations. Like Down's Syndrome their risk increases with maternal age. And like Down's Syndrome they can both be detected by amniocentesis. Now, according to to this article, earlier testing will become available.

 

Now, women will be able to make important decisions earlier on, says the article. There is only one important choice that we are allowed to make, as women. Everyone tells us so. When we talk about women and choice we are talking about the choice not to. The choice not to have a child who is less than perfect, the choice not to have a child with less than perfect timing, the choice not to have a child who doesn't fit into our plans, our budget, our lifestyle. We are not allowed be radical, or make sacrifices (except of our fertility). Whilst screening for such conditions could allow a family to prepare for a disabled child, perhaps learn more about what their condition entails and engage with support services available before the baby is born, this is not what is implied. The fact that many unborn children with these conditions will not survive to full-term is a tragedy and I do not wish to negate the suffering caused by such events. But abortion is not the solution. It will not mean the baby does not suffer and it will not mean the parents do not suffer. Earlier testing will not lead to better choosing or better preparation or more research about why such things happen, it will only lead to more deaths as we gradually seek to eliminate every single inconvenience (and especially inconvenient people) from our world.

We're all going on a summer holiday

...no more mass for a week or two.

I have noticed, in recent years, a sharp decline in the number of families at mass during the school holidays. (This is anecdotal evidence: I have not conducted actual research.) Now, I realise that people go away during the holidays, but given the amount of elderly people in my parish, and the lack of Catholic churches in the area, there should presumably also be a counter-balancing influx of families visiting grandparents. What seems to be happening is that people don't go to mass in the holidays and certainly don't bring their children along.

I find this a bit odd.

I know people who struggle to get their teenage children to go to mass, especially with the competing demands of weekend sporting activities, but there does seem to be a prevailing idea that children (and adults) can be let off from mass attendance during the holidays. The problem with this (and I don't have children, so if you do and think I'm completely wide of the mark, ought to shut up etc etc) (aside from the whole of missing mass), is that this forms a link between school and church as concepts, presumably generating similar associations when the end of the holidays come and one has to go back to both of these ie school and church are both boring, we need breaks from both, they aren't necessary all year round and so on. Two of the three longer school holidays are based around Christian holidays, so it also seems slightly ridiculous to not go to mass at these times.

There are no holidays in the adventure that is Christian Life. There may be times when things are perhaps easier or harder, but we cannot, should not, do not get breaks from being Christians, whether from Monday to Saturday or during the school holidays. Being a Christian is not a job, or an activity, it is an identity: it is about being, not doing.