British Association of Clinical Anatomists: origin and future

srgry02A paper for the meeting of the British Association of Clinical Anatomists at the Burton on Trent meeting, 14 December 2017

In the beginning was the Word, and the Word was with God, and the Word was the Anatomical Society and the Journal of Anatomy. They were in the beginning with God, and without them was not anything done in anatomy that was done. And the Professors of Anatomy saw themselves as the Lord Almighty. They terrorise and pulverise. They march through the breadth of the earth to possess the dwelling places that are not theirs. They are terrible and dreadful, their judgment and their dignity proceed from themselves. And lo, it came to pass that the people rebelled inwardly in their hearts. They cried to the Lord “wilt not thou deliver us from these bitter and hasty foes?” And the Lord raised up prophets, Coupland of Nottingham and Scothorne of Glasgow. And through them the Lord came to the aid of the oppressed. And lo! BACA was born.

It’s fun to see the formation of BACA in these Biblical terms, and it is not inaccurate. But there’s a bigger story to tell, and since this year marks BACA’s fortieth birthday, I shall do so. Of course, I’m not an historian, but I’m one of the few people alive who witnessed BACA’s birth in 1977 just along the corridor from my office in Nottingham. My recollections are thus first-hand and are as reliable as memory ever is.

First, a brief autobiographical sketch. I was at Cambridge for preclinical studies and then King’s College Hospital in London for clinical training and preregistration house jobs, as they were then known. I went to Nottingham as anatomy demonstrator in 1976 then Lecturer in 1977. In 1988 I began as Professor of Anatomy at the Royal College of Surgeons in Ireland, in Dublin—a medical school as well as a postgraduate college—and then in 2003 was appointed to Nottingham’s Graduate Entry Medical School at Derby. In 2006 I was ordained into the Church of England, becoming Vicar of Burton in 2014.

The origins of BACA are intertwined with two main medicopolitical trends: first, the decline of anatomy as a discipline in the medical curriculum, and second, the loss of medical graduates from departments where they had been predominant. I know that I am talking today to a mixture of scientists, physios and medics, and I apologize if what follows seems irrelevant to many of you, but it is important in the embryonic development of the society, so bear with me.

The decline of Anatomy

I enjoyed undergraduate anatomy. I was riveted by the first lecture in October 1969 concerning lemurs and lorises and thumbs, part of a series on the evolution of Man. Subsequent anatomy memories centre on Max Bull, the doyen of Cambridge anatomy teachers, who gave us a definition of anatomy that has stayed with me: “the study of the structure and function of the growing and changing living organism, not necessarily human”. Like a thong, it’s not elegant but it covers the essentials, especially, as he was at pains to emphasize, the growing and changing bit.

I was fortunate in the Cambridge anatomists of that time, who with one exception were affable, approachable and interested in nurturing students. So when during clinical years I realised that practising medicine was not for me, I thought that if being an anatomist involved what Max Bull did—welfare and nurturing of students using the vehicle of a subject that interested me—then an anatomist is what I would be.

In the third clinical year I approached several professors of anatomy about a job, and ended up in Nottingham because it was a lovely day when I visited and Rex Coupland, the professor, was charismatic. It was a good decision. I immediately saw the value of the brand new systems-based course that resulted in anatomy being significantly trimmed down, with much less time spent on dissection.

Listening to colleagues who had done time at other places, I realized how fortunate I’d been in Cambridge. I heard that more than a few Professors of Anatomy elsewhere were belligerent and irrational, and bullied their juniors and students. I witnessed it in external examiners

This is relevant to the decline of anatomy. In the 1970s and 80s, all the influential people in medical schools had had to endure hours wasted on dissection, all had been made to learn anatomy in excessive detail, and a fair few had suffered from the bad behaviour of some anatomists. Not surprisingly, they resented anatomy and they resented some anatomists. They were determined to cut anatomy down to size. They were abetted by the new discipline of Medical Education, then on the march, many of whose enthusiasts stated openly that doctors no longer needed to have facts at their fingertips. There was growing opposition to what they, wrongly, called didactic teaching

Things did not get better. The systems-based curriculum developed in many places in a way that may have suited metabolic processes but all but wiped out regional anatomy. The understanding of human biology as a product of evolution and adaptation, as imprinted upon me by Max Bull, sank without trace. I must be one of the last medical students to have enjoyed a term studying serial sections of pig embryos as part of an undergraduate course.

What was to be done?

With their clinical training and their clinical eyes—Coupland had begun to train in neurosurgery—BACA’s founding fathers were certain that only medically qualified staff were capable of teaching clinical anatomy. But there were hardly any left. So the question for them, given the image problem and the brain drain, was: how can we in anatomy recruit and retain medics?

The answer, they thought, was twofold: money and status. Rex told me that he saw BACA as a trade union that would lobby for preclinical medics to be paid more. Furthermore, the founders saw it a means of having medical anatomy recognized as akin to a clinical specialty. The trouble was that Rex and Ray didn’t know how to achieve these aims—indeed, given that they were both adept medical politicians in university life, they displayed surprising naivety.

First, money. Formerly, medics in preclinical departments had been paid more than non-medics doing the same job, but this differential had been abolished some years back. No salary committee in its right mind would reverse that decision for the sake of a miniscule number of peculiar medics. Perhaps the founders were thinking in terms of a salary enhancement, for Rex was the recipient of a hefty NHS merit award for which he attended at most one ward round a week. If he thought that that arrangement would catch on with NHS administrators, he must have seen pigs with wings. As for payment for clinical duties undertaken by anatomy staff, of which I was for over a decade a beneficiary, the resentment created by my not being available for university duties for one session a week was considerable. That wouldn’t have survived in the increasingly regulated NHS.

Second, status. I’m afraid Rex and Ray were living in cloud cuckoo land in imagining that clinicians would support any proposal to give senior anatomists clinical privileges. Unless the definition of clinical was twisted to mean what it patently does not, anatomists could never be clinical. At that time I became a member of the BMA Medical Academic Staff Committee, and believe me I know just how little support there was for such an idea. The clinicians simply laughed. In any case, Rex and Ray were wrong. Neither money nor status would have dealt with the image problem. Medics in anatomy were considered either maimed, unable to cope clinically, or, like me, deranged in turning their backs on clinical practice and salary.

It was all too late. King Canute couldn’t stop the waves, and neither could BACA.

Consequences

In the eyes of junior staff, BACA was compromised from the beginning. It was snobbishly hierarchical. For full membership you had to be a medic, and a senior anatomist to boot. Anything else meant a lesser category. And right at the bottom—sorry about this, all you scientists—were the ‘mere’ PhDs. The Association looked like an exclusive club for Rex’s and Ray’s friends and relations. My non-medic colleagues were outraged. The powers that be eventually relented, and this discrimination was abolished, though not soon enough. It left a bitter taste, and non-medic anatomists shunned BACA in favour of other scientific societies, leaving BACA meetings in the early days with little of great worth other than a good meal.

How did clinicians view BACA? I can only go by what I deduced from meetings. I should say that I was never a great meetings enthusiast. As a teacher I felt an impostor as scientist. As someone who did one ENT clinic a week, I felt an impostor as clinician. I was at home with students, provoking them to explore, to think, to imagine, to learn, and to ask questions, but to be on the receiving end of a comment from an eminent scientist which began “Dr Monkhouse, I listened to your paper and I have a question” was to render me incoherent in the sure and certain knowledge that evisceration was imminent. But to proceed. Many of the presentations at early BACA meetings came from only a handful of research groups—we’re back to the private club. Most surgeons looked elsewhere to flex their academic muscles, and few were enthusiasts for BACA or indeed anatomy. I was astonished to hear a Professor of Surgery tell me, the Professor of Anatomy, that he didn’t care what a structure was, or what it was called, or how it developed: all he cared about was whether or not he could cut it.

For these and other reasons, BACA was viewed by non-medical staff as elitist, and by clinicians as not really kosher. BACA meetings and the journal Clinical Anatomy came to be regarded by some in both camps as second or third best. It was fighting for its life as soon as it was born.

The future

I’ve been off the game for over a decade, so what value my comments have is for you to judge. However, as Max Bull remarked over 45 years ago, I have an analytical brain, added to which the view of the forest is better from the edge than from the middle.

The organization I work for at the moment is run by yesterday’s people making decisions for tomorrow without heeding the concerns of those that will have to bear the consequences. Is this true of BACA? Judging from your website, I think not, indeed I have the impression that you have worked hard to move on from those incestuous and hierarchical early days.

The future of an organization depends upon its capacity to be of service to others. So I suggest that you continue in that direction in the knowledge that you are on the right course. The future of BACA depends not on juniors tugging the forelock to grand old men, but on the extent to which those with experience can be useful to those trying to acquire it.

You rightly offer yourselves as a forum for gaining experience to anyone who wishes to explore clinical anatomy, no matter how tangentially. Find out what trainees need and work with them to provide it. Help them build their portfolios, and gain skills in presentation, writing and editing. Think back to when you were young and ask yourself what made you anxious. Help trainees to master these things.

Your committees will need to include more than a token trainee, so sling off the superannuated. If trainees are hard pressed to find time to serve, then organize things to suit them. I don’t want to get overly theological about this, but didn’t someone once say that the first would be last and the last first?

Many of the scientists among you will know more embryology than the medics. Teach them! It is hugely important in several clinical and scientific areas. How can anyone understand the function and layout of the cranial nerves except in terms of evolution and embryology? How can anyone understand how a weak voice might signal a mediastinal tumour except in terms of evolution and embryology? The medics among you can help nonclinical staff get to grips with some of the more obscure consequences of regional anatomy in terms of diagnosis and treatment. Work with the Anatomical Society—after all they are wealthy while you, I understand, are merely comfortable.

Is there anything to be gained by working with the Royal Colleges in training programmes? I know it’s difficult to work with surgeons, especially those who are big in the Royal Colleges, for as with Yorkshiremen, you can’t tell them anything: they are multitalented and omniscient. But there are other disciplines …

Another flight of fancy. Alternative medicine is on the up. See if you can cooperate with some of its more anatomical branches. I was in terrible trouble early in my Dublin days for having conversations with osteopaths and physical therapists about how we could help with their training. My knuckles were well and truly rapped by protectionist surgeons. I still see nothing wrong with those conversations and remain unrepentant, especially since they had money to pay us. One of the things I learnt from osteopaths was the way in which neglected ideas from the past surface years later. For example, the gut brain, once sneered at, has a new lease of life. It was an osteopath that directed me to a book entitled “The Autonomic Nervous System” by the unfortunately named Albert Kuntz, published in 1929. There are some prescient nuggets in there that might repay imaginative thought.

Now there’s a word: imaginative. Imagine how you could serve. Imagine how things might develop and plan for them. Maybe that’s the best advice anyone could give the Association as it looks towards the next forty years. You’ve done well to come from a precarious postnatal period to the state you’re in now, so keep your eyes open and your antennae alert and let your imaginations flower. You can be proud of yourselves.

Finally

When I saw that BACA was coming to Burton, my first thought was “perhaps they’ll give an honorary member, or whatever I am, a free dinner”. And so you did, last night. It pays to be cheeky: “ask and you shall receive” is a phrase I read somewhere. It’s lovely to meet you, to renew friendships, and a real pleasure to begin to get to know Neil Ashwood. When we first met he asked me if I knew any connexions between Burton and Anatomy to which he could refer in his speech. I said modestly “not really, only me.”

Friends, thank you for your invitation, for feeding me, and for listening to me. May the Lord light up your life ….

…. any scholar of Carry on up the Khyber knows that the correct response to this is: and up yours.

Cathedrals: Annuntio vobis gaudium magnum

28A recent report from the C of E tell us that cathedrals are “amazing” places doing awesome things. Leaving aside the inflation of language that I so deplore, it occurs to me to wonder how well ordinary churches would do if they had access to at least half the resources thrown at cathedrals.

One of my churches is about the size of a small cathedral, such as Derby, Birmingham, Carlisle. It is staffed not by several paid clergy, paid musicians, paid administrators, paid finance directors, paid fabric managers etc—none of these—but by one third of a Vicar—that is, girls and boys, me (only a third of me because I have two other churches, one almost as big). That’s it. End of. Its regular congregation is about 30 who give of their time, energy and resources generously and sacrificially.

Of course, I don’t begrudge the cathedrals their worldly success, and I’m not in the least envious. Not at all. Not one iota. It’s important for the C of E to serve, as cathedrals undoubtedly do, the people who already have so much. Ministering to the middle classes is what the C of E is for, after all. (On first typing that last sentence my autocorrect had not middle classes, but idle classes. I should have left it.)

I have a cunning plan.

In order that cathedrals might be even more successful, I propose that without further shilly-shallying at least half the parish churches in the country should be closed—I’m quite happy to make the decisions—so that even more funds can be directed to cathedrals to help them do even better.

Furthermore, the clergy of the churches that will under the Monkhouse plan be closed can be redeployed in Diocesan offices thinking up more initiatives and demands to dump on the fewer and fewer parochial clergy that are left. This will result in an all-round increase in job satisfaction and wellbeing.

My final thought on this matter concerns the press release announcing to the world this great joy, and all similar spin. It’s taken me a long time—dunce that I am—to realise what they call to mind. They are like media reports from Pyongyang. Similarities don’t stop there, of course, for it’s well known amongst North Korean cognoscenti that Kim Jong-il’s birth took place on a mountainside and was heralded by inter alia a bright star appearing in the sky.

I’ll get my coat. And my P45.

The effects of transmitted stress

4167-newtons-cradle-2SWMBO draws my attention to an article in yesterday’s Church Times (13 October 2017) that explores the effects of clergy stress on clergy spouses.

The background to this is a recent survey in which clergy declare themselves on the whole happy and fulfilled in their jobs. This came as a bit of a surprise to me, knowing what I know and hearing what I hear, and it made me wonder if the clergy who responded to the survey were predominantly those with permanent “I’ve found Jesus” smiles on their faces, rose coloured spectacles, and a complete inability to see reality.

The article is illustrated by a picture of Newton’s cradle—the toy with balls suspended from a frame, the only balls that move are those on the edge, those in the middle remaining motionless but transmitting the considerable resulting forces. That’s the clergy spouse. Susan found it particularly telling because that image describes exactly how it was for her during the three years I was a Rector in the Church of Ireland.

The problem was not in Portlaoise—ministry there was varied and stimulating. It arose in neighbouring Ballyfin out of a Diocesan policy to force groups of parishes into unions. In C of E terms it would be the forced merger of separate Parochial Church Councils into one PCC. I shan’t tell the story here—I reserve that for another day when I have time and energy to work through my detailed diary of events and emails. In short, what I came up against in effecting diocesan policy can be boiled down to:

  • the way Diocesan council ignored local feeling;
  • the meddling of members of Diocesan council without my permission—I suspect this to have been in part Masonic intrigue;
  • what appeared to me to be a sense of entitlement in families who, by design or default, filled the gap in rural society resulting from the departure decades earlier of the Protestant Anglo-Irish aristocracy.

The final straw was when, my having done what was required of me, that Diocesan policy was abandoned.

It was extremely unpleasant for me. But I was only a ball on the edge. On the other edge was Diocesan policy. Poor Susan was all the balls in the middle. Having reflected on that hell, I’ve come seriously to wonder if I’d witnessed a case of possession. Certainly, the word diabolical is not inappropriate, at least in its being an antonym of anabolic. There was splintering caused by behaviour that appeared malicious and malevolent. Read the Prologue to Andersen’s The Snow Queen.

I understand therefore something of the malignant effects of clergy stress on the clergy family. The article tells me how courageous one must be to go public with it. The fear is that by so doing you will mark the card of your spouse who will then be noted unable to cope and/or unfit for preferment—if preferment is your thing (it shouldn’t be, but humans are human).

The combination of Protestant work ethic and a perversion of the suffering servant mindset is insidious and profoundly harmful. The more I think about Jesus and his ministry, the more I think that he came to abolish religion. I’ve heard it said that when Linda Woodhead asks her students to invent a religion, not one of them has ever suggested that clergy are necessary.

A few days in Texas

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2014

Susan, Ed and I had a few days with granddaughter Abby, Hugh’s widow and her extended family. It was lovely to see them. I was with Hugh’s former colleagues, and some friends of his came from Seattle to see us. All very moving, but poignant because of—I’m sure Hugh would relish this metaphorical mess—the absent elephant in the room.

I crumple up very easily. One of his mates, a Seattle fire fighter, has lost too many of his colleagues and friends in the course of jobs and military service. He copes by remembering the good things and the good times, for life moves on. And so it does. But not for me yet: it’s a matter of getting the clocks to start ticking again. Or waiting.

Anyway, enough of this. What I want to comment on in this piece is the contrast between the image of what, according to the Bolshevik Broadcasting Corporation, life must be like under President Trump, and the reality. I tell you, life there is pretty much as it was under Obama. Surprisingly, immigration at Houston was quickest ever. Whataburger is still Whataburger. IHOP* is still IHOP, and I’ve gotten to like waffles and pecan syrup with my eggs and b, though as with the carfee Amurcans don’t know what “hot” means. And the number of fat people on mobility scooters seems much the same as it was two years ago (Burton is catching up).

This last comment puts me in mind of a 1973 episode in surgical outpatients at King’s College Hospital. The consultant was the Professor of Surgery, a lovely, gentle, lowland Scot who lived in modern architect-designed residence in Sydenham, regarded by cognoscenti as important enough to be illustrated in Buildings of England, London volume II (as it was then). He was not in the least like Lancelot Spratt, though he was well known for a fondness for the products of distilleries—say no more. On this particular afternoon he walked into a cubicle where on the couch was an enormously fat man with acres of flab wobbling over both edges. The worthy professor stopped, turned his head towards us, and with a terrifically wide grin on his face said in his gentle burr “hmmmm, a trifle obese, I see”, after which he conducted the rest of the examination with a joyful expression on his face.

But I digress. What of the floods? I hear you ask.

Nothing. We were in north Houston—Northampton, Tomball and Magnolia to be precise. We didn’t venture south to the mosquito-infested swamps on which central Houston is built. But we heard about the heroism and neighbourliness of people who were not affected as they dealt and deal with those who were.

And the wall?

When you live as close to the Mexican border as they do, and when you’re relieved that Mexican drug cartel bosses are being rubbed out, you might well be delighted at the prospect of a wall.

* International House of Pancakes. Don’t laugh. I think there’s a branch in Mexico. Or possibly Canada.

Placentas and pizzas

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Placenta

Mrs Windsor née Middleton is pregnant. It’s in the newspapers so it must be true.

First, I have to get this hobbyhorse off my chest. The correct spelling of fetus is fetus, not foetus, the word being related to felix, femina, etc. The incorrect spelling occurs first in the late writer Isidorus (570-636 AD) who fancied that the word could be derived from foveo (I cherish) instead of feo (I beget). So there.

Now to the hard stuff.

Is it an embryo that is taking root in Mrs Windsor’s genital system? Yes indeed. Is a fetus? Is it a baby? Is it a child? Embryo and fetus are defined by convention: you can look them up if you like. Baby is a meaningless term. Is it a parasite? Well, it steals mama’s nutrients and dumps its rubbish on her. It guzzles into her flesh so that its placenta can plug itself in to mammy’s tissues and get up close and personal with her blood vessels. It consumes the contents of parental wallets for at least two decades. Make up your own mind.

Some people worry about when the fetus becomes human. Not I. It’s human because the spermatozoön and ovum that produced it came from gonads belonging to humans. Reputedly. Anyhoo, however royal this fetus may be, it’s also a chordate, a vertebrate, a mammal, an ape and a primate. This is much more important than royalness.

The royalness will doubtless induce the Church of England to produce a prayer for the royal products of conception—it may already have done so—the usual crass, meretricious, tendentious, wordy drivel that comes from Lambeth. Products of conception include placenta, amnion, chorion, umbilical cord. Are they royal too? Are we to have a prayer for the royal placenta? Will a specially consecrated pair of scissors be used to cut the royal umbilical cord?

Killing the fetus

When do you think it should be permissible to kill the fetus? Or perhaps, when should it no longer be permissible? Well here’s the thing as I see it. Despite what the law may say, there is no single moment during the whole course of pregnancy at which the fetus is significantly different from what it was the moment before. There is no event that takes place that sufficiently differentiates what the fetus was before that event from what it is after the event. Fetal development is a continuum. From this point of view, if it’s permissible to kill a fetus at 18 weeks, then it’s permissible to kill a postnatal child or an adult. For those of us who have a little list of people not one of whom would be missed, this is comforting.

Why are we born when we are born?

The short answer is nobody knows. Brain size must have something to do with it. If we stayed inside any longer, our heads would grow so big that we wouldn’t be able to get through mama’s pelvis. But like I say who knows?

We are born very immature. A newborn horse can canter off pretty soon after birth, but not a newborn human. Unfortunately. Neurologically (spinal cord tract myelination—look it up), some of us mature more quickly than others. If earlier, we shall be better at physical activity and sport at an earlier age. If later (like me, dear reader), we shall have the shit kicked out of us at school for being physically inept.

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Pizza

Placenta

Placenta in Latin means flat cake. It is a most interesting organ, much under-researched. Its evolution is fascinating. Some mammals have lots of little placentas. Some, like mice and humans, have a single placenta. A primate (therefore human) placenta is about the size of a small pizza. Looks like one too. Some twins have separate placentas, some share.

A mouse placenta is similar in size to the head of a small drawing pin. Believe me, I know. I’ve dealt with hundreds of them in my time. When our three products of conception were little, the eldest drew a picture of me at work with the caption “my daddy studies mices kidneys”. Adrenals, actually, and fetal ones at that, but the gist was spot on. She had not mastered the apostrophe by that stage (like an increasing number of adults, but don’t get me going), but had grasped that plurals are normally formed by the addition of a terminal s, and that in conjugating the verb ‘to study’, y sometimes becomes ies. Pretty good, huh?

Please understand, dear reader, that the placenta is fetal. Entirely fetal. The only bit of maternal tissue that comes out with the placenta is that which is torn away from the uterine lining when the placenta detaches itself, hopefully after birth. This is why bleeding may occur.

The placenta, like the infant that it nourishes, is a foreign organism as far as the mother’s immune system is concerned. Why is the placenta, which comes into intimate contact with maternal tissue, not rejected? Well, sometimes it is. And so arise spontaneous abortions and other obstetric headaches.

A bit of history

In the fourth, fifth and sixth Egyptian dynasties the placenta was held to be the seat of the external soul. There existed the ceremonial position of Opener of the King’s Placenta. Some have suggested that in Abigail’s flattery of King David (1 Samuel 25:29) she calls on this image, the ‘bundle of life’ (KJV) being the placenta, though this is not mentioned in recent Biblical commentaries. Some societies suppose the placenta to be ‘the twin brother or sister of the infant whom it follows at a short interval into the world’ — and in a way, it is. In central Africa a belief in reincarnation leads to the afterbirth being buried at the doorway, or under the threshold of a hut, practices connected with the divine doorkeeper and the widespread custom of carrying the bride over the threshold.

The great fry up

And now, children, finally for today’s “Listen with mother”, remember that the placenta is a most nutritious organ. It’s not that different from black pudding: blood, connective tissue and other bits and pieces.

Fried with eggs, mushrooms bacon and tomatoes it would make a right royal breakfast.

Questions and answers

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Langwathby. River Eden left, Settle-Carlisle right

I’ve recently been asked to answer questions about my life. Here are some of them with my responses.

Family and growing up

I suppose I’m a border reiver, a hybrid Cumbrian Scot. I was born in Carlisle and brought up 20 miles south along the river Eden in Langwathby. I retain Cumbrian flat vowels as evidence.

Arthur, my father, was the second of five children of William, a Langwathby farmer and merchant, and Janet (née Dobinson) his gentle, somewhat patrician north Cumbrian wife from Roman Wall territory. Jeanne, my mother, was the second of five daughters of the Kirkoswald butcher Stanley Cranston and his wife Nellie (née Reid), a miner’s daughter from Fife. My sister was born during the Second World War when things were very tight. I was born in the expansive post-war period when we’d “never had it so good”. So essentially we were both only children with childhoods that were quite dissimilar.

We lived in a house where my paternal grandparents had lived before they moved across the road next to Arthur’s sister’s family. Up the hill were Arthur’s youngest brother with his family, lording it over the rest of the village more than just geographically. To complete this vignette of the Monkhouses, Arthur’s eldest brother was a Methodist minister in Carlisle, and another worked in a bank in Carlisle and sang tenor in the Cathedral choir. It wasn’t until I started organ lessons that I knew anything of our common interest in church music.

Nellie was reputed to be the youngest of 16 children. She went into service in Edinburgh in her teens. My cousin told me that she, a somewhat statuesque lady, was more than occasionally to be found in the pub dragging her husband out. Typical Methodists. Stanley liked to be called Stan by his grandchildren, and I assumed that was another nickname for a grandfather, like Pop or Papa. It never dawned on me that it was short for Stanley until I was a teenager.

CranstonsNellie and Stan had five daughters, from left to right Stella, Anne, Helen, Jeanne, Margaret (Stella and Margaret were twins—I might have them wrong way round). Anne,the eldest lived in Carlisle, Jeanne my mother came to Langwathby after nursing at Wrightington and Bradford Royal Infirmary, Helen went to Darlington, and the twins ended up in Warwickshire. I have photos of the Cranston sisters, most striking with high cheekbones and almond eyes. Like Nellie when she was young, they look Slavic, oriental almost. I wonder about Nellie’s ancestry, and whether a sailor from the east contributed to their—and my—gene pool. Maybe that accounts for my interest in Russian Orthodoxy.

1950s Langwathby

11My father was fascinated with all things automotive, and spent the Second World War as driver and batman to a General in Greenock on the Clyde. We had a green Morris MRM 261 and so were able to get away from time to time, but with few private cars in the village, most of my school contemporaries were not so fortunate. There’s a picture of my sister and me in Trafalgar Square: she looks about 12 so I must have been about 4.

The village school was next to the railway station on the Settle-Carlisle. You could get trains from the village to Leeds, Bradford and Blackburn as well as, of course, Carlisle and Skipton. There was maybe even a stopping train to Edinburgh that went up the Waverley line. The daily passing of the Thames-Clyde and Thames-Forth expresses was eagerly awaited especially if school playtimes coincided.

Despite living less than 100 yards from school, I was made to stay for school dinners. The emetic qualities of the tapioca, rice pudding and semolina, were memorable: great globules of pearly snot in a mixture of vomitus and semen, not that I could have put it like that then. I never ate puddings, so as punishment was kept in the whole dinner break, deprived of playtime. I found books to read.

OLYMPUS DIGITAL CAMERADaily assembly consisted of a hymn and a prayer. It was a C of E school, though I don’t remember the Vicar ever visiting, and prayers were from the Book of Common Prayer. This Methodist child was bowled over by the language, especially the one that goes “defend us in the same … neither run into any kind of danger … ordered by thy governance”. The words, the syntax, the poetry, the other-worldliness—entrancing to this 6 year old. It didn’t feature every day, but as soon as the Headmistress began “O Lord and heavenly father” my antennae twitched. And they say the BCP has no mission value.

Eden Valley in the 1950s

It was isolated. There was no M6. The Pennines to the east meant that for much of the dark year we were cut off from Hexham and Scotch Corner. When my aunt and family visited from Darlington, they were gone by 3 pm to ensure safe passage over Stainmore. The road over Shap with snail-pace nose-to-tail traffic, impassible for much of the winter, meant that journeys south were fraught and slow. I still think southerners begin at Lancaster. To the north was Scotland, and we went that way more than south or east, not least because of friends in Greenock. Trips west to Keswick don’t feature much on my radar. My abiding images of the Lake District are of gloom, pines, rain and hills that fence me in.

So it was part of England, but detached from England. At school we sang songs about the Scots ravaging Carlisle, and about dreadful Sassenachs. It was almost Scottish and had been Scottish, but it was not Scotland. It was fiercely independent-minded and self-reliant. But—and this affected me deeply—intensely closed minded, anti-intellectual, socially conservative and oppressive.

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Tilting train near Penrith

And this did not begin to change for two decades, when the M6 snaked its way up through the Lune gorge (I was in the third year at Cambridge by then), and electrification of the West Coast Main Line a couple of years later, Penrith and Carlisle gaining a rail service undreamt of by 19th century engineers.

Studies and work as an anatomist

I was moulded into medicine by my parents. I’m not aware of ever having had any choice. I qualified as a doctor in 1975 after three years at Queens’ College Cambridge where I read Medical Sciences (2 years) and History of Art (1 year), and three years clinical studies in King’s College Hospital, London.

Things that stand out in my intellectual formation include (1) realising that as human beings we are apes in the long line of evolution from primaeval soup; (2) embryology—we carry our structural and genetic history with us; (3) the year spent in History of Art where I began to learn to think (as opposed to remember) at the feet of such luminaries as Anthony Symondson and David Watkin. It was a most entertaining and transformative year in all sorts of ways.

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Rex Coupland

In 1975 as a final year medical student it became clear that the practice of medicine was not for me. I spent much of my time fearful that I would do the wrong thing; the responsibility was terrible. I can’t remember things unless I have a framework to hang them on, and in medicine there’s an awful lot of random stuff to remember. But I never forgot my fascination with the history of the human form—evolution and embryology—so I approached several medical schools to see if there was any scope for a job in that. I ended up as Anatomy Demonstrator, or Temporary Lecturer as it was called, at the then new medical school at Nottingham. That grew into a permanent Lectureship.

I must have been a disappointment to the Professor, the late great Rex Coupland, because I was interested in teaching and student welfare—pastoral stuff—and he pointed out that I had no future unless I made a research name for myself. This was not what I wanted to hear. Nevertheless I managed to get a PhD and a few papers published.

In the mid 80s, when the Universities were being squeezed by the Thatcher government, I saw that my future at Nottingham after Rex’s imminent retirement would be precarious. In early 1987 I saw an advert for Professor of Anatomy at the Royal College of Surgeons in Ireland, which despite its title is the biggest Irish medical school, and I applied. On 3 January 1988—not a great time of year to be arriving in a foreign jurisdiction for a new job—we rolled off Sealink ship St Columba at Dun Laoghaire: Susan and me, with Victoria (12), Hugh (10) and Edward (8). Hugh and Edward were choristers at Southwell and Ripon respectively, where they remained until secondary school in south Dublin. With ferries and airports and one thing and another that was a very fraught few years. It affected our wellbeing. I wouldn’t do it again.

As a result of death, resignation and retirement, I found myself as essentially a one-man show. The arrangements for handling cadavers for dissection were redolent of Frankenstein’s laboratory in a Hammer horror, and having come from the new set-up at Nottingham, the medical course was if anything worse. I set about modernising both, and had some pretty awkward fights for money and for the place of anatomy, not only from colleagues begrudging the quality of our teaching, but also from educationalists who were beginning to maintain that medical students didn’t need to know facts so long as they could look and act ‘caring’. It was hard work.

The other thing that got me into trouble with my colleagues was the strange notion that since the medical students paid our salaries (which they did at RCSI), we should actually listen to their concerns.

In about 2000 I was in my office in Dublin thinking what next? I’d had two textbooks published, still in print, and it came to me that it was time to move on. I took a sideways step into computer-assisted learning, but that did not turn out well for me, and after a couple of years I was back in UK as foundation anatomist at the new medical school in Derby.

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The perfect pastor

How has this affected ordained ministry?

I see theology and pastoralia through the lenses of evolution, embryology and medical science. It’s incarnational, of course, and I have no hesitation in saying that if theology and biology disagree then the theology needs to be modified or ditched. I’ve come to the view anyway that Jesus shows us the way to abundant life—no more, no less—and that doctrine is at best poetry and at worst oppressive nonsense. Theology is a human construct, so if our brains are evolving, theology must evolve too.

My training also leads me to value straightforwardness and candour. I am told that I’m frighteningly blunt. Telling the truth seems to be the most serious sin a priest can commit, for people expect a vicar merely to confirm their prejudices while drinking their tea.

What did you most enjoy in medical studies and practice?

In medical studies it was seeing that we humans, primates (apes not archbishops), mammals, vertebrates, chordates, all fit into the procession of life. I wonder how we will continue to evolve, or whether we’re the end of a road. I rather hope the latter, for we’ve so cocked things up that mass extinction would give the opportunity for a fresh start, Noah’s flood wise, with evolution doing a better job next time round. As I get older (I’m 67) I think it must be quite nice to be an orang-utan picking fleas out of a friend’s fur.

In my year as a full time medical practitioner one of my jobs was in Ear, Nose and Throat and Plastic Surgery where I enjoyed doing mucky stuff like wound cleaning and sucking out pus from mastoid cavities, and such like.

.. and most difficult?

Not letting people die with dignity. I’m haunted by an infant with biliary atresia who was repeatedly operated on merely, as I saw it, to provide practice for surgeons. Though I was at the bottom of the food chain, I was not without opinions, and one day I—a 26-year-old neophyte—had the temerity to voice them to the assembled professors and consultants, knowing that the parents were on my side. I think the response is best left to your imagination. I’m not a natural respecter of rank.

What was your first experience of God? How has that developed?

Beauty. I’ve already told you about my response to poetic language. For a boy who was fat, asthmatic, uninterested in football or cricket, and without any aspiration to spend his adult life knee deep in cow shit, life in 1950s Langwathby was universally grey and often cruel. When, through organ lessons at Carlisle Cathedral in the early 1960s, I discovered beauty, I was transfixed. I was able to combine this with what I’d learnt about beauty of humanity from Bible stories, and this began to forge a notion of the Divine. I was repelled by Christian Union types at Cambridge, confirming me on a theological journey towards what I have come to understand as the apophatic and mystical incarnated into the pragmatic and practical.

When did you take on ordained ministry?

I remember discussing the itch to seek ordination with the biology teacher at Penrith Grammar School. Back in Derby in 2003 someone who had known us in Nottingham asked me what plan I had for the future. I could hardly answer, and knew that that was the time to scratch the itch. Every door opened. I started training with the East Midlands Ministry Training Course in 2004, was deaconed in 2006, and priested in 2007.

The two years with EMMTC were intellectually the most stimulating of my life. I was fortunate to have as course Principal Michael Taylor, a former Catholic priest who had been through the hands of Ratzinger and Rahner amongst others, and provided a perfect stimulus for me. So for two of the three years I was setting up anatomy at Derby, I was also studying theology out of hours—well actually sometimes during hours …

Grief at Hugh’s death

It’s not two years yet, and I still find grief at the death of my elder son to be fierce and bitter. We don’t really have the verbal images for this, but it’s like being covered in a blanket that blots our sun, moon and stars, that makes it impossible to move, that extinguishes delight. For 18 months there was never a day without my hearing King David’s lament at the death of Absalom, 2 Samuel 18:33. That voice has largely faded now, but the aching lassitude, exhaustion and apathy persist.

If one accepts that a father’s role is to protect his offspring, and if one manifestly has failed to do that, then one deserves to die. That is the logic that I had to confront, and if I had to confront it, then it may be that other people in my position must have to deal with it too.

Parishioners and colleagues are unobtrusively supportive, but a woman from another parish said to a colleague after 9 months that it was time I got over it. After all, she said, she’d buried two husbands. I can’t say I’m surprised. I didn’t want to be signed off, and indeed the regular weekly liturgy gave a structure to my life that I couldn’t have done without.

In the end you have to navigate the turbulence of grief for yourself, because it is yours alone and nobody else’s. There is very little to help fathers who lose adult offspring, most literature being concerned with mothers and the loss of babies or children. The only book I found helpful—very helpful indeed— is Inside grief, edited by Stephen Oliver.

Music

I learnt to play hymns in Methodist chapels, so I know how to use the organ to control a congregation—not a skill that many organists have. I’ve been organist and singer at churches in central London, Nunhead, Nottingham, Dublin (St Ann’s in the city centre) and Derby. Along the way I picked up a prize in the ARCO diploma, and managed to pass FRCO. I doubt I’d do either of those things now. My hearing is poor and my one functioning eye glaucomatous. Nevertheless, I recently gave a concert as part of a series at St Modwen’s and I was pleasantly surprised. As the organist said—he was turning pages for me—“you’ve not lost the magic”.

The blog

I can’t remember why I started the blog. It’s a mixture of autobiography, criticism, prophecy, theology, provocation and puerility. The muse scarpered when Hugh died and she hasn’t reappeared, though sometimes I think I glimpse her skulking round the corner. I’m so enraged by the crassness of the bishops and much that goes on in the church that were I to write about them the blog would soon descend into dyspeptic vitriol, so I promised myself that when I do start again it’ll not be about church stuff. Anyway who cares any more?

Favourite sound?

There are so many, all musical. Fauré Dolly; Bach 6 part Aus tiefer (BWV 686) – is there anything so profound? I play it over and over again and find something new each time; the opening of Handel Dettingen Te Deum—when the choir enters it’s like a rocket launch, at least under Simon Preston’s baton; Bartok Concerto for Orchestra, Dvorak Slavonic Dances. Russian church music. I could go on.

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Max Bull, ten years before I knew him

Greatest influences?

Max Bull, anatomist in Cambridge, Rex Coupland, anatomist in Nottingham, Andrew Seivewright, Carlisle organ teacher. And most of all my beloveds: Susan and the three people who have taught me most about myself, Victoria, Hugh and Edward.

What do you pray for most?

I’m not sure what prayer is other than a journey into one’s inner being. If pushed I’d say I ache for justice without which there will never be peace (John XXIII, Pacem in terris). I’m not sure that peace in the sense that we use that word is a Christian concept. We need to fight.

What makes you angry?

  • Political correctness, particularly that which sees working class white people marginalized.
  • People in government who live behind electric gates in the Cotswolds or the Home Counties and have no idea what ordinary people have to endure.
  • The anti-intellectualism and corporate managerialism of the bishops, Philip North excepted. It’s almost as if when they meet, their sherry is laced with rohypnol, the effects of which don’t wear off until they leave. Of course, I yield to no-one in my admiration for bishops, especially those to whom I have pledged canonical obedience over the years. Anyway, as a cradle Wesleyan I’m not sure what bishops are for other than the pastoral care of clergy.
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From our Tree of Life carpet (Qum)

What makes you happy?

I don’t think anyone has the right to be happy. We have a duty to contribute. But if you press me:

  • Intellectual eye-twinkling vitality.
  • Vibrant colours, especially red, in gardens, glass and fabrics.

What gives you hope for the future?

  • Biological processes that should wipe us out for a fresh start.
  • The intellectual suppleness and open-mindedness of young people. So of course the church is the ideal working environment for me …

 

A Swiftian circular argument

wmNone for ages, then three at once. Like buses. Funerals I’m talking about. And what a trio: the 20-year-old murdered in Jerusalem, then two from the same extended family with strong church and business connexions—big funerals.

They don’t half take it out of you. Or rather me. The 20-year-old’s last week was excruciating for personal reasons, nails hammered in wounds still raw, but the most difficult that I’ve ever had to do, Hugh excepted, was about 10 years ago, very soon after ordination. A thirty-something-year-old mother of four dropped dead as she was preparing supper. No warning, just kerplunk. I was just about doing OK at the funeral until, during my address from the pulpit, my eyes rested upon the four year old weeping into her teddy bear. Ye Gods.

It’s not easy to process all this—at least I don’t find it so. I asked for some advice from an experienced colleague about coping mechanisms and he said that he imagined the emotion passing down his body into his feet and thence into the earth. He’s something of a Buddhist Christian, and I see that that might do the business for him, but it doesn’t work for me. I’m not sure what does. Sleep possibly.

All jobs have their stresses. I don’t pretend clergy stress is worse than that of any other occupation. After all, we have a free house even though the kitchen is dire, a non-contributory pension (for how much longer?), about £24K a year (no, we don’t get to keep wedding and funeral fees), and, as has been so frequently pointed out to me, we only work one day a week. This remark retains its freshness even on the 137th hearing. So amusing.

Notwithstanding, parochial ministry brings stress of an unusual and peculiar intensity of emotion. Funerals illustrate one aspect, but there’s the stress that comes from the disconnect between the expectations of others, for example that the Vicar will always be smiling and willing to agree with whatever loopy and self-serving notions that fall on his ears, and the demands of the organization and—dare I say—demands of the Gospel to confront hypocrisy and injustice. Like a former Vicar of Chesterfield and Archbishop of Cape Town, Geoffrey Clayton, I was determined when I was ordained that nobody should ever say of me “our nice new Vicar.” Nobody ever has. Or will.

Is this the reason why there is so much fallout from parochial ministry? They are leaving it in droves for such as chaplaincies (much better pay, defined hours of work, protection against exploitation) or civil employment. One of the curates ordained the year before me stuck it for about 18 months, then said she wanted her weekends back.

Anyhoo, it’s time for a palate cleanser, a tart lemon sorbet to mop up the funeral emotion and start the salivary juices flowing again.

I see that novelist Ian McEwan is in the soup for suggesting that before long all the old people who voted Brexit will be dead so we can vote again to stay. Let’s take it a step further. Does it not strike you as a waste of NHS resources that so many old people have expensive hip replacements and then die soon after? Maybe the surgery is too much for them. Maybe they’re shoved downstairs by some avaricious trout who wants their money or house or whatever. It may be practice for the surgeons, but would it not be better to spend the money on getting young people back to work? And what about all the mobility scooters? Would it not be better to force the occupants to go to the gym three times a week and tone up, shed flab and strengthen the heart? There is no better medicine than human sweat. It might be cheaper.

But wait a minute—they might live longer. We can’t have that. Such a drain on the national purse. Maybe we should be forcing cream cakes down people’s throats to send them to the starry heights sooner. Or feeding them antibiotics so that they’ll be carried off by superbugs, leaving only the genetically resistant to repopulate the earth. This is a most attractive notion. It grows on me. A government commission should surely be set up. I shall chair it.

Bearing in mind how I began this piece, you might say “but it will mean more funerals for you”. I doubt that. More and more funerals—sorry I mean Celebrations of Life—are in the hands of non-religious celebrants. Well, I say non-religious, though I gather that they have prayers and very often the Our Father. It’s important to retain a bit of folk religion even though Christianity is actually a middle-eastern religion and it might be more English to go for the pure pagan. Have you seen The Wicker Man with Christopher Lee? There’s something to think on: why wait for people to die?

I’ll get my coat.