Half Marathon Chris

imag0171I’ve been steadily getting more interested in fitness, running, and healthy living. Over the last couple of years, I’ve lost a decent chunk of weight, and started running and cycling a lot more. I still sweat like a geriatric horse, unfortunately.

In the last 18 months I’ve completed my first Triathlon, my first 10K road race, and this weekend, my first Half Marathon…

Location

ehm-course-mapI pretty much got pushed by circumstance into doing the race. A newly fit, running enthusiast friend told me I had to sign up around 6 weeks ago, but it wasn’t until I discovered another friend was travelling over from Sheffield that I decided to give it a go.

Warrington’s slightly pompously titled “English Half Marathon” is a mildly hilly course with total rise and descent of 110m. Click the course map on the left for more details. Its 21km, obviously.

Training

I did better than with my 10K. Not hard, because my training for that was close to non-existent. Sure, I didn’t run quite as much as I’d have liked, but I have been running at least 5km twice a week for the last couple of months, and I even did a training run of 16km!

As usual, 10 days before the race I rang my sports performance specialist friend Jon, asking “How do I train for an event that I should have already trained for”. He remained unimpressed with me.

I settled on trying to run 6km most days for a week, including one longer 16km route. Then, in the week running up to the race I ran 3 times:

Monday 4K
Tuesday 3K (limited by children)
Wednesday 6K before work, 8K after
Thursday Long walk
Friday 8K (up a Welsh hill)
Saturday 5K (personal best 22:50 mins)
Sunday Rest
Monday Rest (planned to run, failed)
Tuesday Rest
Wednesday 5K (slow pace with child)
Thursday 7K before work, 9K after
Friday Rest
Saturday Rest and carb load

Regarding nutrition, I planned to carb load on the two days before, and managed to suck down quite a lot of pizza. Unfortunately, my family caught a nasty virus that gave them nausea and abdominal pain. That hit me a little late on Saturday evening, but thankfully only hit me full force the day after the race.

On the morning of the race, I had two crumpets with loads of jam on them, approximately 80g of carbs, two hours before start time. That’s a bit less than the Runner’s World recommendation, but I was feeling a little queasy already. I also drank around 400ml of decaf coffee, keen to avoid dehydration, but also avoid weeing too much. I find that caffeine can make me feel nauseous on an empty stomach, so I felt it best to give it a miss…

Experience

It was a lot of fun. As has become my habit before parkruns, I started with the group behind where I hoped to finish, joining the 2 hour timing group at the start line. I did this for two reasons: firstly, I hoped their early pacing would be a little slower, and encourage me not to wear myself out in the first 3km, drained prematurely.

The second reason I like to start further back, is that I find gradually overtaking people throughout a race is a huge emotional boom.

Being fairly run fit, and concentrating early on my pacing was key to having a good time.

I kicked off at around a 4:45min/km, consciously slowing myself down, checking my phone for my pace fairly frequently over the first few kilometres. After that, I relaxed into the pace, and didn’t worry too much about going too fast, just used my muscle memory to keep me on track.

Just after 2km I needed a wee, and you can see my detour into Black Bear Park for a desperate pitstop on the GPS route (check the graphs and map further down the page). Immediately following it I sprinted to catch up, so probably made up most of the lost time, although the adrenaline hit was a bit draining. This coupled with my slightly upset stomach to give me some tummy cramps, but luckily a few sips of water settled this before it affected my pace.

The main uphill was between 3 and 8km, so things became a little harder work there, but I actually maintained my pace fairly easily. I got out the other side feeling pretty great – mostly because lots of people around me seemed to be struggling a bit, which helped competitive Chris feel like a winner. From 11km onwards, I felt very energetic, and clocked up 3 sub-5-minute-kilometres in a row. My legs started to cramp up a little from 17km onwards, but, by then, the end was in sight, and my brain forced me through (see me running the final 100m in the video).

Frustratingly, some little niggly plantar ligament in the sole of my foot decided to randomly go on the spritz around 19km. Like a lot of these things, it hurt a bit at the time, but didn’t properly flare up until the next day. 4 days later, its still hurting enough to limit me walking, which is also rather annoying.

Nutrition wise, I’m sure carb loading was the reason my legs retained plenty of bounce past the halfway mark. My glycogen stores only noticeably ran low towards the end. This was not helped by the placement of the carb gel stands on the run – I got one gel at around 7km, and didn’t get another one until I hit 18km – waay too late, although I managed to grab some powerade (off the floor) at around 14km which probably helped a bit…

Results

imag0172I had no particular expectations, nor any frame of reference for this run. One of my sponsors refused to pay up unless I beat 2 hours, so that was my key motivation. Using the Runner’s World Race Time predictor from my 10K result, I was given an estimation of around 1 hour 43 mins. (Although this does assume appropriate training for the distance…)

What did I manage? A respectable 1 hour 47 minutes and 47 seconds (according to my timing chip)I came 619th out of 2,204 (28th centile).

All in all, I had a good time. My thoughts on the event are marred by the fact I still can’t walk due to the foot pain, and I’ve been in bed for nearly two straight days with a stomach bug. That said, I think I’m a long way away from ready for a full marathon. My next plan is to do a bit more trail running, perhaps another 10K race, and see where to go from there.

As ever, most importantly, I got to eat 5 mini pizzas following the race. Win.

Bad Medicine: Why the doctors are striking.

This is a cross post from my Huffington Post column. Feel free to read it there instead…

I am a big believer in Good Medicine.

Notice the capital “M”? We all know about “medicine”, which often takes the form of tablets that help you to get better. But Medicine is the art of getting people better. Learning Good Medicine is a process of skilled training that takes doctors decades of experience, practice, mistakes and reflection.

Good evidence = Good Medicine

GoodmedicineScience means “using evidence to prove a theory”. Applying science to Medicine means that all our actions need to be based on reliable, good quality evidence.

It is impossible to practice Good Medicine without evidence – a fact that is drummed into us at medical school. Science is the reason doctors don’t try to cure impotence with electrocution, cure migraines by drilling holes in people’s skulls, and never encourage people to drink their own urine.

Look at some of these examples, to see how important evidence is:

Why do we ask Mrs Jones to take tablets for blood pressure?
Because the evidence shows that it reduces her risks of strokes, heart attacks, heart failure, kidney failure, and lots of other nasty things.

Why do we use paracetamol when little Timmy is burning up with his sore throat?
Because the evidence shows us that it relieves distress in children with raised temperatures.

Why does Mr William’s GP always ask him about smoking?
Because evidence shows that simple advice from a GP nearly doubles the chance that Mr William will quit in the following year.

Being a good doctor means practising Good Medicine. If we are going to take risks with people’s lives, we need to be sure that what we are doing is helpful; I’m sure you agree.

The government doesn’t have good evidence

Unfortunately, there is a problem. The NHS isn’t run by nurses, and doctors, and pharmacists, and radiologists, and dieticians, and the many, many other professionals who understand that evidence is the most important underpinning of everything we do together.

David_Cameron_(28_January_2011)The NHS is run by politicians. Politicians like David Cameron, and Jeremy Hunt. Politicians who don’t seem to understand that Medicine without evidence is Bad Medicine. We, the doctors, are terribly concerned, that the politicians are in a hurry.

We want a 7 day NHS. Oh yes! We want a better health service, no doubt about it. But “7 day health service” is a buzzword. On its own, it doesn’t mean anything. Even if Jeremy Hunt sits on the toilet one morning, and has a brilliant idea, its very important that we test his idea.

Many of you will remember the incident in 2006 in London when a new drug, TGN1412, was given to 6 men, all of whom nearly died, with multiple organ failure. Ultimately, there was several problems with that trial, but a fact point is: aren’t you glad they didn’t try that drug on thousands of people at once?

The government isn’t proposed untested drugs, but it does want to roll out a junior doctor contract across the country, without testing it first. The junior doctors are concerned that it runs the risk of making problems much worse. Why is there such a hurry to take action without getting more evidence first?

What evidence we do have doesn’t support the government’s claims

Mr Hunt claims he has evidence that 11,000 people die each year due to weekend staffing. But let me read you a line from the conclusion of the very report he is quoting:“It is not possible to ascertain the extent to which these excess deaths may be preventable; to assume that they are avoidable would be rash and misleading.” In other words, he is claiming the study as strong evidence to support his actions: but the report makes it very clear that it is absolutely not.

Mr Cameron wants us to “become the first country in the world to deliver a truly 7-day NHS“. But he talks about 24/7 GP practices, despite the initial evidence we have not supporting this in practice. The Public Accounts committee grilled policy advisers on what their cost-benefit analysis evidence was, to discover that they haven’t done any. They asked a key question: “If you don’t know in broad terms what the answer is, how can you be doing the policy?”.

We would agree, strongly. If the government doesn’t know its changes will save lives, how can they be implementing them?

Why the junior doctors are striking

The government has said they are going to force a new contract onto doctors. But they don’t have any evidence that the new contract will save lives. We, the doctors, are very concerned that it will cost lives, and we keep saying it, but the government isn’t listening to us.

Knee jerk decisions?
That’s Bad Medicine.

Actions without evidence?
That’s Bad Medicine.

Changing the NHS that 53 million people rely on without trialling to see if the changes are harmful?
That’s Bad Medicine.

Bad Medicine kills people. Support your junior doctors, and tell the Government we want a safe, evidence based NHS, and we are willing to take the time to do it properly. #notsafenotfair

I’ve cross posted this on my personal site, AllAboutChris.org. If you feel strongly, please post it on your site too. Feel free to contact me me on twitter as @bigonroad. Thanks for reading!

What next? How we save the NHS.

This is a cross post from my Huffington Post column. Feel free to read it there instead…

The Government, and Jeremy Hunt, have said they will impose the new Junior Doctor contract.

In so doing, they continue to demonstrate their disappointing lack of respect for the commitment and intelligence of the 53,000 junior doctors who work for the NHS, not to mention the 377,000 nurses, 97,000 senior doctors and 74% of of the general public who seem to understand that if we lose significant numbers of juniors, the whole system will collapse…

So, what’s next? We could get all angry; but we have a responsibility as doctors. We have a duty to remain professional, to protect patients, and to save the NHS. We want to prevent damaging, poorly thought out reforms, whilst holding strong to the cornerstone of modern medicine: evidence based practice with patient care as a priority.

Action One: Give them some evidence.

There are three simple things we can do to make the Government see the scale of the problem. None of these will cause you trouble with your training, and most importantly, none of them will impact on patient care.

DSC_0642Firstly, go online and apply for a GMC Certificate of Good Standing. This is the form you need for working in another country. It’s simple and free to do, just visit GMC online.

Even if you are not currently planning to leave the country, it gives you faster options if the situation worsens, doesn’t commit you to any action, and demonstrates a potential intent to leave. 200 JDs getting a certificate each week makes headlines (see right). Imagine the news that 98% of junior doctors are considering on leave the country?

Next, my dear colleagues, its time to actually fill in those breach forms. I’m not talking about one annoying F1 kicking up a stink. I’m talking about the 10,000 unpaid hours we logged in 5 days in October. Of course we can’t work to rule – we all feel pressured into working extra hours by our caring attitudes and the low staffing levels: leaving work on time would put patient safety at risk.

However, a BMA coordinated hospital-by-hospital submission of breach forms daily from every ward gives clear evidence of how hard we already work. Put patients first and work late unpaid – most of us regularly do – but let’s let everyone know about it!

Warn them you are thinking about quitting. We need a BMA sanctioned letter for us each to send to our training deaneries, line managers and rota co-ordinators, along the lines of “I am writing to warn you that I am incredibly concerned about the actions of the Government in imposing a new junior doctor contract. We are concerned that the new contract is not evidence based, and comprises a significant risk to the stability of the NHS. In solidarity with many of my colleagues, I wanted to give you the courtesy of telling you that we are considering our options, resignation from our posts being a distinct possibility. We do not feel it would be professional for us to accept a contract that may do so much harm to patient safety and staff morale“.

This gives the Government, and just as importantly, the newspapers, lots of clear evidence that many doctors are talking seriously about leaving, and how much time we are already giving out as goodwill.

They will be more effective if well organised: delivered piecemeal they would lack the impact of an orchestrated BMA campaign. I really call on the BMA to use its management skills to deliver a focused, media savvy approach.

Action Two: Strikes

Junior Doctors StrikePatient safety first. NHS first.

The problem with strikes is they provide a risk for patient safety. So does the new contract, but I know that many of us feel uncomfortable with the fact that withdrawal of emergency care is likely to increase that risk significantly.

How about we take the moral upper ground and plant a massive “Doctors care about the NHS more than we care about money” flag in it?! 

My proposal? We start one week, full strike for all of us – no money – but we still provide emergency care – for free!

That’s right. We say “We can’t afford to let the NHS die, but the NHS can’t run without us”. We have a picket line for awareness – but with just 6 people on it at any time. Everyone else goes to work in A&E. No routine work, but emergency care is filled with professionals in tshirts saying “I’m not getting paid today, I’m working for free because I want to save the NHS”. 

And we co-ordinate this with the senior doctors and nurses and other unions. Because if we let them gut the junior doctor contracts, they will go after the consultants next, the nurses next. The BMA needs to talk to the other unions, promise that if they stand with us, we will stand with them if the Government tries any similar nonsense with them.

Let’s get the hospitals filled with unpaid volunteers who love the NHS. With junior doctors, and nurses and consultants and porters, all volunteering, all saying “This is not about money, its about saving the NHS“.

Action Three. “The Nuclear Option”

And after one week of this emergency care only strike action, if still the Government persists, the BMA co-ordinates a mass resignation from all junior doctors. We sign the forms, give them to our BMA rep, and they deliver 500 at once to every trust in the country at 9am on the same day.

It’s actually fairly low risk for us.

Firstly: the Government can’t let it get that far. Even our enormously foolish health secretary knows that.

Secondly, if they do, your trust will immediately need to hire a locum to fill your job. So, you’ll likely get paid more for a few weeks, and once the dust settles, they’ll have to let everyone back onto their training schemes. It may even be possible to negotiate immediate new locum contracts for all resigning doctors, given that trusts will appreciate that they have no other option…

Thirdly, both Scotland and Wales have made it clear they are keen to have us. Let alone Australia, New Zealand, Canada, South Africa…

So, there you go, a three step plan to saving the NHS.

I desperately feel we need this level of clear, co-ordinated campaign from the BMA. It demonstrates to the Government that we are serious, that we know how to plan and organise, and that we are willing to push very hard in the interests of patients, staff morale and a national health service that still has a heart beat.

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The junior doctors aren’t striking for themselves.

This is a cross post from my Huffington Post column. Feel free to read it there instead…

This week, the junior doctors are going on strike. Again.

Most of the people reading this won’t know why. All these professionals, who claim to be committed to caring for some of the most vulnerable in our society, why would they refuse to turn up to work?

The government has done its best to confuse the issue. Some of the more biased newspapers have followed suit. There are headlines claiming that junior doctors are greedy, that they’ve been offered a 11% pay rise, but they want more. The general theme of the spin has been simple: the junior doctors are looking out for themselves.

I’d like to let you in on a little secret. The junior doctors aren’t striking for themselves. There’s actually lots of things they aren’t striking about:

moneyIt’s not about money. Sure, I think doctors would be right to be upset about the new contract, which – despite government claims of a “pay rise” offer – actually threatens huge cuts in pay. Mr Hunt has offered to increase the “base rate” of pay by 11%, but refuses to say what will happen to the “banding” that the vast majority of trainees also receive.

As a personal example, my pay is made from the base rate plus a 45% banding rate. I may lose my entire banding rate. Even with an 11% increase in base pay, that’s a drop of nearly 25% in my annual salary. How would you feel if your employer announced a non negotiable drop in your salary? Great video asking members of the public the same question here…


It’s not about working long hours.
Doctors are used to working long hours, we know its par for the course. We actually work more hours in our contracts than most professions, 48 hours rather than the more common 37.5 or 40. We understand that – despite the Government’s blindness to the fact – the NHS runs a 24 hour service, and we are all part of providing that.

What scares us is the removal of current safeguards: at the moment, if a hospital breaks the rules and forces juniors to work extra hours, there is a significant financial penalty. This happens fairly often. In the new contract, the hospital may just be asked to enforce the limits, with no penalty. How would you feel if your employer decided to start ignoring the time limits on your contract?

It’s not about weekends. Junior doctor already work weekends. I’m a GP trainee, but I’m still working 2 of the next 3 weekends. Do I get days off either side? Nope. I only have one day off in the next 18. Its going to be hard work!

The government keeps talking about the risk of being in hospital over a weekend. Whilst this has been extrapolated from statistics that prove nothing of the sort, it does mean there is a push to further jeopardise our junior doctors’ already limited opportunity for normal social lives. How would you feel if you were told Saturday is now the same as Monday morning? How would you balance family, friends, childcare…

Money, long hours, weekends. These may seem like totally reasonable causes for a strike. But there are even more important issues at stake…

It’s about safety. Junior doctors are on the front lines. We know how understaffed A&E is; we see how thin on the ground clinical cover is during hospital on calls, and how GP surgeries are fighting against a sinking ship of paperwork, appointments and shrinking finances.

We know that patients are suffering, and, currently, junior doctors are working out of goodwill to hold up the creaking system. Junior doctors logged more than 10,000 hours of unpaid overtime during one 5 day period in October. Push the junior doctors harder? Goodwill gives way to exhaustion. Do you want a tired, unhappy doctor?

It’s about making sure we have enough doctors. The government scares us. They don’t value junior doctors, and they don’t see that junior doctors become senior doctors.

I posted previously about how general practice and psychiatry training schemes are running half empty. Five years ago, over 71% of newly qualified doctors joined training schemes. Last year? 52%. With record numbers of doctors leaving to work overseas, Jeremy Hunt is causing an exodus of professionals we desperately need.

juniordoctorcontractIt’s about saving the NHS. The NHS is at risk of being terminally ill. It needs treatment, or its going to die. Trust us – doctors know about this sort of thing.

I’ll be brutally honest here. If the NHS fails, I’ll be okay.

Sounds cocky, but its probably true. In fact, I’ll probably earn more than I do currently. I’ll be able to afford health insurance premiums for my family, for myself. I’ll be fine.

If the NHS fails, Jeremy Hunt will definitely be okay. More than okay. He will join a private healthcare company board, and earn vast bonuses in a climate of charging people for care they currently receive for free.

If the NHS fails, there’s a big group of people that will not be okay. It’s not doctors. It’s not irritating politicians. It’s the poor. 

There will be hard working people at the bottom choosing between healthcare… and food.
People getting cancer, then losing their homes.
Patients deciding its better to live in depression than in debt.
Children dying because they don’t have parents with enough money to afford treatment.

And that’s not a United Kingdom I’m willing to accept.

Junior doctors aren’t striking for themselves. They are striking for all of us. Support them. #notsafenotfair

‘Will I Be Able to See You Next Time?’

This is a cross post from my Huffington Post column. Feel free to read it there instead…

Or… “Why patients miss having a regular doctor, and how the new junior doctor contract risks making the situation worse.”

Despite being nearly thirty, married for nearly a decade, with two children, I am a “junior” doctor. Technically, I am a GP Registrar. It’s written on my door, and none of my patients understand what it means. I often get the joke “Does that mean you can marry us after you’ve listened to my chest?”.

2016-01-11-1452522367-1128787-gpregistrar.jpg

I explain that “registrar” means that I am a trainee GP, with one year left before I’m a fully qualified GP.

They always follow this up with the same question: “Does that mean that you are staying here long term…” There’s always a look of hope in their eyes; that I can be a familiar face who knows them; a traditional family GP; a doctor, and a friend.

General practice has changed dramatically over the last 20 years. Practices were commonly run by one or two partners. My training practice has more than 10 partners. Getting an appointment is a scramble of ringing continuously at 8am – hoping to get lucky today – and there’s no guarantee you will see the same doctor each time.

I know that patients are suffering from this lack of continuity: because they complain to me about it. It is no exaggeration to say that 5 patients each day mention how hard it is to get an appointment. Sometimes, on a day when I’m frankly fed up with nodding defeatedly and apologising, I explain why things are changing…

“Why is it so hard for me to get an appointment, doctor?”
You see, Mrs Jones, these days people visit their doctor more often than they used to.

In 1995, on average, a patient would see their GP 3.9 times per year. In 2008, this had risen to 5.5 times. If that trend has continued, in an average practice of 9,000 patients, that would mean a practice will need 22,153 more appointments in 2016 than they did in 1995.

A GP will see around 40 patients a day – although some will see many, many more than this. To meet people’s desire for seeing a GP, every practice would need 3 new GPs. This is the reason nurses have become so vital in GP practices; they help to share the burden of extra appointments.

“Why don’t we just hire more GPs, doctor?”
Unfortunately, Mrs Jones, there aren’t as many GPs as there used to be.

When I applied, 4 years ago, GP training was relatively popular, and there were 30 trainees in my year, locally. This year? We have 7. In London, the problem is less extreme, but it has been devastating across the rest of the country. My colleagues in Chesterfield have just 12 trainees; Lincoln, just 4. And Bassetlaw? Bassetlaw have no new GPs being trained this year. Overall, 30% of General Practice training posts remain unfilled in the UK.

To make the problem worse, GPs are retiring much faster than replacements are being trained. In a recent survey, more than a third of all the GPs in the country plan to retire in the next 5 years – and many others plan to go part time!

Just to keep numbers stable, we would need to graduate 4,000 new GPs a year. This year? Only 2,732 new trainees started GP VTS training, a figure that’s reducing annually. We are heading for an absolute crisis, a shortfall of tens of thousands of GPs across the country.

“Oh dear doctor. What can be done?”
Its a difficult problem Mrs Jones, and no one really has an answer. But there are some simple things that need to be addressed:

We need more medical students. At the moment, there are only 6,800 places in medical schools each year in the UK. In 2007… there were 7,300! Why, oh why, is that number going down? We would need 58% of those students to graduate and become GPs in order to address the crisis that is happening. That would leave the rest of the health service with just 2,800 a year – or just 2.5 new doctors annually for each of our 1069 hospital sites.

We need more encouragement to junior doctors. Jeremy Hunt has tried to unilaterally impose a wildly unpopular new junior doctor contract. There are fears of increased normal work hours, uncertainty about pay cuts and, most worryingly, a very forceful attitude that is leading to a strike tomorrow by junior doctors. Right now, junior doctors need to decide whether to apply for specialty training: primary care is going to see even worse recruitment unless the uncertainty is resolved quickly and positively.

“Is there anything else we can do, doctor?”
Well, Mrs Jones, I’m glad you asked that…

We need to use our brains. The patient before you attended because he had a spot on his nose. Since yesterday. Did he really need to see me? When I work in A&E, I regularly see people who have mild sunburn. I see patients who’ve had a sore throat for 3 days and saw their GP earlier today, but want a second opinion. I’ve seen parents at 9pm because their 2 year old hasn’t gone to sleep yet.

We seem to be afraid to say it, but the NHS needs patients to take some responsibility for minor ailments. Every doctor you will see has a hundred stories about patients attending needlessly. We need a prescription of that very British quality: good old common sense.

If we are going to save the NHS, we need to work together, doctors and nurses, patients and politicians. Its our health service, and its up to us to keep it healthy!

Now, Mrs Jones, let’s get back to you. How can I help you today?
“Well you see doctor, my nose has been running since Monday. I went to the Urgent Care Centre last night, but its not better yet. I thought maybe you could give me some antibiotics…”

Looking back at 2015

I’ve started to write this on December 30th, sitting on a train in Lincolnshire at 7:30am, on my way to work. It’s still completely dark outside, and half the country is still on holiday. I feel slightly jarred, like the alarm clock went off, but no one else has had to get up.

Feeling disjointed is somewhat appropriate – it aids my reflections on the last 12 months.

2015 has been a year of experiences. We’ve lived in three continents; I’ve had an epiphany in healthy living, exercise & weight loss; my medical skills, for the first time, feel formed; and, as a family, we’ve started to have some clarity about how we want to live.

Home

This year has shaken my understanding of home. In many ways, “home” still means “Epping” to me. My parents live there, I grew up there – the streets feel familiar, comfortable and safe.

“Home” is any place that has touched your heart.
Leaving doesn’t stop that.

But in a much more practical way, our lovely house on Woodthorpe Avenue in Boston is home. It’s the place we can best exhale. We can kick off our shoes, settle comfortably onto a high chair on the breakfast bar, and watch the chickens, dogs and children flap around in the garden.

YEditedGroupPhotoet Restore Church, full of our friends, is also home. We seek the heavenly realms together, we drink moderately bad cups of tea together and we laugh about the projector turning everything purple again. This whole year has been a mess of realising that “Home” is any place that has touched your heart. Leaving doesn’t stop that.

If you’ve read Harry Potter, there’s a concept where Voldemort tears apart his soul and stores it into objects that have emotional value to him. That’s not quite how I’m feeling – home is not a horcrux – but there’s no doubt that putting roots down involves investing a part of oneself.

Now I’m coming home
I’m coming home to you again
I hope things haven’t changed
New Found Glory

Many homes

This year, “home” has been Mseleni hospital in South Africa. It’s been Sea Point in Cape Town. Jackson in Missisippi. Alterna community and Koinonia Farm in Georgia. QC Family Tree in North Carolina. Grace & Main in Virginia. The Simple Way and Inner Change in Philadelphia. A little bit of us still lives in the homeless shelters of the Catholic Worker movement in New York City

IMGP3158

Returning to the UK has brought us face to face with the contradiction of “home”: it means a state that is temporary and yet, somehow, extraordinarily enduring.

Our idea of home is shaped by the setting and society we live in. This year it’s meant our children sitting naked, in dusty mud, next to the road. It’s meant seeing giraffes on the drive to the shops. Getting excited about a visit to the town café that pretty much only sells chips. Friends who have never had – and will never have – the life opportunities that I take for granted. Patients who have never slept in a bed, and thus don’t know how to sleep when they are admitted to hospital. Evenings without a TV, without electricity, without water, spent cooking pizza on a wood fire, and laughing. So much laughing.

John M PerkinsAnd it’s meant eating sweet potato wedges with John M Perkins. Jugs and jugs of sweet tea. Contemplative silence in LaGrange, and board games late into the night. Cooking pizza for the entire residency of Koinonia farm. Shaving heads and eating chocolate.

In Charlotte, it meant reincarnation through recycling, through gardening, through relationship, through reimagining an unloved locality. And a little girl doing a poo in a public water fountain. It’s meant permaculture, community gardens, ultra thick milkshakes and sitting on porches in Danville. In Philadelphia it meant pizza (home == pizza), and gunshots, and an understanding that all of us need our home to be sustainable. New York meant $1 pizza slices, enjoying glorious mess surrounded by healing people, and my first ever visit to a board game cafe!

Returning to the UK has brought us face to face with the contradiction of “home”: it means a state that is temporary and yet, somehow, extraordinarily enduring. In common with many others who have crossed cultures, there will always be a discomfort in us, even in situations that have been familiar to us for years.

wp-1451644198031.pngHealth

Alongside learning more about the mental framework we use to fit into the world, I’ve also come to terms with my physical existence here.

For the first time, I can say I genuinely love exercise. I even hate running a bit less!

Sure, 2013 was the year I decided to start losing weight. And 2014 was the year that I realised healthy eating is going to be a life long commitment. But 2015 was the year I started to understand the link between health and happiness.

For the first time, I can say I genuinely love exercise – I even hate running a bit less! I’m more aware than ever how rubbish I feel after an episode of gluttony – Ben & Jerry’s, I’m talking to you here – and I’m starting to have the self control to just not go down that path.

I’ve hammered out a few personal milestones, such as my first Triathlon, my first sub 25 minute 5k, and consistently dropping below 70kg. I’ve also managed sustained periods of exercise, accountablity and weight management – see my blog series: six kilos in six weeks.

Medicine

babychris-800x817Working in South Africa was a privilege – a scary one at points. Having a baby named after me was a highlight, as was being signed off as competent to perform caesarian sections without supervision. It was also the first time I’ve ever worked with a degree of autonomy, and the only time I’ve been at a grass-roots level in the midst of the community I live. Being a doctor… at home.

When I was 17, I made a decision to apply to medical school. I’m now 29.

As I look towards the end of my training, I know that the only way I’m going to be able to sustain the enthusiasm and purpose I need is for my career to have integrity. When I was 17, I made a decision to apply to medical school. I’m now 29. It’s only at the end of this year that I will no longer be on a training scheme. I’ll actually be an adult, able to apply for a job where I get told in advance where I’ll be working, what hours I’ll do and how much I’ll be paid! I’ll be able to raise concerns and suggestions for improvement without putting my entire career at risk! Brill.

In 8 months, I’ll be able to choose my hours, select my workplace and start to explore my sense of vocational calling. Medicine needs to line up with our life goals, my heart and my sense of home. Who knows exactly what shape that will take, but its an exciting prospect.

Next

The bible is full of phrases like this:

“And calling the crowd to him with his disciples, he said to them, “If anyone would come after me, let him deny himself and take up his cross and follow me. For whoever would save his life will lose it, but whoever loses his life for my sake and the gospel’s will save it.”
Mark 8:34-35

When I read a passage like that, I think: “I’m not really doing that”. I’m not saying that I believe God calls us all to martyrdom; but I do believe a luke-warm 50% lifestyle simply doesn’t cut the mustard.

SAM_0952I’ve become certain of one thing this year: we desire to live out the gospel. Really live it. Not half live it, tacking on a bit of grace and love to a plastic Western lifestyle, but LIVE it. Our hope is to explore, sacrifice, pray and practice until “The Kingdom of Heaven is near” starts to resonate with us.

“Home” this year has meant common threads: friends, community, adoption, Jesus, vegetarianism, pizza, board games, fitness, laughter… shared values in others that reflect the hope we have for this life.

One of our mentors, Colin, recently said to us “You need to find your tribe“. As we continue to explore what and where “home” is for us, I think God will make it clear to us who our tribe is. Maybe it’ll be through pulling on some of those common threads, and more importantly, following back to the heart behind them, one that says “My God; my neighbour; our life together.”

Thanks for reading this, and thank you to everyone who has been part of home for us this year. Have a great 2016!

PS. I leave you with a song that is very much on the same page as us…

Six kilos in six weeks: the final push.

wpid-wp-1447062912089.jpgRead the first post in this series here – Six kilos in six weeks: finishing what I started.
Just a warning, I’m going to be talking about weight loss, dieting and body image. If you struggle with your relationship with food, or have any self image difficulties, you may find it hard to read.

How am I doing?

Not well. For some reason, emotionally, I just had a terrible weekend. I decided that a strict diet was not going to improve my mood, so I took off the brakes. I’d like to note that on both days I was still careful with my breakfast calories, avoiding having too big a meal at night, and generally still applied a modicum of self control.

Pizza featured slightly too heavily this week...
Pizza featured slightly too heavily this week…

I still, pretty impressively, managed miss my deficit target by 2540kcal in two days. In context? I was aiming to eat just 2400kcal, and I was 2540kcal over that target. More than doubling it. I’m really good at this eating thing, eh?

On the plus side…

  • I was under my calorie goal on two days this week…
  • …but on my worst day I was over by 1549kcal.

Overall, based on a basal metabolic requirement of 2400 kcal per day, I’ve averaged a daily deficit of 736kcal, leaving me just over 5000 kcal down for the week. Despite the weekend, its actually not my worst week – I did better than in week 2!

Getting sweaty

I suspect this is due to fitting in a lot of exercise: I smashed it this week. Cycling 26 miles to work one day helped, as did beating my personal 5km and 10km running times

  • Week 1: I burnt off 1157 kcal doing exercise
  • Week 2: 945 kcal.
  • Week 3: 2150 kcal.
  • Week 4: 2235 kcal.

This week? 3505 kcal burnt off! Press ups are getting easier, there’s a snap to my star jumps, and I’m easily breaching the 5 minute kilometre mark when I run.

WhaWeek 5 weight grapht is my weight?

I think we knew this was coming: I’m not going to lose 6 kilos in 6 weeks.

My weekend caused an uptick to the red average line that has likely scuppered any chances of a last minute come back. I start week 6 weighing in at 69.3kg, a devastating 3.4kg behind where I should be! I suspect there are a few reasons behind the slow loss – beyond my love of chocolate – but I’ll have a proper look at them next week.

I’m not demoralised – I’m approaching the fittest I’ve ever been, and I’m seeing a completely reasonable weekly 0.5kg drop in my red trend line. Losing fat is a long game, and it was always optimistic to aim for a solid thousand grams of it per week.

Macros!

Following my decision to try to improve my macros this week, you’ll be excited to hear that I performed… completely terribly! This week, I only ate 12% protein – every other week I managed more than 17%.

Challenged by some excellent advice from Andrew Lloyd, I’m rededicating myself to the challenge of hitting my protein targets; there’s no point in dieting and losing muscle mass instead of fat.

Changes, changes, changes.

Sorry – I promised Christmas socks this week, but could only find these with red bobbles on the toes…

 

weightlossweek5

This challenge has always been about getting healthier. I want to get my body fat percentage down to six pack territory, and I want to add some more weight. It’s going to take me longer than six weeks, but frankly, I couldn’t have done much better, not in a sustainable way.

  1. Stay at a 1200 kcal target. I completely failed at this last week, and it made me much more miserable: but there’s only one more week left and I want to win!!! When I continue the diet after these six weeks, I’ll be going back up to 1400: much more sustainable.
  2. Carry on the exercise. 2000 kcal of exercise is a nice amount for me. Going to carry on the same routine, but I think its unlikely I’ll manage the highs of last week.
  3. Try to eat 25% protein. It seems pretty likely that dipping much below 20% puts muscle wasting into the “a significant possibility” category.

Shout out thanks to Jon Smith for keeping me accountable, and texting me daily to tell me to “put down the butter dish and walk away”. Check out his ace 5K running app at RunwithKick.com

Results

These are all updated live from a central database, so feel free to check back daily for updates…