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Are you a difficult patient?

DR BOIMA
HEALTH ISSUES

Have you ever felt like a “difficult patient?” It might not be all in your head if you think a doctor is getting impatient or annoyed with you.

Often times we come across patients that we term as “difficult”, just as many patients can recall doctors whom they would say are difficult to work with as well.  This kind of patients can evoke feelings of anxiety, dread, frustration, and even anger and seem to breakdown the doctor-patient relationship leaving the doctor feeling like the patient cannot be helped, does not want to be helped, or is sabotaging his/her care. “Difficult patients” can be seen as a problem to be tolerated or terminated from practice, though the real difficulty lies in the relationship, not simply the patient and there are techniques and strategies to help clinicians improve that relationship and retain its therapeutic nature.

Who are ‘difficult’ patients?

Angry – smileless faces, furrowed brows, clenched fists, and wringing of the hands are some of the signs that can show that something is wrong with the patient. When we see these signs, we try to uncover the source of anger for the patient and pay attention to the way his or her emotions relate to the medical issues at hand.  For example, a patient who is in pain and has been waiting for an hour because the doctor has been tending to a hospital emergency (and has been briefed so…) might be quite angry (reasonable enough…) when the doctor finally gets to the room. A sincere explanation and apology by the doctor such as, “I can understand why you are upset, and I appreciate your waiting for me,” would go a long way toward easing the patient's frustration and getting back to business.

It is normal to feel a certain way after all especially if you are in pain and feel let down. However, there are patients that will remain forever angry despite lack of a trigger and choose to always be on the opposing end of the hospital staff. Some patients are in a habit of yelling insults and can even be physical with the staff, to an extent that assistance from law enforcers to forcefully remove them is sought. For their own safety, doctors will naturally shy away from seeing this kind of patients of if they do the care can be compromised.

Somatizing patients – These patients often present with long standing, multiple vague or exaggerated symptoms. They often “doctor-shop” and have done multiple diagnostic tests without any significant results being yielded. Keys to productive encounters with somatizing patients include describing the patient's diagnosis with compassion and emphasizing that regularly scheduled visits with a primary physician will help to mitigate any concerns. Be sure to effectively manage any comorbid psychological conditions as well. It is important to refrain from suggesting that “it's all in your head,” and avoid the cycle of vigorous diagnostic testing and referrals.

Manipulative patients – Patients often make requests that doctors think are inappropriate, such as requests for additional pain medicine, frequent or longer sick leaves, increased phone contact or clinic appointments, etc. These patients are often sweet-talkers, they ride on the privilege that the doctor gives them, often playing on the guilt of others, threatening rage, legal action or suicide. They tend to exhibit impulsive behavior directed at obtaining what they want which can be quite dangerous. The key to managing encounters with manipulative patients is to calmly explain and realize as the doctor that that sometimes it is okay to say “No.”

Ungrateful – Patients who, for medical or non-medical reasons, appear ungrateful or frivolously utilize medical care but never satisfied with anything are very hard to manage. They may continue to seek medical attention from you but never report anything positive despite the visible changes. They might start their sentence by saying “I don’t know if you will manage, but these are my issues…”  They are generally hard to please and they throw doctors into a frozen state every time trying to explain that indeed we have moved from sate A to B. They hardly heed the advice they are given.

Patients who know it all – There are many ‘Dr. Google’ out there. And it either eases or complicates the consultation or the Doctor-Patient relationship. When we say empower yourselves in medical knowledge, it means ‘have an idea’ so that you do not ask the most basic questions, it saves time (and money). It means know your disease and learn how to live with it. It means understand your treatment and contribute towards it to save yourself some distress and complications.

IT DOES NOT MEAN GOOGLE AND COME UP WITH A DIAGNOSIS THAT YOU THINK FITS YOUR SYMPTOMS AND TELL THE DOCTOR HOW TO TREAT YOU.

These kind of patients are the most difficult to deal with and to manage and unfortunately they have been reported not to get much benefit from the doctors’ help because they come with already made-up minds. They perish out of ignorance rather than knowledge. Stay away from this and let the doctor be the doctor!

Non-adherent – Every patient is special. We do not only take care of the patient’s disease but mind, soul and their surroundings as well. So that takes care of the psychological, religious, spiritual and social aspects of their lives. Where any part of that conflicts with the treatment plan we make time to sit them down, counsel them, be patient with them, counsel them again, bring their support structure like family if permitted, do more counseling until they understand the dangers of their choices. However, if we are happy that they understand the dangers but still choose not to adhere to the management plan, we respect their autonomy or power to do so. with severe symptoms, with an underlying mental disorder or who were less functional.”

Worried well patients, patients with poorly controlled chronic pain, who are non-compliant with medical regimens, seductive or manipulative, consume a lot of clinician-time and health care resources, somatisize, or are self-destructive or attention-seeking may also be labeled ‘difficult’. (Krebs et al., 2006; Elder et al., 2006)

well for patients of mine in similar situations. I would like to make a contract with you to see you every two to four weeks – often enough to see if there is anything truly new going on. If something significant develops that has not already been worked up, we will do more tests. We will meet frequently enough to provide you some assurance that we are not missing anything, and we will avoid uncomfortable and costly tests and procedures unless they are clearly necessary.”

Grieving patients. Recognizing the effect of grief on some patients' health requires familiarity with the normal stages of grief and the cultural context in which it occurs. Look for vegetative signs of depression and maladaptive behaviors that prevent progression through the normal grieving process, and treat them. Help grieving patients by validating their emotional experience and making sure they understand that grief is a process that takes varying degrees of time for different people. Encourage open communication, avoid inappropriate medication to suppress emotions, and caution against major lifestyle changes too early in the process.

“Frequent fliers.” These patients may stand out due to the sheer bulk of their medical charts. They may be lonely, dependent or too afraid or embarrassed to ask the questions they really want answered. They may also be patients with a large number of perfectly rational questions, the “worried well” or simply patients who have been given misinformation that needs clarification.

The first step to a productive interaction is to identify the underlying reasons for the frequent visits. Begin by acknowledging that you notice the pattern of frequent visits, and explain that you have seen other patients schedule frequent visits for different reasons, including concern about undiagnosed symptoms, a need for reassurance, a need for relief from chronic pain or a need to talk. Ask whether any of these reasons apply or whether the patient has other ideas as to the reasons for the frequent visits. Showing understanding of the patient's reasons often will foster an open discussion of the “reasons behind the reasons.” Contract with the patient for regularly scheduled return visits, and use patient education and support personnel as needed. Well-honed pain-management skills may also come in handy for patients who schedule frequent appointments due to chronic pain

For comments or questions please email agboima@yahoo.com

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Hell Up in Judea

24th August 2021

A case can be made, General Atiku, that history’s most infamous Roman is Pontius Pilate. It was Pilate who condemned Jesus, the  “Son of God”, to the most cruel, most barbaric,  and most excruciating of deaths – crucifixion –  and cowardly at that as the gospels attest for us.  

Yet the exact circumstances under which the crucifixion took place and what followed thereafter far from jells with what is familiarly known. The fact of the matter was that there was a lot of political wheeling and dealing and boldfaced corruption on the part both of the Jewish authorities and the Roman establishment in the person of Pontius Pilate.  In this piece, we attempt, General, to present a fuller photo of Pilate as the centre of the whole machination.

Pilate’s historicity, General, is not in doubt. In 1961, an Italian archeologist unearthed a limestone block at Caesarea Maritima on the Mediterranean coast of Israel, which as of 6 AD was the Roman seat of government as well as the military headquarters.  The block bore the inscription, “Pontius Pilate, the Prefect of Judea, has dedicated this Temple to the divine Augusti” (that is, then Roman Emperor Tiberius Caesar and his wife Livia).

Pilate also gets varying degrees of mention in the works of Roman senator and historian Cornelius Tacitus (56-117 AD); the Hellenistic Jewish philosopher and chronicler Philo of Alexandria (25 BC to 50 AD); and the legendary Jewish historian Flavius Josephus (37-100 AD).

Although his year of death (37 AD) is documented, his year of birth is a matter of conjecture, General. He came from the Pontii tribe (hence the name Pontius), a tough, warlike people. The Pontii tribe was of the equestrian class, the second-tier in the Roman caste system. Originally, the equestrians were those Romans with ample pocket power to bribe their way to knightly ranks in the Roman army. Pilate was born to Marcus Pontius, who had distinguished himself as a general in Rome’s military campaigns.

Following one of his particularly sterling military exploits, Marcus was awarded with the Pilum (javelin), a Roman decoration of honour for heroic military service.  To commemorate this medal of valour, the family took the name Pilati, rendered Pilate in English and Pilatus in Latin.

The son, Lucius Pontius Pilate, also distinguished himself as a soldier in the German campaigns of Germanicus, a prominent general of the early Roman Empire. Thanks to his scintillating military profile coupled with   strategic connections in the hierarchies of the Roman government, Pilate was able to wend his way into the heart of Claudia, the granddaughter of Caesar Augustus, the founder of the Roman Empire and ruler from 27 BC to 14 AD.

Claudia’s mother was Julia the Elder, who was also the biological mother of the apostles John and James. When Claudia was about 13 years of age, Julia sent her to Rome to be reared in the courts of Emperor Tiberius Caesar, to whom Julia was once married from 11 BC to 6 BC.

Although Tiberius was not the biological father of Claudius, General, he gladly acquiesced to being her foster father in deference to the memory of her late grandfather Caesar Augustus.
Pilate arrived in Rome when Claudia was sixteen years of age. In AD 26, the two tied the knot. Needless to say, it was a marriage based not on love as such but on political opportunism.

ASSIGNMENT JUDEA

The high-placed connection who facilitated Pontius Pilate’s smooth landing into the inner sanctums of Rome’s royalty and put him on a pedestal that saw him take pride of place in the cosmic gallery of rogues was Aelius Sejanus. Like Pilate, Sejanus came from the subordinate equestrian class, who would never be eligible for a seat in the Senate, the legislative council of ancient Rome.

Sejanus, however, had over time become Emperor Tiberius’ most trusted lieutenant and to the point where he was the de facto prime minister.  He had been commander of the Praetorian Guard, the elite Special Forces unit created by Augustus Caesar as a personal security force, which developed under Sejanus’ command into the most significant presence in Rome.

In AD 26, the emperor was not even based in Rome: he had confined himself to the 10.4 km2 island of Capri, about 264 km from Rome, and left control of Rome and the government of the Roman Empire to Sejanus. It was Sejanus who recommended the appointment of Pilate as prefect, or governor/procurator of Judea. The appointment was pronounced right on the occasion of Pilate’s nuptials with Claudius.

Philo records that when the bridal party emerged from the temple where the marriage ceremony was celebrated and Pilate started to follow the bride into the imperial litter, Tiberius, who was one of the twelve witnesses required to attend the ceremony, held him back and handed him a document. It was the wedding present – the governorship of far-flung Judea – with orders to proceed at once to Caesarea Maritima to take over the office made vacant by the recall of Valerius Gratus.

Pilate was notified by Sejanus that a ship was in fact waiting upon him to transport him to Palestine right away. The only disadvantageous aspect about the assignment was that Pilate was to leave the shores of Rome alone, without the pleasure of spending a first night in the arms of his newly wedded wife: by imperial decree, the wives of governors were not allowed to accompany them in their jurisdictions. Pilate, however, was a royal by marriage and so this prohibition was waived. By special permission granted by His Imperial Majesty Tiberius Caesar, Claudia soon joined her husband in Judea. The wily Pilate had calculated well when he married into royalty.

A SADISTIC ADMINISTRATOR

The Judean perch was not prestigious though, General. The prefects of Judea were not of high social status. At least one – Felix, referenced by Luke in the Acts of the Apostles – was an ex-slave, which says a great deal on the low regard in which the province was held by Rome.

Pilate was only secondarily sent to Judea on account of having married into royalty: his posting to the volatile province stemmed, primarily, from his being of a inferior social pedigree. Be that as it may, Pilate relished the posting in that it gave him the chance to exercise power, absolute power. Absolute power corrupts absolutely and in Pilate was the archetypal example, General.

Pilate’s brief was simple: to collect taxes, maintain law and order, maintain infrastructure, and keep the population subdued. Although he was born lowly, he positively had the power of life and death over his Jewish subjects. Let us, General, listen to Josephus in his allusion to Coponius, Judea’s first Roman governor and who like Pilate was from the same subservient social class: “And now Archelaus’ part of Judea was reduced into a province and Coponius, one of the equestrian order among the Romans, was sent as procurator, having the power of life and death put into his hands by Caesar.”

Pilate, General, was callous to a point of being sadistic. He was scarcely the scrupling judge with the rare soft spot that we encounter in the gospels. Philo charges him with “corruptibility, violence, robberies, ill-treatment of the people, grievances, continuous executions without even the form of a trial, endless and intolerable cruelties”.

He further declares him to be a “savage, inflexible, and arbitrary ruler” who was of a “stubborn and harsh quality” and “could not bring himself to do anything that might cause pleasure to the Jews”. The essentially humane character of the Pilate who presided over the trial of Jesus as portrayed in the gospels may not be wholly fictitious but is highly embellished, General.

Why did Pilate have such a pathological hatred of the Jews, General? Sejanus had more to do with it than the spontaneous leanings of his own nature. According to Philo, Sejanus hated the Jews like the plague and wished “to do away with the nation” – to exterminate it. In AD 19, for instance, he forced the Jews in Rome to burn their religious vestments and expelled them from the city without much ado.

For as long as Sejanus was in power, General, Pilate could do pretty much as he pleased. He didn’t have to worry about compromising reportage reaching the emperor as everything went through the implacably anti-Jewish Sejanus. Sejanus was unrivalled in power: golden statues of the general were being put up in Rome, the Senate had voted his birthday a public holiday, public prayers were offered on behalf of Tiberius and Sejanus, and in AD 31 Sejanus was named as Consul jointly with Tiberius.

The Judea posting also gave Pilate a golden opportunity to make money – lots of it. The governors of the Roman provinces were invariably rapacious, greedy, and incompetent: this we learn not only from Jewish historians of the day but from contemporary Roman writers as well such as Tacitus and Juvenal.

As long as the money skimmed from the provinces was not overly excessive, governors were allowed a free hand. It is said of Emperor Tiberius that, “Once he ordered a governor to reverse a steep rise in taxes saying, ‘I want my sheep shorn, not skinned’!” For those governors, such as Pilate, who had support from the very acmes of Roman power, General, they were practically a law unto themselves.

PILATE’S WINGS ARE CLIPPED

Pontius Pilate, General, was untrained in political office. Furthermore, he was a sycophant to the core who was prepared to go to any length in a bid to curry favour with and prove his loyalty to the powers that be in Rome.    Both these attributes gave rise to a series of blunders that brought him the intense hatred of the Jews.

The first abomination he committed in the eyes of the Jews, General, was to set up a temple dedicated to Emperor Tiberius, which he called the Tiberieum, making him the only known Roman official to have built a temple to a living emperor.  True, Roman emperors were worshipped, but Tiberius was the one exception. According to the Roman scholar and historian Suetonius, Tiberius did not allow the consecration of temples to himself. Pilate’s act therefore, General, was an overkill: it was not appreciated at all.

Throughout his tenure, General, Pilate had a series of run-ins with the Jews, some of which entailed a lot of bloodshed and one of which sparked an insurrection that paved the way to Calvary. Then it all began to unravel, General. On October 18 AD 31, his patron Sejanus was summoned to the office of Emperor Tiberius and an angry denunciation was read out to him. It is not clear, General, what caused Sejanus’ fall from the emperor’s good graces but circumstantial evidence points to the perceived threat to the emperor’s power.

As the ancient historian Cassius Dio puts it, “Sejanus was so great a person by reason both of his excessive haughtiness and of his vast power that to put it briefly, he himself seemed to be the emperor and Tiberius a kind of island potentate, inasmuch as the latter spent his time on the island of Capri.”  Sejanus, hitherto the most powerful man in Rome, General, was thrown into a dungeon.

That same evening, he was summarily condemned to death, extracted from his cell, hung, and had his body given over to a crowd that tore it to pieces in a frenzy of manic excitement. His three children were all executed over the following months and his wife, Tiberius’ own daughter, committed suicide.  The people further celebrated his downfall by pulling his statues over.  Meanwhile, General, Tiberius began pursuing all those who could have been involved in the “plots” of Sejanus.

In Judea, Pilate, a Sejanus appointee, must have been badly shaken, General. Were his friends and family under suspicion? Would he be purged like others? Imperial attitudes to the Jewish race seemed to have changed now with the riddance of Sejanus. Tiberius made sure this was the case by appointing a new governor for Syria (who went by the title Legate and to whom Pilate was obligated to report).

The governor, Lucius Pomponius Flaccus, arrived in Rome in AD 32. Philo records that Tiberius now “charged his procurators in every place to which they were appointed to speak comfortably to the members of our nation in the different cities, assuring them that the penal measures did not extend to all but only to the guilty who were few, and to disturb none of the established customs but even to regard them as a trust committed to their care, the people as naturally peaceable and the institution as an influence promoting orderly conduct.”

So Pilate, General, had lost his supporters at the top, his new boss was on his doorstep, and there had been a change of policy regarding the very people he was in charge of. Surely, he would have to watch his step. The fact of the matter, however, General, was that he hardly did so.  In November 32 AD, for instance, he provoked a mini-uprising by the Zealots led by Judas Iscariot, Theudas Barabbas, and Simon Zelotes. It was this revolt, General, that culminated in those three “crosses” of Calvary that are indelibly etched on the mind of every Christian.

NEXT WEEK: ZEALOT REVOLT AGAINST PILATE

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Hustle & Muscle

24th August 2021

Until as recently as the 1980s a career often meant a job for life within a single company or organisation. Phrases such as ‘climbing the corporate ladder’, ‘the glass ceiling’, ‘wage slave’ & ‘the rat race’ were thrown about, the analogies making clear that a career path was a toxic mix of a war of attrition, indentured drudgery and a Sisyphean treadmill.

In all cases you fought, grafted or plodded on till you reached retirement age, at which point you could expect a small leaving party, the promise of a pension and, oddly, a gift of either a clock or watch. The irony of being rewarded with a timepiece on the very day you could expect to no longer be a workday prisoner was apparently lost on management – the hands of time were destined to follow you to the grave!

Retirement was the goal at the end of the long, corporate journey, time on your hands – verifiable by your gifted time keeping device – to spend time working in the garden, playing with the grandchildren, enjoying a holiday or two and generally killing time till time killed you.

For some, retirement could be literally short-lived. The retirement age, and accompanying pension, was predicated on the old adage of three scores years and ten being the average life expectancy of man. As the twentieth century progressed and healthcare became more sophisticated, that former mean average was extended but that in itself then brought with it the double-edged sword of dementia. The longer people lived, the more widespread dementia became – one more life lottery which some won, some lost and doctors were seemingly unable to predict who would succumb and who would survive.

However, much research has been carried out on the causes of this crippling and cruel disease and the latest findings indicate that one of its root causes may lie in the former workplace – what your job entailed and how stimulating or otherwise it was. It transpires that having an interesting job in your forties could lessen the risk of getting dementia in old age, the mental stimulation possibly staving off the onslaught of the condition by around 18 months.

Academics examined more than 100,000 participants and tracked them for nearly two decades. They spotted a third fewer cases of dementia among people who had engaging jobs which involved demanding tasks and more control — such as government officers, directors, physicians, dentists and solicitors, compared to adults in ‘passive’ roles — such as supermarket cashiers, vehicle drivers and machine operators. And those who found their own work interesting also had lower levels of proteins in their blood that have been linked with dementia.

The study was carried out by researchers from University College London, the University of Helsinki and Johns Hopkins University studying the cognitive stimulation and dementia risk in 107,896 volunteers, who were regularly quizzed about their job.  The volunteers — who had an average age of around 45 — were tracked for between 14 and 40 years.  Jobs were classed as cognitively stimulating if they included demanding tasks and came with high job control. Non-stimulating ‘passive’ occupations included those with low demands and little decision-making power.

4.8 cases of dementia per 10,000 person years occurred among those with interesting careers, equating to 0.8 per cent of the group. In contrast, there were 7.3 cases per 10,000 person years among those with repetitive jobs (1.2 per cent). Among people with jobs that were in the middle of these two categories, there were 6.8 cases per 10,000 person years (1.12 per cent).

The link between how interesting a person’s work was and rates of dementia did not change for different genders or ages.Lead researcher Professor Mika Kivimaki, from UCL, said: ‘Our findings support the hypothesis that mental stimulation in adulthood may postpone the onset of dementia. The levels of dementia at age 80 seen in people who experienced high levels of mental stimulation was observed at age 78.3 in those who had experienced low mental stimulation. This suggests the average delay in disease onset is about one and half years, but there is probably considerable variation in the effect between people.’

The study, published this week in the British Medical Journal, also looked at protein levels in the blood among another group of volunteers. These proteins are thought to stop the brain forming new connections, increasing the risk of dementia. People with interesting jobs had lower levels of three proteins considered to be tell-tale signs of the condition.

Scientists said it provided ‘possible clues’ for the underlying biological mechanisms at play. The researchers noted the study was only observational, meaning it cannot establish cause and that other factors could be at play. However, they insisted it was large and well-designed, so the findings can be applied to different populations.

To me, there is a further implication in that it might be fair to expect that those in professions such as law, medicine and science might reasonably be expected to have a higher IQ than those in blue collar roles. This could indicate that mental capacity also plays a part in dementia onset but that’s a personal conclusion and not one reached by the study.

And for those stuck in dull jobs through force of circumstance, all is not lost since in today’s work culture, the stimulating side-hustle is fast becoming the norm as work becomes not just a means of financial survival but a life-enhancing opportunity , just as in the old adage of ‘Find a job you enjoy and you’ll never work another day in your life’!

Dementia is a global concern but ironically it is most often seen in wealthier countries, where people are likely to live into very old age and is the second biggest killer in the UK behind heart disease, according to the UK Office for National Statistics. So here’s a serious suggestion to save you from an early grave and loss of competencies – work hard, play hard and where possible, combine the two!

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The Lord Ties The Knot

18th August 2021
JUDAS

… as Judas Iscariot takes strong exception

The gospels which were excluded from the official canon, the New Testament, at the Council of Nicaea are known as the Apocrypha. One of these Apocryphal works, General Atiku, is the gospel of Phillip.  In this gospel, the intimate relationship between Jesus and Mary Magdalene is openly discussed thus:

“And the companion of the Saviour is Mary Magdalene. But Christ loved her more than all the disciples and used to kiss her often on the mouth.  The rest of the disciples were offended by it and expressed disapproval. They said unto him, why do you love her more than all of us? The Saviour answered and said to them, why do   I not love you like her? … Great is the mystery of marriage, for without it the world would never have existed. Now, the existence of the world depends on man, and the existence of man on marriage.”

It is clear from the above statement, General, that Jesus held marriage in high regard because he himself was part and parcel of it.  The disciples (that is, most of them) were offended not because he and Mary were an item but because they simply did not approve of her as she was a Gentile and a commoner.

Otherwise, the kissing was not offensive at all: it was a customary expression of mutual affection between the sacred bride and groom. This we gather from the prototypically romantic Old Testament text known as The Song of Solomon, which opens with the words, “Let him kiss me with the kisses of his mouth: for thy love is better than wine.”  As the Davidic groom, Jesus was therefore entitled to kiss Mary Magdalene as his bride.

THE FIRST MARRIAGE

In September AD 30, General Atiku, Jesus and Mary Magdalene had their First Marriage ceremony. Jesus had turned 36 in that year, the appropriate marriage age for a Davidic heir, and September was the holiest month in the Jewish calendar.  Having been born irregularly himself (in the wrong month of the year because of his father Joseph’s intransigence), Jesus was determined that he himself follow the law to the letter so that his child would not suffer the same indignities as he did. The First Marriage is captured in LUKE 7:35-50.

The marriage took place at the home of Simon the Pharisee. This, General, was another name for Simon Zelotes, the stepfather of Mary Magdalene. Although Mary Magdalene is not directly named, she is described as a “sinner”. This was another term for Gentiles, as in the eyes of the Jewish God, they were unregenerate and therefore hopeless sinners.  Mary Magdalene, whose mother Helena-Salome was of Syrian origin (Syro-Phoenicia to be specific), was a Gentile.

On the occasion, Mary Magdalene performed three acts on Jesus as set out in LUKE 7:38. She wept; kissed his feet; and anointed him with ointment. This is what a bride was supposed to do to her groom as clearly evinced in The Song of Solomon, a series of love poems concerning a spouse and her husband the King.

Of the three rites, perhaps it is the weeping that require elucidation, General. This was at once symbolic and sentimental.  The First Marriage was simply a ceremony: the moment the ceremony was over, the husband and wife separated, that is, they lived apart until the month of December, when they came together under one roof.  This was in accord with Essene stipulations for dynastic marriages, that is, those of the Davidic Messiah and the priestly Messiah.

Prior to the First Marriage, the bride was known as an Almah, meaning a betrothed Virgin. After the First Marriage ceremony, the Almah was demoted to a Sister. This was because the ensuing three-month separation meant husband and wife would not indulge in sexual activity and so the wife was as good as a sister to her husband. The imagery of Sister also being a wife is seen in 1 CORINTHIANS 9:5, where the apostle Paul refers to his wife as Sister. In ACTS 23:16, Paul’s wife is again referred to as his Sister.

Now, when the Almah became a Sister, General, she was metaphorically called a Widow, because she was being separated  from her newly wedded husband. As such, she was expected to symbolically weep on account of this separation. That explains why Mary Magdalene had to weep at her first wedding. It is a pity, General, that most Christians and their clergy miss the real story so wrongly indoctrinated are they.

In December AD 30, Jesus moved in with Mary Magdalene to consummate the marriage. It was hoped that Mary would fall pregnant so that in March the following year, a Second (and final) Marriage ceremony would be held.  Sadly, conception did not take place. According to Essene dynastic procreational rules, the couple had to separate again. They would reunite in December AD 31 for another try at conception.

The reason they separated was because for a dynastic heir, marriage was purely for procreation and not for recreational sex. But even that year, General, Mary did not fall pregnant, necessitating another year-long separation. What that meant was that Mary would be given one more last chance – in December AD 32, by which time Jesus would have been 38.  If she did not conceive this time around, the marriage would come to an end through a legal divorce and Jesus would be free to seek a new spouse.

THE FINAL MARRIAGE

In December 32, Mary Magdalene, General, finally conceived. When Jesus was crucified therefore in April 33 AD, his wife was three months pregnant. By this time, the Second Marriage ceremony, the final one, had already taken place, this being in March. The Second Marriage is cursorily related in MATTHEW 26:6-13; MARK 14:3-9; and JOHN 12:1-8.The John version reads as follows:

“Jesus, therefore, six days before the Passover, came to Bethany, where was Lazarus, who had died, whom he raised out of the dead; they made, therefore, to him a supper there, and Martha was ministering, and Lazarus was one of those reclining together (at meat) with him; Mary, therefore, having taken a pound of ointment of spikenard, of great price, anointed the feet of Jesus and did wipe with her hair his feet, and the house was filled from the fragrance of the ointment.

Therefore said one of his disciples – Judas Iscariot, of Simon, who was about to deliver him up – ‘Therefore was not this ointment sold for three hundred denaries, and given to the poor?’ and he said this, not because he was caring for the poor, but because he was a thief, and had the bag, and what things were put in he was carrying. Jesus, therefore, said, ‘Suffer her; for the day of my embalming she has kept it, for the poor you have always with yourselves, and me you have not always.’”

This story (also see JOHN 11:1-44) centres on four people primarily, General. They are Jesus; Lazarus; Mary; and Martha. “Mary” was actually Mary Magdalene.  “Martha” was a titular name for her mother, Helena-Salome.  In the Lazarus story, the two ladies are referred to as “sisters”. This denotes conventual sisters, like the Catholics refer to conventual nuns, and not sisters by blood. Helena-Salome actually headed a nunnery. By the same token, the reference to Lazarus as “brother” has a connotation akin to what Pentecostals refer to as “Brother in Christ”.

Thus, the story revolves around Jesus the groom; his bride Mary Magdalene; his father-in-law Simon Zelotes; and his mother-in-law Helena-Salome. This is a family affair folks, which provides strong hints as to the exact relationship between Jesus and Mary. The raising from the dead of a man called Lazarus, sadly, was not a miracle at all:  it was a ceremonial restoration from excommunication back to the Essene governing council, which comprised of Jesus and his so-called 12 disciples.

The “Lazarus” who was thus restored was actually Simon Zelotes, at the time the most “beloved” by Jesus of the entire apostolic band, who had been demoted under circumstances relating to a Zealot uprising against Pontius Pilate.  More will be said on the subject at a later stage.

The anointing of Jesus by Mary with “spikenard”, General, harps back to ancient married rituals as patently demonstrated in The Song of Solomon. This was the second time Mary had anointed Jesus, first at the First Marriage in September AD 30 AD and now at the Second Marriage in March 32 AD. On both occasions, Mary anointed Jesus whilst he sat at table.

In SONG OF SOLOMON 1:12, the bride says, “While the King sitteth at his table, my spikenard sendeth forth the smell thereof”.  The anointing in the gospels was therefore an allusion to the ancient rite whereby a royal bride prepared her groom’s table. Only as the wife of Jesus and as a priestess in her own right could Mary Magdalene have anointed both the feet and head of Jesus.

The anointing in effect had two purposes: first, to seal the marriage, and second, to officially announce to the Jewish nation that Jesus was the Davidic Messiah (and not his younger brother James, who had been so promoted by John the Baptist).  It all harped back to the tradition in ancient Egypt and Mesopotamia, where Kings or Pharaohs were anointed for office (in their case with crocodile fat) by their half-sister brides.

The King’s bride actually kept the anointment substance for use for one more time – when the King died. You can now understand, General, why Jesus said “the day of my embalming she has kept it” in reference to his anointing by Mary Magdalene and why the first person to feature at the tomb of Jesus was none other than Mary Magdalene!

Three passages in the Lazarus story     (in JOHN11: 1-44) are particularly telling.  They are Verses 20, 28, and 29. They read as follows: “When Martha heard that Jesus was coming, she went out to meet him, but Mary stayed in the house … After Martha said this, she went back and called her sister Mary privately. ‘The Master is here,’ she told her, ‘and is asking for you.’ When Mary heard this, she got up and hurried out to meet him.”  The reason Mary (Magdalene) first kept her place before proceeding to meet Jesus, General, is not supplied in the Johannine gospel.

However, the Apocryphal document which has come to be known as The Secret Gospel of Mark sheds more light, General.  It explains that on the first occasion, Mary did come out to meet Jesus along with her mother Martha (Helena-Salome) but upon being rebuked by the disciples of Jesus, she repaired back to the house. Why was she lashed out at, General? Because according to the Essene matrimonial code, she was not permitted to come out of her own accord and greet her husband: she was to wait until he had given her express permission to emerge.

There is yet another element in the conduct of Mary Magdalene that has parallels with Solomon’s queen, General. In the back-and-forth romantic dialogue between the couple, the queen is referred to as a “Shulamite” (SONG OF SOLOMON 6:13). The Shulamites were from the Syrian border town of  Solam and we have already seen that Mary’s first foster father, Syro the Jairus, was a Syrian, as was her mother Helena-Salome.

JUDAS DENOUNCES THE MARRIAGE

The marriage of Jesus to Mary Magdalene was vehemently opposed by most of his so-called disciples. The most vociferous on this position, General, was Judas Iscariot. The writer of the John gospel characterises Judas as a “thief” who used to pilfer alms money but that is a smear.  The gospels were written post-eventual and therefore Judas’ name was already in ignominy.

His detractors therefore had a field day at sullying his character. Yet prior to the betrayal, Judas Iscariot, General, was one of the most respected figures among the Essene community. At the time of Jesus’ marriage, Judas was the second-highest ranking Essene after Simon Zelotes (that is the meaning of “Judas of Simon” in the passage quoted above, meaning “Judas the deputy of Simon”): Jesus was third, although politically he was the seniormost.

Judas opposed the marriage on grounds, primarily, that Mary Magdalene was not only a Gentile but a commoner. Judas had the right to pronounce on Jesus’ marriage because it was he who was in charge of the Essene’s order of Dan, to which Mary Magdalene belonged prior to her marriage to Jesus and therefore had the right whether to release her for marriage or retain her in the convent. Judas would rather the spikenard (the most expensive fragrance of the day, the reason it was only used by queens) was sold and the money generated donated to the Essene kitty (“the poor” was another name for Essenes: when Jesus in the Beatitudes said “blessed are the poor”, he was not referring to you and me: he meant the Essenes).

Sadly General, as high-standing as he was, Judas had no right of veto over the marriage of a Davidic heir: only Simon Zelotes had by virtue of his position as the Essene’s Pope. Simon Zelotes was Mary Magdalene’s step-father and there was no way he was going to stand in the way of the marriage of his own daughter. Moreover, Jesus had already begun to fancy himself as Priest-King.

As far as he was concerned therefore, he was at once the Davidic Messiah and the Priestly Messiah – the Melchizedek. Thus even if Simon Zelotes had perchance objected to the marriage, Jesus would have gone ahead with it anyway. It was Jesus’ highly unpopular appropriated role as the Melchizedek, General, that set him on the path to Calvary.

NEXT WEEK: A NEW GOVERNOR COMES TO TOWN

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