In the dark?

Burton Hospital Eye Outpatients, 26 June 2020

Exchanges between hospital staff (HS) and me.

Me            Good morning. Outpatients, 9.30.

HS            assumed: can I have your name please?

Me            Sorry I’m deaf, can’t hear.

HS            still not loud enough: can I have your name please?

Me            I need to see your lips move, so please can you take your mask off? 

This does not go down well. After giving the requested information:

HS            We don’t seem to have your phone number. Can you let me have it?

Me            after having given it: that’s odd, you know, because somebody rang me last Monday to tell me about the appointment, and somebody rang me yesterday to confirm that I would attend.

HS            bluster bluster.

Me            Upstairs as usual?

After an affirmative nod, up I go. Upstairs is laid out differently from last time. I normally sit on the left to be near the place where staff call for patients, since none of them speaks very clearly. After about 20 minutes having been ignored:

Me            Am I in the right place?

HS            Have you had your temperature taken?

Me            No.

HS            Well, you should be over there in a red chair.

Me            after moving: It might be a good idea if the receptionist were to tell people that.

HS            There are notices in the lift and on the stairs.

Me            thinking: Notices? Notices? In small print? FFS, this is an eye clinic.

But I merely smile and relocate my backside.

Before long my sight has been tested, my right retina scanned, and in I go to the consultant. All very pleasant, though taking longer than usual. The consultant is very gently spoken and not easy for me to hear.

HS            What sort of surgery have you had?

Me            perplexed since he has the notes in front of him: Well I had the procedure that fries the ciliary apparatus last year and in 2018.

HS            Here? In the theatre downstairs?

Me            Yes.

HS            You had retinal surgery (not a question).

HS            No, not here, that was in Derby in 2008 by Mr Chen.

Him           So what was the operation here?

Me            after dredging my memory: cyclodiode laser treatment.

HS            Here?

Me            Yes, twice. You have the notes there: is there no record?

HS            Well, I can’t find them. Those records are digitized and kept offsite. We are completely in the dark.

Boom boom!

Me            trying to keep a straight face: that’s crazy ridiculous.

HS            shrug of the shoulders: That’s the way it is. Tell me when you had the cyclodiode.

So I did, and he wrote it down.

Ocular pressure on both sides is good. Glaucoma on the right is under control. It turns out I have a substantial cataract on the right, as well as glaucoma. Because that’s my only functioning eye, and surgery carries the risk of my being left totally blind, his advice is to live with the cataract until normal daily activities become impossible. I’m happy enough with that. I ask if successful surgery would mean that I could drive, to which the response is probably not.

After these moderately entertaining exchanges, he rationalises my seven lots of eye drops to five.

This is good, except that he insists that the drops I use should be from individual sachets without preservative, rather than with preservatives from a plastic bottle (cheaper). It seems the preservatives are damaging my corneas. He tells me that I must insist that the GP prescribes the individual sachets and not the generic drops in plastic bottles. Knowing as I do how difficult it is even to get a GP appointment, I express doubt that this will work and tell him why.

HS            Oh well, that’s the problem we all have to deal with. Good luck.

Then I’m dismissed with cordial farewells and I pootle off to hospital pharmacy to get the first new prescription. Do you know it takes 50 minutes to find two boxes, put them in a plastic bag, and give them to me?

I don’t fault the treatment one little bit. Burton Hospital has been very good to me. But I do wonder about administration, record keeping, the ability of one computer system to talk to another, and the difficulty people seem to have in imagining what it’s like from a patient’s perspective. 

All hail the NHS!

Experts and skeptics

Sayings of Richard Feynman, Nobel prizewinning physicist:

  • There is no harm in doubt and skepticism, for it is through these that new discoveries are made.
  • Science is organized skepticism of the reliability of expert opinion.

In our response to covid, we are witnessing the lack of expertise of experts.

We assume that science is incontrovertible. It may well be.

Scientists, however, are not. They are human. When they “speak science” to us, we do well to remember that actually they are speaking not science, but science as interpreted by scientists. Not the same thing at all.

We observe scientific phenomena. Observations rely on our senses and intellects. We measure scientific phenomena. Measurements rely on instruments and techniques. In biological science we observe and experiment on animals, human and non-human. Animals have “personalities”. They are not predictable. Personalities influence responses.

When a scientist inspects cells or tissues under a microscope, they have been pulverised in all sorts of ways to render them observable. If yesterday’s work is to be compared to today’s and next week’s, you need to be pretty damn sure that all the conditions and chemicals and temperatures that held yesterday are absolutely identical to today’s and next week’s. This can never be. 

There are so many variables in biological science. It is very messy. Mathematics is pure. Physics is almost pure, but is a bit messy since it has to be observed. Chemistry is messier still. Biology is very messy indeed, as I explain above. Messiest of all are things like psychology and social science, the latter once defined as the study of those who don’t need to be studied by those who do.

In the biological sciences, it’s necessary to amass a large amount of data. Those data must be tested, time and again, and robust statistical analyses applied, before even tentative conclusions can be drawn. 

I’m not saying that it’s not possible to draw conclusions in biological science. But it is time consuming and laborious, and it requires meticulous work from researchers whose personalities are well suited to meticulous work: focussed, capable of paying attention to detail and possessed of almost infinite patience. A bit anal you might say. Being on the autistic spectrum certainly helps.

Most of all, scientists must be impervious to the pressures from themselves and others to get their results to conform to expected patterns that suit their own ideas or those of the organisation and funding bodies for whom they work. 

In short, scientists need to be uncontaminated by personal bias. Good luck with that.

You see, the problem is that scientists—experts—are human.

Back in the 4th century, Evagrios the Solitary said “there are three groups [of demons] who fight in the front line: those entrusted with the appetites of gluttony, those who suggest avaricious thoughts, and those who incite us to seek the esteem of men. All the other demons follow behind and in their turn attack those already wounded by the first three.” Evagrios clearly had a profound knowledge of human psychology.

The third of those demons, seeking the esteem of men, is by far the most insidious and dangerous. And that is at the root of the sin of the expert, of the scientist in general, and indeed of humanity.

We all want to be well thought of. It is good for the sake of pay, pension, reputation, self-esteem and ego. But seeking the approval of others requires that we choose those whose approval is worth having. Therein lies the problem.

The ego of an unscrupulous scientist can lead to his ignoring inconvenient results, even fabricating data. It can lead to a pet model overriding observed data, the latter being squeezed and deformed to fit the model just as the ugly sister’s toe was amputated so her foot might squeeze into the glass slipper. Researchers employed by drug companies are particularly vulnerable to such pressures in order that their results will best enhance company profits, and thus reputations and prospects.

I need not perseverate. You can see how the demon of seeking esteem infects us all—and in the realm of science, you can I hope see how such pressures and biases can distort the interpretation of biological data.

And that brings us to covid.

In the covid case we are dealing with a novel virus. People use that word, and yet they don’t see that novel carries with it uncertainty and unpredictability, for if something is novel we can not reliably assume or deduce anything on the basis of what we have known heretofore. When a scientist comes along with a model, people latch on to it. “We need something,” they cry; “this is something; this will do”. 

Well, it might not do. Indeed, it did not do at all.

They, we, should assume nothing but instead proceed cautiously, adjusting and refining our ideas on the basis of data, rather than on the basis of some preconceived model. Instead we did the opposite: “we have a world expert modeller; we know better than the rest of the world; we know what the virus will do”. We certainly do not know what the virus will do, or how we will respond to it. 

What we need is constant wariness, a readiness always to adjust, refine, question. As Richard Feynman is reported as saying, “Science is the organized skepticism in the reliability of expert opinion.” 

Experts, I repeat, are human and subject to all the deceptions and foibles of human nature. The problem is that we put too much weight on what they say. We treat them as infallible. We do not question them. We should. We need dissenters to say, “hang on a minute; what if … ?” Unfortunately dissenters, whistle blowers, are rarely if ever applauded. Richard Feynman could himself be a skeptic, for former US Attorney General William Rogers said of him “Feynman is becoming a real pain in the ass.” 

We need more, many more,  pains in the ass.

Looking ahead

I suspect that Floyd and Colston riots are in part manifestations of frustration and inconvenience of a policy drawn up on the basis of expert opinion insufficiently questioned and now seen to have been ineptly handled. The spark, I’m in no doubt, was anger at the behaviour of the Prime Minister and his adviser.

We are in for months of civil unrest—the rest of the year and possibly more. The privations, unemployment, business failures and shortages of covid will be as nothing compared to those resulting from the now almost inevitable hard brexit. The shysters in government will use the former as serendipitous cover for their treacherous and self-serving pursuance of the latter.

Politically, I have no axe to grind. In my time I’ve voted for everything except the Greens. But I come to the view that the best option for the immediate future would be an early uprising that would replace this morally bankrupt government with a “war cabinet” that includes Mr Starmer who already has acquired the gravitas and discernment that eluded most of his predecessors and that far exceeds anything in the present administration. Quite how this uprising could be provoked is something to ponder. 

It’s interesting to note that following the Irish general election months ago, there is still no government in Leinster House. And yet Dr Varadkar remains Taoiseach, the Irish go about their business, and two days ago the lockdown was eased considerably. 

Who needs a government? Who needs politicians? We urgently need loyal dissenters.

Ad multos annos

When I was about 10 I sometimes wondered what it would feel like to be 70. Now I know.

I also wondered what it would feel like to be dead. I’ll get back to you on that.

I’m glad to have reached this day, for I’ve long had a niggling suspicion that I might not. I’ve outlived my mother by three years, and if I manage another 12 months I’ll have outlived—just—my father. My sister is seven years older and still going strong, but then women tend to last longer, my mother excepted.

Life has fallen into several compartments: Langwathby: Penrith and Carlisle; Cambridge; London and marriage; Nottingham; Dublin; Derby. Then came ordination after which the pace of change quickened: Wirksworth, Chesterfield, Portlaoise (Ireland again), Burton. Ten house moves since marriage in 1973 and four Irish Sea crossings with resultant administrative hassle of tax, banks, utilities and whatnot in UK and Republic of Ireland, the latter involving both punts and euro. Susan and I became experts in organising moves from one jurisdiction to another, again and again. We learnt the value of renunciation—chucking out—physically and psychologically.

For much of the time, trying to juggle this with the demands of family, career, job politics, and being English in Ireland in the late 80s, I felt like a rabbit in headlights. This was not helped by the agony—and I mean agony—between 1988 and 1991 of living in Ireland while having first both sons then one at boarding schools in England until they were ready for Irish secondary school. Think ferries, overnight drives, unaccompanied flights for the boys, nine or ten times a year. Other people seem to cope well with such like but I did not. In the 1990s I needed lots of help. And later I came to realise that, as with many parents, the job, and in my case the students, got a better part of me than my family did. Thankfully, the feeling of guilt is now behind me.

The children navigated the turbulence of adolescence in a new country, and settled there making great friends and going on to college. Victoria married an Irishman, and Edward took Irish citizenship. Hugh, the middle one, went off to pursue his childhood American dream. After travelling around, then in order Seattle, marriage, fatherhood, and Wasilla (Alaska), he and his family ended up in Texas near his wife’s folks, where in The Great Catastrophe of 2015 he died. When I saw him last we were planning road trips “if I’m still alive” said I, to which he replied “you’ve thirty years in you yet”. He didn’t even have thirty days.

But the rest of us are still extant. We talk to one another and we love each other unconditionally and unlimitedly. I could not have survived without them.

So what does it feel like to be 70? 

My blood pressure is 135/80, give or take—woefully shocking for someone who consumes eggs, salt and butter in industrial quantities. It just goes to show that you shouldn’t listen to doctors or take statins. My resting pulse (lying in bed first thing of a morning) is just below 60. I feel better than I did 10, even 20, years ago, funny turn notwithstanding: https://ramblingrector.me/2020/05/07/a-funny-turn/. 

In my head I’m immaturing with age, I feel like a stroppy teenager. Long may it continue.

I have a great future behind me.

It feels fine.

A funny turn

3B10211C00000578-4002910-image-a-7_1480976584455As Facebook friends may have read, a couple of weeks ago I had a funny turn.

Out walking the dog I felt fuzzy headed, vision even more blurry than usual, unable to walk in a straight line, slurred speech. No drink taken. Transient ischaemic attack (ministroke) thought I as I was lumbering about. Or brain tumour, or cerebellar disease, or inner ear disease.

I sat down, minded by two kind passers by who said I was pale and unsteady. Susan walked the dog home, brought the car and off to hospital. I was in hospital a fair bit as a child for tonsils, nasal polyps (x 3), appendix, teeth and broken bones, so I dislike hospitals intensely. Not only that, people die in them. So the fact that I willingly went says something important.

A&E was quiet. I was tended with efficiency and good humour. I was given a mask and learnt that nobody knows how to stop them steaming up your specs. ECG normal, head CT normal, BP 135/75 – beat that, suckers, given the amount of salt and butter I consume.

High dose aspirin was administered, blood thinner and statins prescribed. Statins I don’t like. Doctors don’t always know the difference between good and bad cholesterol. and the evidence for the efficacy of statins is equivocal. Anyhoo, when I had them once before they didn’t agree with me so I stopped them PDQ.

There’s an MRI next week and they mentioned continuous ambulatory heart monitoring. But I feel as if I’ll be wasting their time. I’ve no idea what caused the symptoms, and they don’t fit into any recognised disease pattern.

You see, dear reader, we’re just machines, and machines have glitches. Sometimes we know what causes the glitch, sometimes we don’t. I’ve found that the cure for a computer glitch is usually to turn it off then on again; for a TV or washing machine glitch, a hard bash or three usually does the trick.

So on this well-established principle, my treatment for this funny turn (a recognised medical expression by the way) was: kill or cure. The very next day I took up running.

Back in the 1980s I was a regular runner – not particularly fast but I could go for ages. Often up at 5.30 am to run a few miles in north Nottingham to Bulwell and back from Sherwood (a suburb, not the forest). A friend and I often went for a few miles round Wollaton Park at lunchtime, showering afterwards in the Anatomy mortuary, much to the amusement of the staff if not the cadavers. I even ran three half marathons.

In the 1990s I was at it again at lunchtime in Dublin from St Stephen’s Green to Phoenix Park and back with a colleague (students were shocked to see that Professors had legs), and at home in Djouce woods in County Wicklow. I opened the car boot, in jumped Petra (a ridgeback/lab cross, a wonderful dog) and up to the woods. We had a great time on the tracks and pathways. The woods, opposite Powerscourt waterfall, were known as an IRA training ground, but we never saw or heard anything interesting. I was really quite fit and lean. Then life intervened and I became, let’s say, less lean. Weightlifting became my thing.

Now senza gym and provoked by a funny turn it’s back to running.

But gently—not because I might die, for I certainly shall, but because I wish to minimise pain. At the age of 70 next month, muscles are good but ligaments and tendons are much more brittle. It hurts when they tear or rupture.  Joint cartilages, too, need care.

Will I ever be back at the gym? When will it re-open? Will I at this age be allowed out of the house? Let me tell you, girls and boys, if the government says I’m not, I may well need to be visited in prison because doubtless some nosey parker reincarnation of an East German Stasi gobshite will report me for being a very naughty boy.

What if running provokes a catastrophic blowout? Well, that’ll be that. You’re welcome to the party after the funeral, if allowed. What doesn’t kill me makes me stronger, as my ole pal Fred Kneeshaw said.

But never mind. Her Majesty’s Government is in control. I have every confidence that they will act sensibly over gyms: reopen them now please. I have every confidence that they will raise money to pay for the largesse they’re doling out by making the super-rich pay more tax, by making multinationals like Amazon pay more tax, by stopping drug companies (they’re all evil) charging extortionately for things that are cheap to make, and by closing tax havens. Funds will cascade into government coffers. As I say, I have every confidence.

Meanwhile, back at the ranch, every day in every way it gets easier and easier. And the dog is having a great time.

Corona and Cassandra 2

Blue-COVID-BannerAn update of my previous blog.

“When we get back to normal …”

Not when, but if.

Coronavirus is the virus. Covid19 is the disease it causes. Coronaviruses have been with us a long time. The flu virus is one of them. Some common colds are caused by coronaviruses. Covid19 is caused by a new strain—hence the adjective novel. I dare say, dear reader, that you knew this. But I’m ashamed to say it hadn’t dawned on me until fairly recently. Now on with the plot.

I don’t see any prospect of controlling this pandemic until herd immunity has been achieved. Herd immunity comes from a combination of immunisation and recovery from infection.

  • A vaccine is at least a year away and anyway vaccines don’t always work. The first recorded influenza pandemic was in 1510. We haven’t yet fathomed the disease and a flu vaccine is as far away as ever. Furthermore, the common cold, sometimes of coronaviral aetiology, eludes all cures. The polio vaccine took decades to be usable, though we’ve moved on scientifically from then. I’m old enough to remember the polio epidemic of 1957/8. As an asthmatic child often fighting for breath, pictures of children in iron lungs terrified me.
  • For recovery from infection we need about 60% of the population to be infected, with the inevitable proportion having life threatening disease and dying. The trouble is that this virus has great propensity to mutate. Its mutated forms could be more vicious than the present one, and herd immunity, or vaccines for that matter, for the present strain won’t necessarily work for new ones. So we are faced with the possibility of wave upon wave of epidemic. Epidemics in general are occurring with increasing frequency (Asian flu, polio, SARS, foot & mouth, Ebola, now this … and more).

And of course there’s always the possibility that new viruses will emerge.

Viruses are clever. They use other creatures for reproduction—their only concern—remorselessly. Just as tectonic plates do the “things that come naturally” leading to quakes and tsunamis, so viruses do the “things that come naturally” leading to morbidity and mortality in vulnerable creatures including humans. It is the natural order.

Viruses are as much part of creation as we are. Praying to a sky pixie for delivery from the pestilence of viruses, as religious nutters do, is no more than human arrogance and hubris. We have viruses in our intestines, necessary for digestion, just as we have billions of bacteria living in us and on us, all necessary for an efficient bioeconomy. Are they asking the sky pixie to discern which bugs to zap and which to leave unhindered?

If covid19 were left unchecked, the best option scientifically, it would amount to survival of the fittest. The trouble is that the burden on the health services would soon be catastrophic. The strategy adopted, distancing and such like, spreads the load over a longer period. But no matter how we get there, herd immunity is needed—and may never be achieved. I suspect that governments have been informed of this, but dare not admit it publicly.

This brings me to the reliability of what we are told. Take today’s BBC news item “New data has added to growing evidence that the number of deaths linked to coronavirus in UK care homes may be far higher than those recorded so far.” Note the vagueness. “Deaths linked to coronavirus” – what does that mean? Deaths “may be” linked. They may not. Just because someone with a cough and pneumonia dies, it doesn’t mean they died of covid19, nor does it mean that the virus contributed to their death. Only testing will tell, so we need reliable tests. Not all tests are reliable. If one reads only the headlines, and many of us do just that, it’s easy to panic.

Ultimately—and I wish people would realise this—we’re all going to die, if not of covid19 this month, then something else later. And let me repeat that as someone with a great future behind him, I would expect a younger person who could get back to work to jump the treatment queue before me. I’m ready to die, though I don’t want to yet.

I don’t much care what others think this says about my morality: to me it’s pragmatic necessity. I acknowledge that I have a peculiar, even brutal, attitude to death. It comes from having seen death as welcome in severely ill people especially babies, having handled cadavers in anatomy dissection rooms for 30 years, and having suffered the death of one of my sons.

Turning from biology to economic and political affairs, the consequences of the pandemic could be serious in Europe, and cataclysmic elsewhere.

  • In the west, an economic slump of staggering magnitude is almost certain: some economic historians have said the worst in 10 generations (400 years), others 200 years, and certainly 100 years. As one commentator put it, it’s almost as if the virus were tailor-made to strike at capitalism. The financial markets are in turmoil. What will happen to the banks? Fewer people will be able to buy houses, house prices will plummet (a good thing you might say), savings wiped out, pensions destroyed. Power cuts, shortages, rubbish uncollected, unemployment, poverty, civil unrest, suicides. Back to the middle ages. Governments won’t be able to bail us out: national economies will be in the doldrums for decades after the financial largesse already being handed out. Taxes will rise. This economic reality is already fuelling demands for the lockdown to be lifted so that people can get back to work.
  • Elsewhere – a worst-case scenario
    • China is already buying up commodities now that the prices are rock bottom.
    • The US sees covid19 as China’s fault and demands reparations. China says no. The US refuses to pay back interest on its substantial loans from China. China sees this as an act of economic war. Then what?
    • The slump in oil prices destabilises the Middle East, especially Saudi. Oil supplies are cut. Dictators emerge.
    • The Russian economy being too dependent on oil, Putin invades Ukraine for food and the Baltics for minerals. Will Western Europe fight for the Baltics?
    • The peace since 1945 has been dependent upon economic prosperity. When that is taken away nationalism rises and fights are picked.
    • Africa is devastated. Infected migrants hammer at Europe’s doors. Shots are fired to keep them out: many will be killed.
    • I imagine something similar could happen in South and Central America – poor and populous.
    • The already creaking EU disintegrates.
    • Surveillance becomes intrusive (it’s getting that way already).
    • Totalitarian governments take over. Maybe China takes over. Or Russia.

Now, you may say that this is unduly bleak. But none of it is beyond the bounds of possibility.

I could be wrong. Part of me hopes I am. Part of me thinks that our lifestyle in the West is dissolute and decadent and needs sorting. But events that lead to correction of our lifestyle will likely lead to horrific, in human terms, sequelae for the third world—which now includes much of our inner urban areas.

Life is a terminal disease, its death rate 100%. People are going to die of this and other viruses. Measles is coming back. Polio and Ebola and Foot & Mouth lurk in the shadows ready to erupt unpredictably. The best thing we could do for one another is to help each other come to terms with uncertainty and mortality. I did my best from the pulpit and I do my best through my blog.

The fact is that there are too many people on the planet. There are far too many cooped up. Maybe the planetary ecosystem is resetting itself. I’m not a proponent of the Gaia theory, but I know that we reap what we sow. At present we are reaping. As far as creatures of the earth are concerned, apes like us are vulnerable, impotent and expendable.

But never mind. The sun is shining, the sky is clear, riverbeds visible, air cleaner. The night sky is spectacular. This virus is doing the planet a favour. Perhaps too it’s the scalpel that releases pus from the putrid abscess of aggressive capitalism.

I thank James Drever and others for help with this, but please don’t associate them with my prognostications.

Corona and Cassandra

Cass

Cassandra

Informed guesswork.

Even experts must be scratching their heads a bit in dealing with the pandemic. It can’t be otherwise, for this is a novel virus, and novel means novel. The virus is more infectious/contagious than was first thought (but not as much as say measles) and more virulent/fatal (but not as much as say Ebola). It’s difficult to plan in such circumstances.

I left full time medical practice in 1976, and I’m no political pundit, but I have a certain breadth of vision, so bear with me as I look ahead.

I don’t see any prospect of “controlling” this pandemic until herd immunity has been achieved. Herd immunity comes from a combination of immunisation and recovery from infection. A vaccine is about a year away, so in the meantime that leaves recovery from infection. We are faced with the prospect of more than half the population needing to be infected with the inevitable proportion having life threatening disease and dying.

If the disease were to be left unchecked, the burden on the health services would soon be catastrophic. The strategy adopted—distancing and such like—spreads the load over a longer period. But ultimately herd immunity is needed. I suspect that governments have been informed of this, but daren’t admit it publicly to a populace that has forgotten how to deal with uncertainty and mortality.

The trouble is that even if herd immunity is achieved, coronavirus, being an RNA virus, may well mutate, the new strain possibly more virulent than its predecessor. So back to square one. And of course there’s always the possibility that new viruses will emerge.

We’re a drop in the ocean compared to New York, Africa, India, the Far East, Central and South America. Economic and political consequences could be serious in Europe, and cataclysmic elsewhere. Read on.

  • China is already buying up commodities now that the prices are rock bottom.
  • US sees covid19 as China’s fault and demands reparations. China says no. US refuses to pay back interest on its very substantial loans from China. China sees this as an act of war. Then what?
  • The slump in oil prices destabilises the Middle East, especially Saudi.  Oil supplies are cut. Dictators emerge.
  • Vladimir Vladimirovich has economic problems in Moscow, the Russian economy too dependent on oil, and invades Ukraine for food and the Baltics for minerals.
  • Africa is devastated. Infected migrants hammer at Europe’s doors. Ammunition is deployed to keep them out.
  • The EU, already creaking, disintegrates.
  • Surveillance becomes intrusive (it’s going that way now).
  • Totalitarian governments take over. China takes over? Russia takes over?

As for the financial largesse being doled out at present, that will have to be paid for. Meanwhile, power cuts, shortages, economic hardship, civil unrest, back to the middle ages.

Now, you may say that this is unduly bleak. I admit I can be a bit of a catastrophist. But none of this is beyond the bounds of possibility. Interesting times ahead – a distraction from brexit anyway (remember that?). Don’t expect a quick resolution.

There are too many people on the planet – or at least too many banged up in cities. As far as creatures of the earth are concerned, apes like us are vulnerable, impotent and expendable.

Maybe the planetary ecosystem is resetting itself. A spring clean.

I thank James Drever, Andrew Paterson, and others for their help with this, but please don’t associate them with my prognostications.

Clearing out stables?

2AP1TD2-b598c7937e0cb7c3ddb3d98f6d897d82Isolation, distancing, handwashing

I understand some of the reasons for what we are told to do.

I understand the vague concept of herd immunity, but not the ins and outs of it in this Corona virus phenomenon, which, I gather, is not like other viral epidemics. As a medical student, I never took to epidemiology. It is mathematical in a way that probability and statistics are mathematical, and they always provoked mild panic in me.

In the mid-1970s, virology wasn’t much in evidence on the medical course. As for handwashing, the Professor of Microbiology, one P A Boswell, told us that since urine is sterile but hands are most certainly not, men should wash their hands before having a piss, not after. That has stayed with me.

But …

In an idle moment in Dublin several decades ago I did one of those personality questionnaires that appeal to vanity. It told me that I was more than a little fatalistic. Oddly enough, for such questionnaires are often drivel, I could see that there was truth in that verdict. I am indeed.

So despite my unwilling, chuntering conformity with most instructions from on high at present, a large part of me thinks we should remove all restrictions and let nature take its course.

People will die.

People will die anyway. Part of the present hysteria stems from the expectation that “I can live for ever”. The NHS panders to the notion of immortality and to the notion that at 70 I should feel as good as I did at 20. And it encourages irresponsibility in that people think they can do what they like in the expectation that the NHS will sort them out. In this regard, the NHS is complicit – but that’s another story.

People say “we should protect the vulnerable”. Why?

Both Susan and I are in the at-risk category, or soon will be. One of us is 70, the other 69. One of us has diabetes-2, the other asthma with a propensity to chest infections. One or both of us might die. But that’s going to happen anyway.

If treatments must be rationed, I can’t see why I should be favoured more than younger people with dependants. I have a great future behind me: theirs is in front of them. There is a discussion to be had on the allocation of resources in hard times, but it seems nobody will have it. Instead it all comes down to unexamined “motherhood and apple pie” sentimentality.

Earth cleanses itself

I’ve never had any doubt that there would be some catastrophic event that culled humanity. I’ve wondered about an eruption of the Yellowstone caldera such as may have wiped out dinosaurs; or an extraordinarily large eruption of sunspot plasma that would completely disrupt the earth’s magnetism, electrics and electronic communication; or wars over the availability of water; or MRSA; or viruses.

There are too many humans on the planet. Nature will deal with it.   One thing I’m sure of is that if humanity is wiped, viruses and bacteria and archaea and insects and … will still be around, so evolution can get to work again.

It’s extraordinarily arrogant of humans to expect that other creatures of this earth, including viruses, should stop doing the what-comes-naturally for the sake of human comfort.

I am in control of nothing. Thou art in control of nothing. He/she/it is in control of nothing. We are in control of nothing. You are in control of nothing.

They, viruses, have the future in hand.

I can probably survive like this for a week. The prospect of 12 weeks makes me reach for a sharp knife with which to slit my throat. Of course it’s possible that economic factors will mean no pensions, lootings, hyperinflation, supermarket fights, no food, so I could well have died before then through inanition.

It will do me no harm to live day by day without expectations, even though I find that extraordinarily difficult.

Sex

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Lunar landing

As some of you will know, the church has its knickers in a twist about sex.

The church—be in no doubt about this—talks bollocks. One of the reasons it can’t recognize balls is that it’s stuck in the past (“surely not” I hear you say) and it ignores biology, the most fundamental thing of all.

So to get the juices flowing, and in preparation for things to come, I offer you this.

Structure

The gonads of the early embryo can develop into either testes or ovaries. It seems that the ovary develops unless hormonal conditions at a certain stage of development ‘switch’ on the testis, as it were. The female is the default setting. Very rarely (1 in over 80,000 births), an individual may have an ovary on one side and a testis on the other, or a gonad may contain both ovarian and testicular tissue.

The ovary stays more or less where it started, but the testis descends into the scrotum. Undescended testes, this descent having been arrested, are common: about 3 in 100 male births. In a sense, an undescended testis signifies incomplete male development.

The clitoris and penis both develop from the same embryonic precursor. The female, again, seems to be the default setting. Penile congenital anomalies such as hypospadias, where the opening is on the under surface of the penis, are surprisingly common (some say 1 in 300 male births). They can be regarded as varying degrees of reversion to the female anatomy. How small does a penis have to be before it is a clitoris? If you’re interested, there are websites (so I’m told) that show all sorts of penile anomalies and how some people have them modified.

The scrotum and the labia majora develop from the same structures: the scrotum is the two labia sewn together. You can see the ‘seam’: you’ll need a mirror unless you have a tolerant friend. How large do labia have to be before they become scrotum-like?

Every adult male prostate gland contains a vestige of the precursor of the uterus.

Every adult female has structures that in males develop into the tube conveying spermatozoa from testis to penis.

Some people are born with external genitalia of one sex and internal genitalia of another. Or a person may be born with genitals that seem to be neither one thing nor the other—a girl may be born with an abnormally large clitoris, or lacking a vaginal opening, or a boy may be born with a small penis, or with a divided scrotum, like labia.

Structural anomalies in the male are more common than in the female, though you may recall the fuss about the South African ‘female’ athlete who was reported to lack both ovaries and uterus.

Chromosomes

Normal male: XY chromosomes. Normal female: XX chromosomes. The incidence of newborns that are neither XX nor XY has been put at about 1 in 1700. Here are some examples:

    • XXX: 1 in 1000. Female, often no other manifestations.
    • XYY: 1 in 1000. Male, often no other manifestations.
    • XXY: Klinefelter’s syndrome. 1 in about 1000, often sterile, males with female fat distribution. May never be diagnosed, so may be commoner than we think.
    • XO: Turner’s syndrome. 1 in about 3000. Appear female, nearly always sterile.
    • Mosaic, some cells XX, some XY. Very uncommon.

Psychological sex – ‘what do I feel or experience?’

We know very little. It seems that a part of the brain may be switched on to ‘I think I’m a male’ at a certain stage of development. It seems, again, that the female is the default state. There are reports of people who feel as if they have been born into the body of the ‘wrong’ gender. There are reports of an area of the human brain that in homosexual men is more like that of heterosexual women than that of heterosexual men: male body, female brain perhaps.

  • If a man admires or envies the muscularity of a male athlete, does that mean he is homosexual? Do rugby players who grab their opponents’ bollocks in the scrum have something else on their minds?
  • If a woman admires a Rubens lady of generous proportion, does that mean she is lesbian?

My view is that we are all on a sliding scale of sexuality, and we move to and fro. But the unfashionable truth is that we don’t know much for certain.

Defining man/male and woman/female

We simplify sex categories into male, female, and sometimes intersex, for cultural purposes. This is unsubtle. There is much scope for naturally occurring structural and chromosomal anomaly, and a spectrum of psychological sex.

Pleasure

To what extent did ancient writers associate procreation with sexual intercourse? In Biblical times, the roles of ova and spermatozoa were not as we know them today. It was held at one stage that semen merely initiated the development of the embryo in the mother, and at another stage that a spermatozoon contained the miniature human and that it was ‘injected’ into the mother, who was merely the vessel (oven) in which the embryo grew. (As an aside, both these shed interesting light on notions of virgin births in Biblical times, even accepting that virgin as we understand the word is the correct translation – which it isn’t.) This matters to the same-sex debate, because it is relevant to whether or not the ancients recognised the importance of pleasure in sexual intercourse—what we might term the psychological “reward” effects that come from the flood of endorphins released in orgasm.

If we say that sexual pleasure is banned, and that intercourse is only for the purpose of procreation, then intercourse must be restricted only to those times in the menstrual cycle when conception is possible. This turns current Catholic teaching on its head, for using the safe period for the avoidance of conception should surely be just as much a ‘sin’ as using a condom. Catholic teaching logically should restrict intercourse to the unsafe period.

So, how do we define man and woman?

  • Inspecting genitalia mightn’t give a definite answer, and who would be daft enough to suggest it?
  • Chromosomal tests might not be a reliable indicator of what gender the person feels.
  • Assessing the ability to engage in vaginal intercourse might do the trick. Doubtless assessors could be appointed by the state – a job for voyeurs (what’s wrong with voyeurism?). If one or both partners were infertile, then intercourse would be only for pleasure, so there might have to be pleasure police.

Conclusion

If we say we are certain, we deceive ourselves, and the truth is not in us.