Cambridge exam memories 1975

For Church Magazine, October 2020 

I qualified as a doctor in June 1975. As I’ve explained before, since autumn 1972 I’d attended King’s College Hospital in south London but nevertheless remained a student of Cambridge, albeit one who was “using” King’s for the clinical course – a Cambridge cuckoo in a London University nest. At that time Cambridge didn’t have enough resources to look after all its own students (similarly for Oxford, but that’s a dump so we don’t mention that car factory on the upper Thames).

It was, therefore, to the city on the edge of the fens that I repaired for all exams – written, face-to-face, and exams with patients. In those days that meant taking the 36 minutes past the hour from London Liverpool Street calling at Harlow, Bishop’s Stortford, Audley End and Cambridge, then on to Ely and King’s Lynn. 

I have two vivid exam memories from summer 1975. 

The first is the Obstetrics and Gynaecology clinical exam.

“Monkhouse to the patient in bed 23”. I was instructed to take a history from her. So I did.  After about 10 minutes, the examiner hove into view to give me the third degree in front of said lady. The examiner – coincidence or what? – was one of the King’s consultants, Michael Brudenell, a descendant of the Charge of the Light Brigade Brudenells. If he recognized me, he didn’t let on.

Surprisingly, his first words to me were “why would Mrs X know more about her pregnancy than most people here?” A strange question, you might think. In those days I was a very quick thinker and I said without hesitation “because she is a librarian”. Think about that – he wanted to know if I’d been thorough enough to discover her occupation. I most certainly had – such attention to detail was drummed into us from the beginning. 

Then: “what advice would you give Mrs X about feeding her baby?” Without hesitation I said “breast, for breast is best.” “Come, come” said Mr Brudenell, “explain yourself”. “Because” says I “cow’s milk is for cows, and human’s milk is for humans”. Then I thought “you fool, Monkhouse, this is not the time for being a dick”.

Mr Brudenell looked at me for about three seconds – which is a very long time when your underpants are at risk of being soiled. “Haw, haw haw! Very good, Monkhouse. Off you go.”

And that was that.

He didn’t want to know if I’d read the latest research (I hadn’t), or knew the likely cause of a very rare disease found only in Papua New Guinea (I didn’t). All he wanted to know was that I was safe, thorough and coped under pressure. He evidently thought so. Perhaps he liked my impertinence.

By the way, I am right. Cow’s milk is more poisonous to humans than is generally acknowledged. Think snot, allergies, bellyache, bloating, belching, colonic dysfunction, farting, lactose intolerance, and more. As a child of the 1950s in a Cumberland village I had milk from an uncle’s cows poured down my throat. I speak from sad experience and numerous unnecessary hospitalizations. It was another hospital consultant at King’s – can’t remember the name – who said that cow’s milk should come in bottles labelled “poison”.

The other 1975 exam memory is being grilled by three eminent surgeons, all professors or Knights of the Realm. It went something like this.

Examiner: Good morning. Take a seat. Name?

Me: Monkhouse (no such thing as Christian names then).

Examiner: College?

Me: Queens’.

Examiner: And which medical school?

Me: King’s, London.

Examiner: Haw, haw, haw, a royal flush, eh? Haw, haw!

After I’d picked myself up from rolling around on the floor in fawning laughter, I was shown a radiograph (x-ray) of a wrist. There was a fracture of the bone at the base of the thumb where it meets the wrist. I recognized it.

Me: Ah, a Bennett’s fracture.

Examiner: Good, Monkhouse, very good. Pause. Tell me, who was Bennett?

Me, confidently, looking smug: a nineteenth century Dublin surgeon.

Examiner, surprised: Oh. Long pause. Quizzical look. Was he really?

Me: I’ve no idea. I was just guessing. There were so many eminent nineteenth century Dublin surgeons, so I thought the chances were good.

Examiner: Haw, haw. Very good.

Then followed a brief discussion of fractures that can result from falling on the outstretched hand, before I was dismissed. 

The irony is that Bennett was indeed a 19th century Dublin surgeon – in fact (how spooky is this?) he was one of my kind-of predecessors at the Royal College of Surgeons in Ireland. There must be a God after all. The commonest wrist fracture, by the way, is named after Abraham Colles, another of my Dublin predecessors – perhaps the most famous of all. See what I mean.

It was very entertaining. Comedy really.

The stirrer stirred

I became a Clerk in Holy Orders at the end of June 2006, just over 14 years ago. 

When I was accepted for ordination I was working as the Foundation Anatomist in the new Graduate Entry Medical School of the University of Nottingham, sited in Derby. It was the plan that I continue in that job and in my “spare time” be an unpaid clergyman, a bit like the post-WW2 French worker priests (Mr Google will tell you more).

Shortly after beginning training in 2004 I began to feel that this wasn’t right. Given a personality with more than a few obsessive traits, I could see that I would want to do both jobs too well for my own good, and would therefore do neither properly. I applied for a change in status from non-stipendiary (unpaid) to stipendiary. After a bit of huffing and puffing and form filling I was sent for two more interviews at one of which the interviewer’s first words to me on opening her front door were “are you insane?” I was accepted for full-time ministry and in July 2006 I began as Assistant Curate – jargon for apprentice – in Wirksworth.

People confuse Wirksworth with Worksop. Wirksworth is an ancient lead mining village near Matlock on the edge of the Peak District. It’s a bit like a northern version of Rye in Sussex, full of nooks and crannies, curious houses (semidetached, one above the other, not next to it), tightly packed lanes and hills. It has a remarkable artistic presence displayed at the annual Wirksworth Festival. It attracts retired professionals, artists and academics thus providing a thriving intellectual life, far exceeding what you’d expect from a population of under 5500. 

Hidden away in the middle of town (village really, but they have notions) is the large cruciform church. When you find your way through one of the ginnels you are confronted by a charming cathedral close in miniature, so unexpected it quite takes your breath away.

Here it was in 2006 where under the watchful eye of the Rector David Truby I began to learn the ropes of being a parish priest. Some Assistant Curates have a terrible time with trainers who are inadequate or feel threatened. Not so David – the prospect of having a trainee (me) seven years older fazed him not one iota. He knew his job, and I my place—and it was a good place.

Though a brief curacy, only 20 months, it was a time of extraordinary richness. It seems incredible that so much happened in so short a time. Without a doubt the highlight was the explosion of ideas at the theology discussions at the Curate’s House, and the gin afterwards. I couldn’t have articulated it at the time, but I began to see that rather than a priest (whatever that means, and nobody knows in the C of E these days), but a rabbi and a prophet, comforting the disturbed and disturbing the comfortable. I have spent my entire working life provoking others to think and learn, and shake them out of their complacency, and – let’s face it – there’s no more apposite word for the C of E. 

After about 18 months, the Bishop invited me to go as incumbent to parishes in west Chesterfield. Perhaps wrongly I felt that an invitation from the Bishop was not to be ignored – wrongly for maybe that post was not right for me. I recall being grilled at an introductory meeting by a host of posh people in twinsets, pearls and blue rinses (and that’s the men) and thinking “beam me back to Wirksworth” with a good few profanities thrown in. I could have said no, and maybe I should have, but back then I was more inclined to heed the “advice” of bishops than I am now.

West Chesterfield is wealthy and socially very conservative: expensive properties behind electric gates: they are inclosed in their own fat and their mouth speaketh proud things. Yes, I know I shouldn’t judge, but my response was visceral. I had a similar response – worse – when a couple of years later I applied for the post of Vicar of Helmsley and associated villages. After having been driven around the area and told of the local landowners – Sir This, Lady That, and Lord Howsyourfather, my guts screamed “get out of this hellhole”.

Despite the many good things and lovely people in west Chesterfield it would be true to say that I spent much of the time railing like an Old Testament prophet (Amos – read chapters 4 & 5). Paradoxically – and maybe because of this – my time there bore fruit in, I’m told, the loosening of attitudes, the widening of vision, the involvement of more people than just the elect few, and most particularly in the nurturing of vocations. I was moved at a Derby Cathedral ordination in 2019 to meet six Chesterfield people who said that I’d kicked them up the backside on the journey to ordination or readership. 

We need people to stir us up, but it comes at a cost to the stirrer.

Unexpectedly, 2011 saw our daughter in Dublin having problems such that we felt we should be closer at hand. There was no point looking for a job in the diocese of Dublin: those jobs tend to be reserved for the up-and-coming with a great future in front of them, rather than a 61-year-old has-been with a great future behind him. However, the diocese that covers the south east of Ireland had a few vacancies. I contacted the Bishop and was offered the incumbency of Portlaoise, one hour from Dublin. 

My intention was to stay there, for there is much about Irish life that is good: the Irish look forwards, outwards, onwards, and are well educated. Unfortunately I found myself in the midst of a huge row between one of my parishes and the diocese. I was aware that there was a problem, but in my arrogance I felt that my experience enabled me to handle it. I was wrong. You cannot begin to appreciate the bloody mindedness and bone-headedness of some Church of Ireland farmers. As time went by, with solicitors’ letters flying in every direction, and Susan becoming more and more affected by what it was doing to me, the writing was on the wall. The crunch came when the diocesan policy that caused the problem was rescinded. My work had been in vain, the rug pulled from under my feet. I was livid. My successor didn’t last as long as I did, and neither did his.

Fortunately, the post in Burton hove into view. It has been a good end. It has included civic and town centre ministry to which I took like a duck to water, never losing an opportunity to berate MPs and fat men in swords and uniforms on civic occasions. I also had charge of an Anglo-Catholic church in an urban priority area, where I developed a real sense of anger at the way in which the C of E – and society – ignores the poor, not least the white poor. To my great satisfaction the church became the venue for the Burton night shelter for the homeless. Despite all the goodness of my ministry in Burton, though, I felt that I could have done more: I’d been in post only 14 months when our elder son died. I was never the same again.

I was thinking of staying in post until I was 70 in June 2020 but I had such a bad chest infection in early 2019 that I reconsidered. When you’re single-handed in town centre parishes with schools, Advent and Christmas are relentless. So I retired in October 2019. I said to Susan that since she’d followed me around for decades, it was her turn to decide where we ended up. With friends in Burton, Derby, Wirksworth, Chesterfield and Nottingham, good train, air and bus connexions (this matters since my eyesight is very poor and Susan’s deteriorating) we moved across the road.

The C of E does not look kindly on retired incumbents staying in the parish where they were last at work because of the possibility of interfering with a successor. There’s no chance. I need seemly liturgy, decent music and thoughtful preaching. In today’s C of E you’re more likely to get second-rate game-show hosts who are purveyors of doggerel songs, playschool prayers and infantile preaching.

So I’m thinking of becoming a pagan.

It’ll take me back to maypole dancing at Langwathby May Day in the 50s and 60s, only this time naked. What a prospect.

Sarf London medic

In previous posts, I’ve explained why going to see the doctor can be dangerous, and why we should treat mental illness with compassion without embarrassment. This piece is much more personal.

The Cambridge medical course was and is six years long, three in Cambridge 1969-1972, three on the wards 1972-1975. In my day the hospital at Cambridge couldn’t cope with 250 medics each year, so it was the custom for almost all of us towards the end of second year to apply for a clinical place in another medical school for years 3-6. Most of us went to one of the London schools, and I ended up at King’s College Hospital on Denmark Hill (Camberwell), not too far from the Peckham of Del-boy. Peckham has now been well gentrified, but it most certainly was not so then.

In late summer 1972, a couple of weeks before the course was due to start, I arrived in London on the overnight sleeper from Carlisle, and met up with David and Steve, two more Cambridge medics, in search of student bedsit(s). We stayed in north Clapham with another friend who had already begun work in the Bank of England. I remember most vividly the invertebrates slowly sliming across the “bathroom” wall. Salubrious, huh? 

King’s was in south London but my two mates were attending more central medical schools: David in Whitechapel, east London, and Steve in Hammersmith/Fulham, so wherever we ended up, we would have to travel. We allotted ourselves search areas: mine was Paddington and north Kensington (think Grenfell but long before).

After a few days up and down the smelly and stained staircarpets of shifty letting agents, we settled on renting a basement flat on the South Circular road between Clapham Common and Balham (gateway to the south). It had its good points. It was a short walk to Clapham South tube, the living room and bedroom were spacious, and the gaff had its own side entrance. Less good were the fact that the bathroom and bog were just an incompletely partitioned area of the kitchen, culinary and other smells blending appetisingly, and the second bedroom was actually a cupboard under the stairs up to the ground floor. 

We were not in the least put off by any of this, not even by the flock wall paper that I see in my mind’s eye in the living room with its scenic eye-level view from the bay window of discarded cans and dog turds on the pavement. We invited a nonmedic friend of Steve’s to share the rent. He was a Nigel Planer (The Young Ones) type – lanky, lugubrious, long black hair – and was supposed to be at some college or other but as far as I could see spent most of his time on a mattress in the tiny, smelly, windowless under-stair cupboard with his girlfriend, doubtless engaged in mind-improving activities with mind-altering substances.

This meant that David, Steve and I shared the bedroom. Three blokes. We got to know each other pretty well. Single beds before you ask.

I had a daily commute across town of 3.5 miles each way. No car in those days. I knew nothing about London buses, but as a rail nerd I had a working knowledge of tube and rail networks, so my journey was 100 yards walk to the tube, two stops on the Northern Line to Clapham North, across the road to Clapham railway station, two stops to Denmark Hill station, 200 yards walk to King’s. I did it on foot sometimes along Acre Lane through Brixton – pleasant enough if I wasn’t pressed for time.

My first student attachment was at Dulwich Hospital, a couple of miles from King’s, up and over Dog Kennel Hill, one of the steepest in south London. A year later, after Susan and I were married, I cycled a fair bit, and up and over the hill got me quite fit.

Three things I remember quite clearly from my time at Dulwich.

The first is that there’s nothing new under the sun. Peter Friedlander, a most delightful and gentle consultant physician in his late 60s, told us that his first line treatment for any stomach upset was liquorice. “Oh sure”, thought we, “what would an old codger who was at medical school in the 1930s know of modern all-singing-all-dancing medicine?” Well, boys and girls, he was absolutely right in this as in so much else. Liquorice root is indeed the active ingredient of several therapies. Just because it comes from a plant and not a laboratory doesn’t mean it’s no use—the opposite in fact. Also from plants come aspirin, morphine and digitalis, and from mould, penicillin. Dr Grundy in Cambridge drilled into us that these drugs are four of the five essentials you need to have if stranded on a desert island. The fifth is insulin. (By morphine people actually mean heroin – diamorphine – but they have a fit if you call it that.)

Dr Friedlander also taught us that for patients on a lot of drugs, it’s often wise to stop the lot and see what happens. You see, the trouble is that drugs interact with each other, and when several are taken together they have unpredictable effects that make things worse. That message—keep it simple—still informs just about everything I do.

The other Dulwich realisation was that sometimes—often in fact—the best thing to do is let someone die. Too often I saw patients suffer unnecessarily just for the sake of being kept alive for an extra week or two or month or two, often in great distress. Why? Well sometimes it makes the doctors feel they’re doing something (doctors like you to think they’re omnipotent), but also sometimes—and I saw this in ordained ministry too—because family members use someone else’s pain as a weapon to score points off each other.

It was while I was living in Clapham South that Susan and I rekindled our school friendship. By then she was a primary school teacher in Droylsden, east Manchester, and one weekend in late 1972 she came to visit the grubby basement. An evening walk to Clapham Common found us in the Windmill tavern. I, then a junior clinical medical student, asked her to marry me. The wedding would have to wait four years, said I, until I was earning. 

So, dear reader, we were married within months in August 1973.  But all that’s another story. Until then, I leave you with this vignette from my bachelor social life at that time.

The year is 1973, the time Friday evening. The story concerns four young men attending King’s College Hospital Medical School who were taking an evening stroll. As they proceeded from Camberwell in a north-westerly direction towards The Oval, a thirst descended upon them somewhere in salubrious north Brixton.

“Behold, seest thou yonder hostelry?”
“Yea, verily. Let us hie thither and slake our thirst.”
“Aye, aye. Come, let us make haste.”

It was the Skinners’ Arms on Camberwell New Road. The four knights did enter.

“If it be thy pleasure, fair wench, we parchèd wanderers each desire a tankard of thy most toothsome nectar.”
“Most certainly, wandering knaves,” quoth she.

Some time and several flagons later, behold the lights did dim. Music rang forth and lo, a lady materialized on the podium. The knaves salivated in eager expectation. The performing lady gradually divested herself of her habiliments until she stood before the assembled company in a two-piece bikini that didst cover only the barest of essentials. She had a midline scar below the umbilicus.

“Ah, comrades, spiest-ye the scar?” saith I (for yes, I was one of the four). “Perhaps the lady hath undergone an hysterectomy.”

It was not that the utterance itself was foolish, but rather the volume at which it rang forth, for the intended whisper cameth more as proclamation. If thou understandest that, thou dost apprehend the nub of the issue.

“Thou art mistaken, fair friend,” quoth the lady, “for ‘tis an appendix scar.”

And having uttered those very words the bikini-clad performer hied herself to the bench at which the knaves sat, and reclined on the knee of the writer, and polished his spectacles with one of her removèd undergarments.

Now, the knaves were, admittedly, very junior medical students, but they possess’d enough anatomical knowledge to know that appendicectomy requirest not a midline incision but rather a right-sided incision. Nevertheless, they sensed that circumstances were not propitious for elucidation. They felt that discretion was in their interests, and without further quaffing or quoting they legged it back to their lodgings. The young men were lucky, methinks, not to have been set upon by the lady’s supporters. 

The moral of the story? To draw conclusions from observations is good, but proclamation of same should be judicious if one wants to avoid getting one’s head kicked in.

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.