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.

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!

Mental illness

For the church newsletter, a sequel to “Should I go to the doctor?” https://ramblingrector.me/2020/05/16/should-i-go-to-the-doctor?/

If you have a broken arm, you go to hospital where it’s dealt with. If it happened playing sport or doing something heroic, your injury will be a badge of honour. If you’re a schoolboy whose arm was broken in a rugby match, you’ll be unbearable as you flaunt the evidence of your manliness. I don’t know how schoolgirls regard bones broken in, say, a hockey match because I’m not a girl.

If you have a faulty electrical circuit in your brain and become depressed, or self-harming, or in any way unable to cope, chances are you will not consult a doctor, but will soldier on, telling nobody, sinking deeper into the doldrums. If you tell someone else you run the risk of being patronised or ridiculed as odd, inferior, inadequate, even possessed by evil spirits—yes, that view is still held by some and is common in some cultures.

We can see, touch and understand a broken bone or a leaking blood vessel or a blocked tube. But we’ve little or no idea about what goes on in the brain. We talk about and are even proud of our broken bones, but we are embarrassed about and even ashamed of our broken minds. It should not be so.

Why do people become mentally ill? 

Maybe because some people don’t produce quite enough of a certain brain chemical which is used for one nerve cell to communicate with another. Maybe because some people produce too much of a different chemical. The one might result in depression, the other in mania or overactivity. Maybe some mental illness arises because repeated traumatic childhood experiences result in the development of electrical networks in the brain that enabled us to cope then but are unhelpful now. Maybe some people develop such networks in the brain as a result of genetic inherited patterns. It’s all a bit of a mystery.

If you use your imagination you might be able to see that some of these conditions can be helped by learning to think differently: counselling and cognitive behavioural therapy (CBT). Believe me, these are hard work and take time. Other conditions can be helped by chemicals. Sometimes a bit of both is good, with drugs kick-starting a longer period of counselling or CBT.

Recognising mental illness is difficult. We all have different personality types. Some people are prone to depression, others to overactivity. When does an exaggerated characteristic become illness? 

Sometimes such instability is productive. You may have heard of Tourette’s syndrome in which people have a mind that fizzes with ideas and a mouth given to uttering a constant stream of shocking profanities. If you are, for example, a jazz musician who is most productive when Tourette’s is at its height, the last thing you need is for the symptoms to be taken away with drugs, especially if it’s the jazz that puts bread on the table. Being “abnormal” in this way is no bad thing. There have been studies showing that the most original and creative scientists and artists can in some way be regarded as not quite mentally “normal”.

Please remember that there is in truth no such thing as “normal”: it is merely a statistical definition. To give one example, “schizophrenia” is used in different ways in different societies. In totalitarian states the chances are that if you are critical of the way society is organised, constantly sniping at government policy, you’ll be declared schizophrenic and confined to an asylum (for “protection”) or prison camp. Our society is highly critical of this, but hypocritical in that we do the exact same thing using different criteria. I leave you to think about that. Perhaps “normal” means “able to cope with society”. But what if society itself is abusive and oppressive? We need to fight for justice.

It’s also true that the brain receives information from all parts of the body and we know little about how this affects mental health. There is growing evidence that what goes on in the intestine affects our mental wellbeing – the “gut brain” sending information to the “head brain”. You know about gut feelings – this is what I’m on about. So, eat well, treat your intestines with respect, and if your diet upsets you in any way, change it. Don’t be a fool.

Similarly, exercise. It releases brain chemicals that improve the mood. It gives a sense of achievement. The best medicine is your own sweat produced by exercise. Just do it. 

Let me give you my theory about how some mental illnesses arise. We need to start with some evolutionary history. 

As you pass forwards (upwards in apes like us) from the spinal cord you come to the brainstem. In simple terms this deals with automatic things, control of breathing and heart rate, balance, coordination, awareness of position in space – stuff that we need but have no real control over. Next come the paired structures, right and left cerebral hemispheres. These are where awareness and thinking occur: we process information in order to make decisions. Part of the hemispheres deals with urges (sex, hunger, fear), memory, mood and emotion (these are linked) and another part with logical thinking, analysis, reasoning. 

I’m pretty sure that some mental problems result from tension between these two parts. For example, I might in a fit of anger feel the urge to punch your teeth down your throat, but the thinking part of my brain tells me that if I do, there will be undesirable consequences for me, and therefore I override the urges and refrain. Too much of this kind of repression results in a building up of frustration that, if not dealt with by exercise or kicking the cat or some such, is not good for mental health. Learning to recognise and cope with anger is a good thing. Anger, by the way, is good. It spurs us to improve what needs to be improved.

This is only a theory and it can’t be proved, but neither can it be disproved.

I said above that counselling was useful therapy, and to my mind it would be better named “listening”. Every single one of us is capable of being a listener. It’s one of the things that people with mental illness need. They do not need to be judged. They do not need to be told what to do. They do not need to hear your opinion or why you think they’re in the position they’re in. What they need from you is simply companionship. Look at that word “companionship”. In the middle of it is panis, Latin for bread (pain in French). Bread together. What they need is for you to take them for tea and something to eat. Sit with them. Listen to them. Keep your ears open and your mouth shut except when eating and drinking.

If you do that you’ll be increasing the amount of delight in the world. There is no better thing to do.

Men suffer disproportionately from depression. It is said that Staffordshire has the highest rate of young male suicides in the country: you will know how often the A38 is closed and the rail service disrupted for undisclosed reasons. Men are less likely to talk about their feelings than women who often need no encouragement. 

In Burton there’s a charity supporting men’s mental health. It deserves your support. 

Nobility in lockdown

At first, the virus signalled the end of the world. Now we know it to be neither particularly lethal nor particularly infectious.

We have been led to hysteria.

Opinions differ about the lockdown. Evidence is equivocal: its effects, however, are not. The economic consequences will be felt for generations, and the geopolitical maelstrom is only just beginning. 

But whatever about the big picture, the lockdown has been desperately cruel for many, especially the chronically ill, the dying, the grieving, and those in sheltered accommodation and care homes. 

The purpose of this piece is not to provoke discussion about the handling of the pandemic or the nature of the lockdown, but rather to let a dear and longstanding friend tell the story of how it has affected him and his wife. They are examples of the heroism that has emerged from this terrible wound that our society has inflicted upon itself. 

Over to you, friend.

I already look with horror at the misery caused not by the virus but by our response to it. My wife, sadly, has dementia and Parkinson’s disease, and has lived in a care home for over three years. I was excluded from visiting her altogether from the day lockdown started and left her the day before that wondering if I would ever see her again. Her capacity precludes any meaningful contact by telephone or video calling. 

The home has been visited by the virus with proportionate fatalities, but she has not so far been infected as far as I know. But over the first two months she gave up eating and drinking properly, lost more than half a stone in weight and has not been out of doors other than to make two trips to A&E following falls with injuries. Without saying how, I have found my way round the restrictions on visiting though I am limited to one visit per week at present. She is now showing more interest in eating and her mood has lifted at least some of the time.

I am slightly nervous, as lockdown is lifted, that my access may perversely be blocked again for reasons of preventing virus spread in the interests of others. The national policy has been one of panic rather than reasoned risk assessment with measured responses.

Should I go to the doctor?

53263-03c5ce5a93f30da8d6bc9c71b8abfcc3A piece for the church newsletter, provoked by my son who asked pertinent questions last week

I’ve been to A&E twice recently. It was very quiet, in contrast to what it was like BC – before covid. I hear that GP surgeries are quiet too because people are nervous about going. What with the virus and all, people are anxious about lots of things, especially their health – or lack of same. This is because they’ve not been taught properly about human biology. I thought I’d begin to rectify the defect.

The first and most important rule is: it’s probably not worth going.

  • When cats and dogs are ill, they lie still until they get better. On the whole, we get better despite doctors, not because of them.
  • Surgeries and hospitals are full of ill people so you might catch something.
  • People die in hospitals, so if you don’t go, you won’t die (there’s a logical fallacy there).
  • Doctors sometimes don’t listen: they jump to conclusions because they’re in a hurry to get rid of you due to government rules.
  • Doctors often don’t know, but they bluster because you expect them to know everything.

Now, read my lips: if you can’t see blood, if you can walk and talk normally, if your excretory functions are more or less as usual, and if you have only a few aches and pains, stop moaning and don’t be such a wuss. It’ll probably get better on its own, though you may die first.

Sometimes, though, needs must.

  • Blood belongs in blood vessels – end of. If you see blood where it shouldn’t be, take action. Of course, if you cut yourself, you’ll bleed – I don’t mean that.
  • Broken bones, torn ligaments and torn tendons need fixing. If it’s not a bit better after a few days, find a joiner.
  • Plumbing. This is a biggie. There are lots of pipes in the body: blood, lymph, food, digestive juices, piss. They can get blocked, they can leak.
    • Always look at your faeces. Any inexplicable change in colour, consistency or smell needs attention. Blood on or in stools or on bog paper is suspicious unless you can account for it (e.g. piles). Dark stools might mean bleeding higher up, perhaps in the stomach, the blood being digested on the way down giving dark turds. But be sensible: if you had six pints of Guinness last night, don’t be surprised if the turds are dark. If you’re on iron tablets likewise. Use common sense if the Guinness has left you with any.
    • If you’re constipated, you probably need to adjust your diet. There are other more serious causes, but common things are common so we’ll stick with common.
    • If you’ve got the squits, chances are you’ve got an infection. Let it out. Diarrhoea is the body’s way of expelling the irritating agent, so don’t take things to bung yourself up.
    • Urine: again, blood or inexplicable change always need attention.
    • The combination of pale stools and dark urine is serious. Bile (gall), dark green, passes in a tube from liver to intestine to help digest fats. If it doesn’t get there (gall stones or some other blockage) stools will be pale and, because fats are undigested, fatty and floating. Bile needs to get out somehow, so it passes into the blood, makes the skin yellow (jaundice), and is excreted by the kidneys into the urine, so the urine is dark. Gallstones are usually associated with pain and are easily dealt with, but other causes of blockage are not. The bile duct passes through the pancreas so pancreatic cancer can block it. By the time symptoms appear, the cancer is well advanced so it’s time to contact an undertaker.
  • Electrics: nerves and brain. Funny turns, weakness, tingling, numbness, paralysis, and so on. Doctors like to know what the cause is, and if it’s something pressing on the brain or nerves, then there’s hope. Otherwise, little can usually be done except easing the symptoms. Nerves recover very slowly if at all. If part of the brain is wiped out, another part can sometimes be trained to take over its function, but it’s very slow and unpredictable.

Some people think that disease is a punishment from an irascible sky pixie for stuff you’ve done or not done. This is drivel. We are machines. Machines break down. Things go wrong. Sometimes they can be fixed. Sometimes they can’t. Sometimes the treatment is worse than the disease so it’s better to put up with it, though this may be a great burden for you and those you live with.

Take responsibility for yourself. If you stuff your face with cream cakes don’t be surprised if you get fat and suffer from the diseases of obesity. And don’t expect to feel at 65 as good as you did at 20. Get real.

You’re going to die, and you don’t know when, so no matter how young you are, make a will, get your affairs in order, and make peace with those you feel you need to (but don’t go overboard – some people are gobshites and they’re not worth the effort).

Meanwhile, keep smiling, and remember that life is a terminal condition.

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.