A nose that runs in the family

Workhouse, then City General, then University (so full circle)

Workhouse, then City General, now University (so full circle)

Carlisle hospitals saw quite a bit of me when I was young. Chatsworth Square Nursing Home took my tonsils when I was about 5. All I can remember is dark green walls and glass partitions. The Ear, Nose and Throat fraternity made me one of theirs after that, with a sinus job, two nasal polypectomies and an operation on the nasal septum when I was about 17. Somewhere in all this came appendix, two teeth operations (they’re wonky at the front), and an arm job. Mostly, I was at the City General, but the appendix and arm were done at the (old) Cumberland Infirmary where for the appendix in 1960 I was in Ward 18 opposite grandfather W P Monkhouse, then in his 80s.

For one of the nose jobs I was in a side room with a boy from Workington whose sister was called—and this is what it sounded like to me—Hughery. I’d never heard of that name and asked him to say it again, just to be sure. Yes, it sounded like Hughery. So that’s what I said. It wasn’t until years later that it dawned on me that it was Hilary, and he was probably in for a palate operation, so pronouncing ‘l’ was a problem. He thought he was saying Hilary and I heard Hughery. No wonder he was cross with me: I suppose he thought I was making fun of him.

One thing illness does for you, popular wisdom has it, is make you patient. It makes you take each moment as it comes. It teaches you not to have too many expectations. You learn that when doctors say you might be home at the weekend, you equally well might not. You learn to laugh off these little disappointments. When you expect to be going for an operation on Tuesday, and it’s cancelled because you have a chest infection, you learn to take it in your stride. That’s what popular wisdom says illness does for you.

Let me tell you that popular wisdom is piffle. Complete twaddle. Especially if you’re a child. As is well known, I am the most patient and even tempered of God’s creatures, but not even I was able to bear with equanimity the unpredictability of illness. I was in despair when some sign of progress did not materialize as I thought it should.

Dangerous rubbish

Dangerous rubbish

My nose would have been less inclined to run in the family had I not had cow’s milk shoved down my throat ‘when I were a lad’. It should come in bottles marked ‘poison’. Cow’s milk for cows, human’s milk for humans. It’s a snot generator. In the 1990s an Ear, Nose and Throat colleague told me my nose would be better if I stopped milk. I have, except in tea, and it is. The other thing that affected me was grain and meal that, since my father ran an agricultural feed manufacturing plant, put money in our pockets.

Milk and wheat are not good for Rambling Rector. I wonder how different my life would have been if I’d known sooner. As for cats, which always know that I’m allergic to them, the best place for them is under the wheel of a heavy truck.

One of Grimm’s Fairy Tales has a man whose nose grows so long that people trip over it.

Pigeon ‘pie’

From the BBC website

From the BBC website

Something to cheer the drooping spirit on a cold and gloomy January day.

Frances Wadsworth-Jones makes brooches using crushed precious and semiprecious stones and sells them for up to £2,500. ‘Nothing special about that’ you may say. Oh yes there is. They’re inspired by pigeon droppings. She says ‘I like to try and find beauty in the unexpected and I quite often look at the floor. Ealing is great for inspiration.’

The streets of Ealing must be paved with—err—gold.

‘People must think I’m mad’ … surely not … ‘because I have to take pictures of poo too. I’ve got hundreds.’ There’s no law against it, apparently. Do you suppose they’re stored on computer?

I’m very childish. There’s nothing quite like talking about poo to bring on a smile, though maybe talking about farting does too. I was taught that before flushing it away one should always inspect poo for colour, smell, consistency, and ‘does it float’? Note particularly any changes. Poo is a good indicator of inner health.

Actually, the intestines aren’t ‘inner’ – they’re outer’ because the ‘inside’ of the tube is continuous with the outside world through mouth and anus. This is the basis on which rests the distinction between carcinoma and sarcoma. But this is not supposed to be a pathology tutorial.

Pigeon poo isn’t just poo. That’s the black stuff in the middle. The light stuff round the edge is, in our terms, urine.  Whereas we eutherian mammals have separate holes for wind and piss (though you wouldn’t think so listening to some people – and piss is in the King James Bible so don’t moan at me), birds have only one. Everything gets mixed together, so. The evolution of the sphincters and sex region is utterly fascinating.

I watched an episode of Benidorm the other day (I’m a recent convert to this wonderful, wonderful series) in which a turd is found floating in the swimming pool. I wonder if this will interest Frances. If pigeon poo brings luck, as she says, what will human poo bring?

Of mice and men

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Animal experimentation is certainly an issue that polarizes. I wonder how many opinions are based on facts and experience rather than sentiment and propaganda. How many of those vehemently opposed are principled enough to refuse antibiotics, or question how they were tested?

For several years I worked on the mammalian adrenal gland. The mouse Mus musculus was the creature of choice. I could not have done the work without killing. The question is: was it worthwhile?

Zhou Enlai, when asked about the importance of the French revolution, is reported to have said that it was too early to tell. I feel rather the same about much research in general, and mine in particular. I certainly don’t claim it to have had any impact, but this is not to say that in the future someone will not build upon it in a way that enlightens us about endocrine processes.

Headline-grabbing results are rare. Scientific research is like chipping fragments from a stone, a sculpture gradually emerging. Researchers build upon the work of others, and slowly, slowly knowledge accumulates. After a great deal of accumulation, conclusions can perhaps be drawn. It is dangerous to draw them too soon.

Yes, there are alternatives to animal experimentation, and they are increasingly used. More will be developed. But, in the words of my friend Andy, ‘at the moment they can’t simulate the real deal because mammals are so delightfully complex and still so poorly understood—despite the hubris of the scientific community.’

Is animal experimentation evil, immoral, bad? It concerns me that too much is done simply as CV boosting, as truthfully in my case, and there are problems with the way that research is politicized by factions and industry, but that’s another story.

I suspect that opposition to animal experimentation is most vociferous among those who are furthest removed from living and working with animals. You won’t find much opposition in the agricultural community. If you hold that all creatures are God’s creatures like us, then the only logical position is Jainism: non-violence towards all living beings. How do you define living? Plants? Fungi? Bacteria? Slime moulds? Clergymen?

Much of what we know of how the inner ear works comes from research that was done on human subjects in 1930s and 1940s Germany, in circumstances that may well appall us. We have benefited from that research not least in the development of hearing aids and cochlear implants. Knowledge of some neurological conditions comes from experiments on monkeys and apes. It’s all very well to object—until, that is, you get the disease.

When we lived in Nottingham, our children attended a school patronized by sandal-wearers, amongst whom there were more than a few objectors. Our children said “my daddy works with mice’s kidneys” (kidney/adrenal confusion understandable at that age) and drew pictures of my office. I did rather fear reprisals.

I was a reluctant researcher—a disappointment to the eminent Professor Rex Coupland, I didn’t enjoy the nitty-gritty of research and much preferred teaching, scholarship and administration. Rex was a big man with a long stride, so there was warning of his approach as he stomped along the echoing corridors. When professorial footsteps were heard in the distance, one could either dodge into the Dissection Room, or dash into the khasi, or else nip downstairs, along the corridor on the floor below, and then up again at the other end. Silly or what?

Medical ‘exams’?

I hope he knows where to put that finger

I hope he knows where to put that finger

Over the last 15 years, I’ve witnessed the introduction of exam regulations such that examiners may not penalize students for bad spelling, bad grammar, and the inability to muster arguments.

Now, let it be known that I yield to no one in my enthusiasm for the worship of mediocrity, but there are consequences for medicine.

One letter altered in a word can change meaning: it could be the opposite of what was intended. One letter or syllable altered can mean an entirely different drug. One letter or symbol altered can increase or decrease a dosage by a factor of 100. An inability to organize thoughts logically signals an inability to formulate a treatment plan. And so on.

Students with certain conditions are allowed extra time in exams. I wonder how they will manage when they are on duty in the emergency room. Is it unreasonable of me to hope that they will not be there when I need attention? I know of one who claimed extra time on the basis of being able to read only the first syllable of a word, then guessing the rest. Tolerating that doesn’t have much to recommend it when over 70 drugs begin with ‘chlor’.

What drives this? Partly political correctness, and partly disability legislation.

Medical education is not alone in suffering from the baleful influence of theorists who lack common sense and practical experience, but it is one of the few areas where the consequences of such idiocy can be fatal. The public needs to know. When I need the services of a medical professional, I would like them to be competent and knowledgeable.

I think I shall form a new society: the Association for Restoration of Sanity in Education. ARSE. Also a new blog for the exposure of such lunacy. I am seeking a title for the blog. A colleague suggests Rumbling Rectum. Other ideas welcome.

A fairy story

clavicle_plate02Manchester airport last night on the way back from a funeral. For the first time EVER my metal right clavicle (collar bone) caused the metal detectors to go off. The rather grumpy security man (he’d had a long day, I expect) poked and prodded me, and seemed unwilling to accept my explanation. I was taken off and almost stripped (not a pretty sight). Eventually, he had to let me go. He could find nothing. The cupboard was bare. I was rather pleased. Such things give a warm glow of satisfaction. Beating the system.

Once upon a time in the mid 1980s Jack was cycling home in Nottingham. Jack was returning to the nest after a particularly tedious University Senate meeting followed by several particularly refreshing jars. The sky was moonlit, but the street was ill-lit. A motorcycle parked transversely was sticking out into the road. The motorcycle and Jack’s cycle became embroiled in discussion. The motorcycle fell down, and Jack fell down and broke not his crown but his clavicle. A fall onto the outstretched hand damaged not the scaphoid nor the radius nor the humerus, but the clavicle.

The treatment, a mere sling, was utterly inadequate. Any fool could see that. Jack needed a figure of 8 bandage to pull the shoulder back. Would A and E staff listen to Jack? No, they would not. So the clavicle ‘healed’ in the form of a Z.

Weeks and months went by. Drinking tea became fraught, for as the arm moved, the two mobile edges of the clavicle jammed up against each other, their sudden springing apart causing the cup to jerk and the tea to spill. Jack was not happy and neither was Jill.

So by and by Jack had had enough. Jack was cut open, part of the clavicle was replaced by a piece of metal from the planet Krypton, and chips of bone grafted in from Jack’s iliac crest.

And they all lived happily ever after. Until Manchester airport yesterday. The moral of the story is: brace yourself with jars before meetings, not after them.

Eyes have they, and see not …

Communication problems

Communication problems

I’ve been fiddling with fonts and colours.

I was ‘short sighted’ by the time I was 8 and I’ve had specs ever since. About 10 years ago I found I needed them less and less for distance vision, and could often do without them altogether. Now they’re most likely perched on my forehead, and I forget about them. I go looking round the house for them for ages before realizing where they are. Like Mrs Richards in Fawlty Towers.

In 2008 some of my left retina became detached. It was operated on fairly pronto, but despite that most of it died within 6 months, leaving me with only a central field of view. This might have been OK but for a subsequent cataract on the same side. It too was operated on, but with no perceptible improvement.

So it’s right eye only. Fortunately, I was told there was no risk of retinal detachment there. As eyes go, though, it’s not what it used to be. Now, I need a magnifying glass, especially in the evening. I’m thankful for computer screen and Kindle where text can be ’embiggened’.

I’m conscious of the legibility (is that the right word?) of websites. I need contrast. I prefer dark type on light background than light type on dark background. I find sans serif fonts like this easier to read than serif fonts, though I think the serif fonts more elegant. Nobody with even the slightest smidgeon of good taste would tolerate jokey fonts, and I don’t find it easy to read italics. Size matters, of course. If it’s too small, I don’t bother with the website; if it’s too big, it’s like being in the infant class, and if it’s CAPITALS it’s like being shouted at. It’s no easy matter to get things right.

What about colour? Bright white is, well, too bright. I’ve gone here for a sort-of Cambridge blue—not for any reason of loyalty, but because SWMBO said it looked well and went with Wider than the heavens (see the bar at the top).

Something’s going on with the hearing too. Is it me, or do people talk too quickly and without proper enunciation? Mangled vowels, inaudible consonants. I’m not talking accents here – I like the Birmingham accent, the Dublin accent etc – but about articulation. People could start by opening their mouths a bit more. Speech discrimination, I suppose, is what the audiologists might call my problem. Or maybe I’ve got a brain tumour. Or maybe I’m just a grumpy sod.

If you have any constructive criticism about fonts and colours on this blog, I’d be glad to have it. Comments about my grumpiness you can keep to yourselves.

Letter from Malawi

Ryall's - not this posh when i was there

Ryall’s – not this posh when I was there

I’ve been to Blantyre three times, once to discuss setting up a new medical school, and design the science building, once to see the first graduates, and once as external examiner. The first time was in Hastings Banda days. I stayed at Ryall’s Hotel. On the second, Banda still alive, Susan was with me and we stayed in a hospital house just off Mahatma Gandhi road with some postgrads from the US. Servants lived in a shack at the bottom of the garden. The third time was after Banda. I was on my own at Ryall’s again.

Tuesday 14 November 2000, room 33, Ryall’s Hotel, Blantyre. Sunny, breeze outside, blue sky, white clouds like Simpsons opening credits. Yesterday was thundery; the plane from Lilongwe couldn’t land and had to return to wait for an hour before setting out again. Second time lucky.

I’ve just read about the botfly that lays its eggs on clothes, then larvae burrow into the skin and after 8 weeks or so of growth and development, they wriggle out of what seems like a pustule. Oh joy. The bedroom walls don’t reach the ceiling, I’ve just noticed.

Tuesday evening. More thunder. I’ve been marking exam scripts all day and now find – quite inexplicably – a Malawi gin and tonic inside me. I seem to have sleepwalked across the road to the Africa Commodity Traders ‘superstore’ where my eye lit upon a bottle of the said substance at 414 Kwacha (approx £3) labelled ‘drink me.’ Quite delicious. Is it the gin or the tonic or both? There must be importers somewhere.

Medical College now

Medical College now

Wednesday evening. 22 candidates, mostly very good or good. Nobody inadequate. Why spend a lot of money on educational resources when people who have so little are every bit as good? Another majestic thunderstorm. No tap water in the hotel or, more importantly, no bog-flushing water. The electric sockets in the bedroom don’t work today though they did yesterday.

Thursday morning. When it rains, water pours through the roof of the hotel corridor. So they move all the pot plants under the leaks. Brilliant! Water off again after a brief window of opportunity for bog flushing. Day off today, exam conference tomorrow. Writing this is displacement activity: I should be getting on with work that I brought that must not be allowed to wreck the Christmas break (again). Never quite fathomed why, when we are so near the equator, it’s not hotter than it is. We are high above sea level – perhaps that has something to do with it.

Saturday. No thunder since Thursday. Economy grim, set to get grimmer. Racial tension mounts – not blacks/whites, but blacks with money/blacks without. Bring back Banda from the grave say some. Home soon, Air Malawi south to Jo’burg in a plane with propellers and elastic bands, then sardine tin to London with my knees in my chin. Queasy belly. Something suspiciously like dysentery gurgling away.

Monday. Jo’burg check in, asked for aisle seat so I could rush to bog if necessary. Lady says perhaps you should stay here until you’ve recovered. Had a bit of a job (no pun intended) to persuade her that I was well enough to travel. Should’ve kept my mouth shut. I must have looked better than I felt because I’m just about to board the London flight. Fingers crossed. And legs.