Sunday, August 28, 2011

Riots, Pulmonary Embolism, Mercedes, Schubert, Bournemouth Air Show

August 20th, 2011
It’s possible to write about anything, the question is as to whether it will be interesting.  The aftermath of the riots in London and elsewhere has led to a variety of reactions ranging from incomprehension to detailed socio-economic analysis.  It has already produced some fine responses in the Daily Telegraph letters pages.  An early one was ‘I note that no bookshops feature among those premises looted’.  Another suggested that the usual beginning of Autumn term essay subject ‘What I did in the Summer holidays’ might make more interesting reading than usual.  For me there is a sense of inevitability about it that is clearly linked with the direction our society has taken over the last 60 years.  But it’s not easy to come up with a solution.  One thing is sure, there is no Quick Fix.  The last time there were major riots in the headlines, in Summer 1981, I had just started work as a research fellow at Duke University Medical Center in North Carolina, USA.  I remember the puzzlement of my American colleagues and a general feeling of shame, though already I was not quite British, a feeling which became more intense the longer I stayed in the beguiling environment of the American South.  Just a few months later, in the summer of 1982 I remember an even more striking sense of puzzlement and lack of insight when a friend said to me, ‘Andy, whatever is going on in these Falkland Islands?’  At that time I had not been back in the UK for nearly a year, and I felt and thought like a local from North Carolina.
A week ago, faced with the need to continue my blogging career, I really could not face sitting down at the keyboard and writing.  It seemed that nothing exciting had happened in our lives.  The only excitement had been making a diagnosis of massive pulmonary embolism in a 21 year old boy.  Without revealing any details – the BMA and GMC warn against blogging about patients – my curiosity was idly aroused when Lindsay casually mentioned that this young man, a super obese distant member of the family with a venous malformation in his leg (Klippel-Trénaunay-Weber syndrome) had complained that his leg was hurting and he was breathless.  I didn’t want to be involved.  Then I heard he was going to see the GP anyway.  On Monday morning however, a fax from the GP surgery asked whether I thought there was anything to do in the face of ‘this ECG’.  The tracing (taken the preceding Friday) was diagnostic of massive PE.  Seeing him some 30 minutes later produced a full house of classical history, raised venous pressure with a positive Kussmaul sign, right ventricular cardiac impulse, pansystolic murmur due to high pressure tricuspid regurgitation.  One of the few occasions I have called an ambulance to our house...
But medical scenarios apart, the week was not that exciting.  As I observed to my colleagues at the hospital, it made an exciting change from old ladies from Canford Cliffs with palpitations.
This last week has brought some excitement, the excitement of anticipation really.  I have been to see several new cars lately and have decided on a Mercedes SLK.  Crucial tests like ‘Can my golf clubs fit in the boot’?  ‘Does Lindsay like it?’  She keeps saying that she doesn’t like driving my car, that the seat position is not comfortable, etc.  In three and a half years with my BMW 320D coupé I can scarcely recall having anybody ride in the back seat, so a two seater car doesn’t seem unreasonable.  Since at least half of the GPs at my local practice and most of my patients seem to have a Merc I don’t see why I shouldn’t join them.
Enough of cars.  Two fun events this week.  The first was on Wednesday 17th when we went to Minterne for our last visit this year to the Summer Music Society of Dorset.  It was to hear Die Winterreise.  We have heard the pianist Roger Vignoles before.  He is an exceptional accompanist, in the Gerald Moore class.  Previously he played for Olaf Barr in Die Schone Mullerin.  This time Olaf was indisposed and we had the exceptional Thomas Bauer as replacement.  Our evening started with a delectable picnic jointly created by Lindsay and Philippa (Dickins).  Philippa had visited Waitrose and purchased some lovely starters tastefully composed on scallop shells.  Vranken champagne was an excellent accompaniment.  Then we moved on to Lindsay’s brochette of chicken and peppers with courgette mousse and salad.  White Vacqueyras.  Finally Philippa had made her damsons into a magnificent crumble.  Wonderful.  Inside, the distinguished of Dorset (and we four) were staggering into the magnificent front reception room of Minterne House (seating capacity 170) in front of the great Trafalgar painting of the heroic actions of Sir Kenelm Digby to hear the Schubert.  Lindsay’s friend Valerie was page turning for the redoubtable Roger.  Thomas Bauer was magnificent.  Now I love Schubert, but song cycles are a little difficult to appreciate.  They don’t grab one in quite the way the piano music and the C major quintet can do.  The poems by Wilhelm Muller are individually very striking, universally gloomy, and illustrate the pain and weltschmerz of the man who has been betrayed in love, or at least has failed to win the girl he hoped for.  Other than the general theme of lost love and morose gloominess, there is no real journey.  The final poem is entitled ‘The Hurdy-Gurdy man’.  Quite why I’m not sure.  But the acting skills of Herr Bauer were fantastic, and he moved easily between the harsh double forte anguish and the gentle lamentation of the verses.  When one hears the songs performed live with such a sympathetic piano accompaniment the enjoyment is so much greater.  The piano moves between the moods beautifully, capturing some of the ghostly effects, and including the almost military sound of the verse which involves the post horn.
I was able to listen to the Gerald Moore and Dietrich Fischer-Dieskau recording of Winterreise the following evening as I drove back from my day with the Scottish Medical Golf Society at Walton Heath.  Having heard it at Minterne I enjoyed it so much more on disc than I have previously.
Walton Heath is as near as one can come to golfing Royalty.  The prestigious club at Walton on the Hill near Epsom obviously included some well-heeled and well-connected early members.  I believe that their first President was the Prince of Wales, and their first professional was the immortal James Braid, the Jack Nicklaus of his day.  The area of heathland which they used to create their course was enough to allow two full 18 hole courses to be built, though nowadays the southern edge of the courses is noisily close to the M25, unpleasantly heard but fortunately not seen.  The chief hazard is the omnipresent heather, which at the time of year that we play it is a blend of beautiful pinks and purples, but wrist wrenchingly difficult when the ball goes into it.  It was a wonderful day, though the golf was variable.  Remarkably, considering the forecast, we had very little rain.  This contrasted with what happened back at home, when so much rain fell in Poole and Bournemouth that the town centre was flooded and tarmac was wrenched up in the road.
On Friday, I took Anna for lunch at the RMYC.  It was excellent, with scallops for me and fillet of bream for Anna.  The weather improved as time went on, and the Bournemouth Air Show was able to get under way.  Sitting in my boat at the RM we were able to see the Battle of Britain flight pass over – a wonderful sight.
Gloomy on Saturday, and even some rain at lunchtime, but after that the sun came out and it was very hot.  We cycled to the East Cliff to watch some of it.  Then we went for a swim at Canford Cliffs – bracing, but OK when we got into it.  Sad to hear of the probable death of one of the Red Arrows on their way back to Bournemouth Airport.  A lovely early evening for us however with cricket watching (England doing well in the 4th Test) and football (Chelsea beating WBA 2-1). 
The recent riots started at Tottenham.  Nice little one liner from Bryan Goodrich at the golf dinner a week or so ago – ‘Did you hear Tottenham have made a new signing?  An Italian.  He’s called “Grabatelli”.’
That’s all for now!

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