Wednesday, November 25, 2020

CORONA DIARY - Chapter 16 - November 8th to November 25th

 

Monday November 9th

 

H.M. The Queen as a poker player?  She would be a good one, judging by her expression yesterday at the Remembrance Day parade as she stood on the Whitehall balcony.  Princes Andrew and Harry conspicuous by their absence.  Her expression, was neither of sorrow nor happiness, but alert, impassive, unchanging, and not missing any detail of the elaborate choreography of the salutes and the wreath laying.  She stood also, completely alone; the Duke of Edinburgh now not being fit enough to endure the ceremony.  One of the red tops this morning had a headline which went something like ‘Harry Wreath Snub’.  This was occasioned by the fact that Prince Harry, Duke of Sussex, had commissioned a wreath, but its delivery to the Cenotaph had been officially refused, since he is neither a serving nor honorary officer, nor now an official member of the Royal family.  Prince Andrew, Duke of York, was not there for more obvious reasons.  Piers Morgan is involved in another Twitter spat with the Sussexes, for calling out their equally carefully choreographed visit to a U.S. war memorial as a PR stunt.

 

We had our own rather more subdued Remembrance Day event.  Lindsay’s father, a Spitfire pilot, used to visit his friend’s grave every Remembrance Sunday.  His friend was another pilot, killed on a training exercise in 1942.  We continue the tradition.  A light rain falls.  Poole Cemetery is in a rather hidden away spot, just off Dorchester Road, a short distance from the Ringwood Road.  There is no-one else.

 

Last week saw the final BSO concert for the time being; the programme now halted by lockdown.

 

An excellent article in The Telegraph this morning, by Tim Stanley.  Stanley is a young journalist, but has an impressive CV including a BA in Modern History from Trinity College, Cambridge, an MPhil, and a PhD.  His PhD was on Edward Kennedy and the infighting in the U.S. Democratic party.  His article today is headed ‘Trump is a louder, cruder version of America.’  His thesis is that there is nothing particularly unusual about Trump as American politics goes.  He states: ‘Trump was not the least racist president ever (his words), but nor was he the most racist.  That title might go to Thomas Jefferson, who owned slaves, or Teddy Roosevelt, who said “9 out of 10” Native Americans were better off dead, or Woodrow Wilson, who imposed segregation on the federal government.  Wilson was a Democrat, a party that was for slavery before it was against it, against civil rights before it was for them – just as Biden backed an anti-crime bill in 1994 that, its critics say, led to the mass incarceration of African-Americans for minor offences.  Now he is the candidate most aligned with Black Lives Matter, although the Democratic Party’s halo is slipping, Trump gained votes among many ethnic minorities including Muslims.’  The byline of Stanley’s article is ‘The idea that the defeated president is a shocking anomaly in U.S. national politics is a liberal delusion.’   The last word?  ’…They (liberals) seem to have an impression that pre-Trump America was fundamentally decent, but he was no alien invader who conquered the system – merely a louder, cruder version of all we ever knew.’

 

This might be an historic day.  The lunchtime news carries the announcement that Pfizer have a coronavirus vaccine, and that the trial results suggest that it prevents nine out of ten infections.

 

Thursday 12th November

 

After indifferent weather (though still mild), today is bright, sunny, and windy.  A lovely six mile walk in the New Forest, starting at a place called Janesmoor Pond.  The walk leads in a complicated fashion through the woods to emerge at the Sir Walter Tyrrell pub, and then, after a visit to the Rufus Stone, wends its way back.  For 32 years, since my removal from South London to Dorset, I have intended to visit the Rufus Stone, but never have until now.  Listen up, Americans and Canadians, it is part of your history too.  It commemorates the spot where, in 1100, William the Second, aka William Rufus, was killed while out hunting by an arrow fired by the said Sir Walter, which allegedly glanced off a tree.  He was buried in Winchester.  Very muddy conditions in a number of places on this walk, but the weak autumn sun glancing through the trees is lovely.

The glades of the New Forest

The Janesmoor Pond

The Rufus Stone

 

The UK has advance purchased 40 million doses of the Pfizer vaccine, but now (of course), doubts are being expressed.  It apparently needs to be transported and stored at -80deg C – a logistic nightmare for any practical use.  We haven’t seen the safety data yet either.  But quite a number of vaccines are nearing trial completion, so we will see.

 

Yesterday we visited Greenslade’s fish shop on the quay, and bought some halibut and scallops – lovely.

 

After finishing ‘Go set a Watchman’, the novel by Harper Lee, which certainly shocks with its much cruder depiction of the racial issues in the South than ‘To kill a Mockingbird’, I have turned to much gentler fare, which I am enjoying immensely.  It is ‘Excellent Women’, by Barbara Pym.  A novel of the 1950s.  Having languished in obscurity, and had the manuscript turned down for publication, her career was re-launched by Philip Larkin’s description of her as ‘one of the most underrated novelists of the 20th Century.’  The humour is gentle, the sarcasm beautifully understated, and it conjures those ‘lives of quiet desperation’ in the post-war world as though one was living it – which to some extent I was.

 

Mediocrities – are not we all?  With a few exceptions.

 

Saturday 14th November

 

How we will move into our house in two weeks I do not know.  Everything is half finished and the dust lies thick everywhere.  The lowering of spirits is compounded by a deeply depressing day, with continuous rain.  A third of the way around the world to the west, the weather in Georgia looks lovely, as the belated U.S. Masters golf tournament gets under way.  No azaleas, but fall colours.  Ridiculously difficult golf holes.  After early rain the course is soft and scoring is good, the halfway best total being 9 under par.  Bizarrely, the autumn home rugby internationals get under way again (we’ve only just completed last season’s games).  Dominic Cummings, the prime minister’s aide is unceremoniously sacked, after briefing against the P.M.  There has been an internal power struggle in Number 10, Downing Street.  Donald Trump has still not conceded the U.S. election.  Amusing comment from a U.S. political commentator, Anderson Cooper, after a press briefing by Trump described as ‘rambling.’  Cooper says on live TV, ‘This is the President of the United States, that is the most powerful person in the world and we see him like an obese turtle on his back, flailing in the hot sun realising his time is over.’

 

More epidemiologists on TV this morning.  One issue raised is as to whether the vaccine not only reduces the physical manifestations of Covid-19 but whether the transmission and spread of the virus is reduced – an important side issue.  Stupid queries again from interviewer, ‘How can we be sure the vaccine is safe?’  A self-evidently silly enquiry.  One of the epidemiologists, who should know better, gets the acronym for the MHRA (the Medicines and Healthcare Products Regulatory Agency) the wrong way round.

 

To return to the subject of mediocrity, a melancholy affliction which is the lot of most of us.  There is, of course, an allied question of self-esteem, something that is at a very low ebb in the heroine (probably the wrong word; narrator or central character is better) in the ‘Excellent Women’ novel.  Her name would be Mildred, of course.  I remember being shocked at the end of ‘Amadeus’, which I was fortunate to see at the National Theatre very early in its first run.  Paul Schofield, to whom one’s attention was drawn the entire time on stage, as to a magnet, faced the audience in his wheelchair (as Salieri), and said, as if in a benediction, ‘Mediocrities, I absolve you all.’  For the first time, I had not thought of it before, I realised I was a mediocrity.

 

George Eliot too, has a lot of observations on ordinariness, and mediocrity.  I struggled with Middlemarch, the favourite novel of so many.  I kept wanting to shake Dorothea and to say – ‘Snap out of it, you stupid woman.’  These remarks may bore you – as Eliot says, ‘We do not expect to be deeply moved by what is not unusual.’  This is the remit of TV programmes like Casualty and Holby City.  Situations and diseases which crop up perhaps once in a doctor’s career, or certainly, infrequently, happen roughly ten times in a single hour on the TV.  Otherwise it would not be exciting.  QED Ms Eliot.  There are certainly many fine, quotable lines in the book, but interspersed with the dreadful inevitability of the suffocation of the heroine’s hopes.  Another piercing blow suffused by a little hope comes at the end of Middlemarch.  ‘But the effect of her being on those around her was incalculably diffusive: for the growing good of the world is partly dependent on unhistoric acts; and that things are not so ill with you and me as they might have been, is half owing to the number who lived faithfully a hidden life, and rest in unvisited tombs.’  Oh dear, how many unvisited tombs are there?  Mediocrities again.

 

Time to leave the Glums and the glooms.

 

Monday 16th November

 

A grey day.  We discover that the tilers have laid tiles inside which were intended for outside.  A depressing bombshell.  The tiles look alike but have different grip finishes.  There is nothing we can do about it.  In a very low mood we leave the site.

 

A short while ago we attended the funeral of a neighbour who had been suffering from Lewy body dementia.  These distanced limited number affairs enhance the feeling of gloom too, but the service is well managed.  I discover belatedly, that this man’s cousin taught me at Haverfordwest Grammar School between 1959 and 1961.  I did not comprehend at first: the relative said that I must know cousin Leslie, but since there were several teachers with the same surname of Thomas at the school, it did not resonate.  Then I realised that he must have been Mr L C Thomas, who of course was known to the boys as ‘Elsie’.  Small world.

 

The Masters Golf ends with a triumphal round and deserved victory in a record total of 20 under par for Dustin Johnson.  England footballers look lacklustre in a 2-0 defeat by Belgium.

 

Wednesday 18th November

 

I’m conscious that I haven’t mentioned Covid numbers for a long time.  Deaths are increasing, but are nowhere near as many as in April and May.  Numbers of diagnosed cases are up hugely – but this is a reflection of the vastly increased numbers of tests.  The reduced numbers of deaths and the fact that these are already plateauing has prompted many to complain about the government’s latest lockdown.  Critics have also pointed out that Boris Johnson, who is now self-isolating following exposure to another case, is probably immune, and could be swabbed and tested every day to ensure that he is able to continue working.  If overpaid footballers can still be tested and play football, they reason, how come the P.M. and his advisers aren’t using a bit of common sense here?

 

Friday 20th November

 

Yesterday was clear and bright, today miserable and grey.  Temperature 5 deg C this morning, quickly rising as the latest batch of rain sweeps in.  I rarely mention our house build in this diary, because reactions could vary between extreme boredom and jealousy.  Nothing to be jealous about this week.  Apart from the tile disaster, the bathroom designer has allowed a washbasin unit for the cloakroom which is too large.  (One could view this as a casualty of lockdown: the CGI creators were furloughed at the time we needed the images).  As the electrician says, ‘If you have norovirus it could be useful: you could evacuate both ends without having to move from the seat.’  And another basin turns out to have a blemish and its backplate has cracked as it was fixed to the wall.  We are becoming inured to these mishaps.  Ordinarily, one would be deeply upset to lose a thousand pounds or so.  In the context of the build, one needs to place this in proportion.  Mistakes have generally been few and far between.

 

Michael Deacon, journalist, previous parliamentary sketch writer and now food critic, has turned 40.  In an article this week he gives 40 ‘precious pieces of wisdom.’  Some of the truest seem to me to be:

·       The best smell in the world is chip shop vinegar.

·       The greatest year for pop music was whichever year you turned 14.

·       Politics is just football for the kind of people who got picked last for games.

·       Social media was invented to undermine the faith of sensible people in freedom of speech.

·       There is no better false economy than a cheap bed.

·       The most enjoyable drink of the night is always the first.

·       Love is being able to sit together saying nothing, without feeling an anxious need to break the silence.

 

News today that Professor Tony Gershlick, of Leicester, has died of Covid-19.  A great colleague and deservedly regarded clinical scientist.  He was about three years younger than me by my reckoning.  This seems to bring the pandemic very close to home.

 

But to end today on a brighter note.  This week, Lindsay left her mobile phone somewhere on Poole Quay.  Having had one stolen in the past we feared the worst.  (N.B. if you do this, do not ring the phone.  Try ‘find my iphone.’  Once you ring it the person who has it will realise you can find them and switch it off).  Also – block the Sim card.  On this occasion however, when we located it, a call came through – it had been found and the finder wanted to return it.  I hotfooted into Poole to find two Macedonian families, obviously very poor people, who returned it, and initially refused any reward until I insisted.  As the gentleman pointed out, Lindsay’s credit card was in the inside pocket of the cover.  It had not been used.  There are still good people.

 

During this week we have had news that Moderna Pharmaceuticals have an effective vaccine; and although the efficacy data is not out for the Oxford vaccine, it has been shown to be well tolerated and to induce a good antibody response in older people.  Hooray!

 

Saturday November 21st, 2020

 

I put the year in above to remind me that we are still in this nightmare year, and how far into 2021 we have to travel before we are all vaccinated and (presumably) protected we do not as yet know.  Among the various wry comments that I receive or read, one captured my imagination.  A lady, rising from the couch after an examination by her doctor says, ‘Doctor, how long will it be before there’s a cure for the coronavirus?’  The doctor, a caricature figure with a white coat and a stethoscope, says, ‘I’m sorry I don’t know; I’m not a journalist.’

 

Do many others have a completely disrupted sleep pattern?  If I wake at any time after 4am my brain whirrs with thoughts for the day, and our impending move.  I find it best to get up, to drink Green & Black’s hot chocolate, and to exercise my brain in a crossword or tablet game of patience.  Then I go back to bed.  Tonight is a little different.  Yesterday’s dream involved walking in the Romansch area of Switzerland and trying to remember to say ‘Allegra’ for hello.  Then being told off for arriving for the evening meal in the chalet at 5.45pm instead of 5.30 (how very Swiss).  Tonight it was a flying dream.  Psychologists love flying dreams.  Looking on line you can see virtually any interpretation of them.  If the flying is easy and you soar, glide, and swoop, then this is due to a feeling of power, of conquering some problem, of freedom.  If difficult (as it was for me tonight), then it is due to being weighed down by current problems.  That is the interpretation I might take tonight – but it is a little like necromancy or fortune telling – the clever fortune teller will give you something that chimes so well with your current preoccupations that you instantly hail them as a true genius with a glass into the future.  Of course Freud and Jung had great fun with flying dreams, and inevitably sex had a lot to do with it!

 

 

Tuesday November 24th

 

Very much preoccupied with move back to our new house.  Several visits per day are now the norm.  There is always some minor item which contractors want to discuss.

 

On Sunday we had a lovely walk over on the Studland side of the harbour.  Normally we walk along the beach all the way to the village and then sometimes on to the Bankes Arms, a well situated pub with an area of lawn which overlooks Poole Bay and Old Harry Rocks.  This time we walked inland, skirting the so-called ‘Little Sea’, an inland stretch of water which is home to migrating waterfowl at this time of year.  Despite walking in the area many times before, I have never been to the Little Sea, which is a calm and peaceful place, ideal for bird watchers.  Then we walk back to the ferry using the beach, marching through the naturist area with not a naked torso in sight.  The Maritime Management Organisation wants to make Studland Bay a marine reserve, because they have discovered sea horses in the eel grass at the bottom of the bay.  This would disbar thousands of people who love to play, sail, surf, and anchor here, year on year.  Leisure anchorage has been going on here for many years, and it is only a few years ago that the sea horses have been detected by some eager divers.  We don’t know what the upshot will be.  A remarkable feature of our inland heath walk is the huge amount of lichen which covers the knolls, heather and trees here.  So it presumably remains very unpolluted.

'Trouble with Lichen' - the heather walk to the Little Sea.  An otherworldly landscape

The Little Sea, Studland

Furloughed liner, Studland Bay, and Old Harry


Sandbanks Ferry

 

News this week that the Archbishop of Canterbury is to take a sabbatical, which provokes some risibility on the part of those people who like to write to newspapers.  Some are of the questioning variety.  The Archbishop apparently wants to spend some time in prayer and reflection.  Many question, ‘Is this not what he is supposed to do anyway?’

 

Wednesday November 25th

 

The day before we start moving.  Very busy.  Little to add.  If our computers get up and running the other side of this move I will write more…

 

 


Sunday, November 8, 2020

CORONA DIARY CHAPTER 15 - October 12th to November 7th, 2020

 Thursday October 15th, 2020

 

Instead of Bloomsday, which is the sixteenth of June, it seems to be Gloomsday, though exactly where in October to pitch this unfortunate day is unclear.  We are no further on with the Covid-19 pandemic, and the government have introduced a partial lockdown situation, with three tiers, categorised as Medium, High, and Very High.  Note that there isn’t a Low.  Scenes of wild partying in Liverpool, prior to their being the only locality to get the severe treatment, are depressing.  I once wrote a song – many years ago, which included the lines

 

‘In the Autumn of the year

When the leaves are wan and brown

The cold wind of love’s displeasure

Takes the leaves and casts them down.’

 

And that is how it feels at the moment.  Hard to work up the enthusiasm to give a rendition of Monty Python’s ‘Always look on the bright side’, but perhaps tomorrow.  Yesterday, as we crossed the wee burn at Parkstone’s 8th hole in sparkling sunshine I observed to my friend how lucky we are, so I must take that thought forward.  But news last week and yesterday of new cancers in really close friends and relations is hard to take too.

 

I read James Joyce’s ‘Ulysses’ with a sense of duty in my 20s, but it had escaped my attention (maybe I had fallen asleep) that it all took place on June 16th, 1904.  Until I happened to be in Dublin on that June day in 2004 for a cardiology conference on rehabilitation.  Now Bloomsday is a big thing.

 

So, my mission to establish Gloomsday falls flat at the first hurdle.  I had thought of it this morning as ‘A touch of the Glooms’, and had imagined this related to some old radio show, but the only reference I could find is in a blog by author Misha Herwin, who says that her heroine, Letty Parker, uses this phrase.  Perhaps it was ‘The Glums’, a ground-breaking radio show (q.v.) which ran on the BBC in the 1950s.  As a child aged around six I remember my parents’ avid listening to this programme which featured a dysfunctional family consisting of Ron and Eth and Ron’s father, played by Jimmy Edwards, a handlebar-mustachioed comic who was a mainstay of 50s and 60s radio and TV.  In a subsequent TV series, ‘Whacko’, Jimmy Edwards played a headmaster who was always threatening to cane somebody.  How prehistoric does that sound now?  This week there was an article urging people in Scotland to inform on someone if they saw them smacking their child (smacking is illegal in Scotland).

 

Mention of Eisenhower and Dr Paul Dudley White in my last diary entry reminds me that it is said of senior doctors that as they age they become more interested in medical history, probably because they are no good for anything else.  But after so many years in medicine, we realise we need to take the long view.  In my own field, the doyen of Cardiology historians in the UK was Arthur Hollman.  Arthur was the consultant I was attached to on my first clinical firm at University College Hospital.  He had links to Sir Thomas Lewis, and a great interest in gardening.  Hence he was the warden of the Chelsea Physic Garden and in later life published a biography of Sir Thomas.  He continued as archivist for the British Cardiac Society (later the British Cardiovascular Society).  He was an abrupt man with no respect for reputation.  A favourite saying was ‘The books all say that, but the books are wrong.’  Once, during a presentation by a famous physician, of a child with severe hypertension, he was asked to look at the ECG, which showed gross left ventricular hypertrophy.  ‘He must have had a 4th heart sound’, he averred.  ‘I didn’t hear one, Arthur’, responded the famous physician.  ‘Then I think we’ll take it you missed it.’  Was Arthur’s response…

 

Although brusque, Arthur was one of the few physicians who had the entire firm to a tea party in his garden in Ealing at the end of our first year, and in later life, on accepting me to the cardiac fold, he addressed me as ‘Andy’.  When he cleared out some of Sir Thomas Lewis’s archival material at UCH he sent me one of Lewis’s early ECG recordings, dated 1913.

 

Walking down memory lane again, and far more trivially, Lindsay’s potato masher broke yesterday – a rivet had gone.  ‘I bought that with Green Shield Stamps’, she announced indignantly.  Although Green Shield stamps (q.v. if interested) lingered into the 1990s they were effectively dead in the water after Tesco’s, who espoused them, abandoned the stamps in a price war starting in 1977, preferring to ‘pile high and sell cheap’.

 

Sunday October 18th

 

Forgive me for being gloomy again.  The world has no response to Covid-19.  Previously successful countries have seen dramatic rises in cases, e.g. Germany, Italy, and France.  Substantial numbers of cases are again being admitted to hospitals across the UK.  I never knew we had so many professors of epidemiology, public health, and virology.  A new one pops up every day on the BBC.  There is a pretty one from Edinburgh.  Prof Gupta does not seem to have been given much column space this week.  An epidemiologist from Cambridge (I think his name is Chris Smith), who always appears surrounded by banks of electronic instruments does usually seem to be quite lucid, and points out that with low herd immunity at the moment, we are faced with a disease which kills perhaps half of a percent of all those infected, so this would mean something like a total of 300,000 dead in the UK (we are now approaching 50,000), and an impossible number being admitted to hospital.  But complete lockdown is also unconscionable, because of the economic cost, and every day we hear stories of other illnesses failing to be treated by our ‘Wonderful NHS’.  Even James Lefanu, GP, in the Telegraph, laments that every GP surgery seems to be surrounded by barbed wire.  My original thought was to follow Prof Gupta’s strategy of building up immunity among the young, and carefully shielding the old and vulnerable.  But I have not yet heard (as I hope to do) any clamouring for cutting to the chase in the vaccine stakes and getting on with an immunisation programme.  A paper from the National Institutes of Health this week in the NEJM reports excellent results in the achievement of immunity and indeed prevention of infection after SARS-Co-V2 administration in primates (Evaluation of the mRNA-1273 vaccine… etc).  Other papers address studies with different vaccines in humans.  A paper from two doctors at the FDA discussed the EUA (Emergency Use Authorisation) protocol and concluded that a two-month follow up period after the full course of vaccine administration to all participants would be adequate to allow use of a vaccine.  They do point out that there is a risk (of course) – trials of anti-shingles vaccines had a follow-up of three to four years before FDA approval.  Surely this is the only way ahead for most countries?

 

A hard hitting editorial in NEJM (‘Dying in a Vacuum’, NEJM, October 8,2020) puts the blame squarely on ‘our leaders’, a clear-cut euphemism for Donald Trump.  ‘They have taken a crisis and turned it into a tragedy.’  The introductory paragraph points out that rates of death in the USA are more than double that of Canada, and exceeds that in Japan (a country with a huge very elderly and vulnerable population) by a factor of fifty.

 

Our own leadership in the UK flounders around too, but in truth, neither political party could do any better, and Britons are just too obstreperous and bolshy to behave like the Chinese and control this epidemic.

 

Oh dear.  Sorry.  Lindsay and I had a lovely five mile walk in the New Forest this afternoon, enlivened by a couple of New Forest ponies muscling in on our picnic, and by the last mile of our walk beside the Linford Inclosure, where hundreds of thousands of crab apples covered the ground between the trees.  Perhaps next week will be better.

 

New Forest pony trying to muscle in on my lunch

Another one joins the luncheon party

Nature's bounty - New Forest crab apples




Wednesday October 21st

As I type that I belatedly realise that it is Trafalgar Day, though the recent ‘woke’ responses and cancel culture insist that Nelson was a racist so-and-so and we shouldn’t be celebrating.  Memories of the Naval School in Verdala, Cospicua, Malta, where 21st October was a big day and we always sang ‘Eternal Father, strong to save, whose arm doth bind the restless wave’ in morning assembly.

 

It’s a grey rainy day, and golf is cancelled.  Lindsay has gone with a friend to Stourhead, one of the gems in the National Trust crown.  I deal with doors, hinges, and fencing and now get some time off to write.

 

A superb article by Ambrose Evans-Pritchard in the Telegraph last week is entitled ‘Macron caught in a net as he tries to hold Brexit to ransom.’  I have mentioned AE-P before (see June 8th, the ‘Modern Day Cassandra’).  He does indeed write well, his article about the EU CFP (Common Fisheries Policy) and Macron’s insistence on ‘maximalist claims on sovereign British waters’ amounting to ‘indefensible overreach and “cakeism”’.  There are signs that Germany in particular is becoming impatient with him.  ‘Handelsblatt asks how he can expect to perpetuate a regime in which French trawlers are entitled to 84pc of the catch off the coast of Cornwall while Cornish fishermen are left with just 9pc.  It marvelled at a relationship where European boats can come to within six nautical miles of the British coast while British boats must abide by the EU’s 12-mile rule.’  Most sensible economists in Germany point out that a trade war is not in the EU’s interest.  They are concerned about tariffs (à la Trump) on what amounts to £48bn of car exports and £20bn of farm goods which flow our way from the EU.  I do like the way he writes as well.  I feel ignorant as I read his clever use of French terms – en coulisse, for example, which means ‘behind the scenes’.  Démarche means a step or an approach.  But an education at Trinity College, Cambridge and the Sorbonne has obviously helped.  The article is easily found by searching AE-P Telegraph articles.

 

Cycle sport is confusing at the moment.  We are in the last week of the Giro d’Italia, but the Vuelta a España has also started.  Primož Roglič wins stage 1 of this, so he is back to form.

 

‘It will all end in tiers’ is an appropriate pun to end up today’s entry.  Local lockdowns are the new normal, in places where incidence of Covid is high (a three tier system is now in place).  Inevitably there is political argy-bargy, the left claiming that not enough financial support is being given to the lockdowned areas, and our government are cold mean bastards (that’s what they mean, even if that is not what they say – the Labour mayor of Greater Manchester, Andy Burnham is particularly choleric).  I heard snatches of an interesting Radio 4 discussion this morning on broadcasting impartiality.  I may return to this subject.  The vested interests behind the news media companies mean that most coverage is anything but impartial, and outright lies are often promulgated as a way of reinforcing a point of view.

 

I am going to go back to:

1.      Making my lunch.

2.     Playing my guitar and working on my contemporary blues song.

3.     Making some sourdough bread.

4.     Reading Robert Harris’s ‘The Second Sleep’, which is curiously relevant to today’s apocalyptic coronavirus mood.


Saturday October 24th, 2020 

When I was young, this day was celebrated – as United Nations Day – but seems to be majorly overlooked nowadays.  I remember in the School Assembly at Haverfordwest Grammar School (Pembrokeshire, Wales), we had to stand and listen to the headmaster’s peroration about the unity of the world and how it was important to acknowledge this day.  And that is all I can remember of it.  But I also remember that the whole school was given a half-day off when an old boy was playing scrum half for Oxford in the Varsity Match – and watching it with a sense of pride on a neighbour’s very indistinct black and white TV – whereas nowadays it is only on a paid for satellite channel that one can watch this event.  The school’s motto was ‘Patriae prodesse paratus’ – which means ‘Ready to serve one’s country’, though perhaps it was brought in before Wilfred Owen’s poem which gives the lie to it: ‘Dulce et Decorum Est’, which was published in 1920.

 

What a gloomy day.  The rain started in late morning and has beaten at the windows with increasing ferocity as the day has gone on.  I have now finished The Second Sleep – very good but not ideal if the atmosphere is gloomy.

 

We have not been able to visit Lindsay’s son and his wife to celebrate their wedding anniversary.  A little boy’s parents at their son’s nursery have tested positive for Covid, so I guess we are right in not going, and they will be isolating…

 

Tuesday October 27th

 

The last few days have passed in a blur of bad weather and lack of excitement.  Tao Geoghegan Hart’s winning of the Giro d’Italia in a last gasp victory in the final time trial was an enjoyable finale to a remarkable bike race in which the 25-year old Londoner and the Australian Jai Hindley contested the last stage.  Uniquely for any Grand Tour these two were on identical times going into the final stage.  Emotions were also stirred by the finish in front of Milan’s wonderful (I refuse to call it iconic) cathedral.

 

More reading, having started ‘Go set a watchman’, the only other novel by Harper Lee, I have been decoyed by the much more readable ‘Lady in Waiting’, the autobiography of Lady Anne Glenconner.  Some idea of the difference between Lady Glenconner’s world and ours can be gleaned from the fact that, when she was a child at Holkham Hall, in Norfolk, the Palladian home of the Earls of Leicester, an enormous stately pile, the footmen would place a raw egg in a bain-marie, and walk towards the children’s nursery in the opposite wing to the kitchen.  By the time the eggs reached the nursery breakfast table they were done perfectly…

 

Sometimes it is the small articles which catch one’s attention, and which remain.  Even more so than the achievement of getting to the end of some enormous but classic tome.  In this respect, I still have the cutting of Frances Wilson’s marvellous diary introduction to last December’s Literary Review, which she entitled ‘Fay Weldon Took the Light Bulbs’.  She bought the house in which Fay Weldon wrote some of her classic works in 2001 and was somewhat surprised to find that the author had taken not only the light bulbs but the oven.  This gave her scope to write about other writer’s houses, including Dove Cottage (Wordsworth), and the homes of D H Lawrence, Emily Dickinson, Thomas Carlyle, Virginia Woolf, and Iris Murdoch.  The longest section is reserved for the havoc wreaked on Dove Cottage by its subsequent (and longest) inhabitant, Thomas De Quincey, known mainly for his ‘Confessions of an English Opium Eater’.  Now this is a book which I did read (in childhood), and the reason is that as far as I could ascertain, De Quincey is, or was, the only famous alumnus of my old school, King Edward’s, in Bath.  But perhaps we should now include the comedian and musician, Bill Bailey.  General Sir Jack Deverell should probably be included too, and Professor Chris Rapley, who was in my physics group at school, who has worked doggedly on climate change at UCL, and was one-time director of the British Antarctic Survey.  I would anticipate a knighthood at some point for Chris.

 

There are significant skirmishes in Government at the moment, with ill-feeling concerning the free school meals initiative, which the footballer Marcus Rashford wants extended into half term and the holidays, and the powers that be say are covered by extra local allowances.  But the most striking thing that seems to be part of the national mood at the moment is a very distinct anti-lockdown feeling.  People (even journalists are people) say, ‘We’ve been here once before; it didn’t work.  There isn’t much point in doing it again.’  Wales has imposed an extraordinarily strict lockdown, which they are calling a ‘Firebreak’, a lockdown by any other name.  There is enormous resentment to this.  It’s clear that the lockdown measures result in the disadvantaging of the poorest in society – self-employed; those in temporary employment; those who cannot produce tax returns from consistent employment.  And it seems that there has been about £2 billion of fraudulent claiming from the initial furlough and support schemes.

 

President Trump, of course (how could I not mention him) has told us that a vaccine is only a very short time away.  This was one of the very few of his statements which was corroborated by the U.S. Health adviser, Dr Anthony Fauci, in a superb interview with Andrew Marr on Sunday’s current affairs programme.  As well as being a clear scientific speaker, Dr Fauci’s appearance was a masterclass in how to deal with awkward or rude questions.  Challenged by Andrew Marr, for example, with the direct quotation that President Trump had called him a fool and an idiot, Fauci merely said that he didn’t think answering to such a conversation was helpful, and that he was merely doing his job to the best of his ability.

 

Thank heavens that we are only a week away from the end of the ghastly process which is the U.S. election.  We have relatives in Lancaster, Pennsylvania, and there was footage of a Trump campaign rally there.  I noted an Amish straw hat prominently in the background behind the President, no doubt an example of his all-embracing devotion to any U.S. citizen.  But I also noted an interview in the last week with an unemployed steel worker saying that Trump had not turned around the fortunes of manufacturing America, and that the steel towns were still rusting.  ‘I won’t make the same mistake again’, said the interviewee.

 

Friday October 30th

 

But sadly, good news for Trump today in that there has been a 33% upturn in the U.S. GDP, so the election is still too close to call.

 

Here at home, the atmosphere is gloomy and bleak, matching the weather, with substantial upturn in coronavirus cases, and now we do know someone in the family with Covid.  The government is criticised at every turn, but there is also panic and confusion in the Labour party.  An independent report (UK human rights watchdog) has found that there is not only anti-Semitism within the party, but that the leadership broke the law in failing to stamp it out.  Corbyn has said this is gross over-dramatisation of the true position, and Sir Keir Starmer has suspended him from the party.  Part of the problem (my own view), is that the trendy lefties espouse freedom fighters everywhere (IRA terrorists for example), irrespective of whether there is universal suffrage in the country in question.  Whereas it is fine to support Palestinians in their fight for an appropriate share of their homeland, i.e. a certain degree of anti-Zionism might be reasonable; to equate this with opprobrium for Jews in general is not appropriate.  Having trekked through the Sharah mountains in southern Jordan, and viewed to the west what Israel calls Israel and the Jordanians call ‘Occupied Palestinian Territories’, I have some sympathy with the anti-Zionists.  On the other hand, it’s hard not to have some feelings for Israel too – the country is on the hit list of virtually every other Arabic nation.  Iran in particular has its own modern day version of ‘Carthago delenda est’, the famous three-word speech of Cato in the Roman senate in the second century B.C. (it translates as ‘Furthermore Carthage must be destroyed’).

 

This week I saw the obituary of Leslie Iversen, the pharmacologist, in the newspaper.  Iversen was a brilliant scientist, whose PhD thesis on ‘The uptake and storage of noradrenaline in sympathetic nerves’ was a model of scientific method.  Unusually for a PhD thesis, it became a book which we all bought.  Leslie lectured us in Part II Pharmacology.  Everyone wanted to do their final year research with him – it was clearly such a vital and interesting field.  Sadly, I did not get to do so, working on the properties of a serotonin inhibitor called cinanserin on structures such as the smooth muscle of guinea pig ileum.  Cinanserin disappeared without trace and never made it to market.  There is a lot of serendipity in research labs – my predecessor had worked on a drug called AQ110, made by Allen & Hanbury pharmaceuticals.  Research papers quickly followed, and drug became a winner – salbutamol.  Leslie Iversen and his wife, also a talented psychoactive drug pharmacologist, became Cambridge’s golden research couple in that era of the late 60s and early 70s.  I was sorry to hear that he had died at the relatively early age of 82 (seems relatively early in that I am only 10 years younger…).

 

Another BSO concert this week, with works by Fauré, Ravel, and Saint-Saëns.  Advertisements for performances at a venue in Frome which I sometimes attend – Cheese & Grain, a converted warehouse.  Most striking are the clever names which tribute bands invent to link themselves to the originals.  We all know of the Bootleg Beatles, and the Illegal Eagles, but ‘Coldplace’ and ‘The Unravelling Wilburys’ were new ones to me.

 

Monday November 2nd

 

Weather has been generally poor but we are promised high pressure and better weather from Wednesday.  This contrasts with the gloomy state of our coronavirus situation, with the government announcing a total lockdown from Thursday.  Exact details are awaited.  The schools will not close.  Predictable unhelpful response from the teachers’ unions.  I’ve avoided numbers now for some weeks if not months, but the curve of hospital admissions shows a very substantial rise, with nearly 11,000 hospitalised Covid patients, and nearly 1,000 in ventilator beds, though whether this means assisted ventilation or full endotracheal ventilation is not stated.  Deaths are rising, though it is alleged that the mortality figures are not as high as in the first wave (by this I mean the case-fatality rate).  Opposition MPs are making hay by saying the government has not reacted fast enough to the scientific advice, but the Chief Medical Officer, Chris Whitty, did say that ‘I cannot emphasize enough that there is no perfect time to introduce a lockdown.’  Several pundits have quoted the famous but misattributed Einstein saying; ‘Insanity is repeating the same thing over and over and expecting a different result.’

 

Deaths this week of two sporting heroes, Nobby Stiles, world cup winning footballer, and J J Williams, speedy Welsh rugby winger.

 

Tom Lehrer (still alive, but in his 90s), writer of wonderful and satirical songs, has released his oeuvre from copyright.  He is credited, when asked about Trump and modern political satire, as saying; ‘Political satire became obsolete when Henry Kissinger was awarded the Nobel peace prize.’  Many tributes also today to Sean Connery, the original and best James Bond, who has died at the age of 90.  A fine actor and patriotic Scot, but not patriotic enough to want to live in Scotland and pay Scottish taxes, preferring the Bahamas instead.  His memory perhaps also slightly sullied by Trump claiming that Connery intervened in the fuss over his wish to build one of his Scottish golf courses to allow him to proceed.  Also in the triviasphere today, Johnny Depp, film actor, loses his libel action against the Sun newspaper, who claimed he was a ‘Wife Beater’.  The Sun marked the passing of Sean Connery with a picture of his Bond persona and the tag line ‘Oh Oh Heaven.’

 

Tuesday November 3rd

 

Lockdown looms again.  November 5th.  Not a trace of irony it would seem.  ‘Remember, remember, the fifth of November…’  ‘Once the rockets are up, who cares where they come down.  That’s not my department says Werner von Braun.’  Grassroots sport, gym, everything, will be in abeyance, but those hugely overpaid footballers will still be in action.  Bobby Robson (Sir Bobby Robson) said: ‘”Twenty thousand a week?  I wouldn’t pay them twenty thousand a year.”  You have to remember he said that probably twenty years ago!  Multiply by around ten for current earnings.

 

At least today is clearer and sunnier after all that rain.  The United States goes to the polls today.  Footage of President Trump’s campaign visit to Fayetteville, North Carolina.  Huge, uncritical, unrelenting and unrepentant support for him there.  At Duke in the 1980s we used to call it ‘Fayette-nam’, an epithet coined for it because of its redneck character and the fact that it is essentially the city which is linked to the enormous U.S. army base of Fort Bragg (yes, named for a Confederate general).  Many of my colleagues at Duke used to moonlight down at the hospital there.  It gave them excellent experience of dealing with Friday and Saturday night violence and shootings.  A colleague told me an extraordinary story about his moonlighting there.  He was an Ivy leaguer (name withheld), who in college (name withheld), dated a very attractive woman, but they subsequently drifted apart.  Some years later, after he had married, he was attending an ambassador’s reception in Washington, where he met this girl who had obviously gone up in the world.  She looked a million dollars, was wearing the most expensive designer dress, festooned with diamonds, and was on the arm of a somewhat older Washington politician.  She greeted him warmly, and in response to questions about her career post Ivy league, she vaguely mentioned modelling and the movie industry.  My colleague was somewhat in awe and dumbfounded.  Back at Duke, he did the usual weekend sojourn down in Fayetteville.  Sleeping in the on-call doctor’s room, he idly turned to one of the provided magazines as reading material.  They were obviously intended for those intent on a solitary good time and suffering from Portnoy’s complaint.  Suddenly he found the ex-girlfriend within the pages.  Not only was she completely naked and indulging in a variety of sexual acts and unusual positions, but animals featured too.  A chastening experience, but just a flavour of what was on offer in Fayette-nam…

 

A relative in Pennsylvania has been shopping, not because of a lockdown on the horizon, but because he thinks it might be safer to stay indoors for a while after the U.S. election.  (I think that above juxtaposition as a figure of speech is called bathos).

 

Saturday November 7th

 

I had intended to write something about the U.S. election, but had no idea that it would drag on for so long – nearly 5 days now and counting; apparently there are still some votes to come in.  But it is clear that Biden has enough votes to be declared the 46th President of the United States.  The only person who disagrees it would seem is Donald Trump, who has threatened legal action to contest some of the individual state results.  But whether he goes quietly or loudly, it now seems certain that he will go.  A recent interview with a government minister by Andrew Neil, the highly intelligent and well informed TV journalist was a substantial grilling.  Neil pointed out that Trump was for Brexit while Biden was against Brexit.  I feel sure that a degree of pragmatism will attend any new White House regime, and Europe will be the least of his worries for the moment in such a deeply divided country.  In the meantime, an excellent article in the Business News of the Telegraph by Matthew Lynn states ‘Trumpism without Trump is what the world needs right now.’  He points out the very real economic achievements of the Trump administration (probably undertaken by some very savvy economic advisers rather than the Donald himself).  The Corporate Tax system, one of the least competitive in the world was reformed at a stroke.  The rate was cut from 35pc to 21pc, inviting corporate monies to return to the USA.  The rising tide of regulation was attacked – a slew of regulations was repealed.  Finally, enterprise zones did achieve the revitalisation of some (but not all) urban areas.  Other achievements include trade and continued improvement in volumes of trade with China.  As Lynn says, nobody is going to miss the bullying, the narcissism, or the temper tantrums.  Nobody will be sad to see the back of his divisive language, his ugly attitudes towards women, or his rambling attempts at rhetoric.  But…

 

Nonetheless, for me and for many the days of the deeply unattractive 45th President will hopefully soon be just an unpleasant memory.

 

In the meantime, the weather this week improved so that we had enjoyable autumn days with cold mornings but bright clear sunshine.  I seem to spend quite a lot of time on the obituary columns, but this is because I have reached an age where so many people who have taught me, who have formed my thinking as a physician and cardiologist, are leaving us.  This time it was the turn of Professor Peter Sleight, aged 91, Oxford cardiologist and researcher, who showed us that large scale trials could be done quite simply, if they were not exclusive.  The power of these trials came from the fact that their results could be generalised to all patients, and not just a highly select ‘safe’ treatment group.  A heart attack trial that I recruited for him (among many other hospitals) was presented at one of the big U.S. cardiology congresses in the early 1990s.  A famous American doctor stood up and said it was ‘low tech’, whereupon Peter took off his shoes and socks and presented at the lectern as what he called a ‘barefoot doctor.’  He was no respecter of reputations either.  He led a teach in on cardiac pacemakers for many of us senior registrars in Oxford one day.  A famous lady cardiologist vehemently expressed an opinion.  Peter asked her how many pacemakers her unit had put in in the last year.  The answer was about a fifth of what Oxford and some of the centres that we worked at was.  ‘So I think we can take it, …..,’, said the Prof, ‘That yours is a minority view.’  I enjoyed his company at meetings, in lectures, and on the golf course.  He was an original and stimulating thinker, and he challenged you.  His style of cardiac trial was rightly mentioned as being the forerunner of large simple trials such as the NHS study which has shown the value of dexamethasone in the treatment of Covid pneumonitis.  R.I.P.

 

It is time to finish this chapter of the Covid diary.  We are back in lockdown.  No golf, no pubs, no restaurants.  The tantalising prospect of a vaccine looms, we are told.  But not yet.

 

Meanwhile, as The Donald sinks slowly in the West, in a welter of lawsuits, we cannot like Malcolm report of the Thane of Cawdor, ‘Nothing in his Presidency became him like the leaving of it.’  (Macbeth).

Monday, October 12, 2020

Corona Diary Chapter 14: September 24th to October 11th, 2020

Thursday September 24th

 A recipient of my blogs who actually seems to read them says that he really likes the pictures.  This is possibly a polite way of saying that he only likes the pictures, so I had best start with some views of Poole, Dorset, and environs:

Autumn anemones in Poole

18th green and 1st hole, Parkstone Golf Club


Wild swimming.  Much in the news.  I’ve felt guilty not to have been swimming in the sea this year, so just before the current warm spell ended we went for a morning dip.  Bournemouth sea temperature was allegedly 18 degrees C, though at the very bottom of the equinoctial high tides, one had to wade out for miles and the water further out felt distinctly chilly on Tuesday 22nd.  I have great admiration for those who swim day in, day out, because it certainly felt too cold for me to continue beyond this week.  But I can understand why people become addicted.  Cold shock is a powerful way of stimulating any number of powerful body hormones.  A review of the scientific literature reveals contrasting findings.  In particular, studies of habituated cold water swimmers may not be valid for occasional cowardly dippers like me.  Some studies are undertaken after vigorous exercise so that the body is markedly warmed.  Some are after non-exercise but after sauna exposure.  Some have a blatantly commercial message, from health spas and the like.  It is very difficult therefore to know what the physiological realities are.  But, acutely, there is discharge of adrenaline and cortisol, and a commensurate increase in blood pressure, sometimes with a reflex drop in heart rate.  Within the brain, the design of scientific studies is much harder, with speculation about validity of results.  The suggestion is that intra-cerebral noradrenaline, dopamine, and beta-endorphin release is increased.  My own findings are that afterwards you feel fantastic, but whether this is just from the feeling of accomplishment, or the feeling of survival, is unclear.  The stress and increase of catecholamines together with increase in blood pressure means that I (and other experts) do not recommend it for most cardiac patients.  Additionally, if one is on the verge of heart failure, with attendant accumulation of fluid, the G-suit effect of water compression will deliver substantial increased volumes of intravascular fluid to the central circulation and can be catastrophic.  I have seen this in a patient with critical aortic stenosis and another patient with early heart failure secondary to mitral regurgitation.

 

Anyway, I felt great, but I’m not sure when I’ll be back in the water.

A silhouette is the most flattering view at my age...

 

If you thought that was enough science for today, I’m sorry but think again.

 Huge advances in technology have resulted when humans have had a specific challenge.  Unfortunately, too often that means the technology of war (but see the biog. of Dr Werner von Braun).  Sometimes it is the need to develop new materials, methods of energy generation, or propulsion (see the Space Race and Dr Werner von B again).  In the current crisis it is of course the universal effort to combat the coronavirus.

 New technologies of testing are being developed which harness the tools of molecular biology.  Methods with names like CRISPR, SHERLOCK, HUDSON, and SHOT, have been developed.  Partly for my own education I will try to explain.

 

Viral antigen testing (to see if the virus is present in a patient) relies on traditional PCR techniques.  PCR – polymerase chain reaction – is a method by which a nucleic acid replicating enzyme, which is present in normal cells to reproduce DNA, can be harnessed to endlessly multiply a tiny fragment of DNA or RNA.  Such amplification can be used to identify DNA sequences, for example in forensic samples.

 

More modern techniques have been developed after finding that even simple bacteria can have defences against viruses.  ‘CRISPR’ is ‘Clustered Regularly Interspaced Palindromic Repeats’.  These are DNA sequences found in simple cells such as bacteria which turn out to be due to a bacterial mechanism, a molecular pair of scissors if you like the metaphor, which chops up nucleic acid from foreign invaders, namely viruses.  This effect is mediated by enzymatic processes, which can now be used for gene editing, and have the potential to treat human genomic diseases by DNA repair, insertion, or excision.  I don’t fully understand the technology here, but CRISPR has the ability to identify specific pieces of DNA or RNA against a high background of non-relevant nucleotide sequences.  Such detection processes have been characterized as ‘SHERLOCK’ – Specific High-sensitivity Enzymatic Reporter UnLOCKing.  Those who also love their Conan Doyle will be pleased to learn that an additional method, ‘HUDSON’, is also useful.  HUDSON is Heating Unextracted Diagnostic Samples to Obliterate Nuclease.  HUDSON and SHERLOCK can now be combined together to detect viral RNA and DNA with speed and precision.  The latest report, in the September 16th New England Journal of Medicine, details a rapid form of testing for SARS-CoV-2 – STOP – or Sherlock Testing in One Pot.

 And ‘Stop’, I hear you cry.  Well, at least you probably read it here first.

 

This week we have had the dispiriting, but somehow inevitable, news that Covid is on the rise again in the UK, lagging only slightly behind France and Spain.  An inkling that Big Brother (the Government) was coming in to bat with fairly heavy bats came on Monday, with the announcement that the medical and scientific experts, Professor Chris Whitty and Sir Patrick Vallance, would address the nation.  This time they were on their own, and it was clear that they were paving the way for Boris Johnson’s announcement the next day for further restrictions, though stopping short of repeat total lockdown.

 Camilla Tominey, in the Telegraph, elegantly extended the cricketing metaphor further.  ‘They were like two groundsmen preparing the wicket for Boris Johnson to go into bat, but it soon became apparent that rain was going to stop play.  And not just for a few weeks, but another six months.’

 

Friday September 25th

 

It has rained quite a bit in the last few days and morning temperatures are now in single figures, so our heating has been fired up for the first time in months.  The Chancellor of the Exchequer has announced a new wage subsidy scheme which will assist workers when the furlough arrangements cease.  But again, I’m interested in the trivia, and the intervention by the Sussexes (Harry and Meghan) in the United States, in a video message urging people to vote (“reject hate speech, misinformation, and online negativity”), has drawn disclaimers from Buckingham Palace, and comment from President Trump.  Such a speech is clearly aimed at poor, black and minority workers, and likely to enhance a Democrat vote.  Trump said: “I’m not a fan of hers and I would say this, and she probably has heard that.  But I wish a lot of luck to Harry, because he’s going to need it.”  For once Donald, I’m in agreement…

 

Lovely to see my daughter for a flying visit this week.  Very hard not to hug your nearest and dearest, and I guess everybody feels that.

 

Monday September 28th

 

A pleasant but very windy weekend.  Spoke to a friend in Edinburgh yesterday (it was her birthday) and she had just seen the first frost of the autumn on the lawn.  Dispiriting that the Scottish restrictions are so tough that only one other person can be in the household so no party and no fun.  Scotland, led by the ‘Scotweiler’, has generally had tougher restrictions than England, and initially at any rate, the death toll appeared to be lower than England, but a host of factors could explain that (larger conurbations in England, more immigrants, BAME, larger families with no opportunity for social distancing, etc.).  Ms Sturgeon’s name is an anagram of the anti-emetic Stugeron, which I first noticed and found amusing but nobody else is laughing, especially in Scotland.

 

A lovely walk in the New Forest, starting near the High Corner Inn, and walking up and over Ogden’s Purlieu and through some of the inclosures (sic).  Found several of what we took to be crab-apple trees, but might just be domestic apples gone wild.  10Kg of fruit is currently being turned into crab-apple and mint jelly.  Christmas presents sorted.

Apples or crab apples?  New Forest

 
Crab apple jelly on the way

A typical New Forest scene, though some may be puzzled at the lack of forest

New Forest ponies (with forest)



When we travel, I usually have a short list of elderly and housebound friends and relatives to whom I send postcards.  Belatedly realising that they haven’t received anything this year I rummage in the postcard drawer and send a couple off.  Rewarded by a phone call from my 92-year-old aunt to say that Bruntsfield Links, on her postcard is exactly where she lived when she left school and went to work in Edinburgh.  Delighted.

 

News this weekend that Donald Trump is not respecting the dying wish of the recently deceased Supreme Court judge, Ruth Bader Ginsburg, to wait for the next Presidency, to appoint a replacement.  His nomination is a 48-year-old Roman Catholic woman with seven children, Amy Coney Barrett, who is, needless to say, not ‘pro choice’.  I’m sure I must be treading on millions of devout Catholic toes when I weigh in on this issue, but to have seven children in an overpopulated world is an appalling act of personal aggrandisement versus the needs of our World Community in general.  When I first visited the United States of America, 50 years ago, I picked up a flyer in the streets of Manhattan.  The Choicers versus the Right to Lifers was a big thing at that time.  The flyer said something like, ‘My mother already had six children, and when she became pregnant again she was urged to have an abortion because my parents couldn’t afford to feed another child.  But she refused.  And so I was born.’  The name at the bottom of the flyer – Artur Rubinstein, the great, some would say the greatest, classical pianist.  I was profoundly moved at the time (I was 22 and had heard Rubinstein play at the Royal Albert Hall), but I now realise that there have been many great classical pianists.  Democrats in the US have been angered by a Republican T-shirt which mimics Ruth Bader Ginsburg, who was known as ‘The Notorious RBG’, but substituting ACB for RBG.  Ms Barrett needs to be shut up in a room for a few days with a copy of Richard Dawkins’ ‘The God Delusion’.  A Judge with seven children?  Does she need help from Fraulein Maria?

 

Why do I say so little of UK politics?  It is not because I am confused about the rule of six – though I am – it seems bizarre.  It is because we are faced with an insoluble problem and I am fed up with the political infighting over it.  I genuinely liked Boris Johnson, but I am now fed up with his blustering imprecise style of speaking, his poor leadership (e.g. the Cummings episode), and now Brexit has again reared its ugly head with Johnson threatening to commit an illegal act under international law to guarantee UK government independent decision making in violation of the withdrawal agreement.  (No, I don’t fully understand it either, but it has something to do with the Irish Backstop).

 

Talking of insoluble, there was yet another dispute between scientists at the weekend.  I had a lot of sympathy with the view expressed by an Oxford epidemiologist (Professor Suneetra Gupta) that in view of the lack of risk to the young and healthy, we should just let them all get infected and recover, building up herd immunity, while shielding the vulnerable and elderly.  Unless there is a vaccine soon, the UK and the International economy seems doomed, and unless we allow more normal activity, we are going to be paying for this for decades to come.  And sometime in the next few years an even more deadly pandemic might strike – e.g. Nipah virus, another RNA virus from bats – estimated case fatality rate 50 to 75%.

 

I wrote an e mail to a friend the other day.  In it I used the word ‘policeman’ to explain how I was visited by an officer the other day to tell me about a local break-in.  Outlook didn’t like it and underlined it.  When I right-clicked on the error it told me that I should substitute ‘police officer’, but honestly guv, this was a policeman.

 

It seems to be a time for more philosophical thinking; it is 50 years since, etc, etc.  50 years since I left university for my last long vacation (and then I wonder whether Summer/Autumn 2020 is ‘my last long vacation’), and spent a fantastic summer in the United States.  More perhaps later.

 

Wednesday September 30th

 

“To Poole (as Samuel Pepys would have put it), to the Great Hall to hear the Players”.  The Players in this instance being the Bournemouth Symphony Orchestra and the Great Hall being Poole Lighthouse as the Poole concert hall is currently named.  This was no mean occasion, the first live concert since the March lockdown, and the longest interval without a performance in the BSO’s 127-year history.  Unfortunately, Kirill Karabits, the orchestra’s chief conductor, was stranded by quarantine regulations in Zürich, and David Hill stepped in at short notice.  The hall was only open to season ticket holders and then only a minority of us.  It was literally ‘Un Ballo in Maschera’.  The programme was shorter, but an uplifting one.  Bach’s arrangement of Luther’s hymn ‘Ein feste burg ist unser Gott’, Ives’ ‘The Unanswered Question’, Britten’s arrangement of the second movement from Mahler’s 3rd Symphony, and finally Beethoven’s 7th symphony.  The stage was greatly expanded in size to accommodate a smaller but distanced orchestra, and full use of the choir stalls was made in order to accommodate most of the brass instruments.  This produced an unusual separation of sounds – like a sort of ‘super stereo’, which was not unpleasing, but different.  Solo parts were much easier to distinguish.  At the end (and I know in the USA standing ovations are the norm, but not here in the UK), all members of the audience who could rose and applauded.  An emotional occasion.

 

BSO and David Hill

In view of the 50 year memories, I couldn’t help thinking of my room-mate at St Catharine’s, who was a good enough trumpeter to play a double concerto with John Wallace, who loved the 7th symphony, and had played it with an orchestra in the Manchester area.  We had to hear the triumphal descending trumpet motif many times by carefully dropping the stylus of the record player onto the trio section of the third movement.  On this occasion, the fanfare-like brass in the third movement was impossible to ignore, as the two trumpeters sat right at the top of the choir stalls.  Then I got to thinking that the neuronal activity which such memories evoke, thought to be stored in some molecules of RNA somewhere in my brain, was so fragile and evanescent, and will someday be extinguished forever.  Unless, and I suppose this is partly why I am writing, this manuscript will surface again somewhere.

 

‘Forever, and forever…’, or ‘Ewig’, the closing word of Mahler’s ‘Song of the Earth’.  I am reminded of this by reading a book about cricket, ‘That will be England gone’, previously alluded to.  Or is it not about cricket?  The digressions are extraordinary, and one of them is about Kathleen Ferrier, the British contralto, who died young, and who came from the Lancashire mill towns which gave birth to the Football League and to the system of cricket called the ‘Lancashire Leagues’.  Michael Henderson argues that Kathleen Ferrier was such a superb artist, so involved with the music, that during a performance of the Song of the Earth under Bruno Walter, she was unable to sing the closing line (Ewig, ewig…) because she was in tears, and the orchestra played gently on until the end.  Bruno Walter, the friend and disciple of Gustav Mahler, said that the two greatest things in his life were that he had known Kathleen Ferrier and Gustav Mahler, ‘in that order’.

 

Links within links.  When I moved to London to start clinical medicine at UCH, there was a plaque and tribute to Kathleen Ferrier in the Radiotherapy department, where she had been treated for her breast cancer (she died aged 41 in 1953).  I wonder if her name is still preserved somewhere within that Brave New Hospital?

 

The world famous Colston Hall, in Bristol, has now been renamed.  Edward Colston made some of his fortune from industries allied to the slave trade and he is now persona non grata in Bristol.  So the hall has been rebranded as ‘The Beacon’, a clear reference to Poole’s ‘Lighthouse’.  Ho hum…  I also have happy memories of the Colston Hall.  It was where I went to my first BSO concert; where I heard Silvestri; Dorati; Ashkenazy; where I heard Roy Orbison live; Peter, Paul & Mary live, etc.

 

Thursday October 1st

 

A beautiful, sunny, breezy day.  A friend has suggested that this should be the final day of swimming in the sea (she has apparently been swimming regularly) so I, accompanied by three ladies in their sixties, agree to swim too (again!).  The water temperature is 16.9 deg C.  It feels very cold.  The cold shock goes in about five minutes.  Even more of a shock is the immersion of one’s face in the water to do the crawl.  This is the physiological test known as the ‘diving reflex’, accompanied by a vagal (reflex in one of the so-called autonomic nerves) discharge which dramatically slows heart rate.  Nowadays, in hospitals we usually use intravenous adenosine to mimic this, or occasionally massage of the carotid (sinus) artery.  In the distant past, when we did not have adenosine, I occasionally used the diving reflex to treat heart rhythm disturbances.  As you may surmise, I survived this insult with the usual exhilaration and supercharged feeling that comes with the release of god-knows-what hormones.  But that’s enough.  There has been much about ‘wild swimming’ during this lockdown summer, and I did once read an interesting book about year round swimming, by Al Alvarez, called ‘Pond Life’, a sort of diary, and a compelling read.  You can probably pick up a copy very cheaply.

 

Swimmers, and furloughed cruise liner

Survivors

While driving around I listened to the last movement of the Schubert ‘Great’ C major symphony (Classic FM usually only play a single movement because they have to get the adverts in).  Those little bits of RNA jingle-jangled again, and I was back to Hamilton, Ontario, in the summer of 1974, being introduced to it by one of the PhD students in the immunochemistry lab at McMaster.  He was called Ross or Russ, and like several others, was a Vietnam draft dodger from the USA (even in 1974 this was an issue).  Eventually I bought the exact same Deutsche Grammophon vinyl recording, by Karl Böhm and the Berlin Philharmonic.  Oddly, the rhythmic motif of this final movement reminds me of our epic journey back from Malta in 1958, where, somewhere in Austria, we came across the town band, in full traditional regalia, playing the same sort of bouncy oompah wind band feeling that this music engenders.  Such a happy memory.  Ross or Russ had catholic tastes in music though.  I remember him playing Janis Joplin, Big Brother and the Holding Company, so loud that Ole, the Norwegian post-doc, came down to complain.  I do recognise that some might find writing about classical music and happy memories a tad pretentious, and I have tried to make my thoughts about it genuine, and not worthy of sending off to Private Eye for its ‘Pseuds Corner’ section.

 

Friday October 2nd

 

Heavy rain in the night, and storm Alex has arrived with us.  The wind is so strong the Sandbanks ferry is not running.  Golf is cancelled, as on Wednesday.  Time to write a diary.

 

The main news this morning is twofold.  Donald and Melania Trump have tested positive for Coronavirus and are isolating.  They seem to have caught it from an aide, but there have been many pictures of Trump not wearing a mask, and he is regularly with other staff inside the cramped helicopter which takes him to Andrews air force base.

 

Strangely, having written about Kathleen Ferrier (and I have never heard of any other Ferrier), a Scottish MP called Margaret Ferrier is in the news today, having travelled around with symptomatic Covid, even travelling to Westminster and addressing Parliament after she knew she had a positive test.  Turns out she was a major critic of Dominic Cummings; the biter bit as they say.

 

Saturday October 3rd

 

Relentless rain.  Storm Alex continues, unusual in that it developed over France and has moved northward instead of the usual equinoctial gales which work their way in from the Atlantic with their first landfall upon the Emerald Isle.  Scotland got away with it yesterday, but not today, as the storm has moved northwards and the coverage of the golf from North Berwick (the Scottish Open) gives one a sense of schadenfreude as we watch the pros battle with the horrible weather.  My Edinburgh correspondent refers to it as ‘dreich’.

 

Attendance at our usual one hour circuits session at the gym this morning gives me a sense of achievement, and a feeling of righteous justification in having a large breakfast, a chunk of my freshly baked sourdough granary loaf, a leisurely bath, some additional chocolate at lunchtime, and a lovely G&T this evening.  Still working my way through ‘That Will Be England Gone’, which is as much a lament for older standards of behaviour, literature, broadcasting, music, theatre, as it is about cricket.  The two are fortuitously linked together by an excellent section on Harold Pinter, a great cricket lover, who cunningly gave names of famous cricketers of the ‘Golden Age’ to his characters in the play ‘No Man’s Land’.

 

News this morning that Donald Trump has now been shipped off to Walter Reed Hospital, the flagship U.S. Army hospital.  His gainsaying of the seriousness of Covid-19 and frequent refusal to wear a mask, indeed his mocking of people wearing masks has come back to haunt him.  Needless to say he has had the best treatment, and has already had convalescent serum injected.  No doubt he has been started on remdesivir, and medics are standing around with syringes full of dexamethasone.  No mention as to whether he’s had Dettol or hydroxychloroquine.  That word schadenfreude seems to be justified again, perhaps more so than in the case of those rain-soaked professional golfers.

 

Sunday October 4th

 

The rain has continued unabated.  I spend the morning finishing ‘That Will Be England Gone’.  A fascinating read, but mainly for the non-cricket parts.  Those who would be harshly critical would draw attention to the name-dropping and perhaps slight pretentiousness of some of the writing.  E.g. he shares cricket hospitality boxes with Tim Rice, dines with Harold Pinter, and rubs shoulders with many ‘greats’ of the cultural world.  ‘Simon Rattle’s father took me aside and told me this story’… is a good example.  But maybe I am writing with the politics of envy here.  It would be wonderful to meet so many of those people.  And he interweaves the world of culture rather well with the story of county grounds and county cricket.  Taunton and Somerset come rather near the end.  What is it about Somerset though, that makes so many people unhappy?  Trescothick, Roebuck, Robertson-Glasgow, Gimblett.  Three of these committed suicide.  As a little footnote to Henderson’s concise and unemotional paragraphs about Roebuck, here, as Denis Rattle would have said, is a little story.

 

My final year at school was not a year.  Told I had to stay on for a term to take the Cambridge scholarship exam rather than going straight up to University, I floundered for something to do.  The exams took place in December, and after that there was little to do.  I had some projects from the Chemistry master, and I spent one day a week at the nascent Bath University, in their microbiology department, with a lecturer whose main interest was the Cephalosporium genus of fungi.  I only stayed for the term from January to Easter because the CCF were organising an arduous training week in Skye (ancestral home of my clan).  Nowadays, with more funds from BOMAD (Bank of Mum and Dad) I would have gone somewhere exotic to help build a school (a ‘Gap Yah’), but only VSO was available at that time and I was too late for that.  At Easter therefore, I was cast adrift.  I spent a few unhappy weeks trying to sell ice cream in one of the coldest Easters of the decade, driving a clapped out Bedford van which would certainly have not passed an MOT.  I was paid £10 a week for a six day week with hours from 0800 to 1800, and Mondays off.  But then my headmaster appealed to me to go and help out at a private prep school in Bath (salary £18 a week), where Peter Roebuck was one of my pupils.  My duties were to teach Latin and English and assist with organising sports.  Peter Roebuck struck me as a delightful, smiling, open-faced boy with a touch of mischief about him.  He was only nine years old.  Despite bowling my best deliveries to him in the nets I could never get him out.  ‘Yes, he’s brilliant’, said the second master, ‘But have you seen his sister play?  She’s even better.’  How little we know.  Peter went on (of course) to Millfield School, cradle of sportsmen and women.  That enthusiastic, smiling lad went on to become an academic of a batsman, and an academic of a writer.  But perversion and depression somehow crept in and I was aghast when I heard of how he took his own life, when the police came to call in Cape Town, by jumping out of a hotel window.

 

Rain and a brisk westerly wind notwithstanding, we walked on the beach this afternoon.  The waves were impressive.  Flecks of foam left on the beach fly to the East towards Bournemouth.  I’ve sometimes wondered about the bubbles and foam.  Why do they occur?  If you take some salinated water and whip it up, no bubbles form.  Surely it is not due to detergents?  The polluted waters of British rivers in the 60s and 70s with their mass of foam are no more.  But if you whip up water with protein in it you will get foam.  Every first year medical student learns that foaming when passing urine may be an indicator of kidney disease, due to excessive protein loss from diseased kidneys.  I can only surmise that proteinaceous seaweed, or small animals within the water provide the substrate for the phenomenon.

 

Beach foam

Kiting in Whitley Bay


On returning home we see the final metres of today’s second race of the Giro d’Italia.  Geraint Thomas seems well placed.  Liege-Bastogne-Liege (one of the ‘Classic’ one-day races) is won in bizarre manner as Alaphilippe sits up to celebrate too soon, and Primož Roglič pips him by a centimetre or two.  Alaphilippe is subsequently demoted to 5th for interfering with Hirschi (in the cycling obstructive sense, not the Roebuck sense, you understand).  In the Scottish Open, played in rather better conditions than yesterday, Fleetwood is beaten in a surprising manner in a playoff by Rai.  French horses win all the laurels in the Qatar Prix de L’Arc de Triomphe, and ‘Enable’ with Frankie Dettori up is ‘Unable’ to win for the third time.  And at the time of writing, Spurs are 4-1 up against Manchester United.  I have Catholic tastes in Sport.  It is like harmless war.

 

I look forward to a visit from friends to celebrate a birthday and their wedding anniversary, cleverly chosen to be on the same day.

 

Friday October 9th

 

Poor Geraint Thomas.  A freak crash caused it seems by a bidon coming loose from a bottle cage during the neutralized zone rollout caused a heavy fall onto his left side, with lots of rips in his lycra and a struggle to finish the day’s stage, many minutes down.  Further scanning in hospital revealed him to have a fractured pelvis so he is out of the race, which he was favourite to win – partly because it included three time trial stages of which he is a proven master.

 

Mixed weather this week, but on Tuesday we went to West Sussex to celebrate my step-daughter’s birthday.  Great fun with the grandchildren and their two small kittens.  Much work on the land of their new house is taking place.  In particular the felling of some tall ash trees which are suffering from ash dieback.



  In the afternoon I was invited to play golf at Goodwood Downs course, a layout designed by James Braid in 1914.  Views up to the racecourse and down over the intervening land to Chichester Cathedral, and further on to the Isle of Wight and Portsmouth’s Spinnaker Tower.  Red kites wheel over the higher ground, and pheasants and woodpeckers strut and hop the fairways.  The 18th century ‘Kennels’ clubhouse adds to the grandeur of a glorious round.  Evening is special with a fish theme and some pink Laurent-Perrier makes an excellent aperitif.

Goodwood Downs course and Chichester Cathedral

Stormy skies above Goodwood Downs


 

Morning sees us pack in leisurely fashion and wend our way through the densely treed Sussex lanes via Haslemere to the A3, and home.

 

A number of memes about Trump, of course, ranging from the mildly satiric: ‘Donald Trump has tested positive for Covid-19; our thoughts are with the virus at this difficult time’, to the unprintable.  Ever the reality TV show-off, he is apparently furious when the medical announcements imply some weakness, e.g. he needed oxygen on a couple of occasions, and takes to a motorcade, driven round outside the hospital waving to his ecstatic and uncritical fan club.  More leisured analysis of this circus expresses horror that he would expose his drivers and security staff to his illness.  The medical staff, understandably, throw the pharmaceutical book at him – he has dexamethasone, remdesivir, and previously untrialled antivirus-specific monoclonal antibodies, and recovers quickly and is back at the White House within three days.  It is noted that he is breathless after walking up the White House steps.  Given this ‘Trumptail’ of treatments, he thus becomes a victim of ‘VIP Syndrome’, the different treatment given to those who are famous, in the hope that they will do better.  Given that dexamethasone can produce ‘steroid psychosis’, which is often characterised by hypomania and delusions of grandeur it will be hard to know whether he has this side effect.

 

A leading article in the NEJM (New England Journal of Medicine), while not overtly critical of Trump, cleverly contrasts the measured press briefing of Dr Paul Dudley White, famous Boston cardiologist of the 40s and 50s, after the heart attack of President Eisenhower in 1955 with the media briefings about Trump.  Ironically, Eisenhower too was a candidate for re-election in the immediate future.  The author, Dr Thomas H Lee, makes it clear without saying so that the press briefing in 1955 was far superior to that of 2020 (see NEJM October 6th, 2020).

 

News that Emmanuelle Charpentier and Jennifer Doudna, who discovered the CRISPR-Cas9 gene-editing mechanism have been awarded the Nobel prize for Chemistry.  And you read about it here first, before this award was announced!  They are only the 6th and 7th women to receive a Nobel for Chemistry.  The Nobel for Medicine is announced shortly afterwards, the three men who characterised the Hepatitis C virus.  When I was a student, many patients presenting with ‘Idiopathic Cirrhosis’ were actually victims of hepatitis C infection, although we did not know this in the early 1970s.

 

Stricter lockdown measures have been introduced in the Central Belt of Scotland, and there is talk of further restrictions in England.  Hidden in the original scare-stimulating report from Imperial College is a suggestion that stopping schooling would not be helpful, though it seems this was overlooked at the time.  The advice now is to work from home rather than come into work, so Boris’s encouragement to go back to work has now been stood on its head in quite short order.  There seems to be quite some groundswell behind the revolt against restrictions and lockdown, and, at least to me, some form of acquisition of herd immunity seems to me to be the only viable strategy if the economy is not to be completely destroyed, with hundreds of jobless, penniless young people contributing to rampant unrest, illness, and public disorder.

 

Sunday October 11th

 

A slight feeling of agitation and uneasiness.  We are out of here (Brunstead Place) in 7 weeks’ time.  Yet our house has a very unfinished look and feel to it.  The floors are only covered with tiling matting and the walls have not had their finished rendering.  The house is still festooned in scaffolding.  There are no lights.  The electrician and his assistant have been very unwell (fortunately not Covid) so they have not been on site.

 

Still, it is a beautiful day and we have a walk of nearly 5 miles along the beach and around the harbour back up to Canford Cliffs.  Five large mothballed liners in the bay and some sails of racing yachts and a solitary water skier emerge from a sunny halo of light on gazing across to Old Harry.  There is a lot of sport on today.  The Giro d’Italia stage is won by an EF Procycling team member which will please my daughter who works for their kit company.  Tyrrell Hatton wins the PGA at Wentworth.  Rafa Nadal wins the French Open for a record 13th time, and England have just kicked off against Belgium at football.  There is IPL cricket too.

Another reason for feeling uneasy is the venom and spleen expressed on the morning Andrew Marr show about the restrictive measures in place in the North of England and the catastrophic economic consequences.  Labour’s Lisa Nandy, shadow foreign secretary, in her flat Manchester accent can’t say enough bad words about the government policies.  A government minister, Robert Jenrick, is a reasonable spokesperson, but staves off any definite answers ahead of further possible announcements in parliament tomorrow.  Marr points out that the number of Covid patients in hospital is very similar to that at the commencement of lockdown in March.  It seems that we are on a rather sorry roundabout which has revolved to the point at which we came in just over six months ago.  The government walks a tightrope, or even perhaps an arête, on either side of which slippery slope there are hazards – more deaths or more economic disruption.  ‘Events, dear boy, events.’  As Harold Macmillan famously said in response to a query as to what might throw a government off course.  And all that is without even mentioning Brexit.

 

And on that note it is surely time to finish this episode of my diary, except to say that it was lovely to see my younger daughter who came down briefly for a friend’s 30th birthday bash at the Shell Bay café.