Friday July 17th
A beautiful day.
Today our aim is to walk in the Test valley again, then visit Mottisfont
Abbey, which is open, but only to timed tickets. A first this week was sitting on the terrace
at the golf club, being served from the bar (no wandering around), after a
moderately successful round of golf (at least after a par on 18 and winning 1
up) and in front of me a pint of Sixpenny Handley best bitter. Apparently now brewed in Cranborne and not in
the eponymous village. The week was
notable too for the failure of the England cricket team in the first test match
against the West Indies. I realise that
this is rarely an unusual news story.
But with the crammed nature of the fixtures, at least we started again
yesterday at Old Trafford and have topped 200 runs for the loss of three
wickets only.
 |
| A fine trout at Mottisfont |
Mottisfont Abbey
Returning to the topic of free speech however, and one’s
right to an opinion, there was an excellent article in Tuesday’s Telegraph by
Benedict Cooper. This is in response to a
Guardian (inevitably) article by the musician and left wing activist Billy
Bragg. Bragg takes issue with the
quotation from George Orwell, carved in stone outside the BBC headquarters (I
did not know this): ‘If liberty means anything at all it means the right to
tell people what they do not want to hear.’
It would take too long to embellish this, but Bragg rails against the
reactionary right for a tendency to quote George Orwell out of context and says
this is an argument for licence and not free speech. Cooper points out that there is a tendency
for writers and academics and for social media to extrapolate from Orwell, and
produce opinions about how he would have reacted today. In a neatly constructed piece, Cooper clearly
shows what Bragg believes is wrong, and ends by amplifying the original
quotation in Orwell’s words: ‘I am well acquainted with all the arguments against
freedom of thought and speech – the arguments which claim that it cannot exist,
and the arguments which claim that it ought not to. I answer simply that they don’t convince me
and that our civilisation over a period of four hundred years has been founded
on the opposite notice.’
We live in dangerous times – dangerous because of social
media. To give an example; a picture
posted on Twitter or some similar platform shows a young white woman, masked,
in company with others, in bright sunshine, holding aloft a placard which says
‘Black Lives Matter!’. The person who
posted this points out that behind the young woman, there is a clear cut shadow
of her hands in the air – but no shadow of the placard. In other words, the Photoshop user who
doctored the original photograph forgot about the shadow.
A despairing letter in the newspaper tells how the writer
was in Boots the chemists. There was a
woman there wearing a face mask. She
kept her face covered almost all the time, only removing the mask when she
needed to cough and sneeze before replacing it.
‘God help us’ he pleaded. While
not being aware of God keeping an eye out for problems in Boots I would probably
still endorse his final plea.
Sunday July 19th
After another beautiful day yesterday, it is cloudy and
drizzly, but the weather at Old Trafford should be good today. England, for once, made a huge total on
Thursday and Friday, thanks to big century innings by Stokes and Sibley. Saturday saw continuous bad weather and not a
ball bowled. I well remember trying to
explain English cricket to my American friends in North Carolina. The incredulity that one stopped for lunch
and tea, and that play could go on for five days, even then without reaching a
result. We are engrossed in series 2 of the
West Wing, a TV series made nearly 20 years ago, but which is relevant today,
most of the world’s problems recurring with a depressing inevitability (African
coups d’état; India-Pakistan conflict; problems in the Persian Gulf). This sentence is not entirely a
non-sequitur. We have just made the
acquaintance of the feisty and attractive political analyst, Ainsley Hayes,
played by Emily Procter. Her accent took
me straight back to North Carolina. True
North Carolinians have a very distinctive vowel sound, which I have great
difficulty in imitating, but which once assimilated is unmistakable. Many of my colleagues at Duke had other
accents – a widely varying mixture – but Lewis, a student from rural NC doing
pre-graduate experience in our lab had the characteristic accent. So it was a pleasure to look up Emily’s bio
and to find that she was raised in Raleigh, NC, and is an alumnus of East
Carolina University.
There is no clearer indication of how age saps one than to
look at our own cycling last weekend (32 miles up and down in Hampshire on
Sunday; exhausting) and to compare it with my daughter’s Strava of her weekend
break in the Cotswolds (32, 93, and 70 miles).
Ichabod.
Just finished a book called ‘The Porpoise’, by Mark Haddon,
author celebrated for ‘The curious story of the dog in the night time’. Don’t think he quite pulled off the magical
realism, but a remarkably inventive book.
It helps to have read Shakespeare’s ‘Pericles’ beforehand.
We finished our little walk in King’s Somborne and
Horsebridge on Friday with a drink outside at the John of Gaunt pub. Dutifully handed over our names and phone
numbers for subsequent identification should any customer prove to have
coronavirus and be interrogated for their movements (track and trace). I then realised what a hostage to fortune we
were. Should we be contacted, could we
claim that we were outside and socially distanced? Would we be forced to self-isolate? Would our builders have to stop work? Given that we always meet the building team outside,
would this provide sufficient protection for the health hounds to not disbar
them from work?
Main scientific news this week has been that vaccine
preliminary trials have been going well with minimal side effects and definite
antibody and T-cell response. Also that
both China and Russia are trying to hack into Oxford University’s research
(denied on TV this morning by the Chinese and Russian ambassadors. MRDA.
Mandy Rice-Davies Applies). The
virus has now been found to vary substantially in various locations. A single aminoacid mutation in the spike
protein gives it greater affinity for its ACE-2 receptor and greater
infectivity. In other research, it would
appear that a particular variant is mostly responsible for the severe
pneumonitis clinical pattern. Whether
this is of practical use is unclear. It
has also emerged this week that death figures from PHE (Public Health England)
may be overstated. Apparently any death
recorded in a person who at some time has tested positive for coronavirus is
attributed to the virus, irrespective of whether that death is due to the virus
or not. For example, if somebody had
Covid in April and died in a road accident in June, that death is automatically
slated to be due to coronavirus. Some
work required here, and evidence that PHE is ripe for reorganisation and
probably some funding too.
It is now possible to see where our new house is heading,
what the architectural concept is, and we hope it will prove a suitable
memorial to our late friend and the originator of the project, Richard Horden
(qv). It is not quite as Richard
originally conceived it. We felt that we
could not afford the ‘Belvedere’ on the third floor. Richard wanted this to echo the ‘conning
tower’ design on the top of the famous 1938 Oliver Hill (qv) house, ‘Landfall’,
which stands close by, and which Richard greatly admired. His colleague in the architectural firm
replaced this with a clerestory, which will create a virtual third storey, and
also bring light into the upper hall.
During construction and visits to the roof, it has become clear that the
original Belvedere would not have gained the most spectacular view, which is
from the Eastern end of the roof and which takes in Old Harry rocks, but
Richard could not have known this. A
recent review of the new edition of Pevsner’s buildings of Dorset complained of
the expansion in size of the book, due largely to inclusion of many examples on
Sandbanks, examples which the reviewer termed the ‘Lombard’ school of
architecture. We hope that Crichel Point
will not be of this school. (Lombard
stands for ‘Loads Of Money But A Real Dickhead’).
Friday July 24th
It’s hard to know where to begin when so many events have
caught the eye and the ear in the last five days, but this is the hazard of not
making a daily entry. So I will start
with a confession. I have been a long
standing fan of Boris Johnson, but I am not any more. Why a fan?
Enthusiasm; wit; a refusal to be boring; allied with a very real sense
of history and classical scholarship. In
addition (and both Remainers and Brexiteers do not know whether this will be a
good thing), I was in favour of leaving the EU.
I voted (yes, I was old enough to vote) in the original referendum that
took us into Europe. It was a vote for
free trade within our European partners.
We were told that stupid taxation differences between countries would be
eliminated, that there would be better standardisation – I remember thinking
that all electric plug sockets would eventually be the same in whichever
country we visited (faint hope), and that there would be widespread reform of
policies and rules with regard to agriculture and fisheries (faint hope). Naively I thought that French wine might be
cheaper. But Christmas booze cruises,
evidence of cheaper continental prices, continued until quite recently. In about 2000, I even bought a car in Holland
because it was much cheaper than in Britain.
When we joined, you may remember, it was called the EEC, the European
Economic Community. Now it is a ruling
federation, which seems primarily to exist to improve the lot of poorer
countries at the expense of others, and I can’t remember how many countries,
many with lower standards of accountability, are now members. Scientists and liberals whinge that the future
of research will be destroyed if we leave the EU. But what they fail to realise is that the
main driver of the sharing of scientific knowledge and cooperation in the last
20 years has not been the EU, it has been the internet. The jury is out, and I suspect it will be out
for at least 20 years before we know whether it was a good or bad thing to
leave. So, some future writer will have
to assess whether Boris has done good or ill by spearheading our leaving.
But in domestic policy, Boris has shown himself to be
pathetic. A friend has loaned me a copy
of the London Review of Books, LRB, mainly to read an article about Shakespeare,
but the leading article, a clear and cool eyed view of the Johnson era, was eye-catching
reading. Entitled ‘Superman Falls to
Earth. Ferdinand Mount on Boris
Johnson’s first year’; it is hard to disagree with this intricate dissection of
the current government. The beginning is
superb: ‘Precaution and continence, as we know, are not qualities that
characterise Boris Johnson in any sphere of his life’. The article is too long to paraphrase, and
hindsight is certainly a wonderful thing, but we do know that Johnson failed to
attend five COBRA meetings, and that his initial approach to the pandemic was
casual to say the least. Mount, who
interestingly was head of the Number 10 Policy Unit in 1982-3 under Margaret
Thatcher, goes on to say that ‘it is jarring to hear Ministers claim that they
are proud of our achievements in the middle of a pandemic which has cost, so
far, more than 50,000 lives. The world’s
second highest death rate per capita – wow, that’s really something. Bolsonaro, Trump and Johnson: these are men
you wouldn’t put in charge of containing an outbreak of acne’. There is more, but I did not mark it, as I
seem to remember Casca saying in Julius Caesar.
Which leads me on to Shakespeare, the main reason for the
LRB donation. Michael Dobson, director
of the Shakespeare Institute in Stratford-upon-Avon, reviews a substantial book
about the language of Shakespeare, by of all people, a Swiss scholar called
Margaret Tudeau-Clayton. Musing about
the influence of Shakespeare, who is unchallenged in the role of ‘National
Poet’, he points out that many of the Bard’s references to England are
slighting and not at all celebratory.
Even the dying John of Gaunt’s This England speech, ‘…this royal throne
of kings, this sceptered isle, the envy of less happier lands…’ reveals that
when the main verb arrives after 19 lines, it laments that (England) is now
leased out…like to a tenement or pelting farm’.
Hardly a recommendation for those forced to live in it. There are amusing diversions. Richard III, just before Bosworth, condemns
the invaders from France as an effeminate gang of sexual predators:
‘If we be conquered, let men
conquer us, and not these bastard Bretons…
Shall these enjoy our lands? Lie
with our wives? Ravish our daughters?’
Curiously, Shakespeare is almost more famous in Europe than
he is in England, or should I still say ‘Great Britain’? The first national society for the study and
appreciation of Shakespeare was founded in 1864 – in…… Germany!
The city of Gdánsk in Poland boasts the stunning Teatr Szekspirowski,
three quarters funded by the EU (Ha!), and opened by Donald Tusk in 2014. Despite the very learned discourse and
fascinating facts, I find Dobson’s critique hard to follow, probably because he
comes to no very clear conclusion about what it is that Margaret Tudeau-Clayton
is saying in her book, which is entitled ‘Shakespeare’s Englishes: Against
Englishness’. But perhaps neither does
she.
All of this does not give the reader who has persisted any
very real feel for how the latter part of July has gone on in Poole and
Dorset. The weather has mostly been
kind. Reported Covid-19 deaths in the
last 24 hours are still over a hundred – 123 – and there is the hint of an
upturn in the number of daily cases reported with a very persistent tail in the
death rate. Today a new rule of wearing
masks in shops was introduced, with a £100 fine for non-adherence. The young woman in front of me when I
collected my newspaper this morning was blatantly not wearing a mask; the woman
who entered the store as I came out was wearing a mask which only covered her
mouth… I continue to have a very
variable and unpredictable sleep pattern, and some others I’ve spoken to
experience the same. A hot chocolate and
some guitar practice in the middle of the night can be enjoyable. A BBC Sounds download called ‘The Sleeping
Forecast’ consisting of chanting of the mantra of the forecast from the various
shipping areas against a background of calm music can help to get one back to
sleep.
The most extraordinary piece I have noted in the last few
days was posted by a Twitterer who said she thought it was a joke, but
apparently, unless I can contradict this from later experience, it is not. AP (Associated Press), major news gathering
agency, have issued in a new ‘Style Matters’ advice, the instruction that
whenever the word black is used to describe someone it should be capitalised;
as in ‘Black’. But not white! White is not to be capitalised. Did you notice that I was only able to do
that because it started a sentence?!
What a crazy world we’re living in, as Joe Brown sang in 1962.
‘Dad’s gone down the dog-track; Mother’s playing Bingo;
Grandma’s boozin’ in the parlour, you ought to see the gin
go.
No-one seems to notice me, isn’t it a sin?
What a crazy world we’re livin’ in…’
The only note I had made to help me write my diary was that
I was going to fill you in on Thin Film Amorphous Boron Nitride, but perhaps
that had better wait for another day.
Parenthesis. A lovely
large and vigorous grass snake observed on Wednesday on the Ladies’ 3rd
tee at the golf club. It was keen to get
away.
 |
| Grass snake rapidly vacating the 3rd tee |
Monday July 27th
To begin with a gripe against gripers. Quite suddenly, the government has announced
that all incoming people from Spain must quarantine for 14 days. There has been an upsurge of coronavirus
cases in Spain, and particularly in Catalonia.
Following this the BBC’s coverage in its morning news (the talking heads
programme, you will remember) has been of grumpy individuals complaining that
this is ridiculous and wondering whether their employers will pay them if they
cannot go back to work after their week or two of lazing in the sun. If the current Welfare State, or social
support systems that we regard as comprising Britain (I hesitate to use Great)
do not provide everything for you on a plate, it seems that Britons will
gripe. Where is one’s sense of personal
responsibility in this? We are not in a
normal year where for the price of a few hours discomfort and overpriced snacks
Ryanair will fly you to and fro for your mandatory Spanish suntan. Granted there are some anomalies. The rate in the Balearic Islands and the
Canaries does not show this surge, and perhaps there could have been a bit more
logic applied. But the BBC does little
to counteract the mindless anti-Government griping. At least this morning, it had the rather
clever Jason Leitch, clinical director for Scotland on the programme, who not
only tells it like it is, but phrases his dialectic in language most can
understand. I am not holding a candle
for the Government here; but am just fed up with the BBC. As someone else said; ‘Why do you have to go
to Spain? Why not support the British
holiday industry?’
This last weekend saw the end of the Premier League football
season, with the sadness of our local team, Bournemouth, being relegated after
five years in the top flight. But our
cricketers have been doing well again in the final match of the series vs the
West Indies, somewhat curtailed today by rain in Manchester.
Moore’s Law, originally posited in the 1960s, states that
the number of transistors on a chip or integrated circuit doubles every two
years. A recent article in the Economist
questioned whether we have reached saturation point. As the electrical links between transistors have
become finer and closer together there is a problem of charge leakage due to
the tiny gaps that now exist between connections. But a new material shows promise in
insulation. Thin film amorphous boron
nitride can be pasted by vaporisation to create a sub-microscopic insulating
layer. So Moore’s Law seems to be safe
for a little while yet. This discovery
seems to have been the result of research primarily in South Korea. South Korea is in the news again today –
blamed by North Korea (of course) for its first reported case of Covid-19!
Moore's Law
After some lovely weather we have had a fair amount of rain;
torrential on Saturday, and on and off today.
It promises to warm up and become drier from tomorrow. No cricket in Manchester today though.
Saturday August 1st
The weather cleared in time for England to pull off a
substantial victory in the Test Match.
Otherwise there has been improvement through to more record high
temperatures on Friday, resulting in the now expected influx of people to
Bournemouth and Poole beaches, with more cars parked in roads leading to the
sea than ever seen before. Most of the
day trippers would presumably have been in French campsites, Spanish hotels,
and Greek beach resorts, so now they have invaded us. We decided beforehand to cycle today and to
risk the Sandbanks ferry over to Studland.
The traffic had become gridlocked through Lilliput and all
approaches to the beach. Weaving our way
through stationary vehicles we reached the ferry and were allocated our ‘box’
to stand in with our bicycles. On the
other side cars were parked on both sides of the verge in the Ferry Road for
nearly two miles up towards the Knoll House Hotel, and then also on the verges
to access the beaches beyond. On
returning later in the afternoon we noted that almost all of these vehicles had
been ticketed, presumably for encroaching on the roadway. As I get older the routes which I used in the
early 1990s seem steeper and harder, and on reaching the Swanage turn I push my
bike up the slope to the obelisk on the ridge, where formerly I would pedal
up. A short ride further up from the
obelisk (built to celebrate the bringing of fresh water to Swanage) and it is
two miles of glorious downhill on grassy track towards Old Harry, with the view
ahead of the Isle of Wight and the bay filled with mothballed cruise ships,
including the gigantic ‘Empress of the Seas’.
Picnic near Old Harry, and then cycle to visit friends in Studland, and
relax in their garden. Coming back to
the ferry, there is a commotion as three ambulances roar past on their way up
the hill (apparently a woman has fallen off the cliff), followed by a complete
jam as a fire engine tries to get through.
Traffic approaching the ferry is stationary from the village
downwards. There is the biggest queue I
have ever seen of pedestrians and cyclists waiting for the ferry, but only a
few cars are allowed on because of gridlock on the Poole side as well, and the
rest of the car deck space is eventually filled by walkers and cyclists. A remarkable sight and experience. One can only assume that many of these people
visiting Poole would be elsewhere at this time of year as mentioned above.
 |
| Sandbanks Ferry, Friday 31st July |
 |
| The new normal |
It wasn't this one who fell off the cliff
Monday August 3rd
A lovely walk yesterday from Rockford in the New
Forest. Although the car parks are
crowded there is space enough and once on the tracks away to the East over
Rockford common there are only a few walkers to be seen. Picnic by the Dockens stream, a rather poor
little brook at this time of year.
England won again on Saturday in the match against Ireland, and Arsenal
beat Chelsea 2-1 for a deserved victory in the belated FA Cup final.
At our house this last two weeks, the windows have arrived
and are being fitted by a charming team of Albanian window fitters, most of
whom speak pretty good English, but all of whom smoke. Enthusiastic conversations about Norman
Wisdom ensue. He’s still a legend in
Albania, with statues of him all over the place.
 |
| Windows |
Our mountain bike 24 miles pales into insignificance by
comparison with my daughter’s 75 miles in the Haute Chaine du Jura. Although based in France, their route took
them over into Switzerland on Saturday (passports required) where they were
surprised to discover that it was Swiss National Day. Anna obviously had forgotten our experience
in Lenzerheide in her earlier years, though apparently vague memories of the
street fair, incessant Swiss music, and evening fireworks came back
eventually. Anna and Graham have all the
kit and the posh bikes, though I remain proud of my (very old) cycling jersey
with the Mapei and Latexco logos emblazoned on them. Two years ago, while cycling in Brittany, I
was approached by a man with a Belgian car registration plate, who asked me if
I was Johan Museeuw (no I can’t pronounce it either). He was disappointed, but also astonished that
I hadn’t heard of this famous Belgian who had been the star of the renowned one-day
cycle races some years ago. Races with
odd names like E3 Harelbeke. Having
looked up Johan I would be surprised if he now looked as old as me, but maybe
cycling over that pavé day in, day out, ages one severely. I now have a lot of empathy with Mapei
because I understand we will be using their products to make our shower
watertight. My cycling daughter works
for Rapha, and has sometimes been approached for articles emphasizing cycling
for women. When she was a baby I would
not have envisaged her one day going public on the virtues of cycling without
knickers.
I am not a particular fan of motor racing. Formula 1 consists of cars whining their way
around the track using vast amounts of fossil fuel with often very little
happening, until eventually someone waves a chequered flag. But seeing that it was being transmitted from
Silverstone yesterday, I tuned in for the last few laps. What a race!
Perhaps the most dramatic finish ever seen (now that’s a ridiculous
hyperbole), but almost as soon as I switched on, Bottas almost came off the
track as his tyres started to delaminate, and Lewis Hamilton, who had built up
an enormous lead over Verstappen began to experience the same thing on his
penultimate lap. With the cars sliding
all over the place, sparks flying from the ground contact, and Verstappen
rapidly overhauling him, Hamilton crossed the line with not a moment to spare
as bits of rubber flapped wildly in the breeze.
Apparently it was unusually hot for Britain, which led the tyres to
deteriorate more quickly. Friday was
again a very hot day, up to 38 deg C at Heathrow.
To more serious matters.
It has worried me for some time that the Twittersphere is filled with
grudge holding junior doctors, seemingly with the world, or at least a chip, on
their shoulders. Everyone on Twitter is
always right, and it is not a place for reasoned debate. But it distressed me when I read a Tweet from
a junior doctor saying ‘Finished my last ever A&E shift, thank heavens,
1/10’. Are things really as bad as
that? Are they in the wrong job? The expectations of young doctors are
ridiculously high it seems to me. If
life isn’t perfect all the time they take their moans to the world in 140
characters. I thought that the days of
the great autocratic consultants had gone, but I am not entirely sure about
that. Our own experiences of 50 years
ago at UCH filled us with a burning ambition to be better, kinder, more
tolerant, and I’m upset if things have not improved. For the whole of my medical career I tried to
remain connected to my juniors, to help and to instruct, to support and take an
interest in them. It pleases me that so
many of them now fill excellent posts in Medicine and Cardiology. In Nottingham for instance, as a junior, one
could rarely have wished for more supportive consultants than I worked for
there. Nottingham was an interesting
place to work. Many of the older consultants
(before my arrival) were smokers, and had hit the buffers in the late 1960s, so
the people I worked for, with the exception of one lovely older and avuncular
consultant, were young, dynamic, and enthusiastic.
I was reminded of Nottingham particularly because one of our
teachers there, who had also trained and worked for the same boss as I at UCH,
has written a letter to the Telegraph about stethoscopes. This was occasioned by a feature in the
Telegraph on 27th July by Dr Michael Fitzpatrick, about
‘point-of-care-ultrasound’ which suggests that the stethoscope is now obsolete.
Fitzpatrick states that stethoscopes are
rarely cleaned, potential vectors of infection, and that they are of little use
in assessing heart and lung disease.
Peter Toghill disagrees. ‘For
diseases such as lobar pneumonia, heart failure, pericarditis and pneumothorax,
using one can provide a working diagnosis with seconds’. It would be sad to see the stethoscope
disappear. Most of the personnel one
sees in hospital wearing one are no longer doctors – nurses, physios, care
assistants. Indeed I have observed
several of my younger cardiology colleagues doing ward rounds without a
stethoscope. Armed with the latest
ultrasound, CT, and MRI imaging reports about their patients, they do not need
a stethoscope. The problem is – about
99% of those who carry a stethoscope do not know how to use one properly. And some of the cheaper clinic stethoscopes
are almost useless. An experienced
cardiologist can diagnose, for example, mitral valve prolapse, in a few
seconds. I recall once watching a very
famous cardiologist place his stethoscope on the chest of a patient for about a
second. When challenged about whether he
could reach a diagnosis so quickly, he merely replied; ‘I knew already what I
was going to hear.’ As Toghill says, the
cost per diagnosis made is a fraction of the cost of an ultrasound
machine. But the limitations of the
stethoscope are well known. When I was a
medical student, I was asked to present a case blind to the senior students’
round at UCH by Peter Heaf, the famous chest physician. One had to go to talk to the patient and
examine them, but not look at the notes or investigations, and then reach a
diagnosis. I saw the lady, a very
pleasant person in her 50s, who was obviously distressed and short of breath. I did the examination assiduously and carefully. The venous pressure seemed normal, she did
not look anaemic. I listened to her
heart and chest, felt for lymph nodes, checked the abdomen. Nothing.
Terrified I walked into the lecture theatre. Heaf asked me to present the case. I did so.
‘And what were your findings?’ he enquired. Shamefacedly I had to admit that I had found
nothing wrong except that she was clearly very breathless. ‘Yes, that’s the whole point’, said
Heaf. He then posted up the chest
X-ray. A myriad of abnormal white
shadows, all over the lung fields, was evident even to the first year’s in the
back row. The unfortunate lady had
metastatic thyroid cancer. I had missed
the faintest of scars on her neck which might have given a clue, but the point
about the limitations of the stethoscope was well made.
In Britain we seem to be a long way behind other countries
as regards point-of-care ultrasound.
Twenty years ago I had a junior working for me who was from East
Germany. She explained to me that they
had all been taught to use ultrasound in the Emergency Room when medical
students.
But perhaps the last word on the stethoscope should go to
that wonderful doctor, gentle humourist, and subtle educator, the late Michael
O’Donnell. O’Donnell founded and edited a
journal called ‘World Medicine’, which functioned as a sort of Private Eye for
doctors, though that is probably to belittle it. Amongst other iconoclastic articles, well-known
doctors were also asked to contribute a ‘Mea Culpa’ column, where they talked about
their own mistakes for the interest and benefit of others. I doubt that the lawyers would permit it
nowadays. I particularly remember an
article by an anaesthetist who worked for a surgeon who was never sober after
about 8pm, though apparently during daytime hours he operated well. He knew that the surgeon refused to operate
on a patient unless blood was available in theatre for transfusion if
necessary. Knowing this, and called to
an emergency operation late at night, he pretended to trip on entering the
operating theatre with two (glass) bottles of blood, which of course smashed
and spilt on the floor, thus preventing the operation from taking place. Cursing the anaesthetist, the surgeon left
for home, returning sober to complete the operation in the morning. As you will realise, the fact that the blood
was contained in glass bottles means that this happened a long time ago. O’Donnell first wrote about the stethoscope
in this magazine. His article was
hilarious, and he had toned down some of the anecdotes by the time he came to
write the British Medical Journal article in 2008 cited below. On one occasion, he was asked to visit and
examine an attractive lady who was known for her dalliances. At this point, I should mention that when a
heart murmur heard through a stethoscope is very loud, the vibrations travel to
the surface of the chest, and are palpable.
This is called a ‘thrill’ and often implies serious disease. O’Donnell, prior to placing his stethoscope
on this lady’s ample charms, as she rapidly peeled off the flimsies she was
wearing, placed the flat of his hand over the heart. ‘What are you doing?’ enquired the lady,
fluttering her eyelashes provocatively.
‘Madam, I am feeling for a thrill’, said O’Donnell. She removed his hand and placed it firmly at
a much lower spot of her anatomy. ‘If
you try there’, she said, ‘we could both feel a thrill’. O’Donnell, we are informed, remained
professional. Otherwise it is clear that
the story could not have been recounted.
Here is his marvellous reply to Des Spence, a Glasgow GP, who asserted in
the BMJ that the clinical examination was outdated. Sadly, in the Coronaculture of telephone
consulting nowadays, what Spence requested might come to pass, but here is
O’Donnell at his best:
‘Salute to the Stethoscope’
BMJ 2008; 336:1326.
‘Is Spence really unaware of the pioneering work of the
postwar generation of general practitioners who established the stethoscope as
a valuable aid not to auscultation but to meditation? I can still recall the thrill of discovering
that if I placed the business end of my stethoscope over an inert portion of a
patient and used the other ends to plug my ears, I could create the perfect
ambience for contemplating not just trivial problems such as “What is the matter
with this patient?” but more serious ones such as “What is his or her name?”,
or “What crisp, reassuring, non-discussion provoking phrase will get me out of
here in time to watch the football on television?”
The beauty of this clinical manoeuvre is that the very act
that enables you to struggle with your own problems gives your patients the
impression that you are thinking deeply about them. As a result, you can make decisions free from
the pressure of time. The longer you
take, the more your patient is impressed by your thoroughness.
Sophisticates improve this empowering quality by bunging the
earpieces with cotton wool to eliminate distracting sounds that may intrude if
they inadvertently place the instrument over the heart or other noisy
organ. Sound proofed stethoscopes are
particularly useful for dealing with talkative patients whom a doctor can halt
in full flow by applying the instrument to their chests and telling them to
breathe deeply.
Over the years, doctors have found many uses for the stethoscope
– as a tourniquet, a paperweight, a hook for retrieving hats that have fallen
behind chests of drawers, and an effective binder for boxes with loose
lids. I knew a senior doctor who used an
old stethoscope to keep his trousers up, and a junior one, who, when faced with
a personal credit crunch, would use his stethoscope to siphon petrol from cars
left overnight in the hospital car park.’
They don’t write them like that anymore, and especially not
on Twitter.
Oh, and by the way, it is a beautiful day.
 |
| Borage flowers awaiting a date with a summertime glass of Pimms |
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