CORONA DIARY Chapter 25 - November 8th to December 23rd, 2021

 

Thursday November 25^th, 2021

Winter dawn from Crichel Point

 

‘…we are here, as on a darkling plain

Swept with confused alarms of struggle and flight,

Where ignorant armies clash by night.’

 

Matthew Arnold (1822-1888) wrote ‘Dover Beach’ shortly after his marriage, in 1851.  The personal romantic feeling in the earlier stanzas is eventually replaced by a pessimism about the world, and a more realistic reflection of one’s insignificance in it.  But in November 2021, with the coronavirus pandemic refusing to go away, we have seen the clashes of ignorant armies in Belgium and Vienna, as passionate antivaxxers and right-wingers who prize personal freedom above other societal considerations have rioted, clashed with police, and torched vehicles and public buildings.  There has been a substantial rise in cases in some continental countries, particularly Austria, where there is now a complete lockdown and a mandatory order to be vaccinated in the absence of any contraindication.  There are many personal freedom espousing Brits (‘My body, my choice’ is the usual rallying cry) who object to vaccination.  In France, the imposition for mandatory vaccination for healthcare workers has seen the vaccination rate jump from about two thirds to ninety-nine percent.  Belatedly, this will be the norm in the UK, but only from next year.  Letters in the papers point out that as children, we were all routinely vaccinated against smallpox without demur.  Many countries in the past refused entry to those who were not in the possession of a yellow fever vaccination certificate.

 

All scientific advances bring problems with them.  The internal combustion engine, for example.  The identification of nuclear fission.  But the internet, the pace of data exchange, Facebook, Twitter, have brought to moronic millions the same misinformation, the same tribal fears, that characterised the inquisition and the Salem witch trials.  It seems extraordinary that in this modern world there are so many deluded people.

 

This segue leads me on to a favourite writer, young but highly skilled at the art of satire.  One could argue that he learned it as a parliamentary sketch writer, where so much is risible, Michael Deacon of the Daily Telegraph.  His ‘Way of the World’ column extends the gentle art of politician baiting to the world outside Westminster.  He writes:

 

Michael Deacon

COLUMNIST

13 November 2021 • 7:00am

“Student activists come in for a lot of flak these days. Personally, though, I think we should try a little harder to understand why they behave the way they do. Because they deserve our sympathy.

It may sound hard to believe. After all, practically every week we learn of some fresh outrage they’ve perpetrated. A no-platforming here, a cancellation there. In the past few days alone, we’ve read about a mob of activists trying to intimidate the Israeli ambassador after she gave a guest lecture at the London School of Economics. Meanwhile, a debating society at Cambridge thankfully abandoned a proposal to create a “blacklist” of visiting speakers.

Recently we’ve seen a professor at the University of Sussex, Kathleen Stock, driven out of her job by student activists who wrongly accused her of transphobia. There are countless more examples, but in particular I think it’s worth recalling the time Amber Rudd, the former Home Secretary, was invited to address a society at Oxford – only to find her appearance cancelled just half an hour before she was due to speak after objections from Left-wing students.

All these developments are troubling. Ultimately, though, I don’t think it’s the students themselves who are to blame. It’s whoever encouraged them to go to university in the first place.

The sad truth is that these days, our universities contain far too many people who shouldn’t be there. People who simply aren’t cut out for higher education, and who don’t understand what it’s for. People who aren’t capable of participating in the free exchange of ideas, or of grasping an opposing point of view. And yet they’ve been raised to believe that they must go to university, no matter what.

Frankly, I feel sorry for them. Sending these poor morons to do a degree is cruel. It’s like making a bear learn to dance. Yes, with sufficient training the bear can just about do it, after a fashion. Fundamentally, though, it’s an affront to the bear’s dignity – and the experience is liable to drive it mad.

This, I suspect, is what’s happened to these student activists. Unable to adapt to a world that requires intelligent discussion and critical thinking, they lash out, by holding furious demonstrations against lecturers, and trying to smash the car windows of visiting speakers. The poor creatures can’t help it. They don’t know any better.

In my view, it’s time we ended this cruel practice of sending morons to university. As for the activists who are already there, the kindest thing we can do is to expel them all at once. They’ve suffered long enough”.

 

 

Breeze and sunshine in Poole Harbour

 

Late night view of Poole Harbour entrance; Brownsea Island and castle on the left

Sunday November 28^th

 

We have a new variant of coronavirus, the omicron variant.  This has slightly different clinical characteristics, and multiple mutations in the ‘spike’ protein, and was first picked up in South Africa.  Two planeloads of arrivals in the Netherlands from South Africa identified over 60 positive cases – about 10% - what on earth is happening to this ‘testing before travel’ policy?  We await further news, but there is a reintroduction of facemasks in shops and on public transport from Tuesday.  The naming of the variant is intriguing.  The last one I heard of was delta, so where have epsilon, zeta, eta, theta gone?  (Showing off my knowledge gained from Greek ‘O’ level).  Apparently the next names on the list were ‘nu’ and ‘xi’, but nu was thrown out because Americans couldn’t distinguish nu from ‘new’, and xi was felt to be a little close to home, being the name of the Chinese leader.  A wry distinction.

 

Saturday December 4^th

 

It is hard to know where to start.  The lockdown diary was an everyday activity.  Life is more or less normal these days.  There seems so little time to record the many happenings.

 

Perhaps best to start with the big things.  Christmas is coming and we are usually assailed (should that be wassailed?) with warnings how few shopping or posting days there are until Christmas.  Graham Norton (comedian) announced last night that President Joe Biden has stated that there are only ’20 more sleeps until the end of the day’.  And ‘Sleepy Joe’ is seen as such a soft touch by world leaders that Putin (Russia) has amassed, almost without comment, huge numbers of troops on the border with Ukraine.  This is possibly the most directly worrying situation.  What will NATO do about this?  Hard to second-guess it.  In the early 1960s, General De Gaulle wanted to pull out of NATO.  He mentioned this to Dean Rusk, U.S. Secretary of State.  ‘I want all U.S. Military out of France as soon as possible’, he said.  Rusk replied, ‘Does that include those who are buried here’?

 

There are disastrous famines in Northern Kenya.  Ethiopia is virtually in a state of civil war after Tigrayan incursions.

 

Let us start on a different tack.  ‘All institutions outlive their usefulness’.  Discuss.  A feeling I have had about the Royal College of Physicians for a number of years.  The College has recently weighed in with its advice about the management of M.E. syndrome.  M.E. stands for Myalgic Encephalomyelitis, a term which only doctors can understand.  M.E. is a puzzling entity, which probably encompasses a number of causes for the fatigue, lethargy, loss of energy and ‘get up and go’, together with difficult to describe aches and pains that characterise sufferers.  Sceptics generally accuse sufferers of ‘lack of moral fibre’ or say ‘Get a grip’.  There are sufficiently well-attested cases to show that there is some, as yet undefined, reason behind this syndrome.  One of the most famous is of course, Clare Francis, yachtswoman, author, businesswoman, high achiever, whose life went on hold for a number of years after experiencing M.E.  Our medical assessment organisation, NICE, the National Institute for Clinical Excellence, has recently announced that exercise programmes are not recommended for M.E., despite testamentary evidence that some sufferers find it helpful.  The Royal College of Physicians has countered this statement with the delightfully obscure advice that sufferers should have a ‘Person-centered Energy Management Programme’.

 

The Royal College, a bit like the Royal family, tries to reinvent itself from time to time.  ‘Ars longa, vita brevis’, is its motto.  ‘The art is long, the life short’, is the translation.  The College usually invokes the Latin, rather than the original Greek from Hippocrates:

Ὁ βίος βραχύς,

ἡ δὲ τέχνη μακρή,

 

(The meaning is the same).

 

When I gained the Membership of the Royal College, in 1975, after paying the necessary fees, I attended the welcome dinner for new members, at which the President, Sir Cyril Clarke, pointed out that this was the only thing we were likely to get for free from the College (he was right in this, at least).  He welcomed all of those who had got there by their own hard work, rather than the ‘Pappworth’ short cut.  Maurice Pappworth (1910-1994) was a gifted physician, ethicist and teacher who was denied advancement in Medicine, initially for anti-Semitic reasons, and eventually had to set himself up as an independent consultant in London.  He established a coaching and training programme, which dramatically enhanced the pass rate for the MRCP, and wrote an excellent book, ‘A Primer of Medicine’.  Practical examination, interview, and clinical demonstrations were a part of his technique.  Nowadays this sort of training is regarded as essential.  Pappworth further distanced himself from the establishment by publishing ‘Human Guinea Pigs’, a book detailing unethical medical research.  These efforts eventually led to better surveillance of research applications.  Even in 1975, he obviously remained persona non grata, but his methods are now copied by the college and commercial teaching companies.  He was eventually awarded an honorary fellowship – a year before he died.

 

A rather obscure, but good record from the 1960s, has surfaced as an advertisement on TV for something or other.  Lesley Gore’s ‘You don’t own me’.  The lyrics: 

‘You don’t own me, I’m not just one of your many toys’ clearly prefigure the more trumpeted ‘Girl Power’ era of the Spice Girls in the mid-1990s.  There is nothing new under the sun.

 

To return to omicron.  Doom and gloom pervades.  The Prime Minister has announced mandatory mask wearing again on public transport and in shops.  Hospitality is exempt (I suspect this is because of difficulties with enforcement).  Germany is reportedly considering the introduction of mandatory vaccination.  But there are many who feel that omicron is unlikely to represent a significant change in threat level.  A colleague whose wife is an emergency care doctor tells me that she has eventually succumbed to the frustration and exasperation of dealing with yet another anti-vaxxer being admitted with serious complications of Covid-19.  Last Christmas there was a late announcement that forbade us from staying with family.  There is nervous expectation about this Christmas.

 

But, on another note (forgive the pun), I attended a Bournemouth Symphony Orchestra concert at which the new artist-in-residence, Felix Klieser, was due to play the Mozart 4^th Horn concerto.  I hadn’t read his biography beforehand.  I, and many of the audience, were astonished when Klieser accompanied the conductor to the podium.  He had no arms.  Seated in a chair, his horn mounted on a fixed bracket, he slipped off the clogs he was wearing to reveal bare feet.  He used his left foot to operate the valves.  Remarkable and inspirational.

 

Wednesday 8^th December

 

There is ‘trubble at t’ mill’, or rather, at Yorkshire Cricket Club.  In fairness, this is now an old story, having been reverberating in the cricket world now for weeks.  Azeem Rafiq, a Pakistani cricketer who was under contract to Yorkshire has detailed multiple racist remarks and victimisation by Yorkshire and Yorkshire players.  Many Yorkshire administrators and coaches have resigned or been sacked.  Michael Vaughan (ex England captain) has been accused of saying ‘There’s too many of you lot’.  And yet it emerges that Rafiq himself was guilty of anti-Semitic texts some years ago.  The response smacks of slightly disproportionate ‘wokeism’.  Cricket fans have been wont to call teams by nicknames – the Aussies, the Poms (that’s us), the Windies, the Banglies, and, heaven forbid, the Pakis.  Taken logically, Paki is a reasonable term – the short addition ‘stan’, meaning the place where the ‘Pakis’ live.  But used in an individual sense, e.g., as a term of abuse in the U.K., viz ‘Bloody Paki’, the name is clearly abusive and inappropriate.  There is a certain sense of helplessness here when one tries to negotiate these terms, and Pakis is now on the red list of terms which have come to be regarded as the same horror as n----r.  I’ve only got one grudge against the Pakistanis – spending a whole day in July 1967 at Taunton cricket ground watching Hanif Mohammed accumulate one of the slowest centuries on record against Somerset C.C.C.  Apart from a slight tendency for active Pakistani terrorist minorities to attack buses of cricketers, that is.  Wokeism remains rampant.  John Cleese (comedian) has cancelled himself from universities, before he was cancelled by them.  Henry Morton Stanley, the explorer and colonial administrator, has narrowly escaped having his statue removed from Denbigh, after allegations were made that he employed slaves (it seems this was not true), but more seriously because he explored the Congo region as an agent of Leopold II of Belgium.  Again, it seems that Stanley had no foreknowledge of the atrocities, which would be perpetrated by the Belgians.  A narrow squeak for Stanley, but Edward Colston will not regain his plinth in Bristol, and Colston’s School will be renamed next year.

 

Carving of the 'Green Man', English Oak vineyard, Lytchett Matravers, Dorset - walking group walk, Friday 17th December

Tuesday 14^th December

 

Writing this in the very early morning after waking at 0430.  It’s not full moon for another four days, so there is no obvious reason for being wide awake.  For the UK, omicron is the only story at the moment.  But the USA has suffered a tornado in Western Kentucky, which was more devastating than any ever seen before.  A 200 mile swathe of destruction has killed many and completely destroyed towns in its path.  Global warming again, perhaps?  Current events certainly give one a sense of human insignificance in the face of global forces.  We used to joke about the extinction of the dinosaurs, but now that seems a bit close to home.  Nonetheless, to plow on with life on earth, or in our patch of it: the Government (viz Boris Johnson) has announced a return to working from home if possible, or ‘Shirking from Home’ as one correspondent wittily dubbed it.  Most hospitality venues, despite being officially open, have seen large numbers of cancellations.  The omicron variant is more transmissible than others, and the doubling time for UK infections is now only two to three days.  A Machiavellian response to this has been the conjecture that maybe the exposure of most anti-vaxxers to the virus will at last bring about a herd response and substantial natural (herd) immunity.  The variant is allegedly less severe than delta, but already the first UK death from omicron has been recorded.  An almost impromptu address to the nation on Sunday night by the prime minister has urged people to get booster jabs and announced a massive roll out of action to facilitate this.  Unfortunately, the website to get lateral flow tests crashed, as did the capacity to book jabs.  Great idea, but the logistics failed to keep pace.  Can’t understand why our local surgery has still not asked me to attend to vaccinate, despite having jumped through all the hoops required, even including signing a contract (but see below).

 

The Government, or at least the Johnson coterie, has seemingly been riding roughshod over its own rules of late.  The rumours of an industrial fat-cat bankrolling the redecoration of Boris’s private apartments have (almost, it seems) been substantiated.  Allegations, and some video evidence, of parties in Number 10 at Christmas last year, have surfaced, together with an embarrassing video of the press secretary, Allegra Stratton, joking about it.  She has resigned in tears.  An amusing Instagram post shows Boris in front of Number 10, Downing Street, denying the rumours while coloured lights and music play in the windows behind him.  As usual Matt has the best take on this:

 

 

 

 

Any public servant, including even my role as a public hospital governor, has to adhere to standards of behaviour, enshrined in the Nolan principles, put forward by Lord Nolan in a government task force in 1994.  These are: selflessness, integrity, objectivity, accountability, openness, honesty, leadership.  Quite a lot to live up to.  A letter in the Telegraph suggests that Boris’s knowledge of the Nolan principles is limited to asking when the sisters’ next reunion tour is going to be (for readers outside the UK, the Nolan Sisters are an Irish group who grew up in Blackpool and pioneered the way for many girl groups to follow.  They were most prominent in the 1970s and 1980s but have reformed sporadically since).

 

Thursday December 23^rd

 

And more party pictures – this time of a summer garden party, with quite a few present, including Carrie Johnson.  Protestations that this was a working meeting, but dubbed by some – a Cabernet Meeting.

 

First day of vaccinating for me, at an Army Reserve Centre.  An interesting experience, and good to discover that sticking needles into people is a bit like riding a bike; one automatically remembers how to do it.  Interesting mix of vaccinators – a medical student, some Royal Marine Commandos, a couple of Army professional doctors, and a local GP.  Efficient use of the Army squaddies, with vaccine being diluted, drawn up, and a syringe appearing magically at your right hand like a white rabbit from a conjuror’s hat.  A walk-in clinic, though not that many attendees, it being two days before Christmas.  Most of the clients are for booster jabs, but one elderly gentleman attended for his first ever vaccination.

An apposite Private Eye cartoon - it is Christmas after all

 

Trouble with Lindsay’s knee, which is very limiting, and her MRI scan exhibits a substantial catalogue of pathology.  Our Christmas present to ourselves is therefore an exercise bike.  As encouragement one can watch the screen while pedalling over various hills worldwide, and be shouted at by a woman with a Californian accent who instructs you to ‘Get up out of your seat’ (I remember the Evangelist Billy Graham used to have that as a catchphrase) and occasionally to ‘floor it’.  After a session or two, I chose to link my phone to it and enjoyed listening to Peter Phillips talking about Renaissance Polyphony.

 

Covid-19 is really worrying people now.  The omicron variant is much more transmissible than others, with a doubling time of only two or three days, but it also appears less virulent.  After days of deliberating, the government has announced that there will be no new restrictions at Christmas time, allowing families to gather and to be together.  There are newer anti-Covid therapies available, and a combination of dexamethasone and spironolactone seems useful in reducing risk of severe disease.  We have known about dexamethasone since the early days of the Covid clinical trials, but the addition of spironolactone (the combination is known as Spidex) seems helpful too.  The rationale for this is that spironolactone binds to and is an antagonist of angiotensin II receptors – and it is these cell surface receptors that the virus spike protein hooks on to in order to gain cellular entry.

 

I’m ending this pre-Christmas blog by not only wishing all a peaceful and happy time, but by making a plea for Paul Simon to get the same recognition as Bob Dylan – namely the Nobel prize.  Perhaps Paul Simon’s lyrics are not as deliberately obscure as Bob Dylan’s (obscurity is beloved by Nobel committees), but they are as skilfully and memorably constructed.  Look at the lyric of virtually any Paul Simon song – it is fantastic.  Here is just one memorable first line, and if you are not an aficionado of guitars please Google ‘National Guitar’, especially the Tricone design dating from 1927.  ‘The Mississippi delta was shining like a National guitar…’  Unfortunately, one often gets beguiled by the music (tune) and fails to pay attention to how memorable the words are.  This is a point that can rarely be applied to some of Dylan’s dirges.  To be fair to Dylan, very early on in his career, academics – chiefly Professor Christopher Ricks of Oxford and sundry other universities, have been rhapsodizing about his way with words.  But it’s time for us to stand up for Paul Simon.  Paul Simon is a true poet.  It is the way of the world for authors who are popular not to achieve major prizes.  John Betjeman is a good example.  As regards Nobels?  See October 8^th entry re George Bernard Shaw.  Happy Christmas everybody.

 

Corona Diary Chapter 24 - September 15th to November 8th, 2021

CORONA DIARY CHAPTER 24

Friday September 17th

 Ring-a-ring o’roses

A pocket full of posies

A-tishoo Atishoo

We all fall down

 When training in medical school we were told that the rhyme had its origins in the fear of typhoid fever – the characteristic rose red spots of severe typhoid being found on the anterior trunk, perhaps in a ring distribution.  But every reference I can find to the rhyme indicates a link with the plague, and I can’t find any reference to typhoid.  The rash of the plague is not a ring however, and plague antedated this rhyme by several centuries.  Sneezing is not a strong feature of either illness, but the myth persists.

 

A recent interview with a musician has related how pleasant it is to go to a concert and not to be assailed with coughing and sneezing.  When concerts opened up after the first lockdown, the slightest cough or sneeze would be enough to have the entire audience look at the perpetrator accusingly.  Social distancing, lack of transmission of ‘flu and other viruses, together with the most vulnerable – coughers, asthmatics, COPD sufferers not attending, have all contributed to a blissful listening experience.

 

The weather continues calm and the early morning swimming has become quite addictive.  A bit like running, the endorphin release afterwards is a pleasurable experience.

 

Early morning, Branksome Chine

Tuesday September 21^st

 

The equinox.  The weather remains beautiful.  A visit from a relative from the U.S. yesterday sees us enjoying lunch outside.  A small reminder of climate change: he has not lived in the U.K. for many years.  He observes how strange it is to see grown men walking around in shorts in Britain in September.  Today the walking group met near Badbury Rings and enjoyed five or so miles of countryside walking in warm weather with the oblique sunlight and long shadows from the trees and hedgerows creating a blissful rustic idyll of sunlight bouncing off the small stalks of the harvested wheat.  The burry heads of the wild clematis (Old Man’s Beard) top the hedgerows.  A final circuit around one of the ramparts of the rings, dating from two and a half thousand years ago and we are back to modern life, waiting beside the racetrack of the road through the avenue of beeches to cross back to our starting point.

 

Early morning mist over Parkstone Golf Course, 22nd September

Wednesday September 29^th

 

I wrote before about alternative scenarios; the dystopian novel, etc.  The book club is reading HHhH by Laurent Binet.  A book about Reinhard Heydrich, the chief of the Sicherheitsdienst, the German ‘Security Service’.  The style is extraordinarily irritating.  A historical novel, more faction than fiction, where the author breaks the Fourth Wall on a regular basis.  But the French perspective on many aspects of WWII is interesting.  He quotes a book by Ėric-Emmanuel Schmitt, ‘La part de l’autre’, in which Hitler passes his art diploma instead of failing or dropping out.  “From that instant, his destiny and the world’s are completely altered: he has a string of affairs, becomes a promiscuous playboy, marries a Jewish woman with whom he has two or three children, joins the Surrealists in Paris and becomes a famous painter”.

 

The author expresses his disgust of realistic novels.  His girlfriend finds a quotation from a French author’s life of Bach.  ‘Has there ever been a biographer who did not dream of writing, “Jesus of Nazareth used to lift his left eyebrow when he was thinking”?  ‘Yuk’!  He says.

 

Anybody who reads this might accuse me of being one of the musicians on the deck of the Titanic, reading minutiae, ignoring the important matters of moment that preoccupy the nation and indeed, the World.  But it is in the small pleasures, the tiny details, the ‘plaisanteries’ that we live our lives, and many of us are grateful for that.  We have food, we have enough to get by, we have good partners and friends.  We cannot be perpetually worried about the world order, like the Labour Party, who are meeting in Brighton at the moment.  Michael Deacon, the parliamentary sketch writer, has drawn attention to Sir Keir Starmer’s plans to tax the Public Schools (private schools), and withdraw their charitable status.  They will go bust.  ‘Where will the next generation of Labour leaders come from’?  Deacon asks, enumerating the very long list of Socialists who attended fee-paying schools.  Where indeed?

 

And after some torrential rain, it is once again sunny, though the morning dip was slightly more chilly than of late.

 

Thursday September 30^th

 

‘The big ship sails on the Ally-Ally-O,

The Ally-Ally-O, the Ally-Ally-O,

The big ship sails on the Ally-Ally-O

On the last day of September’.

 

The children’s nursery rhyme becomes an ear-worm as we congregate at the beach again for another 0730 swim.  As I gurgle along in my pathetic front crawl, I remember the last verse… ‘The big ship sank to the bottom of the sea, the bottom of the sea, etc’.

 

Friday October 8^th

 

“I can forgive Nobel for inventing dynamite, but only a fiend in human form could have invented the Nobel Prize”.

 

George Bernard Shaw, who also rejected a knighthood, attempted to refuse the Nobel Prize for literature in 1925.  It was the financial award that particularly irked him; he pointed out that he had more than enough to get by.  It is Nobel time of year again, and there was much discussion on Radio 4 last night as I drove home from the beautiful West Sussex Golf Club.  The presenters were firmly of the opinion that the pioneers of the mRNA vaccine should receive the Physiology and Medicine and Chemistry awards, though I believe that Emmanuelle Charpentier and Jennifer Doudna were responsible for much of the gene-editing technology and were recognised in 2020.  A spokesman for the Nobel Committee merely said that, to paraphrase, off-the-cuff awards, in response to public opinion, were often not the best decisions.  Aforementioned: ‘Political satire became obsolete when Henry Kissinger was awarded the Nobel Peace Prize’ (Tom Lehrer).  One of the worst, perhaps, among many, was the 1918 Nobel award to German chemist, Fritz Haber, who synthesized ammonia from nitrogen and hydrogen gases, paving the way for agricultural fertilizers.  Sounds appropriate, yes?  Except that Herr Haber was an enthusiastic proponent of and adviser on the application of poison gas utilization in World War I.  And there are many more.

 

The literature award for 2021 sounds particularly ‘woke’, an author called Abdulrazak Gurnah.  Born in Zanzibar in 1948, Gurnah lives in the UK and has for many years lectured at the University of Kent.  The citation states ‘uncompromising and passionate penetration of the effects of colonialism and the fate of the refugee in the gulf between cultures and continents’.  But in looking at the list of laureates from inception to the present day, there are only a few eyebrow raisers – authors hugely popular in their time but not so frequently read today.  Galsworthy, Saul Bellow, William Golding, Mikhail Sholokov (His book ‘And Quiet Flows the Don’ was on the list of 100 ‘must reads’ from my headmaster before we left school).  Kipling (recipient 1907) probably wouldn’t get a look in nowadays since he is branded as an unreconstructed colonialist (not my view).  The more I have read about Gurnah, the more it sounds as though he has been quietly ploughing his own furrow, and the shock of such recognition has come as a complete surprise.  His work sounds interesting.  I will order ‘Paradise’ which was a Booker shortlisted issue in 1994 and sounds a good one to start with.

 

There was euphoric praise also on the radio for Cush Jumbo’s portrayal of Hamlet at the Young Vic theatre.  Fortunately, very few people read my blog, but to criticize the glowing statements about the production (first black female Hamlet) and Cush’s charisma seems churlish without my having seen it.  It will be streamed soon, so I should try to watch it.  Some may know of my addiction to Hamlet, which was first stimulated by performing a small part in it at school in Bath in the 1960s, and watching John Oliver, in my opinion one of the best ever poetic verse speakers, play the role.  John (sadly deceased), became a minister in Cape Town, South Africa.  I can imagine that to hear him speak in church was profoundly inspiring.  On searching for his official title (merely Fr John Oliver), I can see that he was such a revered figure in South Africa that a series of lectures is now given in his honour, the first lecture in the series being delivered by the Rev Peter Storey, a long-time fighter against apartheid, and a key figure in the Cape Town Interfaith Initiative, which was I believe started by John.  It seems unlikely that the major religious figures in South Africa will read this blog, so I will retail the unfortunate fact that John would give us readings from a variety of ‘smutty’ books in the Senior Prefects’ room during lunch breaks, because we loved the sound of his voice.  I must add that this was very much at our behest.  ‘Candy’ by Terry Southern and ‘Lady Chatterley’s Lover’ were particular favourites.  I can still hear his beautiful voice saying, “’Oh gosh’, said Candy”.  Fortunately, John moved on to more spiritual recitations.  I cannot leave Hamlet without stating that the best ever version of it (again, my opinion), is the 1964 Russian film starring Innokenty Smoktunovsky, filmed in black and white, using the fortress of Ivangorod on the Russian-Estonian border for the castle scenes.  The play is cut (to good effect – original performances of the entire First Folio, or amalgamations of the Quartos and Folios run to well over four hours; it is Shakespeare’s longest play).  The powerful music is by Shostakovich, the translation by Boris Pasternak, and the director, Grigori Kozintsev spent 10 years working with and producing the Pasternak version on stage and then on film.  The dialogue is in Russian, which has a magically poetic and resonant sound, and the Shakespeare text appears as subtitles.  Wonderful.  Even Olivier acknowledged Smoktunovsky’s performance as better than his own.  See: https://thescriptlab.com/features/screenwriting-101/7555-story-behind-screenplay-grigori-kozintsevs-hamlet-1964/

 

Sunday October 10^th

 

A friend who has recently vacationed in France, where his sister-in-law lives writes in condemnatory fashion on Facebook about Britain’s poor pandemic response compared with France.  He’s also clearly not a fan of Boris.  But leaving Boris aside (who seems determined to repopulate the UK with white Anglo-Saxons entirely on his own), it is never easy to tease out the data correctly.  Disraeli’s old saw about statistics (‘Lies, damned lies, and statistics’) seems apposite.  Britain is doing more testing than other countries, so it is therefore highly likely that we will find more cases.  But there are more serious issues afoot.  The rise in cases in Britain is almost entirely due to cases in young people, particularly secondary school pupils.  Case incidence remains low and is not rising in older people.  Of over 51,000 deaths  occurring in the first six months of this year, the proportion of those who were double vaccinated made up only 1.2% of all deaths.  Deaths in doubly vaccinated people are vanishingly low compared with unvaccinated subjects.  In other words, the usual suspects, cancer and vascular diseases are responsible for the vast majority of disability and death.  As if that were not enough, an example from Dorset shows exactly where the strains in the hospital service are: within the last week, the total number of Dorset hospital beds occupied by coronavirus patients is 38; the total number of ‘bed-blockers’ is 200 in East Dorset hospitals alone.  It is not politically correct to call them bed-blockers nowadays.  A little while ago we described them euphemistically as ‘delayed discharges’, but we now call them ‘Patients remaining in hospital who no longer meet the criteria for secondary in-patient care or treatment’ (or at least something similar).  So for a typical 30 bed ward, we have over five times as many patients who need social care as Covid patients.  Governments talk the talk about social care, but the problem is as yet unsolved.  Given that we have one of the lowest rates of bed provision per 100,000 population in Europe (cost-cutting strategies), one can readily appreciate the seriousness of the situation.

 

3rd October.  0400 in Poole Park, the start of my friend's walking virtual London marathon.  Looking across the lake to Poole Hospital

 

And the finish line, 26+ miles later, in the afternoon

Tuesday October 12^th

 

Where to start with recent news – there is so much of it?  In general terms for the UK, the most pressing problems of late have been a fuel shortage and a 250% rise (I still can’t bring myself to call it ‘hike’) in natural gas prices.  The fuel shortage has been due to the dearth of HGV drivers, and the result has been panic buying and shortages at the pumps.  Some fuel stations have limited supplies to essential workers, e.g. in the NHS.  The driver problem has been exacerbated by (but is not exclusively due to) the Brexit-induced return of many foreign drivers to EU countries.  Falling numbers of drivers has been an issue for a long time.  The gas scenario reflects a failure to buy ahead (and thus effectively tie in to a contract) by power suppliers, together with a somewhat Machiavellian strategy by Vladimir Putin, whose second pipeline into Germany avoiding Ukraine has been stalled.  It seems he has reduced the amount available to push up prices.  Multiple labour issues affect many industries: the shortage of abattoir workers and a reduction in Eastern bloc demand for pork has meant that we have a glut of pigs, which cannot be ‘processed’.

 

The issue of GP appointments, or lack of them, continues to surface.  A nice cartoon (see below) cleverly juxtapositions two of the current problems.

 

 

Today it emerges that the data submitted by GPs giving the frequency of face to face contacts is flawed because many of the telephone-only consultations have been included.  Lindsay has had a pain in the knee, very severe at times.  Following the usual ‘e-consult’ the ‘Care Navigation Team’ got in touch and offered at some future date, a ‘telephone consultation with a physiotherapist’.  As a friend said, ‘That sounds like an oxymoron’.

 

The Conservative party conference has ended with what was apparently a barn-storming speech by Boris Johnson, which many critics feel was long on style but short on substance.

 

In the meantime, I report that beautiful autumn weather continues, tempting us to continue swimming, and even tempting my daughter to visit for two days of off road cycling with some friends.  She has recently cycled the TNR (Turin-Nice Rally) with them.  So we are introduced to Lael Wilcox, and her wife, Rue.  I have heard through Anna that Lael, who hails from Anchorage, Alaska, is sponsored partly by her company, Rapha, and somewhat naively I ask what she does.  The answer is ‘cycling’.  They all set off for some fun over in the Isle of Purbeck.  Somewhat embarrassed later to Google the said Lael to find that she is without much doubt the best Ultra-Endurance cyclist in the world.  Her biggest achievement seems to me to be winning the 4,200 mile Trans-Am race, beating not only all other women, but all other men as well.  See: https://www.bicycling.com/racing/a25729046/lael-wilcox-best-ultraendurance-cyclist/

 

Friday, October 21^st, 2021

 

After dramatic storms the last two days have brought sunshine and strong winds.  The water temperature is now 15 deg C, but we haven’t swum for a while because of Lindsay’s bad knee.  Today the Rheumatologist took us through the MRI scans which show some degenerative cartilage changes, tibial separation, bone bruising, and a ruptured Baker’s cyst – none of which would have been visible on plain X-ray.  The knee has now been injected with local anaesthetic/steroid mixture and the hope is that conservative management will settle it down.  It seems clear that vigorous physiotherapy would have exacerbated the pain and inflammation, though presumably the proposed ‘Care Navigation Team’ management from our GP, which was only a telephone call from a physiotherapist, would at least not have made it worse.  How did we manage cases before MRI?!  I suspect that empirical injection of the knee would have been the strategy anyway, so hopefully the end result would be the same…

 

If one writes a diary, the same preoccupations come round every year, and I see that a year ago I wrote about Trafalgar Day (21^st October), so I won’t revisit, except that a friend whose father was a Naval officer in Malta displays several different rums that she plans to sample to celebrate.

 

Newcastle United F.C. have been in the news recently.  The fans have been delighted by the news that a Saudi conglomerate, at least partly bankrolled by the Royal Family of Saud, have bought the club from Mike Ashley (Sports Direct) who has owned the club for 14 miserable years.  Others are not so pleased.  The murder of the journalist and critic Jamal Khashoggi was laid at the door of Crown Prince Mohammed bin Salman.  The involvement in U.K. Football is seen as an example of ‘sportwashing’.  A ‘funny’ on Whatsapp from a friend says that Steve Bruce (Newcastle manager) is likely to be the first premier league manager to be stoned to death before Christmas.  He is of course sacked, but Newcastle’s dire form continues.

Bournemouth footballers warm-up before a game, soon after the announcement that their Number 7, David Brookes, has been diagnosed with Hodgkin's Lymphoma.  All with Number 7 shirts 'Together as one.  Stay strong Brooksy'

 

My thoughts on the disaster which is primary care were aired by James Le Fanu in the Daily Telegraph on Monday 18^th October.  At least the criticism is now propounded by someone who himself is a GP and primary care provider.  James mentioned my name so now I must wait for the hate-mail to arrive…

 

Twitter is the ultimate ego-fest for celebrities.  A 23-second movie of her legs walking is today published (Tweeted) by a TV personality who has recently had a mastectomy for breast cancer.  Why?  It seems to me to mock the thousands of experiences of less famous women who are themselves recovering and recuperating.  Had she chosen to provide some charitable purpose to the video I would have been more impressed.  A few days later and she has posted a picture of the bra she’s been recommended to wear.  All this while a G20 summit in Rome and the COP 26 global warming climate conference is starting in Glasgow.

 

Two weeks ago we endured a difficult drive to London (various roads closed) to take part in the filming of ‘Great British Bake Off – an Extra Slice’.  This is a spin off programme from the GBBO itself.  The reason – our friend, ‘Maggie the Seaside Baker’ as she is now styled, had been in the show and was booted out the previous week.  TV programme makers love an iconic disaster, and Maggie had provided one by forgetting to include flour in her sticky toffee pudding mix.  The programme is hosted by comedians Jo Brand and Tom Allen, and lasts an hour, though we were actually at the studios for nearly six hours.  Multiple retakes, rehearsals, etc.  Maggie is determined to maximise her 15 minutes of fame and is regularly on the radio and social media doing charity bakes, emerging from the sea at Sandbanks clutching a cake, etcetera.  Maggie is baking fit to bust, and in response to a request from me for some ‘kouign-amman’ (Breton butter cakes), appears with a tray of six beautiful examples.

 

With TV star 'Maggie the Seaside Baker'

Kouign-Amman, courtesy of Maggie the Seaside Baker

Monday November 1^st

 

‘It’s Double Summer Time! The hawthorn called’.  Charles Causley (1917-2003) wrote these words in his poem Hawthorn White; and they come to mind today as the clocks went back yesterday, so I am up betimes, to use an archaic phrase, and start back into writing.  Double Summer Time was a world war two strategy to increase the hours of working daylight, and stopped in 1945.

 

Friends from Frome (what alliteration?!) visited this weekend, and we went to see Ralph McTell at Poole Lighthouse.  Nearly 77 he is still touring, and has released a new album, ‘Hill of Beans’, with some of his clever and poignant new songs on it.  All with an autobiographical touch, and gently and whimsically introduced.  A fine acoustic guitar player, and a voice that remains reasonably strong.  He performed songs influenced by two of the great blues/ragtime players, namely Robert Johnson and Blind Arthur Blake.  This is stuff on my wavelength.  Eric Clapton called Johnson the greatest blues player who ever lived.  His death (cause disputed) at the age of 27, could possibly be said to have started the legend that revolves around musicians who have died at that age…  Anyway, thoroughly enjoyed Ralph.

 

Yesterday morning saw the strongest storm that we’ve experienced since living here.  I watched as a fairly heavy patio chair slid across the deck for about 10 yards before being whirled onto the grass.  Torrential rain.  Trees down throughout Dorset and Hampshire.  Today is a calmer day, and our friend wants to go swimming in the sea.  The website tells me that the sea temperature is now down to 14.2 deg C.

 

COP 26 is starting in Glasgow.  The city has narrowly avoided a refuse collection strike, and is apparently plagued with rats.  Extraordinarily some Labour politician has blamed this on Margaret Thatcher (who was last in Government in 1990 and died in 2013), but more considered opinions lay the blame at Nicola Sturgeon’s door in Edinburgh.  There is an obvious grudge in Glasgow at the Lothian-centric approach to Scottish affairs.  The other day, some clever lip reader worked out that the Queen had said to some ladies she was visiting that she would be more impressed if they (Governments) did less talking and took more action.  In this, she surely echoes the thoughts of the nation.  How can they glibly talk of reducing carbon footprint when it seems that there are something like 25,000 delegates at this meeting?  No doubt more to come on this.

 

England, having destroyed West Indies and Australia in the World T20, today see off Sri Lanka, though not without some difficulty.  Magnificent 101 not out from Jos Buttler with a six off the last ball of the innings.

 

Sea swim – probably the last for this year.  Vigorous waves following the recent storms.

Remember, remember, the First of November...

 

Sunday November 6^th

 

Yesterday evening a new first.  Golf at night.  Invited by friends to participate in a tournament at their 9 hole golf club.  I was intrigued to see how this worked.  The balls are similar to golf balls in size and weight but made of solid translucent plastic.  A central core carries a miniature glow stick, which is inserted just before starting.  The course is shortened and the tees and pins are lit with glow sticks as well.  A head torch helps to see the ground and away you go.  The match was played as a Texas scramble so the scores were good, and we managed level par (not enough to win).  Good fun though, and accompanied by the occasional crackle and firework from the surrounding countryside.

Luminous golf ball, pink tee marker, head torch.  What can go wrong?

 

Much comment about the COP 26 hypocrisies: world leaders flying in in private jets, etcetera.  There seems to have been some agreement about reducing deforestation, but a lot of empty rhetoric.

 

Another Matt comment from The Daily Telegraph

I have had a booster jab, and a flu jab.  There is a new drug (which is made again by Pfizer), called Paxlovid, (and there is another produced by Merck, molnupiravir) which, given with a standard combination antiviral ritonavir, reduces the risk of severe Covid-19 illness or death by 90%.  The drug is a protease inhibitor, which inhibits intracellular viral replication.

 

I’m reminded of the space race, and other endeavours, some sadly due to wartime priorities, which create spin-off technologies to benefit mankind.  It could be that Covid-19 will galvanise medical research to cure many other diseases.  There is even some new treatment (antibody?) which prevents and cures malaria, which is responsible for millions of annual deaths.

 

With regard to the pandemic, it is important to note that daily testing numbers remain relatively static, but actual Covid cases have fallen 13% in the last week, and deaths have fallen by 7%.  The majority of course are in the unvaccinated, but the concern is that over-70s with a history of double vaccination are still succumbing to the disease.  As ever, it is ‘watch this space’.

 

Monday November 8^th

 

Clear night last night but by the morning it is overcast and the temperature is sufficiently high that working in the garden feels hot.  It’s time to publish, so I will end with a comment from a Telegraph reader who expresses concern that the BBC is likely to lose the rights to televise the London marathon.  ‘The only two international events left for it to cover (he says) will be the World Paint Drying Championships and the World Grass Growing Championships.  I do believe that if we can get through the heats we have a good chance of gold in both’.

 

Another dawn

18th Hole, Red Course, Berkshire Golf Club, November morning

6th Hole, West Sussex Golf Club, Pulborough, October morning.  The swan never moves...

CORONA DIARY CHAPTER 23 - July 28th to September 14th, 2021

 

CORONA DIARY CHAPTER 23 – July 28^th to September 14^th, 2021

 

August 5^th, Thursday

 

‘I mean, if Beethoven had been killed in a plane crash at twenty-two, the history of music would have been very different.  As would the history of aviation of course’.

 

A quixotic quote from Tom Stoppard gets us started on the roller coaster which is life today.  Strange non-sequiturs from every side assail us.  The pandemic and the constantly changing rules about foreign travel, quarantining, and so on and so forth.  The Olympics: events for 12 and 13 year olds such as skateboarding.  Issues of sex and gender.  Wokeism.  Is it right to criticise an Olympic presenter because she can’t say her g’s?  Perhaps it is just unfortunate that we have so many sports with a G at the end.  Swimmin’, shootin’, fencin’, boxin’, rowin’, cyclin’, and that is before we switch over to the Affletics to watch the Atherletes.  Why is the BBC employing a footballer as an Olympic presenter?  Is she flavour of the month?  As comedian Kenneth Horne used to say, ‘These and many other questions will not be answered in the following programme’.

 

Looking back on this diary, soon after the first lockdown I made an entry every day.  Life changed daily.  But now, with endless ennui, my entries are fewer.  So to the personal.  The book club has read ‘Old Filth’ by Jane Gardham.  I looked forward to it, having been born in Hong Kong.  F-I-L-T-H stands for ‘Failed in London, Try Hong Kong’.  But although it was an easy read, I found the characters at bottom uninteresting; the denouement unshocking, and the overall effect disappointing.  But I think to some extent that is me – fiction is rarely riveting or enjoyable these days.  At my age we have encountered virtually every plot motif which exists.  Someone once said that there are only two plots: a stranger comes into town; or someone goes on a journey.  Christopher Booker (q.v.) has defined nine plots.  A popular book which I noticed on the shelf of a journalist being interviewed during lockdown cites 20 plots for authors to use.  Fiction, like most things, was at its most exciting when it was new.  So for me that was probably from the age of about seven to seventeen, and even then, as I got older, I chose to read some Zola or Maupassant for variety.  It is no surprise that the older reader prefers non-fiction – it delivers more.  ‘You should read Burke’s Peerage, Gerald.  It is the finest thing in fiction the English have ever done’, said Oscar Wilde.  I remember the excitement and the feeling of empathy reading most of the great Hemingway works in my late teens.  Many years later, perhaps at the ripe old age of thirty, I bought and read ‘Islands in the Stream’, his last work.  I found it pathetic, predictable, pastiche, like a Sebastian Faulks parody of the author’s early style.  I haven’t touched Hemingway since.  I once had a collection of essays, which sadly I have lost, but which pointed up the unreliability of Hemingway’s analysis of everything from bullfighting to big game fishing.  For example, in ‘The Old Man and the Sea’, which was probably the clincher for his Nobel prize, there is a scene where the Old Man tells the boy, as he has a bite on the line which is at roughly a thousand feet depth, that he knew that this was a male fish.  Of course it had ‘cojones’.  Given the lack of touch or feel of any line at such a depth it would clearly be impossible to assess what fish had taken the bait, much less to assess its sex.

 

Let us move on to other serious writers.  The death of John Woodcock, the Times cricket correspondent, is to be lamented, though at the age of 94, he would probably have been among the first to admit that he had outlived his sell by date.  ‘His opinions’, said the Times obituarist, ‘Were expressed in an elegant but understated style that conveyed gravitas without apparently straining to do so’.  He had a remarkable life, living in a small thatched cottage in Longparish, Hampshire, just across the road from the one in which he was born.  Alan Gibson dubbed him ‘The sage of Longparish’, and the nickname stuck.

 

Before we leave the subject.  ‘There are three rules for writing novels’, said Somerset Maugham, ‘Unfortunately no-one knows what they are’.

 

‘The writer’s best friend is the wastepaper basket’, said Isaac Bashevis Singer.  But the word processor has a habit of retaining the rubbish which is deposited there.  So I crave my reader’s indulgence.

 

August 29^th, 2021, Sunday

 

Bathos: a sequence in a sentence which leaves a distinct feeling of anti-climax, or weakness.  It is often but not always humorous.  When we learned the figures of speech in English literature – perhaps in the fourth form, under Bill Currie, at school in Bath, they had strange names like litotes, metonymy, and pleonasm.  Bill’s example of bathos was taken from Act 1 of Julius Caesar, our set Shakespeare text for ‘O’ level.  It describes the example of Pompey, who the speaker considers to be a truly great Roman.  ‘Many a time and oft/Have you climbed up to walls and battlements/To towers and windows, yea, to chimney tops/Your infants in your arms and there have sat/The livelong day in patient expectation/To see great Pompey pass the streets of Rome’.  Apart from the anachronism of chimneys in ancient Rome, the chimney tops come as something of an anti-climax after battlements and towers.  I thought of bathos and Bill Currie, and Shakespeare, when I came across the following death notice in the Daily Telegraph of yesterday:

 

DUNNETT. – (Wick).  It is with great sadness that we announce the sudden, but peaceful passing of Major Graham Thomas Dunnett TD, on Monday August 23^rd 2021, aged 92 years.  Former Lord Lieutenant of Caithness, ex Seaforth Highlanders and Shoe Shop Proprietor.

Perhaps the obituarist did not need to mention the shoe shop, even in capital letters, after the more remarkable achievements of the late lamented Major?  Though surely a fine example of the literary figure of speech?

 

Is this trivial?  Perhaps.  We have a lot to be serious about at the moment.

 

Most recently, U.S. President Joe Biden pursued the policy initiated by Trump to withdraw troops from Afghanistan.  But military strategists have been dumbfounded by the rapid recrudescence of Taliban incursion and control of virtually the entire country.  It seems that somehow the reduction in U.S. led activity throughout the region, particularly air strikes, allowed the dramatic re-establishment of Taliban rule.  Particularly serious has been the almost immediate regaining of control in Kabul, resulting in an undignified, squalid, and tragic airlift mission, seemingly mostly by British and American forces.  It also seems clear, as if we needed to be made aware of this, that NATO forces (here read mostly EU) could not organise the traditional piss-up in the brewery, and Russia must be licking its lips at the craven nature of any EU organised force.  Trump has made political capital from the failure of ‘Sleepy Joe’, stating that it made the final withdrawal from Saigon (Vietnam War) look like a huge success (true).  Many Afghanis who collaborated with U.S. and Allied forces have failed to get out of the country, and will no doubt be hunted down and murdered by the Taliban.  The final inglorious moment?  Two suicide bomb attacks at the airport, killing many civilians and thirteen U.S. personnel.  This will clearly go down as a black mark against Biden, and may stymie his presidency.  He is now seen as a weak President, but has also reacted badly to criticism by British politicians, which will also probably harm the ‘Special Relationship’.

 

More nostalgia.  Taking out a record (vinyl disc) from my collection to enjoy my indulgence of a newly acquired turntable and hi-fi, a Palestrina mass and motets, I see that I purchased it on August 22^nd, 1969, fifty-two years ago.  I was working in Cambridge that summer, at the University Arms Hotel.  My parents had moved to a remote part of Scotland (Coulport, Loch Long, Argyllshire), where there was almost no other person of my own age.  I spent my spare money earned in the kitchens on classical records…

 

Covid cases have shown a recent surge, with signs of a possible slowdown and even a slight fall towards the end of this month.  Much is normal – at least if you count pop festivals as normal.  We have been to see Bournemouth play football – with a capacity crowd.  Capacity in Bournemouth is about 11,000 people!  Maybe as a consequence of this, Lindsay has been ‘pinged’ and went off for a PCR test today.  Result awaited.  It is nice to know that some other countries seem to be less efficient than the UK.  A friend went to Switzerland recently.  She flew to Zürich, did the requisite tests (negative), but was contacted by Swiss track and trace to say she had been in contact with somebody while travelling on a train in France!

 

We have continued to swim in the sea (water temperature approximately 18 deg C).  I pointed out to a friend who was swimming with us that during hypothermic cardiac surgery, the human heart spontaneously fibrillates on reaching about 25 deg C.  Certainly I have to wear a fleece for the entire morning after an early morning swim.

Branksome Chine, Poole

The ex-Brunstead Place film club (consisting only of Lindsay and I, and formed during lockdown), convened once again the other day and enjoyed ‘Yesterday’.  The idea is original.  A lowly achieving musician has a bang on the head, and when he comes round, the world has changed inasmuch as nobody has ever heard of the Beatles.  He capitalises on this, is befriended by Ed Sheeran who admires his song-writing skills, and becomes an international star.  It has some great touches, and of course, the music is incomparable.

 

But perhaps its originality is just a twist on a number of dystopian ideas about ‘what might have happened if…’

 

More than thirty years ago, I met a musician, a friend of a friend, who was a superb cabaret artist, playing the piano and singing his own songs.  He told me that he was writing his own novel about the sixties based on a similar premise.  His novel started with Marilyn Monroe waking up, in August 1962, having failed to die from the overdose of barbiturates.  In the alternative scenario, Lee Harvey Oswald proved to be an appalling marksman, having failed to hit President Kennedy.  And so on…  I last saw him performing his cabaret act celebrating ten years of coming out and declaring his homosexuality.  It was called ‘Ten Years Out’.  I wonder what became of him?

 

Sunday, September 5^th, 2021

 

A fairly dry period, with high pressure unusually located well north of us.  The winds have been from the north and east.  The system has now moved towards the Baltic, and the winds now being drawn in are from the south, giving a substantial rise in temperature.

 

Yesterday was memorable for several things.  Natalie Clein’s Purbeck International Music Festival has restarted.  The only concert I booked was yesterday evening, in St Edward’s Church, Corfe Castle.  Appearing with Natalie’s guests (and friends) was Stephen Kovacevich.  I last heard him play in about 1966 at the Colston Hall in Bristol, when I was still at school.  At that time he went by his family name of Stephen Bishop, but later took his Croatian father’s name.  So it was a pleasure to hear this now 80 year old musician play again.  After the first piece, with Tamsin Whaley-Cohen, violinist, a Debussy sonata, Stephen explained that although we might not have noticed, his hands were still cold in the church, and he would go offstage for a few minutes to warm his hands in hot water.  He duly returned, his hands looking decidedly pink, to play Beethoven’s sonata number 31.  Fantastic.  It was pleasant to sit in the garden of The Fox pub afterwards and share a beer with friends.

Stephen Kovacevich, Brett Dean, Natalie Clein live in Corfe Castle (Tamsin Whaley-Cohen out of shot)

 

Tranquil evening scene at Corfe Castle

But the event was also marked by an unusual happening.  I had decided to cycle to Corfe Castle.  On my way to the ferry, I was passed by numerous ambulances and police cars, and the peninsula was suddenly closed to traffic.  I had to turn round, go home, and take the car all the way round via Wareham.  The reason – a ‘wing walker’s’ plane had ditched in the sea right by the Haven Hotel.  Miraculously neither the pilot nor the wing walker were injured.

The scene at Sandbanks ferry (copyright Sky News)

 

And we swam in the sea with several friends this morning.  Lovely.

 

Monday September 13^th

 

I took Lindsay’s ticket and went to watch Bournemouth play football against Barnsley.  Fairly straightforward 3-0 win, but it should have been more.  The weather has continued fine and dry though we are promised some rain tonight.  Meals and drinks outside quite often.  My daughter and her partner visited – in the middle of a round of weddings (seems like their contemporaries’ biological clocks are ticking).  Two weeks ago a ‘hen do’ in Majorca followed by a flight to Rome for a wedding in Castel Gandolfo, this week Poole, next week Edinburgh, the week after back in Poole.  Visited by some American friends on Friday.  Interested to hear their take on Afghanistan.  They think the great U.S. public will have forgotten all about it in a year’s time – that is, unless we have another Nine Eleven.  The football match took place on Nine Eleven and it was impressive and moving, and perhaps surprising, to see and hear that the entire crowd remained silent for a whole minute in tribute.

Our 'Nine Eleven' tribute

 

History in the United States moves on, fortunately; and in another sporting fairytale: the 18 year old British girl, Emma Raducanu, won the U.S. Open tennis without dropping a set, having come through qualifying – an achievement never before matched.  Stunning tennis from both finalists.  And Novak Djokovic was beaten by Dimitri Medvedev.  It couldn’t happen to a nicer person… a few more racquet replacements required for Novak…

Copyright USA Today (I think)

 

Deaths from Covid are slowly creeping up.  We are told that the rate of serious illness and death is far higher in unvaccinated subjects, but it is difficult to tease out the data on the relative risk.  The ONS have just released data for January to July this year showing that of 51,000 deaths, only 256 have occurred in subjects who were fully double vaccinated.  Major news today is that the Government have adopted a policy of vaccinating 12 to 15 year olds, or at least, that is what the medical advisers say.  The strategy is aimed at reducing disruption to education.

 

This morning another swim.  I’m quite looking forward to this near daily dose of masochism nowadays.  We seem to have reached the stage where the air temperature is now the same or slightly colder than the water temperature.

 

A calm morning in Poole Harbour

A more serious philosophical and practical medical debate: I had the experience of trying to help and advise a friend and nearby neighbour who was in difficulties a week or so ago.  Please read the following and consider…

 

Our friend lives a couple of hundred yards away.  He is 77, previously extraordinarily fit (mountaineer; long distance cyclist), who has an unpleasant cancer arising from the region of the maxillary sinus (i.e. inside the skull).  He had severe pain in the face and damage to the right eye.  The tumour is inoperable.  He has been enduring radiotherapy and immunotherapy.  He has had difficulty swallowing and severe drowsiness from the morphine analgesia.  For three days he had taken virtually no fluid or food.  I was asked to go and see him.  It took about a minute to assess him as severely dehydrated, and by this stage somewhat stuporose, and to decide that he needed intravenous rehydration and feeding, or at least a fine bore nasogastric feeding tube  This could only be delivered in hospital.  General practitioners no longer take call-outs, and if you ring your GP you get advised to ring 111, the NHS emergency advice number.  Not wishing to burden the overburdened 999 ambulance service (equivalent to 911 in the USA) further, I did so.  After about 20 minutes and various option choices of tapping on the phone I spoke to someone, who went through a box-ticking exercise.  She was perfectly pleasant.  After all her boxes had been satisfactorily ticked, and she more or less accepted that our friend would need admission, she pointed out that she was unable to authorise this, and asked if I would like to speak to a clinician.  I answered in the affirmative.  After a while during which I was cut off the ‘clinician’ who turned out to be a nurse, rang back.  She too was perfectly pleasant!  After discussion she told me that she could either arrange a home visit from a GP, or, knowing that I was a doctor, she could authorise admission.  Clearly a GP would have visited and confirmed the latter plan, so we opted for a direct admission.  We then had a discussion as to the priority for an ambulance.  I readily accepted that he was not a ‘blue light’ case, and we agreed that a ‘within two hours’ request would be reasonable.  Nearly three hours later, his wife phoned me to say that nothing had happened.  It was after 10pm by that time.  She rang 111 again who advised her to call 999.  Ambulance control told her that they were very busy, and if she could take him herself to the hospital ER, it would be advisable.  Her son came round and they took him to the hospital.  He was put on a trolley.  An IVI was started.  Some hours later he was transferred from a trolley to a bed.  By about 7am he had been moved to the Acute Admissions Unit.  In general, his care within the hospital was excellent.  They ‘sorted him out’, prescribed medication for his severe infected conjunctivitis (he was unable to open his eyes), and by the time of discharge some five or six days later he was much better.  It still begs the question of how to prevent malnutrition and dehydration in the future, but let us leave that for the moment.

 

This whole sorry episode just indicates how poor the primary care service now is, and how overstretched every aspect of the health service has become.  This is not a new phenomenon, and it is worse since Covid, but it was bad before.

 

If a blog is anything, it is a sounding board for the personal views of the writer.  In view of the fact that I qualified as a doctor in 1973, and retired after 43 years in the NHS, I feel that I should record my twopenn’orth.

 

When I began my hospital career, GPs were a dedicated band of doctors who were well rewarded for working long hours, and showed a high degree of understanding and knowledge of their patients.  My evenings as a House Surgeon in Basingstoke District Hospital were punctuated by regular calls from GPs who had already done an evening surgery, and were now on their rounds seeing their patients on emergency home visits.  Long experience told them which patients should be admitted to hospital, and which could be reviewed in morning surgery.  It was rare to decline a request for admission.  The failure of the system to reward them with adequate time off in compensation for a long day and the heavy evening commitment soon led to their forming deputising services, often run by GPs themselves, to take over the night calls.  Again, generally these were experienced doctors, the only disadvantage being that they rarely had prior knowledge of the patient.  As the longevity of the National Health Service increased, patients who remembered the old days and ‘didn’t want to bother you, Doctor’ declined in number and the expectations of the younger population increased, as did the number of emergency calls.  Inevitably the number of trivial reasons for a callout increased too.  A friend of mine, a surgeon, had a father who was a GP in Edinburgh.  He told me that his dad had eventually retired because of the ‘Yiftae’ syndrome.  When I asked him what that was, he replied that it was quite common for his dad to pick up the phone to be greeted, not with, ‘Good evening Doctor, sorry to trouble you…’ but ‘Yiftae come and see the bairn’.  No please or thank you.

 

Another factor in the demise of active primary care in the emergency management of their patients has been the increase in the number of women doctors.  The expectations of women doctors are different.  When I qualified it was rare for either male or female graduates to be married.  But marriage, or at least partnership, and the adoption of family life, together with an expectation that one only needs to work a 40 hour (maximum 48 hour) week (fostered and facilitated by the ridiculous all-encompassing European Working Time Directive), has produced a generation of doctors who don’t expect to have to work the long hours of their predecessors, and who, sad to say, can be perfectly well remunerated for a short working week.  Some 20, yes, 20 years ago, one medical trainee hospital registrar pointed out to me that her colleague and contemporary, now a partner in a general practice, was earning £100,000 per year for a 4-day working week with no weekends or on-call.  And if that doesn’t seem right to you, I would entirely agree.

 

Working in the United States in the early 1980s, there was definitely a disquieting macho assumption that working very long hours as a medical resident (the key is in the name) was a good thing to do.  Residents would tell me that they started rounds at 7 a.m.  The surgeons would then boast that they started at 6 a.m. in order to commence work in the OR at 7.30.  The urologists then told me they started rounds at 5 a.m. in order to start in the OR at 6.30 a.m.  And so on.  But in 1984, the death of a 19 year old called Libby Zion, attributed at least in part to an overworked medical resident (she had a serotonin syndrome reaction due to being prescribed pethidine in addition to her phenelzine anti-depressant), led in 1989 to what was called ‘Libby’s Law’, which limited resident hours to 80 per week, averaged over a 4 week period.

 

In the U.K. we now have a situation where a senior doctor can be disciplined if he or she asks a junior to stay over their allotted time of work by even a few minutes.  This is not the atmosphere of mistrust or laissez-faire that we should be following.  I have had to send medical students home, when they wanted to stay on in the hospital to observe an interesting case or an interesting procedure.  It’s profoundly dispiriting.

 

Successive governments, submissive to the BMA (which is a Union founded essentially in General Practice), have accepted the decreasing commitment of primary care doctors to out of hours work with almost no demur.  They have sought ‘new ways of working’, which essentially means that my experience of the other evening is now the new norm.  It is no wonder that emergency departments are now doing the work of GPs as well as their previous work, and are full, and ambulances cannot even unload their patients in some circumstances.  Of course, there are other factors.  There is a much larger ageing population who are more likely to need emergency care; there are also more things that can be done for patients, other than the old maxim of ‘take two aspirin and call me in the morning’.  Bed-blockers, or in the polite ‘woke’ parlance, ‘delayed discharges’ are more common because relatives are less likely to be local and increasingly unlikely to want to look after Gran or Grandad.  Many years ago, a Greek doctor whom I worked with in London expressed amazement.  ‘Andrew, there is no such problem in Greece.  Everybody in the family lives in the same home anyway.  Of course the old people come back to live at home with their family’.  I don’t suppose that is still the case…  I spent a while as an inpatient in a Greek hospital many years ago.  It was interesting to see that most of the nursing care was undertaken by the relatives of the patients – because there were so few nurses.  As I recovered from septicaemia due to an insect bite I was put to work folding bandages for sterilisation and helping other patients.  ‘Good, Johnny, good’, said the elderly war veteran patient with half his skull missing.  He seemed to be a professional in-patient.

 

As a Governor of a newly formed University Hospital Trust, I now find myself a custodian of a system which I no longer really believe in.  Tantamount to treachery I suppose?  But if I don’t participate, who will?  Somebody with less appreciation of the system, and how it has become what it is now.  But it is the primary care service which desperately needs the reform, so I suppose, like Vladimir and Estragon, ‘I must go on’.

 

The National Health Service is now a sacred cow, and is untouchable.  This has been fostered by the many instances of staff going beyond the call of duty during the pandemic.  The weekly ‘Clap for Carers’ was the high point of this enthusiasm for all things NHS.  But we are still down in the health leagues compared to many other countries, despite the money being sprayed bountifully from above.  All governments know that to dismantle the NHS is the ‘Third Rail’ of politics.  Touch it and you die.

 

NHS - a final fatal fracture?  Picture from Daily Telegraph

And that is probably enough to be going on with….

 

Tuesday September 14th

 

Or almost enough.  An article in today’s paper by Harry de Quetteville points up all of the problems mentioned above.  GPs are the gatekeepers to further care, and increasingly patients find that gate closed.  An average GP now earns £100,700 p.a., but only 11% of GPs work a standard full-time contract in a single surgery.  According to the Institute for Government, funding for GPs has increased over the last decade in real terms by 20% but demand has only increased by 9%.  Charlie Massey, CEO of the General Medical Council… noted that “Doctors are no longer prepared to stick with the traditional career paths”, and added that they were “making choices for a better work-life balance”.  Hmm…

 

Finally, another anecdote, which might illustrate how far we have come, or indeed how far we have retrogressed.  My research director at Duke University in the USA had done his clinical training at St Bartholomew’s Hospital in London.  His only slight deviation, as a gifted researcher, was to do a PhD in Pharmacology before returning to clinical studies.  Much as we did a decade later at UCH (University College Hospital), as a House Physician at Bart’s to the Professor of Medicine, he was expected to live in the hospital residence and to be on call on a permanent basis (by my time it was 1 in 2 on call).  David had met his wife Lisa, an attractive Danish blonde, in a jazz club, and with the enthusiasm of young love, they had got married while he was still a student.  Lisa lived in a little flat elsewhere in London.  One evening, Professor Scowen (later Sir Eric Scowen), whom David worked for, stopped just outside the hospital where David was waiting at the bus stop.  He gazed at him uncomprehendingly.  ‘Shand? Is that you’?  He enquired.  ‘Yes sir’, said David.  ‘What are you doing outside the hospital’? Asked the Professor.  ‘Waiting for a bus to go home to see my wife sir’ was the reply.  Scowen nodded, with a blank look which indicated incomprehension.  ‘All right, Shand’, said Scowen and walked off with a look of bewilderment.

 

Nobody can believe that the system should revert to that of the late 1950s.  But similarly, no one can accept that how we live now is right either.  Food for thought.

 

More swimming.  Raining; big waves; fun.