CORONA DIARY CHAPTER 23 – July 28th to September
14th, 2021
August 5th, 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 29th, 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 23rd 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 22nd, 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.
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| 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 5th, 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.
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| The scene at Sandbanks ferry (copyright Sky News) |
And we swam in the sea with several friends this
morning. Lovely.
Monday September 13th
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.
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| 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.
Thank you Andrew for another very interesting blog.
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