CORONA DIARY CHAPTER 21 - MAY 13TH TO JUNE 3RD 2021

 

May 13^th, 2021

A friend's daughter practises her yoga in front of Mt. Agung, Bali

 

A period of wetter, slightly warmer weather, interspersed with some lovely sunny periods.  The wind is rarely light though, and sitting outside is usually only feasible when well wrapped up.

 

Interesting elections last week.  In Dorset, the only person on the ballot list was the police and crime commissioner.  Both of our electricians have recently had their vans broken into and tools worth many hundreds of pounds stolen.  Both with complete police inaction.  So one doesn’t feel terribly enthusiastic about this vote, irrespective of the candidate’s political affiliations.

 

In Scotland however, MSPs have been up for re-election (Member of Scottish Parliament).  Nicola Sturgeon, the Scotweiler, has claimed her substantial number of seats is an endorsement for what they call IndyRef2, another referendum on Scottish Independence.  Having lived in Scotland, it is hard for people down here in England to realise just how significant is the antipathy for England felt by Scots.  800 years of history doesn’t help.  Not for nothing was Edward the First nicknamed ‘The Hammer of the Scots’.  Unfortunately, the Scots are not well-informed as to how lucky they really are.  The so-called Barnett formula gives Scotland a substantial benefit in public services allocation compared with England.  In the Health Service, it has been recognised for a very long time that monies have been more freely available for Scottish patients than English patients.  It is how Nicola Sturgeon chooses to spend this allocation that gives many Scots the impression that they are hard done by.  Cycling the North Coast 500 a few years ago, it was very clear that the only good roads in rural Scotland were the ones that had large sign boards beside them saying ‘Built with assistance from the European Union’.  In the distant past, with the focus on the oil industry based in Aberdeen, the Scots were able to accuse the English of ‘appropriating our North Sea oil’, but this is a contracting sector of the economy, and apart from tourism and whisky, and perhaps some fish it is hard to see how Scotland can maintain its prosperity as an independent nation.  The majority of Scottish exports are indeed consumed in the rest of the UK, whether those exports be technical or otherwise.  Finally, Sturgeon has indicated that when Scotland gains independence, the British nuclear deterrent submarine services will be pushed out of the Gareloch and Loch Long (both deepwater lochs), giving us a real problem in maintaining this service, as well as losing many Scottish jobs.

 

Further south, a by-election in Hartlepool has resulted in a significant conservative majority, in what is regarded as ‘Old-Labour’ heartland.  Even Laura Kuenssberg, BBC political editor, a ‘pink’ intellectual, has pointed out that the old demographic of highly unionised solid Labour voters has changed and gone.  The fallout in the Labour party has been bitter indeed.  An old hard-line Jeremy Corbin tail of left wingers is still trying to wag the dog, and the centrist Labour of Tony Blair is in disarray under Sir Keir Starmer.  It is remarkable that despite all the renewal of ‘Tory sleaze’ allegations, that Boris Johnson, a man who certainly made mistakes in his management of the pandemic, remains extraordinarily popular.  The success of the vaccination campaign is the equivalent for Boris of Margaret Thatcher’s Falklands success in 1982 in persuading the public to keep on ‘steady as we go’.

 

Un bout de nostalgie.  Now that I have a record player again, I have enjoyed playing some old favourites, at random.  One such was Judy Collins’ ‘Colors of the Day’ compilation.  As well of some of her own songs, her covers of many great songs are surely some of the finest around.  Her version of Leonard Cohen’s Suzanne is fantastic; the Beatles’ In My Life’ is wonderful.  The same applies to ‘Both Sides Now’ (Joni Mitchell), ‘Who knows where the time goes’ (Sandy Denny), ‘Sons of’ (Jacques Brel), ‘Amazing Grace’, and the folk standard ‘Farewell to Tarwathie’.  This latter song, dating from the mid-19^th century, about the Greenland whale fishery, has a haunting soundtrack of whale noises.  In 1972, when I bought this album, it seemed gimmicky.  Now I find it plaintive and appropriate.

 

Another parenthesis.  When sailing, many years ago, on what was at once the most enjoyable and also horrible voyage, from Tromso to Spitsbergen, I asked our skipper why it was that all of the whaling songs mentioned Greenland and dated from the 1800s.  I knew that whaling had been a part of the Spitsbergen (Svalbard) voyages.  His answer was simple: whaling started on the Svalbard route in the early 1600s, the prey being the bowhead whale.  By the 1700s they had killed them all…  The initial targets were bowhead, gray, Northern humpback, and right whales.  As these were rendered nearly extinct, other species of whale were sought.  The remnant of the Gulf Stream runs up towards Spitsbergen, rendering the North sea, the Norwegian sea, and even the Barents sea mostly ice free.  Later whaling focussed on the Davis Strait, between Western Greenland and Baffin Island, north of the Labrador Sea – a more dangerous and challenging environment.

 

Football, as well as being the ‘beautiful game’ (rarely so), is a hugely moneyed irritation.  Almost three quarters of most sports coverage in any newspaper sport supplement in Britain is filled with football.  So when Geraint Thomas, the Welsh cycling hero and winner of the Tour de France, won a significant UCI tour event recently, the Tour de Romandie, there was zero coverage, and nothing from the BBC, which focussed on the riot at Manchester United football ground against the club’s American owners.  It is very difficult to get true facts about participatory sport.  Running appears to be very high, though it is possible that swimming exceeds it – over 2.5 million participate every week.  But cycling weighs in at nearly two million a week.  In the past it used to be said that angling was the most popular sport, though recent data don’t confirm this.  Football, tennis, and golf are high on the list, after athletics, swimming, and cycling, and perhaps surprisingly, equestrianism.  My point is that football is grossly over-represented in the press.  A reader might be tempted to observe that riding hobby-horses must be up there too.

 

Sunday 16^th May

 

The showery, and still not especially warm, weather continues.  An excellent walk with a friend the other day in Wareham Forest was lovely – wildlife and bluebells.  As we circumnavigated a puddle on one of the gravel tracks Lindsay spotted a newt.  This encouraged me to post the picture on Instagram.  I used a quotation, which I think must have come from Brian Redhead or John Timpson on the Today programme many years ago.  After an interview with a naturalist who waxed lyrical about newts and lamented their loss of habitat, we cut back to the studio where Brian (or John) intoned solemnly, ‘Well I do hope that they can do something to help these little guys, because I always say, when they’re gone, there’ll be nothing so missed as a newt’.  (Transatlantic readers may not understand this).

 

The Wareham Forest newt

Wildlife.  We have had several visits from a Sika deer (very common in Dorset), which seems to enjoy tasting our new grass, and indeed any new shooting shrub.  It chews the grass down to where I’ve attempted to cut it with a strimmer.  I don’t think it is as careful as I am not to damage the seedlings.

 

In a week where two friends have died, well before their time, from malignancy, it was an uplifting experience to take the open road north to Blandford Forum and see the new lime-green colouration of the trees in spring.  One huge oak in particular, had leaves which were almost lemon-yellow.

 

Much depressing correspondence in the newspapers about the difficulty of seeing a General Practitioner.  A trenchant article by Meirion Thomas, a cancer surgeon, states that the whole system needs reform, but that there is huge opposition from our union, the BMA.  This is true.  The BMA, for all its claim to represent all doctors, was founded by General Practitioners, and remains a union with a strong protectionist stance (personal view).  The Royal College of General Practitioners is another bastion of the status quo – or at least almost so.  Unfortunately, changing from a capitation fee system (with top-ups for meeting ‘targets’) to a fee for service system) risks even more abuses.  Many years ago, a friend returned from a Canadian emergency room with about double the number of stitches (sutures) that were needed in a skin wound.  The explanation?  Doctors paid on a ‘per suture’ basis!  To end this depressing scenario, we’ve seen this week the Department of Health state that advice for the future should be for GPs to undertake online or video or telephone triage before agreeing to see a patient in person.  Such was the outcry that this advice was quickly withdrawn within 24 hours, and an acceptance that the norm should be that the GP should see the patient.

 

As a doctor, it is important to remain humble (unless you are a surgeon).  Sir Thomas Lewis, doyen of early 20^th Century cardiology, was a remarkable clinical investigator.  He was on the staff of University College Hospital, where I trained.  In forgotten nooks of the UCH system, such as the Temperance Hospital and St Pancras (North wing), it was still possible to find patients’ notes in which the Great Man had written.  Early on, I was deputed to see a lady in St Pancras’ Hospital, who was elderly and now dementing.  I was awe-struck to find Sir Thomas’s outpatient notes.  The lady’s name I still remember: it was a Miss Ivy K.  Written in Sir Thomas’ neat, small handwriting in the early 1940s, her occupation was given as ‘Christmas Card Ribboner’.  The diagnosis was rheumatic heart disease.  The first clinical observation was ‘Obvious capillary pulsation of the face’.  Lewis diagnosed triple valve regurgitation.  At the end his summary was: Prognosis – poor; triple valve incompetence.  I found it instructive and humbling that Ivy K had outlived Sir Thomas by a minimum of 25 years…

 

With regard to the General Practitioner, I will close this homily with the words of Sir James Mackenzie (1853 – 1925).  Let us hope that some GP may someday read them.  Sir James Mackenzie (born Scone, Scotland) was the first true cardiologist in Britain, but he started his practice life as a GP in Burnley, Lancashire.  Mackenzie is beloved by the Royal College of General Practitioners because of this fact.  In his ‘Diseases of the Heart’, first published in 1908, he wrote, with regards to the history of the complaint and the patient’s symptoms:

 

“In order to determine the value of any given symptom in affections of the heart, a long and patient inquiry is needed…”  He goes on to say that “Observations must be made at various periods of the individual’s life…”

 

“It is evident that such observations can only be undertaken by a physician who is likely to see individual patients during all these circumstances, and that can only be done by the general practitioner.  Such a line of observation I have attempted, and I warn those who would follow this line of research that it is no primrose path.  The investigators in hospital wards and laboratories have little idea of the difficulties the general practitioner has to encounter.  He must ever be on the alert, prepared to make an observation at any hour of the day or night, and may have to spend many hours in a wretched hovel watching the changes in a woman in labour.  Attacks of illness, which may arise suddenly during day and night, must find him prepared to take advantage of his opportunities.”

 

Amen to that.  A different world of medicine.

 

And before leaving the medical world; an anecdote.

 

As a medical student, at lunchtime, we dutifully trooped up the back stairs to the observation area of the post-mortem room.  Above us as we walked, in gold lettering: ‘Mors Ipsa Docet Succurere Vitae’.  ‘Death Itself Teaches Us To Sustain Life’.  The other side of the barrier was reserved for the pathologists, senior doctors, and visiting firemen.  On one occasion, we were confronted with the body of a lady of relatively young years – perhaps in her 40s.  She had suffered from severe SLE (autoimmune disease).  The only treatment at the time was high dose steroids, but despite this she had developed diabetes and end-stage kidney failure.  A few months before her death she complained of difficulty with vision.  This had progressed.  She had become completely blind.  It was an inexorable process.  At that time there was no CT, no imaging of any kind except X-ray.  There was a visitor from the United States.  The pathologist exposed the skull, the brain and nasal sinuses.  An indeterminately grey mass of tissue extended from the nose up into the brain, completely enveloping the optic nerves and indeed the orbits.  The American pathologist told us that preliminary microscopy and culture had established that this was mucor mycosis, a very rare fungal disease, spreading up from the sinuses into the skull and the brain.  It had generally only been described in seriously uncontrolled diabetes and severe immunosuppression.  I tell this story because the spectre of this rare disease has arisen again, in India.  Many of the fatalities from Covid-19 have been found to be due to mucormycosis, generally of the lungs.  This is probably due to the steroid immunosuppression, which is used in India, without the advantages of intensive care management.  In India it is known as ‘black lung’.

 

Finally today, a complete non-sequitur.  We have been following and enjoying the Giro d’Italia, the three week grand tour cycle race.  Feelings of longing for the spectacular destinations.  The other day a French team raced into the overall lead.  In the Tour de France, the leader wears the coveted ‘yellow jersey’.  In Italy it is the ‘Maglia Rosa’, the pink jersey.  Shots of the jubilant French team bus with the team toasting in champagne and in the background – yes, the song was ‘La Vie en Rose’.

 

Monday May 24^th

 

Very ‘iffy’ weather.  Friday blew a gale and rained.  We had a golf exchange day I could not get out of.  We survived but the golf was fragmentary.  The course, Hindhead in Surrey, is an attractive mix of heathland and downland valleys.  Wikipaedia says that it is the highest village in Surrey.  During lunch I noted a picture of Sir Arthur Conan Doyle playing golf.  He was the club’s first President, in 1904.  He seems to have had a good shoulder turn judging by the photograph.  The 9^th green is spectacularly surrounded by specimen rhododendrons and azaleas.  Some conversation about how Parkstone G.C. could be made more attractive.  Apparently some of the more traditional members have been heard to mutter that it is ‘A Golf Club, not a Garden Centre’.

The 9th green at Hindhead G.C. (in the rain).  Note the river running down the middle of the green.

Nationally and Internationally there is great concern about ‘The Indian Variant’.  Of course, the reader will immediately realise that I am talking about coronavirus.  In a pre-pandemic world he or she might have thought that I would be about to discuss the game of chess.  Another faux pas by the government was the announcement that flights to the UK from India would not be allowed but failing to implement this with immediate effect.  Many Indians who can afford to have of course flown to the UK, if only to escape the risk and devastation in India, where the pandemic is out of control.  Evidence this week that our current vaccines have reasonable protective effect against the Indian variant.

 

There is also virtual war in Israel/Palestine.  Rocket attacks by Hamas from Gaza on Northern Israel.  Retaliatory strikes into Gaza City.  Many more Palestinians than Israeli dead.  Joe Biden is seen as a weak President, and has given both sides the equivalent of a slap on the wrist; but at last there seems to be a ceasefire.

 

Major news this week is the new report into the Martin Bashir affair, which finds the BBC culpable in not realising his crooked ploys to gain the attention of Earl Spencer and Lady Diana in the 1990s.  The then DG of the BBC, Tony Hall, clearly got it completely wrong, but so far has not been called to account.  Prince William has stated that the BBC’s actions fostered the paranoia and press frenzy which ultimately led to his mother’s death.  It would seem that there is only a minor grain of truth in this.  A well presented interview with the official personal protection officer for Diana points out that her fatal mistake was to reject official protection and to rely on the dreadful (my word) Fayed family’s personal protection system, which unfortunately included a drunk chauffeur.

 

Alternating sunshine and heavy showers today.  Still rather unseasonable late May weather.  We are promised warmer weather for the late May Bank Holiday weekend.  Two friends have died in their 60s from malignancy this last week – one not affected by the pandemic, but the other presenting late, and possibly not investigated due to the barbed wire fence which surrounds our GP surgeries.  Carpe diem.

 

The weather relented sufficiently for a small group of us to join our Sicily tour guide on a walk from Lymington to Brockenhurst.  Although we have walked this area before, it was fun to meet up with him again, and one of his team.  On the way we re-explored Boldre church, and saw the memorial to HMS Hood, sunk by the Bismarck almost exactly 80 years ago.  A devastating loss for the Royal Navy and a significant effect on national morale at the time, the explosion of the aft magazine triggered an immediate sinking and the loss of all but three of her 1418 personnel.

 

HMS Hood memorial, Boldre church

Arriving back in Brockenhurst we also explored the little church to the south of the main village.  A sign stating ‘Commonwealth War Graves’ directed us into the churchyard.  An unusually large number of the classic WWI headstones surprised us.  These turned out to be almost all New Zealanders.  A substantial ‘tin city’ existed south of the village from 1916 primarily to rehabilitate New Zealand soldiers wounded in battle.  One can only wonder at the mental drive or stimulus that took young men in their early 20s from New Zealand to fight in a meaningless war on the other side of the world.

 

Commonwealth War Graves, Brockenhurst churchyard

Final link to World Wars: a recent review of an excruciating play in the paper recalled a famous story which I hadn’t seen for many years about a production for the stage of the ‘Diary of Anne Frank’.  The actress (a loose term here), Pia Zadora, played Anne.  The play was so bad and her acting so poor that early in the second half, as the Gestapo entered the house, one wag in the audience yelled out ‘She’s in the attic!’

 

Wednesday 2^nd June

A beautiful day, as it has been now for a week.  Last night we re-established our (all male) book club, sitting outside in a friend’s garden to the north of Wimborne and discussing Nevil Shute.  Life seemed almost normal.  Two joined by Zoom from the Shetland Islands (new trendy destination for staycationers), one from London and one from his boat.  This latter was wearing rather curious braces, which could have been deep sea yachting trousers, could have been a cookery apron, but turned out to be genuine braces, having just emerged from court (he’s a barrister), and obviously the uniform still includes the ‘Masters of the Universe’ attire.  Nevil Shute was a rollicking good read.  Next time we have a joint meeting with a ladies’ book club – the choice – Bernardine Evaristo’s Mr Loverman, which is likely to be a bit different.

 

Last week saw a brief, 24 hour, visit to Bridport to stay with friends (now allowed), and the start of this good weather.  Lovely to walk the Jurassic Coast again.  Impossible to get into the Anchor Inn at Seatown – even on a Wednesday, such is the pressure from stay at home holidays.

Jurassic coast, looking west towards Lyme Bay

 

Morag and Lindsay, looking east towards West Bay

Colmer's Hill, aka 'Tufty'

Having woken at 6am this morning (broad daylight), it seemed appropriate to write something today – yesterday was the first day since the pandemic began that there were no Covid-related deaths in England and Wales.  There has been a recent surge in Bolton, related to the importation of the ‘Indian Variant’.  Possibly due to the lamentably low vaccination uptake in ethnic minorities.  It remains surprising that so many hospital employees in some areas of the country have not been vaccinated, and the government is toying again with the idea of making vaccination of health workers compulsory.

 

A frightening episode the other day, with the aligned Western nations, and the EU, powerless to do anything about it.  A Ryanair flight en route Athens-Vilnius was diverted to Minsk after the pilots were informed there was a possible bomb on board.  A jet fighter from Belarus shadowed it.  Once on the ground, a Belarus dissident and critic of the strongman leader (dictator) of Belarus was arrested together with his girlfriend.  A state-sponsored hijack.

 

And the theory that Covid-19 may have been synthesised in the Wuhan virus research institute has re-emerged.  Sir Richard Dearlove (ex-MI5) says that one can be sure any evidence that this is the case will have been expunged by China long ago.

 

Finally, Boris Johnson married Carrie Symonds in a secret wedding ceremony at Westminster Cathedral the other day.  This has helped to defuse the fallout from yet another Dominic Cummings effusion of vitriol about his time as special adviser in Downing Street.  Highly critical of the PM (unfit for office), and the health secretary (Matt Hancock), ‘He should have been fired at least 15 to 20 times’, his splenetic outpourings have probably damaged his hopes of a revelationary book because everything that might have been a surprise has now been revealed.  His main point about Hancock is the disastrous events early in the pandemic where hospitalised Covid patients were sent back to care homes to lethal and devastating effect.  In his defence, Hancock’s team have indicated that our testing capacity at that time was so poor that this would not have been feasible.  Nonetheless it remains a disaster, but Cummings of course is blessed with 20-20 hindsight; curious in view of his need to drive to Barnard Castle to test his eyesight.

 

It was noted that Boris and Carrie married in a Catholic cathedral.  A Telegraph letter writer (always plenty of good material in these) notes that Oscar Wilde’s late conversion to Catholicism was explained by the writer as joining a church where ‘Every saint has a past and every sinner has a future’.

 

Last week we visited a friend who has been treated for bowel cancer, and were asked to do the Covid rapid tests (known as lateral flow tests) before visiting.  The little testing strip is rather like a pregnancy test.  After a throat and nasal swab, the cotton bud is dipped in a special buffer solution and then two drops are placed in the testing well.  The result is read after 30 minutes.  Negative.  We were also visited by my daughter and her partner who routinely did the tests at home in London before coming down to stay with us.  The new normal.

 

Another sign of a different normality.  Cricket (Test Match Cricket that is) starts today with England vs New Zealand.

Thursday June 3^rd

A day off from house problems.  Walk over in Purbeck.  Lucky to see the ‘endangered’ sand lizard on Godlingston Heath.  Lovely views: Swanage bay, the Isle of Wight, Poole harbour.

 

The chalk stacks, near 'Old Harry'

Ballard Down and Poole Harbour

Sand Lizard, Godlingston Heath

Yesterday evening a lovely session with friends.  Richard and I played guitar duets together (Carulli; nothing too challenging).  It’s so long since we have been able to play together that we were virtually sight reading the piece.  I remember the sleeve notes to the John Williams and Julian Bream ‘Together’ album.  Chopin is reported as saying once that there was no sound more beautiful than the guitar, save perhaps two guitars.  Anybody who does not remember vinyl or does not possess 12” LPs will not know what ‘sleeve notes’ are.

 

A mysterious acronym was reported the other day.  A woman journalist, divorced, has entered the fray of online dating.  She reports that one man, seemingly quite pleasant and a possible match, stated that he was ‘Not interested in ONS’.  She was surprised that somebody should be so upfront about his lack of interest in the Office for National Statistics.  Admittedly they have been in the news quite a lot lately, what with their gatherings of data on Covid deaths, spread of variants, etc.  Further enquiry revealed that in this context, ‘ONS’ is an acronym for ‘One Night Stands’.

 

And a nice cartoon from the Literary Review shows a celebrity author, dark glasses on, sitting on a tropical beach in his swimming costume.  He’s typing away:  ‘It was a dark and stormy night…’ 

Corona Diary Part 12. Monday August 3rd to Tuesday August 25th

 

Monday August 3^rd

 

Davina Thompson was the first person in the world to receive a triple transplant – heart, lungs, liver, in late 1986.  Her face, lovely smile, and extraordinary character came back to me in an instant when I read of the death of Professor Roger Williams, the liver specialist, who established the world famous liver unit at King’s College Hospital, where I worked for many years in the 1970s and 1980s.  I don’t know what it is about extraordinary pioneers, but there are some readily recognisable characteristics, and Roger Williams had these in spades.  Firstly, he was clearly very intelligent and gifted.  Secondly, he had enormous drive.  A twelve-hour day was the norm.  Thirdly, though there are obviously some fourthly and fifthlies, he did not care much about setbacks or criticism, and almost always overcame them.  There are some who would say that this characteristic is an ability to ride roughshod over authority, and Roger was certainly able to do this, and indeed seemed to derive some pleasure in doing this on occasion.  For example, the Professor of Medicine during Roger’s early years at King’s was a much less gifted individual who nonetheless had some reputation in bone metabolism.  He had ordered a device for cutting thin sections of bone for microscopic study, a large and expensive piece of equipment destined for an underutilised area in the medical school, but he did not follow through on his plan to supervise this himself.  As a result, some six months after the supposed installation of the bone-cutter, the Prof was showing some visiting overseas specialists around King’s.  ‘And this’, he said, as he swung the door of the lab open, ‘Is the bone-cutter room…’  The bone-cutter, unused, had been parked in a corner, and everywhere he looked, white-coated research scientists were at work, pipetting reagents into test tubes, looking down microscopes, setting up chromatographic columns.  Needless to say, this was Roger Williams’ nascent research laboratory under way.  Exit speechless Professor.

 

Another typical Williams strategy which did not endear him to other consultants on the staff at King’s was the way in which he always commandeered a car parking space in pole position at the front of the hospital.  If he had been called away to see a patient at the Cromwell Hospital, for example, when about to return, he would send his secretary down to stand outside the building in the car park and bodily block a space until Roger’s own car steamed in.  On one occasion this almost led to injury when another (nameless) consultant physically pushed the poor secretary out of the way with his own car.

 

Mrs Thompson had been admitted to the liver unit for further investigation in 1986, and a cardiac opinion was requested.  She was suffering from an advanced liver condition, primary biliary cirrhosis, and a liver transplant was being considered.  As the ‘new boy’ in the cardiac department (only two years into my consultancy) I was deputed to ‘pop up to Roger’s ward and take a look at this lady.’  Mrs Thompson was breathless as well as jaundiced and I brought her back to our department for an echocardiogram.  I went to report on the findings to Professor Williams and he asked me for a full workup of her heart which included a right and left heart catheterisation procedure.  The preliminary findings suggested that she had fibrosing alveolitis, an associated lung condition that sometimes occurs in PBC.  When we undertake catheterisation procedures the patient is conscious, but we use local anaesthetic so that the study should be pain free.  Patients are understandably always scared however, and one very underrated skill of a cardiac operator is to chat to the patient during the procedure, explain what is going on, and put them at their ease.  I always like to take the opportunity to ask the patients about themselves and give them to chance to talk freely.  In Mrs Thompson’s case, I was aghast.  She came from a mining area in South Yorkshire, had had to leave her daughter at home when she came down to London, and her husband, a miner, was effectively out of work due to the miners’ strikes.  I felt desperately sorry for her.  Not only the domestic issues, but a real life limiting major disease to cope with seemed just so unfair.

 

Roger’s clinical presentation rounds were always held in his liver unit seminar room on a Saturday morning.  Attendance from everyone who worked for or with him was mandatory.  In addition, one of the registrars would have to examine the case blind, formulate a diagnosis, and give a treatment plan.  It was like going into the courtroom to argue with Judge Jeffreys.  Roger’s style of teaching would not be condoned today, but it was certainly effective.  You never forgot an experience in that cauldron.  In view of the fact that I was both a consultant, albeit a junior one, and also from a different unit, Roger always treated me courteously and kindly.  The same politeness did not extend to his juniors.  Fortunately, the registrar that day was a very switched on individual, and he was able to detect the signs of pulmonary hypertension, the prominent right ventricular ‘heave’ as it is called, though Roger called him to task for failing to hear the loud pulmonary second sound in the pulmonary area just to the upper left of the sternum.  ‘So what are we going to do about it?’  Queried the Prof.  ‘Well, sir, we could transplant lungs as well’, came the reply.  ‘What does Dr McLeod think?’, enquired Williams.  ‘Well, sir, as I’m sure you know, in pulmonary hypertension, you have to transplant both heart and lungs.  If you just transplant a heart, it cannot cope with the high pressure in the lungs.  If you just transplant the lungs, the damaged heart will fail anyway.’  ‘So’, came the reply, ‘We would have to think about a triple transplant.  Lungs, heart, liver.’  ‘Yes, Professor.’  ‘Hmm’, was the response.  I’ll talk to Professor Calne and see what he thinks.’

 

And that was it.  Sadly, I never met up with Mrs Thompson again, but she survived her pioneering operation with a good quality of life for a further twelve years.  In my brief meetings with her I found her to be a truly lovely person.  Everything I have written above is true, and because of the wide publicity it is all in the public domain, so I do not believe I have transgressed any confidentiality.

 

 

Tuesday August 4^th

 

Awake from about 0430.  Tried listening to some relaxing music, placed the eye cover on to block the rather too bright light from my Sony radio alarm clock, which has worked so well for about 20 years, so I have been loth to replace it.  No success.  Remember that I was woken in the middle of explaining what was going on at a cardiac catheterisation to a junior doctor who could not understand what he was seeing.  The catheter was in the left coronary artery.  A tiny amount of contrast medium flowed in to a vessel which terminated within half a centimetre of its origin.  A nub of contrast.  ‘What’s going on?  I don’t understand.’  ‘It’s all right.  The left main coronary is blocked.  All the supply is from the right side.’  ‘How do you know?’  ‘Simple, the patient is alive, isn’t he?  The blood must be getting to his heart from somewhere.’  Wakefulness put an end to the clinical scenario, and eventually I got up and started in on the next few weeks of diary entry.

 

Saturday August 8^th

 

The weather has been good and getting hotter.  Temperatures in the high 30s.  Apart from some pleasant golf in midweek I was privileged to go fishing yesterday, and out on the water it was at least a little cooler than indoors.  We motored down to Christchurch Ledge and drifted with the tide.  On the way, we passed the Aurora and the Arcadia, the unused P&O cruise liners.  Both of them looked a little tired, with rusty paintwork, and the Aurora had a substantial dent in the port stern quarter.  This was followed by a lovely evening yesterday in a friend’s garden with champagne, two different Malbecs, one French, one Argentinian, and the remains of the Hauner Sicilian Malvasia.

 

The weather remains unpleasantly hot; just okay sitting outside in the shade, but in our rental house the converted roof space means our bedroom is at 31deg C.  Not good for sleeping.  Almost like North Carolina.  I remember when living there and the Fall arrived, people used to talk about ‘Good Sleepin’ Weather’, and here in Poole at the moment, it is not good sleepin’ weather.

 

Sunday August 9^th

 

A five mile walk in the New Forest.  Lovely, especially in the shady inclosures.  Some thatched cottages at Hale, and the beautiful Thomas Archer designed Palladian Hale House.  A memorial to him (architect of Chatsworth, Chettle House, and St John’s, Smith Square) stands in the little church nearby.  A reminder of bygone plagues – his first wife died within a year of their marriage from smallpox.

 

Hale House (1715), New Forest

Memorial (in Latin) to Thomas Archer.  Note 'Variolarum Lue', another plague (Smallpox)

Monday August 10^th

 

It is just too hot to sit up here in our little office and type a diary.  So this will be resumed another day.  Some may have noted however that I have lost interest in the coronavirus, having devoted so much space to it early on.  There is a clear cut upsurge in cases over the last four weeks, but interestingly no uptick (as it’s now known) in deaths.  Perhaps the congregating young are the cases and their mortality is low?  Don’t know.  Our heatwave is echoed on the continent (vague du chaleur, or canicule, in France), but it is worse.

 

Friday August 14^th

 

We have now come out of the one-week heatwave.  The last three days have been punishingly hot.  At times I have thought I was back in North Carolina.  The Seniors golf tour to Devon went ahead this week – with numbers reduced from 32 to the ‘Valiant 9’, but social distancing seemed fairly well observed.  We stayed in the Best Western Dartmouth Golf Hotel and Spa, which I would describe as cheap and cheerful, but was good value for money.  The staff were unfailingly helpful and friendly and one felt sorry for them working and serving behind visors, especially in the heat.  The River Exe mussels on the menu were excellent, though the plaice came with cockles (to which I’m possibly allergic) and was only slightly larger than the plaice we threw back when fishing the other day.  But a good time was had by all.  Golf at Churston, which is near Paignton was excellent, but the Dartmouth course was spectacular, with a lot of climbing and descending those steep little Devon valleys.  Nice to renew acquaintance with that distinctive red Devon soil again, which now ingrains the sole and grooves of my clubs.  Our last day was at Thurlestone, which was besieged by har on arrival, but which later cleared to give those views which are so spectacular, particularly on the further parts of the course which overlook Bantham, the Aune estuary, and the famous Burgh Island with its Art Deco hotel.  The hotel, as is widely known was the location for the famous Agatha Christie book, ‘And then there were none’, which is an unusual book in that it has been through three metamorphoses of name.

A challenging par 3 at Dartmouth Golf and Country Club

The weather broke in dramatic fashion in the evening with monsoon-like thundery rain, and this morning is overcast, humid, and a touch gloomy.

 

Watching the news again this morning, there is a plethora of what I previously called ‘talking heads’, but which a friend reminded me the other day are called in the media ‘Vox Pops’.  Vox Populi, Vox Dei is surely a contradiction in terms.  Today the vox pops are related to the predicted grades for A level students which came out yesterday, and have caused many to be disgruntled.  The BBC is quick to focus on the suggestion that predicted grades for posh private schools are thought to be higher than ordinary schools.

 

Cricket has resumed in the second test match against Pakistan, in Southampton.  There were rain interruptions yesterday, and a delayed start this morning.

 

During the last week I received a moving message from a close friend and former nursing colleague, who has endured multiple surgical procedures for primary and metastatic bowel cancer (chiefly liver), and for whom no more can be done.  She has always been something of a ‘wild child’, though I hasten to add, in her career, absolutely committed and professional.  She told me some time back she was looking forward to some druggy bliss, and floating away.  Subsequently, with Krukenberg tumours and drains for peritoneal ascites, she has gone through so much uncomplainingly.  Offering to visit, and/or to supply home-made marmalade which I know she loves, she writes in reply (direct quote): ‘Very weak at the moment with my two syringe drivers.  Just about able to converse for 20 mins so don’t really see anyone in real-time.  Getting weaker every day.  Just wish I could hurry up and die.  It’s very boring waiting to go!!!!!  Love to you both…’  What a person.

 

In complete contrast to the previous paragraph, and to lighten the mood, another story surfaced early this week.  An approach was made by a White House official to the governor of South Dakota, with the possible suggestion that the famous Mount Rushmore carvings of Presidents Washington, Jefferson, Theodore Roosevelt, and Lincoln be extended to include President Trump.  The governor thought this was hilarious, until she realised that the White House emissary was not joking.

 

Finally, the other day, I saw that BBC4 were to screen a recording of Mahler 8 (the Symphony of a Thousand) in a performance from the Royal Albert Hall, conducted by Simon Rattle.  It featured the National Youth Orchestra, and combined total of soloists and choirs of around 800 people.  I watched with love and awe – the scale of the orchestra was fantastic.  The young man with his mandolin, a total of four harpists, and at the end, a kiss on both cheeks from Rattle for the young leader of the orchestra – will we ever see scenes like this again?  It took me back to the only time I’ve seen it live, in 1973, at the same venue… wonderful.

 

Wednesday August 19^th

 

Torrential rain today allows time to catch up on a number of things, particularly the diary.  Following many months of aches and pains (I won’t bore with detail) I have an appointment with a rheumatologist later this week.  It is the lot of ageing folk to look with envy on the exploits of the younger.  Last night we were talking about friends who have moved to Lymington and how their bike excursions take them up and around the Beaulieu river, and I was reminded of the John Betjeman poem ‘Youth and Age on Beaulieu River, Hants’ (I think that’s the title), which I first came across, not in my collected edition of his poems, but on an LP (for younger readers that stands for Long Player, a vinyl disc 12 inches in diameter which rotates at 33⅓ rpm, the transducer being a diamond mounted on a piezo electric crystal [stylus]), entitled ‘Betjeman’s Banana Blush’, a collaboration between Betjeman and the remarkable musician and arranger, Jim Parker.  Parker’s music perfectly complements the beauty of the spoken word.  You could try this link: https://m.youtube.com/watch?v=UsNliZAN_7y

And for the record, I am ‘Mrs Fairclough, sipping tea…’

 

About three years ago, my daughter and her partner completed the ‘French Divide’ (qv), a bicycle endurance event, not a race, from Bray-Dunes, near Dunkirk, to Mendionde in the Pyrenees, mostly off road.  And this year’s iteration has been happening, with the leader completing the course of 2400 Km in 9 days.  I would love to do this event – but sadly there is a time limit of 15 days.  I think I could manage it in a month or two.  It was during the briefing for this event that I learnt that if you need fresh drinking water in France, the best place to head for is a cemetery.  Apparently there is some sort of national edict requiring local authorities to provide fresh water in cemeteries– the intent being to maintain flowers on graves.

 

This week has been notable for the fallout of the catastrophic attempts to give A level results when there have been no A level exams (for US friends they are the high school graduation tests which essentially determine whether you get to University or not).  It seems the government have been desperate to avoid ‘grade inflation’ so some sort of algorithm has been used to give results, rather than the pupils’ own teachers’ predictions.  Much distress all round.  This Thursday the lower level GCSE exam results will appear, based on teacher assessments, and a week later the algorithmic results, and pupils will be allowed to choose the higher grade from the two methods.  GCSE results are of no real use to man nor beast, unless you leave school at 16, but no doubt there will be a lot of anger and aggro.  The vox pops this week have been many – angry students not getting to University etcetera.  When I was their age I used to think that Universities were only there for really bright people, but now I realise that the higher education sector is yet another Leviathan, dependent on getting ‘bums on seats’ to secure its funding, and to a large extent merely self-perpetuating degree courses to sustain so-called academics who are not particularly academic at all.  I heard an interview with a teacher who clearly did not know the difference between ‘less’ and ‘fewer’ – she referred to ‘less places at University’ for example.  I despair.

 

Language should always adapt and change, but precision is also important.  Another irritant these days is the PC attempt to desexualise words – the word ‘actor’ is now used to describe actor and actress, for example.  Hero is another word and case in point.  Nobody seems to like to use the word ‘heroine’ nowadays, no doubt for PC reasons too.  Should we be describing the unfortunate South African runner, Caster Semenya, as a ‘heroine’?  Interested parties might enjoy ‘The Conversation’, https://theconversation.com/ten-ethical-flaws-in-the-caster-semenya-decision-on-intersex-in-sport-116448

 

As I write, it is pouring with rain, so golf today is off.

 

The US election campaign is hotting up with much malevolence on the Trump side following the launch of the Democrats’ initial session.  A post on Facebook by a friend speaking of the mess with A level results refers to the malevolence of the present government, thus revealing herself as a probable Guardian reader, but speaking as a hawkish Right Wing Socialist (which is probably how I portray myself) I think the correct word should be ‘incompetence’ rather than malevolence.

 

So now to something really important, and sad to report, the death of Julian Bream, one of my heroes (that word again).  Not only was he a wonderful guitarist who pioneered the classical guitar in Britain, before John Williams came along, but he also did a huge amount of good work rekindling interest in the lute and Elizabethan consort music.  Much of his consort work was in the 1960s, so I was very lucky to hear a late-night Prom sometime in the late 1970s where he reconvened many of his friends to play in a London church.  I also heard him a number of times in recital and was privileged to be introduced to him during a recital by Martin Best in the church of St James in Kingston, Dorset.  The other day I heard the new kid on the block, Sean Shibe, playing Bach’s first lute suite.  The technique was breathtaking.  But my old recording of Bream playing the work, at a much slower tempo, is much nicer.

 

Musically speaking, I am on guitar what in golf we would term a ‘handicap player’, so it was always a pleasure to me to see how hard Bream had to concentrate and to work to produce the music that he did.  I remember him playing a transcription of the 6^th Bach cello suite.  He said that the cello suites got harder as they went from 1 to 6 (I don’t know if that is true), and the effort needed to play it was transfixing.  I also saw John Williams a number of times and the feeling with him was one of coldness and detachment, not that he wasn’t a magnificent player.  I mentioned this one day to a musical friend who observed in a down-to-earth nonsequitur, ‘Yes, but he bonked Anna Ford, didn’t he?’  There is no answer to that.

 

My original recording of the Rodrigo guitar concerto was the 10-inch LP by Narciso Yepes, for some years the only one available.  When Bream’s recording came out in about 1967 I bought it, but was also entranced by the section on the album where Bream’s consort played his own arrangements of the ‘Courtly Dances from Gloriana’ by Benjamin Britten.  They are fantastic.  If you don’t believe me, here is a fascinating piece of trivia: they were selected by Paul McCartney as one of his Desert Island Discs.  It’s true.  The sense of astonishment is similar to that which visited me when I heard that one of David Beckham’s choices was ‘Si Tu Vois Ma Mère’ by the jazz soprano saxophonist Sidney Bechet.  Bechet was originally a clarinettist but discovered the straight soprano saxophone during a visit to London.  The piece can be played on either instrument.  I accompanied the late John Oliver in a school concert while he played it on the clarinet and I strummed the guitar chords that he had written out for me.  A far cry from King Edward’s school concerts is perhaps the most beautiful modern version - by the French group ‘Avalon Jazz Band’ – check them out on Youtube.  Their version of Charles Trenet’s ‘Ménilmontant’ is also breathtaking.  Django Reinhart-style guitar playing.  Super.

 

My diary has wandered far from the Corona days.  Nobody seems to know where we are going with it.  There has been a significant upturn in cases without a commensurate increase in mortality.  Wider testing of milder symptoms, some asymptomatic individuals from track and trace, and the increased spread among young and therefore healthier subjects is thought to be the cause.

 

I am due to join a walking group in North Dorset.  For most of this summer we have walked in approach shoes, but following the rain I feel I should wear boots.  To be on the safe and secure side I get out my Leki walking poles – they have cobwebs on them.

 

A final shoutout for Trump.  Following the recent story of the Mount Rushmore enquiry, some wag has doctored a photo of the mountain showing the four presidents with stone hands over their faces.

 

Sunday August 23^rd

 

My father would have been 102 today.  Exactly two years ago I climbed Schiehallion with a friend.  It was a favourite mountain of my father’s.  I had never climbed it.  For at least half the ascent there are boulders strewn in random fashion and there is no real path.  Although the vertical climbed is minimal – one starts at several hundred metres of elevation, the ground underfoot is better suited to mountain goats.  On the way down, we stop, and in an unguarded moment, I turn to my friend, miss my footing, and bang, fall.  The rocks are hard.  So concerned about the bash on my leg which hurts a lot and makes me wonder if it’s broken (it isn’t), I don’t notice the complete subluxation of my right little finger until I try to grip my pole.  My friend puts it back.  There is so much pain from my leg and hip I don’t notice the pain from the reduction.  So now I am left with a crooked little finger, a memento to remember my Dad by.

 

It was with a sense of ennui d’automne that I drove northwest from Poole, skirting Wimborne, and started out on the road that leads past Kingston Lacy, with its magnificent avenue of beech trees, and turned north up the Tarrant valley to join friends for a walk.  The wheat fields had been cut and neatly rolled cylinders of straw dotted the landscape.  No sheaves or stooks as I remember from my childhood but efficiently machine rolled butts of pale yellow.  The sun shone after rain and fleecy clouds drifted overhead.  In the church yard at Tarrant Monkton, beside which I parked, the beautiful small building of All Saints, built of stone and flint, stood in silent modesty.  Parts of this date back to 1400 (the chancel), but my eyes were caught by other memento mori, the weathered and lichen-clad headstones.  On the stone commemorating a woman who died in 1880, there is the following:

 

            This languishing head is at rest

            Its thinking and aching are o’er

            This quiet immovable breast

            Is heaved by affliction no more.

 

Amen to that.  Our walk takes us East out of the valley up an old drove track, and looking northwest over towards Cranborne Chase.  Through fields and woodland, purpled with elderberries, where pheasants cluck and whirr, and martins flutter, to the hamlet of Manston before winding back by a more southerly route.  It’s a time to chat with walking colleagues not seen since before lockdown, and the heat of the sun is such to allow me to put the car roof down to meander back past Badbury Rings and Wimborne.

All Tarrant Monkton and above the Tarrant Valley

 

In such an elegiac mood of Weltschmerz, it would be easy to dwell on impermanence, put on Strauss’s Four Last songs, and drift away, but eventually the real world returns (‘Life is real, life is earnest’) and it is back to the here and now.

 

A front page headline caught my eye the other day.  Some academic doctor in Bristol has stated that we must not use the term ‘turning blue’ because it is racist.  To elaborate, he seems to think that because Black people cannot turn blue, we should not be using the term.  Since he is presumably a modern creature and may not have done Latin at school I suggest we substitute the term ‘cyanosis’.  Anyway, he is wrong.  If a black person is cyanotic one can see it in the mucosae and fingernail beds, the areas where we always teach medical students to look because ‘central’ cyanosis is usually more important than ‘peripheral’ cyanosis.  This political correctness is really getting me down at times.

 

Nice ‘phone call from my younger daughter who is off to Tuscany.  Great.  Sensible small Air B&B type accommodation.

 

Spend ages trying to draw to scale how I would like my walk-in wardrobe to be constructed.  With a minimalist house and no attic, there is a small room for clothes storage for each of us, and everything is to be tidied away, a bit like a well-organized yacht.  I might have to change the habits of a lifetime.

 

And a visit to a rheumatologist to discover that my hip pain is not arthritis or myeloma from my IgM paraprotein, that axillary skin tags are not mycosis fungoides (I had worked that one out), and that my backache is spinal stenosis which is not severe enough to require operation.  Anno domini seems to be the watchword for this week.

 

The end of the week has been cheered by England’s performance in the Test match against Pakistan, where after crumbling to around 100 for 4, a stand of over 300 runs by Crawley and Buttler has allowed England to declare on 583 for 8, and Pakistan are currently 77 for 5.  What is it about sport at the national level that lifts us, encourages us, and warms the heart?

                                                                                    

I must now get back to ‘To Kill A Mockingbird’, the current choice for the book club.  Re-reading and musing over it, the power of the narrative and the setting of 1935 Alabama, with the terrible miscarriage of justice, it remains such a powerful book.  But there seem to me to be huge problems with it as a text for schools.  The vocabulary of the Southern USA is completely alien to most UK readers.  Who has heard of scuppernongs, kudzu, Hoover carts, and chinaberry trees, for example?  It is also hard to get the image of Atticus played by Gregory Peck in the film out of one’s mind.  Peck justifiably won the Oscar in 1963 for best actor.  Apparently he was so entranced by the book he read it in a single night.  ‘In the Heat of the Night’ you might say.

 

Monday August 23^rd

 

Ennui extends to coronavirus now.  After the initial excitement, alarm, anxiety, and significant lockdown, most people are obviously returning to normal or near normal activity.  Crowds of people flock to pubs, restaurants, and any other venue they are allowed to.  What is different still is the huge reduction in people going to a place of work rather than ‘working from home’.  WFH is a new acronym which everybody understands.  Sports venues, cinemas, and theatres are also empty.  Young people have moved on, and it is only the older generation like me which is still more or less housebound.  Two corona developments to report.  First is definite evidence of reinfection in some cases.  The second infection, recorded in Hong Kong, is a clearly genetically different strain of virus.  Then there is a suggestion that ACE or ARB blood pressure lowering drugs may reduce mortality in Covid-19 infection.  You will remember that the virus competes for the ACE-2 receptor for its ingress to the cell.  Perhaps the drugs block ingress?

 

My daughter seems to have lucked out somewhere in the middle of Tuscany.  Shots of lovely looking infinity pool…  And she’s supposed to be WFH!  Meanwhile my other daughter has just learned that the planned mountain bike event/race in northern Norway will not work out for her because all UK visitors to Norway have to quarantine for 14 days after landing.  £800 down the drain apparently.  A pity because she has been training intensively for this including an 80-mile off-road route last weekend.

 

But here in the modest surroundings of BH12 one still finds interest and amusement in the daily news.  I have written before of the remarkable ability to find humour in the most awful situations, viz. the Nazi concentration camps as exemplified by collations in the Holocaust Museum in Washington, D.C., and although one can in no way compare our current situation with that, it is pleasing to find that we can still make jokes.  My favourite today is related by the Telegraph correspondent who has been to the (socially distanced) revival of the musical Camelot.  Now, following the dictum of my closest school friend, MJW, ‘Mac, never go to a musical’, I have no intention of going to this, but the review is amusing.  King Arthur’s appearance in a shiny grey business suit is mentioned as perhaps not in keeping with the general theme, but the reviewer records the famous words of Noel Coward on attending the premiere which was supposed to last for two hours and forty minutes, but ended up in excess of four and a half hours.  Coward remarked that it was ‘Longer than Götterdämmerung and not nearly as funny.’  In view of the fact that John F Kennedy loved it however it has come to define his presidency.

 

A definite irritant, however, in the news, is a linguist who has stated that older people should not put punctuation in texts, particularly full stops (or ‘periods’ to Americans) because young people find them intimidating.  Oh dear.  Sorry Dr Lauren Fonteyn, whoever you are.  But I don’t expect you will read this.

 

Tuesday August 25^th

 

Torrential rain and heavy winds hit from Storm Francis.  Major flooding in Wales.  Seems doubtful that we will get any cricket today in Southampton, and another limping draw is the likely upshot.

 

Duke University messages me to let me know that students are going back this month, with novel approaches to teaching, including spreading seminars out into the evenings to achieve smaller class sizes.  These will be so-called ‘Pyjaminars’.  At Cambridge in the 1960s, evening teaching in seminars was the rule, sometimes accompanied by a civilized sherry from the tutor, though always finishing in time to allow the dons to get to ‘Hall’ for their chance to sup at High Table.  We were required to attend these in jackets, ties, and gowns, and the question of pyjamas never came up.  In view of the modern concerns about university and school lecturers having sexual relations with their students, nobody seems to have thought about the female undergraduates appearing before their tutors in skimpy nightwear and the possible results therefrom.  Maybe it will all be by Zoom meetings?