Evening Hill Diaries - 8 - a warm October...

Early morning swim, Branksome Chine beach, 9th October 2023

We visit a friend in Somerset.  She lives in a tiny village near Castle Cary.  In the afternoon we walk the tracks and lanes in the steep sided valley of Hadspen, which lead towards Bruton (the trendy place for bucolitropic London celebrities who don’t wish to move to the Cotswolds).  Current residents include Stella McCartney, George Osborne, Alice Temperley, Sam Taylor-Johnson, Don McCullin, and other movers and shakers.

Our walk is interesting not because of the distant views of this little town but because our friend knows many of the farmers who allow us to walk through their apple orchards, heavily laden with apples destined for cider.  I try several different apples – all taste awful and it seems strange that nonetheless they will make wonderful cider.

Very close by is Hadspen House, formerly owned by the Hobhouse family – childhood friends of our host.  Relatively recently taken over by a South African industrialist who has transformed the gardens of the estate, which he has renamed ‘The Newt’ as a treasure house of apples from every county in England and a repository of rare varieties.  Fabulous cider on sale at fabulous prices.

The Newt

Cider orchards near Hadspen

October 7^th

For the south (not Scotland) a dreamy spell of Indian Summer with temperatures set to reach 25 degrees today.  A visit this week to the wonderful West Sussex golf club.  The signature hole, a long drive across a lake, still has a marvellous show of water lilies.

6th Hole, West Sussex Golf Club

Some Swiss friends visited and had never seen the Agglestone – so here it is.

Agglestone Rock, Isle of Purbeck

And a regatta off Old Harry rocks (Handfast Point)

Old Harry rocks

And more hot weather.  But though we enjoy a few more days of record October temperatures, there is a major convulsion in the World Order on Saturday October 7^th.  A substantial incursion of HAMAS fighters into Israel, and slaughter of many innocent families and children, including a summary massacre of some 250 or more people attending a music festival, irrespective of nationality.  One Israeli military commander likens it to ‘Our Nine-Eleven’, and when the body count is finally totted up the numbers will indeed likely be in the thousands.  Addendum: currently estimated 1400.

Israel, unsurprisingly responds in kind.  No doubt also irked by their intelligence failure to predict this coming.  We are now (October 10^th) into the 4^th day of a new middle-east war.

As if we needed another war…

October 17^th

Over the last few days the temperature has plummeted.  We have gone from T-shirts to windproofs and beanies.  The Dorset Gentlemen’s Walking Society today braved chill temperatures and storm force winds, but bright sunshine.  Storm Babet arrives tomorrow, currently wending its way across the Atlantic.  Lovely Country trails with distant views of Crichel House and crossing and recrossing of the chalk stream River Allen, where some sizeable trout can be seen, tails waving in the current.

In these confusing times, and I speak of gender issues now, I have come across a quotation from Henry James in 1894, who was so perplexed at the new incursions of enlightened feminists (many wearing men’s clothes, or openly bisexual, and published in the famous ‘Yellow Book’) that he wrote in ‘The Death of the Lion’, a short story, of a character complaining: ‘In the age we live in, one gets lost amongst the genders and the pronouns.’  Perhaps reassuring to the heroic J K Rowling?  (Item courtesy Sara Lodge, Senior Lecturer in English at St Andrew’s University).  I saw an interview with Frederic Raphael recently in which he was asked about ‘woke’ issues and in particular about J K Rowling and the hate mail she has been subject to since her pronouncements on gender.  He did not hold back, particularly when asked about the attempts to dissociate themselves from, and criticise her views by the Harry Potter film franchise stars, Emma Watson, Rupert Grint, and Daniel Radcliffe.  ‘Little s…s’ was his verdict.  ‘She’s made them millionaires and this is how they reward her’.  (I may have slightly misquoted – but the expurgated phrase is exact).

 

October 29^th, 2023

The day when the clocks go back and daylight is greater in the morning but less in the afternoon.  Terrible weather and appalling floods in Scotland recently.  Golf course closed frequently.  I braved the rain last weekend to cycle to the Bournemouth match against Wolves.  Lost 2-1.  Attended again yesterday – first win of the season versus Burnley, 2-1, though a neutral would have observed that they tried hard to lose it.

Main event this week was attendance at the hospital trust’s Governors Board meeting.  The minutes of the first part are in the public domain so I feel I can report my reactions fairly and without risk of breaching confidence.

I am not quite sure why I want to continue to be a Governor, other than at least trying to contribute in some small way, though the Governors’ role legally is restricted and very different from the role that other governing bodies fill, for example at schools and other institutions.  (In NHS Trusts, the non-executive directors are the direct supervisors of the CEO and Executive Board).  Perhaps it is a need to continue to try to do my best for local healthcare.  But I always find these meetings a little depressing.  Review of the hospitals’ performance is neatly contained in a monthly report called the IPR (Integrated Performance Report).  To keep things simple, a traffic light system indicates performance against national criteria (targets).  Frankly, it is a sea of red.  There are few areas where we reach what we are supposed to.  Financial report – gloomy – again.  There is always discussion around what we used to call ‘bed blockers’, subsequently the less demeaning term ‘patients medically fit for discharge’ and now a new slightly more woke term which is something like NCTR (No Criteria to Reside), the officially approved NHS term (honestly it is, you can Google it).  This gives a ‘Discharge Ready Date’ which of course differs from the actual discharge date.  We are apparently something of an outlier, and it is not related just to the age of our population.  We have some 200 patients who can be discharged but have nowhere to go to.

While musing about this, I recalled sitting in my first Fellows’ welcome and address speech at Duke University Medical Center, in 1981.  The address was given by the hugely famous Professor James B. Wyngaarden (expert on inborn errors of metabolism), Chairman of the Department of Medicine.  Wyngaarden was soon to be summoned from Duke to head the National Institutes of Health at the request of President Reagan.  This is a paraphrase of something he said: ‘At the time I am speaking to you new fellows and residents, the occupancy of our beds in Duke Hospital is 57%’, he said.  ‘And I am relying on your energy and competency to substantially increase that percentage over the coming year’.

To a refugee from the NHS (bed occupancies in excess of 98%), to say that I was dumbfounded would be an understatement.  But in the USA, empty beds make no money…

Along with our perusal of the IPR there is a new initiative mentioned.  It is called Patients First, and is apparently a national initiative together with the (inevitable) training modules.  I can scarcely believe my ears.  ‘Isn’t this what I have spent my medical life trying to do?’ is the thought bubble which floats above my head and is fortunately not noticed by others present.  The meeting draws to a close just after 7pm.  There is an American rock band called ‘Rage Against the Machine’, a feeling which comes to mind.  And Jonathan Swift’s epitaph, ‘He lies where savage indignation can no longer pierce his breast’.  I am not courageous but sometimes I feel that I wish I were a modern day Jonathan Swift.  Heads and brick walls also come to mind where the Leviathan of the Health Service is concerned.

I then go to visit a 78-year-old friend who is in the Acute Medical Unit with pneumonia.  He is on oxygen but able to talk.  There is an incessant beeping from his intravenous infusion which shows a high pressure alarm.  When I leave him I go to the ward desk and tell the nurse about this, and request that something is done about it.  ‘Yes’, she says, ‘But we’re just about to have report’.  Refraining from asking whether she has done the ‘Patients First’ module I leave the ward fuming.  ‘Report’ has been the bugbear of my life as a consultant.  Following the Salmon report many years ago into nursing practice, it was decreed that patient handover should be more formalised.  But in our hospitals nowadays, the poor continuity of staffing in many cases, and the very high turnover of patients, mean that many staff coming on for their shift have never met many of the patients now under their care.  In practice, this means that the entire nursing staff withdraw to an office for a long (sometimes up to an hour) handover, leaving patients to fend for themselves.  Handover used to happen when I was a house physician, but it was done by the bedside, the ward sister moving from bed to bed and briefing the next nurse to take charge.  It was not necessary for the entire ward staff to stop work and ‘have a meeting’ – the curse of the NHS.

Well, that is one hobby horse addressed.  Where next?  The England cricket team?  But some topics are beyond saving…

The war in Gaza is appalling.  Israel, by virtue of what seems to be very arbitrary bombardment in Gaza (civilian and children’s lives lost) would seem to be losing the propaganda war, despite the horrendous atrocities inflicted in the raid into Israel by HAMAS.  The BBC has stopped short of labelling HAMAS a terrorist organisation, using the phrase ‘Labelled as a terrorist organisation by UK Government and others’.  The new phase is on the ground incursion by Israeli military.  The unrest has spread, with Lebanese Hezbollah fighters now attacking Israel.  There is concern that Iran will now become more overtly (formerly secretly) involved.  The most worrying headline of the week has been that HAMAS representatives have been welcomed to Moscow by Putin.  A recent social media post revealed a telling quote from Mahatma Gandhi: ‘An eye for an eye leaves the whole world blind’ (the quote is probably by Gandhi’s biographer, Louis Fischer).

Maybe there will be some better news someday.

 

Saturday November 18^th, 2023

A seemingly never ending sequence of storms has deluged much of the UK and caused significant disruption.  Parkstone Golf Club has measured rainfall from 1^st October to 16^th November at 350mm (14 inches).  Storm Ciarán (more in a moment) has been replaced by Storm Debi.  It hit this week and represents the earliest time in the storm season that we have reached the letter ‘D’ in the meteorological alphabet.  Such storms mean that swimming can be dangerous due to the overflow from an overloaded sewage system, and as usual, Matt has the 'mot juste'.

Matt, the Daily Telegraph

There is little to report in the way of light relief from the Middle East.  The phrase ‘In war, the first casualty is the truth’ has been attributed to Aeschylus.  He meant of course, the deceptions practised in the Ancient World by opposing armies and did not live to experience the rise of propaganda.  In the word strewn wars of the internet, claims and counter-claims on this phrase particularly push the claims of some U.S. Senator called Hiram something in originating the phrase.  One of these internet warriors, interestingly, tells us that Aeschylus lived from 456 BC to 524 BC, i.e. backwards.

The best recent example of propaganda or misinformation was an explosion in Gaza which HAMAS claimed was an Israeli missile strike on a hospital.  Israel counter-claimed that the explosion was due to a misfiring Palestinian missile which had landed not in the hospital but in the car park.  U.S. surveillance suggests that the latter is true, but we cannot be certain.  What is undoubted is that there are substantial civilian casualties in Gaza.  Now that the Israeli Defence Force has invaded it may be that warfare will be better directed against HAMAS fighters, though there are stories of their gunmen downing weapons, and stealing hospital clothing in order to escape the on the ground fighting.

Propaganda, is of course, as classicists will know, the neuter plural gerundive (or gerund) form of the verb propagare to spread or propagate.  Mention of gerunds reminds me inevitably of Nigel Molesworth and his struggles with most school subjects.  Molesworth thought that the Gerund was some sort of animal.  Here is Ronald Searle's illustration from the Molesworth books:

The original use of the word propaganda, as in Congregatio de Propaganda Fide was an attempt by the Vatican in 1622 to spread the Christian (Catholic) message.  As such its original use was neutral, i.e. a simple attempt to spread an ideology or a message.  Its later use, incorporating the sense of manipulation goes much further than ‘being economical with the truth’ and includes falsehoods to achieve an aim.  Its progeny would now include ‘Fake News’, ‘Misinformation’ and ‘Disinformation’.

Enough.  My step grandson (aged 6) came home from school the other day.  Indignation was painted across his face.  ‘Mummy, what do you think the school play is this Christmas?  Jesus again!’  He has seceded from casting in this year’s event.  He is something of a character, and the headmaster has accepted this without demur.

On a mission to visit football grounds where AFC Bournemouth are the visiting team, my wife announced that we should go to Manchester to see the Etihad stadium.  I object to merely travelling there and back, so we have a mini-break,.

Day one was meant to be climbing Moel Famau, a hill on the northern section of the Offa’s Dyke path.  Storm Ciarán had other ideas, so we explored Chester in the rain.  A University graduation ceremony was taking place in the cathedral (ancient but remodelled by Sir Gilbert Scott 1868-75) and there was some fine organ music being played.  The bass notes caused even the massive stone pillars of the building to vibrate.

Moving on we debate how to spend the next day when the weather forecast is better.  From our hotel on the shores of the Irish Sea we walk into Prestatyn to discuss this and dine at the Crispy Cod (highly recommended).  Dessert courtesy of Tesco’s across the road.  The last of the big spenders.  Our meal the following evening in ‘Bryn Williams at Porth Eirias’ (a TV chef who is of course not there) costs four times as much and is ‘okay’.  The only chardonnay on the wine list by the glass is from Conway (North Wales) and is a little sharp…

Our Friday therefore begins with a trip taking our bicycles on the train to Bangor.  As we arrive, the heavens open and the charming (?Victorian) station is deluged with water as rain cascades into the (?Victorian) iron pipes which have probably not been cleared for years.  Huge gouts of water backflow at the bends of the pipes and the platform resembles a lake.  ‘Didn’t we have a luvverley time, the day we went to Bangor’ I carol.  A passenger standing nearby reminds me that the song is about Bangor, Northern Ireland, but I think he gets my drift.

We begin the first of 44 miles, saving grace being a backwind.  The cycle route is mostly excellent, National cycle route 5 (Sustrans), and lies largely along small roads and some remarkable cliff skirting bike paths.  Eventually we reach the Conway estuary, with the dark grey castle looming over the town and blending into the dark grey landscape.  It would be possible to glance at the town from the estuary and miss it, despite its immense size.  A quick pit stop and then on over the headland past Llandudno into the sweep of Colwyn Bay.  More persistent rain and we are soaked by the time we get back to The Beaches hotel.  A sense of achievement nonetheless, the longest bike ride for us on normal road bikes for a very long time.

'Didn't we have a luvverley time?'

OK

Looking East near Penmaenmawr

Conway Castle

The Smallest House, Conway

Saturday is our trip to watch the football.  A veil can be drawn over Bournemouth’s performance here.  But in the evening, staying with my cousin, a retired brewer, we have a pub meal and some excellent beer.

Armistice Day respect at Manchester City

Any readers will deduce that we have been short of excitement to write about recently and they would be right.  So, on to discuss ‘Book Club’.  After nearly five years in our all male book club we have read 40 books.  The most recent choice was ‘The Loved One’ by Evelyn Waugh (1948).  As a 17-year-old I loved the gallows humour and satire and probably missed a lot of the nuances.  I was surprised but pleased to enjoy it on re-reading.  I was struck by the pithy satire, e.g. at Sir Francis Hinsley’s house, the narrator states ‘English titles abounded now in Hollywood, some of them authentic.’  And some of it is prescient, for example, with regard to funeral services in America, ‘Liturgy in Hollywood is the concern of the stage rather than of the Clergy’.  One cannot help thinking of the elaborate pantomime of Michael Jackson’s funeral – broadcast worldwide.

Waugh comes up with names worthy of Dickens, ‘Mrs Leicester Scrunch, Mrs Theodora Heinkel, Mr Joyboy, Aimée Thanatogenos, Sophie Dalmeyer Krump’.  I noted a fair whiff of anti-Semitism.  I had to look up the slang when one character says of Hollywood directors: ‘Your five-to-two is a judge of quality’.  And I loved the definition of Hogmanay, ‘People being sick on the pavement in Glasgow’.  Waugh’s cruel sense of humour extended to mistreatment of his own family, in many well documented accounts.  ‘The nastiest tempered man in England’ was one description.  On the other hand, no less a critic than Clive James wrote: ‘Nobody ever wrote a more unaffectedly elegant English…’

At our discussion of the novel, it scored highly.  On to my own choice of book!

I had in mind to choose Brecht’s ‘The Threepenny Novel’, which again I read as a teenager, and after recently being dazzled by the Edinburgh Festival’s ‘Threepenny Opera’.  But I was dining with several cardiological friends, and we talked of book clubs.  ‘There is a book club’, announced a friend, ‘Based, I think, in Moscow, where they only ever discuss one book.’  Immediately thinking of how much time we could save, not to mention cost in ordering our books, I was immediately intrigued.  The book turned out to be ‘The Master and Margarita’ by Mikhail Bulgakov.  Written under threat of Soviet repression and censorship in the 1930s, it eventually surfaced after the Second World War in samizdat copies in Russia, but these were incomplete and portions were suppressed or redacted.  The full novel appeared only in the 1970s, by which time Bulgakov had been dead for many years.  I obtained a copy and read it in three days (it runs to 450 plus pages).  I urge you to read it – I would describe it as extraordinary.  But I would also accept that it is a little like Marmite – some may not like it at all, particularly as it predates and presages much 20^th Century Magical Realism.  I have worked hard to provide my club members with a list of characters – Russian names: given name, patronymic, family name, together with nicknames or shortened and diminutive forms are always a source of difficulty.  This is available to anybody who would like it!

And on Wednesday November 15^th, the only day recently with good weather, the walking group toured the New Forest trails around Lyndhurst and Rhinefield.  Oblique sunshine glinting through golden leaves made us all feel better about life.  Fording some of the streams was difficult but we repaired to The Oak Inn at Bank afterwards for good beer and food.  As we approached a tiny hamlet, we were met by a family of pigs foraging for acorns – an ancient right in the New Forest protected in law as ‘pannage’.

New Forest, November 15th

'Your tiny streams are swollen'

Porky 'pannage'

And during another rainy day of Lindsay’s absence when I gained unrestricted access to the kitchen, I attempted to recreate a wonderful Breton pastry which we have enjoyed while cycling in France – the Kouign-Amann (Breton for ‘Butter Cake’).  Here is the result:

Kouign-Amann

In my personal opinion, ingestion of one of these could substitute for a GTT (glucose tolerance test) - if anyone does those any more.

I sent the picture to our friend Maggie who was a contestant on ‘The Great British Bake-Off’ two seasons ago.  She came straight round.  ‘The important thing is that you gave it a go’, she said.  A delightful double-edged compliment.

And I expect the next diary entry will be for Christmas…

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

Thursday September 24^th

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

Autumn anemones in Poole

18th green and 1st hole, Parkstone Golf Club

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

 

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

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

 

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

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

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

 

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

 

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

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

 

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

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

 

Friday September 25^th

 

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

 

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

 

Monday September 28^th

 

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

 

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

Apples or crab apples?  New Forest

 

Crab apple jelly on the way

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

New Forest ponies (with forest)

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

 

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

 

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

 

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

 

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

 

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

 

Wednesday September 30^th

 

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

 

BSO and David Hill

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

 

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

 

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

 

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

 

Thursday October 1^st

 

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

 

Swimmers, and furloughed cruise liner

Survivors

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

 

Friday October 2^nd

 

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

 

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

 

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

 

Saturday October 3^rd

 

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

 

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

 

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

 

Sunday October 4^th

 

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

 

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

 

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

 

Beach foam

Kiting in Whitley Bay

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

 

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

 

Friday October 9^th

 

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

 

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

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

Goodwood Downs course and Chichester Cathedral

Stormy skies above Goodwood Downs

 

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

 

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

 

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

 

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

 

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

 

Sunday October 11^th

 

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

 

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

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

 

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