We spent the first hour grumbling about how our regulated society was stifling research, inhibiting education, undermining government, taking away the art and enjoyment of life, but risk aversion was part of a cycle.   In medicine, it was probably triggered by the dreadful revelations about Dr Harold Shipman; in economics,  by the greed of the bankers.    

A nervous society finds its ways of getting rid of those who will not conform to its stringent regulations.  We are both reading The Hemlock Cup by Bettany Hughes.   It’s about Socrates’ life, but takes as its starting point, his death.  Accused of being a free thinker and corrupting the youth by speaking against the Gods, Socrates was condemned to take his own death by drinking a cup of hemlock.   My old friend, Maurice, was incarcerated in a mental institution last year on the grounds that he was a danger to society.  Always resentful of authority,  Maurice was targeted by the police and neutralised.  Even the spurious interpretation of a brain scan using nuclear magnetic resonance was used to reinforce the case against him.    

David and I have reached an appropriate stage of seniority when we can with impunity comment on what we see as the failings of the medical establishment.  But this privilege has been hard won.  We are both first born and have both shouldered the burden of our parents’ ambitions for most of our lives.  David commented that it was not until the age of fifty that he escaped the straitjacket imposed by a reputation in medical research and felt free to indulge his interest in philosophy.  At around the same time, he became aware of his parents not just as projections of himself, mum and dad, but more objectively in the context of their own lives.  My trajectory ran parallel to his.  At 49, I started to retrain as a psychoanalytical psychotherapist and at 53 I retired and began writing my book.  Perhaps this was our age of reflection,  the time that we could at last be ourselves,  rail about the restrictions bequeathed to us by our parents indulge in a more liberal intellectual life. 

Does late middle age constitute a similar age of reflection for others besides the eldest sons of ambitious parents?

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0610 GMT  04/12/10

Minus 15 with precipitation!  Visibility 200 yards.  Ice! 

Transport held fast.  Frost forming on rigging. 

Troops down in mouth.  Fog freezing on beards!   Try to encourage.  ‘Chin up!’  But supplies low.  Half rations. Last banana.  No brandy.  Fear mutiny.

 If no improvement, will try dash to base camp tomorrow

Scott, i/c expedition.

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Snow flurries overnight but pressure rising.  Blizzard yesterday made transport impossible; even sledges didn’t run.  By 6pm, snow tractor got through.  Now stuck in drift. Troops digging out.  Mount Sheffield completely cut off.  No radio contact. 

Supplies will last another week.  Plenty of logs for oven.  Bags of flour, so can make bread.  Half a cauliflower and a few potatoes, two cans of chick peas, pasta and rice and lots of spice.  Oates gone, but lots of muesli.  Huskies hungry – don’t like the way they stare at me and salivate.  Must let them go.    

Please arrange air drop of skis, brandy, tomatoes and onions.    

Predicted minus ten tonight, breaking out winter duvet.

Chin up, as always. 

Scott

PS. Who needs the Gulf Stream anyway?

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Wally had worn his best suit, a smart three piece Harris Tweed with Pavane of Paris on the label.  He sat at the table just inside the door alongside the still debonair Michael, who had flown Spits, and    greeted his guests as they arrived.  He was polite and charming as ever; he’d had years of experience, but with a slight mist of vacancy that the Prince of Wales tends to adopt, as if he knew he knew them but couldn’t quite place it.  But they knew the script and so did he.  One by one, they fed him the comic leads and right on cue, he never failed to come up with the expected response.  His eccentricity was so much more acceptable now that he was older.  He had grown into the part.  Peter, who had first announced himself to me as ‘Piss ‘ed Pete from Pitminster’, before taking a chip or two from dad’s plate, parked his tractor behind the hedge and came in with glasses askew and dressed in his trade-mark navy-blue boiler suit.  ‘You’re a star turn, Wally,’ he declared – a compliment dad acknowledged with courtly bow and wave.  

Wally was still an outrageous flirt, only now he could get away with it.  When the barmaid, buxom and pretty, asked him if he would like anything else, he had replied, eyes a twinkle ‘yes, darling, you on my knee.’ 

Two of his ‘old flames’ turned up.  Heather drove in from Langport.   She must have been in her eighties, but was still an attractive woman. She had been his secretary.  ‘And as for that Heather Ridgeway’, her name erupted frequently during the rows between mum and dad during our last year at Blagdon.  But she was engaged in secret trysts with Ron by that time.  Peggy was about the same age and now lived by herself in a cottage in Staplehay.  She winked broadly at me after he had given her that  particularly wet embrace her reserved for prize crumpet, ‘Your dad was always such a rascal.’

It must have been at least fifty years, since he had last seen Bryan.  His wicked eyes and waxed moustache gave him the air of an elderly  country squire; a latter day Sir Jasper.  They had worked together in the Northern Assurance Offices in the thirties.  He recalled them going to dances with some local floosies and dad stealing bottles of whisky, which he hid in the tails of his frock coat.   Dad stared at him, smiling, as if he were listening to a story on the radio.  But if Bryan was disappointed, he didn’t let on.       

But there were few that remembered dad before his accident, and none that he would remember. As his sister, Doreen put it, he went to war a laughing boy and came back a truculent middle-aged man.  The extensive damage to his frontal lobes, he had sustained when he was thrown from the cockpit of his Hurricane, had all but destroyed his personality along with a large tranche of memory.  To survive, he’s had to reinvent himself.  It was particularly hard on mum, they had had just a weekend of married life together before he had to join his squadron in the Orkneys, and then he’d crashed and he was never again the man she had married.  He’d had to reinvent himself.  After four years rehabilitation in my grandmothers pub, he was able to return to work but as a different person. 

Most of the guests only knew Wally in his reincarnation.  But they were all like extensions of the personality created for himself, bit players in the production called Wally, what he would like to be.  I suppose that also applied to me and Simon. We had in his eyes the social standing he aspired to, me the doctor, Simon the artist.   They were all characters,  larger than life, caricatures from an age that was fast disappearing.  Grizzly looked a bit like Eadward Muybridge in his full grey beard, but was a farm worker from Clayhidon who had drunk a bit too much cider.   Paddy trained race horses, kept a stable of women, and was always in a bit of bother with the authorities. He pulled me to one side and from beneath his coat showed me a photograph, no not of a lady, but of a slightly pot bellied horse and said furtively .  Champion steeplechaser, this Nick.  I just want one more person to put in ten grand and he’s yours.  I’ll do all the training of course.  Ginge had dressed himself up in a smart blue suit and a red tie around the collar of his check shirt, but his uncut red hair sprouted from his head like a carrot top. I don’t like to think of the times he had wheedled cash out of dad, but he still brought a beautifully Sunday roast up to the house every week. 

But it would be a mistake to regard all of dad’s friends were rogues and vagabonds.  Many, such as Jonathan the doctor, who lived in the Brigadier’s house, John the airline pilot, Graham and Joanie who used to run a retail outlet in Romford, and Richard the solicitor, added a certain air of respectability to the ménage.  Richard wore a smart white suit and looked happy and debonair and had a whispy blonde on his arm, whom he announced as my fiancée.  He was a different man since his tumour had been removed.  Robby was sitting with his daughter and Tigger the dog, he had bought to console him after his wife had run off with the secretary of the golf club. 

Two years older than Wally and so sharp and vivacious, Anne his sister, whom we as children always knew as Auntie Flossie, that is until she adopted her middle name as more becoming, flirted with Michael.  She helped dad cut the cake,  but couldn’t stop him spilling his wine over it and then smudging the imprinted photograph of  a smoulderingly handsome 16 year old Wallace, dressed in the puritan’s uniform of Queen Elizabeth’s College.  The school said he was good enough to get a scholarship to Oxford,  but he left school instead to join an insurance company.  ‘That way, I could meet a better class of crumpet than I ever could as a student.’  

It didn’t seem right for me to tell funny stories about Wally; too many conflicting memories, I guess.  And I wanted to remember my father, not as a figure of ridicule,  but as a survivor, a kind, generous and even curiously wise man, who inspired great affection in people and who I could respect.  So I  thanked everyone for their support they had given to dad over the years and then deferred to Paddy, who looked panic stricken and instead led a boisterous chorus of Happy Birthday and Three Cheers for Wally. 

There were tears in his eyes as we drove back through Blagdon, up the hill and round the hairpin bend.   He was quiet but as we drew up in the yard and the lights came on, he turned to me and Simon.

‘Nice crowd there tonight.’

‘Yes’

‘Didn’t know any of them!

‘Oh’

‘Nice place!.’

‘Yes’

‘Easy!’

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So she cancelled her dinner engagement with Rob and stayed late again, agreeing to meet him for a drink when she’d finished.  But she was hungry.   Was there anything in this Godforsaken hole that she could eat.  Ah, the baked beans!  She fed them to her volunteers and measured the hydrogen they exhaled.  There were cans of them stacked all around the room, enough to launch a Zeppelin.  OK, she’d fart all night but what the hell.  She was hungry. 

So she opened a can and stuck it on a tripod and lit the Bunsen burner.  Then the phone rang in the office.   ‘Could we talk about this last set of experiments.’  ‘Could you open up the database and just check…..’   By the time she’d finished, she’d forgotten all about her beans.    Bloody smoke alarm was blaring somewhere.  But, it was always going off.   Fuck it, she was late and needed a glass of wine.  And now the bastard lift wasn’t working and something had happened to the lights.  Nothing for it but the stairs, but she was on the eleventh floor.   

It still didn’t register when she saw the fire engines.  There were five of them lined up in the road, sirens still blaring,  blue lights sweeping the buildings on either side.  Firemen in helmets and bright yellow overalls with axes and torches were tumbling from the cabs and rushing past her to the stairs.  Funny time for a fire drill, she thought, as she rushed out into the cool night air. 

Rob was none too pleased about being kept waiting, but he could see she was flustered,  ‘Did you get anything to eat, love?’ he asked.

She stared  at him, with focussing, unfocussed,  then  her eyes grew wide and her mouth opened    ‘Oh fuck! Oh fuck, fuck, fuck!      

They’d started evacuating the patients by the time she got back.  Some were standing there in little groups, shivering in their light green hospital dressing gowns, more were coming out in chairs or on stretchers.  She tried to get in but a policeman stopped her. ‘You can’t go in there miss; there’s a bomb.’

‘No there isn’t, it’s only a can of beans.’

‘Aye, you might say that, but move along now.’

When she got back to Rob’s, the news was on.  ‘We break into the programme to report a possible terrorist attack on Sheffield’s Royal Hallamshire Hospital.’  She listened in shocked silence.  She could see it all, the beans charring, catching fire, setting the papers and the boxes alight, the cans exploding, the sprinklers going off, the lights shorting, panic, evacuation.  Oh fuck!  It was the only thing she could say. 

It was all over the newspapers the next morning.  Terrorist attack in Sheffield!  There were even  questions in the house.  ‘Why had the right honourable gentleman ignored our warnings?’  ‘Why hadn’t this government improved security in our public institutions?  Why had they cut funds to the fire service and the police?    There was no way the government, already in trouble, could survive a vote of no confidence.  They held  a snap election and lost.  ‘Fired’, the headlines screamed.  The Conservatives got in on a ticket of Health and Safety.  And six months later, Britain joined the Americans and declared war on Iran.

It’s all chaos. A butterfly flaps its wings in West Africa and there’s a typhoon in the South China Sea.   Karen cooks beans on toast ……. and well, anything could happen.

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‘Now alternative nostril breathing.’  Pinch your nose between the thumb and ring finger of your right hand, breathe in through the right nostril,  close the right nostril, breathe out through the left, breath in through the left’.

‘What are you doing?’ 

A man, in his thirties, I’d guess,  looking somewhat weatherbeaten, and dressed in a black waterproof tracksuit sat cross-legged in front of us.  He was clutching a plastic bottle containing beer and proceeded to roll a cigarette.  I felt a bit wary, but he seemed ok. 

‘We’re doing yoga.’

‘Oh I know yoga.  Ali Akbar.  It makes you fit.’

‘ Yes. You can join in if you like.’ 

He looked at me curious, undecided.    

I carried on.  ‘Close the left nostril, breathe out through the right, in through the right, close the right nostric, breathe out through the left…..’ I sneaked a look at him.  He was looking perplexed but I didn’t want to have a conversation with him.  We were after all engaged in spiritual exercises

‘I had a few drinks with me mates last night.  I was so tired, I covered myself with cardboard and went to sleep by the motorway. 

 ‘I walked over here this morning.  I’m going to meet a friend.  She’s got a big belly.’  He winked at me. ‘You know what I mean.  I want to congratulate her’

I abandoned alternate nostril breathing and went to the next exercise.  Take a deep breath through your nose and then breath out and make a humming noise.  As you breathe in count up to five and as you breathe out, count down from 10.’  We all took a noisy breath in, held it and hummed for about 15 seconds.  Then we took another deep breath in, ….    My eyes were closed but I could hear him muttering. 

‘Now lie down in sharvasana.’  We lay flat on our backs.  Hands slightly away from your body, legs slightly apart, breathe gently through your nose.’

‘Ah that’s relaxation, that’s good for you,’  he muttered.

I went through the routine of progressive muscular relaxation.  My eyes were closed.  He was quiet.  I didn’t know whether he was joining in or not. 

‘Now as you lie there, you will be very sensitive to the things around you, the distant hum of traffic, the sounds of the birds, the gentle hiss of the river, the smell of a cigarette,  a light breeze blowing over your face and the faint heat from the sun permeating your skin and spreading into all the cells of your body.  We lay still and quiet, emptying our minds.  I lost all thought of him. . 

After about 10 minutes silence, I said, ‘Just move your hands and feet and keeping your eyes closed, sit up in a meditative posture.  Rub your palms together, place them over your eyes.  Feel the warmth of your hands.  Feel your eyes, your forehead relax.’   I was aware he was joining in. ‘Now take your hands away, open your eyes, blink a little.  Look around.  Say an affectionate Namaskar to the people around you.’  We put our palms together and held them close to our chest in an attitude of prayer and bent towards him and said ‘Namaskar’.   He repeated the gesture.  

‘What’s that mean?’

‘It’s a hindi greeting.’

‘On Hindi, that’s India isn’t it?  I can speak all those languages; hindi, urdu – all of them. 

‘That’s good, I said, so you’ll know this. 

I put my palms together again and together we chanted, Ooohhm, shahnti, shahnti, shahnti-ji   

In our own time, we stood up.  He got to his feet too.  ‘My names Rick.  It’s nice to meet you’.  He then shook hands with each of us.  I thought for a moment he was going to hug me but perhaps my look of apprehension put him off.

 ’Take care.’  I said.   

‘God bless you’, he replied and looking in my eyes, added, ‘I mean that.

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He is one of those slightly odd  anti-heroes who confound and irritate the hell out of those who take themselves too seriously.   Playing tennis, he  has his own idiosyncratic method of serving, a back and forth movement of the racquet as if he was putting a pizza in the oven and then a smack, leaving his more professional opponents muttering darkly.  But don’t we love him just because he has a go?  His  car breaks down at the funeral gates but when he opens the boot to get his tools, the inner tube rolls into the wet leaves where it is mistaken by the funeral director as a wreath and hung on the tomb.  The wreath deflates but the mourners pretend not to notice and come up to shake M. Hulot’s hand for his courtesy.   And of course, it‘s Monsieur Hulot who gets to dance with the pretty girl, but there is no hint of guile or seductiveness is his behaviour.  He is just enjoying the innocent fun of being  Monsieur ‘Ulot on ‘oliday.   

If it wasn’t French, we would say that Monsieur Hulot’s holidays is a charming example of British humour,  the precursor of Mr Bean and Monty Python’s Flying Circus, but it’s more subtle than either of those.  M. Hulot is not so much a belly laugh as a whimsical set of observations of people doing the sort of things that people do on holiday.  We are laughing at ourselves.  Jacques  Tati has a wonderful girt of mirror to all of us and saying with a slight smile,  ‘aren’t we all a bit absurd when we think about it?’

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It was like a metronome, every second.  Simon worked out that at this rate, she would say oh dear, 3600 times an hour,  up to 50,000 times a day,  15 million times a year.  But the mantra had some more intense variations;  ‘oh no,  oh no, oh no’ or just ‘no, no, no no’, and worse still, ‘oh please, oh please, oh please, oh please’ and then ‘oh Nick, oh Nick, oh Nick’  Anybody listening to this would be bound to think, ‘Whatever is he doing to that poor woman?’ 

Every so often she would stop and ask where we were going.

‘We going to Chatsworth mum. You know to my cottage’ and I’d make a motion with my hand as if to open the latch. 

‘Chatsworth.’, she’d say puzzled and then she would get it.

‘They brought the lambs in.’ 

‘Yes that’s right.’

‘What are we going there for?’

‘We’re going to have tea; turkey sandwiches, Christmas cake, mince pies.’

‘You going to leave me there.’

‘No, of course not.’

‘We’ll have tea and then take you back home.’

‘Home?’

‘Yes, to your flat.’

‘My flat?’

‘Yes, number 9 the Woodlands, Shore Lane.’

‘Do I live there?

‘Yes.’

‘And then you’re going to leave me to walk?’

‘No!’

And the litany would all start again, ‘oh no, oh no, please, oh please’.

It is all very tiring.  Although I am not doing anything awful to her, it feels like it.  The reality is that her life is dreadful. She has lost her identity.  She cannot remember anything from one moment to the next and so everything is alien to her, confusing. She  doesn’t know where she is or what is happening. 

And so a pleasant drive in the country is torture to her.  She has been taken out of her environment along roads she can barely remember to an unknown destination for no clear purpose.  And because she has never really been able to trust that things will be allright, she fears she will be abandoned and never find her way back.  It must be terrifying. 

When the Red Army invaded East Prussia in the winter of 1945, millions of people were forced by fear of murder and rape to flee their homes and join the columns of refugees escaping in sub zero temperatures towards the west.  That was their dreadful reality.  They didn’t know where they were going or why and many died on the way. Mum’s world must seem just as threatening.  She does not know where she is, she has no home and she sees confusion and danger everywhere.  Sometimes when I have to repeat the same facts to her for the twentieth time, it is important to realize that this an anchor point, however ephemeral, in a devastated world.

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‘I can’t eat these. I have sensitive teeth.’

‘Well just try swallowing them and feel the cold go all the way down,’ I suggested. ‘Look it’s easy.’  And with that I popped one into my mouth, let it roll down back into my pharanx and swallowed, then waited for the wave to slide it down.   

The grape was as hard as a marble and cold as a lump of ice.  It got so far and stopped just behind the sternal notch, generating a dull ache that spread like a band around my chest.   I swallowed again. It still wouldn’t budge.  In fact I could feel it coming back up again and the pain intensified.  I swallowed a third time.  Nothing.  I could feel my face turning red and a wave of nausea rising up from my stomach. 

I stood there, my neck sunk into my chest, eyes bulging, not sure what to do. Simon was laughing, tears rolling down his face. ‘You’re such a  daft bugger!’

At that I started laughing too and then stopped.  There was a real risk of asphyxiation and while it might be a good way to go, I wasn’t ready for that yet. I needed to stay calm. I breathed gently in and out and when I felt in control, swallowed some water and felt the grape move painfully down.   

I turned to Judy, who was a scientist.  ‘Why don’t you write this up as an experiment  – the induction of reverse peristalsis by an ice cold bolus?  But first we need to test its reproducibility.’  Emboldened by experience,  I took another grape and swallowed.  The  obstruction behind my breastbone was exquisitely painful this time and it was so hard not to laugh when others were swaying about with general mirth.  But another glass of water did the trick.  Eureka! 

‘Now, Judy, we need to try this on somebody else. What about Roz?  And we need a genetic control.  Simon would do. And then you must do a series.  You could put a capillary tube down and measure pressures or you could fill the grape with contrast medium before freezing and then X-ray your volunteers.  Reverse oesophageal peristalsis is controversial in humans, but this could be the proof.  You could be famous, Judy.  It could be known as the Donnelly Provocation Test.  You could patent it.’ 

Ah well,  you can lead a scientist to water, but ………  Judy was not impressed.  Another opportunity missed! 

All of this reminded me of a demonstration forty five years ago in Cambridge. Dr Giles Brindley, then a young lecturer in physiology, stood on his head on the class bench and swallowed water through a rubber tube from a large Winchester bottle, just to prove that swallowing does not occur by gravity but by persistalsis.  The next issue of the Med. Soc. magazine demonstrated the trick.  Beneath the bench was the laboratory assistant who was opening a stop cock to drain the bottle. 

Who said science wasn’t theatre?

A Health and Safety Warning.  These experiments are risky. Please don’t be tempted to try them at home.

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She glanced at her clipboard and announced briskly;  ‘Now, Dr Read, examine this man’s chest.’  

I carefully went through the procedure, inspection, palpation, percussion, auscult……… 

‘Hurry up! Hurry up!’ 

‘I think the patient has a right pleural effusion,’  I offered tentatively. 

‘You only think he has!  You’ll have to do better than that.  Now, examine this mans heart.’  She wafted an imperious arm in the direction of the next bed. 

I got out my stethoscope, bent over the patient, but before I could listen to his heart, I heard the lady comment. 

‘He’s alright, but he’s very nervous!’

A resolve, like controlled anger, stiffened inside me.  I was quick.

‘Opening snap, mid-diastolic murmur with presystolic accentuation, splinter haemorrhages under his nails; Mitral Stenosis with SBE.’

‘OK. Next.’

‘Intention tremor, nystagmus.  This patient has cerebellar ataxia.’

‘Next.’

‘Enlarged liver and spleen.  Rubbery Lymph nodes in both groins.  I suspect lymphoma.’ 

‘Good! Now, just examine this mans eyes and anything else you think might be relevant.’ 

The patient eyed me with mischief.  I got my ophthalmoscope out and noted he had microaneurysms, blot haemorrhages, hard waxy exudates.  I took in the puncture marks, the lumps of fat under the skin of his abdomen. With a pin, I tested sensation in his arms and legs. Finally, I bent down and smelt his breath. 

Feeling confident now, I turned round, faced up to the lady and announced firmly.

‘This patient has long standing insulin-dependant diabetes with retinopathy and neuropathy.  He was probably admitted in diabetic coma, since I can still detect the ketotic smell of Golden Delicious apples on his breath.’

The lady was smiling, a curious almost triumphant smile.  So was the patient!  Confused, I looked down at his plate. My heart sank. It was the patient who broke the silence. 

‘Funny you say that doc!  I’ve just finished that apple.’    

This article was submitted to commemorate the 150^th anniversary of the MRCP examination by the Royal College of Physicians on 15^th September 2009.  My examiner was Professor Dame Sheila Sherlock.   

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