end of year report

In keeping with a tradition begun by Samuel Pepys in his great diary, I offer today a brief look over my shoulder at the year ending and a glance ahead to the next one.

The year began with my knowing it would be my last year as a full time doctor. Having served 37 years of continuous, full time duty in the NHS, I feel I have earned at least to some extent my place in the sun. But the change of life has been much on my mind. Will I slip into the depression so commonly reported by people whose main function has been amputated? Or will I, like my father before me, relish my new freedom and in a few brief months describe myself as busier than I ever was before I retired? I hope so, but I am aware that all this is very much down to me, and no one else.

Financially I began the year on a very secure basis, and close out in what promises to be an even more secure one. The sale of my surgery building, my pension lump sum and a very good pension, plus the 18 grand pa I shall make continuing to work part time will ensure that whatever else my worries may constitute, they will not include money. And for that I am very grateful. I have never really worried about money, knowing that the security it offers is only a small part of the formula for happiness. Having said that, I would not ignore its importance. I always go by the following axiom:

"Life is like a shit sandwich: the thicker the bread, the less shit you taste"

As for buying a new house, I still intend to do this, but only when the right house comes on the market, and not before. If this takes more than a year, so be it.

Culturally, it has been a very good year. I have read 45 books (which I think is a personal record) and seen 90 films (also a record) In addition I have seen operas, plays and several other delights on the stage. I have written 5 short stories, some of which I flatter myself to believe are quite good and possibly publishable, given a bit more work on them.
My orincipal regret of 2010? Deleting my pictures from Belgium. Yes, I still feel burned by my stupidity over that.

My marriage has survived another year, despite the strains placed on it by her frequent trips to the West Bank and also her new found obsession with her latest toy, the iphone, which so often comes between us it is almost like having a lover living on-site. Seriously, she contines to be a sterling source of comfort and support to me as we both struggle to come to terms with the loss of our son 4 years ago. You go, girl! (but put the damn iphone down, now!)

My health has been largely good, with only 2 heavy colds, and, unusually, no chest infections. I have kept up my exercise programme, with about 80 "city hill-walks" and maybe 15 longer walks through the year, involving substantial ascents, to say nothing of the 80-plus hand-weight sessions. (I intend to do one as soon as I have finished this blog) The only real blot on the horizon is the continuing deterioration of my teeth. Next year I have 3 impants planned, at a cost of £2500 each. It will mean a lot of discomfort and general upset, but hopefully I shall live long enough to take advantage of my investment. Yesterday a report appeared in the Lancet suggesting as many as 20% of people currently alive and under 50 will live to see 100. As I am 60 rather than 50, and continue to smoke heavily, so it seems distinctly unlikely I will be one of them. But I could have 10 or even 20 years left to read, see movies, write and perhaps even make a small difference in the world.

I have had some very good holidays this year: city breaks in Brussels and Bruges, and Amsterdam. I have also had a great week in Ireland (though not our stay in the six counties; I do not recommend anyone to stay there unless they are fully prepared for the unwelcoming, unfriendly and downright hostile attitudes of the inhabitants)
Finally, our stay in the Holy Land in October must go down as one of my greatest trips: seeing the Old City of Jerusalem, swimming in the Dead Sea and performing my juggling show for the orphans of Bethlehem (well, some of them, anyway) which may not have been faultless, but nonetheless seemed to go down well enough with them. I shall continue to practise my circus skills in the knowledge that it is good for my mind, body and spirit, as well as being something I can use to entertain others, albeit at a strictly amateur level.

I'll be in touch next year. All the best for the New Year to everyone!

december book and film review

Welcome to the last review of 2010. I should remind followers that the list, like all the previous ones, represents books and films I have encountered for the first time (surprising though this may appear; like everyone, there are gaping holes in my cultural education which I am slowly attempting to fill in)

BOOKS

SCARLET AND BLACK (La Rouge et le Noir), BY STENDAHL. An absolutely stunning exploration of morals and sensibilities (or complete lack of them) in early 19th century France. It feels so modern it could have been written by one the existentialists of the mid 20th century! Terrific.
SEVEN BY FIVE, BY H.E. BATES. A collection of short stories by the doyen of the post war "rural tale", he conjures a lost world of cowslip picking, love and loss in the English countryside. Most are passably interesting; a few quite excellent.
CHARLES LAUGHTON: A DIFFICULT ACTOR, BY SIMON CALLOW. Hailed as one of the great theatrical biogs, it is certainly a detailed and fascinating dissection of one of Britain's greatest screen and stage talents. Absorbing.
A CHRISTMAS CAROL, BY CHARLES DICKENS. Heaven knows how I let this one get past me for so long. Only 100 pages long, it constitutes one of the great contributions to Victorian literature, with its marvellous descriptive passages and superb construction. If, like me, you have overlooked this one so far, remedy your oversight immediately.
MANHATTAN TRANSFER, BY JOHN DOS PASSOS. Said by some to be merely a "warm-up" for his magnum opus "USA", it remains a highly readable account of New York high and low life in the 2nd decade of the 20th century.

FILMS

FOUR CHRISTMASES (D-SETH GORDON, 2008)Vince Vaughn and Reese Witherspoon's dream Christmas in Tahiti is cancelled due to fog, and they decide, recklessly, to visit each of their 4 estranged parents in turn, who turn out to be nightmares on wheels, each in their own horrific way. I like Reese a lot, and even warmed a little to Vince in this quite fun offering.
THE COUNTRY GIRL (D-CLIFFORD SEATON, 1954) I have yet to work out why it's called that because it's more about an over-the-hill, alcoholic song and dance star given his last shot at the big time, played by a remarkably good Bing Crosby. They gave Grace Kelly an Oscar for her efforts, denying Judy Garland in the even better "A Star is born"
A MAN ESCAPED (D-ROBERT BRESSON, 1952) Prison break French Resistance style as Bresson, almost in documentary mode, depicts the grimly determined efforts of a condemned man to free himself from the clutches of his gestapo captors. Slow, but typically for Bresson, gripping nonetheless.
TEXASVILLE (D-PETER BOGDANOVICH, 1990) "The Last Picture Show" 25 years on. Now in living colour (was this a mistake?) it comes close to, but ultimately fails in conjuring the uniquely nostalgic atmosphere of its predecessor.
WITNESS FOR THE PROSECUTION (D-BILLY WILDER, 1957) In a role that might have been created specifically for him (though it wasn't) Laughton shines as the acerbic but brilliant QC given the role of defending (the excellent) Tyrone Power in a high profile murder trial. Scintillating stuff.
A MIDSUMMER NIGHT'S SEX COMEDY (W-D- WOODY ALLEN, 1984)Allen very much on top form with this Fitzgeraldish (though a lot funnier) romp through the woods. The closing sequence is quite magical.
AVATAR (D-JAMES CAMERON, 2009) The most successful, and indeed one of the most expensive films ever made. As we might expect (or certainly hope) it is a highly impressive technical achievement (I didn't see it in 3D, by the way, because I have always believed that is an overrated gimmick) but, I cry, where's the heart? True, its green credentials (evil humans trying to fuck up an extraterrestrial paradise) are impeccable, but I failed to become truly engaged with the characters, except perhaps for the estimable Sigourney Weaver) Plus the continual flips between "Avatar" and "real life" formats create a distraction and a hindrance to continuity. If you want a really good Cameron film, try "Terminator" or "Aliens". Both are much better than this.

a sense of unreality

BTW today, and throughout the morning a sense of unreality, or even surreality, pervades the whole session. Almost every patient expresses surprise, shock, or some such extreme emotion on discovering my imminent (semi) retirement. Many have seen me, and only me, for year after year, and some are in a state of considerable distress, which state I am scarcely in a position to alleviate. But they are reassured a little by my telling them I shall still be available for comment on Mondays, but I can see them thinking it through and realizing that things are going to change for them as well as me soon, and big time.

This afternoon should have been a baby clinic day for me, but it has been cancelled as is usually the case between Christmas and the new year. But I remain on call for emergencies until 6.30 pm, and indeed a call has just come in and I may have to go out shortly. Could be a busy afternoon...

tears for films

I blogged recently about the therapeutic use of movies to induce crying. Without making any conscious effort I have since "used" several other classics: "Casablanca", "It's a Wonderful Life" and "Shane" all produced the hoped for turning on of the old waterworks, though perhaps a little unfortunately I saw all these in company, which inhibited me from expressing my emotions as freely as I would have liked. Well, you can't have everything. I had to content myself with brimming eyes and a few little chokes and catches in my voice when I tried to speak.

It does not require the insight of a Jung or an Adler to work out what this is about: trying to release the deep sadness about the death of my son, still undimmed after more than 4 years. Certain pieces of music, Mahler and Tchaikovsky, for instance are quite good too.

I have, like many men, found it very difficult to cry in the past. I read once that the average man cries about once every 10 days, but I think that's bollocks. Most men I know can't remember the last time they cried, and will have to delve way back into their childhoods to find a good weep, unless of course they have experienced a major bereavement like myself. And I don't mean the dog or the cat either. Is it really therapeutic to cry? I doubt if any formal research has been done on the subject, so it remains an instinctive thing. I know there are tremendously powerful feelings in me that lurk just beneath the surface, and that crying sometimes seems to ease my pain, at least temporarily. I imagine I will continue in this way for ever...

murdoch rules, OK?

COMMENT

Christmas week's big story was the shock-horror drama of a politician being caught out telling the truth. The business secretary Vince Cable, reckoned by many to be the most popular politician in Britain, apparently thought the increased power being sought by Rupert Murdoch was a bad idea for our nation, he being quite powerful enough already. He also said 1 or 2 other things that were perhaps a little less well judged, like him holding some sort of nuclear trigger with which he could nuke the government. Well, he thought he was speaking privately (he checked in advance whether this was to be an off-the-record conversation, and the liars from the Daily Telegraph confirmed that it was) and in those situations you can let your mouth run a little- we've all done that.

But what disturbs me is that the story's energy has been expended on the disastrous "fall of Vince" and not on what he actually did say- that Murdoch and his monopoy building is bad for us, and bad for the freedom of the world as a whole. And how do the (tory) government respond? They replace Cable (anti-Murdoch) with Jeremy Cunt, who couldn't be more pro-Murdoch if he tried. He's gone public more than once saying how wonderful he and his organisation is. I wonder how that decision about giving him even more control is going to go now? Well duh...

it's panto time!

That's right! Today my mum, brother, wife and me (we spared my FiL the agony this time) went to see "Cinderella", featuring Brian Connley (who he?- Ed) as Buttons. A splendid time was had by one and all, as far as I could tell. The highlight was dragging 4 little kids on to the stage and doing a "kids say the funniest things" routine. One mortified child (I'd say he was about 6) actually forgot how old he was. What a hoot!

This morning I did a weight session (the ice having prevented any walks for some time, except for my forced marches to and from the surgery earlier in the week). Meanwhile my mouth is still smarting from all the meat-eating it had to do yesterday

Fortunately a thaw is due on Tuesday, and not a moment too soon. My car has been safely ensconced in the garage for over a week now, but I must get it out on Wednesday, because my wife will need her car all that day. Please God the hard packed ice in the back lane will have turned to slush by then.

a merry christmas to one and all!

I have just finished watching Dr Who, always required Christmas night viewing in our house. The effects were certainly impressive; like Avatar, the money is right there up on the screen. But it just didn't do it for me this time. Katherine Jenkins was a mistake: Charlotte CHurch would have been a much better choice.

As it happens, we were back from Christmas dinner at my mother's place only just in time. On the whole, it wasn't too awful, quite fun in some ways. There was one cock-up, however, and it was my doing. Given the task of grilling the morsels of dark turkey meat my brother had prepared earlier, I thought I would have enough time to nip outside for a quick fag. Unfortunately I left it a minute too long to come back, by which time one side had become more than a little toasted. Ironic really, as this was part of my brother's plan to offer something my toothless father-in-law (and me too, if to a lesser extent) that he could chew easily. Everyone doggedly ploughed through the dark meat pieces, ignoring the fact that they had the texture (if not the flavour), of overdone bacon scraps.

Later in the afternoon, my mum asked my FiL how he was doing. He thought hard about it for a while, then said:
" You know, it's about twelve and a half years since my wife died..."

It was a moment of sublime poignancy on a sun drenched, freezing Christmas day. It's what I'll remember the most, anyway.

christmas rush fails to materialise

I have known Christmas Eves past as nightmares of frenetic activity; once I saw 28 patients not including 4 housecalls, but today, despite the media's renewed interest in swine flu, the slippery conditions underfoot won out and only 18 patients turned up, some, (in the right age group, ie 18-30), really quite ill with the "swine flu" (if that really is what it is)

Nonetheless I still refrained from offering any of them tamiflu, as I have been distinctly underwhelmed with its efficacy. Often it seems to do little other than adding diarrhoea and vomiting into their already diverse mix of flu'-like symptoms.

I stayed at home in the afternoon, waiting by the phone in case anyone rang in for advice (I wouldn't go out to see any of them; the weather excuse being hard to argue against), but by 4.30 pm no one had called and I can now relax into a holiday mood, which tonight will involve watching "Avatar" on Sky premier (HD, no less). OK, it won't be in 3D, but I have yet to be convinced that that has ever enhanced any movie. But it may take our minds off the gigantic problems currently facing my father-in-law, who has now reached such a degree of degradation that he wets the bed every night (he refuses to wear the pads kindly provided by the "incontinence nurse") and lies for much of the night in a urine soaked bed. How much worse can he get? When he becomes doubly incontinent he will no longer be able to live independently, but that day may never come.

mixed feelings

I am working on my own this morning, though it remains quiet as the pre-Christmas rush seems to have frozen up in the continuing icy conditions. Although the larger roads are now easily passable (though sides roads remain tricky), hard packed snow/ice covers the pavements in all parts of the city and only the really determined ones will fight their slippery route through to my surgery.

For myself I feel a sense of lethargy which is close to a depression. Perhaps it is the season, (I hate Christmas and wish it were over already) or perhaps it is the continuing conflict of feelings surrounding my imminent retirement. At one moment I find myself thinking: God! What a drag this is; I'll be glad to be shot of this- followed by the thought that I will miss, and miss badly, the unique energy of the doctor's surgery and my (all too soon to be relinquished) power in that setting.

But the die is cast: I must somehow find a way to adjust and even thrive in my post-retirement life. I must settle in gradually, give myself time to fit into my new suit of clothes. Please God I will not slip into the deep depression that often accompanies the letting go of the biggest part of one's life.

christmas rush

As expected, people have been coming in thick and fast with their problems which they hope and believe I am going to be able to solve by Saturday. Unfortunately, whereas last week I could have told them there was a good chance of them being better by Christmas, by now I can no longer do that with any degree of confidence: ie, if you've got a cold or 'flu today then I'm afraid you're probably still going to have it over the holiday weekend- sorry about that.

Also this morning I saw the young man I had been impatient with last week and to whom I had sent an unsolicited apology. I asked him if he had received my letter and apparently it had not yet arrived (a little hard to believe as it been posted by hand). I explained its contents to him, to which he responded:
"Oh that. Don't worry about it, doc. I'm like that sometimes, and it doesn't mean anything"
In other words, he all but apologised to ME over the incident. Funny how things work themselves out sometimes, n'est pas?

I clear a path

Knowing damn well no one else would think of it, this afternoon I walked in to work half an hour early to clear a path from the pavement to the front door of our surgery. Certainly it did not occur to my partner who was in this morning. His family back home in Benares is probably of very high caste; I'm sure it is against their religion, or at least custom, to engage in any kind of manual work. But if a patient slipped and hurt themselves on our practice premises and we had done nothing to alleviate the conditions underfoot it could make some ugly publicity for us.

In the event it took only about 15 minutes, which I have counted towards my weekly work-outs. It certainly warmed me up nicely!

snow closure

I walked in to work today, (that's 1 successful Pelagius prediction), the back lane still impassable from the snow of last Friday. As I walked it began snowing again, very fine flakes whipped around by an icy wind. I saw 18 patients who had struggled in, about half with viral or flu like symptoms; none serious. I decided to shut up shop at lunchtime, as 4 more inches had fallen by then. I calculated the patients would be more at risk on the pavements than any benefit they might gain from seeing me. It was my call, one of my last as senior partner. How much will I miss having this sort of clout? Not that much I suspect.

I intend to walk in again tomorrow, because we must be open, in part because no more snow has fallen since lunchtime today; besides, they will be desperate to see me by then. Additionally, there is no way I am going to attempt to get my light-weight, rear wheel drive sports car out of the garage and into the back lane. It is, as they say, a potential death trap...

Perhaps by Wednesday the snow will be sufficiently packed down in the back lane to enable me to get the car out. That's all I can hope for, because apparently there's no immediate prospect of a thaw. My brother's car journey up from Kent on Thursday could be quite interesting. Rather him than me...

no business like snow business

There has at ;east been no fresh snow since Friday night, but the 6-8" covering has not diminished either, as the temperature as I write has not risen any higher than it is now, minus 3.5. So it is a day for staying in, checking on the rents to make sure they are provisioned up and not lying deep-frozen at the bottom of the stairs. I considered sweeping my F-in-law's front step, but the ice is densely packed; what is more this area seems to be targeted for some more big falls early next week, so wha's the point, eh?

Tomorrow I shall don my walking boots and trek the 2 miles into work and hope nobody wants a house call. They ain't gonna get one.

This is the harshest pre-solstice winter I can remember in my close-on 60 years of life, and it is shaping up to be the toughest winter of any kind since what I call the "Great Snow of '82, when there was 36 inches of snowfall in 3 days and the entire city came to a virtual standstill for 10 days. Oh, heady days! One thing I do remember: From a rate of 3-5 house calls per day (it's less now), the requests for home visits fell magically away to zero throughout that 10 day period. With the thaw the rate rapidly returned to normal. Funny that...

big day yesterday; bigger decision today

On Thursday night, waiting for 4 o'clock the following morning to come around, I watched "Breakfast at Tiffany's" for the first time in years. I can't say it is a really terrific film, but certainly by the end, with Holly relenting and going back to rescue the cat she had so cruelly abandoned only minutes earlier, I was blubbing like a baby. Tears poured down my cheeks in a good old fashioned weep that was almost ecstatic in its release. My cats, however, were a little nonplussed; even a little distressed by my wailings and so I felt I had to rein in the most uninhibited, and loudest expression for their sakes.

Tried going to bed at 11, took nearly 2 hours to get off. When the phone call came to say she was approaching the airport, I was deeply asleep. On the way there, in sub-zero conditions, though with a clear skies, I dared, after carefully checking for other traffic (there was none) to venture over a red traffic light. Immediately I was aware of 2 flashes. So I am presumably for it, £60 fine and 3 points on the licence. Oh well, it's not the end of the world. I have lived through other periods in my life when I've had 3 points against my name, and I can live with it.

On our return journey it began snowing heavily. It came down in large uniform flakes falling quickly and almost vertically. And falling on tarmac frozen for many hours, it settled instantly, as if by magic. In the space of just 1 mile along the motorway, the prevously clear road was now an uninterrupted layer of white, and getting thicker by the minute. By the time we got home 20 minutes later, there was a good 5 cm accumulation.

Friday morning, sleep deprived, but glad to get my girl home again in 1 piece, I go into work for morning surgery. I return home at lunchtime, but I have to be back at 2 pm for my annual appraisal. This is a 3 hour dissection of my PDP ("personal development plan") over the previous year. 30 hours must be accounted for. I chose my appraiser at random from a list, and in the event turned out to be a Malaysian female, perhaps 28, and totally Anglicised. She proved an intelligent, warm and remarkably easy person to work with. She was particularly interesting about her take on China's role in shaping the world's future. The 3 hours seemed to go by very fast (I had only 1 recourse to a sly fag break), before she seemed to be winding it up. I was scared to ask, "So, do you think I've made the grade this year?" and also perhaps because it was fairly obvious from her body language that I had. Inter alia, she told me how the hours requirement for appraisal is due to be increased, to 250 hours in 5 years (from 250). And tellingly, also how there are certain techniques of "accounting" of time, if you will, by which the "score" for some kinds of work can be doubled or trebled. Thank God. I wasn't looking forward to having to keep up the same level of post graduate study as a full time doc, even though I'm only 22%.

By the time I left the surgery it was dark and snowing again. Clearly several centimetres of fresh snow had fallen. The larger arterial roads were passable, if treacherous, but side roads and lanes, such as the one leading to the garage at the back end of our garden were calf deep in soft, luxurious and virginal snow. Half way up it, 50-odd metres to go before my shed, I finaly lost traction completely. I got out and went up to my house to request my wife's help. We remained calm very well, and between us were able to get it as far as just outside the garage entrance. The snow was at least 15 centimetres deep by this time, and I could not get any grip at all. Finally I sent my wife to enlist help from a neighbour while I occupied my self with digging all the snow away from the car and its sharp-right hand turn up into to the entrance of the garage. In very few minutes he had come, and tutored me in the arcane art of "rockinng slowly back and forth" as he invited me to do. I was't entirely sure what he meant, but did what I thought he meant, and damn me if it didn't wactually wrk very quickly. In no time my dear car was safely ensconsed. I offered a bottel of wine to my neighbour in gratitude, but he wouldn't take it.
"It's just what neighbours do", he explained. He was right, and behaved most gracefully as always.
We collapsed into bed at last somewhere around 9, and slept long and extremely well.

AND TODA'YS HEADLINES:

The main story today is Pelagius's decision to leave the home he has lived in for 27 years and buy a new house in some rather more salbrious area in our fair city. And he vowed that the project would be completed by the end of next year.

Asked to explain (this coming from a man who had always hitherto maintained he would be perfectly happy to die in his current residence). Dr Pelagius said it was about money and using it to enhance the quality of one's life. True, he lived in a lovely rambling Victorian house he had grown to love, with its relatively big garden and large garage at the end of it. But when he had fallen in love with the house in the 80s, he had paid scant regard to the brutal maxim of "location location location" To buy a house of similar qulaity in a "naicer" area, even it just meant that he would not have to clean the diarrhoea off his back step, left after some junkie had given himself rather too much of his chosen hit and had lost control of his bowels. Just missing that would be nice, he said.

COMMENT, FROM OUR CORRESPONDENT AT THE SCENE

I was there this afternoon when Dr Pelagius talked to the press, and I can say there was a gleam of determination in his eye, make no mistake about it. Clearly the effects of losing, first his wife and then later son in that house are not miniscule, even for a tough mind like Pelagius's. But I think the key here is in what he himself said: "money". We know he is selling his surgery premises to his partners shortly, and will elicit some profit from the sale. Plus he is to retire next year, allowing him access to his very generous pension fund. Part of his package involves a not insubstantial substantial lump sum. Then the profit on the sale of present house. Factor in to his existing savings comes to a figure which should enable him to take that jump into a more leafy part of the city he seems to need so badly at this moment in his life. Perhaps the good doctor is looking forward to undertaking a big project partly to give him some other meaning for living in his first retirement year. I know for a fact he is terrified of that apherism which says that in the over-60s, retirement itself is a major cause of death. And knowing him, I think we can all be sure he'll fight against it with a fierce will.

bad weather forecast, and more on the way

The nation sits quaking with terror at the latest prediction of snow and ice for much of the country. Overnight here the forecast is for rain which will then freeze, leading to "treacherous" conditions. Great. Because at 4 am I have to go to pick my wife up from the airport and the route involves negotiating some rural roads that won't have been gritted. Then we are due to drive to London on Saturday when the snow is believed to have kicked in big time. Now as it happens, I'm one of those people who, when police advise drivers only to undertake journeys if they are absolutely essential, actually takes notice and doesn't go out. Which is a luxury I cannot afford tomorrow morning. Wish me luck...

COMMENT

Today, Bob Ainsworth, the former labour drugs minister, has come out with what he dared not do while he was in office: say that drugs should be legalised. He draws an interesting parallel with the prohibition of alcohol in America, where, during the 13 years it was in place, distribution was taken over by organised crime- just exactly the same situation which now obtains with controlled drugs now. Legalising them would pull the rug out from under the big time dealers (drugs is apparently, after the military industrial complex, the second biggest business in the world) and the users would no longer need to resort to crime to pay for their habit, crime which currently forms anything up to 40% of the total number of crimes reported in Britain.

Obviously there would be an interim phase where drug use would increase, but it is essential that a long view of this issue is taken- and not the completely inappropriate strategy now employed by successive governments: namely, appeasing the right wing press and their fascist masters.
STOP THIS NONSENSE NOW!

doctor much missed, apparently

One of my old timers came in today; a patient who has been on my list since the 80s. There are perhaps a thousand or so of these tried and trusted friends. She told me she was sitting in her local recently (geographically it is the nearest pub to my surgery), when someone came in and announced:
"Have you hard the news? Pelagius is retiring!" At this, a frisson spread round the bar, with one person after another saying words to the effect of:
"Christ! What are we going to do now?"
I hastened to inform her that I while I was retiring, I would be continuing to work one whole day a week, so that anyone suitably attached to me would still be able to secure an appointment, though they might have to book well in advance. As at least half of my appointment slots are indeed "book-ahead", it shouldn't be too hard. I asked her to disseminate this information as far as possible, which she agreed to do. I am now targeting other patients with a lot of connections to do the same. I don't want my best friends abandoning me en masse because they think I've been banished into the outer darkness. Her story from the pub is obviously a huge compliment, though.

For myself I am beginning to feel increasingly anxious about the whole thing. It's like someone with second thoughts who has committed himself to marriage and with the wedding only days away, feels it's too late to do anything about it now. I AM committed, and it IS too late to reverse it now.

worried well

The dreadful spectre of swine flu has reared its terrible head in the media once more, causing a number of (apparently) perfectly healthy people with mild cold symptoms to come in for me to make sure they're not going to die shortly. I offer one example:
An extremely attractive young woman from New Zealand, who also seemed to be positively glowing with youth and vitality, tells me she has had a persitent cough, sore throat, muscle aches and feeling hot and cold, and wishes me to check her out. I cannot find a single thing wrong with her, and intimate that I think she probably has a "severe cold" ( I can't just say "cold", because that might humiliate them) and offer to give a sick note to cover her for the week. She declines, saying she is much too busy to have time off. Then she asks me: "Is it all right to continue going to the gym. I like to go every day after work. I ask her if she really feels well enough to take on strenuous exercise. "Oh sure" she replies. So, tell me: what exactly is she doing here?

You know, when I retire, this is the sort of scenario I shall not miss one little bit.

retirement looms large

At least 5 times a day I will say to my patients: "just make an appointment to see me an a month's time".
Today marks the first time when I am no longer able to say this. Because a month from now I will be retired, and although I'll continue to work 2 sessions a week on Mondays, as I have always done, I cannot guarantee they will be able to see me personally. People will have to book well in advance to avoid disappointment, and many will decide it is simply no longer practical to see me on a regular basis. But this is the way of things and I (and they) will just have to get used to it. I can think right now, however, of a hard core who will wait all day, or all month if necessary, in order to see me and only me. Pity then, that some of them I don't even like...

I've finished shelling the nuts. In 3 marathon sessions I eventually completed the task in something over 7 hours, rather quicker than I had predicted. I did not allow for practice, which gradually increased my speed till by the end I was fairly ripping through them. A satisfying job in some ways, though I would hate to do it full time...

welcome to palestine

A very long lie-in this morning, which is unusual for me. I suppose I must have been a little sleep deprived. That can creep up on you and cloud your judgement if the REM deficit is not restored quickly.

I popped over to see my mum this afternoon for a brief, if pleasant chat, but I needed to get home for 5 o'clock sharp, at which time I was expecting a call from my wife, currently embedded deep in the West Bank with her coterie of students and other general admirers trailing in her awesomely meaningful wake. Also wishing to come on the line would be her Palestinian firm friend and ally --. Right on cue the call came through. My wife went to a Palestinian wedding last night (she pronounced it "the best wedding celebration I've ever been to") and was currently being entertained, students in tow, by his family. Sounds like the high life, Arab style. After a brief chat -- duly came on the line and opened up with heavy artillery his barrage of requests, statements, egad-I swear at one point in the proceedings he was on the point of DEMANDING, specifically that I come over with my wife and stay as his guests in his house. Soon. Preferably immediately. Certainly without delay. In fact he was trying to get us to come over and spend THIS coming Christmas with him for Chrissakes, which might actually be quite interesting if I had no external responsibilities, but it certainly couldn't work this time.

Now. Fortunately in my trade, or specialty if you will, I am well experienced in taking the heat from someone trying to impose their will over mine. And I'm equally well versed in dealing with it calmly and courteously. So I was able to fend
him off perfectly easily.

But WOW! The pressure!. I guess it must be a cultural thing, though let's face it, people are people the world over, and they're all complicated bastards under the skin.

Bottom line, -- is a really nice guy, and has indeed been of great assistance to my wife in finessing the many diverse projects she juggles with out there in that grim, world-forsaken land. Good on you, mate. And stay safe, darling. I miss you.

a big day in 2 ways than 1

I made 2 important decisions today:

1. I have started to take aspirin (dispersible; 75mg) on a daily basis. I have been pondering the question of prophylactic aspirin for a while now, and watched as the consensus on its value shifts and sways over the years under the breeze of "current medical opinion"

But last week's piece in the Lancet did it for me. Seems it protects against some forms of cancer, such as brain cancer; always one to avoid, I find. The protective effect doesn't begin to kick in until several years after the regime has been initiated, so, I thought, might as well get started right away. Then you have to run the gauntlet of the gastrointestinal haemorrhage: it's a tiny risk statistically, but no less devastating when it happens. But it is a rare event, so I'll take that small chance willingly. Thus in this way I shall continue until the day I die (on that particular day it won't be that relevant anyway). How many days they will finally amount to in the event is, of course, hard to say. How about, say, wild guess, 10,000 more days? Why, that's nearly 30 years! Can I really live until I am 90? It sounds like a pretty big ask to me, what with me smoking and all, but I've seen it done, and more than once at that. In my experience they are usually scrawny little gits who "can't keep still"

2. The 11th of January marks my 60th b'day in case you hadn't already noticed (sorry to go on), and it will also mark the year's anniversary of my keeping this blog. I want to continue posting my blog until I have posted the good round number of 365,and then finish. In fact I don't think I have missed that many really. I had a 5 day break in Ireland, and a tiny handful elsewhere. I digress. The point is that on 11th January 2011 I will open an account with Facebook, which , like my blog, I will try to update my page every day (like everyone else does, right?) Obviously I will not be going in under Dr Pelagius, rather some play on my real name. I intend to use it MY way, however, which may not be everyone's way. I may continue to keep a blog of sorts, though it will inevitably be very different from this one. One thing I'm particularly looking forward to exploring is how Facebook may be used as a political tool. I can hardly wait!

the world's biggest problem?

COMMENT

I have in the past cited the racist abuse suffered by the Palestinian people at the hands of the Israeli government as the world's greatest human rights issue. But perhaps I have not been thinking globally enough.

China has a population of 1.3 billion people. 1.2 billion of them continue to live in a state of abject rural privation, even though China's economy is now one of the most vibrant on the planet, having expanded by an astonishing 500% since 1989. An important year that one, because the demands of the students who were so brutally suppressed that summer remain no more realized now than they were then.

In Oslo last night there was an empty seat which should have been occupied by Liu Xiaobo. Dubbed a "criminal" by the Chinese authorities and dealt with accordingly (he's serving an 11 year prison sentence) his main "crime" has been to write a book called "Charter 08", the title referring to Vlacec Havel's famous "Charter 77", and like that earlier crucial text, is a wish list of human rights for the ordinary people of his homeland. China is supposed to be a communist state, but Marx must be spinning in his grave over that travesty of the truth. The real situation might be summarised as follows:

"Government of the people, by the elite, for the maintenance of their power and the enhancement of their personal wealth"

1/3 of the seats at the Nobel Prize ceremony last night were unoccupied last night, which shows how long China's reach is in manipulating other countries into toeing their line. The West gets rich using cheap Chinese labour to manufacture their goods, so we dare not fall out with them over such trivial issues as human rights. What a bunch of craven cowards we are!

the doctor's shame

I behaved badly this morning. A young man comes in to discuss his antidepressant treatment. I know him well. He has been tried on a variety of therapies; drugs, counselling, assessment from the local psychiatric team: none has been of any real benefit to him. The psychs wonder if he has a "depressive personality disorder" which is another way of saying they can't do anything for him, and don't really want to try any more. He saw one of my partners a couple of weeks ago, when a range of options was put to him, without any firm conclusions being drawn. I read out the notes made by my colleague on that occasion, and invite comment. He just seems to stare out past my right shoulder and says nothing.
"Excuse me, are you even listening to me?", I ask, a little brutally.
His eyes fill with tears and he stands up.
"I just can't talk to you" he states, and makes to leave. I attempt to stop him, saying we must talk, but it makes no difference.
"Please!" I shout, but he is gone. There is a moment's anger. What the hell am I supposed to do? I ask myself. But then I realize I have stamped on his fragile ego in a quite unacceptable way. Without waiting for him to issue a complaint about my behaviour (I doubt if he would anyway, such is his apathy and lack of drive), I write a letter of apology for my unprofessional conduct and arrange for my staff to deliver it to his flat by hand. This is something I very rarely do, but it seems the right thing to do in the circumstances. For the rest of the day I am in the shadow of my appallingly insensitive behaviour.

This afternoon I begin the arduous task of shelling the 2000-odd hazel nuts harvested from the tree in our garden. It takes me back vividly to the autumn of 2006, just after my son died, when there was a similarly bumper crop, and it seemed God was compensating us for our loss by granting us this small bounty. In truth it requires a fine, warm summer for our hazel tree to perform. The summers of 2007, 8 and 9 were all miserable, damp and cool, and we didn't find a single nut in any of those years. But now I have this wonderful (if time consuming) gift once again. When I have finished, and I calculate the whole project may take anything up to 10 hours, we will have enough for 3 or 4 nut roasts to share with carefully selected friends and neighbours. And it gives me something to do while the girl is away. I have yet to hear whether she has arrived safely in the Holy Land, but there have been no reports of plane crashes either, so I assume she is OK...

busy baby

Today has been one of the busiest baby clinics for many months: 11 babies and 4 "extras" (emergency adult patients tacked on to the end) My practice manager's view: it is busy today because next week and the one after mums will be fully occupied in making arrangements for Christmas. Good luck to them.

As a doctor, I absolutely hate this time of year. Everyone seems to wind themselves up into a state of unbearable tension (possibly myself included), men and women alike, and that's nothing compared to what happens afterwards, when we get a rush of misery-laden folk streaming in, suffering from what I call "post Christmas blues". All that stress, then what happens? The kids have broken their toys even before lunch is served. Then, much worse, dad, cooped up in the house for much longer than he is used to, finally snaps under the strain and goes down the pub and gets well pissed, only to return home and get a furious row from her indoors who's had to look after the kids, parents AND inlaws while he's been out indulging himself. It is the women I feel most sorry for: they do 90% of the work for 10% of the recognition; no wonder they come in in a highly dejected state in the first week of the new year. Poor dabs...

Tonight looks like being quite exciting: my wife departs for the West Bank again, and the flight is at an extremely inconvenient 5 o'clock in the morning. I have agreed to take her to the airport (at 2.30 am). It's some 30 miles distant- cheaper than a taxi but still a bloody drag. Plus I'll have to pick her her up at a similarly ungodly hour next week. But what the hey, she'd do the same for me. She's already bought in a tranche of easy-to-prepare meals to last me over the interim. She really is a sweetie...

they're out to get him

COMMENT

So, Julian Assange is under arrest in London, denied bail and awaiting extradition to Sweden, from where, if the Yanks get their way, he will in turn be extradited to the US where he will face the wrath of an American establishment furious with his particular brand of press freedom.

The leaks of diplomatic cables has certainly been an eye opener to a political lightweight such as myself. The revelation that Israel and Saudi Arabia are of one mind in their loathing of the Iranian regime is fascinating, as is the fact that China is getting bored with the ridiculous posturing of the North Korean leadership. Then there's Hilary Clinton's invitation to all American diplomats, basically to spy on their opposite numbers, and the conservative party's intention to be strongly pro-American and buy more American war materiel if they got into power.

But Julian has made some, well, rather a lot of very powerful enemies, and I fear for him if he ever gets into their clutches. Can you see a sweet thing like him in the American prison system? He'd be eaten alive. And all this despite the fact that as yet he has been shown not a single scrap of evidence against him. Like Ken Loach, who spoke on Radio 5 earlier today, I believe the whole thing STINKS.

east winds kill

This morning my practice manager comes to me suggesting ever so gently that I might wish to dilute the amount of venom contained in my letter of response to my female ventolin addict I sent packing last week. My manager is an excellent "vox populi", and I rarely ignore her advice. So gone are my acid comments about her outrageous pleading of poverty as the reason she couldn't take up her hospital appointment. In are an apology for any offence that she may have taken away from the consultation, along with advice for how she might go about getting reimbursement for her bus fare. I retain my original remark about her letter being rude and offensive (manager she say that OK), and the letter is now going out; a marvellous example of measured hypocrisy. I hate not speaking my mind openly, but I have to remember the correspondence might one day be seen by authorities further up the line and they must not be able to find anything in the least bit objectionable. Ahh...

Weather conditions remain extremely unpleasant. The temperature continues to hover around zero, but humidity levels have risen and freezing fog envelops the city. What breeze there is continues to approach from the east. I remember from my earliest childhood being told by my mum not to go out in the east wind. "It's bad for your chest" she would say (I had much more severe asthma in those days)and I think she was on to something. Today I saw a veritable procession of small children with flu like illnesses and chest infections. As for me, I'm positive I will die on a day when the east wind is blowing.

sunday morning frost

This morning broke in bright sunshine, but yesterday's thaw froze solid last night leaving the roads and pavements extremely treacherous. A friend informs me you can't accuse an inanimate object (in this case ice) of high treason, but I fear he misses the point: it is only an example of the literary device known as "personification", the attribution of human characteristics to objects and has been in use at least since the time of Shakespeare. In this context the term refers to conditions which appear to be innocuous, but in reality are highly dangerous for those foolish enough, or alternatively forced by circumstances, to venture out on the streets. A case in point is my father-in-law, who somehow dragged himself down to the corner shop to secure the Sunday papers, miraculously avoiding serious injury. And short of chaining him to his armchair, there's no way to stop him doing it, regardless of whatever danger might lurk under foot.

Speaking of him, we had a call mid morning from the care company, who now visit 3 times a day, to tell us they were worried he might have a chest infection. They were thinking of calling the doctor out, but were aware that there could be a delay of several hours between calling the doctor and him (or her) actually showing up. So instead I said I would go round and assess the situation myself. So, armed with my stethoscope and prescription pad just in case, I popped round and confirmed my suspicion gained by talking to him on the phone, namely that there was no real problem. But the only way to be sure was to examine his chest for myself.

back to good old maritime again

Last night the temperature shot up to 4 degrees, having barely surpassed zero for the last 2 weeks. With that it began to rain, good old fashioned rain like this country is supposed to enjoy in November and December, and not the icy conditions that have caused such havoc here and much hilarity in other countries where metres and metres of snow are the norm from October onwards. Apparently, countries like Norway like to close their news reports, you know, the "and finally slot" with comical little items about non-polar countries being brought to a standstill by a mere dusting of the white stuff. Personally, the anarchist in me loves the chaos brought about by nature (though I'd probably feel a little differently if I were stranded overnight in a snowdrift)

COMMENT: SO WE DIDN'T GET THE WORLD CUP. SO WHAT?

I was listening to Radio 5 reporting live from Zurich on Thursday while the nation was agog with anticipation. I mean, with such luminaries as the PM, Saint Beckham formerly of United and Prince Willie Wales, how could we lose? Quite easily, it turns out. What are we to learn from all this? First, that DC has a lot less political nouse than we might have credited him with. Putin was a lot sharper. Declining to make the trip himself (well, he probably knew it was a shoe-in weeks ago) and pouring scorn on Cameron's desperately misguided decision to show up in person. Second, that FIFA is riven with corruption at the highest level (no news there) and thus it is demonstrated that he who bribes biggest, does best. Hence Russia, now virtually a criminal state, and Qatar, fiefdom of a family so rich its fortune has to be measured in trillions, rather than mere billions, could not lose. My wife put it best, I thought:
"it's just like the Eurovision Song Contest", she said. "Now everybody hates us, they all get together to make sure we're screwed" Wise words indeed...

the complaint arrives

Right on cue, this morning's post contains a 4 page letter of complaint from my ventolin loving female patient. It is addressed to "Mr Pelagius" and the first line of the letter explains why:

"I do not intend to dignify him with the title "doctor" as he is unworthy of such a description". She then goes on to list my various sins which, summed up, label me a sub-human monster unfit to serve even to lick her stamps, never mind being given the privilege of treating human beings.

I was intending to give a response including the standard apology framed along the lines of "I am sorry if my behaviour or manner in our consultation gave any cause fr offence; this was entirely inadvertent on my part" and then turn to a rebuttal of the detailed points in the letter of complaint. Instead I go straight for the jugular, beginning with the statement that I found her letter extremely offensive and completely out of order, going on to point out her own rudeness and aggressive conduct, and closing by pouring scorn on her claim that she could not raise the £5 bus fare to visit the hospital.
"I have many patients of limited means in my practice: never has anyone ever claimed to be so short of money they could not afford to travel to a nearby hospital to have their problems treated"

It is never a nice thing to be called in so many words a piece of shit, but one has to get used to this in general practice. The real problem here is that she has probably touted her business around a number of practices over the years and most if not all, according to her own testimony, have raised the issue of her overuse of ventolin. I, however, am perhaps the first to take her on and give as good as I got in the ensuing debate. But then I'm like that...

a deal is struck

In a very agreeable exchange this morning with my partner, we quickly settled on a sum for the sale of my surgery premises: £270,000. It is perhaps unfortunate the value of the property has only increased by £20,000 in 7 years, but I fancy the "North Atlantic Crisis" as the Chinese refer to it, has affected many people a lot more adversely than this. I could have haggled, but I (and possibly she too) felt that for the sake of ongoing harmony within the practice we should come to a mutually acceptable sum quickly.

After lunch I set out for the biggest of my several city walks. The whole area has been so afflicted by unseasonably cold air over the past week it did not seem any colder at 350 metres above sea level than it did in my own garden (a mere 30 metres above the shoreline). Possibly my silk long-johns helped...

COMMENT; I LIKE BRIAN COX NOW.

I used to be a little wary of Brian Cox, that toothy astronomer and latterly big time science populariser. Doubtless his IQ is in the 3 hundreds, but he often seemed to wear a slightly suspect smirk, the kind some convicted criminals adopt as they are escorted from the dock. But last night he thoroughly redeemed himself in my eyes. Speaking in the RTS (Royal Television Society) lecture series, his main thrust was an attack on the obsession of the media for "balance and impartiality" which can actually detract from the genuine truth of a issue. As an example he chose a clip from ITN news, where they gave the estimable Dr Ben Goldacre a tiny slot to give his views on the MMR debate (this was a couple of years back) He chose to cite an enormous study produced in Denmark where nearly half a million children who had either had, or not had, the MMR jab. There was no difference in the rates of autism or inflammatory bowel disease in the 2 groups. Yet despite this overwhelmingly conclusive evidence, ITN made sure that the piece was bookended by a "health warning" that Dr Goldacre's views were his own entirely- "a personal view" was how Alistair Stewart described them. God forbid that facts should interfere with the media's own agenda of highlighting the (entirely fictitious) dangers of the MMR vaccine.

We have seen this before: in the 1980s, the BBC adopted the same "impartial position" to ensure advocates of apartheid got as much airtime as the people opposing it. And they do the same thing now with the Palestine issue. Sometimes the media world has to wake up, smell the coffee and realise that some things are just wrong, period, and start proclaiming injustice from the rooftops, instead of engaging in the weasel-like quest for "balance"

too poor to go to hospital

In surgery this morning I meet a young woman recently registered with us. My receptionist calls me to let me know she is downstairs, angrily demanding yet another ventolin inhaler (a widely used asthma treatment) and that she has gone through no less then 11 inhalers in 9 weeks. Either her asthma is well out of control or there is something badly wrong with this picture. I call her up to see me and question her about her use of the inhalers. At first glance it is clear that she is not at this moment in severe difficulties, but also that there is an edge of aggression about her (this was reported by my receptionist as well) which is really quite scary. I point out that we have over 200 asthmatics on our books, some of them really severely disabled by their condition, but she was using more ventolin than any of them. She scowls ominously at this, and just says: "Well I need it"

I listen to her chest and there is indeed a slight wheeze present. I then offer to refer her to the local chest clinic for a thorough assessment of her problems. But she responds thusly:
"Is that at the hospital just outside town?"
I confirm it is.
"Well in that case I shan't be able to go. I'm a student and I don't even have enough money to buy Christmas presents this year"
At this point I almost snarl at her:
"To be perfectly frank, that is the most ridiculous thing, the most stupid thing I've heard anyone say in this room. Here you are with your asthma which is clearly not adequately, or certainly not appropriately, treated, yet you tell me you can't even come up with the fare for a 4 mile bus journey. It's absurd!"
She wouldn't have it though, accusing me of failing to appreciate her problems, addressing her in a rude and unacceptable manner. She then announced she would leave the practice, but not before putting in an official complaint about my treatment of her.

I prefer it when I get pre-warning of a complaint. In between seeing other patients I wrote out in longhand a response to her imminent written assault, making sure to mention her comments about refusing to have a hospital appointment on the grounds of cost.
Even my wife was totally behind me when I explained the situation to her. And she's usually highly objective about such things. The reality here, of course, is that the patient is quite obviously psychologically addicted to ventolin, but doesn't yet have the courage to admit it.

november book and film review

BOOKS

ZEN IN THE ART OF WRITING, by Ray Bradbury. One of the books recommended to me my eminent author friend/patient, this books goes into the category of books I did not finish. I have always been suspicious of books on "how to write"; I have never (yet) been on a "creative writing course". To me you've either got it or you ain't, and if you have, then the best thing to do is do it, and keep doing it until you get results. I'm afraid this book fulfilled these reservations. Bradbury enjoins the writer to engage his passion (sounds good) and then write, furiously. My writer friend told me all that in a handful of sentences: I didn't need a whole book to underline its truth. In summary: if you wanna write, then write, damn you!

MRS DALLOWAY, by Virginia Woolf. Now here's someone who has it all right. It is the story of 1 day in the life of an upper-class lady as she organises a high society party in her Mayfair home. Not the easiest book to read, but my God, once you get into it it more than repays the effort. Its subtlety, its beauty of language is quite sublime. Wonderful.

FILMS

DIARY OF A COUNTRY PRIEST (1951) d-Robert Bresson. A young priest with what today we would call a serious eating disorder (he confines himself to red wine in which he dunks dry bread) upsets everyone in the community he serves, from the peasants to the ruling class. His efforts to raise the spiritual tone of his parish are well intentioned but horribly misguided. An odd piece of work, but still somehow gripping.

LANCELOT DU LAC (1974) d- Robert Bresson. Some call this a "highly stylised" take on the Arthurian legends, others might say Bresson's budget was so hopelessly limited he had no option but to make it look like it was shot in a barn and a small adjoining copse. But even so, such is the skill of this great french auteur it remains highly watchable.

LA NOTTE (1961) d- Michaelangelo Antonioni. A man visits his dying friend in hospital, then distracts himself from his woe by taking his wife to a fashionable party, where all kinds of romantic misunderstandings take place. Kubrick cited it as one of his 10 favourite films, and it certainly is an outstanding piece of Italian cinema. Try it.

CELEBRITY (1998) w-d- Woody Allen. There are always beautiful women in Allen's movies, but in this offering everyone is so stunning it almost gives you a headache. Allen was a bit hit-and-miss in this part of his career, but I liked this: it's often very funny and sometimes delightfully ironic. My only problem: Kenneth Branagh's performance. It is abundantly clear that Allen mus have told him: "Just do me" and the result is indeed a watered down version of Allen himself.

TWILIGHT NEW MOON (2009) d- Chris Weitz. Edward wanders off and leaves Kristen Stewart to her own devices, proving the folly of leaving a beautiful woman alone. Soon she's pursued either by people who want to love her, or eat her. If you liked the first one in this series, I guess you'll like this too.

JULIA (1977)d- Fred Zinnemann. Jane Fonda plays Lilian Hellmann, who, hypnotised by the charisma of her friend Julia (played superbly by Vanessa Redgrave), tries to find her when she goes to ground in pre-war Germany. If Fred Zinnemann ever made a poor movie, I haven't seen it. Catch this if you haven't seen it already.

A KISS BEFORE DYING (1956) d-Gerd Oswald. Robert Wagner, who has never looked more gorgeous, plays an all-American heart-throb and psychopathic killer. Everyone seems to take a long time to rumble him; meanwhile people are popping off at a rate of knots. It looks sumptuous on the screen and is quite worthwhile.

2012 d- Roland Emerich. This date is predicted by several sources (the Maya calendar, Nostradamus, etc) as when the World will end. Turns out this is the year all the continents decide to rearrange themselves, leading to mega-tsunamis and hypervolcanic eruptions (yawn) More of the same old same old from the guy who made "The Day After" which was quite enjoyable hocum, whereas this is just annoying. Give us a break will ya?

a rare good day for the palestinians

Apologies for missing my blog yesterday, but it was an exceedingly busy day. In the event, our "make a difference for Palestine" get-together proved a great success. Over 40 people turned up, and we raised over £600, which could rise to as much as £800 in the next few days. Many of my favourite patients showed up as well as our hard-core friends and neighbours. 2 highlights linger in the memory: first, one of our next door neighbours, a professor of biochemistry and the possessor of a very sharp mind, let slip some astonishingly racist views on Arabs in general, citing them (on his experience at least) as a band of priapic near-monsters who are ardent for sex with men, women and perhaps even camels if all else fails. Thing is, he is Jewish. Could this explain a lot? But he showed up for the event, so you have to give him credit for that...

Second priceless moment: as two other neighbours left, like us confirmed tennis fans, I confidently predicted to them that Roger Federer was "without a prayer" in his upcoming match against Rafa in the ATP finals at the O2 arena. And what did he do? Put it to Rafa extremely convincingly, as it happens. I shall ring them later and tell them what I would seriously advise you, dear reader: Do not, under any circumstances, place any bets based on Pelagius's sporting predictions. Seriously.

snow underfoot

Much of today has been taken up with logistics for tomorrow's Palestine benefit get together at our place. We expect as many as 50 to turn up, and everything must be perfect. Hah! No, I'm sure it will be fine. I will give a small speech at one point before announcing the raffle prizes, and also, as my wife informed me today, I am also responsible for selling all the raffle tickets. Great...

There was about 5cm of snow last night, which under clearing skies turned into a glass hard crust by morning. The temperature has hovered around zero all day today, and while the gritters have done a serviceable job on the thoroughfares, minor roads and especially pavements have become quite treacherous. I feel for people like my F-in-law, who struggle out every day upon deep instinctive compulsion, regardless of conditions. We've checked on him twice today just to check he's still alive, which he is, just. Mum's smarter. She's wisely stayed at home all day.

big snow little snow

Many years ago, my father introduced me to this expression, which he insisted came from the Native American people. Thus:

"Big snow, little snow. Little snow, big snow"

More or less self explanatory, it of course refers to the size of snow flakes as being connected to the depth of snowfall. I have no idea whether it is actually a saying of the "Red Indians" as he would have called them, but it does seem to work.

It began to snow just as I was driving home from my mother's house on the coast, where the conditions were more like a middle way between wet snow and sleet, which is quite a subtle distinction. I expected it to turn to rain as I approached the heat island of our city, but it has persisted now for a couple of hours, and indeed, the snow has got smaller as it has begun to settle on the grass. We shall have to see if the temperature drops after dark and the whole city receives a generous coating.

My mum seemed in fine fettle today, her morale upbeat and her memory passably good, though she did not know the day, while knowing full well that she did not know it, if you follow me. My father-in-law, on the other hand, continues to give rise to significant concern. His aricept was increased a few weeks ago, and he now seems to be demonstrating bizarre "automatic movements" with his hands and coming out with a series of unconnected statements. Could this be one of the not inconsiderable list of side effects of the drug itself, or is he simply deteriorating steadily? It is almost impossible to be sure, though for my part I have little faith in the reputed wonder drug. I have rarely seen it produce tangible results, but I have often seen it make people worse, and in some quite horrible ways; depression, psychotic reactions and other strange effects are not uncommon. And now they are thinking of giving the stuff to my mum. I'm not at all happy about the prospect...

another tooth bites the dust

At work this morning, I see my author and sometime literary advisor. After sorting his several complex medical issues, we discuss writing. Much to my delight he said he liked my story "A Killer Holiday", though as usual he has spotted a number of what he calls "little bits of carelessness" It's still highly encouraging, however. My brother, whose opinion is not worthless, but scarcely as qualified as my patient's, thought one of the twists in it was implausible, which did upset me a little. However, I always "believed in the story" as you might say, and I'm glad I didn't revisit it to modify the text.

This afternoon I had my tooth removed: much injecting, followed by a deal of twisting and wrenching and finally the appalling job was done. As I write, I am waiting for the local anaesthetic to wear off so I can start the paracetamol. The dentist told me I could eat normally tonight, but he overlooked the fact that I am unable to eat on the contralateral side, so there'll be no "eating normally" for me for at least 3 months. He has made me an appointment for 7 weeks time, to begin the process of replacing this last tooth with my second implant, or "cyber-tooth" as I like to call them. And it will be a goodly time after that before I can eat properly on that side. Later still I intend to have 2 more cyberteeth fitted to my right upper jaw, so that eventually I'll be able to eat on both sides, something I haven't been able to do for the better part of 3 years.

short changed on teaching

Today I travelled 50 miles to a nearby city for 6 hours of post graduate training, specifically under the heading of "emergency medicine". I have always believed that all doctors should keep themselves up to date with this most important area. Whether in the surgery, the street or on the road, literally anything can happen and we must be ready to act quickly and appropriately. But in the "keynote" lecture, the lecturer immediately strayed from his agenda and instead spoke for nearly an hour on hand injuries, a subject he openly admitted was actually prepared for junior orthopaedic surgeons (there were no orthopods present) and not GPs (of which about 30 were present).

Later however, by way of compensation, there was a much more interesting discourse on serious eye conditions.

Lunch consisted of a perfectly passable lasagne, but the day then reached a new low when we were subjected to an hour's talk on the paperwork issues surrounding controlled drugs (mainly diamorphine, used for the most severe pain). At one point a straw poll revealed that 2/3 of GPs have solved the problems of keeping morphine in the surgery and in the "black bag", by simply not carrying it at all, as I have done for nearly 10 years now. So what's the point of this? I wanted to shout.

The final lecture was entitled "the sick child" but I ducked it and made my way home an hour early instead. Thing is, when you've got a sick child in general practice, you just send it to hospital, quick sharp. End of story.

human rights violation

Having just returned from the local bakery where I had secured a large granary loaf and settled down with my book, the phone went to report that the builders were outside my father-in-law's house, ready to fit his new hand rail, but he was refusing to allow them access. I hurled myself from the couch and within 5 minutes I was there. As I went to use my key, one of the workmen muttered: "Hope he hasn't left the key in the lock". Thank goodness he hadn't, and I let myself in.
"These folk are here to put in an extra handrail on your stairs, old chap. Shall we just let them in to do their work?"
"Oh no, don't worry. I don't really need it"
But I had already waved them in and directed them to proceed with their work.
"Tell you what", I said. "Why don't you just make a cup of coffee for us while they're doing their job?"
Which he duly did, realising at some deep level that there would be no point arguing the point with me. And literally in less time than it takes to make and drink a cup of coffee they had completed their task and were gone.
It is possible my actions breached his human rights, but they were carried out quite naturally, in the same sort of way one would behave with a young child.

At work I am asked to visit a sick child at home. To the best of my knowledge no one has even requested such a thing for nearly 3 years. Apparently, mum is reluctant to bring the child out because it was running a temperature. I instruct my receptionist to inform mum that "doctors don't visit children at home any more" and also that there was no danger in bringing a child with a fever out in cold weather. This worked, and half an hour later the child was brought into surgery. When they came up, I thanked mum effusively for coming out, before examining an extremely vigorous child and casting my reassurance that there was no serious problem.

shit on the back step

I have been aware for some time that junkies use the space in front of our garage as it opens onto the back lane. It is set back from the lane slightly and there is a little overhang to provide some shelter.

I regularly find Rizla papers, aluminium foil and empty cans of white lightning when I open the steel roll-up door in the mornings. Once I even bumped into them coming home late one night in the summer. This I can put up with: I assume they're from the nearby YMCA, where I imagine it is quite hard to cook up a little brown without attracting attention. But this morning I found a nasty little pool of diarrhoea right up against the door, and indeed extending down from some way up on the door itself. It might have been doggie-doo, but as far as I know they don't wipe their bottoms with tissue paper and leave it where it is. As there was no rain over the weekend it had hardened into an unpleasant patina which will be hard to dislodge until the next heavy rains. Just for once I am hoping that it will come soon.

meet the parents

Parent the first:

My father in law. He called round this morning while my wife was out for a run, so I sat him down and made him a coffee ("4 sugars please") while we waited for her to return. Turns out he had lost his front door key again. This has happened at least 4 times in the past 6 months, despite there being spare keys stashed around the house in open view. They've all disappeared, one by one, until we are now down just to the keys in our possession. My wife seems unphased, and peacefully takes him back to his house to let him in. But when she returns home again she is clearly badly upset by the incident. As the only child, all the pressure of dealing with his huge problems has fallen on her, and the stressing effect is cumulative.

Parent the second:

My mum. She also has the diagnosis of Alzheimer's, but she is years back down the road to oblivion from where my father-in-law is. In fact, she seems to have maintained her rally from her low point in the summer surprisingly well. Visiting her this afternoon she presented much of her old, sharp-witted, upbeat ways. I just hope she can keep it up over Christmas. That will be the crucible. Personally I have my doubts...

retail therapy

An enjoyable morning photographing stills from Woody Allen's 1997 film "Celebrity", followed by a rousing raid on the city centre shops where we were able to achieve at least some of our targets.

Successes: my wife's suitcase. Whilst in Palestine recently, she had realised her zip was on the point of failing, which is very worrying mid trip, so I promised I would get her a really good one in time for her to go out again in early December. Choosing John Lewis, my wife's eye was immediately drawn to a case in the Samsonite range with a finish like metal, though it wasn't. What it was was incredibly light, less than 3KG, which for a 100 lire capacity bag is pretty amazing. The cost: £299, unfortunately, but you've got to pay for quality: last time we paid £120 and it lasted less than 2 years.

Failures: My jeans. My wife promised to buy me a pair of Diesel jeans in return for the case, but in the event I found them to hang too low on the hip for my preference. I tried several other lines, including Calvin Klein and the inevitable Levis, but none proved to fit the bill. I told her my real dream was to have a pair of Armani jeans, and she liked it, though in fact it was something that had come into my head quite spontaneously at that moment. But it does sound fun, and even if I have to subsidise her a bit, I think we can afford it.

friday set fair

At last a weather window has intervened to lift the gloom of the last few days. So I was indeed able to do my hill-walk today under clear, if somewhat watery-blue skies. A great little walk: it takes under 40 minutes and is barely 4K, but the 130 metres of ascent is achieved only by a nasty little pitch of 25% or worse. My smoker's lungs are screaming for respite by the time I attain the trig point, though I am relieved to report I have recovered my oxygen debt inside 2 minutes and ceased to pant like a sweating dog.

On the way down I heard the persistent cries of a bird of prey. I looked up and not far above my head a red kite ducked and wheeled under the ferocious mobbing of a single magpie. It couldn't have been a quarter of the size of the majestic raptor, but it was bullying the larger bird relentlessly and loving it. And the kite could do nothing about it.

At work I have a long chat with a patient who reported multiple joint pains a couple of weeks ago and upon whom we had performed a battery of blood tests. It turned out they were all pretty much normal with the exception of a slightly high cholesterol reading. Mortified at hearing this, the patient protested that their diet was exemplary and expressed something close to despair that all their recent efforts had been in vain. We recalled a result from 5 years ago, and we both noted how the WHO has adjusted their optimal levels down by a considerable degree in the intervening 5 years. In other words, what used to be thought of as normal is now unacceptably high. I did no more than suggest renewed efforts on their part, knowing an offer of statins would likely be politely rejected.

Business over, we spent a little time shooting the breeze. I mentioned the blog I keep, and I felt I trusted the patient enough to reveal its name. I emphasised secrecy: if my real name reached the public I could find myself in the deepest shit imaginable, invoking the ire of the local health authorities, the GMC and possibly the police to boot. Moreover, the patient has a very powerful job and is extremely well connected. But then, that sort of person is usually accustomed to keeping their cards close to their chests, so I should be safe.

one of those november days

In much of Britain November is one of the wettest and murkiest months of the year. Indeed, this has been the case for several days now. The forecast promised intermittent breaks in the weather, but when I left the surgery at lunchtime it was drizzling steadily, thereby putting paid to my proposed hill-walk, in preparation for which, expecting damp conditions, I had packed my walking boots in the car. I shall have to try again tomorrow. I need to do 2 walks each week along with 2 10 minute sessions with my hand weights to ease my conscience about getting enough exercise.

So I went home, did the weights, followed that after half an hour's recovery time with a ball spinning session, before going online to select an appraiser for my annual appraisal which must be completed by the end of December. Only then did I permit myself the luxury of settling down with my book and my bottle of whiskey for an hour or 2.

I phoned the care company that has taken on my mum this morning, only to find she has accepted only the most minimal package, insisting she can manage (almost) completely by herself. They seemed pretty sanguine, however; they must be used to their clients demonstrating this kind of self deception. They know as well as I do, that soon this package will have to be increased, especially if, as I fear, the DVLA expresses their misgivings about her continuing to drive. This will be the critical point: when she sees her car being taken away it will inevitably (as it would with any of us) bring about a profound crisis of confidence. It could even kill her...

marital dysharmohny

The hospital kept my father-in-law in hospital overnight, and indeed the TLC must have done him a power of good, because he was raring to go this morning and anxious to return home. But there remains a question mark over the private care company we have used. As I reported yesterday, they didn't notice the large pool of blood on the hall floor, nor the fact that his hair was thickly matted with blood. The social workers are also not best pleased and have launched an investigation of their own.

At work, I have 2 consecutive woman patients come in with the same story: they discovered their husbands were having an affair by the recourse of scanning their Facebook accounts ("perhaps he wanted to be found out" one of them said sadly). In both cases, a confrontation ensued followed by the husbands moving out within days. One said how betrayed she felt. "We both took our vows, and for me at least they meant something" I feel the same way. Since I got married 7 years ago I have been presented with temptation on several occasions. But those vows meant something to me too, so I kept it in my pants. Why couldn't these arseholes?

mid surgery crisis

My wife very rarely calls me at work. If she does, there's a 90% chance it's about my mum who has had some sort of crisis (usually emotional) and has called my home number. This time, however, it was to say she wouldn't be waiting for me when I returned home, because she was taking her dad up to our local A and E (accident and emergency) department to fix the large laceration he had sustained to the back of his head in a fall some hours earlier. There was quite a large pool of blood on the hall floor, so it could be quite serious, though blood quantities are classically over-estimated on initial appearances.
Funny thing: the people from the care company, who visit him on a daily babis, failed to notice a thing...

I shall call her on her mobile shortly to check the situation. Meanwhile I have sustained myself with a couple of slices of buttered toast slavered with peanut butter, washed down with a deep draught of tomato juice (with added tabasco and soy sauce). Mmm!

the reckoning draws near

At our partners meeting today I was finally able to winkle out from a curiously reluctant partner what their valuation of my building comes to. Turns out it's £270,000, only £6000 less than mine. Of course this does not take into account the bill to fix the damp in the cellar, but it is still a lot better than I had hoped. So as long as fixing the damp doesn't go into 5 figures (please don't tell me it could) I shall be making a reasonable profit. Which is only fair, as GPs regard this as an important (if unofficial) part of our retirement package.

At home I am now working on the second draft of my new "non-fiction short story" sort of post Truman Capote if you like. My wife made some approving noises, so I feel encouraged it might go down well.

remembrance of what exactly? sunday

COMMENT

It is just past the 11th hour of the 11th day of the 11th month. In solemn ceremonies up and down the country its war dead are honoured, as indeed they should be. To give one's life in service of the state is a noble, if sometimes misguided act.

I have to inform you that I have not worn a poppy this year, despite the intense (if subtle) peer pressure one comes under to comply. But for many years I have had reservations about what I see as buying into a militaristic culture. And I have to say I find it extremely worrying when I see every single MP across the political divide in the days and indeed weeks preceding the 11th sporting their poppies "with pride". When the state comes together in complete unity like this, I feel it somehow represents a loss of freedom, of diversity of thought. And that's never a good thing. The same thing applies to each and every news presenter, regardless of which channel they serve, leading the eminent journalist Jon Snow to divulge that he had been put under some pressure to fall in line, labelling this sort of manipulation "poppy fascism". I have had a lot of time for Snow ever since he turned down a highly prestigious OBE on the grounds that as a member of the 4th estate he had no business aligning himself with the state itself.

Don't misunderstand me: I am no pacifist, and I am well aware that sometimes there is no option other than military force. In World War 2, for example, the Nazis and Japanese militarists had to be crushed, almost by whatever means necessary. And I salute those men and women who were killed and injured carrying out that grim duty. But in recent years I have not approved of the military campaigns with which the UK has embroiled itself. And I worry about the civilians caught up in war. WW2 was the first war in history where more civilians were killed than soldiers, and it's been getting worse ever since. In Iraq many more civilians were killed than combatants (although the US in particular has worked hard to conceal the figures) and the situation is no better in Afghanistan. Where is the remembrance day for them?

history is made

The actual date was Thursday November 11th, 2010. It marked the first time I have used texting to contact a patient as an emergency. I had finished work for the day and had come home, when I was rung by the surgery and asked to contact a patient who had just experienced a traumatic delivery. I rang her mobile number and got only an answerphone message. Next I tried her landline, but this proved to be unobtainable. It was then that my wife suggested I text her and invite her to call me back. And within 2 minutes she had done just that and I was able to assess her situation.

Then this morning I used it again. At the concert we attended in Manchester last week, I had taken a couple of covert pictures of the girl in action with her clarinet. When she later learned of this, she asked through my wife if I could email them to her as jpegs. This I duly did. After over a week I had received no acknowledgement, so this time I conceived the idea of texting her about it. And dammit it if she didn't text me back in less than a minute to effuse her apologies for not getting back to me earlier.

I am glad I can say I have embraced the texting culture before I reached retirement age. It would perhaps be a tad embarrassing to have missed that little deadline..

mother's day

This afternoon was all about my mum. I drove over to the coast in steady, driving rain and then took her to the local memory clinic in her car.

Once there we were separated, and while she underwent a series of tests and assessments, I was interrogated by a kindly OT (occupational therapist) about every aspect of her life, right down to questions like how much sleep did I lose worrying about her.
"A little" was my answer to that one. Only later did I realize that I myself was being assessed as I am now, de facto, her carer.

For her part, Her score on the mini-mental scale had fallen, so there is now no doubt she is gradually deteriorating.

Then, within minutes of arriving home, as arranged, the manager from the private care-providing company rang mum's very elegant four chime door-bell. Once ensconced on a lounger, she also quizzed the pair of us in detail about her increasingly parlous condition and what help would be needed for her to retain her independence. One immediate problem is the car. Now she has a formal diagnosis of Alzheimer's disease, she must inform the DVLA, who will have to decide whether she can retain her driving licence or if she must take an extra test. Or even simply to have it withdrawn altogether. My mum remained calm at the news, but I knew inwardly she was terrified. Poor thing. One day I'll be in the same situation (if I live that long) and I won't like it any more than does.

toothless wonder

Up to the dentist this afternoon to receive the grim news: yet another tooth must go, making it 4 now in 3 years.

The tooth is so important for eating, being a molar, that it's either another implant, or that dreaded word, a denture. I have 2 weeks of grace, while my temporary cap holds out, before I face a period of anything up to 4 months of eating just with my front teeth. Great...

For some days now, high winds have been predicted for today, and right on cue, preceded by skies of a quite ominous yellow-grey, they arrived just before darkness fell. Pressure here is low at 28.8 inches, but 2 days ago when conditions were still calm, my barograph had fallen to 28.6 inches, the lowest figure it has recorded since March 2008. I must remember to check for fallen slates in the morning...

more building frustration.

At the end of morning surgery I go to my partner to ask if her valuation has come in. I know it has been done, because I spoke to the guy myself while he was in the course of carrying it out 2 weeks ago. But no, he has insisted she must now get an estimate (well, "2 or 3" was what he said) for fixing the damp in the cellar, which is certainly an issue. But how long will that take? And how much will it cost to remedy, for Christ's sake? Thousands? Who knows? I bloody don't, except that I can see my profit on the sale melting away in front of my eyes. It's not a nice feeling.

COMMENT

1. So. George Dubya has brought out his memoirs and sung for his supper in a slew of prime-time interviews. Why did he think water-boarding was legal? he was asked. Because his lawyer told him it was, he snapped back, quick as a flash. What about any moral or ethical considerations? I might have followed up with (the interviewer didn't bother to inquire any further) but I guess he would have simply replied words to the effect of "If I can save people from being blown up using these techniques, who cares?"
Well, George, I do. Because if we resort to torture to obtain information, this makes us little better than our enemies. In WW2 the Nazis used the reprisal trick for dealing with terrorist attacks on their troops. On one occasion in Italy, 30 soldiers were killed by partisans. In response the Germans selected 300 Italian citizens ans shot them in the back of the head. After which there was a distinct reduction in terror attacks. Why don't the Americans try that? It might work. Or maybe, without telling anyone, they already have...

2. David Cameron and his 40-strong entourage are in China as I write, prepared to skate over any discussion of that nation's frankly appalling human rights record, or indeed say or do anything that might get in the way of the Big Plan: increasing our exports to that cash-engorged country. But in a beautiful example of how it is impossible to decipher a different culture's psyche, they were taken completely by surprise when the Chinese expressed unease at the display of poppies adorning the breast of each and every British delegate. Turns out they felt it could be construed as a reference to the opium wars fought between the two countries in the mid nineteenth century (and which of course we won) Apparently it was thought to be uncool to take them all off, so they stayed there, doubtless giving off a faint fragrance of mortification all day long...

I admit a sick kid

I have always said that GPs are very good at things they see every day. This is because in this way they learn what normal looks like, and any deviation from the normal is quickly spotted.

As was the case today with a year old babe who was grey of face, noisy of chest and, most worryingly, decidedly lethargic in presentation. I had no hesitation in admitting the child for observation. Hopefully they will let it go quickly, perhaps in less than a day if they are happy with its condition on the ward. But you can't be too careful. Fatal meningitis often presents in just this way.

Later I saw one of my "favourites" (live with it: all GPs have them)for his 4th session of acupuncture for his tennis elbow. I have no idea how it works, despite the elegant explanations offered by the traditionalists. But on an empirical level it does, and best of all I have never made anyone worse with it, which is more than I can
say for all the drugs I prescribe, many of which have made patients worse, and a few have died as a direct result. So when I say to them "the worst thing likely to come of this treatment is that you won't get any better" that is a very big thing.

I buy tempoary relief

I performed my surgery this morning. Just. As they involve placing the tongue on the teeth, saying any sibilant or "l" sound was acutely uncomfortable. I quickly discovered the value of listening, but try as I may, I had to say something, sometimes. I ended up deploying the glottal stop, as this was less painful. Other vocal and phonetic adjustments were also tried, which left me speaking, not so much like someone with a sore mouth than a middle class drunk with a penchant for gobstoppers.

I was able to secure my emergency dental appointment; however, where the razor edge of the tooth was duly filed down and a temporary cap fitted, providing almost instant relief, the tongue, having suffered repeated lacerations in the last 36 hours will take a little longer to settle down. Critically, I can now speak normally again. I have to go back in 3 days for them to determine the fate of the deeply diseased peg. I think we know the answer...

While waiting at the dentist's I opened a Daily Telegraph and found an item on Macao, off shore gambling den to the burgeoning ranks of Chinese nouveau riche. This tiny offshore island has been home to several casinos for over a century, but it has now reached the point where its annual turnover exceeds that of Las Vegas. Now that's serious money...

pain on sunday

The broken tooth has left an inner edge like a serrated razor: naturally this has generated a quite deep laceration on the left lateral border of my tongue. If I try to talk, eat, drink or even swallow my own saliva (which I seem to be developing in copious quantities) there is a severe wave of pain. As a result I have only been able to get a little soup and yoghurt down me all day. Probably totalling no more than 1000 calories in all, it constitutes a fairly harsh diet. Whisky seems to just about go down all right, however.

I am learning to swallow with my mouth wide open, this being the only way I can avoid rasping my tongue against the cutting edge of the tooth stump. Oddly, this a skill usually practised only in the dentist's chair. Tomorrow I must see that dentist. Will he pronounce the tooth doomed and remove it or can it be conserved? Right now I'd settle for him simply filing the sharp edge off it. I can only hope the word "emergency" works the same magic as it will in my own practice, where the staff are trained to fit patients in on the same day if they drop it. But tomorrow is my busiest day, so some disruption is inevitable. But what can I do?

teeth decay

My friend duly arrived last night, and with his daughter and her girlfriend in tow. We ordered in a curry and washed it down with champagne. A highly enjoyable evening was had by all (I like to think, but what do I know? There might have been some highly complex inter-personal dynamics going on tonight, and I may not have noticed.. It would be just like me...

Today he helped me with some things he knows intimidate me. The darling man: he has been doing this sort of thing for me for so many years now. Later, in the afterglow left by the force of his personality, I was enjoying an apple from our garden (this year has produced a bumper crop of crisp and beautifully succulent fruit of a kind you simply cannot buy in a supermarket), when a tooth in my lower left jaw sheared off right at gum level. This is heavy stuff. I have few enough teeth remaining as it stands, and this one is almost essential for eating. I may need another implant, with all the hassle and expense that that implies. But as the French have it:
"Il faut manger"
Bugger...

up north

Apologies for missing yesterday's blog, but we were fully occupied, driving up to Manchester to see a close friend perform her clarinet concerto. It proved a long, miserable journey, under leaden skies and heavy rain throughout. But we made it without incident and in good enough time to find a curry place before the concert started. In the event this proved not to be too difficult, as the venue lay close to the famous "Curry Mile", home to a thousand and one more or less exotic food outlets. As we were on foot and the rain was still driving heavily on the Manchester streets, we chose pretty much the first one we came to, which wasn't too bad, thankfully.

Then off the the RNCM (Royal Northern College of Music) for Hannah's big night: performing Scott McCallister's "X". It is a strange, quirky tribute (the notes said) to the grunge music movement of Seattle. Her performance? She was wonderful! Now I'm no great authority on music, but even I could see the piece was extremely difficult technically, and that as far as I am concerned, her interpretation was quite marvellous. Afterwards, still in the afterglow of the hormone surge needed to bring her through her performance, it was clear she had had utter confidence in herself, and the fact she had performed faultlessly clearly came as no surprise to her.

Oh, for that level of confidence in just about ANYTHING I attempt to do in my life...

This morning, after a fair night's sleep in the nearby hotel Ibis, we visited the Whitworth art gallery (good collection of Turner watercolours though not well presented enough) and even had a quick round of the Manchester museum, complete with its "vivarium": a fascinating collection of (living) poisonous frogs, from the famous "poison dart" frogs of the Amazon rain forest to other huge things that just lay there like a lump of poo, waiting for some hapless arthropod to wander past before snapping them up with their huge, venomous fangs. Nasty.

And now, home once more after a relatively easy drive home (why is the return leg always somehow easier?) we await our visitor for the weekend, one of my oldest friends who now lives irritatingly, 60 miles away. Damn his eyes.

back in the comfort zone

COMMENT

So. The Americans have had their customary mid-term protest, a phenomenon, let's face it, we know something about ourselves. Obama has been dented, but the Tea Party idiots did not sweep all before them as some of us feared. The Californian candidate for governor for instance, spent no less than 160 million clams on her campaign and still bummed out. I tell you, buying elections these days sure is hard.

Now the senate is controlled by one side, while the house of representatives is in the hands of the other. And this is what your American likes to see. They have an inherent distrust of centralised government (so do I oddly, though for very different reasons)and nothing makes them happier than to see it hamstrung in precisely this way.

I wouldn't rule out O winning again next time, but he is entitled to wear a bit of a worried frown right now. Good luck, mate. You're gonna need it...

curtains drawn and tired

Ever since my demented father-in-law tugged furiously at the curtains in our front room, instead of using the draw-cords provided, they have not been the same. Today I found that the mountings fixing the supporting bar to the wall are pulling away, leaving them hanging precariously and impossible to draw at all. So my wife went to "Curtains are Us" or some such, and found that, like so many other little problems in life, this can be solved by the simple recourse of throwing money at it. In this case, somewhere around £500. Oh well...

In surgery I saw 21 patients in 195 minutes, and by a considerable effort of discipline was able to see almost all of them on schedule. This despite the best efforts of some of them to present me with problems of great complexity. Like say, the very pleasant Pakistani lady who complained of multiple limb and joint pains, but who politely refused my offer of performing even the most perfunctory physical examination, or the boy who was hit on the head by a football a month ago and "hasn't been the same since, doctor"

language barrier

There is a facility provided by our PCT that GPs may use called the "language hotline". It purports to be able to get an interpreter of virtually any language on the phone within seconds. In practice, as you might imagine, it is a very different matter. Even with commonly used languages such as Mandarin, Urdu or Farsi, we are informed they will be available "shortly", which often means hours later. Meanwhile there's some poor sap sitting in front of you who needs help now.

Then there is the problem I saw today, where a Pakistani male thought he could speak English, going on the basis that if he says enough English words quickly enough the doctor has a good chance of understanding the problem. Which he doesn't, actually. Plus the man stinks of body odour and clothes that don't look like they've been washed in a couple of years. His English may be limited, but he understood sufficient that when I suggested he might want to wash his clothes and have a nice hot bath before he comes to the surgery next time, he affected deep offence.

But I have to think of the other patients sitting in the waiting room, and having to put up with his stench for many minutes at a time. And I'm not having that. I could be racist about this, but in fact the last time this happened the man concerned was thoroughly Anglo-Saxon. Half an hour later I still had not got the smell of him out of my nose, despite window opening, air freshener and a powerful fan.