silver tongued flatterer

A polish woman comes today. She has seen both the other 2 partners, but this is the first time we have met. The others have indicated in the notes their displeasure at her refusal to take medical advice, along the lines of "I didn't think I needed the antibiotics the other doctor gave me, so I didn't take them" and other material of a similar ilk.
She is actually very attractive, with passable English, but there is a little edge about her which is not so pretty.
"I read your profile in the practice leaflet", she purrs, "you know, that stuff about your holistic approach, and thought you would be the one for me"
Part of me wants to crush her full lips with hard kisses, but I restrain myself and try to stick to her medical issues. I order a tranche of investigations of her pelvic pain "just to be nice and scientific about it", including an ulta-sound scan of pelvic apparatus, urine analysis and numerous blood tests. This goes down well, and as she leaves, she coos:
"You're the first doctor I've found in Britain who speaks to me on my level. I'm coming back to you..."
Whoa boy! I've heard this sort of thing before. I had an American patient in recently and she was all over me like measles until I dared to challenge her on her own highly individual approach to treatment. She hissed that I was "a brute" and then announced she was going to put in a complaint and change doctor. She did indeed carry out the first threat, though oddly did not follow up on the second. Beware the flatterer: in no time they can turn into your torturer...

baby day

has come around again. It should have been next week, but I will be away then so we swapped to even things up.
In baby clinic I was accompanied by an observer, namely my practice nurse's 17-year-old daughter, who is planning to be a midwife. She saw some good typical scenes: 8 week olds for their first general examination and first batch of immunisations, little ones with viral infections and the like. I think she derived something of value from it.

Back home for a lengthy session of juggling practice, which included no less than 6 run-throughs of juggling in synch to the beat of the Arab track. I really think it is coming together at last, which is a good thing, as the show is barely a week away.

a fortuitous lapse

Up bright and early this morning to take my mum for her gastroscopy. When I arrived I could clearly detect the faint smell of cooking. I enquired as to the origin of the smell and she informed me that she had indeed enjoyed a bowl of porridge just an hour earlier. Somewhat ironic, I felt, in view of the fact that the endoscopy was arranged to investigate her persistent nausea and loss of appetite, yet on the very day she NEEDED to fast she ate a hearty breakfast!

Naturally I am to blame: I should have warned her to starve herself prior to the test when I phoned her last night. I just took it for granted she would know all about it, which in retrospect was incredibly stupid of me.

But we went up to the gastroenterology clinic anyway and went through the process. I clearly heard my mum flat out deny she had eaten anything and I forbore from contradicting her at that point. Then it occurred to me that if the procedure went ahead and she vomited mid-examination, she might inhale vomit and die of aspiration pneumonitis.

So I drew the nurse aside when she had completed her questions and quietly told her what mum had told me earlier. Within minutes the consultant came in to the cubicle to speak to us and straightway announced that it was off. He followed up with a series of questions that led him to conclude that the investigation (which involves passing an endoscopic camera down the gullet into the stomach and beyond, and is well known to be extremely unpleasant) was probably not necessary after all, and that a change of anti-emetic might be a better option. How about that? I'd say she had a lucky escape.

My day off work, however was not totally wasted. While driving her to the hospital in her car she read out a letter she could not understand: it was from the DVLA and stated that she had not renewed her tax disc and had been fined £65. When we got home I phoned the direct-line "paying fines hotline" then with some difficulty unearthed her registration, insurance and MOT documents and drove straight to the post office to renew her disc. This is the first time to my knowledge she has forgotten to keep up with her legal responsibilities, and I must say I was a little disturbed by how blase she appeared about the whole thing. I tried to explain she could have been arrested or even had her car seized, but her "belle indifference" had kicked in big time.

let the building recommence

COMMENT

Yesterday the moratorium on building Israeli settlements on the West Bank ran out, and even before midnight people were busy hacking out foundations for their new homes.

I heard an Israeli house builder on the radio saying:
"Everyone has the right to build his home where he pleases"
Well, no actually. He can't come and build one in my back garden because it's mine and I don't want him to. But that doesn't work in the occupied territories. The land is Palestine, but the Israelis don't care about that. It seems they regard the Palestinians as irrelevant. It says it belongs to the Jewish people in the Bible, and that marks the end of the argument as far as they're concerned. And as for human rights for the Palestinian people? Turns out that isn't relevant either, because the Jews don't really, in their hearts, believe they are human- remember the rabbi who only a couple of weeks ago publicly called on God to bring down a plague on the Palestinians and basically do away with them all? Is this the prevailing view of ordinary Israeli citizens? I'll be in a position to answer this for myself quite soon. Watch this blog...

not so lazy sunday

Following yesterday's epiphany moment, I have today been practising again with my 3 large pink balls (if you'll forgive my use of the expression) plus some of the other "extras" my wife and I going to show: spinning plates, spinning ball and yo-yo.

Our Indian summer is hanging on by its fingernails, giving warm, bright conditions, though out of the sun the north-easterly breeze makes itself felt keenly. In the garden our hazel nut crop seems to have come to end. It needs a good summer to perform, hence the for the last 3 years we have had jack. But this year we have collected nearly 5KG- enough for several nut roasts. That, of course will be after I have shelled them all. This I will leave until after our return from abroad and my performance is done.

COMMENT

Who'd a thunk it? The lefty brother won out over his more-fancied centrist sibling. This is good news for Labour, and good news for the nation if he ever wins power. But how did he do it? I think the unions wanted him because when they start mounting big-time protests against the public spending cuts, they're going to need all the friends they can get. They know they'll be shafted by the establishment press, and by most of the electronic media as well, but it might just work. After all, it was the strikes in the 1979 "winter of discontent" which sealed the fate of the incumbent government at the time. We can only hope...

friday comment

COMMENT

1. I recently took a friend of mine to task for publicly criticising the singer Morrissey's comments on the Chinese people. His criticism was in 2 parts: firstly that he had referred to the Chinese as a "subspecies of humanity" and secondly, that he had chosen to highlight their poor treatment of animals ahead of any condemnation of their record on human rights. For the first part I have some sympathy: these insulting words are scarcely conducive to constructing any meaningful dialogue. For the second, however, I can only add my support. True, the Chinese record on human rights is appalling, but I believe the level of civilisation of any society can be measured by their treatment of dumb animals, and as the Chinese have no laws covering cruelty to animals, they have carte blanche to abuse, torture and ruthlessly exploit their animals with no fear of retribution from the authorities. And that's wrong, in ANY society.

2. Another measure of the level of civilisation in a society might be their treatment of offenders. In America today, specifically in the state of Virginia, they will put to death a woman who arranged the murder of her husband and son (the actual murderers were given life sentences, but avoided the death penalty) Yet this woman's IQ is 72, just 2 points above the threshold for a diagnosis of "mental debility" which would have excluded her from capital punishment. China and the US (with Iran in 3rd place) are the 2 biggest users of this archaic and inhuman form of punishment- what does this say about their claims to being civilised countries? Capital punishment is not deterrence, it is state sponsored vengeance- and that's WRONG.

3. And finally: Stephen Hawking, God bless him, has stated that it is not necessary to introduce the concept of a supreme being to account for the Big Bang. Bad news for God fans everywhere, then. On hearing this, I was reminded of a piece of graffiti I once saw in the London underground:

"God is alive and well and working on a less ambitious project"

juggler's despair

is the name given to an affliction of unfortunate practitioners of natural magic, prestidigitation or the manipulation of one or more objects, as juggling is also known. At least from the time of Egypt's middle kingdom (that's around the time when the Pyramids were built, and way before Stonehenge was thought of) people have entertained others with this subtle art; indeed, there is a small statue from that era showing someone performing the extremely difficult "knee catch".

But non practitioners will know little of their great travails and continual frustration as they attempt to perfect the tricks of their trade. Circus skills are every bit as hard to master as an oboe or piano. The musician fears the bum note: jugglers dread the equally humiliating drop.

I have now reached the stage in my preparations where I do repeated "run-throughs" of my modest, 3 minute routine. I've always said to myself I would settle for 2 or 3 drops, but this afternoon I was dropping more like 20 times, leading to some sort of desperate anguish which could only be expressed with a sustained, agonised scream. Only the cats heard, and they made themselves scarce. For my part, I resumed my practice with a slightly lighter spirit.

Later I remind myself that my audience, which could number anything up to a hundred 4-12 year-olds will, with any luck, never even have
seen juggling before. Please be the will of Allah...

busy indian summer's day

We have been enjoying some good late summer days, perhaps in compensation for a rather disappointing August(though statistically only 1 in 4 Augusts are good in terms of warmth and sunshine)

So after a relaxed morning at work, troubled only by a rather strange man, who, despite his obvious intelligence, could not connect the fact of his feeling continually drained and unhappy with the death of his mother earlier this year, I returned home for what was as close to being a perfect afternoon as I ever get these days: no difficult or unpleasant mail waiting, followed by lunch (tinned mackerel in a spicy tomato sauce), 40 pages of my book read, 1/2 an hour's juggling practice and finally, to justify my existence, mowing a lawn that has grown only slightly shaggy in the 3 weeks since I last did it

FOOTNOTE- MY SKY PLUS BOX

I was going to write a glowing testimonial of my sky plus box, and how, with its recording facility and HD channels (which are about 10% better than normal, though not "5 times better" as the advertising blurb claims) is genuinely changing my life for the better, if only in a minor way.

But over the weekend, it, and I understand thousands of others, went down when an automated update succeeded only in disabling the system altogether. Left only with a tiny batch of terrestrial channels, I finally rang yesterday and got them to restore it. All very well, but then I found it had gone down again today. I pointed out to the call handler that I was being deprived of services for which I was paying, and that therefore I might be legitimately be entitled to a refund. At this point she offered to send an engineer round to look at it and perhaps to replace my box if it keeps failing.

new day new hope

Today my wife took my laptop to PC World and, being made of sterner stuff than myself, was able to persuade them that my space bar problem could fairly be described as a fault, and as the computer was still under warranty (I bought it in December of last year) it should be repaired without delay. They agreed and have taken it away, to be returned in 5 working days (allegedly; we shall see)

Thank God for the little dearling*! She is so good at this sort of thing. I'm good in a crisis, she says; she's good in pretty much every other situation- what a gal!

*not a typo: the word darling comes from this more achaic, but still valid word

sunday morning reflection

After one of my angry outbursts, powerful feelings remain for a couple of days. First a sense of relief, as if a pressure valve has been released, allowing the system to run with renewed efficiency. Second, a feeling of regret that once again I have lost control over my emotions and in so doing have negatively affected people around me.

I have had explosions like this every 6-8 weeks for as long as I can remember. Of late one could have put it down to the loss of my son, and while that did not exactly help, the phenomenon far pre-dates that. You might say it is down to events in my early childhood when I was admitted to hospital with severe asthma and eczema and was bound to my cot-sides to prevent me scratching myself. Unfortunately that information may be interesting, but it is scarcely of any use to me now. All I can do is to continue to grapple with my little problem and endeavour to prevent other people being hurt in the shrapnel blast.

FOOTNOTE

My camera, having recovered itself for a couple of weeks, has now failed altogether. Now I have no option but to abandon it and get a new camera in time for my trip to the Holy Land. Hot contenders include the Canon G11 and the Canon Powershot S95. But I still feel bad that I am going to have to chuck away a camera I paid well over £300 for less than 2 years ago. Is this really how it goes these days with high-tech equipment or is it just me?

space bar rage

Ever since purchasing my laptop (a Sony Vaio if you must know) I have been having trouble with my space bar. You may think this is pretty trivial, but the space bar is hit as often, or more often, than any other key. It is now at the point where I am having to jab the bastard thing so aggressively I am hurting my index finger. Every blog you have read includes several extra minutes going back through it to insert spaces where there were none, and no matter how vigilant I am, I still find that as soon as I have concentrated on my writing for even a second it fails and I have to go back over it again. Such are the problems of the modern world, or my world at least...

Today,
all my suppressed rage against the machine, building now over a period of months, boiled over and I started slamming about it about in a way that actually terrified my poor wife, who hates loud noises and indeed any displays of anger. She eventually persuaded me to take it to PC World where they told me that it has to be struck precisely in the middle "as it should be sir, the rubber is in the middle, you see" My saying that the space bar is the length it is so it may be accessed all along its length to facilitate easy typing fell on deaf ears. It is "not a fault" apparently, and the only solution, according to them, is to send it back to Sony and get them to replace the keyboard (time: 4-6 weeks; cost £125) Yet I paid £700 for the fucker only 9 months ago, and at the beginning at least it worked fine, as does my wife's earlier model Vaio.

Now, in order to decrease domestic strife generally, she has offered to take it to the Sony shop in Town on Monday to see what they have to say. That is really sweet of her. Now I have to cope with my anger (now subsiding, but leaving behind a nasty aftertaste) and continue jabbing furiously. Or just throw it in the bin and get a new lapgtop (not a Vaio this time, I promise you) But the waste! The waste!

nursery blues

We live next door to a children's nursery. Apparently, local bye-laws say they should be allowed to be outside for a minimum of 2 hours each day, which sounds reasonable- unless of course you happen to live next door. They let them out into the garden and within seconds they are shrieking, roaring and yelling at the tops of their little, high-pitched voices. Worse still, they ride along in little foot-driven cars which trundle up and down their garden so relentlessly it sounds like the marshaling yards at Crewe junction. I have complained (politely, I assure you) many times, and the noise levels subside for a week or so. But then, like some Alzheimer's sufferer, they simply forget all about the crabby guy next door who likes his peace and quiet and the din resumes with renewed vigour.

It's the one thing that makes me think of moving, especially after I retire when I will inevitably be spending more time at home. Or I can long for the damp, grey months of winter when they aren't let out of doors very much. Then I shall have a little repose. But fancy dreading the summer! It's crazy, but it's true...

significant events

If a practice discusses 6 "significant events" in a year at its plenary meetings, it attracts a certain payment for so doing. And this is what we did today, or 3 of them anyway. One was particularly frightening (thank God it did not involve me) Apparently a patient rang in to enquire whether her scan result was back yet, and as the story went, she was told by an (as yet) unidentified receptionist that as it was late coming back to us it "was probably all right anyway"
At this point I exclaimed: "That's terrible"

It gets worse. It then emerged that the patient didn't visit the surgery for several months, until the facts eventually came out in an unrelated consultation. The result unfortunately indicated an early cancer. Perhaps the doctor should have spotted the result and contacted her straightway... Amazingly, no formal complaint was ever made about this clear failure of duty of care, and thus the episode is closed. A scapegoat was needed, however, so we decided it was probably the receptionist who had left our employ some time ago, but who was working here at the time of the incident. The doctor involved bravely admitted his own part in the disaster, after which we moved on to other events, which I am relieved to report were pretty small beer by comparison.

You might think financial inducement should not be necessary for a practice to engage in this sort of self-examination, but the fact remains it has been effective. Practices are now more efficient than they have ever been, and this is is partly due to the clever system of bonuses that are awarded for reaching higher standards of excellence in a wide variety of criteria. It's sick, but it works.

a heart warming letter

Today I receive a letter from the son of one of the men who died last week. Meticulously written in capital letters, but with correct spelling, it stated the following (I paraphrase)

DEAR DR,

I WAS SORRY NOT TO BE ABLE TO MEET YOU FOR THE FIRST TIME WHEN YOU CAME TO SEE MY MOTHER LAST WEEK. I KNOW MY DAD COULD BE A DIFFICULT CUSTOMER, BUT I ALSO KNOW HE HELD YOU IN HIGH REGARD BOTH AS A DOCTOR AND AS A PERSON. THANK YOU SO MUCH FOR ALL THE KIND CARE AND ATTENTION YOU GAVE HIM OVER THE YEARS

It's always the same. The people you feel you simply gave your usual standard of work to are always the most grateful. And the ones you felt you went out of your way for, travelled the extra mile, as it were, are so often the ones who end up putting in a complaint.

But I am wary of allowing a glowing testimonial like this to go to my head. I offered to show my appraiser last year the sheaf of "thank you" letters I had received the previous year and he dismissed them with a wave of his hand. "I don't want to see those" he said, "Let's see the complaints book"

tired and angry

A woman of 35 comes today to renew her prescription for prozac. I ask how she is, and all the suppressed rage against life pours out of her in a torrent. She is a talented actress,but has been "between engagements" for nearly 2 years- "it's the cuts, innit" she fumes.

She is also an extremely attractive woman as well as possessing of a superior intelligence. But this unusual combination of gifts is no solace to her: she doesn't know how to be happy, and I don't know how to help her to be so. She has had several courses of psychotherapy over the years which have achieved zilch, and of course the prozac is little better than a placebo, though of course the doctor has to feel he is doing something. I give her a handful of diazepam for the worst of her anxiety symptoms, warning her they are addictive, and finally arrange to see her again in a month.

It's what I do.

incident of the day

40 patients seen today. Normally at the end of a day my receptionist will ask me:
"And how did it go today?"
To which I usually answer:
"Well nobody was horrible to me, and that can't be bad"
I was not, however, able to say it today. One man came in on behalf of his son requesting more powerful pain relief for his (the son's) escalating back pain. He has already been seen at the spinal clinic who don't really know what to do with him. I started by expressing concern about how much analgesia he was using, but the dad was that sort of "working-class-clever-with-sarcastic-overlay" person; that is he had a dismissive answer ready for everything I said with the unpleasant attitude thrown in for free.
I responded in kind, insisting he treat me with some respect, but he simply took that as his cue to berate the medical profession in general and me in particular. I threw him out.
I then phoned the son on his mobile and invited him to come in tomorrow for a full airing of his problems. With any luck he won't bring his dad with him. If he does, I'll just have to throw him out again

musy sunday

After more than a month's mental preparation, I began writing my new story yesterday. I had made quite extensive handwritten notes last week, and I wrote about 600 words in a single session of about 2 hours. Not many perhaps, but now I have found my "stylistic technique" all that remains to be done is the work of putting it on paper. I think it will be quite short, perhaps no longer than 2000 words. The plan is to have completed it before I go away: about 3 weeks.

But today is a day for a long lie-in, with a trip out to the coast to see my mum who is actually looking a little better, though I'm still not sure she's eating properly. We found most of her meals-on-wheels packs in the fridge, where they are ruined because they should be frozen.
"Well, it doesn't really matter; I didn't like them much anyway" was her breezy response.

in camera

I've been having some trouble with my digital compact lately. It's started disobeying orders and behaving in an unpredictable and unreliable manner. I'm not sure why. I have got it wet once or twice recently which might have something to do with it; also I dropped it on a hard surface from about a foot not long ago, which might also be not wholly unrelated.

It's a nice little machine, refreshingly retro in design and quite versatile, but I'm off to the Holy Land soon, and I don't want it to start acting up the moment I enter, say, the Dome of the Rock.

Today was the day scheduled for going into Town and cutting my losses by obtaining a new camera and abandoning the old one altogether. But it seemed a shame to have to dump it. But then this week it has started behaving itself, almost as if it knows its future is in jeopardy, so it is obeying all the many commands I have been giving it all week to test its reliability thoroughly.

So I've held off, at least for the moment. My backstop is the duty free shop at Heathrow, but I'm hoping it doesn't come that. It's a nice little camera and I don't want to chuck it in the bin just yet...

camera- Lumix LX3, bought Dec 2008

somatising city

At work today, everyone seemed to have issues of "somatisation". What used to be more commonly referred to as "psychosomatic disorders" these have been understood for a long time, certainly since Freud. Indeed, I would not be surprised if even even ancient physicians also had a handle on it. I have often wondered how physicians of the past inspired so much confidence, in view of their extremely rudimentary diagnostic techniques and even fewer weapons of effective treatment. But people have always feared death, and therefore revered the person who might deliver them from it. Even today a major part of the doctor's job is to reassure people that their symptoms are not life threatening, and perhaps physicians in antiquity were also skilled in recognising self limiting ailments and were thereby able to ease their patient's minds.

Certainly that seemed to be all I was engaged in from 9 through 12: hyperacidity, irritable bowel syndrome, asthma, and perhaps most interestingly, a 6 year old child with school phobia manifesting as "headache and not feeling very well"

it's all about cuts, allegedly

COMMENT

The tory (sorry, coalition) government is telling us that deep cuts in public expenditure are essential to salvage our battered economy. Because of the reckless profligacy of the last labour administration (you thought it had something to do with the greed of the banks in concert with the greed of ordinary people who borrowed way more than they could afford to pay back? Wrong, apparently), there's now officially (remember Liam Byrne's quip about all the money having run out?) no money left, and what with our unprecedented national debt, well, cuts, deep cuts, are inevitable.

I beg to disagree. Cutting public spending is in the tory's blood: they've always believed that far too much is wasted on benefits and the health service (they voted against the NHS prior to its introduction in 1948, not now maybe, but that's only because that would be electoral suicide) A proper tory believes capitalism should be allowed to let rip, and devil take the hindmost.

Ed Balls (he's one of the labour leadership candidates who's going to lose to David Milliband) has pointed out (though who's listening?) that our economic health, to say nothing of our national debt, was (allowing for adjustment) even worse just after the end of World War 2 than it is now, yet it wasn't felt necessary then
to cut public spending to anything like the degree now proposed by George "Bullingdon Boy" Osborne. We didn't go bust: in fact we steadily climbed out of our recession to be, by the early 60s, one of the world's most vibrant economies.

songs and death

Last night we attended a wonderful a capella choir singing liturgical texts set to music by the Estonian composer Arvo Part. The venue, appropriately, was in a church, its Victorian high kitsch packed to its neo-gothic rafters by the fairly great and quite good of our fair city. At times a drone effect was to be heard, and it sounded almost exactly as if there had been a number of cellists bowing out a single, sustained chord. Amazing!

Today I visited the 2 widows of the men I wrote about in Monday's blog. They were very different. One was devastated, continually breaking down into tears, while the other took, ostensibly at least, a much more sanguine approach. "It comes to us all" she pronounced in an extremely philosophical manner. For both of them the real problem will come after they have attended their respective funerals: then, after everyone has gone back to their lives and is feeling better, only then will their problems of aloneness kick in properly.

skinny ribs

Today I see a 17 year old girl with severe anorexia. When I saw her 3 months ago her BMI (Body Mass Index) was 17 and she looked, well, quite stunningly beautiful in fact. (point of interst: Kate Moss's BMI is 18) But today she looked terrible: grey, drawn and a BMI that had fallen to 13. This is barely compatible with life, which disturbingly, is exactly the way she likes it. She is filled with self loathing, to such a degree that wishes only to die. "A slow motion suicide, then" is how I put it to her and she does not demur.

Few things are as heartbreaking as seeing young, attractive girls slowly killing themselves by starvation. I imagine the CMHT (Community Mental Health Team) will take a hand soon and section her for her own safety. But depressingly often these cases do not turn out well.

COMMENT

I heard the other day that 66% of New Yorkers want to stop the building of a mosque near ground zero. If you visit the Big Apple you can easily be persuaded it is a cosmopolitan melting pot where all points of view are out there and acceptable- a false impression as it turns out. Then today I heard that Americans are planning to burn copies of the Koran on the anniversary of 911, and that even general Patraeus, head of the US troops in Afghanistan, has begged them not to as it may endanger his men on the front line. Is there no limit to the bigotry of the American people?

losing old pals

2 patients died today. One was the chap I have mentioned in recent blogs. Irritatingly for me, I had promised him he wouldn't die in the hospice, but in the event it was that very place where he did succumb. I can only wonder whether one of his last thoughts was along the lines of:
"Bloody doctors! Never get anything right!"

The other man was of the same generation; in his 80s, born in a gentler era when doctors were trusted implicitly and never questioned. These men, and many others, were in their 50s when I first met them in general practice. Over the years we have become friends. Now, inexorably, they are falling by the wayside in ever increasing numbers. I won't miss this part of the job when I retire next year...

idees recues

I recently read Julian Barnes's "Flaubert's Parrot", an ultimately disappointing book, but one which did contain a lot of interesting info concerning the great man himself. What I did not find in it, however, was that he compiled a famous dictionary of "idees recues" or "fixed ideas", or perhaps today we might call them "received wisdom"; those pieces of "knowledge" which are accepted without further debate. Today I offer some of my own which Flaubert might be considering if if were alive today.

1. Mental illness, especially in children, is always the fault of the parents.
2. Anti-social behaviour in young people: see no.1
3. Miscarriage is no big deal: just go away and try again.
4. The Jews have always had a hard time. Now the Palestinians are trying to throw them into the sea.
5. If we Brits adopt the euro we'll lose our national identity and become just another sub-division of the "European super-state"
6. Western religions are a force for good in the world. Beware Islam, however, which is a threat to our western way of life.
7. Allowing continuing immigration into Britain of people from other cultures will weaken and disintegrate our own culture.
8. Celebrities are better and more fascinating than ourselves, so it is legitimate to garner as much information about them as possible from every sort of media outlet available. Conversely we are also jealous of them and long to bring them down if we can.
9. All "street" drugs are bad and the use and distribution of them should be criminalised and stamped out- and that this is possible if enough resources are deployed.
10. Britain needs its monarchy, as without it we would degenerate into a mere "republic" like the US, thereby losing our souls.

kilvert's day

A long drive today takes us deep into Kilvert country, on the Welsh marches in south Herefordshire. Our walk takes us past his old church, on to the famous red-brick bridge over the river Wye, before climbing the 300 metre ridge that guards it. Most of the climb was in one of those "sunken paths", often Roman roads originally, that arrow straight up the slope in a long, sweaty trudge. Good for the heart though.

Kilvert was an Anglican priest who lived in the latter half of the 19th century. His diary, or what little survives of it, is a vibrant, incident packed journal which provides a unique insight into the mind of a priest, and the man within. He reveals occasionally, for instance, his more than passing interest in a neatly turned ankle; indeed it was this candour that caused his wife to destroy most of his diaries after his death. Shame. What remains is still a remarkable document of a man and his time. But what was lost...

some better news

Today I speak to my mum's GP for a good old doctor-to-doctor chat about her predicament. Apparently she was tested and scanned in some detail during her recent spell in hospital, and nothing particularly abnormal was found. But her nausea and vomiting remain, to the point where she is scarcely eating at all and has lost nearly a stone in weight (6kg) in 2 months. So what is to be done? Her GP is forced to admit there is case for upper GI (gastrointestinal) endoscopy to make sure nothing nasty was missed on the scan.

It's all a bit of a conundrum, but I feel a little better that I have at least done something.

Of course it will have to be me who accompanies her on the day, requiring probably a whole day off work. I suppose I'll just have to bear in mind one of my wife's more zen aphorisms:

"It is what it is"

Thanks love, for that one.

bleak thursday

After work I head out to my mum's place to assess the situation. She is up, dressed, reasonably well orientated and coherent. But she is still not eating properly and I fear she is continuing to lose weight. For the first time I put it to her that if we cannot restore her appetite she will considered as not safe to be left alone in the house and will therefore have to live in an OPH. There. It is done: a rubicon has been crossed. She is not as horrified as I feared might have been the case, but does insist she can still manage at home, especially if she gets some more help with shopping etc.

My task now, and I do not relish it, is to try and organise this. First step: chase up the social workers and get them to do an assessment visit. Wish me luck...

After leaving her, to clear my head, I have a long, strenuous walk in the dunes nearby, under dazzling blue skies that have prevailed for the last few days. This is our Indian summer. Pray God it continues.

dying to see me

A housecall today to a man dying quite rapidly of cancer of the colon. I saw him last week when the pain was already beginning to set in, and started morphine slow release tablets. But he's already experiencing "breakthrough" pain, so I add "oramorph", a morphine syrup he can use as a "top-up" I also call the local hospice to arrange admission soon. There's nobody better than them to get the pain under control. They may suggest a syringe driver. I go through my little speech to the patient along the lines of:
"Now, you're going there for rehabilitation purposes; to make you feel better, not to die. In fact they hate people dying in there: they'll want to get you home again as soon as possible. Is that OK for you?"
He doesn't look like he believes me, but accepts what I say quietly.

At home at lunchtime, a call comes from one of my mother's friends. She hasn't turned up at her recent bridge appointment, or indeed her latest planned golf game either. She then went round to her house and was shocked by her weight loss and general frailty. I promise to alert the social services immediately, which I do. They say they will arrange an urgent assessment and the pressure is taken off me a little, much to my relief. I ring mum to tell her of the developments, and for the first time she accepts that social services must become involved. She then tells me her doctor called this morning and announced that she should no longer drive her car. I feel for the poor thing. No one, and I mean NO one, wants to hear this. It can only mean one thing: you're on your way out, and she knows it...