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.