Reminiscences on a Train

It is raining.

Flecks on the glass become droplets,

coalesce into rivulets, turn horizontally

and gather pace as

the train outraces the rain.

The shower becomes a downpour,

then a storm. Spouts of water

bounce off passing streets; torrents 

gush from downpipes, overpowering gutters, 

converting roads to rivers. And 

with each moment the scenery changes;

the years roll back, until I sense the

cold, biting wind of a Yorkshire dale;

your hood-framed face smiling through

a curtain of dripping water.

I hear, too, the wind raging around

a cliff-top cottage on Lundy Isle,

as you sip wine by candlelight;

and I sense the humidity as you shower

outside amidst the heat of a Maldivian storm.

With every cloudburst, the dust

of the years is washed away, revealing

memory after memory until the

scene settles on two stone steps

within a Lincoln doorway, framing

an umbrella,

and two people, twenty years younger;

and I know the intensity of that

rain-soaked moment when

I knew.

© Copyright Robert M Jaggs-Fowler 2011

Growing up is hard to do

I think the line ‘growing up is very hard to do’ was part of the lyrics from the song ‘Heart of Gold’ by The Kinks (a 1960s London rock band, for those who think history is anything that happened before 1980). If having an octogenarian father who believes he is a perpetual teenager wasn’t enough proof of that proclamation, three recent conversations most certainly proved the point.

The most recent involved a professional conversation with an eighty year old lady, who declared upon leaving my consulting room that there was nothing wrong with her that a young man couldn’t fix. Unfortunately for that particular spirited lady, the local NHS budget doesn’t presently run to the provision of such therapies; at least not at present, but who knows what may be round the corner with the new Health and Social Care Bill?

Reversing in time, the second conversation was one overheard in a village pub in the Yorkshire Dales last week. Please picture two octogenarian men, both wearing cloth caps and tweed jackets, sitting at a small wooden table, and each supping a pint. In walks a third such character, with a profusion of hair protruding from beneath his cap and obscuring his collar.

           

‘You need a haircut, George.’

           

‘I had one last September,’ came the reply.

‘Just how old do you think you are?’

‘76 next birthday.’

‘Ah, a mere youngster. That’ll explain it then.’

However, those two conversations just added to what I had already perceived closer to home one month ago. The occasion was dinner with a friend, who is normally a respectable, suited, high-powered business man. For the sake of clarity, he is in his forties and I am in my fifties. We were dining in a rather splendid establishment in East Yorkshire when the conversation turned to an ‘App’ called ‘Foursquare’ that one can download for mobile telephones and other such devices. It allows the user to ‘check-in’ to wherever they are. This in turn allows their friends to keep track of their whereabouts. Points are gained for every ‘check-in’, and there is a table ranking one’s friends in respect to their week’s activity. In addition, if you have checked in the most times to a particular location, you become the ‘Mayor’ of that establishment; a fact that is then made known to the entire electronic world via Twitter, Facebook and any other social networking facility available. It is rather pointless and somewhat childish. It is also exceedingly good fun, and had us both near to hysterical laughter; especially when my friend discovered that I am now the Mayor of the Elsham Railway Crossing and also the Barton Recycling Plant.

Traditionally, 18 is considered to be the age we become adults. However, a survey by the financial company Scottish Widows concludes that we are more and more delaying taking on the roles and responsibilities of adulthood. Apparently, half the population didn’t feel like responsible adults until they were 25. More intriguingly, 49% of those who don’t presently feel like a grown-up think they will never do so.

The population of our country may be an ageing one, but it would seem that there is proof that the aged are getting younger, in mind as well as in body. As Bernard Baruch (American presidential adviser) wrote in Newsweek in 1955, ‘To me old age is always fifteen years older than I am’. It would appear that his concept has firmly crossed the Atlantic.

(First published in the Scunthorpe Telegraph, Thursday 29^th March 2012)

The Book of Genesis Guide to Pensions

I recently set myself the challenge of reading the entire Bible in preparation for a Master’s degree in Spirituality, Theology and Health.  Of course, I have read it through before; twice in fact; once when I was in my teens and again in my twenties. Thereafter, I have only dipped in and out according to need or the time of year. This time I am aided by a version called the Bible in One Year, which neatly divides it into 365 manageable chunks.

The first thing that struck me as I commenced my literary marathon, apart from being reminded of the difficulty presented by certain Hebrew names, is that Old Testament characters lived to an astonishing age. For example, we are told that Adam lived 930 years and Noah managed 950 years. Abraham only managed 175 years, but that is still fairly good going by today’s standards. Theologians will no doubt be able to explain this in scholarly terms. However, having read the latest dietary advice from HM Government, I have developed a theory of my own; but more of that later.

There is an old saying that proclaims ‘you are what you eat’, and we increasingly have the evidence to support such a bold statement. Few of us now cannot know that we should avoid unsaturated fats, reduce our cholesterol intake, increase dietary fibre, eat at least five portions of fruit and vegetables per day, moderate our alcohol consumption, and stop smoking if we hope to live to a healthy old age. It seems that the maxim ‘an apple a day keeps the doctor away’ is no longer enough for the modern era.

The latest exhortation from Westminster is that many of us still eat too much red meat. Of course, red meat has featured in the British diet for generations. Roast beef, lamb shank, steaks, sausages, bacon, burgers; they all feature high on the communal list of our nation’s favourite dishes. Changing such entrenched habits can take a lifetime. However, the truth is, not to do so can also cost a lifetime. The evidence is mounting, and in today’s parlance, carnivores are not cool.

The proof is in a paper recently published in the Archives of Internal Medicine. Researchers studied 100,000 people over a 28 year period. In so doing, they came to the conclusion that every 3oz of red meat eaten each day increased the risk of dying from cancer by 10% and heart disease by 18%. Processed meat holds even greater risks: for every two slices of bacon or one hot dog, the risk rises to 16% in respect to cancer and 21% for heart disease.

Scientists have for a long while studied what is generally known as the Mediterranean Diet, and have shown that this may well hold the secret to good health and longevity. Rich in fish, chicken, beans, nuts, fruit and low-fat dairy products, the Mediterranean diet does not contain a high percentage of red or processed meat; which brings me back to the Book of Genesis.

We know from the Bible that the diet of 4,000 years ago was typically composed of fruit, grains and fish; the ‘fatted calf’ was a precious commodity and as such was only killed on religious feast days and for other special celebrations. In essence, the likes of Adam, Noah and Abraham followed an ancient version of the Mediterranean Diet. Now, Biblical scholars may well show that there are disparities in the way they measured and recorded time in those days. However, one thing is for certain, the health of our early ancestors certainly seems to have prospered in the absence of a diet rich in red meat. It has just taken us a long while to remember that fact. So, if the Government wants us all to change our habits, perhaps the pension companies should also be warned to adjust their actuarial tables and take into account the Old Testament effect.

(First published in the Scunthorpe Telegraph, Thursday, 22^nd March 2012)

Space

It all started when I looked up to a clear night sky this week and was captivated by the proximity of Jupiter and Venus; two very bright planets surrounded by a myriad of small stars in a black sky of nothing much else. That led me to thinking about the subject of space, both in terms of the universe, and also at a more down-to-earth level in respect to the space between us as individuals; that ‘area of unoccupied ground’ as the Oxford English Dictionary describes it.

Space is very important; it gives structure and meaning to things. For example, without the small spaces between these words, you would not be able to easily read what I have written. Art galleries use space to display their works of art in a manner which can be appreciated; small objects often have a vast area between them and the next artefact, and this emphasises the beauty or intricacy of the item concerned. We also see space utilised in public, often with large garden areas, squares or parkland around important buildings in order to accentuate the grandeur of those buildings.

As individual human beings we also have a need for space. Whether it is the space around your favourite chair at home, your desk in the office, the nominated area of the car-park with your name on it, or that bit of the beach temporarily claimed for your family, we cherish those defined areas and easily become perturbed if something happens to erode that personal territory.

For humans, psychological spaces are equally important. Most of us understand that ill-defined distance that needs to be kept between two strangers if we are not to appear threatening to, or to feel threatened by, the other person. Being invited into that personal space is a sign of accepted friendship and increased intimacy. A hug or a kiss requires crossing that no-man’s land between you; a process which, in its infancy, is often a highly charged moment whilst each person weighs up the other person’s reaction to the apparent intrusion.

However, the opposite is also true. When people are too tightly bound to each other, it is possible for one or both to feel constrained and restricted; we speak of ‘breaking free’ from a relationship, or use phrases such as ‘I need some space’. It is notable that the dictionary also defines space as the ‘freedom and scope to live and develop as one pleases’. In ‘The Prophet’, the Syrian writer Kahlil Gibran, considering the subject of marriage, said ‘let there be spaces in your togetherness’. Just as with trees in a forest, human beings need space to grow and develop within a relationship. We also need space to be seen as the individuals we all are; just as with the objets d’art in the art gallery, or important public buildings.

Yet, though space is important, it can also work against us and cause social divide. The act of inviting someone into your space can be an important act of friendship. Such actions can even help to break down barriers between cultures and communities, and help to remove a sense of isolation that people often feel in the most crowded of places. Reaching out to someone from a different culture or social background, making contact across that psychologically dividing space, can have a profound impact and change lives for the better. ‘I was a stranger and you welcomed me’ wrote St Matthew in the Bible (chp.25, v35).

So, just a few moments of staring into a night sky led to several hours of re-evaluation as to how I see and treat the space around me. Do I have enough personal space to psychologically grow, and do I allow sufficient space around others that they might do likewise? Am I too protective of my space, erecting barriers to keep people out of it? Do I do enough to welcome people into my space? These are important questions if harmony is to exist within our lives and relationships. Space may be an area of emptiness, but I suggest that it is also one of our most valuable commodities, being worthy of our respect and consideration.

(First published in the Scunthorpe Telegraph, Thursday, 15^th March 2012.)

The Ultimate Charitable Donation

For many years, I have had the great fortune to travel widely in the world. However, on several continents I have very sadly been witness to a dissonant contrast between rich and poor within the same country. The scale of such poverty is fortunately far beyond what we now see within our own country, and almost has to be seen to be believed.

What has often struck me most in such situations is the manner in which the richer members of the given society almost blindly ignore their starving, ill and dying neighbours. Although opulent wealth, mansion-style houses, serviced swimming pools and expensive cars sit cheek-by-jowl with crowded slum dwellings in shanty-style townships, there is little evidence of organised relief from the rich to the poor. It is almost as though the high walls and fences that divide the two disparate populations form an invisibility cloak, allowing the poor to see the rich, but not the converse. As a result, the rich throw large quantities of unwanted, but perfectly edible, food away, not thinking to donate it to their neighbours and thereby perhaps salvage a human life or two. Meanwhile, the poor and destitute can only look on with pleading eyes and outstretched hands; watching helplessly, whilst what they need most is wasted and ruined in landfill sites or rubbish incinerators.

Sometimes the distressing images are shown on our television screens, albeit sanitised by distance and, quite significantly, the lack of smell. The immediate impact on our senses and emotions is therefore reduced. However, we still usually profess a sense of indignant shock, fuelled by the sight and knowledge of what is happening; often with a profound sense of disquiet and a resultant desire to help.

To our shame there is a poignant analogy in this country, which we choose to ignore. For us, it is not so much food that is blatantly thrown away in sight of those who are desperate for help in saving their lives; it is our bodies – our hearts, livers, lungs and kidneys; organs that are of no use to us once we have finished with them, but could be the difference between life and death for our still living, but seriously ill neighbours. Instead, many of us ignore their pleas for help and choose to bury perfectly good, functional organs in cemeteries or submit them to the incinerators of the crematoria. The analogy between our actions and the foreign scenes described above cannot be ignored.

In the UK alone, there is a 7,800-strong transplant waiting list. Sadly, every year some 400 people die in A&E departments without attempts being made to utilise their organs. Even sadder is the 35% refusal rate amongst families who are asked if their loved one’s organs can be retrieved. However precious that person was in life, their organs are no longer any use to them; but they could save the lives of up to four or more other people. Not to offer the organs to those in need is akin to throwing away a decent meal in front of a starving man.

As a result, the BMA has re-opened the debate on whether organ donation should be made compulsory, with the possibility of keeping dead bodies artificially ventilated until the organs can be retrieved. Clearly, this is a controversial move and will no doubt spark an intense ethical debate. It is, however, a debate that is urgently needed. Shamefully, many more of us say that we would be willing to receive a donated organ than would be prepared to donate our organs after death. That is a disparity which has to be morally wrong and we need to work hard and fast to alter our society’s double-standard and ensure that our own death gives life to those who still have a chance to live. Society may not be ready for the BMA’s debate, but it is one which is long overdue and must be had. After all, organ donation is the ultimate in charitable giving. For more information call the donor line on 0300 123 23 23 or go online to http://www.uktransplant.org.uk

(First published in the Scunthorpe Telegraph, Thursday, 8th March 2012.)

Cat Naps, Seasons and Body Clocks

‘The woods are lovely, dark and deep, but I have promises to keep, and miles to go before I sleep.’

The words of the poet Robert Frost will ring true for many readers who stretch the working day into the dark hours whilst others sleep. However, not even the most hardened workaholic or insomniac can run in the fast lane without the occasional pit stop. Our bodies are influenced by a circadian rhythm, whereby we experience a dip in our state of alertness twice in every twenty-four hours. This produces a state of sleepiness at some stage during the afternoon, bringing the urge to ‘cat nap’. The good news is that research has shown that the performance of those who sleep for less than six hours at night and then power-nap during the day is as good as those who sleep for longer at night. Indeed, a post-lunch nap improves work performance into the afternoon and early evening.

The circadian rhythm is influenced by how hungry we are. Our bodies have a mechanism whereby the brain keeps us alert when we need food; a mechanism which switches off when we have satisfied our hunger. That is a second reason why the urge to nap in the afternoon is irresistible for many, and explains why we have trouble sleeping when we are hungry.

However, our body-clocks have a greater influence than just affecting our state of alertness. The author Ernest Hemingway was showing more insight than he realised when he half-jokingly said ‘I love sleep; my life has a tendency to fall apart when I’m awake’. It is estimated that the body-clock controls some 15% of the activity of our genes; which means that disruption of the body-clock can affect a long list of bodily functions apart from sleep patterns. Our metabolism is very sensitive to such alterations, with the effect that insomnia, mood changes, heart disease, cancer and disorders of the brain can result. Because the body cannot fight infection until it recognises that one exists, we are more prone to infection at times of day when our metabolism and wakefulness is at its lowest ebb. Interestingly, research has shown that patients with septicaemia (blood poisoning) are at greater risk of dying between 2 a.m. and 6 a.m. This has in turn started scientists looking at what the optimum time is for antibiotic administration in order to fight infection with greater success.

When to give medication is also a question in respect to heart disease and high blood pressure. Both of these conditions are linked to high levels of a chemical called aldosterone. The latter is affected by the circadian rhythm, which means that drugs controlling blood pressure may be best targeted at specific times. Death in the early hours is an occurrence well known to doctors and funeral directors; and for those living near natural waterways, it is noticeable that the time of demise often occurs when the tide is out. Given the various research we are commenting on, this is perhaps not such a daft observation as previously thought.

Finally, the seasons also play a part in our well-being. Once again, research has found that blood pressure is better controlled during the summer, with the rates of heart attacks and strokes being higher in winter. This may not be just because of the cold weather, as people tend to exercise less, eat more, and increase weight during the winter. Diets during the winter months also tend to be higher in salt content.

All in all, it is increasingly clear that there are forces at play which influence us in more ways than previously imagined. Our individual lifestyle is a key factor, and armed with the knowledge of such research as above, it is open to us to take measures which may have a profound effect on our well-being. As Leonardo da Vinci said, ‘a well spent day brings happy sleep’. It may also bring health and a long life.

(First published in the Scunthorpe Telegraph, Thursday, 1st March 2012)

Decisions, Decisions, Decisions...

‘An empty book is like an infant’s soul, in which anything may be written. It is capable of all things, but containeth nothing.’

So wrote Thomas Traherne in the 17th century. Sadly, a converse situation arises for many older people. We end up as a full book but, for some, the capability to do anything in a meaningful or reliable way starts to wane and mental incapacity is the result.

Whilst well, we take mental capacity for granted. Certainly as adults, we decide for ourselves what time to get up in the morning, which clothes to wear, what to eat, where to go, how to spend our money, and so on. This is called ‘capacity’. Capacity means that we can make our own decisions in our own best interests. It is something which is considered a ‘right’ and is protected in law.

By ‘mental incapacity’ we mean the inability to make our own decisions. The causes are many, although the commonest for the elderly is dementia. That said, there are also conditions which affect younger people and affect their capacity to make decisions; congenital disorders, brain damage at birth, head trauma due to accidents, brain tumours, mental illness, severe physical illness, and the effect of drug or alcohol abuse are examples.

For some people, the loss of capacity may be a temporary state of affairs; for others it is permanent. Whichever the case, the loss of capacity can have a devastating effect on our lives. During such times, we rely on those we trust to make decisions on our behalf. However, there are some decisions which even one’s next of kin cannot take without the legal authority to do so.

In 2005, a law was passed called the Mental Capacity Act. The law is intended to protect a person who lacks capacity, and thereby ensure that decisions continue to be made in that person’s best interests and in accordance with what their own wishes would be if they were still able to make decisions for themselves. Five principles underpin this law. The first is that a person is assumed to have capacity unless proven otherwise. The second is that any decisions made on a person’s behalf must be as close as possible to what that person would have wanted. The third principle is that, wherever possible, a person should be assisted in making a decision for themselves (for example, by using very simple language or a different form of communication to explain the issue). The fourth principle is that a person has the right to make unwise decisions, as long as they understand the effects of such a decision. Finally, any decision made for a person should be the least restrictive and cause the least disturbance for that person.

Capacity is tested by the application of four questions: Is the information understood? Can the information be retained long enough to make a decision? Can the information be weighed up? Can the person’s decision be communicated in some way? The answer must be ‘yes’ to all four questions to prove capacity.

If a person lacks capacity, they need someone to act on their behalf. Many people will legally appoint a person to do this. That person has ‘Lasting Power of Attorney’. However, such a person can only be appointed whilst someone still has capacity. If no such appointment has been made, the person lacking capacity is protected by the Court of Protection, which will either appoint someone to act on behalf of the affected person, or will directly make decisions on that person’s behalf. Naturally, it is better if we appoint someone we know and trust, so we should all be granting a Lasting Power of Attorney to someone whilst we still have capacity, and regardless of how old we are or whether we are currently healthy or unwell.

A helpful leaflet on capacity can be downloaded from the Royal College of Psychiatrists’ website at http://www.rcpsych.ac.uk/mentalhealthinfo/problems/mentalcapacityandthemental.aspx. Further information can also be obtained from the Alzheimer’s Society, Mencap, MIND, your solicitor and GP.

(First published in the Scunthorpe Telegraph, Thursday, 23rd February 2012)

Medical War Zone

In 2000, I retired from the Royal Army Medical Corps. However, reading through this week’s medical journals, I had the distinct impression that I should be taking my uniform out of the mothballs; for it appears that a war is even now taking place; one that I am firmly embroiled in, whether I like it or not. The battle ground is the National Health Service, and it currently has several open fronts.

The most important issue is the saga of the Health and Social Care Bill, which at the time of writing has just entered the Lords for its final stage there. As readers of this column know, I originally voiced serious concerns at the content and intention of this Bill in one of my earliest columns back in 2010. At the time, I was one of the few who dared to break ranks and speak out against the Government’s plans. Many of my immediate colleagues were muttering behind closed doors, but few would pin their colours to the public mast of disquiet and dissent. However, I thought the public had a right to know what was going on. After all, the NHS is your service as well as mine and, if there are to be major changes which will adversely affect the way health services are made available and delivered to patients, then the public has a right to understand.

However, in recent months, the map of those organisations expressing foreboding and alarm at the content of the Bill has altered considerably. Despite a continued rhetoric from the Government that the medical profession is behind the plans, there is now clear evidence that the majority of the health care professions are against the Bill. Such organisations include the British Medical Association (BMA), Royal College of Nursing (RCN), Royal College of General Practitioners (RCGP), Royal College of Midwives, Royal College of Radiologists, UK Faculty of Public Health, Academy of Medical Royal Colleges, Royal College of Physicians, Royal College of Anaesthetists, and the Royal College of Surgeons. Many are calling for the Bill to be withdrawn completely, on the grounds that it will do irreparable damage to the NHS.

Of course, there has already been damage inflicted, despite the fact that the Bill has not been enacted. Even before the Bill had gone through the first stages, the Department of Health was re-organising the local Primary Care Trusts, with widespread redundancies taking place in anticipation of the Bill being passed by Parliament. These changes cannot be reversed even if the Bill now fails, as important people have been lost to the service; people with a vast experience of running the NHS. In my opinion, that in itself deserves a judicial review. It is a gross misuse of a government’s power when it brings about widespread fundamental changes well ahead of a Bill’s debate and enactment in law. It is political arrogance beyond belief.

As a distraction to the above, there is the less well-known roll out of a service called NHS 111. At its core, this is a good idea; a national number to ring when health assistance is required at times other than in an emergency (when telephoning 999 is appropriate). However, the pilots have raised serious concerns for patient safety. In all, there have been nine serious untoward incidents across four of the seven pilots, wherein potentially life-threatening delay has occurred in patients getting assistance. The view of the medical profession is that the service should not be rolled-out until it is safe. The Department of Health is, as usual, playing deaf.

Other battle-fronts include the intended abolition of practice boundaries, thereby increasing the pressure on over-stretched GP practices that already feel under siege. Then there is the significant reduction in funding for practices, a GP recruitment crisis with unfilled vacancies, the imminent GP Revalidation process, and the need to register practices with the Care Quality Commission. That is all before we mention the subject of pension fund changes.

A recent study found that four in ten GPs have emotional exhaustion, a sense of depersonalisation, negativity, and a reduced sense of accomplishment; in effect they are burnt-out. Sadly, that finding is not a surprise, but it should raise significant public concern.

(First published in the Scunthorpe Telegraph, Thursday, 16th February 2012)

Who Do You Think You Are?

‘Are you the poet?’

It was an interesting question; especially as it was posed towards the end of an entirely unrelated conversation. Well, it was towards the end of a medical consultation to be precise. I admit that it took me a little by surprise; not least because this heretofore unknown patient somehow knew that I write poetry. However, being something of a pedant, the question immediately raised further questions, particularly in respect to how I answered my inquisitor.

For example, the obvious difficulty for me was my patient’s use of the definite article. By using the word ‘the’, the implication was that there existed only one poet, which clearly wasn’t true if the question is taken in the context of the wider world of writing. However, to my knowledge, none of my medical colleagues in the surgery writes poetry, so the answer could be in the affirmative if that was the intended focus of the question.

The second conundrum was based on the concept of when is a person one thing as compared to another? For example, I think of myself as a doctor regardless of whether I am seeing patients or not. But am I a writer when I am not writing; or a poet when I am not physically writing poetry? Furthermore, can I be a doctor, a writer and a poet all at the same time? In our society, we tend to define ourselves and others by the person’s employment. So, for example, once a baker retires, he becomes ‘retired’; he is no longer a ‘baker’, and very rarely a ‘retired baker’. The fact that he is no longer baking tends (rightly or wrongly) to render the skill redundant when it comes to describing the person. So you can now see how such a small question can inadvertently lead me into a minefield of indecision in respect to giving a truthful answer.

Another question which now stumps me is ‘Where are you from?’ Until a few months ago, I would assume that the question was an enquiry into where I started life, in which case I would instantly reply that I am a Kentish Man. However, thanks to a research unit based in Cambridge University, I now have difficulty in answering even that seemingly innocuous question.

It is all Dr Peter Foster’s fault. He is the director of a research programme called Roots for Real (www.rootsforreal.com), which analyses a person’s mitochondrial DNA (mtDNA) and Y-chromosomal patterns and correlates the findings to a database linking modern-day man to the earliest of humans stepping out of Africa and, more specifically when, on their subsequent journey, their DNA mutated to its present-day form. The science is complex but fascinating, and I will leave you to read more on the website should you so wish. However, the upshot is that my Y-chromosomes (inherited through my father) originated 10,000 years ago from an area now known as northern Italy, at about the time of the last ice-age. As for my mtDNA (inherited through my mother’s maternal line), that is firmly centred on Crete and dates back some 40,000 years ago (yes, one of my great great etc. grandmothers knew Neanderthal Man). Furthermore, the same mtDNA has been identified in the remains purported to be those of the disciple, St Luke; thus making him a distant relative. St Luke, of course, was also a physician. So, when someone asks why I became a doctor, at least I can now honestly say that it is ‘in my genes’. However, it brings a whole new meaning to the question ‘who do you think you are?’ To answer honestly, I now need to know whether to take my reference from 52 years, 10,000 years or 40,000 years ago; for I now seem to be a Kentish Greco-Italian of an indeterminate age.

As for the original question, ‘are you the poet?’ I admit that I took the easy route. After a moment’s deliberation, I smiled and simply said ‘yes’.

(First published in the Scunthorpe Telegraph, Thursday, 9th February 2012)

Revisiting the Expert Patient

‘Generally, society deals with death in a near hysterical manner, viewing practically every death as a tragedy and bereavement as an illness requiring healing.’

Such is the view of Blair Robertson, an NHS chaplain (BMJ, 14 Jan 12). His words were interesting to read as, in the same week, I had taken the topic of dying as the subject for this column. Society’s response to death is hardly surprising when we read of the remarkable lives of people such as Professor Stephen Hawking, the famous cosmologist, and author of the best-seller, A Brief History of Time. Only one week previously an article appeared in the national press informing the world that Prof Hawking was too unwell to deliver his 70th birthday speech (Telegraph, 9th Jan 12). Of course, Prof Hawking is always too unwell to deliver any speech, owing to a condition called motor neurone disease. In reality, any speech he has is electronically composed letter by letter, and then delivered by him using his cheek muscles to operate a voice synthesiser.

Prof Hawking is a wonderful example of how people with long term conditions can still lead remarkable lives. The fact that he has even seen his 70th birthday is a modern-day miracle. Although we tend to use the verb ‘to suffer’ in order to describe the process of living with a chronic condition, Prof Hawking is an example of how people can lead fulfilling and enjoyable lives despite their condition. I am sure that suffering does come into the equation, but so too does a life of satisfaction and pleasure. The trick is to know how to turn around the perception of unavoidable misfortune and pull from life a positive outlook and a sense of well-being.

Last year, I wrote about a new course available in North Lincolnshire. At the time, NHS North Lincolnshire was looking for ‘Expert Patients’; volunteers to train to deliver the course known as the Expert Patient Programme. Now, having seen the satisfactory completion of the first course, patients wishing to participate in future courses are being asked to put their names forward. Delivered during one afternoon per week over a six week period, the course is aimed at people living with long-term conditions. Note that I use the term ‘living with’ rather than ‘suffering from’, for that is indeed what this course is aimed at bringing about. It teaches the skills of self-management and action planning, how to deal with pain and extreme tiredness, how to coping with feelings of depression, the skill of relaxation and how best to exercise, tips on healthy eating, the need for communication with family, friends and health professionals, and last but no means least, how to positively plan for the future.

Writing in the Times Literary Supplement in September last year, the writer and poet Hugo Williams described his reaction to his need for dialysis to treat his kidney failure. Given the choice of dialysing on a daily basis at home or visiting the hospital four days a week, Williams chose the latter on the grounds that it would offer him the chance to ‘pretend to be still in the old free world’. That was his way of trying to ‘live with’ his condition rather than allowing it to take over his entire life. I have no doubt that both Williams and Prof Hawking would fully approve of the Expert Patient Programme.

Christopher Hitchens is another writer who I am sure would have given his seal of approval to the course. Sadly, he died last December. However, true to his inimitable self, and in spite of various tubes and other paraphernalia attached to him, he insisted on being propped at his desk during his final days and finished writing an article just hours before his own ultimate deadline. Hitchens amply demonstrated Prof Hawking’s exhortation: ‘Remember to look up at the stars and not down at your feet. However difficult life may seem, there is always something you can do and succeed at; it matters that you just don’t give up.’

(First published in the Scunthorpe Telegraph, Thursday, 2nd February 2012)

Doctor on Patrol

As a doctor, one of the delights of living within a rural area is the strong sense of being part of that community. A large number of the local inhabitants know the doctor, and the doctor usually has a fairly good idea as to who you are, as well as often knowing your parents, children, cousins, aunts and so. A stroll up the High Street becomes punctuated by nods, smiles of acknowledgement, fleeting conversations and other casual greetings. A ‘big fish in a small pond’ perhaps, but in a world where we live in an increasingly large ‘global village’ it can be an enjoyable sense of belonging.

However, there is a downside to the local pseudo-celebrity status afforded the country doctor. If one is not careful, walking to a meeting with the local solicitor at his office becomes an al fresco surgery; a quick trip to the supermarket can turn the aisles into a gauntlet of patients ceasing the moment to quiz the doctor about their latest symptoms or acquaint him with the outcome of their hospital appointments; an evening with one’s wife at a restaurant can even be interrupted by enquiries about blood test results from diners or waiters who also happen to be patients. One memorable day, whilst standing in the queue at a bank, the chap in front started to inform me of the lump he had recently detected in his nether regions. His hands were quite graphic in illustrating the size and whereabouts of the problem; a display which attracted curious and amused attention from others in the bank. His opportunism was brought to an abrupt halt when I politely suggested that he could either drop his trousers and I would take a look there and then, or alternatively he could make an appointment to see me in the surgery.

However, all of this is about to change if the Department of Health gets its latest wish granted. The NHS Future Forum, a sort of health ‘think-tank’ for the government, has made the recommendation that all healthcare professionals should ‘make every contact count’ to promote health. According to the forum, doctors should miss no opportunity to quiz their patients about their lifestyle, advise them on their diets, and counsel them to reduce alcohol consumption, stop smoking, reduce weight and take more exercise; as if we haven’t already been doing that for years.

Nonetheless, according to the government, it should be the role of doctors to ‘make use of contact with patients wherever appropriate’. So, the table may be about to turn folks. If trying to consult your doctor in a public place is acceptable to you, no doubt you will not mind if we wave an admonishing finger as you enter the wines and spirit aisle, have a quick review of the contents of your trolley at the checkout, or make ‘tut tut’ noises when you order a particularly creamy, sugar laden pudding on your evening out for dinner. Perhaps larger medical practices could start local ‘community doctor patrols’, making the round of fish and chip shops and other takeaway outlets at lunchtimes. One can see the scenario now: ‘No, Mrs Smith, with your obesity, uncontrolled diabetes and high cholesterol you really shouldn’t be ordering that large portion of chips. Put it back and let me introduce you to the salad bar down the road.’ Like young boys in danger of being caught scrumping by the village policeman years ago, patients will start placing lookouts at the door of the cake shop, and furtive shouts of ‘Psst! Watch out, the doctor’s about!’ could become commonplace.

Alternatively, we could all agree to act reasonably and live in respectful and tolerant harmony with each other. As a doctor, I will keep my comments regarding your less healthy habits to the confines and privacy of my consulting room if, when we meet in the street, the shops, a restaurant or the bank, you promise to talk to me about anything other than the state of your arthritic knees, the quality of your phlegm and the difficulty with your bowels. Paraphrasing Ecclesiastes (chp.3), there is a time and place for everything, despite what the government says.

(First published in the Scunthorpe Telegraph, Thursday, 26th January 2012)