July; a run in the park.

The shining meadow pulses to    

the fragrant hum of limes,

the sheeps’ tickle of seed heads,

the tangles of yellow trefoil,

while playful martins trace patterns

of spotlight under the oaks.

 

High on the breathless hill,

sunlit harebells flower in the grass

by the glowing rocks and   

toasted bracken that smells of wood.

The yellow bird chinks its coins and

orders bread without any cheese.

 

And where nettles crowd the stinging path,

toadflax clings and brambles tear,

the hogweed casts its giant shade,

and foxgloves lay out landing lights

by minarets of willowherb, spreading

cranesbill, vetch and happy ox-eye daisy.

 

But returning through the wooded shades,

rank with mould and thick with canine mercury,

the leafy bird asks the same question.

‘But why, but why, but why?’

 I frown, look again to the dark. 

‘I wish I knew, I knew, I knew.’

 

The sparrows chatter on under the eaves.

 

Show! Don’t tell! An appraisal of The Reader.

 

Show! Don’t tell!  Let the reader decide why the characters behave as they do.  Keep them guessing. It’s what can turn a good book into a great one.  But, to be honest, I didn’t think The Reader was a great book when I first read it about three months ago.  The plot, I thought, was barely credible and the characters far too sketchy.  That was before I saw the film.

You’ll know the story.  It is 1958 in Berlin. Michael, just 15, meets Hannah in the porch of her apartment.  It is raining, he is ill.  She is kind to him.  When he recovers some weeks later, he returns to thank her.  They have an affair.  Hannah, much older,  is in control; she demands he read to her, then they make love, but their trysts end abruptly when she leaves suddenly without telling him.   

Michael next encounters Hannah when he is a law student attending the war trials. He is shocked to recognize her as one of the prisoners.  She was in the SS and was responsible with 7 other officers for transporting 300 Jewish prisoners. There was an air raid, the church in which their captives were locked, burnt down and all except one of them died.  The guards could have opened the church doors but they didn’t.  The other women accuse Hannah as the ringleader.  They say that it was her who wrote the false report of the incident.  To validate their claims, Hannah is asked by the presiding judge to provide a sample of her handwriting.  Instead, she admits she wrote the report and is sentenced to life imprisonment. 

But Michael guesses the truth.  He realizes that Hannah is illiterate.  That’s why she was so keen he read to her.  She couldn’t have written the report.  He could have saved her. 

Some twenty years later, after his marriage has failed and he is living alone, Michael again reads to Hannah via a Dictaphone and sends the tapes to the prison.  Hannah devours them eagerly and uses them to teach herself to read.  It is her purpose and a kind of redemption.  She has no family.  When her time for release comes up, Michael is contacted to take care of arrangements for her, but he is reluctant.  The night before he is due to pick her up, she hangs herself.   

Stripped down to its essentials, this is a raw disturbing story.  The plot is roughly sketched in broad brush strokes. The film, directed by Anthony Minghella, captures it brilliantly.  Kate Winslet conveys the nuances of Hannah’s defensive secrecy to perfection. David Kross, who plays the young Michael, convinces as the callow youth ridden by guilt.  The love scenes are tentative and caring without being salacious.  But the greatness of this film and indeed the book resides in how it raises questions, days, weeks after the credits have wound down.    

What was Hannah’s background?  Where was she from? She had no family. What had happened to her parents?  Why was she illiterate?  Did she have no education?  We suspect a deeply disturbed background, perhaps abuse. 

And why did she join the SS as a guard?  Was she afraid her illiteracy would be discovered.  Was it this fear of exposure that caused her to run away from Michael. She had just been promoted from being a conductor on the trams to work in the office. Her shame would be discovered.   

And why was her illiteracy such a deep source of shame that she would rather die than admit it.  Did it represent another shame?  Or was it more a fear that if she exposed her illiteracy, her vulnerability could be exploited? 

Hannah is an enigma. Her secrecy is her protection and power. Those who are so fearful of being exploited themselves, tend to exploit other people.  Hannah undoubtedly exploited the innocence of Michael for both sexual and intellectual gratification. She  devastated his life.  He could not love again.  But darker still, there were hints from the trial that she would target the weaker of her captives, get them to read to her, perhaps gratify her lust and then select them for the gas chambers. 

But could she have done that?  We are sympathetic to Hannah. We see her through Michael’s eyes, a kind woman caught up in an awful situation. She is the victim of a miscarriage of justice. 

We all need to know that the one we love is good and will care for us. We cling to the romance of it all, the make believe.  The reality can be impossible to bear.  So why didn’t Michael rescue her?  Why did he say nothing?  Did the trial strip away the illusion,  expose Hannah as a human being who could perform the most evil deeds if the risk of not doing so demanded it.  Michael had glimpsed her dark side. Did he fear her liberty?  Or was it the shame of exposure that he feared?  How could he admit that he had consorted, not only with a much older woman, but he had loved a war criminal and mass murderer?    

The only way Michael could reconcile his obsessive and enduring love for Hannah with the awful truth was to conduct their relationship at a distance by reading to her and sending her the tapes.  She was safe in prison. He could express his love with no risk to himself.  But then, the stark reality of her release fractured the cover. He had to look after her. His ambivalence was obvious. How could Hannah commit herself to a dependant relationship with anybody, let alone a man who could no longer care for her unequivocally. It was impossible. How could she manage outside prison. She had to kill herself.        

    

The Reader was released late last year.  Kate Winslet was successfully nominated for Best Actress at the Oscars.  

 

Sixty-four.

 

Arriving at the watershed

between regret and despair.

when fate replaces hope and

is companioned by fear,

the mind fixes on  a

 moment of being,  

of  belonging; 

not to compete,

more to repair;

  less an excursion as  

a better …. way

…. home.    

 

A Bridge too Far

 

Psychotherapy is a strange world.  It claims to help people resolve conflict and change, yet the whole profession is deeply split.  The psychoanalysts, humanists and behaviourists are all convinced their approach is only true one, but when it all boils down, there is more to connect different therapies than to separate them.  While claiming allegiance to a particular modality, most therapists develop their technique and attitude from an eclectic theoretical background and would, I think, agree that the success of therapy does not so much depend on the modality as on the quality of the therapeutic relationship and depth of communication. 

Nevertheless, attempts to bring the different therapeutic disciplines together has been beset with difficulties, so much so that the United Kingdom Council for Psychotherapy has relinquished the effort and claims instead to supports diversity, whatever that means.  Clearly integration is seen as a bridge too far. 

Separation cuts deep into the human society.  It exposes enormous ambivalence.  While we desire to belong, at the same time we wish to also be separate, independent, autonomous.  Donald Winnicott captured the resolution of that dilemma, when he said that the aim of our psychological development is have ‘the confidence to be ourselves in the company of others’.  But the company of others implies belonging to certain professional groups, societies or teams that encompass a particular set of interests or attitudes. 

That immediately introduces a split. If we belong to a certain group, we don’t belong to other groups.  While Pi, in Yann Martel’s wonderful allegory, The Life of Pi, might practice as a Christian, a Moslem and a Hindu, he causes consternation among all three sects.  He must choose; he can’t be all three.  The same seems to apply to the psychotherapies.  Psychoanalysts tend to dismiss cognitive behavioural therapy with ill concealed disdain, yet they would agree that the goal of psychoanalysis is for an understanding that brings about a change in thought and behaviour. 

Even the most inclusive societies seem to demand we make a choice.  This starts early in life.  At the age of 14, I had to decide whether I was going to study arts or sciences.  Later I decided to be a doctor, which meant not dedicating myself to my first love, zoology and ecology.  Then I chose gastroenterology and not neurology.  More devastating in its consequences, although I discovered it was possible to love more than one woman, I had to choose one and abandon the other.  To fudge, to be indecisive or deceptive challenges the social order, even though it might make perfect psychobiological sense. 

So perhaps separation is part of our encultured identity.  Society demands difference, encourages diversity.  There must be something about agreement, sameness that does not lead to progress.  Society is like a shark; if it doesn’t keep moving forward, it dies!  Difference and the anxiety and competition this induces, keeps society alive.  If The Government were not continually being challenged by the opposition, then there would be no recovery.  The only time coalitions thrive is when there is an overwhelming external threat.   

So each of us embodies a certain set of beliefs and attitudes that make us who we are and sets us apart from others.  That is socially acceptable as long as understanding and tolerance exists between groups.  It’s when different groups feel attacked for their beliefs and are forced to adopt adversarial positions and ever more extreme attitudes,  that difficulties ensue. 

Unfortunately psychotherapy, which purports to be the most understanding of professions, is riddled with sectarianism to the detriment of therapists as well as their clients. 

We need to built bridges, not broad bridges that reduce everything to its lowest common denominator, but bridges with a café in the centre of them that facilitate communication and understanding.      

At the last meeting of The Hallam Institute of Psychotherapy on July 1st, Keith Tudor, a Humanistic Psychotherapist and co- founder of  Temenos, a Sheffield group promoting Person Centred Therapy, delivered a seminar entitled Building Bridges over Troubled Waters;  regarding humanistic and psychodynamic psychotherapies. 

 

Are accidents ever accidental?

A few years ago, while staying in London,  I was coming down the stairs carrying an open suitcase,  but there were more steps than there were at home, I couldn’t see where I was putting my feet and I was preoccupied with anxieties about being away from home.  Three steps above the bottom of the staircase, I stepped out – into nothing – and landed heavily on my left leg, rupturing my quadriceps tendon and rendering me disabled for three months.     

It was an unfortunate accident, but how accidental was it?  On reflection, I realised there  was a trail of causation. 

Accidents are often caused by mistakes, lapses in concentration or errors in perception resulting in behaviour that is clumsy or inappropriate.  Our expectations of what might happen are not only determined by what we really see or hear, but by habit – what usually happens.  Most of what happens in our lives is familiar, we go through it on auto-pilot.  We see what we expect to see, hear what we expect to hear, as long as things proceed on cue, we don’t think about what we’re doing; we just do it. 

Our thoughts and actions are so conditioned by experience that for the most part, we don’t have to pay much attention.  Training and experience have set up circuits that cause us to react automatically to a whole variety of familiar circumstances.  To take a current example, Roger Federer is a tennis playing automaton for much of his game.  Hard wired into his brain is an extensive repertoire of responses to every possible nuance of court conditions, ball trajectory, his opponents method of play, the state of the game, the weather;  he reacts without thinking and can produce the perfect cross court volley in the right situation.  He functions in the moment; things only go wrong if he regrets the last shot and worries about the next.  But for most of us, life is not a tennis match, everyday life always throws up the unexpected and unless we are alert and paying attention and able to adapt our responses, we can all too easily assume the expected and cause an ‘accident’. 

Our focus is more likely to be distracted if we are tired, upset and preoccupied about something else.  If our mind is not on the job, we ignore the cues, we expect something to be there but it isn’t.  So if we are in charge of a dangerous machine, operating equipment at work or driving a car, or even just walking down the stairs, we are more likely to make a mistake and have an accident.  My mind was so distracted by domestic worries, I was not focussed on being ‘in London’ and so my legs behaved as if I was coming down the stairs at home. 

Accidents do not always occur because of lapses or distractions.  Emotion can play its part. Desire is not only a potent cause of distraction but can make us take the most enormous risks.  Fury has to be satisfied no matter the consequences.  Guilt or shame can induce a wish for punishment or even injury and death, that is often expressed in the most foolhardy and dangerous behaviour. 

Just as we all possess an instinct for self preservation, so there is a much darker side, an urge to self destruction.  Among the various manifestations of this death wish are overindulgence in alcohol or drug abuse.  Many people use drugs or alcohol to achieve a state of oblivion, so releasing them from the normal inhibitions and calculations over risk.  I used to belong to the Night Climbers of Cambridge.  After a heavy night in the pub, my friends and I would go out and, completely unprotected by ropes or pegs, climb up the walls of the colleges, clamber over roofs and leap from one building to another.  What was that about; a confirmation of the immortality of youth, an urge for self destruction, or a desperate attempt to attract a pretty girl? 

Accidents often have a trajectory, a trail of consequences, stemming from a single  decision made for the wrong reasons and leading in some cases to injury or death.  So when a  woman accepts the invitation of her boss to dinner, drinks too much, has sex with him and then has to drive fifty miles back home in the middle of the night, all the components, tiredness, preoccupation, fear, guilt, self disgust and being in charge of a lethal machine, are assembled for a major accident.        

Accidents also have a purpose.  If you are injured, then you don’t need to do something you don’t want to, to take an exam, have an awkward meeting, take a difficult decision or own up.  The accident does the job for you, extricates you from an impossible situation, and at the same time, recruits the love and care your spouse, family and friends.   

For me, my accident allowed me time out from external distractions while providing the time and space to relax, rest, feel the confidence of being cared for at home and finish my book.  In time my tendon mended and so, for a while, did the connections with my family.

 

A Pledge of Owls

Where the reeds meet the meadow,

By the longer shades of day,

Pale as scalded milk, you ghost by  

weave arabesques in still air,  

your faint heart scans for signs of life   

the fluorescent tag of fear. 

Then you twist on folded wings,

turn on a tussock, drop, reach,    

close and fly  away to the barn

to devour, digest and spit out the bones.

 

And where the bracken is defended

by walls of stone, above the first blush of heather,

and the late surrender of the cotton grass,

as rustic as oat meal, you patrol your expanses,

conceal your intent with patches of white,

keep to dead ground,  row swift then glide

with certainty through a rising dawn,

your face impassive as a clock, as,

driven by instinct  born of empty hunger,

you hover, pounce and feast in the sedge.

 

Peer review or publicity; how to deal with a problem like Ida.

Ida was no more than two feet in length, she had a cat-like face, a long tail and judging from the shape of her ankle, walked upright.   Cladistic analysis might have suggested she was probably related to lemurs, but she was heralded as a missing link between other mammals to primates.   

The issue raised by Dr Martin Whyte’s paper, entitled ‘Ida; new light on Palaentology,’ was not so much about the validity of these claims as by how scientific discovery should be publicized. 

Ida was extracted from the Messl Lakes, fossil rich deposits of brown coal in Germany, and sold to a collector, who kept her in his private collection before selling her on to the Museum of Oslo for a very large sum of money.  To recoup their investment, the museum engaged a team of scientists to investigate her.  They published their ‘findings’ in an on-line journal at the same time as the film and the book were released.    

The publicity of findings in other sciences;  physics, medicine and zoology, for example, depends on peer review and publication in reputable scientific journals. Some scientists and indeed some journals may wish to issue a press release on discoveries they think are particularly important, but for the most part, whether a finding is publicized is a matter of luck.  Somehow, publicity is seen as pandering to commercialism.  Science, like religion, is above all of that . 

Palaentology is different. The commercial opportunities are too great.  Fossils all too often find their way into the hands of illegal entrepreneurs who will prepare the specimens for collectors, who purchase them for large sums of money and may then, like the Oslo Museum, seek to recoup the scientific capital of the discovery.  With so much money involved, there is too much temptation for fraudulent claims, like the Piltdown hoax of the thirties. 

But publicity occurs in other branches of science too.  How pervasive would the philosophy of Sigmund Freud had been without the efforts of his publicist, Dr Ernest Jones?  And would we have been celebrating the bicentenary of Darwin’s birth this year were it not for his champion, Dr Thomas Huxley?  All great discoveries need to be discovered by somebody who can get them into the public arena.  Some scientists are also great self publicists.  Among contemporary examples are Baroness Susan Greenfield, Lord Winston and Richard Dawkins.  Never discount the role of PR and commerce in science, even though many scientists regard self publicists with envy and disdain and put their faith in peer review.

But peer review is not a council of truth.  Think of Dr Andrew Wakefield’s proposal of a link between MMR vaccine and autism.  The data was seriously flawed but The Lancet still published it. 

And peer review can be quite corrupt.  Journals often ask authors to suggest their reviewers and, of course, they volunteer their friends, who reciprocate the favour.  You scratch my back and I’ll scratch yours.  There are often just a few people around the world working on a given research topic.  They have a self interest to ensure that their work is kept in the public eye and continues to raise funds.  Scientists often come of unspoken agreement to support each other.  Any interloper whose work threatens to undermine this cosy arrangement, is likely to see their papers rejected for publication.  Drug companies recruit teams of ‘independent’ opinion leaders to investigate their products.  The results are nearly always presented in the best light for the company and supported through the peer review system by other scientists working on the same drug.  Nobody is keen to bite the hand that feeds them grants, sponsors their journals,  underwrites their academic positions and arranges and pays for their attendance at key conferences.  Having been invited on the international merry go round, scientists would do almost anything not to fall off it. 

A few years ago, an eminent colleague of mine, Professor Juan Malagelada from Barcelona, proposed that given the exponential expansion of papers, everything should be published on the internet.  Peer review by friends and other ‘interested’ groups, would be abolished and replaced by a much more open public review, similar to the reviews and critiques of new artistic works.  In this way, he concluded, only the genuine and valuable would be quoted and rise to the surface – a kind of populist peer review.  This system is would have its abuses, of course, the publicists would continue to push their own finds.  Money would change hands as scientists would try to ensure their work gets maximum exposure.      

So maybe it’s Palaentology that’s the missing link, sitting awkwardly between arts and sciences.  As a science, Palaentology is underfunded; it needs museums and private investors to fund the field work and the high tech scientific analysis.  New findings need hyperbole to excite interest in the area.  In that regard, the subject is not unlike art critique. Indeed, many fossils are very beautiful. If Van Gogh had had to rely on peer review, his work would never had been discovered.  He needed the support of his brother and friends to bring his paintings to public attention.  In a similar way, The Museum of Oslo had to hype up Ida to get visitors though its doors and encourage other museums to spend large sums of money to loan the specimen.  Peer review is too cautious and unlikely to excite public interest.  On the other hand, the more the hype, the greater the risk of exposure.  Public appraisal can turn on a sixpence!          

 

The problem of Ida was the topic of a talk given by Dr Martin Whyte of Sheffield University at the Chapel Allerton Cafe Scientifique on June 22nd. 

 

Death, desire and despair at the Odioun; the pholly of Phedre.

She had desired Hippolytus since the day she married his father, Theseus.  Proud,  aloof, disdainful of women; he had all the strength of the father but none of his sire’s weakness for sexual temptation, or so it seemed. He was a real challenge.  She had to possess him, but Hippolytus was also her stepson;  Theseus, a fierce and vengeful man, would kill both of them.  Phedre had to protect herself.. So she denied her love, even to herself, she avoided her stepson, she criticized him, complained about him, even had him exiled.   She had to expunge the temptation of prohibited desires.  

But then Theseus went on another adventure and placed his court, including his wife, his children, even Aricia, the captured daughter of Erechteus, the previous King, under Hippolytus’ protection in Trozion.  Phedre could no longer escape her destiny.  She encountered Hippolytus ever day and the thought of him propelled her into a torment of lust and guilt.  She hid herself away from the all revealing God of the sun, she became ill, tried to take her own live; anything to get Hippolytus out of her mind. 

Then news from Athens announced that Theseus was dead.  Phedre is free to express her desires, claim her prize.  But Hippolytus recoils; he is already in love with Aricia, and  just as Phedre has revealed the full extent of her lust, cheering from the port brings the news that Theseus hadn’t died after all, but had escaped the underworld with the help of the Gods.   

Terrified of Theseus wrath, Phedre allows her husband to believe that Hippolytus raped her.  Theseus is furious; he evokes the assistance of Neptune to destroy his son.

Neptune does his bidding.  Hippolytus is attacked by a sea monster on the beach as he races to marry Aricia.  His chariot is destroyed and he is dragged and trampled by his own horses.  Aricia drags the sack containing the bloodied corpse into Theseus’ presence, who is stricken by grief.  Phedre appears, having swallowed a lethal dose of poison.  She admits Hippolytus’ innocence and dies.    

It’s another night of entertainment and adventure at the Odeon.  Life in a giant tub of popcorn!

Falling in love is the most dangerous thing any of us can ever do.  The power of lust evokes the threat of annihilation through exposure, exploitation and abandonment.  As the desire rises so does the fear.  Fearful lovers protect themselves from their appalling risks of their own vulnerability in many ways; denial, infidelity, disregard, rejection and by evoking jealousy, being too busy, playing hard to get.  These are the games insecure lovers play.  Phedre just took it to lethal proportions.  Terrified of her husband’s rage, she was prepared to sacrifice her lover and his son. 

Great passion is a game of life and death. The Gods understood it and were not averse to a little interference.  Hormone, the term for a mediator of emotional response, comes from a Greek word meaning messenger from the Gods.

 

Phedre, starring Helen Mirren and Dominic Cooper,  is currently playing at the National Theatre, but on June 25^th it went global and was beamed by satellite from the South Bank to cinemas around the country and across the world.

 

It only hurts when I laugh; living with an injured back.

When I was a physiologist,  I used to ponder the cause of the sensations I felt in my body, the reactions of my gut, what is was about feeling sick that made me yawn or sweat, why a headache made he muscles on the back of my neck sore.  I even thought of writing a book of such observations, but like so many of my grand ideas, it ran into the sand trap of time and was forgotten. 

Now the pain protecting the healing bones in my back offers a whole new insight on life.  What I originally took for granted, didn’t think about, is suddenly, painfully brought to mind.  I have to be careful how I walk.  Keep the back straight, let the feet do the work, keep the head up, swing the arms for momentum but not too vigorously.  It’s amazing how much we use the trunk, the back, to add fluidity to our walking; the constant balances and adjustments that occur at every step.  All of these are now forbidden.  The back has to be locked rigid, the damage protected in a rigid case.

Lead off up the stairs with the left food not the right.  Any sudden movement with the right foot, brings on a spasm of pain that makes me cry out.  Use both arms to support when sitting up.  Don’t bend the back; reach down for things by using the knees.  Keep the back straight at all times. 

 Breathe deeply and evenly and try not to cough. Coughing is so painful. The sharp contraction of diaphragm and intercostals jerks the wound, dislodging the broken ends of bone and creates an anguish of spasm.  A chest infection is the most dreaded complication of broken ribs.  Secretions collect in bruised tissues and can easily become infected.  The cells lining the bronchioles and bronchi have a carpet of cilia, tiny hairs that beat in waves wafting the secretions upwards.  But this ciliary escalator can only get secretions as far as the trachea, if that.  There they collect, tickle and have to be coughed up.  Try to suppress the cough reflex, grunt to move the collection and move the phlegm into the pharynx, from where it can be swallowed. 

 Just as you use the knees to reach down, let your colon do most of the work in defaecation.  Learn to relax and take your time.  Think, evacuation – a bit of self hypnosis.  Imagine your gut like the M1 with the traffic flowing evenly smoothly.  Breathe deeply, allow your colon to ease, squeeze the plug of waste down until it is in the firing position.  Allow the sensation to build until, almost like orgasm, it demands release.  And then just a small graded increase in abdominal pressure will hopefully expel it all in one shot. 

Sorry to go on about it so much, but if you’ve hurt your back, constipation can become a real torture.  Take plenty of fibre, fruit, drink syrup of figs or prune juice, take a dose of lactulose every night, add a senna – do what it necessary to keep the contents of your colon soft, but not too much that they are liquid and urgent – you don’t want to be caught short.  Remember you can’t hurry, even if your bowel wants to.  Adjust the dose so your faeces are soft and pliable, then you can relax and let peristalsis do most of the work.  So, take your time. Remember, laxative and relaxation have the same derivation.  The ancients knew it.  So should we! 

But there is one thing you cannot always prevent.  It sneaks up on you when you are relaxed, catching you off guard, tearing into your back and causing the most intense spasms of pain.  That is emotion!  Not any emotion, but the sudden surges of anger and laughter. 

Emotion takes over the control we exert on our lives.  It demands expression, satisfaction.  Grievance, loss, depression can make it impossible to think of anything else.  The chemicals inundate the brain, controlling our thoughts and movements, distracting, preoccupying,  obsessing with the same insistent thoughts. There can be no escape.  

The same happens with acute spasms of emotion, though such flash floods of chemicals can catch you unawares.  An attack of frustration while climbing the stairs can cause you to forget, lead off on the wrong foot, unlock your back and leave you hanging on, wracked  with the most intense pain.

And laughter, the repetitive contractions of intercostals and the inescapable build up of tension as you try to stop laughing, is murder. You can die laughing or it seems so.  The ridiculous can stab you in the back.  Avoid it at all cost.  Turn your face and your back to stone – for the time being anyway.

 

The dangers of going to bed

                                                                                                                                                                                                                                                                                       It had been a long night.  Although my hospital bed allowed me to adjust my position,  the slightest movement of my back was agony, and I could not get comfortable.    The plastic mattress was damp with sweat and my pyjama top was rucked up my back and impossible to adjust.  I was terrified of coughing and avoided drinking so I didn’t have to go to the loo.  Sleep was impossible.  Kyle, opposite babbled incessantly in his sleep and Arthur’s laxatives worked their poison noisily on him throughout the hours of darkness.  My sole consolation was the morphine; the spreading warmth of the injection, the distancing of pain, near oblivion with just a residue of hope.  I think I would go into hospital just for the morphine. 

The next day started well enough.  I sat out in the chair for breakfast, but when Beckie, the staff nurse - she of the sidelong glance and provocative eyes, asked me if I wanted to have a shower,  I could have kissed her.  Getting to the shower was painful but not impossible, but the luxury of hot water was nothing short of bliss.  I ripped all the ECG tabs off and soaped myself all over.  I even managed a bit of a bowel action and I collected the urine sample, Beckie, wanted – though it more resembled a glass of pink grapefruit.   

It was the sample that did it.  Haematuria ++++!  Bugger!  Beckie was back in a few minutes, eyes raised, smiling.  ‘The doctors want you to have a scan of your abdomen and’ she added with a note of triumph,  ‘you’re to be on strict bed rest’ 

The scan showed I had fractures of 3 lower right ribs, fractures of the transverse processes of some of the vertebrae and collections of blood above the liver and around the kidney.  I must have had quite a biff.  It’s probably a mercy I have no recollection of the event.

The edict was reinforced.  I felt like a man who had been let out of prison only to be recaptured a few hours later.  I had already been walking about.  I was moving, feeling better with each step, my urine was crystal clear like a mountain spring.  This restriction seemed very negative. 

I rebelled.  I sneaked to the loo when Becky wasn’t looking, but she always caught me.  But in the end, I gave in.  I was a doctor.  If I couldn’t obey the rules in hospital, then who could?  But I didn’t agree with the rules.  Nobody had discussed them.  But I didn’t want to get Beckie into trouble, so I submitted – for a bit!    

Bed is the most dangerous place if you don’t need to be there, particularly a hospital bed.  The body needs to be active to recover.  Lying in bed does not encourage your to breathe deeply.  Secretions can collect and stagnate at the bases of the lungs.  Stagnation encourages infection and hospitals are breeding grounds for the strangest and most resistant of infections.  Coughing is often painful and non-productive.  The worse complication of being in hospital is a chest infection. 

The second is probably a urine infection. It is difficult to pass urine while lying in bed. People don’t drink enough and hold on.  Stagnation of urine can allow it to become infected, especially in women who are especially to infection rising from the perineum through a short urethra.

Another torment of bed rest is constipation.  Using a bed pan to pass faeces is an acrobatic feat.  Sore muscles and ribs make it impossible to strain.  The result: your waste just sits there, producing noxious gases,  irritating the rectum with its presence, eating into your mind.  There are few ailments as depressing and frustrating as constipation. 

If bed rest is prolonged for more than a few days, it is accompanied by other perils, such as muscle wasting, loss of bone, impairment of appetite and depression.

When bones are fractured, the inflammation and the spasm in surrounding muscles act as a natural splint.  Broken limb bones can be protected in plaster or pinned or plated, but fractured ribs and vertebral processes must be allowed to heal up by themselves, surrounded by their splint of inflammation and muscle spasm. Muscles that are not used, waste with great rapidity and no longer protect damaged bones. 

Bones become weak and brittle if not used, leaching calcium which can deposit in the kidneys as stones. 

The appetite suffers when we are not active.  Hospital food often doesn’t help.  This combines with other losses,  of mobility, the companionship of friends and family to cause depression, debility and the a decline in the essential will to recover.   

Bed rest is essential if you have an infection or a heart attack or a flare up of colitis or rheumatoid arthritis, you just don’t feel like doing anything else.  The effect of the infection and tissue damage gives you no energy and no choice.  But if you have had none of these things, then enforced bed rest is one of the greatest perils of being in hospital.  So if your body tells you it’s ok and there is no obvious risk of movement, get up as soon as you can, keep moving, exercise, stretch.  Listen to your body.  Believe me; it will save your life.

I am slightly, but only slightly, ashamed to admit that I ignored the edict and as soon as seemed polite and feasible (that same evening!) took my own discharge.  They do say that doctors make the worst patients in that they won’t always do as they’re told, but I sometimes think that their insight gives them the opportunity to get better more quickly.  

It is just six days after the accident and I just have completed an inspirational old man’s shuffle down Dove Dale and back.  I feel tired, sore, but healing up.