June 2009


Ida1,property=Galeriebild__gross (Large)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. 

Phedre_main (Large)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 25th it went global and was beamed by satellite from the South Bank to cinemas around the country and across the world.

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.

                                                                                                                                                                                                                                                                                       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.

IMG_0002 (Large)Arcadia is perhaps Tom Stoppard’s best play.  Its eclectic blend of literary history and science bubbles and fizzes with ideas and wit.  Stoppard not only explores the shifting mindscapes between between science and literature, he tackles the divisions between classicism and romanticism, and deterministic and unpredictable theories of the universe.  

The play spans two centuries and is set in Sidley Park in Derbyshire, the large country home of the Coverleys.  What makes the play intriguing is that while one group of characters seeks to determine the future,  the other tries to reconstruct the past. But as the play builds to its tragic conclusion and a kind of truth is revealed, past and present converge and the quest for knowledge itself becomes the essence. 

The play opens in April 1809.  Thomasina Coverley, aged 13, is in the midst of a lesson with her tutor, a Mr Septimus Hodge.  Thomasina is precociously clever; she is not taken in by Septimus’ ‘literal’ evasion of her enquiry about carnal embrace.  But Septimus has his reasons to be evasive since it is he who has been observed in carnal embrace with Mrs Chater.  And now Mr Chater demands satisfaction.  To Septimus, this is tiresome.  

‘Good God, Man!  First your wife wants satisfaction; now you!.  I can’t be spending all my days satisfying the Chater family.’ 

To evade unnecessary bloodshed, he flatters Chater by praising his latest book of poetry, ‘The Couch of Eros’, even though he has previously written a damning anonymous review of his previous work.  Septimus knows about poetry.  He is a contemporary, a friend even, of  Byron.  Byron’s home, Newstead Abbey, is close by and Byron has been a shooting guest at Sidley. 

Fast forward two centuries.  Hannah Jarvis, a successful author is researching her book on the Coverleys.  Bernard Nightingale is interested in the possible reasons why Byron fled to Portugal shortly after his stay in Sidley Park.  Finding the letters from the Chaters, he assumes that Byron has killed Chater in a duel.  He is wrong.  There is no duel.  Chater and his wife go plant hunting with Captain Brice.  Chater discovers a new kind of dahlia but dies abroad after being bitten by a monkey.  Brice marries Mrs Chater.  Byron has his own reasons for his dash to Lisbon; probably fear of exposure of his ‘illegal’ homosexual liaisons.  

There is a tangible sexual chemistry between  Bernard and Hannah that manifests itself in  a lacerating repartee, so wonderfully created by Neil Pearson and Samantha Bond.  In fact the whole play seems to sizzle with sexual opportunity.  Septimus is clearly a red blooded romantic.  Not only is he susceptible to Mrs Chater’s rural charms, but he is infatuated by Lady Croom and, by the end of the play, is clearly not averse to his pupil’s budding attractions. In a clever interweaving of plot and time, Thomasina persuades Septimus to teach her to waltz on the eve of her seventeenth birthday, as Gus, in period costume, also invites Hannah to waltz,  but we already know that on that same night, Thomasina is consumed by a conflagration in her bedroom.   Septimus becomes the mad hermit in the park.  Byron prowls in park and gazebo.  Valentine conducts a futile wooing of Hannah.  Even his autistic brother, Gus, is entralled by Hannah and presents her with an apple to go with her computer.

The plot is set against a back drop of change.   The Enlightenment and the Millennium are  exciting times to be alive.  The intellectual landscape was changing along with the physical.  In many country houses in England, the formal continental gardens of the 16th and 17th centuries had been ploughed and planted with grass and trees, streams had been dammed up to create lakes, sweeping vistas have been opened up. The aristocracy were no longer hemmed in by the continental confines, of hedge and flower bed, they were  now masters of all they surveyed.   Lancelot ‘Capability’ Brown has created an environment that represented the freedom and confidence of an expanding empire.  But hard on the heels of empire, something different is taking place.  The sweeping vistas are being turned into something romantic, picturesque, clandestine even.    Rocky hillsides are being planted with trees, grottos are being created, ruins are preserved,  waterfalls constructed.  This is an environment of privacy, secrecy where assignations can take place and the feminine principles of sex and romance can prevail. The formal appearance of the great house is preserved, but in the garden, there are more exciting opportunities. Nancy Carroll’s Lady Croom simmers; she doesn’t approve of the changes, her new landscape architect, Mr ‘Culpability’ Noakes is wreaking on the estate.   

A similar change is occurring in the mental landscape of ideas.  Newton had created the formulae for a new order.  Thomasina is precociously aware of Newtonian calculus and philosophy.  ‘You cannot stir things apart.’  Two centuries before computers will do the job for her, she conceives the iterative algorithm, an algebraic equation the describes the nature of natural phenomena by encapsulating the forces acting on them, and then putting the solution ‘y’ back into the equation as ‘x’, to create a three dimensional model.  She uses it to build a model of an apple leaf, but two centuries later, the intense Valentine uses the same approach to describe fluctuations in the populations of grouse on the estate.    Everything, it seemed, could be described by mathematical rules.  If we knew the rules we could predict the future; the weather, politics, financial markets, illness, the natural world – everything.  The solutions may be complex, but a confident, emerging Empire understood these and could control them.  Since the outcomes were predictable, the future could be controlled.     

Two centuries later, it is so different.  We cannot predict the weather accurately, any more than Valentine can predict the populations of grouse on the estate because as Valentine expresses in his frustration, there is too much fucking noise. The new mathematics is the mathematics of unpredictability, chaos; how a seemingly disconnected event occurring a long way off can set in train events that make a fundamental change in whatever we are studying.  A butterfly flaps in wings in China and a hurricane occurs in North America.  A building society goes bust in America and creates a world wide credit crisis.  A junior minister has a meaningless sexual liaison with a call girl and brings down a government.  We are beginning to understand the how minor, seemingly disconnected chance events, can have profound effects.   

The greatest sounce of perturbation and noise confounding the outcome of human endeavour, is love.  And in Arcadia, the very air sizzles with sexual energy.  Bernard bounces with it, Septimus, his friend Byron, and Mrs Chater, Hannah fears being overwhelmed by it and defends herself strenuously,  but the innocents, Mr Chater and the tragic clever Thomasina are destroyed by it. 

Love can confound the most robust equations, generating chaos out of order,  threatening to disrupt the most ordered lives, but at the same time, making what seems remote and impossible, a frightening, risky possibility that could lead to destruction but also, if one keeps one’s nerve,  re-creation. 

Stoppard is one of most exciting living playwrites because he, like Septimus, Thomasina, Hannah and Valentine, has the sheer balls to expose the destructive forces within our society while at seeking to harness them to discover a kind of truth.

I have absolutely no recollection of what happened.  I stayed and wrote up my notes for a bit.  Then I went into the basement, collected my keys and drove up through Broomhill and westwards out along the Fulwood Road towards the moors.  I can’t remember what I was thinking.  Mum had been quite clinging and demanding early in the afternoon.  She had become tearful,  then cross when I announced I needed to go to see my patient.  I had not needed to be firm but gentle.  Perhaps it was something else.  

Anyway the last thing I remember was filling up the car with petrol at the Tesco services in Fulwood.  It was nearly empty and cost nearly £40.  Next I was lying on the stretcher in the ambulance.  They said I was going to the Northern General.  ‘Oh No!’, I said.  So I must have lost best part of an hour.

From what I could piece together,  I had driven through the Mayfield Valley and up to the junction with the Ringinglow Road.  That was where the crash occurred.  A Ford Fiesta had run into my Corsa. Both cars were write offs.  The Fiesta must have crashed into the driver’s door.  The three lower ribs on the right side were fractured, there was grass on my clothes and  I was passing blood when I first arrived. But what happened?  Did I fall asleep?  Was I preoccupied and just pulled out? 

Post traumatic amnesia seems to have the purpose of protecting the individual of the full impact of the occasion.  But is it really purposeful.  Isn’t it just something that happens?  I wonder if the shock just wipes the memory, like a computer exposed to an electric discharge, and only afterwards we ascribe some kind of protective purpose to it. People have told me that I was asking the same questions over and over again – like, where was my computer and what happened to the other driver?.    

But the memory is not completely lost.  It is there like an undercover agent, unseen, unknown, but influencing our thoughts and actions in ways that betray its intentions.  And, of course, post traumatic amnesia can be recovered under hypnosis.        

In the meantime, I have a black hole in my universe, that sucked a hour of my life into it.  It happened once before on this very unit, when they were trying to provoke my cardiac arrhythmia and my heart stopped.  I should stop coming to the Chesterman Unit.

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Her trick is her tail,

Flashing red, flicking,

vibrating, shivering,

never still, seducing,

enthralling, enticing,

her whistle a question

the answer a scold.

She’s such a tease!

 

Please!  Oh, please!  

But to be frank,

She’s not a lot to look at,

a dull olive green,

she hides herself in leaves,

but the tail’s a give away,

this brazen hussy

is all tail.

 

But what of the male? 

Such a serious mate;   

Above his bill, a headlight,

his bib as black as soot,

Chest and belly a flame,

His back as blue as dusk,    

But his shame, his shame too

is in his tail.

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Soft, silent, you came

With the breeze over the pines,

a northern angel,

wings spread,

Feathers like fingers,

Feeling, catching  

Every nuance.

 

A master of energy,

you exploit the faintest

currents of air. 

You hardly seem to move,

No beat, no flap, just

a hint of tilt,  and an

opening like a fan,

of wingtip and tail.  

 

You close the span,

narrow the profile,

incline the head

bend the wings

and you are a missile,

swift across the valley.

 

And then, sensing,

A rise of air and heat,

you spread out, stop,   

tilt, spiral

up, up, up,

high, so high,

you are just a dot

against a patch of bluer sky.

‘Oh Nick, Oh Nick!  Please!  Please!’ 

 ‘What is it mum?’

 ‘I don’t know. It’s all gone wrong.’ 

 ‘Try to rest, mum.’

 ‘But I’m so hot!’ 

 I take the blanket off her.

 ‘My feet are so cold.’

 I put her slippers on.

 ‘Oh these are too heavy. Take them off.’ 

 I remove them.

 ‘My mouth is so dry.’

 ‘Shall I make you a cup of tea?’

 ‘Mmm’, she gives a slight nod.

 I return with the tea and after a few minutes lift the cup to her lips. She recoils.

 ‘Too hot!’

 I wait another five minutes or so and try again.

 ‘Much too cold!’    

 ‘Oh Nick, why are you doing this to me?’ 

 I hold her in my arms, cuddle her.  I tell her to relax, to rest, but she can’t.  She leans forward again, puts her head in her hands and utters a few sobs.’   

 ‘What is happening to me?’

 ‘It’s very frightening, isn’t it?’

 ‘Hmmm.  Oh please let it end now.’

  

Mum is losing her mind.  A year ago she was stalking the corridor round her flat for hours on end searching, but she couldn’t remember what she was looking for.  She had lost it!  Now, it seems she is shipwrecked on an alien coast, frightened and so lonely, terrified of what’s going to happen to her.  She’s on her own desert island.  Although people sail past, she is in a place in her mind that they can’t reach. 

Losing her mind means losing the ability to think, the cognitive control over her emotions and what happens.  Cruelly, her emotions are quite intact.  People with dementia often know that something awful is happening to them, but don’t know what it is.  The most tragic and merciless aspect of dementia is that their distress cannot be buffered by thinking.  Most of us can calm our anxiety,  silence our frustration and ameliorate our distress to some extent by reason and strategies; resolution, avoidance, distraction, seeking company, relaxation.  Those with dementia cannot do this. Their reason has flown, there are no strategies.  For mum, something small, like me leaving the room to make tea or answering the telephone, can cause a flood of grievance, that may take hours to exhaust itself.    

Cognition is a consequence of memory.  If we can remember what has happened to us, then we can think about it and derive ways of dealing with the same situation again.  We can learn.  The fundamental defect in Alzheimer’s Disease and other forms of dementia is the loss of short term memory.  So, for mum, losing her mind means losing the ability to learn.   She can’t understand and engage with what happens or what she is feeling from  moment to moment, she just reacts, complains and needs to be rescued. 

Unable to learn, recognise and engage with people or the things around her, she has lost the sense of who she is and who anybody else is.  She has lost her identity.  That’s the most tragic thing about dementia.  How often do we hear relatives and friends complain sadly,   ‘I’ve lost her.  She’s not there anymore.’   No she’s not!  Like mum, she’s sailed away to a lost world that they can’t access. 

Dignity is one of the last things to go.  Loss of dignity implies the loss of personal boundaries that separate the essence of us from other people.  While I was staying in her flat last week, mum fell while trying to get to the commode.  I heard the crash and found her sitting on the floor like one of the little old ladies I saw in Uganda years ago in their wattle and daub huts.  She had wet the back of her nightie.  I lifted her and pulling up the back of her nightie, placed her on the commode.  Then while she sat there, I found a clean nightdress, removed her wet one and put the clean one on.  It was a shocking act of compassion.  Mum had been such a private, not to say defended, person.  She would have been horrified that I had had to be so intimate with her, but she had lost all sense of who she was and so that didn’t seem to matter any more.       

It’s the short term memory that people with dementia lose; their ability to retain and make sense of what is happening.  They often have screen memories of the distant past, videos of events, recollections of sayings, snatches of song that are stored like isolated loops in their neural circuitry, but these lack any meaning because meaning requires them   to make sense of memories in the present and the present is just a confusion of torments.  Just a few weeks ago, mum could gain a sense of consolation from her memories.  We would talk about grandma, the pub, Wednesday afternoons sampling the miniatures from the top shelf,  we would sing bits of song together (Flanagan and Allen were favourites),  recite bits of poetry.

 

I dreamt I did die and to heaven did go.

Where have you come from, they wanted to know.

I’ve come from Bristol, and how they did stare!

Come on inside, you’re the first one from there.

 

It was a connection, and through it we could link to the present.  Memories of tea dances at Carwardines could be connected to a recent episode of Strictly Come Dancing.  And she was proud of reaching 93 and defying Auntie Lily, who berated her for going out to wartime dances with no vest on.  ‘You’ll never make old bones, m’dear!’

‘Well, I showed her, didn’t I?’

Now, it seems, she cannot gain any consolation from the past.  Looking at old photographs is torture.  She senses they mean something, but doesn’t know what, and that is infinitely distressing. 

‘Take them away! Oh, please, please!  Take them away!’ 

So her past has gone for her; it only exists in the minds of the people, like me, Simon, and just a few very distant relatives.  Her funeral will be very sparsely attended. 

And there is no future.  The future requires imagination. And her failure to learn and make sense of what happens has choked off imagination.  She cannot project herself into the future.  Without a clear sense of the present, she is unable to think of how things might be. It is quite impossible for her to plan or look forward to the future.  There is no expectation, no hope, just a nameless dread, an existence dominated by need and fear.  She is in her own private prison, locked up in the misery of the present with no meaningful past and no future.  It must be purgatory, a living hell!  Without cognition, her life has coalesced to a torture of meaningless emotion.    

The degree of misery that the lost, tormented souls with Alzheimer’s Disease feel, must depend on the emotional themes of their lives; simply speaking, whether the mug of life if half full or half empty.  Mum has always been nervous and insecure. An emotional orphan, her father died in the Battle of the Somme when she was just two years old.  Her mother Daisy, worked all hours in the fish and chip shop so that she and her daughter would survive; not only survive but escape the threat of poverty and starvation.   She succeeded, but at a cost. With no siblings and few friends, just busy adults, mum always felt in the way and grew up needy for attention, unable to tolerate her own company for very long and very sensitive to being ignored.  Like Daisy, but in an emotional rather than a financial sense, she has had to focus all her energies on survival.  Mum has always been self-centred, a lonely princess, who never really understood other people. Friends, husbands, children had to be there for her.  Without their support and solicitude, she was desperate; she couldn’t survive. 

With widowhood and ageing,  these traits have been concentrated until with the loss of meaning, her emotional life has become a pure essence of anxiety and grievance.  There is no peace and joy,  just a fretful restlessness.  My brother and I used to joke that the only satisfaction she had in life was when she had a justifiable grievance against somebody, but now even that has gone.  She feels the grievance, but without knowing why, she cannot feel justified.   Any attempts to help her, to make her comfortable, to satisfy her demands, can never be enough because they can’t assuage this fundamental grievance.  Life for mum, has not been fair, even the good bits.  Ron, her second husband, was good to her and they were happy together, but theirs’ was an exclusive marriage; two lonely children who shored themselves up against the ineptitude and perceived exploitation of others.  She was an excellent needlewoman, she made wonderful skirts, waistcoats, suits, even hats, but she kept them all to herself.  She was too distrusting of others to be generous.  But Ron let her down in the end and died, fulfilling the prophecy that people would not be there for her. The real tragedy for mum, now, is that while there is life, there is dissatisfaction.  Left to her own emotional imperatives, she doesn’t know what to do except to make demands. 

So, is there anything more that can be done?  Mum now has twenty-four hour care from a local company of private carers.  They are very good to her.  They respond to her slightest whim with infinite patience.  She has the command of a dowager, but nothing is ever good enough.  In her last essential loneliness, she is intolerant and inconsolable.  She is desperate for rescue, but nobody can rescue her from her own persecution.    

I live close to her now and look after her. I am the one to whom she looks to sort it all out.  I feel that I am expected to make up for all the accumulated unfairness of her life.   It was ever thus.  And of course, because her expectations of me are so high,  I am the one who must inevitably let her down the worst. How ever hard I try, it will never be enough and my failure just adds to the pile of  disappointment and grievance. She is hard to love, and there are times when she exasperates me, but I do love her.  I am there for her and promise her every day I will remain so.  I suppose I see aspects of me in her.  I understand her desperation.  I feel it and cannot walk away, but neither can I submit to her needs. 

The situation is changing week by week and I am learning on the hoof.  I have come to the conclusion that it does not help her for me to just respond to the unending litany of demands.  She will never be satisfied.  She now has the mental age of an infant; all emotion and no capacity to understand.  She must be reassured with cuddles.  She must be stroked, her back rubbed, her hands held.  Physical communication is, I feel, so much more important than words; she doesn’t understand the meaning of words.  They can’t be trusted. 

She must be distracted.  Her mental environment must be changed; a walk into the kitchen to look in the cupboards,  standing on the balcony, reciting familiar poems, singing songs,  preparing and eating a meal together, even going out into the garden in a wheelchair. She may not understand, but she will feel the breeze, smell the trees, taste something nice, feel in some way connected.  As cognitions fade, senses, emotions are enhanced.  She is exquisitely sensitive to the timbre of others’ moods.  By doing things with her, however frail and querulous she is, she will sense the relaxation and pleasure in me instead of tension and exasperation. Soon the light will go out.  My hope is for a fading and dimming to extinction and not a restless flickering and guttering. 

‘Please, please mum,  do go gentle into that goodnight!’

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Beeley Moor at ten thirty, on Sunday.   

A column of grey four by fours

Barbour and tweed in a huddle,  

Sausage and eggs and plus fours,

 

Top dogs! And so eager to show off   

Their bright eyes, the shine on their coats. 

The day may be cold and depressing,  

Their senses, wag-tailed and wet-nosed. 

 

The crack of a discharging shotgun,

The toss of  the heather-bound lure,

The straining of haunches, the release of the leash

If he finds it in time, he will score. 

 

A mobile olfactory sensor 

Scanning shark-like first this way, then that  

For a bean bag clad in green plastic

and the scent of the sweat of a hand.    

 

Buttoned up and tense with frustration,

She leans out above the dark lake,

And with vowels and gesticulation, 

She strains to correct his mistake.

 

A panic, a blank of confusion     

The reward, mislaid or ignored,

lies beneath the dull red rhododendron, 

Submerged, like her hopes of reward. 

 

And here where the bracken grows darker,

In the shade where the rain never falls,

The omega wins, not the alpha.

He’ll not think; he’ll just do as he’s told.   

 

 …  …  …  …  …  …  …  …  …  …

 

And when I asked my friend,

What drew him late to such pursuits,

he stroked a thoughtful chin..

‘It’s only to amuse,  I go on shoots,

And to compete.  I guess you’d say

I’m a dogless wonder; all bite and no bark!

 

 

                                                      The Bollard of Edensor

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