Time with the family

Politicians who leave office involuntarily often say they are departing to spend more time with their family.  I know whereof they speak. After 1965 as my professional life got increasingly crowded with research and teaching and cluttered with out of town meetings, I resented the way my work was eroding leisure evening hours and weekend days I wanted to share with Wendy and our children. Looking back on it however, I believe I managed the balance between work and family life well, if more by happenstance than careful planning.

The balancing act began imperceptibly and without thought on my part or Wendy’s. In early 1960 we drove our Holden station wagon from Adelaide to Sydney where I did my first year of public health training. We traveled leisurely, staying overnight with friends Jan and Alan Fry on their farm near Bordertown, then at motels along our route. We repeated the process on the return journey to Adelaide at the end of the academic year in November. Those two road trips, each of 3 or 4 days, thrust us all together at close quarters, Wendy and I on the front seat, Rebecca and David in the back.

Near Canberra en route between Sydney
and Adelaide, 1960

Rebecca supervising Alan Fry and his son John

Those were happy times, the whole family at close quarters for several days, two adults, two tiny tots and Helen our dachshund bitch. Wendy and I were aware of the stress on our two toddlers and bribed them shamelessly with frequent doses of candy and ice-cream. At weekends after we reached Sydney we explored the ocean surfing beaches and the spectacular harbour. Rebecca and David loved to guddle in the sand, so we spent many leisure hours at the ocean beaches, some on the crowded harbour beaches. I’d have been bored if I hadn’t got so much vicarious pleasure from watching our children digging in the sand during those all-together family times.

In 1961 we all traveled to England where I had a 12-month visiting scholar position in the MRC Social Medicine Research Unit in London. As almost everyone did until the late 1960s we traveled by ship; air travel was prohibitively expensive in those days. We chose to travel on a cargo ship carrying 12 passengers, rather than a regular passenger liner. It was an inspired choice. Wendy and I had a marvelous time, meals at the captain’s table with a cabin steward minding the kids while we ate. The cabin steward was a rather plump young woman and one day David, who was teething, bit her arm. She carried tooth marks for a fortnight and we were too poor to tip her as generously as we ought to have done. In all other respects that sea voyage was a wonderful experience and helped to bond our family. 

Wendy and Rebecca stride past the leaning tower

Wendy and Rebecca beside the Arno
and the Ponte Vecchio, 1962 

The return journey to Adelaide in 1962 further strengthened the family bonds with the added bonus of interesting ports of call. We boarded our ship in Rotterdam and took on more cargo at Antwerp, Marseille, Genoa, Livorno (near Pisa and Florence with time to visit both) and the Turkish port of Iskanderum, at the North-East corner of the Mediterranean. All were interesting, child-friendly ports, and we had plenty of time to explore them. 

Michelangelo's David

R and D on a Marseille sidewalk, 1962

At sea I began the much loved custom of reading to the kids from Winnie the Pooh, Wind in the Willows, Charlotte’s Web and The Magic Pudding. (When we ran out of kids’ books in the Indian Ocean, I made up the story I began to write down for the first time 52 years later in 2014).

Our 3 kids on deck, Brisbane

Climbing to the upper deck, 1964

In January-February 1964 we had another long sea voyage, from Sydney to Brisbane, across the Pacific through the Panama Canal to Kingston, Jamaica, Vera Cruz, Mexico, then up the eastern seaboard of the USA. I signed on as ship's surgeon and got a free passage with greatly reduced fares for the family - and luxury accommodation in a spacious air-conditioned cabin. There were three kids now, the youngest, Jonathan, six months old and very fragile, born with a life threatening congenital heart defect.  He wasn’t given much chance of surviving but reconstructive heart surgery a few years later was spectacularly successful. Nearly 50 years later he is still going strong. I’ve described that sea voyage in detail elsewhere.  We were en route to Burlington, Vermont where I’d been invited to become assistant professor of epidemiology and community medicine at the medical college of the University of Vermont. We bought a Volkswagen van to get about with space for all the paraphernalia small children need, and in my time off we explored the North-East corner of the USA rather thoroughly. That was more family bonding time.   

A year later a choice between two invitations didn’t challenge us: should I take the family to live in the ancient city of Edinburgh, Scotland, or to Johns Hopkins School of Hygiene and Public Health in Baltimore, Maryland, 50 miles from Washington DC, with a salary twice as high?  In Baltimore we’d have to live at least an hour’s commute from my office, probably more.  Long working hours, frequent evening meetings and a lot of travel to distant research sites would reduce family time drastically. Besides that, we were out of sync with American values and customs like the use of guns to solve problems.

Jonathan beside our VW camper at Loch Lomond, 1967 

In Edinburgh we bought another VW bus, this one equipped as a camper. In fact we bought two, because the first one didn’t accommodate all of us when we camped. We traded it in for one with a lift-up roof, which provided space for Rebecca and David to sleep above us in bunks, and delicate little Jonathan slept at the back on the flat area above the engine.  Boomer, our Labrador, slept on the floor below the queen-size bed for Wendy and me, adding fragrance to the air with his uniquely pungent doggy farts. 

What times we had in that VW camper van!  We got to know very well the ancient city of Edinburgh and its environs. We visited Edinburgh Castle more times than I can count and never tired of it. At weekends we went several times to Loch Lomond and on to the west coast, gazing out from the Argyle hills to the islands in and near the Firth of Clyde.  Our kids loved pottering about in the ruins of mediaeval castles, Dirleton on the Firth of Forth, Tantallan on the North Sea coast near the lovely little fishing village of Dunbar, and the grim bottle dungeon beside the castle at St Andrews. A bottle dungeon is so called because it is shaped like a bottle, a narrow neck at ground level and underground below it, slimy inward sloping walls no miscreant could possibly climb, opening out to a level space at the bottom, large enough to hold perhaps a dozen or twenty criminals who remained there until they died. Bottle dungeons appealed to David’s macabre mind; but he never told us whom it was he’d like to incarcerate.   

Wendy and kids at Dirleton Castle, 1968

We had some truly wonderful weekend excursions in our VW camper van. We had a few disasters too. There was the weekend it never stopped raining, a soft, but infinitely penetrating rain that soaked anyone foolish enough to venture out of shelter for even a minute or so – as all of us had to from time to time to inspect the toilets some distance away. It was the season of midges too. Midges are tiny flying insects that particularly troubled Wendy because they got behind her glasses to feast on the moisture in the corners of her eyes. The kids were miserable and grizzly. Boomer tried to drive the midges away by emitting pungent farts even more poisonous than usual.  As we drove away over the pass called Rest and Be Thankful at the end of that weekend fiasco, all of us smelling like wet dogs, Wendy and I resolved that next summer we’d cross the sea to the continent of Europe, away from all the rain and the midges, to lands of warm sunshine, Mediterranean beaches, bountiful fruits, tasty cheeses and wines fit for the gods.

Wendy about to prepare lunch,
Austrian Tyrol, 1967

Swiss Alps from Grossglockner Hochalpenstrasse

We had European VW camping holidays in 1967 and 1969, two near-perfect experiences, holidays replete with memories enough for several lifetimes. We took much the same route for both: south from Edinburgh on the A1/M1 to Harwich, car ferry to ‘S Gravenhaage (“Hook of Holland”) and along the Rhine to south Germany, the Black Forest, then along the autobahn through Bavaria to the Austrian Tyrol, over precipitous passes, Grossglockner Hochalpenstrasse, Furkapass, St Bernard’s Pass, down into northern Italy, eastward to Venezia, on a further 30 Km beyond Venice to the wide sandy beach at Iesolo. This was a perfect beach for small children with calm warm seas to adults’ hip level 15-20 meters from the shore, like an enormous paddle pool. We camped everywhere at the very well set up European camp grounds.  We stayed 7-10 days at the Iesolo camp, eating fresh fruit, spicy barbecued chicken from the camp store, bread and gorgonzola which David loved as much as I do, though fortunately he didn’t acquire a taste for the wine that Wendy and I consumed by the flask.  In 1969 we went on from Iesolo to camp by the Arno at Florence, re-introduced Rebecca and David to Piazza della Signore, the statues in the loggia, Michelangelo’s David outside the Palazzo, and the delicious food of Tuscany. We went to Sienna which the kids enjoyed more than Florence because there were no crowds, and San Giminiano with its towers, and Poggibonsi because the name captivated the kids and because it’s whence comes the best chianti.  We took 4-5 days to reach Italy from Holland, and a week to get back via Switzerland, camping usually in places noted for their beauty, artistic and cultural treasures, historical significance, or all of these qualities. We visited Mad King Ludwig’s castle at Neueschwanstein, some of the castles along the spectacular fortified stretch of the Rhine, had a brief cruise on a Rhine steamer, visited Venice and had a ride in a gondola. Wendy and I stored memories to last a lifetime, knowing by the time of the 1969 holiday that we would soon be leaving Edinburgh for Ottawa, uncertain whether we’d ever have another chance to see these wonderful places.

Dining al fresco, Florence, 1969

Jonathan at our camp in Iesolo

David in the sea at Iesolo

In a gondola, Venice, 1969

  

Those European camping holidays were uniformly happy times, although not 100% happy 100% of the time.  Wendy’s feet are marred by unsuccessful bunion surgery when she was a teenager. For the first 25 or so years of our married life I spent many hours waiting for her in shoe shops where she tried in vain to find elegant shoes to fit. In Venice she insisted against all my protestations in buying a costly pair of fashionable sandals. A few days later she complained that they pinched her toes: she couldn’t wear them any more.  I made an ill-considered sarcastic remark, whereupon she erupted like a volcano and thus began the worst quarrel ever in our 55 years together. The kids who observed it all were terrified that the parents they loved were breaking up forever. It blew over like a passing summer storm after an hour. Wendy and I forgot it and moved on, but months later a remark of Rebecca’s reminded us how impressionable children can be, how easy it is for them to become emotionally disturbed by seeing and hearing their parents fight. I knew this well of course from scrappy memories of the fights in my parents’ doomed marriage.  Wendy and I were blessed by a harmonious union in which that tumultuous dispute on our last day in Iesolo was a rare blemish. We soon forgot it, buried it under innumerable happy and even hilarious memories, some captured in photos illustrating this memoir fragment.

Here are a few fragments of happier memory:

On a one-lane track in the west of Scotland we came over a hummock to be confronted by shaggy highland cattle, one of them barely 2 meters away on the track glaring us down, its long prehistoric horns aimed menacingly at us. We couldn’t advance until it got out of our way, which it took interminable time to do.

Immobilized in a traffic jam on the autostrada near Milan, David was overcome by an irresistible urge to void his bowels.  We had a miniature potty for Jonathan so David was obliged to perch precariously upon this. Somehow in the jerks of frequent stops and starts he managed to do what he had to do without spilling anything, despite filling the tiny potty almost to the rim.

Driving desperately to reach Harwich for the early morning ferry, we couldn’t find the campground where we’d planned to stay the night before embarking. Darkness descended. We found an open space that appeared to be common land, and tucked in for the night, R and D above us, J behind us atop the engine. We were awakened at dawn by heavy trucks grinding their gears as they tried to pass our camper van to enter the landfill site where we’d partially blocked the entrance.

Camped next to us at Loch Lomond on that infamous wet weekend were a young couple who arrived on a motor bike and set up a tiny pup tent with commendable efficiency. All we saw of them after that was a hand and arm that emerged from the tent to flip the steak or sausage they grilled on a small spirit stove. The tent was too small for them to stand up but Wendy and I thought they looked randy enough not to be interested in standing up anyway. They probably enjoyed their weekend more than we enjoyed ours. 

On the autobahn outside Cologne we wanted to find a quieter road. Wendy consulted our excellent road map and directed me to an exit. We found ourselves to be not on a road but on a wide pathway in a municipal park with law-abiding Germans pushing babies in strollers, gazing disapprovingly at these barbaric Britishers who couldn’t tell a road from a pedestrian path.  

We were camped in Bavaria during the first moon landing; near our VW camper bus was a German caravan with all the latest bells and whistles, including a TV.  It was a small screen and black and white, with commentary in German that I translated as best I could for Wendy and our kids - and it turned out, for dozens of others in the rather large crowd that gathered to see this spectacle. We watched for well over an hour, quite late in the evening, keeping the kids up long past their regular bed time. It was a lovely, warm, velvety summer night with a full moon. It gave all of us memories to last a lifetime.

More photos to finish off --

Bath time on MV Pretoria (1961)

Rebecca's dolls' party in our cabin
on MV Morelia (1962)

Admiring scenery of Suez Canal (1962)

Heavy seas off Queensland (1964)

David, Rebecca, Wendy in Ship's Pool (1964)

Rebecca flirting with 2nd Engineer

Windswept mid-Pacific

Getting Hallowe'en pumpkin
Northern Vermont 1964

Souvenirs of Vera Cruz

Winter in Vermont 1964-65

Last's patented ice yacht on Lake Champlain,
winter 1964-65

Tantallan castle ruins and Bass Rock

Wendy and David beside lagoon, Venice, 1967

Ahab's Wife

Somewhere in the rich prose of Herman Melville's masterpiece Moby Dick, there is a short paragraph in which Melville tells his readers that Ahab, captain of the whaler Pequod, has a wife. Sena Jeter Naslund, distinguished teaching professor at the University of Louisville, Kentucky, constructed from that brief allusion the story of Una Spencer, the Kentucky farm girl who became Ahab's Wife. I remember reading reviews of Ahab's Wife when it came out in 1999. The New York Times rated it one of the best books of the year. For the past few days I've been reading Ahab's Wife with pleasure, admiration and wonder. It is a magnificently imagined picaresque novel that follows Una Spencer from early adolescence to middle age, from her parents' farm in Kentucky to her aunt and uncle's home on an island off the Massachusetts coast where they tend the lighthouse. Una was schooled in Shakespeare and Keats by her mother, and by her early teens her mind is well formed, full of ideas and independent, sceptical thoughts. She is attracted to two young men, Kit Sparrow and Giles Bonebright, who come to repair the lighthouse. She follows them to New Bedford, disguises herself as a boy and goes to sea with them on a whaling ship, the Sussex, signing on as the captain's cabin boy. One day she glimpses Captain Ahab, master of the Pequod, through the captain's telescope when the two ships are sailing close together. Her keen eyes and excellent vision lead to her task as lookout for whales from the vantage point of the crow's nest high on the ship's mast. Una and the two young men are appalled by the bloody barbarity of whaling but accept it as a necessary part of the American economy. Then the Sussex is rammed by an aggressive whale - perhaps Moby Dick, though it's never stated - and sinks. Una, Kit and Giles, the captain, the captain's little son, and some sailors drift for many days in an open boat. All but Una, Kit and Giles die, or are killed and eaten, before the three survivors are rescued by another ship, the Albatross. Giles falls or jumps from the mast into the sea and drowns. Kit and Una transfer from the Albatross to the Pequod which is homeward bound to Nantucket; they are married at sea by Captain Ahab, but Kit goes mad and after arriving at Nantucket, Una survives by sewing and helping a couple who run an inn on the outskirts of the town. She meets Captain Ahab again and after a whirlwind courtship, marries him. He establishes her in his substantial but almost empty mansion with enough funds to furnish it comfortably. Overnight Una becomes a wealthy woman. She goes to Boston with her neighbour the judge as escort to buy furniture for Ahab's mansion, meets the journalist and feminist Margaret Fuller, and through her meets Ralph Waldo Emerson and other notable New England intellectuals both real and imaginary. Other memorable characters populate this long, opulent literary fiction: a runaway slave girl, a dwarf slave catcher, the Mitchell father and daughter who are amateur scientists on Nantucket. Una is a fascinating young woman: highly intelligent, eager to learn much more than the secure foundation of Shakespeare and Keats she had from her mother, outgoing, adventurous, capable.  

Novels populated by characters invented from the background figures in great literary masterpieces have a special appeal to me. I've tried my hand at writing one myself. The parrot that sat on Long John Silver's shoulder in Robert Louis Stephenson's Treasure Island is the hero - heroine, actually - in the children's story I've been working on for the past year or so. Many others have tried, few have succeeded. Lloyd Jones succeeds in Mister Pip, but this is loosely linked more to Charles Dickens than to Pip in Great Expectations. Sena Jeter Naslund has succeeded brilliantly. I found Ahab's Wife as richly erudite as Moby Dick, easier to read (like others with whom I've discussed it, I found Moby Dick best taken in small doses when I read it 50-60 years ago and life's too short for a second reading). I'll be recommending Ahab's Wife to all my friends who love books and reading. 

Our Souls at Night

A few years ago I read and admired Plainsong. I admired the writing: not a wasted word, not a superfluous word in it. It's a simple story about ordinary people and their ordinary lives. At the time I had a great pile of other books on the bedside table, so I passed on without further ado. I didn't even register consciously the name of the author. 

Now I have. The author was Kent Haruf. I was intrigued about the provenance of his family name until I discovered in his obituary that it is the Americanized spelling of a German name which challenged many who saw it written but couldn't pronounce it correctly. He was an eminent writer, winner of a Wallace Stegner Award, a PEN-Hemingway Award among other distinctions. His final book, published in 2015 just after his death aged 71, is Our Souls at Night. This is a beautiful little book, prose like poetry, a keeper that will go on the shelves with other books I treasure. The story is set in Holt, the fictional Colorado town where all Kent Haruf's novels are set - all of which I now feel impelled to read. Our Souls at Night  describes a year or so late in the life of Addie Moore, an elderly widow who calls on her neighbour Louis Waters and invites him into her bed, not for what my beloved Wendy called wee romps, but for company, for pillow talk, and as she gets to know him better, to hold her hand as she drifts off to sleep. In that small town where everyone knew everyone else, they had known each other all their lives. Some are scandalized by the behaviour of this elderly pair, some are envious, some perhaps admire Addie and Louis.  Louis's wife had been Addie's good friend until her death from cancer. Addie's son Gene's marriage is breaking up and her 6-year old grandson Jamie comes to stay. He cries himself to sleep, so he too shares Addie's king-size bed. Louis gets Jamie a dog. After a few months, Gene and his wife try again to save their marriage; Jamie and the dog go home. Gene is ashamed about his mother Addie's 'immoral' relationship with Louis; he moves  her to an assisted living residence. After that Addie and Louis have occasional, secretive phone conversations, secretive because Gene disapproves. This is a simple, commonplace story about ordinary people, joyful and sad like life itself. Kent Haruf wrote only six small novels: it's a slender portfolio; but if each is as perfectly polished as this, there will be much pleasure in store when I read all of them.   

Ecological Determinants of Health

A Working Group of the Canadian Public Health Association led by Dr Trevor Hancock has been deliberating on the implications of the environmental and ecological trends that are apparent to all of us. These trends have consequences for public and population health, indeed for everyone's personal health.  The Working Group has produced a Discussion Paper, available at http://www.cpha.ca/uploads/policy/edh-discussion_e.pdf.  It is a brief, clearly written document, setting out the most obvious trends: climate change, stratospheric ozone depletion and increased ultraviolet radiation, resource depletion, especially fresh water for drinking and irrigation, environmental pollution, species extinction, reduced biodiversity, desertification. For more than 30 years beginning in the early 1980s I wrote and spoke a great deal on this cluster of trends and changes in our world and its life-supporting ecosystems. I chaired a study  group of the Royal Society of Canada and an international workshop convened under the auspices of Health Canada, and was a special adviser to the World Health Organization. Occasionally I was an official Government of Canada reviewer of scientific reports of the United Nations' Intergovernmental Panel on Climate Change (IPCC). A chapter on "Human health in a changing world" was the centre-piece of the 2nd edition of my book Public Health and Human Ecology (1997). Colin Soskolne at the University of Alberta helped me to expand and update this as Chapter 52, pp 925-937 in the 15th edition of the massive reference textbook Maxcy-Rosenau-Last Public Health and Preventive Medicine (2007).  

The fire in my belly is beginning to subside into glowing embers and my expertise on these important topics is becoming dated and no longer carries much weight. Accordingly I was especially pleased to read Trevor Hancock's report. It is required reading for all thoughtful Canadians, especially those who care about the world we will leave to our descendants. Among much else, Trevor Hancock's report has political implications. Nobody who heeds its message could ever vote for a political party that regards life supporting ecosystems as irrelevant, or considers sustaining them to be an impediment to economic growth and business as usual. In the fire-eating mood that sometimes overtakes me, I regard political parties with that view of the world as enemies of life on earth. It's incomprehensible to me that such political parties attract support, let alone enough support to win elections as they often do in the USA and did in Canada last time. I would as soon take a dose of cyanide as vote for any candidate of such a party. Alluding to that sort of weltanschauung, in 1991 I entitled an article in World Health Forum "Homo sapiens - a suicidal species?" That message, and that article were well received by readers around the world.

There is often an omission from the litany of dangerous factors threatening the survival of the world as we know it. Many writers avoid any discussion of population growth and population pressure on fragile environments and ecosystems, or if they mention it, they pussyfoot around the edges, seemingly afraid of arousing the wrath of those who uphold what are often called "family values."  Publishers' editors discouraged me in the 1980s when I wanted to discuss in depth the harsh reality that the population exceeded the earth's carrying capacity by at least an order of magnitude. Our present numbers, about 7.4 billion, are unsustainable. The world would be a more comfortable place to live, more peaceful withal, and a happier place for everyone, if instead of 7.4 billion of us, there were 740 million (or perhaps as few as 74 million, two orders of magnitude fewer).  I have been concerned about population pressure since my medical student days in the 1940s.  My very first professional publication, in 1949 a few months before I graduated from medical school, included a brief discussion of population and my concerns about the rate at which the world's population was increasing. At that time it was rising by about 10 million/year, trivial compared to the present annual increase of more than 70 million. 

As I recall those times just after the end of the 1939-45 world war, I think of the clean air, the pristine beaches, the sparkling clear seas around the South Australian coast, the abundant fish in the sea, the thriving bird and insect life of the Australian bush. How everything has changed!  Although parts of the world were scarred by the destruction of the 1939-45 war, it was a golden age environmentally speaking. The environmental and ecological deterioration that is so obvious now even to a casual observer such as me, had not begun in those immediate postwar years. The concept of global climate change hadn't even been imagined, and nor had any of the other global ecological and environmental changes that threaten all life on earth. I remember a night in, I think, 1948, when I was 22 years old. Petrol rationing had ended; On a limpid warm evening I had driven into the Adelaide hills with my girl friend of the time, determined to lose my virginity. I didn't succeed in that aim, but many my age did around then. The consequence was the Baby Boom. It began with a bang, a hyper-exponential population surge that very soon overloaded the world with more people than it could comfortably hold. The hyper-exponential surge has subsided but the increased numbers in the fertile years gave fertility rates enough momentum to maintain the unsustainable population growth rate.  Vastly greater numbers now than a generation ago in China, India, Brazil, Indonesia, are affluent enough to afford automobiles to take their girl friends, their families, from cities to the countryside, and to use their cars to commute, rather than use public transit systems. Every one of them adds a moiety to the global burden of greenhouse gases that are changing the world's climate irrevocably. It's no wonder that polar and alpine ice caps are disappearing, glaciers are receding, sea levels are rising. At the same time pesticides intended to enhance agricultural production are exterminating insects including bees that are essential for pollinating many crops.  Artificial fertilizers are causing huge dead zones around pelagic run-off regions from all the world's large rivers, monoculture - genetically homogenous - crops are reducing biodiversity; industrialized fishing methods are destroying fish stocks. And underlying it all, worst of all, the increased atmospheric burden of carbon dioxide from combusted carbon fuels is not only changing the climate inexorably, it is acidifying the world's oceans and lakes; and this is disrupting ecosystems and reproductive cycles, with consequences not much less dangerous than the global temperature rise that is now an absolute certainty. The world of my childhood and youth is lost to us forever. 

Trevor Hancock's report is more positive than my gloomy prognostications, so read that rather than this blog post. I'll try to be more cheerful next time.    

Thinking in Pictures

Nosology is a domain of scholarly activity in which I've trodden from time to time. The word doesn't mean the scientific study of noses, as one of my friends derisively remarked years ago after a learned article on the subject was published under my name. Nosology is the systematic classification of diagnostic labels. This is a necessary prerequisite if we are to think constructively, rationally and critically about diseases, injuries, disabilities, causes of death, and especially about causes of mental, emotional and personality disorders. The Diagnostic and Statistical Manual of Mental Disorders is an attempt to create an authoritative classification or nosology of the ill-defined, often murky world of disturbances that can afflict the mind.  Its fifth edition, DSM5 for short, has been the latest word on nosology of mental disorders since 2013. Like its predecessors DSM5 has been heavily criticized.  The most cogent criticism is that it attempts once again to define the boundary between 'normal' and 'abnormal' human behaviour. It draws a sharp line where the reality is an extremely vague and fuzzy blur. Nowhere is this truer than in its discussion of autism.

DSM5 provides a lengthy description of symptoms and signs of autism, emphasizing deficits in social communication and interaction, and restricted range of behaviour,  interests and activities. By DSM5 criteria, appreciable numbers of epidemiologists and medical statisticians are autistic.  When I was compiling the first edition of the Dictionary of Epidemiology, I presided over a fascinating scholarly exchange of views about the definition of several important basic terms all epidemiologists must understand and agree upon.  One of these scholars thought about and defined these terms in words and concepts; the other scholar defined the same terms in mathematical formulae. This was an example of two fundamentally different thought processes, both equally valid.* One is the customary way most of us think, i.e in words and concepts; the other is comparable to Temple Grandin's description of the way she thinks: in pictures. Perhaps the experts who compiled DSM5 should have consulted Temple Grandin. She is a renowned veterinary scientist who has exceptional empathy with animals. Her best known achievement is the design of humane slaughter houses in which sheep and cattle proceed placidly along a curved ramp and cannot see the fate that is in store for them. Her designs are now used by over half the slaughter houses in the USA and many in other countries.

By the accepted criteria of DSM5 - and her own criteria - Temple Grandin is autistic. She has exceptional capacity for introspection and analysis of her own thought processes. She says that while most of us think in words, she thinks in pictures. Her analysis is probably correct. I'm sure some people do think in pictures, or in symbols or concepts. But Temple Grandin can think, or at any rate can write, in words too. Her memoir, Thinking in Pictures, is a clearly written account of some aspects of her life and work, notably an insightful account of how she adapted to her autism, her adaptation to her physical need to be constrained when she wants to relax or sleep.  She invented and built a device she calls her 'squeeze machine' which tightly embraces her body, providing a substitute for the hugs of loved ones that she can't tolerate. Like many autistic people, she can't tolerate intimate interaction with other people.  In a moving clinical essay about her, published in his collection called An Anthropologist on Mars, Oliver Sacks implies that he may be an exception in that he does seem to have established rather intimate interaction at any rate with her thoughts and emotions; Temple Grandin's account of their relationship, and a photograph reproduced in Thinking in Pictures, reinforce my impression that he and Temple Grandin did achieve a degree of emotional interaction that is highly unusual in autism. But then Oliver Sacks is not only a physician, a clinician who first encountered Temple Grandin in a doctor-patient relationship, he is also a man of exceptional empathy and charisma, despite his assertion that he is a very shy man. Temple Grandin describes how using her 'squeeze machine' enabled her to relax, and to interact more effectively with animals - to think as animals do, to acquire empathy for them. That is perhaps a large part of the reason why she is such a brilliant veterinary scientist, particularly in the field of behaviour and emotions of animals.

Oliver Sacks and Temple Grandin are each in their own way demonstrations of the difficulty, indeed the futility, of attempts to establish a workable nosology of mental disorders, in which diagnostic labels are, so to say, carved in stone. The problem arises with that word 'disorder' - what is a disorder, and what is an unusual variation of normal that makes a person exceptional in the highly desirable way that Temple Grandin and Oliver Sacks are both exceptional?   I doubt if we will ever satisfactorily answer this question.  

* This exchange of ideas in letters to me from these two eminent epidemiologists is now among my collected papers and correspondence held in the National Archives of Canada.

Can't we talk about something more pleasant?

Roz Chast has been a frequent cartoonist in the New Yorker for many years. Her cartoons, usually a page, resemble the panels of a comic strip, and tell a story. Her humour, while not quite black, often comes in assorted shades of grey.  Now she has drawn and written a memoir of the last years of her parents, George and Elizabeth Chast, a devoted couple of retired school teachers who had been married for 67 years. They were offspring of Jewish immigrants who came to the USA from Russia at the cusp of the 19th-20th century. They were an inseparable couple, parted only during the war which for them lasted from 1941 to 1945. George spent much of the war in New Guinea; during that period of separation, he and Elizabeth wrote to each other almost every day.

This book is mostly humorous in shades of grey that sometimes descend into the blackest of black and are not so much funny as heart-breaking.  It is a memoir of the slow decline of an elderly and fiercely independent couple into senescence, dependency, loss of autonomy, loss of mind, loss of control of bodily functions, and it is a sobering message to all of us about the tragic, unspeakably unpleasant fate that awaits us if we postpone death for too long. Like many old people, they were in denial about their increasing need for help. There are lessons for all who have to care for aged kin who have lived on long past their "Best Before..." dates. Long-term care of the very old is a labour-intensive business, a 24/7 business that is very hard on the care-giving kin, taking over their lives, sometimes tearing them apart from their own spouses and children. Roz Chast doesn't say anything about this even by hints or inference but it must have been hard on her husband and teen-age daughter. Long term care is a business that generates big profits for the owners of nursing homes and assisted living establishments,  and for the pharmaceutical and surgical supply corporations. It can pauperize the dependent elderly, in extreme cases can pauperize their next of kin too.  Roz Chast does describe in searing detail how costly it all is. Fortunately her parents had good pensions, but the vitally important features of their health insurance coverage were valid only in New York, and ceased when Roz Chast had to move them from their cluttered apartment in Brooklyn to an assisted care residence nearer to her home in Connecticut. The book reproduces Roz Chast's hand-written accounts  of the major crises on her parents' lives, illustrating these not only with cartoon panels but also with photos of her parents' tiny, cramped apartment, the unworkable mess of piled heaps of papers on their "work stations," her father's old electric shavers, her mother's old blenders.

There are sobering lessons here for all old people, and for all who are growing old, becoming less autonomous, more dependent upon others for help, then ultimately for mere survival.  There are lessons for me! My father and grandfather lived to advanced old age, until they became blind, bedridden, lost control of bladder and bowel, lost all autonomy: after lifetimes of independence that in my father's case was fierce to the point of savagery, they became utterly dependent upon others in order to survive.  My father was infantilized, washed, fed, diapered like a baby, a fate that he must have felt almost worse than death, although he was too proud ever to say so. Above all else I want to avoid that fate! I hope by the time I need it, assisted suicide will be legally permissible in Canada.

Few of us get our preference about how we will die.* Advance directives and legally sanctioned assisted suicide (if Parliament decrees this) can help us old farts get our wish - everyone’s wish - for a tidy, stress-free end of life. Unfortunately the harsh epidemiological reality is that increasing numbers languish for years, even decades, in warehouses for the partially dead that we euphemistically call nursing homes. Aging baby boomers could exercise political clout that might lead to enabling legislation, but many are like Roz Chast’s parents: in denial. I’m closing in on my 89th birthday and somewhat in denial although I can still fend for myself, do my own shopping, bathing, dressing. I have help with cleaning and cooking. When/if the need arises I’ll squander my kids’ inheritance to pay for personal care worker, home nursing care: stay home and evade warehouse demi-living. When push comes to shove, however, I’ll probably shy away from assisted suicide because like my father before me I’m intensely curious about the world, and about my progeny’s lives and what they will do next.  

* My preference is to be shot in the back by a jealous husband on my 98th birthday. I’m sure I won’t get that wish!

The Guardian's campaign on climate change

The CBC Sunday Edition's feature today on the UK/global newspaper The Guardian pulled a few punches, but still made the point: climate change is the greatest threat to life on earth since the cataclysm 65 million years ago that wiped out the dinosaurs. The Guardian is continuing a long tradition of campaigning newspapers. My homeland, Australia, and my adopted country, Canada, both depend on fossil fuel extraction for much of their wealth. But The Guardian is right, political leaders in Canada, Australia, and many other countries that have become wealthy and influential because they extract and/or use prodigious quantities of carbon fuels, are wrong, dead wrong, to believe and eagerly disseminate the lies, half-truths, misinformation and obfuscation of carbon fuel advocates. For my grandchildren's sakes, and for the sake of all who come after them, may truth and the good guys prevail! The Guardian's call for society's opinion leaders to divest from the fossil fuel industry is a sound strategy. It might work if the boards of the Bill and Melinda Gates Foundation, the Wellcome Foundation, and others took up the challenge.

The first punch pulled in this morning's CBC feature was to say that "90%" of scientists support the scientific evidence. The truth is nearer 99%. The media's near-universal obsession with "balance" leads them into the trap set by the carbon fuel advocates and their tame "scientists," lobbyists and shills. It is a reprise of the artificial "debate" in the 1960s about smoking and lung cancer. In reality there is no "debate" - all the facts, all the evidence, confirm the reality of climate change. The hard facts can't be refuted. For instance, 14 of the 15 hottest years ever recorded have been in this century, which is only 15 years old. The relentless retreat of polar and alpine glaciers and ice-fields is further irrefutable empirical evidence. The underlying science has been known and studied for well over 100 years. Almost all of the so-called "scientists" recruited by industry or drawn into debates and discussions for other reasons are either pronouncing on scientific evidence outside their domain of expertise, like Freeman Dyson, bloody-mindedly obstinate, or have been bought, body mind and soul, by the carbon fuel industry, which has virtually unlimited wealth and has obvious reasons to promote its own interests.   

Of course other global changes are occurring. In an article I wrote for the Annual Review of Public Health in 1993, I focused on stratospheric ozone depletion and its far-reaching biological consequences. Even the right-wing ideologue Margaret Thatcher, UK prime minister, was persuaded by this evidence, and was an eloquent advocate for the Montreal Protocol (1987) to limit production and use of ozone-destroying substances. In the same review article I summarized the evidence on greenhouse gas accumulation and its horrendous impact. In the 22 years since then, climate change has become the dominant threat, but the harmful biological effects of increased ultraviolet radiation remain menacing even though they have been partially contained by controlling production and use of many ozone-destroying substances. 

Other global changes - resource depletion, especially of fresh water for drinking and irrigation, species extinction, emerging pathogens, reduced biodiversity, population pressure, unprecedented migrations, industrial development, environmental pollution and desertification, have been synergistic with climate change, but climate change is the most dangerous. Its immediate effects have been increasingly apparent in recent years and are becoming more serious much sooner than the theoretical models were predicting 35 years ago when I first became seriously engaged with the implications of climate change for public and population health. Changes that the theoretical models predicted for late in the 21st century or even further off, are already happening. It is increasingly likely that ice-melt in Greenland and Antarctica that was predicted by the models to be several hundred years away - plenty of time to prevent by aggressive mitigation initiatives - will happen before the end of this century, in the lifetime of my grandchildren. This will cause a sea level rise of 5-7 meters, that will inundate Amsterdam, London, New York, Miami, Washington-Baltimore, Lagos, Kolkata, Shanghai, Tokyo, Rio de Janeiro and many other large cities located at or near sea level. More than half a billion people live within a meter of current sea levels. Well over a billion will lose their habitat when the Greenland and Antarctic glaciers and ice-fields melt.  Desertification is rapidly advancing too.  California is becoming a desert because shifting Pacific ocean currents are causing a drastic decline in precipitation, rainfall and snow on the coastal mountains. This is a longterm climate change, not a consequence of capricious weather in recent years. Ocean currents are changing direction and force because ocean temperatures are rising. California's carrying capacity is at the beginning of a longterm, irreversible decline. Where will all the parched Californians go? There are many more than there were Oklahomans who moved to California in the dust-bowl 1930s.    

Perhaps these trends presage a major evolutionary upheaval, the end of the dominance of homo sapiens  and the rise of arthropods - beetles, cockroaches and ants - that are more tolerant of deserts and heat, more efficient converters of energy from their food intake, than hot-blooded humans.

The craft and art of Oliver Sacks

Oliver Sacks is dying of malignant melanoma with metastases in his liver. He described his predicament in a lyrical Op-Ed essay in the New York Times in February 2015.  He is English by birth and education. After graduating in medicine from Oxford and the Middlesex Hospital Medical School in London and the obligatory internship in the UK, he set off for North America, footloose and fancy free for a while, living a roving, restless life with which I strongly identify. He came to rest eventually in San Francisco where he gravitated into neurology. This proved to be his intellectual and spiritual home. He continued exploring this calling after he moved across the continent to New York where he came to rest more or less permanently, associated initially with Beth Abraham, a chronic neurological hospital affiliated with Albert Einstein College of Medicine in the Bronx. I think it was during this period that I first met him, in the early 1970s during a site visit for the NIH Epidemiology and Disease Control Study Section. It was a transient meeting, as was another a few years later during my sabbatical year at Mount Sinai Medical College. Like Oliver Sacks, I have poor facial recognition ability: all I can recollect is a large man with great charisma (not enough, however, to persuade the hard-nosed Study Section to award high priority to an application for research funds).  By then his award-winning book, Awakenings, had been published in the UK but perhaps not yet in USA and he had not yet established his reputation as the greatest medical writer of his time. Awakenings is about the dramatic improvement of vegetable-like victims of post-encephalitic Parkinson's disease when given l-dopa; it was later made into a very good movie starring Robin Williams as Oliver Sacks. I have read every one of Oliver Sacks's books - mostly personal accounts of patients with bizarre neurological or neuropsychiatric aberrations. Most have been best sellers and several, e.g. The Man Who Mistook His Wife for a Hat and his essays on the autistic savant Temple Grandin (An Anthropologist on Mars) who transformed slaughterhouse practice in USA, have passed into our culture. I think Oliver Sacks would be a more worthy candidate for the Nobel Prize in literature than some recent recipients. Not only is he a master of English prose; he is a great humanist, with profound understanding and insight into the human condition.

Now I am reading his final book, a memoir, On the Move. He writes more openly than hitherto about his homosexuality, and describes frankly and objectively his adventures and misadventures with illicit drugs. His accounts of weekend high speed travels on his motor-bike from Los Angeles to the Grand Canyon and back almost make my flesh creep. I hardly know him, but regard him as an old friend because I know him so well through his brilliant essays. I am very glad he was spared an untimely death despite his self-destructive behaviour.     

Anzac Day is 100 years old

About a quarter million young men on each side were wounded and about 135 thousand died in the appallingly badly planned Gallipoli campaign that was launched by the intellectually retarded military leaders of the 'Allied' forces on April 25, 1915. It is recognized as one of the great military disasters of all time, a fiasco of massive proportions. The 100th anniversary of what henceforth was called Anzac Day, like the 100th anniversary of the Armenian genocide which is commemorated on April 24, is not an occasion for celebration. There is, however, something to celebrate: they fought on opposite sides, but Turks and Australians have been firm friends ever since. When Wendy and I were taken to the Gallipoli battlefields by our Turkish hosts in October 2004, we encountered several groups of young Australians, many of them high school students, and were struck by the obviously affectionate relationship between them and their Turkish hosts who also looked to be about high school age. Friendships forged between opposing sides in 1915 have become firmer in recent generations, reinforced by these visits of young Australians.

My memories of Anzac Day date from my very early childhood, probably 1931 when I was 5, soon after my mother took my brother Peter and me to live with her in a bungalow at Brighton, a seaside village separated in those days from Adelaide by several miles of orchards and vineyards.  One morning she woke me very early and dragged me unwillingly to a dawn commemoration service. Peter was too young to come with us and I resented the fact that he stayed home warm in bed, while I had to get up on this cold morning and listen to a series of men making speeches about matters I didn't comprehend. In the years that followed, I came to appreciate Anzac Day as a sacred remembrance ceremony at which we honoured those who died in the 1915 Gallipoli campaign. They included my mother's brother, my Uncle Lidie, QMS Elias Judell, 9th Light Horse Regiment, who died like so many others in an artillery bombardment from the heights above that the ANZAC forces could never conquer. ANZAC is the Australian and New Zealand Army Corps.  They were the backbone of the forces at Gallipoli, and were supported by British, Indian, French, and even a tiny company of the Royal Newfoundland Regiment - now proudly but falsely claimed as 'Canadian' by our current bellicose government, which seizes upon every imaginable excuse to proclaim that Canada has always been a warrior nation.  

Another of my mother's brothers, Cedric, also served at Gallipoli; so did Wendy's father who was wounded there, and two of my father's uncles. Most families in Australia and New Zealand had members who fought at Gallipoli, and many had family members who died or were maimed there.  All are scarred by the experience.  It is true to say that the two nations, Australia and New Zealand, were born on the battlefields of Gallipoli. 

My impressions of and emotional reaction to the battlefields at Gallipoli, and some photos, are in my post on this blog, on March 10, 2012.

An early 20th century genocide

In his CBC Radio program The Sunday Edition, Michael Enright reminded us that this year marks the 100th anniversary of the Armenian genocide of 1915. The Turkish military authorities arrested, tortured, and executed the Armenian intellectuals in Constantinople, and local authorities drove the populations out of Armenian villages and urban enclaves all over the nation. Men, women and children were herded on forced marches into arid regions lacking water, food, and shelter. Women and girls were subjected to mass rape, many who fell by the wayside on forced marches because they were too feeble or too ill to continue, were summarily executed - which, it could be argued, was a kinder fate than forcing them to keep walking until they died. An estimated one and a half million Armenians died in the genocide of 1915.  Abundant documentary and photographic records confirm that this genocide really happened. Among other more or less impartial observers, the German ambassador and American consular officials reported back to their leaders in Berlin and Washington quite detailed accounts of what was happening. In the protracted discussions in Paris in 1919 to draft a peace treaty after the carnage of the Great War of 1914-1918, the 'allies' who claimed victory were anxious to win over the charismatic Turkish army officer Mustafa Kemal (later to name himself Kemal Attaturk). They therefore refrained from drawing attention to the brutal slaughter, rapes, dispossession, destruction of churches - obliteration of all traces of Armenian culture - in order to get Kemal's signature and support for the peace treaty.

The mass killings, rapes, dispossession, destruction of cultural artifacts, obliteration of an ethnic and cultural minority in Turkey are now recognized almost everywhere as a genocide. The most recent leader to acknowledge publicly what happened is Pope Francis. Almost the only national leaders to deny what happened are in Turkey. American presidents, anxious to retain Turkish friendship, have equivocated and never stated in forthright language that there was a genocide. The US Congress voted a few years ago that there was a genocide.

Why did it happen? The Armenian population in Turkey was a distinct, readily recognizable group. The Armenians are Christian, the oldest or second oldest Christian community in the world. They are mostly well educated, relatively well-to-do, rather influential movers and shakers. These qualities are enough to arouse the envy and suspicion of the majority. A paranoid belief took root that Armenians were traitors, spies, supported the Russians, and sought to bring about the defeat of Turkey, Austria and Germany in the Great War.

One consequence of the genocide was the Armenian diaspora. Gifted writers, artists, actors, musicians, film makers of Armenian heritage have greatly enriched the intellectual life of many Western nations in the 100 years since the genocide. The first to cross my cultural horizon was William Saroyan. His parents had actually left Armenia earlier and he was born in an agricultural community in California in 1903; he and the Armenian community to which he belonged, became hosts to survivors of the genocide, some of whom considerably strengthened the nascent film industry. One consequence of my peripatetic life is that I've been obliged to discard many books as I've moved from one country to another. I acquired William Saroyan's Pulitzer Prize winning novel, The Human Comedy early in my medical student years and kept it, I recall, long enough for it to migrate from Adelaide, Australia to Edinburgh, Scotland. As best as I can recall, Saroyan's allusions to the Armenian genocide in that charming novel are oblique and low-key. His comments in some of his other writing, which I also had and have discarded, were angrier, more demanding from the Turkish authorities an acknowledgement that a genocide occurred in 1915, and suggesting that they should plead for forgiveness. That's all the Armenians want: they don't seek revenge, just recognition by the Turks that they wronged and harmed their Armenian minority, and should ask for forgiveness. Well educated modern Turks are aware of what happened. Some, including the Nobel Laureate Orhan Pamuk, have spoken out courageously. How much longer will the Armenians have to wait?

We can't be on both sides! It would be more sensible to be on neither.

The increasingly savage conflict in Yemen seems to be a proxy war between Saudi Arabia and Iran; USA is supporting the Saudis with satellite intelligence and heavy weapons. The Salafist Wahabi faction in Saudi Arabia is the philosophical base of IS or ISIS, and Iran, a Shia Islamic republic, is fighting against ISIS, with covert US (and Canadian) support. Iran supports the Assad regime in Syria, and despite this regime's war crimes, USA (and Canada) are getting closer to overt support for Assad and Iran too. But USA (and Canada) regard Saudi Arabia as a staunch ally in the Middle East, along with Israel, which doesn't get along well with Saudi Arabia and is implacably hostile to Iran. USA (and Canada) seem to be on both sides at once. I'm bewildered. I'd prefer to be aloof, neutral in this melee.

Wrongly interpreted events

Canada's Harper government has seized on the horrible events in Iraq and Syria, exhorting all Canadians to close ranks against a perceived threat from a barbarous band of unprincipled evil-doers, with the Harper government of course, leading the nation bravely into war against these evil-doers. Meantime a few thousand Km south-east in Kenya, a handful of Al Shabaab fighters (4 or 5 altogether) from Somalia descended on a small undefended private university just across the border in Kenya, separated the Christian and Moslem students as they slept in their dormitories, and slaughtered 147 of the Christians. The Harper government hasn't proposed military action against Al Shabaab. However, its statements imply that a holy war is in progress between genocidal Islamists and the defenders of righteousness (of Judeo-Christian persuasion). A few troubling facts suggest this is at best only partly correct. It may be utterly wrong.  Some of it is based on the same fantasy that asserted the Iraqis would welcome as liberators the American forces who invaded their country in 2003. One fact is that aerial bombardment, even with terrible weapons like napalm and cluster bombs, can't defeat a grass roots movement. Another fact is that populations who have been targets for napalm or cluster bombs (or any other form of aerial attack) do not perceive those who bombed them as friends. The bombing campaign the Harper government has so eagerly embraced, which will cost over half a billion dollars in the next year, will not win friends for Canada in Iraq and Syria. The Islamic State - an aspiration, a grass roots movement, not a real state - has committed some appalling atrocities. We have TV evidence from their own skilled propagandists as proof of this. But truth is the first casualty in all wars and I doubt if this is an exception. What reliable evidence is there of genocide? Another fact is that IS, or ISIS, or ISIL, is a Sunni Islamic movement; Shia Islam is its mortal enemy. That's the reason Iran, and the Assad regime in Syria, are aligned against IS - with Canada and USA. This is a Sunni-Shia war. On the basis of the old saying that 'My enemy's enemy is my friend' we have (the Harper government has) become an ally of Iran - where we recently closed our embassy - and of the reviled Assad regime. In the meantime, some 25,000 well educated youngsters from many western nations have made their way to the ruins of Syria and Iraq, eager to join IS. Why? What do they know that the rest of us don't know?  It's all very bewildering.

These events suggest to me that getting involved in a war against IS may be the most stupid mistake yet made by the Harper government - a government not noted for evidence-based decisions, noted by some of us at least for some spectacularly stupid policy decisions.

There is another interpretation of the dreadful wars and unconventional forms of conflict in progress in the Middle East and Africa. Rather than being based in disputes about faith and belief, the real underlying cause is a quest for what Hitler and the Nazis called lebensraum - living space and resoures. The most important fact of all may be that the world is overpopulated by at least an order of magnitude. The world would be a better place for all humans if instead of more than 7 billion of us, there were 700 million.

Dashing and dawdling

A glossy magazine insert in my daily newspaper had a revealing graphic about high speed trains in various countries. The speeds are shown in the obsolete US notation, MPH, rather than KPH, but make the point regardless. The slowest are the Belgian and Italian high speed trains; they reach 190 MPH; the Eurostar (London-Paris via the Channel Tunnel) hits 200 MPH on the sturdy French tracks, noticeably less as it crosses Kent and descends below the English Channel. In France, TGVs travel at 240 MPH. Japanese Shinkansen ("Bullet") trains and the German Transrapid reach 275 MPH. The fastest are the new Chinese high speed trains, which use an innovative propulsion system I learnt about in First Year University physics in 1944; they average just over 300 MPH but theoretically could travel at twice that speed. I've traveled on all except the Chinese high speed trains. They are all very comfortable and most are quiet. The Eurostar scores highest in my experience for comfort and quiet - and serves gourmet meals and very good wines. The Shinkansen can be noisy, but it has an unblemished safety record, no accidents in over 40 years. Indeed, all these high speed trains have excellent safety records, except the Eurostar and the newest entry in the field, the Chinese trains, each of which has had one or two crashes, though none with major loss of life or even injuries.  

London to Paris, Geneva to Paris  in 3 hours! With trains this fast, there's no contest with air travel: add check-in time and planes in line for an hour or more waiting to take off, and it's time-saving as well as much less stressful to take the train. If you've a mind to, you can get a lot of work done on one of these train journeys.

Intercity trains in Canada aren't included in the graphic. It's embarrassing to reflect how far behind Canada has fallen. Ottawa-Toronto "express" trains go as fast as they can on dubiously secure rail-beds with the antiquated diesel engines that pull them. For several brief periods they achieve 100 MPH, but the average speed is below 75 MPH. There are many level crossings as well as unreliable rails and rolling stock, and most trains make several stops. The Ottawa-Toronto trip typically takes 5 hours for a journey that a TGV or Shinkansen could make in well under 2 hours. 

In the early 1970s there was talk about modernizing train service in the Windsor-Quebec City corridor, with a diversion through Ottawa. There's been occasional desultory talk about modernizing train services ever since. Lately there have been subversive murmurs about contracting out to China the work of strengthening the rail-bed, constructing under-passes and bridges to eliminate the level crossings for many of which current trains must slow down, perhaps even allowing China to supply rolling stock.  It won't happen in my lifetime. Perhaps my grandchildren will live long enough to travel by train from Ottawa to Toronto in less than 2 hours, but I wouldn't bet on it.  

A Life Like Other People's

In 1961-62, Wendy and I and the two toddlers we had in those days had to survive for a year in London on a stipend meant for a single man without dependents. We rented a furnished part-house in Finsbury Park, 30 Newington Green, from a biochemist at St Mary's Hospital Medical School, who had a sabbatical year in USA. Most days I walked several miles to my office in the Social Medicine Research Unit behind the London Hospital Medical College on Whitechapel Road. Wendy made our financial survival possible by feeding us very well at rock bottom prices, walking two miles each way to Ridley Road street market, pushing David in the stroller, with Rebecca walking beside her. Usually Rebecca's little legs couldn't manage the walk home as well, so Wendy came back from the market balancing both kids on top of the spuds, sprouts, carrots and cheapest cuts of meat in the stroller. It was the nearest we came to living in real poverty. It was a wonderfully happy year, in some ways the best year we ever had, the year in which we discovered all the things you can do in London without having to spend a lot of money, or indeed, any money at all. 

We were too poor to take in the rich theatrical offerings available in the West End of London. My father took us to a vaudeville show once. And I took Wendy to see Beyond the Fringe as a special treat for her birthday. We saw it with the original cast and the original skits. It was one of the best things we ever saw on stage. The cast, Peter Cook, Dudley Moore, Jonathan Miller, and Alan Bennett, were four youngsters, fresh out of Oxford, on the threshhold of outstanding, brilliant careers.

Alan Bennett - quiet, lethally witty, a penetrating social critic - was the most thoughtful of the four.  He went on to achieve fame as a playwright and man of letters, best known for his TV plays Talking Heads, and for the west end success of his stage play that became an even more successful movie, The Madness of King George.

Recently I've been reading his memoir, A Life Like Other People's.  I knew that he, like Peter Cook, came from a working class family in the north of England - his accent reveals this, mellowed though it is by his years at Oxford. I knew nothing about his family or about the circumstances in which he grew up. His quietly understated account of working class family life in the aftermath of the great depression of the 1930s and during the 1939-45 world war describes his mother's recurrent bouts of severe depression, the shadowy family history of suicide, and the emotional ups and downs of his two aunts. One aunt joined the WAAFs and went to exotic foreign parts - India, the Far East - while the other stayed on in a department store. Both had emotional and marital troubles. The story reads to me like a family with the heritable condition, bipolar disorder. It describes also how such families made their way in the world, living hand to mouth, making their own entertainment, finding happiness in simple pleasures.  His unhappy Mam laments that theirs is not a life like other people's, but I think Alan Bennett describes a family life very much like that of tens of thousands of other people in England at that time. He is a master of the English language, and this little book, like everything of his that I've read, provides genuine aesthetic pleasure from the prose alone. I picked it up for a dollar in a jumble sale.  It's a keeper, that will go into the set of book shelves where I keep my most precious books. 

Alone in the Classroom

I haven't counted heads but I have a strong impression that among talented, successful fiction writers, women outnumber men by a considerable margin - at any rate in Canada. I think it's because empathy is an important quality for a writer to possess, and women tend to have a higher quotient of empathy than men do. I'm not a slow reader, quite the reverse in fact, but I read haphazardly and without reference to best seller lists. Thus I caught up with Alone in the Classroom,  Elizabeth Hay's best seller from a few years ago, only last week. It's a story in which her empathy for her characters comes through loud and clear. I've read her previous novels, greatly enjoyed her Giller prize-winning Late Nights on Air. I think this is a better book, a complex story that extends over three or more generations and manages to present three dimensional views of several people whose lives and loves are intertwined. Good and great story-tellers must have several qualities. They must be able to tell a story: narrative skills are important. They must be able to create characters, preferably well-rounded, believable people. They must be able to develop tension, conflict, challenge and response, crisis and resolution, so readers will ask "Then what happened?" -- and will eagerly read on to find the answer.  Another quality creative writers require is empathy, the ability to see the world through another person's eyes, and to present that other perspective with credibility and compassion. In much great literature and in most good fiction, this is the most important quality of all.  It is a quality Elizabeth Hay possesses in abundance, perhaps particularly in presenting her female characters, although she does pretty well with the two most prominent men in this book too. When I finished Alone in the Classroom, I knew the free-spirited Connie, the twisted, driven Parley, dyslexic, talented philanderer Michael, and half a dozen others with whom their lives collide. I've known real people like each of them. I'm less confident that I can identify among my friendship network a real person who resembles the sometime first-person narrator Anne, perhaps because she is too self effacing. Her personality is clear enough, her appearance less so. The physical appearance, clothing styles, mannerisms, as well as the personalities of the other principal characters are sketched so convincingly I would recognize them if I saw them in my neighbourhood supermarket. Probably every reader of this blog has already read Alone in the Classroom. If there are any who haven't, try it. You'll like it. 

What is this age we live in?

This is the age of hate and paranoia. Astute (cynical?) political leaders know that nothing binds a nation's people together as firmly as an easily identifiable hate figure. In the early 1930s when I was about 8, I began to read newspapers and listen to the radio. Benito Mussolini, leader of Italy's fascists, attracted our loathing because he was bombing and strafing Abyssinians armed with muskets and spears. The communist ideology made manifest by Stalin's regime in the Soviet Union and by some Australian trade union leaders was the object of paranoid hatred propagated in many print media and the radio stations they sponsored. A curious child increasingly aware of the world around me, I wondered why we should fear and hate a political philosophy that had many features resembling the teachings of Jesus as expressed in the Sermon on the Mount. As I went through puberty and my early teens, my country which was Australia in those days, went to war against Germany, Italy and Japan; we were part of the Free World, in contrast to the totalitarian regimes of Nazi Germany and Soviet Russia. It was easy to see and hear for ourselves if we understood German as I did - I was learning it at school - that Hitler was a very evil man. The USSR was evil too, or its leader Stalin was. He had show trials that led to execution of the intelligentsia, and brutally invaded Finland. Then a problem arose: in 1941 Soviet Russia was invaded by Nazi Germany and overnight became our second-best friend, surpassed only by Great Britain. That didn't last long though. By the late 1940s, many on the extreme right, my father among them, were asserting that we should nuke the Soviet Union before they too, like USA, got the atom bomb. Germany split asunder into good (democratic) West Germany and bad (communist) East Germany. All the countries of eastern Europe and the Baltic states were satellites of the USSR. They were bad. My passport wasn't valid for travel to any of those bad countries. 

Meanwhile, bewildering political changes swept over former colonial empires. French Indo-China became Vietnam, the Dutch East Indies became Indonesia, Northern Rhodesia became Zambia, Southern Rhodesia became Zimbabwe.  Portuguese East Africa became Mozambique, Belgian Congo became the Central African Republic, French Equatorial Africa fragmented into a dozen countries. Some of the leaders of these former colonies were on our side, therefore good, others weren't, therefore they were bad. Most were and are ruled by violent, bloody dictators, good friends if they grant us mining rights, our evil enemies if they don't. In Latin America, national boundaries remained intact but many countries that had been docile client states of the USA began to assert their autonomy and several had revolutions and civil wars. In Colombia the war between the government and the left wing FARC has been smouldering for 50 years.  Some leaders were bad, some not, depending mostly on mining rights and whether they had democratic elections (no matter how dodgy the election may have been). Cuba was a special case. Cuba sloughed off a repulsive criminal dictator, Battista, and for a few weeks the new leader, Fidel Castro, young, handsome, bearded, speaking quaint English that made much sense, was our hero, got a ticker-tape parade in New York. Then he said some things that were labeled communist (or maybe socialist - it's a long time ago, and I forget).  So overnight he became bad, and remained bad ever after. In Chile, the bloody military coup that ousted Salvadore Allende was a CIA operation that almost everyone in my personal and professional networks perceived as a profoundly evil example of American imperial excess - the worst until G W Bush's invasion of Iraq, which is having unintended consequences that seem likely to be with us for many years, perhaps until my grandchildren are my age.  

In the Far East (Australia's near north) China, which had been our ally in the 1939-45 world war became the People's Republic of China and our enemy. When the PRC flexed its muscles a little bit, very nasty wars broke out in the PRC's neighbouring states, Korea and Vietnam. The Korean war began in 1950 and never ended, or at any rate there's never been a peace treaty. North Korea is the baddest of the bad, the worst of the Evil Empire, and acts accordingly. The war in Vietnam was unequivocally a war of liberation in which the people of Vietnam sought freedom and autonomy from French colonial oppressors. In one of the great political tragedies of my lifetime, American administrations saw Vietnam as another 'domino' that would fall into the evil hands of the leaders of the PRC unless they intervened. They expended untold blood - mostly Vietnamese blood - and American treasure in ultimately futile attempts to keep Vietnam within the orbit of what they chose to call the Free World. Future historians may identify the Vietnam war as the turning point that marked the end of American global hegemony.

Iran, formerly Persia, was our friend when ruled by the benevolent Shah (our leaders said he was benevolent and of course they were honest men). The Shah aspired to have atom bombs, had a large army and air force, and had secret police who pulled out schoolboys' fingernails - one little schoolboy grew up to become a student of mine in Edinburgh 10 years later. When he was 9 or 10, his fingernails had been pulled out by the Shah's police in front of his father, using needle-nosed pliers, in an attempt to persuade his father to confess to subversion of the Shah's regime.  His deformed fingers never fully recovered. Then the Shah was replaced by the Ayatollah Khomeini, who was bad. His revolutionary guards were more brutal, more malevolent, than the Shah's secret police. My Iranian friends tell me many are the same people, even wear the same uniforms. My Iranian friends, almost all academics, despair of seeing changes for the better in their lifetimes. Iran is the living residue of one of the oldest organized civil societies in the world. It is sad, indeed tragic, that it is the target of bitter and perhaps paranoid hatred of the Israeli government. As for the Israelis, they seek to maintain a Jewish state in the implacably hostile Middle East. I have lost count of the number of wars they have fought against their neighbours, especially the unfortunate Palestinians. With American support, they have won all these wars. So far. They have nuclear weapons, and no doubt others as terrible. I think it is unlikely that they will go on winning these wars forever in the future. A few of my Israeli friends share my doubts and have left Israel to live in more tranquil countries. The closest I've come to the perpetual hostilities in the Middle East was during a visit to Beirut in 1998. The Lebanese civil war had ended but the scars remained everywhere in central Beirut, for example the top floors of the tower of the Holiday Inn, blackened, burnt out, destroyed by artillery and rocket propelled grenades. At night when the traffic noise quietened, I could hear distant artillery and small arms fire along the line of demarcation between the Israeli Defence Force and the Hezbollah forces in southern Lebanon; this was a constant background noise throughout the weeks I spent in Beirut. My Lebanese colleagues told me they barely recalled a time when distant (and sometimes very close) gunfire could not be heard. No one can honestly say who is good and who is bad in this cauldron of ancient hatreds.  

This is a haphazard partial summary based on memories that are bound to be selective. I do my best to stay abreast of these changing political alliances although some make me recall a song about the Vicar of Bray (dating from Restoration England) that a possibly subversive school teacher taught my Grade 3 or 4 class when I was 8 or 9 years old. The Vicar of Bray might be a useful role model for us all in these turbulent times.

44 Scotland Street, Edinburgh

One of my most refreshing pleasures is to live a while with the occupants of the flats at 44 Scotland Street, Edinburgh, and their friends and acquaintances. The latest instalment is "Bertie's Guide to Life and Mothers" in which Bertie turns 7; his appalling mother Irene wins a prize air trip to Dubai where she is confined in a sheik's harem in the desert and starts a book club for the sheik's wives; Angas Lordie's sleepwalking is cured by a single consultation with Pat's father, the psychiatrist Dr McGregor, who acquires an email-ordered companion from the Czech Republic; Pat falls in love with a handsome furniture-maker; Angas Lordie's wife Domenica is visited by their former neighbour Antonia and Sister Maria-Fiore dei Fiore di Montagna, her aphorism-prone fellow-nun; Matthew and Elspeth and their triplets Rognvald, Tobermory, and Fergus (indistinguishable except for their names, and Matthew has mixed them up at least once so their birth order is now unknowable); their au pair Anna from Denmark and their au pair's Danish au pair Birgitte, relocate from India Street to a manor house in the Pentland Hills, Big Lou takes on a foster child, Finlay, who becomes Bertie's protector; and under Alexander McCall Smith's gentle, occasionally profound plot-weaving, (almost) everyone is happy and content. This partial synopsis is my attempt to explain why  the 44 Scotland Street books are my favourites of all the delightfully inventive series by the prodigiously prolific emeritus professor of medical law at the University of Edinburgh.

The 44 Scotland Street series (9 books so far) describe the lives and times of the occupants of the 8 flats at 44 Scotland Street. Wendy and I lived in a comparable commodious flat at 22 Eyre Crescent, just around the corner from Scotland Street, for several months in 2002; there’s no #44. Bertie Pollock, the ‘gifted 6-year-old’ lives with his ultra feminist Mum and his statistician Dad in one of these flats. Other characters live in the 7 other flats in the building, or nearby. “The Sunday Philosophy Club” is the 1st book in the Isabel Dalhousie series, also set in Edinburgh, also 9 books so far; each of the Isabel Dalhousie series comes nearest to containing a ‘cosy mystery’ but that’s not why I read them. McCall Smith is a distinguished bioethicist, and he smuggles ethical conundrums into both series, and into his other books about the Number One Ladies’ Detective Agency (15 so far) set in Botswana. I’m addicted to the two series set in Edinburgh because they massage my nostalgia for that loveliest of cities, because Alexander McCall Smith writes very well, because they are gently humorous - and occasionally hilarious - and because they are about basically decent people, even the appalling Irene Pollock, who means well but is the worst mother ever for a little boy who just wants to be a normal little boy, not a gender-neutral child as his Mum aspires to mould him to be. I’d hoped to meet Alexander McCall Smith when the University of Edinburgh gave me an honorary doctoral degree in 2003, but he attended the convocation for the faculty of law, not the faculty of medicine where I got my robe, hood and parchment. He must be a remarkable man, well into his 80s now, still churning out several very well written, well-plotted, always thought provoking books every year. He types his books rather than using a word-processor, and one of his neighbours told me that on summer evenings when everyone’s windows are open, they hear his typewriter tapping away every night, far into the night. He inserts real people, other Edinburgh writers like Ian Rankin for instance, for minor walk-on parts in his Edinburgh-based stories.

Memories - true or false?

False memories have had a lot of attention lately because a respected TV news reader has been caught telling little white lies, or great big ones - the sort called porkies in rhyming slang. I've commented in earlier posts in this blog on the physiology of memory, and I've described my memories of many experiences, often in detail. Are all my memories true? Do I have any false memories? Many experiences I've described in posts on this blog are reinforced by photos I took at the time, and some are further supported by my notes or other records. Wendy's diaries and scrap-books reinforce my accounts of some highlights. I don't think I have any false memories.

Photos in our family albums have evoked and strengthened many memories, but there's no photo of that fig tree or the man in it, or of the three policemen watching it cautiously.

I'm sure Wendy kept a diary in 1957, but my diligent search has failed to find it. She must have destroyed it. That's unfortunate, because I'm sure she would have recorded my encounter with the rifleman in the fig tree.  I told her all about it less than an hour after it ended, and she provided much needed comfort in the week or two afterwards when I was still shaking. I have all of Wendy's diaries from 1951 until she became unable to write a few weeks before her death from motor neurone disease (ALS) with the single exception of her diary for 1957. It was a stormy year (see my post of June 28, 2013) so she probably had good reasons to do away with it when tranquility - if that's the word I want - came back into our lives.

My vivid memories of that scary episode include details such as the fact that the man had a bandage on his wrist and the policeman in charge had bad breath. Perhaps there's a police record, if the suburban police in Adelaide keep records for that length of time. I doubt if the event made it into the Adelaide Advertiser or the News (Rupert Murdoch's paper, from which he launched his worldwide media empire). Readers of this blog will just have to take my word for it. 

Does facing death require courage or bravery?

I was 6 or 7 when our bouncy terrier was hit and fatally injured chasing after one too many cars. We wrapped him in his old blanket which soon got badly stained with his blood. I watched as his breathing became laboured and his obviously painful whining faded into silence. Then the sparkle disappeared from his eyes: they went sightless and without anyone having to tell me, I knew he was dead. It wasn't the first death I was aware of in my family, but it was the first time I observed and understood the difference between living and dead. I was about the average age at which children can grasp this concept, the distinction between life and death. I could comprehend the fact that the transition is irreversible. Once we are dead, there is no way back to life again, at any rate outside the pages of gothic and supernatural fiction. 

Paediatric cancer specialists with empathy know that it is cruel and wrong to withhold the truth from children over the age of about 8, when ultimately their cancer is going to kill them - and that this might happen rather soon. Children of that age have enough insight and self awareness to recognize that they are getting worse, not better.  They do not like their parents and their doctors to lie to them, and it is harmful and wrong for parents and doctors to deceive children who want to decide for themselves who will get their most treasured possessions. What's more, many children who face this fate are able to do so with courage and good humour. I have not had to care for many children facing inevitable and imminent death, for which I am thankful. In 1952 when I was a paediatric resident at Edgeware General Hospital in North London, a little girl about 9 years old was dying of bone cancer. She was cheerful most of the time, except when the pain of her cancer escaped our best efforts to suppress it.  She played happily with her doll and her teddy bear, reading aloud to them. She got sad when her parents came to see her because, she said, her Mum always cried and her Dad looked so unhappy. My chief, Dr Margaret Baber, asked the child if she knew what was going to happen to her.   I can't recall her exact words, but she knew her leg had been cut off near her hip because it had got cancer, knew that the cancer had come back, and knew that she would soon die. As far as Dr Baber, the experienced nurses, and I could tell, she accepted her fate calmly, without bitterness or anger. Was she courageous? Perhaps. She may have been in denial. I can't say one way or the other.

I've seen enough deaths to be aware that courage or bravery aren't usually important issues. Wendy and I knew immediately that the neurologist Pierre Bourque gave her a death sentence when he told us his diagnosis of her vaguely defined symptoms and signs was ALS, or motor neurone disease. She accepted it calmly, more calmly than I did, and we lived with the inevitability of her death for 14 months until it became a reality. Previously we had talked several times about the end of our lives and how best to prepare for this. In our mid-80s we were well adjusted to the certainty that death would come to us sooner or later. We were greatly reassured when our palliative care physician Louise Coulomb described how Wendy would die and what we could do to minimize distress. Philosophical acceptance of inevitability describes her attitude, and mine, better than courage or bravery. We were both profoundly grateful for long, useful, well-lived lives that turned out much more interesting, exciting, and fun than we'd have expected if we'd thought about it on the day we decided to join our lives together.

My own first unequivocal close encounter was my departure from Paris in April 1952. I flew, to allow me to have the maximum time in Paris. As we took off from Orly to return to Heathrow, an engine caught fire, the pilot slammed on the brakes and we ended nose down, propellers buckled, in a ditch well beyond the end of the runway. I had a momentary flash of alarm as I looked out the aeroplane window and saw all the flames and smoke pouring from the engine; after that everything happened so quickly there was no time to feel afraid. I had a delayed bout of something like panic as a replacement aeroplane raced along the runway a couple of hours later, and I was shaking all over for a few minutes, but it passed off once we were airborne.  In November 1958, Wendy and I and baby Rebecca flew to New Zealand to meet Wendy's family. I was incubating a nasty chest infection as we flew across the Tasman Sea, and a few days after we arrived at Mum and Pop Wendelken's home I was delirious with a high fever.  My recollection of the next few days is very hazy and incomplete. I was admitted to a local hospital and put in an oxygen tent with a detergent mist to loosen the sticky mucus that  was choking me. For a day or two, in my lucid moments I and the young chest physician caring for me thought I might die. Well, he thought I would die; I was delirious and unaware for much of that time, but as I began to get over the worst, I became obsessed with anxiety about my seemingly imminent death - anxiety about leaving Wendy destitute with baby Rebecca not yet a year old and Wendy heavily pregnant with another one. Since the 1950s I've had several more terrifying experiences in the air or approaching a runway in bad weather. It hasn't helped when the aircraft have been in an obvious state of disrepair. Flying out of Medellin in Colombia between towering mountains, into Hong Kong in a monsoon deluge, in and out of boondock airports in Indonesia, also in monsoon rains, were nail-biting experiences but at the time none felt like my last moments. There've been near misses in traffic a few times too, and once at least when swimming in heavy surf off a North Shore beach in Sydney when I really thought for a few moments that I would drown. My life didn't flash before my eyes but as in the oxygen tent in Blenheim, New Zealand, the thought of leaving Wendy and the kids ill prepared financially made me determined to live. That didn't require courage, just muscle power enough to fight the waves and the tide rip for a few moments longer until I was out of harm's way. Courage or bravery weren't what I needed and found, just determination to survive. My father and his wife possessed it too, when they survived in a lifeboat in the North Atlantic off Iceland after their ship was torpedoed a week before Christmas in 1940. Several others in the lifeboat younger and perhaps fitter than they were didn't survive. 'Will to live' - whatever that is - accounts for it I suppose.  When we were young and middle-aged adults Wendy and I had plenty of will to live. Now, not so much.

Battlefield conditions in wartime are far from the only setting in which courage and bravery - and their opposites - are revealed and displayed. The display may be unobtrusive, low-key, or dramatic, flamboyant. The accompanying states of mind likewise vary greatly. Wendy's state of mind throughout her terminal illness can be summed up as philosophical acceptance. Mine was much the same. I had mixed emotions about facing life without her, on one hand, thankful that I was behaving as a gentleman should, letting her go first, sparing her the emotional stress of clearing up after a long, loving marriage ends; and on the other hand, sadness and even despair at the thought of life without her by my side.  Four years later, those emotions are unchanged, but I've accepted my fate and am trying as best I can to carry on without her.