Medicine and literature

Let's go back to books again. In the late 1990s my friend Karen Trollope Kumar invited me to take part in a symposium or colloquium on the role of the humanities in medicine and healing. I accepted with pleasure, gave a talk that was well received, and subsequently got this published. This is not part of my list of essential books, although a few are -- I'll come to those in a later post sometime. To go on with, I will paste here the text of those remarks at McMaster University Medical School in 1999.

Medicine and Literature

Passion, compassion, confusion and other emotions in stories about sickness and healing

A complete physician needs insight transcending the knowledge, skills and attitudes that professional training provides. How can this be achieved? Personal experience of illness and suffering, or that of a close family member or a loved one, can do it. It is painful, but it can be a good way to comprehend the complexities of life, and of human nature.

Another way is through the humanities -- a rich source of insight into the human condition and the role of healers. The ethical, moral, and spiritual dimensions of sickness and healing are eloquently displayed in the creative arts -- in music, painting, sculpture, and most of all, in literature -- drama, poetry, fiction. Here I can only skim over the surface, touching without penetrating into the immense variety and richness to be found in literary works. (I mean real literature, not what authors of journal articles commonly call “the medical literature” -- a phrase that is almost always an oxymoron).

Our understanding of the complexities of society and human nature, and our values, come from good literature as well as from our medical experience. Fiction can portray social conditions brilliantly, as Charles Dickens did, for instance in Oliver Twist (1837) Dombey and Son (1848) and Little Dorritt (1855). Good writers often reflect life and the values of their time. HG Wells, in Kipps (1905) and Anne Veronica (1909); JB Priestley, in The Good Companions (1929); Sinclair Lewis, in Babbitt(1922); John Steinbeck, in The Grapes of Wrath (1939); George Orwell, in Down and Out in Paris and London (1933), and The Road to Wigan Pier (1937); and legions of others in many countries have upheld this tradition through all the wars and turbulent events of the 20^th century. John Updike’s four books about Harry (“Rabbit”) Angstrom, which dissect the life and values of an “average” American man and his family over the four decades from the 1960s to the 1990s are a good contemporary example.

The workings of the mind, and the whole range of emotions are another fruitful field for novelists -- and for poets. James Joyce's Ulysses (1922) perhaps the greatest novel in the English (or any other) language may be the best textbook ever written about how the mind works. Sylvia Plath and Anne Sexton revealed their tormented souls in their poems. Moran Campbell, a former chairman of the department of medicine at McMaster University, movingly described his bouts with the peaks and troughs of manic-depressive disorder in his autobiography, Not Always on the Level. The 19^th Century Scottish poet James Hogg captured the personality of a paranoid psychopath in The Private Memoirs and Confessions of a Justified Sinner (1824), a work of fiction that reads chillingly like fact.

And the works of Shakespeare, of course, are the human mind laid bare, displayed in all its glory, misery, squalor, high spirits, splendour, imaginative sweep. Shakespeare's plays are at the highest pinnacle of a tradition that began with Homer and the Greek tragedians and continues through Samuel Beckett and Arthur Miller. Shakespeare is the undisputed master. If you would understand humanity, heed Hamlet, know Lear, love Rosalind, roister and frolic with Falstaff.

You can learn about the human dimensions of many aspects of disease and medical care from literary accounts:

· How tuberculosis affects people, from Thomas Mann's Magic Mountain (1946) and in a more emotionally wrenching way, from The Rack (1958) by the pseudonymous AE Ellis.

· About the sorrows and pleasures of growing old, from Love in a Time of Cholera (1989) by Gabriel Garcia Marquez.

· About transsexuality, from Melisio, who becomes Mimi, in Isabel Allende's magic realist novel Eva Luna (1988)

· About the impact of mental illness, and the deplorable way it has been treated by sadistic mental hospital staff, from Ken Kesey’s One Flew Over the Cuckoo’s Nest (1962) which was made into an excellent movie.

· About the descent into the self-destructive vortex of alcoholism, from Under the Volcano (1947) by Malcolm Lowry, also made into a good movie.

· What the long, slow death from multiple sclerosis is like from the inside, in Journal of a disappointed man (1964) by W N P Barbellion (which is fact, not fiction).

· And about terminal illness and the inevitability of death, from many accounts, best of all perhaps in Leo Tolstoy's masterly short story The Death of Ivan Ilyich (1884).

Passion, compassion, confusion, and other emotions encountered in medical practice have been described by many creative writers, including some doctors.

In “The Use of Force,” William Carlos Williams, a family doctor, and a lyrical poet and short story writer in depression-era Paterson, New Jersey, described the passion of anger. He absolutely had to look at a little girl's throat because he suspected she had diphtheria. She fought him every step of the way. Her throat was hers! No busybody doctor was going to see it. She knocked his glasses off, kicked, scratched, and bit him. He got really angry. Here, abridged a little, is William Carlos Williams in New Jersey in the 1930s:

... now I had grown furious -- at a child. ...the worst of it was that I too had got beyond reason ... I could have torn the child apart. It was a pleasure to attack her... The damned little brat must be protected against her own idiocy ... in a final unreasoning assault I overpowered the child's neck and jaws... I forced the heavy silver spoon back of her teeth and down her throat till she gagged. And there it was -- both tonsils covered with membrane. She had fought valiantly to keep me from knowing her secret. She had been hiding that sore throat for three days at least and lying to her parents to escape just such an outcome as this. Now truly she was furious. She had been on the defensive before, but now she attacked. Tried to get off her father's lap and fly at me while tears of defeat blinded her eyes.

I’m sure this is a true story. Not long before I first read it, I had slapped a girl about that age, in front of her mother too, because I was fed up with her tantrums. (It was the act in my professional life that I am most deeply ashamed of, but at the time, more than 40 years ago, it felt satisfying and amply justified -- and it worked. Now it would be a criminal offence).

William Carlos Williams's gritty, real-life Doctor Stories are beautifully written accounts of real events and real people, but they are not comfortable reading. They explore the most powerful emotions a doctor can experience in dealing with sickness and suffering, birth and death.

Samuel Shem had just finished his internship year when he wrote The House of God about 20 years ago. Its black humour has been compared to Catch 22 and Mash but it is more obscene, scatological, cruelly callous -- yet also it is compassionate, sometimes very funny, and it can be deeply moving. A few scenes are unforgettable. One is the suicide of an intern who can't take it any more. Well, that's the facile, superficial explanation. The reality is that premonitory signs notwithstanding, no one, including the narrator, Samuel Shem’s alter ego, attempted to intervene as the unfortunate Potts slid into irretrievably profound depression. Another is a brief scene, sketched in just a few lines, of a young married woman who is brought in by the police for a medical examination after being raped. Her husband joins her. In a few lines about their body language, Shem describes how their lives and their loving relationship have changed forever:

“Have you called your husband yet?”

“No... I’m too ashamed,” she said, and she lifted her head up for the first time and looked me in the eyes, and first her eyes were dry cold walls and then, to my relief, they broke apart into wet pieces, and she screamed and screamed out, sob after sob ... after I did the workup for rape I called [her husband]. He’d been worried stiff and was glad she wasn’t dead. He could not know, yet, that part of her had died. [Her husband comes to collect her]... I watched them walk down the long tiled passage. He went to put his arm around her, but with a gesture I knew was disgust at the ruination of her body by a man, she pushed it aside. Separate, they walked out into the savageness...

They never will touch one another again as they did before that night's evil was done. Vignettes like this elevate Shem above the brutal obscenity and ribaldry in the rest of this excellent book.

Doctors are often confused. The Yale surgeon Richard Selzer, a superb writer who ultimately quit surgery to write full-time, described how he once was transported back to the Middle Ages, confused, fearful, possessed by a devil, when on opening an abscess he was confronted by something alive, a hideous face with antennae and eyes staring at him. Reading this makes the hair on the back of my neck bristle. He managed to snare this unearthly beast with a pair of forceps, got it into a bottle of formalin. It was the maggot of a bot-fly, the abscess a common one in cattle, rarely seen in people. It was a deeply disturbing, confusing experience.

Confusion? Pity Emma Bovary’s cuckolded husband, poor Charles Bovary! In medical school he didn't even begin to understand what he was being taught, and when he became a country doctor he could not apply any of it. He lurched and staggered from crisis to crisis, reaching the depths with a major medical disaster, a badly botched diagnosis, at the same time as his marital disaster. He was dazed and constantly bewildered as a medical student:

The curriculum that he read on the bulletin board staggered him. Courses in anatomy, pathology, pharmacy, chemistry, botany, clinical practice, therapeutics, to say nothing of hygiene and materia medica -- names of unfamiliar etymology that were like so many doors leading to solemn shadowy sanctuaries. He understood absolutely nothing of any of it. He listened in vain; he could not grasp it. Even so, he worked. He filled his notebooks, attended every lecture, never missed hospital rounds. In the performance of his daily tasks he was like a mill-horse that treads blindfold in a circle, utterly ignorant of what he is grinding.

I can recall feeling a little like that once or twice when I was a medical student, but not all the time, thank goodness. I can also think of one or two students like Charles Bovary whom I’ve tried in vain to teach...

Confusion and disaster go together in Isabel Allende's account of the tragic death of her daughter, Paula -- brain dead in an episode of acute porphyria, and a long, slow death in deep coma. No one should read Paula as an account of a personal family tragedy due to a medical misadventure, though it is that too. Paula is about much else -- the Allende family, the culture and politics of Chile, lovemaking and childbirth as well as death, the evil of the Pinochet era and the good that overcomes that evil (themes that recur in Isabel Allende's other books) and her own passionate nature and the magic reality of her own life. And the long-term home care of a comatose patient with a tracheostomy... Paula is a celebration of life, and I think it will become a classic.

I am an epidemiologist, so I like books about epidemics. Berton Roueche’s “Annals of Medical Detection” in the New Yorker aroused my interest when I was a medical student, long before I thought of becoming an epidemiologist myself. Two and half thousand years later we puzzle, over Thucydides’ meticulous account of the epidemic that struck the Athenians at the end of the first year of the Peloponnesian War. Now we debate its possible cause, because we can't identify it despite the details Thucydides gives us. Daniel Defoe described in fiction 60 years after the fact the outbreak in 17th century London in Journal of the Plague Year (1722). Samuel Pepys who was in London in the plague year described it too, made it come to life so you can feel the fear and fatalism that infected Londoners even when the plague bacillus did not. Albert Camus's La Peste (1948) is ostensibly about the outbreak of bubonic plague in Oran, Algeria, in 1946; but it is really an allegory of how people become infected with evil ideas and beliefs like fascism. Camus fought in the French Resistance, and knew what he was talking about. Alexander Solzhenitsyn's Cancer Ward is another allegorical novel, a treatise on the cancerous onslaught of Soviet communism on the body and soul of Russia.

There is plenty of humour in fictional works about the doctor's trade. Much of it is satirical, deflating the egos, pricking the pomposity that prevails among too many of us. Shakespeare and Dickens let doctors off lightly considering the professional shortcomings of their times. Not Moliere or Laurence Sterne though: Dr Slop in Tristram Shandy (1759-64) is contemptible as well as a figure of fun. Proust’s description of one of his many doctors, who could discretely palm his fee like a magician, makes me smile ruefully. I had a partner like that when I was in practice... Sir Roderick Glossop, the brain surgeon in P G Wodehouse's novels, is a ludicrous caricature with no medical credibility. George Bernard Shaw was merciless, sceptical about the irrational behaviour of doctors in the first half of the 20^th century. In Doctors’ Dilemma, which Shaw called a tragedy, he reserved his most savage criticism of medical customs and mores for the Preface which is salutary reading for everyone in the medical profession who is beginning to suffer from hubris. If Shaw were writing now, would he think we have improved? Have we improved?

It takes a real doctor to display our profession in ways that make me laugh out loud. Has there ever been an account of how to treat a belly-ache that can top A Cure of Serpents? Alberto di Pirajno’s treatment regimen was not only unorthodox, it was highly unethical. But it was very effective! (You must read his book to find out what it was; I won’t reveal it here). Richard Gordon and Colin Douglas, two pseudonymous modern British light novelists can make us laugh out loud too. Gordon's Doctor in the House (1952) and Doctor at Sea (1953) ring hilariously true. I find Doctor at Sea especially satisfying, having been a ship's doctor myself a few times, and had experiences like some of those that Gordon describes.

We have fictional portrayals of noble and good doctors too, like Tertius Lydgate in George Eliot’s Middlemarch. (1871). One “fictional” character from the early 20^th century was a real person, the anthropologist and psychiatrist W H R Rivers, who treated shell-shocked soldiers in the Great War. He is brilliantly and sympathetically brought back to life in Pat Barker’s superb Regeneration trilogy.

The honour roll of doctors who deserted their calling to become writers is long and impressive. But some marvellous writers stayed on. It is a deeply satisfying aesthetic pleasure to read them. William Farr's success as a social reformer owes as much to the power of his language as to the facts he displayed in his Annual Reports (in Vital Statistics, part of his job as Compiler of Abstracts to the newly created Office of the Registrar of Births and Deaths in England and Wales). He held that office for over 40 years, from 1839 until near his death in 1883. Not a year went by without his beautifully crafted, rich and rolling phrases tugging at the emotions and the sensibility of his political masters. In his Report in 1874, he addressed the dramatic differences in health levels among English towns:

Take for example the group of 51 districts called healthy… turn to the district of Liverpool. Here it is evident that some exceptional causes of death are in operation in this second city of England. What are these causes? Do they admit of removal? Is this destruction of life to go on indefinitely? Of 10,000 children born alive in Liverpool, 5396 live 5 years, a number that in the healthy districts could be provided by 6554 annual births. This procreation of children to perish so soon, the sufferings of the little victims, the sorrows and expenses of their parents, are as deplorable as they are wasteful. In Liverpool the death of children is so frequent and dreadful that a special system of insurance has been devised to provide them with coffins and burial ceremonies. The mother when she looks at her baby is asked to think of its death, and to provide by insurance not for its clothes but for its shroud and other cerements.

Farr’s contemporaries wrote well too. Read Florence Nightingale's Notes on Hospitals (1863) or her better-known but slight and slim volume of Notes on Nursing (1859). Read John Simon on Filth Diseases (1876) or on English Sanitary Institutions (1890) or go back to 1798 and read Edward Jenner’s Inquiry into the causes and effects of the variolae vaccinae, which describes his experiments with cowpox vaccine -- probably the most important advance in public health sciences of the past thousand years.

William Osler's Principles and Practice of Medicine, published in 1892 was a tour de force the like of which we will never see again, because it is no longer possible for the mind of one person to encompass and write about the entire body of medical knowledge. Osler's textbook is worth reading today, not only for the timeless clinical wisdom (clinical signs haven't changed) but also for Osler’s graceful, elegant prose style.

Alas, as every medical editor knows, such gifts that once were common among learned people are rare nowadays. Far too many authors of papers in contemporary medical journals are like cuttlefish, hiding in their own ink. Pitifully few can communicate an important medical or scientific message in good prose -- the verbal equivalent of a musician with perfect pitch.

Lewis Thomas did it, in sparkling essays, many of them published as “Notes of a Biology Watcher” in the New England Journal of Medicine. Collected in book form they won two Pulitzer Prizes. Peter Medawar did it, and Oliver Sacks can do it too. But the little company of medical writers whose prose is like music or poetry is shrinking. I can count on my fingers the ones who give me pleasure as I read, and whose thoughts I admire.

You too can make life more pleasant for medical editors and for those who read what you write: learn to write well by following these examples! Even the good writers among you can become better. But of course this is not the real reason to read books like those I have mentioned here. The real reason is to enrich the mind and spirit and experience the pleasures of reading.

Books on the sciences

There's a corridor between the tower block we live in and the car garage, and in this corridor there's a set of shelves in which people place books they have read and no longer want to keep. I'm often intrigued at the diversity of our neighbours' reading habits. Predictably there is a preponderance of thrillers and mysteries, a steady trickle of books on economics, politics etc, a few travel books, and occasionally some rather heavyweight philosophical literature. Of course some of the books are in French, because that's the first language of ten or a dozen of our neighbours. Today somebody left there a copy of Thomas Kuhn's ground-breaking book, The Structure of Scientific Revolutions, which looks as if it's been read by the former owner and by nobody else. I snapped it up instantly. It's mine now, perhaps the fourth or fifth copy of this book that I have owned -- somehow, copies of this book, which I used to keep on the shelves of my office at the University of Ottawa, went walkabout more often than almost any other book.It's hardly surprising. It's one of the absolute essentials for all serious scholars of science, whatever branch of science one engages in. Kuhn's concept of paradigm shifts has been almost of biblical significance ever since it first came out, in 1962 according to the copyright page of this copy, which is the umpteenth printing of the second, enlarged edition, first published in 1970. I think I would rate this book among the absolutely essential works that all serious students of any of the sciences must read (the others include Claude Bernard on experimental medicine, preferably in a better translation than the one I struggled through, Peter Medawar's Induction and Intuition in Scientific Thought, and going back a while, Charles Darwin's Origin of Species. Having said this, I've just looked at Kuhn's footnotes and realized something I only half-remembered from the last time I read his book, that his citations are almost entirely confined to the physical sciences, astronomy and chemistry. I don't think there is a single reference to biological or medical sciences. Perhaps he didn't consider these to be sciences at all. I shall have to settle down and read the book again nearly 40 years after I first read it, to see whether I still consider it to be an essential part of the scientific literary canon.

Crab apple wants in

I can't resist adding one more from yesterday, a large crab apple tree in full bloom beside the Dow's Lake pavilion. This was a "point and click" photo out the driver's side car window when I took my foot off the accelerator pedal, let the car creep very slowly forward. I daren't stop. Not only threatening signs but a traffic police lady just behind me might have got very cross if I'd stopped. A flower I forgot to mention yesterday is the native trillium, a delicate three-petal flower that grows in the shade under trees. Not many around the Canal, but lots further afield, and like everything else, better this year than any time in the past 40 years.

Spring time in Ottawa

Our seemingly never-ending spring continues after a momentary interruption, a steamy, oppressive day yesterday. But today was another lovely day of clear warm sunshine with occasional clouds. The profusion of blossom and spring flowers was the best I've ever seen in Ottawa, too lovely to enjoy on my own, so I bundled Wendy into the car and took her for a short spin along Queen Elizabeth Drive around the Rideau Canal to Dow's Lake to enjoy the display of tulips that are at their best now. As well as tulips, there are large beds of daffodils, crab apple blossom, lilac in full bloom, magnolias, apple blossom and others I don't recognize. Even the thousands of yellow dandelions in the grass that most people think are weeds looked splendid I thought, better than lawns that are nothing else but manicured grass treated with pesticides. Our enlightened local government has banned pesticide treatment of lawns. The two photos above are among the selection I took today. I'm tempted to add others but these are enough to show what the city looks like today. Wendy thoroughly enjoyed her day out, so it was well worth it. Incidentally, the office tower visible above the tree tops and the bed of orange-colored tulips is where Rebecca works. I suppose she was hard at work in there while Wendy and I were admiring all the flowers and blossoms.

Smoking kills

One of the ineffable pleasures of life is reviewing proposals that publishers receive from aspiring authors. Publishers reward reviewers handsomely in cash or kind for this service: they invest a lot of money in making, marketing, promoting the books they publish; if the book is rubbish that nobody buys, the loss is substantial. In the case of scholarly books, scientific books, textbooks, reference books and the like, reviewers provide a vital additional service, a detailed critical review, analyzing the science, the logic, the new discovery, whatever, that the book is about. Sometimes my reviews of books in that category were many pages of single-spaced typescript in length. One long review of that sort (a negative review, advising the publisher not to invest in publishing the book in question despite an eloquent proposal, detailed outline, and sample chapter) earned me a fee of $500. The book was eventually published of course, by another publisher; and reviewers for specialized journals cut it to pieces; it sold very few copies, and later I saw whole rows of remaindered copies in a New York book shop. I reviewed many proposals for Oxford University Press and almost always asked for books to the value of the money I would otherwise have earned. My book shelves, and our grandchildren's, are the richer for this. About five years ago I reviewed for the Wellcome Foundation for the History of Medicine, a proposal by Conrad Keating for a biography of Richard Doll. The book has been published, and I've been reading it with the same kind of ineffable pleasure that I got from reading the original proposal and many others like it.

I knew Richard Doll for about 50 years, at first as a highly respected colleague in my field, then as a friend. I met his wife, Dr Joan Faulkner, who was the executive secretary of the Medical Research Council, early in 1961 when I was a visiting fellow in the MRC Social Medicine Research Unit, then met, or rather heard Richard speak, on several occasions later during the same year. I first got to know him and his wife Joan as friends when they stayed with us at our home on Island Park Drive in the early 1970s. Our rather snobbish neighbour was horrified that Sir Richard and Lady Doll were shucking strawberries in our kitchen, helping Wendy and me to prepare for the guests -- my colleagues and assorted dignitaries -- whom we had invited to meet the Dolls that evening. I didn't bother to mention to that neighbour that Richard Doll, like several other distinguished British doctors who grew up in the 1930s, was for many years an active member of the Communist Party; perhaps I should have. During the last 10-15 years or so of his life, I became, as he was, one of the elder statesmen of the International Epidemiological Association, although of course I merit that term "elder statesman" many orders of magnitude less than he! And during those years we became good friends who shared many values beyond our commitment to epidemiology. The book that Conrad Keating has written, Smoking Kills: the revolutionary life of Richard Doll, is excellent. Keating writes well, explains and interprets for lay readers the results of Richard Doll's research with accuracy, clarity and eloquence that rarely grace the prose of non-scientists who write about science. For me there is the added pleasure of knowing as colleagues and often as friends a high proportion of the people mentioned by name in the book. I've seldom enjoyed a biography more than this one, indeed on reflection, I don't think I ever have. I'm sorry to say that the book is not very well made -- like a few others sponsored by the Wellcome Foundation, I am left with the impression that they went to tender to get it published, and selected the lowest bidder. The end result is acceptable, just, but could have been so much better if the book had been published by one of the university presses for instance. It's a small blemish though. The contents count for more that the slightly shoddy book-making. And I give the contents three thumbs up.

A Wedding is Coming in July

Last night Desre and David Skype-phoned us from Toronto with the happy news that they are to be married in July, in a small private ceremony at the home of Desre's sister in Irvine, California (a little way south of Los Angeles). We are delighted for them. They are clearly a well-matched couple. Desre is a widow; her first husband died of cancer of the pancreas. David's marriage to Dorothyanne ended in an amicable divorce after 23 years and three grown up children. They face some logistic problems. David has just been appointed head of the department of politics and economics at the Royal Military College in Kingston; Desre is on the research staff of Waterloo University in the faculty of health studies; she is a PhD sociologist, and she lives in Toronto, commutes westward to Waterloo but works also from her Toronto home. David commutes to Toronto at weekends, and sometimes Desre commutes to Kingston when there is a function she wants to take part in, like some of the formal ceremonies and balls at RMC. It's an easy 2-hour commute by train, and they don't seem to mind or find it tedious. They will sort out their living arrangements in a few years when David's term as department head comes to an end. The photos above are of the happy couple at Christmas time and at a ball at RMC in September 2009. May they have long and happy lives together.

Another oil spill

In the 1990s I was at the age and career stage where my descent into senescence was punctuated by the receipt of awards and distinctions. It almost always meant that I had to make a speech. At one of the most pleasant of these, the annual meeting banquet of the American College of Epidemiology, I spoke about ethical and moral dilemmas epidemiologists confront, and then launched into some remarks that I believed were thought-provoking, about the philosophical foundations of epidemiology: why do we do it, what's its purpose in the grand scheme of things? Are we trying to discover the secrets of life and its diseases with the aim of making man immortal? Speculating about what our successors 100 years on might think about our priorities, I used the analogy of the internal combustion engine to speculate about what Nikolaus Otto, Karl Benz, Gottfried Daimler, and the other inventors and developers of the internal combustion engine would think of the world they have wrought, if they could return and see it today. Every time there is an ecologically damaging oil spill that thought returns. Perhaps the internal combustion engine will turn out to be mankind's worst ever mistake. It's made us so dangerously addicted to petroleum fuels that we will take any risk to obtain a supply sufficient to feed momentarily our insatiable, insane lust for it. In almost every way I can think of, addiction to petroleum fuels is deadlier than addiction to cocaine, heroin, or even tobacco. To feed this addiction, humans have despoiled lovely places all over the world, pristine wildernesses, peaceful villages, tropical rain forests, sandy deserts with fragile webs of life, Arctic barrens, the seabed itself, with its life sustaining organisms at the base of marine food chains, and all the tasty gourmet treats that come from the sea - shrimps, oysters, scallops, crabs, lobsters. We care greatly about these, and about the damage to the habitat of migratory and other birds, but it's the plankton and micro organisms at the very base of the marine food chain we should care about the most. Destroy these and all higher in the food chain are imperilled too. The current spill off the coast of Louisiana and Mississippi in the Gulf of Mexico comes from the sea bottom, from an oil deposit at a depth below the surface of about a kilometre. Miniature unmanned robot submarines are being deployed in attempts to seal the leakage, but so far it seems unstoppable. If it can't be stopped soon, this could become the worst marine eco-disaster ever. Will we learn from it? I guess not. Plans will no doubt be prepared and assurances given to protect the far more sensitive Beaufort Sea deposits offshore from the North Slope of Alaska and Northern Canada - and the Caribou breeding and feeding grounds as well as the rich profusion of Arctic sea life. I believe those assurances almost as much as I believe the promises of politicians and used car salesmen. The marine life in the region off the coast of Alabama, Louisiana, Mississippi is rich and varied, harvested to feed millions of people; so it is economically very important. It is ecologically even more important. If it is gravely damaged by this oil spill, it will demonstrate yet again the dependence of human health on ecosystem health.

Staying connected as best we can

My brother Peter recently emailed a photo of his grandson Tom Porter, a handsome young man whom my grandchildren have never met. Our family is like many others in Canada, a migratory family starting a new 'dynasty' in this country. In many ways the scattering of genes widely about the world is a good thing, biologically, socially, culturally; but it's sad that it necessarily means many of those born into the next generation don't know and may never even meet their close kin who are the offspring of the siblings who stayed in the land of their birth. That's a cumbersome, clumsy way to put it; to make it more personal, my three grandchildren have never met their close relations in Australia and New Zealand, and unless they travel or their second cousins down under travel overseas, they never will meet. It's not harmed them or their peace of mind but it saddens me a little and I think it saddens my brother too.

Lately we have had several emails, letters and phone calls from relatives and friends, commenting on things I've posted on this blog. The blog, of course, started as a way to stay in touch with many who are close to us by blood ties or long-standing friendships, and with whom our present circumstances make it difficult to stay in close personal touch by letters, emails or phone calls. Wendy isn't able any longer to maintain the vigorous flow of letters to her family members and many friends as she has done as long as I've known her. Letters between us bound us together, and both she and I have always loved writing and receiving letters. Nowadays that custom of writing letters has begun to die out, replaced by emails, or interrupted by the death of the person at one end of the correspondence. It's just about impossible for me to find the time to write 'personal' emails now that I spend so much time caring for Wendy, so it's comforting to have confirmation that at least some of the most important former recipients of our letters have been reading the posts on this blog.

In the past few days I have in fact found time to send personal emails to a few family members and close friends with updates on Janet Wendy's condition. I mention it infrequently in these blog posts because there's not much to report. We have a personal support worker who comes in at present four days a week (not on Fridays because I help her get up early, one of her friends collects her at 9.30, and drives her to her Scrabble game). On the other week days the support worker has taken over my task of helping her to get up, accompanying her for her daily dip in our swimming pool, and dressed for the day; the support worker, a delightful, cheerful Canadian born lass of Jamaican origin, also administers one or two of the daily ritual of fully inflating her lungs with a resuscitation bag. She is slowly getting weaker and more stooped as her spinal muscles waste away, her speech is more often hard to understand, especially when she is tired; and she sleeps more and more of each day, unless there is some compelling reason for her to remain awake, as there was last weekend when Wendy and Ivon Hurst were visiting. We also have regular visits from the community nurse, the occupational therapist, and Louise Coulombe, our palliative care physician, intermittent visits, emails or phone calls from a nice lady who works for the ALS Society, and we visit the ALS clinic about every other month, or when they ask us to come for a special assessment, as they have for instance in a couple of weeks to try her on a machine to assist her breathing. She remains adamantly opposed to any assistive devices like a feeding tube, and as her ability to swallow food and fluids is becoming more precarious, this travail that she is cheerfully enduring may not be very long-lasting. The most important thing is that most of the time she is in good spirits, cheerful, engaged with the world around her; and she has no pain or distress. We can't ask for much more than that.

Now for something completely different. There's a bizarre criminal case unfolding in Canada. The commander of the largest military air base in Canada was arrested a few months ago. He was charged with murdering two young women, and with two counts of break and enter. Today he was charged with 82 additional break and enter offences and it was disclosed that the charges relate specifically to stealing women's underwear -- an act that was called "snow-dropping" in Australia when I was a boy (I suppose the etymology or provenance of the term comes from the usual colour of women's underwear in those days). It all has to be proved in court of course, and if it is it will emerge that this formerly senior military officer is afflicted with a rather obscure underwear fetish that went badly wrong for the two unfortunate women who died. It's very sad, especially for the two young women who died. No doubt the sordid details will keep Canadian tongues wagging for a while to come.

Gallipoli, Anzacs, and commemorating stupidity

The two photos above are the very moving English portion of Kamal Attaturk's inscription at the Turkish memorial to the disastrous 1915 campaign at the tip of the peninsula on the European side of the Dardanelles near the fishing village we call Gallipoli; and a small portion of the war graves at Anzac Cove, the worst of the killing grounds where Australian and New Zealand troops went ashore at dawn on April 25, 1915, Anzac Day.

Following up on the previous posts that mentioned Anzac Day, here is an excerpt of my travel journal of our trip to Greece and Turkey in 2004, about our visit to Gallipoli and nearby parts of Asia Minor:

In emails before we left Canada I had mentioned to my host, Çagatay Gφler, that I hoped we would be able to visit Troy and Gallipoli, but I never expected that he would take over a week off immediately before hosting the National Public Health Congress in order to take us there himself as well as show us his beloved Istanbul. He and his cheerful, linguistically challenged protege Etem Erginoz met us at our hotel at 8 am on the morning of October 22. I assumed the plan was to take us to a tourist agency, but soon realized that they planned to take us themselves to Gallipoli and Troy.

I had heard about Turkish hospitality. We were about to experience it. Çagatay Gφler is one of the nicest, kindest people we’ve ever known, altogether a lovely man. His English is adequate, not as fluent as that of many of his colleagues, although better than Etem Erginoz’s often mangled mishmash. (English is the language of instruction and communication in many Turkish medical schools but only partially at Hacettepe University in Ankara, Çagatay’s base). His accent and comprehension are adequate, and he compensates for imperfections with endearing turns of phrase, the most memorable of which is “In my childish time” when reminiscing about what life had been like in Turkey, especially in Istanbul, when he was a small boy.

With Etem driving, we headed south out of Istanbul on the expressway that leads to the border with Bulgaria, then cut across yet another mountain range to the road that runs beside the Sea of Marmara, and made our way by lunch time to Gelibolu which we call Gallipoli, a fishing village and small seaport at the inner end of the Dardanelles. Seeing that rugged terrain close up made me realize even before we reached the landing beaches that the plan to invade and conquer the Ottoman Empire by seizing the peninsula at the European end of the Dardanelles was one of the most extraordinary acts of stupidity of all the many perpetrated by the military planners in the 1914-1918 blood bath that irrevocably wounded European civilization. The landing places and especially Anzac Cove, could not have been more ill-chosen, on a steeply shelving beach where the sea is two meters or more deep only two or three meters from the shore, the beach itself is very narrow, the sand soft, and the crumbling sandstone cliffs are up to 20-30 meters high and nearly vertical. The Turks were forewarned and were well dug in with machine gun emplacements all along the tops of the cliffs. Wendy’s father and several of my uncles went ashore there in 1915, and one of my uncles is buried there. A huge diorama in the Ataturk Museum in Ankara helps to show why so many died. It is sacred ground now to Turks as well as to Anzacs, Brits, French, Indians. The toll of dead and wounded was about 250,000 Turkish defenders (mostly in naval bombardments) and about 215,000 on ‘our’ side. The former battle ground is dotted with many small graveyards rather than with a few large ones as in France – most of the dead are buried where they fell. So on the green lawn of Anzac Cove, in Shrapnel Valley, and several other places where we stopped to look, there are little neat rows of headstones. Interestingly, no distinctions of national origins are made in the Allied graveyards – Brits, Anzacs, French, Indians lie side by side. I was more moved – as much by anger at the stupidity of it all, as by sorrow – than at Gettysburg, Monte Casino, or the Somme and other battlefields of Northern France.

After a good look at these battlefields and the impressive Turkish memorial which includes the inscription above, a short ferry ride took us across the narrow seas of the Dardanelles at the Hellaspont, to Çanakkale, a city on the Asian shore near the bottom end of the Dardanelles. We used a new five-star tourist hotel in Çanakkale as base to visit some of the archeological sites on the Asian side of the northern Aegean. The first of these and by far the most interesting, more so than Gallipoli, was Troy. All who read Homer want to see Troy. It’s over 2000 years older than the city for which Priam, Hector, Achilles, Agamemnon, Odysseus and others waged the 10-year war Homer described. That took place about 800 BCE. Heinrich Schliemann did much damage with his ignorant digging in the 1880s but more carefully trained archeologists since then have unraveled the nine layers, dating back to 2500 BCE and earlier. We had a long, leisurely look on a hot sunny day, and I would have been happy to spend longer. This was obviously a great city several thousand years ago. The original harbour has long since silted up and is now a fertile plain several Km from the open sea, but it’s easy to recognize the strategic importance of this place in and before Homer’s time. We visited several other sites that day, most memorably a hazardous climb to the remains of a Temple of Athene on the top of a spectacular akropolis at Ossos overlooking the Aegean and the island of Lesbos, home of the Greek lyric poet Sappho whose reputed sexual orientation gave us the word lesbian.

To return to where I began this post, what distressed and angered me as I looked at the war graves scattered over the site of the futile battles of 1915, is that we, i.e. Australians and New Zealanders, have turned Anzac Day into a sacred (and also drunken) commemoration of one of the stupidest blunders perpetrated by the war planners of the 1914-1918 Great War. Winston Churchill who also planned the disastrous Canadian commando assault on Dieppe in 1943, led the team of "Whitehall Warriors" who planned the Gallipoli campaign. He is duly honoured for holding the line against the Nazis in 1940, but as a military strategist he was a one-man disaster.

Three Kiwis

So as a postscript to yesterday's post, here is my photo of three Kiwis, on Anzac Day 2010 in the living room of our apartment at 300 Queen Elizabeth Drive in Ottawa. From left to right we have Ivon Hurst, Janet Wendy Last, Wendy Hurst, shortly before I had to bundle Ivon and Wendy into my car and drive them out to Ottawa International Airport for the next leg of their round-the-world travels.

Anzac Day - Aussies and Kiwis united and parted again

Here are two photos taken by Jonathan at a delightful al fresco meal that we all enjoyed yesterday, April 24, 2010, on the patio beside the pool in the back garden of R&R's home in the west end of Ottawa. The topmost picture is Rebecca, John and Richard; and the lower one is Richard, Janet Wendy, Wendy Hurst, Ivon Hurst. It's really most unfortunate that the unpronounceable Icelandic volcano burped when it did, depriving us of several days' company with Janet Wendy's nephew Ivon Hurst and his wife Wendy last week, when they should have been here. Instead we had a truncated two-day visit (really only one full day, yesterday, the late afternoon of the previous day, the day they arrived, and the morning today). At any rate the weather throughout was perfect and we managed to catch up on a lot of each other's news and views. (David couldn't join us, unfortunately. He had a complicated logistic operation all day yesterday in Waterloo and Toronto, for which he recruited daughter Christina from Trent University in Peterborough, and son John from Kingston. They had to clear older son Peter's belongings from his apartment in Waterloo, put them in storage, then drive back to Toronto, whence John took their car back to Kingston). When I collected them from Ottawa Airport, Ivon and Wendy Hurst were approaching the end of a round-the-world trip that took them first to Switzerland from their farm on the Canterbury Plains behind Timaru in the South island of New Zealand, then on to Paris and London. When he was young, Ivon worked for a few months on a farm in Switzerland, and they went back to visit his former host family. From what they told us, their travels in Europe and the UK were a success, and so was the enforced extra few days in London, courtesy of that volcano. When I phoned them in London to check up on their revised travel plans, I interrupted their sightseeing tour of Hampton Court Palace. In Ottawa there was time yesterday only for Rebecca to give them a quick sightseeing tour and 2-3 hours in the Museum of Civilization. Fortunately Rebecca took them past the tulip beds beside Dow's Lake yesterday, because today a 10-K or 20-K road race closed Queen Elizabeth Drive and frustrated my plan to drive them around the Canal past those same tulips -- which are a glorious blaze of colour at present, thanks to the unseasonably warm and sunny weather we've had throughout most of the past month. By the time the annual Tulip Festival gets underway in the second week of May, the tulips will all be long gone. Wendy and Ivon may have imported some alien respiratory viruses: they both had terrible colds when they arrived. We are all holding our breath and hoping for the best, hoping that we are immune to whatever viruses had afflicted them.

Today is Anzac Day, April 25, a date commemorated in Australia and New Zealand because on this day in 1915, the Australian and New Zealand Army Corps, supported by contingents of Indian and British troops and a naval bombardment by the Royal Navy, landed near the tip of Gallipoli peninsula in Turkey, in what proved to be a catastrophic military blunder that led to the slaughter of the Anzacs and of the Turks; in 2004, Janet Wendy and I visited Gallipoli and saw for ourselves the place where her father and several of my uncles had their first experience of the appalling and bloody Great War of 1914-1918; her father was wounded there, and one of my uncles is buried there. I've written about that elsewhere; maybe if I run out of things to say, I can paste some it into this blog.

Artist's samples

For the benefit of those who haven't seen Selected Works of Janet Wendy Last, I'll place some samples of her paintings in this post. These three of her paintings all appear in her book. The bottom picture is a view of Hampton Park from our town house in Buell Street. This is a water colour, one of my favourites among all the pictures she has painted; the landscape shown in the topmost picture is the view we had from our home at 5 Greenbank Crescent, Edinburgh: this is what we saw when we looked out our living room or dining room windows, or out our bedroom window (orDavid's bedroom window) upstairs. It's a spectacularly beautiful view, along Braidburn Park with its little stream ("burn" in Scots) towards Fairmilehead and the backdrop of the Pentland Hills. Even after more than forty years since we sold our home in Edinburgh and moved to Ottawa, I miss that view. The middle picture is a profusion of flowers in Janet Byron Anderson's garden at her home near Cleveland, Ohio. Wendy painted this from photos that Janet sent us. She lives so close to Ottawa, just across Lake Ontario, it's such a pity we've met only when she visited us in Ottawa a few years ago.

Today's the day we expect Janet Wendy's nephew Ivon Hurst and his wife Wendy to arrive in Ottawa, a week later than originally scheduled, but better late than never, and they will have the added bonus of spring in its full glory, the Canal full rather than the muddy ditch it is until the lock gates are closed. I must soon leave to collect them at the airport, so I'll sign off this post.

Spring has sprung

I've been almost afraid to think the thought, let alone utter the words or write them down for fear of breaking the spell, but I can't put it off any longer: we are having the most fantastic, wonderful spring in all the 40 years that we have lived in Ottawa. Today I walked along our street in strong, bright, almost hot sunshine; the temperature is 21 C; the tulips are out in full flower, the crocuses have almost finished blooming - they came out 2 or 3 weeks ago, along with the forsythia. Magnolia blossoms are the best I've ever seen on the little tree in our block, and on the huge one on the next block over. Only one phase in the life cycle of deciduous trees comes close to the beauty of maples aflame with autumn colours; that is the beauty of delicate, almost translucent leaves first emerging from winter dormancy. This year, that phase in the life of trees, or really their leaves, seems to have gone on for weeks. There is one in front of our apartment building, for instance, that seems to have been frozen in that delicate phase for weeks. Looking down from our eleventh floor windows on all the trees in this city of trees on a sunny afternoon with the sun shining through these delicate new leaves, they really are extraordinarily lovely. This year too the grass is greener sooner. It was a mild winter so there wasn't much winter-kill, and the warmth of the sun must have penetrated to the roots of the grass sooner than usual. The green is as rich, as intense, as in Ireland or the south of England.

I saw my first skein of northbound Canada geese before the end of February, and all the other migratory birds came back earlier than usual, established their territories, began nest building, several weeks ago. There seem to be more redwing blackbirds this year, but fewer robins; on my walk this afternoon I saw no robins and heard the lovely territorial call of only one. I'm half afraid to think about what all this means, because it's yet another set of signs and signals about global climate change. All the signs I've seen indicate that climate change is advancing faster than ever. It is probably unwise to boast about this great spring weather until we have survived the coming summer; if it's as much warmer than usual as this spring has been, we may be in for killer heat waves like the European summer of 2003. Of course I need to keep things in perspective;it's been colder than usual for this time of year in Eastern Siberia and Mongolia... Another local observation, then I'll stop. It's very, very dry. We had very little snow last winter and we have had hardly any steady, soaking rains this spring. The ground is very dry, the risk of forest fires is already quite high. I walked home with a neighbour who lives below us; she spent the afternoon over in the Gatineau farmlands, which, she told me, are already experiencing drought conditions. The ground where corn should be emerging is dry, dusty, unyielding. I'll take Wendy for a drive over the weekend (the first time both of us will be free of other commitments) so she can share in the beauty of this lovely spring on a slightly wider scale than the little slice of it that's visible from our apartment windows, although that is lovely enough to be true. I can't remember when we've enjoyed spring more, except perhaps one of our years in Edinburgh -- but that was ephemeral, truly beautiful while it was happening, but it lasted less than a week. This one seems to be going on forever.

Finally in this celebration of the season, today brought a further unmistakable sign of better times ahead than dull winter: the Canal is filling with water. In a day or two, the shallow pond a few hundred meters from our front door, a spawning ground for carp, will be swarming with dozens of fat mature carp, jostling and stirring the sandy bottom as they go about the serious business of reproducing their own kind. Like the lock gates will soon be doing, my cup runneth over.

Antiquarian books

In 1961-62 I was a visiting fellow in the MRC Social Medicine Research Unit, based at the London Hospital Medical College, on Whitechapel Road in the east end of London. The most interesting and productive work I did during that mind-expanding year was field-work in three industrial towns in the north of England, specifically, interviewing just under 100 randomly selected general practitioners in these towns, Stoke on Trent, Wigan, and Middlesborough. One rainy day I got off the inter-city express from London in Stoke a few hours before my first interview. An earlier interview I'd prearranged for that day had been cancelled, leaving me at a loose end for a couple of hours. It was raining as only it can in the north of England, steady, soaking rain that penetrated my raincoat in a matter of minutes as I ran from the station to the nearest cover about fifty yards away. On the corner, below street level, an electric light beckoned me into a little book shop stacked to the rafters with dusty, musty old books. Really, really old books. It was warm, dry, interesting, a perfect place to spend a couple of hours browsing the book shelves for whatever treasures they might hold. Alas, not a lot that interested me, mainly unreadable and perhaps forever unread volumes of sermons by long-forgotten dead clergymen. But among them were several very small volumes of a late 18th century equivalent of modern paperbacks, cheap, mass-produced reprints of classics. I emerged eventually into skies that had cleared a little, with three volumes of an edition of The Life and Adventures of Robinson Crusoe, published by Chas Cooke of Paternoster Row in about 1790, for which I had paid sixpence each. We were desperately poor that year, I had to support a wife and two small children on a scholarship stipend intended for a single man. I went without a pint of beer with lunch that day, and had only a single sandwich, to compensate for my extravagance. These were the first really old books I ever owned. I wondered how many other people had read these well-thumbed little volumes before I got hold of them, and for how many they were, as Robinson Crusoe had been for me, the first book I ever read entirely on my own without help from any adult. I suppose those three books were the beginning or premonitory symptoms of bibliomania, the book-disease from which I narrowly escaped. A few years later when we lived in Edinburgh I had a slightly larger discretionary income and no other vices, and I began to add steadily and purposefully to my collection of really old books. The first was another bargain, the 8th edition of The Whole Works of that Excellent Practical Physician Dr. Thomas Sydenham, Corrected from the Original Latin, published by another Paternoster Row printer, J Darby, in 1722. I bought that in 1966; and for the next 30 years I was a fairly serious and purposeful collector of antiquarian books on medicine, public health sciences, and natural history -- my collection of natural history works included the 6th English and the first American edition of Darwin's Origin of Species and an early edition of the Voyage of the Beagle with beautiful steel plate engravings. I still have the Robinson Crusoe, and Darwin's account of the Voyage of the Beagle. But in 1995 I donated more than 700 other antiquarian and historically important modern books on public health sciences to the library of the Royal College of Physicians and Surgeons of Canada, where they repose in the Roddick Reading Room, accessible to scholars and comparatively secure against theft and vandalism. I parted from them reluctantly but I think wisely. At the time we lived in a home that was demonstrably vulnerable to theft and break-ins; we had been burgled twice, and I feared that next time my precious books might be vandalized. The collection was valued at nearly $100,000 although of course I hadn't paid anything like that much for the individual books. I had almost stopped seriously collecting them about ten years earlier because collecting antiquarian medical and scientific books had become fashionable and wealthy collectors had driven prices skyward. I can visit the Roddick reading Room to consult my books at any time,but I'm content now to accumulate cheap paperbacks and to cling to a few reminders of former glory days, like those little books of Robinson Crusoe's adventures, and the Voyage of the Beagle, which as I think about it, could be added to the travel books I wrote of a few days ago.

Will things be moving again soon?

Our television provider offers us some 300 TV channels, of which we can see about 100 without extra charges, including about 20-30 in high definition. Among these is BBC World (as well as several BBC specialty channels). It's worth having just for BBC World, which carries some excellent documentary programs as well as hourly news bulletins. This evening's BBC TV news included an item on the airline industry: several of the major international carriers have lost their patience with the meteorologists and volcanologists who are saying that the unpronounceably named volcano in Iceland could continue to disgorge vast quantities of dust and grit for weeks, even months. They've announced this evening that tomorrow they may begin air services again, volcanic dust or no. They've covered their backsides by sending planes up to test the air quality; British Airways sent up what looked like a 747; presumably they will very carefully dismantle and look inside the engines and rotor blades, as Lufthansa and Air France have done. I wonder whether Air Canada will follow the leaders (if leaders is what they are, not just reckless risk-takers). If so, perhaps we will soon see Wendy and Ivon Hurst, even though we have almost given up hope of a visit from them: if they are travelling on a fixed itinerary, they will have to by-pass Ottawa if they are delayed in London beyond tomorrow. We will soon find out.

Books about travels

It's inevitable that I love books about travels, because I love to travel myself. I've been reading travel books as long as I can remember. Some are good or even great literature as well as accounts of exotic, sometimes unique travel experiences like Thor Heyerdahl's marvellous book, The Kon-Tiki Expedition, or ordinary, almost mundane travels like Laurie Lee's Depression era book, As I walked out one summer morning. This is a beautifully written account of his rambles across England and France to Spain, where he got mixed up in the Spanish civil war. Laurie Lee was a poet, so it's not surprising that this is such a beautifully written book. Sea voyages appeal to me especially because I love the sea so much. Early in my reading life I stumbled upon Joshua Slocum's Sailing Alone Around the World, written in the plain and simple language of a seafaring New Englander. Slocum was the first of many solo seafarers. Some have questioned his truthfulness about his adventures but I believe that everything he says happened really did happen.A travel book that I believe qualifies as literature is Apsley Cherry-Garrard's wonderful account of a winter trek across the ice fields of Antarctica, The Worst Journey in the World. Towards the end of his life I met Cherry-Garrard in London, in 1951. He wore thick-lensed glasses and I wondered whether he had those in the Antarctic winter; but what I remember best are his teeth, cracked and broken by the frostbite he suffered during that winter walk. Eric Newby is a professional travel writer, and The Last Grain Race is hilarious as well as exciting reading. Newby makes frequent adjectival use of the Swedish or Norwegian word for sail-making, focking, thereby evading the prohibition at the time he wrote of the fine old Anglosaxon monosyllable that everyone knows not to utter in the presence of their elderly maiden aunt -- although I recall hearing a very maiden-auntish lady outside Selfridges on Oxford Street in London a few years ago remarking to her companion, "What's happened to our fucking bus," and thinking the same thing myself (we were both waiting for a 73 bus it turned out, when a whole flotilla of 73 buses eventually hove into view). Newby wrote other travel books, including A Short Walk in the Hindu Kush which is packed with fascinating detail about that exotic corner of the world as well as very funny in places. But for a hilarious combination of interesting travel and laugh-out-loud humour, nobody comes close to Bill Bryson. Even when he is being serious, as in The Mother Tongue, his excellent book length essay about the English language, he can't altogether suppress his wit, which bubbles up to the surface from time to time. His travel books have made me laugh out loud on bumpy air flights and enough to wake Wendy when I read one in bed. All are worth reading; I like best his walk around the island of Britain, Notes from a small island,, his walk along the Appalachian Trail, and his travels in my homeland, Australia. But they are all very good, and all very well written, as is to be expected from someone who loves the English language as much as he obviously does. There are so many more travel books I'd like to talk about! But I have work to do, and must get on with it.

Dusty delay

The best-laid plans o' mice and men gang aft agley, or words to that effect. If the world worked as it ought to, in the middle of the afternoon that's just ended, Rebecca and I would have met Janet Wendy's nephew Ivon Hurst and his wife Wendy at Ottawa International Airport, where they ought to have disembarked from their trans-Atlantic flight that should have left Heathrow about lunchtime today, London time. But a few days ago, a volcano in Iceland erupted, disgorging a plume of volcanic ash and grit that is drifting high in the atmosphere over all of western Europe. Those tiny particles, small and light enough to float in the air, even in microscopic concentration at stratospheric levels, can clog the jet engines of wide-body passenger aircraft and shut down all engines, causing the plane to crash, so every airport in western Europe is closed until the cloud of ash and grit has drifted on further east or dissipated enough for safe air travel. It's been like this for two days now, and Britain's senior meteorologist on tonight's BBC TV news predicts that these conditions could continue for several more days. It's one of those times when I recall (not fondly) the delays and disruptions at airports around the world that I've experienced in my time of bouncing about between continents. I feel sympathetically for Wendy and Ivon, and hope they are holed up comfortably in a hotel near Heathrow, not trying to catch a few moments fitful sleep on the benches that British Airports Authority has thoughtfully provided for stranded travellers. They could be there for days, may have to bypass Ottawa altogether if the ash cloud drifts slowly enough to delay them for more than 3 or 4 days. It's the sort of event, Mother Nature flexing her muscles, that makes me aware of how puny we humans are in the grand scheme of things. I hope it blows through quickly, that gale force winds will clear the air in time for Wendy and Ivon to have at least a couple of days here in Ottawa, where Janet Wendy is looking forward to seeing her nephew again -- and so am I. I hope Mother Nature blows brisk gales across southern England and gets rid of the dust in a timely manner. Certainly there is no human intervention that can clear the air and make this little family reunion happen.

Janet Wendy: Another Progress Report

Janet Wendy's speech is getting more difficult to understand, especially when she is tired; her back is more bent and her neck muscles have wasted away so much that she has great difficulty holding her head up. Her increasing weakness is accompanied by increasing tiredness, so she sleeps more during the day; but as so often happens with illnesses such as this, she is insomniac at night, so she needs a small dose of a sleeping pill to help her get a good night's sleep. Our regular regimen remains much as it was when I described a typical day in the first post on this blog. There is a regular daily routine of eyedrops for her glaucoma, I use a resuscitation bag to inflate her lungs fully several times daily; daily dips in the swimming pool under my supervision, now mainly for exercise rather than swimming; high calorie meal preparation, and help with dressing and undressing. We get frequent visits from members of the team caring for her. This team includes Louise Coulombe, palliative care specialist physician; a visiting nurse, physiotherapist, occupational therapist (who is full of useful sensible suggestions) and now for the past 2-3 weeks, Sharon Morrison, a personal care worker who so far has been more of a domestic servant than a personal care worker, but this is changing subtly as each time Sharon comes she does more to help Wendy with dressing, grooming, etc. She has been coming in for 2 hours twice weekly, and soon we will bump this up to daily visits. The most important thing to report is that she is in good spirits, accepting her increasing disability philosophically and with equanimity. Inevitably there are times when she gets downhearted and frustrated by her inability to do simple housewifely tasks that were a matter of course all her life until a few months ago; but those times are rare, fortunately. She has a common feature of motor neuron disease (or ALS as it's known here) in that her emotions are very close to the surface; so she cries very easily, whether the stimulus is a visit from someone she cares about, a sentimental play or even a news report on TV or radio. These crying fits soon pass and she can then take part in normal back-and-forth conversations; but it can be disconcerting for old friends whom she hasn't seen for a long time. She has an increasing array of equipment and labour-saving devices to make life easier for her, many at the suggestion of the excellent occupational therapist, Courtney Henderson, who has been assigned to care for her. Yesterday Courtney measured her and assessed her manual dexterity for a power wheelchair that will make it easier for her to get about. Soon she will be able to fulfill her ambition to get out and terrorize the neighbourhood, speeding dangerously along the sidewalk, scattering small children, dogs and old people walking with canes in her wake.

History books

The six years in medical school almost destroyed my mind. In the three preclinical years I had to learn and understand vocabulary equivalent to three or four modern languages, like Spanish, Russian, Greek, Danish, the technical terms of the basic biological sciences, which I had never learnt in school because they weren't taught, then the technical terms used in anatomy, biochemistry, physiology, altogether some 14,000 to 16,000 new technical words, and the phrases that linked some of them together; That was just the beginning. I moved on to the clinical years, three more years of learning other new words and phrases, the ones that really matter in caring for the sick, names of symptoms, diseases, diagnostic tests, operative procedures, and drugs used to treat them. At night I would toss and turn restlessly trying to sleep, while these strange new words and phrases chased each other about the surface of my brain. One night, desperately tired after many insomniac nights, I picked up a history book, H.G. Wells's Outline History of the World. It was an abridged edition of a larger book by H G Wells that I later acquired and read from cover to cover. But I started modestly on the smaller book, devoured it and fell asleep, relaxed and contented after learning things I had never known before about the history of the world, all written in plain, simple English without a weird technical word or phrase anywhere. That was the beginning of a wonderful voyage of discovery that went on in parallel with learning the languages of medicine and was far more enjoyable. I moved on to other history books, Arthur Bryant's histories of England and the English people, another history of England by a man named Greene that was a textbook for first year university modern history, and several more while I was still a medical student,histories of the Classical Greek and Roman civilizations (The Glory that Was Greece and The Grandeur that was Rome, among others, a bit hackneyed and overloaded with cliches, but both basically accurate I believe). Others from those times when I was a young doctor include Xenaphon's March of the Ten Thousand, his account of a famous retreat by his defeated army across Asia Minor to the Aegean Sea, that made me wonder who will be the Xenaphon to tell of the Dunkirk defeat/victory in which much of the British army was saved from destruction by an armada of English small boats in 1940. Other books from those early years of reading history include Julius Caesar's account of his conquest of Gaul in what seemed a racy and eminently readable Penguin translation, Herodotus's "histories" -a fascinating compendium of fables, gossip, travels and snippets of genuine history including accounts of the famous battles between the Greeks and the Persians. I've been reading history books off and on ever since. When I back-packed around Europe in 1953 and 1954, I carried a Penguin book or two; one was Thucydides' History of the Peloponnesian War, written by a soldier-scholar who fought in it, a great book, a "desert island" book, still, two and a half thousand years later, a wonderfully vivid and fascinating account of human folly and fruitless conflict that solved nothing and created problems worse than any that caused the war in the first place. I read Rex Warner's translation, brand new in the 1950s, now the standard English translation. Not long after that I sailed home to Australia as ship's doctor on a freighter, a long sea voyage for which I was well prepared with a large supply of books, including Winston Churchill's account of the 1939-45 world war -- a rather self-serving account as I later realized, but a beautifully written book. Whether it was worthy of the Nobel Prize for literature is another matter, but all the civilized world including the Swedish Royal Academy was grateful to Churchill for saving civilization from the Nazis, so few objected to the award. Probably Toynbee came next, with a theory of history that offered explanations for the rise and fall of civilizations; and along the way and ever since there've been historical biographies and detailed accounts of interesting periods, like the Elizabethan age, the 1920s, the Roman conquests, Prescott's histories of the Spanish invasion and conquest of the civilizations of Mexico and Peru, the Jazz Age, histories of Paris, Vienna, the Mediterranean, histories of Australia, of Canada, of the USA and of Scotland, nations where I've lived long enough to put down roots. As successive volumes of Will Durant's massive history of civilizations and human progress were published, I bought and read them. I realized pretty quickly that the scholarship was sometimes shoddy, but there were well written which made for very easy reading. The main benefit was the pointers they gave to more reliable and scholarly histories, of India, of Islam, China, the Byzantine empire, Napoleonic Europe. I'm still at it in my 80s; among my recent acquisitions is a small paperback history of the Hundred Years War, a series of conflicts really that included Henry V's battles against the French and his great victory at Agincourt. David has just borrowed it, so I shall have to wait until he returns it before I can read it thoroughly. Next time I tackle this challenging subject of "what to read and why" I can perhaps write about books on science.

children's books, again

Why, someone asks, are The Wind in the Willows, and Charlotte's Web, on my list of essential books for children? Two excellent reasons are that both describe magical worlds where animals talk and as far as feasible, act like human beings, their actions and their values resemble the actions and the values of several easily recognizable kinds of human beings; children can learn a great deal about human values from what they hear or read about the actions and motives of Ratty and Mole, Badger and Toad; and Fern, Charlotte, Templeton, and of course Wilbur, the runty piglet who becomes the prize-winning pig in the middle of it all. And the second good reason why children should read these two great books, or have parents or others read to them from these books, is that they are written in language that is the best that English can offer, language as rich as Shakespeare, if perhaps a little simpler, but not dumbed down, never patronizing, but as often capable of evoking tears as laughter. No one need ask more of great prose than that!

children's books

My post on children's books provoked several comments. Jonathan mentioned the Swallows and Amazons series, which meant a great deal to him - as they had also to his older siblings Rebecca and especially David. I never read these books when I was young. The first in the series, Swallows and Amazons, was published in the early 1930s but didn't become widely known and read by youngsters until the series was fleshed out with more books, and that didn't happen until after the 1939-45 world war. Our kids read these books on their own. By the time the first one appeared in our home they were reading books on their own, not having books read aloud to them by Wendy or me, usually by me, because reading aloud to our children was one of my great pleasures in life. Jonathan also mentioned The Finn Family Moomintroll by Tove Jannson; that's another I never read. But I did read The Borrowers, and The Railway Children, and many others, as a child reading to myself, as a father reading to his children, or both. The ones I listed in that earlier post are just the few that meant the most to me. If others who read this blog care to weigh in, I have no doubt that the list of important children's books will grow much longer. For instance, our grandchildren have been captivated by all seven Harry Potter books, and the books Terry Pratchet has written about his imaginary worlds. Then there is Philip Pullman, whose marvellous books about the little girl called Lyra are, I think, better written and have greater depth than J K Rowling's books about Harry Potter, Hermione Grainger, Ron Weasley and the other richly realized characters associated with Hogwarts School. Of the making of books there is no end, and this is as true of books written primarily for child readers as for any other kind of reader. I'm sure I will have plenty more to say in this blog about books and reading.

Janet Wendy's progress

As we begin April of 2010 we have unprecedented heat. Yesterday, Easter Saturday, it was officially 29 C but the outdoor thermometer on our balcony, shielded from direct sunlight, was reading 30-31 C in late afternoon. We have had several weeks of warm and mostly sunny weather with average temperatures in the low to middle teens at a time of year when it is usually still very cold with blizzards and snow still thick on the ground. The weather has lifted Wendy's spirits and mine too (I try to overlook the unpleasant fact that it's another unmistakable sign of climate change occurring more rapidly than predicted). There's no doubt at all that we are more cheerful when we look out our windows at blue skies and sunshine. This year when it's usual to squint against the glare of sunlight on snow on sunny days in late March and early April, we look out at grass that is already green, at trees where the buds of the new leaves have swollen in the unusually warm weather and are beginning to burst into leaf. The crocuses are in full bloom, spears of tulips have burst through the grass, and on the lawns between the University of Ottawa campus and the Rideau Canal, innumerable clusters of daffodils are almost ready to open up their bright yellow flowers. We can hear red-wing blackbirds marking their territory with their rasping call; as the skies lighten just before dawn I hear geese honking overhead as they make their way from their overnight roosts to the feeding stations in farmers' fields where they will gorge themselves before the next leg of their journey northward -- or, in many cases, fatten up and breed here on the banks of the Ottawa, Rideau and Gatineau Rivers or on lawns and fields beside the Rideau Canal. I saw my first immense skeins of northbound geese before the end of February, and they have been heading north in vast numbers ever since. The crows have been active too, and I think Wendy has begun to get over her aversion to crows; David Attenborough's documentary series about the life of birds has made her aware that crows are, after all, the Rhodes scholars and Nobel prize-winners of the bird world, the most intelligent of them all. The bright sunny weather and the return of bird life have probably helped to lift Wendy's spirits. In recent weeks she has been understandably a bit depressed at times, as she comes to grips with her increasing inability to do all the things she has been accustomed to do all her life - the housework, the sewing, preparing meals and all the innumerable activities that filled her days. I've taken over some of these as best as I can although inadequately, and realize when I do her jobs how energetic she has always been. So I understand how frustrating it is for her not to be able to do these things anymore. Anyway, this glorious weather, the signs of spring, the greening all about us, the bird life, all help; and more so are visits by good friends. Mariem Martinson was in Ottawa for several days, left to go back to Victoria BC yesterday. Her daily visits while she was in Ottawa cheered Wendy immensely. It's sad that she lives so far away now. I hope I have convinced her to persuade her husband Ross to install Skype on their computer so we can chat back and forth that way and see each other's faces in the same way we see David and Desre when we chat to them. Another thing that has helped Wendy lately is the twice weekly working visits by Sharon Morrison, a bright and bubbly brown-skinned lassie whose parents came from Jamaica to settle in Ottawa. So far Sharon's role has been to help with the housework, but as Wendy's condition advances, Sharon will help also with feeding, dressing and grooming. It's valuable for them to get to know each other before that stage comes, because later on Wendy will have difficulty speaking too, so learning how to communicate with each other in alternative ways is important. Sharon, I hope, can help us all to achieve this. But for now, we will go on as we are, taking life one day at a time and making the best of every one of them.

What to read and why

David looked over my bookshelves and asked a good question. Could I make a list of essential books, and why they are essential. I'll try. I'm know I'll overlook some if I do this hastily, so there will be second, third and probably more thoughts on this later. But I'll start now.

To begin with, here are a few essential children's books: The Wind in the Willows, Charlotte's Web, and before either, Mother Goose Nursery Rhymes to help beginning readers learn to read. I'm doubtful about fairy tales, Hans Christian Anderson or the Brothers Grimm, and I'm doubtful about the Dr Suess books. As I remember Anderson's fairy stories, they suggest that the meek shall inherit the earth or alternatively that virtue is unrewarded -- neither of which are helpful messages for small children. Dr Suess wasn't part of my childhood and although our kids loved The cat in the hat, Green eggs and ham, etc, I don't think they meant as much as other books; and that's the problem of the fairy stories too. I still have a copy of Grimm's Fairy Tales that descended to me from my father, but I don't remember that any of the stories had an impact on me at all like the impact of other children's books. In my own childhood, the first two books I read on my own were Peter and Wendy, an abbreviated child reader's version of Peter Pan; and a similarly modified version of Robinson Crusoe. I still have both, and other children's books, A A Milne's two volumes of verse for children, or for parents to read to children, When we were very young, and Now we are six. And of course, I have Winnie the Pooh to go with them. A few years later I read Treasure Island and Tom Sawyer, two other essential books for boys, essential because each in its way introduces subtly some important values, such as the concepts of taking responsibility for one's own actions, being honest with others and true to one's-self. Louisa May Allcott's books may have a similar role for girls of the same age. Some time in early adolescence I read Alice in Wonderland and Through the looking-glass. These are essential books too. But they meant less to me in childhood than they have later, when every subsequent rereading discloses further layers of meaning I had previously missed -- first the mathematical meaning, then the symbolic logic, then the political commentary. A few years ago I reread Tom Sawyer, and was pulled up short when I realized that some of its language would be considered racist nowadays. So, undoubtedly even more so, would Huckleberry Finn. Yet it would be wrong to dilute or change Mark Twain's words and phrases, to change 'nigger' to 'coloured person' or 'African American' as some school boards evidently do, or to omit certain episodes because they describe actions or events that outrage modern sensibilities. What about Tolkein's Hobbits? They hadn't been written when I was a child; we read them aloud to our children, two of whom were already able to read themselves so they impatiently took off to read the books for themselves. I can't judge whether they should be part of the literary canon but I think perhaps it's rather too soon to say whether they will join the ranks of books for all time. Later in adolescence I came to Sherlock Holmes, and on a different wavelength and set in a different though timeless period of English class structured society, Jeeves and Bertie Wooster. I still have Arthur Conan Doyle's stories about Sherlock Holmes and Doctor Watson, and I still have one of the P G Wodehouse books about Jeeves and Bertie Wooster. Why are they part of the literary canon? They are well-written. Doyle's stories reinforce a value system that distinguishes right from wrong. Wodehouse wrote beautiful prose about an imaginary time that might be Edwardian or England in the 1920s if there had been no Great War. Are his stories morality plays? No, they are amoral if they are classifiable on moral grounds. They do seem destined to survive though. In my school years I was blessed with curriculum planners who make wise - inspired - choices. Shakespeare was there of course, with a swashbuckling perspective on The Merchant of Venice, Macbeth, and The Tempest. That was a good way to become familiar with Shakespeare so later, more multifaceted interpretations became easier. It was the same with the poets, Milton, Byron, Shelley and Keats, Wordsworth, Blake, Coleridge, Henley, Tennyson, Masefield, Sassoon, Wifred Owen and a dozen others from whose works I remember and can quote when the occasion merits it, a verse or a few lines. I was introduced to Pride and Prejudice too, in my last year at school, and have reread this, among the greatest of all novels in English, more times than I can count, each time finding gems I had previously overlooked. But here, I think, this first foray into the complex empire of words should end. I've said enough to make me realize that this subject is, for me anyway, far to large to deal with in one short note. There will be more, maybe next time on the ancient classics of Greece, or on books dealing with aspects of history.

Thomas the tank engine

A woman was pontificating on the radio today about Thomas the tank engine. When our kids were at an age that called upon us to read aloud to them, we read Thomas the tank engine, and another story about trains, or a train, The little engine that could. I'm quite certain that we never gave so much as a nanosecond's thought to the political significance of these or other stories for tiny tots. We read these stories because our kids really loved hearing them (and to be truthful, so did we love reading them). The woman on the radio was indignant about the message these stories convey to impressionable small children. Of course she hasn't been reading the stories out loud to her little girl: they have watched the televised version of these stories that appears on children's TV. She seemed to have two complaints. One is that the stories are sexist -- all the main characters are male; if female characters appear at all they have minor, insignificant roles. A second complaint of this indignant mother of a small girl child, is that Thomas the tank engine inhabits a very hierarchical society in which everyone has a preordained place, and deference of those in the lower classes towards those above them is automatic and immutable; it is a sexist society too with females only in very minor subservient roles, and it is authoritarian. I'm not bright enough to read that much into a simple nonsensical little story, and I feel genuinely sorry for this indignant woman who does. I feel even sorrier for her daughter, but hope that as that daughter grows up she will be able to re-educate her mother about things that really matter in this life.

Bibliophilia

A columnist in a recent issue of the British Medical Journal described the condition called bibliomania which can be defined as a compulsive urge to acquire books, and quotes from a 19th century poem about it:
"What wild desires, what restless torments seize
The hapless man who feels the book-disease"
I don't think I am or ever have been a bibliomaniac, but I have been and still am a bibliophile, a lover of books. I've spent many happy hours amid the dusty, musty, shelves of old books where an occasional treasure would catch my eye, and I might stand a while reading bits of it to decide whether I cared enough about it to buy it, inhaling all the while the unique smell, the perfume, of legions of old, used books. Often I would be so absorbed in browsing and reading that I would have no idea how much time had passed, emerging sometimes to discover with surprise that afternoon daylight had turned into dusk after sunset on the short Edinburgh winter days. Browsing was more of a way of life in Edinburgh than ever before or since, because that lovely old city had a great many wonderful second-hand book shops. I've browsed in used book shops also in London, Oxford, Cambridge, Sydney, New York, San Francisco, Boston, Baltimore, Chicago, in the only substantial used book shop in Adelaide when we lived there, and for the past 40 years, in Ottawa. I've browsed in Geneva, Zurich and Basle, and along the banks of the Seine in Paris where there are rows of large book boxes with hinged lids that open up to disclose more books. The first time I was in Athens in 1953 I was a millionaire in Greek drachmae because the currency had recently been deeply devalued, so I browsed there too and still have the book I bought, a collection of artistic photos of classical Greece. I've always had a limited budget so browsed and read on site far more than I bought; but I still bought a lot, and despite discarding many each time we moved house, the ranks of books expand from year to year, demanding new shelves to accommodate the swelling throng. Probably the number of books reached the zenith in our row house on Waverley Street where there were several book shelves on every floor of our narrow three story home. I never measured the length of the shelves we had in our Waverley Street home but it was at least 8 and may have been 12 metres more than in our next home on Echo Drive, where we had 72 metres of book shelves, every one of them full to overflowing. Each time we moved house I've discarded books, sold some, passed some on to our kids who all love books too; and given others away. A year or two before we left our home on Echo Drive, I donated more than 700 valuable antiquarian books on public health, epidemiology and other aspects of medicine and science to the Roddick rare book room of the Royal College of Physicians and Surgeons of Canada. I did this because our Echo Drive home was very vulnerable; we had two break-ins, and I feared that this valuable collection could be vandalized if we had future break-ins. Nowadays I buy books as much as ever but seldom browse in book shops. I've yielded to the seductive appeal of the internet: I buy most of my books on line, because they are usually sold at a steep discount, commonly 30% and if the order exceeds a certain amount, $39 in the case of the main Canadian on line supplier, they rather than I pay postage and handling. At that rate, hard cover books that have just been published cost less than the paperback version that isn't published until a year or two later. I miss the hours of browsing, the odours, the atmosphere of second-hand book shops, and the rare serendipitous find that gave me the indescribable thrill of finding treasure amid the dusty rows of rubbish, but if I stand too long these days I get a backache, and life is too short to spend several hours once in a while browsing. Even without all that browsing, I can't keep pace with all the books I buy, and they would accumulate far more rapidly if I did spend time in book shops - as I know well from experience on the rare occasions when I do venture through the doors to scan the shelves. Maybe I am a bit of a bibliomaniac, because when I've developed an interest in a topic, a theme, a domain of scholarly study, like particle physics or the ancient civilizations of Asia Minor, I've been inclined to buy more than I ever read, then am embarrassed to discover that some are dull, or too specialized for me to understand, and there's no space to stow them on the overcrowded shelves, so out they, or other books, must go. This has become a serious problem in our condominium apartment where bookshelf space is more restricted than ever before. When we downsized to move from our home on Echo Drive I faced the challenge of cutting my books from those that fitted on 72 metres of shelves to 24 metres. What an agonizing task that was! Fortunately all our kids, and our grandchildren too, read and love books, so they willingly took many, but many more remained. There was a market for a few of them although the prices dealers give for old books are derisory; so for most of the surplus books there was no alternative to giving them away. Even now, more than ten years later, I can't remember exactly the fate of some books I have a fancy to reread, and search vainly for them, only to realize that what I seek must have been among the multitudes I no longer possess. But many old friends, a precious few I've had since early childhood, are still with me. Some, like Pride and Prejudice, I've reread so many times that they are falling to pieces. I'm almost afraid to take Winnie the Pooh down from his place on the shelf because the binding has given up the ghost and almost all the pages are loose, would fall out if I didn't keep a strong grip on them. Books like these are part of me, and I won't part with them, not now, not ever.