Bloomsday

Bloomsday. June 16. For once I've remembered to commemorate it on the actual date, June 16, the date in 1904 that Leopold Bloom, Stephen Daedalus, Molly Bloom, and the other characters in James Joyce's great novel did all those mundane and memorable things in Dublin. I spent an hour or two in their company this morning and came away as convinced as ever that Ulysses is one of the greatest novels in the English language, perhaps the very greatest. When we lived in Manhattan in 1978-79, one of the book shops we frequented had a reading on WNYC of the entire novel, all the way from "Stately, plump Buck Mulligan..." to "yes I said, yes I will Yes." It took all day and well into the evening, read by well known stage actors and radio personalities. Wendy and I went into that book shop mid morning, couldn't tear ourselves away until a very late lunch time. Ulysses read aloud is addictive.

John Last writes: Haphazard memories.

(Adapted from my contribution in the commemorative Festschrift book)

Thank you all for all the kind and wonderful things you’ve said about me.

And special thanks, Mariella Peca, Jen Collins and others, for all your hard work organizing this celebration and assembling this anthology to commemorate it.

I’ve been described as a ‘living legend’ and as a ‘towering figure’ (this, obviously, by people who’d never seen me in the flesh). My daughter Rebecca used politically correct language to describe me as ‘vertically challenged.’

Having survived 90 years, I’m not, and never was, superstitious.  But I have had a very lucky life, no doubt about it. I chose a fortunate birth cohort, the babies born in 1926.  It’s the birth cohort of Fidel Castro, Marilyn  Monroe, Hugh Hefner of Playboy, and our lady sovereign Queen Elizabeth. Oh, and Winnie-the-Pooh came into this world in 1926.

Childhood before the 1939-45 world war was a time of innocence.  I explored the beaches and rock pools where the hills came down to the sea near Adelaide, and rode my bike through the orchards and vineyards behind the coast, in a bountiful land where the climate and weather were nearly perfect.  When the war came, cousins a few years older than I put on uniforms and disappeared. One never returned. His widow, a pretty young woman and her baby daughter, moved in with my uncle’s family. Wartime austerity was petrol rationing and gas producers, large bags of combustible gas on car roofs.

In the 1940s my brother Peter and I lived with our mother in a bungalow in the seaside Adelaide suburb of Glenelg.  This was a 25-30 minute tram ride from the city centre, and a 5 minute bike ride from a wide, sandy beach where we could swim in warm, calm sea from October to April. Our family was broken: our father, a country doctor who later became a surgeon and anatomist, walked out of his marriage to our mother when I was about 6 and Peter about 3.  Our mother was left to raise two boys on her own. Peter and I and many others agree that she did a superb job, equipping us with social graces, work ethic, and values that took us far in life.

Scholarships and bursaries paid for a first class education at St Peter’s College, an excellent boy’s school, and paid in full for tuition at the University of Adelaide where I started the medical course in 1944, at the age of 17. I intended to take leave from the medical course and join the army when I turned 18, but it was clear by then that the 1939-45 world war was winding down so it was unnecessary for me to join the armed forces and help to defend Australia.

There was a lawn in front of our home that was screened with chain link fencing after the war ended, and became a lawn tennis court. Here on Sundays my medical student friends, reinforced with several nurses, enjoyed tennis parties every weekend. Some of my happiest memories are of those tennis parties and of the celebrations we held as we passed milestones – the formidable examinations and practical tests of clinical skills in medicine, surgery, obstetrics and gynecology, etc. Birthday and engagement parties as the tennis players paired off in a process of assortative mating, punctuated an otherwise placid social life.

I graduated from medical school in 1949, and spent 1950 as an intern at the Royal Adelaide Hospital. At that stage and age I did not feel ready to settle down, so like many other young Australian doctors, I headed for the UK where I spent three years getting experience, mainly in internal and emergency medicine, in National Health Service hospitals in and on the outskirts of London. In 1952, I took the excellent postgraduate course mounted by the Royal College of Physicians of Edinburgh, and lived in the lovely city of Edinburgh for several months; but I flunked the exams at the end of the course, partly because I chose a very difficult specialty, cardiology, partly because my heart really wasn’t in it. I was more interested in broadening my cultural horizons and exploring Britain and Europe in back-packing holidays.  I went to Paris in the spring of 1952 and fell in love with the City of Light. It was the first of many visits to Paris.

In 1954 I returned to Australia, traveling as a ship’s surgeon on a freighter carrying 12 passengers.  We sailed from Tilbury Docks to Tenerife in the Canary Islands, then nonstop down the west coast of Africa, around the Cape of Good Hope and across the Southern Ocean in the ‘Roaring Forties,’ to landfall off Kangaroo Island, South Australia – four weeks without a port. I look back on that sea voyage as one of the highlights of my life, a magnificent experience in every way. I love the sea in all its moods, saw all of them on that long voyage, and loved every minute of it. One way I'm lucky is that I don't get sea sick.

I joined the Western Clinic, a large suburban group medical practice in the western suburbs of Adelaide.  I greatly enjoyed family doctoring, was judged by my colleagues to be competent and capable. I was an active member of the nascent College of General Practitioners and began to tiptoe tentatively into research in the context of general practice. As much by accident as design, I began to study epidemiology.  I found it an exhilarating and exciting career path.

On Sunday September 25 1955, on my way to play golf, I picked up two young women hitch hikers, nurses who’d just finished a year at Princess Margaret Rose children’s hospital in Perth, one from Zurich, Switzerland, one from Christchurch, NZ. I was instantly attracted to the New Zealander: 5-10 minutes after we met I made a suggestion that changed our lives. They were on the wrong road for their intended destination; I should have dropped them at the next cross road.  Instead I abandoned my planned golf game, suggested that they change their plans, to let me show them some of the beautiful dairy farming and wine growing country south of Adelaide.  By the end of that magical day, after long conversations with the Kiwi called Jan Wendelken, also known as Wendy, I knew she was the maid for me.

Jan Wendelken and John Last
planning a better world, Yankalilla, S Aust, 1955.09.25

Our courtship began with 125 letters, mostly 8, 10, 12 handwritten pages, between October 1955 and May 1956, two or more letters a week, back and forth across the Tasman Sea between Adelaide and Christchurch. We never ran short of things to say.  Then she phoned me – a big deal, a huge deal in 1956, an international phone call – and we agreed that she’d come back to Adelaide, nurse at the Children’s Hospital, while we conducted a more conventional 20^th century courtship.

Wendelken-Last Correspondence 1955-56 (125 letters, mostly 8-10 handwritten pages)

  

Signing the marriage registry, St Peter’s College chapel, 1957.02.14

We married on Saint Valentine’s Day 1957 and had 55 wonderfully happy married years of writing, research work, adventurous travel and multiple intercontinental migrations – we lived long enough to put down roots in Adelaide, Sydney, London, Burlington, Vermont, Edinburgh, Scotland, and Ottawa. Later there were sabbaticals: we lived in New York City for a year in 1978-79, and for several months in Canberra and Sydney in 1986. There was much other travel, holidays in Europe, trips back to Oz and NZ to visit our families, and working travel for me in Colombia, Indonesia, Sri Lanka, India, Thailand, Saudi Arabia, Kuwait, Lebanon, Pakistan, China and Japan as well as many places in UK and Europe.  Also, of course, much travel in Canada and the USA.  At times I virtually commuted back and forth across the Atlantic, to Geneva, Stockholm, London, and Paris.

Our early travels were by sea on freighters carrying 12 passengers – by far the best way to travel long distances across the world. From 1965 onward, we nearly always flew, enduring all the discomforts and petty anxieties of air travel.

We found enough spare time to produce 3 children, all of whom have interesting, worthwhile lives.

David, Jonathan and Rebecca
On deck, mid-Pacific,
January 1964

Jonathan, Rebecca, David
Burlington, Vermont,
January 1965

Wendy inspired me, breathed life into all my professional endeavors, encouraged my scholarly activities, all our travels. When our kids were grown up, she usually came with me on these travels, enriching them with her astute observations.

In 1960 I left the Western Clinic and our little family, Wendy and I and two toddlers, Rebecca and David, lived on my savings while I did the DPH, then had a most exciting year as a postgraduate scholar in the Medical Research Council’s Social Medicine Research Unit, based in those days at the London Hospital Medical College in Whitechapel, in the East End of London. My mentor was Professor J N (‘Jerry’) Morris. It was without doubt the most mind-expanding year of my life. I met and networked with the movers and shakers of public health sciences in the English-speaking world and beyond, absorbed ideas from them, occasionally contributed ideas of my own.

Alas, most of those wonderful women and men of public health science who were my friends, collaborators and colleagues, have preceded me into the great field study in the sky – have fallen off their perches before me.  That’s one of the penalties one pays for a long life: it could lead to a lonely old age if I hadn’t cultivated friendships with younger colleagues. (I’ve often said that I’ve kept my youthful enthusiasm by constant reinfection from younger colleagues).                                                                           

At the end of my year in the MRC Social Medicine Research Unit, we went back to Sydney and I joined the staff of the School of Public Health and Tropical Medicine at the University of Sydney. Intellectual life there was stultifying but I was lucky: before long I was saved from stagnation by an invitation from Kerr White, to join his research team at the University of Vermont. This was another mind-expanding year.  I met and got to know most of the leaders of epidemiology and public health sciences in the USA. But we were culturally at odds with some aspects of the American way of life.  Kerr White invited me to accompany him when he moved from Burlington, Vermont to Johns Hopkins School of Hygiene and Public Health in Baltimore, Maryland.  Fortunately I’d had another invitation, to become a top-scale senior lecturer at the University of Edinburgh. It took barely a microsecond to choose between Baltimore and Edinburgh.

We had five very happy, and for me, very fruitful years in Edinburgh. I landed on my feet, becoming principal investigator in several inter-related research studies for the Royal Commission on Medical Education. Soon distinguished visitors were coming to the Usher Institute of Public Health, not to visit the professor and director, but to visit me. I also began to get attractive invitations to leave Edinburgh, to relocate to other prestigious universities elsewhere in the UK or in the USA.

When I applied for two posts in Australia and was passed over in favour of well-connected local men, I began to take the US invitations more seriously.

The climax came in the summer of 1969. I was invited to take a cross-appointment between the Harvard Medical School and the Harvard School of Public Health. Harvard is probably the best medical school in the world. Obviously I had to look this over very carefully.  I flew across the Atlantic once again and after several days of rigorous interviews, was offered and provisionally accepted this position.

There were some obvious snags. The position was soft-funded, not tenure-track, and politically fraught – and academic politics can be vicious. Housing in Boston and Cambridge was beyond our reach: we’d have to live in a distant suburb and I’d face a very long commute, 2 hours or more at the beginning and end of every working day. And neither Wendy nor I were enthusiastic about living again in the USA, where we felt out of sync with prevailing values.  I’d had another invitation, from the man who headed the department of preventive medicine at the University of Ottawa. This was a nonentity of a university, but my friend Wendell McLeod, former dean of the University of Saskatchewan, who was executive director of the Association of Canadian Medical Colleges, urged me to consider it: it’s got nowhere else to go but up, he said. You can do a lot to lift it up. This turned out to be a prophetic statement.

I flew from Boston to Ottawa on a hot and steamy summer afternoon. I’d been booked into the lovely old but dilapidated Bytown Inn, on the corner of O'Connor and Slater streets, long since demolished and replaced with a characterless modern high rise hotel.  I walked up to Parliament Hill, then around the Canal until I came to the Glebe -- very close to where I live now. It was nearly dusk by then. Parents sat on their front steps, sipping wine, while their kids played street hockey. The University of Ottawa was just across the Canal. I had an epiphany: this was the place! This would be a much better place to raise our kids than some far distant outer suburb of Boston or Cambridge!

So we came to Ottawa. It was a most happy choice.  Half a century later I look back with a sense of accomplishment, of successful educational innovation and experiments in which students eagerly participated.  Ably aided by capable staff, notably Anne Amberg, a social worker, I integrated hospital-oriented clinical experience and a community-based focus on support networks, acquainting students with the work of the social agencies in Ottawa and Eastern Ontario. I encouraged selected students to take a ‘gap’ year to travel and work in developing countries. I was appointed Canadian representative on the NIH Epidemiology Study Section, invited to become editor in chief of the massive American textbook of public health and preventive medicine, editor of a Dictionary of Epidemiology, and wrote or edited several other successful books as well as the Canadian Journal of Public Health.

With my two dictionaries, at APHA, 2007

Five editions of Public Health and Preventive Medicine
("Maxcy-Rosenau-Last") and other books I've written or edited 

 I consulted often for the World Health Organization in developing countries and at WHO HQ in Geneva. Looking back on it all, I feel satisfied with a worthwhile life, saddened only by my beloved Wendy’s death in 2010. But it was after 55 magical years; and I console myself with the thought that by letting her go first, I behaved as a gentleman should.  I feel great pride when I reflect on her accomplishments. She could dash off a poem or a short story in an hour or two, she painted some lovely pictures that decorate our walls; and her selfless altruism and service to others led to her

Wendy receiving Caring Canadian Award
from her excellency Adrienne Clarkson,
Governor General of Canada, 2003

richly deserved Governor General’s Caring Canadian Award. 

Along with family and friends I applauded enthusiastically that day. I’m sad that she wasn’t there to applaud at the investiture in 2012 when I was appointed an Officer in the Order of Canada.

Investiture May 2012, John admitted to Order of Canada as an
Officer of the Order, by His Excellency David Johnson,
Governor General of Canada

At our 50th (Golden) wedding anniversary banquet, 2007.02.14
Standing: Jonathan, Rebecca, David
Sitting: John, Wendy

                                           John and Wendy at 50^th Anniversary Banquet, 2007.02.14

A festschrift, or celebration of my life

On Thursday May 19, my colleagues and friends assembled to celebrate my life and work. Not only Ottawa University colleagues were there. The event attracted old friends and colleagues from across the pond, Miquel Porta from Barcelona, Raj Bhopal from Edinburgh took their places at the podium to sing my praises. So did Arthur Frank from Philadelphia. 'Scutch' - Doug Scutchfield from Lexington, Kentucky, sent a moving video which I'll try to link to this brief report. Trevor  Hancock flew in, all the way from Victoria BC. Those from nearer home included Karen Trollope Kumar from Hamilton, whom I first got to know, and mentor, when she and her husband Pradeep Kumar ran a network of rural community clinics in the Himalayan foothills near Dehra Dun, Eva Grunfeld from Toronto, Rama Nair and Ian McDowell, my uOttawa friends and colleagues for many years. It was a delightful and moving occasion. I especially liked that the 'formal' proceedings were hijacked twice by former students who wanted to say how I had influenced their lives. (The 'formal' proceedings were quite rightly so relaxed they hardly merit the word 'formal')

The  remarks of all who spoke are preserved in an elegant commemorative book that I'll get next week.  I'll recycle selections from it as a post or posts on this blog.

Here is what I said at the end of the day:

Thank you all for all the kind and wonderful things you’ve said about me.

And special thanks, Mariella Peca and friends, for all your hard work organizing this celebration.

I’ve been described as a ‘living legend’ and as a ‘towering figure’ – this presumably by people who’d not seen me in the flesh. (My daughter Rebecca uses politically correct language to describe me more accurately as ‘vertically challenged.’)

At school I was briefly nicknamed ‘lucky’ Last. I stomped on this: such a nickname was tempting fate; would surely bring bad luck.

Having survived 90 years, I’m not, and never was, superstitious.  But I have had a very lucky life, no doubt about it.

I chose a fortunate birth cohort, the babies born in 1926.  It’s the birth cohort of Fidel Castro, Marilyn  Monroe, Hugh Hefner of Playboy, and our lady sovereign Queen Elizabeth. 

On Sunday September 25 1955, I had my greatest ever stroke of luck. On my way to play golf with three friends, I picked up two young women hitch hikers. I was instantly attracted to one of these hitch hikers: five minutes after we met I made a suggestion that changed both our lives. They were on the wrong road for their intended destination; I should have dropped them at the next cross road.  Instead I abandoned my planned golf game, persuaded them to change their plans for that day, to let me show them some of the beautiful dairy farming and wine growing country south of Adelaide.  By the end of that magical day, after long conversations with the Kiwi called Jan Wendelken, also known as Wendy, I knew she was the maid for me. I’m very, very sad she isn’t here today: she died in 2010 after a brief, not very distressing illness.

Our courtship began with 125 letters, mostly 8, 10, 12 handwritten pages, between October 1955 and May 1956, two or more letters a week, back and forth across the Tasman Sea between Adelaide and Christchurch. We never ran short of things to say.  Then she phoned me – a big deal, a huge deal in 1955, an international phone call – and we agreed that she’d come back to Adelaide, nurse at the Children’s Hospital, while we conducted a more conventional 20^th century courtship.

We married on Saint Valentine’s Day 1957 and had 55 wonderful years of adventurous travel and multiple intercontinental migrations – we lived in Adelaide, Sydney, Adelaide, London, Sydney, Burlington, Vermont, Edinburgh, Scotland, and Ottawa. There was much other travel, many holidays in Europe, trips back to Oz and NZ to visit our families, and working travel for me in Colombia, Indonesia, Sri Lanka, India, Thailand, Saudi Arabia, Kuwait, Lebanon, and China and Japan as well as many places in UK and Europe.  Also, of course, much travel in Canada and the USA.  At times I virtually commuted back and forth across the Atlantic, to Geneva, Stockholm, London, and Paris.

Our early travels were by sea on freighters carrying 12 passengers – by far the best way to travel long distances across our planet. From 1965 onward, we flew, enduring all the discomforts and anxieties of air travel.

We found enough spare time to produce 3 children, all of whom have interesting, worthwhile lives.

Wendy inspired me, breathed life into all my professional endeavors, encouraged, aided and abetted all my scholarly activities, all the travels. When our kids were grown up, she usually came with me.

I met and networked with the movers and shakers of public health sciences in the English-speaking world and beyond, absorbed ideas from them, occasionally contributed ideas of my own.

Alas, most of those wonderful women and men of public health who were my friends, collaborators and colleagues, have preceded me into the great field study in the sky – have fallen off their perches before me.  That’s one of the penalties one pays for living too long: it can lead to a lonely old age.

I’m best known as a medical writer and editor. I edited 3 editions of the massive public health textbook, eponymously known as Maxcy-Rosenau-Last, and 4 editions of the Dictionary of Epidemiology, as well as a Dictionary of Public Health; and co-edited an Encyclopedia of Public Health. I loved editing, took to it like a duck to water. If there’s a god, it’s what she meant me to do, and I did it with gusto and enthusiasm.

I first got involved in medical writing while still in general practice in Adelaide in the late 1950s. In Sydney in 1962-63, I wrote several chapters and helped to edit a book on child health and determinants of healthy child development.

In Edinburgh, in 1966, Jim Robson and Reg Pasmore invited me to edit the ‘Community Medicine’ chapters in a massive, Edinburgh-based 4-volume textbook, A Companion to Medical Studies. This immersed me in most phases of scientific book production.

In Ottawa I became the Canadian representative on the board of directors of the (US) Association of Teachers of Preventive Medicine, and thanks to my track record, a member of the publications committee. In that capacity, I spoke with knowledge and experience about priorities and problems in producing a multi-author textbook. The board of directors thanked me and I came home to Ottawa carefree and happy.

A few weeks later I had a phone call from the chairman of the search committee responsible for finding an editor in chief for the massive American textbook of public health, previously compiled and edited by a team based at the Harvard School of Public Health, then a different team based at Johns Hopkins School of Public Health. The publishers, conscious of changing times and priorities, wanted to take the book out of schools of public health, place it in medical school departments of preventive medicine who were regarded as more in touch with changing times and new problems.  The publishers, and the search committee, wanted me to be editor in chief. A lot of politics was involved; in my innocence, I was unaware of this until years later, which was just as well for my equanimity and peace of mind.

Reluctantly, and only after I’d refused several times, I agreed to take on this editing task.

The book was a success.  It led to an invitation to carry out a far more enjoyable task, compiling and editing a Dictionary of Epidemiology. There isn’t time to go into details, but I was at the epicentre of a world-wide network of oddball epidemiologists, all of us concerned about precise use of technical terms, the words and phrases used to label the concepts, methods, and procedures of epidemiology.  It was the most fun I’ve ever had with professional work.

The Dictionary of Epidemiology was the most successful book on OUP-USA’s publications list. It’s gone through multiple editions, 4 under my watch and 2 more since, and has been translated into at least 14 other languages. It made my name known to epidemiologists all over the world. At international meetings I feel like the Eiffel Tower: everyone wants their photo taken standing next to me. 

On the day we met, Wendy and I got into a deep discussion about the moral and ethical foundations of nursing and medical practice. We discovered that we shared the same values – values slightly (sometimes a lot) out of sync with prevailing majority views. It gave us something else in common, added to my conviction that Wendy was the maid for me.  As we bonded more closely, our shared values became as one.

Concern for human rights, individual autonomy and freedom of choice balanced by concern for the collective, for society and the community as a whole – indeed for all life on earth as an entity – were ideas we dimly perceived in the 1950s. Our ideas evolved as we matured, although some retreated into subconscious memory for many years, to resurface in the 1980s when I got involved in developing guidelines for ethical conduct of epidemiology and public health. The seeds were sewn in that conversation Wendy and I had over our pie and lemonade lunch on a hillside above Yankalilla Beach, South Australia on September 25, 1955.

Again, my heartfelt thanks to all of you for contributing to this festschrift.

A Celebration

Last Thursday, May 19, my colleagues held a celebration of my life, a sort of mini-festschrift.  I'd been rather dreading this, not because it was yet another marker on the inevitable downward pathway to senescence and oblivion, but because I was embarrassed thinking about what my friends and colleagues might say and do.  I needn't have worried.  It was a thoroughly delightful experience in every way. I was really chuffed that two good friends traveled all the way across the pond for the occasion -- Miquel Porta came from Barcelona, and Raj Bhopal came from Edinburgh. Trevor Hancock came from Victoria, BC, which is about as far away as Barcelona and Edinburgh. 'Scutch' -- Doug Scutchfield, from Lexington, Kentucky -- didn't travel to Ottawa for the event, but did sent a lovely video tribute, which in a way is better because I have a permanent electronic record, which I could post on this blog if I knew how to do it. Mariella Peca, our longtime faithful office manager whom I recruited when she was still in her teens 40 or more years ago, has collected many tributes and is assembling these in a book which I'll see and be able to peruse at leisure next week. I could have had it sooner but I added my thanks and appreciation on the day, which delayed matters a little bit. There are also photographs along with quite a large number of written tributes, I understand. I'm eagerly looking forward to holding the book in my hands and reading it, I hope as soon as this Victoria Day long weekend is over. I put together a few photos myself, in a small Powerpoint slide deck and had this ready to accompany my thanks to everyone at the end of the day. But hardly anyone showed slides.  The event was held in a splendid setting, the Museum of Nature, just a few hundred meters from my condo.  It's a superb setting for an event such as this, but doesn't lend itself well to showing slides. It was catered supremely well, one of the best banquets I've ever attended. That was better than looking at a lot of slides! I'll probably be able to include some photos in the next post on this blog.

Stuff Matters

Stuff Matters is the most interesting, entertaining, educationally enhancing book I've read in a long time. The 'stuff' Mark Miodownik writes about is the often anonymous material we use every day in all manner of ways, and take for granted; but without it, society as we know it, civilization indeed, couldn't function. Steel results from heating iron in the presence of small -- and varying -- amounts of carbon, sometimes subjecting it to being beaten as it cools from a molten or near-molten state.  The Japanese craftsmen who made Samurai swords discovered this empirically thousands of years ago, and so did a few other small, select tribes or clans in various parts of the world. This enabled them to make swords strong enough to vanquish enemies in warfare without their swords shattering as they would have if made merely of cast iron, or softer, more malleable bronze.We use steel in innumerable peaceful ways too of course, most successfully perhaps in the chemin de fer, the iron roads -- rails -- on which our trains run. And of course also to build the bridges, viaducts and earth-moving equipment that smoothes the uneven terrain over which the rails, and the trains, must run.   Concrete, exploited by the Romans and reinforced with iron, made the magnificent dome of the Pantheon temple in Rome, still after 2000 years I think the largest (and surely the most aesthetically lovely) dome in the world. Did you know that concrete results not from the drying-out of a liquid paste of its ingredients, but from the absorption of water into this paste? I didn't, but now this factoid is part of my lifetime accumulation of information. Paper is one of the four great Chinese discoveries, also enormously important, indeed essential to civilization in everything from battle plans to intimate love letters (Mark Miodownik reproduces a love letter from his wife to him, to illustrate this use of paper). The essential ingredient of paper is a paste of cellulose that dries to varying thickness and durability. There was so much I didn't know before I read Stuff Matters. I didn't know that the Shard, the extraordinary glass pinnacle beside Tower bridge in London, is the tallest building in Europe, or that some 3000 people work in it -- it looks smaller in its pictures. I do know that it's the most striking architectural structure of the contemporary London cityscape, the one I'd most like to go back again to London to see for myself. Ah, life's too short: so many things I want to do but can't because my range is increasingly restricted by infirmity and old age.  

Doom and gloom

Where did April go?  It's a sign of advancing age when the days and weeks flash by so quickly that I'm hardly aware of their passing. 

I've been trying to keep a finger on the pulse of world events as they flash by, though goodness knows why I bother: most events reported in the media are so depressing, I would like to escape, as the Soviet newsmakers used to do by reporting only good news -- the output of tractors, the achievements of football teams. I'd prefer not to hear the trumpeting of the deplorable, bombastic ignoramus the Republican party in the USA has selected as its candidate in this year's presidential contest. And contest is a suitable word to describe what is going on, the whole thing is, perhaps quite rightly, being treated by the media as if it were a wrestling match.

As for international affairs, the news out of Syria is alarming and profoundly depressing. I find it incomprehensible that seemingly nothing is being done to restrain the ruthless and murderous regime of Bashir al-Assad. Is this because of President Obama's aversion to getting drawn into yet another Middle East entanglement? It's tempting to bury one's head in the sand, as seemingly are the leaders of the western nations.  

The international news is bad enough, the ecological news -- especially at the global level -- is worse. Global climate change continues relentlessly, destroying vital life-supporting ecosystems, most ominously marine ecosystems, where the consequences are profoundly destructive for terrestrial as well as marine life-support systems. The combination of a seemingly trivial rise in sea temperature and equally imperceptible declining pH -- increasing acidity -- kills coral reefs, which are dying everywhere, and disrupts the growth of every life form that has a calcium-based exoskeleton. 

My birth cohort was indeed a very lucky one. We had the best of all worlds. All those born since the beginning of the new millennium will have a much harder struggle just to survive, let alone to prosper in an increasingly hostile world.  All the dice are loaded against them.  I am sad and very sorry for my grandchildren.                    

Dublin and Limerick, 1967

In 1965 I published a paper on the organization and economics of medical practice in Australia in the New England Journal of Medicine, a rather astonishing honour when I think about it. The paper was superficial, descriptive, had nothing new to say about efficacy or outcomes. I made partial amends in a second paper in the UK general practice journal, Practitioner in 1966, in which I was able to include some analytic data from my national study of medical 'manpower' in Australia. These papers were studied with interest by senior officials in the Irish Medical Association, and I was invited to address their annual meeting in the early summer of 1967.

I flew from Edinburgh to Dublin on one of those rare perfect days of which there might be 6 in a good year, sparkling sunshine, no wind, the first spring day I hadn't needed a coat. It was the same less than an hour later in Dublin, but otherwise it was like a different planet. In Edinburgh, the businessmen, bankers, lawyers were dour, unsmiling as they made their way along George Street where Wendy had dropped me by the city terminus of the airport bus. I thought of the fire breathing Church of Scotland parson Wendy took our unwilling kids to hear (believing any religious instruction is better than none). That parson's message was simple: "Life is grim... and the goal is but the grave."   An hour later in Dublin the weather was identical but everyone looked cheerful, they greeted each other happily, people whistled as they skipped along in the spring sunshine that's as rare there as in Edinburgh.  I went into one of those marvellous Dublin pubs -- it could have been one frequented by Leopold Bloom -- on a lane leading off O'Connell Street by the post office with its bullet scarred portico. The bullet holes have mellowed, but are unmistakably bullet holes, a sad reminder of the Easter Rising.  Michael Enright's brilliant radio documentary on the 100th anniversary of the Easter Rising provoked this post, which I intended as a ringing endorsement. But this post is taking a more cheerful course. I'd deliberately arrived in Dublin a few hours early to explore and absorb a tiny moiety of this city, so I could compare it to Edinburgh where we'd made our home, were putting down roots. I spent much of the day, strolling Dublin's streets, browsing book shops, absorbing the atmosphere. 

That evening I met the President, the Secretary and the Treasurer of the IMA. Between the four of us, we'd fathered 32 children. Two dinner table conversation topics were unlike any I'd had at comparable gatherings in UK or Oz: the relative merits of available minibuses to take the family for a Sunday afternoon drive (Mercedes minibus, all agreed). The other topic was totally new and foreign to me: What's the best electric potato-peeler on the market? They described this device to me: you drop potatoes, preferably round and about the size of tennis balls, into a receptacle where sharp blades abrade the skin until it's all gone. This handy kitchen aid costs about as much as 6 months wages for a kitchen maid...

Next morning I was driven across Ireland's green and pleasant land, lush, fertile, cattle up to their midriffs in lush green pasture. In Limerick, there was abundant time for sightseeing this prosperous small city, which gave off warmly welcoming vibes. I don't recall any details of the next two days scientific papers and other presentations.  My paper on the organization and economics of general practice in Australia was part of a package that included similar papers on the situation in New Zealand and Canada, and one other, perhaps Rhodesia, but I've forgotten the details, probably never having absorbed them in the first place. I do remember many questions, more directed at me than at any other of the speakers. I got the impression that half or more of the audience left the meeting resolving to inquire about how to migrate from Ireland to Australia.

The highlight of the meeting was yet to come -- a mediaeval banquet in Bunratty Castle,which is on the outskirts of Limerick. Mediaeval banquets are rather hackneyed affairs nowadays but this one, the first I'd ever attended, was smoothly and efficiently mounted. The serving wenches wore low-cut blouses with scooped necklines. They served mead as well as ale so before long the atmosphere was softened by a benign haze. I'd learn't by that time to watch and control my alcohol intake at such functions, but mead was a new drink for me, far more powerful than I'm expected. Fortunately I managed to stay sober enough to remain respectable.