A few things I’ve been thinking about this week. The forty-second post of a series.

A great post on the LRB blog this week by Liam Shaw makes the fundamental point that “prescribing a course of antibiotics shouldn’t be an isolated consumer transaction; rather, treatment should be part of an integrated system with continuity of care”.

On one of its front pages this week, alongside a headline reporting that “Truss was a disastrous dalliance who served only to remind us what a real leader looks like,” the Daily Mail claimed to offer “unrivalled reports and analysis.”

Only 79 days previously, one of their headlines informed the readership that “Liz has the boldness, vision and strength of conviction to build on what Boris began.”

Only 45 days previously, their banner headline celebrating Liz Truss’s selection by the Tory membership screamed, “cometh the hour, cometh the woman.”

Only 27 days ago, their front page proclaimed the disastrous mini-budget to be “a true Tory budget” offering the “biggest boost for 50 years.”

There’s only one way in which these reports and analyses are unrivalled: their distance from reality.

“The possible return of this unscrupulous leader who damaged the moral credibility of the Conservative Party is causing a lot of concern,” says Cécile Ducourtieux in Le Monde, with understatement.

And this editorial is stinging:

Still traumatized by the shock of Brexit and the never-ending negotiations and extreme division it brought about, the UK is struggling to point to its exit from the EU as the trigger for the downgrading and destabilization impacting the country. Growth and investments are at half speed, with exports slowed, and there is the renewed risk of secession by Scotland and Northern Ireland. For a while, Covid masked the damage of Brexit, which has become the elephant in the room that few people, even those in the opposition, want to see. From this perspective, Ms. Truss’s time in office, which claimed to “take advantage of the freedoms of Brexit,” looks like a terrible crash test.

Learning the lessons will be long and painful. But it is hard to see how the UK can return to stability and prosperity without escaping from the denial and silence about the consequences of a decision that has isolated it and cut it off from neighbors and natural partners on the continent.

Eshe Nelson in the New York Times:

Since Brexit, the nation has had more barriers with its largest trading partner, the European Union, business investment has been lackluster and companies have lost easy access to a large pool of workers. The National Health Service is overburdened, and the immense backlog of patients needing care is keeping many of them out of work.

In addition, like many nations, Britain is enduring the highest pace of inflation since the 1980s, taking the momentum out of consumer spending and economic growth.

While Britain shares some economic problems with other advanced economies, its outlook for inflation is particularly painful. Consumer prices in the country rose 10.1 percent in September from a year earlier. with the annual inflation rate returning to its fastest pace since 1982.

Tom McTague in The Atlantic, even before this week’s events:

For the first time in my adult life, there is a genuine sense of decay in Britain–a realization that something has been lost that will be difficult to recover, something more profound than pounds and pence, political personalities, or even prime ministers. Over the past three weeks, the U.K. has been gripped by a crisis of crushing stupidity, one that has gone beyond all the turmoil of Brexit, Boris, even the great bank bailouts of 2007, and touched that most precious of things: core national credibility.

None of this is fixed by changing Prime Minister. It’s hard to imagine our country side-stepping some kind of fundamental constitutional reform after this level of destruction, probably beginning with the break-up of the nation.

Wendy and I have been visiting someone in Berwick-upon-Tweed this week, in only our second visit to the town, despite speeding through on the train many times. We particularly enjoyed a stroll around the town walls, only a few weeks after I did the same in York. We also popped to Bamburgh on the way back, though the world-renowned majesty of the Northumberland coast was enveloped in fog, so really we could have been anywhere.

A few things I’ve been thinking about this week. The forty-first post of a series.

One of the sillier apps I have on my phone is Conqueror Virtual Challenges, which takes the distance I walk and plots it along a given “challenge” route. This is qualitatively absurd: schlepping from the sofa to the fridge for more chocolate is not sensibly comparable to trekking a few metres further up a mountain.

It therefore feels mildly fraudulent (but also a little bit lovely) to have received this medal this week. It commemorates having walked the length of Route 66, a total of 2280.5 miles, since September last year. I’ll happily confess that I’ve made no special effort, it’s just my normal, everyday steps.

I think I’ve only bought two of the top 20 biggest-selling debut albums in UK history, both on CD, though there are another two that I might have bought. I can’t remember for certain, and I’ve no idea where any of them are now.

I shop at IKEA more than most people. I tend to consider it to be an easy place to shop. It’s painless to check stock before visiting, it’s easy to pop in and pick up the needful, and if you want to view something before purchase, the layout is logical and well-signposted. They’re far from perfect, but they are at least thoughtful about their impact on the environment. I pop in just to use the restaurant occasionally.

I’m therefore always tickled by articles about it being a labyrinth. These often seem to be based on the more common experience of wandering the entire store at the busiest time of the week, trying to make stressful decisions about large furniture purchases, all in a novel and unfamiliar environment. The articles are frequently very funny tales or analyses of stressful experiences—but not at all like my experience of IKEA.

Tory MPs are telling us again that they are ruthless about getting rid of leaders, less than six weeks after they finally dispatched Boris Johnson following a psychodrama that dragged on and on and on for years. Facts needn’t hinder party mythology.

The thirteenth Chancellor of the Exchequer of my lifetime was appointed this week. The first six served for my first 25 years on the planet. Jeremy Hunt must serve thirteen years if the second seven are to draw level that record. This seems unlikely.

A few things I’ve been thinking about this week. The fortieth post of a series.

I’ve been reading Andrew Holleran’s The Kingdom of Sand this week. About a third of the way through the book, the narrator reflects on his decision to continue living in his parents’ house:

I liked the idea of keeping the same post office box, the same bedroom with the same books I’d had to read in high school lined up in the headboard of my bed, in a little compartment whose sliding door I merely had to push back to pull out my well-worn paperbacks of Hamlet and The Great Gatsby. I liked never having to write the alumni magazine to say I had a new address, never having to switch banks or have to ask my dentist to forward my records to a new town. I wanted to stay in one dear, perpetual place. I wanted to watch what happened to it over time.

Even the act of reading that makes me feel a bit claustrophobic, a bit suffocated. I couldn’t disagree more.

I went to my quarterly appointment to give blood this week. I look forward to it: I enjoy the unusual experience of being able to lie back in a public place, undisturbed, and just spend time with my own thoughts for ten minutes or so.

It makes me think of a passage in the sixth edition of Oxford Handbook of Clinical Medicine which made a big impression on me as a Foundation Doctor. I used to think about it almost daily.

This is not one of those passages about how you should be kind to the patient, explain in full what you are going to do, talk him or her through venepuncture, label the bottles carefully, and make a plan for communicating the results. Be all this virtue as it may, there is something else which needs communicating about the most menial of our tasks: the act of taking blood. It is partly to do with the fact that as blood is life, and, because, as Ruskin taught us, ‘there is no wealth but life’, we are led to the conclusion that what is special about taking blood is that for once we are being given something valuable by the patient. What is this wealth? The answer is time. For while the blood is flowing into our tube we cannot be disturbed. We are excused from answering our bleeps, and from making polite conversation (a few grunts in reply to patients’ enquires about the colour of their blood is quite sufficient)—and we can indulge in that almost unimaginable luxury, at least as far as life on the wards is concerned, of being alone with our own thoughts. Thinking of this sacred time as a sort of hypnotic holiday is excellent. For however many nights we have been awoken, and through however many wards we have traipsed to this bedside, this little holiday will be worth an hour’s sleep—if our mind is furnished and ready to empty itself of all objectivity. The best sight in haematological practice is, during venepuncture, to watch for those occasions when, owing to some chance characteristic of flow, the jet of blood streaming into our tube breaks up into countless globules, and before coalescing again, these globules jostle together like the overcrowded chain of events which led us to this bedside.

I’d forgotten, until I looked it up, that this passage leads into eight lines from William Blake’s Milton, complete with a footnote explaining some of Blake’s imagery and the completely unconnected influence of Blake’s editor on breast cancer surgery. That’s a whole other level of authorial indulgence.

But back to my blood donation… it was with mild dismay that I noted that the patient information sheets have been updated to include a section on things patients can do if they fear boredom during their ten-minute donation. Top of the list is playing with their mobile phone.

Having got my vintage 2004 OHCM off the shelf (well, Wendy’s copy, actually) I wondered what bon mots it may have about my current specialty. It didn’t disappoint:

Many of the diseases which preoccupy consultants in infectious diseases are new—food-borne E. coli, waterborne Cryptosporidium, airborne Legionnaire’s disease, blood-borne hepatitis C, and sexually transmitted HIV have come to the fore only in the last 30yrs. Why have these years been so tumultuous in the ID world? The short answer (at least for some of these) is greed, and our desire to exploit nature. For example, economic drive builds dams (increasing breeding grounds for vectors by orders of magnitude) and forces land development, putting people closer to vectors, eg ticks, mosquitoes, and rodents. Intensive farming is also making it easier for infectious agents to jump the species barrier (think of CJD).

Can we win? No: we cannot win against infectious diseases. All we can do is live with them. To help us do this in ways which are not too destructive, we need robust public health surveillance institutions, political will, quarantine laws, and above all, openness and cooperation. SARS and its spread underline these facts in a particularly graphic way: as the Chinese and other less-than-open societies have found out, when it comes to reporting infectious diseases, lying means dying.

I gave a conference presentation and an in-person MSc lecture this week. I’m not certain, but I think this is the first time since the start of the pandemic that I’ve done either of those things. I think I’m rusty, and that neither was as good as it could have been. Yet, the sheer number of thoughtful and caring messages of appreciation I received following the former gave me a bit of a boost this week.

The images in this post are all AI-generated images for the prompt “a junior doctor taking a blood sample in a hospital ward, oil painting” created by OpenAI’s D-ALLE 2.

A couple of things I’ve been thinking about this week. The thirty-ninth post of a series.

I gave a presentation this week to prospective public health trainees. I’m told that my enthusiasm for my job was “obvious and infectious”, which is a surprise after the last three years.

Eleven years and five months ago, Wendy and I spent ages browsing shop upon shop, trying to find two decent sofas. This week, we’ve been doing it again.

Now, as then, only a tiny proportion of sofas are to our taste. There are frequent exclamations of “Who would want that in their house?!”

A few things I’ve been thinking about this week. The thirty-eighth post of a series.

Nobody tell “pro-growth” Liz Truss, but my taxpayer funded job is terrible for this country’s Gross Domestic Product.

By preventing people from catching serious infections or being harmed by chemical, radiological or biological hazards, I’m sucking millions out of the economy. I’m denying the country all the economic activity which could have been generated from decades of expensive medical treatments, or hugely costly spells in hospital or eye-wateringly costly stays in intensive care or isolation units. All those private companies whose drugs will sell slightly less well, or whose facilities management will have one less bed space to clean, or whose disability aids will have lost a potential customer must be raging at me.

And—which may be worse—I’m reducing productivity by making business focus on protecting their staff and customers from harm, instead of freeing them up to spend more time making widgets.

My entire job is based on the outdated socialist ideology that people’s health is worth something, even while reducing those all-important GDP figures: I’m the scourge of modern capitalist Conservatism, and yet the Treasury pays my wages.

That. Is. A. Disgrace.

Our local Councillors like to shove newsletters through our door every so often. One of the topics they frequently cover is recycling, and specifically, what residents may or may not put in their recycling bin. Their missives often end with the exhortation, “if in doubt, leave it out.”

For years, I’ve wondered whether they meant “if in doubt, leave it out for collection” or “if in doubt, leave it out of your recycling bin”. Both options seem reasonable: one increases the proportion of waste that is collected for recycling rather than landfill; the other protects the purity of the recycling stream.

This week, for no particular reason, I thought I’d search online to try to solve the puzzle. It appears that this is a commonly used slogan across different parts of the UK and is meant to communicate the latter message.

I guess this is proof that slogans don’t need to be clear to be catchy.

The previously mentioned closed branch of Barclays on my route to work is now plastered in Barclays notices headlined “Here to help”—despite that being demonstrably false. Bizarrely, they even say “pop in and arrange a time to talk”.

The small print shows that they’re advertising a seven hour per week service at a local cricket club.

Wendy and I finished watching the ten-part series The First Lady, a historical drama interweaving the lives of Michelle Obama, Betty Ford and Eleanor Roosevelt. I struggled to get into it at first: it’s difficult to get over the barrier of other people playing characters as familiar as the Obamas, and Kiefer Sutherland as Theodore Roosevelt was… a stretch.

But there is some fantastic acting in there, and we both found that the series gradually got under our skin. It’s worth sticking with.

The images in this post are all AI-generated images for the prompt “a physician and a First Lady of the United States, photographed from behind, sorting mixed recycling in an old-fashioned banking hall” created by OpenAI’s D-ALLE 2. Interesting that the physician is dressed in traditionally male clothing in all cases.

A few things I’ve been thinking about this week. The thirty-seventh post of a series, and the second during this national period of mourning.

An incomplete list of unexpected places I’ve been offered written condolences on the Queen’s death: a billboard over the A167(M); the Amazon app; the Apple App Store; the Argos app; the ASOS app; the British Airways Executive Club app; every screen in the window and interior of Charles Clinkard; the Costa Coffee app; a signature on the bottom of an email from a local Council officer; the CrossCountry Trains website; the Deliveroo app; the EasyJet app; screens in Eldon Square; every single notice in several estate agents’ windows, because there’s nothing as disrespectful as advertising a house for sale; the window of Fenwick; the GoPuff grocery delivery app; the menu board in Greggs; Haymarket Metro station; the window of HMV; the window of HSBC, in a notice featuring the Queen wearing an outfit in the bank’s black and red colour scheme, because mourning presents an opportunity for brand reinforcement; the IKEA website; the John Lewis app, as well as their shop window; the LNER app; an email from The London Library; the M&S app and shop window; Matt Goodwin’s Substack; the Newcastle City Council website; one (and only one) of the entrances to Newcastle City Library; the Next app; an email from the Royal Society of Medicine, though maybe I should have expected that one given the name; a wall inside a Samsung Experience Store; the Selfridges website; the window of Skipton Building Society; the window of Specsavers, in surprisingly small writing; the Superdrug app; a broken screen in the window of TSB which I think was offering condolences, but for all the text I could read may have been suggesting the overthrow of the monarchy; screens in the window of Vision Express showing photos of the Queen wearing glasses, because mourning presents an opportunity for a sales pitch; a little A5 sign on the Waitrose deli counter; the window of WHSmith; emails from no fewer than four people above me in the management chain at work, no doubt time well spent; the Yeo Valley website; the window of the Yorkshire Building Society.

So, where was I (last week) when I heard? I’d been in the office, and aware from news websites of the concerning update from Buckingham Palace regarding the health of the monarch. Without really any knowledge to back it up, I half-expected an announcement at 5pm, which didn’t come.

As I walked home from work, assuming I’d be unable to stomach whatever Radio 4’s was offering, I listened to John Pieneaar and Stig Abell on Times Radio. They were delivering a pitch-perfect live programme reflecting on the life of the Queen. The hour I heard was focused on the response around the world to the concern about Her Majesty’s health. Correspondents from a string of countries reported on how their national news media was covering the story and shared insights into those countries’ longstanding relationships with the Queen.

As 6pm drew near, Pineaar and Abel prepared listeners for an expected ‘significant update’, cueing up 6pm with a well-chosen clip of the Queen’s “we’ll meet again” speech. There was some palpable filling after the top-of-the-hour when the expected news didn’t come, with the usually prompt headline sequence following only minutes later.

As I arrived home, Wendy had BBC News on the TV. At 6.30pm, I spotted a Press Association update on the web, which announced the death. Wendy and I sat together, anticipating the BBC’s announcement. Once Huw Edwards had broken the news a few minutes later, we got on with dinner.

Shortly afterwards, my on-call phone rang with news of a multiagency Tactical Command Group called that evening by a local police force as the North East elements of Operation London Bridge began to be implemented. And the world kept turning.

I’m loath to criticise anyone for over-reaching with days of continuous coverage of a single story to fill, but some may have pushed it a little far. I’m not convinced that we can infer much about King Charles’s approach to kingship from his haircut, as one weekly newspaper suggested. While technically true, I’m not certain that it’s all that illuminating to discuss our new monarch as an ‘orphan’, as one news channel did. And I’m not confident that the King’s response to a leaky pen really gives us quite the insight into his psyche that so many media outlets proposed.

A few things I’ve been thinking about this week. The thirty-sixth post of a series, and the first in a period of national mourning.

The eighth Prime Minister of my lifetime was appointed this week. The first four served over my first 25 years on the planet. Prime Minister Truss must serve until 2035 if the second four are to match that record. This seems unlikely.

The second monarch of my lifetime ascended the throne this week. The first reigned over my first 37 years on the planet. The King must reign until he is 110 years old to match that record. This seems unlikely.

The Government has announced a tenth Bank Holiday in 2022. There have never been so many in a single year in my lifetime. There must be two huge national events in the same year for this to happen again, or fewer if one or more new standing Bank Holiday(s) are introduced. Neither contingency seems unlikely, but history suggests that both probably are.

A few things I’ve been thinking about this week. The thirty-fifth post of a series.

I’ve been reading Geoff Dyer’s The Last Days of Roger Federer this week, and, while describing someone’s house, he mentions in passing that

the previous time I was there, I’d held a human brain in my hands (a visiting neuroscientist happened to have one in the trunk of his car).

This was one of those arresting moments: of course, I (and many of my friends) have held human brains while studying anatomy at medical school. It’s so normal among us as to be unremarkable, but in the wider scheme of human existence, it’s a bit… weird.

In our anatomy exams, bits of cadavers would be presented to us with flagged pins stuck in them, like miniature golf flags. The task was to ‘name the structure first pierced by Pin A’, for example, with the classic easy example of the ’beautiful tortuous splenic artery’, as we were all accustomed to calling it.

When it came to the brain, we were often presented with slices of brain with pins in them, much like thick slices of strangely shaped ham with seemingly random placed markers. This was meant to be important because this is typically how the brain is imaged, in CT scans for example. I was hopeless at this bit. In retrospect, I think this was related to my (relative lack of) colour vision: the slices looked uniform colours to me, whereas Wendy tells me there were shades to them. Anyway, my total lack of ability in this clearly wasn’t enough to prevent me from qualifying in the end.

I started reading Jia Tolentino’s Trick Mirror this week, and was particularly struck by this passage:

I have become acutely conscious of the way my brain degrades when I strap it in to receive the full barrage of the internet—these unlimited channels, all constantly reloading with new information: births, deaths, boasts, bombings, jokes, job announcements, ads, warnings, complaints, confessions, and political disasters blitzing our frayed neurons in huge waves of information that pummel us and then are instantly replaced. This is an awful way to live, and it is wearing us down quickly.

It’s reminiscent of Bo Burnham’s Welcome to the Internet distilled into a paragraph, and it’s hard to disagree.

This week, I’ve seen young couples turning up to a hotel breakfast with an iPad, which they’ve propped up on the table so that they can jointly and collaboratively fill in a crossword. This happened on several days with different couples each time. I’ve never seen that before.

The images in this post are all AI-generated images for the prompt “a Vermeer style painting of a man holding a human brain” created by OpenAI’s D-ALLE 2.

A few things I’ve been thinking about this week. The thirty-fourth post of a series.

Jhumpa Lahiri’s Whereabouts introduced me to the Italian word for jewellery box: portagioie, which can be literally translated as “joy box”. This initially struck me as beautiful, but became more and more depressing the more I thought about it.

In the TLS, Ysenda Maxtone Graham says

I always feel sorry for the poor consumptives of history, who would probably far rather have stayed in their home bedroom in England, but were dragged off in some bone-shaking vehicle in search of better air in the south of France, where they died anyway.

Now I do, too.

Also from the TLS, I leaned that the bestselling author James Patterson used to be the CEO of Toys’R’Us and also wrote its jingle… and that his autobiography is called James Patterson by James Patterson: Stories of My Life by James Patterson.

Your email signature should reflect the role in which you are sending the email. That is its main function. People who have a list of different roles in their signature, such as professorships and editorships, are basically show-offs who don’t understand basic principles of governance.

Julian Barnes’s piece in the LRB comparing Ingres’s Madame Moitessier and Picasso’s Woman with a Book was fantastic, and made me look at both paintings more closely than I’ve looked at any painting in years.

In the depths of lockdown, Wendy and I said that we’d make an effort to go to more galleries and exhibitions of art in a post-lockdown world, but we’ve somehow still not quite got round to it.

Having only recently watched My Octopus Teacher (without me), Wendy was distressed to see octopus toasties on a menu this week.

It also got us trying to remember the correct plural of ‘octopus’—Wendy thought ‘octopuses’, I thought ‘octopodes’, and we both thought ’octopi’ was wrong. The OED lists all three options, with ‘octopuses’ first… though the 1989 edition didn’t include ‘octopi’ and had ‘octopodes’ as the first option. The right answer is clearly to never have more than one: they are fairly solitary creatures in any case.

The images in this post are all AI-generated images for the prompt “digital art of an octopus reading a dictionary and emerging from a jewellery box” created by OpenAI’s D-ALLE 2.

A few things I’ve been thinking about this week. The thirty-third post of a series.

I’ve been reading Cal Flyn’s Islands of Abandonment this week, and the introduction introduced me to the lovely word ‘palimpsest’:

We have written ourselves into the DNA of this planet, laced human history into the very earth. Every environment bears a palimpsest of its past. Every woodland is a memoir made of leaves and microbes that catalogue its ‘ecological memory’. We can learn, if we want, to read it—to observe in the world around us the story of how it came to be.

It looks like it comes from the Latin palimpsēstus which has almost exactly the same meaning as the modern word (a parchment on which the original text has been overwritten by another).

On my walk to work each morning recently, I’ve been passed by a push-bike with a trailer which has “catering for Manchester by bike” written on it. I assume no-one is really cycling 140-miles to cater for Manchester, but then I suppose stranger things have happened.

The public information sign lying that “The Government and NHS are well prepared to deal with this virus” has finally been taken down from the men’s toilet wall at work, two-and-a-half years on. The poster advertising a long-closed staff survey for an employer which previously occupied our office remains.

I feel seen.

The images in this post are all AI-generated images for the prompt “a drawing on parchment of a person cycling past a toilet.” created by OpenAI’s D-ALLE 2.