Depressions of Age

!!!This blog comes with a warning: Do Not Read If You're Depressed!!!

Mid-summer approaches, and the rising sun is now well to my left, not yet dazzling my eyes. Midsummer's day is the saddest day. Not for nothing is it called the longest day, for it is hard to get through. After midsummer, the nights draw in and cold winter looms ahead. As my steps slow, and even going up stairs grows more painful, I am growing maudlin in mind as in pace. It is good to be surrounded by young people, for the old grow old like me. But there is a dark side to seeing youth: the clear skin and bright eye, the energy and hope and optimism that one loses with age, yet yearns for yet. I remember an SF story, where a rich old man grants a poor boy all his riches, to exchange minds with him. Bernard Shaw too, for all he had achieved, looked back with nostalgia in Back to Methuselah.  I read it when young, and thought it a poor play, but now it resonates, and I look on youth with envy, not with joy, and yearn to run and play again as once we did.  How we took our youth for granted, like a spoilt child brought up in riches, never thinking that his fortune might be spent. The only consolation is platitudes: "You can't turn back the clock", or "You had a good life" or "It could be worse". But you can keep your platitudes and stick them where you will; they do not console.

If Death Should be The End

If death is the end, it is better to die
in the cradle without pain or strife;
yet on we live.
Through thought and writing,
by poetry and art,
in children and friends
we live on.
All we are and all we have been
is poured out through them.

When friends die and children die,
do we then die with them?
It is said that when someone dies,
whole worlds die with them.
We each contain a world of thoughts,
of habits learnt and feelings won,
of loves known and memories earned,
worlds awaiting death.

How little passes on;
some trick of speech,
some memory of a distant day's event,
some happy moment.
How little is the recollection now
of once dear grandparents;
yet all that exists of them may be
that tiny and fragmented memory.
Somehow you try to ingrain it
in children of your own.
But you forget, or they forget,
and though their insidious influence
creeps through your every act,
everything that was and made
that individual fades gradually away
into insignificance,
as surely as their name fades
on an old tomb stone until
one can barely read the scratched out lines.

JHM

The BBC calls me

An article by the BBC today told of the falling numbers of GPs, to which I responded saying how I would love to work as a part-time locum again, but current regulations prevent me returning unless I go through an intense process of re-training and six months of work under supervision as a trainee. I wrote in to suggest that perhaps there should be a new level for people such as me who no longer wish to be principles or take on a management role, but just offer clinical support to our hard-working and over-loaded GPs.

I was immediately contacted by Richard Irvine-Brown, a BBC journalist, who interviewed me by phone to expand on this. If it does get some publicity, perhaps it will be the start of a new grade and  more retired GPs may be encouraged to return to part-time locum work.

Perhaps I may join them, always assuming I am well enough. I do seem to be increasingly tired, and often spend large parts of the day asleep, with little energy to do much in the garden or round the house. I continue to have diarrhoea for which I have to stuff loperamide (Lomotil) into myself, and although my urine is thankfully now free of blood, it does show large amounts of urobilinogen, a breakdown substance from the blood. None of the causes for this look particularly healthy, so I can only wait and see what develops next in this sad body!

Cuts all round

Last week I was a member of the Labour Party; this week, no longer so. Disgruntled with the two factions of parliament tearing each other apart, I sent in my letter of resignation, and am now a member of the Brexit Party, in the hope that such focus may bring matters to a head and sort out the mess one way or another. For the first time in my life, I am ashamed to be English.

As I age, I find I do more and more "sillies", such as going for a plate and bringing back a cup, or trying to put the milk in the cupboard rather than the fridge. Usually, the sillies are more forgetful than dangerous, but now I have done another silly, this time to myself. Going to the toilet on one of my regular excursions, I generally know my way well enough to not put on the light until I get into the bathroom. This time, I pulled the door shut ready to click on the light, but had not moved my foot far enough over the sill, and the door sliced into my toe like scissor blades. I could do nothing until I had reached the toilet and sat down, for when I need to go I need to go quickly.

Across the floor were little puddles of blood where my foot had trod. I wrapped a handful of toilet tissue round the toe, which rapidly turned red. Finally the flow was staunched, and with toilet paper wrapped round and wedged between my toes I hobbled downstairs to dress it as best I could, with a great swathe of bandage to hold it in place, and a sock over all in case it leaked through to the bed sheets.

Chronic renal failure - a textbook case study

I am going into pedagogue mode now, speaking as a medical professional to all who wish to learn about chronic renal failure (CRF) from the standpoint of the sufferer. So sit still and learn, or change channels now.

Anatomy. We all know they're somewhere towards the lower back part of the body, one on each side, and we know they must have little tubes connecting them to the bladder in some way. But when they're working and pain-free, no one knows where they are, and no-one cares. Only when they have a problem do we care - then the pain in the lower back on one or the other side points to their location in no uncertain terms.

Physiology. They do a lot of things we take for granted: they maintain fluid balance to prevent a build up of excess water; they constantly adjust the pH of the blood to be not too acidic nor too alkaline but "just right"; they maintain salt balance - not just the sodium chloride we shovel on our fish-and-chips, but all the other salts we usually ignore - potassium, calcium, phosphorous, and carbonates. They also bear some responsibility for regulating blood pressure, stimulating haemoglobin levels in the blood, and helping the immune system to cope with life's traumas and the nasties constantly trying to invade our bodies. Oh yes - on top of all this, they get rid of much of the toxic waste our bodies generate each day from burning food for energy ('good' waste), and breaking down all the rubbish we throw into our stomachs ('bad' waste) - especially from the evil meat, that palatable temptation of the devil to ingest poison in the guise of tempting steaks and succulant stews. Be not deceived - the stuff is poison as I have learnt to my cost. [Oops - I am straying from the true disinterest of the good medical text here.]

Clinical manifestations of CRF. These are the manifestations of each of the functions of the kidneys. Having many functions, it follows that there may be many manifestations. At the moment, I seem to have them all.
I have had erratic hypertension and been anaemic for some time. This leaves me tired; I would add irritable, but I think this is just my normal state, not the CRF. The toxic wastes and acidity of the urine makes it burn like crazy, and I need to keep running every hour or two (dysuria and frequency), or I won't make it in time (urgency), and there are horrid sharp pains shooting up my insides like knives. Last night I woke with bad nausea and had to sit downstairs sipping water with a bowl beside me.  The toxic products irritate the skin, and I now have red blotches everywhere, especially the back and legs, that itch like crazy and bleed easily everytime I scratch too vigorously (generalised pruritis). Additionally, a strong immune system helps prevent cancers developing, and the depressed immune system allows them to develop. I therefore blame the CRF for giving me two independent cancers (melanoma and bladder cancer), rather than the other way round.  In short - and in lay parlance - I'm a miserable wreck.

Management. I have to drink plenty and watch my diet. Basically, I must leave off all the things I like (bananas, tomatoes, oranges, olives and avacado) which have too much salt and potassium, and eat plenty of all the things I dislike (broccoli, cabbage, cauliflower and onions!). Also, I repeat, leave off the poison of red meat. If the CRF continues to deteriorate, younger men than me might be offered dialysis to rest the kidneys and remove the toxins, or ultimately renal transplant. Neither option is available for old men over the hill, so I shall have to continue on the downward slope.

The only other management options are to hope for a miracle (trip to Lourdes?), and be thankful for someone like Ann to put up with the grouchiness, and administer creams and drinks and manage my diet like an angel!

Rehabilitation and magic

Rehabilitation

On castle walls Budapest

After the tortured night I suffered following a carnivorous lapse into meat eating (see Confessions), I have resolved to give the poor old kidneys a chance for recuperation. I did not dare stray too far from the hotel with its salvation of a toilet at a time of urgent need, so I remained behind while Ann and Edwin explored the great metropolis of Budapest.

In perfect weather, I strolled the gardens below the hotel, looking back on the castle walls for which it is famous, then ended up in a little street cafe where I had a modest meal of cheese and salad, washed down with home-made lemonade. Delicious, and hopefully it will prove to be restorative. Passing water is still extremely painful and too frequent, but hopefully there will soon be improvement in the poor old pissaroo.

Yesterday, we all explored local attractions, including the Houdini Museum. This contained a potted history of his birth in Hungary and his fame in America in the early 19th Century. The highlight of the visit was a performance by a stage magician, who asked if we all believed in free will. Most of us shouted back "Yes", but Edwin insisted on shouting "No".

The conjurer asked him his name: "Edwin".
"Do you like shopping Edwin?" - "Yes".
"What shop did you go to last?" - "Tesco's."
"What did you buy?" - "Jackfruit."
"Did you have free will to buy it?" - "No. I was influenced by advertisers."
The magician shrugged and nodded as though agreeing. Then, just as the rest of the show was finishing, he said "It's strange, I had a strong urge to write a note to myself just before the show started," and he fished from his pocket his wallet, opened it and took out a tightly folded piece of paper. This he handed to Edwin and asked him to read it.

Edwin took the paper, unfolded it and read, "A man called Edwin will go into a shop called Tesco and purchase some Jackfruit." Naturally, we all applauded wildly and – having seen Edwin's face – I couldn't stop laughing all the way back.

Confessions

Grandad-John in the Flamingo Chair

I must admit a confession to my reading public, one borne with shame and one from whose admittance I must expect ridicule and condemnation in equal measure. We are in Budapest, a most beautiful city where we are taking a short break from the rigours of a peaceful village. Yesterday we indulged in quaint history at the museum of electrical inventions from the turn of the 19th century (old motors, switches, bells, telephones etcetera), followed by a visit to the Museum of Sweets and Selfies - a bizarre collection of colour and toys designed more for young adolescents than grown respectable ladies and grizzled bearded men, but heaps of fun battling through a forest of pink bananas or relaxing in a pink flamingo chair. We followed this by a sudden dive into a gluten-free bakery Edwin had spotted where we indulged in gluten-free beers and a choice of delicious cakes and pastries. But I am glossing over the confession.

Ann in Museum of Sweets and Selfies, Budapest

That evening, being late, we dined in the hotel restaurant where – although nominally vegetarian – I succumbed to a starter of Hungarian goulash. This was filled with large cubes of succulent beef, suspended in a carefully spiced stew of vegetables, and I will not pretend it was not delicious.  But then to crown my sin I selected a dish of wiener schnitzel: a large dish which covered the plate in bread-crumbed Bambi. Retribution was swift. I had forgotten how poisonous red meat is to the kidneys. Mine are already shot to pieces, filled as they are with large cysts and in the throes of advanced renal failure, and they were completely unable to cope with the added load of lethal nitrogenous waste to which I challenged them.  The unaccustomed load of heterocyclic amines and breakdown products of urea and uric acid so irritated my kidneys and bladder that I was awake every hour throughout the night having to run to for a painful wee. 

Today I am confined to my room, unable to stray far from the toilet. Believe me, if anyone suffers from kidney disease, the revenge of the animals can be swift and sure. Today, I am dining on salad leaves and drinking weak tea.

A Philosophy for Life

23 April 2019

I am told by people who generally know these things that my blog posts are mostly vacuous, the kicking of  the empty can down the road of life. My reply is, they are written not to plunge the reader into fits of anguish or self-loathing, but are splashed upon the page simply for my own pleasure; to remind myself that the great world rolls on, delighting in trivia, silly jokes, and minor anecdotes about each other. Occasionally, it gives me platform to rail pitifully against the stupidity or ignorance of our political masters. I know my ineffectual voice is but the clucking of an idle hen, but it helps release the impotent frustration bottled within.

My critics tell me that the world awaits depth and insight into the anguish of dying; that I should grip the reader round the throat and throttle the joy and life out of them; that their greatest desire is to see as it were a mirror held to reflect the inner agony and suffering of inevitable extinction. I shall not oblige them. I attended the dying and dead over many years of general practice, and tried to bring ease to pain, or comfort to the bereaved; I have ministered to suffering in a hospice, some of which could not be relieved and brings me to tears even now; as police surgeon I attended fatalities and unexpected deaths by the score, many at their own hand or that of another. Every news item is filled with grief and suffering in the world. This I used to express in poetry, often writing at three a.m. on my way back from some dire night call, and there it lies for any who care to read such things. These emotions do not need repeating; they remain raw and I have no wish to relive them.

For tears, read the news, satisfy yourself with the slaughter in the world, the mindlessness of impersonal violence wielded without purpose. Better to rejoice that most of us prefer to release our exasperation and despair through the grin, not the gun; through bombast rather than the bomb; in trivia rather than travail. I have no wish to emulate Dostoevsky or Tolstoy; had I such talent I would chose to be a Waugh or Wodehouse every time.

And yet... and yet... to be a purveyor of the soul, it should ring true, it should go deep; but this is not a secret diary, filled with secret longings or shame, it is a public document and must respect the sensitivities of others. And so I will continue to intersperse the trivial and mundane with occasional glimpses of the darkness lurking behind existence. I may tell of inner pain and conflicts; but above all, I seek the momentary release that humour may provide, the incongruities that underpin relationships, and the absurdities of our very existence.