The Service is Resumed

Writing a blog is hard work. Not just the time spent on writing, but also the mental drain of having to think, and trying to generate coherant chunks of clear prose from vague, nebulous thoughts. For the few readers I seemed to have, mostly family, it hardly seemed worth the effort, so the blog ceased for this long while, until I recieved an unexpected email from an unknown reader who describes herself as "a passionate advocate for cancer awareness and support".

She has asked me to promote a site for cancer support: Resources for Cancer Survivors. This led me to revisit the blog, and I suddenly found a good number of comments (mostly positive!) which for some reason the site had not forwarded to me, and I have now added them manually to the various articles. So appologies, if you, dear reader, had contributed a comment and been ignored! It was not intentional. One reader, for instance, commented: "Its been awhile since you last posted, Jhon. Is everything alright? I love reading your blog and although I have been just a silent viewer for much time I cannot help but feel the need to check in right now. Best wishes." I did not realise I still had an audience; yet last month, even with no new posts, I seem to have had 688 visitors, and over time nearly 60,000 reads of my blogs. I am encoaraged therefore to try and write a little more.

The unknown person who asked me to promote  Resources for Cancer Survivors made me think about support generally for people who suffer. With my usual suspicions about unexpected emails asking me to click on a site, I naturally checked it through very carefully before clicking blindly, but the site is genuine, though situated on the website of Mystic Meg. I suspect she must get many questions from people affected by cancer as much as by problems in their love life, though for the young the problems of love can be every bit as painful. 

Nobody in this life has a pain-free existence, whether physical or mental - we all experience suffering in some form, and at some time. The question then is, where do people turn for support? For some, no doubt, it may be Mystic Meg, or the Tarot, or other suppliers of words of universal or vague comfort. For many, it may be family or friends, and if you have such support (as I do), be very grateful, and don't forget that they in turn will need your support: be not slow to provide it. Some may turn to vengeance, seeking to alleviate their pain by transferring it to those they believe were its cause. Others turn to religion, seeking balm from silent prayer or mesmerising clapping or chanting. That is good, and should not be despised by empty agnosticism that may offer no solace. Whatever one's belief in the reality or otherwise of faith, I do believe that there would be fewer suicides of these desperate, lonely, people could join some group offering support, be it of prayer or simple words of comfort.

For myself, I seem to be in remission at the moment. At the last scan, the melanoma had stopped spreading and even seemed to have regressed a little. I do have good family support, for which I thank them. I also know a lot of people were praying for me in their various homes and churches, and I thank them too. But I was also started on a new treatment for atopic dermatitis a year ago, and I suspect this may have had unexpected beneficial effects too. I have therefore written a paper on this drug, and enlisted the support of my dermatologist who has agreed to add his name to it. We hope to get it published next year, possibly in the British Journal of Dermatology, in the hope that it may mark a new option in the management of metastatic melanoma. I will keep the blog posted about any progress with this.

Andre and Edwin in the choir

On a more cheerful note, we trogged north through the snow at the beginning of the month to visit family members. I try to make it in daylight now as I don't like driving at night, but it's good to still be able to make the journey. Then on Sunday, we went to a carol service at the Methodist church in Bury-St-Edmunds, where Andre is choirmaster and Edwin sang a tenor role. Afterwards, they treated us to a welcome, warming Indian meal.

Celebrations and consternations

Ann on the roof terrace of the Thames House

 Again, we oscillate between good news and bad. Dan and Faye have looked after a house on the Thames during the owners' absence, and on Thursday they invited us to stay for a night. Cardinals Wharf on Bankside sits between the new Globe theatre and the Tate Modern. It is a house of three stories plus a basement and a roof top terrace, where we enjoyed tea in the sun overlooking the Millenium Bridge and St Pauls Cathedral, while watching curious passers-by walking along the embankment. The house is very old, and has survived the blitz and massive redevelopment over the centuries across the rest of London. The basement is on the site of an old inn where it is said that Shakespeare may have trod the same flagstones after his stints treading the boards of the original Globe.

Welcoming the grandchildren

Then on Saturday we welcomed a good crowd of thirty plus to our "Heave awa'" party, celebrating my survival twelve months after the oncologists pronounced that I only had a year to live. Mind you, sometimes it has seemed touch and go, especially with the pains I now get, possibly from gall bladder inflammation, but they're controlled with good pain killers. Ann too continues to get breathless and coughs badly with her heart failure, but we're hopeful that it will be controlled once she gets some treatment. The doctors' repeated strikes do not help.

Today, Bronte is ill. She has a massive swelling in her abdomen about which the vets can do little, and she too is on Metacom, the canine equivalent of ibuprofen. She has had periodic diarrhoea and incontinence for some time, but today she has lost her appetite and been repeatedly sick. We will take her to the vets again tomorrow and let them decide her fate. Then, to add to our problems, both cars have developed a fault in sympathy with each other. The windscreen wipers on Ann's car have become erratic, stopping mid-wipe and leaving us blinded by the rain and wondering when they will restart, so I dare not risk a dirty motorway journey with them. And today, a warning light has come on in the Teguan, which our garage man diagnoses as a glow plug failure; these are things that pre-heat the fuel before the engine will start, so as we don't want to end up stranded miles from anywhere, I may need to get it fixed urgently.

Some really good news, and one small problem

One brilliant piece of news this week: Edwin posted: "Andre asked me to marry him, and I said, 'yes'." Edwin had had an onsite workday when Andre joined him so they could go to Tiffany's to select the rings. They were met by appointment and treated like royalty, with champagne and a full assessment of just what they hoped for. The rings were boxed and gift-wrapped, then they strolled across the Millenium Bridge when Andre went on one knee to pose the eternal question. They then followed the Brazilian tradition of wearing the ring on the right hand during the engagement, to be swapped to the left hand on marriage. Edwin's has a small diamond to tokenise the engagement ring, while Andre's is a heavier solid gold affair.

We were thankful for this wonderful cause for celebration as I, alas, have little news to celebrate otherwise. No one wants the gory detail but, in outline, my gut oscillates from constipation to diarrhoea like Balaam's donkey: it can't make up its mind. For three days, it went on strike refusing even to work to rule. I offered it more carrots or anything else it fancied, but it protested with bouts of severe colic until my body, in protest, spiked a high temperature. At that point, we decided to try to get professional help or support. The doctor's surgery of course just uses a metallic voice to announce: "If it's an emergency like a stroke or heart attack, phone 999. For anything else, phone 111." Ann duly phoned 111 and went through a complex series of multi-choice answers, half of which seemed to refer her to flow charts online, and others to sending her a text message. It is not easy switching constantly between screens on a small phone, or trying to retrieve texts, and Ann was finally abandoned in a labyrinth of complex, contradictory instructions. If this happened to Ann, who was a research officer and used to train students to use computers, what hope is there for lesser intellects; the whole complex business seems designed to deter people from using the system. Then, we thought, we have been given an emergency number for the hospice who are now supposed to be responsible for my care. Alas, it is a hospice where cancer only exists between 9 and 5; it was now 5:30pm, so another recorded message reported that the lines were closed. p

Ann had taken wine at lunchtime so was reluctant to drive; we therefore asked Edwin if he could ferry us to the Emergency Department (ED) at WSH, which he duly did, abandoning a dinner with Andre, their minister and his wife at which they were discussing wedding plans. That is true sacrifice. Ann came to sit with me, although a notice announced, "Wait for triage nurse, 2 hours. Wait for doctor, 4 hours." Later, that notice changed to, "Wait for doctor, 6 hours." It was therefore 01:30 a.m. when I was assessed with a provisional diagnosis of 'hepatic enlargement with possible inflammation of gall bladder and pancreas secondarily to hepatic metastasis of the melanoma", so the registrar decided to admit me to a ward for observations, and to await the result of a CT/PET scan I'd had earlier in the week. By 3:30 a.m. I had been waiting in a hard plastic hospital chair for 8 hours. Edwin too was waiting with me, having returned from his dinner and driven Ann home. Then three chairs without armrests became vacant to I moved across and tried to sleep lying on these. 

Waiting for a bed at 4:30 a.m. after 9 hours at WSH

By 4:30 a.m., the ED outpatients was filled with people dozing in chairs, also waiting for admission. My aches and tiredness had become unbearable, so I went to the front desk and announced that, clearly no bed would suddenly become vacant now, so I wanted to go back to my son's and sleep on his spare bad. The receptionist said, if I discharged myself, I'd have to go through the whole process again when I came back. I said, I wasn't intending to discharge myself, but after nine hours I couldn't stay on those chairs a moment longer, so I merely intended going out for some fresh air and a rest, but would be back in the morning to take my place in the queue for beds. After a moment's reflection, she said she would see what they could do, and led me through the ambulance entrance to the emergency assessment bays. Most were already filled with other people waiting beds, but she found one at the end still vacant, so I could finally get a couple of hours sleep in relative comfort on a trolley in ED. Edwin had brought a flask of tea with him, which was brilliant as no other drinks were available.

It is often reported that it is the elderly who demand hospital attention. But the ED at West Suffolk Hospital was mainly filled with young people; people who, as a GP, I would mostly have assessed to have minimal serious illness but wanting minor treatment or reassurance. Now, GPs are grossly overpaid for doing less and less work and minimal hours. GPs are paid according to the number of patients on their lists. My first solution to the resource problems of the NHS would be to change this scheme and pay general practioners strictly for each patient they attended, with double pay for out-of-hours consultations. This would immediately shift primary care back where it belongs: in the community, and it would relieve the A&E departments of much of the minor care they are obliged to provide now, most of which is neither accident nor emergency.  Despite this, care and professionalism by the staff at WSH was first rate. Doctors, nurses and ancilliary staff without exception treated every patient with consideration, care and respect: young or old, trivial or serious, drunk, depressed or moaning, or even handcuffed to police officers.

At ten in the morning the consultant came round who agreed with the registrar, but thought I should be returned to the dermatology department as they had organised the scan and could take over my management. In the meantime, I was to go back home and treat the pain with paracetamol. Yipee!!

The dominos of an interconnected society

We have a wonderful local bookshop in Clare, where Kate welcomes visitors, recommends selections, offers to gift wrap presents, and offers hot toddies at Christmas. Walking past the other evening, though, we noticed she had set out a row of books like dominos on the shelf in her window and, like dominos, one had slipped and knocked over all the others, some tumbling onto the display below. Such is the nature of modern society - rows of tightly bound units in which one fall brings all down. Edwin and Andre returned from three weeks in Brazil to the chaos of rail strikes, the August bank holiday traffic jams,  and a UK-wide failure in air traffic control (ATC), with routes falling like Kate's domino books. We learnt of the failure just before setting off to meet them, but it had occurred when they were over half-way across the Atlantic with no possibility of return, so they were one of the flights prioritised to land at Heathrow. Waiting for the boys at Terminal 3 we were among a crowd of people sitting on cases or jamming the cafes whose flights were cancelled or delayed when the ATC people had to land planes more infrequently under manual control, and their flight wasn't delayed by even five minutes. 

Mary-Anne is exceptionally busy these days, working as postmistress plus having to ferry two teenagers to Bury or Sudbury for work, or college, or to visit or stay with friends, and she likes to spend time at the weekend with Sam and the girls. Although she only lives a ten-minute walk away, we hadn't seen her for over five weeks, but Ann had asked if she could look in to let the dogs out during the day,  if she had any free time in the afternoon. Ann was still in her nightie to clean the house before getting dressed when MA phoned to say she was out walking her dogs and would call in now before we left. I was out getting the car emptied and checking oil and water ready to get the boys, so Ann had to rush to get dressed leaving the hoover in the middle of the floor and nothing done, but it was lovely to see MA again. 

Getting old definitely requires a change in outlook. I have to pace myself even for small jobs such as cleaning the car and checking the tyres. Doing even a limited amount of work demands I sit down for a regular break and have to carry things out in small stages. Walking the dogs, my route seems to get shorter and shorter, and favours routes where I know there is a bench so I can sit half way round to recover. Luckily, Byron will often find a ball lost in the bushes, so I can kick it for him to chase. Bronte merely follows wearily at my pace now, so she doesn't need much exercise and prefers lying down all day. They say people grow like their dogs; certainly, Bronte and I seem to be on convergent paths.

Another profound change is the need to wee at night. Every two or three hours, I wake feeling the urge, and though not much is produced, I have to make myself go "just in case". I sometimes dream I need to wee and am in a building somewhere in an embarrassed state, wearing just a shirt or pyjama top, desperately looking for a toilet. These dreams wake me very quickly. Even worse, the rare times I dream I am actually weeing, either in a toilet or in a pile of sand or mud somewhere. Such dreams are frightening as I dread the thought of incontinence, and I instinctively reach down as I wake to check I'm not soaked; happily, it is not happening yet, but I have a box of man nappies in the cupboard ready should I need them. Bronte, too, leaks now during the day and we have to make her wear doggie nappies now in the house. Luckily, she quite likes them and stands happily to let me pull her tail through the hole and Velcro them on. She parades in front of Byron as if to say "look what I've got," and he looks wistfully thinking we're favouring her. They probably make her more comfortable, as they keep her legs and fur dry, but even in this way we are converging.

Irreversible ablation treatments

Ann's pulse has ricocheted from heights of 186 bpm (beats per minute) to depths of 46 bmp, sometimes over periods as short as an hour, since she went into atrial fibrillation (AF) twelve months ago, leaving her exhausted and she often needs extra sleep through the morning or afternoon. Electro cardioversion is a crude method of attempting reversal of AF, basically by sending a massive electric shock through her chest under sedation to stop the heart, and hope it restarts in a more natural rhythm. A previous attempt to reverse it failed, so Ann was started on even stronger drugs which didn't help much but brought their own unpleasant side-effects. Yesterday she had another blast of high voltage therapy, but this time it seems to have succeeded; the heart is mostly in sinus rhythm (SR), though still with bouts of AF. Because of the junior doctors' strike, Ann was the only patient brought onto the ward that morning, so she was attended by the great man himself (no, not God this time). The receptionist looked up from her empty desk to greet Ann, "back again?" and three different nurses kept coming in to see if she was comfortable or wanted another cup of tea. It is too early to tell if she will be less exhausted, but this morning she is back in bed with the heart moving between SR and bouts of AF, which confuses her Apple watch monitor that reports it as "inconclusive".  The next step will be ablation therapy, which means the deliberate obliteration of the natural pacemaker in the heart wall. 

Hundon football team play on a steeply sloping field opposite our house, which means that for half of the match, each team has to run uphill towards the opponents' goal. A few years ago, they moved up a peg from the lowest village league to enter the Cambridgeshire village league. I watched as they swung the ground round by ninety degrees to play across the slope rather than up and down it. They also had to install fancy new goal posts with proper nets. I watched as the groundsman explained they had to break up their old goal posts (a simple cross piece on two uprights) to comply with FA regulations requiring their complete destruction. This change means that hard hit balls go into the hedging at either end, and Byron can be relied on to fish one out on his regular walks round the field to run off with great glee holding the invariably punctured trophy high before him. He then gets his exercise by dropping the soggy bag at my feet to be kicked a few yards away for him to chase.

Ablation therapy for Hundon football club

Alas, Covid seems to have destroyed the team, which never reformed as players moved on and were unable to bring younger people on board. The clubhouse became dilapidated, and now is being smashed down. Walking past the destruction I am reminded of how we, full of hope, play across the field of life only to end in lethargy, despair, and final destruction. There is an air of terminal sadness as I walk on. They talk of building houses on the field; this would double our limited village housing stock but its future seems uncertain.  The town of Haverhill continues to expand and has crept up the hill to flood the fields beyond on its way to coalesce with Keddington, an expanding village between us and Haverhill. They have laid in massive water and sewage works outside Keddington ready to service its gross enlargement with nothing to stem this expanding concrete wall and the constant ablation of our life-sustaining arable and green country.

For a moment as we stepped from the car into the underground carpark in Bury for my eye test, I thought my eyes had gone completely. It was total darkness - all the lighting had failed and not a carlight or even emergency light was switched on. The automatic car headlights had guided us in, but now we had to switch on our phone torches and grope our way to the exit door. The ticket machine was still working though, and took our money willingly while lit by the torches. Then Edwin phoned to say that one third of the whole of Brazil was under a major power cut - it was just a strange coincidence for the rest of Bury was OK though, Brazil was set off by outage of one power station in an overloaded system; the car park was just one switch had been triggered. Strange, though, that there is no emergency lighting.

Nature's destruction

 My office is upstairs, facing east. It is where I continue a low level of work for the company I have supported for twenty years; it is where I have written all the cosmology papers I have had published, and where I write my short stories or poetry. In winter, the sun rises far to the south, before slinking off close to the horizon. Gradually sunrise moves round until it hides for a while behind our neighbour's house before peering over the roof, then continues its move northwards to rise behind a mature lime tree, flecking my room with its leafy shadows imprint of shadows before finally reaching the wide horizon of the distant hill. 

Lime trees can reach a height of 150 feet, the tallest broadleaf British tree, and live for 500 years; this tree was old, and well over 100 feet in height, and Ann and I loved looking out on it. It was the last of a row of trees dividing our properties, shelters for a variety of birds, and home to bat colonies which teamed out at dusk to brighten the fading sky. All these trees were butchered one year when we were on holiday, leaving a blank view of the house next door; only the lime tree remained. Coming back this morning, we were met by our neighbour, Lynda, who boasted that the tree was coming down. The sin the tree had committed to invite this destruction? It shed some of its leaves in Lynda's garden and she couldn't be bothered to sweep them up! Ann was too tearful to stay and ran inside, and I turned without comment to follow her. Lynda's feeble cry as we walked in, "Oh, I've upset Ann." The woman has no idea how valuable that tree was; the last of a great number of limes, from which one of the houses down the hill was named. To look at the constant activity of the birds it supported was a mark of continuing life; its form broke up the distant skyline; and the passage of the sun past and through it marked the seasons. Ann and I both love trees; I used to lean my cheek against some huge, rough oak and stroke the contours of its rough bark, watching the acorns form, ripen and fall. My father admired the different woods, working their grain with affection and understanding. He would not allow us to put shoes on a wooden table, and believed in touching wood for luck, sensing the spirit of life they represent. Even the bat colonies had returned finally to this remaining tree.

Destruction

We have a large sycamore to the side of our house. It needs regular pruning, and its leaves fall on the side garden, the drive and over the fence into the back. Each year I sweep them up, and find it therapeutic to be able to do some light gardening and see a direct benefit by way of a clear drive and lawn, unlike most gardening which is backbreaking and often seems to give little reward. In addition, birds mess the cars from its boughs, but we would not dream of cutting it down to save a little work.

Somehow, the loss of this last tree, over one hundred feet high and probably two hundred years old, home to bats and squadrons of  insects and birds, represents something deeper: the loss of life and continuity, the end of an era. So many people round Hundon have destroyed their trees; it is a sad village for encouraging such destruction when the whole world is crying out for reconstitution of the natural order.

POSTSCRIPT: Edwin and Andre left for a three-week holiday in Brazil to stay with Andre's family, leaving their empty house for us to spend the day away from the sight and noise of the broken landscape. We returned in the evening and another neighbour tapped on the door. She came specifically to see Ann as Lynda had met her and said how upset Ann seemed and  she was upset too as the tree blocked her view of the row of houses beyond it. The upshot of the disagreement was that Lynda was named a bovine beast, so they comforted each other in the grief Lynda had caused, inspired by the cherry tree which, in Japan, symbolizes new beginnings and good fortune; life-affirming ideas that embody a positive and resilient nature.

Psychotherapy

 Hundon has a village shop selling basic essentials, and a pub that's open four-and-a-half days a week, but all other amenities are a drive to Clare, Haverehill, Bury or Sudbury. Kelly, our hairdresser, works in Clare and Ann has relied on her for many years. There are several hair stylists in Clare, and Kelly had worked in one of the bigger salons before setting up on her own. She has an air of calming reassurance that makes the visit a pleasure as well as a necessity, and I now always try to go to her too, having abandoned my regular cutter in her old salon. I have started a portrait of Kelly hovering over Ann's scalp, but it doesn't seem to come right; I made the figures too small and they seem buried in the dull background wall, but I also took inspiration from Kelly for my new poem, Psychotherapy.  

Psychotherapy

The dark grey chair hears her troubles:

Lost dreams, threads of fraying hope, thin wishes,

Voiced despair, absorbed like fallen hair 

hitting the ground unheard; 

swept away to indifferent oblivion.

On the wall a giant clock, 

black against the white cell wall, 

sweeps away each second, 

timing the closed session to its allotted ending.

Her hands, professional, calm, relaxed, reassuring, 

massage as the hair is washed, worked, cut, curled, set and sprayed,

Absorbing sound like a velvet curtain while problems slide past.

John H

Yesterday I was able to cut the grass, which had grown hugely with all the recent rain but finally the sun has returned. Too long for the mower, I could strim it down to a manageable level. The battery-powered strimmer gives me a hint of old rural life, when most of Hundon laboured on the surrounding farms, scything the crop. It is a satisfying motion that induces relaxation and contentment like a physical psychotherapy, and I only needed to sit once for the whole lawn, unlike when I mow it and need to sit several times with a drink of Crabbies to revive me. 

Near the pond, a frog jumped out before my approach but hopped away to scramble on the patio, risking the sun before my blade. He won't be able to hide in the grass now but will shelter under one of the rocks skirting the pond's brim. I love frogs, their lythe shape, their amphibious lifestyle, and their wonderfully exposed lives: from bursting out as a clump of swelling spawn, to displaying openly their quiet development of head and wriggling tail, and the sudden growth of legs and loss of tail and gills as they continue to evolve, unlike the hidden changes of mammals. The tadpoles do not fare well in our pond, for the fish see them as fresh ready meals and few survive. We stocked the pond many years ago when I first dug it with a pair of goldfish brought proudly home in plastic bags from the fair at Long Melford, supplemented with a few others from the garden centre. Two or three have grown large, and there seem to be new fry every spring, somehow keeping the numbers steady.

The lone frog reminds me of the cruelty of some boys who boasted of 'blowing' frogs. This led to an edict from the headmaster that any boy caught doing this would be caned, but I always wonder if such behaviour is a pre-requisite for men who go on in other regimes to become torturers or vicious jailers or perform other acts of cruelty, now relieving their inner torment by destroying trees or shooting wildlife, or persecuting weaker people.

Alba Donati's New Book

The boys are off to Brazil for three weeks soon, so invited us round for a farewell meal. Andre prepared a Nut Roast Wellington in a perfect puff-pastry envelope even decorated with pastry flowers, all worthy of a top prize. We didn't get back till midnight. Ann continues to have debilitating bouts of tachycardia but insists on continuing her housework between sessions of lying down. Hopefully the repeat cardioversion booked for next week will be successful.

I've just finished Diary of a Tuscan Bookshop by Alba Donati. This too, like all books that grip the imagination, is psychotherapy. The beautiful descriptions of landscape, events and people carry me to those mountainous regions of Italy and illuminate them and the characters as though I am among them. Donati, too, shares her love of books and scatters recomendations like dandilion seeds, feeding new ideas for reading. If I were younger, I would have gone on a pilgrimage to Donati's little village in the hills just to sit among her books and draw in the air. But when I was younger, I was materialistic, full of other ambitions and pilgrimages, so it is only now in the serenity of years that I can discover the calm of words beyond medical notes and scientific texts. Such is the way of our unbalanced lives.