Go on – Knock me out!

Anaesthesia is different from sleep: pretty much instant and rather disorientating. On this occasion, at least, I rather enjoyed it, in spite of having been rather nervous beforehand, this being only my second experience of complete knockout in over 40 years. 

Crucial to making my little op a good experience was once again the standard of care given by the staff at UCH: warm, empathetic, open to questions from the patient. You will notice that I am once again referring to the hospital by its original name, University College Hospital. A taxi-driver friend put me right when I referred to it on facebook (crikey! am I connected or what?) as UCLH, which stands for “University College London Hospitals”, which is the trust that runs the hospital: what my friend referred to as a “branding cock-up” some years ago. The hospital itself—being the destination he has doubtless delivered many people to in the course of his work—remains UCH.

If you are still awake after that burst of pedantry, we will get back to the events of Friday 20 January. I slept little before rising at shortly after 5am, when I took what would be my last drink for several hours and pottered around a little too much, emptying the dishwasher and fretting slightly, so that I managed (just) to miss the fast train I had intended to catch into town. The slow train soon after that still got me to Waterloo in time to make the short connection to Warren Street and the now familiar white and green tower of the hospital that meets the gaze as soon as one emerges into daylight from the Underground.

I have reflected before and since on the journeys we make in life and their many and various purposes. Each step in the journey may be small, but by the end you are in a very different place emotionally and psychologically from where you started. To outside eyes I was any other commuter, but on this day I was once again to be a patient, making a transition from the plod of the everyday into the shallows of surgery. After presenting myself at reception on the sixth floor (“Adult Inpatients”) I sat in the waiting room for about half an hour before being called by a young doctor from the anaesthetic team. I was glad to have got this far as the only identity evidence I had on me was my appointment letter. I had been advised not to bring valuables and was only carrying cash to cover my rail fare and provide a modest surplus: no credit cards, no mobile phone, not even my door keys, since my wife would be coming to collect me when the medics had finished their work. Alongside anxiety about the forthcoming surgery wild scenes had been playing in the theatre of my mind about outlandish complications resulting in my being in the middle of London without enough cash or other means of payment (my principal credit card doubles as my Oyster card, the modern way of paying for public transport in London) and without the ability to make phone calls. While there was only ever the slightest risk that I would have to fall upon the mercy of strangers to procure the cost of a fare home or other emergency expense, I nevertheless felt a peculiar sense of nakedness being without the contemporary props of relative affluence and security that I had previously taken so for granted.

The anaesthetist looked at my throat to check that it would accommodate the tube that would help me to breathe while unconscious, asked whether I had any loose teeth that might be vulnerable to being knocked out by the passing tube (not a common occurrence), and accepted my assurance that I had no allergies to any drugs.

Back to the waiting room for another distracting read of the magazine I had brought with me. After another vague interval—I was not watching the clock but trying to go with the flow—a young surgeon called me out of the room and back to the curtained area where I had seen the anaesthetist. Here she gave me an explanation of the procedure that lay ahead to supplement that given by the consultant I had seen before Christmas and I was relieved to find out that the resulting wound was not expected to be as substantial as I had first thought. Fistulae are tricky items though and the surgeon does not know quite what procedure will be needed until the patient is out cold and can be probed to see what possibly devious route “the abnormal communication” (as the medical profession rather coyly calls it) has made through the nether regions. Those unfortunate enough to be abducted by aliens of course undergo such investigation without the benefit of anaesthetic, if their accounts are to be believed; you’d think beings savvy enough to make it all this way across the far, uncharted reaches of the cosmos would have figured out all we lesser creatures have managed to about pain management, but perhaps their persistent ignorance on the matter will have to remain one of those myriad inscrutable mysteries of the universe.

Back to the waiting room again until I was called by a nursing sister, who took me through the paperwork and wrote my name, date of birth and hospital number on plastic bands which she then fastened around each of my wrists. That done, I signed the consent form. She gave me a large plastic bag into which I would later put my clothes and shoes, but which at this point contained: hospital-issue gown and dressing gown, paper underpants, tight anti-embolism stockings and foam slippers. After this further step in the overall rite of passage I returned to the waiting room for a final period that turned out to be the longest yet, as one is not asked to change into surgical clobber until the patient ahead in the list is quite well advanced on their own path. An hour passed but then it was my time and another nurse called me from the room.

These preceding stages had all helped accommodate me to the atmosphere of surgery and I was quite calm as I changed out my everyday things and into the kit supplied. I wrestled a bit with the stockings though; the mistake was to try and follow the instructions on their cardboard packaging rather than apply common sense. Once I had got the tricky items on and looked down on my now more visually pleasing legs, I could reflect on the fact that calf-enhancing hose was common wear for men for several centuries.

"Mmmmmm, nice pins, Sir Walter!"
"Yes, stow that in your hold and sail away, Sir Francis!"

I shuffled alongside the nurse in my cheap foam slippers to the antechamber of the operating suite, where there was a nurse in theatre garb checking patients into…another waiting room. This one was very different in atmosphere to the first: it had fewer chairs and even fewer patients, just me and another man, also of course dressed ready for his own encounter with anaesthetic, knife and whatever other instruments the surgeons had in store. I made my way to a chair, joking that I needed to make sure that it was what it appeared to be as by now I was without my glasses and everything was blurred. We exchanged simple remarks but then an unbreakable silence fell between us: this was no place, radio and spacey blue light feature notwithstanding, for casual conversation. Every encounter with surgery, however minor or routine, confronts us with our mortality and everybody knows it; we may come back from that precipice on any particular occasion, but we are inevitably sobered by the experience and the thoughts it brings. The professionals, at least in this hospital and on this occasion, behaved with a priestly calm and the sensitivity to be expected of pastors, lightened by humour. In a little while I was the only patient left in the room and the attendant nurse came in and, after asking whether I would mind, retuned the radio to Magic FM from the classical station that had been the preference of the patient who had just left. I was ready for a change of soundscape as Shostakovich’s 5^th Symphony, while an excellent piece, was fraying my nerves somewhat with its martial passages. An anaesthetic nurse came in and sat beside me, asked a few questions and then asked me what I did for a living; a short but lively conversation helped things feel more natural until it was at last time to go into the next room to meet the anaesthetic consultant.

Here I lay on the couch placed centrally in the room and tilted up at one end, while he introduced himself. I took the liberty of looking closely and myopically at his name badge to make sure I had heard his name correctly. We spoke about the distant country from which he had come over five decades ago. After I had pumped my fist a few times and the nurse had squeezed my arm above the elbow to raise the veins in the back of my left hand, the anaesthetist placed the needle through which the same hypnotic chemical that did for the King of Pop would soon pass into my own system. First there was a premed that made me feel slightly drunk and slurred my speech. I was given oxygen to breathe through a transparent mask and after a minute or two came the coup de grace: a large syringe of propofol that soon sent a mild ache up my arm and followed this with oblivion.

I woke up in exactly the same position and did not immediately grasp that I had been unconscious, let alone for any appreciable period of time. Minutes passed but I had no strong sense of this as I took in my surroundings again, growingly conscious of two new sensations: a raspiness at the back of my throat that testified to the passage through it of a breathing tube and a very mild discomfort at the operation site. It still took a while for me to conclude that the operation was over and that I was now in the early stages of recovery. Faces appeared at my side and voices asked me how I was feeling. I asked them how long I had been under: about 50 minutes. I felt greatly relieved and very peaceful. How much of this blissful mood was drug-induced and how much the work of my own onboard chemical factories? Each surely played a part, but knocking seductively around my mind was the thought that I wouldn’t mind more of whatever cocktail it was they had given me.

Still lying on the couch, I was wheeled to a curtained recovery area and a jug of water and a tumbler were placed on a table within reach. I was offered a hot drink and chose tea (milk, no sugar); digestive biscuits and shortbread fell from the heavens as I was encouraged to eat and drink again. I ate slowly and with relish at each mouthful, sipping the warm tea and the cool water. More tea and biscuits were offered and eagerly accepted. My clothes and shoes reappeared in their plastic bag. Time passed, I dozed some more, but by now the nurses were chivvying me along a bit. They had telephoned my wife and she was on her way; no, she was already here, waiting for me in the car at the rear entrance of the hospital just as I was putting my shoes on, having first retrieved my glasses, wrapped in a sock, from one of them. It was still all a bit trippy, a bit weird, but things were working out; the fog was clearing with gentle grace, not outstaying its welcome.

A nurse escorted me down in the lift to meet my wife and in no time at all we were home. I could sit in the car and did not have to lie down on the back seat as I had anticipated. Since then I have had only mild discomfort and have not needed the codeine and paracetamol painkillers the hospital gave me to take home. The surgeons want to see me again in eight weeks. If I have any problems my first port of call will now be the GP. I have been pottering about at home over the last few days, still sitting down carefully but feeling, sleeping and eating OK. Today I managed 26 press-ups.

Perhaps you remember the TV advertising campaign for Tango fizzy drinks that began in the 1990s, in which, typically, an unsuspecting person has a swig from a can of Tango and then looks disconcerted. The footage is then “replayed” at a speed that “reveals” that the man has been approached by a bizarre individual (in one advert, for example, dressed as Napoleon—a classic trope of lunacy) who has rushed up to him as if from nowhere and subjected him to some indignity too fast for him to take in consciously. The Napoleon figure waves a large orange rubber glove in the man’s face; on another occasion a man shouts "Oranges" into a woman's ear while she is waiting for a train. The slogan, hysterically announced at the end of the short film, is “You’ll know when you’ve been Tango’ed!”

I knew the medics had done something, but I didn’t see them do it. Anaesthesia is like sleep, but different.

Shifting Goal Posts

If you read the last entry you will be expecting that I will have had the operation. Sorry to disappoint, but there has been some more shuffling of dates in the last 48 hours or so, with the result that it should now be all-systems-go on Friday, 20 January. This is an improvement on the previous dates, as it happens, because my wife will not be expected at work for the four days after the op, which are when I expect to need her help the most.

I will let you know how it all goes.

In the meantime here is an image from the annals of medicine, or is it religion, or is it magic?

A skull that has received the attentions of Inca brain surgeons, or were they priests, or shamans?
A case of trepanning the light fantastic (sorry!)

New Procedures and Old Truths

Today I went back to UCLH to meet some new people and in the process have my fitness assessed for the forthcoming operation (now due on 18 January). Specifically pre-assessment focuses on one’s ability to cope with anaesthesia, in my case 10 minutes or so of unconsciousness.

I made my way to the clinic over a bridge in the hospital atrium in whose floor were inset enlarged photographs of medical life in the early decades of the 20th century. One was of a woman closely resembling our own dear Queen standing rather stiffly beside a bed made more child-friendly by the presence of cuddly kangaroo and plush teddy bear. The little girl in the bed and the nurse standing by looked very chuffed to be in the presence of royalty and the shot leaves one in little doubt that the visit of Queen Mary would have aided the patient’s recovery no end. Surely the late Queen smiled on occasion but are there any photos showing this? Perhaps, as with our present monarch, the everyday cast of whose features tends to the solemn and inscrutable, Queen Mary’s smile was a sunny benediction.

It was all pretty quick and I was in and out of all three stages of the pre-assessment in just over an hour. Stage one was a series of questions about my medical history from a nurse, who also weighed me and measured my height, as well as giving me a couple of leaflets about the joys of anaesthetics to read on the train home plus instructions not to eat after 2am on the day of the op or drink after 5am. I find myself more apprehensive about being knocked out next week than I was the last time this happened when, aged 12, I had several teeth extracted to make room for more.

If the first stage was rather dead pan, stage two was a bit more jolly and the quickest electrocardiogram I have yet undergone. The nurse conducting the process said that this was because I was relaxed. It is reassuring to know that I am doing something right although, if this is relaxed, show me tense.

After I had taken the printout of the heart examination back to the reception clerk, it was time for the final stage of the pre-assessment: the now all too familiar blood test. Going about his work the phlebotomist sang along quietly to Adele as the sound of her latest release drifted across from the radio on the opposite side of the examination suite and we found a brief rapport in our shared appreciation of her wonderful voice. On this occasion I did not have to wait for the result of the test, trusting that it would be added to my surgical file in due course.

Free to go, I had time to spare before I was due in Richmond for lunch and so I made my way to the British Museum, but not before heeding the advice displayed here and cleaning my hands with the gel provided.

Animated virtual nurse projected within a perspex outline giving free advice by the hospital exit.
Part of a plan to have all leadership and advice dispensed in time by human simulacra.
Hmmmm, come to think of it, has anyone seen the real Andrew Lansley recently...?

I walked to the museum along streets that I have long loved, but whose rich heritage I came to value with a new intensity when I trod them with my wife and brother while undergoing chemo last summer. On the journey I noted the blue plaque commemorating the first general anaesthetic procedure carried out in England. In 1846 the house at 52 Gower Street, no longer standing, was the home of an American botanist, Francis Boott. Here, on 19 December of that year, a dentist named James Robinson removed a tooth of a Miss Lonsdale under ether anaesthesia. Two days later at University College Hospital, Robert Liston amputated the leg of a chauffeur, Frederick Churchill, while a medical student called William Squires gave an ether anaesthetic. It is comforting to know that there has been such a long history of pain management at my favourite hospital. Probably not much of a pre-assessment in those early days though, let alone soothing leaflets in plain English.

Once at the British Museum I rode the lift to the Upper Floor and ambled through rooms gleaming with priceless artefacts to the displays of European articles from the 16th century, my chosen period of study. Here I saw mazers, wooden drinking bowls for shared use that came to be replaced by individual vessels, particularly among the more affluent. Also chalices and plate, produced in greater numbers as the Protestant Reformation bedded in and the common churchgoer increasingly expected to take Holy Communion rather than that this should be the privilege of the priest alone. There were elaborately decorative gilt clothes fastenings–hooks and clasps–both on display and illustrated in small reproductions of contemporary portraits so that one could see the devices in use.

In a separate display was the Waddesdon Bequest, the gift of a Victorian member of the Rothschild family. This is a staggeringly impressive collection of craftsmanship, particularly in religious objects from mainland Europe. This little item held my gaze for many minutes. I never knew such things existed.

A rosary bead carved in boxwood in the early 1500s, Flemish work.
Such exquisitely crafted objects were produced to aid the devotions of the wealthy and the nobility and were highly prized. The bead measures no more than a couple of inches in diameter and opens up to reveal intricate scenes from Scripture in high relief.
The uppermost scene here is of the Crucifixion and in it the spears of the soldiers are as fine as hairs.
Do go and see it if you can.

On the more vernacular side I spent some time contemplating trenchers: in this case circles of wood, like large coasters, whose plain side was used for the serving of various sweetmeats at banquets and the like. Once the goodies were consumed, the trencher was turned over to reveal its painted side decorated, for example, with painted flowers, scrolls and various other curlicues framing short verses setting out various contemporary conceits. This verse sets out a bittersweet truth of human experience. Enjoy the antique spelling.

There is no sweet within our power

That is not sawled with some swore.

For so it fawles out now and then,

The worser luck the wiser men.

Looking Back, Looking Forward

Surely I am not alone in wondering at the fact that another year is nearly over. Many too are now commenting in the media about what an extraordinary year it has been, with political convulsions across Europe and the Arab world and continuing economic confusion and stagnation.

The Roman god Janus
Beginnings and transitions were his department and January is named after him. Since he watched over entrances and exits, we also get the word "janitor' from him.

Someone at least was happy as I encountered him in our local garden centre a week or so before Christmas, although I wonder what fate has befallen him since. Did he find a buyer or is he even now on his way back to to some distribution centre on the basis that he found himself in Twickenham on “sale or return”?

Karaoke Santa, stuffed not with turkey but with animatronics and cheesy tunes.

Horrible things happen all the time: a teenager fatally stabbed on Boxing Day in London’s Oxford Street; an Indian student shot and killed at point blank range in Manchester in an attack apparently motivated by racial hatred. These are but two examples of the way that lives can be lost in an instant, the perpetrators surrendering to the red mist of rage and hatred that maybe lurks in all of us. The soul needs good food just as the body does and we are what we eat. What are we feeding on? What are others tucking into or even being forced to consume? I was saddened in the closing weeks of this year by the death of the writer Christopher Hitchens. Although I disagreed with him on matters of faith, among other things, it always seemed to me that his was a voice one could trust because of his fearlessness in seeking the truth and speaking it in some of the finest language we will ever hear. A good diet therefore, even if some of the meat was rather tough.

Christopher Hitchens (1948-2011)

His brother Peter, paying tribute, quoted Hilaire Belloc’s “Dedicatory Ode”: “From quiet homes and first beginnings, Out to the undiscovered ends, There’s nothing worth the wear of winning But laughter and the love of friends”.

I'll raise a glass to that and to his memory.

For me it has been a year of treatment and recovery, significant intake of chemo and other medications, numerous blood tests, two bouts of hair loss and, as we enter 2012, hope that my disease has been kept at bay (my third CT scan and bone marrow biopsy, both expected in the next couple of months, should establish whether this is the case). I have had much rest and spent relatively little time doing the work I am paid for. Family ties and friendships have deepened wonderfully and new friends and acquaintances have entered the scene. I have been grateful for the very best that the National Health Service can provide and rather less appreciative of its worst offerings (I refer of course to the food). This has been a year of personal remaking and the development of new interests in writing and history. I am looking forward to the future, buoyed up by exciting discoveries made in the genetics of Waldenström’s and the hope that these offer for the development of new and even more targeted and effective treatments.

I hope for a happy, healthy and peaceful new year for all of you. See you somewhere, some time after Big Ben has next struck twelve.

The amaryllis in our kitchen, an early Christmas present bursting into bloom just as the old year ends.
It has two up on Janus, as its blooms face in four directions. Perhaps it is taking stock of the fleeting present as well as scanning what has been and looking towards what will be.

The Sawbones Spells It Out

You could be forgiven for thinking that I had abandoned this blog, but it is not so. I have just been writing Christmas cards instead along with a family newsletter. I have held off writing one of these last since 2004 and have this year proceeded with caution and restraint, mindful of Simon Hoggart’s two satirical compilations of other people’s misfired festive bulletins. We decided to base our letter on a selection of photographs and a minimum of text to lessen the chances of our getting above ourselves and risking scorn.

I have learned today, although this news has been clearly on the horizon for some months, that I will have to undergo a small operation in mid-January. I have debated whether to go into any sort of detail about this here, as the problem to be remedied is in an area of the body notable for being fraught with embarrassment. Nevertheless, if this blog has been about anything, it has been about a medical journey and a true description of any journey should be able to accommodate the bits where the skies darken, the rain falls and the going gets less pleasant. So it is that I am going to tell you about my arse, or, for transatlantic readers, my ass. If you find the word a bit much at whatever hour you are reading this, I can only apologise, but there is something bold about the very sound of its single syllable that clears a path through self-consciousness and it has a perfectly respectable and ancient etymology, so far as I can discover. We all have one, after all…

This morning I presented myself at the fifth floor of the Rosenheim Building of UCLH, meaning that the only floor of this doomed structure I have yet to visit is the fourth. The fifth is where the colorectal surgeons, among others, are hanging out until the building comes down to make way for something new and shiny. The clinic was running two hours late and the tiny waiting area was very crowded, two doctors having been prevented from coming into work by personal circumstances. One of them had a “plumbing problem” at home and the charming consultant I eventually saw had a bit of a chuckle with me at the irony.

Readers who followed my recent stay in UCLH for high-dose chemo and stem cell graft will recall that my low immune system allowed an anal abscess to develop and that great was the pain thereof. Although the abscess itself did not last that long, subsequent healing of the area has not been complete, as is not unusual, and a tiny tunnel has been formed between my rectum and The Great Outdoors. This is known as an anal fistula and the kind surgeon did a few little drawings to explain how these wretched things develop and to illustrate the various procedures that can be used to induce them to put up and shut up.

After a brief examination, he said that he would recommend “laying open”the fistula, that is to say cutting it open to create a wound that would then, with regular dressing, take about six or seven weeks to heal. The operation would take about ten minutes and be under general anaesthetic. I should be able to go home the same day, although I will have to get to Central London by 7am. My return to work in the new year will be disrupted and somewhat delayed.

In somewhat subdued, but resigned, mood I wandered down Tottenham Court Road looking for somewhere not too crowded to have a light lunch. I took my time over a ham and cheese baguette and sipped the comforting froth of a cappuccino sprinkled with chocolate and nutmeg, calming my nerves by watching passersby through the large windows of the warm café. I took the slow train home from Waterloo so that I could read at a relaxed pace and enjoy the small bar of Cadbury’s Fruit and Nut that in the circumstances of this particular day I felt I had earned.

Another sort of butt

The Love of Three Objects

The church that my wife and I attend encourages its members to join “Life Groups”, a zappy name for small groups that meet regularly in homes for friendship, mutual support and encouragement, study, prayer and general fun.  Over the 21-plus years we have been at the church we have been fortunate to be in groups whose leaders have been unfailingly creative in varying the diet of activities.

This Tuesday, for example, we went to spend the evening in the dwelling of our farthest-flung member, which is a canal boat moored at the bottom of one of the hills of North Middlesex, part of that county which has disappeared from the structures of local government but which lives on in the hearts of its residents and the drop-down lists used by website designers (I have on more than one occasion not been able to complete an online purchase without selecting the otherwise vanished entity as part of my address). As well as sharing fruit, cheese, dips, wine and juice that we had brought, the members of our group (eight on this occasion) had been asked to talk about up to three objects that had been especially important to us in the course of our lives.

A rich and beautiful evening it turned out to be, as we gave each other time to tell something of our personal stories and were introduced to some very interesting items. In the end “objects” was interpreted loosely, as some of us had brought pictures or used objects as symbols of a particular time or activity that had been important to us. Our host produced a photograph from 1854 of his great-grandfather in military uniform sitting proudly on a horse; the gruff-looking gentleman (the ancestor, that is, not our host) took part in the Charge of The Light Brigade and survived, finally dying in 1915. Someone else brought along the black velvet cap that he was entitled to wear as the recipient of a PhD from Cambridge, its style reassuringly unchanged since the 16^th century and its tassels containing threads of real gold. We saw a postcard of Bath, the ancient town holding happy memories for one of our members. Another spoke of her love of family and social history and produced a volume of old family photographs—some of its subjects tantalisingly unidentified—as well as tiny envelopes containing letters from the time of the First World War. Yet another told us of how she had come on her own from Hong Kong at the age of 16 to study piano and been welcomed by a distinguished English musical family, the memorial service of one of whom she had attended that very afternoon.

These are the things I took to the gathering.

First, the walking cane that my grandmother brought back from Iraq (which she generally referred to as Mesopotamia) in the years just after World War I. This is its second appearance in this blog. It is not, I think, ebony, as I once believed: its dark colour seems to come from staining rather than being natural to the wood. Granny used to tell me how she and my grandfather had courted all those years ago and of romantic boat trips on the Tigris, of Arabs in long robes armed with rifles. She gave me the stick on my twenty-first birthday and it reminds me of many happy hours spent in her loving company; it speaks of my childhood and of its place in the family story, which I am in fits and starts documenting; it speaks of her youth (she lived to 101) and carries with it a distant echo of my dignified and beloved Grandpa, who died when I was eight; it testifies to the past of our nation, the troubles of Iraq to this day resting in part on Britain’s imperial ventures in the early 20^th century.

The stick with the silver snake head

Can anyone tell me what the Arabic says?

Or this bit?

Next came the third drum that I ever bought, in a shop on the Portobello Road, in 1977. I still have my first percussion instrument, a very cheap pair of bongos purchased in Oxford, as well as the second, a Kenyan drum of indifferent quality made for the tourist trade and bought at the Ideal Home Exhibition, of all places. It was however the aluminium darbuka pictured that  first fed back to me a sound that encouraged me to develop as a player, although I never learned to play it in any authentic Middle Eastern style. Particularly satisfying were the cracking high notes achievable at the edge of the head, contrasting with the deep booming tones produced towards the centre, the fruit of the drum’s flaring shape. The drum does not have its original vellum head or plastic hoop, the hoop having broken in rehearsal when I cranked the tuning up too high for the flimsiness of the plastic. I was at the time in a group called Cloud that led worship at Holy Trinity Brompton (then getting better known as “HTB”) until 1988. Cloud was an eclectic mix of classical players and pop-folkies who, when I joined them in 1981, had to cluster around one or two microphones. I was their first regular percussionist, having—most unlike my then timid self—approached the group’s leader and principal songwriter, Phil Lawson Johnston, after an evening service. Cloud had already brought out three albums of original material and was planning a fourth; by the time the group disbanded a total of seven albums had been produced. My wife-to-be heard the sound of this drum on our recordings when she worked in Uganda in 1983 but we did not meet until 1985, when she joined the group. Cloud’s material is difficult to track down these days, never, so far as I know, having made it on to CD, but I did find a cover version of the song they sang at our 1987 wedding here. Our voices were less schooled than those on display in the clip, but the singers have reproduced the harmonies used on Cloud’s 1982 release Hallowed Ground, whose opening track began with a pattern on the darbuka.

Yashica FR, the last camera the company made with a brass body (it's heavy!)

Finally there is the single-lens reflex camera that my father gave me when I was in my late twenties, sensing my growing interest in photography. He had lent me one of his own cameras when I went to stand on Ludgate Hill to watch the wedding procession of Charles and Diana in 1981. Sadly only a few of my photos of the day and none of the gathering dignitaries and celebrities actually came out, as the camera failed to wind the film on, although this was not apparent while I was shooting as the frame counter had continued to work. Dad clearly decided that the time had come for me to have a more reliable camera of my own and so we made a trip to Tall’s Cameras in Twickenham (long since disappeared). The camera still works, although I have not used film for many years, abandoning it in 2003 when I bought my first digital point-and-shoot. I miss slides, which were my preferred medium with the old Yashica, but one has to be an earnest and determined person to use film these days and I was never into the paraphernalia of the darkroom. The camera reminds me of my father, who died in 2005, and of his own love of photography, for which he had a natural aptitude.

Darbuka, perfect for accompanying belly-dancing (although this one never has, shucks!)
Still visible is the sticker of the long-defunct London Drum Centre.

On Monday I had learned a bit more of the personal history of a friend of the family. We had gone to have lunch with my mother-in-law and also there was the friend, who is a very spry 91. He told me after the meal about his having worked in Hamburg for some months before World War II and mentioned that he had been able to get a sighting of Hitler. The dictator’s name passed through the cosy English room like an electric shock. My mother went to the same city as an army nurse after the war, but by then the inhabitants of the centre were eking out a living in the basements of devastated buildings.

God is Small

Over the last few days my attention has been drawn to small things. In part I have David Attenborough’s current enthralling TV series Frozen Planet to thank for this. This week we could view, miraculously: tiny polar bear cubs born to a mother half asleep in the midst of the brutal Arctic winter finding their way to suckle on milk nine times richer than the human variety; starfish failing to escape a deadly column of salinated ice snaking down to their previously secure habitat; a fragile emperor penguin chick being cradled in its father’s feet and so kept away from contact with icy ground that would kill it in seconds. There are many miracles here: the sights themselves, of course, but also what goes on behind the lens in the accumulated ingenuity and determination of the film crews, the technology required to brings us the images and transport the crews to achingly remote and hostile environments.

Emperor penguins and chick (this one made it through the winter).
Among many adaptations that enable it to survive on land and for up to 18 minutes underwater is unusually structured haemoglobin that allows the bird to function with low blood oxygen and not lose consciousness.

Yesterday, I went to my places of work, St Olave Hart Street and St Katharine Cree (both in the City of London), for the first time since my recent treatment. My main destination was St Katharine’s on this occasion, of which more in a moment, but I called in first to St Olave’s, mainly because I love it. One of the few mediaeval churches left in the City, it is a place that rarely fails to touch those who enter it from the mad rush going on outside. Rehearsal was under way for one of the musical recitals that have taken place there at least twice a week for over 50 years, the acoustic enabled by the 15^th-century stone interior and 20^th-century wooden ceiling (as well as some now rather tired carpet) being quite peerless. The trio performing were a bit out of the ordinary as their performance would include elements of improvisation, including an invitation to the audience to submit their mobile ringtones, on which the group would then create musical variations. The micro builds the macro.

On then to St Katharine Cree for her Patronal Festival, the annual celebration of the saint. St Katharine of Alexandria was a scholar in the 4th century and, in recognition of her status, the address at the Patronal Festival traditionally focusses on the meeting place of faith and intellect. The speaker this year was Andrew Briggs, Professor of Nanomaterials at Oxford University, who treated us to a lightning summary of his work, which is aimed at assembling and arranging infinitesimally small components for use ultimately in quantum computing. This is bleeding-edge science and a practical quantum computer—incomparably faster than current digital computers—is some years off (say 10, for the sake of putting some sort of figure on it). His title was “Your God Is Not Small Enough”, encouraging us to see God as concerned and involved with the small, often hidden, details of our lives, just as He is with the great things: the World, the Universe, Space etc. It is in the outworking of small decisions and behaviours that our life is built. Heady stuff, not least because it came with the authority of a man who has spent over 30 years studying the tiniest of structures and I fear that I am not beginning to do his fine talk justice. The micro builds the macro.

St Katharine Cree on a previous occasion.
Architecturally unique in London, the present building was consecrated in 1631 by Archbishop Laud,  whose conduct of the consecration liturgy–small actions in the fabric of one day–was used by his enemies
to help build a case of crypto-Catholicism against him and so led to his execution.
Photo by Esperey

I made a small purchase earlier in the week: highlighters with which to mark up the texts I read to research the historical figure on whom I plan to base my fiction. Will this micro build a macro?

An iris in a Sussex garden, Spring 2011
It reminds me of Jesus's words about some of the small things in the world, when he urged his followers to consider the lilies of the field, who "toil not, neither do they spin, yet Solomon is all his glory was not arrayed like one of these".