Month: September 2021

One of the most popular songs played at funerals is, you will not be surprised to hear, ‘My Way’, that self-aggrandizing hymn of defiance, associated with and immortalised by Frank Sinatra. It never fails to raise a collective wry smile among the grieving on hearing that the normally retiring Mr Albert Thwaite did it his way. Leaving aside the thorny question of what his way was, it’s usually pretty clear that Mr Thwaite did not. Do it his way I mean. A life of kowtowing to some nameless council boss was not what Sinatra had in mind. So unless you count that unfortunate episode with the karaoke machine Ethel hired for cousin Gladys’s 21st birthday, Albert did not do it his way. And many who heard his treatment of the aforementioned song that day, fuelled by two glasses of Tesco Amontillado, are still reluctant to talk about it.

Albert’s rendering of the song that day remains etched in the memory of any who heard it. Not everyone recognised the song, so idiosyncratic was the performance. Many who did never thought of it the same way again. Somehow Albert managed to condense the anger of a lifetime of servitude into three minutes of jawdropping catharsis. In some ways that is what the song is about. Just not Albert’s apparently arbitrary and wandering choice of key and tempo. Listeners stared at their shoes as the song ended. After several seconds of tumbleweed, Ethel broke the embarrassed silence with a single handclap and invitation to guests to address the buffet.

Albert was buried in an old dark suit, it’s lining long since given over to moths. Nobody mentioned the song.
Least said this, thought Ethel.

Howard Hughes can legitimately claim to have done ‘it’ his way. Bill Gates and Steve Jobs the same. Their lights burn bright, their greatness unequivocal, their single-mindedness unassailable. Men who genuinely did do things their way. But what of the millions in between Albert and Bill, Steve or Howard?

Tomorrow I shall attend the funeral of a friend, a clinical anaesthetist and one of my former PhD students. Neither Albert Thwaite nor Howard Hughes. I’ve been asked to say a few words about the person I knew all those years ago. Others too from different parcels of his life. And above all it has made me aware of how compartmentalised our lives are. The messages of remembrance each provide another piece in the jigsaw. I can only speak of the time I knew Guy. He was a gentle man and a gentleman. The product of his upbringing and strong parental models. He was an only child and in many ways a private man. But at the same time he was gregarious and entertaining. Larger-than-life if you will. Not many knew that he enjoyed heavy rock music and among his final acts was the choice of music for his own funeral. Logically this would be the point where I draw the strands together and say that ‘My Way’ was among the choices.

Mercifully it wasn’t.

He chose ‘The Chain’ by Fleetwood Mac, reflecting his love of Grand Prix racing (the instrumental solo in the middle of the song associated forever with TV coverage of racing) and, little-known by others, the fact that he played the bass guitar himself.

Mr Blue Sky was another perfect choice. Patients loved him. His bedside manner was calm and encouraging, reassuring anxious patients, soothing jangled nerves of the preoperative patients. In many ways he was Mr Blue Sky.

And the final song? Growing up on the south coast, with its chalk scarps and green fields, it could only be one – White Cliffs of Dover sung of course by Vera Lynn. The perfect choice.

Guy would never have claimed to have done it ‘My Way’. He would have snorted at the absurdity. Guy knew, better than most, that life throws spanners into the best laid plans. He knew that life was about doing the best you could, where you could and how you could. He accepted no grand design, no masterplan from on high, just the simple pleasure of knowing that he had done his best. It wasn’t necessarily his way or anybody else’s. It was just the way. And that’s all that mattered.

A good friend of mine has an observatory in Malta. Well, I probably make that sound more grand than he would feel comfortable with. It is not Mount Palomar or the Hubble space telescope. There are no huge white domes here with massive mirrors and lenses. This is on a much smaller scale – basically a reflector telescope on a rooftop. Not a colossal structure but nevertheless, in the sense it has a telescope trained on the night skies, it is an observatory. Keep that in mind whilst I tell you more of where this telescope has taken him.

JR would be quick to tell you that he is an amateur not a professional astronomer. Astronomy is many things to many people but for JR and myself it is mostly about staring in gaping awe at the majesty of the heavens rather than computing, calculating and correcting the orbits of objects so terminally uninteresting as to leave even the theoreticians cold. JR is all about the beauty of the heavens and their visibility.

Astronomy is not about numbers (well it is but we will come to that in a minute). It is a paean to beauty and, if you are of that leaning, doubtless speaks to you of creation.

Over the last several years JR has taken a series of breathtaking photographs of what we astronomers call deep sky objects – deep sky in the sense of being way beyond our own solar system. Galaxies, globular clusters of stars, nebulae, supernova remnants, the fragmented graveyards of red giants and the blue nurseries of infant suns. These are the places where stars are born. Elsewhere stars at the end of their celestial journey fade into darkness in a final ruddy glow.

I was quick to dismiss numbers earlier but of course there are necessary to find your way round the heavens. Every astronomical object has a location in right ascension and declination, in essence it’s postcode. And whilst you can locate each nebulae or galaxy with little more than that, the faintest nebulae will still be darker than the most penetrating eyesight. So rather than stare into the darkness itself, why not use technology to one’s advantage? A laptop, some software and a motor drive on the telescope allows one to find and photograph things you cannot even see. And of course you don’t even need to enter the coordinates on the scope. You can do it through the Internet.

All of which is rather long preamble to last Saturday night when JR invited me, through the power of the World Wide Web, to take a photograph of a deep sky object of my choice. I think partly it was an exercise on software compatibility, to see whether one could take pictures remotely. But I didn’t need to be asked twice. I jumped at the chance.

But which object should I photograph? The Horsehead nebula? Perhaps the globular cluster in Hercules? Or how about the Ring nebula in Lyra? Or the Sombrero Galaxy? It was like a chocolate box with all your favourite soft fondant centres and no nut clusters.

I chose the Dumbbell Nebula (Messier catalogue M27), a planetary nebula discovered in 1764, in the tiny faint constellation of Vulpecula (the little fox). An elegant little nebula – not perhaps a premiership object but pleasant nonetheless with a white dwarf star at its centre surrounded by a gaseous veil.

We linked the two computers – in Kent and Malta and, before I knew it almost, I was giving the scope its coordinates and watching as it revolved into position. It would take several long exposures but as it did so we watched the image build on the screen.

I would like to say that it was my photograph based on less than an hour of learned expertise but the truth was that it was a collaboration between myself the neophyte and JR the expert. Not to mention a pricey telescope, software, camera and more. It was by no means my solo!

It’s one thing knowing that your operation is to take place in the autumn but quite another to know exactly the date and location. The email (or perhaps that should read THE email) arrived today, confirming in black and white, the date when I go under the knife. No, I’m not going to announce it here but let’s just say that if it goes well, there will be fireworks!

Immediately after reading the email, I begin to notice a change in myself. Suddenly things previously only discussed in the abstract are transformed subtly into tangible realities. And that makes all the difference. ‘In the autumn’ is vague and comforting. The ‘Xth of November’ is unsettlingly immediate. Okay it’s two months away. Plenty of time to pack my hospital bag and be ready. Ridiculous then, as I did, to fish out an overnight bag and start packing it. Better to make a list. And calm down.

I sat for a moment or two on the edge of my bed while I gathered my thoughts. I’d be lying if I said I wasn’t nervous. No matter how routine the procedure, how skilled the surgeon and how reassuring the statistics it is still enough to raise the heart rate a little. That’s only natural. Any procedure in which your brain is opened up to the atmosphere, however briefly, is likely to engender at least a modicum of anxiety. After all, we have evolved skulls for very good reasons – to keep the brain in and the atmosphere out. Neurosurgery respects no such distinction.

Reduced to its basic acts, the surgery is straightforward. You could do it on the kitchen table*.

1)       Toss a coin – heads  for left, tails for right.

 2)      Saw a hole on one side of the skull using a drill and a circular saw attachment (£29.99 in B&Q until the bank holiday). Oh, about the size of pound coin I guess.

3)       Jab the brain with the electrode (that’s the one that looks a bit like a cocktail stick). You might want to practice this stage beforehand – say with a cocktail stick and maybe a raspberry milk jelly until you’ve got the hang of it. Better safe than sorry.

4)       Fill the hole with Polyfilla (or whatever the surgical equivalent is) and drag wires out under the skin to the chest. You remembered the wires, right?

5)       Implant the battery pack (about the size of a Baby Bel cheese portion) on the left-hand side of the chest and connect to the electrodes.

6)       High five the surgical team, wake up the patient and wash down the table ready for the kids tea when they’re back from school.

7)       Succumb to a brief moment of panic when you realise one of the Baby Bels for the children’s tea is missing. Turns out to be in your pocket.

8)       Note to self: cheese has no place in the operating theatre.

Joking aside (you did realise I was joking, right), the first part of the surgery is genuinely Neolithic. Boring holes in the head (trephining) was a popular treatment for insanity, seizures and headaches in those cave dwelling times. If leeches didn’t work, opening up the skull was the next step in the Neolithic manual of medicine. Amazingly, some of those trephined survived. Well, long enough to have the procedure repeated – there are examples of Neolithic skulls with evidence of repeated trephining, some holes being partly healed.

As I write this I realise that I’m probably not painting the best possible picture for those whose enthusiasm for DBS might be wavering in the light of such revelations.  I’ll stop.

Sat on the edge of the bed, my mind wanders beyond the simple list of toothpaste, deodorant et cetera. Soon I’m thinking of the whole surgical procedure and how it’s assessed. For the most part, the presurgical workup involves discussion between patient and the DBS team (neurologist, neurosurgeon, DBS nurse, and a few others) of what to expect. We talk a lot for instance about expectation management. That sounds like some kind of administrative or managerial term but it’s really no more than checking that the patient has good enough insight into their condition to know what kind of improvements to expect. In simple terms, make sure the bar is at the right height. If a patient believes DBS is a cure, they are on course for a disappointment. If they think that a small reduction in tremor is their best possible outcome, then they will be pleasantly surprised.

I like to think that my expectations are realistic and I will go through them in more detail in a later blog as D-Day, or should that be D(BS)-Day draws nigh. In general, I’m more interested in numbers now. I am no longer satisfied with verbal descriptions – ‘the chances of anything wrong are  very low’. what I want to read is that the likelihood of perisurgical stroke, heart attack or infection is X, Yand Z% respectively. For the same reason phrases like ‘big improvements in motor scores‘ fails to float my boat either. I want to see A% improvement in sleep scores, a -B change in gait asymmetry and so on.

I have an innate impatience with descriptors that don’t adequately describe. After all one person’s ‘huge improvement’ is another person’s ‘better but no big deal‘. So I want to see that they both had a 15% improvement in UPDRS scores. Or whatever.

But there’s plenty of time for that. The email detailing the date of my operation invites me to get in touch if I have any questions about the procedure and the time in hospital. They may regret that. Because I have questions. Boy do I have questions.

*No, don’t actually do this on the kitchen table. Or any table. In fact, don’t do it at all. Don’t even think about doing it. This is a procedure for skilled professionals and, in case you’re wondering, no that’s not you.

I started collecting LPs when I was 15. I can remember the record in question (Hot August Night by Neil Diamond) and the first classical album I bought shortly thereafter (Peer Gynt by Grieg). At first I bought infrequently – I was only a schoolboy and my pocket money went only just so far. But I listened to a great deal of music and consequently bought discerningly.

By the 1980s, when I was in my early twenties, with four years of university behind me, I found myself drawing a salary as a research assistant. In terms of stacking up the vinyl I had money to burn. Almost literally. It was an opportunity to buy all those albums I had coveted. No more months of grim self-denial. It was time to splurge.

Almost every Saturday would find me skulking amongst the racks at the HMV Shop on Oxford Street, The Virgin Megastore at Tottenham Court Road or Tower Records at Piccadilly Circus. And for classical music, nothing could beat the Music Discount Centre (formerly Ron’s Music Shop) opposite Charing Cross station. Occasionally I would dive down into the back streets of Soho in search of rare jazz recordings. The shops got to know me and would keep me abreast of anticipated shipments of specialist live recordings as they euphemistically described what everyone else knew as bootlegs. And I walked everywhere, connecting the dots between the tube stations, piecing together a retail homunculus of London’s West End.

One might suppose this to be a young man’s indulgence, put aside or curtailed by each sequential life event – marriage, children and so on, with their associated dips in spending power. Wrong. Although I never quite ever topped the unfettered retail assault of my twenties, the habit continued unabated. I am now in my early 60s and the record (LP and CD) collection stands at a giddying 4000 discs. 4000 discs in 48 years is 83 albums per year. That’s a disc every 4 1/2 days. On average. I don’t know whether I should be ashamed or proud.

The truth of it is I love music. Almost every form or manifestation of music. From the Taiko drummers of Japan to the Fado singers of Portugal. From unaccompanied folk singers in Northumbria to the Symphony of a thousand by Mahler. From the jingle jangle of Javanese gamelan to the woody resonance of a solo cello. A cornucopia of music.

And it had to be on LP or, latterly, CD. I was never a huge fan of cassettes. The quality was never adequate despite the weight of advertising trying to persuade us otherwise. Cassettes flattered to deceive. I started with LPs and postponed the decision to swap over to CD (or not) until the late 80s. I’m not sure why I was so reticent. The price differential between LP and CD was certainly offputting, with CDs essentially double the price of LPs. That wasn’t the sole cause of my caution.

Mixed messages seemed to emerge from the CD lobby. “Perfect sound forever” was the courageous claim of the CD manufacturers. Forever is a long time. And this kind of perfection was difficult to reconcile with those bizarre adverts showing CDs daubed with butter, strawberry jam and whatever. There are surely better ways of demonstrating the durability of this then new vehicle. In any case, it hardly a fair comparison. I have always taken my LPs neat – no butter or jam.

CDs were easy – put them in the tray, press play. That was it. All of it. What could be easier? I guess that was another attraction for many listeners. They didn’t need to worry about any rigmarole.

Okay so the the sound seemed better on unbuttered CDs – brighter, clearer and more detailed. You really could hear one of the trombonists quietly break wind in the seventh bar of Mahler 5. On LP, his blushes were spared by the background rumble, snap, crackle and pop of the LP’s groove. For classical music, the pleasure of hearing the music emerge from silence, apart from the occasional flatulent brass player (why is it always the brass?) was worth the premium. For rock, the claimed advantages of CD were less obvious. And certainly you would have been hard pressed to detect any trouser coughing against the backdrop of John Bonham’s drumming.

I think my reticence in changing over completely to CD was twofold. Firstly and most obviously perhaps, I liked the physical presence of LPs much more than CDs. In the early days of CDs, often the cover design was little more than a scaling down of the equivalent LP and whilst the writing on an LP sleeve was readable, the same could not be said for the minuscule text on the CD booklet. Call me picky but I quite like being able to read those background notes. Especially on jazz albums where documentation is everything – “Jellyroll Morton played this with a sprained thumb causing him to miss the entry in the second bar of Cold Ravioli Blues”. That sort of thing.

But the real root of my reticence is what I called the rigmarole. Secretly I think I quite enjoyed it. Putting the record on the turntable, carefully wiping it down with a carbon fibre brush to clear the surface dust, brushing the stylus with isopropyl alcohol before slowly lowering the arm down onto the disc. It was my way of showing my respect for the music and for the record itself. If I looked after it then it would look after me. So many of my friends paid little attention to such preparatory ritual and paid the price with records that showed their age in the ingrained surface debris and compromised sound.

And what of my LPs, mostly 30 or more years old and largely unplayed for most of those three decades? How do they sound? well, pretty good if I’m honest. With a decent if not state-of-the-art turntable, they have aged well. Protective sleeves have helped. The sound is bright and musical and whilst the flatulent trombonist is inaudible, the rest of the brass section rings out clearly.

I haven’t failed to notice the recent resurgence of LPs. And whilst I was reticent 40 years ago to change from LP to CD, I’m in no hurry to change back again. Sonically I think CDs hold the edge unless competing with the kind of turntables that need a mortgage. Pound for pound, CDs remain superior (in my humble opinion). No end of side distortion, more limited dynamic range and ever so slightly muddier sound quality. Plus, most remarkably, they often cost more than the equivalent CDs. That seems to me particularly paradoxical.

And when it comes to streaming, don’t get me started. Well at least not for the moment.