microbrewery

Invited to an October beer celebration at a new small brewery.
Not sure if it will be outside; the weather is wet. Perhaps we should stay home.

But the rain clears.

Friends drop in to see us off.

We drive to the brewery and try a variety of their specialty products.

My daughters share a seat and chat.

Later we eat at an Afghan restaurant and come home. Despite my protestations my wife drives. I have theatre in the morning but after the daytime drinking I must admit I feel a little flat.

vastly enjoyable

Hay fever or a cold? I don't know. Perhaps medication-induced rebound nasal congestion - an ironic condition.

Repeat vaginal repair and unexpected enterocoele (vault hernia). That never happens with my repairs because Eddie Lillie taught me to plicate the Uterosacral Ligaments after the hysterectomy. They have a high rate of repair failure once they happen though. I suture it firmly to the sacrospinous ligament after closing the hernia sac then suture my posterior wall locking stitch with the remaining the end of thread at each throw, effectively running a double suture line down the wall to the introitus, then the usual levator plication (yes, I know some people think it is more painful, and unnecessary, but I disagree) and a subcuticular perineal closure. This is followed by an intravaginal TVT sling for proven urinary stress incontinence - as loose as possible to minimize post-op retention, always worse when there is co-existing urge incontinence. She is prepared for every eventuality including self- catheterization if necessary since all other treatments have failed. In my experience, in these circumstances the surgery always works perfectly just to make you feel stupid for not doing it a year earlier. I both love and fear surgery, so satisfying most of the time but so disappointing when there are complications. For that matter I also love and fear obstetrics......and my wife a little bit.....and getting older.
Actually, I love getting older, always have(and my wife of course). When I was younger it meant I was ever closer to the day I was in charge of my own life. Later it meant I would finish my training, then improve my skills and then gain respect for my wisdom. It is certainly no disadvantage to have grey hair in my profession though I have seen some eminent-looking doctors who had long passed their best. Later still, getting older means I will be able to retire and learn to speak French and play tennis properly at last.

Just finished another book, about a fat man who loses weight, meets different people, learns lessons and gets his life in order. In a critical mood I consider many of the books I have read recently. They usually come highly recommended and have an interesting premise; they are usually skillful at leading the reader on, maintaining the tension, leading to an inevitable revelation or climax, but they struggle to find a satisfactory conclusion that doesn't sound like a variation of they all lived happily ever after. We don't believe in fairy tales but don't want to learn that Cinderella got older and developed prolapse and urinary incontinence either. Perhaps the solution is to have a glorious death at the climactic end of the novel - exhilarating , and without the depressing gradual decline....although we generally do not prefer that in real life.

So, now I am off for the weekend. As always, I don't know what to do with myself. The children aren't here and I am bored with restaurants and shopping.  Furthermore, while I support them in principle, in reality I do not like live shows. Well, there are exceptions, but live shows ask for my commitment and I just want passive entertainment. Shameful, I know. When I think about it I find that even passive entertainment has lost its attraction. I rarely watch the television now. I don't even know how to use the device on which the children load all of their pirated films and TV shows from their laptop computers to play on television. I'm just not that interested. I don't drink much alcohol any more. Bottles of wine accumulate beneath the stairs. I decide to try one and watch a TV show with my wife.

She doesn't drink so that she doesn't get a migraine, but I open a bottle anyway. Pinot noir 2005. The show is all right, a fantasy series from 1989, but the wine does not induce any conversation and I feel tired. The show ends. My wife goes to bed. My bladder is full and I don't want to disturb her so I step out the back door, beneath the small iron-roofed porch. I discover that there is a constant warm gentle rain falling evocatively on the corrugated iron above, and the garden and courtyard all round. I stand at the edge of the falling raindrops, swaying from the effect of the wine, unzip my fly and make my own small contribution to the warm precipitation. That is as good an ending as any.

third person

I want to be supportive. I want everyone to feel good about themselves while struggling with psychological problems, addictions, cravings, and other forms of self-harm, but I just don't grasp why a person cannot simply decide to do something and then do it. You can tell your body to do anything that is physically possible. You can decide to put one leg in front of the other and walk. You can walk out of a casino or betting shop. You can decide to pick up a cigarette or an unhealthy food item or not.You can push the accelerator down further or lift it up and stay within the speed limit.
We have voluntary control over ourselves. When we say we cannot behave as we would like it seems to me that we are really just choosing to behave in a certain way. We do not have to decide to stop smoking. We are actually taking up smoking every time we pick up a cigarette. But we pretend that the choice is not ours. We are merely the third-party victims of  some first person who has control of us.
There is the imaginary creation of a different entity for beliefs and planning on the one hand and actual action on the other. There is a philosophical dichotomy between thought and action, principles and behaviour. Yes, the required behaviour may be uncomfortable for a while but we should be able to tell ourselves to do things that are temporarily uncomfortable for long term gain.
Of course if we have convinced ourselves that we are not in charge then the imaginary monster that controls us will always prevail.

So maybe I should take my own advice and just go to sleep instead of being tired all the time.

further confession

And I liked Waterworld (but not Dancing With Wolves).

not a hipster

Looking at my list of favorite films and notice that I seem to lean towards arthouse. Well I must admit that I liked Titanic, Avatar and Forrest Gump.
 I have seen them all more than once.

damn

Damn. I've done it again. I am a sleepless fool.
But it feels so good when I finally close my eyes; no thoughts, no dreams.
Nothing.

Except those damn birds.

fancy hotel toilets

symposium

Apparently symposium is derived from a synthetic Greek word meaning a drinking party or a convivial meeting after a dinner so I suppose that is an accurate description of my experience although the drinking has been done the night before. The alarm functions well. I shave and dress then make my way to the conference hotel, too expensive for me to stay in overnight.

The meeting is held in the hotel ballroom. Morning tea and lunch are served in the foyer outside.

The meeting itself is smoothly run, compact and informative.The eminent speakers are cosily familiar with the fairly eminent local organisers. I would rather like to meet some of them but their cameraderie      is an effective screen.I could make an approach but would probably say something overly obvious  just to make conversation and then feel like a dumb loser trying to talk to the popular kids at school. There are opportunities to ask questions after each group of presentations but I feel similarly inhibited, a country bumpkin among the slick city folk. I notice that many others seem to feel the same, so the only questions are eruditely posed by other experts.

It is still a good conference. I learn that some people are astonishingly skilled or brave or both in laparoscopic surgery. Modern equipment could significantly help my operating technique. Hereditary thrombophilias have little effect on foetal well-being. Obesity can seriously reduce fertility, especially in assisted reproduction. Some people operate on amazingly fat patients, babies in the womb, and endometriosis so severe as to require bowel resection. Melatonin may prevent cerebral palsy. Activin antagonists may be the key to prevention and treatment of pre-eclampsia. Adolescents with severe period pain can be successfully treated by a hormone-releasing intrauterine device.

I stay for the included dinner and talk to a colleague from my district. The speakers and organizers are thanked and given presents. I have a little wine without too much nausea. Then  I am alone and leave the empty foyer.

I leave the hotel, and now it is night.

I want to go home.

night before the symposium

There is just too much work for me to go to a week-long conference but a one-day meeting is attractive. It is an opportunity to see some of the latest ideas and clinical practice in a concentrated form. I booked a cheap room nearby to avoid a long drive in early morning peak-hour traffic at the start of the day.After paying online I noticed a link to reviews of the apartments I had chosen. Many were dissatisfied and angry, imploring the reader to avoid this service. It seemed I had made a mistake although the apartment cost less than a hundred dollars, was close to the city(and to the conference site at an elite hotel), and had free parking. Too late to change my booking, I drove there on the Thursday night after my afternoon clinic.

Reception was friendly and the rooms were more than I needed, among streets of beautiful old terraces.

There seems to be a meanness of spirit in internet commentary.People presumably feel uninhibited due to their relative anonymity. It is a disappointing discovery about human nature. Apparently there is a common behaviour known as trolling. Linguistically this seems to be an amalgamation of trawling, as in fishing for a bite or response, and the word troll - adopting the persona of an evil creature. It is a little like a child pretending to be bad as part of developmental play, an imaginary game where the child may feel the exhilaration of being wickedly dangerous without consequences. To some extent this behaviour is treated much like that of a child by experienced internet users - their intent is identified and they are asked to stop: "You are trolling. Please leave this thread." They wouldn't do it in a real-life discussion but I suppose it is unavoidable in this new medium. I expect that eventually these people mature but meanwhile they upset those who are trying to use the web for genuine communication. They are annoying speed humps on the information superhighway. I'm sure that has been said before.

Back to the night before the conference. I am now in the big city alone. I can do anything I want.        It is a bit lonely.         However I take my current book(by Arthur C. Clarke) and walk into the city to see what I can find. Exclusive shops line the streets, closed but displaying their seductive products. There is a restless warm breeze and a scattering of raindrops as dusk turns to dark. Small groups of people stride down the footpaths talking loudly, laughing and bumping into each other carelessly, some late from work, some early in their night on the town. Ahead I hear an insistent electronic beat which I find is coming from a well dressed crowd drinking champagne in the forecourt of a tall building where a new fashion shop is celebrating its opening.I wish them well though I am not sure if it is money well spent. Further into the building foyer I recall there is a good Japanese restaurant, my cuisine of choice. I thread my way through the crowd and find the discreet establishment is still there and open for business. I enter and ask for a table for one.

I am hidden from the rest of the diners.
The meal is splendidly sparse.
I drink hot sake and finish with camomile tea.



The night is still young and I am free so I pay my bill and leave. The fashion crowd is gone. A couple of  tattooed roadie types, in black jeans and black T-shirts, are putting away the sound equipment. I wander down the street, a little inebriated from the sake, seeing the world from a different perspective.

Soon I find a microbrewery pub and decide to try one or two. I order a pint and find a seat, pulling out  my book and occasionally looking up at one of the TV screens which are showing a world cup rugby match between England and Scotland. The book is entertaining and the rugby is dour as I sip my beer. Gradually the beer goes down and I find it harder to concentrate on the book. The rugby is easier to follow.

I finish my glass and leave with the game still in the balance; float onto the street again, another nameless ant weaving among the towering  architecture. For once I don't have to drive home, don't need to worry about my blood alcohol level. A familiar bar appears and I know what I want.

The beer is good although starting to suffer from the law of diminishing returns. The more you drink the less you can taste. I sit alone again, unable to read my book, and eventually the inane music videos penetrate my increasingly incoherent awareness. I finish my beer and gladly leave the thumping demanding noise behind, giddy in the cool night air, vaguely heading back to my rooms on foot, snatches of traffic and city lights registering intermittently on my brain.
There is a park to cross, fairly well lit although I know from my medical student days nearby that it can be unsafe at night. The alcohol allays my concerns as I traverse the otherwise empty gardens. Flowers line the paths, vivid even in the dark.

I would have made an attractive target as I reeled through the historic park so close to the city centre.

Then I am through and find myself standing before my old medical school obstetric hospital, now some sort of apartment building, no longer the busy, somewhat frightening birthplace of my professional life.I am suddenly sad at this loss. I am old and the world has moved on, but so much that I do every day brings a small memory of this place, so alive in my mind. I realize that many of those awesome consultants who taught me my lifelong lessons are retired or have died. I am a lonely maudlin drunk.






After walking back and forth along the footpath I fail to find anything familiar and resume my journey past quiet street-lit houses to my quarters.







I stumble into my room, remove a random selection of my clothing and fall asleep on top of my bed. I wake later and complete my undressing, hazily set the alarm and climb beneath the covers, dreaming of my youth.

birthday

I was born on the feast day of St Luke, the patron saint of physicians and surgeons. My father was a doctor and my mother was a nurse. She had been in labour for forty eight hours with fulminating pre-eclampsia and was heavily sedated after finally suffering eclamptic convulsions . My survival was not a priority but I was eventually delivered by forceps. My mother cannot remember the first five days of my life.There is no specific treatment for pre-eclampsia - the cause is still unknown.

St Luke, or Loukas, is also the patron saint of artists, students and butchers.

                                                                                                    

kookaburra, apple blossom, sunset

alcohol

My father was an alcoholic.
He joined AA and stopped drinking when I was seven years old.
My older son was not an alcoholic but he stopped drinking three years ago. He was repelled by the excess consumption of his fellow college students, often having to look after them in a state of alcoholic poisoning. He would frequently need to call an ambulance for an unconscious undergraduate who will one day be a pillar of the medical or legal community.

I drank too much alcohol when I was at university - so much that I was fortunate to pass the first two years of my course.

I was fifteen years old when I had my first alcoholic drink. It wasn't available in our house because of my father. I was a drinks waiter at a progressive parish dinner, moving to a new house for each successive course. I assume it was intended to raise money for charity. My job was to serve the alcoholic drinks that were matched with each segment of the meal. The first house provided hors d'oeuvres with sweet or dry sherry, the second house entrees with white wine, then main meal with red wine, dessert with liqueur wine and finally cheese and port.
I had a delusion that I might be unaffected by liquor, or at least that I would only feel the pleasant effects of it. It was easy to try the drinks without anyone missing one or two of the dozens of glasses at each venue. The whole evening seemed strangely hilarious. I particularly liked the sweet sherry and the port - the first and last offerings of the night. Eventually I was dropped home where my mother was waiting for me. She asked me if I was all right, at which I collapsed to the floor with laughter. She tried to help me up but I kept hysterically falling back down. Luckily my father was on call at the hospital. My mother correctly guessed that I was inebriated and assisted me to my bed despite my merry protestations. She said it might be best not to tell my father what had happened. In our family we did not go out or have friends for dinner in order that my father wouldn't have to deal with alcohol, so it was a sensitive subject.
I was not particularly frightened of my father, though, who was a masculine but kind and loving man. In fact, not long before this, I had attacked my father in a blind adolescent rage. Despite the fact that I was muscular and athletic he had calmly, and to my genuine relief, flipped me flat on my back on the lounge room floor. Why would I launch an enraged assault on my loving father? I would like to know the answer myself but can no longer remember. It is true to say, however, that I did many more stupid things than that as an adolescent and somehow survived to make a contribution to society.
I would like to say that I vomited all night or had an unbearable hangover the next day, and that did indeed come to me many times later, but in this first experience with intemperance I was simply infused with a narcotic-like euphoria. I woke the next morning in a state of exhilaration, delighted with the previous night's outcome. I couldn't wait to try it again but there were few opportunities and I had a busy life of sport, music and education. Eventually,however, my time did come.

Having gained entry into a medical course by hard work and good marks I only had to pass each year to become a doctor. I was planning to be a general practitioner so there seemed no point in working hard. I could drink and party all I liked so long as I managed a bare pass. I wasn't the only university student with this short-sighted immature plan so I had plenty of company.
My more conservative friends thought I was amusing, turning up to lectures still inebriated and without sleep. I would carry textbooks with me but never read them. Yet I somehow passed my first year.
I started my second year with new resolve and actually did quite well in the first of three terms. In fact I calculated that I could pass with only about thirty percent marks for the rest of the year. Therefore I didn't turn up for lectures or do any study for the next two terms. I reached the stage where I would take my own two litre flagon of cheap wine to a party at least every second night, meeting notorious people and having liberated fun, doing illegal drunken things in the night. But as the last term progressed without me, I gradually developed the sinking feeling that I was never going to be a doctor.
One night, late in the term, after a lot of poorly coordinated dancing in a crowded room, I went outside to cool down, still swigging freely from my large flagon. It was quite cool but I wasn't noticing as I lay on my back on the grass in the garden, the loud music muffled inside the house. I lay as if crucified, with the flagon still in one hand, and briefly drifted off.
I awoke a short time later in the early dawn light looking up through the branches of a purple Magnolia, its leafless branches abundant with early spring flowers, as a gentle rain filtered down onto my bare torso. I let myself feel the cold and the wetness and the prickly grass beneath my back, and pondered the state of my life. I was alone. The music had stopped.The examinations were in two weeks. I knew I couldn't pass. I wondered if I could fail by little enough to be allowed to sit for supplementary exams. Suddenly I felt I had a challenge. I staggered up and walked to the road outside, leaving my empty flagon under the flowering tree. I stuck out my thumb and an old VW van pulled over to let me in, wet, shirtless and barefoot, my breath reeking of stale cheap wine. I was on my way.

still alive

Once, when I was a senior registrar, I removed a ten-week ectopic pregnancy from a Fallopian tube. The tiny foetus, about the size and colour of a cooked grain of rice, sat momentarily on the tip of my gloved right  index finger, surprisingly still alive.

Its heart was beating.

I didn't know what to do.

Christmas and supermarkets

                  October 8th - the first time I have noticed Christmas displays in a store.

This is an easy game. People write to the newspaper every year remarking on the early appearance of Christmas or Easter-related products. Not everyone is unhappy with this commercial distortion of traditional celebrations. One friend(OK, my wife - that's sort of a friend) told me that she likes hot cross buns so why shouldn't she have them when she feels like having them? Well obviously I can't argue with that, mainly because I am not religious, but I feel that I am losing some of the landmarks of my life.

It is as though the seasons no longer change. I once worked in a city where it was too warm for many deciduous trees to lose all their leaves in winter. Despite good job prospects I moved back to my cooler origins so that time did not become an unchanging season, even if I could no longer grow hibiscus and frangipani in my garden. If Christmas extends throughout the year it has lost its cultural as well as any religious significance.There is nothing to look forward to since it is already and always present.

But Christmas is just too commercially attractive. Every year it encourages celebration, more spending and greater profits, so it must be tempting to grab a little bit more of it, to start a little bit earlier; or to take some of its elements for use throughout the year. I shouldn't be surprised to see this since a supermarket is simply an enterprise for the purpose of making money, not a heritage organization for the preservation of our cultural history. And, as my wife makes clear, it can only act with the support of the public - who no longer live in the same kind of world that spawned these traditions.

 Having defended the supermarkets for their right to be soulless and unscrupulous, I would like to say that, in my opinion, they play a major role in the increasing obesity and consequent increasing ill-health of our community. A supermarket is a giant-sized convenience store, promoting an unhealthy diet, attractively packaging unhealthy fats and highly processed high-GI foods. Whole aisles are devoted to biscuits containing the harmful but commercially advantageous(cheaper,longer shelf life) palm oil. Refrigerated shelves are laden with yoghurts proclaiming that they are ninety eight or ninety nine per cent "fat-free" despite the same calorie content and less satiety leading to overeating and obesity. It is implied that confectionary which is nearly one hundred percent sugar is actively health-promoting by eye-catching "fat-free" labels. Unhealthy foods which are impossible to disguise are offered as the indulgence "you deserve" in promotions that bypass the rational mind of many vulnerable people.

So, what to do? Well my wife has found quite a good solution. She doesn't go to the supermarket for her shopping except for irregular visits for kitchen and laundry supplies. She goes to the greengrocer for fruit and vegetables, which also supplies milk and bread. She doesn't have to run the gauntlet of temptation all the way to the back of the shop just to get some milk. She gets bread from the baker and meat from the butcher: not so useful for Christmas treats and decorations in early October but she is losing weight by eating healthy foods.

fashion

There is something about people that makes us act together. This gives us greater power. We can undertake great projects, defend our lands and use our resources more efficiently. We can build the pyramids, create the Roman Empire, and transform scientific research into the everyday structure of our lives. But to do this we must think as a group.

Perhaps we only exist because our ancestors were better at working together to our evolutionary advantage. Therefore it is no surprise that we have a pronounced need to conform. This both protects us by allying ourselves to the strength of greater numbers, and also allows us to coordinate our actions for goals beyond the capacity of an individual. Even fashion in clothing is a group behaviour resulting in greater efficiency in production and distribution. Once established,however, a fashion industry then acts to reinforce the mass behaviour from which it profits. Of course there must be a few independent thinkers to steer this army of conformism, the celebrated designers who we look to for guidance in the most acceptable methods to cover our nakedness.

This desire to belong must explain such phenomena as the religious conversions of whole countries - in theory, this requires the otherwise unlikely simultaneous recognition by millions of people that their philosophy of the nature of existence is flawed and that only one particular alternate interpretation is likely to be correct. These changes have not always been forced upon people by war although such mass changes in thinking have certainly contributed to wars. Eight million people are thought to have died in the Thirty Years War of 1618-1648. Much, though by no means all, of the impetus in the conflict derived from the new Protestant ideas such as Lutheranism and the newer Calvinist thinking which spread rapidly through the central countries of Europe, just as Christianity itself once had done. Ideas do not necessarily proliferate to the advantage of their believers. Their creation of a common community of thought seems to be more powerful than personal well-being. So group belief can be an overwhelming social force, but ripe for manipulation by anyone in search of influence, power, or money.

What would you say if I offered you my product for which you would pay for the privilege of damaging your health, causing cancer, as well as lung and arterial disease without any compensating benefit? It would damage the health of your family and place a burden on the whole of society. Yet with the help of advertising and nothing more to gain than the profits of a few companies our society accepted this insane offer to smoke. No wonder we accepted Nazism, Fascism and Jim Jones. To be fair we also sustain the group endeavours of a functioning society such as health, education and transport systems, so we can't entirely abandon the basis of our social cohesion. But if we want to succeed against destructive group behaviours such as rising obesity, addictions and racism we need to either use the tools of mass manipulation or try to foster greater independent thought. Some form of Social Anarchism or Social Ecology is good in theory but would probably fail like communism and other political theories in the real world of greed, ambition, guns and paranoia as the "celebrated designers" hijack the compliant multitudes for their own gain.

raining

rain coming

in the afternoon. The clouds gather ominously, barely moving as a rain-laden easterly weather front meets the prevailing westerly stream. Like an arm wrestle the two sides meet directly overhead then slowly rotate as the east takes control.

The sky darkens as a distant rumbling thunder rolls in.

Through a gap in the trees rain can be seen on the next hill. It is still dry but a freshening wind brings the evocative smell of wet earth.

Spring flowers seem to be waiting...

                                                                                   for the rain to begin.

                                                                                   
The rain gets heavier...

                                                 













                                                      and heavier,







but the flowers don't seem to mind.

                          

partial enlightenment

At last I understand the serve. Not just theoretically. It is only truly understood when it can be physically performed . The integration of the concept and the practice is an exquisite pleasure after a year and a half of lessons and enthusiastic practice. In theory I don't care but it is enjoyable to win games with my new action.

On reflection it is interesting to find out that most of the components of a good serve happen automatically if the basic movement is right. You don't consciously need to force your weight forward or upward or think about shoulder rotation if the underlying action is correct. Technically my main problem was to slow or delay the ball toss but I just couldn't make myself do it. I was willing but psychologically unable. It just felt wrong so I tried everything else for more than a year then went back to the advice I was given in my first lesson.
A child who has lessons from the beginning would not need to think about their service action. It would simply be. But I love my newfound combination of awareness and execution.

I'm sure that there is an analogy here for other areas of life. Firstly, there is a world of difference between academic and practical knowledge. That is never more clear than in obstetrics and gynaecology. I recall one highly credentialled resident, when I was a registrar, being judged with the statement ,"As an obstetrician he makes a very good physician."

Secondly, it is not necessarily wrong to live an unexamined life but full consciousness is more satisfying and might prevent much of our flawed group behaviour, since a group encourages us to give up our independent critical thinking. In tennis I understand my serve. If it becomes faulty I can correct it. Most people can't understand why they are obese, or addicted to smoking or gambling because they are not in the habit of examining the basic principles on which their lives are constructed. Perhaps they are frightened of what they might find, the old existential terror. Don't look. We just want to be told what to do. Perhaps that explains the rise of personal trainers, although the great mass of people can't afford them.For them we have daytime television.

Now I just need to understand the forehand, the backhand and the volley.

actually on holiday

                       Another sunny day, this time with fluffy clouds over the nearby hills.

                                                                             





Insects are out and about.






























                  Alone for the day, I have a cooked lunch - cubes of fillet steak seared with oil, red wine and Worcestershire sauce, fried onion, blanched broccoli, and fresh capsicum, carrot and tomato.

Outside, birds sing all day and bees hum from flower to flower.

                                     

                                             So this is what happens while I'm at work.