Saturday, 26 November 2011

Travels

Illuminated fish parade in Durham

No blogging for a while because we’ve been travelling. When Lois was a student at St Andrews, she did a trip around Scotland on a bike and envied people in campervans. So, we did the trip in our new van. We also took in the Lumiére in Durham on the way.
videoThe Lumiére was fascinating, I hesitate to say illuminating, because most of the time I had no idea what was going on or why. For example, a parade of children walks through the streets each child holding illuminated fish, made of paper maché. The fish are about 2 or 3 feet long and on sticks so they appear to float above the crowd. An enormous Heron, similarly illuminated, leads them. Why would fish be led by a Heron? Don’t Herons eat fish? Or has someone just discovered that Herons are now into fish farming? Anyway, it filled the street with a massive crowd all saying oooh and aaah. If you get enough kids from enough schools taking part, I guess you are guaranteed a big crowd of parents, aunties, uncles and other associates. I loved the huge perspex bubble over the statue. Filled with polystyrene balls and fans it made a snowstorm, like those little models you turn upside down.

One thing I did notice was the body mass of the people in the crowd. Mostly they look thin and fit. Durham centre is largely pedestrianised and full of steep hills that everyone must walk up and down to get anywhere at all. Have they solved the obesity crisis by getting everyone to take more exercise? It ought to be possible to compare obesity in hilly towns with flat ones. Someone should get onto it.


Throughout the town there are fixed displays, often exploiting reflections from the river that winds through Durham. Other features light up ancient buildings in novel ways, sometimes telling stories, sometimes just making ancient beauty visible. I found it hard to take good pictures because there were so many people milling around that it was very difficult to get a clear view of anything. 

After Durham, we set off north, hoping to find a service station to park at overnight. Unfortunately, we missed the last one on the A1 because the car park signs were confusing and we rapidly found ourselves in a position where there was no way back. A 23foot motorhome is not an HGV, not a coach and not a car or a caravan, so sometimes, particularly in the dark, it can be hard to guess where they want you to park.
Lois doing her own breakfast

Further north we found the road closed, with diversion signs. Very diverting, in that we spent the next hour in low gears winding and zig-zagging around parts of Northumberland, gradually running low on fuel and wondering what sort of maze we had stumbled into. We eventually emerged onto the A68 and found a lay bye with a sign that implied that there would be a snack truck during the daytime. We took that as an indication that it might be OK to park for the night slept. In due course, I had breakfast served by Sally who provides meals to truckers every day from 7am until 2pm. Such roadside meals are awash with gluten, so Lois ate in the van.

Sunrise on the A68
The truckers told us there was a fuel station a few miles south, so we went back that way. Unfortunately, the crucial sign giving directions was almost invisible behind a mass of foliage and we ended up on the A69 going east. As luck would have it, we had enough fuel to get into Newcastle, so filled up and spent the morning at the Sage centre and the Baltic Gallery.


The Baltic had an exhibition of the Turner Prize contestants. I’ve looked at many Turner exhibits over the years but this one did the least for me that I can remember. OK so it’s good to give one’s scoffing muscles a work out from time to time, but fortunately, there were another exhibits in the Baltic, and they were more fun, as was the graffiti on the walls outside. 

The most northerly surf beach on mainland UK
From Newcastle, we went to Aviemore, too soon for snow, but a good chance to check things out. The next day we headed on north until we could get no further.







Along the way we started getting messages that there had been progress on the house selling front so headed home rather than on around the north and west of Scotland.



We came down through the Great Glen, not seeing any monsters on Loch Ness, went through Glen Coe, around Loch Lomond through the traffic in Glasgow and down the M6. 

Thursday, 10 November 2011

Reflections on the Michael Jackson case

I'm not surprised that the jury found Micheal Jackson's doctor guilty. Using a drug that is pretty much a general anaesthetic, as a sleeping aid, always seemed unwise. The pity of the whole thing is that there has been little exploration of the deeper issues. I suspect that if the doctor had refused to use this drug, or something similar, then he would simply have been fired. Very rich people, who live in a bubble to protect them selves from the downside of their celebrity, have an inevitable tendency to surround themselves with yes men. There are probably yes women involved as well; I don't want my use of the cliché to be sexist.
This is not just true of pop stars or tycoons in general; politicians suffer the same problem. When you are in a position of power, it is most important to surround yourself with people who will tell you the truth, whether or not it is uncomfortable. The Jackson trial at least does all the underdogs in that situation a favour. We can at least imagine a conversation where the next Dr Murray says, "No I won't give you that drug. Look at it this way, if I do, I might get four years, but you will be dead. Your choice."
Of course Dr Murray may have factored all that into his calculation, maybe he figured he would be fired before he accidentally killed Micheal Jackson. Maybe he figured that if he got four years, probably out in two for good behaviour, then he was still being paid pretty well on average, plus of course he will have plenty of time in prison to write the book and that will bring in a dollar or two.
OK I am lapsing into cynicism, it seems that Dr Murray is actually being foolish enough to spend some of his hard earned money on appealing. If he is not careful the lawyers will have all his money before he even gets the book written. It would be better to blame Jackson and announce to the world that he is sorry that he succumbed to the pressure of the money, the celebrity and everything else. Substantial parts of the media still call Micheal Jackson, "Wacko Jacko". There must be an argument for Murray along the lines of, "you have no idea how crazy it was, I regret that I was sucked into it all, I should have been stronger, I cared for him a great deal, I thought that if I quit then he would just hire someone less competent who would be persuaded to take even bigger risks, I'm sadder and wiser now." Something along those lines would probably get him back on the medical register. Maybe he should retrain as a psychiatrist.
Despite that, Dr Murray does deserve a lot of what has befallen him, because one way or another he brought some of this on himself. It doesn't matter exactly what happened. I remember the professor of anaesthetics saying to us "Once you give patients these drugs you have taken over responsibility for keeping them alive." Murray either never had that lecture, or he forgot. Whether Jackson in a semi comatose condition took some extra drug, or whether Murray gave too much, does not matter. Anyone using a drug that powerful, takes on a responsibility to make sure that nothing goes wrong. That means continuously monitoring what happens. Murray’s defence was futile; by admitting that he was not in the room, he had effectively admitted guilt. If the right level of observation had been in place then Jackson could not have given himself more of the drug. Equally, if proper monitoring had been in place someone would have seen that Jackson had stopped breathing and done something about it. 
The trial had to focus on what happened and who was to blame, but trials can sometimes ask the wrong question. If we ask instead "What would it have taken for this not to happen?" we get a very different answer. I am paraphrasing that question from something that was said to me by a man who investigated airplane crashes. I think it is a very powerful question because it tends to focus on learning and solutions rather than blame.
What would it have taken? It needed a doctor who could stand up to Michael Jackson's foolish demands. Someone who would not use a general anaesthetic as a sleeping pill. Of course if he had had such a doctor Jackson might well have fired him. It would take someone who not only stood up to Jackson, but also managed to do so in such a way that he wasn’t fired.
It is tough for an individual doctor in such circumstances, do you quit, or get fired, knowing that your patient may well take even bigger risks with a new doctor; or do you soldier on trying to walk the line between safe practice and not getting fired. This is only really a problem in private practice. In an institution, like the NHS, or a large hospital, an individual doctor could appeal to higher authority, to someone not connected with the individual case, who could impart wisdom and insist on sensible practice. This sort of system is called clinical governance, and that was what was lacking in Dr Murray’s case. He was accountable to no one, and supervised by no one, until the court case.
Politicians and the media often rail against medical institutions and make it seem as though an individual private doctor is the top of the range as far as care goes. Sometimes it is, sometimes it isn’t, but unless you are sure you can tell the difference, no matter how rich you are, you are safer with a system or an institution.