Home births

I heard a piece on the Today programme about home births. It was a follow up to a statement from the Royal College of Midwives. According to these various reports, only 2.4% of women in England have home births, because they are being scared out of it.

It made me think back to a period when I used to do night calls for a GP locum agency. At the time I also worked as a GP part time, but I didn't do home births. One night I was called up by the agency and asked to see a woman who needed sutures, having delivered a baby at home. I protested somewhat, on the grounds that I didn't sign up for that sort of thing, but they insisted that no one else was available. In the end, I went to the agency to collect a suture kit.

I found the house OK and was shown into a bedroom upstairs where a woman was lying in a big double bed, with a small baby lying in a little cot. The lighting could best be described as romantic, certainly not bright. There appeared to be no way of getting it to be any brighter. Luckily, I had a big torch. Usually I used it to be able to see house numbers from the car. It is surprising how small some people make their house numbers. No doubt they are discrete and artistic, but damn hard to see from the road.

Any way, there I am staring at this woman lying in a double bed that sags a lot in the middle. If she moved, it sagged wherever she lay.

I'm not going to go into the gory details as to exactly what has to be sewn to what, but it needs both hands to do it, and you can't hold a huge spotlight in your teeth.

With the torch balanced on the bed, I started off by putting in as much local anaesthetic as I had, because the last thing I needed was the poor woman to feel anything as I worked.

Of course, the main effect of the local was to remove any anxiety from the woman and transfer it to me.

Cold beads of sweat really do run down your back.

It all went together very well; maybe it was a good thing that I did more than 80 episiotomies when I was a medical student. I also worked Monday nights in a busy casualty department for five years and learned a few plastic surgery techniques. So, as far as I could see by the light of a powerful torch, it all looked beautiful.

That's when the really scary thing happened. As I was clearing up, and to the accompaniment of a very small gurgling baby the lady said, 'I had my last baby in hospital and it was awful, and really painful being stitched up. This time it's been lovely and I didn't feel a thing when you did the stitches. I'll definitely have my next baby at home.'

That woman was making a rational choice, based on the information that she had; information seriously distorted by all the local anaesthetic that I had available.

She wasn't scared - I was.

I’m not sure whether it is mothers who are scared into hospital delivery or doctors who are scared out of home births.

I am sure there are midwives who will say that doctors are not needed for childbirth, which may be true enough so long as all goes well. The real problem is that a whole system is needed and successive governments seem to be doing their best to break everything up into little pieces that are bought and managed separately.

If we really want to know the right number of home births and give mums and families the choice they should have, then we all need to work together. Any chance of that in 2011?

Bob Dylan 1966 - a piece of nostalgia

Despite my reservations about Rupert Murdoch, there is something wonderful about Sky Arts. This morning I accidentally listened to Mickey Jones, Bob Dylan’s drummer on the 1966 tour talking about that tour and showing bits of his movies taken at the time.

It took me right back. I was at the concert at the Odeon in Birmingham, not the one where someone shouted Judas - that was Manchester.

The first half was Dylan doing an acoustic set, pretty much like the previous tours, except better sound than the old town hall in Birmingham.

When the curtains came back for the second half there was a massed bank of amplifiers and speakers, and I mean a massed bank. From where I was sitting, it looked like a ten-foot high stack, and it may have been bigger than that. The band rolled in with isolated twangs and strums, almost as if they were tuning up.

Gradually the isolated notes begin to pick up, one guitar, then another and then the organ and more instruments coming in and gradually coalescing into a rhythm and then a massive crash on the drums that almost hit you off your seat, with everything else coming in at the same time in a huge wall of sound - probably the loudest that any band had ever played in Britain at that time.

‘Tell me Momma.’

I can still hear that crash now.

Then they just slammed on, weaving complex, intricate and very, very loud, melodic, intoxicating, rhythms around Dylan’s words. I remember being completely blown away from the first note.

The audience fragmented into two groups, or maybe three - if you count the ones who started walking out as a group. Among the rest there were many who boo-ed, some standing on the seats to boo louder. The rest, like me were clapping and cheering. I think maybe the boos won; but I knew was that I was hearing the best music ever. All the wild and rebelliousness of rock and roll woven together with the poetry of Dylan’s words.

By the end of the concert, I was exhausted and flying high at the same time, without the aid of any illegal substances, I might add. Back then I was an impoverished medical student living in a little flat, and the only sound system I had was an ancient portable record player. For days I sat and played my old Dylan records, over and over and over. I only had the acoustic albums, because the electric ones had not come out. Listening to those tracks with the concert still pounding in my head, I could imagine that sound in Dylan’s mind all along. I think it was always there, in the cadence of the words, the strumming and picking on the guitar and the harmonica breaks.

I watch as Mickey Jones talks about how the audience didn’t get it at the time and I’m almost shouting at the TV.

‘I got it.’

I got it from the first note.

A note added afterwards - the programme is actually incredibly boring, as a programme, and Mickey Jones is a somewhat self indulgent commentator, but none of that matters if you were there.

Telephone insanity

My mum’s phone has an intermittent fault. It sometimes cuts out in mid conversation and sometimes it doesn’t ring.

I have tried to report this.

I rang BT. They ask me what number I am calling about, then take me though umpteen menus ending up by telling me that it is not a BT line, so they can’t help.

After four attempts, trying different menus and coming at it via the 100-operator number or through the 0800 route I always end up being shut out in the same way. So far, all I have talked to are tape recorders.

So, I phoned Tesco, who do my calls, after a couple of false starts when their tape recorder told me they were closed, but open every day at times that included my call, a conversation with a friendly human actually took place. They couldn’t help either unless I knew who was the provider for my mum’s calls.

Why don’t I phone her up and ask her? because her phone isn’t working. I am reminded of that song, ‘there’s a hole in my bucket.’

My next attempt was to call Ofcom.

Why can’t BT or Tesco pass on my fault report to my mum’s provider? because it would infringe competition rules. One provider can’t know who is providing to other numbers. So, it is official policy to have a fragmented system that does not connect.

All they need is a central fault service that is independent of the phone providers. I suspect that a computer and a few tape recorders could do it.

How did we manage to set up a telephone service where competition is more important than service?

The insurance companies have a central fund to deal with car crashes involving uninsured drivers, and all those companies are in competition – ask any Meerkat. So why can’t the phone operators have a way of dealing with faults that is foolproof.

I at least have done my bit and suggested to Ofcom that they might look into it. It is their responsibility to regulate the whole system. My guess is that I won’t hear anything from them and nothing will be done. I suspect that the underlying assumption is that we all have mobile phones and can fend for ourselves.

The Ofcom chap implied that I should know who was providing my mums calls, so I asked him if he knew the provider of his mum and anyone else he cared about. No answer to that.

‘Can’t you phone her?’

There’s a hole in my bucket.

Happy Christmas everyone.

The riddle of Santa Claus

I watched part of a movie last night in which Whoopi Goldberg is persuaded to become Santa Claus. I woke up early dreaming about Santa Clause, which is why I’m writing while it is still dark. Whilst it is somewhat improbable, I'm sure Whoopi would make a great Santa, though she did take some persuading. While she was resisting the idea she did ask the obvious question, how do you get to three billion children in one night?

Assuming that night lasts about six hours, (though there’s no night at all around the south pole at Christmas, but fortunately no children live there) and being aware that time sort of moves around the globe on a daily basis I reckon that gives about 30 hours to get the job done, so a billion children every ten hours.

What is the average distance from one child to the next? I have no idea. Some children live very close together, but what about the little boy who lives down the lane? If we make the wild assumption that kids are on average a tenth of a mile apart, it keeps the arithmetic simple at least. Santa would need to cover a hundred million miles every ten hours - ten million miles per hour.

Light travels at 186282 miles per second, so at that speed he could cover the distance in less than a minute, leaving 59 minutes every hour for dashing up and down ten million chimneys and dropping off the parcels. At least that accounts for why we can’t see him, he’s going way to fast for the human eye to register.

It is possible therefore to conclude that Santa Claus doesn’t have to actually break any known laws of physics in order to get the job done, assuming he only has to do our planet. He could cover the distance and we wouldn’t see him if he did. Like Whoopi Goldberg being Santa it is improbable but not impossible.

That gets me on to the second part of my dream.

Douglas Adams invented the Infinite Improbability Drive. I’m not sure if invented is the right word, he included the notion in fiction, in the Hitch Hiker’s Guide to the Universe series. A spaceship fitted with the drive could visit everywhere in the universe, pretty much at the same time. To work it, all you had to do was know when to get off.

In the case of Santa Claus, all he has to know is what to drop off. I woke up being somewhat surprised that Santa didn’t feature in Douglas Adams’ books. The great thing about the notion of infinite improbability is that it fills the gap between very unlikely and impossible. Think of a place that is so hard to get to that it is almost impossible, and that’s where Santa Claus lives. Infinitely improbable but just possible.

A novel look at novels

I guess I am a sucker for playing with data, but the new Google thing called Ngram viewer is too much fun to resist.

As many people know, Google has been digitising all the literature that it can lay its hands on for some while. They have now made available a new tool based on this stuff. What it lets you do is explore the use of words and phrases as they have occurred over time in the sample that they have made available. They are caling this culturomics, see www.culturomics.org

My first instinct was to explore the word novel. Here I am trying to write them, so I need to knowwhere they sit in the culture. The first graph (fig 1) shows you what comes up. It looks like they are going out of style. I am fifteen years too late.

Like any investigator finding a disappointing result, I immediately began querying the data. How do I know that the sample means anything? According to the paper in Science, (Science DOI: 10.1126/science.1199644) this tool looks at about 5.2 million books, 4% of all the books ever published. It could still be a biased sample and the bias could change over time. I emailed the authors of the science paper about it and they agreed that I had a point and gave me some more information, but not enough to resolve the question in my mind.

I am stuck with the elephant in the room that so often is never talked about in popular writing in the media; can I rely on the data?

What things are constant? I asked myself. I fell back on Benjamin Franklin who said “nothing is certain but death and taxes” and he said it in 1789, before the Google sample starts, so I’m not adding bias or double counting by relying on it. Franklin said this in a letter to one Jean-Baptiste Leroy. By an amazing coincidence, one of the authors of the Science paper is also a Jean-Baptiste. Jean-Baptiste gets no score at all and Benjamin Franklin varies widely, peaking in 1940, so I stuck with death and tax.

Franklin may be right that they are certain, but if this literature is to be believed, our interest in them is not constant (fig 2). I’m still left with the elephant in the room, so I tried elephant, alongside death and tax (fig 3). Elephants live a long time and I don’t think they go in an out of fashion much, so perhaps it is no surprise that they give a relatively constant score.

I tried running novel against elephant, it shows a rise of popularity, as compared to elephants, but it still peaks fifteen years ago. Is my writing career really doomed?

I tried running thriller against elephant because I write thrillers, and I did get some encouragement, thrillers are a lot less popular than elephants but are clearly on the up. Finally, I ran thriller on its own, and it gets better still. I leave you with thriller in the American English data (fig 4), because that’s the most encouraging graph, while I rush to get back to writing before they go out of style.

No fear

A woman from Iowa has no fear, because she has damage to her Amygdala. For those of you who did not study the anatomy of the brain, that is a chunk of grey matter deep in your brain. There are two amydaloid bodies, one on each side a few inches back from your eyes. It has been known for some time that it is associated with emotional learning.

Following the press reports we find that this woman has no fear and apparently as a result has been in several life threatening escapades, from which we are told she is lucky to have emerged alive.

So what this tells us is that being fearful has survival advantages, it is OK to be scared. Actually, that is pretty obvious, I guess. If being scared had no purpose, it is hard to see how it would have survived as a human trait.

I am reminded of that little poem by Piet Hein, (he called them grooks).

To be brave is to behave

bravely when your heart is faint.

So you can be really brave

only when you really ain't.

There is speculation in several of the reports that this knowledge might somehow lead to a cure for fear, or possibly for PTSD. You have to love our media; first they tell us the woman is lucky to be alive and that having no fear has almost killed her. So what do they conclude? That a drug to get rid of fear would be a good idea. Can I suggest that it ought to be tried out on reporters and editors first?

Luck, skill, books and films

Nassim Nicholas Taleb was on the radio this morning. Some while ago I read his ‘Fooled by Randomness’. Apart from being very smug in parts, the book is a good read with some important lessons. What impressed me most was the way he dealt with skill and luck.

If you think you have been skilful when in fact you have been lucky, then you are making a very unsafe error. If you do the same thing again, and because you thought your success was down to your skill, then you might expect it to work the next time. You are unlikely to be successful, knowing how luck works.

The safe thing to do is to assume that you have been lucky when in fact you have been skilful. That would tend to make you continue to try hard and not expect too much.

Taleb takes his examples from the stock market, where skill and luck can lead to big rewards and also to big losses. How does it work for writing? When an agent turns me down, do I put it down to bad luck or to my lack of skill? The safe thing to do is to assume that it is because of my lack of skill. That should make me try harder, keep revising and produce a better product.

If in fact my lack of success was down to bad luck then there is a reasonable chance that I will do better next time. If my skills improve then that should help too.

What this makes clear is that it is a bad idea to assume that I am a good writer but I’ve been unlucky, which is what people tell me. Why do they tell me that? Because they think it will make me feel better, but feeling better won’t make me a better writer.

Trying to write better is not helped by the huge success of badly written books. I used to be a bit shy about saying that, but I’m helped by a polemic in the Observer (see http://www.guardian.co.uk/books/2010/dec/12/genre-versus-literary-fiction-edward-docx). I’ve read all three of Stieg Larsson’s books and seen two of the films. The books are so full of telling not showing that they ought to become textbooks for what not to do. They are also padded out with a lot of stuff that has little to do with the plot of the story. It is worth noting that both films start about 60+ pages into the book. I remember one of Elmore Leonard’s nostrums being that writers should take out the bits that feel like writing.

I’d like to propose another rule: - Take out what the film will leave out. I have two reasons for suggesting this, one is that it will make the book shorter and more dramatic, the other is that thinking about the film may provide a bit of added inspiration when the writing is proving hard.

Cafe Rouge

My wife Lois blogs about food, (http://blissglutenfree.blogspot.com) gluten free food to be precise. Recently she’s taken to the road or more exactly to restaurants armed with a new phone.

For the last year or so she has been very wary about eating anywhere away from home because it only takes a tiny amount of gluten to cause a couple of days of symptoms.

This picture was taken at Café Rouge in Worcester, her blog gives the details but the upshot is we will probably go there again. This is something of a turnaround because we ate in Café Rouge a long time back and had a bad time. The waiters were rude, the food took a very long time to come and wasn’t worth the wait. It felt like they were trying to replicate the worst of classic French café dining. Arrogant, tardy waiters may be essential to a holiday experience, giving the English something to moan about when they get back home, but it doesn’t work in Birmingham. There are too many other great places to eat, so we never went back to Café Rouge. Advertisers and management consultants take note; one rude waiter might lose you a thousand pounds worth of business over the years. Multiply the thousand we might have spent by all the other people who may have been similarly offended, and it comes to quite a dent in any business model.

So why did we go back? Because Lois came across a feature about a gluten free menu somewhere on the web and felt honour bound to try it, complete with new phone and ready to blog.

Of course our pleasant experience may be down to just one nice waitress in that particular branch of the chain, it’s not proper market research we are talking about here. We are not collecting statistics and we are probably biased.

What is fascinating is that Lois's blog post about Café Rouge has had more hits than anything she has ever posted and for a brief period yesterday had her up as far as the second page of hits on a Google search on Café Rouge. Why are so many people searching on Café Rouge? Perhaps it’s because it’s the Christmas season and lots of people are looking for places to eat.

My impression was equally favourable, speaking as someone who has no specific dietary problems apart from hating cucumber. I’m happy to report that there was no cucumber in anything I ordered. This is slightly surprising, because it seems to get added to a lot of things for no good reason that I can discern. Maybe that’s a seasonal effect as well. It’s a bit cold for growing cucumbers at the moment.

The picture (taken with my iphone) shows Lois composing her blog on an HTC Desire Z, an Android phone. The little keyboard works well, but she still hasn’t cracked how to get material from there to her blog in one seamless move. I’m sticking with Apple.

Gmail spam scam?

I just recieved the following email. It seems to me to be very unlikely that it has in fact come from anone at Google. If they really were having congestion on their servers it would be a big surprise. Surely Google of all people can afford a few servers. It seems to me that this is an obvious scam. In fact it is so obvious that I am amazed that google don't have some automatic way of detecting stuff like this. How hard can it be, given that their name is all over it? Gmail ✆ to support.info

show details 14:28 (45 minutes ago)

We are shutting down some accounts due to congestion in our database system and your account was chosen to be deleted. If you are still interested in using our email service please click reply and fill in the space below for verification purpose:- Full Name: Pasword: Occupation: Year of Birth: Country of Origin: Note: This email is only for Gmail users (Users should reply within 48 hours to avoid "Permanently Lockup" Account) Thank you for using Gmail ! The Gmail Team So there it is. I'd be interested to know if anyone else has had anything similar.