Archive for July, 2009

How to dismantle an atomic bomb

Vinoth Ramachandra quotes Robert McNamara‘s account of the bombing of japan, toward the end of the second world war found in the documentary the fog of war.

McNamara in turn quotes General Curtis Lemay as saying

if we’d lost the war, we’d all have been prosecuted as war criminals

McNamara himself said

but what makes it immoral if you lose and not immoral if you win

And Ramachandra’s view

the bombing of densely populated urban centres, even when there were no military targets, was simply removed from the category of war crimes at the nuremberg and Tokyo trials, simply because the allies did it much more than the axis powers

Indeed in it was the dense urban bombings and massive loss of civilian life that seemed to bring the war to a bloody and messy close.

Constructive summer

Let me think. Where does the time go. I need to have a dictaphone with me. Something to pop down a few blog ideas down on. Something i can come back to and flesh out when i get the time.

I watched this movie. And liked it.

Bought one of these to replace my slightly ageing one and absolutely love it. All i need now is a band to play in and some accommodating neighbours to let me turn up the amp.

I did put this song on the site, without the aid of the pod. Which is probably new to most of you who follow this. Apart from you, so don’t get too excited there.

I did some on call in work and tried to sort out a dislocated shoulder and a gunshot to the belly

I drove to the north coast and had a lovely walk here and a good night here. [Despite the terrible website].

I spent some time here, before retiring here and returning to work here which was kind of oddly quiet seeing as how everyone seems to have gone on holiday here and they’re probably getting sick there instead.

I ended up back here and then drove 4 hours to here which is an awful long way but at least there was this and this once i got there. Had a nice walk round here. Ate some of these.

And in between read some of this and discovered this, and realised i could also use it on this, and it’s been all downhill since.

I did find this which was most interesting and perhaps deserves a blog of its own. But maybe that’s just me missing the point.

That about brings us up to speed.

How to dissappear completely – part 4

Slept very, very well.

Massive fry up for breakfast which seemed like a good idea at the time until bacon’s revenge caught up with me and you’re downing water within 5 minutes of starting.

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Passed through two lock gates and some pretty annoyed salmon fishermen – apparently they paid 150 quid to fish on the river and now on one of the best days fishing days of the year their day is being cut short because they’ve opened the flood gates at Toome and the river level is rising too high for fly fishing.

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Good example of all the competing interests on the river. There’s a big drive for tourism but the need for the lock gates and the weirs leads to big safety issues. One time a boat lost power and drifted against the flood gates at the cutts and Coleraine and the people had to scramble onto the gates before the boat was pulled under. So the lock keeper guy told us.

There’s a big demand from the fishermen, who at least pay large sums on money to use the river, and naturally they get a bit miffed at all us boaters and paddlers coming down and disturbing the water. In fact Griff Rys Jones is in the Times yesterday arguing just this point from the canoeists point of view. Instead of a right to roam it’s a right to float.

And then there’s the farmers who must get annoyed when the level of the river pops up and down like a yo-yo depending on what someone somewhere wants the level of the lough to be. The lough trumps all it seems. And I think that law was originally made in the interest of the farmers.

Everyone wants a bit of nature, a bit of the countryside to go play in. It’s hardly wilderness with so many people fighting over it. It’s the big thing that you just can’t get in Ireland – the whole place is too packed with people and too easy to access.

The longest you could get lost in the mournes for is just over a day.

Back to the trip.

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Gorgeous paddling up around Loughan and coming into Coleraine. Trees on both sides and the kingfishers everywhere. With the sun shining through the trees you could be anywhere in the world.

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Just as last time the flood gates were open at the cutts in Coleraine, creating too much of a draw to safely approach the canal round them. So we stopped just before at Castleroe forest and phoned the ‘support team’ – or wee liz and morsies. We said we’d get them t-shirts with ‘crew’ written on them for next year.

Good trip, good times. Pulled out the old hip flask and poured into the river a libation for the gods and one for ron and thanks for a trip well done. Not the same trip. Not the same life. But good bits remain none the less.

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How to dissappear completely – part 3

I take it all back. Tents are great places to sleep.

Lights out at 2230 last night and after a few pages of Winston I was out like the light. Woken only by a car alarm going off at 0130. Simy looked up briefly and mumbled a confused “but I don’t have a car” and rolled off to sleep again.

Morning refused to bring with it the long promised rain but did bring a brisk easterly wind and a dank grey morning.

After a quick brekkie and clear up we paddled out of the harbour at the marina. After some water over the deck and a shift of 100 yds towards shore wisdom got the better of valour and i made the gentle suggestion to simon that maybe we don’t do this at all. This was followed by a hasty “I concur” and we headed back to the harbour with our paddles between our legs. (now that would have been most impressive…)

A full 10 mins canoeing we got in. All just to go 3.5 miles across the top of the Lough and we couldn’t manage it.

We could have done it. say if I was carrying vital plans to destroy the death star or there was a man with a pointy stick chasing me then no worries, I’m your man in a canoe.

But since “the incident” we’ve both grown rather cautious. Too scared of the newspaper headline – “idiot brothers die in stupid frigging canoe accident leaving behind distraught family members and pretty but entirely unaffected black Labrador”. I can see them already.

Seeing as the Neill family is already down to 3/4 strength (well maybe 4/5 if we count morsies, or maybe it should be 5/6 if we count the dog, maybe I’m just confusing things…) I would feel mighty silly if we lowered the ratio any further.

I have, over some 28 years, become really quite attached to the older brother and would be really quite upset to lose him at this juncture.

So with all that going through our heads I think we made the right call.

That left us in Ballyronan with no transport and having to wait 3 hours for Simon’s most wonderful of wives to come pick us up and drop us in the river at Portglenone so we could continue the trip.

It’s not that Ballyronan doesn’t have it’s charms (the mace, three pubs, the arch that was put up special for the twelfth, the LOL, the filling station) it’s just not really a place to spend a wet and windy Saturday morning.

Now normally I’d be as happy as a pig in it’s own excrement to sit in a pub and read the paper but at 1030 in the morning even the punters in Ballyronan haven’t the stomach for a pint and watching the horse racing on the telly.

I walked round it twice. Bought the paper. Went down to the marina and tried to read a broadsheet in the wind with predictable results. Made some coffee. Tried to find somewhere out of the wind. Simon kept trying to entice dogs over so they might play with him, like he was the dog whisperer. Listened to some radio 4. Went to the mace again to buy ham and bread and lo and behold morsies has arrived. Wa hey.

Not wanting to give up on the day entirely we went back on the river at Portglenone where the wind couldn’t get at us. It still gave us half a days canoeing in one of the prettiest bits of the whole river.

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Just before our last stop we came to Portna locks. One of five lock canal and lock gate systems on the lower bann. Put in the fifties to allow boats to get up and down the bann avoiding the positively lethal flood gates and weirs that were put in to control the level of lough neagh.

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Even the sight of the lough gates makes me think horrible thoughts about getting sucked under them and pinned against a tree or something. We asked the guy at the lock had that ever happened and he said no but every now and again you get the odd cow pulled in.

The whole system seems a bit lethal if you ask me.

No doubt some mentalist kayaker has ran them before. I must check YouTube.

But anyhow. Now in the Portneal lodge in Kilrea. Some kind of odd travel lodge type place that happens to have a jetty at it so we can just stop and lift out the canoes and book in.

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We stayed here two years ago when it was pissing down and we were looking for somewhere to camp and then out of the storm this place appeared like in a vision.

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It’s pissing down again here so I’ve maybe not got pleasant things to say about Kilrea.

We dandered into town to find some where to get some food and found two chinese take aways and a chippy and a variety of pubs. The whole place was a bit empty

There was a police land rover sitting in the square and seemed to be overlooking a group of about 15 men putting up a few union jacks around the war memorial. I’m pretty sure you don’t normally need 15 men and a police land rover to put up a few union jacks but when there’s a sinn féin and SDLP office staring at those flags then maybe you do.

Back in the travel lodge we are still the only people staying here. As we were two years ago. I have no idea how this place stays in business. As the rain lashes the window I am terribly glad it does.

Spent the evening watching T in the park on tv (I know, crazy isn’t it) and I now feel culturally relevant as I could pick katy perry out of a line up and I know who Calvin Harris is. I could still punch lady gaga in the face mind you.

2158. Both boys tucked up in bed. Rock on.

How to dissappear completely – part 2

I sleep fitfully in tents. Time passes. I’m not sure I really sleep. Otherwise it’s a wonderful experience.

Didn’t get up till after 9 and fought the chickens off to get at the food to make the breakfast. By time we had the bacon and eggs and potato bread down us and camp cleared away it was after 11.

Thankfully the wind had died a bit and we made it across the open bay of the Lough on calm water with nothing but the flies for company.

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The silence is overpowering. You have most of Northern Ireland all round you (we never decided if it was 4 or 5 counties) and you’re here in this tiny wee boat in the middle of it all. Good times.

Lunch was at Ardboe below an old ruined church. Pot noodles aren’t as good as I remember them.

In the afternoon the wind picked up and thankfully more in our backs. Unfortunately this drew up a bit of a swell which kept trying to send us more west than north west.

The waves have a tendency to catch your tail end and spin you whichever way they want you. It is possible to surf them but it takes a lot of effort to keep yourself in the right direction.

In the end it was quite hard work but we made pretty impressive speed across the lough with only eel boats and sand dredgers for company.

Ended up on Ballyronan marina at 5 pm and got a 99 from the bored teenager at the ice cream stall.

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I’d tried to book a space in the camp-site about 5 days ago but was told that it was fully booked.

When we arrived there were 2 caravans on the site with at least 10 empty bays. Maybe people had cancelled. We chanced our arm with the lady in the office and gave her our sob story about canoeing for 10 days solid and how we had to eat the ships dog and she felt sorry for us and let us squeeze on the site.

We were ever so grateful.

It’s now 10 pm and there are now 3 caravans and 9 empty bays. Now either people here turn up really late to their caravan site or someone is telling little fibs.

But oh the joys of a shower. Only two days without washing and it was still so good to stand under the shower and feel it burn on the sun burn on your face. A shower is one of life’s great pleasures. So’s a ‘shar’ – which is the same thing but with a northern Irish accent.

For some reason the shower curtain was covered in images of little yellow ducks with the slogan ‘bobbing along’. Seemed a tad out of place in a council public toilet.

The main reason we choose Ballyronan marina is that it has a great Chinese restaurant. Every marina should have one.

We asked for a table for tea near a plug socket so we could charge the phones. Just like Ray Mears does.

Starters and main course and some Tsing Tao later we’re having a wee dander round the marina wondering what the earliest acceptable time to go to bed is.

About now I reckon.

How to dissappear completely – part 1

So

Two years ago we did this trip. Canoe from Portadown to Coleraine. 4 days on the river and the Lough. Outdoors, doing manly things.

Two years ago I’d just arrived back from my little escapist adventure to NZ. Two years ago I looked at my life and kept repeating to myself that I was the luckiest man alive. That no one alive had the opportunities and options and experiences that I had. All of which undeserved.

Two years ago we did this trip with Da and he’s declined to make the repeat trip with us. Some lame excuse about being dead and all that.

Two years ago and now everything is changed. So it goes.

Nice start eh? It gets better honest.

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Spent all day yesterday packing and repacking trying to think of all the things we might need, trying to see if everything we need might fit into the two canoes. Being hopeful that simon’s somewhat damaged canoe might be up for the job.

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Credit to Liz for our new addition of braces – old man braces from Matalan – that keep the spray decks high enough to stop the water leaking in.

My spraydeck is made by perception – a respectable name in canoe circles. According to the lapel the model is ‘gaybo’ which is I suppose not so respectable in many circles. Mine is ‘gaybo’. Simy’s isn’t. Read into that what you will.

The other useful addition is 3G (or more likely GPRS) and facebook which enables me to post lovely photos while the rest of you are skiving in work on facebook or reading blogs.

Hence why I’m lying in the tent at 2345 writing this while the waves lap at the shore of the island.

Anyhow. By the time we’d eaten the requisite poached egg and bacon and remembered the stuff that Simon had forgotten we were on the water shortly after lunch.

There’s nothing that exciting on the upper Bann between Portadown and Lough Neagh. It’s nice from Banbridge to Portadown as previously noted. And it’s lovely on the lower Bann. But this bit is mainly flood plains and cows staring at you. Simy loves cows. I don’t.

It was windy. Wind is hardly the canoeist’s friend. It just means you have to paddle twice as hard for less progress. It was a northerly wind. Kind of unfortunate seeing as we were paddling basically due north. Apart from the brief bit when due to the nature of meanders we were paddling south at one point.

The tough bit was getting out to Coney. There was a fair ould swell on the Lough with the wind casting up waves the full length of Lough Neagh. We were stuck paddling across them and it left us feeling more than a little nervous and twitchy if we were truthfully honest.

We’re into this canoeing for the scenery not the adrenaline. Waves aren’t really our thing.

But we made it. A tad damp from the splash but we made it.

Set up camp and sat round a picnic table while Peter (the warden who lives on the island and a bit of an all round legend) greeted us with beer and good conversation. The man has such good stories I could listen to him all day.

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BBQ and some time at the camp fire and look at the time it’s dark and we’re shattered and it’s off to bed for the Neill boys.

I haven’t even had a second to read more Churchill or try and sew my sandals back together.

Unless the lough rises 4 feet by morning or we’re killed by swine flu then we’ll still be here and I can tackle those really pressing issues then.

Bullet proof… I wish I was

On leaving no amunition available for the japenese with the impending fall of Singapore.

the obvious method is to fire the ammunition at the enemy…

Winston Churchill

History of the second world war Vol IV

It’s the end of the world as we know it

Not that I plan to turn the blog into a “swine flu is going to the end the world as we know it” blog, but some it is really quite interesting to watch it evolve.

We have changed from containment to treatment. A few days after the rest of the UK, seeing as we were a bit lower on the numbers. Which basically means that if you get flu, then it’s most likely the swine variety and we don’t test you, or we either give you the tamiflu, (which no one knows works or not by the way), and you get better or we tell you to get a box of kleenex and sit in the house for a week and you get better anyway. Or in rare cases, you actually get sick and wind up in hospital, or even rarer – you die. Which understandably what everyone is worrying about.

Currently there are mortality rates about the world quoted from anywhere in the region of 1.5% to 3%. I consider that pretty high. But remember that it overestimates the death rate cause that only counts the numbers who attend medical services and get tested. Lots of people are at home with the kleenex getting better all on their own.

We had a big meeting about in work. Lots of people in a room trying to come up with some way to plan responses. Some of whom were more useful and contributory than others. If I hear anyone else talk about “blue sky thinking” then I’ll explode.

It is reassuring to know that we have actually thought about this and if the whole thing becomes like outbreak then we do have a plan in place.

Someone managed to project figures of 400/day attending our emergency department. At the minute we see 300 on a busy day, so imagine over doubling our numbers at the drop of a hat.

Via the BMJ blogs and the NEJM I found an article (not yet published) going over some of the historical perspective of influenza outbreaks and how something like this comes about.

Regarding the reemergecne of a 1950 strain in 1977

This finding suggested that the 1977 outbreak strain had been preserved
since 1950. The reemergence was probably an accidental release from a laboratory source in the setting of waning population immunity to H1 and
N1 antigens

Sacry eh?

In a different outbreak in an american military base in 1976, there was the ideal opportunity to study th epidemiology in controlled circumstances.

[Incidentally military bases and recruits have been huge contributors in infectious disease, with studies in them revelaing links of strep to rheumatic fever and huge amounts about the bugs that cause meningitis. However it means that the applicability of the science may not hold true. In other words penicillin may not stop you getting rheumatic fever unless you’re young, male, with a tendency to violence and a shaved head…]

In this case they decided to vaccinate a large proportion of the population. To the tune of 40 million. Yes that’s right – 40 million people.

To quote

The emergence of swine influenza at Fort Dix led to the implementation of a mass vaccination program, which resulted in 40 million civilian vaccinations and 532 cases of the Guillain-Barré syndrome (a rare side effect of influenza
vaccination), including 32 deaths

We killed 32 people (and gave a horrible experience to 500 others) with our vaccines. Was it worth it?

The simple question to ask if the UK were to consider a vaccination program (using purely theoretical figures – new vaccines may not cause GBS at all) is – is a 32/40,000,000 death rate acceptable in the light of a x/40,000,000 death rate from swine flu?

Too many variables in the equation as yet.

What might be more reaistic is what will be the outcome of giving vast numbers of people tamiflu. This could be one of the largest trials of efficacy and side-effect profiles in the history of therapeutics. If there are nasty side effects of tamiflu that either weren’t known about or even sweeped under the rug (have we learned the lessons from thalidomide) then they’re gonna come out be assured.

Too young to die

Robert Frobisher on choosing death over life:

People are obscenities. Would rather be music than be a mass of tubes squeezing semi-solids around itself for a few decades before becoming so dribblesome it’ll no longer function.

Cloud Atlas

David Mitchell

The sadness

OK so i’m on a roll with my BMJ RSS feed.

I find this aspect of medicine one of the most interesting and complicated boundaries of medicine and the emotional and the spiritual and the just plain old “life”.

I am completely unclear as to what to make of psychiatric illness in the context of the human experience. I have a few psychiatrist friends who i’m sure could make much more sense of all this.

I do sick people – and pretend that that just means abnormal physiology. I avoid psychiatry, leaving it as someone else’s problem, just as i do with many of the difficult ethical medical debates.

Anyhow.

One guy puts it this way:

In truth, “depression” is a very difficult thing to define and any doctor who says that they can reliably differentiate it from sadness is deluding themselves.

Another takes issue and puts it this way:

Depression is not the same as ordinary unhappiness. It is a state unlike any other I have experienced. Ideas about being vulnerable neither made me ill nor ameliorated my distress: in truth like many twenty-year olds, before it hit me I had thought myself invulnerable. Defining suffering away does not diminish it. It insults it. Be wary what you mean when you say to patients, as Ginn does: you do not need anti-depressants, you’re a lot tougher than you think. It could be the cruellest form of paternalism yet.

Any thoughts?

Pigs, sheep and wolves

There are lots of interesting things about the mass hysteria associated with swine flu.

Part of it is genuine – that one day an influenza epidemic may sweep the planet and knock off a siginificant proprtion of the human race.

Another part of it is the fact that this current swine flu epidemic seems by all standards to be pretty benign so far. It has simply gained a lot more attention.

Our place has been involved in the management of a couple of possible cases. I’m not actually sure if we’d had a confirmed one. And they have received a disproportionate amount of attention – ie “wear this mask, follow me, bypass this queue of waiting sick people, this consultant will see you immediately”. All a little bit unfair seeing as the 80 ear old granny with pneumonia has been waiting two hours.

Everyone had a 10 minute session on mask fitting that involved a computer, some tubing, and a guy getting paid 800 quid a day to say “yes the mask fits”.

The BMJ has many wonderful blogs if you’re an interested medic, and i suppose even if you’re not. Tom Nolan has been blogging on swine flu and provided this quote from a London GP.

My feeling is that the main beneficiaries of this policy are the drug company that makes Tamiflu, who must be dancing with glee at the business.  The other aspect is that I suspect Tamiflu or similar drugs will now be considered necessary for all sorts of flu in the future – plenty of future business too.

If the word swine were removed from all of this then GPs would just be doing what they always used to do – give advice about staying at home, drinking plenty of fluids and so on. The current flu seems to be no worse (and possibly even a bit better) than seasonal flu.

So why does this attract so much significant change in practise and funding (and with good reason) when simple things like ICU beds and overall hospital capacity don’t (when they have much better reasons)?

A good man is hard to find

[As is the very nature of blogs, this is the usual ill informed ranting so feel free to interject with corrections and thoughts]

OK. So something that I’ve been thinking about for a long time is this very simple truth –  that yes, indeed it’s true, all men are bastards.

Not that I’ve turned into some kind of transgender hyper feminist or anything – but i have for quite some time carried around a distinct unease about my half of the human race. Kind of like the nagging guilt you feel for being white anglo-saxon protestant. You know you are one, and you know that as a group you’ve not always covered yourselves in glory.

Now most of this is exceptionally obvious and perhaps won’t take a great deal to persuade many of you.

Violence

from as early as bearded men in universities will tell us, we’ve been adept and keen on beating the tripe out of each other. Or if not each other, then furry creatures, and if not that then nature herself. And oh how we seem to love beating the tripe out of our women folk.

Our tendencies to violence, anger and brutality are everywhere. We have left our mark in the history of human culture smeared in the blood of everyone else.

And in every context (though no doubt i can be corrected) it will be the XYs leading the way.

Open a newspaper or a news website these days and it will be full of men doing violence to others.

Of course women do violence as well, but in proportions far out weighed by what we seem to manage to achieve.

Sex

From rape, to female circumcision (although some would argue that one) and child abuse it is men leading the way. What is most horrifying is that the majority of the sexual violence committed occurs with someone that the perpetrator is in some form of relationship with. These are not random strangers. We are raping the people we love.

The recent case of the young care centre worker and mother who was convicted of sexual abuse of children in her care attracted so much attention because it went against the stereotype.

Power

No doubt linked in many ways with the former two, but if you get asked to name significant historical figures you’ll come up with a whole lot of blokes. Be they good or bad.

In the modern age, despite a major shift in thought, there are still huge pay discrepancies and differences in who is more likely to hold a more senior position be it from academia to business to medicine.

Relationships

Now this is where it gets controversial and mainly anecdotal. You look around some times at people you come in contact with and you ask yourself the simple question – “why the flip are with you going out with that person?”

And the majority (though not nearly so over overwhelmingly as the others) of the time i find myself asking the question of why the girl is with the boy. I don’t get it, he’s an idiot, why are you with him?

I have wisely learned to keep such opinions to myself you’ll be glad to hear.

Even more anecdotally and unsupported – my limited experience with adultery (please don’t read into that too much) seems to tell me yet again it seems that the men are the bastards. Though this must be untrue to some degree because unless married men only sleep with single women then surely the split must be more equal than that.

Parenting

Where I live is one of the more socially deprived areas of town. Not that they’re eating grass or living in tents like the proper poor places of the world. But there is a huge increased prevalence of single parent house holds. And yes, almost inevitably these will be led by women.

There’s a great line in Fight Club when Tyler says that we’re a generation of men raised by women and that another women is the last thing we need. Which perhaps side steps the obvious point that it is the men who have abdicated their role in the upbringing.

Is it too facile to see some truth in this? [Genuine question, I’ve never quite understood the verse].

Is it all as simple as a social construct, that we got all the power at an early stage in human culture and we’ve simply taken it to its logical conclusion? That if women were in our position they’d be just the same?

Even if it is an accident of history and biology that we have become the perpetrators of such evil then what are we doing about working against it. We are meant to be some kind of counter-cultural force in the world.

So i suppose from this slightly ashamed member of half of the human race comes a humble apology for my association with it.


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July 2009
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