Saturday, 22 December 2012

Placating the Gods of Macula Lutea

Here in Kinellar for full many a day there has been a miraculous falling of small very wet droplets in innumerable numbers from a sky simultaneously dark from the absence of light and wet from the presence of the aforesaid rain-like particles.  I know not if you have had similar experiences where you dwell.  Some say that this may presage a cosmic Bath-Night of the Soul, but fortunately The Lord has provided us with Welly Boots of Holy Rubber, which has a remarkable tendency to keep out the wetness and so protect the moral integrity of the sacred feet. The peculiarly named Burn shows as yet no tendency to warmth despite its Quicke Speedinesse, on the contrary it seems an ideal strategy not to follow the urgings of the Gravitational Principle and fall into the chilly flood, although no doubt in the event of such a downfalling arising it would be amusing enough to cascade at high velocities into the Village downstream and thereby  occasion much dumbfoonerment among the Pagan Villagers dwelling therein as they stagger from the Fish & Chip Shop sated with unleavened vinegar and unsanctified salt.  Yea, even the Mudde which supporteth and encourageth all our activities upon this land of Extreme Dubs rejoiceth in the muddiness thereof, for as the Holy Profiteroller sayeth, He that is without Mudde, Howe then shall he be Muddied?

As may perhaps be gathered from the mood and affective tenor of the foregoing, no new item of pathological science has manifested itself upon my person for over a Fort-Night.  Indeed the Spectacularly Raised Blood Pressure, explicable to the Ancient Greeks and Dr. Galen alike as arising from an excess of Fire from the Liver combining with the natural Choler and Biliousness, found in any aging gentleman, to urge the heart to greater efforts than are strictly necessary, has been ameliorated and considerably mitigated through modern pharmacological means, to wit, Blockers of the Calcium Channels.  To reach this ideal cusp of pharmacology versus kilopascalogical balance it was of course necessary to endure multiple investigations whereby the inner secrets of my cardiac cycle were recorded by nothing less than Electrical means, a cunning device being set in tireless motion to record the Pressures of my Bloodstream every twenty minutes for a full day irrespective of the circumstances, and on one occasion, by special arrangement a jet of peculiarly inaudible sound being directed by a young lady into the intimmers of one's thorax the better to espy how the powerful ventricles and marvellous Valves might respond to the inunction of oils to the praecordium by the same female person.  Fortunately this Instrument was insufficiently perceptive to divine what base and extraordinary suggestions consequently emerged from the subconscious but erotogenous zones whose business such intuitions are, no matter the unusual circumstances, although had she directed her Sonic Spatula loinwards who knows what clinically interesting outcome might have eventuated?

All of this was both instructive and entertaining, no less so as it gradually became clear that the imminent prospect of being struck down by the angry gods and compassionate Eumenides for a lifetime of Hubris, Naughty Thoughts and Dissipation had for the moment somewhat receded.

It may be, however, that at some point I had unintentionally offended Theia and Hyperion, the blessed gods of sight and light, perhaps through my regrettable insufficient attention to the arts of Limning and Illumination, and of a sudden it became necessary for me to travel, in imitation of Orion the hunter, who journeyed in search of a means to restore his sight, towards the East, in which direction, although somewhat short of Delos, after many adventures through lunch-time traffic I finally arrived at a vast Temple known as The Department of Ophthalmology, where dwell beings in whose form and function I recognised Helios, Eos and Selene, possessed of extraordinary powers including High Definition Optical Coherence Tomography, Fluorescein Angiography and Fundus Autofluorescence Photography.  All of these various and diverse arts were then practised upon my yielding person, for as may be imagined, there was neither occasion nor opportunity for either argument or struggle.

Following the administration of strong Pharmakia to the ocular parts all these dark arts and bright skills were now brought into play, with the result that my previous familiarity with inner worlds of transendence and visionary clairvoyance were completely eclipsed by artifice hitherto unknown.  Bright flashes were immediately followed by after-images equally bright but in colours complementary and of surpassing brilliance.  All this went on for what seemed to be an interminable time, and yet although the occasion was intense it could not have been described as unpleasant;  on the contrary, it occurred to me that were the Religious Leaders of whom we hear so much these days to come to hear of such experiences, it might be that their ceremonies involving wine and crumpets might benefit to no small degree from some high-technological addenda.

Once I had been subjected to these remarkable ocular inquisitions, there ensued considerable talk of malfeasant entities known as Lipofuscin, Drusen and the particularly dreaded Vascular Endothelial Growth Factor or VEGF, and at times the conversation came close to the limits of even my considerable understanding of Principia Physiologica.  After a considerable but not unduly uncomfortable period of meditation and fasting in the precincts of the Temple, I was led for the second time into the presence of a beautiful and accomplished priestess of the Cult of Hippocrates of Modern Times, who reviewed in detail the many visions generated by her divine technical assistants, and after due consideration counselled me that the Fates, allied to the sub-species of Fate known as Genetics, had decreed that I had a condition known as Age Related Macular Degeneration or AMD of the Wet variety.

Helios to my Orion, the priestess stated that an effective remedy, in the event that the gods were well-disposed, would involve the direct application to the Retinal Layer of the Eye-Ball, through a specially-prepared serpent's hollow iron tooth, of a magical substance known to the laity as "Lucentis", but whose hieratic name to the initiated is RANIMIZUMAB - pronounce it at your peril, O Readers!  Remarkably, she had by her a store of this precious material, and although I was perturbed to see no evidence so far of a sacrifice having been made to placate the gods, I was induced to lie down in a supine position on the altar in a particularly special area of the Temple open only to high initiates.

Here, once suitable ceremonies in honour of Hygeia had been conducted in the standard way using traditional holy antibacterial agents and consecrated drapes, I was commanded to look upwards and to the left, presumably to ward off evil influences, and grasping the Lucentis-bearing vessel surmounted by its tiny stiletto, the Lady proceeded with the Intraocular Intoxication, an event somewhat scarier to describe than to experience.

The effect was at least as remarkable as the sequelae of the investigative phase of my visit to the Temple, for immediately a bright blue-green vision appeared, peopled by cells whose form resembled the Photoreceptors with multiple stacked disks familiar to me from my explorations in the sacred texts.  But before I could ask the questions which came bubbling to the surface of my by then considerably scrambled consciousness, principally, "How TF can a retina image itself??", the Priestess had vanished into Thinne Air.

All the signs are that this procedure has succeeded so far, for lo, warm colours are returning and linear distortion is diminishing.  Perhaps I made a good impression on the Priestess, for she (Who Must be Obeyed) has instructed me to return after thirty days, and seems to think it would be best if we should meet regularly in the Temple for some time to come.  Certainly there is much to recommend my continued compliance with the will of the gods of vision and light, if only that I may continue to appreciate the elements of Earth, Fire and Air as well as Water, through senses other than those finely attuned to Wetness alone.

In the meantime I have sent through subtle channels a message to merchants from afar with the intent that they should acquire on my behalf a Musical Instrument of the variety known as Ukulele, in hopes that, once the said Instrument has been transmitted to my domicile via the Xanthamaxi or White Van System, through earnest and unceasing application of my considerable Skills of Intellect and Musicianship I will succeed in pleasing the god Apollo, who will perhaps spread joyous news and satisfactory reports of my abilities in the strophic hymn "When I'm Cleaning Windows".

© Donnie Ross 2012

Thursday, 25 October 2012

The Parthian Look

Any artist who becomes a doctor, or vice-versa, is bound to feel a degree of ambivalence on looking back on his or her career from time to time and wondering: “What if…?”  And it’s true that when I look at the advances in every aspect of medical science that have appeared thick and fast during the 50 years since I began my studies, and when I notice the fabulous resources now available in electronic form on the iPad and on the internet, my feeling is one of intense envy of contemporary medical students.  It would be so good to go back to the age of 17 or 18 and start again, only this time I would pay far more attention!

Still.  As a newly-qualified doctor, I may have been a little bit lacking in book-learning and no doubt I had the regrettable tendency of youth to give scant respect to authority, but I’d been taught good clinical skills, and once I had the responsibilities it turned out I had the Scottish work ethic in spades.

A 24-hour receiving period might involve admitting a dozen or twenty patients to the internal medicine or surgical ward.  As well as admissions, there were routine duties in looking after a couple of hundred patients as the sole doctor on duty in the hospital, and dealing with whatever emergency situations cropped up.  Oh, and Casualty to look after.  Much of this was in reality unsupervised, although I did have the telephone number of a consultant, and if things got really difficult I could call in someone a year or two more senior than myself.

There were two saving graces to this fragile arrangement.  The first was that I learned very quickly to pay attention to the nursing staff.  The experienced staff-nurse who could drop respectful hints about whether or not to admit an apparently minor head-injury, without infringing the strict rules of the doctor/nurse hierarchy of those days.  It was always worthwhile to read their body language too, when making a decision.  In those days, decisions really were agonising, since one never had enough knowledge and only a tiny amount of experience on which to base decision-making, and there was rarely the kind of training and educational network which clinicians these days rightly insist are absolutely essential for trainees.  Should I admit the patient or allow them to go home?  Discharge from the clinic or come back in 6 weeks – hopefully to see someone else?  How am I going to tell a 30-year old woman that her husband has just died of a heart attack, when I currently have the emotional maturity of a new kitten?

The second safety-net was to deploy one’s powers of observation very carefully, and day-by-day to develop them through constant practice.  To examine the patient, to go away and think about the overall picture, to strive for perspective, to go back and try to calibrate what you saw and felt and heard against how the patient’s condition was changing or even against some nascent intuitive feeling that things were not as they seemed.

Clinical skills, then, firstly involved reviewing the patient’s entire medical record, if one was available, followed by taking a full medical history at the bedside, direct from the individual.  Every bodily system has a series of questions which need answering, negatives being as important as positives, and a particularly salient point in those days was that the medical history was taken by the junior doctor, who then took responsibility for communicating relevant facts and information to the rest of the clinical team.  That was a kind of ownership which led directly to a deep sense of responsibility as well as providing a foundation for good teamwork.

Following history taking, the patient was examined minutely and systematically.  Musculo-skeletal system, cardio-vascular system, respiratory system, neurological systems including an examination of the cranial nerves and looking through an ophthalmoscope at the retinal fundi.  In those days we never ommitted a rectal examination;  to miss a palpable tumour in the rectum or reproductive system would have been unforgiveable by oneself, one’s colleagues and, worst of all, by one’s patient.

The clinical examination skills were particularly interesting to me.  To practice obervational skills and become able to see things with every-increasing clarity, to be alert to common or unusual abnormalities while gaining an understanding of normal variations, these were aspects which required constant attention.  Auscultation of the praecordium:  that means listening to the heart by placing the stethoscope-bell at a series of prescribed positions on the patient’s chest, and listening intently throughout the cardiac cycle for normal and abnormal sounds as the valves open and close and blood jets from one heart-chamber to another or from the heart to the aorta or pulmonary artery.  The skill of auscultation has a particular attraction for anyone with a deep interest in music, for it demands an ability to hear events in detail, and to remember them with such clarity that they can be thought about and re-examined in the mind over and over again.  In this way the physician extracts the maximum possible information and relevant meaning from observations which depend on the senses of vision, hearing and touch. 

Even the sense of smell shouldn’t be ignored;  on one occasion I actually saved a young woman’s life by sending a blood sample for plasma glucose estimation, having been alerted by her peculiar smell to the fact that her unconsciousness was not necessarily attributable to a drug overdose as everyone involved had presumed, but to a metabolic disorder, which ultimately was shown to have been caused by pituitary failure – Sheehan’s Syndrome.  However this event may be viewed, it was certainly a matter of a junior member of the clinical team being alert to the actual reality as opposed to heeding what his more senior colleagues were telling him!  Once I’d taken an excited telephone call from the laboratory about “the lowest blood glucose I’ve seen in 40 years!!”, it was a matter of finding a fat glass ampoule of concentrated sugar, persuading it into a syringe, and waking the girl up within minutes of its injection into a vein.  Damn, lucky for her I didn’t go to art school!

© Donnie Ross 2012

Tuesday, 2 October 2012

!Leonardo Mind for Modern Times, by Donnie Ross

!Leonardo Mind for Modern Times, by Donnie Ross
Downloadable from the Apple iBookstore FREE!

The definitive Atlas of Facial Expressions from Aardvark to Zebra, the acoustic design of car-door slamming, musico-erotic compositions for cello, these peculiar topics lead the reader into the first Findo Gask Mystery.  A fierce bronze Greek gynecoid is dredged from the sea in a fisherman’s net off northern Scotland, while a plot is hatched to displace the quasi-assassinated  Holy Emperor Tony Blair from his niche as a cryochilled presentation to future generations, but what on earth is happening in the University of Aberdeen’s Department of Anthropomimetic Genetics?  Never mind that, who is this Memus44, who spends the last ice age in quite a well-known cave in the Cairngorm Mountains, polishing his mind and emerging from time to time to make sure culture triumphs but Findo Gask doesn’t?

The first Findo Gask Mystery in the Trilogy can hardly be expected to solve the entire mystery, but it might be fun to find out just how far !Leonardo Mind for Modern Times might succeed in answering all these questions, as a series of apparently unconnected preliminary short stories covering a wide range of human experience finally coalesces into an extraordinary postmodern interactive sci-fi novel, building to a powerful climax before falling apart into glittering fragments.  Expect cave ravens, masses of medical detail, excruciating jokes, non sequiturs, invented languages, philosophical posturing, a treatise on sculpture in Plato, erotic encounters of half a dozen kinds.

Illustrated with videos, drawings and paintings by the author, this chaotic book has several underlying intentions - but a sense of humour is essential.  And, if you can find it, a copy of the Atlas of Facial Expressions from Aardvark to Zebra.

Wednesday, 27 June 2012

Sensations of Sfumaturia

Sensations of Sfumaturia

Thanks, sez Professor Coco, my lecture went OK, although there wasn’t a standing ovation as you kindly suggested might have been appropriate, not even so much as a semi-recumbent ovulation eventuated going forward, or indeed sideways.  We were not downhearted though as it was a very interesting session and a lot of good people avec whom to spik.  Fuck this autocorrection, it seems to have no sensations of sfumaturia.

There was as ever a minor problem of inaudibilibinousness, but it was as ever easily solved by the multidudes, by vertu of ignoring 20% VAT vas I saying and schliding semisubconscioussubversibly into the Vatters von Lethe. No mutter, it was the same for all, especiously the very highly academic people who actually read (pron. red) their Abstrouce Pieces, no B minor matter they being full of big words etk to busting.

The next big thing, as Coco further animadvertisses, is iBooks Author.  By the swift agency of this Soft Ware Programmmme, an averagely renaissanslynonensological Person can throw together Elements from Texte, Imauges, Drawinges, Soulefulle Pomes, Scabrous Scatirical Scetches, Musickall Utterances & Ejaculations,  Videos Nasty & Nice and so on and so Forth Salve et Valley not excluding Earth, Air, Fire, Water, Bile, Phlegm, wo!evah into a single integrated UrMegaBlisteringFabbyUberkunsteWerke. The Productio of such Konzepzione then being Promulgated and haemodynamically Bruited Abroad via iBooks upon such PlattteForms as iPad, iPhone & iJimmyChoos.

But now we must off the better furtae celebrate the inconcarnetenation of occasions such as the Turing Centenary, the Epoch of Leopold Bloom, the Craze for Ziggy Stardust, the Siciliani Desperati, the Resuscitation of Enoch BadBadBadBad-Powell and the iPlayer Compendium of the Archers (not).  Coco and I say nothing about footeball, we merely wish most heartily that it woulde cease and desist, preferablie forthwith.

© Donnie Ross 2012

Tuesday, 1 May 2012

Death and the Piano, Unfinished

Only looking back can one see the old folks or rather as they were then the young folks of 33 and 36 respectively having taken over the pavilions as their new home, only now can one begin to pin down the family dynamic and get to grips with the misunderstandings, the difficulties, the irritations and frustrations which then were to me either obscure or frighteningly intense, the harbinger perhaps of an unknown fate, stressful anxiety oozing up out of those past layers, only now can I meet it with equanimity.  There was love there.  My parents did get on well together at that time.  And their time was short – 1942 to 1976, thirty-four years.  Hardly enough, not enough time to get to know each other well.

The photographs are always of women and children, families and children.  At the beach, on the farm, at the harbour and on Sunday school picnics.  Kids everywhere, having fun.

By bus to Fraserburgh.  Smell of diesel, engine-sounds.  Dad’s pulmonary TB, cystitis, dermatitis – I seem to know them like the back of my hand.  Before I was born.

The power and the glory of electronic music or music sounding like classical music only generated through notes written in standard fashion on a computer, going somewhere.

With tertiary neurosyphilis, aka general paralysis of the insane, the old guy was an absolute treasure trove of clinical signs.  I didn’t have a lot of spare time as a junior doc, but whenever I could I would go to Mr. Spottiswood’s bedside, lean on the patient-retaining bars and gaze at his unequal pupils, listen to his jagged, paranoid conversation, test his slow tendon reflexes and examine his cranial nerves.   An enormous tuning fork forms part of the toolkit when examining the central nervous system.  Give it a bong and plonk the end on someone’s shin, and mostly people will feel the vibration;  not Mr. Spottiswood, though.  Meanwhile he would be muttering on about the Kenyan Indians who had escaped from persecution to persecute himself;  this was quite amusing for me at the time, since my senior-doctor-in-a-striped-suit was a Kenyan Indian.  Syphilis, the great imitator:  lurking behind all the scenarios of potential diagnoses, the pale-as-death treponema pallidum strikes again and again, constantly changing, presenting new and confusing symptoms and signs for both doctor and patient.  The latter, of course, is utterly fucked.  The wages of sin, God’s answer to three minutes in the garden of earthly delights, take that, Schubert!  And the hundreds of thousands of you others we’ve never heard of, consigned by the wrath of God to a lingering necrotic gummatous decline which only Hieronymus Bosch comes close to adumbrating…

Playing through the first page of the Ravel piece, Pavane pour une infante defunte, it became apparent that each line, each phrase, could be perfected to a much higher degree through attending to expression, aftertouch, emphasis, volume, timing, phrasing.  Each bar would need to be practiced over and over again until the fullest possible potential from the music can be extracted.  But then, within each bar, all the notes, the individual little passages linking from one to another, these also need practicing.  Soon, I find weeks are passing while I work on the first note of the Pavane.

And so, Schubert.  The signs of neurosyphilis, in order of decreasing frequency, include:
                Hyporeflexia - 50%
                Sensory impairment (eg, decreased proprioception, loss of vibratory sense) - 48%
                Pupillary changes (anisocoria, Argyll Robertson pupils) - 43%
                Cranial neuropathy - 36%
                Dementia, mania, or paranoia - 35%
                Romberg sign - 24%
                Charcot joint - 13%
                Hypotonia - 10%
                Optic atrophy 7%
Neurosyphilis is divided into 2 general categories: (1) early involvement of the CNS limited to the meninges and (2) parenchymal involvement. The 6 groups comprise:
                Acute syphilitic meningitis
                Meningovascular (arteritic) syphilis
                Tabes dorsalis (parenchymal)
                General paresis of the insane
                Optic atrophy
These syndromes overlap into combined forms. Early neurosyphilis affects mesodermal structures, whereas late neurosyphilis affects the brain and spinal cord parenchyma.
I close up the piano and head for the refrigerator.
© Donnie Ross 2012