The Lockdown Diary – Day 16

Geneva, Tuesday 31 March 2020


The Thai-Cambodian border, 1988. The International Committee of the Red Cross ran a surgical hospital in one of the sprawling camps that were home to over 500,000 Cambodian refugees. The population that the hospital served included the refugees and anyone coming from inside Cambodia brave enough to navigate their way through the border minefields. (About 15% of our patients were mine-injured.) The hospital ran like clock-work under the all-seeing eye and disciplined but compassionate rule of the Head Nurse. Within twenty four hours there, I realised that she was the star of the show. 

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It was an extraordinary experience for a young surgeon! When on duty, it was for all-comers. Anything surgical arrived at the door. There was no specialist referral. Médecins Sans Frontières ran the maternity service next door. Many of their clients came from over the border after two or three days in labour. If the MSF midwife asked us to do a caesarian section – a daily event- there was no need for discussion. There was no possibility of an ultrasound scan. As a result, we would never know if the be-laboured woman was carrying twins until, having delivered one slippery little screamer, I exclaimed to the team “Wait a minute, there’s another one in here!” They never, ever believed me until I held up the evidence. I often wonder how often these days an obstetrician would undertake a caesarian section not knowing it was for twins.  

Given seven years of field surgery, a glass or two of wine and a captive audience, I would happily tell surgical stories until the end of lockdown. But, I’ll stop here. There is a much more important COVID-19 story for repetition long after lockdown. It is the everyday and seemingly mundane story of running a hospital wherever it is. The provision of safe and effective curative medicine and surgery is dependent on a whole team of health-care professionals. They, in turn, are dependent on infrastructure including the equipment, machines, medicines, instruments, sterilisers, cleaners … the list is long. This infrastructure is held together by administrators responsible for recruiting and paying the staff, purchasing and putting in place the infrastructure, ensuring a constant supply of electricity and water, a functioning and dignified mortuary, drains that drain, disposal of medical waste  … another long list. You get the picture? The COVID-19 pandemic has rightly elevated health-care workers to a position in public perception of being necessary for national integrity. This position, up to now, has been the near-exclusive domain of the armed forces. (This does not excuse constant use of terms like “war,” “battle” “frontline” “weapons” and “heroes.”) Let’s be clear though, the fuel of this engine is neither clever medicine nor swashbuckling surgery; it is the care provided by all the professionals concerned and, in particular, nursing care. Whilst health care is impossible without infrastructure, without care, it doesn’t even resemble health care. Go nurses! If during the next days and weeks, I drop other surgical stories into the Lockdown Diary, please bear this in mind.

The putting competition….. Yesterday I won 2 up; today 1 up. The running total is: 9 games to 4 in my favour.  For those who have witnessed my wife’s putting for real on the course, this is most unexpected. But, if we believe the epidemiologists, there’s still a long way to go!

So, a moth goes in to see a dermatologist. “Hello” says the dermatologist. “What can I do for you?” The moth replies “Well, doctor, I’ve been feeling a bit down. I’ve lost my job. I’ve split up with my girlfriend. I’m maybe drinking a bit too much. Life’s a bit of drag, really.” The dermatologist says “I’m sorry to hear about all that. But I’m a dermatologist. I do skins. Maybe you should see a psychiatrist. Why did you come in here?” The moth says “Well, your light was on!”

The Lockdown Diary – Day 15

Geneva, Monday 30 March 2020


Our blog – Talking Beautiful Stuff – was set up by Isaac Griberg and me in 2013. We’ve had fun! One post about a sculpture in Cairo airport, has been read by more than  60,000 people. We expanded the blog’s remit to accommodate the Lockdown Diary. Thanks to all who follow the Diary and for the many comments received. The writing of it has helped me to get my head around this unprecedented event, to share my thoughts on it and to make observations about living the lockdown. It has also reconnected me with many old friends from all over the world.

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Here are some stats from the Talking Beautiful Stuff web site. When the blog is idling in neutral, we have about 100 page views per day. Since the first post of the Lockdown Diary on Monday 17 March, the blog has had up to 570 page views per day. The spike of Saturday 21 March corresponds with when I reported my failure to make a banana cake! The average duration of each visit to the blog is 1.07 minutes. For such a blog, this is surprisingly long. It seems many of you are reading what I write! 

From your comments and emails, I gather we are all experiencing a similar range of emotions a result of the pandemic. Dominant for me is a kind of visceral disquiet brought on by just how surreal the situation is; I am aware of a background anxiety that wakes me in the early hours. I think we all know that post COVID-19 the world will be different. I already feel a kind of grief for the loss of what we will look back on as “better times.” By this, I don’t just mean losing, for example, those easy and cheap flights to exotic locations. We will think twice before buying tickets for massive sporting or musical events. It will take a long time before we feel comfortable with being in close proximity to numbers of people. We may even be reluctant to greet friends with handshakes, hugs or kisses. It is difficult to imagine what the new normality will be. You can bet face masks will be a feature. 

In our small apartment here in Geneva, we’ve noticed that we are no longer glued to the news nor seek updates of the COVID-19 stats coming in from every corner of the world. We get up and have breakfast. I write this diary and maybe draw or paint. My wife tele-works. We have lunch together. We do our little putting competition. We walk or jog in the park. We have dinner together with a glass of wine. We speak to friends and family. Yesterday evening, we realised that we have already established new habits and routines. Boredom can be kept at bay. Were it not for the news that we now look at once a day, we would be having, well…. a nice, quiet time. We hear that doing lockdown on your own is not so easy but is manageable. Friends with children tell us that, despite the circumstances, lockdown has given them quality family time. All of us are beginning to adapt and accommodate both practically and emotionally to this situation. I do not think we will move past the surreal for weeks or even months; the surreal will become the norm.

The news from India makes me uncomfortable with what I have written above. Here, we can do lockdown – and hopefully manage the spread of the virus – because we have access to clean water, electricity and shops that have food on the shelves. We can do social distancing because our living and working spaces permit it. If we are sick, we can go to hospital. The affluent, like us, will most likely pull through. By contrast, in India, the rapidly imposed lockdown has precipitated a fearful and crowded mass movement of hundreds of thousands of hungry migrant workers and their families out of major cities. Many will be carrying the corona virus back to their homes. Poor people the world over face a human catastrophe. Their post COVID-19 normality is unimaginable.

Sorry, I’ll leave reporting the putting competition for tomorrow.

The Lockdown Diary – Day 14

Geneva, Sunday 29 March 2020


A young friend on the other side of the world is an avid Asterix fan. Let’s give him a roman name: Maximus Rex. Lockdown has caused him to re-read many of his favourites. Look what he found! This is from “Asterix and the Chariot Race” published in 2017. 

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From: “Asterix and the Chariot Race” written by Jean-Yves Ferri and illustrated by Didier Conrad. This is the 37th book in the Asterix series originally created by Albert Uderzo and René Goscinny. Publishers include: Dargaud / Hachette / Orion

Maximus clearly has an eye for the pertinent image. We gather Coronavirus is the name of the champion charioteer. His chariot is pure predator. His sidekick is a dumb brute called Bacillus. (Bacillus is a bacteria and therefore susceptible to antibiotics; not so, the all-conquering Coronavirus!) The four horses are all black – filched from a high-speed hearse? Do the saddle blankets indicate that the favourite team is sponsored by the People’s Republic of Red Flags? And what’s the symbol on those blankets? Omega! The last letter of the Greek alphabet indicating…. the end. Eek! Did Messrs Ferri and Conrad know something in 2017 that we didn’t? However, the design of Coronavirus’s smiling mask has clearly not been influenced by those now-all-too-familiar scaremongering false images of his namesake. Contrast this with the mask of a policeman enforcing lockdown two days ago on an Indian street. Baffling and bizarre!

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Copyright: Getty Images

We cycled up to the Swiss – French border today. There were lots of joggers and dog-walkers out and about. A border-crossing point that we have never seen attended was diligently controlled by frontier guards on both sides. Every vehicle was stopped. Papers were checked. Like seeing a long queue at our supermarket or empty buses and streets on a weekday, this was a fundamentally disturbing sight. It brought home the sobering reality of what we are living through.

Wishing to distract myself from all things coronavirus at some point in my day, I’ve been working on a small abstract painting. I finished it this afternoon and can report that I am not entirely unhappy with it. I thought I’d give it the title “Latent grapefruit autoproxy 27 (linear).” Cool, eh?

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This Blogger, LGA27(L) Neocolor 35cm x 35cm 2020

My lovely wife was working on her laptop. “What do you think of my painting, darling?” I asked, confident of admiration. She looked up, squinted at it and replied “Looks like a coronavirus to me!” A low blow! I’ve renamed it “COVID-20 (exponential).” Dark, I know.

Ah!….. The putting competition. Well, there’s a tradition – still alive and well in St Andrews, Scotland – that one doesn’t play golf on Sunday. A cold north wind blew over our balcony today. We decided to respect the tradition. The abandoned match of yesterday will be addressed tomorrow.

The Lockdown Diary – Day 13

Geneva, Saturday 28 March 2020


I can’t help wondering what my father would have made of the COVID-19 pandemic. Although he practiced medicine in a different era, I’m sure he would have had wise words for the thousands of health-care workers who are doing their level best under the most trying of circumstances. 

My father was 27 years old when he moved with his wife and son (my older brother, Garth) to rural Norfolk in 1953. His single-handed general practice was based at home where he had a consulting room and a dispensary. His practice was, to a large extent, self contained. He was permanantly on-call for his patients. He made up to twelve home visits per day. Emergencies were rarely sent to the Norfolk and Norwich Hospital an hour’s drive away. It was the early days of free health care under the then new National Health Service. Patients had few expectations beyond the care and attention of their doctor and that he “did his best.” Doing his best was often repaid with a chicken or a box of apples. 

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He had this poster from the early 19th century in this consulting room. I think it was to remind him and his patients just how much medicine had moved on. It also served as a warning about quacks selling potions. As a former trauma surgeon, I can’t help being amused by the claim that Dr Sibly’s solar tincture was a “speedy and certain cure for stabs and gunshot wounds.” But the problem is, people have always believed in magic potions. They still do and are exploited as a result.

In the mid 1950s, my father was the first doctor in the area to give the new oral penicillin outside a hospital setting. He told me on one winter morning in 1956, he had a message from a man who barely made a living by cutting reeds for thatch far out on the marshes. One of this fellow’s young twins had a high fever and ear ache. My father knew the family. Both parents were illiterate. 

To reach their house, he had to take his old motorbike along the edge of the railway line that connects Norwich to Great Yarmouth. It was snowing. He was welcomed in by the concerned mother to the most basic of homes. There was little warmth. The two twins, a boy and a girl, about seven years old were huddled together on a filthy sofa. The girl was sweating and clearly out of sorts. On looking in her ear, the obvious diagnosis was otitis media, a very common childhood condition at the time that could have serious consequences including brain abscess and permananent deafness. 

My father explained his findings and that he had brought with him a new wonder medicine called penicillin that was most effective against precisely this kind of infection. He explained that the syrup had to be taken four times a day and the child might have difficulty swallowing it because of its unpleasant taste. Convinced the mother understood, he said he would return in 48 hours.

Following his tracks in the snow from his previous visit, my father returned to the house two days later. The girl twin had no fever and seemed to have made a miraculous recovery. He asked if it had been difficult to swallow the new medicine. The mother replied that her daughter had no difficulty at all taking the medicine because she, the mother, had given it to the boy. She claimed any time the girl was sick, the boy happily took the medicine and this always made the girl better!

Today, in the face of the greatest global health emergency ever, my father would have warned us of those who take advantage of the poor and the uneducated by blurring the distinction between magic and medicine. Modern medical practice is steeped in ethics as it should be. It protects patients even if they believe in magic. I spent some years working as a surgeon for the International Committee of the Red Cross in conflict zones and under-developed countries. The most valuable thing I learnt about big health emergencies is that the greater the crisis, the more susceptible people are to exploitation by the Dr Sibly’s of the world and the more important it is for health-care workers to adhere rigidly to the tenets of medical ethics. It’s all about the patient being sure he or she can trust the doctor or the nurse to act in their best interests.

My father had one most demanding patient; a well-to-do but unhappy lady in her sixties. Her only source of joy was her little dog that she deemed so handsome that she wanted to enter him into a show. She asked my father if he had advice about lightening the dark line down the little chap’s back; a feature she was sure would lose points. My father suggested seeing Mr Jones, the village chemist; he’d certainly have a suitable product. Now Mr Jones was a good old Norfolk boy and it so happened that, a day or two later, my father was chatting to him when he saw the lady in question about to come into the chemist’s shop. My father hid behind a shelf of cough remedies. He heard the lady ask Mr Jones if he had something to lighten the colour of dark brown hair. He produced a bottle for her inspection. “Now, Mr Jones” she asked in an ernest tone “Do you think this will be OK on my chihuahua?” Mr Jones scratched his head and said “I reckon so, Madam. But I’d advise you not to ride a bicycle for a few days!”

Today’s putting competition got delayed through house work and phone calls. We started late. Wait for this…. We had to abandon the game on the second play-off hole because of poor light. And neither of us had missed one of our twenty putts!! 

The Lockdown Diary – Day 12

Geneva, Friday 27 March 2020


Last night’s “clapping for carers” at 21:00 here in Geneva was longer and louder than ever. I clapped until my hands were sore. I clapped for my 100 hour weeks all those years ago in the British NHS. I clapped for all those fabulous nurses who ran the hospitals of the International Committee of the Red Cross for war-wounded in Afghanistan, Pakistan, Somalia, Cambodia, Sudan and more. I clapped for the whole notion of tireless and ethical health care with tears in my eyes.

As before, our ingenious non-Scottish neighbour contributed to the cacophony with his home-made bagpipes. (Not sure what the tune was but it really was a tune…. of sorts!) This morning I got a snap of him and his creation.

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Big news today. The number of cases on a global basis continues to mount exponentially. The USA has now recorded more cases of COVID-19 than China and has, after western Europe, become the third “epicentre” of the pandemic. Just wait for Africa to kick in! This is really serious, world changing stuff.

Looking at the science – or lack of – behind images of the coronavirus for yesterday’s post, got me thinking. All it took was just one little coronavirus virus to undergo a mutation in its RNA strand to allow its many offspring to spread from human to human and infect people in numbers in 194 countries within about four months. In another context, you might call this a wonder of nature. But for us humans, it has revealed our inherent susceptibility to this kind of disease that comes with cities of millions and unfettered international air travel. Only a few weeks ago, we still believed that the only tune we had to dance to was our own. 

There are knowns and unknowns to ponder. We know that this emergency has united communities, given opportunity for creativeness and kindness, boosted respect for healthcare professionals and proved the immeasurable value of the internet, the web and social media. We know that this pandemic will pass; we don’t know when. We know that people will die; we don’t know how many nor how many of those deaths could have been prevented. We know that preventive measures will be necessary after the curve has peaked; we don’t know for how long after. We know that there will be a heavy impact on the world economy; we don’t know how big nor whether there will be a bounce back.

I have just seen a heartbreaking video of hundreds of Indian factory workers, unemployed as of yesterday, queueing in the street and in close proximity to each other waiting for their midday meal. What a choice: eat or risk infection! As I write, I hear that the UK’s Prime Minister, Boris Johnson and his Health Secretary Matt Hancock have both tested positive. One thing we know now and absolutely for sure is that every human on the planet is in this together.

I presume that every world leader has had to undergo a crash course in the epidemiology of infectious diseases. They will have learnt that the bedrock principle of the whole exercise – that allows us to draw these epidemic curves with which we are all becoming familiar and which have to be flattened – is: if you want to manage it, measure it. Got that one, Mr Trump?

On a different scale of thinking and not really wishing to get back onto the toilet roll issue…. Here at home, we did our own little measurement exercise that will help us to manage our supplies. When the empty roll is discarded, we mark the date (usually forgotten) on which we put the new roll on the holder ready for action.

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I’ve never given much thought to how quickly we go through this commodity but I can reveal now that this roll’s predecessor delivered effective and selfless service for seven whole days of lockdown. I could, as a result, tell you how many weeks’ stock we have but I won’t having derided all those who were (also!) buying in bulk.

The putting competition stands at 7 to 4. I won again today, 2 and 1. Stress! We putt at 2.2 metres from the hole. The Swiss government recommendation for social distancing is “at least two metres.” There is absolutely no connection at all here other than that sinking putts at 2.2 metres distance with regularity means that your game is in satisfyingly good order.

Sleep well, humans. We’ll see what tomorrow brings.